Medicine and Health Sciences Commons^™

World Allergy Organization (Wao) Diagnosis And Rationale For Action Against Cow's Milk Allergy (Dracma) Guidelines Update – X – Breastfeeding A Baby With Cow's Milk Allergy, Vicki Mcwilliam, Merryn Netting, Evelyn Volders, Debra Palmer, Ignacio Ansotegui, Stefania Arasi, Amal H. Assa'ad, Sami L. Bahna, Antonio Bognanni, Rose Kamenwa

Paediatrics and Child Health, East Africa

Cow’s milk allergy is rare in exclusively breastfed infants. To support the continuation of breastfeeding an infant after diagnosis with a cow’s milk allergy, it is critical to examine the evidence for and against any form of cow’s milk elimination diet for lactating mothers. In this narrative review, we highlight the lack of high-quality evidence, hence subsequent controversy, regarding whether the minuscule quantities of cow’s milk proteins detectable in human milk cause infant cow’s milk allergy symptoms. Current clinical practice recommendations advise a 2–4 week trial of maternal cow’s milk dietary elimination for: a) IgE-mediated cow’s milk allergy only if …

Antenatal Dexamethasone For Improving Preterm Newborn Outcomes In Low-Resource Countries: A Cost-Effectiveness Analysis Of The Who Action-I Trial, Who Action Trial Collaborators, Katherine E. Eddy, Joshua P. Vogel, Nick Scott, Dagnachew Fetene, Shabina Ariff, Sajid Bashir Soofi, Lumaan Sheikh, Farrukh Raza, Almas Aamir

Department of Paediatrics and Child Health

Background: After considerable debate, there is now unequivocal evidence that use of antenatal corticosteroids improves outcomes in preterm neonates when used in women at risk of early preterm birth in reasonably equipped hospitals in low-resource countries. We aimed to evaluate the cost-effectiveness of dexamethasone administration in the management of preterm birth in a cohort of pregnant women from five low-resource countries.
Methods: We performed a cost-effectiveness analysis using data from 2828 women (and 3051 babies) who participated in the WHO ACTION-I trial, a multicentre, randomised, placebo-controlled trial that assessed the safety and efficacy of dexamethasone in pregnant women at risk …

Micronutrient Supplements Can Promote Disruptive Protozoan And Fungal Communities In The Developing Infant Gut, Ana Popovic, Celine Bourdon, Pauline W. Wang, David S. Guttman, Sajid Bashir Soofi, Zulfiqar Ahmed Bhutta, Robert H J. Bandsma, John Parkinson, Lisa G. Pell

Centre of Excellence in Women and Child Health

Supplementation with micronutrients, including vitamins, iron and zinc, is a key strategy to alleviate child malnutrition. However, association of gastrointestinal disorders with iron has led to ongoing debate over their administration. To better understand their impact on gut microbiota, we analyse the bacterial, protozoal, fungal and helminth communities of stool samples collected from a subset of 80 children at 12 and 24 months of age, previously enrolled into a large cluster randomized controlled trial of micronutrient supplementation in Pakistan (ClinicalTrials.gov identifier NCT00705445). We show that while bacterial diversity is reduced in supplemented children, vitamins and iron (as well as …

Mid-Upper Arm Circumference Assessment And Comparison With Weight For Length Z-Score In Infants ≤6 Months As An Indicator Of Severe Acute Malnutrition, Mahjabeen Zehra, Ali Faisal Saleem, Zaubina Kazi, Sadia Parkar

Department of Paediatrics and Child Health

Objective: To assess the frequency of severe acute malnutrition (SAM) and to determine the validity of mid-upper arm circumference (MUAC) as compared to weight for length z-score (WLZ-score) as an indicator of the nutritional status in this age group.
Methods: A cross-sectional study, with a purposive sampling was conducted from March 2018 to November 2018 to enroll 540 infants ≤6 months of age from three different sites in Karachi, Pakistan. The anthropometric measurements (MUAC, length and weight) were taken by experienced community health workers. The data were analyzed using SPSS. MUAC was compared with WLZ-score for sensitivity and specificity to …

Cohort Profile: The Alliance For Maternal And Newborn Health Improvement (Amanhi) Biobanking Study, Fahad Aftab, Salahuddin Ahmed, Aneeta Hotwani, Muhammad Ilyas, Mohammad Javaid, Fyezah Jehan, Farah Khalid, Usma Mehmood, Muhammad Imran Nisar, Muhammad Sajid

Department of Paediatrics and Child Health

No abstract provided.

Implementation Of An Infant Male Circumcision Programme, Pakistan, Shazia Moosa, Ammar Ali Muhammad, Sohail Asghar Dogar, Sundus Iftikhar, Walter Johnson, Asad Latif, Lubna Samad

Section of Paediatric Surgery

Objective: To retrospectively review outcomes of a health provider-led infant circumcision programme in Pakistan.
Methods: Based on World Health Organization guidelines, we trained surgical technicians and midwives to perform circumcisions using the Plastibell device at two Indus Health Network facilities. Programme tools include a training manual for health providers, information brochures for families, an enrolment form and standardized forms for documenting details of the procedure and outcomes. Infants aged 1-92 days were eligible for the study. Health workers contacted families on days 1 and 7 after the procedure to record any adverse events. We compared the characteristics of infants experiencing …

A Public Health Approach For Deciding Policy On Infant Feeding And Mother-Infant Contact In The Context Of Covid-19, Nigel Rollins, Nicole Minckas, Fyezah Jehan, Rakesh Lodha, Daniel Raiten, Claire Thorne, Philippe Van De Perre, Mija Ververs, Neff Walker, Rajiv Bahl

Department of Paediatrics and Child Health

The COVID-19 pandemic has raised concern about the possibility and effects of mother-infant transmission of SARS-CoV-2 through breastfeeding and close contact. The insufficient available evidence has resulted in differing recommendations by health professional associations and national health authorities. We present an approach for deciding public health policy on infant feeding and mother-infant contact in the context of COVID-19, or for future emerging viruses, that balances the risks that are associated with viral infection against child survival, lifelong health, and development, and also maternal health. Using the Lives Saved Tool, we used available data to show how different public health approaches …

Frequency Of Immediate Neonatal Complications (Hypoglycemia And Neonatal Jaundice) In Late Preterm And Term Neonates, Muhammad Salman, Heeranand Rathore, Shabina Ariff, Rashid Ali, Ausaf Ahmed Khan, Muhammad Nasir

Department of Paediatrics and Child Health

Background: Evidence suggests that neonates born at 34-36 weeks should not be considered full-term neonates, given the magnitude of morbidities they experience compared with term infants. Neonates born at 34 to 36 weeks are at increased risk for early illness such as hypoglycemia and hyperbilirubinemia compared to term infants.
Objective: This study's objective was to determine the frequency of immediate neonatal complications (hypoglycemia and neonatal jaundice) in late preterm and term neonates.
Subjects and methods: A serial descriptive case study was conducted at the private tertiary care hospital. Random samplings were taken, and the sample size was calculated on Epi …

Determinants Of Infant And Young Complementary Feeding Practices Among Children 6-23 Months Of Age In Urban Pakistan: A Multicenter Longitudinal Study, Shabina Ariff, Kamran Sadiq, Javairia Khalid, Laila Sikanderali, Batha Tariq, Fariha Shaheen, Gul Nawaz Khan, Atif Habib, Sajid Bashir Soofi

Department of Paediatrics and Child Health

Background: Suboptimal feeding practices have a negative impact on children's health and growth in the first 2 years of life and increase their risk of undernutrition, morbidity, and mortality. The aim of the study was to assess the factors that influence infant and young child feeding practices among urban mothers in a hospital setting at Karachi, Pakistan.
Methods: A longitudinal multi-center cohort study was conducted in four countries, MULTICENTER BODY COMPOSITION REFERENCE STUDY (MBCRS) to produce normal body composition reference data in healthy infants from 3 months to 24 months of age. Repeated anthropometric (weight, length and head circumference) and …

Stunting In Childhood: An Overview Of Global Burden, Trends, Determinants, And Drivers Of Decline, Tyler Vaivada, Nadia Akseer, Selai Akseer, Ahalya Somaskandan, Marianne Stefopulos, Zulfiqar Ahmed Bhutta

Woman and Child Health

Background: Progress has been made worldwide in reducing chronic undernutrition and rates of linear growth stunting in children under 5 y of age, although rates still remain high in many regions. Policies, programs, and interventions supporting maternal and child health and nutrition have the potential to improve child growth and development.
Objective: This article synthesizes the available global evidence on the drivers of national declines in stunting prevalence and compares the relative effect of major drivers of stunting decline between countries.
Methods: We conducted a systematic review of published peer-reviewed and gray literature analyzing the relation between changes in key …

Anaesthetic Management Of Nesidioblastosis In Two Infants, Muhammad Saad Yousuf, Mohsin Nazir, Fauzia Khan

Department of Anaesthesia

Nesidioblastosis is the most common cause of non-transient, recurrent and persistent hypoglycaemia in neonates and infants. It is a disorder of diffuse proliferation of beta cells of the pancreas leading to hyperinsulinemia and hypoglycaemia. The main aim is to prevent the severe episodes of hypoglycaemia which can cause damage to the brain and/or mental retardation. In this case report we present two cases of nesidioblastosis and their perioperative anaesthetic course for near-total pancreatectomy. First case was a 7 months old female who had repeated episodes of convulsions since birth. Second case was a 4-month-old female child who again presented with …

Harlequin Colour Change, Suneeta Khemani, Shirin Bahadur Ali, Sarfaraz Karim, Mohammad Ali Yezdan

Department of Paediatrics and Child Health

Harlequin colour change (HCC) is a rare, benign and transient colour change presenting in normal healthy neonates in initial days of life and resolves spontaneously. It is thought to be due to hypothalamic immaturity, leading to capillary bed dysregulation. Gravity might also play a role, as this is apparent on the dependent side. It is important for physicians to recognize this phenomenon so that they do not order any irrelevant investigations. Here, we present a case of a healthy neonate who had HCC, which was unilateral, well demarcated erythema, with patchy pallor. Baby was vitally stable at that time. This …

Neonatal Mortality Within 24 Hours Of Birth In Six Low- And Lower-Middle-Income Countries., Abdullah H. Baqui, Dipak K. Mitra, Muhammad Imran Nisar, Fyezah Jehan, Muhammad Ilyas, Murtaza Ali, Imran Ahmed, Shabina Arif, Sajid B. Soofi, Sachiyo Yoshida

Department of Paediatrics and Child Health

Objective: To estimate neonatal mortality, particularly within 24 hours of birth, in six low- and lower-middle-income countries.

Methods: We analysed epidemiological data on a total of 149 570 live births collected between 2007 and 2013 in six prospective randomized trials and a cohort study from predominantly rural areas of Bangladesh, Ghana, India, Pakistan, the United Republic of Tanzania and Zambia. The neonatal mortality rate and mortality within 24 hours of birth were estimated for all countries and mortality within 6 hours was estimated for four countries with available data. The findings were compared with published model-based estimates of neonatal …

Opportunities To Improve Postpartum Care For Mothers And Infants: Design Of Context-Specific Packages Of Postpartum Interventions In Rural Districts In Four Sub-Saharan African Countries, Els Duysburgh, Birgit Kerstens, Seni Kouanda, Charles Paulin Kaboré, Danielle Belemsaga Yugbare, Peter Gichangi, Gibson Masache, Beatrice Crahay, Gilda Gondola Sitefane, Nafissa Bique Osman, Severiano Foia, Henrique Barros, Sofia Castro Lopes, Susan Mann, Bejoy Nambiar, Tim Colbourn, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: Postpartum maternal and infant mortality is high in sub-Saharan Africa and improving postpartum care as a strategy to enhance maternal and infant health has been neglected. We describe the design and selection of suitable, context-specific interventions that have the potential to improve postpartum care.

Methods: The study is implemented in rural districts in Burkina Faso, Kenya, Malawi and Mozambique. We used the four steps ‘systems thinking’ approach to design and select interventions: 1) we conducted a stakeholder analysis to identify and convene stakeholders; 2) we organised stakeholders causal analysis workshops in which the local postpartum situation and challenges and …

Factors That Affect Attachment Between The Employed Mother And The Child, Infancy To Two Years, Naureen Kassamali, Salma Amin Rattani

School of Nursing & Midwifery

To explore a mother's feeling of attachment and the affects her working status on the attachment relationship with her child, upon ethical clearance from the institutional ethics committee, in-depth interviews of nine participants were conducted. Mothers enrolled were those who resumed the employment within the first year of post-delivery and were having a child up to two years of age. Results revealed that maternal employment itself does not enhance or deteriorate attachment with the child. It is combinations of factors that revolve around it impact on their bond. Overall, maternal integration or the balance of the dual roles of employment …

Disease Patterns And Outcomes Of Neonatal Admissions At A Secondary Care Hospital In Pakistan, Syed R. Ali, Shakeel Ahmed, Heeramani Lohana

Department of Paediatrics and Child Health

Objectives: This study aimed to determine the disease patterns and outcome of patients admitted to the neonatal unit of a secondary care hospital in Pakistan from January to December 2009.
Methods: Retrospective data from the medical records of all neonates admitted during the study period were reviewed and analysed for age, weight, sex, reason for admission, duration of hospital stay, diagnosis and final outcome. Trends were examined to identify the indicators of inpatient neonatal deaths.
Results: The total number of neonates admitted during the study period was 1,554; 979 were male (63%), and 575 were female (37%). A total of …

Impact Of Vitamin A Supplementation On Infant And Childhood Mortality, Aamer Imdad, Mohammad Yawar Yakoob, Christopher Sudfeld, Batool A. Haider, Robert E. Black, Zulfiqar Ahmed Bhutta

Woman and Child Health

Introduction:Vitamin A is important for the integrity and regeneration of respiratory and gastrointestinal epithelia and is involved in regulating human immune function. It has been shown previously that vitamin A has a preventive effect on all-cause and disease specific mortality in children under five. The Purpose of this paper was to get a point estimate of efficacy of vitamin A supplementation in reducing cause specific mortality by using Child Health Epidemiology Reference Group (CHERG) guidelines.

Methods:

A literature search was done on PubMed, Cochrane Library and WHO regional data bases using various free and Mesh terms for vitamin A …

Klebsiella Osteomyelitis Of The Right Humerus Involving The Right Shoulder Joint In An Infant, Maqbool Qadir, Syed Rehan Ali, Mumtaz Lakhani, Pervaiz Hashmi, Ahsen Amirali

Department of Paediatrics and Child Health

Osteomyelitis in newborn infants is a rare infection. Lower extremity joints are commonly affected. Most of the cases have a haematogenous spread. Aerobes are the common group of organism involved, of which Staphylococcus aureus is the commonest. Klebsiella osteomyelitis has been reported as a cause of Osteomyelitis. However, to the best of our knowledge, this is the first case report of Klebsiella pneumoniae associated osteomyelitis in an infant from Pakistan.

Anaesthetic Management Of An Infant With Epidermolysis Bullosa Undergoing Inguinal Hernia Repair, Khalid Maudood Siddiqui, Sobia Khan

Department of Anaesthesia

Epidermolysis bullosa is a group of inherited disorders characterized by blistering of the skin as a result of minor trauma. We managed an infant with epidermolysis bullosa undergoing inguinal hernia repair. Anaesthesia was induced with oxygen/nitrous oxide mixture and sevoflurane. Oral tracheal intubation was done with a lubricated laryngoscope blade with KY jelly using atracurium 0.5 mg/kg and fentanyl 0.1 microgm/kg. To avoid frictions on the skin, endotracheal tube was tied with ribbon gauze and fixed around the neck. Pulse-oximetry probe and electrocardiogram electrodes were placed, and then attached to the patient's skin covered with KY jelly. Peripheral venous access …

Intracranial Tumour In An Infant Presenting As Iron Deficiency Anaemia, Rashid Jooma, D N. Grant

Section of Neurosurgery

No abstract provided.