Risk Of Infection In Children Research Articles

Children and COVID19: Understanding impact on the growth trajectory of an evolving generation.

The COVID19 pandemic has forced the world to be closed in a shell. It has affected large population worldwide, but studies regarding its effect on children very limited. The majority of the children, who may not be able to grasp the entire emergency, are at a bigger risk with other problems lurking behind the attack of SARS-CoV-2 virus. The risk of infection in children was 1.3%, 1.5%, and 1.7% of total confirmed COVID-19 cases in China, Italy and United States respectively which is less compared to 2003 epidemic of severe acute respiratory syndrome (SARS), when 5–7% of the positive cases were children, with no deaths reported while another recent multinational multicentric study from Europe which included 582 PCR (polymerase chain reaction) confirmed children of 0–18 year of age, provide deeper and generalize incite about clinical effects of COVID19 infection in children. According to this study 25% children have some pre-existing illness and 8% required ICU (intensive care unit) admission with 0.69% case fatality among all infected children. Common risk factor for serious illness as per this study are younger age, male sex and pre-existing underlying chronic medical condition. However, we need to be more concerned about possible implications of indirect and parallel psychosocial and mental health damage due to closure of schools, being in confinement and lack of peer interaction due to COVID19 related lockdown and other containment measures. The effects can range from mood swings, depression, anxiety symptoms to Post Traumatic Stress Disorder, while no meaningful impact on COVID19 related mortality reduction is evident with school closure measures. The objective of this paper is to look at both the positive & negative effects in children due to COVID19 related indirect effects following lockdown and other containment measures. There is a need to gear up in advance with psychological strategies to deal with it post the pandemic by involving all stakeholders (parents, teachers, paediatricians, psychologists, psychiatrists, psychiatric social workers, counsellors), proposing an integrated approach to help the children to overcome the pandemic aftermath.

NUTRITIONAL STATUS AND ITS DETERMINANTS OF CHILDREN WITH ACUTE LYMOPHOCYTIC LEUKEMIA ATTENDING THE OUTPATIENT CLINIC, SMOUHA ALEXANDRIA UNIVERSITY CHILDREN'S HOSPITAL

Acute lymphoblastic leukemia (ALL) is the most common pediatric malignancy, representing 75%–80% of acute leukemias among children. ALL children are at increased risk for malnutrition mostly due to the treatment related adverse events. This fact is often ignored during their management. Malnutrition may vacillate between weight loss and excessive weight gain. The goal of nutritional assessment in children with cancer is to assess the nutritional needs, to provide the optimal nutrition, to prevent or treat nutritional disorders and the increased morbidity and mortality that accompany them. Nutrition is a supportive care modality that can improve tolerance to chemotherapy, survival, increased quality of life, and decreased risk of infection in children undergoing anticancer therapy.Aim of the work Assessment of nutritional status of children with ALL attending the Pediatric Hematology Oncology Unit (PHOU), Smouha Hospital for Pediatric Medicine and Surgery, to give a basis for providing patients with nutritional intervention .

First evidence for continuous circulation of hepatitis A virus subgenotype IIA in Central Africa.

Although a high seroprevalence of antibodies against hepatitis A virus (HAV) has been estimated in Central Africa, the current status of both HAV infections and seroprevalence of anti‐HAV antibodies remains unclear due to a paucity of surveillance data available. We conducted a serological survey during 2015‐2017 in Gabon, Central Africa, and confirmed a high seroprevalence of anti‐HAV antibodies in all age groups. To identify the currently circulating HAV strains and to reveal the epidemiological and genetic characteristics of the virus, we conducted molecular surveillance in a total of 1007 patients presenting febrile illness. Through HAV detection and sequencing, we identified subgenotype IIA (HAV‐IIA) infections in the country throughout the year. A significant prevalence trend emerged in the young child population, presenting several infection peaks which appeared to be unrelated to dry or rainy seasons. Whole‐genome sequencing and phylogenetic analyses revealed local HAV‐IIA evolutionary events in Central Africa, indicating the circulation of HAV‐IIA strains of a region‐specific lineage. Recombination analysis of complete genome sequences revealed potential recombination events in Gabonese HAV strains. Interestingly, Gabonese HAV‐IIA possibly acquired the 5’‐untranslated region (5’‐UTR) of the rare subgenotype HAV‐IIB in recent years, suggesting the present existence of HAV‐IIB in Central Africa. These findings indicate a currently stable HAV‐IIA circulation in Gabon, with a high risk of infections in children aged under 5 years. Our findings will enhance the understanding of the current status of HAV infections in Central Africa and provide new insight into the molecular epidemiology and evolution of HAV genotype II.

Serious infection risk in children with psoriasis on systemic treatment: A propensity score-matched population-based study

Psoriasis is increasingly treated with systemic medications, yet their safety is not well characterized in children. We sought to estimate the 6-month risk of serious infections in children with psoriasis treated with biologics, systemic nonbiologics, and phototherapy. Using insurance claims data, we identified children aged <18years with psoriasis and compared the frequency of serious infections in those initiating biologics, systemic nonbiologics, and phototherapy. Relative risks were estimated before and after 1:1 propensity score matching. Among 57,323 children with psoriasis, the 6-month risk of infection was 4.2 per 1000 patient-years in 722 biologic initiators, 5.1 in 988 systemic nonbiologic initiators, and 1.1 in 2657 phototherapy initiators. The relative risk (95% confidence interval) of infection in biologics vs nonbiologics was 0.67 (0.11-3.98), in biologics vs phototherapy was 1.50 (0.25-8.95), and in nonbiologics vs phototherapy was 5.00 (0.59-42.71). The background risk of infection in children with psoriasis was 1 per 1000, almost double the risk compared with children without psoriasis (relative risk, 1.84; 95% confidence interval, 1.15-1.97). We found no meaningful difference in infection risk between biologics vs nonbiologics and no robust difference between systemic users vs phototherapy. Independent of treatment, children withpsoriasis had a higher risk of infection than those without psoriasis.

A 2-month intervention study of preventive clothing against mosquito bites among malnourished and well-nourished children under 5\xa0years of age living on the Atlantic Ocean Coast of Lagos, Southwest Nigeria

BackgroundMalnutrition is appreciated as a global leading paediatric burden that indirectly or directly contributes to child mortality. In children, malnutrition has profound effects on health and development; and has been associated with poor outcomes in paediatric diseases. However, it is not clear if malnourished children are at an increased risk of having malaria. This study was conducted to evaluate the risk of malaria infection in children with malnutrition.MethodsThe study design was pre-post. A protective clothing against mosquitoes (pCAM) was given to 102 under-five children in two coastal communities, after screening for malaria parasitaemia. The children’s weight, height and body temperature were measured at recruitment. Blood was also taken at recruitment and monthly for malaria parasitaemia, haemoglobin concentration and random blood sugar. The parents/care-givers were visited daily for 1 month only, after recruitment, to ensure that the children wore the pCAM daily from 5 pm and the children were followed up monthly for 2 months.ResultsOf the 102 study participants, 60 (24 males and 36 females) were rapid diagnostic test (RDT)-positive at recruitment, indicating 58.8% prevalence of malaria parasitaemia. The prevalence of malnutrition and of stunting were 32.3% (33/102) and 54.9% (56/102), respectively, while 7.8% (8/108) children were wasted. Twenty (60.6%) of the malnourished children and 30 (53.6%) of those stunted were RDT-positive at recruitment. At the first post-intervention screening, only 7 (31.8%) of the malnourished and 13 (28.9%) of those stunted were RDT-positive. Malnourished and stunted children were 2.57 times and 2.31 times more likely to be malaria infected (OR = 2.57, 95% CI 0.97, 6.79; OR = 2.31, 95% CI 1.01, 5.26 respectively). Malnourished females were 2.72 times more likely to be RDT-positive compared to malnourished males (OR = 2.72, 95% CI 0.54, 11.61) and stunted females were 1.73 times more likely to the positive for malaria parasites than stunted males (OR 1.73, 95% CI 0.59, 5.03). The prevalence of anaemia at recruitment decreased from 82.4 to 69.6% after intervention. The mean haemoglobin concentration (g/dl) at recruitment was significantly lower (P < 0.05) than that at 1st and 2nd post-intervention measurements (9.6 ± 1.4, t = − 3.17, P-value = 0.0009 and 10.2 ± 1.3, t = − 2.64, P-value = 0.004, respectively). Mean random blood sugar (mg/dl) of females (91.8 ± 12.7) was significantly lower (t = 2.83, P-value = 0.003) than that of males (98.5 ± 11.2).ConclusionResults from this study suggest a higher risk of malaria infection among malnourished and lower risks among stunted and wasted children. Females were at a higher risk of malnutrition, stunting and wasting than males. Protective clothing against malaria seemed to reduce malaria infection and improve anaemia status.

Prevalence Maps and Climate-Based Risk Map of Toxocariasis in Iran

: This study aimed to design the prevalence maps of toxocariasis in different provinces of Iran. Moreover, the effects of three climatic parameters were explored on Toxocara egg maturation in various provinces using geographical information system (GIS). A review was conducted to examine the studies of the prevalence of human and animal toxocariasis and the contamination of public places with Toxocara eggs. Climatic data were converted into raster layers in ArcGIS 10.3 software and subjected to spatial analysis. A climate-based risk map was drawn for the whole country. Iran was classified into four different classes. Golestan, Mazandaran, Guilan, Khuzestan, Fars, Hormozgan, and Lorestan provinces were located in class four with the highest possibility of parasitic egg development due to proper humidity and temperature. Further, the results showed a high prevalence of human toxocariasis antibody titer in Khuzestan and Fars provinces and high prevalence of infection among carnivores in East Azerbaijan, Tehran, Razavi Khorasan, and Mazandaran provinces. Given the high prevalence of anti-Toxocara antibody titer reported in various studies and the high risk of infection in children, the results of the present study can be helpful for physicians and healthcare staff in high-risk provinces.

Does delay in initiation of intravenous antibiotics correlate with wound infections in children with open fractures?

Introduction: One of the common complications of open fractures is an infection which may be dependent on the time of administration of antibiotics. The study aimed to determine the prevalence of wound infection due to the delay in the interval between the initiation of intravenous (IV) antibiotics and time of paediatrics open injury. Materials and Methods: Retrospective observational study included paediatrics patients (0 to 16 years) with open fractures. A retrospective chart review was performed to identify patients with open fracture, who were treated between May 2012 and October 2013 at the tertiary care centre. The time between the injury and the first dose of intravenous antibiotic was calculated from transfer and hospital records. Fracture groups were stratified according to the severity of soft-tissue damage as determined with use of the Gustilo- Anderson system for the classification of open fractures. Results: Sixty patients with 84 open fractures were included in this study. Majority of 31.58% of participants had type III B Gustilo - Anderson fracture type. The proportion of grade IIIA, I, III C and II fracture was 29.82%, 21.05%, 14.04% and 3.51% respectively. 43 (71.6%) received IV antibiotics within 6 hours of injury of which eight had documented wound infections. Of the 17 (28%) patients who received IV antibiotics after 6 hours, 7 (41%) were diagnosed with wound infections. The incidence of infection was high in higher grades of Gustilo- Anderson opens injuries. Conclusion: The immediate administration of appropriate antibiotics on presentation is crucial to minimise the risk of infection in children.

Malnutrition, morbidity and infection in the informal settlements of Nairobi, Kenya: an epidemiological study

BackgroundMalnutrition constitutes one of the major public health challenges throughout the developing world. Urban poverty and malnutrition have been on the rise, with an increased rate of morbidity. We herein explore the relationship between infections and nutritional status and the related association with hygienic conditions as risk of infection in children residing in the slums of Nairobi.MethodsCase-control study based on a secondary analysis of quantitative data collected from a cluster randomized trial carried out in two slums of Nairobi. The following information about resident children were selected: babies’ anthropometric measurements, related life conditions, data on infant-feeding practices, food security, hygiene, immunization coverage and morbidity were collected and updated with structured questionnaires until 12 months of life. Prevalence of malnutrition was calculated, then both bivariate and multivariate analysis were used to explore the relationship between malnutrition and its determinants.ResultsThe study involved a total of 1119 babies registered at birth (51.28% male and 48.03% female infants). Overall the prevalence of malnutrition was high, with 26.3% of the children being stunted, 6.3% wasted and 13.16% underweight. Prevalence of wasting was higher in the first months of life, while in older children more case of stunting and underweight were captured. Wasted infants were significantly associated with common childhood illnesses: with cough and rapid breathing as well as with diarrhea (p-value< 0.05). Stunting was associated with hygienic conditions (p-value< 0.05 in households that did not perform any water treatment and for children that had a toilet within the house compound), immunization program and low-birth-weight. Moreover, regression analysis showed that significant determinants of stunting were sex and feeding practices. Underweight was significantly associated with socio-demographic factors.ConclusionsIn the specific environment where the study was conducted acute malnutrition is correlated with acute infections, while chronic malnutrition is more influenced by WASH conditions. Therefore, our findings suggest that one cannot separate infection and its risk factors as determinants of the whole malnutrition burden.

Determining Health Utilities for Immunosuppression in Pediatric Inflammatory Bowel Disease

Background and Hypothesis: Inflammatory Bowel Disease is a significant cause of gastrointestinal pathology in children and adolescents, with increasing incidence. The medications used to control this disease have an overall low risk of detrimental side effects, but when they occur can be serious or life-threatening. The most important side effects of immunosuppression in IBD are infection and malignancy, but little is known about how these risks affect patients’ and their families’ decisions about medication use. Clinical utilities are a standard methodology used to assign risk to various hypothetical health states. We hypothesized that lower health utility scores would be assigned to scenarios related to cancer than to infection, even if the risks or severity were similar. &#x0D; Experimental Design or Project Methods: This study determines the clinical utility of immunosuppression and cancer / infection risk in children with inflammatory bowel disease using the standard gamble technique. The standard gamble technique measures individual preferences for many different therapeutic modalities, under uncertain results. The study will look at the health utilities of at least 50 families at Riley hospital for Children and IU North, with at least 25 patients with ulcerative colitis and 25 patients with Crohn’s disease. In addition to the perfect health and death, we propose to utilize six different hypothetical health states during this study: (1) untreated IBD, (2) on a medication with no side effects, (3) on a medication with risk of a treatable infection, (4) on a medication with risk of an untreatable infection, (5) on a medication with risk of a treatable cancer, (6) and on a medication with risk of an untreatable cancer. We will also gather subject demographics, family education, family income, and perform an assessment of numeracy. These variables will then be used in a regression model to assess the effect of these confounders. &#x0D; Results: We have not yet enrolled subjects, but now that the tool and Standard Gamble design are complete, we expect to rapidly accrue enrollment over the next two weeks and will update results at that time. &#x0D; Conclusion and Potential Impact: Health utility data in pediatric IBD are quite scarce, with room for further research. It is crucial to understand the health utilities in individuals with inflammatory bowel disease (IBD), specifically in pediatric patients. This allows for cost-utility analysis to play a role in determining effectiveness for a wide variety of treatment modalities. It is also important when discussing treatment options with families when the risk of infection or cancer are present. Knowledge gained from this study may help us design interventions that focus on educating families about the nature and magnitude of these important risks in immunosuppressive therapy.

The Debate is Over: Continue Anti-Tumor Necrosis Factor Therapy Throughout Pregnancy

Data in support of the safety of biologic use during pregnancy continues to grow. Utilizing a national French database with linkage between mothers and children, Luu et al. demonstrated that anti-tumor necrosis factor (anti-TNF) therapy exposure did not increase infection risk in children, though the mothers had higher rates of infection. Stopping therapy prior to 24 weeks gestation led to a higher rate of disease flares in the mother with no benefit to the infant compared to continued therapy.

ANALYSIS OF FACTORS ASSOCIATED WITH PUBLIC CONFIDENCE IN VACCINATION AGAINST VIRAL HEPATITIS B IN ARKHANGELSK REGION

To reveal factors associated with negative attitude to vaccination against viral hepatitis B we performed two crosssectional studies including 1243 adults aged 18–39 years, recruited by a public opinion agency applying a quota sampling method to achieve a data set with similar age- and sex-distribution as the population in Arkhangelsk, and 2896 parents, visiting child’s health-care facilities of Arkhangelsk region. Binary logistic regression was used to analyze factors associated with negative attitude to vaccination. Among 1243 adult respondents 3,5% expressed a negative attitude to vaccination against viral hepatitis B. According to serological testing 15,9% of participants who demonstrated negative attitude to vaccination had serological markers of viral hepatitis B infection (HBsAg, antiHBc-antibodies, sometimes in combination with antiHBs-antibodies). Respondents younger than 30 years and people who had standard risk factors of infection (injecting drug use, blood transfusion, surgery, induced abortions, tattoo, 5 and more sexual partners in a year), more often demonstrated positive attitude to vaccination against viral hepatitis B in comparison with others. Among 2896 parents 1,6% expressed a negative attitude to vaccination of their children against viral hepatitis B. Factors associated with negative attitude to vaccination were age younger than 25 years, high education, concerns and misinformation about vaccines, distrust in physicians. Thus, young adult people, who had standard risk factors of infection, had positive attitude to vaccination against viral hepatitis B. Young parents underestimated the risk of infection in children and importance of timely vaccination. The major reasons for negative public attitude to vaccination against viral hepatitis B were lack of information about vaccination and, as a consequence, unawareness of the need of immunization.

Antibiotic Prophylaxis Practices in Pediatric Cardiac Implantable Electronic Device Procedures: A Survey of the Pediatric And Congenital Electrophysiology Society (PACES).

Cardiac implantable electronic device (CIED) infections are associated with significant morbidity in the pediatric device population, with a tenfold higher risk of infection in children compared to adults. The 2010 American Heart Association (AHA) guidelines recommend a single dose of systemic antibiotic (ABX) prophylaxis prior to CIED implantation and no post-operative (OP) ABX. However, there is limited data regarding adherence to this recommendation among the pediatric community. To assess current clinical practices for CIED ABX prophylaxis in pediatrics; whether the AHA guidelines are being followed; and if not, the reasons for non-adherence. An anonymous web-based survey was sent to physician members of the Pediatric And Congenital Electrophysiology Society regarding ABX prophylaxis for new CIED implants and reoperations. 75 (25%) members responded. Only 7% of respondents follow the 2010 AHA guidelines. While all respondents give pre-OP IV ABX, 64% routinely treat patients with 24-h post-OP IV ABX with additional oral or IV therapy. 69% of respondents are cognizant of the guidelines but 88% of those cognizant do not follow the guidelines for a variety of reasons including lack of data and different substrate (pediatric patients). 79% stated that pediatric-specific data would be required for them to change their practice and follow the published guidelines. The majority of pediatric EP physicians who responded to this survey do not follow the current AHA guidelines on ABX prophylaxis and administer post-OP ABX. Most pediatric EP physicians believe that the increased risk of infection in children merits additional ABX.

Polymorphisms in α-Defensin-Encoding DEFA1A3 Associate with Urinary Tract Infection Risk in Children with Vesicoureteral Reflux.

The contribution of genetic variation to urinary tract infection (UTI) risk in children with vesicoureteral reflux is largely unknown. The innate immune system, which includes antimicrobial peptides, such as the α-defensins, encoded by DEFA1A3, is important in preventing UTIs but has not been investigated in the vesicoureteral reflux population. We used quantitative real-time PCR to determine DEFA1A3 DNA copy numbers in 298 individuals with confirmed UTIs and vesicoureteral reflux from the Randomized Intervention for Children with Vesicoureteral Reflux (RIVUR) Study and 295 controls, and we correlated copy numbers with outcomes. Outcomes studied included reflux grade, UTIs during the study on placebo or antibiotics, bowel and bladder dysfunction, and renal scarring. Overall, 29% of patients and 16% of controls had less than or equal to five copies of DEFA1A3 (odds ratio, 2.09; 95% confidence interval, 1.40 to 3.11; P<0.001). For each additional copy of DEFA1A3, the odds of recurrent UTI in patients receiving antibiotic prophylaxis decreased by 47% when adjusting for vesicoureteral reflux grade and bowel and bladder dysfunction. In patients receiving placebo, DEFA1A3 copy number did not associate with risk of recurrent UTI. Notably, we found that DEFA1A3 is expressed in renal epithelium and not restricted to myeloid-derived cells, such as neutrophils. In conclusion, low DEFA1A3 copy number associated with recurrent UTIs in subjects in the RIVUR Study randomized to prophylactic antibiotics, providing evidence that copy number polymorphisms in an antimicrobial peptide associate with UTI risk.

Single nucleotide polymorphism in IL1B is associated with infection risk in paediatric acute myeloid leukaemia

We evaluated single nucleotide polymorphisms (SNPs) associated with infection risk in children with newly diagnosed acute myeloid leukaemia (AML). We conducted a multicentre, prospective cohort study that included children aged ≤18 years with de novo AML. DNA was isolated from blood lymphocytes or buccal swabs, and candidate gene SNP analysis was conducted. Primary outcome was the occurrence of microbiologically documented sterile site infection during chemotherapy. Secondary outcomes were Gram-positive and -negative infections, viridans group streptococcal infection and proven/probable invasive fungal infection. Interpretation was guided by consistency in risk alleles and microbiologic agent with previous literature. Over the study period 254 children and adolescents with AML were enrolled. Overall, 190 (74.8%) had at least one sterile site microbiologically documented infection. Among the 172 with inferred European ancestry and DNA available, nine significant associations were observed; two were consistent with previous literature. Allele A at IL1B (rs16944) was associated with decreased microbiologically documented infection, and allele G at IL10 (rs1800896) was associated with increased risk of Gram-positive infection. We identified SNPs associated with infection risk in paediatric AML. Genotype may provide insight into mechanisms of infection risk that could be used for supportive-care novel treatments.

Hematocrit may be an indicator of surgical site infection risk in children with cerebral palsy

Hematocrit may be an indicator of surgical site infection risk in children with cerebral palsy

A survey of Angiostrongylus species in definitive hosts in Queensland.

Despite the recent sporadic reports of angiostrongyliasis in humans, dogs and wildlife in eastern Australia there has been no systematic study to explore the epidemiology of Angiostrongylus spp. in definitive and intermediate hosts in the region. Little is known about the epidemiology of Angiostrongylus species in the definitive host in southeast Queensland, since the only survey conducted in this region was performed in the late 1960s. In this study, free-living populations of Rattus spp. were sampled and examined for the presence of adult and larval Angiostrongylus in the lungs, and of larvae in faeces. The prevalence of infection with Angiostrongylus spp. was 16.5% in Rattus spp. trapped in urban Brisbane and surrounds. This prevalence is much higher than estimates of earlier studies. This highlights the possible risk of zoonotic infection in children, dogs and wildlife in this region and indicates the necessity for public awareness as well as more detailed epidemiological studies on this parasite in eastern Australia.

Evidence based community mobilization for dengue prevention in Nicaragua and Mexico (Camino Verde, the Green Way): cluster randomized controlled trial

Objective To test whether community mobilization adds effectiveness to conventional dengue control.Design Pragmatic open label parallel group cluster randomized controlled trial. Those assessing the outcomes and analyzing the data were...

Borreliose im Kindes- und Jugendalter

Borreliosis is the most common tick-borne disease with the highest risk of infection in children between 5 and 14 years old. It is defined as an inflammatory multisystemic disease. A distinction is made between the early localized form (erythema migrans), the early generalized form (e.g. neuroborreliosis and lymphocytoma) and later forms (e.g. Lyme arthritis). It is well-known that borreliosis is diagnosed too frequently and one of the main reasons is the relatively high prevalence of anti-Borrelia antibodies in healthy children and adolescents. Erythema migrans is a clinical diagnosis and no further serological investigations are necessary. A clear recommendation for lumbar puncture exists once clinical symptoms of meningitis (with or without facial palsy) occur. In cases with isolated peripheral facial palsy, German expert committees recommend a lumbar puncture but American guidelines do not. This article also summarizes the currently valid recommendations for treatment of borreliosis with an emphasis on the European guidelines.

Acid-reducing drugs could increase risk of bacterial infection in children

Acid-reducing drugs could increase risk of bacterial infection in children

Tight Glycemic Control After Pediatric Cardiac Surgery in High-Risk Patient Populations

Background— Our previous randomized, clinical trial showed that postoperative tight glycemic control (TGC) for children undergoing cardiac surgery did not reduce the rate of health care–associated infections compared with standard care (STD). Heterogeneity of treatment effect may exist within this population. Methods and Results— We performed a post hoc exploratory analysis of 980 children from birth to 36 months of age at the time of cardiac surgery who were randomized to postoperative TGC or STD in the intensive care unit. Significant interactions were observed between treatment group and both neonate (age ≤30 days; P =0.03) and intraoperative glucocorticoid exposure ( P =0.03) on the risk of infection. The rate and incidence of infections in subjects ≤60 days old were significantly increased in the TGC compared with the STD group (rate: 13.5 versus 3.7 infections per 1000 cardiac intensive care unit days, P =0.01; incidence: 13% versus 4%, P =0.02), whereas infections among those &gt;60 days of age were significantly reduced in the TGC compared with the STD group (rate: 5.0 versus 14.1 infections per 1000 cardiac intensive care unit days, P =0.02; incidence: 2% versus 5%, P =0.03); the interaction of treatment group by age subgroup was highly significant ( P =0.001). Multivariable logistic regression controlling for the main effects revealed that previous cardiac surgery, chromosomal anomaly, and delayed sternal closure were independently associated with increased risk of infection. Conclusions— This exploratory analysis demonstrated that TGC may lower the risk of infection in children &gt;60 days of age at the time of cardiac surgery compared with children receiving STD. Meta-analyses of past and ongoing clinical trials are necessary to confirm these findings before clinical practice is altered. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00443599.