Risk factors of dengue shock syndrome in children.

BACKGROUND: Dengue shock syndrome (DSS) is a major public health problem with high morbidity and mortality, especially in a case of prolonged shock with subsequently massive bleeding. The morbidity and mortality from DSS can be decreased by early diagnosis of shock and adequate replacement of plasma loss. Therefore, determination of risk factors of DSS is crucial for early detection and proper management of shock. OBJECTIVE: To determine the risk factors of dengue shock syndrome in children. MATERIAL AND METHOD: Medical records of 110 patients with dengue hemorrhagic fever (DHF) and 55 with DSS admitted at BMA Medical College and Vajira Hospital between January 2003 and December 2005 were collected by simple random sampling. Clinical data including age, sex, signs and symptoms, and laboratory data (before defervescence) of patients with DHF and DSS were comparatively analyzed. Risk factors of DSS were determined by Mantel-Haenzel test, simple and multiple logistic regression analysis. RESULTS: Of the 165 children, 110 were in the DHF group (grade I, 72 children; grade II, 38 children) and 55 were in the DSS group (grade III, 53 children; grade IV, 2 children). The age, sex, nutritional status, and duration of fever between both groups were not statistically different. Risk factors of DSS were bleeding, secondary dengue infection, and hemoconcentration of more than 22%from baseline hematocrit (adjusted OR (95% CI): 5.1 (1.5-17.1), 21.8 (5.3-90.8), 15.5 (4.4-54.6), respectively). CONCLUSION: Risk factors of DSS are bleeding, secondary dengue infection, and hemoconcentration of more than 22%. Patients with DHF who have one of these risk factors should be closely observed for early signs of shock, as prompt and adequate fluid replacement can prevent the progression of shock.

Growth of breast-fed and formula-fed infants compared with national growth references of Thai children.

OBJECTIVE: To compare the growth patterns of breast-fed (BF) and formula-fed (FF) infants with national growth references of Thai children and to determine whether the Thai growth references can be used to assess growth of BF infants who were fed according to Thai guidelines of infant feeding. DESIGN: Cohort study. MATERIAL AND METHOD: One hundred and fifty six term infants (78 BF and 78 FF infants) were followed prospectively for 12 months. Milk was the only food source during the first 4 months and solid foods were introduced after 4 months of age. Body weight, length and head circumference were measured at the age of 1, 2, 4, 6, 9 and 12 months. RESULTS: Of the 156 infants, 140 completed the study (71 BF and 69 FF infants). BF and FF infants had similar mean weight and length from 0 to 6 months, thereafter BF infants had lower weight and length than FF infants with significant difference at 9-12 months in male infants and at 12 months in female infants (p < 0.05). Compared with national growth references of Thai children, mean weight and length of BF and FF infants in the study were significantly lower than the mean values of Thai infants from 0 to 1 months, thereafter mean weight and length of BF infants were close to the Thai references but those of FF infants were higher than the Thai references after 6 months with significant difference in weight from 9 to 12 months and length at 12 months. The incidence of malnutrition and obesity at 1 year of age was not different between the two feeding groups. Inadequate complementary food was the risk factor of infant malnutrition (adjusted RR 4.7, 95% CI 1.1-21.9, p 0.04). CONCLUSION: BF and FF infants had similar weight and length from birth to 6 months, thereafter, FF infants had higher weight and length than BF infants and Thai growth references. Growth of BF infants correlated well with the national growth references of Thai children, so the Thai growth references can be used to assess growth of BF infants who were fed according to Thai guidelines of infant feeding.

Incidence and risk factors of iron deficiency anemia in term infants.

OBJECTIVE : To compare the incidence of iron deficiency anemia (IDA) between breast-fed (BF) and formula-fed (FF) infants and to identify the risk factors of IDA in these infants. DESIGN: Cohort study. MATERIAL AND METHOD: A study of 140 full- term infants (70 BF and 70 FF) was conducted at BMA Medical College and Vajira Hospital from February 2002 to November 2003. All infants were followed at the age of 1, 2, 4, 6, 9 and 12 months for growth and developmental assessment. Blood samples were analyzed for hemoglobin (Hb), hematocrit (Hct) and mean corpuscular volume (MCV) at 9 - 12 months; and infants with Hb < 11.0 g/dl were further investigated for the cause of anemia. RESULTS: The mean values of Hb, Hct, MCV and serum ferritin of BF infants were 10.8 g/dl, 32.8%, 70.9fl and 16.7 ng/ml respectively, which were significantly lower than those of FF infants (11.4 g/dl, 35.1%, 73.3fl, and 36.9 ng/ml, p < 0. 05). Anemia was found in 27 BF infants (38.6%) compared with 10 FF infants (14.39%). The incidence of IDA in BF infants was significantly higher than FF infants (25.7% vs 2.9%, p < 0.001). Risk factors of IDA included low birth weight, breastfeeding and inadequate complementary food (adjusted RR (95% CI): 3.1(1.1 - 9.1), 6.3(1.5 - 25.0), 7.7(2.8 - 20.0), respectively). CONCLUSION: IDA is more prevalent in BF than FF infants. Risk factors of IDA are low birth weight, breastfeeding and inadequate complementary food. Prevention of IDA in infants should be achieved through adequate iron-rich complementary food and screening for Hb or Hct at 9 - 12 months of age in high risk infants.

Nocardia pneumonia with empyema thoracis in a healthy neonate: a case report.

A 40-day-old male infant presented with fever and non-productive cough for 3 weeks, tachypnea and dyspnea 5 days before admission. The chest radiograph and computed tomographic (CT) scan revealed right lung consolidation with pleural effusion. Pleural tapping showed frank pus that grew Nocardia asteroides. The CT scan of the brain and abdomen were normal. The patient was treated with 15 mg/kg/day of trimethoprim and 75 mg/kg/day of sulfamethoxazole intravenously for 3 weeks and then orally for 6 months with complete recovery. T cell quantitative studies were normal and anti-HIV was non-reactive. A flow cytometric assay with Staphylococcal aureus and phorbol myristate acetate (PMA) as the stimulants showed normal oxidative burst which represented normal intracellular killing. One year after completion of treatment, he was healthy and the chest radiograph was normal.