Morbidity In Children Research Articles

Determinants of pneumococcal vaccination dropout among children aged 12-23 months in Ethiopia: a secondary analysis from the 2019 mini demographic and health survey.

Vaccination is a cost-effective public health program that helps reduce significant morbidity and mortality in children under the age of five. Worldwide, the number of vaccine-preventable causes of child death has significantly decreased since the Expanded Program of Immunization (EPI) was introduced. However, for a variety of reasons, 23 million children did not have adequate access to vaccines in 2020. Therefore, this study aimed to evaluate the determinants of pneumonia conjugate vaccine (PCV) dropout among children aged 12-23 months in Ethiopia. The study analyzed cross-sectional data obtained from the 2019 mini Ethiopian demographic and health survey. Multilevel binary logistic regression analysis was utilized, and the best fit model was chosen using the Akaike Information Criteria. The study comprised a weighted sample of 989 children aged 12 to 23 months. The study presented the Adjusted Odds Ratio (AOR) along with a 95% Confidence Interval (CI) to identify the significant factors influencing PCV dropout. The PCV dropout rate was reported at 20.2% in this study. In the multilevel analysis, possession of a health card (AOR = 0.076, 95% CI: 0.019, 0.04), vaccination for PCV 2 (AOR =0.002, 95% CI: 0.023, 0.263), and region 7 (AOR = 6.98, 95% CI: 10.1, 48.31) were significantly associated with children's PCV dropout. Having a health card, having received the PCV 2 vaccinations, and region were significant predictors of PCV dropout. Consequently, health education on immunization for all mothers and region-specific, customized public health interventions are needed to reduce the vaccination dropout rate.

Radiological Assessment of Hand and Wrist Bones in Malnourished Children

Abstract Background Protein energy malnutrition (PEM) is still an important health problem that is responsible for childhood morbidity and mortality leading to permanent impairment of physical and mental growth. Objective This study is designed to assess the appearance of ossification centers of lower end of radius and ulna, carpals, metacarpals and phalanges in normal children and malnourished children then comparing between them, to detect early changes in bone growth in malnourished children. Subjects and Methods This case-control cross-sectional study included 45 malnourished children and 45 age and sex matched controls whose ages ranged between 6 months and 5 years. The patients were recruited from Pediatric Nutrition Clinic of Ain Shams University. All children (malnourished and control) were examined for anthropometric parameters (weight, height, body mass index (BMI) and mid upper arm circumference (MUAC)), investigated for serum calcium, phosphorus, alkaline phosphates and had a plain X-ray done on left hand and wrist (posteroanterior (P-A) view), the X-ray was analyzed by using A Digital Atlas of Skeletal Maturity. Results The plain X-ray hand and wrist showed delayed appearance of ossification centers in malnourished infants and children (97.8% had delayed bone age) when compared to controls (25.5% had delayed bone age) which was statistically highly significant with P-value < 0.01. Signs of vitamin D deficiency rickets together with serum calcium, phosphorus and alkaline phosphatase were statistically significantly lower in the cases when compared to the controls with P-value < 0.01. The statistical measurements of mean ± SD regarding weight of case group and control group was (9.05 ± 2.48, 13.54 ± 3.81) with P-value < 0.01 which is highly significant, regarding length or height was (79.51 ± 12.78, 88.94 ± 15.02) with P-value < 0.01 which is highly significant, regarding MUAC was (11.38 ± 1.91, 16.02 ± 1.26) with P-value < 0.01 which is highly significant. Conclusion X-ray hand and wrist for malnourished infants and children showed delayed appearance of ossification centers when compared to matched controls.

Nutrition assessment of school-going children in the rural area of District Swabi, Pakistan

Anemia and malnutrition are global health problem among all nutritional disorder with high morbidity and mortality in school aged children. Therefore the aims of the study assist the prevalence and risk factors of anemia, and malnutrition among school-going children of District Swabi Pakistan. A total of 600 school aged children of aged 4-15 years were included in the study in 2023. Hematocrit level was obtained using a centrifuge microhematocrit, and converted to hemoglobin using standard conversion. Nutritional status was determined by the anthropometric measurements, and demographic characteristics were obtained by questionnaire. Anemia and malnutrition were defined according to the World Health Organization standards. In current research work 600 children were selected for the assessment of nutritional status in which 105(17.5%) were found malnutrated. Moderate frequency of assessment were found among anemia 25(23.80%), stunting 22(21%) and underweight 18(17%) respectively. High frequency was found in malnutrition 40(38%) while very low frequency was seen in wasting 2(1.90%). Gender wise assessment of the students shows that the nutritional deficiencies were slightly high in male as compare to female students in comparison of Anemia, Malnutrition, Stunting, and Underweight and in wasting respectively. Aged group wised assessment of the students shows that the nutritional deficiencies were slightly high in low aged student (4-7 years) as compare to 8-11 years and 12-15 years in both gender. Among them Malnutrition were very high leading by Anemia while Underweight and wasting of very low frequency respectively.

Generative Pre-trained Transformer for Pediatric Stroke Research: A Pilot Study

BackgroundPediatric stroke is an important cause of morbidity in children. Although research can be challenging, large amounts of data have been captured through collaborative efforts in the International Pediatric Stroke Study (IPSS). This study explores the use of an advanced artificial intelligence program, the Generative Pre-trained Transformer (GPT), to enter pediatric stroke data into the IPSS. MethodsThe most recent 50 clinical notes of patients with ischemic stroke or cerebral venous sinus thrombosis at the UTHealth Pediatric Stroke Clinic were deidentified. Domain-specific prompts were engineered for an offline artificial intelligence program (GPT) to answer IPSS questions. Responses from GPT were compared with the human rater. Percent agreement was assessed across 50 patients for each of the 114 queries developed from the IPSS database outcome questionnaire. ResultsGPT demonstrated strong performance on several questions but showed variability overall. In its early iterations it was able to match human judgment occasionally with an accuracy score of 1.00 (n = 20, 17.5%), but it scored as low as 0.26 in some patients. Prompts were adjusted in four subsequent iterations to increase accuracy. In its fourth iteration, agreement was 93.6%, with a maximum agreement of 100% and minimum of 62%. Of 2400 individual items assessed, our model entered 2247 (93.6%) correctly and 153 (6.4%) incorrectly. ConclusionsAlthough our tailored generative model with domain-specific prompt engineering and ontological guidance shows promise for research applications, further refinement is needed to enhance its accuracy. It cannot enter data entirely independently, but it can be employed in tandem with human oversight contributing to a collaborative approach that reduces overall effort.

Pili Torti: A Clue to Life-threatening Illness – A Rare Case Report

Menkes kinky hair disease (MKHD) is a rare inherent error of copper metabolism presenting during early infancy with multi-system involvement. It is associated with high morbidity and mortality in early childhood. Characteristic hair changes mirror internal metabolic alterations. Here, we report a case of 13-month-old male child who presented with peculiar changes of skin and hair along with convulsion and high-grade fever. Dermatoscopy and hair mount examination showing pili torti with pigmentary dilution pointed toward the diagnosis of MKHD, which was further enforced with blood investigations showing low copper and ceruloplasmin levels. Cutaneous findings play a crucial role in early diagnosis, thereby reducing morbidity with timely treatment.

Comparative analysis of machine learning algorithms for predicting diarrhea among under-five children in Ethiopia: Evidence from 2016 EDHS.

Background: Diarrhea is a major cause of mortality and morbidity in under-5 children globally, especially in developing countries like Ethiopia. Limited research has used machine learning to predict childhood diarrhea. This study aimed to compare the predictive performance of ML algorithms for diarrhea in under-5 children in Ethiopia. Methods: The study utilized a dataset of 9501 under-5 children from the Ethiopia Demographic and Health Survey 2016. Five ML algorithms were used to build and compare predictive models. The model performance was evaluated using various metrics in Python. Boruta feature selection was employed, and data balancing techniques such as under-sampling, over-sampling, adaptive synthetic sampling, and synthetic minority oversampling as well as hyper parameter tuning methods were explored. Association rule mining was conducted using the Apriori algorithm in R to determine relationships between independent and target variables. Results: 10.2% of children had diarrhea. The Random Forest model had the best performance with 93.2% accuracy, 98.4% sensitivity, 85.5% specificity, and 0.916 AUC. The top predictors were residence, wealth index, and child age, number of living children, deworming, wasting, mother's occupation, and education. Association rule mining identified the top 7 rules most associated with under-5 diarrhea in Ethiopia. Conclusion: The RF achieved the highest performance for predicting childhood diarrhea. Policymakers and healthcare providers can use these findings to develop targeted interventions to reduce diarrhea. Customizing strategies based on the identified association rules has the potential to improve child health and decrease the impact of diarrhea in Ethiopia.

Prevalence of Iron Deficiency Anemia and Iron Deficiency Without Anemia Among Moderate and Severely Acute Malnourished Children.

Iron deficiency remains one of the globally recognized leading causes of morbidity and mortality in children, among developing countries like India as compared to the Western world. To estimate the prevalence of iron deficiency anemia (IDA) and iron deficiency without anemia (IDWA) among malnourished children. This cross-sectional study was conducted in the Department Of Pediatrics, Tertiary Care Hospital, Western Rajasthan. Demographic data and serum samples were collected and analyzed. Hematological and biochemical values were determined for 300 children aged 6 months to 59 months. A total of 93.9% of severe acute malnutrition (SAM) children and 83.24% of moderate acute malnutrition (MAM) children had anemia as perWHO definition, with moderate anemia (47.66%) being the predominant type of anemia. About 64% of children showed iron deficiency with a prevalence of IDA and IDWA being 94.27% and 5.72%, respectively. The mean values of serum ferritin, serum iron, serum total iron binding capacity (TIBC), and transferrin saturation in children with IDWA were 8.34±2.85, 17.43±7.57, 454.09±40.76, and 4.09±1.44, respectively. The proportion of anemic children in both SAM and MAM groups was very high. Our study shows that more than 60% of the MAM and SAM children were iron deficient. We recommend future measures for the prevention and control of anemia, including increased coverage of nutritional supplementation, fortification programs, and supplement iron in this sub-group (IDWA) to take care of their symptoms due to iron deficiency even before the development of overt IDA.

Characterization of bacterial and viral pathogens in the respiratory tract of children with HIV-associated chronic lung disease: a case–control study

IntroductionChronic lung disease is a major cause of morbidity in African children with HIV infection; however, the microbial determinants of HIV-associated chronic lung disease (HCLD) remain poorly understood. We conducted a case–control study to investigate the prevalence and densities of respiratory microbes among pneumococcal conjugate vaccine (PCV)-naive children with (HCLD +) and without HCLD (HCLD-) established on antiretroviral treatment (ART).MethodsNasopharyngeal swabs collected from HCLD + (defined as forced-expiratory-volume/second < -1.0 without reversibility postbronchodilation) and age-, site-, and duration-of-ART-matched HCLD- participants aged between 6–19 years enrolled in Zimbabwe and Malawi (BREATHE trial-NCT02426112) were tested for 94 pneumococcal serotypes together with twelve bacteria, including Streptococcus pneumoniae (SP), Staphylococcus aureus (SA), Haemophilus influenzae (HI), Moraxella catarrhalis (MC), and eight viruses, including human rhinovirus (HRV), respiratory syncytial virus A or B, and human metapneumovirus, using nanofluidic qPCR (Standard BioTools formerly known as Fluidigm). Fisher's exact test and logistic regression analysis were used for between-group comparisons and risk factors associated with common respiratory microbes, respectively.ResultsA total of 345 participants (287 HCLD + , 58 HCLD-; median age, 15.5 years [IQR = 12.8–18], females, 52%) were included in the final analysis. The prevalence of SP (40%[116/287] vs. 21%[12/58], p = 0.005) and HRV (7%[21/287] vs. 0%[0/58], p = 0.032) were higher in HCLD + participants compared to HCLD- participants. Of the participants positive for SP (116 HCLD + & 12 HCLD-), 66% [85/128] had non-PCV-13 serotypes detected. Overall, PCV-13 serotypes (4, 19A, 19F: 16% [7/43] each) and NVT 13 and 21 (9% [8/85] each) predominated. The densities of HI (2 × 104 genomic equivalents [GE/ml] vs. 3 × 102 GE/ml, p = 0.006) and MC (1 × 104 GE/ml vs. 1 × 103 GE/ml, p = 0.031) were higher in HCLD + compared to HCLD-. Bacterial codetection (≥ any 2 bacteria) was higher in the HCLD + group (36% [114/287] vs. (19% [11/58]), (p = 0.014), with SP and HI codetection (HCLD + : 30% [86/287] vs. HCLD-: 12% [7/58], p = 0.005) predominating. Viruses (predominantly HRV) were detected only in HCLD + participants. Lastly, participants with a history of previous tuberculosis treatment were more likely to carry SP (adjusted odds ratio (aOR): 1.9 [1.1 -3.2], p = 0.021) or HI (aOR: 2.0 [1.2 – 3.3], p = 0.011), while those who used ART for ≥ 2 years were less likely to carry HI (aOR: 0.3 [0.1 – 0.8], p = 0.005) and MC (aOR: 0.4 [0.1 – 0.9], p = 0.039).ConclusionChildren with HCLD + were more likely to be colonized by SP and HRV and had higher HI and MC bacterial loads in their nasopharynx. The role of SP, HI, and HRV in the pathogenesis of CLD, including how they influence the risk of acute exacerbations, should be studied further.Trial registrationThe BREATHE trial (ClinicalTrials.gov Identifier: NCT02426112, registered date: 24 April 2015).

Status Epilepticus in Children at a Tertiary Care Center in India: Etiology, Preventable Risk Factors, and Short-Term Outcome

Abstract Introduction Status epilepticus (SE) is a common neurological emergency in children. Recent guidelines suggest initiating treatment after 5 minutes of seizure activity. Objective This study analyzes the clinical, laboratory parameters, and treatment outcomes of children with SE to identify preventable risk factors. Materials and Methods Prospective observational study of 150 children. They were evaluated for relevant history, clinical features, laboratory investigations, treatment, course, and outcome. Results The risk factors that had an impact on outcome in children with SE were identified as red flag signs on initial pediatric advanced life support (PALS) assessment, malnutrition, abnormal head circumference and number of seizures before child presented to hospital. The strongest predictor of outcome was stable status of children on initial PALS assessment (odds ratio = 20.174 [1.117, 364.393], p = 0.042). Presence of abnormal head size was 86% less likely to have favorable outcome and if the child had lesser number of seizures before child presented to hospital (single), it was 3.7 times likely that it would yield a favorable outcome. Conclusion Aggressive treatment of seizures, identification of red flag signs on initial PALS assessment, identification and treatment of malnutrition, anemia, hypocalcemia, and sodium derangements, strengthening vaccination to prevent central nervous system infections, and early intervention for developmental delay, can all help to combat morbidity and mortality in children with SE.

Characterization of Herpesviridae Family Members, BK Virus, and Adenovirus in Children and Adolescents with Nephrotic Syndrome.

A prospective study was conducted to determine the genome identification of the viruses Epstein-Barr (EBV), human cytomegalovirus (HCMV), human herpesvirus 6 (HHV-6 type A and type B) and 7 (HHV-7), polyomavirus (BKV), and human adenovirus (HAdV) in plasma and urine samples of pediatric patients with NS. A total of 35 patients aged 1 to 18 years with NS and under immunosuppressant drugs participated in the study. Plasma and urine samples were collected at regular intervals during a median follow-up of 266 days (range 133-595), and DNA was analyzed to detect the selected DNA viruses. Eleven patients (31.4%) had active virus infections, and patterns were classified as coinfection, recurrent, and consecutive. Of these, six patients (54.5%) presented viral coinfection, six (54.5%) viral recurrence, and seven patients (63.3%) had viral consecutive infection. Ten of the eleven patients with active infection had a proteinuria relapse (91%) and eight (72.7%) were hospitalized (p = 0.0022). Active HCMV infection was the most frequent infection and was observed in six patients (54.5%), three of the eleven patients (27.2%) had suspected HCMV disease in the gastrointestinal tract, and one had HHV-7 coinfection. The frequency of other infections was: 9% for HHV-6, 45.5% for BKV, 27.3% for HHV-7, 18.2% for EBV, and 18.2% for HAdV. viral infections, especially HCMV, can be an important cause of morbidity and nephrotic syndrome relapse in children.

Evaluation of Empiric Voriconazole Dosing and Therapeutic Drug Monitoring in Hospitalized Pediatric Patients.

Invasive fungal infections are a significant cause of morbidity and mortality in children with immunodeficiencies. Current dosing recommendations for voriconazole often result in subtherapeutic exposure in pediatric patients. In this single-center retrospective study, we reviewed hospitalized pediatric patients receiving voriconazole with at least one inpatient serum trough concentration measured. Patient characteristics and voriconazole dosing courses with associated trough concentrations were summarized for all patients as well as grouped by age (0 to 1 y, 2 to 11 y, and 12 to 18 y). Of 106 included patients, the median age was 9 years (range, 29 d to 18 y). Five hundred ninety courses of voriconazole were administered with 365 associated troughs. Most troughs were subtherapeutic (49%) and 30% of patients never attained a therapeutic trough. The median oral daily dose associated with a therapeutic trough was higher in younger age groups: 21.6 mg/kg 0 to 1 year, 17.9 mg/kg 2 to 11, and 9.5 mg/kg 12 to 18 years ( P <0.001). Patients younger than 2 years had the largest proportion of subtherapeutic troughs and variability in dosing. Attainment of therapeutic voriconazole concentrations was challenging across all pediatric age groups. Higher starting doses for patients younger than 2 years are likely needed.

Morbidity and unplanned healthcare encounters after hospital discharge among young children in Dar es Salaam, Tanzania and Monrovia, Liberia

BackgroundResearchers and healthcare providers have paid little attention to morbidity and unplanned healthcare encounters for children following hospital discharge in low- and middle-income countries. Our objective was to compare symptoms...

Integrating DNA/RNA microbe detection and host response for accurate diagnosis, treatment and prognosis of childhood infectious meningitis and encephalitis

BackgroundInfectious meningitis/encephalitis (IM) is a severe neurological disease that can be caused by bacterial, viral, and fungal pathogens. IM suffers high morbidity, mortality, and sequelae in childhood. Metagenomic next-generation sequencing (mNGS) can potentially improve IM outcomes by sequencing both pathogen and host responses and increasing the diagnosis accuracy.MethodsHere we developed an optimized mNGS pipeline named comprehensive mNGS (c-mNGS) to monitor DNA/RNA pathogens and host responses simultaneously and applied it to 142 cerebrospinal fluid samples. According to retrospective diagnosis, these samples were classified into three categories: confirmed infectious meningitis/encephalitis (CIM), suspected infectious meningitis/encephalitis (SIM), and noninfectious controls (CTRL).ResultsOur pipeline outperformed conventional methods and identified RNA viruses such as Echovirus E30 and etiologic pathogens such as HHV-7, which would not be clinically identified via conventional methods. Based on the results of the c-mNGS pipeline, we successfully detected antibiotic resistance genes related to common antibiotics for treating Escherichia coli, Acinetobacter baumannii, and Group B Streptococcus. Further, we identified differentially expressed genes in hosts of bacterial meningitis (BM) and viral meningitis/encephalitis (VM). We used these genes to build a machine-learning model to pinpoint sample contaminations. Similarly, we also built a model to predict poor prognosis in BM.ConclusionsThis study developed an mNGS-based pipeline for IM which measures both DNA/RNA pathogens and host gene expression in a single assay. The pipeline allows detecting more viruses, predicting antibiotic resistance, pinpointing contaminations, and evaluating prognosis. Given the comparable cost to conventional mNGS, our pipeline can become a routine test for IM.

Knowledge Attitudes and Practices (KAP) of Hand Washing among Selected School Children of Dhaka City

Background &amp; objective: Communicable diseases like diarrhoea and acute respiratory tract infection are the commonest cause of morbidity and mortality in children of developing countries. Children are more vulnerable to food and water-borne diseases. Hand washing is an effective method for preventing communicable diseases particularly water-borne diseases. The purpose of this study is, therefore to evaluate the knowledge, attitudes, and practices (KAP) of hand washing among selected primary-level school children of Dhaka City as a mode of disease prevention. Methods: From January 1st to June 30th, 2016, primary school students (only those in the fifth grade) in Dhaka City participated in this descriptive, cross-sectional survey. Following ethical approval from the school authority, the local guardian of the children, a total of 252 children were purposively enrolled from various elementary schools in Dhaka City. The knowledge of hand washing included in this study comprises information on cleaning hands before meals, after urinating, defecating, and playing, procedures for washing hands, information about World Hand Washing Day, instructions for washing hands, facilities for washing hands, and materials for washing hands. We offered each respondent ten questions, with a mark of 1 for each accurate response, to gauge their degree of expertise. Results: Over 70% of the respondents were 11-12 years old with the mean age of the respondents being 10.8 ± 0.7 years. The boy-to-girl ratio was roughly 11:9. While respondents’ fathers were primarily service-holder (about 55%) mothers were generally housewives (70%). Sixty percent of the respondents had 3-4 members in their family. The majority (98%) of the respondents knew about hand-washing. However, over two-fifth (42.2%) of them were completely unaware of the steps of hand-washing, and nearly 70% did not know the minimum hand-washing time to wash out the bacteria attached to the hand surface. Overall, 55.2% of the respondents had good knowledge, 32.5% had adequate knowledge, and 12.3% had excellent knowledge about hand-washing. Conclusion: The study concluded that most of the students usually wash their hands in critical times; however, they do not know the correct way and steps of hand washing. So, more attention is to be paid to training children to adopt healthy hand-washing behavior. The importance of hand washing should be included in their regular curriculum. Ibrahim Card Med J 2023; 13 (1&amp;2): 66-70

Risk Factors for Urinary Tract Infection in Children

Background &amp; objective: Urinary tract infections (UTIs) are a common cause of febrile illness in young children. Due to the absence of overt clinical features in young children, appropriate collection of urine samples, and basic diagnostic tests at first-level health facilities in our country, UTIs are not generally reported as a cause of childhood morbidity. Due to a lack of studies on the epidemiology, risk factors, diagnosis, treatment, prognosis, and prevention of UTI in children in our country, the exact picture of this disease is yet unknown. This study is intended to identify the risk factors of UTI in children in our country. Methods: The present cross-sectional study was carried out in the Department of Pediatrics (both indoor and outdoor) of Bangabandhu Sheikh Mujib Medical University, BIRDEM, and Dhaka Medical College Hospital over a period of 1½ years from January 2015 to June 2016. A total of 201 children with signs and symptoms suspected of having urinary tract infections were subjected to urine culture; of them, 98 had definitive UTI and the rest 103 had no UTI or possible UTI. Several factors such as circumcisional status, constipation, encopresis, previous hospital admission, and premature birth were investigated whether they had any role in contributing to the development of UTI. Result: The children with UTIs were relatively young compared to those without UTIs. However, the age incidence of UTI was found to differ by sex. About one-third of UTI cases in boys were found in the first year of life, one-third between 2nd to 3rd year of life, and the rest one-third in 3rd year onwards. However, the peak age incidence in girls was observed to be 3rd year and onwards. In terms of clinical presentation, fever, and anorexia were more or less common (52% and 43.7% respectively), abdominal pain was less common (18%), and irritability and vomiting were seldom observed. The presence of constipation was significantly associated with UTI in children (p = 0.001). Encopresis was considerably higher in the UTI group than in the non-UTI group (p = 0.169). Conclusion: Children with UTI usually present with fever with or without dysuria, frequency, anorexia, and abdominal or loin pain. While boys more often acquire the disease in their infancy, girls usually present with the problem from 3 years during their toilet training. Thus, the children presented with unexplained febrile illness or any other signs and symptoms should be suggested for a urine culture to find the clue of febrile illness. Identification of risk factors of UTI will go a long way in preventing the same illness in the future. Ibrahim Card Med J 2023; 13 (1&amp;2): 60-65

Efektifitas Pijat Woolwich Terhadap Produksi Asi di Bidan Praktek Mesra Wilayah Puskesmas Pintu Padang Kecamatan Batang Angkola Kabupaten Tapanuli Selatan

In order to reduce child morbidity and mortality, the United Nations Children's Fun (UNICEF) and the World Health Organization (WHO) recommend that children should only be given breast milk for at least six months (Infodatin, 2020). Adequacy of breast milk prevents hunger and malnutrition, reduces infant mortality, improves mental and cognitive development of infants. Woolwich massage increases the hormones prolactin and oxytocin which play a role in stimulating the release of milk in mothers after giving birth. Woolwich massage. carried out in the area of the lactiferous sinuses exactly 1-1.5 cm above the areola mamae, with the aim of removing the milk that is in the lactiferous sinuses. The purpose of this study is to analyze the effect of the woolwich massage method on increasing breast milk production for the adequacy of babies in postpartum mothers in the Pintu Padang Health Center area, South Tapanuli Regency. Quasiexperimental study Woolwich massage on mammary glands. Population Mother post partum 1-4 days. The total population sample is 20 respondents. Research time June to November 2022. The results of the Pearson correlation test of 0.751 with a significance level (p) of 0.058 indicate a strong correlation and a positive direction where the woolwich massage facilitates the release of breast milk in meeting the needs of the baby. Midwives are motivated to do woolwich massage in the mammary area after assisting in childbirth.

CNSC-02. PEDIATRIC BRAIN TUMOR CONSORTIUM (PBTC)-056: A PHASE 1 STUDY OF THE ADAM-10 INHIBITOR, INCB007839, IN CHILDREN WITH RECURRENT/PROGRESSIVE HIGH-GRADE GLIOMAS TO TARGET MICROENVIRONMENTAL NEUROLOGIN-3

Abstract BACKGROUND Pediatric high-grade gliomas (pHGGs), including diffuse intrinsic pontine glioma (DIPG), are a leading cause of central nervous system tumor-related morbidity and mortality in children. Neuronal activity promotes growth of HGGs; one key mechanism is neuronal activity-regulated shedding of neuroligin-3 into the glioma microenvironment, mediated by the protease (A Disintegrin and Metalloprotease) ADAM10. ADAM10 inhibition slows tumor growth in preclinical pHGG models. Here, we report results of the clinical trial PBTC-056 (NCT04295759) evaluating safety and tolerability of INCB007839, an inhibitor of the ADAM 10 and 17 proteases. METHODS Patients aged 3-21 years old with recurrent/progressive pHGGs, including DIPG, were eligible. Additional eligibility criteria included measurable disease and failure of at least 1 standard treatment. One dose level (120mg/m2/dose twice daily [BID]) was tested, and the trial was subsequently amended to require prophylactic anticoagulation with enoxaparin due to an unanticipated toxicity. The primary objective was to assess the safety and tolerability of INCB007839 for children with pHGGs. RESULTS 12 of 13 eligible subjects were evaluable. Median age was 13.5 years (4.9-20.7 years). Diagnoses included: DIPG (54%), glioblastoma multiforme (31%), anaplastic astrocytoma (8%) and CNS primary tumor NOS (8%). All patients were treated at DL1 and remained on study for 1-4 courses. The most common toxicities were lymphopenia, elevated transaminases, and fatigue. There were 3 dose-limiting toxicities: Grade 5 cerebral venous thrombosis (n=1), Grade 3 alanine aminotransferase increase (n=1) and Grade 2 thrombocytopenia (n=1). Ten patients progressed/relapsed during active treatment, 1 patient died on treatment, and 2 patients withdrew (1 prior to starting therapy). CONCLUSIONS INCB007839 was generally well tolerated with a recommended phase 2 dose of 120mg/m2/dose BID and concurrent prophylactic anti-coagulation. These data, combined with foundational preclinical studies targeting neuron-cancer interactions, open the door to possible cancer neuroscience strategies, including combination therapy, for pediatric high-grade gliomas.

Hyperemesis gravidarum and the risk of offspring morbidity: a longitudinal cohort study.

Hyperemesis gravidarum has the potential to affect the long-term health of offspring. We examined whether maternal hyperemesis gravidarum was associated with the risk of hospitalization for childhood morbidity. We conducted a longitudinal cohort study of 1,189,000 children born in Quebec, Canada, between April 2006 and March 2021. The main exposure measure was maternal hyperemesis gravidarum requiring hospitalization in the first or second trimester. The outcome was any pediatric admission between birth and 16years of age, with follow-up ending in March 2022. We used Cox regression models adjusted for maternal and socioeconomic factors to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the association between maternal hyperemesis gravidarum and childhood hospitalization. Among 1,189,000 children, 6904 (0.6%) were exposed to maternal hyperemesis gravidarum. Hospitalization rates at age 16years were higher for children exposed to hyperemesis gravidarum than unexposed children (47.6 vs 43.9 per 100 children). Relative to no exposure, hyperemesis gravidarum was associated with a 1.21 times greater risk of any hospitalization before 16years (95% CI 1.17-1.26). Hyperemesis gravidarum was associated with hospitalization for neurologic (HR 1.50, 95% CI 1.32-1.71), developmental (HR 1.51, 95% CI 1.29-1.76), digestive (HR 1.40, 95% CI 1.30-1.52), and allergic disorders (HR 1.39, 95% CI 1.24-1.56). When contrasted with preeclampsia, hyperemesis gravidarum was a stronger risk factor for these outcomes. Maternal hyperemesis gravidarum is associated with an increased risk of childhood hospitalization, especially for neurologic, developmental, digestive, and atopic disorders. • Hyperemesis gravidarum is associated with neurodevelopmental disorders in offspring. • However, the effect of hyperemesis gravidarum on other childhood morbidity is unclear. • In this longitudinal cohort study of 1.2 million children, maternal hyperemesis gravidarum was associated with a greater risk of hospitalization before age 16years. • Exposure to hyperemesis gravidarum was associated with developmental, neurologic, atopic, and digestive morbidity in childhood.

Prevalence and Correlates of a Positive Screening for Eating Disorders: A Cross-Sectional Study among Children in Lebanese Schools

ABSTRACT Background: Eating disorders (ED) are one of the most common psychiatric illnesses that may lead to physical and psychosocial morbidity in children. Our study aimed to determine the prevalence and factors associated with a positive screening for ED among children and young adolescents in multiple Lebanese schools. Method: This cross-sectional study included a convenience sample of 253 students (45.5% females; 76.3% Syrian refugees) aged between 8 and 13 years and recruited from Lebanese private schools. Students were interviewed between February and June 2018 to collect information about sociodemographic factors and health characteristics. Logistic regression analyses were performed, using the SCOFF questionnaire for screening ED as the dependent variable. Results: Among the students, 36.4% tested positive for SCOFF. Logistic regression analyses revealed significant associations between a positive screening for ED and the following factors: being between 8 and 9 years old (p = 0.029), obesity (p = 0.010), experiencing fatigue (p = 0.017), encountering a stressful accident (p = 0.027), undergoing changes in residence, school, or country (p = 0.01), consuming meals from restaurants ≥3/week (p = 0.013), consuming ≤2 fruits/week (p = 0.01) and consuming ≥5 eggs/week (p = 0.01). Approximately 13.4% of students were underweight, while 24.5% were classified as overweight or obese. One-third (32.1%) of students spent between 2 and 5 h/day using digital devices. Half of the students (54.1%) purchased fast food ≥3/week from school cafeterias, and over three-quarters reported fluctuating their food intake in response to emotions such as sadness, fear, anger, or happiness. Conclusion: These findings emphasize the importance of early detection and intervention in addressing abnormal eating behaviors among children.

Enteric viral pathogens and child growth among under-five children: findings from South Asia and sub-Saharan Africa

Enteric viral pathogens are associated with a significant burden of childhood morbidity and mortality. We investigated the relationship between viral pathogens and child growth among under-5 children. We analyzed data from 5572/22,567 children enrolled in the Global Enteric Multicenter Study across seven study sites (2007–2011). Multiple linear regression was used to examine the association between the viral pathogens and changes of length/height-for-age (HAZ), weight-for-age (WAZ), and weight-for-length/height (WHZ) z-scores, stratified by diarrheal symptoms and adjusted for potential covariates. Rotavirus (18.51%) and norovirus (7.33%) were the most prevalent enteric viral pathogens among symptomatic and asymptomatic under-5 children, respectively. Infection with individual enteric viral pathogens hurts child growth in asymptomatic children. However, the relationship with HAZ was less clear and statistically non-significant. On the other hand, the combined viral pathogens demonstrated a strong negative influence on child growth [WAZ: β coef.: − 0.10 (95%, CI − 0.15, − 0.05); P < 0.001 and WHZ: β: − 0.12 (95% CI − 0.17, − 0.07); P < 0.001] among asymptomatic children. Infection with any viral pathogen was associated with growth shortfalls [HAZ: β: − 0.05 (95% CI − 0.09, 0.00); P = 0.03 and WAZ: β: − 0.11 (95% CI − 0.16, − 0.07); P < 0.001 and WHZ: β: − 0.13 (95% CI − 0.18, − 0.09); P < 0.001], though the relationship with HAZ was less evident and became statistically non-significant in older children. Notably, among symptomatic children with moderate-to-severe diarrhea, individual enteric viral pathogens, as well as the combined effects of these pathogens [WHZ: β: 0.07; (95% CI 0.01, 0.14); P = 0.03] and the presence of any virus [HAZ: β: 0.09 (95% CI 0.05, 0.13) & WAZ: β: 0.08 (95% CI 0.03, 0.12); P < 0.001], exhibited positive effects on child growth. While previous studies hypothesized that several viral pathogens had a conflicting controversial role in child growth, we find clear indications that enteric viral pathogens are associated with growth shortfalls, specifically among asymptomatic children. These findings highlight the need for preventive strategies targeting children with enteric viral pathogens, which could address the consequences of growth faltering.