Post-neonatal Age Research Articles

The Robust Negative Binomial Regression Model on Under-five Mortality due to Pneumonia in the Province of East Java

Robust Negative Binomial regression model (RNBR) is a modelling method to overcome a problem if there are outliers and overdispersion in the data. Outliers are data points that are significantly different from other data. Outliers have a significant effect on modelling to the resulting model. Furthermore, overdispersion is indicated by the presence of too large values of Pearson statistics. In this study, the RNBR model was used to determine the factors of the toddler immune variable at post neonatal age that significantly influenced the number of under-five deaths caused by pneumonia in East Java Province. Based on the modelling obtained, it shows that the RNBR model provides more robust results in handling outlier and overdispersion problems. This can be seen from the AIC value of the RNBR model is smaller than the AIC of the Poisson regression model. In addition, and which are measures of the influence of outliers on the model, decreased from 1 for the Poisson regression model to around 0.42 for the RNBR model.

Estimation of the reference value of pubofemoral distance in normal infants by ultrasonography: A pilot study in Indian population

Objectives: The objectives of this study were to determine the normal values of pubofemoral distance (PFD) and its variation with age, sex, and laterality of hip in infants in the Indian population. Material and Methods: The PFD was measured in 141 infants falling under Grafs categories I, IIa, and IIb (Males: 77 and Females: 64) divided into two groups comprising the neonatal group (<1 month) and postneonatal group (>1–12 months). PFD measurement and Grafs’ method of alpha- and beta-angle measurement were both performed at the same time by doing an ultrasound of the hip. Probe was placed in the coronal plane in lateral decubitus with the flexed position in a neutral position. PFD was measured between the superior pubic rami and femoral head epiphyses. Results: The average PFD in 141 infants (282 hips) was 3.23 ± 0.83 mm. It was 3.15 ± 0.79 mm in the neonatal group (88 patients) and 3.47 ± 0.84 mm in the postneonatal group (53 patients). In males, the average PFD was 3.29 ± 0.85 mm, and in females, it was 3.23 ± 0.81 mm. No significant difference was observed in the average PFD among the two sexes and between the left and right hips of both neonatal and postneonatal groups. Conclusion: The study demonstrates reference PFD values in infants aged 0–12 months in neonatal and postneonatal age groups. Mean PFD values were not significantly influenced by the laterality or sex of the patient in both groups, however, increased with age. Further studies need to be done however to find its values in the cases with developmental dysplasia of the hip to determine the cutoff in such cases.

Temporal trend, spatial analysis and spatiotemporal clusters of infant mortality associated with congenital toxoplasmosis in Brazil: Time series from 2000 to 2020.

To analyse the spatial, temporal and spatial-temporal patterns of infant mortality associated with congenital toxoplasmosis in Brazil between the years 2000 and 2020. Ecological study of time series, with spatial analysis and spatiotemporal scan of infant mortality associated with congenital toxoplasmosis from the records of deaths of the Mortality Information System of the Brazilian Ministry of Health. The rates were smoothed by the Local Empirical Bayesian model. The Global Moran Index, Global Geary's Contiguity and Getis-Ord General statistics were calculated for spatial autocorrelation assessment. The trends were evaluated by the Joinpoint method. We identified 1183 infant deaths associated with congenital toxoplasmosis in Brazil between 2000 and 2020. The predominant characteristics were male sex (52.1%), post-neonatal age group (51.9%), white race/colour (45.7%), and Southeast region of residence (40.0%). The infant mortality rate associated with congenital toxoplasmosis showed an increasing trend in the country in the years analysed. The spatial analysis showed heterogeneous distribution of mortality in the Brazilian territory and found no evidence of spatial autocorrelation; but spatial-temporal analysis identified three risk clusters involving 703 municipalities. Infant mortality associated with congenital toxoplasmosis is a persistent public health problem in Brazil. The risk factors male sex, indigenous race/colour, early neonatal age, North and Northeast regions and risk clusters mapped in this study should be observed for future analysis and planning of health care policies in the control of infant deaths associated with congenital toxoplasmosis. Health surveillance strategies and public health policies need to be strengthened.

Neonatal versus postneonatal presentation of intestinal malrotation: A retrospective cross-sectional study in a tertiary care hospital at Hyderabad, India

Background: Malrotation commonly presents in neonates with bilious vomiting. It may also present in post neonatal age group with vague symptoms such as chronic abdominal pain, vomiting, and failure to thrive. These indistinct symptoms also result in delay of diagnosis. Aims and Objectives: This study is done with an objective to know whether age of presentation in malrotation determines morbidity and mortality. Materials and Methods: This is a retrospective study conducted in Gandhi medical college and Hospital, Hyderabad, from 2017 to 2020, based on the records of 50 patients who were diagnosed to have malrotation. The differences in clinical presentations, diagnosis, management, and outcomes were analyzed with respect to age. Results: Children who presented in neonatal period had classical symptoms (P<0.00001) and early diagnosis (P<0.0239). Children who presented later (>1 month of age) had higher incidence of atypical symptoms (P<0.00001) and delay in diagnosis (P<0.0239) compared to neonatal age group. Plain X-ray abdomen is readily diagnostic in neonatal age group (P<0.0004) and diagnosis was confirmed by contrast study, whereas in older children, plain abdomen X-ray findings were not always distinct and most of them needed contrast series to reach definitive diagnosis. The incidence of bowel gangrene and mortality was not statistically significant (P value of 1) between neonatal and post neonatal groups. Conclusion: In post neonatal age group, lack of classical presentation may lead to difficulty in diagnosing malrotation, but may not have significant difference in terms of morbidity and mortality. Considering malrotation early in differential diagnosis leads to timely intervention even in older age group children.

Patterns of infant dermatoses: An observational study from the dermatology outpatient clinic of a tertiary referral center

Objectives: To study the pattern of dermatoses among infants who attended the dermatology outpatient clinic of a tertiary referral center. Materials and Methods: We included 270 consecutive infants (children aged 1 year and below) with dermatoses who attended the outpatient clinic of the department of dermatology of our tertiary referral center. Using a preset proforma, we collected information on patient profile, evolution of dermatosis, and clinical features. The dermatoses observed were classified as transient and non-infective conditions, nevi and other developmental defects, genodermatoses, infections and infestations, inflammatory dermatoses, reactive dermatoses, and other miscellaneous conditions. Results: The study participants included 162 males (60%) and 108 females (40%). Fifty-three infants (53/270, 19.6%) were neonates. The most common dermatoses observed among the study participants were infections and infestations (86, 31.9%) followed by inflammatory dermatoses (83, 30.7%). Among the neonates, the common dermatoses observed were napkin dermatitis (14/53, 26.4%), transient neonatal pustular melanosis (6/53, 11.3%), and congenital melanocytic nevus (6/53, 11.3%). The common dermatoses observed among infants above 28 days were fungal infections (32/217, 14.7%), atopic dermatitis (23/217, 10.6%), miliaria (22/217, 10.1%) and infantile seborrheic dermatitis (21/217, 9.7%). Limitations: The study carried out in the outpatient clinic of the dermatology department of a tertiary referral center and the cross-sectional design were the major limitations. Conclusion: Fungal infection was the most frequently observed infection. Whether, this indicates an epidemiological shift in the prevalence of dermatophytosis in pediatric age group needs analysis in future multicenter studies. Napkin dermatitis and atopic dermatitis were the most common non-infective dermatoses in the neonatal and post-neonatal age groups, respectively.

Respiratory Syncytial Virus-Associated Mortality Among Young Infants in Karachi, Pakistan: A Prospective Postmortem Surveillance Study.

BackgroundRespiratory syncytial virus (RSV) is an important cause of infant morbidity and mortality and a potential target for maternal immunization strategies. However, data on the role of RSV in young infant deaths in developing countries are limited.MethodsWe conducted a community-based mortality surveillance from August 2018–March 2020 for infants ≤6 months in Karachi, Pakistan. We tested (reverse transcription–polymerase chain reaction) nasopharyngeal swabs from deceased infants for presence of RSV. We performed verbal autopsies and calculated odds of RSV-associated mortality with 95% CIs and used multivariable logistic regression to evaluate associations.ResultsWe collected 490 nasopharyngeal specimens from 1280 eligible infant deaths. There were 377/490 (76.9%) live births and 14/377 (3.7%; 95% CI: 1.8–5.6) were RSV positive. Most deaths occurred in neonates (254/377; 67.4%), males (226/377; 59.9%), and respiratory illnesses (206/377; 54.6%). Postneonatal age (10/14, 71.4%; OR: 5.5; 95% CI: 1.7–18.0), respiratory symptoms (12/14, 85.7%; OR: 5.2; 1.2–23.7), and high RSV season (9/14, 64.3%; OR: 4.4; 1.4–13.3) were associated with RSV mortality. In multivariable logistic regression analysis, respiratory symptoms (OR: 6.6; 95% CI: 1.3–32.5), RSV seasonality (6.1; 1.8–20.4), and age (9.2; 2.6–33.1) were significant predictors of RSV-associated mortality.ConclusionsRSV has a significant mortality burden in early infancy in Karachi, Pakistan. Age, RSV seasonality, and respiratory symptoms were significant predictors of RSV-associated mortality. Our findings have implications for clinical management of young infants with cold-like symptoms, policy development, and research regarding maternal immunization against RSV during pregnancy, in resource-constrained, low-income, and vaccine-hesitant populations.

Evaluation of Oxygenation Index Compared With Oxygen Saturation Index Among Neonates Admitted to the NICU

Oxygenation index (OI) based on arterial blood gas (ABG) test is an invasive procedure and requires indwelling arterial lines. However, the oxygen saturation index (OSI) assessed by the pulse oximetry method is simple and noninvasive for monitoring oxygenation saturation in newborn neonates with chronic lung disease. This study aimed to evaluate and compare OI and OSI among neonates in NICU who underwent mechanical ventilation. A cross-sectional study was carried out among fifty neonates (term and preterm) who were admitted to the NICU of Abuzar Hospital in Ahvaz, Iran. All neonates were examined by both ABG and pulse oximetry methods. Approximately 2 cc of arterial blood sample was taken and sent to the laboratory to determine blood gases. At the same time, the level of peripheral capillary oxygen saturation (SpO) was recorded using a pulse oximeter. OI and OSI were calculated according to their formula. Spearman’s correlation, linear regression, and Bland-Altman scatter plot were used to determine the correlation, association, and agreement between OI and OSI, respectively. Of the total 50 neonates, 26 were female. The mean (range) gestational age was 35.28±3.01 (28-39) weeks, and post-neonatal age was 6.05±7.04 (1-25) weeks. There was a linear and significant association and correlation between OI and oxygen OSI (P<0.001), while the Bland-Altman scatter plot confirmed the agreement between them in mean values. Therefore, OSI utilizing pulse oximetry as a noninvasive method can be a substitute for OI in neonates with respiratory failure. It can also reduce workloads and costs.

Determinants of neonatal, post-neonatal and child mortality in Afghanistan using frailty models

Afghanistan has one of the highest under-five mortality rates in South Asia, 70.4 per 1000 live births. Determinants need to be identified to reduce this rate. Knowledge of the existence of familial and community frailty will also assist in the reduction of under-five mortality. The 2015 Afghanistan Demographic Health Survey, including 32,712 live births, was analysed. Under-five mortality was disaggregated into neonatal, post-neonatal and child mortality and piecewise traditional Cox proportional hazard, variance-corrected and frailty models were developed. All the models identified determinants and the two frailty models examined the existence of familial and community frailty for each age group. There was statistically significant evidence of community frailty. Breastfeeding status was a highly significant determinant under univariable and multivariable analysis for neonatal and post-neonatal mortality. Post-neonates of employed mothers also experienced increased mortality, particularly those whose mother worked in agriculture where the hazard ratio was 2.77 (95% CI 2.10, 3.65). Birth order 5+ was associated with increased mortality for all three age groups. The Afghanistan Ministry of Public Health should identify frail communities. Support, such as daycare facilities, should be provided and early initiation of breastfeeding and breastfeeding throughout the post-neonatal period should also be encouraged. The study identified determinants of neonatal, post-neonatal and child mortality. The study also established the presence of community frailty with respect to under-five mortality in Afghanistan. The study shows that the association of not breastfeeding and mortality is more acute in the early neonatal age group and it extends into the post-neonatal age group. The study identified the association of high birth order and mortality in the neonatal, post-neonatal and child age groups in Afghanistan. Policies should be implemented that encourage early initiation of breastfeeding to continue throughout the post-neonatal period and support for vulnerable families should be provided.

Вроджена діафрагмальна кила: клінічні випадки в дітей позанеонатального віку

Congenital diaphragmatic hernia is a defect of diaphragm development which in the majority of cases is associated with penetration of the abdominal organs into the chest. Purpose is to draw attention of pediatricians, general practitioners and family doctors, pediatric surgeons to the issue of timely diagnostics of congenital diaphragmatic hernia since its clinical signs are manifested in patients of a post-neonatal age. Clinical cases. The first review demonstrates a clinical case of a right false congenital diaphragmatic hernia of 6-month child with acute onset of the disease manifested by combination of respiratory disorders and pathological intestinal symptoms, visualization of intestinal loops in the right side of the chest. The second clinical case describes left false congenital diaphragmatic hernia of a 10-month child with subacute onset of the disease, prevailing pathological respiratory symptoms and visualization of the stomach in the left side of the chest. Due to timely diagnostic examination and surgery performed both patients were discharged home in a satisfactory condition. Conclusions. In spite of more favourable course of congenital diaphragmatic hernia in children older than 1 month of age, its development can be of a fulminant character and associated with danger for life. It stipulates the necessity to carry out an appropriate differential-diagnostic complex for all the infants with acute or chronic respiratory disorders and pathological intestinal symptoms including a competent interpretation of the results obtained after plan and contrast radiography of the thoracic and abdominal organs. The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: congenital diaphragmatic hernia; Infancy.

Global patterns in vision loss burden due to vitamin A deficiency from 1990 to 2017.

To investigate the vision loss burden due to vitamin A deficiency (VAD) at the global, regional and national levels by year, age, sex and socio-economic status using prevalence and years lived with disability (YLD). International, retrospective, comparative burden-of-disease study. Prevalence and YLD data were extracted from the Global Burden of Disease (GBD) Study 2017. The association of age-standardised YLD rates and human development index (HDI) was tested by Pearson correlation and linear regression analyses. The Gini coefficient and concentration index (CI) were calculated to demonstrate the trends in between-country inequality in vision loss burden due to VAD. All participants met the GBD inclusion criteria. The age-standardised prevalence rate increased by 9·2 %, while the age-standardised YLD rates rose by 10·8 % from 1990 to 2017. Notably, the vision loss burden caused by VAD showed a declining trend since 2014. The vision loss burden was more concentrated in the post-neonatal age group and decreased with increasing age. The age-standardised YLD rates were inversely correlated with HDI (r = -0·2417, P = 0·0084). The CI and Gini coefficients indicated that socio-economic-related and between-country inequality declined from 2000 to 2017. VAD was the eighth leading cause of the age-standardised prevalence rate and ninth leading cause of age-standardised YLD rate among fifteen causes of vision loss in 2017. VAD has become one of the significant leading causes of vision loss globally. Efforts to control vision impairment related to VAD are needed, especially for children in countries with lower socio-economic status.

Spatio-temporal assessment of ambient air quality, their health effects and improvement during COVID-19 lockdown in one of the most polluted cities of India.

The present work aims to investigate seasonal variations in air pollution levels in Lucknow and assess the ambient air quality of the city together with highlighting the health impacts of major pollutants like PM10, PM2.5, SO2, NO2, Pb, Ni and aerosols from 2010 to 2019. The maximum and minimum values of PM10, PM2.5, SO2, NO2, Pb and Ni were found to be 270.75 and 122.45 μg/m3, 124.95 and 95.52 μg/m3, 25.60 and 8.05 μg/m3, 75.65 and 23.85 μg/m3, 0.66 and 0.03 μg/m3 and 0.07 and 0.01 ng/m3, respectively. Health impact of particulate matter has also been assessed with AirQ+, and it was estimated that long-term exposure of PM10 was attributed to between 37 and 48% for post-neonatal (age 1–12 months) mortality rate due to all causes, whereas long-term attributable proportions in mortality due to exposure of PM2.5 were to about 19 to 28% from all causes. Further, an attempt has also been made to evaluate the impact of lockdown amid COVID-19 on the ambient air quality of Lucknow. During the lockdown, PM2.5 levels reduced by 65% (at Gomti Nagar), 23% (at central school), 79% (at Lalbagh) and 35% (at Talkatora), due to which, air quality index of Gomti Nagar came down to 43, well below 50 which falls in the healthy range. NO2 levels also came down. However, levels of SO2 did not show significant reduction. Correlating the data between aerosol optical depth and Angstrom exponent by Pearson correlation analysis revealed a significant positive correlation (r = 0.65, P < 0.001).

Prevalence ESBL Producing Escherichia Coli among Children in Indonesia

Introduction: Beta-lactam antimicrobials are the most often antibiotic used for the treatment of infections worldwide, including Indonesia. Continuous exposure of these antimicrobials will induce the increasing of antimicrobial resistance, such as extended spectrum ?-lactamase (ESBL). The carrier of ESBL among people will be serve as a risk factor to get an infection, especially among low immune response hospitalized patients. The aims of this study was to explore the ESBL producing gut flora and carrier rate among children visiting Primary Health Center (PHC) in Surabaya. The cross sectional study was conducted in three PHCs since February 2019 until April 2019. The total 200 children were swabbed from rectal, 100 from neonatal age and 100 from post neonatal age, then sub-cultured in MacConkey medium supplemented with cefotaxime 2 micrograms per milliliter. The growth colonies were then confirmed by DDST (Double Disk Synergy test) for ESBL producer and biochemical test for bacterial diagnosis. Result: Among 100 neonatal age were identified 14 (14%) producing ESBL consist of 9 (64,3%) ESBL producing Escherichia coli,5 (35,7%) ESBL producing non Escherichia coli. Whether among 100 post neonatal age were 37 (37%) producing ESBL consist of 25 (67,6%) ESBL producing Escherichia coli and 12 (32,4%) producing ESBL non Escherichia coli. Conclusion: Prevalence ESBL producing Escherichia coli on post neonatal age was significantly different than neonatal age (p = 0,001). Risk Factors of ESBL producing Escherichia coli on Post neonatal age and neonatal age are history of visiting hospital (p = 0,026), history of antibiotics used by mother (p = 0,043), mode of delivery (p = 0,032)

Indications for blood and blood products transfusions among children in a semi-urban tertiary hospital in Nigeria

Background: Anaemia is prevalent among children in our environment, often necessitating blood transfusions. The knowledge of the common indications for blood transfusion and the required preventive measures is likely to reduce the transfusion rates. Objective: To determine the disease conditions requiring blood transfusion in post-neonatal age children at the Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria. Methods: The hospital records of all children aged 1 month to 18 years admitted into the post-neonatal ward who received blood transfusions over 18 months (1st July 2015to­31st December 2016) were reviewed. Results: There were 710 paediatric admissions out of which 82 (11.6%) received blood transfusions. Ninety transfusions were carried out amongst 82 children, at a ratio of 1.1 transfusions per child. Severe malaria (28.1%), sickle cell anaemia (19.5%) and septicaemia (18.3) were the most common disease conditions requiring blood transfusions. The leading blood products transfused included packed red cells (64.5%) and whole blood (30.0%). Conclusion: Blood transfusion is frequently indicated in the paediatric population in our setting, largely due to severe malaria and sickle cell anaemia problems. Intensifying efforts on the use of long-lasting insecticide-treated nets and environmental control may reduce the prevalence of severe malaria, while improved nutrition, adequate hydration, regular malaria prophylaxis, prompt treatment of infections and regular use of haematinics may minimize the need for blood transfusions among children with sickle cell anaemia.

The Etiology of Neonatal Intensive Care Unit Death in Extremely Low Birth Weight Infants: A Multicenter Survey in China.

The aim of this study is to identify causes of neonatal intensive care unit (NICU) death in extremely low birth weight (ELBW) infants less than 1,000 g admitted in Chinese tertiary NICUs. We retrospectively collected data on 607 ELBW infants from 39 level III NICUs from July 2016 to June 2019. The primary causes of death were compared among different gestation age, postnatal age groups, and areas with variable economic status. Among all 607 ELBW NICU deaths, 47.1% were multiple gestation with high rate of in vitro fertilization (IVF) (43.3%); 53.4 and 34.1% received any or full course of antenatal corticosteroid (ACS). The most common causes of ELBW NICU death were respiratory distress syndrome-related neonatal respiratory failure (RDS-NRF, 43.5%), severe infection (19.1%), necrotizing enterocolitis or bowel perforation (9.4%), severe central nervous system injury (8.4%), and bronchopulmonary dysplasia-related respiratory failure (BPD-NRF, 7.7%). Causes of ELBW NICU death varied across postnatal age groups. RDS-NRF was the leading cause of early neonatal death, while severe infection in late neonatal death and BPD in postneonatal EBLW NICU death. RDS-NRF, severe brain injury, and asphyxia were most likely to die at early neonatal age (median age [interquartile range], 2 [0-5], 6 [3-9], and 3 [1-6] days, respectively) while severe infection and necrotizing enterocolitis (NEC) at late neonatal age, BPD-NRF at postneonatal age. In Chinese tertiary NICUs, the major causes of death in extremely low birth weight infants were RDS, infection, NEC, brain injury and BPD, and they varied with postnatal age. Developing specific prevention strategies for identified causes of death in ELBW NICU may potentially improve ELBW survival.

Association between ethnicity and under-5 mortality: analysis of data from demographic surveys from 36 low-income and middle-income countries

SummaryBackgroundThe UN Sustainable Development Goals (SDGs) call for stratification of social indicators by ethnic groups; however, no recent multicountry analyses on ethnicity and child survival have been done in low-income and middle-income countries (LMICs).MethodsWe used data from Demographic and Health Surveys and Multiple Indicator Cluster Surveys collected between 2010 and 2016, from LMICs that provided birth histories and information on ethnicity or a proxy variable. We calculated neonatal (age 0–27 days), post-neonatal (age 28–364 days), child (age 1–4 years), and under-5 mortality rates (U5MRs) for each ethnic group within each country. We assessed differences in mortality between ethnic groups using a likelihood ratio test, Theil's index, and between-group variance. We used multivariable analyses of U5MR by ethnicity to adjust for household wealth, maternal education, and urban–rural residence.FindingsWe included data from 36 LMICs, which included 2 812 381 livebirths among 415 ethnic groups. In 25 countries, significant differences in U5MR by ethnic group were identified (all p<0·05 likelihood ratio test). In these countries, the median mortality ratio between the ethnic groups with the highest and lowest U5MRs was 3·3 (IQR 2·1–5·2; range 1·5–8·5), whereas among the remaining 11 countries, the median U5MR ratio was 1·9 (IQR 1·7–2·5; range 1·4–10·0). Ethnic gaps were wider for child mortality than for neonatal or post-neonatal mortality. In nearly all countries, adjustment for wealth, education, and place of residence did not affect ethnic gaps in mortality, with the exception of Guatemala, India, Laos, and Nigeria. The largest ethnic group did not have the lowest U5MR in any of the countries studied.InterpretationSignificant ethnic disparities in child survival were identified in more than two-thirds of the countries studied. Regular analyses of ethnic disparities are essential for monitoring trends, targeting, and assessing the impact of health interventions. Such analyses will contribute to the effort towards leaving no one behind, which is at the centre of the SDGs.FundingBill & Melinda Gates Foundation, UNICEF, Wellcome Trust, Associação Brasileira de Saúde Coletiva.

Primary Health Care-Sensitive Hospitalizations in children under one year of age, from 2008 to 2014, in the State of São Paulo, Brazil

The scope of this article is to describe the trends of primary health care-sensitive (PHC) hospitalizations in children under one year of age between 2008 and 2014 in the State of São Paulo, Brazil. It is an ecological study with descriptive and analytical characteristics, based on secondary data from the national health information system. Hospitalizations were classified according to the Brazilian list of PHC hospitalizations considering the Early Neonatal, Late Neonatal and Post-Neonatal age groups. Linear regression models were adjusted for trend analysis of the 851,713 hospitalizations of children under one year of age analyzed, of which 22.6% were PHC-related. The main groups with decreases were: Bacterial pneumonia (-7.10%) and Nutritional disorders (-7.70%) in the Early neonatal phase. The main increases were: Disease related to prenatal/childbirth (+10.14%) and Immunosuppressive diseases and avoidable conditions in Post-neonatal (+14.13%) infants, among which pertussis and congenital syphilis were the main causes of hospitalization. The results showed a deficiency in the primary health care system for infants in the State of Sao Paulo. The estimated trends should be used for planning cost-effective strategies to prevent and control causes of hospitalization in children under one year of age.

Prognostic factors and outcome of Post-Neonatal Tetanus in an intensive care unit of a Tertiary Care Hospital.

Objective:To determine the prognostic factors and outcome of tetanus in children of post-neonatal age admitted in the intensive care unit (ICU) of a tertiary care hospital.Methods:This prospective cross sectional study, carried out in the Pediatric ICU of The Children’s Hospital Lahore from Jan 2013 to March 2017. Children of both genders with age range of two months to 16 years diagnosed clinically as tetanus were included. All 132 patients were scrutinized for all possible risk factors, need for mechanical ventilation and outcome. Data was analyzed by SPSS version 20.Results:Mean age of children was 7.5±3.4 years with male predominance (70.5%). Only (38.6%) received three doses of vaccination but none had booster dose. Trauma (43.2%) encompassed maximum predisposing factor followed by ear or nose prick and ear discharge. Mean duration of ICU stay was 20±13.3 days. Mortality rate was (17.4%). Ventilator support was given to (78.8%). Neurological outcome was normal in (82.6%). Trauma, ear or nose prick in girls and ear discharge were significantly associated with poor outcome and death with p-value of <0.001, 0.011 and <0.001 respectively. Other factors associated with poor outcome were need for mechanical ventilation and neurological impairment with p-value of 0.001 and <0.001 respectively.Conclusion:Tetanus is causing our children to suffer from devastating disease. Vaccination status is not satisfactory and along with trauma, ear discharge and ear or nose prick are identifiable risk factors. To combat these issues large scale vaccination and booster doses remains promising option.

Bacterial Infections of the CentralNervous System.

Bacterial infections of the central nervous system (CNS) continue to be an important cause of morbidity and mortality in children. The spectrum of bacterial infection of CNS includes; focal or multifocal infections like brain abscesses or subdural empyema; or more generalized or diffuse infections like pyogenic meningitis or ventriculitis. Focal and generalized infections may co-exist in an individual patient. Prompt and adequate antibiotic therapy and occasionally neurosurgical interventions are the cornerstone of effective management. The recent emergence of several multidrug-resistant bacteria poses a threat to the effective management of bacterial CNS infections. Several adjunctive anti-inflammatory and neuroprotective therapies are being tried, however; none has made a remarkable impact on the outcome. Consequently, bacterial CNS infections in children still remain a challenge to manage. In this review, authors discuss the current updates on the diagnostic and therapeutic aspects of bacterial infections of the CNS in children (post-neonatal age group).

Zgony niemowląt i noworodków w latach 1995-2015 w Polsce.

AimThe aim of the study was the analysis of trends of infant and neonatal mortality in Poland in 1995-2015, overall and by gestational age, main groups of causes and age at death.Material and methodsData from birth and death certificates from 1995, 2000, 2005, 2010, 2014 and 2015 were used. Infant, neonatal, postneonatal, perinatal and gestational age – specific mortality rates were presented. Main groups of causes of deaths were determined according to the International Classification of Diseases ICD-10.ResultsIn Poland, in 1995-2015 infant mortality decreased more than three-fold, similarly to neonatal and postneonatal mortality. Early neonatal mortality decreased almost four-fold, stillbirths rate - twofold and perinatal mortality - almost three-fold. The progress, to the greatest extend was related to preterm births. Infant mortality in this group decreased from 128.5 per 1000 preterm live births in 1995 to 36.8 in 2015. The main causes of all infant deaths are perinatal conditions and congenital anomalies.ConclusionsThe decrease of infant and neonatal mortality has been continued in the last twenty years and affected mainly preterm births born from the shorter and shorter gestations, what implicates growing demand for long lasting health care and rehabilitation. Deaths of infants and neonates born at term and not related to congenital anomalies are relatively rare and need individual assessment.

Nephron, Wilms' tumor-1 (WT1), and synaptopodin expression in developing podocytes of mice.

Newborn mouse glomeruli are still immature with a morphological feature of an early capillary loop stage, but infant mice do not manifest proteinuria. Little is known about the molecular mechanism whereby infant mice are resistant to proteinuria. Nephrin and synaptopodin are crucial for slit diaphragm and foot process (FP) formation for avoiding proteinuria. Nephrin tyrosine phosphorylation means a transient biological signaling required for FP repair or extension during nephrotic disease. Using an immunohistochemical technique, we examined the natural course of nephrin, Wilms’ tumor-1 (WT1) and synaptopodin at 16.5 days of embryonic age (E16.5d) and E19.5d, 7 days of post-neonatal age (P7d) and P42d during renal development of mice. As a result, nephrin and synaptopodin were detected at E19.5d in S-shaped bodies. WT1, a transcriptional factor for nephrin, was detected in nucleus in podocyte-like cells in all stages. Nephrin tyrosine phosphorylation was evident in glomeruli at P7d, and this was associated with an early-stage of FP extension. Inversely, nephrin phosphorylation became faint at P42d, along with maturated FP. Based on the present results, we suggest the sequential molecular mechanism to protect growing mice from proteinuria: (i) WT1-induced nephrin production by podocytes in S-shaped bodies at E19.5d; (ii) Synchronized induction of synaptopodin at the same period; and (iii) FP extension is initiated at a milk-suckling stage under a nephrin tyrosine-phosphorylated condition, while it is arrested at an adult stage, associated with a loss of nephrin-based signaling.