Thai Journal of Pediatrics

A Study of clinical manifestations in infants born to mothers using methamphetamines: A descriptive study in infants with positive and negative methamphetamine urine tests

Mon, 30 Jun 2025 00:00:00 +0700

Background: The use of methamphetamines during pregnancy has increased. Urine tests of newborns have revealed both positive and negative results for methamphetamine. However, there is limited clinical evidence regarding the differences in symptoms between the two groups of newborns.

Objective: To investigate the clinical manifestations of newborns born to mothers who used methamphetamine during the prenatal period at Hat Yai Hospital.

Methods: A retrospective study was conducted by reviewing medical records of newborns born to mothers who tested positive for methamphetamine in their urine during the prenatal period from March 1, 2021, to March 1, 2024. The symptoms and clinical outcomes of newborns with positive and negative urine methamphetamine results were evaluated. Multivariable logistic regression was used to assess the relationships between variables.

Results: A total of 319 newborns who were born to mothers with urine tested positive for methamphetamine were enrolled. Of those, 277 (86.8%) newborns had urine positive for methamphetamine and 42 (13.2%) newborns had negative results. The median maternal age was 29 years old, with 25.4% of the mothers had attended at least five antenatal visits according to the Department of Health. Severe preeclampsia and postpartum hemorrhage occurred in 16.9% and 7.2% of mothers, respectively. The median birth weight was 2,760 grams. In the positive and negative methamphetamine groups, low birth weight was observed in 20.2% and 38.1% of newborns, respectively, and the 1-minute Apgar score ≤7 in 3.2% and 11.9%, respectively. Newborns with positive urine methamphetamine had a significantly lower likelihood of preterm birth (adjusted odds ratio [aOR] 0.43; 95% confidence interval [CI], 0.21- 0.86), respiratory distress (aOR 0.46; 95% CI 0.23-0.91), hypoglycemia (aOR 0.28; 95% CI 0.08-0.96), admission to neonatal intensive or intermediate care (aOR 0.43; 95% CI 0.21-0.86), jaundice (aOR 0.17; 95% CI 0.03-0.95) and significant higher likelihood elevated body temperature (aOR 1.8; 95% CI 1.04-3.11) than those in the negative group.

Conclusion: This study found that the detection of methamphetamine in the urine of infants born to mothers who used methamphetamine during prenatal period was not correlated with the infants’ clinical manifestations. Therefore, it is recommended to monitor the newborn closely and perform urine testing when clinically indicated to assist in diagnosis and management, such as withdrawal symptoms or seizures.

Associated factors and outcomes of persistent pulmonary hypertension of the newborn in Lampang hospital

Rawee Asawakitipong, Anavat Bupphachareonsuk, Pakawadi Vuttipittayamongkol — Mon, 30 Jun 2025 00:00:00 +0700

Background: The study of risk factors for persistent pulmonary hypertension of the newborns can help develop guidelines for monitoring, diagnosis, and treatment to reduce morbidity and mortality, as well as improve healthcare systems in health districts.

Objective: To study the factors associated with persistent pulmonary hypertension of the newborns and the outcomes of treatment.

Method: A retrospective study was conducted to compare the persistent pulmonary hypertension of the newborns with other causes of respiratory distress from 2018 to 2024. Multivariable risk difference regression analysis was used to analyze factors affecting persistent pulmonary hypertension of the newborns.

Results: Factors affecting persistent pulmonary hypertension of the newborns included cesarean delivery (RR 1.92; 95%CI 1.17, 3.13), meconium aspiration syndrome (RR 3.46; 95%CI 1.97, 6.08), neonatal sepsis (RR 2.53; 95%CI 1.51, 4.23), pulmonary hemorrhage (RR 2.47; 95%CI 1.39, 4.37), pneumothorax (RR 2.33; 95%CI 1.41, 3.84), and heart failure due to patent ductus arteriosus (RR 4.85; 95%CI 3.16, 7.46). The group with persistent pulmonary hypertension of the newborns required more inotropic drugs, vasodilators, and high-frequency ventilation. They had longer ventilation times, longer hospital stays, and higher mortality rates, all of which were statistically significant.

Conclusion: The method of delivery, conditions affecting the heart and lungs, and bloodstream infections were associated with pulmonary hypertension. Therefore, controlling these factors might help reduce persistent pulmonary hypertension of the newborns, which could impact disability and mortality.

Incidence and outcomes of persistent pulmonary hypertension of the newborn at Prachuapkhirikhan Hospital

Patcharin Wongwuttigumjorn — Mon, 30 Jun 2025 00:00:00 +0700

Background: Persistent pulmonary hypertension of the newborn (PPHN) is a critical neonatal condition characterized by the failure of the circulatory system to transition appropriately after birth, leading to elevated pulmonary arterial pressure and impaired oxygenation. If not promptly diagnosed and treated, this condition may result in severe hypoxemia and can be life-threatening.

Objectives: To determine the incidence, clinical characteristics, treatment outcomes , and mortality rate of infants diagnosed with persistent pulmonary hypertension of the newborn at Prachuapkhirikhan Hospital.

Methods: This is a retrospective descriptive study. Medical records of infants diagnosed with PPHN at Prachuapkhirikhan Hospital between October 1, 2020 and September 30, 2024 were reviewed.

Results: A total of 25 infants were diagnosed with PPHN during the study period. The incidence was 4.06 per 1,000 live births. Of the 25 cases with complete data, 19 were male (76%), and 76% were Thai.
The mean gestational age was 37.3 ± 3.2 weeks, and 48% were vaginal delivered. The most common cause of PPHN was congenital pneumonia (52%). The mortality rate was 40%. The non-survivor group had significantly higher maximum positive inspiratory pressure (22.2 ± 3.46; p value 0.029), maximum mean airway pressure (21.8 ± 3.32; p value 0.007), and maximum oxygen index (49.3 ± 13.1; p value 0.001) compared to the survivor group. Pneumothorax was diagnosed in 5 out of 6 non-survivors (83.3%), which was significantly higher than in the survivor group (p value 0.013).

Conclusions: The mortality rate of PPHN at Prachuapkhirikhan Hospital remained high compared to the national incidence in Thailand, which was reported at 1.88 to 3.7 per 1,000 live births. The leading cause was congenital pneumonia. Pneumothorax is a significant risk factor associated with mortality in PPHN.

Mortality rate of persistent pulmonary hypertension of the newborn before and after using KNH one-page care plan for PPHN in King Narai Hospital

Muthita Meesang — Mon, 30 Jun 2025 00:00:00 +0700

Background: Persistent Pulmonary Hypertension of the newborn (PPHN) is a severe condition with a high mortality and morbidities due to limitations in medical staff, medications and inhaled nitric oxide (iNO). In 2018, we developed a guideline for the management of PPHN to improve diagnosis and treatment. As a result, the mortality rate decreased. However, deaths from this condition continue to occur, highlighting the challenges and opportunities for improving treatment in resource-limited settings. Therefore, the KNH One-Page Care Plan for PPHN was developed in 2021, a simple, concise tool that fits on a single page for ease of use. This care plan ensures consistent management of all newborns with PPHN, providing clear reporting points for nurses to physicians and establishes uniform steps for physician-led interventions.

Objective: To investigate the mortality rate of neonates with PPHN at King Narai Hospital after the implementation of the KNH one-page care plan for PPHN.

Method: This study is a retrospective study conducted on newborns with a gestational age of 34 weeks or more, diagnosed with PPHN, between October 1, 2018, and September 30, 2024. We evaluated the effectiveness of the KNH One-Page Care Plan for PPHN at King Narai hospital in term of mortality rate, duration of mechanical ventilation, length of hospital stays and complications before and after its implementation. Additionally, we investigated the factors associated with mortality and identified the appropriate OSI (Oxygen Saturation Index) threshold for initiating pulmonary vasodilator therapy in hospitals without iNO.

Result: A total of 59 infants were included, divided into two groups: 40 infants born before the implementation of the PPHN care plan and 19 were in the group treated after its implementation. The baseline characteristics of the two groups and the causes of pulmonary hypertension were not significantly different. The mortality rate in the pre-care plan group was 27.5%, while in the post-care plan group, it was 0% (p value <0.001). The pre-care plan group had a significantly longer duration of mechanical ventilation (10 days vs. 4 days, p value <0.001). The pre-care plan group had a significantly longer hospital stay (16.9 days vs. 9.7 days, p value <0.001). Factors associated with mortality included an OSI before receiving pulmonary vasodilator treatment and administration of high-dose norepinephrine. The optimal OSI range for initiating pulmonary vasodilator therapy was found to be between 8 and 11.

Conclusion: The KNH One-Page Care Plan for PPHN effectively reduced mortality rates, duration of intubation, and hospital stays in newborns with PPHN.

Risk factors and short outcome of pediatric cerebrovascular diseases at Hatyai Hospital

Tipaporn Thongmak, Najwa Yudhasompop — Mon, 30 Jun 2025 00:00:00 +0700

Background: Pediatric stroke is uncommon; however, it has the developmental consequence. It is classified into two categories: Ischemic stroke and hemorrhagic stroke, each with distinct risk factors.

Objective: This study aimed to evaluate the risk factors and outcomes of pediatric stroke by using the Pediatric Modified Rankin Scale (MRS), at discharge and at a three-month follow-up.

Method: A retrospective study was conducted involving children aged 28 days to 15 years diagnosed with stroke between January 1, 2011, and December 31, 2021, at Hat Yai Hospital, a tertiary care center in southern Thailand. The study analyzed baseline characteristics, clinical presentations, risk factors, and outcomes at discharge and a 3-month follow-up. Descriptive statistical analysis was performed to assess the data.

Results: Among the 50 children enrolled, 56% were male. Arterial ischemic stroke accounted for 60% arterial hemorrhagic stroke for 32% and cerebral venous sinus thrombosis for 8%. The most common presentation in arterial ischemic stroke was weakness, whereas altered consciousness and nausea with vomiting were more common in arterial hemorrhagic stroke. Arterial ischemic stroke, heart diseases, meningitis and idiopathic were the common risk factors whereas thrombocytopenia and sepsis, and unknow cause were risk factors of hemorrhagic stroke. Infection was the most common risk factor in cerebral venous sinus thrombosis. The overall mortality rate of pediatric cerebrovascular diseases was 28%. Many survivors experienced significant disabilities.

Conclusion: Arterial ischemic stroke was the most common type of stroke in children, with risk factors varying across cerebrovascular disease groups. Pediatric stroke remained associated with high mortality and a considerable burden of disability.

Access to education of neuromuscular disease patients in Thailand.

Nattaphorn Roatchanathong, Oranee Sanmaneechai — Mon, 30 Jun 2025 00:00:00 +0700

Background: Neuromuscular diseases are a group of disorders characterized by abnormalities in muscle function, neuromuscular junction signaling, or peripheral nerve function. Neuromuscular diseases cause progressive muscle weakness leading to mobility loss, while brain function and cognition remain intact. Literature from other countries indicates that patients often continue education and live normal lives, but in Thailand, mobility issues frequently lead to dropping out of school.

Objectives: This study aimed to known the accession of education of neuromuscular disease patients in Thailand, to identify factors contributing to the inability of these patients in education access, to explore patients' perspectives, and to assess their needs for additional support in education and classroom activities.

Methods: The cross-sectional study was conducted among patients aged 3 to 25 years old diagnosed with neuromuscular disease, at the Siriraj Neuromuscular Disease Center, Thailand between 1 August 2023 and 31 July 2024. A questionnaire was developed to collect factors associated with education.

Results: Among 105 patients with neuromuscular diseases, 73 were receiving education, 5 had never attended school, and 27 had dropped out. Most were diagnosed with DMD/BMD (36.3%), followed by SMA (26.7%). After adjusting for confounding, unsuitable school environments increased the risk of not attending school by 26.6 times. Patients who were wheelchair-bound or bedridden were 23.5 times more likely to not attend school, while those who had undergone surgery were 13.8 times more likely. Caregiver difficulties were associated with 22.3 times increased risk of school dropping out, and low household income (≤ 30,000 THB/month) was linked to a 10.9 times increased risk.

Conclusion: Among 105 patients with neuromuscular diseases, one-third were not attending school due to various barriers. Key risk factors included mobility limitations, low household income, scoliosis surgery, caregiver difficulties, and unsuitable school environments. Addressing these challenges is critical to improving educational access for these patients.

Initial screening of SMA in high-risk Thai pediatric patients: DBS PCR-based testing with Multiplex Ligation-dependent Probe Amplification confirmation

Mon, 30 Jun 2025 00:00:00 +0700

Background: Spinal muscular atrophy (SMA) is a rare neuromuscular disorder commonly found in children, leading to progressive muscle weakness. Although gene therapy is now available, delays in diagnosis and treatment initiation still occur due to cost constraints, lengthy testing processes, and limited accessibility. These delays can result in treatment outcomes that are below expectations.

Objectives: To report the turnaround time of an initial screening test for SMA using a dried blood spot (DBS) PCR-based method and Multiplex Ligation-Dependent Probe Amplification (MLPA) in high-risk pediatric patients.

Methods: This cross-sectional descriptive study included pediatric patients from newborns with at least 34 weeks of gestational age to adolescents 21 years old who were considered at high risk for SMA. Participants were recruited from Siriraj Hospital and various affiliated hospitals under Thailand's Ministry of Public Health. Blood samples were screened using the DBS PCR-based method, and MLPA was performed to confirm the diagnosis.

Results: Fifty patients (21 males, 29 females) were included. Of these, 8 were diagnosed with SMA using the DBS method. All patients were subsequently confirmed by MLPA, with complete concordance between the two methods. The median turnaround time from analysis to reporting using the DBS method was 2 days (range: 1–30 days), while it was 14 days (range: 1–20 days) for MLPA, (p value 0.001). By the DBS method, three patients were identified as SMA type 1, four as type 2, and one as type 3.

Conclusions: Initial SMA screening using the DBS PCR-based method provided a significantly shorter turnaround time than MLPA. This approach may be a suitable alternative for improving diagnostic efficiency and expediting access to timely treatment.

Treatment of pediatric extracranial germ cell tumors: Outcomes and related factors

Kamolchanok Nitipornsri, Angkana Winaichatsak — Mon, 30 Jun 2025 00:00:00 +0700

Background: Extracranial germ cell tumors are rare, accounting for approximately 3% of childhood cancers, but they are clinically significant due to their potential to cause life-threatening complications or adversely affect growth and development. Germ cell tumors exhibit diverse clinical characteristics, and chemotherapy regimens have continuously evolved. However, treatment outcomes have not yet been comprehensively evaluated, and no institutional data have been systematically collected to date

Objective: To evaluate the clinical characteristics and treatment outcomes of extracranial germ cell tumors

Method: A retrospective study was conducted on patients aged 15 years old or younger who were diagnosed with extracranial germ cell tumors. Clinical characteristics, treatment outcomes, and survival rates were analyzed, and statistical comparisons were made using the log-rank test.

Results: Among 37 eligible patients, the median age at diagnosis was 3.3 years, with a female comprising 54.1% and male 45.9%. Most patients were diagnosed with extragonadal tumors (70.3%), primarily located in the mediastinum (29.7%), followed by retroperitoneum and sacrococcygeal area. Yolk sac tumors represented the most prevalent histological type (32.4%). The 5-year overall survival rate (OS) and event-free survival rate (EFS) were 68.5% and 62.0%, respectively. Survival analysis was performed using the log-rank test, with a p value < 0.05 considered statistically significant. Patients aged over 10 years had lower overall survival (OS) than those aged under 5 years and 5-10 years (p value < 0.001), possibly due to the tendency of more aggressive tumor types in older children. In addition, patients with gonadal tumors had significantly better overall survival (OS) compared to those with extragonadal tumors (p value 0.022).

Conclusion: Extracranial germ cell tumors demonstrated favorable survival rates. However, patients aged over 10 years and those with extragonadal tumors were associated with a worse prognosis.

Survival rate of pediatric acute lymphoblastic leukemia patients with hyperleukocytosis at Udon Thani Hospital

Pitchayanan Kuwatjanakul — Mon, 30 Jun 2025 00:00:00 +0700

Background: Leukemia represents the most prevalent form of cancer in the pediatric population. The majority of affected children achieve favorable outcomes with standard treatment regimens, with high cure rates. However, the presence of hyperleukocytosis at initial presentation has been associated with increased risks of early complications and mortality. Data from studies conducted in developed countries indicated that the cure rate for pediatric patients with acute lymphoblastic leukemia (ALL) and hyperleukocytosis was approximately 64.5%. In contrast, a study conducted by the Faculty of Medicine at Prince of Songkla University reported a significantly lower overall survival rate among pediatric ALL patients with hyperleukocytosis compared to those without this condition, at 37.2% versus 67.8%, respectively (p value < 0.0001). These findings highlight a disparity in outcomes between patients in Thailand and those in more developed healthcare settings. Notably, this is the first collected report at Udon Thani Hospital, thereby providing the rationale for the present study.

Objective: To determine the survival rate of pediatric patients diagnosed with acute lymphoblastic leukemia (ALL) presenting with hyperleukocytosis at Udon Thani Hospital.

Methods: This study employed a retrospective design. Data were collected from medical records of pediatric patients diagnosed with acute lymphoblastic leukemia accompanied by hyperleukocytosis who received chemotherapy at Udon Thani Hospital between July 2010 and November 2019. Patient information was retrieved from the hospital’s electronic medical record database, including demographic, clinical, and laboratory findings.

Results: This study included a total of 22 pediatric patients diagnosed with acute lymphoblastic leukemia (ALL) presenting with hyperleukocytosis at Udon Thani Hospital. The mean age at diagnosis was 6.3 years old (range: 0.3–14 years), with a male predominance (59%). The majority of cases were classified as B-ALL (64%). The most common clinical manifestation was hepatosplenomegaly, observed in 95.5% of patients, followed by fever (81.8%) and abnormal bleeding (54.5%). At diagnosis, the mean white blood cell count was 210,000 cells/cu.mm. (±247,683.7), mean hemoglobin level was 6.6 g/dL (±2.7), mean platelet count was 29,318 /cu.mm. (±17,038.8), and mean lactate dehydrogenase (LDH) level was 5,869 U/dL (±4,579.2).

The most frequently observed early treatment-related complication was tumor lysis syndrome, occurring in 31.8% of patients. The five-year overall survival rate was 68.2%. No statistically significant associations were identified between overall survival and factors such as age at diagnosis, sex, white blood cell count, or leukemia subtype.

Conclusion: The findings indicated that pediatric patients with acute lymphoblastic leukemia and hyperleukocytosis treated at Udon Thani Hospital had a five-year survival rate of 68.2. No statistically significant prognostic factors were found to be associated with survival outcomes.

Mental health screening in children with type 1 diabetes mellitus

Sawinee Kueanui, Somluck Tongmeesee, Supitcha Thamissarakul — Mon, 30 Jun 2025 00:00:00 +0700

Background: The global incidence of type 1 diabetes mellitus (T1DM) in children and adolescents has been increasing by 2–5% annually, a trend mirrored in Thailand. Currently, the incidence in Thailand is approximately 1.27 per 100,000 population. Children with T1DM are at higher risk of developing mental health problems compared to healthy children, with reported rates of 30.56% and 15.56%, respectively. Early identification of psychological issues can lead to timely interventions and support holistic care in children with diabetes.

Objectives: To assess the mental health status of children with T1DM and to identify factors associated with increased risk of mental health problems.

Method: A cross-sectional study was conducted in T1DM patients aged 4–16 years old at Chonburi Hospital (Oct 2023–Oct 2024). The Strengths and Difficulties Questionnaire (SDQ) was completed by parents and children (aged 11–16 years old). Descriptive and inferential statistics were used.

Results: Among 74 participants, the mean age was 10.6 ± 3.6 years, and 55.4% were female. According to the SDQ completed by parents for children aged 4–16 years, 14.9% had abnormal total difficulties scores. For children aged 11–16 years, parent and self-reports indicated emotional or behavioral problems in 14.9% and 9.8% of cases, respectively. Peer relationship problems were the most common difficulty reported (36.5% by parents and 9.8% by self-report). Having diabetes for three years or more was significantly associated with mental health difficulties.

Conclusion: Mental health screening using the SDQ indicated that children with type 1 diabetes are at risk for emotional and behavioral problems, highlighting the need for ongoing surveillance.

Prevalence and associated factors of non-suicidal self-injury among high school students in Mueang district, Nakhon Ratchasima Province

Nidchanan Attaraphadung, Chaloempong Thunyapipat — Mon, 30 Jun 2025 00:00:00 +0700

Background: Non-suicidal self-injury (NSSI) has increased around the world which affects physical, mental health, and long-term relationships. At present, studies in Thailand were still limited.

Objectives: To study prevalence and associated factors of NSSI among junior high school students in Mueang district, Nakhon Ratchasima Province.

Method: Descriptive cross-sectional study gathered information by stratified sampling method on high school students aged 11 – 15 years old at the affiliated schools in the secondary educational service area office Mueang District, Nakhon Ratchasima Province between May 1, 2024 – December 31, 2024. The collected data included demographics data, The Brief NSSI Assessment Tool, Patient health questionnaire for adolescent, Resilience inventory 9, and revised UCLA loneliness scale 6, all in Thai version.

Results: The total number of students were 1,388 cases and 436 (31%) cases reported at least one NSSI. Factors significantly associated with NSSI included female gender, being a victim of bullying, neglectful, depression, high levels of loneliness, and low resilience.

Conclusion: NSSI is found to be high among junior high school students in Mueang District, Nakhon Ratchasima Province, and is related to many factors, especially depression.

Dealing with common congenital heart disease in neonate and infant

Nattakan Khuanhawech — Mon, 30 Jun 2025 00:00:00 +0700

Congenital Heart Disease (CHD) is a heart condition caused by structural defects in the heart. These abnormalities develop during the formation of the heart chambers and great vessels during fetal period. The incidence of congenital heart disease in newborns in Thailand is approximately 8–10 cases per 1,000 live births. CHD can range from simple to complex forms, with varying degrees of severity and a broad spectrum of clinical presentations. A thorough understanding of the disease is essential for medical professionals to facilitate effective treatment planning.