Development and Validation of a Pediatric Hospital-Acquired Malnutrition (PHaM) Risk Score to Predict Nutritional Deterioration in Hospitalized Pediatric Patients: A Secondary Analysis Based on a Multicenter Prospective Cohort Study.

(1) Background: Hospital-acquired malnutrition in pediatric patients leads to adverse outcomes. This study aimed to develop and validate a pediatric hospital-acquired malnutrition (PHaM) risk score to predict nutritional deterioration. (2) Methods: This was a derivative retrospective cohort study for developing a PHaM risk score. The study included data from children aged 1 month-18 years admitted to pediatric wards in four tertiary care hospitals for at least 72 h between December 2018 and May 2019. Data on pediatric patients' characteristics, medical history, nutritional status, gastrointestinal symptoms, and outcomes were used for tool development. Logistic regression identified risk factors for nutritional deterioration, defined as a decline in BMI z-score ≥ 0.25 SD and/or ≥2% weight loss. A PHaM risk score was developed based on these factors and validated with an independent prospective cohort from July 2020 to March 2021. (3) Results: The study used a derivative cohort of 444 patients and a validation cohort of 373 patients. Logistic regression identified gastrointestinal symptoms, disease severity, fever, lower respiratory tract infection, and reduced food intake as predictors. The PHaM risk score (maximum 9 points) showed good discrimination and calibration (AUC 0.852, 95% CI: 0.814-0.891). Using a cut-off at 2.5 points, the scale had 63.0% sensitivity, 88.6% specificity, 76.1% positive predictive value, and 80.6% negative predictive value (NPV) when applied to the derivative cohort. The accuracy improved on the validation cohort, with 91.9% sensitivity and 93.0% NPV. (4) Conclusions: This PHaM risk score is a novel and probably effective tool for predicting nutritional deterioration in hospitalized pediatric patients, and its implementation in clinical practice could enhance nutritional care and optimize outcomes.

Parental Attitudes and Practices regarding Atopic Dermatitis: A Cross-Sectional Study among a Thai Population.

BACKGROUND: Atopic dermatitis (AD) is a chronic inflammatory skin disorder common in children. Successful pediatric AD therapy requires parental assistance. Thus, evaluating parental knowledge, attitudes, and behaviors regarding childhood AD may lead to more educational recommendations to help children control AD in the future. This study examined parents' knowledge, attitudes, and conduct concerning AD in families with and without children with AD. METHOD: The Pediatric Department, Faculty of Medicine, Khon Kaen University, Thailand, conducted a cross-sectional study from June to December 2023. Parents of children who visited the dermatology clinic with or without AD were asked to complete a Google form questionnaire. RESULTS: A total of 372 parents answered a questionnaire about AD pathophysiology, knowledge, attitudes, and practices. The participants were 293 (78.8%) female participants and 79 (21.2%) male participants. The average age was 29.79 (SD 4.91). Most parents (319, 85.8%) did not work in the medical field, and more than half (228 instances, 61.29%) had children diagnosed with AD. CONCLUSIONS: Parents of children with AD understood AD causes and triggers better than parents of children without AD. But, "exposure to furry toys" that may contain dust and allergies and "infection" that may cause AD flare-ups were the most common triggers, regardless of the group. Appropriate information should be supplied because both the parents of children with AD and those of children without AD reported immediate food avoidance without confirmatory testing, which might lead to malnutrition. Clinicians and families handling patients with AD require further education.

Clinical Characteristics and Outcomes of Pediatric COVID-19 Pneumonia Treated with Favipiravir in a Tertiary Care Center.

The COVID-19 pandemic, caused by SARS-CoV-2, has posed significant health challenges worldwide. While children generally experience less severe illness compared to adults, pneumonia remains a substantial risk, particularly for those under five years old. This study examines the clinical characteristics and treatment outcomes of pediatric COVID-19 pneumonia patients treated with favipiravir in Thailand, aiming to identify associated factors for pneumonia. A retrospective review was performed on pediatric patients aged 1 month to 18 years hospitalized with COVID-19 at Srinagarind Hospital, Khon Kaen University, from 13 January 2020 to 15 November 2021. Data on demographics, clinical symptoms, treatment, and outcomes were collected, and logistic regression analysis was used to identify factors associated with pneumonia. Among 349 hospitalized children, the median age was 8 years, with 51.9% being male. Symptoms included a fever (100%), a cough (74.2%), and a rash (24.9%). COVID-19 pneumonia was diagnosed in 54.7% of the children. Favipiravir was administered as the standard treatment, showing mild adverse effects, including a rash (4.3%) and nausea (2.8%). Monocytosis was significantly associated with COVID-19 pneumonia (aOR 30.85, 95% CI: 9.03-105.41, p < 0.001), with an ROC curve area of 0.77 (95% CI: 0.71-0.83). Pediatric COVID-19 patients typically exhibit mild-to-moderate symptoms, with pneumonia being common in the early pandemic phase. Monocytosis is a significant factor associated with COVID-19 pneumonia. Favipiravir demonstrated mild adverse effects. Further studies are needed to validate these findings across different settings and phases of the pandemic.

Clinical characteristics and prognostic marker for hospitalization in children with influenza infection in an emergency setting.

BACKGROUND: Influenza is a main cause of illnesses during seasonal outbreaks. Identifying children with influenza who may need hospitalization may lead to better influenza outcomes. OBJECTIVE: To identify factors associated with the severity of influenza infection, specifically among children who were admitted to the hospital after being diagnosed with influenza at the emergency department. METHODS: A retrospective cohort study was conducted among pediatric patients (age < 18 years) with a positive influenza rapid test who visited the emergency department at Srinagarind hospital between January2015-December2019. The dependent variable was hospital admission, while the independent variables included clinical parameters, laboratory results, and emergency severity index(ESI). The association between these variables and hospital admission was analyzed. RESULTS: There were 542 cases of influenza included in the study. The mean age was 7.50 ± 4.52 years. Males accounted for 52.4% of the cases. A total of 190(35.05%) patients, needed hospitalization. Patients with pneumonia, those who required hospitalization or were admitted to the critical care unit, consistently exhibited an elevated absolute monocyte count and a reduced lymphocyte-to-monocyte ratio (LMR). Various factors contribute to an increased risk for hospitalization, including ESI level 1-2, co-morbidity in patients, age < 1 year old, and an LMR below 2. CONCLUSIONS: ESI level 1-2 and co-morbidity in patients represent significant risk factors that contribute to higher hospitalization admissions. A LMR below 2 can be used as a prognostic marker for hospitalization in children with influenza infection.

Survey of Thai Physicians' Practice in Pediatric Septic Shock.

(1) Background: Sepsis management in children is crucial, especially in emergency services. This study aims to evaluate Thai physicians' knowledge gaps in the emergency management of sepsis in children and to evaluate their adherence to the current sepsis clinical practice guidelines. (2) Methods: This is a cross-sectional survey of Thai physicians' management of septic shock in children. The survey was conducted through online questionnaires from March 2019-April 2019. (3) Results: Of the 366 responders, 362 (98.9%) were completed. Most of the responders were general practitioners (89.2%) and pediatricians (10.8%). The time from positive sepsis screening to being evaluated by physicians within 15 min was reported by 83.9%. The most common choice of fluid resuscitation was normal saline solution (77.3%). The practice of a fluid loading dose (20 mL/kg) consistent with the guidelines was 56.3%. The selection of the first vasoactive agent in warm shock (norepinephrine) and cold shock (epinephrine) according to recommendations in the guidelines was 74.3% and 36.2%, respectively. There was a significant difference between general practitioners and pediatricians in terms of knowledge about initial fluid resuscitation and the optimal vasoactive agent in cold shock (p-value < 0.001). In the multivariate model, factors associated with the guideline-based decision-making of vasoactive agent choice for cold shock were specialist training (pediatrician) and the completion of sepsis management training certification, with adjusted odds ratios (AORs) of 7.81 and 2.96, but working experience greater than ten years was inconsistent with the guideline-based decision-making (AOR 0.14). (4) Conclusions: Thai clinicians were unfamiliar with pediatric sepsis therapy standards, specifically the quantity of early fluid resuscitation and the appropriate vasoactive medications for cold shock. To encourage adherence to the guidelines, we propose a regularly required training course on pediatric sepsis management.

Antibodies against SARS-CoV-2 in unvaccinated children hospitalized with COVID-19: An observational cohort study of pre-Omicron and Omicron variants era.

PURPOSE: This study aimed to investigate the antibodies against SARS-CoV-2 in children hospitalized due to COVID-19 during the era of pre-Omicron and Omicron variants. METHODS: This was a retrospective observational study conducted at a tertiary academic medical center in Thailand between June 2021 and August 2022. We collected the data of children aged under 18-year who were hospitalized from SARS-CoV-2 infection. After hospital discharge, we scheduled clinical follow-up 60 to 90 days post-infection clinical follow-up. We measured antibodies against SARS-CoV-2 anti-spike protein receptor-binding domain in the serum during a follow-up visit and compared the mean difference of antibody levels between children infected with COVID-19 during the pre-Omicron and Omicron eras. RESULTS: A total of 119 children enrolled into the study. There were 58 and 61 children hospitalized due to COVID-19 during pre-Omicron and Omicron era, respectively. The median (interquartile range, IQR) of SARS-CoV-2 antibodies in all cases was 206.1 (87.9-424.1) U/mL at follow-up. Children infected during pre-Omicron had SARS-CoV-2 antibody levels at follow-up higher than children infected during Omicron era [mean difference 292.57 U/mL, 95% CI 53.85-531.28, p = 0.017). There was no difference in SARS-CoV-2 antibody levels between the children based on gender, age, co-morbidities, chest radiograph classification, or diagnosis. CONCLUSIONS: The antibodies response to SARS-CoV-2 infection was weaker during the Omicron era than previous variant of concern. Immunization strategies and policies should be implemented in children even if they had been previously infected.

Burden of Respiratory Syncytial Virus Related Acute Lower Respiratory Tract Infection in Hospitalized Thai Children: A 6-Year National Data Analysis.

Objectives: This study sought to determine the epidemiology, seasonal variations, morbidity, and mortality of respiratory syncytial virus (RSV) infection among hospitalized children with lower respiratory tract infection in Thailand. In addition, we assessed the risk factors associated with severe RSV lower respiratory tract infection (LRTI)-related morbidity and mortality. Methods: The data were reviewed retrospectively from the National Health Security Office for hospitalized children younger than 18 years old diagnosed with RSV-related LRTI in Thailand, between the fiscal years of 2015 to 2020. The RSV-related LRTIs were identified using the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Thai Modification. ICD-10-TM codes J12.1, J20.5, and J21.0, which represent respiratory syncytial virus pneumonia, acute bronchitis due to respiratory syncytial virus, and acute bronchiolitis due to respiratory syncytial virus, respectively, were studied. Results: During the study period, RSV-related LRTI accounted for 19,340 of the 1,610,160 hospital admissions due to LRTI. RSV pneumonia was the leading cause of hospitalization (13,684/19,340; 70.76%), followed by bronchiolitis (2849/19,340; 14.73%) and bronchitis (2807/19,340; 14.51%), respectively. The highest peak incidence of 73.55 percent occurred during Thailand's rainy season, from August to October. The mortality rate of RSV-related LRTI in infants younger than 1 year of age was 1.75 per 100,000 person years, which was significantly higher than that of children 1 to younger than 5 years old and children 5 to younger than 18 years old (0.21 per 100,000 person years and 0.01 per 100,000 person years, respectively, p-value < 0.001). Factors associated with mortality were congenital heart disease, hematologic malignancy, malnutrition, and neurological disease. Conclusions: In children with RSV LRTI, pneumonia was the leading cause of hospitalization. The admission rate was highest during the rainy season. Mortality from RSV-related LRTI was higher in children under 1 year old and in children with underlying illnesses; future preventive interventions should target these groups of patients.

Effect of the COVID-19 Pandemic on Lower Respiratory Tract Infection Determinants in Thai Hospitalized Children: National Data Analysis 2015-2020.

Background: The COVID-19 outbreak emerged in January 2020 and remains present in 2022. During this period, nonpharmaceutical interventions (NPIs) have been used to reduce the spread of COVID-19 infection. Nationwide data analysis should be pushed as the new standard to demonstrate the impact of COVID-19 infection on other respiratory illnesses and the reliability of NPIs during treatment. Objective: This study aims to identify and compare the incidence of lower respiratory tract infections (LRTIs) among children in Thailand before and after the emergence of COVID-19. Methods: A retrospective study was carried out in hospitalized children under the age of 18 in Thailand from October 2015 to September 2020. The International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Thai Modification, was used to identify patient diagnoses (ICD-10-TM). The data were extracted from the Universal Coverage Health Security Scheme Database. Results: A total of 1,610,160 admissions were attributed to LRTIs. The most common diagnosis was pneumonia (61.9%). Compared to the 2019 fiscal year, the number of hospitalizations due to LRTIs decreased by 33.9% in the 2020 fiscal year (COVID-19 period) (282,590 vs. 186,651). The incidence of all three diagnostic groupings was substantially lower in the pre- and post-COVID-19 eras, with a decrease of 28% in the pneumonia group (incidence rate ratio (IRR) = 0.72; 95% confidence interval (CI): 0.71 to 0.72), 44% in the bronchiolitis group (IRR = 0.56; 95% CI: 0.55 to 0.57), and 34% in the bronchitis group (IRR = 0.66; 95% CI: 0.65 to 0.67). Between fiscal years 2019 and 2020, the overall monthly cost of all hospitalizations for LRTIs decreased considerably (p value < 0.001). Conclusions: NPIs may decrease the number of pediatric hospitalizations related to LRTIs. All policies designed to prevent the spread of COVID-19 must be continually utilized to maintain the prevention of LRTIs.

Epidemiology of acute lower respiratory tract infection hospitalizations in Thai children: A 5-year national data analysis.

BACKGROUND: Lower respiratory tract infections (LRTIs) are the most common cause for hospitalization in pediatric patients. Pediatric patients with LRTIs are at an increased risk of morbidity and mortality. The national data analysis of epidemiologic variations facilitates awareness and develops solutions to prevent these conditions in the future. OBJECTIVE: This study aims to evaluate the epidemiology, causative pathogens, morbidity, and mortality of LRTIs in pediatric patients of Thailand from 2015 to 2019. METHODS: This was a retrospective study among pediatric patients aged between 0 and 18 years old admitted in hospitals due to LRTIs in Thailand from January 2015 to December 2019. The data were extracted from National Health Security Office using the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Thai Modification; ICD-10-TM of J09 to J22. RESULTS: A total of 1,423,509 children hospitalized due to LRTIs were identified. Most of the patients were of age 1-5 years. Pneumonia was the most common LRTI (876,557 children, 61.58%) in hospitalized children. Respiratory syncytial virus (RSV) is the main etiologic pathogen of bronchiolitis, which presents in approximately 10.86% of all episodes. Influenza viruses were found predominantly in children with pneumonia (15.52%). The mortality rate since 2015-2019 was highest in pneumonia under 1 year old (P < 0.001). Pneumonia in children under 5 years old had the highest mortality rate, which accounted for 11.85 per 100,000 children in 2019. CONCLUSIONS: LRTIs had a high incidence rate of hospitalization and mortality, especially in children under 5 years old. Influenza virus was the most common pathogen of pneumonia.

Pediatric asthma control in tertiary care setting using telemedicine during COVID-19 era.

Background: During the coronavirus disease 2019 (COVID-19) pandemic, national measures have affected health care services. Children with asthma were a vulnerable population who were advised to avoid needless hospital visits. Telemedicine was utilized in this circumstance. However, data in Thailand is limited. This study aimed to evaluate asthma control in patients who were followed up by telemedicine compared with in-person visits at an outpatient clinic in Thailand's tertiary academic medical center. Methods: This was a retrospective study among pediatric patients with asthma who were followed up in the pediatric pulmonary and allergy clinic of Srinagarind Hospital from 1 January to 31 May 2021. We offered telemedicine (telephone visit) and in-person visits at the hospital by their willingness during this period. All patients were asked about asthma clinical control symptoms, medication compliance, exacerbation events, and hospital admissions by pediatric pulmonologists and allergists. Then, we decided to prescribe in controller medications. In the telemedicine groups, we used the postal service to deliver controller medicine to patients. Results: Among 195 asthmatic children, 83 (42.56%) were followed up by telemedicine. Children who were followed up by telemedicine had more controlled symptoms than the in-person visit group [adjusted relative risk (aRR): 1.219; 95% confidence interval (CI): 1.062-1.400; P value =0.005]. In the in-person visit group, children had more asthma exacerbation events than telemedicine (5 vs. 0, respectively, P value =0.073). Conclusions: During the COVID-19 pandemic, telemedicine follow-up in asthmatic children resulted in well-controlled symptoms and few asthma exacerbation events.

Hand Hygiene Habits and Prevalence of Hand Eczema During the COVID-19 Pandemic.

PURPOSE: This study aimed to explore the prevalence of and possible risk factors for hand eczema with respect to the dissemination of information about new hand hygiene habits to protect against ongoing COVID-19 cross-transmission. The authors conducted a survey among health care workers (HCWs) and non-HCW populations in Khon Kaen, Thailand. RESULTS: A total of 805 participants participated. The prevalence of hand eczema in the study population was 20.87%. There were several risk factors, including working as a HCW, having a history of previous hand eczema, having underlying atopic dermatitis, wearing gloves in everyday life, and washing hands frequently (more than 10 times/day). Hand hygiene with alcohol-based products was shown to be a risk factor for hand eczema, (OR (95% CI) 1.86 (1.03-3.35), P = .04). CONCLUSION: In terms of hand eczema prevention, we suggest that the use of alcohol-based products should be discontinued if other handwashing methods are available. The following factors increase the risk of hand eczema: being a HCW, having previous hand eczema, and having underlying atopic dermatitis. Proper strategies in terms of hand eczema prevention should be addressed, especially in this group, since we need to continue performing hand hygiene during the ongoing COVID-19 pandemic.