Background:Nationwide data on the incidence of central precocious puberty (CPP) and premature thelarche (PT), a benign variant of pubertal development, are limited. Purpose:To evaluate trends in CPP and PT incidence among Thai children before, during, and after the COVID-19 pandemic. Methods:This cross-sectional population-based study used National Health Security Office (NHSO) claims data from 2018 to 2024. CPP and PT were identified using ICD-10-TM (International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Thai Modification) codes. Annual incidence rates (AIRs) were calculated for each NHSO-insured population, while incidence rate ratios (IRRs) were estimated using quasi-Poisson regression. Results:A total of 6,782 girls and 189 boys with CPP, and 1,594 girls with PT, were included. Among girls, the CPP AIR increased from 15.0 per 100,000 person-years in 2018 to 51.7 in 2021 and remained elevated during 2022-2024 (44.1-47.7). The IRR was 2.27 (95% confidence interval [CI], 1.82-2.83) for pandemic versus prepandemic, and 1.06 (95% CI, 0.89-1.26) for postpandemic versus pandemic period. An age-stratified analysis showed the greatest increase among girls aged 8 to <9 years. Among boys, the CPP AIR remained low and stable (0.6-1.0 per 100,000 person-years). The female-to-male IRR was 43.0 (95% CI, 33.5-55.3). The incidence of PT in girls increased from 7.2 in 2018 to 14.6 per 100,000 person-years in 2024, with the largest increase observed among those aged 7 to <8 years. Conclusion:The incidence of CPP among Thai girls increased during the COVID-19 pandemic and remained elevated thereafter, whereas the incidence of PT increased gradually. Both trends were most pronounced in peripubertal age groups. Further studies are required to determine whether these patterns reflect pandemic-related factors or an earlier onset of puberty.

OBJECTIVES:To understand factors associated with proper child safety seat (CSS) use in the Bangkok Metropolitan Region (BMR), Thailand, after the child restraint legislation and to provide evidence to inform policy for increasing proper CSS use. METHODS:A cross-sectional study was conducted. Primary caregivers of at least one child aged 0-6 years or height 135 cm or less, who own a car, reside in BMR, and achieve literacy in the Thai language were included. The recruitment was done by distributing posters with QR codes to access information sheets and online self-administered questionnaires both online and offline (Pediatrics outpatient and postpartum units at Ramathibodi Hospital; 273 public early childhood centers; and 102 kindergartens in Bangkok) between April and December 2024. The questionnaire comprised questions regarding demographic data, knowledge, attitude, practice, and other information about CSS. Data were compared between the proper and improper CSS users via Stata version 17. RESULTS:330 respondents with a median (Q1, Q3) age of 38 (34, 41) years were included; most were female (83.2%) and residents of Bangkok (68.7%). Two hundred ninety-six respondents (89.7%) reported CSS usage, with 170 respondents reporting regular use (51.5%). Among respondents, 135 (40.9%) were categorized as proper users (regularly use an age-appropriate type of CSS and locate it on the back seat). Logistic regression showed factors associated with proper CSS used were higher household income (OR 9.97, 95%CI: [4.06-24.52], p < 0.001) and barriers to using CSS including child-related barriers (OR 0.10, 95%CI: [0.05-0.22], p < 0.001), caregivers-related barriers (OR 0.19, 95%CI: [0.04-0.99], p = 0.049), and car-related barrier (OR 0.38, 95%CI: [0.15-0.92], p = 0.031). The leading reported barriers to CSS use were children's refusal (42%) and the high cost of CSS (23%). The trusted sources of information regarding CSS were social media/internet (43%) and healthcare providers (34%). Respondents preferred educational intervention for improving knowledge (22%) and tax deduction policy (17%) to help increase CSS use. CONCLUSIONS:After the child restraint legislation, the proper usage of CSS to ensure child safety was still low. Factors associated with proper CSS usage included higher household income and barriers to using CSS. Multilevel interventions and policies were suggested to address the issues. Further research could be done to evaluate the effectiveness of those measures and their impacts on increasing proper CSS usage in Thailand.

The impact of fine particulate matter (PM2.5) airway pollution is common in many large cities globally but is particularly prevalent in Asia. Paediatricians have been involved in a front role of child advocacy, but little is known about the knowledge, awareness, and practice (KAP) of PM2.5 among them. This survey assessed the KAP of PM2.5 among Thai paediatricians and explored links to improve PM2.5 health protection in children. The electronic questionnaire was given to paediatricians across various regions of Thailand. Out of 400 respondents, 399 participated. Results showed high self-evaluated knowledge of PM, PM10 and PM2.5. Recognition of PM2.5 impact on children's health, such as asthma, sinusitis, and recurrent infections, was notable. Less understood were the effects of abortion, congenital anomalies, and obesity. Over 90% agreed their communities faced PM2.5 problems and advocating for PM2.5 protection was a paediatrician's role, but 55% felt confident in community communication about PM2.5. Based on the recommendations of the Royal College of Paediatricians of Thailand (RCPT), the practice score indicated that 94% could advise on PM2.5 prevention. Knowledge, awareness, and practice related to PM2.5 issues were associated with each other. Age, subspecialty graduation, advocacy role agreement, and awareness of PM2.5 in their community were also linked to confidence in public communication with PM2.5 issues.In conclusion, associations between knowledge, awareness, and practice related to PM2.5 were observed among Thai paediatricians. While awareness and general knowledge were high, confidence in community communication was relatively low. Recommendations include improving public communication skills and providing environmental health learning opportunities during training and continuing education.

Background: The acceptable fine particulate matter (PM2.5) level in Thailand is double the recommendation of the World Health Organization. It is necessary to have an accurate measure of PM2.5 exposure and its association with health problems in vulnerable groups such as asthma exacerbation in Thai children to urge the Clean Air Act in Thailand, which is currently in the process of revision. Objective: To study the association between PM2.5 exposure and asthma exacerbation in children living in Bangkok Metropolitan Region and Chiang Mai Province. Methods: A pilot prospective observational study was conducted at the Chest and Allergy clinic at Ramathibodi Hospital, Mahidol University, Bangkok and at the Chest Clinic at Nakornping Hospital, Chiang Mai, Thailand, from June 2020 to February 2021. Children with asthma, aged 5–18 years old, were recruited. Respiratory symptoms, including cough, chest tightness, dyspnea or wheezing, peak expiratory flow rate, and asthma exacerbation, were recorded twice daily by caregivers. Estimated average daily PM2.5 exposure levels were calculated using ArcGIS® at exacerbation day, three days before exacerbation (lag day 3), and 7 days before exacerbation (lag day 7). Regression analysis was applied to examine the association between PM2.5 exposure and asthma exacerbation. Findings: Seventy asthmatic patients were enrolled. The median age was 9.7 (IQR 5–18) years old. There were 53 respiratory symptoms, 5 admissions, and 1 intensive care unit admission. Daily PM2.5 levels above 12 mcg/m3 (the US cut-off level for the sensitive group) has higher sensitivity to detect asthma exacerbation compared to Thai cut-off level for the sensitive group (37 mcg/m3) (sensitivity 98.2% vs 32.1%). The average daily PM2.5 level exposure at lag day 3 in the exacerbation vs the non-exacerbation group was 27.5 and 13.6 mcg/m3 (p < 0.01), respectively. The daily PM2.5 level at lag day 3 was also correlated with an acute asthmatic attack (r = 0.62, p < 0.01) with the 0.2 events increasing of asthmatic exacerbation every 10 mcg/m3 of increment of daily PM2.5 level. Conclusions: Our findings suggest that asthmatic children are sensitive to daily PM2.5 levels above 12 mcg/m3. Exposure to high daily PM2.5 levels can lead to asthma exacerbation within three days. Further participant recruitment is needed to emphasize this association and establish the national data.

To conduct a multi-center prospective study over more than one year requires an efficient system that can synchronize collection of data from several sources in real-time and facilitate remote data management. This paper describes the design and use of an in-house data collection and sample information management system that was used in a prospective birth cohort study in Thailand. Participants were enrolled from three hospitals and were required to visit their respective hospital and complete self-administered questionnaires (SAQ) at every visit. The in-house informatics system required integration of the data collection streams that can handle three different types of data (SAQ, clinical record, and laboratory sample tracking). The system has been implemented in the pilot phase of a birth cohort study and has demonstrated its usability for further application to an expanded study.

Background: There is increasing evidence of a link between environmental pollution and preventable diseases in developing countries, including Thailand. Economic development has generated several types of pollution that can affect population health. While these environmental health effects can be observed throughout life, pregnant women and children represent particularly vulnerable and sensitive groups. Methods: The published epidemiological literature investigating environmental chemical exposure in Thai children was reviewed, highlighting those that investigated associations between exposure and subsequent health outcomes. Results: The majority of the Thai epidemiological studies on environmental health in children were cross-sectional in design, with some demonstrating associations between exposure and outcome. The three main types of chemical exposure in Thai children were pesticides, heavy metals, and air pollution, which resulted from agricultural activities in countryside areas, industrial zones (both registered and unregistered establishments), mining, and traffic in inner cities. Major health outcomes included detrimental effects on cognitive function and cancer risk. Pesticide exposure was focused on, but not limited to, agricultural areas. The success of the Thai environmental policy to introduce lead-free petrol can be demonstrated by the decline of mean blood lead levels in children, particularly in urban areas. However, unregistered lead-related factories and smelters act as hidden sources. In addition, there is increasing concern, but little acknowledgement, about the effects of chronic arsenic exposure related to mining. Lastly, air pollution remains a problem in both dense city populations due to traffic and in rural areas due to contamination of indoor air and house dust with heavy metals, endotoxins and other allergens. Conclusions: The increasing number of published articles demonstrates an improved awareness of children's environmental health in Thailand. Chemical hazards, including the improper use of pesticides, environmental contamination with heavy metals (lead and arsenic), and air pollution in inner cities and indoor air, continue to be growing issues.

BACKGROUND:This study aimed to assess the association between exposure to indoor air pollution in DCCs (Child Day Care Centers) and the respiratory symptoms of children under 6 years old.METHODS:Air quality data were collected three times regarding to seasonal variation. Pollutants measured in 11 DCCs included PM₁₀, CO, NO₂, SO₂, O₃, benzene, bacteria, fungi, and dust mite. The frequencyof respiratory symptoms including coughing, rhinitis, and dyspnea were recorded via teacher and parent-report questionnaires. Fractional exhaled nitric oxide (FENO) levels were measured to assess airway inflammation.RESULTS:436 children participated in the study. 83% completed data collection in all 3 seasons. The frequency of rhinitis correlated with PM₁₀ (IRR=70.3, 95%CI=12.4-399.7, p<0.001), CO (IRR=3.2, 95%CI=2.4-4.2, p<0.001), benzene (IRR=2.3, 95%CI=1.8-3.2, p<0.001) and D.Pteronyssinus level (IRR=2.1, 95%CI=1.7-2.7, p<0.001). The frequency of coughingcorrelated with levels of PM10 (IRR=15.2, 95%CI=3.0-78.2, p<0.001), CO (IRR=2.8, 95%CI=2.1-3.7, p<0.001), benzene (IRR=1.4, 95%CI=1.1-1.9, p=0.02). The frequency of dyspnea correlated with D.Pteronyssinus level (IRR=3.9, 95%CI=1.7-9.1, p=0.001). FENO levels associated with high benzene levels (OR=5.9, 95%CI=1.5-22.9, p=0.01). The majority of DCCs had at least one PM₁₀ measurement above the standard level, and these high levels were noted in all 3 seasons. Three DCCs had PM₁₀ levels above the standard level in all seasons. 64% of the DCCs had indoor bacterial counts above the standard level in all seasons.CONCLUSIONS:PM₁₀ and bacterial count is a significant problem in Bangkok metropolitan DCCs. The respiratory symptoms of children positively associated with PM₁₀, CO, benzene and dust mite levels.

Background In 2012, a girl with blood lead level of 166 mcg/dl was admitted in Ramathibodi hospital due to status epilepticus. She lived with her parent in the recycling factory where high lead dust was found around the area inside. Children in the school which located around 100 metres from such recycling factory were investigated and found that the prevalence of high blood lead level (BLL) ≥ 10 mcg/dl was 44.2% (75 in 165 children). Methods We conducted a case-control study with 43 cases of school children with BLL ≥ 10 mcg/dl, and a control group of 43 children from the same school by matching criteria of gender and classroom. The interviewed personal data, information on environmental risk factors and collected household environmental samples were collected by questionnaire and laboratory technique to identify the association between environmental factors, BLL ≥ 10 mcg/dl, and to study the prevalence of low IQ and learning disability among children with BLL ≥ 15 mcg/dl. Determined factors influencing BLL were analyses by univariate analysis and multiple logistic regression analyses. Children with BLL ≥ 15 mcg/dl were tested and compared for significant of IQ and learning disability differences. Results Eighty six of children were enrolled. The multiple logistic regression showed the association between high BLL and school duration more than 4 academic years (p-value = 0.02), father's occupation related with lead (p-value = 0.044) and the distance between home and the factory <500 metres (p-value = 0.029). Children with BLL ≥ 15 mcg/dl, we found that prevalence of low IQ was 25% and of learning disability was 66.7%. Conclusions High blood lead level among children associated with living at home, attending in the school nearby the lead pollution factory, and father's occupation related with lead. The prevalence of low IQ and learning disability among children with BLL ≥15 mcg/dl was higher than average of Thai children. Screening blood lead level among children in industrial area is necessary.

BACKGROUNDPatients with chronic liver disease have been shown to have impaired immune statuses. Liver transplantation (LT) is the standard treatment for end-stage liver disease patients and immunosuppressive drugs are commonly used to prevent graft rejection. There is an increasing evidence of de novo food allergies post LT.OBJECTIVETo investigate the cytokine response of peripheral blood mononuclear cells (PBMCs) of pediatric LT recipients before and six months after transplantation.METHODPBMCs collected before and six months after LT were stimulated with phytohemagglutinin (PHA), beta-lactoglobulin (BLG), tacrolimus (Tac), dexamethasone (Dex), and a combination of BLG and Dex (B+D), BLG and Tac (B+T), BLG and Tac plus Dex (B+T+D). Culture supernatants were measured for IL-5, IFN-γ and IL-10. Blood for liver function tests, complete blood counts, total IgE and specific IgE (sIgE) to cow's milk were recorded.RESULTSA total of five pediatric LT recipients were enrolled in the study. There were no food allergy cases. Total IgE and sIgE to cow's milk decreased significantly after LT. After transplantation, there was a significant increase in IL-5, IFN-γ and IL-10 in culture supernatants of PHA-stimulated PBMCs. Among different stimulations in post transplantation's PBMCs, the level of IL-5 significantly increased in B+D was suppressed with the combination of B+T+D. The level of IL-10 significantly increased in all conditions containing BLG both before and after transplantation.CONCLUSIONThere was an improvement of the in vitro-cytokine responses after liver transplantations. Immunosuppressive drugs used in post transplantation had an effect on the cytokine responses.

BACKGROUND:Food allergy (FA) prevalence is increasing in pediatric liver transplantation (LT). However, the clinical course is still limited.OBJECTIVE:This retrospective cohort study aimed to identify the prevalence, risk factors, and the natural history of de novo FA in children post LT.METHODS:Medical records of pediatric LT recipients from Jan 2001 - Dec 2014 were reviewed. De novo FA was diagnosed by symptoms after exposure to culprit food occurring after LT, and improvement after diet elimination. FA was confirmed if reproduced symptoms after re-challenge or documented sensitization or indicated gastrointestinal eosinophilia.RESULTS:Among 46 post LT children, 54.3% developed de novo FA at a median time of 12.2 months [Interquartile range (IQR) 6.2, 21.3 months] post LT. The confirmed FA was 39.1%. Gastrointestinal symptom was the most common manifestation followed by skin, anaphylaxis, and others. Culprit foods were cow's milk, shellfish, egg, wheat, soybean, peanut, coconut, fish and monosodium glutamate. The risk factors of FA were transplantation during age below 2 years [hazard ratio (HR), 2.62; 95% confidence interval (CI), 1.04 - 6.59; p = 0.03), atopic history in family (HR, 5.67; 95% CI, 1.33 - 24.12; p = 0.01), and Epstein-Barr (EBV) viremia (HR, 2.39; 95% CI, 1.02 - 5.63; p = 0.04).CONCLUSIONS:de novo FA in pediatric LT is not uncommon. Age at LT younger than 2 years, family history of atopy, and EBV viremia are associated with developing FA. Development of tolerance after elimination culprit diets for 3 years is similar to general population.