Illness In Infants Research Articles

Pediatric Cardiogenic Shock in a 7-Day-Old With Poor Feeding and Tachypnea: Case Review

Neonatal cardiac emergencies are often considered masters of disguise. There is inherent difficulty in recognizing and managing congenital heart disease (CHD) in neonates. The incidence of CHD is about 8 per 1000 live births, and the defects are generally classified into cyanotic and acyanotic CHD. According to the Centers for Disease and Control and Prevention, CHDs are a leading cause of birth defect–associated infant illness and death. 1 Centers for Disease Control and Prevention US Department of Health and Humans Services Congenital heart defects (CHDs). http://www.cdc.gov/ncbddd/heartdefects/data.html Google Scholar Infant deaths due to CHDs often occur when the baby is younger than 28 days old. The prevalence of critical cardiac disease in infants is higher than the prevalence of infant sepsis. 2 Anderson-Berry A Neonatal sepsis. http://emedicine.medscape.com/article/978352 Google Scholar Kaci A. Rainey, Member, Delaware ENA Chapter, is ED Staff Nurse, Christiana Care Health System, Newark, DE, and Adjunct Nursing Faculty, University of Delaware, Newark, DE.

Inverse Correlation between 25-OH Vitamin D Levels and Severity of Viral Respiratory Illness in Infants

Inverse Correlation between 25-OH Vitamin D Levels and Severity of Viral Respiratory Illness in Infants

Relationship between Measures of Neonatal Glycemia, Neonatal Illness, and 2-Year Outcomes in Very Preterm Infants

To investigate relationships between early neonatal glycemia, neonatal characteristics, neonatal illness, and developmental outcomes in very preterm infants. A retrospective, observational cohort study of 443 infants born weighing <1500 g or <30 weeks of gestation, and admitted within 24 hours to National Women's Hospital, Auckland, New Zealand. Glucose variability was defined as the standard deviation around the mean after log transformation of all blood glucose concentrations. Absolute glycemic excursions in the first week were used to divide the infants into 4 groups: normoglycemic; hypoglycemic; hyperglycemic, and unstable. Compared with normoglycemic infants, hypoglycemic and unstable infants had lower birth weight z-scores, and hyperglycemic and unstable infants were of lower birth weight. Hypoglycemic infants had similar outcomes to normoglycemic infants. Hyperglycemic and unstable infants were less likely to survive without neonatal morbidity and less likely to survive without neurodevelopmental impairment at 2 years of age. Higher mean blood glucose concentration was seen in the hyperglycemic and unstable groups, and was associated with worse neonatal and 2-year outcomes. Greater glucose variability was seen in the hypoglycemic and unstable groups, and was associated with worse neonatal illness but not outcome at 2 years. No associations between measures of neonatal glycemia and neonatal or 2-year outcomes remained after correction for gestation, birth weight z-score, and socioeconomic status. In very preterm infants, measures of neonatal glycemia are markers of gestational age and intrauterine growth, and are not independent predictors of neonatal illness or outcomes at 2 years of age.

Infant Nutritional Status, Feeding Practices, Enteropathogen Exposure, Socioeconomic Status, and Illness Are Associated with Gut Barrier Function As Assessed by the Lactulose Mannitol Test in the MAL-ED Birth Cohort.

.The lactulose mannitol (LM) dual sugar permeability test is the most commonly used test of environmental enteropathy in developing countries. However, there is a large but conflicting literature on its association with enteric infection and host nutritional status. We conducted a longitudinal cohort using a single field protocol and comparable laboratory procedures to examine intestinal permeability in multiple, geographically diverse pediatric populations. Using a previously published systematic review to guide the selection of factors potentially associated with LM test results, we examined the relationships between these factors and mucosal breach, represented by percent lactulose excretion; absorptive area, represented by percent mannitol excretion; and gut barrier function, represented by the L/M ratio. A total of 6,602 LM tests were conducted in 1,980 children at 3, 6, 9, and 15 months old; percent lactulose excretion, percent mannitol excretion, and the L/M ratio were expressed as age- and sex-specific normalized values using the Brazil cohort as the reference population. Among the factors considered, recent severe diarrhea, lower socioeconomic status, and recent asymptomatic enteropathogen infections were associated with decreased percent mannitol excretion and higher L/M ratios. Poorer concurrent weight-for-age, infection, and recent breastfeeding were associated with increased percent lactulose excretion and increased L/M ratios. Our results support previously reported associations between the L/M ratio and factors related to child nutritional status and enteropathogen exposure. These results were remarkably consistent across sites and support the hypothesis that the frequency of these exposures in communities living in poverty leads to alterations in gut barrier function.

A cohort study of low birth weight and health outcomes in the first year of life, Ghana.

ObjectiveTo investigate the effect of birth weight on infant mortality, illness and care seeking in rural Ghana.MethodsUsing randomized controlled trial data, we compared infants weighing 2.00–2.49, 1.50–1.99 and < 1.50 kg with non-low-birth-weight infants. We generated adjusted mortality hazard ratios (aHR), adjusted illness rate ratios (aRR) and adjusted odds ratios (aOR) for health-facility admissions and absence of care seeking for four time periods: infancy, the neonatal period, early infancy and late infancy – represented by ages of 0–364, 0–27, 28–182 and 183–364 days, respectively.FindingsAmong 22 906 infants, compared with non-low-birth-weight infants: (i) infants weighing 2.00–2.49, 1.50–1.99 and < 1.50 kg were about two (aHR: 2.13; 95% confidence interval, CI: 1.76–2.59), eight (aHR: 8.21; 95% CI: 6.26–10.76) and 25 (aHR: 25.38; 95% CI: 18.36–35.10) times more likely to die in infancy, respectively; (ii) those born weighing < 1.50 kg were about 48 (aHR: 48.45; 95% CI: 32.81–71.55) and eight (aHR: 8.42; 95% CI: 3.09–22.92) times more likely to die in the neonatal period and late infancy, respectively; (iii) those born weighing 1.50–1.99 kg (aRR: 1.57; 95% CI: 1.27–1.95) or < 1.50 kg (aRR: 1.58; 95% CI: 1.13–2.21) had higher neonatal illness rates; and (iv) for those born weighing 1.50–1.99 kg, care was less likely to be sought in the neonatal period (aOR: 3.30; 95% CI: 1.98–5.48) and early infancy (aOR : 1.74; 95% CI: 1.26–2.39).ConclusionFor low-birth-weight infants in Ghana, strategies to minimize mortality and improve care seeking are needed.

Risk factors for postpartum depression among Chinese women: path model analysis

BackgroundPostpartum depression causes harm to both mothers and infants. The purpose of this study was to find out several potential risk factors, and to identify the intrinsic interrelationships between factors and postpartum depression by constructing a path model. The results of this study may help to control the increasing incidence of maternal postpartum depression.MethodsThe study was based on a sample of mothers from a cross-sectional study which was set up at 4 weeks after a mother had childbirth and was conducted in three streets at Kaifu District of Changsha in Hunan province from January to December 2015. Questionnaires were distributed to subjects who responded to questions concerning factors related to pregnancy, delivery and infants within 4 weeks after childbirth. The Edinburgh Postnatal Depression Scale (EPDS) was used to measure postpartum depression. Chi-square test was used to detect significant differences between non-postpartum depression group and postpartum depression group. A path model was constructed to explore the interrelationships between variables, and to verify the relationships between variables and postpartum depression.ResultsThe proportion of maternal postpartum depression was 6.7%. Univariate analysis showed that there were significant differences between non-postpartum depression group and postpartum depression group (all P-values <0.05) on the part of maternal age, parity, frequent exposure to mobile phone during pregnancy, gestational hypertensive disorders, fetus number, premature delivery, birth weight, initiation of breastfeeding, mode of feeding, infant illness within 4 weeks after delivery and infant weight at 4 weeks. Path analysis results showed that the final model could be fitted well with sample data (P = 0.687, CMIN/DF = 0.824, NFI = 0.992, RFI = 0.982, IFI = 1.002, TLI =1.004, CFI = 1.000 and RMSEA < 0.001). Frequent exposure to mobile phone during pregnancy, maternal age and gestational hypertensive disorders had both direct and indirect effects on postpartum depression. Mode of feeding and infant weight at 4 weeks, which was the most total effect on postpartum depression, had only a direct impact on postpartum depression. Fetus number, premature delivery, initiation of breastfeeding and birth weight had only an indirect influence on postpartum depression.ConclusionThe findings of this study suggest that constructing a path analysis model could identify potential factors and explore the potential interrelations between factors and postpartum depression. It is an effective way to prevent maternal postpartum depression by taking appropriate intervention measures and carrying out health education for pregnant women.

Maternal Pertussis Vaccination with a Mono-component Pertussis Toxoid Vaccine is Sufficient to Protect Newborns

Abstract Bordetella pertussis is a highly infectious human pathogen causing serious illness in infants, children and adults. The first pertussis vaccination is administered at two months of age, therefore, infants under two months of age are most vulnerable to infection. Rising incidence of pertussis resulted in the 2012 recommendation by the Advisory Committee on Immunization Practices (ACIP) to immunize all pregnant women to protect infants from birth until their first vaccination. Using a baboon model, we demonstrated that maternal vaccination with the three or four component acellular pertussis vaccines protected newborn baboons from the disease but not from the colonization. We hypothesized this protection was due to the transfer of maternal anti-PT antibodies to the infant. Therefore we evaluated the protection conferred by maternal vaccination with a pertussis toxoid (PTx) only vaccine. Infant baboons born to mothers vaccinated with the PTx-only vaccine were free from disease and had low WBC counts following exposure to B. pertussis at five weeks of age. In contrast, infants born to unvaccinated mothers experienced severe disease with high WBC counts. Our results demonstrate that vaccination of baboons during pregnancy with a PTx-only vaccine is sufficient to protect newborn baboons from disease following exposure to pertussis. Because pertussis toxin is a secreted protein that can be purified from bacterial supernatants, a single-component vaccine comprised of pertussis toxoid is very likely the most cost-effective acellular pertussis vaccine possible. The development and use of mono-component PTx vaccines may enable the extension of maternal vaccine programs to low and middle income countries.

Evaluation of a cocooning programme on infant pertussis infection in the Northern Territory

The Australian National Immunisation Guidelines were updated in 2014 to recommend diphtheria, tetanus and pertussis (dTpa) vaccination for all pregnant women from 28 weeks gestation for each pregnancy.1 Since 2008 the Northern Territory (NT) guidelines have recommended delivering dTpa vaccine to postnatal women and all other household members and close contacts in order to provide a protective cocoon of immunity around the newborn.2 We aim to determine whether the pertussis cocooning strategy reduced pertussis infections in young infants in the NT. Infants <12 months of age diagnosed with pertussis, as per the notifiable diseases register, and born at times when the cocooning strategy was in place (2009–2014) were compared with infants born pre-intervention (2002–2007). The proportion of cases of pertussis occurring in infants <12 months of age was significantly higher in the pre-intervention period (6.7%) compared with the cocooning period (3.3%) (P = 0.0067). The infants infected were similar in gender, ethnicity, geographical location, sex, hospitalisation and outcome, but were significantly younger at diagnosis during the pre-intervention period (P = 0.01). Post-partum immunisation and cocooning strategies did reduce rates of pertussis illness in infants <12 months of age. 1 The Australian Immunisation Handbook, 10th edn. Australian Government Department of Health (updated Jan. 2014). ISBN 978-74241-861-2 2 Immunisation Schedule. Centre for Disease Control, Department of Health Northern Territory, NT, Australia; 2008.

Perinatal and infant mental health in Australia: moving forward towards REAL prevention and early intervention - can we do it?

Australia has been at the forefront of appropriate early intervention. Prevention of mental illness in infants by early identification and intervention in the mental health of their mothers has stalled since the cessation of funding through the National Perinatal Depression Initiative (NPDI, 2009-2015). Whilst screening for maternal mental illness has been widely implemented throughout Australia during the last two decades, services are now diminishing and great opportunities to ride the crest of a wave for appropriate mental illness intervention are receding. Reviews of history and interventions internationally may help guide future directions. Advocacy through across-agency and across-political-party support has been markedly successful for perinatal and infant mental health in the United Kingdom. A solid foundation exists in Australia. Australian psychiatrists have the ability to continue to change the face of prevention and early intervention.

Defining Pediatric Chronic Critical Illness for Clinical Care, Research, and Policy.

Chronically critically ill pediatric patients represent an emerging population in NICUs and PICUs. Chronic critical illness has been recognized and defined in the adult population, but the same attention has not been systematically applied to pediatrics. This article reviews what is currently known about pediatric chronic critical illness, highlighting the unique aspects of chronic critical illness in infants and children, including specific considerations of prognosis, outcomes, and decision-making. We propose a definition that incorporates NICU versus PICU stays, recurrent ICU admissions, dependence on life-sustaining technology, multiorgan dysfunction, underlying medical complexity, and the developmental implications of congenital versus acquired conditions. We propose a research agenda, highlighting existing knowledge gaps and targeting areas of improvement in clinical care, research, and policy.

Family Impact and Infant Emotional Outcomes Following Diagnosis of Serious Liver Disease or Transplantation in Infancy.

Research is lacking into the emotional effects on families of serious chronic illness in infants. We examined the effect of the diagnosis of serious liver disease in infants upon parent psychological symptoms and family functioning. We hypothesized that parent psychological symptoms, family functioning, and father engagement will predict infant emotional outcomes. Parents of infants recently diagnosed with serious liver disease completed validated questionnaires about parent stress, family function, impact of the illness on the family, and father engagement. The measures were repeated after 1 year, with the addition of the Child Behavior Checklist (CBCL). Parents of 37 infants participated. Parent stress and family functioning scores were not elevated. Parent psychological symptoms, family function, and father engagement did not predict infant outcome. For mothers, infant diagnosis other than biliary atresia, number of outpatient visits, and impact of the illness on the family explained 32% of the variation in CBCL (P = 0.001). For fathers, socioeconomic status, infant diagnosis other than biliary atresia, whether the infant had had a transplant, and impact of the illness on the family explained 44% of the variation in CBCL (P < 0.001). Parents and families appear to be resilient in coping with serious infant illness. Infant diagnosis other than biliary atresia and parental perceptions of high impact of the illness on the family are indicators of negative emotional outcomes for infants with serious liver disease. Psychosocial interventions for infants with chronic illness should target reducing the impact of illness on the family.

Hubungan Pola Menyusui dengan Fekuensi Kejadian Sakit pada Bayi

ABSTRACT Based on data coverage of exclusive breastfeedingin Malang on 2014,the coverage of exclusive breastfeeding was 74.13%, while complete exclusive breastfeeding was 56.98%. This achievement had exceeded the target of 72%. Meanwhile, according to data from the Health Service of Malang, on 2014, therewas 871 pneumonia cases, 5405 cough not pneumonia cases, and 1540 diarrhea cases in infants. Those three diseases were the most common cases that occurred to 0-12 months-old infants in Malang. This study aimed to investigate the correlation between breastfeeding patterns with frequency of illness in infants. This study was an observational study with cross sectional design.Sampling method in this studyused purposive sampling method. Result of this study showed that based on statistical test result, the value of likelihood ratio is 0,00 (p<0,05). It means that the pattern of breastfeeding had a relation with the frequency of illness in infants.The conclusion from this study is there is significant relationship between the pattern ofbreastfeeding with the frequency of infantsillness in Pandanwangi,Blimbing district, Malang City.

“Those Who Care Much, Understand Much.” Maternal Perceptions of Children's Appetite: Perspectives from Urban and Rural Caregivers of Diverse Parenting Experience

BackgroundAppetite in children is an important determinant of nutritional intake and growth. Reduced appetite is related to acute illness and systemic inflammation in infants and young children, and is common in settings where high rates of undernutrition coexist with inadequate water, sanitation, and hygiene. The loss of appetite is an indicator of declining health status, and improvement in appetite is an early signal of recovery. Therefore, understanding caregiver's awareness of children's appetite during illness and recovery is important to maximize opportunities for targeting interventions to improve growth and reduce morbidity and mortality risk in young children.Objective1) To understand maternal perceptions and responses to children's appetite; and 2) to identify how these factors differ by type of caregiver, level of maternal experience, and by urban and rural context.MethodsWe conducted twelve focus groups among mothers (nulliparous and multiparous) and alternate caregivers in urban and rural setting in Bangladesh (n=81). All participants were currently providing care for a child under 5 years.ResultsCaregivers most often monitor children's dietary patterns to understand children's appetite, and to a lesser extent physical and emotional signs, and other cues. Healthy appetite, or “taste” and “delight in their mouths” was commonly observed by a child's willingness to eat a diversity of foods, finish offered portions, and by their acceptance of foods without excessive prompting. Child illness was a commonly cited reason for children's lack of appetite, which was manifested through fussiness and crying, coupled with the avoidance of commonly consumed foods, or a heightened preference for comfort foods. Mothers described a limited set of feeding practices (offering diverse foods, playing with children, cheering children with videos) to encourage food consumption among children who lacked appetite. Maternal time stress due to work was noted as a barrier to identifying appetite cues. Urban mothers described a lower access to instrumental social support for child feeding, but more access to informational support (nutrition counseling, child care centers, literature) than mothers in the rural setting.ConclusionsCaregiver recognition of child appetite during healthy and ill periods appears to be a critical component of optimal nutritional caregiving. Understanding caregivers' perceptions of children's appetite, and the signs and cues that mothers and caretakers use to identify the presence and absence of appetite in children, may inform the development of tools to assess changes in appetite as early indicators of change in health or nutrition status among high risk children.Support or Funding InformationSupported by the Bill and Melinda Gates Foundation (OPP1136759).

Severe Parechovirus 3 Infections in Young Infants-Kansas and Missouri, 2014.

Infection with parechovirus type 3 (PeV3) can cause severe neurologic and sepsis-like illness in young infants; clinical and epidemiologic descriptions have been limited. We aimed to characterize PeV3 illness and explore risk factors for acquisition in a cluster of neonatal cases at Children's Mercy Hospital in Kansas City, Missouri. Cerebrospinal fluid specimens were obtained from infants aged <180 days who were hospitalized with sepsis-like illness or meningitis between June 1 and November 1, 2014. PeV-positive specimens were sequenced at the Centers for Disease Control and Prevention. We reviewed the medical and birth charts of the infants and performed face-to-face parent interviews. We analyzed characteristics according to infant age and intensive care admission status. We identified 35 cases of PeV infection in infants aged 5 to 56 days. Seven infants required intensive care (median age, 11 days vs 27 days among those who did not require intensive care; P = .0044). Six of these 7 infants had neurologic manifestations consistent with seizures, and all 6 of them were treated with acyclovir but subsequently tested negative for herpes simplex virus. Virus sequences formed 2 lineages, both of which were associated with severe illness. Half of the infants were reported to have household contacts who were ill during the week before onset. Infants aged ≤7 days at onset were more likely to have been delivered at the same hospital. PeV3 can cause severe neurologic illness in neonates, and younger infants are more likely to require intensive care. PeV3 should be considered along with herpes simplex virus and other pathogens when evaluating young infants with sepsis-like illness or meningitis. More widespread testing for PeV3 would enable us to gain a better understanding of the clinical scope and circulation of this virus.

An outbreak of severe infections among Australian infants caused by a novel recombinant strain of human parechovirus type 3

Human parechovirus types 1–16 (HPeV1–16) are positive strand RNA viruses in the family Picornaviridae. We investigated a 2015 outbreak of HPeV3 causing illness in infants in Victoria, Australia. Virus genome was extracted from clinical material and isolates and sequenced using a combination of next generation and Sanger sequencing. The HPeV3 outbreak genome was 98.7% similar to the HPeV3 Yamagata 2011 lineage for the region encoding the structural proteins up to nucleotide position 3115, but downstream of that the genome varied from known HPeV sequences with a similarity of 85% or less. Analysis indicated that recombination had occurred, may have involved multiple types of HPeV and that the recombination event/s occurred between March 2012 and November 2013. However the origin of the genome downstream of the recombination site is unknown. Overall, the capsid of this virus is highly conserved, but recombination provided a different non-structural protein coding region that may convey an evolutionary advantage. The indication that the capsid encoding region is highly conserved at the amino acid level may be helpful in directing energy towards the development of a preventive vaccine for expecting mothers or antibody treatment of young infants with severe disease.

Difficult diagnosis of atypical kawasaki disease in an infant younger than six months: a case report

BackgroundKawasaki disease (KD) is an acute inflammatory vasculitis of unknown origin.Case presentationWe report the case of a 5-month-old child with an atypical form of KD, characterized by undulating symptoms, who developed an aneurysm of the right coronary artery and an ectasia of the left anterior descending coronary artery.ConclusionThis case report underlines the difficulties in recognizing incomplete forms of the illness in young infants, who are at higher risk of cardiac complications.

Association Between Dehydration and Fever During the First Week of Life.

Trying to differentiate serious bacterial infection (SBI) from a self-limiting illness in febrile infants seen in the pediatric emergency department (PED) is a significant challenge. The aim of the study was to determine the prevalence of dehydration and its relationship to SBI in febrile full-term newborns under 1 week of age seen in a PED. A retrospective observational study was carried out on all children younger than 8 days of age with fever who presented to a single, tertiary care, PED from January 2009 to April 2014. Dehydration was defined as plasma sodium >150 mmol/L or >10% loss of birth weight. SBI was defined by the presence of a positive culture in the blood, urine, cerebrospinal fluid; osteoarticular infection; bacterial enteritis; or pneumonia. The primary analysis was the proportion of children with dehydration. A secondary analysis compared proportion of infection according to hydration status. Of the 895 children under 8 days of age who visited the PED, 69 consulted for fever. Seven patients were excluded because they were transferred from another hospital. Sixty-two eligible patients were included in the final analysis. Of these, 17 (27%) were dehydrated according to our definition. Only 2 patients had an SBI while 2 others had a final diagnosis of viral myocarditis and encephalitis, respectively. None of the 4 children with serious infection fulfilled our definition of dehydration, and all had a plasma sodium level lower than 145 mmol/L. Dehydration is frequently associated with fever in infants younger than 8 days of age seen in a PED. Early identification of dehydration may be useful in limiting the aggressive intervention in some of these infants.

Does rotavirus vaccination reduce deaths from diarrheal illness in infants?

Does rotavirus vaccination reduce deaths from diarrheal illness in infants?

Impact of CD4+ T Cell Responses on Clinical Outcome following Oral Administration of Wild-Type Enterotoxigenic Escherichia coli in Humans.

Enterotoxigenic Escherichia coli (ETEC) is a non-invasive enteric pathogen of considerable public health importance, being one of the most common attributable causes of diarrheal illness in infants and young children in developing countries and the most common cause of traveler’s diarrhea. To enhance study-to-study consistency of our experimental challenge model of ETEC in volunteers, and to allow concomitant multi-site trials to evaluate anti-ETEC immunoprophylactic products, hundreds of vials, each containing a standardized inoculum of virulent wild-type (wt) ETEC strain H10407 (serotype O78:H11 expressing colonization factor antigen I and heat-labile and heat-stable enterotoxins), were prepared under current Good Manufacturing Practices (cGMP) and frozen. Following thawing, the contents of each vial can be used (diluted as necessary) to prepare consistent challenge inoculum, even at different study sites. A preliminary human experimental challenge study using this cGMP inoculum was conducted on a research isolation ward and the clinical and cell-mediated immune responses evaluated. Of the 6 healthy adult volunteers challenged 83% (5/6) developed diarrhea and 50% developed moderate-to-severe diarrhea (MSD). Moderate and severe diarrhea were defined as passage of ≥ 1 liter or ≥ 3 liters of diarrheal stool respectively. We compared the CD4+ T cell responses of volunteers who developed MSD against those who did not and identified significant differences in ETEC-specific cytokine production and gut homing potential. We furthermore demonstrated that increased expression of the gut-homing molecule integrin α4β7 by peripheral T follicular helper cells (pTfh) correlated with decreased stool volume and increased ETEC-specific IgA B memory cell (BM) development. Collectively, despite small numbers of volunteers, our results indicate a potential role for CD4+ T cells, in particular pTfh, in modulating disease outcome following exposure to wt ETEC in a volunteer experimental challenge model.

Bending the Twig Does the Tree Incline: Lung Function after Lower Respiratory Tract Illness in Infancy.

Bending the Twig Does the Tree Incline: Lung Function after Lower Respiratory Tract Illness in Infancy.