Thalassemia and iron deficiency in a group of northeast Thai school children: relationship to the occurrence of anemia

The cross-sectional study assessed anemia, thalassemia, and hemoglobinopathies, as well as iron deficiency, among 190 northeastern Thai school children aged 10 to 11 years. The aim was to analyze the reasons for anemia among the group. Hemoglobin concentration and other hematological parameters were determined using an automated blood cell counter. Beta-thalassemia and other hemoglobinopathies were identified by high performance liquid chromatography (HPLC) analysis of hemoglobin. Alpha-thalassemia was identified by polymerase chain reaction (PCR) and related techniques. Iron deficiency was assessed using serum ferritin (SF) <20 ng/ml as indicator. Based on the WHO criteria, anemia was defined by hemoglobin (Hb) level <11.5 g/dl. Twenty five out of 190 children (13.2%; 95% CI = 8.7–18.8%) were anemic. Iron deficiency was found in only two out of 190 children (1.0%; 95% CI = 0.1–3.8%), but the two iron deficient children were not anemic. The proportion of thalassemia and hemoglobinopathies among the group was 61.1% (95% CI = 53.7–68.0%). As underlying reasons for anemia, thalassemia and hemoglobinopathies were found in 22 out of 25 (88.0%) anemic children. Beta-thalassemia and homozygous Hb E seem to be important, while this was less obvious for heterozygous α-thalassemia and heterozygous Hb E. Conclusion: The results suggest that thalassemia and hemoglobinopathies may be major contributing factors to the occurrence of anemia in this area among the children’s population.     

A community study of clinical traits and risk factors for human metapneumovirus and respiratory syncytial virus infection during the first year of life

Human metapneumovirus (hMPV) and respiratory syncytial virus (RSV) are important respiratory pathogens with similar symptomatology. The aim of this prospective birth cohort study was to identify risk factors for an hMPV or RSV infection during the first year of life in unselected healthy children. We followed 217 children from birth to 1 year of age. Nasal swabs and symptom diaries were collected monthly. Anti-hMPV and anti-RSV IgG antibodies by age 1 year were detected by ELISA, and nasal swabs were analysed for hMPV and RSV by RT-PCR. Logistic regression was used for risk factor analysis. Anti-hMPV IgG was found in 38 children (17.5%), and anti-RSV IgG in 172 children (79%). Risk factors for being anti-hMPV IgG-positive were: (1) being born in the spring (OR = 2.36; 95% CI:1.06–5.27), and (2) having older siblings (OR = 3.82; 95% CI:1.75–8.34). Risk factors for being anti-RSV IgG-positive were: (1) gestational age <38 weeks (OR = 3.39; 95% CI:1.42–8.05), (2) increasing paternal age (OR = 1.85 per 5 yrs; 95% CI:1.28–2.68), and (3) wall-to-wall carpeting (OR = 3.15; 95% CI:1.29–7.68). Being born in the spring was associated with decreased odds of being anti-RSV IgG-positive (OR = 0.27, 95% CI:0.09–0.85). Risk factors for RSV hospitalisation (n = 11) were: (1) older siblings (OR = 4.49; 95% CI: 1.08–18.73) and (2) smoking in the household (OR = 5.06; 95% CI: 1.36–18.76). Exclusive breastfeeding for the first 14 days of life protected against hospitalisation (OR = 0.21; 95% CI:0.06–0.79). In conclusion, this study identifies risk factors for mild and asymptomatic hMPV infections in infancy.     

Lipoprotein lipase gene polymorphisms and risks of childhood obesity in Chinese preschool children

Childhood obesity is increasingly prevalent in the community and is related to many adult diseases. Lipoprotein lipase (LPL) plays a central role in dyslipidemia, and polymorphisms of the LPL gene may result in the disturbance in the lipid’s metabolism. The aim of this study is to test the hypothesis that genetic variants of LPL and serum lipid levels are associated with the risk of childhood obesity. We genotyped +495T > G and PvuII T > C in an LPL gene and measured the serum lipid levels in a case–control study of 124 obese children and 346 frequency-matched normal controls in preschool Chinese children. The variant genotypes of LPL +495GG and PvuII CC were associated with a significantly increased risk of childhood obesity [adjusted odds ratio (OR) = 2.39, 95% CI = 1.09–5.23 for +495 GG; adjusted OR = 2.00, 95% CI = 1.04–3.83 for PvuII CC], compared with their wild-type genotypes, respectively. In addition, compared with the lower serum level cut off by the control median, the higher level of serum triglyceride (TG) (>0.59 mmol/L) was associated with a 1.32-fold increased risk of childhood obesity, and the higher level of high density lipoprotein cholesterol (HDLC) (>1.14 mmol/L) was associated with a 36% decrease in risk of childhood obesity. Furthermore, the median levels of TG were higher in obese children carrying LPL +495TT/TG and PvuII TT/CT genotypes than those in controls, the HDLC levels were lower in obese children carrying LPL +495TG and PvuII CT/CC genotypes than those in controls. In conclusion, the LPL gene +495T > G and PvuII T > C polymorphisms may modulate the magnitude of dyslipidemia in Chinese early-onset obesity.     

Characteristics of pediatric patients with enterovirus meningitis and no cerebral fluid pleocytosis

Human non-polio enterovirus (EV) is the most important cause of aseptic meningitis in children. Only a few studies report the lack of cerobrospinal fluid (CSF) pleocytosis in children with confirmed EV meningitis; however, the characteristics of these children have not been well defined. This paper describes the clinical and laboratory features of EV meningitis in children with no CSF pleocytosis. Clinical, laboratory, and virological data of Dutch patients <16 years diagnosed with EV meningitis, between 2003 and 2008, were analyzed retrospectively. Data of children with and without CSF pleocytosis were compared. A total of 149 children were infected with EV. Patients presented mainly with fever (n = 113), malaise (n = 43), abdominal pain (n = 47), and irritability (n = 61). Of the 60 patients with EV meningitis, 23 had no pleocytosis. Those who lacked CSF pleocytosis were younger [odds ratio (OR) 1.00; 95% confidence interval (CI) 1.000–1.002; p = 0.001], had experienced drowsiness more (OR 9.60; 95% CI 2.24–41.15; p = 0.002), had lower white blood cell counts (OR 0.73; 95% CI 0.61–0.89; p = 0.001), and had higher C-reactive protein (OR 1.13; 95% CI 1.03–1.23; p = 0.006) than those with pleocytosis. Conclusion. These findings show that EV meningitis occurs in the absence of CSF pleocytosis, particularly in young infants, meaning that EV meningitis in this age group cannot be solely excluded by the absence of CSF pleocytosis. They also confirm the importance of genome detection in the diagnosis of EV meningitis in young infants.     

Antibody persistence for 3?years following two doses of tetravalent measles–mumps–rubella–varicella vaccine in healthy children

Two doses of a varicella-containing vaccine in healthy children <12 years are suggested to induce better protection than a single dose. Persistence of immunity against measles, mumps, rubella, and varicella as well as varicella breakthrough cases were assessed 3 years after two-dose measles, mumps, rubella, and varicella (MMRV) vaccination or concomitant MMR (Priorix™) and varicella (Varilrix™) vaccination. Four hundred ninety-four healthy children, 12–18 months old at the time of the first dose, received either two doses of MMRV vaccine (GlaxoSmithKline Biologicals) 42–56 days apart (MMRV, N = 371) or one dose of MMR and varicella vaccines administered simultaneously at separate sites, followed by another MMR vaccination 42–56 days later (MMR + V, N = 123). Three hundred-four subjects participated in 3-year follow-up for persistence of immunity and occurrence of breakthrough varicella (MMRV, N = 225; MMR + V, N = 79). Antibodies were measured by ELISA (measles, mumps, rubella) and immunofluorescence (varicella). Contacts with individuals with varicella or zoster and cases of breakthrough varicella disease were recorded. Three years post-vaccination seropositivity rates in subjects seronegative before vaccination were: MMRV-measles, 98.5% (geometric mean titer [GMT] = 3,599.6); mumps, 97.4% (GMT = 1,754.5); rubella, 100% (GMT = 51.9); varicella, 99.4% (GMT = 225.5); MMR + V-measles, 97.0% (GMT = 1,818.8); mumps, 93.8% (GMT = 1,454.6); rubella, 100% (GMT = 53.8); and varicella, 96.8% (GMT = 105.8). Of the subjects, 15–20% reported contact with individuals with varicella/zoster each year. After 3 years, the cumulative varicella breakthrough disease rate was 0.7% (two cases) in the MMRV group and 5.4% (five cases) in the MMR + V group. Conclusion: Immunogenicity of the combined MMRV vaccine was sustained 3 years post-vaccination. (208136/041/NCT00406211).     

Prognostic values of specific respiratory sounds for asthma in adolescents

Childhood wheezing is a common condition associated with asthma, but the term is often misapplied. The present study aimed to investigate the prognostic values of specific respiratory sounds for asthma onset in adolescence. In a prospective study, six specific respiratory sounds were evaluated for their prediction of asthma. Parents were asked for respiratory sounds of their initially asthma-free children and to describe them in specified terms. Self-reported doctor-diagnosed asthma of 1,569 children aged 5 to 14 years from Germany was assessed at baseline and at follow-up for up to 12 years later. Except for ‘ronchus’ (17%), reported ‘gasp’ and ‘whimper’ had the highest positive predictive values of 15% and 11%, respectively. These sounds also showed the greatest increase in asthma incidence (odds ratio = 3.18; 95%CI, 1.46–6.94 and odds ratio = 2.09; 95%CI, 1.00–4.37). It could be shown that from six respiratory sounds, ‘gasp’ and ‘whimper’ were the expressions with the best prediction for asthma onset. This study suggests that parents can sensibly distinguish between respiratory sounds and that it is important to specify breathing sounds, as not all are good predictors for asthma.     

The prevalence and etiology of anemia among HIV-infected children in India

In this report, the prevalence and multifactorial etiology of anemia among Indian human immunodeficiency virus (HIV)-infected children are described. HIV-infected children aged 2–12 years were prospectively enrolled in 2007–2008. Measured parameters included serum ferritin, vitamin B₁₂, red-cell folate, soluble transferrin receptor, and C-reactive protein. Children received antiretroviral therapy (ART), iron and, folate supplements as per standard of care. Among 80 enrolled HIV-infected children (mean age 6.8 years), the prevalence of anemia was 52.5%. Etiology of anemia was found to be iron deficiency alone in 38.1%, anemia of inflammation alone in 38.1%, combined iron deficiency and anemia of inflammation alone in 7.1%, vitamin B₁₂ deficiency in 7.1%, and others in 9.5%. Median iron intake was 5.7 mg/day (recommended dietary allowance 18–26 mg/day). Compared to nonanemic children, anemic children were more likely to be underweight (weight Z-score −2.5 vs. -1.9), stunted (height Z-score −2.6 vs. -1.9), with lower CD4 counts (18% vs. 24%, p < 0.01), and higher log viral load (11.1 vs. 7.1, p < 0.01). Hemoglobin (Hb) improved significantly among those who started ART (baseline Hb 11.6 g/dl, 6-month Hb 12.2 g/dl, p = 0.03). Children taking ART combined with iron supplements experienced a larger increase in Hb compared to those receiving neither ART nor iron supplements (mean Hb change 1.5 g/dl, p < 0.01). Conclusion Anemia, particularly iron deficiency anemia and anemia of inflammation, is highly prevalent among children with HIV infection. Micronutrient supplements combined with ART improved anemia in HIV-infected children.     

Age effect on whole blood cyclosporine concentrations following oral administration in children with nephrotic syndrome

The aim of this study was to investigate age-related pharmacokinetic differences of cyclosporine (CyA) in children with nephrotic syndrome. Whole blood concentrations of CyA were monitored for a total of 96 times in 36 cases. The 25 male and 11 female patients ranged in age from 1.9 to 19.7 years with a mean age of 9.1 years. Renal biopsy showed minimal change in 33 patients and focal segmental glomerulosclerosis in three patients. CyA was orally administered in two divided doses just before meals. The doses of CyA administered were adjusted such that the target value for blood concentration at 2 h post-dose (C2) was 400–450 ng/ml. The 96 subjects were divided into three groups according to age: group I, 1–5 years (n = 30); group II, 6–10 years (n = 34); and group III, ≥ 11 years (n = 32). In all subjects, peak levels (Cmax) of CyA were reached at C1 or C2. There was no significant difference between the groups for C2, area under the whole blood concentration–time curve up to 4 h post-dose (AUC0–4), and Cmax. The mean CyA doses of groups I, II, and III were 4.8 ± 1.0 mg/kg/day, 3.8 ± 0.9 mg/kg/day, and 3.0 ± 0.6 mg/kg/day, respectively, and there were significant differences between every two groups. In addition, the dose-normalized Cmax (Cmax/dose) and AUC0–4 (AUC0–4/dose) values were significantly lower in the younger group than in the older group. These findings suggested that in children, when the same concentration is targeted, the required CyA dose would vary according to age but would be significantly higher for the younger children.     

Age at menarche in a Korean population: secular trends and influencing factors

This study was designed to identify the secular trend in the age at menarche and to investigate the possible factors that influence the age at menarche using representative Korean data from the 2005 Korean National Health and Nutrition Survey. Three thousand five hundred sixty-two women born between 1920 and 1985 were enrolled to identify secular trends in the age at menarche and 620 girls born between 1986 and 1995 were recruited to evaluate the factors influencing the age at onset of menarche. Mean age at menarche decreased from 16.90 ± 1.25 years for women born between 1920 and 1925 to 13.79 ± 1.37 years for those born between 1980 and 1985, indicating a downward trend of 0.68 years per decade (95% CI, 0.64–0.71) in age at menarche. Mean age at menarche of girls born between 1986 and 1995 was 13.10 ± 0.06 years as estimated by the Kaplan–Meier method. Among girls born between 1986 and 1995, menarcheal girls had a larger waist circumference, a higher body mass index (BMI), and lower maternal menarcheal age and maternal age at birth than premenarcheal girls. The energy and nutrient intake of protein, sugar, fiber, ash, phosphate, natrium, thiamine, riboflavin, and niacin were greater for menarcheal girls than for premenarcheal girls. These data indicate a decreasing secular trend of age at menarche in a Korean population born between 1920 and 1995. Furthermore, maternal menarcheal age, BMI, maternal age at birth, and nutrition are important variables that appear to influence age at menarche in Korean girls.     

Outcome of ventilated infants born at term without major congenital abnormalities

The longer-term outcome of term-born infants without congenital anomalies requiring ventilation in the first 24 h after birth has rarely been reported. Our aims were to determine the mortality and long-term morbidity of such infants and identify risk factors for adverse outcome. The outcomes of 43 of 45 infants born at term consecutively requiring mechanical ventilation were reviewed. The infants had: meconium aspiration syndrome (n = 11), hypoxic ischaemic encephalopathy (HIE) (n = 11), respiratory depression (n = 12), sepsis (n = 5), persistent pulmonary hypertension of the newborn (n = 3) and middle cerebral artery infarction (n = 1). Eleven infants developed seizures (26%), 13 (30%) had abnormal electroencephalograms and 11 (26%) had abnormal MRI scans; 26% had an adverse outcome: six died, and five had severe neurodisability at 2 years. The infants with congenital toxoplasmosis and a middle cerebral artery infarction were excluded from the prediction analysis. In the remaining 41 patients, requirement for anticonvulsants (relative risk, RR = 4.44, 95% CI = 1.48 to 12.70; p = 0.014) and prolonged ventilation (longer than 3 days) (RR 4.83, 95% CI 1.51 to 15.64) predicted adverse outcome. Infants with HIE had an increased risk of adverse outcome (relative risk 5.45, 95% CI 1.01 to 33.85), but an adverse outcome occurred in infants with other diagnoses. Conclusion: Mortality and neurodisability at follow-up were common in infants born at term without major congenital anomalies who required mechanical ventilation in the first 24 h after birth, particularly in those who developed seizures requiring treatment and prolonged ventilation.     

Programmed death-1 (PD-1) gene polymorphisms lodged in the genetic predispositions of Kawasaki Disease

The purpose of this study is to investigate the association of programmed death-1 gene (PD-1) polymorphisms with genetic predispositions to Kawasaki disease (KD). A total of 73 patients with KD and 100 healthy controls were enrolled from 2007 to 2008. Two single nucleotide polymorphisms of the PD-1 gene, rs41386349 and rs2227981, were analyzed. Higher T allele frequency of rs41386349 was found in the patient group than the control group (p = 0.007, odds ratio (OR) = 1.9, 95% CI = 1.2–2.9). PD-1 rs2227981 polymorphism was not significant in patients with KD comparing with the control group (p = 0.4, OR = 1.2 (0.8–1.9)). Furthermore, no difference of PD-1 polymorphisms between patients with coronary artery dilatation (CAD) and those without CAD was found. Our data support the possibility that PD-1 gene polymorphism may be related with the genetic susceptibility of KD in Korean population.     

Risk factors for severe RSV-induced lower respiratory tract infection over four consecutive epidemics

Variability in severity among different respiratory syncytial virus (RSV) seasons may influence hospital admission rates for RSV-induced lower respiratory tract infection (LRTI) in young children. The aim of the present study was to identify through logistic regression analysis, risk factors associated with higher likelihood to acquire RSV-induced LRTI, in children with symptoms severe enough to lead to hospital admission. Over four consecutive RSV seasons (2000–2004), records from children <4 years of age admitted for RSV-induced LRTI (“cases”) were compared with those from children with LRTI not due to RSV and not requiring hospitalization (“controls”). 145 “case-patients” and 295 “control-patients” were evaluated. Independent from the severity of the four epidemic seasons, seven predictors for hospitalization for RSV infection were found in the bivariate analysis: number of children in the family, chronological age at the onset of RSV season, birth weight and gestational age, birth order, daycare attendance, previous RSV infections. In the logistic regression analysis, only three predictors were detected: chronological age at the beginning of RSV season [aOR = 8.46; 95% CI:3.09–23.18]; birth weight category [aOR = 7.70; 95% CI:1.29–45.91]; birth order (aOR = 1.92; 95% CI:1.21–3.06). Conclusions: Independent from the RSV seasonality, specific host/environmental factors can be used to identify children at greatest risk for hospitalization for RSV infection.     

Clinical and diagnostic relevance of Meckel’s diverticulum in children

Meckel’s diverticulum (MD) has varied clinical manifestations and is a diagnostic challenge for pediatricians. This study investigates the clinical and diagnostic characteristics of MD in children with different presentations. We retrospectively reviewed the medical records of pediatric patients diagnosed with MD from 1988 to 2008. The data including the age, sex, clinical features, laboratory data, sensitivity of diagnostic methods, and pathological finding were recorded. These patients were classified into three groups: diverticulitis, intestinal obstruction, and intestinal bleeding. A total of 47 children (35 boys and 12 girls) with a median age of 5.6 years were enrolled and categorized as follows: diverticulitis (n = 12), obstruction (n = 12), bleeding (n = 21), and two diagnosed incidentally. Patients with intestinal obstruction were significantly younger than those with bleeding (3.7, 95% CI, 1.6–5.7 vs. 6.6, 95% CI, 4.5-8.7, P = 0.04). In the obstruction group, intussusception was found in eight of 12 patients, of whom 62.5% were aged older than 3 years. Heterotopic tissues were found in 46.3% of surgical specimens and more frequently existed in patients with bleeding than those with diverticulitis (P = 0.02) and obstruction (P = 0.047). Tc-99m scans yielded a diagnostic sensitivity of about 65% in bleeding patients. Repeated Tc-99m scans and red blood cell (RBC) scans can be good supplementary tools in Tc-99m scan-negative bleeding patients. In conclusion, manifestations of childhood MD are variable and may depend on the presence of heterotopic tissues and the patients’ age. Tc-99m scans supplemented with RBC scans are appropriate to diagnose childhood MD with bleeding.     

Follow-up outcomes of pediatric patients who underwent surgical resection for lipoblastomas or lipoblastomatosis: a single-institution experience with a systematic review and meta-analysis

The objective of this study was to examine the long-term outcomes of pediatric patients who underwent surgical resection for lipoblastoma and lipoblastomatosis (LB/LBM). A single-center retrospective study of pediatric patients with LB/LBMs seen between 1991 and 2015 was conducted. A systematic review, including studies published prior to late August 2018, was performed. Using a random effect meta-analysis, pooled weighted proportions and unadjusted odds ratios (OR) with 95% confidence intervals (CI) were calculated. The retrospective study included 16 patients, while the systematic review included 19 published studies consisting of 381 patients. Among 329 (82%) patients with follow-up information, the pooled recurrence rate was 16.8% (95% CI 10.9–23.5%; I2 = 59%). The reported time to recurrence ranged from < 1 to 8 years. Recurrence risk was greater for incomplete (n = 34) than complete resection (n = 150): OR 11.4 (95% CI 3.0–43.6; I2 = 43%). LBMs (n = 35) had a greater recurrence risk than LBs (n = 116): OR 5.5 (95% CI 1.9–15.9; I2 = 0%). Recurrences were higher for studies with approximately ≥ 3 years of follow-up versus studies with < 3 years of follow-up. Recurrences are more likely to occur with LBMs and/or incomplete resection. Follow-up beyond 3–5 years should be considered given that the recurrence risk appears to be greater in the long-term.     

Voiding urosonography: the study of the urethra is no longer a limitation of the technique

Background  Voiding urosonography (VUS) has proved to be a reliable method for the study of vesicoureteric reflux (VUR). Early reports considered it inadequate for imaging the male urethra. Objective  To determine the usefulness of contrast-enhanced VUS for the study of the urethra. Material and methods  A total of 208 children aged 2 days to 10 years underwent VUS to confirm or exclude VUR for different reasons (n = 150) or for follow-up (n = 58). Patients with unconfirmed suspicion of VUR (99 boys and 51 girls) also underwent VUS for the study of the urethra. Examinations were performed using a harmonic imaging mode specific for contrast (Levovist) enhancement. We used a 6–4-MHz convex probe and a transperineal and/or a transpelvic approach. Results  The neck of the bladder and the entire urethra were visualized in all patients (n = 150). The male urethra was considered normal in 95 boys (95.95%). We diagnosed posterior urethral valves in two patients, diverticulum of the prostatic utricle in one, and diverticulum of the anterior urethra in one. All abnormal cases were confirmed using conventional voiding cystourethrography. Conclusion  VUS can replace voiding cystourethrography as the method of choice for the initial study of suspected VUR in children. This work was presented at the 44th Annual Meeting of the European Society of Paediatric Radiology, Barcelona, Spain, 3–7 June 2007.     

QT interval prolongation and risk for cardiac events in genotyped LQTS-index children

Congenital long-QT syndrome (LQTS) is an inherited cardiac disorder with a disturbance in repolarization characterized by a prolonged QT interval on the surface electrocardiogram and life-threatening ventricular tachycardia. Publications from the International LQTS Registry have provided information that the cardiac risk may be influenced by gender, genotype, exposure to arrhythmia triggers, and previous cardiac events. In children, early-onset of disease, changes in life style, and medical treatment is a sensitive issue and significant, gender-related differences of a first life-threatening event were reported. Thus, we investigated the clinical features of a large genotyped population of LQTS-index children (age ≤16 years) upon a single-center experience and determined risk factors for symptoms. Of 83 children [mean corrected QT interval (QTc) 510 ± 74 ms], 89% had LQT1, -2, or -3. Nine patients (11%) were identified as having Jervell and Lange-Nielsen syndrome. Among symptomatic children (n = 51, 61%), syncope was the most prevalent symptom at initial presentation (49%); however, aborted cardiac arrest (ACA) occurred in 33% and sudden cardiac death (SCD) in 18%, respectively, as the initial manifestation. During a mean follow-up period of 5.9 ± 4.7 years, 31% of the children developed symptoms while on therapy (86% syncope, 9% ACA, 5% SCD). Statistical analyses of risk factors for cardiac events showed that the QTc >500 ms was a strong and significant predictor for cardiac events during follow-up (p = 0.02). Furthermore, a prior syncope [hazard ratio (HR), 4.05; 95% confidence interval (CI), 1.1 to 15.0; p = 0.03] or an ACA (HR, 11.7; 95% CI, 3.1 to 43.4; p = <0.001) identified children with an increased risk for recurrent cardiac events compared to asymptomatic LQT children. LQTS-index children manifest with a high percentage of severe symptoms. Among presently validated risk factors for LQTS, a QTc interval >500 ms and a history of prior syncope or ACA were strong predictors for recurrent cardiac events.     

Factors associated with syndemic anemia and stunting among children in Myanmar: A cross-sectional study from a positive deviance approach

BackgroundAnemia and stunting in children are detrimental to the prospects of a normal, healthy upbringing. Having similar risk factors and serious consequences, the syndemic aspect of these two ailments is mostly underrated, and positive deviant (PD) factors that ensure non-anemic status in stunted children have not been studied to date.MethodsThis study aimed to identify PD factors that have potential to prevent syndemic anemia among stunted children aged 6–59 months in Myanmar. This was a cross-sectional secondary analysis of the Myanmar Demographic and Health Survey (DHS) data conducted in 2016, applying the PD concept, where children who were stunted without anemia were considered as PDs.ResultsAmong 1248 stunted children, those who had the syndemic condition were compared with their PD peers in terms of maternal characteristics as well as socioeconomic and health-related factors. Multivariable logistic regression analyses were used to identify the determinants of syndemic state. The results showed that three out of every five stunted children were anemic. The syndemic risk was decreased among children of maternal age groups 20–34 years and 35–44 years: [aOR] = 0.19, 95% CI = 0.05–0.69; p = 0.012, and aOR = 0.19, 95% CI = 0.05–0.75; p = 0.018, respectively. Moderately stunted children (aOR = 0.53, 95% CI = 0.34–0.81; p = 0.004) and children who were not currently breastfed (aOR = 1.56, 95% CI = 1.01–2.41; p = 0.044) were less likely to develop the syndemic condition.ConclusionMaternal age, stunting severity, breastfeeding duration, and maternal anemic status are strong predictors in determining hemoglobin concentrations among stunted children. This study suggests that nutritional interventions targeting PD factors could represent syndemic action in improving child health.     

Total serum bilirubin levels during the first 2 days of life and subsequent neonatal morbidity in very low birth weight infants: a retrospective review

To determine the relationship between total serum bilirubin (TSB) during the first 2 days of life and subsequent neonatal morbidity in very low birth weight (VLBW, less than 1500 g) infants. We performed a prospective study of 582 VLBW infants born between July 1, 2005 and December 31, 2009. TSB was measured in umbilical cord blood (UCB), at 24 and 48 h after birth. Demographic and clinical characteristics of infants in hospital were recorded. The interaction between TSB variables during the first 48 h of life and subsequent neonatal morbidity were assessed in logistic regression analyses adjusted for multiple risk factors. It was found that TSB in UCB was in a negative correlation with occurrence of respiratory distress syndrome (RDS) [OR 0.626, 95% confidence interval (95% CI): 0.446–0.879, p = 0.007], and there was also a negative correlation between TSB in UCB and occurrence of intraventricular hemorrhage (IVH) [OR 0.695, 95% CI 0.826–0.981, p = 0.020]. However, TSB in UCB positively correlated with hyperbilirubinemia [OR 2.471, 95% CI 1.326–3.551, p = 0.012], and TSB at 24 h after birth was also in a positive correlation with early onset sepsis (EOS) [OR 1.299, 95% CI 1.067–1.582, p = 0.011]. VLBW infants with low TSB levels in UCB were more likely to develop RDS and IVH, and those with low TSB levels in UCB were less likely to develop hyperbilirubinemia. Infants with high TSB levels at 24 h after birth were more likely to develop EOS. The protective effect of raised TSB in UCB with respect to RDS and IVH warrants further investigation.     

Attention-deficit hyperactivity disorder in children chronically exposed to high level of vehicular pollution

The purpose of this study is to explore whether sustained exposure to vehicular air pollution affects the behavior and activities of children. The prevalence of attention-deficit hyperactivity disorder (ADHD) was assessed in two childhood populations. In a cross-sectional study 969 school-going children (9–17 years) and 850 age- and sex-matched children from rural areas were assessed, following the criteria of Diagnostic and Statistical Manual of conduct disorders (DSM-IV) of American Pediatric Association. Data of ambient particulate matter with a diameter of less than 10 μm (PM₁₀) were obtained from Central Pollution Control Board and aerosol monitor. ADHD was found in 11.0% of urban children in contrast to 2.7% of the control group (p < 0.001). Major risk factors were male gender, lower socioeconomic status, 12–14 year age group, and PM₁₀ level in breathing air. ADHD was more prevalent among boys both in urban and rural areas. It was prevalent among 18.0% of the boys enrolled in Delhi against 4.0% of the girls, giving a male/female ratio of 4.5:1. Inattentive type of ADHD was predominant followed by hyperactive–impulsive type and combined type of ADHD. Controlling potential confounder, ambient PM₁₀ level was positively correlated with ADHD (OR = 2.07; 95% CI, 1.08–3.99). Conclusion: The results of this study point to a possible association between air pollution and behavioral problems in children. Though gender, socioeconomic status, and age play a very important factor in ADHD prevalence, the association is highest and strongest between particulate pollution and prevalence of ADHD.     

The role of leptin, soluble leptin receptor, resistin, and insulin secretory dynamics in the pathogenesis of hypothalamic obesity in children

Introduction  In this study, we have investigated the role of leptin, soluble leptin receptor(sOb-R), resistin, and insulin secretory dynamics in the development of hypothalamic obesity. Materials and methods  Children who had hypothalamo-pituitary tumor were divided into two groups. First group included obese-overweight (hypothalamic obese = HOB group, n = 23) and second group included non-obese children (hypothalamic non-obese = HNOB group, n = 16). Exogenously obese-overweight children (OB group, n = 22) were included as controls. Basal and second-hour serum glucose and insulin in oral glucose tolerance test (OGTT), basal serum leptin, sOb-R, resistin levels, and homeostasis model assessment (HOMA) indexes were compared between the groups. Results  Age, sex, and pubertal status were similar in study groups. Median and interquartile ranges of body mass index (BMI) z scores were similar in HOB and OB groups (2.0 (1.5–2.1) and 2.1 (1.8–2.3), respectively). Serum leptin levels corrected for BMI were highest and total leptin/sOb-R ratios (free leptin index (FLI)) tended to be higher in HOB than HNOB and OB groups, indicating leptin resistance (leptin/BMI, 4.0 (1.6–5.2), 1.5 (0.8–3.1), and 2.5 (1.8–3.5); FLI, 2.0 (0.8–3.5), 0.6 (0.3–1.2), and 1.5 (1–2.3) in HOB, HNOB, and OB groups; respectively). Serum resistin levels were similar in groups (2.6 (1.9–3.1), 2.8 (1.7–3.4), and 3.0 (2.2–3.5) ng/ml in HOB, HNOB, and OB groups, respectively). Basal serum glucose, basal and second-hour insulin levels in OGTT, and HOMA index were higher in OB group than the HOB and HNOB groups, indicating insulin resistance in simple obesity; however, increment of insulin to same glycemic load in OGTT was highest in the HOB group indicating insulin dysregulation (p < 0.05). Conclusion  Hypothalamic obesity seems to be related to both dysregulated afferent (leptin) and efferent (insulin) neural outputs through the autonomic nervous system resulting in energy storage as fat. This work has been presented in part in the free communication session of ESPE 2007 meeting (Helsinki-Finland, 2007).