Theory and Clinical Practice in Pediatrics

Impact of feeding practices on nutritional status of infants aged 12 to 23 months in Lubumbashi, DRC: A community based cross-sectional study

Fri, 04 Nov 2022 13:26:05 +0800

Purpose: In the Democratic Republic of the Congo (DRC), malnutrition remains a public health problem despite interventions to improve the nutritional status of children. The objective of this study is to determine the degree of association between dietary practices and malnutrition among infants aged 12 to 23 months in Lubumbashi (DRC).
Methods: We conducted a community-based cross-sectional study of 574 infants between 12 and 23 months of age from urban and semi-urban areas. Door to door survey was done to collect data. Nutritional status was assessed and compared with feeding practices. A multivariate analysis was conducted to evaluate the association between dietary practices and malnutrition in these children.
Results: Bottle feeding before 6 months (adjusted odds ratio [aOR] = 1.8 [1.2-2.8]; p = 0.006), introduction of solid, semi-solid or soft foods before 6 months (aOR = 2.1 [1.0-4.3]; p = 0.042), and insufficient minimum dietary diversity (aOR=2.3 [1.6-3.5]; p < 0.0001) were independently associated with stunting. Late breastfeeding initiation (aOR = 2.4 [1.1-5.0]; p = 0.023) increases the risk of wasting.
Conclusion: Infant malnutrition is sometimes a reflection of inappropriate eating practices from the early stages of a child’s life. Adherence to sufficient nutritional recommendations at birth can reduce this burden in developing countries.

Brief review: Psychological health and life quality of cerebral palsy

Nita Bhatt, Jesse Canella, Julie P. Gentile — Tue, 26 Apr 2022 15:45:56 +0800

Cerebral palsy is the most common cause of disability that develops in infancy. This complex disorder affects adult life in a powerful way. Challenges include performing motor skills and achieving physical capabilities. The majority of individuals also report lifelong psychosocial stressors. Furthermore, mental health issues occur more commonly in this patient subset, as do struggles with employment and education. Often the severity of challenges correlates to the severity of the cerebral palsy. The prognosis of individuals with cerebral palsy has improved over the last three decades, although it continues to be a lifelong condition. In order to promote healthy aging across their lifespan, intervention programs should be considered to improve physical well-being, and care should be taken to maintain mental health.

Neonatal sepsis: A review of the literature

Adonis Muganza Nyenga, Olivier Mukuku, Stanis Okitotsho Wembonyama — Mon, 22 Nov 2021 12:56:41 +0800

Neonatal sepsis contributes significantly to neonatal morbidity and mortality and is a major public health challenge around the world. Depending on the mode of occurrence, a distinction is made between maternal-transmitted infection and that acquired in the postnatal period. Although the etiologies maternally transmitted diseases are well understood, those of postnatal acquired infections are variable depending on the epidemiology of each hospital environment. On the one hand, risk factors for maternal-transmitted infections are maternal sepsis, prolonged premature rupture of membranes, chorioamnionitis, and bacteriuria in the mother during pregnancy. On the other hand, risk factors for postnatal acquired infections are prematurity, low birth weight, lack of hygiene, and invasive therapeutic interventions. The diagnosis is based on a series of anamnestic, clinical and biological features. Although the positive diagnosis is based on the isolation of the germ by culture on a body sample (blood, cerebrospinal fluid, urine, etc.); its low sensitivity leads to the use of markers of the acute phase of inflammation such as C-reactive protein, procalcitonin and interleukins. New molecular biology techniques are promising and offer precise diagnosis with rapid results. Empirical management is a function of microbial ecology while definitive treatment is guided by the results of microbial culture. This article presents the essential elements for understanding neonatal sepsis and discusses new diagnosis and therapeutic management. It offers a thorough reading based on the issue of infections in newborns.

Who sleeps better? Sleep patterns and sleep disturbances in adolescents with recurrent abdominal pain or inflammatory bowel disease and healthy controls

Ann-Kristin Manhart, Angelika A. Schlarb — Tue, 31 Aug 2021 14:34:32 +0800

Background: Sleep difficulties play an important role in the maintenance and course of chronic abdominal pain disorders (RAP and IBD). Particularly among adolescents with inflammatory bowel diseases (IBD) or recurrent abdominal pain (RAP), adequate sleep seems to be important, as the diseases self and the associated symptoms can cause distress and impair daytime functioning. Hence it seems adequate to take a closer look concerning the sleep difficulties within the different conditions of abdominal pain especially in comparison to a healthy control. To our knowledge no former study compared sleep problems in youths with RAP and IBD as well as healthy controls. Thus the aim of the present study was to 1) evaluate sleep problems in the RAP and IBD and 2) compare the sleep problems of these abdominal pain diseases with a healthy control group.
Methods: 129 adolescents (14-25 years) took part in the online survey, with 58 suffering from IBD, 23 had RAP and 48 healthy controls. Adolescents completed sleep questionnaires as PSQI, SDSC or NEQ. Data was analysed by conducting MANOVAs to test differences between the three groups followed by a post-hoc analyses.
Results: Significant differences between both patient groups and healthy controls regarding sleep quality as well as sleep disturbances were found. Results indicate that especially young IBD patients suffered more often from poor sleep quality, sleep disturbances as well as daily effects of nightmares than the control group. The comparison of adolescents with RAP and healthy controls showed elevated scores concerning sleep disturbances for RAP patients. However, IBD and RAP adolescents did not differ significantly concerning most sleep measurements.
Discussion: The study at hand was the first to compare adolescents with IBD and RAP regarding sleep difficulties. Adolescents with IBD and RAP have an impaired sleep quality as well as a higher rate of sleep disturbances and suffer from daily effects of nightmares than the control group. Therefore sleep disturbances should be also addressed when treating IBD and RAP patients to prevent further impairments.

Sleep as a mediator in the context of emotional problems in adolescents with IBD: A pilot study

Ann-Kristin Manhart, Angelika A. Schlarb — Fri, 13 Aug 2021 17:23:30 +0800

Background: Sleep has an impact on daily life. Particularly among adolescents with IBD, adequate sleep seems to be important, as the disease itself and the associated symptoms can cause distress and impair daytime functioning. However, often parental and youth reports differ regarding perceived sleep problems of adolescents. Besides sleep problems, depression and anxiety are often prominent in young IBD patients. To date, the interplay between sleep, anxiety/depression symptoms and IBD is not fully understood. Therefore, the aim of this study was to (1) evaluate sleep problems in adolescents suffering from IBD, (2) compare adolescents’ sleep quality and impairments according to self- and parental reports, and (3) investigate the interaction between IBD symptomatology, emotional problems and sleep disturbances.
Methods: 29 adolescents (age 10 - 22; M = 14.44 , SD = 1.78 ) with IBD and their parents took part in the study. Adolescents and parents completed questionnaires concerning sleep, emotional problems, and IBD symptomatology.
Results: Especially overtiredness, insomnia symptoms, and nightmares play a prominent role regarding sleep problems in youths. Self-rated sleep problems and parental ratings were inconsistent, particularly for nightmares (Z = -2.12; p = 0.034). However, other ratings concerning emotional problems and sleep, especially anxiety and nightmares, were significantly related(r = 0.426, p = 0.034), even though we found no mediation effect for the association between IBD, nightmares and anxiety.
Discussion: The present study revealed the importance of sleep and emotional well-being for adolescents suffering from IBD. Moreover, it became clear that the role of anxiety in youths suffering from IBD and sleep problems is not sufficiently answered yet. Not only emotional behavior but also sleep should be addressed when diagnosing IBD or during treatment of IBD. In addition, these results show the need for further investigation regarding the differences between parental and self-reports concerning sleep problems in young IBD patients.

Risk factors for neonatal sepsis in Lubumbashi, Democratic Republic of Congo: A retrospective case-control study

Wed, 02 Jun 2021 11:40:42 +0800

Purpose: Neonatal sepsis (NS) is a major cause of neonatal morbidity and mortality, particularly in developing countries. Delays in the identification and treatment of NS are the main contributors to the high mortality. This study aims to identify risk factors for NS in newborns in the two university hospitals in Lubumbashi, in the Democratic Republic of Congo.
Methods: This hospital-based case-control study was carried out on 486 mother-newborn pairs using the systematic sampling method during November 2019 to October 2020. Data were analyzed using STATA software (version 15). Binary and multivariable logistic regression analyses were computed to identify the associated factors at 95% CI.
Results: A total of 162 cases and 324 controls were included in this study. Multiple logistic regression analysis showed that the possible risk factors for NS in this study were low level of education (AOR = 9.16 [2.23-37.67]), maternal genitourinary tract infections (AOR = 42.59 [17.90-101.37]), premature rupture of membranes (AOR = 19.95 [7.27-54.76]), peripartum fever (AOR = 26.25 [2.31-297.83]), prolonged labor (AOR = 14.16 [3.88-51.71]), cesarean section (AOR = 3.57 [1.48-8.61]), obstructed vaginal delivery (AOR = 13.40 [1.32-136.19]), birth weight <1500 grams (AOR = 70.38 [8.64-572.95]), and between 1500-2500 grams (AOR = 7.90 [3.04-20.52]).
Conclusion: The study found that maternal and neonatal factors were strongly associated with the risk of developing NS. The present study suggests the possibility of routine assessment of sepsis in newborns born with the above characteristics.

Melioidosis and sickle cell disease: Description of a rare association

Mon, 09 Nov 2020 15:34:33 +0800

Melioidosis and its germ are increasingly reported on the African continent and particularly in Central Africa, probably due to the increased awareness of clinicians and microbiologists and the growing recognition of the organism. It is called "Great Mimicker" because it produces a wide range of clinical characteristics such as would be found in patients living with sickle cell disease (SCD) in particular. However, to date, no publication presents this association between melioidosis and SCD. The authors describe here 3 clinical cases presenting this very rare association between melioidosis and SCD. These are 3 children with SCD (homozygous SS) residing in Lubumbashi in Haut-Katanga province in the Democratic Republic of Congo. One patient presented with sepsis as a clinical form of the disease. All 3 had presented a pulmonary form. Only one patient was treated specifically after the diagnosis of melioidosis; for the other two, this diagnosis was confirmed after their death. Thus the death rate is 66.67%. This article describes, through these 3 clinical cases, a very rare first association between melioidosis and SCD. This association requires research to establish whether, like Thalassemia, SCD can be considered a risk factor for melioidosis. A screening of cases of melioidosis in the general population should allow us to focus on this.

Management of septic arthritis of the pediatric hip

Fri, 18 Sep 2020 02:07:40 +0800

Purpose: The purpose of this study was to compare outcomes and reoperation rate between open and arthroscopic treatment of a suspected isolated septic hip in the pediatric population.
Methods: Retrospective review was performed on two cohorts of pediatric patients who underwent surgical intervention for suspected isolated septic hip arthritis at a single institution. Patients were subdivided into two cohorts based on whether they underwent an open versus arthroscopic approach. Patients were excluded if they received an initial surgery from an outside institution, did not have an acute, active infection at presentation, defined as a hip aspiration leukocyte count <50,000 cells with <75% neutrophils, had extracaspular pathology or osteomyelitis, or had septic arthritis of a joint other than the hip.
Results: Fifty-six hips were included [Open group (n = 36); Arthroscopic group (n = 20)]. Six percent (2/36) of hips in the open group and 26% (5/19) of hips in the arthroscopy group had a positive tissue culture (p = 0.041). Eleven hips (31%) underwent postoperative immobilization in the open group compared to one hip (5%) in the arthroscopic group (p = 0.039).
Conclusions: In the setting of isolated arthritis, arthroscopy is a reasonable treatment modality with no observed additional risk compared to open arthrotomy. However, with concomitant osteomyelitis or soft tissue abscess, open arthrotomy should remain the mainstay approach to address all elements of the infection.
Level of Evidence: Level III

Maternal knowledge and practices regarding childhood acute respiratory infections in Lubumbashi, Democratic Republic of Congo

Wed, 16 Sep 2020 07:45:32 +0800

Introduction: Acute respiratory infections (ARIs) are a public health problem in the Democratic Republic of Congo (DRC) and cover a range of infections, from the common cold to pneumonia. ARIs are the leading cause of death in children under-5, with the majority of deaths occurring in developing countries.
Objective: To assess the knowledge and home-based practices used by mothers of children under-fives during episodes of ARI.
Methods: A cross-sectional study was carried out among mothers of children under-five who were selected in Lubumbashi (DRC). A pre-tested questionnaire administered by researchers was used for data collection.
Results: Of the 582 mothers interviewed, the majority had a good knowledge of the symptoms (87.46%), danger signs of severe ARIs (95.02%) and a good knowledge of the modes of transmission of ARIs (68.73%). Knowledge level was significantly associated with age and education level regarding modes of transmission. Three hundred and sixty-eight (63.23%) mothers indicated that they use traditional remedies: 252 (43.30%) apply palm oil to their children’s noses and as many mothers (n = 252; 43.30%) apply mentholatum ointment to the nose. Almost all of the mothers (n = 579; 99.48%) indicated that they dress the child with several layers of clothes. Oral self-medication was used by 575 mothers (98.80%).
Conclusion: The mothers’ knowledge of modes of transmission, symptoms and danger signs of ARIs was good in the community studied in Lubumbashi. Knowledge level was associated with age and level of education regarding modes of transmission.

Thyroid dysfunction in Congolese subjects with Down syndrome

Mon, 10 Aug 2020 06:42:02 +0800

Objective: The present study aims to assess the proportion and the pattern of thyroid dysfunction in a population of Congolese subjects with Down Syndrome.
Methods: A total of 34 subjects with Down syndrome were recruited from Lubumbashi (Democratic Republic of Congo). Thyroid morphology was assessed by sonography. Serum T3, T4, FT4, TSH, Thyroglobulin, Thyroid peroxidase antibody (TPOAb) and antithyroglobulin antibody (TgAb) were measured.
Results: The mean age of the patients was 13 years (range: 3 and 47 years). Of 34 Down syndrome subjects, 6 cases (17.6%) were found to have subclinical hypothyroidism. No patient had hyperthyroidism. Among 29 subjects with a thyroid ultrasound imaging, 25 patients (86.2%) were found to have morphological abnormalities of the gland. Regarding thyroid autoantibodies, TPOAb was positive in 1 case (2.9%) and TgAb was positive in 1 case (2.9%).
Conclusion: The results were compared between patients with hypothyroidism and with normal thyroid function. There was no statistical difference in terms of age, sex, nutritional status, antibody levels and thyroid volume between these two groups. Conclusions: In our series, the proportion of hypothyroidism is relatively important but it remains largely under the prevalence reported in international studies.