Effect of High-Dose Vitamin D Supplementation on Upper Respiratory Tract Infection Symptom Severity in Healthy Children

By Katrina Hueniken, Mary Aglipay, Catherine S. Birken, Patricia C. Parkin, Mark B. Loeb, Kevin E.Thorpe, David W.H. Dai, Andreas Laupacis, Muhammad Mamdani, Tony Mazzulli, Jonathon L. Maguire on behalf of the TARGet Kids! Collaboration

The Pediatric Infectious Disease Journal, June 2019

 

Observational studies support the role of vitamin D in reducing viral upper respiratory tract infection (URTI) symptom severity in adults and children. This study assessed whether wintertime high-dose vitamin D supplementation (2000 IU/day) reduces URTI symptom severity compared with standard-dose (400 IU/day) supplementation in preschool children. Secondary objectives were to assess effects of high-dose supplementation on outpatient physician visits, emergency department (ED) visits and antibiotic prescriptions for URTI.

This was a secondary analysis of a multisite randomized clinical trial involving 703 healthy 1- to 5-year-old children in Toronto, Canada. High-dose or standard-dose oral vitamin D was randomly assigned for 1 winter season. For each URTI, parents completed symptom checklists based on the Canadian Acute Respiratory and Flu Scale. Symptom severity, frequency of outpatient visits, ED visits and antibiotic prescriptions for URTI between groups were analyzed using negative binomial regression.

Continue reading
21 Hits
0 Comments

Day clinic versus hospital care of pneumonia and severe malnutrition in children under five: a randomized trial

By Hasan Ashraf  Nur H. Alam  Marufa Sultana  Selina A. Jahan  Nurshad Begum  Sharmin Farzana  Mohammod J. Chisti  Mohiuddin Kamal, et al.

 

Tropical Medicine & International Health, May 2, 2019

 

Randomized clinical trial where children aged 2 months to 5 years with pneumonia and severe malnutrition were randomly allocated to DC or inpatient hospital care. We used block randomization of variable length from 8-20 and produced computer-generated random numbers that were assigned to one of the two interventions. Successful management was defined as resolution of clinical signs of pneumonia and being discharged from the model of care (DC or hospital) without need for referral to a hospital (DC), or referral to another hospital. All the children in both DC and hospital received intramuscular ceftriaxone, daily nutrition support and micronutrients

Continue reading
51 Hits
0 Comments

A meta-analysis of randomized controlled trials: Efficacy of selenium treatment for sepsis

by S Li, T Tang, P Guo, Q Zou, X Ao, L Hu, and L Tan

Published in Medicine, March 2019. doi: 10.1097/MD.0000000000014733

 

Researchers aimed to better understand the clinical outcomes of selenium therapy in patients with sepsis syndrome by conducting a meta-analysis of randomized controlled trials (RCT).

 

Continue reading
127 Hits
0 Comments

High burden of co-morbidity and mortality among severely malnourished children admitted to outpatient therapeutic programme facilities in the conflict setting of Borno, Nigeria: a retrospective review

by Chamla D, Oladeji O, Maduanusi I, Mele S, Mshelia H, and Safi N

Published in Public Health Nutrition, 19 February 2019. doi: 10.1017/S1368980018003968

 

 

The study objective was to present evidence on the burden and outcomes of co-morbidities among severely malnourished (SAM) children admitted to outpatient therapeutic programme (OTP) facilities in the conflict setting of Borno, Nigeria.

Continue reading
67 Hits
0 Comments

Growth trajectories of breastfed HIV-exposed uninfected and HIV-unexposed children under conditions of universal maternal antiretroviral therapy: a prospective study

by Stanzi M le Roux, MBChB; Prof Elaine J Abrams, MD; Kirsten A Donald, PhD; Kirsty Brittain, MPH; Tamsin K Phillips, MPH; Kelly K Nguyen, MPH; et al.

Published in The Lancet Child & Adolescent Health, 14 February 2019. DOI: https://doi.org/10.1016/S2352-4642(19)30007-0

 

 

Over 1 million HIV-exposed uninfected (HEU) children are born in sub-Saharan Africa annually. Little data exist on the risk of impaired growth in this population under current policies of universal maternal antiretroviral therapy (ART) with breastfeeding. Researchers aimed to study the growth of breastfed HEU children born to women who initiated ART during pregnancy and compare their growth with that of breastfed HIV-unexposed (HU) children drawn from the same community.  A prospective cohort of HIV-uninfected and HIV-infected pregnant women, who were initiating ART, were enrolled at their first antenatal care visit in a primary care centre in Gugulethu, Cape Town, South Africa. HIV infected women were participants of the Maternal Child Health Antiretroviral Therapy (MCH-ART) study, and HIV-uninfected pregnant women were participants in the HIV-Unexposed-Uninfected (HU2) study. All women were followed up during pregnancy, through delivery, to the early postnatal visit, which was scheduled for the first week after birth. At this visit, eligible breastfeeding mother–child pairs were recruited for continuation of postnatal follow-up until approximately age 12 months. Child anthropometry was measured at around 6 weeks, and every 3 months from month 3 to month 12. Weight-for-age (WAZ), length-for-age (LAZ), weight-for-length (WLZ), head circumference-for-age, and body-mass index-for-age Z scores were compared between HEU and HU children longitudinally using mixed effects linear regression. At 12 months, proportions of HEU and HU children with moderate or severe malnutrition were compared cross-sectionally using logistic regression. MCH-ART is registered with ClinicalTrials.gov, number NCT01933477.  Between June, 2013, and April, 2016, 884 breastfeeding mothers and their newborn babies (HEU, n=471; HU, n=413) were enrolled into postnatal follow-up. Excluding 12 children who tested HIV positive during follow-up, 461 HEU and 411 HU children attended 4511 study visits in total, with a median of 6 visits (IQR 5–6) per child. Birth characteristics were similar (overall, 94 [11%] of 872 preterm [<37 weeks] and 90 [10%] small-for-gestational age [birthweight <10th percentile]). Median duration of breastfeeding was shorter among HEU than HU children (3·9 months [IQR 1·4–12·0] vs 9·0 months [IQR 3·0–12·0]). Although WAZ scores increased over time in both groups, HEU children had consistently lower mean WAZ scores than HU children (overall β −0·34, 95% CI −0·47 to −0·21). LAZ scores decreased in both groups after 9 months. At 12 months, HEU children had lower mean LAZ scores than HU children (β −0·43, −0·61 to −0·25), with a higher proportion of children stunted (LAZ score <–2: 35 [10%] of 342 HEU vs 14 [4%] of 342 HU children; odds ratio [OR] 2·67, 95% CI 1·41 to 5·06). Simultaneously, overweight (WLZ score >2) was common in both groups of children at 12 months (54 [16%] of 342 HEU vs 60 [18%] of 340 HU children; OR 0·87, 95% CI 0·58 to 1·31).  Compared with HU children, HEU children have small deficits in early growth trajectories under policies of universal maternal ART and breastfeeding. Large proportions of both HEU and HU children were overweight by 12 months, indicating substantial risks for early onset obesity among South African children. Although the longer-term metabolic effects of ART exposure in the context of childhood obesity warrants further investigation, addressing childhood obesity should be an urgent public health priority in this setting.  This study was funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Elizabeth Glaser Pediatric AIDS Foundation, South African Medical Research Council, and the Fogarty Foundation.    Article access can be found here.    
85 Hits
0 Comments