BACKGROUND:Donor human milk is the recommended alternative when a mother's own milk is unavailable, especially for high-risk infants. Türkiye has no operational human milk bank, and the attitudes of actively breastfeeding mothers are poorly characterised. AIM:To describe the knowledge, attitudes and concerns of actively breastfeeding mothers regarding human milk banks and to identify factors associated with their willingness to recommend one. METHODS:In this single-centre, cross-sectional study, 310 actively breastfeeding mothers with infants aged 0-6 months were recruited by consecutive sampling at a training and research hospital (March-May 2025). Data were collected using an interviewer-administered, 32-item questionnaire that was content-validated and piloted (not a formally validated scale). Associations were assessed with chi-square tests and binary logistic regression reporting adjusted odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS:Only 37.1% of mothers were willing to recommend a human milk bank, 40.3% were unwilling and 22.6% undecided. Educational level was the only independent predictor of willingness to recommend (adjusted OR 1.59, 95% CI 1.15-2.20, p = 0.005); knowledge and employment were not significant after adjustment. Knowledge of milk banking was higher among mothers who were not employed (44.5% vs 14.5%, p < 0.001). Religious and moral concerns were prominent among those opposing a milk bank (21.9%, and the distribution of concerns differed significantly according to mothers' views on establishment (p < 0.001). CONCLUSION:Willingness to recommend was low but broadly consistent with international figures. Higher education was associated with greater willingness yet appears necessary rather than sufficient, as many reservations are religious or cultural. Expanding milk banking in Türkiye will require culturally sensitive engagement alongside public-awareness activities.
A prospective study of 96 children with one or more WHO emergency signs presenting to a children's emergency department in Papua New Guinea, the case mix included sepsis, pneumonia, malaria, diarrhoea and encephalopathy. Thirty children died during admission. Using a hand-held point-of-care device, a single capillary blood lactate level was measured at the time of presentation. Five clinical signs and capillary blood lactate predicted mortality, and lactate and a low Glasgow Coma Score were the strongest predictors. The mortality rate for a capillary lactate level <5 mmol/L was 7/45 (15%), and if lactate ≥ 5 mmol/L, the mortality rate was 22/52 (42%). When point-of-care lactate is integrated with clinical features of GCS ≤ 13, cold peripheries (or prolonged capillary refill), and low oxygen saturation (or obstructed breathing), high‑risk children can be identified and prioritised for urgent management in a paediatric intensive care unit or area of the ward.
BACKGROUND:The clinical symptoms of thiamine deficiency, or thiamine deficiency disorders (TDDs), present similarly in children with dietary thiamine deficiency and variants in genes of thiamine metabolism. In the rural north of Lao People's Democratic Republic there is a high incidence of TDDs, and the risk of TDDs differs with maternal ethnic group. While low dietary intake is a well-established risk factor for TDDs, the contribution of inborn errors of thiamine metabolism is unknown. METHODS:This study was an adjunct to the Lao Thiamine study, a prospective cohort study of children aged ≥ 21 days to <18 months with and without symptoms of TDDs. Buffy coat samples were selected from 17 hospitalised children with clinical signs/symptoms of TDDs and both echocardiogram and cranial ultrasound changes consistent with thiamine deficiency, and 14 frequency-matched healthy children in the community. Genomic DNA was isolated, and samples underwent next-generation sequencing of genes involved in thiamine metabolism. Ultimately, 22 of 31 selected residual samples provided adequate material to complete gene sequencing. RESULTS:No pathogenic variants were identified in any of the 22 samples with completed gene sequencing. In a healthy infant, there was one variant of uncertain significance in LONP1, a gene implicated in an autosomal recessive disorder. CONCLUSIONS:Variants in genes of thiamine metabolism are unlikely to be a common aetiology of TDDs in a region at high risk of dietary thiamine deficiency. Differences between ethnic groups in the incidence of TDDs are probably related to culture-specific dietary practices and socio-economic risk factors.
Myiasis is the infestation of living human or animal tissue by fly larvae and is most common in wounds, body orifices or necrotic tissue in tropical and subtropical regions where hygiene is poor. Of the various forms of human myiasis, umbilical cord myiasis is exceedingly rare, with most reported cases occurring after the 5th day of life in infants cared for at home. A preterm neonate born at 30 weeks gestation developed umbilical cord myiasis with early-onset sepsis by 36 hours of life in a neonatal intensive care unit. This is one of the earliest and rarest presentations to be reported. Live larvae discovered on a necrotic umbilical cord stump were removed mechanically, and empirical anti-staphylococcal therapy was initiated; subsequent blood cultures confirmed multidrug-resistant Staphylococcus haemolyticus, and the infant recovered with targeted therapy. A structured root-cause analysis was carried out using chart review, staff interviews, and observation of delivery and cord-care practices, while an institutional audit examined maternal hygiene on admission, instrument sterilisation, and family participation in care. These processes identified modifiable gaps, and corrective measures were implemented to reinforce asepsis, educate caregivers, and standardise cord monitoring. This case underscores the importance of root-cause analysis in identifying rare aetiologies of sepsis and in recognising modifiable risks.
Haemoptysis is defined as the expectoration of blood or blood-tinged sputum originating from the lower respiratory tract. Massive haemoptysis, although rare, can often cause life-threatening asphyxia, respiratory failure, shock and, rarely, mortality. Pulmonary tuberculosis (PTB), although common, rarely presents with massive haemoptysis. This case report highlights an adolescent male who presented with life-threatening haemoptysis owing to PTB which was managed by successful pulmonary vascular embolisation.Abbreviations: AV: arteriovenous; BAE: bronchial artery embolisation; BPF: bronchopulmonary fistula; CHD: congenital heart disease; CT: computed tomography; ml: millilitre; mm: millimetre; TB: tuberculosis; U.S.A.: United States of America.
Tuberculosis (TB) is one of the most common infectious diseases in India with paediatric TB accounting for approximately 6-7% of cases. Skeletal and soft tissue are rare sites for TB. Three cases seen in a western tertiary hospital in India aged between 1 and 11 years presented with a swelling on the anterior chest wall. None had any known TB contact. Imaging demonstrated the presence of collections and underlying bony as well as pulmonary/pleural involvement. All were positive for TB on histopathology. They were commenced on anti-TB therapy and there was significant improvement on follow-up. Hence, tuberculosis with intrathoracic extension must be borne in mind as a close differential diagnosis when evaluating anterior chest wall swelling as it is treatable, especially in endemic areas.
Placental chorio-angiomas are rare benign vascular tumours of the placenta which are usually small and clinically insignificant, but large lesions can cause serious fetal complications such as anaemia, hydrops fetalis and an adverse perinatal outcome. We report the case of a 29-year-old multigravida diagnosed at 28 weeks' gestation with a large placental chorioangioma accompanied by sonographic evidence of fetal anaemia and hydrops fetalis. Despite two intra-uterine transfusions which led to partial improvement, the hydrops persisted, necessitating a preterm caesarean delivery at 31 weeks. The newborn required prolonged neonatal intensive care for respiratory distress, hydrops, thrombocytopenia and bronchopulmonary dysplasia, but there was satisfactory growth and neurodevelopment at 12 months of age. This case highlights the importance of early diagnosis and timely, individualised fetal therapy in managing large chorio-angiomas, and underscores how coordinated care through public-private partnership in a resource-limited setting can support effective continuity of antenatal and neonatal management, leading to a favourable perinatal outcome.
Primary ciliary dyskinesia (PCD) is a rare genetic disorder characterised by defective ciliary motility, resulting in chronic pulmonary infections and bronchiectasis. An 8-year-old boy with recurrent pulmonary tuberculosis (PTB) and newly diagnosed PCD by whole exome sequencing (WES) is reported. He presented with a chronic cough, intermittent fever, night sweats and weight loss, 3 months after completing a 6-month first-line antituberculosis therapy (ATT) regimen for drug-sensitive PTB. High-resolution computerised tomography showed bronchiectatic changes and chronic suppurative lung disease. Broncho-alveolar lavage fluid was tested on Xpert MTB/Rif Ultra and detected rifampicin-sensitive Mycobacterium tuberculosis. In view of the bronchiectasis and chronic suppurative lung disease, WES was undertaken which identified a PCD variant of unknown significance. The Primary Ciliary Dyskinesia Rule (PICADAR) score was calculated to be 8. He was diagnosed with PCD and a relapse of drug-sensitive PTB, for which first-line ATT was resumed. In view of possible syndromic conditions such as PCD, this case highlights the need for clinical suspicion and genetic testing in paediatric patients with recurrent pulmonary TB and bronchiectasis.
An 8-week-old infant girl with pertussis-induced respiratory distress, complicated by severe leucocytosis, pulmonary hypertension and respiratory failure is reported. She was treated with mechanical ventilation, exchange transfusion and other supportive measures. A single-volume exchange transfusion significantly reduced the elevated white blood cell count and stabilised her condition. This case underscores the potential role of exchange transfusion as a life-saving intervention in critical pertussis cases with severe leucocytosis.
Thalassaemia is the most common inherited haemoglobin disorder worldwide and a major health problem. Beta-thalassaemia major generally presents with a normal serum lipid profile, but there have been a few reports of its association with hypertriglyceridaemia, the exact pathogenesis of which remains unknown, and where early and regular blood transfusions ameliorate hypertriglyceridemia, thereby preventing its complications and the need for medical treatment of hypertriglyceridemia. This entity was seen in a 6-month-old infant girl who presented with severe anaemia, failure to thrive and organomegaly, and was incidentally found to have hypertriglyceridaemia. Hypertriglyceridaemia thalassaemia syndrome has rarely been described.
Mycoplasma pneumoniae is a common cause of community-acquired pneumonia (CAP) in children. While M. pneumoniae infection is typically mild and self-limiting, individuals of all ages may develop severe CAP or extrapulmonary manifestations such as M. pneumoniae-induced rash and mucositis (MIRM). Severe M. pneumoniae pneumonia with concurrent MIRM in an 8-year-old boy is reported. The clinical course was complicated by persistent fever, severe mucositis and bilateral multi-lobar pneumonia requiring advanced respiratory support. Initial antibiotic and supportive therapy yielded little improvement, but the introduction of corticosteroids resulted in marked clinical improvement of both the pneumonia and mucositis. This case emphasises that MIRM may indicate a more severe course of M. pneumoniae infection, and that early corticosteroid therapy could be beneficial in such cases.Abbreviations: CAP: community-acquired pneumonia; CRP: C-reactive protein; EM: erythema multiforme; HFNC: high-flow nasal cannula; MIRM: Mycoplasma pneumoniae-induced rash and mucositis; PCR: polymerase chain reaction; RIME: reactive infectious mucocutaneous eruption; SJS: Stevens-Johnson syndrome; TEN: toxic epidermal necrolysis; MIRM: Mycoplasma pneumonia-induced.
A 3-year-old boy with atypical skin lesions was diagnosed with syphilis, probably acquired through close daily contact with his grandparents. The case highlights the critical need for syphilis testing in children with non-specific skin findings, particularly when familial exposure is suspected. Physicians should prioritise thorough assessment, including detailed enquiry into the child's medical history, feeding practices, lifestyle and potential exposure to infection. Prompt screening of close contacts including family members and carers is essential in order to identify infection sources and prevent further transmission.Abbreviations: ANA: Antinuclear antibody; ESR: Erythrocyte sedimentation rate; RPR: Rapid plasma reagin; TPPA: T. pallidum particle agglutination.
Acute acalculous cholecystitis (AAC) is a rare but potentially serious disorder associated with Kawasaki disease (KD). Studies have demonstrated that patients presenting with severe abdominal symptoms owing to KD have increased resistance to intravenous immunoglobulin (IVIG) and a higher rate of coronary artery aneurysms. A 5-year-old boy was brought to the emergency department with fever, abdominal pain, vomiting and jaundice. He presented as ACC and was subsequently diagnosed with KD because the symptoms and signs he developed during admission were consistent with that. He was treated with IVIG and high-dose aspirin, and was discharged 7 days later with complete resolution of the symptoms.Abbreviations: AAC acute acalculous cholecystitis; ALT alanine transaminase; AST aspartate aminotransferase; CMV cytomegalovirus; CRP C-reactive protein; EBV Epstein-Barr virus; GGT gamma-glutamyl transferase; IVIG intravenous immunoglobulin; KD Kawasaki disease.
Kawasaki disease is a common childhood vasculitis of unknown aetiology, with infectious triggers often proposed. The association of Kawasaki disease with Dengue is rare. It often poses a diagnostic challenge owing to the close overlap of clinical features and a lack of diagnostic tests for Kawasaki disease. Concominant Dengue fever and Kawasaki disease in a 7-month-old boy is reported, and the possible association between the two conditions is considered. He presented with an acute febrile illness and was diagnosed with Dengue fever based on positive serology. Despite standard management for Dengue, he remained febrile and developed features suggestive of incomplete Kawasaki disease. Echocardiogram demonstrated a small coronary artery aneurysm. There was a dramatic response to intravenous immunoglobulin and aspirin. Follow-up at 6 weeks showed complete resolution of the aneurysm without residual cardiac sequelae. Kawasaki disease should be considered in children with Dengue who have persistent fever or evolving clinical features. Prompt recognition and treatment are essential to prevent coronary artery complications. The rare co-existence of Dengue and Kawasaki disease raises the question of whether this is a mere association or a potential trigger, highlighting an area for future research.
Henoch-Schoenlein purpura (HSP) in children is the most prevalent form of vasculitis. While the lungs are recognised as potential target organs in several vasculitides during childhood, pulmonary involvement in HSP is exceptionally rare. A 5-year-old girl presented with haemoptysis during week 3 of HSP vasculitis. Radiological findings from a pulmonary computed tomography scan confirmed alveolar haemorrhage. The patient was administered pulse corticosteroid therapy at a dose of 30 mg/kg/day for 3 days, followed by a regimen of 2 mg/kg/day and azathioprine. During follow-up, the corticosteroid treatment was gradually tapered, and the patient remains under azathioprine monotherapy without any complications. Pulmonary involvement in HSP can be life-threatening; thorough systemic examination is therefore imperative. Further evaluation should be considered necessary when assessing patients with HSP. Close monitoring for respiratory symptoms is essential in the later stages of the disease.
OBJECTIVES:To describe the socio-demographic and clinical characteristics, treatment outcome and predictors of mortality in patients under 18 years of age with post-neonatal tetanus (PNT) in Abeokuta. METHODS:This retrospective study of 108 PNT cases admitted over a 10-year period between July 2012 and June 2022 was undertaken at two major referral hospitals in Abeokuta, Nigeria. Data on patient demographics, vaccination history, clinical features, management and outcome were analysed. RESULTS:PNT accounted for 0.82% of paediatric admissions during the study period. The median age was 9.0 years, with a slight male predominance (male-to-female ratio 1.1:1). None of the children under-5 were fully vaccinated; only 5.4% of older children received post-exposure prophylaxis. The lower limb was the most common site of injury. The incubation period ranged from 1 to 60 days with a median (IQR) of 8.0 (9.0) days. The case fatality rate was 18.52%. Mortality was significantly associated with lower limb wounds, rapid onset of spasms (<24 h) and the presence of autonomic dysfunction. CONCLUSION:The burden of PNT in Abeokuta is considerable, driven by low vaccination coverage and delayed wound care. Prompt immunisation, early wound management and improved access to critical care are essential to reduce mortality.
The prevalence of post-tuberculous endobronchial stenosis in children is unknown and it is rarely reported. In adults, it varies from 10% to 40%. It has a variable spectrum of presentation; cough is the most common, but there can also be haemoptysis, dyspnoea, chest pain and wheezing. The non-specific symptoms and co-occurrence with parenchymal disease can delay the diagnosis. Bronchoscopy and computed tomography (CT) are the investigations of choice. Depending on the symptoms, chest imaging and bronchoscopic findings, the treatment can be conservative, medical or interventional. A 15-year-old male is presented; he was a known case of clinically and radiologically diagnosed pulmonary tuberculosis and was treated for 6 months with anti-tuberculous drugs. On presentation, there was a progressive cough, exertional dyspnoea, collapse consolidation of the left lung, ipsilateral mediastinal shift and partial stenosis of the left distal main bronchus on contrast-enhanced CT. Flexible fibre-optic bronchoscopy demonstrated atresia of the anterior segment and stenosis of the inferior lingular segment of the left bronchus with a normal right bronchus. Post-tuberculous bronchial stenosis should be focused on and managed early to prevent fibro-stenosis. Early treatment in a symptomatic patient is linked to a successful outcome. The boy showed significant clinical improvement with spirometry, chest physiotherapy and supportive measures, although the radiological features persisted.Abbreviations: ATT: anti-tuberculous therapy; CT: computed tomography; EBTB: endobronchial tuberculosis; ESR: erythrocyte sedimentation rate; HRCT: high-resolution computed tomography; LUL: left upper lobe; TB: tuberculosis.
