Child Survival Research Articles

Cohort profile: the National Congenital Anomaly Registration Dataset in England

PurposeThe National Congenital Anomaly and Rare Disease Registration Service (NCARDRS), part of National Disease Registration Service in National Health Service England, quality assures, curates and analyses individual data on the...

Evaluation of Neurological and Auditory Development in Children with Congenital Heart Disease using Essence Q Questionnaire and Auditory Brainstem Response (ABR) Test.

The progress of cardiac surgery in children and the increase in the survival of children with Congenital Heart Disease (CHD) has led to consider another issue called a neurodevelopmental disorder. In this study, 53 children with CHD were evaluated in terms of development with the Essence Q questionnaire, Otoacoustic Emission (OAE), and Auditory Brainstem Response (ABR) regarding these patients' hearing and risk factors. The Essence Q scores were also examined. In this prospective, cross-sectional study, the researchers included 53 children diagnosed with CHD. Initially, each child underwent ABR and OAE tests. Subsequently, data on potential risk factors associated with neurodevelopmental delay were collected. A trained project associate administered the Essence Q questionnaire, using parents' information as a guide. Following data collection, this study proceeded with an in-depth analysis of the information. Thirty-six boys (67.92%) and 17 girls (32.08%) with CHD were included in the study. The mean age of children was 26.9810.64 months. The mean Essence Q score for boys was 7.482.57. Moreover, the average score for girls was 2.23 8.11. According to this questionnaire, 39 patients (73.58%) had hyperactivity disorder, 46 patients (86.79%) had behavioral disorders, and ten patients (16.98%) had a motor delay. Unlike previous studies, all patients had normal OAE and ABR hearing. This study demonstrated that factors such as developmental delay in the first year, a known genetic disease, and a history of seizures significantly impacted the Essence Q score. However, elements like prematurity, the use of ventilation, abnormalities on the dorsum, and the number of days post-surgery did not significantly affect the Essence Q score. Essence Q can be a reliable tool in screening for neurodevelopment in children with CHD.

Genetics Predicts Later-Life Cancer Risk in Childhood Survivors

Genetics Predicts Later-Life Cancer Risk in Childhood Survivors

Call for Submissions: Special Theme Issue on Preparing Health Systems for Improved Newborn and Child Survival

Call for Submissions: Special Theme Issue on Preparing Health Systems for Improved Newborn and Child Survival

The Management of Children with Pre-School Medulloblastoma – A Review of Four Decades of Multi-Disciplinary and Multi-Institutional Collaboration.

Background: The management and consequent survival and quality of survival for young children with medulloblastoma have undergone substantial improvement over the last four decades. While many of these changes reflect improvements in pediatric neurosurgical, neuro- imaging and radiation oncologic technology and training, as well as in supportive care experience and expertise, this review will focus particularly upon improvements in chemotherapeutic approaches. Methods: This review focuses only upon prospective clinical trials conducted in young children with newly-diagnosed medulloblastoma since the 1980s. The upper age limits for these trials varied from under three to up to six years of age at diagnosis. Results: Certain but not all trials endeavoring to improve outcomes for young children with now- recognized pathological and molecular low-risk characteristics, specifically the Sonic Hedgehog (SHH) sub-type, representing some 50-60% of young children with medulloblastoma, have reaped substantial gains in event-free and overall survival, irradiation-free survival as well as neuropsychological outcomes. Those successful trials utilized either induction including intravenous high-dose methotrexate and intraventricular (intra-Ommaya) methotrexate without consolidation by marrow-ablative chemotherapy with autologous hematopoietic progenitor cell rescue (AuHPCR), or induction with or without intravenous high-dose methotrexate (but not intra-ventricular methotrexate) followed by consolidation with marrow-ablative chemotherapy with AuHPCR. These two approaches have consistently produced superior outcomes compared with other trials. For children with molecularly-characterized Groups 3 or 4 medulloblastoma, representing those at high-risk of relapse, some modest improvements have been made over the years, but much room for improvement remains, especially for those presenting with the highest- risk molecular characteristics (CMYC-amplified Group 3 medulloblastoma) as well as for children with metastatic disease at initial diagnosis. Conclusions: Substantial gains in improving outcomes for young children with medulloblastoma have been achieved with acceptable short- and long-term morbidities of treatment. However, the inclusion of intra-ventricular therapies (conventional chemotherapeutic, radio-labeled monoclonal antibody or adaptive cellular immunotherapeutic approaches) as well as the identification of targeted systemic therapies (biological and/or immunological) and their incorporation into prospective multi-center clinical trials, must be investigated prospectively if we are to improve outcomes for those children at high-risk for relapse, even with the inclusion of refined irradiation therapeutic approaches.

Development of a Simple and Reproducible Cell-derived Orthotopic Xenograft Murine Model for Neuroblastoma.

Neuroblastoma is a common childhood cancer with poor survival for children with high-risk disease, and ongoing research to improve outcomes is needed. Patient-derived xenografts (PDX) and genetically engineered mouse models (GEMM) are reliable models for oncologic research; however, they are resource-intensive, expensive, and require significant expertise to develop and maintain. We developed an orthotopic xenograft murine model of neuroblastoma that utilizes cryopreserved banks of human neuroblastoma cell lines, requires minimal equipment, and is easily reproducible. The neuroblastoma cell line NB1643 was obtained from the Children's Oncology Group (COG) Childhood Cancer Repository. Nod-SCID-gamma (NSG) mice underwent orthotopic injection of 2x106 NB1643 cells suspended in 10 μl of collagen hydrogel directly into the adrenal gland via an open retroperitoneal surgical approach. Mice were monitored by ultrasound and in vivo imaging system (IVIS) until the tumor reached the volume of the ipsilateral kidney. Tumor identity was confirmed by necropsy and histologic analysis. A total of 55 mice underwent surgery. Eight died due to anesthetic or surgical complications. 39/47 (78%) survivors grew primary adrenal tumors. Average anesthesia time was 30 min. Ultrasound and IVIS successfully characterized tumor growth in all mice. Average time to target tumor size was 5 weeks (range=3-9). Gross pathologic and histologic analysis confirmed adrenal tumors consistent with neuroblastoma in all mice with adrenal masses. A cell-derived orthotopic xenograft murine model can be successfully used to create an in vivo model of neuroblastoma. This model can be utilized in environments where PDX or GEMM models are not feasible.

Differences in Breastfeeding Duration by Maternal HIV Status: A Pooled Analysis of Nationally Representative Surveys in Sub-Saharan Africa.

Breastfeeding improves child survival but is a source of mother-to-child HIV transmission among women with unsuppressed HIV infection. Estimated HIV incidence in children is sensitive to breastfeeding duration among mothers living with HIV (MLHIV). Breastfeeding duration may vary according to maternal HIV status. Sub-Saharan Africa. We analyzed pooled data from nationally representative household surveys conducted during 2003-2019 that included HIV testing and elicited breastfeeding practices. We fitted survival models of breastfeeding duration by country, year, and maternal HIV status for 4 sub-Saharan African regions (Eastern, Central, Southern, and Western). Data were obtained from 65 surveys in 31 countries. In 2010, breastfeeding in the first month of life ("initial breastfeeding") among MLHIV ranged from 69.1% (95% credible interval: 68-79.9) in Southern Africa to 93.4% (92.7-98.0) in Western Africa. Median breastfeeding duration among MLHIV was the shortest in Southern Africa at 15.6 (14.2-16.3) months and the longest in Eastern Africa at 22.0 (21.7-22.5) months. By comparison, HIV-negative mothers were more likely to breastfeed initially (91.0%-98.7% across regions) and for longer duration (median 18.3-24.6 months across regions). Initial breastfeeding and median breastfeeding duration decreased during 2005-2015 in most regions and did not increase in any region regardless of maternal HIV status. MLHIV in sub-Saharan Africa are less likely to breastfeed initially and stop breastfeeding sooner than HIV-negative mothers. Since 2020, UNAIDS-supported HIV estimates have accounted for this shorter breastfeeding exposure among HIV-exposed children. MLHIV need support to enable optimal breastfeeding practices and to adhere to antiretroviral therapy for HIV treatment and prevention of postnatal mother-to-child transmission.

Myths About Breastfeeding as Voiced by Lactating Nurses and Midwives: A Qualitative Study at the Greater Accra Region of Ghana.

Breastfeeding has proven over the years to be one of the most effective means to ensure child survival. The advocators and myth busters of breastfeeding myths are supposed to be health professionals. However very little is known about myths surrounding breastfeeding as expressed by these health professionals (nurses and midwives). Hence this study. The study aimed at exploring the myths about breastfeeding as voiced by lactating nurses and midwives. Qualitative exploratory descriptive design was used to investigate the subject matter. Twenty-five nurses and midwives were purposely selected to participate in the study after they had voluntarily opted to be part of the study. Data was audiotaped, transcribed verbatim and inductively analyzed. It was evident that participants believed in myths about breastfeeding. The main themes discovered were breastfeeding myth beliefs and sociocultural myth influences. Six sub-themes identified were green stools/diarrhoea, childhood disease, teeth discoloration, child becoming stupid, culture and close relatives. Health professionals believe in unfounded myths about breastfeeding. Steps should be taken for them to get better lactation support. The outcomes of this study underscore the need for health professionals to address breastfeeding myths, understand the sociocultural context, and support evidence-based practice. Improving lactation support and education for nurses and midwives can lead to better clinical practice and, as a result, help to promote successful and healthy breastfeeding in Ghana.

Could care giving have altered the evolution of human immune strategies?

Life history theory indicates that individuals/species with a slow pace of life invest more in acquired than innate immunity. Factors that decrease the pace of life and predict greater investment in acquired immunity include increased nutritional resources, increased pathogen exposure and decreased risk of extrinsic mortality. Common care behaviors given to sick individuals produce exactly these effects: provisioning increases nutritional resources; hygiene assistance increases disease exposure of carers; and protection can reduce the risk of extrinsic mortality to sick individuals. This study, therefore, investigated under what conditions care giving behaviors might impact immune strategy and pace of life. The study employed an agent-based model approach that simulated populations with varying levels of care giving, disease mortality, disease transmissibility, and extrinsic mortality, enabling measurements of how the immune strategy and age structure of the populations changed over evolutionary time. We used multiple regressions to examine the effects of these variables on immune strategy and the age structure of the population. The findings supported our predictions that care was selected for an acquired immunity. However, the pace of life did not slow as expected. Instead, the population shifted to a faster, but also more cost-intensive reproductive strategy in which care improved child survival by subsidizing the development of acquired immune responses.

Predictors of recovery from severe acute malnutrition among 6-59 months children admitted to a hospital.

Severe acute malnutrition is a threat to child survival as mortality rates in children with severe malnutrition are nine times higher. Globally, about 19 million children are severely malnourished. This study looked at children aged 6-59 months admitted to hospital to see how quickly they recovered from severe acute malnutrition as well as what factors predicted their recovery. The study included 543 systematically chosen children with severe acute malnutrition who were admitted to the stabilization center of a hospital. Data from the patient registry were gathered using a retrospective follow-up study design. In order to find predictors of recovery, the Cox proportional hazard model was applied. From 543 children, 425 (78.27%) were recovered. The median survival time was 8 days. Having grade II edema, grade III edema, and pneumonia were negatively associated with recovery. Similarly, taking ceftriaxone, cloxacillin, and being on a nasogastric tube were associated with poor recovery. Conversely, better recovery rates were linked to exclusive breastfeeding and vitamin A supplementation. Both the recovery rate and the median survival time fell within acceptable bounds. To boost the recovery rate, efforts are needed to lessen comorbidities.

An update on diagnosis and treatment of hepatoblastoma.

Hepatoblastoma (HB) remains the most common paediatric liver tumour and survival in children with hepatoblastoma has improved considerably since the advent of sequential surgical regimens of chemotherapy based on platinum-based chemotherapeutic agents in the 1980s. With the advent of modern diagnostic imaging and pathology techniques, new preoperative chemotherapy regimens and the maturation of surgical techniques, new diagnostic and treatment options for patients with hepatoblastoma have emerged and international collaborations are investigating the latest diagnostic approaches, chemotherapy drug combinations and surgical strategies. Diagnosis of hepatoblastoma relies on imaging studies (such as ultrasound, computed tomography, and magnetic resonance imaging), alpha-fetoprotein (AFP) levels, and histological confirmation through biopsy. The standard treatment approach involves a multimodal strategy with neoadjuvant chemotherapy followed by surgical resection. In cases where complete resection is not feasible or tumors exhibit invasive characteristics, liver transplantation is considered. The management of metastatic and recurrent hepatoblastoma poses significant challenges, and ongoing research focuses on developing targeted therapies and exploring the potential of immunotherapy. Further studies are necessary to gain a better understanding of the etiology of hepatoblastoma, develop prevention strategies, and personalize treatment approaches. We aim to review the current status of diagnosis and treatment of hepatoblastoma.

Physical abuse in the newborn with congenital hypothyroidism: A Case report

Background: Global estimates of child homicide suggest that infants and young children are at most significant risk, with rates for the 0 - 4-year age group. Physical abuse of a child is defined as the intentional use of physical force against a child that results in or has a high likelihood of resulting in harm to the child's health, survival, and development. Case presentation: Here presented baby 0 days old with a wide laceration on the neck. The baby was born spontaneously in the bathroom. The baby was brought in with an injury to the neck area with a two-wound size of 4cmx3cm and a scratch mark on the stomach. The mother said that the baby was fallen and hit by ceramic after the baby was delivered. At the hospital, 10 hours after birth, pediatric surgery did the debridement procedure by primary hecting. This case handled by the Integrated Service Center for the Empowerment of Women and Children, the edge of the wound is sharp, flat, with many angles, and the number of wounds is more than one, indicating sharp violence carried out by sliding. Conclusions: The outcome of child abuse can result from short and long term consequences. At the same time, there are child protection policies that protect the child from any abuse.

Healthy food design and early childhood nutrition: Nutritional and food safety assessment of fermented and malted multi-grains instant weaning porridge fortified with defatted pumpkin (Cucurbita pepo) seed flour

Poor-quality diets are one of the most significant barriers to children's survival, growth, development, and learning today. In the context of this experiment, weaning porridge from complementary flour blends of locally available foodstuffs (millet, sorghum, green beans, and pumpkin seeds) was formulated for nutritional, functional, microbiological, and sensory acceptability. The results outlined that all the developed weaning porridge complied with the energy and nutrient density (zinc, iron, and protein) criteria. Energy (2.06-2.08 Kcal/g), protein (4.09-5.44% g/100 Kcal), iron (3.96-4.59 mg/100 Kcal), and calcium (0.39-1.37 mg/100 Kcal) were the nutrient density values identified. The functional features revealed an excellent reconstitution index (5.25-4.53) with a significant difference (P<0.05), a swelling index ranging from 1.03% to 0.57%, and a viscosity ranging from 195.5 cp to 204.5 cp. This study provides valuable insight that complementary foods made from locally available foods are potential solutions for mitigating childhood malnutrition and providing adequate complementation to breastfeeding in resource-poor and technologically underdeveloped countries by providing the needed energy and nutrient densities for immunity, well-being, growth, and development of young children and infants without fortification.

Routine Childhood Immunization: Its health, developmental, economic and social benefits

Introduction: Immunization plays a pivotal role in public health. It is one of the most cost-effective inventions that have helped bring down a significant amount of burden of diseases among under-five children, some of which are now on the verge of extinction. Objective: To assess the diverse benefits of routine childhood immunization. Methodology: A literature review was conducted using electronic database to understand the broader benefits of immunization. Results: Studies have shown that routine childhood immunization have been able to reduce the incidence of influenza and other targeted diseases (diphtheria, Haemophilus influenzae type b, measles, mumps, polio, and rubella) by 17% and 100% respectively. Conclusion: Vaccines are known to have protective and positive health benefit which extends beyond infancy and childhood. It is therefore one of the best strategies in public health to reduce morbidity and mortality and enable child survival.

Out-of-hospital cardiac arrest: Survival in children and young adults over 30 years, a nationwide registry-based cohort study

ObjectivesWe studied short-term (30-day) and long-term (up to ten-year) survival among children and young adults following out-of-hospital cardiac arrest (OHCA) in Sweden over the course of the past 30 years. We also studied the causes of OHCA in children and examined predictors of survival. SettingThis was a nationwide, registry-based cohort study, using the Swedish Registry of Cardiopulmonary Resuscitation. Our study comprised a cohort of 4,804 individuals aged 0 to 30 years who suffered OHCA between 1990 and 2020, in whom cardiopulmonary resuscitation (CPR) was initiated. We stratified the study cohort to distinct age groups and time periods. ResultsWe found an increase in 30-day survival from 7% to 20% over the span of 30 years. In those under 1 year of age, survival increased from 2% to 19%. Time to CPR decreased from 14 to 2 min. The 10-year survival was high among those who survived 30 days. The etiology of cardiac arrests exhibited significant variations across different age groups but remained relatively consistent over time. Causes linked to mental illness constituted a substantial percentage of these cases. Compared to the reference period (1990–1994), the odds of survival in 2015–2020 was 3.00 (95% CI: 1.43, 6.94; p = 0.006). ConclusionSurvival rate after OHCA in children and young adults has increased three-fold over the past 30 years. Still overall mortality is high underscoring the need for continued efforts to mitigate risk factors and optimize survival.

CONFRONTING PAKISTAN'S OVERPOPULATION ISSUE FOR LONG-TERM SOLUTIONS

CONFRONTING PAKISTAN'S OVERPOPULATION ISSUE FOR LONG-TERM SOLUTIONS

Evaluation of a Community-based Intervention to Improve Maternal New-born and Child Health Coverage in the Rural and Hard-to-reach Communities of Adamawa State Nigeria

The healthcare inequities in hard-to-reach (HTR) areas of developing countries, such as Nigeria, have significant implications for disease prevention and control, particularly in maternal and child health. The aim of this study is to look at how well mobile outreach and health facility outreach programs work to improve health outcomes in rural, underserved, and hard-to-reach (HTR) areas in Adamawa State, Nigeria. The focus is on key indicators of maternal, newborn, and child health. The key interventions include antenatal care (ANC), family planning, routine immunization, vitamin A supplementation, deworming of children under 5 years, and Diarrhea treatment. The study applied a cross-sectional design using before-and-after assessments to assess the outcome of the mobile outreach interventions using quantitative health facility-level data from the District Health Information System (DHIS 2.0) on the intervention. Following a successful intervention, the coverage of these indicators prior to and following the intervention was compared using the data. The study shows a cumulative improvement in ANC (21%), institutional delivery (18%), and Penta 3 coverage (28%). Mobile and hard-to-reach strategies utilizing community health workers and volunteers from the LGA, and health facilities can be effective in improving coverage of MNCH services and hold promise for better maternal and child survival in rural, HTR, and under-resourced parts of Adamawa State, Nigeria, and Sub-Saharan Africa at large. In addition, the mobile outreach interventions have contributed to improving MNCH services in hard-to-reach communities, so scaling up the strategy is highly recommended. Keywords: Hard-to-reach, Interventions, Outreach, Communities, Adamawa State, Nigeria.

Delayed diagnostic interval and survival outcomes in pediatric leukemia: A single-center, retrospective study.

This study primarily focused on the diagnostic interval (DI), defined as the duration from the onset of leukemic symptoms to diagnosis. We investigated whether a prolonged DI is associated with the outcomes of pediatric leukemia. We retrospectively collected data of children with newly diagnosed pediatric leukemia at Okayama University Hospital from January 2007 to December 2022. Survival analyses were conducted using Kaplan-Meier methods, and an unadjusted analysis to compare differences in survival was performed using the log-rank test. In total, 103 children with leukemia were included in the analysis. The median DI was 20 days (interquartile range, 9.5-33.5 days). A prolonged DI (≥30 days) demonstrated no association with either 5-year event-free survival (70.1% for <30 days and 68.3% for ≥30 days, p = .99, log-rank test) or overall survival (84.7% for <30 days and 89.4% for ≥30 days, p = .85, log-rank test). A prolonged DI was not associated with the survival of children with leukemia. If a precise classification of leukemia biology is provided for pediatric patients, a prolonged DI may have little impact on the prognosis of these patients.

Child sexual abuse in Ghana: A multi‐methods exploratory study

AbstractUsing a qualitative multi‐methods approach, this study explored the offence, survivor and perpetrator characteristics, and the lived experiences of child and adolescent survivors of child sexual abuse (CSA) in Ghana. We analysed the contents of local media reports of CSA cases from January 2015 to December 2020 in Ghana, after which we conducted semi‐structured interviews involving five female child and adolescent survivors of CSA. The media content analysis identified 529 eligible reports involving female (n = 516) and male (n = 13) survivors aged 11–18 years who knew the perpetrators. The perpetrators were all‐male youth and middle‐aged adults employed in low‐income status occupations. Defilement was the most reported sexual offence; the survivors were more likely to come from single‐parent families experiencing poverty and economic hardship. The perpetrators employed multiple methods to coerce and elicit compliance from their victims: confidence approaches, violence (blitz methods) and gifts. Content analysis showed that most of the survivors attributed their victimisation to family poverty and dysfunctional parent–child relationships. These findings underscore a need to develop prevention strategies that empower young females and males to identify, escape or avoid (potential) sexual predators and encourage reporting and disclosure of CSA victimisation to formal support institutions.

Lung Transplantation for Pulmonary Vascular Disease in Children: A United Network for Organ Sharing Analysis.

Pulmonary vascular disease (PVD) represents an important clinical indication for lung transplant (LTx) in infants, children, and adolescents. There is limited information on LTx outcomes in these patients. We explored LTx volumes and post-LTx survival in children with PVD compared to other diagnoses. The UNOS Registry was queried from 1989 to 2020 to identify first-time pediatric LTx recipients (< 18 yo). PVD was categorized as idiopathic pulmonary arterial hypertension (IPAH) and non-idiopathic arterial hypertension (non-IPAH) and compared to all other patients as other diagnoses. Univariate and multivariate regression models were performed. 984 pediatric LTx patients (593 before 2010 and 391 during/after 2010) were identified, of which 145 (14.7%) had PVD. There has been no significant change in annual rate of all LTxs over comparative eras. However, there has been a decrease in rate of LTxs for PVD patients. Children with PVD had similar survival to other LTx groups in the early era (p = 0.2) and the latter era (p = 0.9). Univariate Cox models, showed that LTx in patients with PVD was associated with a significantly less risk of mortality for children aged 6-11years compared to younger and older cohorts (HR = 0.4 [0.17-0.98]; p = 0.045), whereas multivariate analysis showed a trend toward higher mortality in 11-17-year-olds (HR = 1.54 [0.97-2.45]; p = 0.06). For PVD patients, oxygen supplementation and ventilator support at LTx were associated with worse post-transplant survival (p = 0.029 and p = 0.01). There has been a decrease in LTx volume for pediatric patients with PVD in the modern era. Post-LTx outcomes for children with PVD are similar to those of other diagnoses in both eras, with children aged 6-11years having the best survival. Given these findings, LTx should be considered for this patient population.