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A 9-month-old female baby was brought to the emergency room (ER) by her parents with reports of noisy breathing, poor feeding, inadequate weight gain and intermediate cyanotic spells noticed for the past month. She was a full-term baby weighing 2.8 kg at birth and had no other comorbidities. On

Introduction The health and growth of children less than two years of age can be affected by the poor quality of complementary foods and poor feeding practices even with optimal breastfeeding. In Ethiopia, empirical evidence on the minimum acceptable diet and its associated factors is limited. Therefore, this study was aimed to assess the level of minimum acceptable diet and its associated factors among children aged 6–23 months in Addis Ababa Ethiopia. Methods An institution-based Cross-sectional study was conducted among a total of 575 mother-child pairs. A simple random sampling technique was used to recruit participants. For infant and young child feeding practices, the data collection tools were adapted from world health organizations’ standardized questionnaire which is developed in 2007. Data entry and analysis were performed using EPI data version 3.1 and SPSS version 20 respectively. Bivariable and multivariable logistic regression analyses were performed to determine predictor variables. Statistical significance was declared at p-value Result In this study, the level of minimum acceptable diet was found to be 74.6%.. About 90.6 and 80.2% of the children received minimum meal frequency and dietary diversity respectively. Having a husband secondary and above educational level [AOR = 4.789(95%CI:1.917–11.967)], being a housewife [AOR = 0.351(95% CI: 0.150–0.819)], having a history of more than three postnatal follow-ups [AOR = 2.616(95%CI:1.120–6.111], Having mothers age between 25 and 34 years [AOR = 2.051(95%CI:1.267–3.320)], being male child [AOR = 1.585(95%CI:1.052–2.388)] and having children age between 18 and 23 months [AOR = 3.026(95%CI:1.786–5.128)] were some of the factors significantly associated with a minimum acceptable diet. Conclusion In this study, the minimum acceptable diet among children aged 6–23 months was significantly associated with the educational status of the husband, mother’s occupation, history of postnatal follow-up, age of the mother, sex of the child, and age of the child. Thus, attention should be given to educating the father, empowering mothers to have a job, promoting gender equality of feeding, and counseling on the benefit of postnatal care visits. In addition, the ministry of health should work on educating and advocating the benefit of feeding the recommended minimum acceptable diet to break the intergenerational cycle of malnutrition.

A newborn who presents for care with bruising, lethargy, or poor feeding requires immediate evaluation. It is important to take a complete history and physical examination to determine what further testing is warranted. Differential diagnoses should include, but are not limited to, nonaccidental trauma, sepsis, or clotting disorders. A history for the baby should include newborn medications after birth, vaccination history, nutrition, and any social information pertinent to the living situation. Maternal medical history should include a list of current medications as well as those taken during pregnancy, any complications related to pregnancy or birth, and pertinent chronic health problems. Bruising on a baby in the first year of life should include laboratory work and may indicate additional radiologic studies to assess for intracranial hemorrhage. This article will help the clinician work through a case study for evaluation and treatment.

Aim: This study was carried out to summarize the systematic literature review on current information about Serious acute respiratory syndrome 2 (SARS-CoV-2 or Covid-19 in children and to determine nursing approach.Methods: Regarding the research, 156 publications were examined between 21 Janu¬ary and 15 November 2020. The review was conducted with the key words of “SARS-CoV-2”, “coronavirus”, “Covid-19”, “child”, “nursing”, which are openly accessible on databases such as PubMed, Science Direct and the WHO.Results: Covid-19 infection may be asymptomatic or characterized by fever and fatigue in children; they can be potential carriers of the disease. Several upper respiratory symp¬toms have been seen, such as nasal congestion and a runny nose. In some patients, abdominal pain, nausea, vomiting and diarrhea occurs. Fever and cough were evident in pediatric patients. As the condition progresses, dyspnea, cyanosis and other signs may arise after typically one week of the disease, along with systemic toxic signs, in¬cluding restlessness or malaise, decreased appetite, poor feeding and reduced activity. Children’s condition might progress quickly and turn to respiratory failure, which cannot be improved by conventional oxygen within 1-3 days. Metabolic acidosis, septic shock, irreversible bleeding and coagulation dysfunction can take place in such severe cases. However, Covid-19 may cause an inflammatory reaction in some children. Those start¬ing with gastrointestinal symptoms may progress to severe conditions and newborns whose mothers are infected with Covid-19 could have severe complications.Conclusion: This systematic review has shown that children generally develop mild Covid-19 disease and these infections are often acquired through community sources. Diagnosis of the disease is difficult in children and there is limited data on children with Covid-19. The disease mainly causes fever, respiratory symptoms and other flu-like manifestations in children. The signs and symptoms of the disease should be carefully monitored. Nurses should know the course and symptoms of the disease well in children and take precautions.

Introduction Congenital nasal pyriform aperture stenosis (CNPAS) is a rare congenital condition of structural nasal obstruction. Respiratory distress, stertor, and poor feeding are often presenting features. Case Presentation We report a case of a newborn diagnosed with CNPAS at 3 weeks of life. The diagnosis was missed on a nasoendoscopy at day 3 of life but was realised following a facial CT when the infant presented with ongoing symptoms of upper airway obstruction. Nasal dilation was performed successfully. Conclusion CNPAS should be considered in any neonate with upper airway obstruction. A normal nasoendoscopy does not exclude the diagnosis.

One of the major causes of poor physical, emotional and cognitive development experience among toddlers of developing and under-developing countries is due to poor feeding practices. The use of com...

We report the case of an adult patient diagnosed with acute SARS-CoV-2-associated meningoencephalitis based on the detection of its RNA on a nasopharyngeal swab, cerebrospinal fluid analysis. The most destructive type of extrapulmonary tuberculosis is tuberculous meningitis, in which the consequences are severe, resulting in death or disability in almost half of all sufferers despite anti-tuberculosis chemotherapy. The aim of this study was to assess the clinical and paraclinical features and laboratory findings and outcome of a patient with tuberculous meningitis and COVID-19 coinfection. Infection of COVID-19 and lymphopenia promotes the development of the severe form of tuberculosis. On the other hand, TBM increased the risk of infection with coronavirus due to the weakened immune system in addition to other immunosuppressive factors (older age and comorbidities such as low socioeconomic status and malnutrition). The patient had a good recovery even if he required intensive neurorehabilitation for a month due to poor feeding and weakness. Treatment, both anti-mycobacterial and anti-inflammatory, early started, guaranteed good recovery.

Background Isovaleric acidemia (IVA) is a rare autosomal recessive inherited organic acidemia caused by a genetic deficiency of isovaleryl-CoA dehydrogenase (IVD). Its morbidity is low, but mortality is high. There is no effective cure for this disease. Early identification of IVA using clinical features can significantly slow disease progression and reduce mortality. Here we report a Chinese neonate with two mutations of IVD and share valuable information on this disease. Case summary A 12-day-old male neonate with "poor response for 1 d and repeated convulsions accompanied by high muscle tension for 6 h" was hospitalized. The patient was the first child of nonconsanguineous ethnic Chinese parents. He was delivered by cesarean section due to breech position at 39 + 1 wk of gestation with a birth weight of 3.27 kg. Initially, he suffered from dyspnea and rhinobyon, and at 10 d after birth the patient suddenly developed poor feeding, low response, lethargy and seizures. Organic acid analysis of blood and urine by tandem mass spectrometry and gas chromatography mass spectrometry showed extremely high concentrations of isovaleryl glycine. The patient had an acute episode of IVA causing severe metabolic stress and eventually died. Conclusion A new case of an IVA patient carrying c.1193G>A (p.Arg398Gln) and c.1208A>G (p.Try403Cys) mutations is reported in China.

Background: Malaria in pregnancy poses a great health risk to the mother and her fetus and causes abortion, stillbirth, intrauterine growth retardation and low birth weight. The symptoms commonly start between 10 - 30 days of age and the symptoms mostly observed are fever, restlessness, drowsiness, jaundice, poor feeding, vomiting, diarrhea, and hepatosplenomegaly. Aim: The aim of this study was to diagnose malaria in a neonate admitted to ICU with fever, jaundice and hepatomegaly. Case Summary: A 32-day-old female child was admitted to ICU for intermittent high grade fever and rapid breathing, pallor, poor feeding, mild hepatosplenomegaly and physiological jaundice of one-week duration. The mother had malaria two years before while visiting her native country, Afghanistan and was treated with chloroquine for three days. Conclusion: High suspicion should be considered in diagnosing malaria during pregnancy to prevent congenital malaria among all neonates who present fever and splenomegaly in malaria endemic areas as well as in women from malaria endemic countries living in non-endemic areas. In this report, we describe the first case of congenital malaria in a child in non-malaria endemic Kuwait.

This investigation describes a rarely reported occurrence of arthrogryposis in trade cattle calf of Gudali breed in Ibadan, Oyo State, South west, Nigeria. The animal was gaunt, with severely compromised gait and notable contracture of the radio carpal and tibio tarsal joints. There were varying degrees of abduction of the limbs. The animal was purchased at the age of six months in Akinyele International Cattle Market (AICM) at Akinyele Village, Akinyele Local Government area of Ibadan, Oyo-State, Nigeria for subsequent fattening operation. The condition was characterized by poor feeding performance and general unthriftiness. The defects were characterized for quality control points in good calf-selection for fattening and rearing from AICM, Ibadan. The haematology showed lower than normal blood parameters except for the Red Blood Cell (RBC) counts and the Mean Corpuscular Haemoglobin Concentration (MCHC), which may be the reason for lethargy and poor growth observed. The calf was recommended for culling due to subsequent pedal paralysis ensued. Thus, age of acquisition of calves for fattening or rearing at AICM is crucial to avoid such congenital abnormality. Acquisition of yearling calf or above age when the abnormality was obvious is recommended with enhanced veterinary support service at AICM.

Objective: The present study aimed to survey seasonal changes in reproductive performance of local cows receiving artificial insemination (AI) in the Pursat province of Cambodia, a tropical country, to investigate if ambient conditions affect the reproductive performance of cows as to better understand the major problems regarding cattle production.Methods: The number of cows receiving AI, resultant number of calving, and calving rate were analyzed for those receiving the first AI from 2016 to 2017. The year was divided into three seasons: cool/dry (from November to February), hot/dry (from March to June), and wet (from July to October), based on the maximal temperature and rainfall in Pursat, to analyze the relationship between ambient conditions and the reproductive performance of cows. Body condition scores (BCS) and feeding schemes were also analyzed in these seasons.Results: The number of cows receiving AI was significantly higher in the cool/dry season than the wet season. The number of calving and calving rate were significantly higher in cows receiving AI in the cool/dry season compared with the hot/dry and wet seasons. The cows showed higher BCSs in the cool/dry season compared to the hot/dry and wet seasons probably due to the seasonal changes in the feeding schemes: these cows grazed on wild grasses in the cool/dry season but fed with a limited amount of grasses and straw in the hot/dry and wet seasons.Conclusion: The present study suggests that the low number of cows receiving AI, low number of calving, and low calving rate could be mainly due to poor body condition as a result of the poor feeding schemes during the hot/dry and wet seasons. The improvement of body condition by the refinement of feeding schemes may contribute to an increase in the reproductive performance in cows during the hot/dry and wet seasons in Cambodia.

Objective: To determine the frequency of a wide range of clinical presentations of inherited metabolic disorders diagnosed in infants and children at a tertiary care hospital in Rawalpindi, Pakistan. Study Design: Cross sectional study Place and Duration of Study: MH Rawalpindi, from June 2015 till June 2016. Material and Methods: 64 children diagnosed with metabolic disorders, reporting to the MH Rawalpindi, were enrolled in the study. History was taken with special reference to family history, consanguineous marriage, sibling’s death and clinical manifestations. Thorough physical examination was done in every patient to find out the clinical signs present. All the data was recorded on a proforma. SPSS-20 version was used to derive the results and p-value of

The urea cycle is a series of metabolic reactions that convert ammonia into urea in order to eliminate it from the body. Urea cycle disorders are characterized by hyperammonemia, which can cause irreversible damages in central nervous system. We report a series of three newborns presenting irritability, poor feeding and tachypnea. Their first gas analysis revealed respiratory alkalosis. Hyperammonemia was confirmed, and three different enzymatic blocks in the urea cycle were diagnosed. Immediate treatment consisted in the removal of ammonia by reduction of the catabolic state, dietary adjustments, use of nitrogen scavenging agents and ultimately hemodiafiltration. Hyperammonemia is a medical emergency whose treatment should not be delayed. This report aims to highlight the importance of suspecting urea cycle disorders in newborns with aspecific signs of hyperammonemia and respiratory alkalosis, and to sum up the broad lines of hyperammonemia management.

The study explored the causes of poor academic performance and anticipated remedy in Islamic university primary school. The study was qualitative in nature and case study design was used. Purposive sampling technique was used to select 28 respondents who were interviewed. Data was collected through semi-structured interviews, documentary analysis and observation. The thematic analysis method was used to analyse data. The findings revealed that the causes of poor academic performance included, absenteeism, poor feeding, language problem, negative teachers’ attitude, inadequate support from administration, and poor school environment. The researchers developed a tool to help improve the academic performance in Islamic university primary school. The tool explains that the school should provide professional administration, teacher motivation, in-service training, learners’ guidance and counselling, improve learners’ communication skills and provide a conducive school environment to improve the academic performance of the pupils.

As in many developing countries, stunting is a public health problem in Burkina Faso. More than one in four children does not reach his or her growth potential. In addition, all nutrition surveys conducted in the country reveal that boys are more affected. This stunting gender bias is supported by the Trivers-Willard theory that there is a natural discriminating investment in reproduction according to sex through sociodemographic characteristics, behaviour and biology. The present study is intended to investigate the role of food quality in the occurrence of this phenomenon. This cross-sectional and explanatory study of children under five years of age is based on data from Burkina Faso’s latest 2010 Demographic and Health Survey. Analyses were carried out on only the subsample of 6994 under-five year old children on which the anthropometric measures were taken. The assessment of child growth is based on the anthropometric index height-for-age z-score and the food quality assessment is based on the joint WHO/Unicef standard. The explanatory model used to examine the effect of the food quality is based on logistic regression. The prevalence of balanced diets among the children was 7.2% and there was no gender difference. On the other hand, stunting prevalence was significantly higher for boys (37.7% versus 32.6%). Children who were subjected to suboptimal feeding practices had three times more adjusted risk of stunting for both sexes. In addition, poor feeding practices led to a significantly higher growth deficit in boys compared to girls. However, when the diet was adequate, this risk gap dwindled. The higher prevalence of stunting of boys in the absence of food discrimination led us to single out behaviour and biology effects as the likely explanatory variables. Girls' natural resilience to certain infections and nutritional deficiencies could explain this difference in risk. Improved under-five year old child feeding practices contribute to improving overall growth stature and contribute also to bridging the gender gap in stunting.

Acute metabolic decompensation (AMD) of maple syrup urine disease (MSUD) must be promptly recognized and treated. In this study, we aimed to identify simple variables associated with AMD in children with MSUD for use in emergency settings. Data were collected retrospectively from 115 emergency visits of 29 children with MSUD over a 4-year period in a major referral hospital. Variables in visits with and without AMD were compared using t test, Mann-Whitney U test, and chi-square test. Logistic regression was used to identify independent variables associated with decompensations. Cut-off values of laboratory variables were determined with receiver operating characteristic curves and correlations with Spearman's rank correlation. Most important variables independently associated with AMD were poor feeding, malaise, anion gap, and especially uric acid, which correlated with leucine levels. Vomiting, dehydration, neurological signs, ketonuria, and ketoaciduria were also associated with AMD. Although sodium, chloride, and glucose were lower in AMD, they had little diagnostic value.Conclusion: In children with MSUD, uric acid and anion gap are key markers for AMD. Poor feeding and malaise are clues before the onset of neurological symptoms. These simple parameters can help determine the presence of AMD in emergency settings.What is Known:• In maple syrup urine disease, acute metabolic decompensations are characterized by gastrointestinal and neurological findings.• Diagnosis requires detection of significantly elevated leucine, which may take a long time or not be available.What is New:• Poor feeding, malaise, hyperuricemia, and high anion gap are parameters that can help diagnose acute decompensations in children with maple syrup urine disease at emergency departments.• Uric acid may be a biomarker for acute decompensations because of its high sensitivity, specificity, and its strong correlation with leucine.

The physical and mental development of pupils could be arrested by inadequate food intake and infection with immediate and long term consequences. This has implications on decreased school performances, lower intelligent quotient levels, poor psychosocial development, and decreased cognitive functions. This study assessed the growth and body fat distribution among pupils aged 5 - 19 years. A cross-sectional study was conducted among pupils from five primary schools in different communities around Kainji Dam. This assessment was based on a comparison with reference standards set by the World Health Organization to determine their deviations. A qualified registered nurse carried out physical measurements to obtain age, height, and body weight using electronic weighing scale and stadiometer. Data were analyzed using Anthroplusv1.0.4 software. The overall prevalence of stunting was 21.5% with 8% being severely stunted. The prevalence of thinness was 35.2% with 11.2% being wasted while the overall prevalence of underweight was not calculated for children > 10 years old. The prevalence of underweight for 5 - 10 years old children was 16.9% with 2.4% being severely underweight. The curves for both male and female children deviated from normal distribution. Females have higher percentage of stunting than males. This study revealed a high prevalence of thinness and stunting which is the consequence of poor nutrition arising from multifaceted and interrelated circumstances such as poor feeding, eating practices and repeated infection. Intervention such as Home Grown School Feeding Programme of the Government is a right step in improving the nutritional status of pupils in rural communities.

Exclusive breastfeeding for the first six months followed by complementary feeding along with breastfeeding is crucial for proper growth and development of a child. This study aims to determine the factors that influence the feeding practice of mothers having the children 6-23 months in Kaski district and to correlate the relationship between complementary feeding practices and nutritional status of children 6-23 months. A community-based cross sectional analytical study was conducted among 453 mothers having the children 6-23 months, applying cluster sampling technique and using the structured questionnaire, salter scale weighing machine, stadiometer and sakir tape were used as research tools. From all respondents 67% started complementary feeding at 6-8 months of age. The practices of minimum meal frequency, minimum dietary diversity, and minimum acceptable diet were 93.8%, 45.9% and 42.4% among mothers of 6–23 months aged children, respectively. More than half of children have worst feeding practices. Types of family, mother’s education, father’s education, mother’s occupation were significantly associated with feeding practices. In term of nutritional status, 62.26% of children were stunted, 7.3% of children were underweight and 3.4% of children were wasted. Feeding practices were significantly associated with children nutritional status based on wasting and mid upper arm circumference. Overall in Kaski district, it was found that majority of mother had poor feeding practices which contribute to the under nutrition. Nutrition messages on Infant and Young Child Feeding Practices (IYCF) should emphasis dietary diversity and frequency of feeding for all the children. Keywords: Associated factors, Children, Feeding practices, Nutritional status

AIM To investigate the incidence and characteristics of complications arising from frenotomy for ankyloglossia (tongue-tie) in New Zealand. METHODS Prospective surveillance among hospital-based paediatricians of complications arising from frenotomy for ankyloglossia to children

Chronic granulomatous disease (CGD) is a rare inherited immunodeficiency disorder, characterized by susceptibility to recurrent infections, including hepatic abscess. These abscesses are typically resistant to antibiotics and surgical procedures. Here, we describe an infant with CGD and liver abscesses that was successfully treated with corticosteroids and antibiotics. A 19-day-old neonate was admitted after presenting with malaise, fever, poor feeding, abdominal distension, and hepatomegaly. Routine laboratory evaluation for sepsis and polymerase chain reaction (PCR) testing for SARS-CoV-2 was done. The PCR test results was negative in two different samples 15 days apart. Ultrasound image showed numerous focal hypoechoic masses in the liver suspected to liver abscess. Nitroblue tetrazolium (NBT) test was sent which showed less than 5% positive leukocytes. The neonate recovered completely, and the liver abscesses were removed once oral prednisolone was started in combination with antibiotic therapy. Corticosteroid therapy and prolonged antibiotic courses can be effective for the management of CGD-related hepatic abscesses. © 2021 The Authors

Background Inappropriate infant and young child feeding (IYCF) practice is the leading cause of malnutrition in children. Data is needed to identify children at risk of poor feeding practice and to target interventions to improve IYCF practices. Therefore, this study aimed to assess IYCF practice and associated factors among mothers of children age 6 to 23 months in Debrelibanos district, north Showa zone, Oromia region, Ethiopia. Method A community-based cross-sectional study design was conducted among 380 mothers of children age 6 to 23 months from March 1 to April 5, 2019. A simple random sampling technique was used to select the respondents. Data was collected using a structured interviewer-administered questionnaire that had been pretested. The data was entered into Epi-Data 3.1 and then transferred to SPSS 21 for analysis. Descriptive statistical analysis was done, and an association between an outcome variable and independent variables was examined in logistic regression models. Result Overall, 65.8% of mothers practiced appropriate IYCF practice. The study revealed that 70.5% of children started breastfeeding within one hour of birth, and 61.6% were breastfed exclusively for six months. Among studied mothers, 79.5% continued to breastfeed their children until 2 years, and 69.2% of the participants started complementary feeding timely at six months. Minimum dietary diversity was observed in 19.2% of children, while minimum meal frequency was found in 79.2%. The majority of mothers (77.6%) fed their babies with bottles. Mother’s educational status of primary school [AOR = 4.50, 95% CI: (1.38,14.61)], husband’s occupation being merchant [AOR = 6.45, 95% CI: (1.51, 27.59)]; antenatal care follows up [AOR = 3.15, % CI: (1.22, 8.12)], radio/television ownership [AOR = 7.41, 95% CI: (2.86, 19.20)], child’s sex being female [AOR = 4.78, 95% CI: (2.26, 10.064) and sufficient knowledge on child feeding [AOR = 2.82, 95% CI: (1.27, 26.26)] were independent predictors for appropriate IYCF practice. Conclusion The prevalence of appropriate infant and young child feeding practice indicators was found to be rather high among the mothers in this study. The use of a bottle to feed babies, in particular is very common among the mothers who were studied. To address child malnutrition, it is critical to educate families about proper IYCF practices. This study suggests that mothers be properly educated about IYCF recommendations at health care facilities during their visits, as well as the promotion of appropriate IYCF through various media.

1. Wendy Si, MD* 2. Hoda Karbalivand, MD*,† 3. Tomas Havranek, MD*,† 1. *Department of Pediatrics and 2. †Division of Neonatal-Perinatal Medicine, Children’s Hospital at Montefiore, Bronx, NY 1. Address correspondence to Wendy Si, MD, Department of Pediatrics, Children’s Hospital at Montefiore, 3415 Bainbridge Ave, Bronx NY, 10467. E-mail: wsi{at}montefiore.org A term male infant is born via elective cesarean delivery with a birthweight of 3.2 kg to a Gravida 2 Para 1 mother. The prenatal course was unremarkable, and there is a consanguineous relationship between the parents (first cousins). The infant’s Apgar scores are 9 and 9 at 1 and 5 minutes of life, respectively. The initial newborn examination is normal. The infant is allowed to room in with his mother and is exclusively breastfed. At 27 hours of age, the infant is brought to the nursery for poor feeding. On repeat examination, he is found to be hypotonic and apneic with poor perfusion. Vital signs show temperature of 92.5°F (33.6°C), heart rate of 40 beats/min, and oxygen saturations of ∼80% on room air. Point of care blood glucose is less than the detectable range. Initial blood gas reveals severe metabolic acidosis with pH of 7.1, base deficit of 22.5 mEq/L (22.5 mmol/L), and immeasurably high lactate level. Positive pressure ventilation is initiated, but no improvement in tone or respiratory effort is seen. The infant is subsequently intubated. Chest radiograph demonstrates clear lungs and a normal cardiothymic silhouette. Over the next 2 hours, the infant receives multiple rounds of chest compressions, multiple doses of epinephrine, a dose of sodium bicarbonate, and several fluid and dextrose boluses. Sepsis evaluation is performed, and antibiotics are started for presumed sepsis. Before transfer to a regional NICU, he is placed on epinephrine and dopamine infusions for hypotension. His hypoglycemia improves on intravenous 10% dextrose solution. Upon arrival to the regional NICU, the infant is noted to be arousable with reactive pupils, weak …

1. Alyssa A. Kerber, MD*,†,‡ 2. Meredith S. Campbell, MD* 3. Sarah C. Rhodes, MD* 4. Elizabeth H. Ristagno, MD, MS† 1. *Department of Pediatric and Adolescent Medicine and 2. †Division of Pediatric Infectious Disease, Mayo Clinic, Rochester, MN 1. Address correspondence to Elizabeth H. Ristagno, MD, MS, Department of Pediatric and Adolescent Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905. E-mail: ristagno.elizabeth{at}mayo.edu A previously healthy infant is brought to a pediatrician at 48 days of age with fussiness, poor feeding, and a fever (100.4°F; 38.0°C). He has a normal white blood cell count and urine, and blood cultures are negative. A diagnosis of left otitis media is made and he completes a 10-day course of cefdinir. Three days after completion of the antibiotic course, he is brought to the emergency department at an outside facility with worsening fussiness, poor feeding, and a reported fever (100.4°F; 38.0°C) at home, measured the previous night. He appears ill with substantial tachycardia but without specific findings on examination. He is afebrile on initial arrival. The white blood cell count is increased to 18.3 × 109/L with a neutrophilic predominance. There is concern for urinary tract infection, with bacteria and clusters of white blood cells on microscopy, although not enough urine is collected to culture. A blood culture is obtained. He receives a 20-mL/kg fluid bolus and a dose of ceftriaxone. His tachycardia improves and he is then transferred to our hospital for further care. Upon his arrival, he is noted to be febrile …

A 5-month-old girl child patient presented to the emergency department for oral thrush and poor feeding but instead demonstrated concern for abuse after physical exam, as findings were consistent with oral injury. Correct identification of the oral findings as traumatic necessitated navigating language and cultural issues before the mechanism of injury and abuse determination could be made. Exploring the involvement of other caregivers was a crucial piece for investigation of the clinical scenario. The incidence of child abuse and pediatric oral injuries concerning for abuse were reviewed in this case report.

Tick paralysis is an uncommon, noninfectious, neurologic syndrome characterized by acute ataxia and ascending paralysis mostly seen in children. Early recognition and prompt management with tick removal helps in complete recovery. If untreated, ascending paralysis can lead to respiratory failure and death in 10% of the cases. Tick paralysis is usually considered as a differential in all cases of acute ataxia and generalized weakness in children and adults but seldom in neonates due to its rarity and differences in clinical presentation in the newborn period. In neonates, tick paralysis may present only as generalized weakness and lethargy with poor feeding. Even though tick paralysis is common in children

A 14-month-old term boy with no significant medical history presents with 2 days of fever, vomiting, and diarrhea and 1 month of weight loss and poor appetite. On further history, his mother reported a 5 lb weight loss over 1 month, change in eating, and loss of developmental milestones. He was previously eating some solid foods but started refusing to eat or drink anything but breast milk. He also had loss of gross motor (he could no longer sit unsupported, crawl, or pull to stand), language (no longer speaking, previously said ∼5 words), and social (no longer exhibiting social reciprocity) milestones. He was last seen by a pediatrician at 6 months of age because of the family moving cross country and changing insurances. On physical examination, he was cachectic (BMI less than third percentile), had decreased muscle bulk and tone, and was mildly hyperreflexic with 3+ patellar reflexes bilaterally. He also had dry mucous membranes and tachycardia. He underwent fluid resuscitation and workup for his acute symptoms of fever, vomiting, and diarrhea and his chronic issues of poor feeding, weight loss, and loss of developmental milestones. Initial differential diagnosis included inadequate caloric intake, metabolic disorders, gastroesophageal reflux, malrotation, volvulus, intracranial process, and nonaccidental trauma. Initial laboratory workup was significant for metabolic alkalosis, hypocalcemia, and mildly elevated C-reactive protein. His infectious workup was notable for a positive Clostridium difficile assay. He was treated with a course of Flagyl. Imaging obtained on admission included chest radiograph, abdominal ultrasound and radiograph, echocardiogram, and skeletal survey for nonaccidental trauma, all of which were normal, and brain MRI, which showed significant diffuse white matter loss. Given his presentation, MRI findings, and the broad differential, neurology, medical genetics, and ophthalmology were consulted. He …

Lay summary The current pandemic of COVID-19 has affected all the countries globally. However, the adverse impact of the pandemic is more seen in the low-income and middle-income countries (LMICs). Although there is evidence on the adverse impact of the SARS-CoV-2 on the health of mothers and neonates, the evidence is mainly from high-income countries. For reducing the mortality and morbidity due to COVID-19 in LMICs, there is a need to generate evidence from the LMICs. The present study is a part of the National Registry of pregnant women with COVID-19 in India (PregCovid registry). Our study demonstrates a higher risk of adverse outcomes such as neonatal sepsis and death in the SARS-CoV-2 infected as compared to the non-infected neonates. The study also showed the risk of SARS-CoV-2 infection in 6.3% of neonates born to mothers with COVID-19. Introduction We describe the clinical characteristics, management, and short-term outcomes of SARS-CoV-2 neonates born to mothers with COVID-19 in a tertiary care hospital in Mumbai, India. Methods The study is a retrospective analysis of 524 neonates born to mothers with COVID-19 admitted from 14th April 2020 to 31st July 2020. Results SARS-CoV-2 infection was detected in 6.3% of the newborns of the mothers with COVID-19. No significant differences were observed between maturity at gestation, birth weight and sex of SARS-CoV-2 infected and non-infected newborns. The risk of sepsis was 4.09 (95% CI,1.28-13.00) fold higher in the neonates with SARS-CoV-2 as compared to the non-infected group (p = 0.031). Poor feeding was significantly more common among SARS-CoV-2 infected neonates (12.1%) as compared to the non-infected neonates (2.7%) (p = 0.017). There was a total of 13 neonatal deaths, of which 3 deaths occurred in SARS-CoV-2 infected neonates (9%) while 10 (3%) in the SAR-CoV-2 negative group. The risk of neonatal death was higher in SARS-CoV-2 infected newborns (OR 4.8; 95% CI 1.25-18.36). Conclusion Neonatal SARS-CoV-2 infection is observed in almost 6% of neonates born to mothers with perinatal COVID-19. There is a higher risk of adverse outcomes such as neonatal sepsis and death in the SARS-CoV-2 infected as compared to the non-infected neonates.

Extracorporeal life support (ECLS) is a life-saving therapy, but neonates who require ECLS have unique nutritional needs and require aggressive, early nutritional support. These critically ill neonates are at increased risk for long-term feeding difficulties, malnutrition, and growth failure with associated increased morbidity and mortality. Unfortunately, few studies specific to this population exist. Clinical guidelines published by the American Society for Parenteral and Enteral Nutrition are specific to this population and available to aid clinicians in appropriate nutrition regimens, but studies to date suggest that nutrition provision varies greatly from center to center and often is inadequate. Though enteral feedings are becoming more common, aggressive parenteral nutrition is still needed to ensure nutrition goals are met, including the goal of increased protein provision. Long-term complications, including the need for tube feedings and growth failure, are common in neonatal ECLS survivors, particularly those with congenital diaphragmatic hernia. Oral aversion with poor feeding and growth failure must be anticipated and recognized early if present. The nutritional implications associated with the development of acute kidney injury, fluid overload, or the use of continuous renal replacement therapy must be recognized. In this state-of-the-art review, we examine aspects of nutrition for neonates receiving ECLS including nutritional requirements, nutrition provision, current practices, long-term outcomes, and special population considerations.

The main manifestations of novel coronavirus usually include fever and cough. Neurological manifestations have not been properly identified in children. A 65-day-old infant was hospitalized due to poor feeding, weakness, lethargy, and occasional cough. She suffered several seizures during her hospitalization. The brain computed tomography scan depicted a minor hemorrhage. Due to the exacerbation of her condition during hospital stay and the presence of respiratory symptoms in her parents, coronavirus disease was suspected. Reverse transcription–polymerase chain reaction (PCR) of coronavirus was positive for both: child and parents. In children with neurological manifestations such as lethargy, recurrent seizures, cerebral hemorrhage, and clinical evidence of respiratory symptoms in his/her relatives, PCR testing for coronavirus is recommended.

Non-ketotic hyperglycinemia (NKH) is a rare autosomal recessive disorder affecting glycine metabolism that is a rare metabolic disorder in infants. The clinical manifestations of poor sucking, hypotonicity, lethargy, hiccups, and seizures develop within six hours to eight days of the birth of an otherwise healthy newborn. The present study introduced a newborn girl with poor feeding and hypotonia in the first day after birth with NKH. In addition, the patient was evaluated regarding hypotonia and poor feeding. The neonatal-onset NKH was diagnosed based on a markedly elevated cerebrospinal fluid/plasma glycine ratio of 0.32 and confirmed by the genetic test. It is extremely rare that NKH is manifested with poor feeding and hypotonia thus considering this diagnosis in infants with poor feeding and hypotonia is highly important.

Background: Malnutrition is a major public health thread in Africa and Cameroon as well. A study of mothers’ feeding practices and child malnutrition can contribute to identify and optimise interventions to control malnutrition. Methods: This was an analytical case/control study with a simple random sampling.Data sources were a literature review to estimate the prevalence of referred malnutrition of children, a community detection of cases and controls. A total of 386 children were included in the study. Results: The prevalence of referred infant malnutrition was 47.89% (95% CI [45.58, 50.2]). The most affected age group was children aged between 6 to 29 months. Inappropriate feeding practices significantly increased the risk of malnutrition in children with OR = 3.44 [2.05; 5.76] (P˂0.05). After adjustment by the confounding factors we obtained an adjusted OR = 3.19 [2.08; 6.35] (P = 0.0007). The most common inappropriate feeding practices were: food taboos, non-fortified porridge, early or late introduction of supplementary foods. Conclusion: The prevalence of malnutrition remains very high in the health district of Pitoa. Poor feeding practices significantly increase the risk of malnutrition. Efficient interventions would include nutritional education and popularization of rich local foods.

The problem of malnutrition in children under five is still a major health problem in the world, including Indonesia. Indonesia is a developing country that still faces considerable problems of malnutrition. Nutritional problems nationally are under-five and under-nutrition children under five. Poor nutritional status is a condition of the body experiencing nutritional deficiencies or below standard. Based on the nutritional status monitoring (PSG) survey in Probolinggo District, there was an increase in cases of malnutrition, obtained in the prevalence of non-compliance with the weight per year in 2017 of 9.44%, an increase compared to 2016, namely 8.65% under-five children under five. Toddlers are considered the biggest nutritional risk because patterns of poor feeding have an impact on growth and development. This causes the toddler age group to increase the risk of morbidity and mortality. Based on a preliminary study in April 2018, data was obtained that Probolinggo was ranked second in the area of ​​malnutrition in East Java. In 2017 there are 130 toddlers who experience malnutrition in the Kalibuntu Coast of Probolinggo Regency. The cause of malnutrition is due to the pattern and intake of toddlers' food which contains less nutrition.The purpose of this study was to analyze the effect of nutritional support programs on feeding patterns and nutritional status of the Kalibuntu Coastal Children in Probolinggo Regency. This research is an experimental study, namely by measuring the increase / comparison of feeding patterns and nutritional status before and after the nutrition companion program. The population in this study were all toddlers with malnutrition in the Kalibuntu Coast of 130 people in Probolinggo Regency. Sampling uses Total Sampling. Samples are all mothers who have underweight and malnourished children under the age of 130 people in the Kalibuntu Coast of Probolinggo Regency. Data collection using observation sheets and interviews. Analysis of univariate data using frequency distribution, bivariate analysis using Wilcoxon match paired test and multivariate analysis using multiple linear regression then drawn conclusions. The results of the Wilcoxon match paired test between nutritional companions on feeding patterns obtained a p value of 0,000

Aim: This study assessed the prevalence of wrongly diagnosed non-febrile urinary tract infections in patients who had not been toilet trained and presented with poor feeding and, or, failure to thrive. The diagnostic value of these signs in predicting non-febrile UTIs was also explored. Methods: We focused on 59 outpatients (56.7% male) with these criteria, who had positive urine cultures and were referred to our Italian University hospital from January 2017 to January 2019. None were on antibiotics and all underwent urine cultures by bladder catheterisation. Wrongly diagnosed non-febrile UTIs were defined by sterile urine cultures. The predictive value was evaluated using logistic regression. Results: The mean age was 8.5±5.7months and 72.9% had wrongly diagnosed non-febrile UTIs. Poor feeding was significantly higher among the 16 patients with true non-febrile UTIs (P=.04). It was significantly predictive of non-febrile UTIs (odds ratio 4.1, 95% confidence interval 1.1-16.6), especially when leucocyturia was present (odds ratio 9.7, 95% confidence interval 2.3-40.7). Conclusion: Wrongly diagnosed non-febrile UTIs were high in children with poor feeding and, or, failure to thrive. Only poor feeding and, in particular, the combination of poor feeding and leucocyturia, significantly increased the odds of non-febrile UTI.

Nephrogenic diabetes insipidus (NDI) is a rare disorder of the renal collecting tubules, characterized by an inability to concentrate urine due to an impaired response to arginine vasopressin (AVP), resulting in dilute urine and polyuria. Causes of NDI are heterogeneous and diagnosing congenital NDI (cNDI) in young infants is clinically challenging, as typical symptoms are often unappreciated or inconspicuous. Instead, young infants may present with non-specific signs such as vomiting, poor feeding, failure to thrive, unexplained fevers, irritability, constipation or diarrhea. We report a 37-day-old infant who presented with polyuria and severe hypernatremic dehydration that was unresponsive to vasopressin. The patient was treated with amiloride, indomethacin and hydrochlorothiazide. Genetic analysis revealed a novel contiguous deletion involving the entire AVPR2 gene and the last exon of the adjacent ARHGAP4 gene. A study of the family confirmed the carrier status in the mother. This case illustrates the importance of molecular testing in confirming the diagnosis in the index patient, as well as in identifying asymptomatic at-risk female carriers so that appropriate genetic counselling can be given for reproductive planning. All pediatric patients with suspected cNDI should undergo genetic analysis for a definitive diagnosis.

Cerebral venous thrombosis (CVT) is an uncommon but fatal disease in the pediatric age group, with a neonatal preponderance. The clinical presentation is nonspecific. Within the first 48 hours, the neonate usually presents with nonspecific signs such as respiratory distress, poor tone, and asphyxia. Neurological signs such as seizures, lethargy, apnea, and poor feeding set in later. We present the case of a neonatal CVT, presenting as asphyxia and respiratory depression on day 1 of life. CVT was diagnosed on neonatal cranial ultrasound. The patient died 3 days later.

Introduction: The best food for the infant is breastmilk as it provides the nourishment in the first year of life. Greater chances of survival are seen more in breastfed children as compared to artifically fed child. But today in many affluent societies, breast feeding appears to have become a lost art. Objectives: To assess the breast feeding practices and to educate the mothers about the importance of breast feeding and its advantages. Materials and Methods: A cross sectional study was conducted in a District Hospital, Koppal. A total of 110 women were included in the study and data was collected using a structured questionnaire for a period of three months from January 2018 to March 2018. Data was entered in Microsoft excel and descriptive proportions were used to analyze the data. Results: Among 110 women who participated in the study 63.7% belonged to 17-21 years age; about 60.9% belonged to lower middle and lower class (60.9%). Gradutaes were 6.4% and more than half of them are living as nuclear family. Majority were from rural background (79%) and 88% had delivered at an institution. 56% women delivered normally and birth spacing of more than 2 years was seen in 77% women. Babies who were fed within 30 minutes after birth were 25% and 65% exclusively breastfed their infants upto 6 months. Colostrum feeding was observed in 83% women while pre-lacteal feed was seen in 17% women. Conclusions: We can conclude from this study that mothers had an average knowledge about breast feeding but had poor feeding practices. It is necessary to educate all the mothers about breastfeeding and its importance. Keywords: Awareness, Breastfeeding, Practices, Reproductive age, Women.

Importance: Alpha1-antitrypsin (AAT) deficiency is a common, but an underdiagnosed genetic condition, affecting 1 in 1500 individuals. It can present insidiously with liver disease in children. Although clinical practice guidelines exist for the management of AAT deficiency, especially with regards to pulmonary involvement, there are no published recommendations that specifically relate to the management of the liver disease and monitoring for lung disease associated with this condition, particularly in children. Objective: To review the literature on the management of AAT deficiency-associated liver disease in adults and children. Evidence Review: A systematic search for articles indexed in PubMed and published was undertaken. Some earlier selected landmark references were included in the review. Search terms included: "alpha1-antitrypsin deficiency"; "liver disease"; "end-stage liver disease"; "liver transplantation" and "preventative management". Recommendations for the management of children with suspected or confirmed AAT deficiency were made according to the Strength of Recommendation Taxonomy scale. Findings: Liver complications arising from AAT deficiency result from the accumulation of mutated AAT protein within hepatocytes. Liver disease occurs in 10% of children, manifested by cholestasis, pruritus, poor feeding, hepatomegaly, and splenomegaly, but the presentation is highly variable. A diagnostic test for AAT deficiency is recommended for these children. Baseline liver function tests should be obtained to assess for liver involvement; however, the only curative treatment for AAT deficiency-associated liver disease is organ transplantation. Conclusion and Relevance: There should be a greater vigilance for AAT deficiency testing among pediatricians. Diagnosis should prompt assessment of liver involvement. Children with AATdeficiency- associated liver disease should be referred to a liver specialist and monitored throughout their lifetimes for the symptoms of AAT-deficiency-related pulmonary involvement.

Dairy cattle productivity is affected by many factors such as genetics, infectious diseases, husbandry and diet. Fodder resources, fodder availability and feeding strategies were assessed by means of questionnaires and interviews in seventeen dairy farms in Addis Ababa, Sendafa and Debre Zeit. Nutrient content was analyzed from hay sample. The farms were categorized as small, medium or large. Nutrient content, as well as milk production for the given rations were estimated per farm. Results showed that most farms were landless and grass availability was seen in only 1/3 of the farms. Purchased hay was of poor quality and needed to be bulked stored for the year. Storage capacity and quality varied with farm size. Supplemental feed varied by farm size and many of them were available only seasonally and were costly. With the exception of large farms, quality of fodder was poor in 70% of the farms, hence likely impacting animal productivity and health. Overall, constraints related to feeding and animal performance were: low fodder quality containing too little protein and energy, poor fodder storage condition, seasonal and costly fodder availability, poor feeding strategy, and lack of knowledge of small and medium farm owners regarding dairy husbandry and feeding management. Key words: Ethiopia, fodder, dairy cattle, productivity, feeding management.

Background: Enteral feeding is challenging in critically ill infants. Target intakes are often not achieved as a result of fluid restriction, procedural interruptions and perceived enteral feeding intolerance. In those infants perceived to have poor feeding tolerance, the use of a peptide nutrient-energy dense enteral feed (PEF) may improve nutritional intake and minimise feeding interruptions as a result of gastrointestinal symptoms. The aim of this observational study was to characterise the use of a PEF amongst critically ill infants in two paediatric intensive care units (PICUs). Methods: Records from critically ill infants aged

Bronchiolitis is a leading cause of emergency department visits and hospitalization in the first year of life with estimated costs to the healthcare system in the United States of $1.73 billion annually. The highest rates of admission occur in the first 3 to 6 months of life. Traditional therapies such as bronchodilators and antibiotics have repeatedly been shown to be ineffective. Thickened nasal secretions cause decreased oxygenation, difficulty sleeping, poor feeding, and respiratory distress symptoms. Bronchiolitis guidelines recommend supportive care such as noninvasive nasal airway clearance with saline to clear obstructed airways, improve oxygenation, and promote optimal infant eating and sleeping. Evidence on the safety and efficacy of use of noninvasive nasal airway clearance as supportive care for infants with bronchiolitis in the acute care setting is presented.

Background Anaemia is the world’s second cause of disability and it affects over half of pre-school children in developing countries and at least 30–40% in industrial countries. In poorer malaria-endemic countries, anemia is one of the commonest preventable causes of death in children under 5 years. This study sought to determine the perceived causes, signs and symptoms as well prevention of childhood anaemia among mothers of children under 5 years in Kumasi, Ghana. Methods A descriptive hospital-based cross-sectional study design with a sample of 228 patients attending the University Hospital, KNUST was used. A simple random sampling technique was applied in sampling and a structured questionnaire was used to collect data which was analyzed using SPSS statistical tools. Results The study found that anemia was mostly perceived to be caused by poor feeding practices (43%) and fever (37%). The signs and symptoms mentioned mostly were pale conjunctiva (47%) and pale palm (44%). It was suggested that it could be prevented by giving adequate nutrition (23%), regular deworming (19%) as well as exclusive breastfeeding (25%). Mothers education and the number of children were found to be associated with the perception regarding anaemia as respondents who had completed SHS/A level were 5.14 times likely to have a higher knowledge score on Anaemia (AOR = 5.14; 95% CI; 1.01–21.8). Also, mothers who had 5 to 6 children were 1.65 times likely to have higher knowledge score on Anaemia (AOR = 1.65; 95% CI; 0.02–2.32). Conclusion Previous experience with Anaemia and higher educational level results in better understanding of Anaemia. Therefore, extensive health education on anemia should be undertaken by the hospital authorities in collaboration with the Ministry of Health to improve knowledge of Anaemia.

Holocarboxylase deficiency (HLCSD) is caused by biallelic pathogenic variants in HLCS and is associated with poor feeding, emesis, lethargy, seizures, life-threatening metabolic acidosis, and hyperammonemia. Skin involvement in HLCSD is typically described as scaly, erythrodermic, seborrhea-like, or ichthyosiform, but there is a paucity of reports. We report three patients, including two siblings, with HLCSD and significant cutaneous manifestations including ichthyosiform dermatitis and a presentation with features of annular pustular psoriasis. In this report, we show that persistent, unexplained rash, even in the absence of other clinical findings, should warrant consideration and potential workup for HLCSD.

Background Alder Hey Children’s Hospital has a tertiary acute general paediatric service with a very high number of admissions. In the context of reduced community-based support for mothers with young infants to establish and sustain breastfeeding or other appropriate infant feeding strategies, we were concerned that some of our neonatal admissions were inappropriately exposing infants to potentially life-threatening infections, whilst having an adverse impact on mothers and their families. We therefore conducted an audit to describe the population of neonates Objectives To evaluate causes of admission to acute general paediatric services for infants Methods A retrospective audit of all infants less than 7 days of age admitted to Alder Hey Children’s hospital, Liverpool from March to September 2019. All the infants were born and discharged from maternity units in Merseyside county, UK. Anonymised data was extracted from the electronic clinical records by three members of the clinical team. Implausible entries were discussed with all the audit team members at monthly meetings and excluded. Results During the 6 months, there were 411 admissions, 160 (39%) were surgical, and 251 (61%) were medical. The majority of the medical admissions were to the acute general paediatric services 241(59%). Of these 93 (23%) had feeding problems. The majority were exclusively bottle –fed 42(45.2%), 35 (37.6%) were exclusively breast fed and 16(17.2%) were mixed feeders. The majority had jaundice 41(44%) but only half of them required phototherapy (21, 22.6%)and a quarter (23,24.7%) underwent a septic screen. However, 29 (31.2%) presented solely with poor feeding. The majority of infants with poor feeding didn’t require any investigations or treatment 44 (47.3%). The mean birth weight of 3.19 kg (SD 0.48), mean admission weight of 3 kg (SD 0.48) and mean discharge weight was 3.12 kg (SD 0.46). The mean difference between birth weight and admission weight was 7.3% and only 12(12.9%) had lost >10% birth weight at admission. Conclusions Although feeding problems may be a sign of severe illness among infants, our audit showed that nearly a third of infants who were admitted in the first week of life to our acute tertiary general paediatric services, did not have any other features of severe illness. These admissions expose mothers and their infants to hospital acquired infections whilst disrupting the ‘rooming-in’ process that enhances the establishment of breastfeeding. These admissions could potentially be averted by optimising community infant feeding support services and discharge criteria from maternity care in the region. Engagement with these services will be a crucial next step in developing strategies to enhance infant feeding support particularly in impoverished communities in the region.

Neonatal HNT in the pharynx is a rare cause of respiratory distress and poor feeding in the newborn, but must be differentiated from teratoma, encephalocele, and nasal glioma. While surgical resection is the preferred treatment modality, we posit there is a role for sclerosis of the glial heterotopic cyst if complete surgical excision is not possible or carries risk of high morbidity. Here, we present a case of a 7-day-old neonate presenting with acute respiratory distress found to have a nasopharyngeal/oropharyngeal mass ultimately treated with sclerotherapy at 9 months of age.