Taona Emmah Mudhluli,1,2,* Kristien Nel Van Zyl,3,* Magdalena Kujawska,4,5 Runyararo Mashingaidze-Mano,6 Charissa C Marsh,3,7 Inam Chitsike,8 Nikhat Zia,1 Justen Manasa,1 Lindsay J Hall,5,9,10 Exnevia Gomo,1 Danai Tavonga Zhou11Department of Laboratory Investigative and Diagnostic Sciences, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe; 2Department of Biochemistry, Faculty of Medicine and Health Sciences, Midlands State University, Gweru, Zimbabwe; 3Department of Biomedical Sciences, African Microbiome Institute, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; 4Intestinal Microbiome Department, ZIEL - Institute for Food & Health, Technical University of Munich, Freising, Germany; 5Department of Microbes, Infection and Microbiomes, School of Infection, Inflammation and Immunology, College of Medicine and Health, University of Birmingham, Birmingham, UK; 6Department of Maternal and Child Health, Paediatrics Division, Faculty of Health Sciences and Veterinary Medicine, School of Medicine, University of Namibia, Windhoek, Namibia; 7DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; 8Department of Maternal and Child Health, Paediatrics Unit, University of Zimbabwe, Harare, Zimbabwe; 9Food, Microbiome and Health, Quadram Institute Bioscience, Norwich, UK; 10Norwich Medical School, University of East Anglia, Norwich, UK*These authors contributed equally to this workCorrespondence: Taona Emmah Mudhluli, Email taonaemmah@gmail.comIntroduction: Understanding the association of HIV exposure, antiretroviral therapy (ART) prophylaxis and human milk oligosaccharides (HMOs) on the gut microbiota of breastfed infants is crucial for developing strategies to promote infant health. Our study explored gut microbiota diversity and development in breastfed infants, analysing the influence of nevirapine (NVP) in HIV Exposed infants and HMOs in HIV Unexposed infants.Methods: Infants delivered vaginally and exclusively breastfed were recruited from City Council Clinics in Harare, Zimbabwe, at six weeks postpartum. A total of 110 infants were enrolled, and stool samples were collected for shotgun metagenomic sequencing. Dried blood spots from HIV-exposed infants were analyzed for nevirapine using HPLC–MS/MS, and breast milk from HIV-uninfected mothers was analyzed for human milk oligosaccharides using UPLC–MS. Of the collected samples, 93 stool specimens passed all bioinformatics quality filters. Alpha diversity and beta diversity were assessed, and associations between microbial diversity and HIV exposure, nevirapine levels, and HMO concentrations were evaluated using MaAsLin2.Results: Our analysis showed no significant differences in microbial diversity across various NVP concentrations in HE infants or in 3’SL and 6’SL in the HU infants group (p ≥ 0.05). HIV exposure was associated with higher levels of Stenotrophomonas maltophilia and Mediterraneibacter faecis (corrected p-values 2.08× 10− 5 and 0.00246), respectively. Moreover, HIV exposure was linked to changes in specific metabolic pathways.Conclusion: Although overall diversity remained stable across NVP concentrations in HE infants and HMO levels in HU infants, specific taxa and functional pathways differed by HIV exposure, highlighting that compositional and functional changes can occur independently of global diversity metrics. Therefore, HIV exposure itself may influence gut microbiota composition and metabolic functions at species level, particularly with an increased abundance of specific bacteria and altered metabolic pathways leading to disturbances in vitamin metabolism.Keywords: HIV-exposed infants, gut microbiota, human milk oligosaccharides, antiretroviral prophylaxis
Atong Abraham Nyok,1 Owiny Augustine Okejomoe,2 Patrick Charles Namisi,1 Robert Sebunya11Department of Pediatrics and Child Health, Uganda Martyrs University, Nkozi, Uganda; 2Department of Pediatrics and Child Health, Mulago Specialized Women and Neonatal Hospital, Kampala, UgandaCorrespondence: Owiny Augustine Okejomoe, Department of Pediatrics and Child Health, Mulago Specialized Women and Neonatal Hospital, Kampala, Uganda, Tel +256773145429, Email owinyaugustine2018@gmail.comPurpose: Sustained seizure freedom is a central aim of childhood epilepsy care, yet long-term outcome data from specialist pediatric services in Uganda remain limited. We estimated the prevalence of documented sustained seizure freedom and examined associated factors among children and adolescents attending a specialist pediatric neurology clinic in Uganda.Patients and Methods: We reviewed records of children and adolescents attending the Pediatric Neurology Clinic at St. Francis Hospital Nsambya. The outcome was documented freedom from all epileptic seizures for at least 24 consecutive months. Under the investigator-confirmed recording rule, blank outcome fields were classified as not achieving sustained seizure freedom. Exploratory modified Poisson models with robust standard errors examined associations among records with usable covariates.Results: Of 520 records screened, 496 were included; 385 met the documented endpoint (77.6%; 95% CI 73.7– 81.1). Structured medicine selections were available for 395 records. Levetiracetam, sodium valproate, carbamazepine, and lamotrigine were selected in both monotherapy and polytherapy records; clobazam and diazepam were additionally selected in polytherapy in these fields. The available-case adjusted analysis included 389 records, of which 379 met the endpoint. Onset at 1– 4 years versus < 1 year had an adjusted prevalence ratio (aPR) of 1.08 (95% CI 1.00– 1.17); polytherapy versus monotherapy had an aPR of 0.93 (95% CI 0.86– 1.00). Point estimates were similar across age-variable specifications, but confidence intervals were close to or crossed the null.Conclusion: More than three-quarters of reviewed records met the documented 24-month seizure-free endpoint. Estimated associations with onset age and polytherapy were small, with uncertainty close to the null across model specifications. They should be interpreted cautiously because the adjusted subset differed from the full cohort and contained few records not meeting the endpoint.Plain Language Summary: We reviewed 496 records from a specialist epilepsy clinic in Kampala, Uganda. A record met the study outcome when it documented no epileptic seizures for at least 24 months in a row. About eight in ten records met this definition. Following the confirmed recording rule, blank outcome entries were counted as not achieving sustained seizure freedom; a blank entry does not itself prove that seizures continued. We also described the medicines recorded for children receiving one or several antiseizure medicines. Comparisons accounting for other recorded factors used 389 records with usable information. The estimated differences related to onset age and the number of medicines were small. The uncertainty means that clear differences cannot be established confidently. These results do not show that using several medicines causes poorer seizure control. Epilepsy beginning before the first birthday warrants timely specialist assessment to clarify the diagnosis and treatment needs.Keywords: childhood epilepsy, seizure freedom, antiseizure medication, polytherapy, treatment outcome, Uganda
Babak Abdinia,1,2 Azar Dastranji,2,3 Yousef Abedifard,2 Sajjad Pourasghary41Department of Pediatric Infectious Diseases, Zahra Mardani Azari Children’s Educational and Treatment Center, Tabriz University of Medical Sciences, Tabriz, Iran; 2Clinical Research Development Unit, Zahra Mardani Azari Children’s Educational and Treatment Center, Tabriz University of Medical Sciences, Tabriz, Iran; 3Department of Pediatric Pulmonology, Zahra Mardani Azari Children’s Educational and Treatment Center, Tabriz University of Medical Sciences, Tabriz, Iran; 4Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, IranCorrespondence: Sajjad Pourasghary, Drug Applied Research Center, Tabriz University of Medical Sciences, Medical Research and Development Complex Daneshgah St, Tabriz, P.O. BOX: 51656-65811, Iran, Tel +989375996070, Email pourasgary@yahoo.com; pourasghary.s@tbzmed.ac.irBackground: Community-acquired pneumonia (CAP) remains an important cause of pediatric hospitalization and severe respiratory illness. Vitamin D has recognized roles in skeletal health and immune regulation, but its relationship with pneumonia severity in children remains uncertain. This study evaluated serum 25-hydroxyvitamin D status in hospitalized children with CAP and explored its association with disease severity and clinical outcomes.Methods: This single-center prospective observational cohort study included 100 hospitalized children aged 2 months to 15 years with radiographically confirmed CAP at a tertiary pediatric referral hospital in Tabriz, Iran. Pneumonia severity was classified as mild/moderate or severe according to British Thoracic Society criteria. Serum 25-hydroxyvitamin D, inflammatory markers, clinical features, radiographic findings, hospitalization duration, pediatric intensive care unit (PICU) admission, and in-hospital mortality were assessed. Vitamin D deficiency was defined as serum 25-hydroxyvitamin D < 30 nmol/L.Results: Seventy-four children had mild/moderate pneumonia and 26 had severe pneumonia. Severe cases had lower oxygen saturation, more extensive radiographic involvement, longer hospitalization, and more frequent PICU admission. Mean serum 25-hydroxyvitamin D was 21.8 ± 7.6 nmol/L in the severe group and 25.2 ± 10.1 nmol/L in the mild/moderate group (mean difference, − 3.4 nmol/L; 95% CI, − 7.2 to 0.4; p = 0.079). Vitamin D deficiency occurred in 92.3% and 78.4% of severe and mild/moderate cases, respectively (p = 0.144). After adjustment, lower 25-hydroxyvitamin D was not clearly associated with severe pneumonia.Conclusion: Vitamin D deficiency was highly prevalent among hospitalized children with CAP, but admission 25-hydroxyvitamin D was not clearly associated with pneumonia severity. The relatively small hospitalized cohort and wide confidence intervals limit the strength and generalizability of these findings. Larger prospective studies with more complete assessment of nutritional, seasonal, clinical, and socioeconomic confounders are needed.Keywords: vitamin D deficiency, 25-hydroxyvitamin D, community-acquired pneumonia, child, disease severity, pediatric intensive care
Fatemeh Enhesari,1 SeyedHamid SeyedBagheri,2 Tabandeh Sadeghi31School of Nursing and Midwifery, Student Research Committee, Rafsanjan University of Medical Sciences, Rafsanjan, Iran; 2Department of Pediatric Nursing, School of Nursing and Midwifery; Geriatric Care Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran; 3Department of Pediatric Nursing, School of Nursing and Midwifery; Non-Communicable Diseases Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, IranCorrespondence: Tabandeh Sadeghi, Email t.b_sadeghi@yahoo.comBackground and Objective: Given the inevitability of blood sampling procedures in hospitalized neonates and the use of natural reflex stimulation as a non-pharmacological method, this study aimed to compare the effects of stimulating the sucking and grasp reflexes on pain intensity and crying duration following blood sampling in hospitalized neonates.Materials and Methods: This quasi-experimental study was conducted in 2024 on neonates admitted to the neonatal intensive care unit (NICU) of Ali Ibn Abi Talib Hospital in Rafsanjan, Iran. Neonates were selected using convenience sampling and randomly assigned to three groups: sucking reflex stimulation, grasp reflex stimulation, and control. In Intervention Group 1, the sucking reflex was stimulated by placing a pacifier in the neonate’s mouth two minutes before and up to one minute after the blood sampling procedure. In Intervention Group 2, during the same period, the grasp reflex was stimulated by placing a soft object (a cotton-filled finger of a latex-free vinyl glove) in the neonate’s palm. The neonates in the control group received no specific intervention. The pain scores were assessed using the Neonatal Infant Pain Scale (NIPS), and data were analyzed using SPSS software.Results: The findings indicated a statistically significant difference in the mean pain scores and crying duration between the sucking reflex group and the control group (P < 0.001), as well as between the grasp reflex group and the control group (P < 0.001). However, no statistically significant difference was observed between the two intervention groups in terms of pain scores and crying duration (P > 0.05).Conclusion: The results of this study suggested that both sucking and grasp reflex stimulations are effective in reducing pain associated with blood sampling in neonates. Thus, depending on the clinical context, either method may be utilized as a non-pharmacological pain management strategy.Keywords: pain, blood sampling, neonates, sucking reflex, grasp reflex
Xiaomei WanDepartment of Pediatrics, The First Affiliated Hospital of Wannan Medical University, Wuhu, 241000, People’s Republic of ChinaCorrespondence: Xiaomei Wan, Department of Pediatrics, The First Affiliated Hospital of Wannan Medical University, No. 2, West Zhe Shan Road, Jinghu District, Wuhu, 24100, People’s Republic of China, Tel +86-0553-5730001, Email 13605534056@163.comBackground: Cytomegalovirus (CMV) is a β-herpesvirus. In immunocompromised individuals, CMV infection can cause life-threatening complications such as encephalitis, pneumonia, hepatitis and organ rejection. In contrast, immunocompetent children often present with mild infection, with thrombocytopenia being a common hematological complication.Methods: A 2-month-18-day-old female infant was transferred to a tertiary hospital due to a 2-day fever and 1-day generalized petechiae. Physical examination revealed scattered skin petechiae without lymphadenopathy, hepatosplenomegaly or other systemic symptoms. Laboratory tests showed moderate thrombocytopenia with a platelet count of 35 × 109/L, and platelet transfusion was not required, elevated liver transaminases, positive CMV IgM and IgG, and detectable peripheral CMV-DNA load, confirming acute CMV infection. The infant received only hepatoprotective treatment during an 8-day hospitalization, without intravenous immunoglobulin or antiviral agents.Results: The platelet count and liver function improved gradually during hospitalization. At two-week follow-up after discharge, blood cell parameters and liver enzymes returned to normal, and peripheral CMV-DNA declined to undetectable levels. Platelet counts remained stable in the subsequent 2-month follow-up.Conclusion: CMV-associated thrombocytopenia in immunocompetent infants is usually self-limiting. Close dynamic monitoring of hematological and hepatic indicators is essential. Antiviral therapy should be prescribed cautiously, and individualized management is recommended for mild CMV infection in young infants.Keywords: cytomegalovirus, thrombocytopenia, infant, hepatitis, self-limiting infection
