Mohamed Abdullahi Ahmed,1 Mohamed Abdi Hassan,1 Walyedin Elnour Mohamed Elfakey,1,2 Jolly Nankunda,1 Abishir Mohamud Hirsi,3 Mohamed Jayte,3 Mohamed Mohamud Farah,4 Zakaria Abdi Said,1 Hamdi Mohamed Yusuf,1 Martin Nduwimana11Department of Paediatrics and Child Health, Kampala International University, Ishaka, Uganda; 2Paediatrics Department, University of Bahri, Faculty of Medicine, Khartoum, Sudan; 3Department of Internal medicine, Kampala International University, Ishaka, Uganda; 4Department of Obstetrics and Gynecology, Kampala International University, Ishaka, UgandaCorrespondence: Mohamed Abdi Hassan, Email mohamedabdih576@gmail.comBackground: In Uganda, prematurity is the main cause of newborn fatalities, accounting for 41% of all annual newborn deaths. There are limited studies in Uganda that have explored preterm births. This study aimed to assess the incidence, risk factors for admission and outcomes of late preterm Neonates at Kayunga and Jinja Regional Referral Hospitals (KRRH and JRRH).Methods: This was a prospective cohort study in which late preterm babies were enrolled at birth. Late preterm neonates (born at 34 weeks and 0 days through 36 weeks and 6 days) at KRRH and JRRH during the study period were enrolled. They were followed up from the time of birth till 4 weeks of life for hospital admission and mortality. Modified Poisson regression in stata version 14 was done to determine the significant risk factors.Results: In this study, we enrolled 329 late preterm neonates. Slightly more than half were males (59.9%). The distributions in the gestational ages slightly increased with gestation age with 31.9%, 33.4% and 34.7% born at 34, 35 and 36 weeks of gestation respectively. Of the 329 late preterm neonates enrolled in this study, 72 were admitted, representing an incidence proportion of 21.9% (219 admission per 1,000 live late preterm births). In the multivariable analysis, maternal age between 35– 45 years, monthly income less than 200,000 Uganda shillings, less than two antenatal care visits, duration of labour greater than 24 hours, and presence of perinatal complications were significant. The overall mortality rate was 1.8% and admission mortality of 8.3%.Conclusion: The incidence of hospital admission among late preterm Neonates was high with maternal and neonatal factors being significant at multivariate analysis. More research with longer follow up should be done to assess the long-term outcomes among late preterms.Keywords: preterm, mortality, hospitalization
Purpose:Agenesis of corpus callosum, cardiac, ocular, and genital syndrome (ACOGS) is a rare disease that has only been described in recent years. To date, nineteen cases have been reported. ACOGS often leads to severe complications and is potentially fatal. However, its pathogenesis and clinical spectrum remain poorly understood by clinicians, and several genetic variants associated with the syndrome have yet to be fully characterized. Patients and Methods:We present the case of a five-month-old infant exhibiting dysmorphic facial features, corneal leucoma, esotropia, nystagmus, agenesis of the corpus callosum, and tricuspid regurgitation. The child was admitted to our hospital with a respiratory tract infection, and eventually diagnosed with ACOGS. Whole exome sequencing identified a novel de novo heterozygous variant in the cadherin 2 (CDH2) gene (c.744G>T). During hospitalization, the patient developed multiple symptoms including respiratory distress, tachycardia, and arrhythmia. Results:Despite intensive interventions-including invasive mechanical ventilation-his condition continued to deteriorate, and he ultimately succumbed to complications. Conclusion:ACOGS is a rare disease with complex clinical presentations and generally poor outcomes. Based on current limited evidence, it may be reasonable for clinicians to maintain a high index of suspicion and to consider early genetic testing. When ACOGS is suspected, whole exome sequencing could be considered as part of the diagnostic workup.
Mohammed Al-Shehab,1,2 Rashad Abdul-Ghani,3 Muneera Muthana Zaid,1 Ahmed A Azazy,4 Sayaf A Alsoofi,1 Reham S Al-Areqi,1 Rawan A Al-Akwaa,1 Mohammed H Al-Arashani,1 Kafa Alwan Ali Alkhder,1 Sahar A Thabet,5 Ahlam Abdulmalik Esmail,6,7 Ahmed S Hudna81Department of Pediatrics, University of Science and Technology Hospital, Sana’a, Yemen; 2Division of Pediatric Emergency Medicine, Department of Pediatrics, Hamad Medical Corporation, Doha, Qatar; 3Department of Medical Parasitology, Faculty of Medicine and Health Sciences, Sana’a University, Sana’a, Yemen; 4Department of Laboratory Medicine, Faculty of Applied Medical Sciences, Al-Baha University, Al-Baha, Saudi Arabia; 5Department of Pediatrics, Modern European Hospital, Sana’a, Yemen; 6Department of Pediatrics, Faculty of Medicine and Health Sciences, University of Science and Technology, Sana’a, Yemen; 7Department of Pediatrics, Al-Thawra Modern General Hospital, Sana’a, Yemen; 8Department of Pediatrics, Faculty of Medicine and Health Sciences, University of Science and Technology, Aden, YemenCorrespondence: Rashad Abdul-Ghani, Department of Medical Parasitology, Faculty of Medicine and Health Sciences, Sana’a University, Sana’a, Yemen, Tel +967 775005239, Email rashadqb@yahoo.comBackground: Pneumonia is a major cause of preventable morbidity and mortality among under-five children, particularly in low-resource and conflict-affected countries. However, evidence from Yemen remains scarce. This study examined child-related, maternal, and environmental factors possibly associated with pneumonia among under-five children in Sana’a City, Yemen.Methods: An unmatched multicenter case-control study was conducted among 302 children aged 2– 59 months at five tertiary hospitals from August to December 2023. The study included 151 children admitted to pediatric wards with pneumonia and 151 controls attending outpatient clinics for non-respiratory conditions and without clinical evidence of pneumonia. Data on potential factors associated with pneumonia were collected using a structured interviewer-administered questionnaire. Univariable binary logistic regression was used to assess associations, and variables with p < 0.20 were entered into a multivariable binary logistic regression model to identify independent predictors.Results: In univariable analysis, low birthweight, prematurity, acute malnutrition, recent upper respiratory tract infection (URTI), having a household contact with respiratory infection, and poor ventilation in the cooking area were significantly associated with pneumonia. In multivariable analysis, acute malnutrition (adjusted odds ratio [AOR] = 1.9, 95% CI: 1.12– 3.36; p = 0.020), recent URTI within the preceding week (AOR = 4.4, 95% CI: 2.49– 7.80; p < 0.001), and having a household contact with respiratory infection (AOR = 1.9, 95% CI: 1.08– 3.34; p = 0.027) remained independent predictors.Conclusion: Acute malnutrition, recent URTI, and household contact with respiratory infection show independent associations with pneumonia among under-five children attending tertiary hospitals in Sana’a. These findings highlight child nutrition, early recognition and management of URTI, and household infection-prevention practices as priorities in this resource-limited, conflict-affected setting. However, these hospital-based case-control findings require confirmation in longitudinal, population-based studies before they can inform context-specific prevention strategies.Keywords: pneumonia, under-five children, risk factors, predictors, Yemen
Background:Congenital heart defects affect over half of children with Down syndrome. Screening is recommended within the first six weeks of life to enable timely management and improve survival. Despite this, congenital heart defect screening remains low and often delayed. Objective:This study aimed to assess the uptake of congenital heart defect screening and its associated factors among children with Down syndrome in Rwanda. Methods:This quantitative cross-sectional study was conducted from February to May 2025. A total of 313 participants were recruited using convenience sampling. The study was conducted in four hospitals and the Rwanda Down Syndrome Organization. Data were collected using a newly developed structured questionnaire that was pilot tested prior to the main data collection. Ethical approval and informed consent were obtained. Descriptive statistics summarized congenital heart defect screening uptake, while multivariable logistic regression was used to identify factors associated with screening uptake. Results:Among 313 children with Down syndrome, 159 (51%) had undergone congenital heart defect screening. Among those screened, 45 (28%) were screened within the recommended first 6 weeks after birth. In the multivariable logistic regression analysis, place of residence was significantly associated with congenital heart defect screening uptake, with higher odds of screening among children in urban areas compared with those in rural areas (AOR = 2.17; 95% CI: 1.29-3.68; p = 0.004). Conclusion:Congenital heart defect screening among children with Down syndrome remains suboptimal, with delayed screening commonly observed. Urban residence is associated with higher screening uptake in the adjusted model. Targeted interventions are needed to improve timely screening, particularly addressing barriers in rural settings.
Uganda's sickle cell disease (SCD) prevalence of 1.3% and sickle cell trait (SCT) prevalence of 13.3% nationally represent a substantial public health burden, with an estimated 20,000 affected infants born annually. On 9 February 2026, Uganda's Ministry of Health launched a nationwide mandatory newborn screening programme for SCD, placing the country among the first in sub-Saharan Africa to implement universal birth screening. This policy builds on over a decade of evidence, including the Uganda Sickle Surveillance Study, and cost-effectiveness analyses showing dried blood spot (DBS) screening costs of $5.88 per child, with viable point-of-care thresholds of $3.07-$5.09. However, the initial rollout relies on rapid diagnostic tests within existing hub-and-CPHL systems and does not yet fully cover private facility births, immunization-based catch-up for missed cases, or older unscreened children. In addition, the current 4-6-week turnaround time with centralized confirmation at Central Public Health Laboratories remains an operational limitation. We propose a differentiated implementation framework to strengthen the programme. It aligns screening strategies with care entry points and age-specific test performance. Private facilities would use a microchip electrophoresis analyzer (Gazelle™) at birth due to reduced accuracy of lateral flow tests in high fetal hemoglobin. Public facilities would integrate Sickle SCAN or HemoTypeSC into immunization contacts from six weeks of age, with the 9-month contact prioritized as the most reliable screening timepoint given the progressive decline in HbF, and school-based programmes would target children aged 1-5 years who were previously missed. All pathways would connect to Uganda's 100-laboratory hub network for electrophoretic confirmation, potentially reducing turnaround time to 48-72 hours. By leveraging existing delivery, immunization, and laboratory infrastructure, this framework offers a feasible and equitable route to translate Uganda's mandatory screening policy into large-scale health impact.
Introduction:Studies conducted in Northern, Central, and Eastern Uganda revealed concerning case fatality rates for children with severe acute malnutrition (SAM). However, there is a lack of research specifically addressing mortality rates among children with SAM in Western Uganda. This study aimed to assess the mortality rates, weight change trends and risk factors for mortality among children with SAM in Midwestern Uganda. Methods:This was a prospective cohort at Hoima Regional Referral Hospital in which children aged below five years admitted with SAM were enrolled and followed up for 6 weeks. The relevant data was obtained via history taking, physical examination and laboratory investigations. The percentage of children that died within 6 weeks was computed. Poisson regression was done to determine the independent predictors. P-values <0.05 were considered significant. Findings:In this study, 146 participants were enrolled. About half of the participants were aged 13-36 months (50.7%). Of the 144 that completed the 6 week follow up, 12 died, expressing a mortality of 8.3% (83 per 1000 children); with majority of deaths (83.3%) occurring in the first 48 hours of admission. In the multivariable analysis, the independent risk factors for mortality were vomiting, lower respiratory tract infection, malaria and hypoglycemia (P<0.05 for all). Conclusion:Mortality among children with SAM in Western Uganda remains high, with most deaths occurring within 48 hours. Early detection and management of vomiting, respiratory infections, malaria, and hypoglycemia are critical to reducing mortality. The relevant data was obtained via history taking, physical examination and laboratory investigations. Bi-variable and multivariate was used, and Poisson regression was done to determine the independent predictors. P-values <0.05 were considered significant.
Yuanyuan Lu, Feng Fang, Hua Zhou, Sainan Shu, Xinglou LiuDepartment of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People’s Republic of ChinaCorrespondence: Xinglou Liu, Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People’s Republic of China, Email liuxinglou@163.comPurpose: Agenesis of corpus callosum, cardiac, ocular, and genital syndrome (ACOGS) is a rare disease that has only been described in recent years. To date, nineteen cases have been reported. ACOGS often leads to severe complications and is potentially fatal. However, its pathogenesis and clinical spectrum remain poorly understood by clinicians, and several genetic variants associated with the syndrome have yet to be fully characterized.Patients and Methods: We present the case of a five-month-old infant exhibiting dysmorphic facial features, corneal leucoma, esotropia, nystagmus, agenesis of the corpus callosum, and tricuspid regurgitation. The child was admitted to our hospital with a respiratory tract infection, and eventually diagnosed with ACOGS. Whole exome sequencing identified a novel de novo heterozygous variant in the cadherin 2 (CDH2) gene (c.744G>T). During hospitalization, the patient developed multiple symptoms including respiratory distress, tachycardia, and arrhythmia.Results: Despite intensive interventions—including invasive mechanical ventilation—his condition continued to deteriorate, and he ultimately succumbed to complications.Conclusion: ACOGS is a rare disease with complex clinical presentations and generally poor outcomes. Based on current limited evidence, it may be reasonable for clinicians to maintain a high index of suspicion and to consider early genetic testing. When ACOGS is suspected, whole exome sequencing could be considered as part of the diagnostic workup.Keywords: ACOGS, CDH2, infant, respiratory tract infection
Background:Vitamin D deficiency remains common among infants and young children, particularly in higher latitudes and among exclusively breast-fed infants. Although routine supplementation is widely recommended, variability in achieved serum 25-hydroxyvitamin D [25(OH)D] concentrations has been reported across pediatric populations. Understanding the consistency of biochemical response across diverse pediatric settings remains clinically relevant for both research and supplementation practice. Objective:To summarize evidence from pediatric clinical studies utilizing a standardized vitamin D formulation and to assess the magnitude and consistency of serum 25(OH)D response across independent investigator-initiated studies. Methods:Relevant studies were identified through company-supported research records and a supplementary PubMed search. Eligible publications were published between 2010 and 2020 and included infants or children ≤18 years receiving vitamin D supplementation with reported baseline and follow-up 25(OH)D concentrations. Studies were required to explicitly identify the study formulation and report serum 25(OH)D outcomes. A narrative synthesis approach was applied. Results:Seven studies (Canada, Australia, Vietnam, and Mongolia; total n ≈ 3,800) met inclusion criteria. Supplementation doses ranged from 400 IU/day to 14,000 IU/week across study durations of 1-12 months. Mean baseline 25(OH)D concentrations (≈53 nmol/L) increased to ≈75 nmol/L (mean Δ ≈22 nmol/L). Daily supplementation at 400 IU achieved sufficiency in the majority of infants, while higher-dose regimens produced proportionally greater increases. No study reported clinically significant adverse events attributable to supplementation. Conclusion:Vitamin D supplementation produced consistent and clinically meaningful increases in serum 25(OH)D concentrations across diverse pediatric populations. The approximately 20-25 nmol/L increase observed across the included studies was broadly consistent with published pediatric vitamin D supplementation literature. These findings support current supplementation practices while highlighting the reproducibility of biochemical response across independent pediatric research settings.
Vedaste Bagweneza,1 Philomene Uwimana,1 Leon Mutesa,2,3 Glorieuse Uwizeye,4 Donatilla Mukamana11School of Nursing and Midwifery, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda; 2School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda; 3Center for Human Genetics, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda; 4Arthur Labatt Family School of Nursing, Western University, London, Ontario, CanadaCorrespondence: Vedaste Bagweneza, University of Rwanda, College of Medicine and Health Sciences, School of Nursing and Midwifery, Kigali, Rwanda, Tel +250788692468, Email v.bagweneza@ur.ac.rwBackground: Congenital heart defects affect over half of children with Down syndrome. Screening is recommended within the first six weeks of life to enable timely management and improve survival. Despite this, congenital heart defect screening remains low and often delayed.Objective: This study aimed to assess the uptake of congenital heart defect screening and its associated factors among children with Down syndrome in Rwanda.Methods: This quantitative cross-sectional study was conducted from February to May 2025. A total of 313 participants were recruited using convenience sampling. The study was conducted in four hospitals and the Rwanda Down Syndrome Organization. Data were collected using a newly developed structured questionnaire that was pilot tested prior to the main data collection. Ethical approval and informed consent were obtained. Descriptive statistics summarized congenital heart defect screening uptake, while multivariable logistic regression was used to identify factors associated with screening uptake.Results: Among 313 children with Down syndrome, 159 (51%) had undergone congenital heart defect screening. Among those screened, 45 (28%) were screened within the recommended first 6 weeks after birth. In the multivariable logistic regression analysis, place of residence was significantly associated with congenital heart defect screening uptake, with higher odds of screening among children in urban areas compared with those in rural areas (AOR = 2.17; 95% CI: 1.29– 3.68; p = 0.004).Conclusion: Congenital heart defect screening among children with Down syndrome remains suboptimal, with delayed screening commonly observed. Urban residence is associated with higher screening uptake in the adjusted model. Targeted interventions are needed to improve timely screening, particularly addressing barriers in rural settings.Keywords: congenital heart defects, down syndrome, screening uptake
Background:Palatoglossal synechia (glossopalatal fusion) is an exceptionally rare congenital anomaly characterized by abnormal adhesion between the tongue and palate. Severe forms present in the neonatal period with restricted oral opening, feeding difficulty, and airway compromise. To our knowledge, this represents the first documented case of complete palatoglossal synechia reported from Somalia. Case Presentation:We report the case of a seven-day-old full-term female neonate who presented with severe feeding difficulty and persistent respiratory distress since birth. Feeding attempts were associated with choking and intermittent cyanotic episodes. On examination, the neonate was tachypneic with increased work of breathing and nasal flaring. Oral cavity examination revealed complete palatoglossal synechia associated with cleft palate, resulting in near-complete restriction of oral opening and absent tongue mobility. Initial management included supplemental oxygen via nasal cannula and nasogastric tube feeding for nutritional support. Following stabilization, the patient underwent successful surgical release of the adhesion under general anesthesia using electrocautery after nasopharyngeal intubation. Postoperatively, the infant showed marked improvement in feeding ability, respiratory status, and oral function. At two-month follow-up, the patient demonstrated effective breastfeeding, normal tongue mobility, appropriate weight gain, and no evidence of respiratory compromise or recurrence. Conclusion:Complete palatoglossal synechia is an exceptionally rare congenital condition that may cause significant neonatal feeding and airway difficulties. Careful oral examination is crucial for early diagnosis in neonates with unexplained respiratory distress and feeding impairment. Early multidisciplinary management and timely surgical intervention can result in excellent clinical outcomes, even in resource-limited settings.
Introduction:Acute abdomen is characterized by acute and severe abdominal pain caused by intra-abdominal disease and often requires surgical intervention. Accurate diagnosis is difficult because of symptom similarity and diverse causes, such as appendicitis, intussusception, and mesenteric adenitis, which can present with overlapping symptoms in pediatric patients. The aim of this study is to analyze the causes, diagnosis, and outcome of non-traumatic acute abdomen in pediatric patients at a tertiary hospital in Mogadishu. Methodology:A retrospective cross-sectional study was conducted from January 1 to December 31, 2023, including 92 children aged 0-18 who presented with non-traumatic acute abdomen and received emergency surgical intervention. All definitive diagnoses were confirmed based on intraoperative findings. Statistical analyses were conducted using SPSS version 26.0, incorporating univariate and bivariate analyses with a significance level of p < 0.05. Results:Out of 6390 pediatric emergency visits, 92 children (1.4%) were diagnosed with acute abdomen. The main reasons were appendicitis (53.3%), intestinal obstruction (16.3%), and perforation (15.2%). Appendicitis predominantly impacted school-aged children (72.7%) and adolescents (66.7%), whereas intussusception was more prevalent in newborns (40.0%) and toddlers (33.3%). Fever was strongly correlated with appendicitis (59.6%, p < 0.001) and perforation (25.0%, p < 0.001). Regarding diagnostic performance, plain radiography was negative in 71.4% of appendicitis cases, whereas ultrasonography demonstrated a significantly higher diagnostic yield of 52.1% (p = 0.015). The median duration of hospitalization was 6 days, with a low mortality rate of 2.2% (p = 0.741). Conclusion:The study demonstrates a significant incidence of appendicitis and other surgical emergencies in this population. We recommend early ultrasonography over plain radiography to improve diagnostic precision and prevent delays in pediatric surgical care in Somalia.
Objective:To summarize the clinical, laboratory, imaging, pathological features, treatment and prognosis of eosinophilic cystitis (EC) in children. Methods:A retrospective analysis was performed on 17 children diagnosed with EC at our hospital from January 2012 to December 2024, combined with literature review. Results:The cohort included 15 males and 2 females, with a median age of 6 years and 3 months. Major symptoms included frequent urination, urgency, dysuria, abdominal pain and distension. Mean disease duration was 42.3 days. Urinalysis showed proteinuria (1+-3+) in 7 cases and leukocyturia in 1 case. Peripheral blood eosinophil percentage averaged 43.6%. All 17 cases had bladder wall thickening on ultrasound; 9 cases were confirmed pathologically by cystoscopic biopsy. Eight cases were complicated with eosinophilic gastroenteritis, 3 by gastroscopic pathology. Treatments included anti-allergic therapy (11 cases), prednisone (7 cases), anti-parasitic agents (2 cases) and surgery (2 cases). During follow-up, 16 cases had no recurrence at 2 years; 1 case relapsed during steroid tapering and remained on low-dose prednisone. Conclusion:Pediatric EC presents mainly with urinary irritation and abdominal symptoms. Diagnosis relies on clinical, laboratory, imaging and histological findings. EC is frequently associated with eosinophilic gastroenteritis. Anti-allergic and steroid therapies are effective; surgery is reserved for specific cases. The overall prognosis is favorable.
Ying Liang, Ying Shen, Yeping JiangDepartment of Nephrology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, 100045, People’s Republic of ChinaCorrespondence: Yeping Jiang, Email jiangyeping@mail.ccmu.edu.cnObjective: To summarize the clinical, laboratory, imaging, pathological features, treatment and prognosis of eosinophilic cystitis (EC) in children.Methods: A retrospective analysis was performed on 17 children diagnosed with EC at our hospital from January 2012 to December 2024, combined with literature review.Results: The cohort included 15 males and 2 females, with a median age of 6 years and 3 months. Major symptoms included frequent urination, urgency, dysuria, abdominal pain and distension. Mean disease duration was 42.3 days. Urinalysis showed proteinuria (1+– 3+) in 7 cases and leukocyturia in 1 case. Peripheral blood eosinophil percentage averaged 43.6%. All 17 cases had bladder wall thickening on ultrasound; 9 cases were confirmed pathologically by cystoscopic biopsy. Eight cases were complicated with eosinophilic gastroenteritis, 3 by gastroscopic pathology. Treatments included anti-allergic therapy (11 cases), prednisone (7 cases), anti-parasitic agents (2 cases) and surgery (2 cases). During follow-up, 16 cases had no recurrence at 2 years; 1 case relapsed during steroid tapering and remained on low-dose prednisone.Conclusion: Pediatric EC presents mainly with urinary irritation and abdominal symptoms. Diagnosis relies on clinical, laboratory, imaging and histological findings. EC is frequently associated with eosinophilic gastroenteritis. Anti-allergic and steroid therapies are effective; surgery is reserved for specific cases. The overall prognosis is favorable.Keywords: children, eosinophilic cystitis, clinical features, diagnosis, treatment, prognosis
Background:Etoposide-based protocols remain the first-line therapy for pediatric hemophagocytic lymphohistiocytosis (HLH), yet 20-30% of patients exhibit primary resistance. Early identification of non-responders is critical to enable timely salvage therapy. We aimed to develop and validate a predictive model for etoposide-based protocols resistance using readily available clinical and laboratory parameters. Methods:A retrospective cohort of 79 pediatric HLH patients (median age 3.5 years; 53% male) treated with etoposide-based protocols (HLH-94/2004) at Hunan Children's Hospital (2020-2024) was analyzed. Patients were stratified into refractory (n=20) and responsive (n=59) groups based on 8-week treatment outcomes. Chemosensitive patients were defined as those achieving complete response (CR) or entering maintenance by week 8; chemorefractory patients were defined as those who died during induction, required salvage therapy due to progression, or failed to achieve CR within 8 weeks. CR required normalization of all quantifiable disease markers (sCD25, ferritin, triglycerides, ALT, hemoglobin, neutrophils, platelets). Pre-chemotherapy and early post-chemotherapy (Day 3) variables were compared using t-tests, Mann-Whitney U-tests, and χ2 analyses. Multivariable logistic regression and ROC analyses identified predictors of resistance, with internal validation via 1000-bootstrapping. Results:Pre-chemotherapy IL-10 >131.2 μmol/L (OR=5.1; 95% CI 1.9-13.7; P=0.001) and pre-chemotherapy platelet count <55.5×109/L (OR=4.2; 95% CI 1.6-11.3; P=0.004) independently predicted refractoriness. A combined model incorporating these parameters achieved an AUC of 0.822 (sensitivity 81.3%, specificity 75.0%). Post-chemotherapy Day 3 platelet count (OR=1.02 per 109/L increase; P=0.01) and lymphocyte count (OR=2.5 per 109/L increase; P=0.03) further refined prediction (AUC 0.880). Calibration curves and decision curve analysis confirmed clinical utility. Conclusion:Pre-chemotherapy IL-10 and platelet count reliably identify pediatric HLH patients at high risk of etoposide-based protocols resistance. Integration of Day 3 post-chemotherapy parameters enables ultra-early and more precise risk stratification, facilitating prompt transition to salvage therapies.
Objective:To systematically review and analyze the literature on intrahospital neonatal transport and synthesize the available evidence to inform the development of standardized transport procedures. Methods:Following the "6S" evidence model, a systematic search was conducted across multiple databases from inception to August 31, 2025. Eligible documents were appraised for methodological quality, and relevant recommendations and evidence statements were extracted and synthesized narratively. The level of evidence and strength of recommendations were graded according to the 2014 JBI evidence pre-grading system. Results:A total of 10 documents were included, comprising 7 guidelines, 2 evidence summaries, and 1 systematic review. A total of 35 evidence statements were synthesized and grouped into 7 themes: transport team; pre-transport assessment and decision-making; preparation of healthcare providers and neonates; preparation of supplies and medications; transport equipment; monitoring and care during transport; and handover and quality management. The evidence base was primarily derived from guideline recommendations, evidence summaries, and expert consensus. Conclusion:This review provides a structured synthesis and critical appraisal of the available evidence and recommendations for intrahospital neonatal transport. The synthesized recommendations may help inform standardized transport procedures; however, they should be interpreted with caution because a substantial proportion of the evidence base is derived from guidelines or expert consensus. Further high-quality prospective, multicenter studies are warranted to evaluate the effectiveness, feasibility, and generalizability of these recommendations across diverse clinical settings.
Purpose:Healthy neonates experience pain during procedures such as vitamin K injections. Pain adversely affects the neonate, so it is important to control it. This study compared the effects of local heat and massage using the flick application on the pain caused by vitamin K injection in neonates. Patients and Methods:This experimental research was conducted on neonates in Rafsanjan, Iran. The samples were selected using the convenience method and randomly placed in three groups: flick application massage, local heat, and control. In the flick application group, a flick was delivered with the thumb and the index finger on the injection site. In the local heat group, injection site was heated to 40 °C using a hair dryer. The pain score was measured using the Neonatal Infant Pain Scale (NIPS), and data analysis was performed using SPSS software. Results:Based on the results, there was a significant difference between the average pain score of the neonates in the local heat group and the control group (P<0.001) and between the massage group and the control group (P<0.001). Neonates in the local heat group experienced less pain than those in the massage group. However, there was no difference between the average pain score of the massage group and the local heat group after injection (P = 0.11). Conclusion:In this study, both interventions reduced the pain caused by the intramuscular injection of vitamin K. These findings suggest that either technique can be used in clinical practice, depending on the conditions.
Background: Among children younger than 5 years, infectious conditions account for the majority of pediatric emergency department visits. Due to nonspecific presentation, early identification of Sepsis and serious bacterial infection is challenging. Procalcitonin (PCT) level has been examined as a marker of sepsis. It has been shown to have advantages over other inflammatory markers. Aim: This study aimed to evaluate the association between high PCT levels and positive blood, urine, or cerebrospinal fluid (CSF) cultures in all infant patients suspected of having sepsis/Serious bacterial infections (SBIs) clinically or using the Pediatric Early Warning as integration between elevated PCT and culture-proven infections with PEWS to improve early risk stratification and guide clinical decision-making in a tertiary. Methods: This retrospective cross-sectional study included all patients aged 28 to 90 days whose PCT was obtained simultaneously with blood, urine, or CSF cultures and a viral nasopharyngeal aspirate, taken under suspicion of sepsis/SBIs, from January 2020 to December 2021. All statistical analyses were performed using the SPSS software (IBM) version 27.0.1. Findings: This study included 352 patients. In total, 205 (58.2%) were between 28 and 60 days old, while 147 (41.8%) were aged 60-90 days. The association between the PCT levels and blood culture outcomes was not statistically significant. However, the association between PCT levels and positive urine culture was statistically significant (p = 0.008). In addition, the analysis revealed a nonsignificant association between PCT levels and respiratory viral infection. Conclusion: In this cohort, as a single center, PCT level is not a predictor of positive blood or CSF culture results. In contrast, high PCT levels are significantly associated with positive urinary culture results. The study was conducted at a single center with small sample size which may affect the generalizability of its findings. Future multicenter research with large sample size is required to validate the study findings.
Background:Appropriate pediatric HIV status disclosure remains a public health challenge in low- and middle-income countries (LMICs). This review aims to describe the existing pediatric HIV disclosure interventions in LMICs and their efficacy. Methods:Literature search was conducted in Medline, Embase, PsychInfo, Cochrane Central Register of Controlled Trials databases, and Google Scholar following PICOS framework to identify interventional studies aimed at improving HIV status disclosure among children and adolescents. Retrieved studies were screened, data were extracted using a piloted tool, and a narrative synthesis and methodological quality assessment were conducted. Results:A total of 260 studies were retrieved and after the screening, 6 studies fulfilled the eligibility criteria, three of which were randomized clinical trials (RCTs) while others were quasi-experimental designs. Only two interventions were based on pre-existing theory. Four interventions were delivered by Health Care Workers (HCWs) only, one by HCWs and peer supporters and one by trained research assistants. The main components of the interventions included education/training, media/videos, books, disclosure counseling, and disclosure support and half of the studies applied multiple components. The commonly assessed disclosure-related intervention outcomes were safety, acceptability, prevalence of disclosure, perceptions, and experiences. Only two studies reported significant changes in outcome (prevalence of disclosure) between control and intervention groups. However, there was marked variation in the methods used to assess outcomes across studies. Conclusion and Recommendations:This review highlights that there are limited interventions addressing pediatric HIV status disclosure in LMICs, targeting different stakeholders in the disclosure process and assessing different outcomes. Additionally, most studies were not grounded pre-existing theories, frameworks and models. There is a need to develop standardized tools to assess disclosure and related outcomes in different contexts, compare the effectiveness of single-component and multi-component pediatric disclosure interventions.
Purpose:To evaluate the efficacy of intravenous methylprednisolone plus nebulized budesonide (IV+NEB CS) versus nebulized budesonide alone (NEB CS) in infants with RSV pneumonia, and to assess the influence of bacterial co-infection. Methods:This retrospective study included 303 patients (≤36 months) with RSV pneumonia. Patients were divided into IV+NEB CS (n=140) and NEB CS (n=163) groups, then stratified by bacterial co-infection and antibiotic use. Primary outcomes were time to cough/fever/wheezing relief, disappearance of pulmonary signs, hospital stay, and glucocorticoid-related adverse events. Results:(1) Wheezing relief was faster in the IV+NEB CS group [2.0 (1.5,4.0) vs 3.0 (2.0,4.0) days, P=0.010], but other outcomes did not differ. (2) Subgroup B (IV+NEB CS without bacterial infection) had the shortest median wheezing relief [2.0 (1.0,3.0) days], pulmonary sign resolution [4.0 (3.0,5.0) days], and hospital stay [4.0 (3.0,5.0) days]. (3) Antibiotic use was independently associated with shorter symptom relief and discharge (all P<0.001); after adjusting for antibiotics, the main effect of IV+NEB CS was no longer significant for most outcomes. (4) Antibiotics also reduced CRP levels (P=0.002). (5) Adverse event rates did not differ between groups. Conclusion:In non-severe RSV pneumonia, adding intravenous methylprednisolone to nebulized budesonide provides no consistent independent benefit after accounting for antibiotic use. The apparent faster recovery with combination therapy was largely explained by antibiotics. Routine intravenous corticosteroids are not recommended. When bacterial co-infection is suspected, antibiotics should be prioritized.
Purpose:Vitamin A deficiency (VAD) is a critical public health issue in Somalia, yet evidence regarding dietary practices remains limited. This study assessed the prevalence, geographical distribution, and determinants of Vitamin A-rich food consumption among children aged 6-23 months. Methods:Using 2020 Somali Demographic and Health Survey (SDHS) data (n=2,806), we employed two-level multilevel mixed-effects logistic regression to identify individual and community-level determinants. Spatial analysis, including Global Moran's I and Getis-Ord Gi* statistics, was performed to assess geographical clustering and identify consumption hotspots. Results:Only 33.75% of children consumed adequate Vitamin A-rich foods. Multilevel analysis revealed that children aged 18-23 months (AOR=2.78), those with formally educated mothers (AOR=1.42), and urban residents were more likely to consume these foods. Conversely, children with a birth order of two or more (AOR=0.44), and those from rural (AOR=0.72) or nomadic (AOR=0.22) households, had significantly lower odds of consumption. Spatial analysis confirmed significant geographical clustering (Moran's I = 0.24, p=0.048), identifying high-consumption hotspots in Awdal and Shabeellaha Dhexe, and low-consumption coldspots in Bari, Gedo, and Woqooyi Galbeed. Conclusion:Somali children face a substantial deficiency in Vitamin A-rich food intake, driven by pronounced sociodemographic and geographical disparities. These findings underscore the urgent need for multisectoral interventions. Strategies should prioritize enhancing maternal education and implementing context-specific programs for rural and nomadic communities to mitigate the burden of VAD in Somalia.
