Illness In Young Children Research Articles

Knowledge, Attitude, and Practices of Mothers toward Infant Oral Care Living in Rural Areas of West Godavari District, Andhra Pradesh

Abstract Context: Early childhood caries is the most frequent chronic illness in young children which affects their overall well-being. It is crucial to educate mothers regarding infant oral care since the young children are dependent on their mothers for their basic needs. Aim: This study aims to assess the knowledge, attitude, and practices (KAPs) of mothers toward infant oral care living in rural areas. Settings and Design: The study was an observational study. Materials and Methods: A total of 630 mothers of infants aged 0–2 years living in rural areas of West Godavari District, Andhra Pradesh, were included in the study using multistage sampling. A validated 25-item questionnaire was used to assess the KAPs of mothers regarding infant oral care. After collecting the filed questionnaires, participants were educated on infant oral health. A scoring scale was given for the responses of each question to assess the total scores of each participant. Statistical Analysis Used: This was descriptive statistical analysis. Results: The mean age of the mothers was 25.06 ± 3.7 years. Among the studied population, about 51.4% of the participants had poor knowledge about infant oral hygiene, 74.1% of the participants had positive attitude toward infant oral care, and 58.5% of the participants had satisfactory levels of infant oral hygiene practices. Conclusion: The majority of the infants’ mothers had poor knowledge about infant oral care and followed unsatisfactory infant oral hygiene practices. However, they exhibited a positive attitude toward infant oral care.

Risk Factors for Urinary Tract Infection in Children

Background & 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&2): 60-65

Estimating averted illnesses from influenza vaccination for children and pregnant women – El Salvador, Panama, and Peru, 2011–2018

BackgroundEstimating the burden of disease averted by vaccination can assist policymakers to implement, adjust, and communicate the value of vaccination programs. Demonstrating the use of a newly available modeling tool, we estimated the burden of influenza illnesses averted by seasonal influenza vaccination in El Salvador, Panama, and Peru during 2011–2018 among two influenza vaccine target populations: children aged 6–23 months and pregnant women. MethodsWe derived model inputs, including incidence, vaccine coverage, vaccine effectiveness, and multipliers from publicly available country-level influenza surveillance data and cohort studies. We also estimated changes in illnesses averted when countries’ vaccine coverage was achieved using four different vaccine deployment strategies. ResultsAmong children aged 6–23 months, influenza vaccination averted an estimated cumulative 2,161 hospitalizations, 81,907 medically-attended illnesses, and 126,987 overall illnesses during the study period, with a prevented fraction ranging from 0.3 % to 12.5 %. Among pregnant women, influenza vaccination averted an estimated cumulative 173 hospitalizations, 6,122 medically attended illnesses, and 16,412 overall illnesses, with a prevented fraction ranging from 0.2 % to 10.9 %. Compared to an influenza vaccine campaign with equal vaccine distribution during March—June, scenarios in which total cumulative coverage was achieved in March and April consistently resulted in the greatest increase in averted illness (23 %-3,129 % increase among young children and 22 %-3,260 % increase among pregnant women). DiscussionInfluenza vaccination campaigns in El Salvador, Panama, and Peru conducted between 2011 and 2018 prevented hundreds to thousands of influenza-associated hospitalizations and illnesses in young children and pregnant women. Existing vaccination programs could prevent additional illnesses, using the same number of vaccines, by achieving the highest possible coverage within the first two months of an influenza vaccine campaign.

2608. Circulating Respiratory Syncytial Virus Genotypes in Hospitalized Children with Bronchiolitis in the United Arab Emirates

Abstract Background Respiratory syncytial virus (RSV) is a major cause of acute respiratory illness in young children and elderly people worldwide. It has a complex molecular epidemiology with multiple strains cocirculating during a single epidemic. Whole genome sequencing is a valuable tool for monitoring genetic diversity and providing genomic information essential for antiviral and vaccine development. In the United Arab Emirates (UAE), little is known about the RSV circulating genotypes, their evolution, and transmission dynamics. Using next-generation sequencing, this study aims to identify RSV genotypes circulating among young children with bronchiolitis in Al Ain City, UAE. Methods This cross-sectional study involved 100 children under two years of age who were hospitalized at a tertiary care facility between April and December 2021 with RSV-positive bronchiolitis. Nasopharyngeal samples were obtained, within 24 hours of hospitalization, for RSV genotyping. MinION nanopore sequencer was used to analyze the whole viral genome. We only sequenced samples with cycle threshold (Ct) < 30 (n=70). After sequencing, 7 samples were not analyzed due to long gaps and small lengths. The remaining 63 samples included 59 RSV-A and 4 RSV-B isolates. Results The median age of the studied children was 4.3 months, interquartile range (2.1-10.4), with 56% below the age of 6 months. There was no significant difference in the clinical characteristics of children having RSV-A compared to those infected with RSV-B. Phylogenetic analysis showed that out of the 59 RSV-A sequences, 58 clustered with the NA1 genotype, and 1 sequence clustered with the GA1 genotype. All RSV-B sequences were classified as BA2 genotypes. The amino acid sequence alignment of the G gene revealed that all 58 NA1 genotypes had 24 amino acid duplication regions from 247 to 282 amino acid positions. We also found four substitutional changes at L248I, H258Q, L274P, and P276Q. Conclusion Phylogenetic analysis revealed that the subtype A NA1 genotype was the dominant strain among the studied children in Al Ain, UAE during the 2021 season. As vaccine development advances, further sequencing of RSV is needed to better understand viral origin, transmission, and genetic recombination, particularly in under-studied populations. Disclosures All Authors: No reported disclosures

Structure of the N-RNA/P interface indicates mode of L/P recruitment to the nucleocapsid of human metapneumovirus

Human metapneumovirus (HMPV) is a major cause of respiratory illness in young children. The HMPV polymerase (L) binds an obligate cofactor, the phosphoprotein (P). During replication and transcription, the L/P complex traverses the viral RNA genome, which is encapsidated within nucleoproteins (N). An essential interaction between N and a C-terminal region of P tethers the L/P polymerase to the template. This N-P interaction is also involved in the formation of cytoplasmic viral factories in infected cells, called inclusion bodies. To define how the polymerase component P recognizes N-encapsidated RNA (N-RNA) we employed cryogenic electron microscopy (cryo-EM) and molecular dynamics simulations, coupled to activity assays and imaging of inclusion bodies in cells. We report a 2.9 Å resolution structure of a triple-complex between multimeric N, bound to both RNA and the C-terminal region of P. Furthermore, we also present cryo-EM structures of assembled N in different oligomeric states, highlighting the plasticity of N. Combined with our functional assays, these structural data delineate in molecular detail how P attaches to N-RNA whilst retaining substantial conformational dynamics. Moreover, the N-RNA-P triple complex structure provides a molecular blueprint for the design of therapeutics to potentially disrupt the attachment of L/P to its template.

Clinical outcomes of COVID-19 and influenza in hospitalized children

We compared hospitalization outcomes of young children hospitalized with COVID-19 to those hospitalized with influenza in the United States. Patients aged 0-<5 years hospitalized with an admission diagnosis of acute COVID-19 (April 2021-March 2022) or influenza (April 2019-March 2020) were selected from the PINC AI Healthcare Database Special Release. Hospitalization outcomes included length of stay (LOS), intensive care unit (ICU) admission, oxygen supplementation, and mechanical ventilation (MV). Inverse probability of treatment weighting was used to adjust for confounders in logistic regression analyses. Among children hospitalized with COVID-19 (n = 4,839; median age: 0 years), 21.3% had an ICU admission, 19.6% received oxygen supplementation, 7.9% received MV support, and 0.5% died. Among children hospitalized with influenza (n = 4,349; median age: 1 year), 17.4% were admitted to the ICU, 26.7% received oxygen supplementation, 7.6% received MV support, and 0.3% died. Compared to children hospitalized with influenza, those with COVID-19 were more likely to have an ICU admission (adjusted odds ratio [aOR]: 1.34; 95% confidence interval [CI]: 1.21-1.48). However, children with COVID-19 were less likely to receive oxygen supplementation (aOR: 0.71; 95% CI: 0.64-0.78), have a prolonged LOS (aOR: 0.81; 95% CI: 0.75-0.88), or a prolonged ICU stay (aOR: 0.56; 95% CI: 0.46-0.68). The likelihood of receiving MV was similar (aOR: 0.94; 95% CI: 0.81, 1.1). Hospitalized children with either SARS-CoV-2 or influenza had severe complications including ICU admission and oxygen supplementation. Nearly 10% received MV support. Both SARS-CoV-2 and influenza have the potential to cause severe illness in young children.

Association between early childhood sleep difficulties and subsequent psychiatric illness.

Chronic disruptions to sleep in childhood are associated with increased prevalence of psychiatric disease later in development. When sleep disruptions remit before adolescence, the increased prevalence of psychiatric disease is no longer observed, highlighting the importance of early detection and intervention. Clinicians typically rely on caregivers' reports for diagnosis and management of childhood sleep challenges. We examined whether findings on polysomnogram (PSG) can offer similar insight into childhood sleep difficulties and the risk of subsequent psychiatric illness. A cohort was identified of 348 children ages 5 years 11 months and younger with sleep difficulties rising to the level of formal clinical workup. A retrospective review of caregiver-reported sleep concerns, PSG results, and subsequent psychiatric illness was completed. PSG findings were compared to presence of psychiatric illness later in life as well as caregivers' reported concerns. Chi-squared and Fisher's exact tests were completed to evaluate correlations and Cohen's kappa was used to evaluate agreement. With only a few exceptions, comparisons between clinician findings on PSG and subsequent psychiatric diagnoses were statistically nonsignificant. Similarly, the relationship between caregivers' subjective reports about sleep and clinicians' findings on PSG demonstrated only slight to fair agreement, suggesting reported concerns were not predictive of PSG results. Parental reports of subjective sleep concerns are indicative of different sleep pathologies compared to sleep pathologies detected on PSG. The addition of PSG to caregiver-reported data appears to have limited clinical utility in understanding sleep concerns associated with the risk of subsequent psychiatric illness in young children. Pease E, Shekunov J, Savitz ST, etal. Association between early childhood sleep difficulties and subsequent psychiatric illness. J Clin Sleep Med. 2023;19(12):2059-2063.

Rhinoviruses A and C elicit long-lasting antibody responses with limited cross-neutralization.

Rhinoviruses (RVs) can cause severe wheezing illnesses in young children and patients with asthma. Vaccine development has been hampered by the multitude of RV types with little information about cross-neutralization. We previously showed that neutralizing antibody (nAb) responses to RV-C are detected twofold to threefold more often than those to RV-A throughout childhood. Based on those findings, we hypothesized that RV-C infections are more likely to induce either cross-neutralizing or longer-lasting antibody responses compared with RV-A infections. We pooled RV diagnostic data from multiple studies of children with respiratory illnesses and compared the expected versus observed frequencies of sequential infections with RV-A or RV-C types using log-linear regression models. We tested longitudinally collected plasma samples from children to compare the duration of RV-A versus RV-C nAb responses. Our models identified limited reciprocal cross-neutralizing relationships for RV-A (A12-A75, A12-A78, A20-A78, and A75-A78) and only one for RV-C (C2-C40). Serologic analysis using reference mouse sera and banked human plasma samples confirmed that C40 infections induced nAb responses with modest heterotypic activity against RV-C2. Mixed-effects regression modeling of longitudinal human plasma samples collected from ages 2 to 18 years demonstrated that RV-A and RV-C illnesses induced nAb responses of similar duration. These results indicate that both RV-A and RV-C nAb responses have only modest cross-reactivity that is limited to genetically similar types. Contrary to our initial hypothesis, RV-C species may include even fewer cross-neutralizing types than RV-A, whereas the duration of nAb responses during childhood is similar between the two species. The modest heterotypic responses suggest that RV vaccines must have a broad representation of prevalent types.

Association of Asthma Risk Alleles With Acute Respiratory Tract Infections and Wheezing Illnesses in Young Children.

Genome-wide association studies have identified several risk alleles for early childhood asthma, particularly in the 17q21 locus and in the cadherin-related family member 3 (CDHR3) gene. Contribution of these alleles to the risk of acute respiratory tract infections (ARI) in early childhood is unclear. We analyzed data from the STEPS birth-cohort study of unselected children and the VINKU and VINKU2 studies on children with severe wheezing illness. Genome-wide genotyping was performed on 1011 children. We analyzed the association between 11 preselected asthma risk alleles and the risk of ARIs and wheezing illnesses of various viral etiologies. The asthma risk alleles in CDHR3, GSDMA, and GSDMB were associated with an increased rate of ARIs (for CDHR3, incidence rate ratio [IRR], 1.06; 95% confidence interval [CI], 1.01-1.12; P = .02), and risk allele in CDHR3 gene with rhinovirus infections (IRR, 1.10; 95% CI, 1.01-1.20, P = .03). Asthma risk alleles in GSDMA, GSDMB, IKZF3, ZPBP2, and ORMDL3 genes were associated with wheezing illnesses in early childhood, especially rhinovirus-positive wheezing illnesses. Asthma risk alleles were associated with an increased rate of ARIs and an increased risk of viral wheezing illnesses. Nonwheezing and wheezing ARIs and asthma may have shared genetic risk factors. Clinical Trials Registration. NCT00494624 and NCT00731575.

COVID-19 Disease in Under-5 Children: Current Status and Strategies for Prevention including Vaccination.

Since the coronavirus disease (COVID-19) pandemic hit the globe in early 2020, we have steadily gained insight into its pathogenesis; thereby improving surveillance and preventive measures. In contrast to other respiratory viruses, neonates and young children infected with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) have a milder clinical presentation, with only a small proportion needing hospitalization and intensive care support. With the emergence of novel variants and improved testing services, there has been a higher incidence of COVID-19 disease reported among children and neonates. Despite this, the proportion of young children with severe disease has not increased. Key mechanisms that protect young children from severe COVID-19 disease include the placental barrier, differential expression of angiotensin-converting enzyme 2 (ACE-2) receptors, immature immune response, and passive transfer of antibodies via placenta and human milk. Implementing mass vaccination programs has been a major milestone in reducing the global disease burden. However, considering the lower risk of severe COVID-19 illness in young children and the limited evidence about long-term vaccine safety, the risk-benefit balance in children under five years of age is more complex. In this review, we do not support or undermine vaccination of young children but outline current evidence and guidelines, and highlight controversies, knowledge gaps, and ethical issues related to COVID-19 vaccination in young children. Regulatory bodies should consider the individual and community benefits of vaccinating younger children in their local epidemiological setting while planning regional immunization policies.

Estimating the economic burden of respiratory syncytial virus infections in infants in Vietnam: a cohort study

BackgroundLittle information is available on the costs of respiratory syncytial virus (RSV) in Vietnam or other low- and middle-income countries. Our study estimated the costs of LRTIs associated with RSV infection among children in southern Vietnam.MethodsWe conducted a prospective cohort study evaluating household and societal costs associated with LRTIs stratified by RSV status and severity among children under 2 years old who sought care at a major pediatric referral hospital in southern Vietnam. Enrollment periods were September 2019–December 2019, October 2020–June 2021 and October 2021–December 2021. RSV status was confirmed by a validated RT-PCR assay. RSV rapid detection antigen (RDA) test performance was also evaluated. Data on resource utilization, direct medical and non-medical costs, and indirect costs were collected from billing records and supplemented by patient-level questionnaires. All costs are reported in 2022 US dollars.Results536 children were enrolled in the study, with a median age of 7 months (interquartile range [IQR] 3–12). This included 210 (39.2%) children from the outpatient department, 318 children (59.3%) from the inpatient respiratory department (RD), and 8 children (1.5%) from the intensive care unit (ICU). Nearly 20% (105/536) were RSV positive: 3.9 percent (21/536) from the outpatient department, 15.7% (84/536) from the RD, and none from the ICU. The median total cost associated with LRTI per patient was US$52 (IQR 32–86) for outpatients and US$184 (IQR 109–287) for RD inpatients. For RSV-associated LRTIs, the median total cost per infection episode per patient was US$52 (IQR 32–85) for outpatients and US$165 (IQR 95–249) for RD inpatients. Total out-of-pocket costs of one non-ICU admission of RSV-associated LRTI ranged from 32%-70% of the monthly minimum wage per person (US$160) in Ho Chi Minh City. The sensitivity and the specificity of RSV RDA test were 88.2% (95% CI 63.6–98.5%) and 100% (95% CI 93.3–100%), respectively.ConclusionThese are the first data reporting the substantial economic burden of RSV-associated illness in young children in Vietnam. This study informs policymakers in planning health care resources and highlights the urgency of RSV disease prevention.

Electrolyte abnormalities and stress dosing predict illness-related hospitalizations among infants and toddlers with congenital adrenal hyperplasia.

Infants and toddlers with classical congenital adrenal hyperplasia (CAH) are at high risk for morbidity/mortality arising from life-threatening adrenal crisis. Management of acute illnesses in CAH requires an understanding of factors leading to emergency department (ED) visits and hospitalizations in the first few years of life. We, therefore, examined adrenal crisis at prehospital and ED stages of illness in young children with CAH as they related to medical outcomes. Retrospective cohort study of 39 children with CAH due to 21-hydroxylase deficiency (0-4 years of age) and 27 age-matched controls. ED visit, acute illness symptoms (fever, vomiting, diarrhoea) and other characteristics (hospitalizations, administration of stress-dose hydrocortisone, electrolyte abnormalities). CAH infants and toddlers had significantly higher rates of ED visits (0.50 [0.25-0.88] per person-year) than controls (0 [0-0] per person-year; p < .001). Moreover, CAH children under 6 months old had significantly higher rates of ED visits compared with older ages. Only 50% (51/102) of illness-related ED visits in CAH children were preceded by the administration of either oral (46/51) or intramuscular (11/51) stress dosing by parents. A total of 10.8% of ED visits resulted in hospital admission. Controlling for age and 17-hydroxyprogesterone at diagnosis, electrolyte abnormalities and administration of parenteral hydrocortisone in the ED significantly predicted hospital admission. Receiving a hydrocortisone injection before the ED was a significant predictor of having electrolyte abnormalities. Infants and toddlers with classical CAH are at high risk for acute illness and hospitalizations and often do not receive adequate stress dosing before the ED.

Uncovering social and environmental factors that increase the burden of climate-sensitive diarrheal infections on children.

Climate-sensitive infectious diseases are an issue of growing concern due to global warming and the related increase in the incidence of extreme weather and climate events. Diarrhea, which is strongly associated with climatic factors, remains among the leading causes of child death globally, disproportionately affecting populations in low- and middle-income countries (LMICs). We use survey data for 51 LMICs between 2000 and 2019 in combination with gridded climate data to estimate the association between precipitation shocks and reported symptoms of diarrheal illness in young children. Weaccount for differences in exposure risk by climate type and explore the modifying role of various social factors. We find that droughts are positively associated with diarrhea in the tropical savanna regions, particularly during the dry season and dry-to-wet and wet-to-dry transition seasons. In the humid subtropical regions, we find that heavy precipitation events are associated with increased risk of diarrhea during the dry season and the transition from dry-to-wet season. Our analysis of effect modifiers highlights certain social vulnerabilities that exacerbate these associations in the two climate zones and present opportunities for public health intervention. For example, we show that stool disposal practices, child feeding practices, and immunizing against the rotavirus modify the association between drought and diarrhea in the tropical savanna regions. Inthe humid subtropical regions, household's source of water and water disinfection practices modify the association between heavy precipitation and diarrhea. The evidence of effect modification varies depending on the type and duration of the precipitation shock.

Spatial resolution of virus replication: RSV and cytoplasmic inclusion bodies.

Respiratory Syncytial Virus (RSV) is a major cause of respiratory illness in young children, elderly and immunocompromised individuals worldwide representing a severe burden for health systems. The urgent development of vaccines or specific antivirals against RSV is impaired by the lack of knowledge regarding its replication mechanisms. RSV is a negative-sense single-stranded RNA (ssRNA) virus belonging to the Mononegavirales order (MNV) which includes other viruses pathogenic to humans as Rabies (RabV), Ebola (EBOV), or measles (MeV) viruses. Transcription and replication of viral genomes occur within cytoplasmatic virus-induced spherical inclusions, commonly referred as inclusion bodies (IBs). Recently IBs were shown to exhibit properties of membrane-less organelles (MLO) arising by liquid-liquid phase separation (LLPS). Compartmentalization of viral RNA synthesis steps in viral-induced MLO is indeed a common feature of MNV. Strikingly these key compartments still remain mysterious. Most of our current knowledge on IBs relies on the use of fluorescence microscopy. The ability to fluorescently label IBs in cells has been key to uncover their dynamics and nature. The generation of recombinant viruses expressing a fluorescently-labeled viral protein and the immunolabeling or the expression of viral fusion proteins known to be recruited in IBs are some of the tools used to visualize IBs in infected cells. In this chapter, microscope techniques and the most relevant studies that have shed light on RSV IBs fundamental aspects, including biogenesis, organization and dynamics are being discussed and brought to light with the investigations carried out on other MNV.

High-resolution structural analysis of enterovirus-reactive polyclonal antibodies in complex with whole virions.

Non-polio enteroviruses (NPEVs) cause serious illnesses in young children and neonates, including aseptic meningitis, encephalitis, and inflammatory muscle disease, among others. While over 100 serotypes have been described to date, vaccine only exists for EV-A71. Efforts toward rationally designed pan-NPEV vaccines would greatly benefit from structural biology methods for rapid and comprehensive evaluation of vaccine candidates and elicited antibody responses. Toward this goal, we introduced a cryo-electron-microscopy-based approach for structural analysis of virus- or vaccine-elicited polyclonal antibodies (pAbs) in complex with whole NPEV virions. We demonstrated the feasibility using coxsackievirus A21 and reconstructed five structurally distinct pAbs bound to the virus. The pAbs targeted two immunodominant epitopes, one overlapping with the receptor binding site. These results demonstrate that our method can be applied to map broad-spectrum polyclonal immune responses against intact virions and define potentially cross-reactive epitopes.

Association of heat wave exposure with increased risk of hospitalization for dehydration or heat-related illness in young children in South Korea: A Time-series study

Backgrounds Numerous studies have investigated the association between summer temperatures and increased heat related hospitalizations in the general population. However, little is known about the heat-related morbidity of heat waves in children. We aimed to evaluate the association between hospitalization for dehydration or heat-related illness in children and heat wave exposure in South Korea. Methods We used the National Health Insurance Service (NHIS) database, which provides medical records from 2015 to 2019 in South Korea. We defined daily hospitalizations for dehydration or heat-related illness of children younger than five years of age during the summer period (June to August). A heat wave was defined using a total of six criteria from a maximum temperature 28&amp;#xb0;C or higher to 33&amp;#xb0;C or higher per day. A time-series analysis was used to investigate the association between the maximum temperature and a heat wave and hospitalization for dehydration or heat-related illness of children younger than five years of age. We used a two stage design involving a meta-analysis after modeling by each city. Results We included 16,879 daily hospitalizations for dehydration or heat-related illness among children younger than five years of age during 2015 to 2019. The relative risk (RR) of hospitalization for dehydration or heat related illness was 1.023 [95% confidence interval (CI): 1.013, 1.034] per 1&amp;#xb0;C increase in the 3-day moving average maximum temperature during summer. The RR due to heat wave exposure (6 definitions: 28&amp;#xb0;C to 33&amp;#xb0;C) was ranged from 1.10 (95% CI: 1.06, 1.15) to 1.05 (95% CI: 0.98, 1.12). In the subgroup, we did not observe statistically significant gender differences. Conclusions Exposure to a heat wave during summer is associated with an increased risk of hospitalization for dehydration or heat-related illness among children younger than five years of age. Keywords: Climate change, Children, Heat wave, Time-series

Looking beyond Pertussis in Prolonged Cough Illness of Young Children.

Pertussis, commonly known as whooping cough, is one of the most poorly controlled vaccine-preventable diseases in the world. South-East Asia is estimated to contribute the most to childhood disease burden while this remains largely unexplored in India. The clinical diagnosis of pertussis in young children is a challenge as the classical four-stage presentation with paroxysmal cough or whoop may be absent. It is also difficult to differentiate from other respiratory infections which can cause pertussis-like illness. Children below two years with prolonged cough illness attending an urban pediatric center in western India, were evaluated for pertussis and viral infections by molecular methods. Bordetella pertussis and B. holmesii were confirmed in three each of 45 suspected cases, and RSV-A and hMPV were the most common viruses that were detected. These organisms can mimic mild cases of pertussis and need to be considered in differential diagnosis of prolonged cough illness in young children. The accurate etiology of prolonged cough illness needs to be detected and documented to ensure appropriate management and accurate estimates of disease burden.

Effectiveness–implementation hybrid-2 randomised trial of a collaborative Shared Care Model for Detecting Neurodevelopmental Impairments after Critical Illness in Young Children (DAISY): pilot study protocol

IntroductionIn Australia, while paediatric intensive care unit (PICU) mortality has dropped to 2.2%, one in three survivors experience long-term neurodevelopmental impairment, limiting their life-course opportunities. Unlike other high-risk paediatric populations,...

The Association Between Vitamin D and Urinary Tract Infection in Children: A Case-Control Study.

Background and objectiveUrinary tract infection (UTI) is one of the common causes of febrile illness in young children. Vitamin D influences the levels of endogenous cathelicidin, an antimicrobial peptide, which improves bladder wall immunity and prevents UTIs. In light of this, we conducted this study to determine the association between vitamin D deficiency and UTIs in children and to identify whether vitamin D deficiency is one of the risk factors for UTIs.Materials and methodsThis was a case-control study of children aged between one to five years. Eighty-two children with the first episode of febrile culture-proven UTI as cases and 82 healthy children as a control group were included in this study. The sera were analyzed for 25-hydroxy vitamin D levels and classified as vitamin-D deficient if their level was below 30 ng/mL. Descriptive statistics were presented as numbers and percentages. Continuous data were expressed as means and standard deviations (SD). Pearson's chi-square test was used to test the significance of the differences in variables between the two groups. Multiple logistic regression equation methods were used to predict the relationship between the dependent and independent variables.ResultsThe mean age of the study and the control group was 2.36 ±1.42 years and 2.57 ±1.26 years, respectively. The mean serum 25-hydroxy vitamin D levels in the patients and controls were 24.27 ±9.70 ng/mL and 31.97 ±10.7 ng/mL (p<0.001), respectively. Vitamin D deficiency was present in 34 (41.5%) patients and 10 (2.2%) in the control group (p<0.001).ConclusionBased on our findings, vitamin D deficiency might be one of the risk factors for UTIs in children. Vitamin D deficiency is significantly associated with febrile UTIs in children between one to five years of age.

Combined blockade of TNF-a and IFN-I receptors in experimental RSV infection: analysis of STAT protein modulation

Abstract Respiratory syncytial virus (RSV) is the leading cause of acute lower respiratory illness in young children. Two cytokines key to RSV pathogenesis are tumor necrosis factor (TNF)-a and type-I interferon (IFN-I). Using a dual receptor antibody blockade of IFNAR1 with either TNFR1 or TNFR2, we previously reported that IFN-I and TNF-a synergistically contribute to clinical disease while also controlling peak lung viral replication in RSV-infected Balb/c mice. The objective of the current study was to investigate the possible effect of TNF-a/IFN-I on prolonged viral shedding and to dissect canonical signaling pathways that would likely mediate the above-described activity. We found that viral titer in the lung of all treatment groups was comparable to the RSV control mice at days six and seven post-infection, indicating that lack of these cytokine receptor signaling was not involved in prolonged viral shedding. We then determined expression levels of total lung STAT1, STAT2, STAT3 and their phosphorylated forms as well as IRF1, pIRF3, IRF7, and IRF9 by western blot. Though RSV/IFNAR1, RSV/TNFR1, and RSV/TNFR2 demonstrated variations in protein expression for several of these signaling molecules, none of these proteins were uniquely modulated by the dual receptor blockade. These findings collectively demonstrate that while TNF-a/IFN-I receptor signaling controls peak viral replication in the lung, they have no effect on extended viral shedding and that STAT1, STAT2, and STAT3 signaling appears to be dispensable for the enhanced viral replication observed in the dual receptor blockade treated mice. Supported by grants from AI062885, AI25434, Clinical and Translational Science Award [(NRSA (TL1) Training Core TL1TR001440)],Supported by UTMB McLaughlin Fellowship