Thai Journal of Pediatrics

Plasma amino acid profiles by using ion-exchange chromatography in neonates from northeastern Thailand

Mon, 31 Mar 2025 00:00:00 +0700

Background: The reference values for plasma amino acids in neonates are essential for making a diagnosis of inborn errors of metabolism (IEM). However, data on plasma amino acid reference ranges for northeastern Thai neonates remain limited.

Objectives: This study aims to establish reference intervals for plasma amino acids in healthy full-term neonates from northeastern Thailand.

Methods: Healthy full-term neonates from northeastern Thailand were enrolled. Two mL of heparinized blood was collected along with newborn screening blood spots during 48-72 hours of age. Plasma amino acids were analyzed using ion-exchange chromatography with post-column ninhydrin derivatization. Due to non-normal distribution, reference intervals were determined using the non-parametric percentile method, defined by the 2.5th and 97.5th percentiles. Results were compared with previous Thai studies.

Results: There were 42 full-term newborns (median gestational age: 38 weeks), of whom 22 were male (52.4%). Plasma amino acid levels were compared with those from previous Thai studies and other reference ranges. Some amino acid levels differed from previous studies, likely due to differences in analytical methods and age groups. Greater variability was observed in non-essential amino acids. When compared to other published reference values. The plasma amino acid profiles were specific to this population.

Conclusions: The reference ranges established in this study provide valuable data for the diagnosis and management of IEMs in Thai neonates. Differences from previous studies may reflect variations in measurement techniques and age groups. These findings emphasize the importance of region-specific reference data, particularly in populations with distinct demographic and environmental factors.

Association between corrected anion gap and mortality in pediatric critical illness

Kantimas Sitthikool — Mon, 31 Mar 2025 00:00:00 +0700

Background: The predictor for mortality in pediatric intensive care units (PICU) is crucial for improving the outcomes of patients. Corrected anion gap is traditionally a biomarker and simple to perform. It has been used as a predictive factor in critically ill adult patients. However, there is a lack of data related to pediatric patients.

Objectives: To investigate the association between corrected anion gap and mortality.

Methods: This observational study was conducted among children aged between 1 month and 15 years admitted to the PICU at Queen Sirikit National Institute of Child Health. Baseline characteristics and medical comorbidities were reviewed. Laboratory variables (pH, base excess, electrolyte, albumin, anion gap, corrected anion gap, and lactate) were measured at the time of admission.

Results: A total of 235 patients with a median age of 25 months were enrolled. The mortality rate was 3.8%. Patients were divided into the survivor and non-survivor groups. Age, gender, reason for admission, and comorbidities were not different between the two groups. The non-survivor group had a significantly higher PRISM III score (p value 0.023), corrected anion gap (p value 0.009), and lactate levels (p value 0.001).
In multivariate analysis, there was no association between the corrected anion gap and mortality.

Conclusions: The corrected anion gap was higher in the non-survivor group but had no significant correlation with mortality.

A retrospective study on the impact of prenatal amphetamine exposure on child development under five years of age

Thidarat Pankaew , Jitraporn Pattamanukul — Mon, 31 Mar 2025 00:00:00 +0700

Background: Amphetamine use within families can impact various aspects of child development, especially when exposure occurs in utero. However, data on its long-term effects remain limited, necessitating further research.

Objectives: To examine the impact of maternal amphetamine use during pregnancy on early childhood development, focusing on its association with developmental delays in gross motor, fine motor, receptive language, expressive language, and personal-social skills.

Method: This retrospective study utilized medical records from Uttaradit Hospital, focusing on children registered in Uttaradit Province between October 1, 2017, and September 30, 2022. Data were collected using the Developmental Surveillance and Promotion Manual (DSPM) from the Uttaradit Health Data Center (HDC). Statistical comparisons were made using risk regression under Poisson distribution, presenting effect sizes with risk ratios across five developmental domains.

Results: A total of 8,453 infants received care at Uttaradit Hospital, with 6,860 having DSPM records in the HDC. The children were divided into two groups based on their mothers' amphetamine use history: 6,798 children whose mothers had no history of use, and 62 children whose mothers had a history of use (48 tested positive for amphetamines in urine, and 14 tested negative). Infants born to mothers with a history of amphetamine use exhibited significantly lower birth weights and developmental delays in the DSPM at 9 months. Additionally, children whose urine did not test positive for amphetamines at birth demonstrated significant developmental delays (3.31-7.33 times) across all domains compared to the group with mothers without a history of use. On the other hand, infants with positive urine tests at birth showed significant delays in fine motor skills, expressive language, and personal-social skills.

Conclusion: The study highlights that children born to mothers with a history of amphetamine use demonstrate significant developmental delays at 9 months of age, even when initial urine tests for amphetamines are negative.

The outcomes of neonatal jaundice management in Phrachomklao Hospital based on the 2004 and 2022 American Academy of Pediatrics, Clinical Practice Guidelines

Nalinporn Tattakorn — Mon, 31 Mar 2025 00:00:00 +0700

Background: Neonatal jaundice affects approximately half of all term infants. According to the American Academy of Pediatrics (AAP), the guidelines for treating neonatal jaundice were updated in 2022, prompting hospitals to implement these changes beginning January 1, 2023.

Objective: To study the outcomes of neonatal jaundice after changing the Clinical Practice Guidelines from year 2004 to year 2022

Methods: A retrospective study was condueted by revieweing the medical records of 3,000 infants born between January 1, 2022, and March 31, 2024. The participants were divided into two groups: 1,500 infants born before January 1, 2023, who received treatment according to the 2004 guidelines, and 1,500 infants born after January 1, 2023, who followed the 2022 treatment guidelines. The jaundice levels of the infants were assessed by measuring microbilirubin levels from heel prick blood tests.
Results: The duration of hospital stay of infants treated according to the 2004 guidelines (n=1,500) and the 2022 guidelines (n=1,500) were 3.4±1.3 days and 3.2±1.0 days, respectively (p value <0.01). The rate of readmission due to jaundice was consistent for both groups at 1.5% (p value 1.00). The rates of phototherapy were 18.2% and 15.3% for the group using the 2004 guidelines and the 2022 guidelines (p value 0.40). The rates of blood exchange therapy were minimal in both group (p value 1.00).

Conclusion: Implementation of the 2022 AAP guidelines, which raised bilirubin thresholds for initiating phototherapy and exchange transfusion, resulted in shorter hospital stay without increasing readmission rates or the need for intensive treatments.

Associated factors for surgical management in preterm neonate with definite necrotizing enterocolitis

Chanakan Sittisomboon, Pichaya Thanomsingh — Mon, 31 Mar 2025 00:00:00 +0700

Background: Necrotizing enterocolitis (NEC) is a devastating disease of gastrointestinal tract in premature infant. The early identification of predicting factors of NEC stage III with surgical intervention might lead to timely intervention and an improved prognosis.

Objective: To identify associated factors for predicting NEC stage III in premature infants with definite NEC.

Method: This retrospective study included 131 premature infants < 37 weeks gestation diagnosed with definite NEC at Maharat Nakhon Ratchasima Hospital between 1 January 2017 and 31 December 2021. Clinical characteristics, laboratory parameters, and clinical outcomes were collected. Multivariable logistic regression was performed to define predicting factors of NEC stage III.

Results: Of the 131 infants in this cohort, 38 infants were diagnosed with NEC stage III. The significant predicting factors of NEC stage III were the platelet count on the first day of diagnosis, with a cut-off value of < 100,000 /cu.mm. (OR 6.0, 95%CI 1.2 – 30.1), serum albumin on the first day of diagnosis, with a cut-off value of < 2.8 g/dL (OR 4.9, 95%CI 1.1 – 21.4), and APGAR score at 5 minutes < 7 (OR 8.5, 95%CI 1.1 – 69.7). The mortality rate in NEC stage III was 58%.

Conclusions: Associated factors of NEC stage III were thrombocytopenia and hypoalbuminemia on the first day of diagnosis and low APGAR score at 5 minutes.

Factors affecting the severity of hypoxic-ischemic encephalopathy in the neonatal intensive care unit

Mon, 31 Mar 2025 00:00:00 +0700

Background: Hypoxic-ischemic encephalopathy (HIE) leads to brain injury and disability in newborns. Other risk factors include fetal oxygen deprivation and intrapartum factors. Examining factors affecting the severity of HIE will help improve the effectiveness of prevention, diagnosis, and treatment methods.

Objective: This study aimed to investigate the factors that influence the HIE in neonates admitted to the neonatal intensive care unit (NICU).

Methods: A retrospective study was conducted by collecting data from medical records of newborns diagnosed with HIE and admitted to the NICU. Data were analyzed using descriptive statistics and Fisher’s exact tests. The relationships among different elements and HIE intensity were also identified.

Results: There was no statistically significant difference between the infants’ gender, mode of delivery, maternal underlying diseases, birth weight, APGAR score at 5 minutes, pulse rate at 5 minutes, and the type of ventilation. Statistically significant differences were found in infection (p value 0.003). Infants with infection and shock were more likely to develop severe HIE.

Conclusion: Infection was a major factor influencing the severity of HIE in newborns.

the The incidence rate and risk factors of healthcare-associated infections in the neonatal care unit at a tertiary care hospital in northern Thailand

Thansinee Apipornphan, Cholticha Laohajeeraphan, Suchada Ruenglerdpong — Mon, 31 Mar 2025 00:00:00 +0700

Background: Healthcare-associated infection (HAI) is a common complication in neonatal intensive care unit (NICU) which is the important cause of mortality and morbidity in neonates.

Objective: To investigate the incidence rate of HAI, risk factor associated to HAI and the bacteriological profile of micro-organisms affecting infection in NICU.

Method: A 1-year prospective cohort study collecting data in neonates admitted in NICU between August 20, 2023 and August 20, 2024.

Results: Total population in this study were 624 neonates founded HAI 107 episodes, the incidence rate of HAI was 17.2%. Risk factors associated with HAI were birth asphyxia (Apgar score at 5 min less than 7) (aHR 2.44, p value 0.03), umbilical venous catheter (UVC) insertion longer than 7 days (aHR 1.88, p value 0.04) and longer length of stay (aHR 0.97, p value 0.02). Common types of infection were primary bloodstream infection (35.5%), ventilator-associated pneumonia (22.4%) and central line-associated bloodstream infection (17.8%). Organism was not detected 55.1%. The three most common pathogens detected were Acinetobacter baumannii (24.3%), coagulase-negative staphylococcus (7.5%) and Escherichia coli (3.1%), respectively.

Conclusion: The incidence rate of HAI in neonates admitted in NICU was 17.2%.

Risk factors for hospitalization in children with pertussis in Pattani Province

Kanjanee Atthamathakul — Mon, 31 Mar 2025 00:00:00 +0700

Background: Pertussis affects people in all age groups and it is particularly severe in young children. The pertussis vaccination rate in Pattani Province had been 73%, below the national average of 88%, and continued to decline since 2022. Pertussis incidence has been on the rise since August 2023. Identifying risk factors for hospitalization in pertussis may help in improving prevention and care.

Objective: To study risk factors for hospitalization in children with pertussis.

Methods: This exploratory prognostic factor research used a retrospective design. Pediatric patients (age <15 years) diagnosed with pertussis in Pattani Province were enrolled from August 2023 to July 2024. Clinical data from hospital charts were collected and reviewed. Patients were divided into children with mild symptoms and those requiring hospitalization. Demographics, pertussis vaccination history, symptoms and pneumonia (n, %, and mean ± SD) were compared using the exact probability test and t-test. Multivariable logistic regression was used to find the risk factors, and presented with multivariable odds ratios (mOR).

Results: Of the 333 children with confirmed pertussis, 56.7% were male, with the mean age of 3.3 years old. Pneumonia was present in 17.7%, and 42% of them required hospitalization. statistically significant higher prevalence in children reguiring hospitalization included young age, fever, apneic spells, paroxysmal cough, posttusive vomiting, pneumonia, leukocytosis (white blood cell, WBC >25,000 cells/cu.mm.), lymphocytosis (lymphocyte >60%) and thrombocytosis (platelet count >450,000/cu.mm.). Multivariable analysis identified risk factors for hospitalization in children with pertussis included fever, paroxysmal cough, pneumonia, lymphocytosis and thrombocytosis.

Conclusions: Children who had fever, pneumonia, lymphocytosis and thrombocytosis were at higher risk for severe symptoms requiring hospitalization.

Prognostic factors associated with dengue shock syndrome in dengue hemorrhagic fever in pediatric patients, Mukdahan Hospital

Suweena Suporn — Mon, 31 Mar 2025 00:00:00 +0700

Background: Dengue hemorrhagic fever (DHF) is an important disease, including diagnosis and treatment. Knowing the prognostic factors associated with dengue shock syndrome (DSS) in dengue hemorrhagic fever in pediatric patients will help in monitoring and treatment more effectively.

Objective: To determine clinical characteristics and the prognostic factors associated with dengue shock syndrome in dengue hemorrhagic fever in pediatric patients.

Method: A retrospective observational study using a prognostic factor research approach was conducted in a pediatric ward, Mukdahan Hospital. Patients aged 1 month to 15 years with a diagnosis of dengue hemorrhagic fever were enrolled between 1 October 2016 to 31 May 2024. Chi-square test and multivariate logistic regression were used to identify prognostic factors associated with dengue shock syndrome.

Result: A total of 120 patients were enrolled in this study and 34 patients (28.3%) were diagnosed with dengue shock syndrome. The most common age group was 10-13 years old (46.7%). The three most common presenting symptoms were fever (100.0 %), nausea (35.0%) and vomiting (34.2%). On multivariate analysis, the significant factors associated with dengue shock syndrome were nutrition status (risk ratio [RR] 11.8, 95% CI 1.4-103.6, p value 0.03), bleeding per gum (RR 16.7, 95% CI 1.2-233.8, p value 0.04) and pleural effusion (RR 14.9, 95% CI 2.2 -101.1, p value 0.01).

Conclusion: Pediatric patients with dengue hemorrhagic fever should be closely monitored during treatment, especially those with abnormal nutrition status, bleeding per gum and pleural effusion.

Factors associated with mortality in children with severe pneumonia and acute respiratory failure in Pattani province: A retrospective case-control study

Suparat Promsalee — Mon, 31 Mar 2025 00:00:00 +0700

Background: Pneumonia is the leading global cause of death among children under five years old. In Pattani province, Thailand, pneumonia is also a leading cause of pediatric respiratory failure and carries the highest mortality rate within the region. Identifying risk factors for mortality is crucial for improving prevention, diagnosis, and treatment.

Objective: This study aimed to determine factors associated with mortality in children with severe pneumonia and acute respiratory failure in Pattani province.

Methods: We conducted a retrospective case–control study of children aged 1 month to 15 years who were admitted with severe pneumonia and acute respiratory failure from January 1, 2020 to December 31, 2023. We classified patients into two groups: those who died (n = 10) and those who survived (n = 60). Data were extracted from medical records and referral forms. We used an exact probability tests and generalized linear models to estimate the risk difference [RD] with 95% confidence interval [CI].

Results: Among the 70 children hospitalized with severe pneumonia and acute respiratory failure, 10 (14.3%) died. In multivariable analysis, the following risk factors were significantly associated with mortality: congenital heart disease (RD 0.39, 95% CI 0.054–0.734), respiratory acidosis (venous blood gas pH < 7.3) on admission (RD 0.24, 95% CI 0.044–0.439), and hypercapnia (pCO2 > 50 mmHg) on admission (RD 0.44, 95% CI 0.071–0.810).

Conclusion: Congenital heart disease, respiratory acidosis, and hypercapnia at presentation were independent risk factors for mortality among children with severe pneumonia and acute respiratory failure. Close monitoring and early intervention for these high-risk patients are essential to reduce mortality.

Efficacy of deferasirox in pediatric patients with transfusion-dependent thalassemia: Single- center 2 year experience.

Rujeerat Kosonsasitorn — Mon, 31 Mar 2025 00:00:00 +0700

Background: Children with thalassemia, dependent on regular blood transfusions, often have high serum ferritin levels due to the frequent transfusions, which can lead to long-term organ damage. Iron chelation therapy is necessary to reduce iron levels in the body. Lamphun Hospital has been supported with deferasirox from the National Health Security Project since 2018, but no studies have been conducted on the drug’s effectiveness.

Objectives: To evaluate the effectiveness of deferasirox in reducing serum ferritin and the changes in serum ferritin levels in patients who had previously received other types of iron chelation drugs, compared with patients who received deferasirox as the first iron chelation therapy.

Methods: This retrospective study collected data from thalassemia patients, dependent on blood transfusions, at Lamphun Hospital, with serum ferritin levels greater than 1000 ng/mL, who had received deferasirox for 2 years. A total of 37 patients were included, with dosage and serum ferritin levels measured every 3 months, along with monitoring of adverse effects from the medication.

Results: After 12 and 24 months of receiving deferasirox, the serum ferritin levels in all patients did not significantly differ from baseline (p values 0.962 and 0.724, respectively). In patients who had previously received other iron chelation drugs, the serum ferritin levels did not differ significantly from baseline (p values 0.501 and 0.686, respectively). Similarly, patients receiving deferasirox for the first time showed no significant difference in serum ferritin levels from baseline (p values 0.301 and 0.936, respectively). The most common adverse effect was transaminitis.

Conclusion: Deferasirox is effective in maintaining serum ferritin levels without increasing them during the first 24 months of use in pediatric thalassemia patients dependent on regular blood transfusions.

Mortality in pediatric acute lymphoblastic leukemia in induction phase of chemotherapy at Hatyai Hospital

Najwa ํีYudhasompop, Nischanan Panichnantho — Mon, 31 Mar 2025 00:00:00 +0700

Background: Acute lymphoblastic leukemia is the most common cancer in children, accounting for 40 percent of Thai pediatric cancers. The overall 5-year survival rate has risen due to the use of intensive chemotherapy. The mortality rate is highest during the induction phase of chemotherapy.

Objective: To study the mortality rate and factors influencing mortality in induction phase of chemotherapy pediatric acute lymphoblastic leukemia patients at Hatyai Hospital.

Method: We performed a retrospective study, collecting data from the Hatyai Hospital database between August 2011 to April 2021. Patients aged under 15 years old who were newly diagnosed with acute lymphoblastic leukemia and treated with the Thai-POG chemotherapy protocols at Hatyai Hospital were included. The mortality rate, cause of death, and the factors associated with mortality during induction phase of chemotherapy were analyzed.

Results: A total of 197 patients were included in this study and 55% of them were male. The most common age range was 4-10 years old (43.7%).Common presentations were fever (79.2%), hepatomegaly (74.6%), lymphadenopathy (62.4%), splenomegaly (59.4%), and anemia (25.9%), respectively. The induction phase mortality rate was 14.7%, and infection was the most common cause of death (79.3%). Risk factors found to increase mortality during the induction phase included thrombocytopenia ≤ 20,000/cu.mm. increased risk by 3.65 times compared with patient platelet >20,000 (95% CI 1.15-11.60, p value 0.028), Invasive aspergillosis infection increased risk by 64.1 times compared with patients without invasive aspergillosis (95% CI 6.24-657.96, p value 0.001). Sepsis increased risk by 32.0 times compared with patient without sepsis (95% CI 7.77-132.17, p value 0.001)

Conclusion: The induction phase mortality rate was 14.7%, and the major cause of death was infection. Thrombocytopenia ≤ 20,000/cu.mm., invasive aspergillosis infection, and sepsis increased the risk of mortality in induction phase of chemotherapy in pediatric acute lymphoblastic leukemia patients at Hatyai Hospital.

Assessing caregiver knowledge of foreign body aspiration in children: A pre-post video education intervention study

Suthasinee Laosakchai, Paweena Wijakprasert — Mon, 31 Mar 2025 00:00:00 +0700

Background: Foreign body aspiration (FBA) in young children is a life-threatening event that can lead to death. Implementing educational programs for caregivers is one method to prevent FBA in children.

Objective: To assess caregivers’ knowledge by administering tests before and after watching a video about FBA in children.

Methods: A quasi experimental research enrolled parents or caregiver of children aged 6 months to 5 years who visited at well child clinic of the Maharat Nakhon Ratchasima hospital. Participants were requested to complete a 36-item test about FBA in children before and after watching the video media providing the knowledge of FBA in children. The scores before (pre-score) and after (post-score) watching the video, as well as the difference between pre-and post-scores (diff-score), were evaluated. Associated factors with the pre-score were identified.

Results: Fifty participants were included in this study. After watching the video media, the scores increased in 90% of participants. The mean post-score significantly improved compared to the pre-score (32.14 ± 2.19 and 25.86 ± 3.88, respectively; p <0.001). Multivariate regression analysis was conducted, revealing no statistically significant association between factors and the pre-score.

Conclusion: Utilizing an educational program on FBA in children through video media can enhance caregivers' knowledge.

Risk factors of first diabetes ketoacidosis in children and adolescents with type 1 diabetes

Lerlak Witthayapraphakorn — Mon, 31 Mar 2025 00:00:00 +0700

Background: Diabetes ketoacidosis (DKA) is a life-threatening complication of type 1 diabetes (T1D).

Objectives: To study risk factors of first diabetes ketoacidosis after diagnosis in children and adolescents with T1D

Methods: Retrospective cohort study was conducted in children and adolescents, aged 1-20 years, with T1D who received care at diabetes clinic from 1 January 2014 to 31 October 2024. The data were retrieved from medical records. Kaplan-Meier curve and log rank test were used to compare time to develop DKA. Multivariate cox proportional hazard model was used to identify risk factors of first DKA.

Results: A total of 120 patients are included in this study. Fifty-nine patients (49.2%) developed DKA during care. BMI z-score (AHR 0.52, 95%CI: 0.35, 0.78), HbA1c (AHR 1.21, 95%CI: 1.04, 1.41), basal bolus vs conventional/modified regimen (AHR 0.33, 95%CI: 0.15, 0.70) and regular vs non regular follow up (AHR 0.42, 95%CI: 0.18, 0.96) were significant risk factors of first DKA in T1D. Overall median time to DKA was 39 months (95%CI: 30.0, 44.5). The cumulative 1 and 3 years survival rates were 84.1 % and 74.5%, respectively. The rate of DKA-free survival within 3 years for patients with HbA1c ≤ 9% and HbA1c > 9% were 97.3% (95% CI: 92.2, 100) and 65.4% (95% CI: 55.8, 76.7), respectively. The difference between these groups was statistically significant (p value <0.001)

Conclusion: Low BMI z-score, high HbA1c level, conventional/modified regimens and lack of follow-up were significant risk factors for the first episode of DKA after diagnosis in T1D. To prevent DKA event, basal bolus regimen, regular follow up and monitoring HbA1c frequently were recommended including closed observe in patient with low BMI z-score and high HbA1c.