Tag: paediatrics

Categories : PaediatricsTags :

US, Europe Report Severe Hepatitis of Unknown Aetiology in Children

On By ModernMedia
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Public health officials are puzzling over cases of severe hepatitis in children reported in Europe and the US. A number of the cases have tested positive for adenovirus and/or SARS-CoV-2, though what role these viruses play is not yet clear.

On 5 April 2022, UK authorities notified the World Health Organization was of 10 cases of severe acute hepatitis of unknown aetiology in previously healthy young children ranging in from 11 months to five years old across central Scotland. Nine had onset of symptoms in March 2022, and all cases were detected on hospitalisation. Symptoms included jaundice, diarrhoea, vomiting and abdominal pain. An article published in Eurosurveillance detailed the cases.

Further investigations across the UK identified a total of 74 cases as of 8 April (including the 10 cases) that fulfilled the case definition. The clinical syndrome in identified cases is of acute hepatitis with markedly elevated liver enzymes, often with jaundice, sometimes preceded by gastrointestinal symptoms, in children principally up to 10 years old. Some cases have required transfer to specialist children’s liver units and six children have undergone liver transplantation. As of 11 April, no death has been reported among these cases and one epidemiologically linked case has been detected.

Laboratory testing has excluded hepatitis type A, B, C, and E viruses (and D where applicable) in these cases while SARS-CoV-2 and/or adenovirus have been detected in several cases. The United Kingdom has recently observed an increase in adenovirus activity, which is co-circulating with SARS-CoV-2, though the role of these viruses in the pathogenesis is not yet clear. They have however been linked to bladder inflammation and infection, and on occasion to hepatitis, but it is rare in children who are not immunocompromised.

To date, no other epidemiological risk factors have been identified, including recent international travel. Overall, the aetiology of the current hepatitis cases is still considered unknown and remains under active investigation. Laboratory testing for additional infections, chemicals and toxins is underway for the identified cases.

Following the notification from the UK, less than five cases (confirmed or possible) have been reported in Ireland, further investigations into these are ongoing. Additionally, three confirmed cases of acute hepatitis of unknown aetiology have been reported in children (ranging in age from 22 months-old to 13 years old) in Spain. A further 9 have been reported in the US state of Alabama, with five testing positive for adenovirus.

Karen Landers, district medical officer for the Alabama Department of Public Health, said that the cases were spread across the state, and no links were found among the children.

“It is not common to see children with severe hepatitis,” Landers told STAT in an interview. “Seeing children with severe [hepatitis] in the absence of severe underlying health problems is very rare. That’s what really stood out to us in the state of Alabama.”

Source: WHO

Categories : Diet and Nutrition PaediatricsTags :

Report Finds One in Four Preschool Children in SA Malnourished

On By ModernMedia
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One in four preschool children (aged four to five years) shows signs of long-term malnutrition, according to a new survey.

The Thrive by Five Index, released on 8 April, was produced by First National Bank and Innovation Edge in collaboration with the Department of Basic Education (DBE). The study surveyed more than 5000 children enrolled in early learning programmes across the country.

The study found about 25% of children were physically stunted, as a result of malnutrition in pregnancy and the early years of life. About 65% of children are either cognitively delayed, physically stunted, or both. This means they are not meeting the learning or growth standards expected of a child their age, and will start school at a disadvantage.

“Children from poorer households tended to perform worse,” said Sonja Giese, the lead researcher in the study. Giese is the founder of Innovation Edge, which was set up to support innovation in early childhood development. The rates of stunting were highest among the poorest children.

She said each child was assessed for about an hour. Children were assessed for things such as early mathematical skills, literacy and communication, motor development and coordination, among other things.

But Giese also drew attention to the positive outcomes of the study, saying that even within the poorest group of children there were some children who performed very well, causing a kind of “positive deviance”.

“I think there are some really interesting lessons we can learn from these outliers …Some children just thrive in difficult circumstances,” said Giese. She said more research could help to figure out how and why these children are thriving.

Giese said as the DBE had just taken over responsibility for early childhood education from the Department of Social Development, the study could show where attention should be focused.

In a statement about the survey, the DBE said that the first five years of the child’s life are the most important and stressed the importance of physical development during this stage.

Data for the survey was collected in late 2021 from a nationally representative sample of children aged 50-59 months enrolled in early learning programmes. The final weighted sample used for analysis included 5,139 children from 1,247 programmes across the country. The school quintile system was used to measure the probable socio-economic background of the children who were assessed. School quintiles are based on the income, education and unemployment levels of households in the school catchment area and for the purposes of the Thrive by Five study, the researchers assumed that the income level of children attending early learning programmes within each school cluster matched the income level of children attending the nearest school.

The researchers included more children from quintile 1 – the poorest – in order for the study to be representative of the country and each province. “That’s how we tried to make sure that it really provides a window into the world of children today in South Africa, exactly where they are and how they’re living,” said Giese.

Giese said that some of the data had not yet been analysed and further findings would be released over the next year.

This story was written by Liezl Human for GroundUp and is reproduced under a Creative Commons 4.0 Licence.

Source: GroundUp

Categories : COVIDTags :

Kids are a Significant Source of COVID Spread in Households

On By ModernMedia

COVID spreads extensively in households, with children being a significant source of that spread. These are the findings from an antibody surveillance study published in CMAJ Open, which also shows that about 50% of household members were infected from the first-infected individual during the study period.

Although kids were less likely to spread the virus compared to adults, children and adults were equally likely to become infected from the first-infected individual.

The antibody surveillance study included 695 participants from 180 households in the Canadian city of Ottawa in Ontario, between September 2020 and March 2021. Included households had at least one member having had a confirmed COVID infection and at least one child within their household.

“Our study was conducted when we were dealing with a less transmissible virus and pandemic restrictions were strongly in place, and we still had a 50% transmission rate within households. Flash forward to where we are today with an extremely transmissible variant of COVID and the majority of pandemic restrictions lifted; it’s safe to say transmission rates will be higher even though we have a high vaccination rate amongst those who are eligible,” said Dr Maala Bhatt, the study’s lead author. 

“I know many want to ‘live with COVID’ and abandon the layers of protection that were previously mandated, but it’s important to be aware of the high transmissibility of this virus in closed, indoor settings, such as schools,” she cautioned.  “Our most vulnerable and our youngest children who are not yet able to be vaccinated are still at risk for COVID infection.”

In the Canadian province of Eastern Ontario, where the study was done, COVID is on the rise once again. Three-quarters of all children admitted to CHEO with COVID have come during the Omicron wave. Since the beginning of January this year a third of the roughly 4900 monthly visits to the Emergency Department were for COVID-related symptoms.

The study hypothesised that children would act as “an even greater source of spread within households with the emergence of more infectious variants.” Children also have “considerable potential to spread” in settings such as school and daycare, where they congregate indoors for long periods, especially now when masking is not required in many jurisdictions.

“While we’re lucky hospitals aren’t currently overloaded, emergency departments are and positivity rates are on the rise, even amongst children,” said Dr Bhatt, paediatric emergency physician and Director of Emergency Medicine Research at CHEO and an Investigator at the CHEO Research Institute.

“We continue to learn more about COVID and its potential long-term health impacts, and we still aren’t clear about how long immunity lasts; these are all things researchers continue to study.”

Source: University of Ottawa

Categories : Cardiovascular Disease PaediatricsTags :

Cardiovascular Risk Factors in Childhood Predict Adulthood Risks

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By tracking more than 38 000 participants from childhood for fifty years, researchers have uncovered direct evidence that the five cardiovascular risk factors when present in childhood predicted cardiovascular risk in adulthood. 

Body mass index, blood pressure, cholesterol, triglycerides and youth smoking, particularly in combination in early childhood, were clinically linked with cardiovascular events that predict poor cardiovascular health in adults.

The international study conducted by the International Childhood Cardiovascular Consortium (i3C) and published in the New England Journal of Medicine, found that the increased cardiovascular risk began as early as 40 years of age.

Paper co-author Prof Terence Dwyer at the University of Oxford commented: “Despite the effect medical and surgical care have had on treating heart disease, achieving the greatest possible reduction in the heart disease burden will depend on including preventive strategies that commence in childhood.”

The findings confirm that prevention must start in childhood. “Longitudinal studies like these have been hampered by a lack of inclusion of comprehensive childhood data around body measurements, blood pressure, and blood lipids and a failure to follow-up at ages when cardiovascular disease becomes common.”

The study involved 38 589 participants from Australia, Finland and the US, who were followed from age 3-19 years for a period of 35-50 years. 

The results showed that increased risk for cardiovascular events was seen in over half the children, with those having the highest risk factor levels, at 9 times the risk for an event as for children with below average risk factors.

“While this evidence had not been available previously, the findings were not entirely surprising as it had been known for some time that children as young as five already showed early signs of fatty deposits in arteries. This new evidence justified a greater emphasis on programs to prevent the development of these risk factors in children. Clinicians and public health professionals should now start to focus on how this might best be achieved,” Prof Dwyer concluded.

Source: Murdoch Childrens Research Institute

Categories : Paediatrics Pain ManagementTags :

Fall in Paediatric Post-surgical Opioid Prescriptions

On By ModernMedia
Children
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A large study has shown that opioid prescriptions for children who underwent one of eight common outpatient surgeries declined over a period of five years. These findings, reported in the journal Pediatrics, suggest that clinicians are using more discretion when considering which paediatric patients require an opioid prescription after their procedures.

Opioids are routinely prescribed after a surgery to help paediatric patients manage mild or moderate pain. However, recent studies have suggested that recovery is similar with limited or no opioid use. Additionally, opioids prescribed to children can result in respiratory depression, which causes carbon dioxide to not be expelled from the lungs properly, and the continued use of those opioids, after acute pain has resolved. Despite these findings, no prior studies had looked at recent data on national opioid trends for surgery in children in the context of whether there has been any shift away from prescribing opioids more broadly.

“Children grow throughout their childhood, and because opioids are often prescribed based on weight, we cannot assume that what is appropriate for a 5-year-old could also apply to an adolescent,” said the study’s lead author Tori N. Sutherland, MD, MPH. “In our study, we wanted to be responsible with our data and consider surgical distribution by age group.”

In this study, the researchers used data from a private insurance database to study opioid-naïve patients under the age of 18 who underwent one of eight surgical procedures between 2014 and 2019. The procedures ranged from tonsillectomies to knee surgery. The primary outcome of the study was whether a prescription for opioids was filled within 7 days of surgery, and the secondary outcome was the total amount of opioid dispensed. A total of 124 249 patients were included in the study. Patients were separated by age into adolescents, school-aged children and preschool-aged children.

The researchers found that the percentage of children who had an opioid prescription filled after their surgery fell across all three age categories. For adolescents, prescriptions dropped from 78.2% to 48%; for school-aged children, from 53.9% to 25.5%; and for preschool-aged children, from 30.4% to 11.5%. Additionally, the average morphine milligram equivalent dispensed declined by approximately 50% across all three age groups.

The researchers also found that there was a steeper decline in opioid prescriptions beginning in late 2017, first in the adolescent group and then followed by school- and preschool-aged children. This trend appeared to represent a ‘trickle down’ effect, but more research is needed to explore the difference in trends by age group.

“Our findings demonstrate that pain treatment for children and adolescents undergoing surgery has changed dramatically over the past 5 years,” said Mark Neuman, MD, senior author. “Understanding what these trends mean for patient experiences and health outcomes is a key next step.”

Source: EurekAlert!

Categories : Paediatrics VaccinesTags :

Intranasal Flu Vaccine OK for Kids with Asthma

On By ModernMedia
Young girl sneezing
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A small clinical trial published in Pediatrics has shown that intranasal flu vaccine is just as safe for children with asthma as the intramuscular vaccine. According to the researchers, within 42 days of vaccination, 10.8% of children who received the intranasal quadrivalent live attenuated influenza vaccine (LAIV4) had an asthma exacerbation compared with 14.7% of those who received the intramuscular quadrivalent inactivated influenza vaccine (IIV4).

According to the researchers, regardless of asthma severity, LAIV4 remained noninferior to IIV4. Among those with mild asthma, one of 25 kids who received the LAIV4 experienced an asthma exacerbation versus three of 16 in the IIV4 group, the researchers reported. In children with moderate to severe asthma, exacerbations occurred in seven of 49 in the LAIV4 group and seven of 52 in the IIV4 group.

“These data add to the compelling safety record of LAIV in children, including those with persistent asthma,” the researchers wrote.

The two groups also did not differ significantly in the frequency of asthma-related symptoms, including nighttime awakening, unscheduled albuterol use, cough, wheezing, or chest tightness, within 14 days of administration. Similarly, no differences were seen in peak expiratory flow rate, or changes in childhood asthma control test or asthma control test scores from baseline through 42 days.

At present, the CDC recommends against the nasal spray vaccine for children and people with asthma, citing an increased risk of exacerbations.

A previous study had suggested that the LAIV was linked increased asthma risk and reactive airway disease in children under 36 months of age, but more recent research has found no difference in risk between the LAIV and IIV, the researchers explained.

“Building off these previous studies, our prospective study suggests that LAIV may be appropriate for some children with asthma,” they noted.

“These data support reexamining precautions to using LAIV4 in children with asthma, which could be particularly important during influenza pandemics, at times when IIV4 supplies are limited, in situations of public/school mass vaccination clinics using LAIV, or for children with significant needle aversions,” they added.

The study was conducted over the 2018 and 2019 flu seasons with children aged five to 11 but expanded to include children ages 5 to 17 in its second year. The primary outcome of asthma exacerbation after 42 days was defined as an episode for which the participant sought medical care or a new prescription for corticosteroids.

The median age of the 151 enrolled participants was 9 years, and 58% were boys.

Systemic reactogenicity events in the 14 days after vaccination were not different between the LAIV4 and IIV4 groups, with the exceptions of myalgia and sore throat, which were more common in the IIV4 group.

Source: MedPage Today

Categories : COVID PaediatricsTags :

Croup – A Previously Unrecognised COVID Complication in Young Children

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Parent with a sick child
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With the spread of omicron infections in young children, doctors have observed the rise of a previously unrecognised COVID complication: croup. Published in Pediatrics, physicians at Boston Children’s Hospital reported on 75 children admitted to the emergency department (ED) with croup and COVID.

The children appeared at the ED from from March 1, 2020 through January 15, 2022. Some cases were surprisingly severe, requiring hospitalisation and more medication doses compared to croup caused by other viruses. Just over 80% occurred during the omicron period. The report was published March 8 in a pre-publication in.

“There was a very clear delineation from when omicron became the dominant variant to when we started seeing a rise in the number of croup patients,” said  Ryan Brewster, MD, first author of the report.

Laryngotracheitis, commonly known as croup, is a common respiratory illness in babies and young children. It is marked by a distinctive barking cough and sometimes stridor. It happens when viral infections cause swelling around the upper respiratory tract. In severe cases, including some seen at Boston Children’s, it can dangerously constrict breathing.

COVID studies in animals have found that the omicron strain ‘prefers’ the upper airway more than earlier variants, which mainly targeted the lower respiratory tract. This may account for the sudden appearance of croup during the omicron surge, said Dr Brewster.

In keeping with the general pattern of croup, most of the children with COVID and croup were under two years old, and 72% were boys. Except for one child with a common cold virus, none had a viral infection other than SARS-CoV-2.

Although all the children survived, nine of the 75 children with COVID-associated croup (12%) required hospitalisation and four of them (44%, or 5%of the total) required intensive care. (By comparison, before COVID, fewer than 5% of children with croup were hospitalised, and of those, only 1 to 3% required intubation.)

Overall, 97% of the children were treated with dexamethasone, a steroid. All of those who were hospitalised received racemic epinephrine via nebuliser, which is reserved for moderate or severe cases, as did 29% of children treated in the ED. Those who were hospitalised needed a median of six doses of dexamethasone and 8 nebulised epinephrine treatments to control their symptoms.

“Most cases of croup can be managed in the outpatient setting with dexamethasone and supportive care,” said Dr Brewster. “The relatively high hospitalisation rate and the large number of medication doses our COVID croup patients required suggests that COVID might cause more severe croup compared to other viruses. Further research is needed to determine the best treatment options for these children.”

Source: EurekAlert!

Categories : Diseases, Syndromes and Conditions PaediatricsTags :

Azithromycin in Infant RSV Does Not Prevent Wheezing, May be Harmful

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A recent study on the impact of the antibiotic azithromycin during severe respiratory syncytial virus (RSV) bronchiolitis overwhelmingly supports current bronchiolitis guidelines in the US, which recommend against antibiotics during acute bronchiolitis.

The anti-inflammatory properties of azithromycin can be beneficial in some chronic lung diseases, such as cystic fibrosis. With that in mind, researchers investigated its potential to prevent future recurrent wheezing among infants hospitalised with RSV. With such babies at increased risk of developing asthma later in childhood, the scientists hoped to find a therapy to reduce this risk.

The study, published in NEJM Evidence, also provided considerable evidence that severe RSV bronchiolitis in early life increases the likelihood of repeated wheezing episodes in early childhood, often leading to asthma.

“The major message is that antibiotics don’t have a role, either in the management of acute RSV bronchiolitis or to reduce subsequent wheezing,” said co-corresponding author Leonard Bacharier, MD, professor of Pediatrics at Monroe Carell Jr Children’s Hospital at Vanderbilt. “As a matter of fact, we found that antibiotics in general in our study of severe RSV bronchiolitis increased the risk of subsequent recurrent wheezing over the following two to four years.”

“We need to discourage the use of this therapy, as it is potentially harmful,” he said.

The study examined children hospitalised with RSV bronchiolitis during a single-center, double-blind, placebo-controlled trial.

An earlier pilot trial enrolled 40 infants hospitalised with RSV bronchiolitis where treatment with azithromycin, and this showed a reduction in the likelihood of recurrent wheeze over the following year.

In the current study, 200 otherwise healthy 1- to 18-month-old children who were hospitalised for RSV bronchiolitis were prospectively randomised to either oral azithromycin or a placebo for 14 days. The group was broadly representative of the population of children who experience severe RSV bronchiolitis.

Antibiotics are sometimes used in the treatment of RSV because co-occurring complications lead medical teams to prescribe them, thinking there is a bacterial component to the illness, Prof Bacharier said.
“This condition can be managed by supportive care – oxygen, fluids, observation, time and love,” he stressed. “If a clinician is going to use an antibiotic in the setting of RSV bronchiolitis, there needs to be a very strong rationale for doing so. There is substantial evidence to suggest that children who receive antibiotics early in life are at an increased risk of developing asthma, and this study is consistent with that evidence.”

Source: EurekAlert!

Categories : Paediatrics Respiratory DiseasesTags :

Indoor Air Pollution Linked to Pneumonia in Children

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Streptococcus pneumoniae. Credit: CDC

A new study published in The Lancet Global Health, highlights the impact indoor air pollution can have on the development of child pneumonia, showing that increases in airborne particulate matter results in greater carriage of Streptococcus pneumoniae.

Streptococcus pneumoniae is a major human pathogen causing more than two million deaths per year; more than HIV/AIDS, measles and malaria combined, but it is also part of the normal microbial community of the nasopharynx. It is the leading cause of death due to infectious disease in children under five years of age; in sub-Saharan Africa, the burden of pneumococcal carriage and pneumonia is especially high.

Household air pollution from solid fuels increases the risk of childhood pneumonia. Nasopharyngeal carriage of S. pneumoniae is a necessary step in the development of pneumococcal pneumonia. More than 2.6 billion people are exposed to household air pollution worldwide. Inefficient indoor biomass burning is estimated to cause 3.8 million premature deaths annually and approximately 45% of all pneumonia deaths in children aged younger than five years. However, a causal pathway between household air pollution and pneumonia had not yet been identified.

In order to understand the connection between exposure to household air pollution and the risk of childhood pneumonia researchers from the UK, Malawi and the United States conducted the MSCAPE (Malawi Streptococcus pneumoniae Carriage and Air Pollution Exposure) study embedded in the ongoing CAPS (Child And Pneumonia Study) trial. The MSCAPE study assessed the impact of PM2.5, the single most important health-damaging pollutant in household air pollution, on the prevalence of pneumococcal carriage in a large sample of 485 Malawian children.

Through exposure-response analysis, a statistically significant 10% increase in risk of S. pneumoniae carriage in children was observed for a unit increase (deciles) of exposure to PM2.5 (ranging from 3.9 μg/m³ to 617.0 μg/m³).

Dr. Mukesh Dherani, the study principal investigator, indicated: “This study provides us with greater insight into the impact household air pollution can have on the development of child pneumonia. These findings provide important new evidence of intermediary steps in the causal pathway of household air pollution exposure to pneumonia and provide a platform for future mechanistic studies.”

Study author Professor Dan Pope said: “Moving forward further studies, particularly new randomized controlled trials comparing clean fuels (e.g. liquefied petroleum gas) with biomass fuels, with detailed measurements of PM2.5 exposure, and studies of mechanisms underlying increased pneumococcal carriage, are required to strengthen causal evidence for this component of the pathway from household air pollution exposure to ALRI in children.”

Professor Nigel Bruce, co-principal investigator, stated: “This study provides further important evidence that emphasises the need to accelerate to cleaner fuels, such as LPG, which are now being promoted by many governments across the continent in order to meet SDG7 by 2030.”

Source: University of Liverpool

Categories : COVID PaediatricsTags :

High COVID Mortality Rate Found in African Children and Adolescents

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African children and adolescents hospitalised with COVID experience much higher mortality rates than Europeans or North Americans of the same age, according to a recent six-country study which included South Africa.

The study, published in JAMA Pediatrics. was conducted by researchers from the Institute of Human Virology (IHV) at the University of Maryland School of Medicine (UMSOM) and the Institute of Human Virology Nigeria (IHVN). Both organisations are members of the Global Virus Network (GVN).

“This study provides important information about COVID among African children, which was not previously available at this scale. We now have evidence from multiple countries to show that African children also experience severe COVID; they experience multisystem inflammatory syndrome; some require intensive care; some also die, and at much higher rates than outside Africa,” said co-first author Nadia Sam-Agudu, MD, Associate Professor of Pediatrics at the UMSOM’s Institute of Human Virology.

The AFREhealth study collected data from 25 health facilities across Nigeria, Ghana, Democratic Republic of the Congo, Kenya, South Africa, and Uganda. The study included 469 African children and adolescents aged three months to 19 years hospitalised with COVID between March and December 2020. The team reported a high overall mortality rate of 8.3%, compared with 1% or less totaled from Europe and North America. Furthermore, African children less than a year old and with pre-existing, non-communicable diseases were more likely to have poorer outcomes.

Eighteen participants had suspected or confirmed multisystem inflammatory syndrome (also known as MIS-C), and four of these children died.

Dr Sam-Agudu, who led the West Africa team for the study, urged health authorities and policymakers in Nigeria and other African countries to act upon the study findings “to protect children by expanding vaccine approvals and procurements for children specifically, as the variants emerging since our study’s completion have either caused more severe disease and/or more cases overall. We cannot leave children behind in the pandemic response.”

Source: University of Maryland