Thai Journal of Pediatrics

Communication strategies on infectious disease outbreaks in early childhood centers to alleviate parental concerns and reduce conflicts with teachers

Piyanun Kosidapun, Phaijittree Chandejrattana, Kaewta Nopmaneejumruslers — Tue, 30 Sep 2025 00:00:00 +0700

Advancements in medical technology have significantly improved the accuracy of pathogen identification, leading to increased public awareness of infectious diseases, particularly following the COVID-19 pandemic. Merely recognizing an infection as viral is no longer sufficient; the public now demands precise information regarding the specific pathogen, disease severity, and appropriate preventive measures. This article presents communication strategies and techniques that pediatricians can utilize to educate and guide teachers in effectively engaging with parents. These strategies aim to alleviate anxiety, reduce panic, and prevent conflicts. Key components include building trust, fostering two-way communication, engaging in meaningful conversations, mastering the art of active listening, utilizing techniques to facilitate communication, and employing nonverbal communication. Implementing these approaches can enhance mutual understanding between teachers and parents, ensuring smoother interactions and minimizing potential conflicts. Beyond communication techniques, teachers should possess a fundamental understanding of infectious diseases, outbreaks, and preventive strategies to accurately and confidently convey relevant information to parents. Strengthening their knowledge in these areas ensures that information is communicated with clarity and reliability, ultimately fostering a more informed and cooperative school environment.

Effects of surfactant therapy on the incidence of ventilator-associated pneumonia in neonatal intensive care unit

Sarinya Thangsittichok — Tue, 30 Sep 2025 00:00:00 +0700

Background: Ventilator-associated pneumonia (VAP) is a significant complication in neonates requiring invasive mechanical ventilation, leading to increased morbidity and mortality. Surfactant therapy is commonly used to manage respiratory distress syndrome (RDS) in neonates, but its impact on VAP incidence remains unclear.

Objective: To evaluate whether surfactant administration results in a reduced incidence of VAP in neonates requiring invasive mechanical ventilation.

Methods: A retrospective study was conducted at Phichit Hospital, including neonates who had been on invasive mechanical ventilator in the neonatal intensive care unit (NICU) between September 1, 2012 and September 30, 2021. Infants were divided into two groups: Those who received surfactant therapy and those who did not. Data on demographics, clinical characteristics, and outcomes were collected and analyzed.

Results: A total of 132 neonates were enrolled in this study, with 66 allocated to each group. The surfactant group had a significantly lower incidence of VAP (27.3%) compared to the non-surfactant group (54.6%) (p value 0.002). Additionally, the surfactant group had a shorter duration of mechanical ventilation (6 days vs. 8 days, p value 0.023). There was no significant difference in the duration of NICU stay or mortality rates between the two groups.

Conclusion: Surfactant therapy was associated with a reduced incidence of VAP in neonates requiring invasive mechanical ventilation. These findings suggested that surfactant therapy might have additional benefits beyond treating RDS, potentially reducing the risk of VAP in this vulnerable population.

Analysis of cholestasis infants with low to normal gamma-glutamyl transferase level

Busara Charoenwat , Khuntol Wichajarn, Kanokwan Imtawil — Tue, 30 Sep 2025 00:00:00 +0700

Background: Neonatal cholestatic jaundice with low to normal gamma-glutamyl transferase (GGT) is infrequent but clinically significant and associated with a wide spectrum of genetic diseases, including progressive familial intrahepatic cholestasis (PFIC). Among these, mutations in the ABCB11 gene are a prominent etiology, as encodes the bile salt export pump (BSEP) are a prominent etiology.

Objective: To investigate the ABCB11 mutations in neonatal cholestatic jaundice with low to normal GGT levels.

Methods: A prospective study was conducted from 2017 to 2021 at Srinagarind Hospital, Khon Kaen, Thailand. Six neonates with cholestasis and low to normal GGT were enrolled. After exclusion of infectious, surgical, and syndromic causes. Urine bile acid analysis was performed to exclude bile acid synthesis defects. DNA was extracted and sequenced in all 28 exons of the ABCB11 gene using next-generation sequencing.

Results: All 6 patients revealed biochemical evidence of cholestasis and liver histological features of hepatocellular injury. No pathogenic mutations were identified in the ABCB11 gene; only benign variants and variants of uncertain significance (VUS) were detected.

Conclusion: The undetectable of pathogenic ABCB11 mutations highlights the need for expanded genomic analysis and functional testing.

Diagnostic yield of neuromuscular gene panel in pediatric patients with congenital neuromuscular disorders in provincial hospitals

Tue, 30 Sep 2025 00:00:00 +0700

Background: Congenital neuromuscular disorders are a major cause of impaired muscle function in children. In provincial hospitals, access to diagnostic investigations is limited, particularly in access to specialized investigations such as muscle biopsy. Recently, the implementation of gene panel testing can improve diagnostic accuracy and ensure appropriate treatment for affected patients.

Objectives: To study diagnostic yield of neuromuscular gene panel in pediatric patients with congenitalneuromuscular disorders in provincial hospitals.

Methods: This prospective study involved pediatric patients with suspected congenital neuromuscular disorders, initially assessed by pediatric neurologists at provincial hospitals between April 1, 2022, and March 31, 2024. Genetic testing available domestically was performed based on clinical presentation included multiplex ligation-dependent probe amplification (MLPA) for duchenne muscular dystrophy (DMD), SMN gene, and CMT1A and HNPP. After normal results from these initial tests, patients received genetic counseling and were referred for further blood testing using a targeted gene panel comprising 211 genes associated with neuromuscular disorders. Collected data were analyzed using descriptive statistics.

Results: Six patients participated in the research, 67% were male. The youngest patient was 10 months old and the oldest was 14 years and 4 months. The mean age of symptom onset was 2 years and 3 months (± 27 months). One patient had a family history of muscle weakness. Pathogenic variants in the DMD gene were identified in two patients, both of whom were diagnosed with Duchenne muscular dystrophy. One patient was found to have a variant in the GAA gene; however, subsequent GAA enzyme assay revealed no abnormality, and a definitive diagnosis could not be established. Three patients were found to have variants of uncertain significance. Therefore, the diagnostic yield of targeted gene panel testing for congenital neuromuscular disorders in this study was 33%.

Conclusion: Targeted gene panel testing for neuromuscular disorders is beneficial in facilitating diagnosis of congenital neuromuscular conditions in pediatric patients from provincial hospitals. This approach reduces the need for invasive procedures and enhances diagnostic and treatment opportunities for children in rural area.

Factors associated with recurrent febrile seizures in pediatric patients after first febrile seizure at Lampang Hospital

Kannikar Srisuwan, Anavat Bupphachareonsuk, Chanoknan Son-oun — Tue, 30 Sep 2025 00:00:00 +0700

Background: Febrile seizure is the most common neurological condition in children. Children experiencing their first febrile seizure have approximately a thirty percent chance of having recurrent febrile seizures. Lampang Hospital encounters a large number of pediatric patients with febrile seizures and recurrent episodes requiring hospital treatment. Therefore, febrile seizures are a significant problem to identify associated risk factors and prevent from their recurrence.

Objective: To study the factors associated with recurrent febrile seizures and the prevalence of recurrent febrile seizures after the first febrile seizure episode in pediatric patients at Lampang Hospital.

Methods: A retrospective cohort study was conducted by reviewing the medical records of pediatric patients diagnosed with first febrile seizure between October 2016 and September 2020.

Results: A total of 331 pediatric patients were diagnosed with first febrile seizure. Of these, 198 were male (59%). The average age of patients at the time of their first febrile seizure was 20.8±10.2 months. Fifty-nine patients (17.8%) experienced a complex febrile seizure in their first episode. A family history of febrile seizures was reported in 24.2%, and a family history of epilepsy in 0.9%. The most common cause of the first febrile seizure was upper respiratory tract infection (39.5%). Recurrent febrile seizures occurred in 80 patients (24.2%). The majority of recurrences (70%) occurred within the first year after the first febrile seizure. Factors associated with recurrent febrile seizures in pediatric patients at Lampang Hospital included age at onset less than 18 months, a history of premature birth, and a family history of febrile seizures. These factors increased the risk of recurrent febrile seizures by 2.05, 2.08, and 1.80 times, respectively, compared to children without these factors.

Conclusion: Factors associated with recurrent febrile seizures after the first febrile seizure in pediatric patients at Lampang Hospital included age at onset less than 18 months, a history of premature birth, and a family history of febrile seizure.

Knowledge, attitudes, and practices of caregivers regarding febrile seizures in children in Pathum Thani Hospital

Satita Jeamsripong — Tue, 30 Sep 2025 00:00:00 +0700

Background: Febrile seizures are common in children aged 6 months to 5 years. Although generally benign, they often cause anxiety among caregivers due to misconceptions, such as fears of brain damage, developmental delay, or increased epilepsy risk. Inappropriate first aid during seizures may also lead to injury.

Objective: To assess caregivers’ knowledge, attitudes, and practices (KAP) regarding febrile seizures and identify associated factors related to KAP.

Methods: A descriptive, prospective study was conducted at Pathum Thani Hospital from September 2024 to April 2025. A total of 478 caregivers of pediatric patients completed a 32-item KAP questionnaire of febrile seizures.

Results: Among the participants, 83.7% were female and 72.4% were mothers. Most had completed secondary education (51.9%) and had low income (78.0%). Overall, 59.6% had low knowledge scores (<70%). Common misconceptions included inserting objects into the mouth during seizures (46.5%), risk of permanent damage or death (72.6%), and increased epilepsy risk (68.7%). Most caregivers (89.2%) felt anxious and unsure how to respond during seizures. However, many reported correct practices such as staying calm (87.8%), tepid sponging (85.7%), and bringing the child to hospital promptly (97.2%). Logistic regression analysis identified significant associations between higher caregivers’ knowledge and the following factors: child’s birth order ≥4, diagnosis of febrile seizures, a family history of febrile seizures, and education (voc. cert., high voc. cert., and bachelor’s degree). Factors influencing attitudes included child’s age ≥5 years, seizure history (1-3 times), and bachelor’s degree. Factors influencing practices included diagnosis of febrile seizure. Good knowledge was significantly associated with a positive attitude (OR_adjusted = 4.6) and appropriate practices (OR_adjusted = 2.1)

Conclusion: Most caregivers had inadequate knowledge and some misconceptions about febrile seizures. Educational interventions are needed to improve understanding, reduce anxiety, and promote appropriate management.

Clinical characteristic of severe neonatal anemia caused by hereditary pyropoikilocytosis

Sumonmaln Klamchuen — Tue, 30 Sep 2025 00:00:00 +0700

Background: This study investigates clinical characteristics of hereditary pyropoikilocytosis (HPP), which causes severe neonatal anemia in patients treated at Sunpasitthiprasong Hospital.

Objectives: To study the clinical features of HPP, which leads to severe anemia in neonates, including diagnosis timeline, mutation types, disease progression, and treatment outcomes, in order to improve diagnostic and treatment strategies.

Method: This descriptive study involved a retrospective review of clinical data from patient records between January 2014 and December 2023.

Results: Of 14 patients, 5 males and 9 females, 64% were preterm. The average birth weight was 1,997 grams. The most common mutation found was homozygous SPTB Buffalo, the SPTB Chiang Mai mutation was not detected. Clinical symptoms included an average hemoglobin level at birth of 5.2 g/dL, neonatal jaundice (100%), hydrops fetalis (7.1%), and respiratory failure occurred in 71.4% of the cases. Among the patients who were diagnosed prenatally and received umbilical cord blood transfusion, 1 out of 3 (33.3%) developed respiratory failure. In contrast, among those who were not diagnosed prenatally and did not receive umbilical cord blood transfusion, 9 out of 11 (81.8%) experienced respiratory failure, persistent pulmonary hypertension of the newborn (35.7%), and hypotension (35.7%). Treatment strategies included fetal transfusion (21.4%), RBC transfusion (100%), phototherapy (100%), exchange transfusion (64.3%) and intubation (71.4%). One patient (7.1%) died from pneumothorax. Of the remaining 13 patients, all had chronic transfusion-dependent anemia, iron overload, hepatosplenomegaly, and cardiomegaly while 84.6% had a weight and height below the age-adjusted average. Other treatments included splenectomy due to hypersplenism in 2 patients (15.4%) and stem cell transplantation in 1 patient (7.7%), which resulted in a cure.

Conclusion: The progression of HPP leads to severe anemia in utero or at birth and can result in death due to respiratory failure. In survivors, regular blood transfusions and iron chelation therapy are necessary. Stem cell transplantation can provide a cure. Prenatal diagnosis and fetal blood transfusion can help reduce the severity of the disease in newborns.

Factors associated with the severity of RSV-induced lower respiratory tract infections in children at Phrachomklao Hospital, Phetchaburi

Nalinporn Tattakorn — Tue, 30 Sep 2025 00:00:00 +0700

Background: Respiratory syncytial virus (RSV) is the leading cause of lower respiratory tract infection (LRTI) and hospitalization in young children, with various severities such as bronchiolitis and respiratory failure.

Objective: To identify factors associated with severe RSV‑associated LRTI (RSV‑LRTI) among hospitalized children aged 0–59 months.

Methods: We conducted a retrospective study of children aged 0–59 months hospitalized with laboratory‑confirmed RSV‑LRTI (bronchiolitis or pneumonia) at Phrachomklao Hospital, Phetchaburi, from 1 July 2022 to 31 October 2024. Severe disease was defined as any of: Admission to the pediatric intensive care unit (PICU) and/or need for high‑flow nasal cannula (HFNC), non‑invasive ventilation, or endotracheal intubation. Data were collected from electronic medical records. Associations were assessed by using logistic regression and presented as odds ratios (ORs) with 95% confidence intervals (CIs).

Results: Of 723 RSV‑positive children, 631 had LRTI, 286 were hospitalized, and 220 met inclusion criteria for analysis. Severe disease occurred in 55/220 (25.0%); 44 (24.5%) required HFNC and 11 (5.0%) were intubated; no in‑hospital deaths occurred. Nearly half were <12 months old (103/220, 46.8%); boys constituted 116/220 (52.7%). In crude analyses, asthma remained independently associated with severity (OR 15.5; 95% CI 3.84–62.65; p<0.001); other evaluated factors were not significant.

Conclusion: One of four hospitalized children with RSV‑LRTI had severe disease. Asthma identified a high‑risk subgroup that may benefit from closer monitoring and earlier escalation of respiratory support.

Clinical outcomes of using high-flow nasal cannula (HFNC) in pediatric patients with acute respiratory distress: A retrospective study.

์Nantanit Wongsawat, Nisarat Sumre — Tue, 30 Sep 2025 00:00:00 +0700

Background: Respiratory distress is an emergency event that requires immediate diagnosis and treatment. Ahigh-flow nasal cannula (HFNC) is widely used as an alternative method for a noninvasive respiratory support. Satun Hospital started implementing HFNC in the pediatric department in 2017.

Objectives: This study aimed to evaluate the outcomes of HFNC in treating respiratory distress in pediatric patients.

Methods: This retrospective study collected data from pediatric patients aged one month to 15 years old who were admitted to the hospital between January 1, 2022 and December 31, 2024. Patients with respiratory distress by WHO criteria receiving treatment with HFNC were included for chart reviews. A total 304 pediatric patients were included. They were devided into 2 groups, those succeeded from HFNC treatment (success group) and those developed respiratory failure (failure group). Fisher's exact test was used to evaluate the differences between the 2 groups. Factors associated with failure were analyzed using logistic regression. p value < 0.05 was considered statistically significant.

Results: The success rate of HFNC treatment in pediatric patients with respiratory distress in 2022-2024 was 93.6% (284 of 304 events). The majority of pediatric patients aged 1-15 years (66.8%). The most common cause of respiratory distress was pneumonia (44.4%). The median length of hospital stay was 5 days. The mean duration of HFNC was 44.5 hours. It was found that after HFNC treatment, the respiratory rate was reduced and the heart rate decreased (p value < 0.001) and the oxygen saturation value increased (p value 0.02). The factors affecting the failure of HFNC treatment were age < 1 year (p value < 0.001), the cause of hospitalization was sepsis-related (p value < 0.001) and congestive heart failure (p value 0.008). The factors affecting the success of HFNC use were asthma (p value 0.08) and hospitalization with the main disease being exacerbation of asthma (p value 0.012).

Conclusion: HFNC treatment in children with respiratory distress had good efficacy. Consideration of early treatment of respiratory distress with HFNC could reduce the chance of intubation and can reduce clinical symptoms.

Prevalence and associated factors of feeding difficulties in typically developing preschool children in Sunprasitthiprasong Hospital

์Nawarat Aroonyadech — Tue, 30 Sep 2025 00:00:00 +0700

Background: Feeding difficulties in early childhood are common and can adversely affect growth, nutrition, and long-term health. Despite global data, local epidemiological evidence in Thailand particularly among typically developing preschool children remains limited, and potential modifiable factors have not been thoroughly explored.

Objectives: To determine the prevalence of feeding difficulties and identify associated sociodemographic and behavioral factors among typically developing preschool children.

Methods: A prospective study was conducted among 385 children aged 6 months–6 years attending the outpatient department of Sunpasitthiprasong Hospital, Ubon Ratchathani. Feeding behavior was assessed using the Thai version of the Montreal Children’s Hospital Feeding Scale (MCH-FS-TH), validated for psychometric properties. Statistical analyses included descriptive statistics, Pearson’s Chi-square test, and multivariable logistic regression to identify independent predictors of feeding difficulties.

Results: The prevalence of feeding difficulties was 31.9%. Multivariable analysis revealed that preterm birth (adjusted odds ratio [AOR] = 2.09, 95% CI: 1.05–4.19) and screen media use during meals (AOR = 2.30, 95% CI: 1.31–4.02) significantly increased the likelihood of feeding difficulties. Low weight-for-age (≤3rd percentile) showed a borderline association (AOR = 1.98, 95% CI: 0.98–3.99). No significant associations were found with parental education or family income.

Conclusions: Feeding difficulties affect nearly one-third of typically developing preschoolers in this Thai cohort, with preterm birth and screen media use during meals emerging as key modifiable risk factors. These findings highlight the need for targeted parental guidance and early interventions, particularly discouraging screen use during meals and providing closer feeding behavior monitoring for preterm children.

Outcome of SARS-CoV-2 infected infants without symptoms and signs of lower respiratory tract infection compared between normal and abnormal chest X-ray groups

Suchanutkawee Boonserm, Pra-on Supradish — Tue, 30 Sep 2025 00:00:00 +0700

Background: Currently SARS-CoV-2 infection causes less severe infection, however infants under 1 year old, who are considered as a high-risk group for severe manifestations, are more likely to be hospitalized and receive chest X-ray in most cases.

Objective: To study treatments and outcomes of hospitalized COVID-19 infants with absent symptoms and signs of lower respiratory tract infection (LRTI), comparing between a normal chest X-ray group and an abnormal chest X-ray group, in order to determine the necessity to perform chest X-ray in this population.

Methods: A cross-sectional study was conducted on COVID-19 infants who were hospitalized during March 1, 2022 to June 30, 2023 in QSNICH. Patients with LRTI, underlying conditions with pre-existing abnormal chest X-ray and no x-ray reports via radiologists were excluded. Clinical data, treatment and outcomes were analyzed.

Result: Among 208 patients, there were 96 (46.2%) infants with normal chest x-ray and 112 (53.8%) infants with abnormal chest x-ray. All of them received oral favipiravir as an antiviral agent. None of normal chest x-ray group developed LRTI, meanwhile 4 of 112 patients in abnormal chest x-ray group proceeded to LRTI (0 vs 3.6%, p value 0.47), substituted favipiravir to intravenous remdesivir (0 vs 3.6%, p value 0.27), and 3 of them obtained antibiotics (0 vs 2.6%, p value 0.43). Defervescence times after receiving antiviral agents, duration of upper respiratory tract symptoms and length of hospital stay were not statistically different between two groups {33.2(24,72) vs 36.2(24,72) hrs. (p value 0.076), 2.44 (0.93) vs 2.56 (0.54) days (p value 0.34) and 2.81 (1.03) vs 2.80 (0.95) days (p value 0.23) respectively. All of them made a full recovery.

Conclusion: There was no statistically significant difference in treatments and outcomes in COVID-19 infants, presenting with no clinical manifestations of LRTI, compared between normal and abnormal chest X-rays group. Performing chest X-ray may not be necessary in COVID-19 infants who do not have symptoms and signs of LRTI.

Re-emergence of pediatric diphtheria patients in Mae Sot Hospital, Tak Province in 2024: A cases series

Wannabhorn Limpitikul, Wannee Limpitikul — Tue, 30 Sep 2025 00:00:00 +0700

Background: The re-emerging of vaccine preventable disease, including respiratory diphtheria reflected gaps of the immunization-administration system among migrants of countries affected by political or armed conflicts.

Objective: To describe the clinical characteristics, management strategies, and outcomes of pediatric diphtheria cases in Thailand-Myanmar border at Mae Sot Hospital, Tak province, in 2024.

Methods: A retro-prospective descriptive study was conducted by reviewing the medical records of five pediatric patients diagnosed with diphtheria, confirmed either by laboratory testing or clinical criteria. Data collected included demographics, immunization history, clinical manifestations, complications, treatment modalities, and clinical outcomes.

Results: Five Myanmar pediatric patients were diagnosed respiratory diphtheria. One case lived in Myanmar and the remaining were in Mae Sot. They were among 4.25-9.08 years old and did not achieve vaccination schedule. Most of them presented with fever, sore throat, and pharyngeal diphtheric patch. Confirmatory lab was performed in 4 cases and the other was presumed clinically diagnosis as diphtheria. Severe complications included upper airway obstruction (2 cases), myocarditis (2 cases), acute kidney injury (2 cases), and neuritis (1 case). The overall case fatality rate was 40%, with myocarditis being the leading cause of death.

Conclusions: Diphtheria remains a significant public health concern among migrant populations and in high-risk areas due to inadequate immunization coverage. Efforts to ensure comprehensive vaccine coverage among both Thai population and migrants are essential to establish herd immunity and prevent the re-emergence of vaccine-preventable diseases.