Breastfeeding Promotion and Nursing Care for Infants with Cleft Palate and/or Cleft Lip in Northeastern Craniofacial Center, Thailand

Background:The common feeding problems in infants with Cleft Palate (CP) and/or Cleft Lip and Palate (CLP) are the inability to suck and swallow breastmilk. Difficulties in feeding may compromise normal growth and disrupt the bonding process.Objective:To evaluate the treatment and breastfeeding rate in infants with CP and CLP.Methods:A retrospective study of infants with CP and CLP who were admitted to the postpartum ward between July 2017 and June 2019 was conducted. Demographic data, type of feeding, nursing activities, and duration of breastfeeding after discharge were collected.Results:A total of 35 infants were included in the study. Twenty-seven cases were non-syndromic complete CLP (77.2%). On admission only 15 infants (42.8%) received breastmilk and alternative feeding techniques were applied for 26 (74.3%) infants. Breastfeeding promotion and nursing care were provided to mothers and infants by an interdisciplinary team at the Craniofacial Center. The median Length of Stay (LOS) was 8 days (range 5-9 days) and infants born at the affiliated hospital (inborn) had a significantly shorter LOS compared to infants referred from other health centers (p=0.019). None of the inborn groups received infant formula. The breastfeeding rate in all groups was 100% at discharge. Exclusive breastfeeding rates at 2-, 4-, and 6-months follow-up were 82.8%, 42.8%, and 31.4%, respectively.Conclusion:Breastfeeding promotion, education, and nursing care from an interdisciplinary team resulted in an improved ability of mothers to breastfeed infants with CLP, particularly in non-syndromic CLP. The exclusive breastfeeding rate after 6-months in this study was higher than in previous studies.</jats:sec

Epidemiological data on nutritional disorders and outcomes in hospitalized Thai children: an analysis of data from the National Health Database 2015-2019

OBJECTIVES Malnutrition in hospitalized patients is a frequently overlooked health issue. We aimed to assess the prevalence and pattern of nutritional disorders in hospitalized Thai children from the National Health Database. METHODS Hospitalized children aged 1 month to 18 years diagnosed with nutritional disorders between 2015 and 2019 were retrospectively reviewed using the National Health Security Office data. Based on the International Classification of Diseases, 10th revision, Clinical Modification, nutritional disorders were classified into 3 major forms of malnutrition: undernutrition (E40-E46), overweight and obesity (E66), and micronutrient deficiencies (D50-D53, E50-E56, E58, E60-E61, and E63). RESULTS Out of 5,188,033 hospitalized children, malnutrition was identified in 115,254 (2.2%). Protein-energy malnutrition (PEM), overweight and obesity, and micronutrient deficiencies were prevalent in 0.21%, 0.27%, and 1.81%, respectively. Among those with micronutrient deficiencies, 95.0% had iron deficiency anemia, 2.2% had vitamin D deficiency, and 0.7% had zinc deficiency. Children aged under 5 years mostly had PEM, followed by iron deficiency anemia. Teenagers commonly had obesity and vitamin D deficiency. Patients with PEM who were admitted with common diseases had significantly longer hospital stays and higher hospital costs and mortality rates than those without PEM. CONCLUSIONS Hospitalized children had various nutritional disorders, particularly PEM, which was associated with higher morbidity and mortality. Nutritional screening tools should be utilized for the early detection and treatment of malnutrition. Specific International Classification of Diseases codes for nutritional care services and intervention should be available. Additionally, nutritional interventions should be reimbursed, along with nutritional education and empowerment of healthcare providers, to improve hospital care service and improve patient outcomes

The impact of short-term exposure to black carbon air pollution on asthma exacerbations in Thai children: a time-stratified case-crossover nationwide study from 2015 to 2022

Abstract Background Black carbon is a critical component of ambient particulate matter and a recognized trigger of respiratory morbidity. Although existing studies have explored the link between black carbon exposure and pediatric asthma, evidence specific to rapidly industrializing middle-income regions remains scarce. In Thailand, increasing industrial activities, agricultural burning, and vehicle emissions have resulted in higher black carbon concentrations; however, comprehensive epidemiological data on the impact of this on children with asthma exacerbations remain limited. Methods We performed a nationwide retrospective study with time-stratified case-crossover analysis of children (< 18 years) hospitalized for asthma exacerbations under Thailand’s Universal Coverage Scheme from 2015 to 2022. Asthma exacerbation admissions were identified using ICD-10 codes (J45.9, J46). Ambient black carbon levels were obtained from NASA’s Modern-Era Retrospective Analysis for Research and Application (MERRA-2). Conditional Poisson regression was used to calculate incidence rate ratios (IRRs) for pediatric asthma hospitalizations per 1 µg/m³ increase in black carbon, controlling for intra-week variations. Results Among 163,825 asthma exacerbation-related hospital admissions (37.3% male, 62.7% female), children aged < 5 years accounted for 49.6% of cases, 5–<10 years for 33.1%, 10–<15 years for 14.1%, and 15–<18 years for 3.2%. The mean black carbon concentration was 1.00 ± 0.46 µg/m³, peaking during summer. On the day of hospitalization (Lag 0), a 1 µg/m³ increase in black carbon was associated with elevated IRR in children aged < 5 (IRR: 1.14; 95%CI: 1.05–1.25; p = 0.002), 5–<10 (IRR: 1.31; 95%CI: 1.18–1.45; p < 0.001), and 10–<15 (IRR: 1.35; 95%CI: 1.16–1.59; p < 0.001). Delayed effects (Lag 1) remained significant for children 5–<10 (IRR: 1.18; 95%CI: 1.06–1.31; p = 0.002) and 10–<15 (IRR: 1.26; 95%CI: 1.07–1.47; p = 0.004) but not for those 15–<18 years. Conclusions Short-term exposure to black carbon significantly increases the risk of hospitalizations from pediatric asthma exacerbation in Thailand, especially among children under 15 years of age and particularly on the day of exposure. These findings underscore the urgent need for effective air quality interventions, such as cleaner fuel technologies, stricter policies on industrial and agricultural emissions, and enhanced public health measures to mitigate black carbon pollution. Future investigations should integrate personal-level exposures, assess interactions with other pollutants, and evaluate the outcomes of interventions to reduce the respiratory health burden in this vulnerable population

Survey of Thai Physicians&rsquo; Practice in Pediatric Septic Shock

(1) Background: Sepsis management in children is crucial, especially in emergency services. This study aims to evaluate Thai physicians&rsquo; knowledge gaps in the emergency management of sepsis in children and to evaluate their adherence to the current sepsis clinical practice guidelines. (2) Methods: This is a cross-sectional survey of Thai physicians&rsquo; management of septic shock in children. The survey was conducted through online questionnaires from March 2019&ndash;April 2019. (3) Results: Of the 366 responders, 362 (98.9%) were completed. Most of the responders were general practitioners (89.2%) and pediatricians (10.8%). The time from positive sepsis screening to being evaluated by physicians within 15 min was reported by 83.9%. The most common choice of fluid resuscitation was normal saline solution (77.3%). The practice of a fluid loading dose (20 mL/kg) consistent with the guidelines was 56.3%. The selection of the first vasoactive agent in warm shock (norepinephrine) and cold shock (epinephrine) according to recommendations in the guidelines was 74.3% and 36.2%, respectively. There was a significant difference between general practitioners and pediatricians in terms of knowledge about initial fluid resuscitation and the optimal vasoactive agent in cold shock (p-value &lt; 0.001). In the multivariate model, factors associated with the guideline-based decision-making of vasoactive agent choice for cold shock were specialist training (pediatrician) and the completion of sepsis management training certification, with adjusted odds ratios (AORs) of 7.81 and 2.96, but working experience greater than ten years was inconsistent with the guideline-based decision-making (AOR 0.14). (4) Conclusions: Thai clinicians were unfamiliar with pediatric sepsis therapy standards, specifically the quantity of early fluid resuscitation and the appropriate vasoactive medications for cold shock. To encourage adherence to the guidelines, we propose a regularly required training course on pediatric sepsis management

Clinical outcomes after surgical resection in asymptomatic and symptomatic children with congenital lung malformations

Abstract Purpose Our study aims to evaluate the outcomes of children with congenital lung malformation (CLM) who have undergone surgical resection. Methods A retrospective analysis was conducted among children under 18 who were diagnosed with CLM and underwent surgery at Srinagarind Hospital, Khon Kaen University between January 2007 and December 2023. We collected data on surgical outcomes, including operative time, postoperative complications, and mortality rate. Results During our study period, a total of 38 children with CLM were undergone surgery. The median time for diagnosis was 9 months (IQR 1–33 months). Congenital pulmonary airway malformation was the most common diagnosis, affecting 26 children (68.4%). Of these, 25 children were operated on when they presented with symptoms, while 13 children were operated on even though they were asymptomatic. The median age at surgery was 12 months (IQR 3–32 months) for symptomatic children and 6 months (IQR 3–12 months) for asymptomatic children (P = 0.201). After the surgery, symptomatic children had a higher rate of postoperative complications than asymptomatic children, with 52% and 15.4%, respectively (P = 0.028). The median length of stay for symptomatic children was 17 days, compared to 11 days for asymptomatic children (P = 0.280). Conclusions Early surgery of CLM in asymptomatic children was associated with a lower rate of postoperative complications. Further studies are needed to investigate long-term complications

Effectiveness of a Mobile App (KhunLook) Versus the Maternal and Child Health Handbook on Thai Parents’ Health Literacy, Accuracy of Health Assessments, and Convenience of Use: Randomized Controlled Trial

BackgroundChildren of parents who have higher health literacy (HL) benefit more from preventive child health care. Digital interventions have been used to improve parents’ HL with high satisfaction. KhunLook is a Thai mobile app conceived using strategies to improve HL. It was developed to assist parents in assessing and keeping track of their child’s health in complement to the standard Maternal and Child Health Handbook (MCHH). ObjectiveThis trial focuses on the effectiveness of using the KhunLook app with the MCHH and standard care (intervention) compared with the conventional MCHH and standard care (control) on parents’ HL. Data on accuracy of parents’ assessment of their child’s health and growth as well as convenience of use of the tool (app or MCHH) in the well-child clinic were collected at 2 visits (immediate=visit 1, and intermediate=visit 2). MethodsParents of children under 3 years of age who (1) had a smartphone or tablet and the MCHH and (2) could participate in 2 visits, 2-6 months apart at Srinagarind Hospital, Khon Kaen, Thailand, were enrolled in this 2-arm parallel randomized controlled trial between April 2020 and May 2021. Parents were randomized 1:1 to 2 groups. At visit 1, data on demographics and baseline HL (Thailand Health Literacy Scales) were collected. Parents in the app group used the KhunLook app and the control group used their child’s handbook to assess their child’s growth, development, nutrition and feeding, immunization status and rated the convenience of the tool they used. At visit 2, they repeated the assessments and completed the HL questionnaire. ResultsA total of 358 parents completed the study (358/408, 87.7%). After the intervention, the number of parents with high total HL significantly increased from 94/182 (51.6%) to 109/182 (59.9%; 15/182; Δ 8.2%; P=.04), specifically in the health management (30/182; Δ 16.4%; P<.001) and child health management (18/182; Δ 9.9%; P=.01) domains in the app group, but not in the control group. Parents in the app group could correctly assess their child’s head circumference (172/182, 94.5% vs 124/176, 70.5%; P<.001) and development (173/182, 95.1% vs 139/176, 79.0%; P<.001) better than those in the control group at both visits. A higher proportion of parents in the app group rated their tool as very easy or easy to use (174-181/182, 95.6%-99.5% vs 141-166/176, 80.1%-94.3%; P<.001) on every item since the first visit. ConclusionsOur results suggest the potential of a smartphone app (KhunLook) to improve parents’ HL as well as to promote superior accuracy of parents’ assessment of their child’s head circumference and development, with a similar effect on weight, height, nutrition and feeding, and immunization as in traditional interventions. Using the KhunLook app is useful and more convenient for parents in promoting a healthy child preventive care during early childhood. Trial RegistrationThai Clinical Trials Registry TCTR20200312003; https://www.thaiclinicaltrials.org/show/TCTR2020031200

Parental Attitudes and Practices regarding Atopic Dermatitis: A Cross-Sectional Study among a Thai Population

Background: Atopic dermatitis (AD) is a chronic inflammatory skin disorder common in children. Successful pediatric AD therapy requires parental assistance. Thus, evaluating parental knowledge, attitudes, and behaviors regarding childhood AD may lead to more educational recommendations to help children control AD in the future. This study examined parents’ knowledge, attitudes, and conduct concerning AD in families with and without children with AD. Method: The Pediatric Department, Faculty of Medicine, Khon Kaen University, Thailand, conducted a cross-sectional study from June to December 2023. Parents of children who visited the dermatology clinic with or without AD were asked to complete a Google form questionnaire. Results: A total of 372 parents answered a questionnaire about AD pathophysiology, knowledge, attitudes, and practices. The participants were 293 (78.8%) female participants and 79 (21.2%) male participants. The average age was 29.79 (SD 4.91). Most parents (319, 85.8%) did not work in the medical field, and more than half (228 instances, 61.29%) had children diagnosed with AD. Conclusions: Parents of children with AD understood AD causes and triggers better than parents of children without AD. But, “exposure to furry toys” that may contain dust and allergies and “infection” that may cause AD flare-ups were the most common triggers, regardless of the group. Appropriate information should be supplied because both the parents of children with AD and those of children without AD reported immediate food avoidance without confirmatory testing, which might lead to malnutrition. Clinicians and families handling patients with AD require further education

Clinical Characteristics and Outcomes of Pediatric COVID-19 Pneumonia Treated with Favipiravir in a Tertiary Care Center

The COVID-19 pandemic, caused by SARS-CoV-2, has posed significant health challenges worldwide. While children generally experience less severe illness compared to adults, pneumonia remains a substantial risk, particularly for those under five years old. This study examines the clinical characteristics and treatment outcomes of pediatric COVID-19 pneumonia patients treated with favipiravir in Thailand, aiming to identify associated factors for pneumonia. A retrospective review was performed on pediatric patients aged 1 month to 18 years hospitalized with COVID-19 at Srinagarind Hospital, Khon Kaen University, from 13 January 2020 to 15 November 2021. Data on demographics, clinical symptoms, treatment, and outcomes were collected, and logistic regression analysis was used to identify factors associated with pneumonia. Among 349 hospitalized children, the median age was 8 years, with 51.9% being male. Symptoms included a fever (100%), a cough (74.2%), and a rash (24.9%). COVID-19 pneumonia was diagnosed in 54.7% of the children. Favipiravir was administered as the standard treatment, showing mild adverse effects, including a rash (4.3%) and nausea (2.8%). Monocytosis was significantly associated with COVID-19 pneumonia (aOR 30.85, 95% CI: 9.03–105.41, p < 0.001), with an ROC curve area of 0.77 (95% CI: 0.71–0.83). Pediatric COVID-19 patients typically exhibit mild-to-moderate symptoms, with pneumonia being common in the early pandemic phase. Monocytosis is a significant factor associated with COVID-19 pneumonia. Favipiravir demonstrated mild adverse effects. Further studies are needed to validate these findings across different settings and phases of the pandemic

Serum procalcitonin and procalcitonin clearance as a prognostic biomarker of sepsis in a pediatric critical care setting: A tertiary care experience 2016-2021.

BackgroundSepsis remains one of the leading causes of morbidity and mortality in critically ill children worldwide. Identifying reliable prognostic markers is essential for improving risk stratification and guiding targeted therapies. While some studies in adults suggest that procalcitonin (PCT) clearance may better predict sepsis outcomes, there is limited information regarding pediatric sepsis. This study aimed to evaluate whether PCT clearance is associated with mortality among children with severe sepsis and septic shock.MethodsWe retrospectively reviewed medical records of children aged 1 month to 18 years admitted to the PICU who were diagnosed with severe sepsis and septic shock at Srinagarind Hospital, Thailand, between January 2016 and October 2021. Serum PCT was measured at 0, 24, and 48 hours after the initial diagnosis. PCT clearance was calculated using the relative change from baseline. The primary outcome was in-hospital mortality.ResultsA total of 242 children were included, with a median age of 8 years (interquartile range [IQR]: 3-14). Most participants (62.8%) had no underlying conditions. The overall mortality rate was 26.5%. An initial PCT level > 2 ng/mL was not significantly associated with mortality (adjusted odds ratio [aOR] = 1.17; 95% confidence interval [CI]: 0.44-3.16, p = 0.8). However, decreased PCT clearance at 24 hours was strongly associated with mortality (aOR = 2.79; 95% CI: 1.11-7.01, p = 0.029). The area under the receiver operating characteristic curve for 24-hour PCT clearance to predict mortality was 0.71 (95% CI: 0.63-0.80).ConclusionsLower PCT clearance in the first 24 hours was significantly associated with higher mortality in pediatric patients with sepsis. Serial PCT measurements and PCT clearance monitoring may offer valuable prognostic information and could be considered as part of routine clinical evaluations in pediatric sepsis management