Research Articles (Paediatrics and Child Health)

Permanent URI for this collectionhttp://hdl.handle.net/2263/2453

Browse

Now showing 1 - 20 of 593

Signal monitoring for adverse events following immunisation with COVID-19 vaccines during the SARS-CoV-2 pandemic : an evaluation of the South African Surveillance System
Sankar, Chenoa; Evans, Stephen; Meyer, Johanna Catharina; Gunter, Hannah May; Sekiti, Victoria; McCarthy, Kerrigan (Springer, 2025-08)
INTRODUCTION : Monitoring of adverse events following immunisation (AEFI) is recommended for post-licensure surveillance. We investigated whether the South African surveillance system could detect signals of disproportionate reporting and whether these signals aligned with globally identified AEFI and adverse events of special interest (AESI) post-coronavirus disease-2019 (COVID-19) vaccination. METHODS : This retrospective pharmacovigilance study undertook disproportionality analysis of the National Department of Health AEFI database from the start of the COVID-19 vaccine rollout on 17 May 2021 to 31 December 2022. We complemented this with AEFI reports for vaccines not on the routine Expanded Programme on Immunisation schedule, to address potential masking of signals due to the high reporting rate of COVID-19 vaccine AEFI. RESULTS : During the study period, 3846 AEFI were reported for 37,537,009 doses of COVID-19 vaccines (BNT162b2 and Ad26.COV2.S) administered. The overall reporting rate was 10.2 per 100,000 doses, 18.1/100,000 and 7.9/100,000 for Ad26.COV2.S and BNT162b2, respectively. Comparison with other countries suggests underreporting. Disproportionate reporting signals were obtained for three and seven AEFI following BNT162b2 and Ad26.COV2.S vaccines, respectively. An additional three AEFI signals from Ad26.COV2.S emerged in the augmented dataset, indicating masking. All Ad26.COV2.S signals, and one BNT162b2 signal, appear in the vaccines’ product information. Among nine AESI evaluated, myocarditis/pericarditis presented as a signal of disproportionate reporting following BNT162b2 vaccination. CONCLUSIONS : This study is one of the first from a lower-middle-income country, using a spontaneous reporting system for signal detection post-COVID-19 vaccination. Signals aligned with those reported globally. The study highlights the need to further investigate underreporting, masking, and system attributes for system strengthening.
All corticosteroids in any formulation are not innocuous and beg to be handled with care
Van Niekerk, Andre (Allergy Society of South Africa, 2025-03)
Many short courses (bursts) of oral corticosteroids (OCS) are commonly prescribed for indicated and non-indicated conditions. These bursts are perceived to be safe and are usually given by prescription for less than 14 days at a time. The global corticosteroid market was USD 5.7 billion in 2023, and with a projected annual growth rate of 4.6% across all regions, reflects its widespread use. Published data of OCS use in South Africa are difficult to find, yet parents of children attending a clinic for immune deficiencies frequently report repetitive prescriptions.
Dr Spur’s mystery case : the case of asthma, autoimmunity and an unexpected diagnosis
Van den Berg, Sylvia; Brauer, Marieke; Van Niekerk, Andre (Allergy Society of South Africa, 2025-06)
Thank you for seeing this 27-year-old woman referred from my practice for recurrent lower respiratory tract infections, chronic sinusitis and worsening eczema. Her main complaints are fatigue, weight loss and joint stiffness over the past year. She was previously diagnosed with asthma (due to persistent wheeze since adolescence), autoimmune thyroiditis and a psoriasis/eczema overlap. Her family history is notable for the death of a sibling in early childhood from pneumonia.
Dr Spur’s mystery case : a case of fragile defences
Swanepoel, Petri; Van den Berg, Sylvia; Van Niekerk, Andre (Allergy Society of South Africa, 2025-09)
I am treating a ten-month-old boy diagnosed with di George syndrome. He has a history of failure to thrive, which was mostly attributed to his cardiac anomalies (more specifically, a ventricular septal defect which has since been repaired). I am concerned about his infection history. Over the past four months he has experienced multiple episodes of upper respiratory tract infections characterised by nasal congestion, clear to mucopurulent rhinorrhoea, intermittent low-grade fever, cough (initially dry, progressing to a productive cough with occasional wheezing), feeding dif昀椀culties and refusal of feeds during episodes. He does not have any palatal anomalies. Despite symptomatic treatment with nasal saline irrigation, antipyretics and antibiotics on at least two occasions, the symptoms would resolve slowly over 10–14 days, only to recur within another week or two. Between infections, he never seems to return to baseline, exhibiting a persistent nasal discharge and a ‘wheezy chest’.
A laissez-faire approach to short bursts of corticosteroids may lead to over- exposure in the fetus and the young child
Delport, Suzanne D. (Allergy Society of South Africa, 2025-03)
Corticosteroids, in whichever form they occur, are potent drugs with serious short- and long-term side effects. Their indications for use encompass many diseases and all age groups, even extending to the fetus. In view of the potency and dangers of corticosteroids though, those who prescribe them must do so only for evidence-based indications and with informed consent. Documenting all exposures reflects corticosteroid stewardship and an awareness of a cumulative end point which determines toxicity rather than the dose and duration of therapy.
Dr Spur's mystery case : the case of the chicken or is it the egg?
Van den Berg, Sylvia; Van Niekerk, Andre (Allergy Society of South Africa, 2025-03)
Re: Advice on recurrent airway infections in a three-year-old patient. I am writing to ask your advice on Michael, a three-year-old patient, whose mother is concerned about the possibility of an underlying immune deficiency. She reports that he is frequently unwell, presenting with airway infections almost every month since she discontinued breastfeeding him at nine months so that she could return to work. He started attending daycare at that point.
Growth, neurodevelopmental outcomes and micronutrient intake in 18-month-old children with exposure to maternal human immunodeficiency virus and placental insufficiency : the UmbiGodisa cross-sectional study
Nyofane, Mothusi; Hoffman, Marinel; Mulol, Helen, Percival; Botha, Tanita , Gladys; Pattinson, Robert Clive; Feucht, Ute Dagmar (Elsevier, 2025-08)
BACKGROUND AND AIM : Maternal human immunodeficiency virus (HIV) and intrauterine growth restriction (IUGR) are both associated with suboptimal childhood growth and neurodevelopment. This study assessed growth and neurodevelopmental outcomes and micronutrient intakes in children who are HIV-exposed-uninfected (CHEU), compared to HIV-unexposed-uninfected children (CHUU), stratified based on evidence of placental insufficiency. METHODS : Placental insufficiency, as proxy for IUGR, was identified using abnormal umbilical artery resistance indices (UmA-RI) on pregnancy Doppler ultrasound. At 18-months postpartum, 264 mother–child pairs were evaluated and categorized into four subgroups: CHUU with normal UmA-RI (control group), CHEU with normal UmA-RI (HIV exposure only), CHUU with abnormal UmA-RI (placental insufficiency only) and CHEU with abnormal UmA-RI (double-exposure). Dietary intake was assessed using a single 24-h dietary recall, and dietary intake of iron, zinc, and iodine was quantified by meal analysis on FoodFinder™ 3.0. Anthropometric data were collected and converted into z-scores. The Bayley Scales of Infant and Toddler Development (Bayley-III) assessed cognitive, language, and motor function. Statistical comparisons used t-test or Mann–Whitney U-tests; associations were analyzed with Spearman's correlation. RESULTS : Children with dual exposure (CHEU/AbN-RI) had significantly lower z-scores compared to the control group, including length-for-age z-score (1.4 ± 1.4 vs 0.0 ± 1.3; p = 0.001), weight-for-age zscore (0.6 ± 1.0 vs 0.0 ± 1.2; p = 0.024) and head circumference-for-age z-score (0.4 ± 0.7 vs 0.9 ± 1.2; p = 0.035). Mean cognitive scores were also lower in this group (93.9 ± 12.9 vs 100.1 ± 10.8; p = 0.042). Language composite scores were low across all groups. Higher zinc intake was positively associated with language scores (r = 0.10; p = 0.042) and weight-for-age z-scores were associated with motor outcomes (r = 0.10; p = 0.028). Among CHEU, better growth parameters were positively associated with cognitive and motor developmental domains.
Paediatric haematology/oncology workforce and training programmes for Africa
Fufa, Diriba; Attia, Asmaa; Salifu, Nihad; Reddy, Kershinee; Rashad, Hanna; Abdelaziz, Riham; Adam, Haileyesus; Amoda, Faizana; Bhattachyya, Arpita; Chirande, Lulu; Du Plessis, Jan; Geel, Jennifer; Kaspers, Gertjan; Maciel, Kaline; Dinkiye, Ali Mamude; Moulik, Roy; Naidu, Gita; Namazi, Ruth; Neethling, Beverley G.; Njuguna, Festus; Renner, Lorna; Reynders, David; Scanlan, Trish; Thomas, Karla; Van Zyl, Anel; Vik, Terry; Yimer, Mulugeta Ayalew; Hessissen, Laila; Omotola, Ayo; Fox Irwin, Leeanna; Mikkelsen, Margit; Naradasu, Srikanth; Balagadde-Kambugu, Joyce; Davidson, Alan; Bhakta, Nickhill; Van Heerden, Jaques; Moreira, Daniel C. (BMJ Publishing Group, 2025-07)
Graduate medical education programmes in paediatric haematology/oncology (PHO) are necessary to train specialists to provide high-quality care for children and adolescents with cancer and haematologic diseases. In this study, we used the Education Program Assessment Tool (EPAT). The study consisted of three components: (1) mapping the PHO workforce and training programmes in Africa; (2) using the EPAT to evaluate the current PHO programmes in Africa and (3) using a design-thinking approach to develop priority interventions to expand PHO training capacity in Africa through a collaborative co-design process. There were 236 fellowship-trained paediatric haematologists/oncologists in 37 countries in Africa. 17 countries (32%), with a total population of 42 million under 14 years of age, had no paediatric haematologists/oncologists. The continent has an average of 205 new paediatric cancer cases per specialist. 22 PHO training programmes completed the EPAT. The average score was 72% (SD 9%). Programmes showed varying strengths in the elements of comprehensive training, with the highest EPAT scores in experiential learning domains. A priority-setting exercise established interventions to strengthen PHO training in Africa, including a PHO curriculum, a leadership skill development process and a path for the creation of exchange opportunities. The PHO workforce and training capacity are highly variable in Africa. Through international collaboration and a systematic evaluation of workforce density and training programme strengths, alignment on key regional priorities and the creation of a shared model of cooperation to enhance training programmes for Africa can be achieved.
Paediatric colistin prescribing practices in South Africa : a clinician survey
Pillay-Fuentes Lorente, Veshni; Nana, Trusha; Black, Marianne; Reubenson, Gary; Thomas, Reenu; Dramowski, Angela; Bekker, Adrie; Du Plessis, Nicolette Marie; Demopoulos, Despina; Chibabhai, Vindana (AOSIS, 2025-08-05)
BACKGROUND : Increasing multidrug-resistant bacterial infections are a global health challenge. Colistin, a polymyxin antimicrobial, has activity against some resistant strains, and despite its adverse effects, it presents a last-line option to treat resistant Gram-negative pathogens. However, paediatric colistin prescribing guidelines are lacking. OBJECTIVES : To determine paediatric colistin prescribing practices and challenges in South Africa (SA) to aid the development of a paediatric colistin guideline. METHOD : We conducted an anonymous online survey of registered medical practitioners in SA who prescribed colistin to patients aged ≤ 14 years in the past 12 months. RESULTS : Of 196 participants, 71.9% (n = 141/196) completed the survey. Eighty-six respondents (n = 86/146; 58.9%) reported prescribing loading doses (LD), with the median LD and maintenance doses of 150 000 IU/kg/dose (interquartile range (IQR), 75 000–150 000) and 50 000 IU/kg/dose (IQR, 40 000–50 000), respectively. Empiric colistin use was reported by 47.2% (n = 69/146), of whom 46.3% (n = 32/69) continued empiric colistin for ≥ 72 h. Using the Likert scale, respondents highly perceived that therapeutic drug monitoring should be readily available (mean = 3.97). The perception that prescribing colistin should be advised by a microbiologist or infectious disease specialist had a mean score of 2.97, indicating moderate agreement. CONCLUSION : This survey demonstrated varied paediatric colistin prescribing practices. Recently, a new evidence-based paediatric guideline for colistin use in SA has been published. A follow-up survey will be conducted to assess the impact of the guideline on paediatric colistin prescribing practices in SA. CONTRIBUTION : This study highlighted paediatric colistin dosing practices in the absence of a paediatric colistin guideline in South Africa.
Cost-effectiveness of broadly neutralizing antibodies for HIV prophylaxis for infants born in settings with high HIV burdens
Alba, Christopher; Malhotra, Shelly; Horsfall, Stephanie; Barnhart, Matthew E.; Bekker, Adrie; Chapman, Katerina; Cunningham, Coleen K.; Fast, Patricia E.; Fouda, Genevieve G.; Freedberg, Kenneth A.; Goga, Ameena Ebrahim; Ghazaryan, Lusine R.; Leroy, Valeriane; Mann, Carlyn; McCluskey, Margaret M.; McFarland, Elizabeth J.; Muturi-Kioi, Vincent; Permar, Sallie R.; Shapiro, Roger; Sok, Devin; Stranix-Chibanda, Lynda; Weinstein, Milton C.; Ciaranello, Andrea L.; Dugdale, Caitlin M. (Public Library of Science, 2025-03)
BACKGROUND : Approximately 130 000 infants acquire HIV annually despite global maternal antiretroviral therapy scale-up. We evaluated the potential clinical impact and cost-effectiveness of offering long-acting, anti-HIV broadly neutralizing antibody (bNAb) prophylaxis to infants in three distinct settings. METHODS : We simulated infants in Côte d’Ivoire, South Africa, and Zimbabwe using the Cost-Effectiveness of Preventing AIDS Complications-Pediatric (CEPAC-P) model. We modeled strategies offering a three-bNAb combination in addition to WHO-recommended standard-of-care oral prophylaxis to infants: a) with known, WHO-defined high-risk HIV exposure at birth (HR-HIVE); b) with known HIV exposure at birth (HIVE); or c) with or without known HIV exposure (ALL). Modeled infants received 1-dose, 2-doses, or Extended (every 3 months through 18 months) bNAb dosing. Base case model inputs included 70% bNAb efficacy (sensitivity analysis range: 10–100%), 3-month efficacy duration/dosing interval (1–6 months), and $20/dose cost ($5–$100/dose). Outcomes included pediatric HIV infections, life expectancy, lifetime HIV-related costs, and incremental cost-effectiveness ratios (ICERs, in US$/year-of-life-saved [YLS], assuming a ≤ 50% GDP per capita cost-effectiveness threshold). FINDINGS : The base case model projects that bNAb strategies targeting HIVE and ALL infants would prevent 7–26% and 10–42% additional pediatric HIV infections, respectively, compared to standard-of-care alone, ranging by dosing approach. HIVE-Extended would be cost-effective (cost-saving compared to standard-of-care) in Côte d’Ivoire and Zimbabwe; ALL-Extended would be cost-effective in South Africa (ICER: $882/YLS). BNAb strategies targeting HR-HIVE infants would result in greater lifetime costs and smaller life expectancy gains than HIVE-Extended. Throughout most bNAb efficacies and costs evaluated in sensitivity analyses, targeting HIVE infants would be cost-effective in Côte d’Ivoire and Zimbabwe, and targeting ALL infants would be cost-effective in South Africa. INTERPRETATION : Adding long-acting bNAbs to current standard-of-care prophylaxis would be cost-effective, assuming plausible efficacies and costs. The cost-effective target population would vary by setting, largely driven by maternal antenatal HIV prevalence and postpartum incidence.
Dr Spur’s mystery solved : Dots connected. Please do screen for lymphoma and other cancers in IEI patients
Teixeira, Miguel Jose; Nagel, Lizelle; Van den Berg, Sylvia (Allergy Society of South Africa, 2024-09)
Thank you for the consultation. CVID is one of the most common inborn errors of immunity (IEI) encountered in practice, and these patients get infections, as well as noninfectious comorbidities like allergic disease, autoimmunity, lymphoproliferation and malignancies.
Comparison of infant feeding practices by maternal HIV status, and associated factors, in a rural district, South Africa 2019
Mukhula, Victoria Temwanani; Zunza, Moleen; Mbira, Thandiwe Elsie; Ramokolo, Vundli; Prendergast, Andrew J.; Tylleskar, Thorkild; Van de Perre, Phillippe; Goga, Ameena Ebrahim; Ngandu, Nobubelo K. (BioMed Central, 2025-04)
BACKGROUND : The prevalence of exclusive breastfeeding (EBF) during the first 6 months and breastfeeding up to 24 months in all mothers, regardless of HIV status, in high HIV prevalence settings of South Africa is not frequently evaluated. This study aimed to describe practices of EBF and breastfeeding beyond 12 months, compare these between HIV exposed (HE(s)) and unexposed infants (HU(s)), and determine associated factors. METHODS : A secondary objective analysis of data from a cross-sectional study conducted during September-December-2019 in a rural South African district, was performed. Mothers living with HIV (MLHIV) paired with their infants in the following age groups: 0 to 3, > 3 to 6, > 6 to 12, and > 12 to 24 months; and mother-infant pairs without HIV with infants aged > 3 to 6 months and > 12 to 24 months, were enrolled. Descriptive statistics and bivariate and multivariable binomial regression were used for analyses. RESULTS : A total of 771 mother-infant pairs, 62% being MLHIV, were enrolled. Among HEs (including 10 living with HIV), the prevalence of EBF was 41.0% and 16.7% in 0–3, and, 3–6 months age-groups, respectively, and breastfeeding prevalence was 19% in 12–24 months age-group. Among HUs, the prevalence of EBF was 7.9% among 3–6 months old and breastfeeding prevalence was 38.0% among > 12–24 months old. Overall, 79.8% and 45.5% HUs and HEs aged 3–6 months were still breastfeeding, respectively. HEs were more likely to exclusively breastfeed at 3–6 months age compared to HUs (adjusted prevalence ratio [aPR] 3.84; 95% confidence interval (CI) 1.55, 9.53). Breastfeeding practice at 12–24 months age was significantly less likely among HEs (versus HUs) and in infants with unmarried/non-cohabiting mothers (versus married/co-habiting) (aPR 0.42; 95% CI 0.27, 0.63 and aPR 0.66; 95% CI 0.47, 0.92), respectively). Among HEs, breastfeeding beyond 6 months was more likely among MLHIV with known HIV-negative male partners (versus known HIV concordant relationships). CONCLUSION : In this study population, EBF was comparably more likely among HEs while breastfeeding beyond 12 months was more likely among HUs. Maternal marital status, frequency of antenatal care attendance and male partner’s HIV status also influenced breastfeeding practice. Overall, there is still room for improvement regardless of infant HIV status, requiring continued client-sensitive strengthening of the implementation of the recommended breastfeeding practices.
Digenic inheritance involving a muscle-specific protein kinase and the giant titin protein causes a skeletal muscle myopathy
Töpf , Ana; Cox , Dan; Zaharieva, Irina T.; Di Leo, Valeria; Sarparanta, Jaakko; Jonson, Per Harald; Sealy, Ian M.; Smolnikov, Andrei; White, Richard J.; Vihola, Anna; Savarese, Marco; Merteroglu, Munise; Wali, Neha; Laricchia, Kristen M.; Venturini, Cristina; Vroling, Bas; Stenton, Sarah L.; Cummings, Beryl B.; Harris , Elizabeth; Marini-Bettolo, Chiara; Diaz-Manera, Jordi; Henderson, Matt; Barresi, Rita; Duff, Jennifer; England, Eleina M.; Patrick, Jane; Al-Husayni, Sundos; Biancalana, Valerie; Beggs, Alan H.; Bodi, Istvan; Bommireddipalli, Shobhana; Bönnemann , Carsten G.; Cairns, Anita; Chiew, Mei-Ting; Claeys, Kristl G.; Cooper, Sandra T.; Davis, Mark R.; Donkervoort, Sandra; Erasmus, Corrie E.; Fassad, Mahmoud R.; Genetti, Casie A.; Grosmann, Carla; Jungbluth, Heinz; Kamsteeg , Erik-Jan; Lornage, Xavière; Löscher, Wolfgang N.; Malfatti, Edoardo; Manzur, Adnan; Martí , Pilar; Mongini, Tiziana E.; Muelas, Nuria; Nishikawa, Atsuko; O’Donnell-Luria , Anne; Ogonuki, Narumi; O’Grady, Gina L.; O’Heir , Emily; Paquay, Stéphanie; Phadke, Rahul; Pletcher, Beth A.; Romero, Norma B.; Schouten, Meyke; Shah, Snehal; Smuts, Izelle; Sznajer , Yves; Tasca, Giorgio; Taylor, Robert W.; Tuite , Allysa; Van den Bergh, Peter; VanNoy, Grace; Voermans, Nicol C.; Wanschitz, Julia V.; Wraige, Elizabeth; Yoshimura, Kimihiko; Oates, Emily C.; Nakagawa, Osamu; Nishino , Ichizo; Laporte , Jocelyn; Vilchez, Juan J.; MacArthur, Daniel G.; Sarkozy, Anna; Cordell, Heather J.; Udd, Bjarne; Busch-Nentwich, Elisabeth M.; Muntoni, Francesco; Straub, Volker (Nature Research, 2024-03-01)
In digenic inheritance, pathogenic variants in two genes must be inherited together to cause disease. Only very few examples of digenic inheritance have been described in the neuromuscular disease field. Here we show that predicted deleterious variants in SRPK3, encoding the X-linked serine/argenine protein kinase 3, lead to a progressive early onset skeletal muscle myopathy only when in combination with heterozygous variants in the TTN gene. The co-occurrence of predicted deleterious SRPK3/TTN variants was not seen among 76,702 healthy male individuals, and statistical modeling strongly supported digenic inheritance as the best-fitting model. Furthermore, double-mutant zebrafish (srpk3−/−; ttn.1+/−) replicated the myopathic phenotype and showed myofibrillar disorganization. Transcriptome data suggest that the interaction of srpk3 and ttn.1 in zebrafish occurs at a post-transcriptional level. We propose that digenic inheritance of deleterious changes impacting both the protein kinase SRPK3 and the giant muscle protein titin causes a skeletal myopathy and might serve as a model for other genetic diseases.
Genetic variants associated with suspected neonatal hypoxic ischaemic Encephalopathy : a study in a South African context
Foden, Caroline J.; Durant, Kevin; Mellet, Juanita; Joubert, Fourie; Van Rensburg, Jeanne; Masemola, Mogomane Yvonne Khomotso; Velaphi, Sithembiso C.; Nakwa, Firdose L.; Horn, Alan R.; Pillay, Shakti; Kali, Gugu; Coetzee, Melantha; Ballot, Daynia E.; Kalua, Thumbiko; Babbo, Carina; Pepper, Michael Sean; NESHIE Working Group (MDPI, 2025-03)
Neonatal encephalopathy suspected to be due to hypoxic ischaemic encephalopathy (NESHIE) carries the risk of death or severe disability (cognitive defects and cerebral palsy). Previous genetic studies on NESHIE have predominantly focused on exomes or targeted genes. The objective of this study was to identify genetic variants associated with moderate–severe NESHIE through whole-genome, unbiased analysis. Variant filtering and prioritization were performed, followed by association testing both on a case–control basis and to compare the grades of severity and/or progression. Association testing on neonates with NESHIE (N = 172) and ancestry-matched controls (N = 288) produced 71 significant genetic variants (false discovery rate corrected p-value < 6.2 × 10−4), all located in non-coding regions and not previously implicated in NESHIE. Disease-associated variants in non-coding regions are considered to affect regulatory functions, possibly by modifying gene expression, promoters, enhancers, or DNA structure. The most significant variant was at position 6:162010973 in the Parkin RBR E3 ubiquitin protein ligase (PRKN) intron. Intronic variants were also identified in genes involved in inflammatory processes (SLCO3A1), DNA repair (ZGRF1), synaptogenesis (CNTN5), haematopoiesis (ASXL2), and the transcriptional response to hypoxia (PADI4). Ten variants were associated with a higher severity or lack of improvement in NESHIE, including one in ADAMTS3, which encodes a procollagen amino protease with a role in angiogenesis and lymphangiogenesis. This analysis represents one of the first efforts to analyze whole-genome data to investigate the genetic complexity of NESHIE in diverse ethnolinguistic groups of African origin and provides direction for further study.
Predicting total body water in infants aged 0.5–24 months and the implications for measuring breast milk intake : a secondary analysis of isotope dilution data
De Sévaux, Marieke A.J.; Kaestel, Pernille; Haisma, Hinke H.; Da Costa, Teresa Hm; Vázquez-Vázquez, Adriana Del Pilar; Thomas, Tinku S.; Biesma, Regien G.; Kuriyan, Rebecca R.; Munthali, Grace K.; Diana, Aly; Santos, Ina S.; Hills, Andrew P.; Wickramasinghe, V. Pujitha; Ariff, Shabina; Lucas, M, Nishani; Costa, Caroline S.; Norris, Shane A.; Jain, Vandana; Mulol, Helen; Feucht, Ute; Thorisdottir, Birna; Thorsdottir, Inga; Davies, Peter S.W.; Loechl, Cornelia U.; Wells, Jonathan C.K. (Elsevier, 2025-09)
Please read abstract in the article.
Neonatal encephalopathy due to suspected hypoxic-ischaemic encephalopathy
Horn, Alan Richard; Pillay, Shakti; Velaphi, Sithembiso Christopher; Ballot, Daynia Elizabeth; Mellet, Juanita; Foden, Caroline J.; Van Rensburg, Jeanne; Babbo, Carina Corte-Real; Kali, Gugulabatembunahlubi Tenjiwe Jabulile; Coetzee, Melantha; Masemola, Mogomane Yvonne Khomotso; Nakwa, Firdose Lambey; Pepper, Michael Sean (Springer, 2025-09)
No abstract available.
Consensus recommendations for the nutritional management of children with cancer in limited resource settings : a report from the International Initiative for Pediatrics and Nutrition
Viani, Karina; Alves, Jullyana; Damasco-Avila, Erika; Murra, Mariana S.; Schoeman, Judy; Walters, Michelle; Ladas, Elena J. (Frontiers Media, 2025-06)
INTRODUCTION : Malnutrition (under- and over-nutrition) is a critical challenge in pediatric oncology, particularly in low- and middle-income countries (LMIC), where supportive care resources are scarce. It negatively impacts treatment toxicity, survival rates, and quality of life. Despite the availability of broad guidelines, there is a lack of practical, context-adapted protocols for nutritional assessment and intervention in LMIC. The International Initiative for Pediatrics and Nutrition (IIPAN) developed adapted consensus-based protocols to address this gap. METHODS : A multidisciplinary panel of experts in pediatric oncology and nutrition from high-income and LMIC settings collaborated to develop adapted nutrition assessment and intervention manuals. The process involved literature reviews, iterative expert consultations, field testing in LMIC hospitals, and subsequent revisions based on real-world application feedback. Training programs were designed to ensure implementation, including in person and virtual mentorship. RESULTS : Two comprehensive manuals and one complementary material were developed: (1) Nutritional Assessment: A Training Manual in Anthropometry, (2) Nutritional Intervention: A Training Manual for Pediatric Oncology, and (3) Appendix for Nutritional Intervention. These resources provide structured detailed guidance on nutrition assessment, interventions, and the management of nutrition-related complications. Their scalability and accessibility are crucial for optimizing nutritional management and improving clinical outcomes in limited resource settings. CONCLUSION : These evidence-based, expert-designed adapted protocols address critical gaps in nutritional care for children with cancer in LMIC.
Nutritional status, body composition and chemotherapy dosing in children and young people with cancer : a systematic review by the SIOP nutrition network
Lovell, Amy L.; Makamo, Nthongase; Veal, Gareth J.; Bernhardt, Melanie B.; Barr, Ronald; Gala, Rajul M.; Gordon, Erin; Ladas, Elena J.; Prasad, Maya; Rogers, Paul C.; Schoeman, Judy; Slone, Jeremy S.; Viani, Karina; Tissing, Wim J.E.; Huibers, Minke H.W. (Springer Nature, 2025-08)
Malnutrition (undernutrition or overweight/obesity) might significantly impact the pharmacokinetics and pharmacodynamics of antineoplastic drugs in children and adolescents (<21 years). A comprehensive systematic literature search was performed on MEDLINE (PubMed), EMBASE, Web of Science, Scopus, ProQuest, Cochrane Trials, and Cochrane Reviews. Databases were searched up to 30 September 2024. Of 4186 articles identified, 150 full texts were evaluated and 12 selected for inclusion. Eight additional articles were identified following a panel review and 6 included, resulting in a total of 18 articles for data extraction. Relevant pharmacokinetic parameters were described for mercaptopurine, vincristine, anthracyclines, methotrexate, busulfan, bevacizumab, and crizotinib. Due to the heterogeneity and limited number of studies per antineoplastic drug, formal statistical analysis or meta-analysis was not appropriate. Variations in the definition of nutritional status, dosing strategies, and type of pharmacokinetic analyses were observed; therefore, no dosing recommendations could be made. With the increasing childhood cancer burden in LMIC, high prevalence of undernutrition, and the global burden of childhood obesity, there is an urgent need for more research in this area. Prospective studies should incorporate uniform definitions and standardised pharmacological approaches to optimise treatment options for children with cancer globally.
Prevalence of chronic and acute malnutrition and association with overall three-year survival in newly diagnosed children with cancer in South Africa
Schoeman, Judy; Kellerman, Ilde-Marié; Ndlovu, Sandile; Ladas, Elena J.; Rogers, Paul C.; Naidu, Gita; Rowe, Biance; Du Plessis, Jan; Herholdt, Mariechen; Thomas, Karla; Vanemmenes, Barry; Mathews, Rema; Uys, Ronelle; Büchner, Ané; Omar, Fareed E.; Reynders, David; Kruger, Mariana (Wiley, 2025-08)
INTRODUCTION : This study investigated the prevalence of malnutrition at childhood cancer diagnosis in South Africa and the association with 1-year post-diagnosis overall survival (OS). METHOD : Nutritional status was prospectively assessed for newly diagnosed children with cancer. Chronic undernutrition was defined as two standard deviations (SDs) or more below zero for height/length-for-age (HAZ), and acute as underweight (weight-for-age [WAZ], and wasted as body mass index for age [BAZ] and mid-upper arm circumference for age [MUAC/A]). The association between the nutritional status at diagnosis and age, sex, disease group and 1-year post-diagnosis OS was analysed with Cox regression and hazard ratios (HRs). RESULTS : Less than 15% were chronically malnourished (stunted: 14.3%) and up to 24.3% acutely undernourished (wasted: 24.3% MUAC-Z and BAZ 8.1%), 11.6% underweight, of 320 patients at cancer diagnosis). More females than males were underweight (12.2% vs. 4.5%; p = 0.027). Children of 5 years of age and older had a higher prevalence of wasting (18.7%) than children under 5 years of age (3.9%) (p < 0.001) at diagnosis, with significant improvement 6 months after diagnosis. Stunting was significantly associated with poorer OS at 3 years after a cancer diagnosis (HR 1.8; 95% CI 1.1, 2.8; p = 0.011). CONCLUSION : MUAC/A identified more children with undernutrition than other nutritional parameters. Stunting was significantly associated with poorer OS 3 years and EFS 2 years after a cancer diagnosis. Optimal nutritional support should be provided for South African children, especially those with acute and chronic malnutrition, to improve OS. SUMMARY Acute malnutrition had a higher prevalence at diagnosis than chronic malnutrition. The prevalence of patients with acute malnutrition decreased during the first 6 months of treatment. Stunting at diagnosis was significantly associated with a worse overall survival 3 years after diagnosis.
Change in the prevalence of extra-uterine growth restriction in very low birthweight infants, following the introduction of a written nutrition protocol, in a tertiary neonatal unit
Mosidi, L.N.D.; Van Niekerk, A.; Coetzee, Melantha (Taylor and Francis, 2024-09-11)
BACKGROUND : Advances in neonatal medicine, resulting in improved survival, have brought the concept of extra-uterine growth restriction (EUGR), defined as postnatal growth failure secondary to protein and energy deficits, to the forefront as an important cause of morbidity, particularly in very low birthweight (VLBW) neonates. OBJECTIVES : This study’s main objective was to determine the prevalence of EUGR in Steve Biko Academic Hospital in VLBW infants. METHODS : This was a pre- (epoch 1) and post- (epoch 2) intervention study. The intervention was the introduction of a written nutritional protocol in the neonatal unit in mid-November 2017. Three definitions were used to identify EUGR, namely: (1)discharge weight < 10th percentile, (2) a change by −1.28 z-score in weight at discharge, and (3) the discharge weight percentile below the nadir percentile. RESULTS : The prevalence of EUGR in epoch 1 was 85.7%, 63.5%, and 88.0% using the above definitions, respectively. The prevalence of EUGR in epoch 2 was 73.9%, 65.8%, and 89.4% using the above definitions, respectively. EUGR using the three definitions combined was present in 95.2% and 92.8% of infants in epochs 1 and 2, respectively. None of the differences in EUGR prevalence between the two epochs were significant. CONCLUSION : The prevalence of EUGR was not significantly different between the two epochs, although it had been proposed that the introduction of a written nutritional protocol would have decreased the prevalence of EUGR in epoch 2. One of the reasons proposed for this finding was poor adherence to the nutritional protocol during epoch 2.

Browse

Recent Submissions