Diarrhoea and malnutrition

The relationship between diarrhoea and malnutrition is bidirectional: diarrhoea leads to malnutrition while malnutrition aggravates the course of diarrhoea. Many factors contribute to the detrimental effect of diarrhoea on nutrition. Reduced intake (due to anorexia, vomiting, and withholding of feeds), maldigestion, malabsorption, increased nutrient losses, and the effects of the inflammatory response are some of the factors involved. High volume stool losses (greater than 30 ml/kg/day) are associated with a negative balance for protein, fat, and sugar absorption. Enteric infections often cause increased loss of endogenous proteins, particularly after invasive bacterial infections. Initially, the major emphasis of treatment of acute diarrhoea in children is the prevention and treatment of dehydration, electrolyte abnormalities and comorbid conditions. The objectives of diarrhoeal disease management are to prevent weight loss, to encourage catch-up growth during recovery, to shorten the duration and to decrease the impact of the diarrhoea on the child's health. Addressing only diarrhoea or only food security is unlikely to be successful in decreasing the prevalence of malnutrition. Existing evidence provides some guidelines as to the optimal nutritional management of children with diarrhoea and novel treatments may prove to be valuable in future.Short Surve

Tuberculosis presenting as cholestatic jaundice in early infancy

[No abstract available]Articl

Diagnosis of haemodynamically significant patent ductus arteriosus in neonates - Is the ECG of diagnostic help?

The presence of a haemodynamically significant patent ductus arteriosus (PDA) in the premature newborn may contribute to the development of bronchopulmonary dysplasia, intraventricular haemorrhage and necrotising enterocolitis. It is therefore essential that the diagnosis of such a PDA be made in time in order to intervene medically or surgically. Echocardiography is at present the prime diagnostic tool, but is mainly available in tertiary hospitals. Chest roentgenography is of little diagnostic value especially in the presence of respiratory disease, which is often present in premature babies. Very little is known about the diagnostic value of the electrocardiogram (ECG) in premature babies. The aim of this study was to describe the standard 12-lead ECG findings in low-birth-weight babies with haemodynamically significant PDAs. Thirty-two babies with haemodynamically significant PDAs, as established by echocardiography, were included in the study. Standard 12-lead ECGs were done in all these babies. In 15 patients ECG abnormalities were found; only 22% had left atrial and left ventricular enlargement indicative of significant left-to-right shunting, while 78% had no ECG changes indicative of left-to-right shunting. In conclusion, the ECG cannot be used to identify haemodynamically significant PDAs.Articl

Factors influencing successful closure with indomethacin of the patent ductus arteriosus in premature infants

The incidence of persistent patency of the ductus arteriosus (PDA) is inversely related to birth weight. APDA contributes to pathological conditions in the neonate and timely closure in these low-birth-weight infants could potentially prevent these complications. Prostaglandin inhibition with indomethacin is one treatment strategy currently available. This retrospective descriptive study evaluated the parameters that influenced the effectiveness of indomethacin in closure of the PDA in 101 consecutive premature infants and the adverse effects of indomethacin in these infants. Independent variables found to increase the risk of unsuccessful closure with indomethacin significantly were caesarean section, lower haematocrit at delivery and severity of hyaline membrane disease, Non-closure also resulted in prolonged ventilation. No significant adverse effects were recorded in the infants who received indomethacin but neonatal jaundice was more common in those infants who responded to indomethacin.Articl

Bone mineral density in long-term survivors of childhood cancer

Bone mineral density (BMD) of the lumbar spine was measured in 97 long-term survivors of childhood cancer 5-23 years after diagnosis using dual-energy X-ray absorptiometry (DXA). They had been treated for acute leukemia (n = 22), brain tumors (n = 16), lymphomas (n = 16), Wilms' tumor (n = 10), neuroblastoma (n = 7) and other cancers (n = 26). The correlations between BMD and the Z-scores for weight for height, height for age and weight for age at diagnosis and follow-up were evaluated with stepwise multiple regression. Correlations with cumulative corticosteroid and radiation dose were examined with Spearman's correlation coefficient. The number and nature of fractures were noted. A BMD Z-score of below -2 was present in 13 and a BMD Z-score of - I to -2 in 31 children. In total, a low BMD was observed in 45% of children. Height for age at follow-up correlated significantly with BMD Z-score. Increasing doses of cranial irradiation (18-54 Gy) were associated with lower BMD (p = 0.001, Spearman). This was true also for 22 children with acute lymphoblastic leukemia (ALL) who had received 18-24 Gy cranial irradiation (p = 0.04, Spearman). Fractures occurred in 14 children following trauma. The difference in BMD Z-scores of children with and without fractures did not achieve statistical significance although the majority of the children with fractures had low BMD Z-scores. The significant inverse correlation between height for age at follow-up and BMD must be interpreted with the realization that DXA is not a volumetric measurement of BMD and that short stature is associated with a smaller skeletal mass. © 1998 Wiley-Liss, Inc.Articl

Common opportunistic infections in HIV infected infants and children. Part 2: Non-respiratory infections

Increased susceptibility to infections is the major cause of disease, end organ damage and death in human immunodeficiency virus (HIV)-infected children. This article will focus on prevention, diagnosis and management of the most common and less common severe infections that are specifically associated with HIV-related immune compromise, as well as some aspects relating to immune reconstitution inflammatory syndrome (IRIS).Revie

Pulmonary tuberculosis in children with rheumatic carditis

Rheumatic carditis is the commonest acquired heart lesion in children in South Africa, and tuberculosis is one of the major health problems in the Western Cape. This study determined that children with rheumatic fever have an approximate nine times increased risk of developing pulmonary tuberculosis. The reasons for this are unclear, but these findings emphasise the need for health personnel managing children with rheumatic carditis to have a high index of suspicion of pulmonary tuberculosis.Articl

Adenylate kinase activity in the cerebrospinal fluid of children with tuberculous meningitis and its relationship to neurological outcome

Cerebrospinal fluid (CSF) adenylate kinase activity was determined in 88 children (mean age 32.6 months) at stage II (n = 40) and stage III (n = 48) tuberculous meningitis (TBM) at, or shortly after, the initiation of treatment, and at weekly intervals thereafter for the first month of treatment, and in 60 children (mean age 40 months) investigated for, but later considered not to have meningitis. CSF adenylate kinase activity in this latter group ranged from 0 to 1.27 u/l (mean 0.59 u/l). Mean CSF adenylate kinase activity during the first week of therapy in children at stage II TBM (2.95 u/l; range 0-9.22 u/l) differed significantly (p = 0.03) from that in children at stage III TBM (5.62 u/l; range 0-18.93 u/l). CSF adenylate kinase activity did not differ between children at stage II and stage III TBM during any of the 3 subsequent weeks. CSF adenylate kinase activity was not related to CSF cell count, total protein or glucose concentration or intracranial pressure at any point during the first month of treatment, but was related to CSF lactate during the first week of therapy (p = 0.001). Consecutive determinations of CSF adenylate kinase activity were available in 34 children. Although CSF adenylate kinase activity tended to increase or decrease in keeping with changes in clinical condition this was not always the case. The close relationship of CSF adenylate kinase activity and lactate concentrations suggests that adenylate kinase activity reflects hypoxic cerebral metabolism and it was unusual for children with increased CSF adenylate kinase activity at the time of diagnosis to be clinically normal on completion of 6 months of antituberculosis treatment. Any treatment modality which significantly reduced CSF adenylate kinase activity in children early in the course of TBM would probably be of clinical benefit to the patients.Articl

Bronchopulmonary dysplasia in infants with respiratory distress syndrome in a developing country: A prospective single centre-based study

The aim of this prospective study was to determine the incidence of bronchopulmonary dysplasia (BPD) in and the outcome of neonates ventilated for respiratory distress syndrome (RDS). The study was conducted in a developing country prior to the use of surfactant replacement therapy and the results are compared to published reports from the developed world. BPD was defined as oxygen dependency beyond day 28 of life. The incidence of BPD over a 9-month-period was 8.2% of all neonates requiring ventilation (n = 169) and 41% (n = 38) of neonates ventilated for RDS (n = 92). Of those neonates who developed BPD, 26% were still being ventilated on day 28. Of the infants, 21 (55%) developed type 1 BPD and 17 (45%) type 2 BPD. There was no statistical difference in the severity of lung disease on any of the study days between type 1 and type 2 BPD although neonates with type 2 BPD required assisted ventilation and supplemental oxygen for a longer period: 30 versus 12 days and 95 versus 49 days, respectively. Of those neonates who developed BPD, 8 (21%) died prior to discharge from hospital and a further 5 infants (17%) died subsequent to discharge. Of the latter five, three died from treatable causes (gastroenteritis n = 2, pneumonia n = 1). Of the 25 (83%) children seen at follow up, 68% were developing normally, 20% were classified as having suspect development and 12% had developed cerebral palsy at corrected postnatal ages of 12-24 months. None of the results differed significantly from those of neonates being ventilated in the developed world, except for the causes of post-discharge deaths. Conclusion. Health services providing ventilation for neonates in the developing world will have to take the needs of children with BPD into account when planning a neonatal service which should include among others a widely available and easily accessible primary health care system.Articl

A prospective evaluation of children under the age of 5 years living in the same household as adults with recently diagnosed pulmonary tuberculosis

SETTING: A South African suburb with a high tuberculosis incidence (>800/100 000). OBJECTIVE: To determine the prevalence of tuberculosis infection and disease in children less than 5 years of age who were in close household contact with adults with pulmonary tuberculosis. DESIGN : Prospective clinical study. SUBJECTS: Children under 5 years of age (of whom >98% had been BCG vaccinated in the neonatal period) in household contact with an adult with tuberculosis. INVESTIGATION: Clinical investigation, Mantoux skin testing, chest radiography, gastric aspirate culture for Mycobacterium tuberculosis. RESULTS: Of 155 children younger than 5 years in contact with 80 index cases (83% smear positive), 14% were infected and 34% diseased. Children aged under 2 years had more severe disease (endobronchial tuberculosis and bronchial compression). Of 154 household members aged over 5 years who were assessed, 17 had culture proven pulmonary tuberculosis (13 smear positive) and a further 16 were placed on antituberculosis treatment on the basis of radiological evidence. CONCLUSION: In a high tuberculosis incidence area evaluation of and chemoprophylaxis for childhood contacts of adults with pulmonary tuberculosis is a rewarding procedure. The detection of culture and smear positive pulmonary tuberculosis amongst adolescent and adult household contacts emphasizes the role of contact tracing in the detection of infectious cases of pulmonary tuberculosis and the prevention of the spread of tuberculosis.Articl