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Kyomugisa B, Were TP, Rujumba J, Munube D, Lorraine O, Kiguli S. "Prevalence, outcome and factors associated with dysglycemia among critically ill children presenting to Fort Portal Regional Referral Hospital: A cross sectional study". RESEARCH SQUARE 2023:rs.3.rs-2734736. [PMID: 37205509 PMCID: PMC10187377 DOI: 10.21203/rs.3.rs-2734736/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Introduction Dysglycemia has been shown to influence outcome among critically ill children. We aimed to determine the prevalence, outcome and factors associated with dysglycemia among critically ill children aged one month to 12 years presenting to Fort Portal regional referral hospital. Methods The study employed a descriptive, cross-sectional design for prevalence and factors associated, and longitudinal observational study design to determine the immediate outcome. Critically ill children aged one month to 12 years were systematically sampled and triaged at outpatient department using World Health Organization emergency signs. The random blood glucose was evaluated on admission and at 24 hours. Verbal and written informed consent/assent were obtained after stabilization of the study participants. Those that had hypoglycemia were given Dextrose 10% and those with hyperglycemia had no intervention. Results Of the 384 critically ill children, dysglycemia was present in 21.7% (n = 83), of those 78.3% (n = 65) had hypoglycemia and 21.7% (n = 18) had hyperglycemia. The proportion of dysglycemia at 24 hours was 2.4% (n = 2). None of the study participants had persistent hypoglycemia at 24 hours. The cumulative mortality at 48hours was 3.6% (n = 3). At 48 hours 33.2% (n = 27) had stable blood glucose levels and were discharged from the hospital. After multiple logistic regression, obstructed breathing (AOR 0.07(0.02-0.23), inability to breastfeed/drink (AOR 2.40 (1.17-4.92) and active convulsions (AOR 0.21 (0.06-0.74), were the factors that were significantly associated with dysglycemia among critically ill children. The results will guide in the revision of policies and treatment protocols to facilitate better management of children at risk of dysglycemia nationally. Conclusions Dysglycemia was found to affect one in five critically ill children aged one month to 12 years presenting to Fort Portal Regional Referral Hospital. Dysglycemia outcomes are good with early intervention.
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Affiliation(s)
- Beatrice Kyomugisa
- Department of Paediatrics and Child Health, College of Health sciences, Makerere University, P.O BOX 7072 Kampala, Uganda
| | - Thereza Piloya Were
- Department of Paediatrics and Child Health, College of Health sciences, Makerere University, P.O BOX 7072 Kampala, Uganda
| | - Joseph Rujumba
- Department of Paediatrics and Child Health, College of Health sciences, Makerere University, P.O BOX 7072 Kampala, Uganda
| | - Deogratious Munube
- Department of Paediatrics and Child Health, College of Health sciences, Makerere University, P.O BOX 7072 Kampala, Uganda
| | - Oriokot Lorraine
- Department of Paediatrics and Child Health, College of Health sciences, Makerere University, P.O BOX 7072 Kampala, Uganda
| | - Sarah Kiguli
- Department of Paediatrics and Child Health, College of Health sciences, Makerere University, P.O BOX 7072 Kampala, Uganda
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Ojo RJ, Jonathan IG, Adams MD, Gyebi G, Longdet IY. Renal and hepatic dysfunction parameters correlate positively with gender among patients with recurrent malaria cases in Birnin Kebbi, Northwest Nigeria. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2022. [DOI: 10.1186/s43162-022-00164-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Abstract
Background
Simultaneous increase in transaminases and bilirubin is an indicator of hepatic dysfunction in malaria. Malaria-induced hyperbilirubinemia has been associated with acute kidney injury and pathogenesis of cerebral malaria which are significantly associated with mortality in malaria infection. This retrospective study was designed to assess the lipid profile, and hematological, renal and hepatic function data of malaria patients in Sir Yahaya Memorial hospital Birnin Kebbi from 2016 to 2020 who are 18 years and above.
Methods
The data of all patients between 2016 and 2020 who are 18 years and above were collected. Complete data of 370 subjects who met the inclusion criteria which consist of 250 malaria subjects and 120 control subjects were analyzed.
Results
The results showed that females constitute 65.2% of malaria patients with complete records while the remaining 34.8% were males. Age distribution of the patients showed that the infection was more prevalent among 26–45 years and least among 65 years and above. Anemia and thrombocytopenia were prevalent among the female malaria patients compared to the male patients. Liver and kidney function parameters analyzed correlate positively with the gender. The infected male showed higher dysfunction in liver parameters while infected female patients showed significant dysfunction in kidney function parameters and lipid profile.
Conclusions
In conclusion, to prevent the potential widespread of acute renal and hepatic failure with the attendant morbidity and mortality among malaria patients, it is recommended that liver and kidney function tests be mandated for patients with recurring malaria and those with a history of treatment failure in the endemic area to ensure early diagnosis of malarial induced kidney and liver injury among malaria patients.
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Sime H, Berhane M, Tilahun T, Kedir T, Dereje D, Beshir M, Tadesse I. Dysglycemia in Critically Ill Children Admitted to Jimma Medical Centre, Southwest Ethiopia. Ethiop J Health Sci 2021; 31:311-320. [PMID: 34158783 PMCID: PMC8188083 DOI: 10.4314/ejhs.v31i2.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Abnormal blood glucose level is one of the most frequently encountered problems in children with severe illnesses. However, its magnitude and outcome have rarely been determined in Ethiopia. We aimed to determine the magnitude, associated factors and outcome of dysglycemia in critically ill children admitted to Jimma Medical Center. Methods Prospective longitudinal study was conducted on children aged 28 days to 14 years admitted with critical illnesses at the different units of the Department of Pediatrics and Child Health of Jimma Medical Center, Southwest Ethiopia, from June to August 2019. Data were collected by trained medical personnel using structured questionnaire and analyzed using Statistical Package for Social Sciences (SPSS) windows version 20.0. Dysglycemia was considered whenever the child had a random blood sugar >150mg/dl or <45mg/dl. Result Dysglycemia was seen at admission in 139/481, 28.9% children; 24 (5.0%) had hypoglycemia whereas 115 (23.9%) had hyperglycemia. The factors associated with dysglycemia at admission were severe acute malnutrition (p=002, AOR=3.09, CI=1.18,7.77), impaired mental status (p=0.003, AOR=4.63, CI=1.68, 12.71), place of residence (p=0.01, AOR=1.85, CI=1.15-2.96) and presence of diarrhea on date of admission. Among the children who had dysglycemia at admission, 16/139, 11.5% died. Conclusion Dysglycemia is a common problem in critically ill children in the setting. Blood glucose level should be determined for all critically ill children, and routine empirical administration of dextrose should be minimized since most of the children with dysglycemia had hyperglycemia than hypoglycemia.
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Affiliation(s)
- Habtamu Sime
- Department of Pediatrics and Child Health, Jimma University
| | | | - Tsion Tilahun
- Department of Pediatrics and Child Health, Jimma University
| | - Temam Kedir
- Department of Pediatrics and Child Health, Jimma University
| | | | - Muktar Beshir
- Department of Epidemiology, Jimma University.,Australian Centre for Precision Health, University of South Australia Cancer Research Institute, SA, Australia.,School of Clinical and Health Sciences, University of South Australia, SA, Australia
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Baker T, Ngwalangwa F, Masanjala H, Dube Q, Langton J, Marrone G, Hildenwall H. Effect on mortality of increasing the cutoff blood glucose concentration for initiating hypoglycaemia treatment in severely sick children aged 1 month to 5 years in Malawi (SugarFACT): a pragmatic, randomised controlled trial. LANCET GLOBAL HEALTH 2020; 8:e1546-e1554. [PMID: 33038950 DOI: 10.1016/s2214-109x(20)30388-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 07/03/2020] [Accepted: 08/14/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Low blood glucose concentrations are common in sick children who present to hospital in low-resource settings and are associated with increased mortality. The cutoff blood glucose concentration for the diagnosis and treatment of hypoglycaemia currently recommended by WHO (2·5 mmol/L) is not evidence-based. We aimed to assess whether increasing the cutoff blood glucose concentration for hypoglycaemia treatment in severely ill children at presentation to hospital improves mortality outcomes. METHODS We did a pragmatic, randomised controlled trial at two referral hospitals in Malawi. Severely ill children aged 1 month to 5 years presenting to the emergency department with a capillary blood glucose concentration of between 2·5 mmol/L (3·0 mmol/L in severely malnourished children) and 5·0 mmol/L were randomly assigned (1:1) by a computer-generated randomisation sequence, stratified by study site and severe malnutrition, to receive either an immediate intravenous bolus of 10% dextrose at 5 mL/kg followed by a 24-h maintenance infusion of 10% dextrose at 100 mL/kg for the first 10 kg of bodyweight, 50 mL/kg for the next 10 kg, and 20 mL/kg for each subsequent kg of bodyweight (intervention group) or observation for a minimum of 60 min and standard care (control group). Participants and study personnel were not masked to treatment allocation. The primary outcome was all-cause in-hospital mortality, assessed on an intention-to-treat basis. Safety was also assessed in the intention-to-treat population. The study is registered with ClinicalTrials.gov, NCT02989675. FINDINGS Between Dec 5, 2016, and Jan 22, 2019, 10 947 children were screened, of whom 332 were randomly assigned, and 322 were included in the final analysis (n=162 in the control group and n=160 in the intervention group). The study was terminated after an interim analysis at 24% enrolment indicated futility. The median age of participants was 2·3 years (IQR 1·4-3·2), 65 (45%) were female, and the baseline characteristics of participants were similar between the two groups. The number of in-hospital deaths from any cause was 26 (16%) in the control group and 24 (15%) in the intervention group, with an absolute mortality difference of 1·0% (95% CI -6·9 to 9·0). Serious adverse events, including hypoglycaemia, hyperglycaemia, convulsions, reduced consciousness, and death, were reported in 47 (29%) children in the control group and 39 (24%) children in the intervention group. INTERPRETATION Increasing the cutoff blood glucose concentration for hypoglycaemia treatment in severely sick children in Malawi from 2·5 mmol/L to 5·0 mmol/L did not reduce all-cause in-hospital mortality. Our findings do not support changing the cutoff for dextrose administration, and further research on the optimal management of severely ill children who present to the emergency department with low blood glucose concentrations is warranted. FUNDING Swedish Research Council and Stockholm Country Council.
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Affiliation(s)
- Tim Baker
- Health System and Policy, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden; Department of Anaesthesia and Intensive Care, Queen Elizabeth Central Hospital, Blantyre, Malawi; Department of Paediatrics, College of Medicine, University of Malawi, Blantyre, Malawi; Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden.
| | - Fatsani Ngwalangwa
- Department of Paediatrics, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Henderson Masanjala
- Department of Paediatrics, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Queen Dube
- Department of Paediatrics, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Josephine Langton
- Department of Paediatrics, Queen Elizabeth Central Hospital, Blantyre, Malawi; Department of Paediatrics, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Gaetano Marrone
- Health System and Policy, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Helena Hildenwall
- Health System and Policy, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden; Department of Paediatrics, Queen Elizabeth Central Hospital, Blantyre, Malawi; Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
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Toro-Polo LM, Ortiz-Lozada RY, Chang-Grozo SL, Hernandez AV, Escalante-Kanashiro R, Solari-Zerpa L. Glycemia upon admission and mortality in a pediatric intensive care unit. Rev Bras Ter Intensiva 2019; 30:471-478. [PMID: 30672971 PMCID: PMC6334488 DOI: 10.5935/0103-507x.20180068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 07/26/2018] [Indexed: 12/03/2022] Open
Abstract
Objectives To analyze the association between glycemia levels upon pediatric intensive
care unit admission and mortality in patients hospitalized. Methods A retrospective cohort of pediatric intensive care unit patients admitted to
the Instituto Nacional de Salud del Niño between
2012 and 2013. A Poisson regression model with robust variance was used to
quantify the association. Diagnostic test performance evaluation was used to
describe the sensitivity, specificity, positive predictive value, negative
predictive value and likelihood ratios for each range of glycemia. Results In total, 552 patients were included (median age 23 months, age range 5
months to 79.8 months). The mean glycemia level upon admission was
121.3mg/dL (6.73mmol/L). Ninety-two (16.6%) patients died during
hospitalization. In multivariable analyses, significant associations were
found between glycemia < 65mg/dL (3.61mmol/L) (RR: 2.01, 95%CI 1.14 -
3.53), glycemia > 200mg/dL (> 11.1mmol/L) (RR: 2.91, 95%CI 1.71 -
4.55), malnutrition (RR: 1.53, 95%CI 1.04 - 2.25), mechanical ventilation
(RR: 3.71, 95%CI 1.17 - 11.76) and mortality at discharge. There was low
sensitivity (between 17.39% and 39.13%) and high specificity (between 49.13%
and 91.74%) for different glucose cut-off levels. Conclusion There was an increased risk of death at discharge in patients who developed
hypoglycemia and hyperglycemia upon admission to the pediatric intensive
care unit. Certain glucose ranges (> 200mg/dL (> 11.1mmol/L) and <
65mg/dL (3.61mmol/L)) have high specificity as predictors of death at
discharge.
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Affiliation(s)
- Luis Miguel Toro-Polo
- Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas - Lima, Peru.,Sociedad Científica de Estudiantes de Medicina, Universidad Peruana de Ciencias Aplicadas - Lima, Peru
| | | | | | - Adrian V Hernandez
- Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas - Lima, Peru.,Evidence-Based Practice Center, Hartford Hospital, University of Connecticut -Hartford, United States
| | - Raffo Escalante-Kanashiro
- Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas - Lima, Peru.,Instituto Nacional de Salud del Niño - Lima, Peru
| | - Lely Solari-Zerpa
- Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas - Lima, Peru
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Tumwebaze A, Kiboneka E, Mugalu J, Kikabi EM, Tumwine JK. Prevalence and outcome of stress hyperglycaemia among severely malnourished children admitted to Mulago referral and teaching hospital in Kampala, Uganda. BMC Nutr 2018; 4:49. [PMID: 32153910 PMCID: PMC7050710 DOI: 10.1186/s40795-018-0258-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 11/29/2018] [Indexed: 01/19/2023] Open
Abstract
Background Stress hyperglycaemia is a transient increase in blood glucose level during stressful events and is common in critically ill children. Several studies have demonstrated increased risk of mortality in these children. There is paucity of information on this subject in sub Saharan Africa.The aim of this study was to describe the prevalence, outcome and factors associated with stress hyperglycaemia among children with severe acute malnutrition (SAM) admitted to the Mwanamugimu nutrition unit of Mulago hospital in Uganda. Methods This study was conducted from August 2015 to March 2016 at the Mwanamugimu nutrition unit of Mulago hospital among severely malnourished children aged 1 to 60 months. Random blood sugar levels were measured. Stress hyperglycaemia was considered as a random blood sugar > 150 mg/dl. The final outcome was ascertained at death or discharge. Statistical analysis was done using the Chi square test and logistic regression. Results Two hundred and thirty-five children were enrolled of whom 50% were girls. The median age was 5.1 months (range 1-60 months). Stress hyperglycaemia was present in 16.6% of the 235 participants. Several factors were significantly associated with stress hyperglycaemia at bivariate analysis; but on logistic regression, only presence of oral sores was associated with stress hyperglycaemia: (Odds ratio 2.61; 95% CI 1.02-6.65).Mortality was higher among children with stress hyperglycaemia (56.4%) compared to (12.8%) in the non-hyperglycaemic group: OR 8.75; 95% CI 4.09-18.70). Conclusion The prevalence of stress hyperglycaemia was 16.6% and was associated with high mortality. It is important to monitor blood glucose levels of severely malnourished children. Hitherto, the main concern among severely malnourished children has been hypoglycaemia. Innovative ways of preventing and managing stress hyperglycaemia among these children are urgently needed.
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Affiliation(s)
- Anita Tumwebaze
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Elizabeth Kiboneka
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Jamir Mugalu
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Edward M Kikabi
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - James K Tumwine
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
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Lindsjö C, Chirambo CM, Langton J, Dube Q, Baker T, Hildenwall H. 'We just dilute sugar and give' health workers' reports of management of paediatric hypoglycaemia in a referral hospital in Malawi. Glob Health Action 2018; 11:1491670. [PMID: 30014776 PMCID: PMC6052417 DOI: 10.1080/16549716.2018.1491670] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background: Acutely sick children in resource-constrained settings who present with hypoglycaemia have poor outcomes. Studies have questioned the current hypoglycaemia treatment cut-off level of 2.5 mmol/l. Improved knowledge about health workers’ attitudes towards and management of hypoglycaemia is needed to understand the potential effects of a raised cut-off level. Objective: This research explored health workers’ perceptions about managing acutely ill children with hypoglycaemia in a Malawian referral hospital. A secondary objective was to explore health workers’ opinions about a potential increase in the hypoglycaemia cut-off level. Methods: We used a qualitative design with semi-structured individual interviews performed with health workers in the Paediatric Accident and Emergency Unit at Queen Elizabeth Central Hospital, Malawi, in October 2016. Data were analysed using latent content analysis. Ethical approval was obtained from the University of Malawi, College of Medicine Research and Ethics Committee P.01/16/1852. Results: Four themes were formed that described the responses. The first, ‘Critical and difficult cases need easy treatment’, showed that health workers perceived hypoglycaemia as a severe condition that was easily manageable. The second, ‘Health system issues’, revealed challenges relating to staffing and resource availability. The third, ‘From parental reluctance to demand’, described a change in parents’ attitudes regarding intravenous treatments. The fourth, ‘Positive about the change but need more information’, exposed health workers’ concerns about potential risks of a raised cut-off level for hypoglycaemia treatment, as well as benefits for the patients. Conclusions: Health workers perceived hypoglycaemia as a severe condition that is easy to manage when the required equipment and supplies are available. Due to the common lack of test equipment and dextrose supplies, health workers have adopted alternative strategies to diagnose and manage hypoglycaemia. A change to the hypoglycaemia treatment cut-off level raised concerns about potential risks, but was also thought to be of benefit for some patients.
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Affiliation(s)
- Cecilia Lindsjö
- a Global Health - Health System and Policy Research Group, Department of Public Health Sciences , Karolinska Institutet , Stockholm , Sweden.,c Astrid Lindgren Children's Hospital , Karolinska University Hospital , Stockholm , Sweden
| | | | - Josephine Langton
- b Department of Paediatrics , College of Medicine, University of Malawi , Blantyre , Malawi
| | - Queen Dube
- b Department of Paediatrics , College of Medicine, University of Malawi , Blantyre , Malawi
| | - Tim Baker
- a Global Health - Health System and Policy Research Group, Department of Public Health Sciences , Karolinska Institutet , Stockholm , Sweden.,b Department of Paediatrics , College of Medicine, University of Malawi , Blantyre , Malawi
| | - Helena Hildenwall
- a Global Health - Health System and Policy Research Group, Department of Public Health Sciences , Karolinska Institutet , Stockholm , Sweden.,b Department of Paediatrics , College of Medicine, University of Malawi , Blantyre , Malawi.,c Astrid Lindgren Children's Hospital , Karolinska University Hospital , Stockholm , Sweden
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Baker T, Dube Q, Langton J, Hildenwall H. Mortality impact of an increased blood glucose cut-off level for hypoglycaemia treatment in severely sick children in Malawi (SugarFACT trial): study protocol for a randomised controlled trial. Trials 2018; 19:33. [PMID: 29325595 PMCID: PMC5765642 DOI: 10.1186/s13063-017-2411-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 12/15/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mortality in children remains high in sub-Saharan African hospitals. While antimalarial drugs, antibiotics and other definitive treatments are well understood, the role of emergency care with supportive therapies, such as maintaining normal glucose and electrolyte balances, has been given limited attention. Hypoglycaemia is common in children admitted to hospital in low-income settings. The current definition of hypoglycaemia is a blood glucose level < 2.5 mmol/L in a well-nourished child. Outcomes for these children are poor, with a mortality rate of up to 42%. An increased mortality has also been reported among acutely ill children with low-glycaemia, defined as a blood glucose level of 2.5-5.0 mmol/L. The reason for increased mortality rates is not fully understood. This proposal is for a randomised controlled trial to determine the impact on mortality of a raised treatment cut-off level for paediatric hypoglycaemia. METHODS A total of 1266 severely ill children (age range = 1 month - 5 years) admitted to Queen Elizabeth Central Hospital in Blantyre, Malawi with blood glucose in the range of 2.5-5.0 mmol/L will be randomised into intervention or control groups. The intervention group will be treated with an intravenous bolus of 10% dextrose 5 mL/kg followed by a dextrose infusion in addition to standard care while the control group will receive standard care only. Children will be followed until discharge from hospital or death. DISCUSSION The first patient was enrolled in December 2016 and the expected trial deadline is January 2019. This study is the first to evaluate the benefits of increased dextrose administration in children presenting to hospital with low-glycaemia. The findings will inform national and international policies and guidelines for the management of children with blood sugar abnormalities. TRIAL REGISTRATION ClinicalTrials.gov, NCT02989675 . Registered on 5 December 2016.
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Affiliation(s)
- Tim Baker
- Global Health - Health System and Policy Research Group, Department of Public Health Sciences, Karolinska Institutet, 171 77, Stockholm, Sweden.,Department of Anaesthesia & Intensive Care, Queen Elizabeth Central Hospital, Blantyre, Malawi.,Perioperative Medicine and Intensive Care, Karolinska Univeristy Hospital, Stockholm, Sweden
| | - Queen Dube
- Department of Paediatrics, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Josephine Langton
- Department of Paediatrics, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Helena Hildenwall
- Global Health - Health System and Policy Research Group, Department of Public Health Sciences, Karolinska Institutet, 171 77, Stockholm, Sweden. .,Department of Paediatrics, College of Medicine, University of Malawi, Blantyre, Malawi. .,Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.
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Mirbolouk M, Derakhshan A, Charkhchi P, Guity K, Azizi F, Hadaegh F. Incidence and predictors of early adulthood pre-diabetes/type 2 diabetes, among Iranian adolescents: the Tehran Lipid and Glucose Study. Pediatr Diabetes 2016; 17:608-616. [PMID: 26764014 DOI: 10.1111/pedi.12343] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 11/13/2015] [Accepted: 11/04/2015] [Indexed: 12/16/2022] Open
Abstract
PURPOSE To evaluate the incidence and predictors of early adulthood pre-diabetes/type 2 diabetes (T2D) among Iranian adolescents during a median follow-up of 9.2 yr. METHOD A total of 2563 subjects aged 10-19 yr, without pre-diabetes/T2D at baseline, were entered in the study. Pre-diabetes was defined as those with fasting plasma glucose (FPG) 5.6 to <7 mmol/L. T2D was defined as anti-T2D drug consumption or FPG ≥7 mmol/L. Multivariate Cox-proportional analysis was applied to examine the association between different risk factors that showed attained statistical significance < 0.2 in univariate analysis, with incident pre-diabetes/T2D. Same method was repeated on 1803 subjects with complete parental data to find the relation between parental risk factors and pre-diabetes/T2D. RESULT The mean age of participants was 14.45 ± 2.78 yr, and 53.6% were female. During follow-up 208 cases of pre-diabetes/T2D occurred, resulting in an incidence rate of 9.61 per 1000 person-years. Multivariate-adjusted hazard ratios (HRs) for incident pre-diabetes/T2D showed significant risk for 1 standard deviation increase in FPG and body mass index with corresponding HR of 1.89 (1.6-2.23) and 1.435 (1.080-1.905), respectively. Among parental potential risk factors, the paternal history of T2D was independently associated with increased risk for pre-diabetes/T2D in the adolescence (HR = 1.63(1.02-2.60)). CONCLUSION About 1% of Iranian adolescents developed pre-diabetes/T2D each year. Among the non-modifiable risk factors paternal history of T2D and, among modifiable risk factors, the presence of general adiposity as well as the higher level of FPG should be considered among adolescents for development of pre-diabetes/T2D later in the young adulthood.
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Affiliation(s)
- Mohammadhassan Mirbolouk
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arash Derakhshan
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Paniz Charkhchi
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kamran Guity
- Cellular and Molecular Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Lanneaux J, Dauger S, Pham LL, Naudin J, Faye A, Gillet Y, Bosdure E, Carbajal R, Dubos F, Vialet R, Chéron G, Angoulvant F. Retrospective study of imported falciparum malaria in French paediatric intensive care units. Arch Dis Child 2016; 101:1004-1009. [PMID: 27281455 DOI: 10.1136/archdischild-2015-309665] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Revised: 05/04/2016] [Accepted: 05/10/2016] [Indexed: 11/04/2022]
Abstract
OBJECTIVE The World Health Organization (WHO) severity criteria for paediatric Plasmodium falciparum (Pf) malaria are based on studies in countries of endemic malaria. The relevance of these criteria for other countries remains unclear. We assessed the relevance of these criteria in an industrialised country. DESIGN Retrospective case-control study. SETTING Eight French university hospitals, from 2006 to 2012. PATIENTS Children with Pf malaria admitted to paediatric intensive care units (cases: n=55) or paediatric emergency departments (controls: n=110). MAIN OUTCOME MEASURES Descriptive analysis of WHO severity criteria and major interventions (mechanical ventilation, blood transfusion, fluid challenge, treatment of cerebral oedema, renal replacement therapy). Thresholds were set by receiver operating characteristics curve analysis. RESULTS Altered consciousness (71% vs 5%), shock (24% vs 1%), renal failure (20% vs 1%), anaemia <50 g/L (7% vs 2%), acidosis (38% vs 0%), bilirubin level >50 µmol/L (25% vs 8%) and parasitaemia >10% (30% vs 8%) were more frequent in cases (p<0.01). All these criteria were associated with major interventions (p<0.001). Respiratory distress (six cases), and hypoglycaemia (two cases) were infrequent. Thrombocytopenia <50 000/mm3 (46% vs 7%) and anaemia (haemoglobin concentration <70 g/L (41% vs 13%)) were more frequent in cases (p<0.0001). CONCLUSIONS The WHO severity criteria for paediatric Pf malaria are relevant for countries without endemic malaria. The infrequent but severe complications also provide a timely reminder of the morbidity and mortality associated with this condition worldwide. In non-endemic countries haemoglobin <70 g/L and platelet count <50 000/mm3 could be used as additional criteria to identify children needing high level of care.
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Affiliation(s)
- Justine Lanneaux
- Department of Paediatric Intensive care, AP-HP, Hôpital Robert Debré, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Stéphane Dauger
- Department of Paediatric Intensive care, AP-HP, Hôpital Robert Debré, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Luu-Ly Pham
- Paediatric Emergency Department, AP-HP, Hôpital Bicêtre, Université Paris Sud, Le Kremlin-Bicêtre, France
| | - Jérôme Naudin
- Department of Paediatric Intensive care, AP-HP, Hôpital Robert Debré, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Albert Faye
- Department of General Paediatrics, AP-HP, Hôpital Robert Debré, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Yves Gillet
- Paediatric Emergency Department, HCL, HFME Lyon, Université de Lyon 1, Lyon, France
| | | | - Ricardo Carbajal
- Paediatric Emergency Department, AP-HP, Hôpital Armand Trousseau, Université Pierre et Marie Curie Paris 6, Paris, France
| | - François Dubos
- Paediatric Emergency and Infectious Diseases Departments, Université de Lille, Hôpital R. Salengro, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Renaud Vialet
- Paediatric Intensive Care Department, APHM, CHU Nord, Marseille, France
| | - Gérard Chéron
- Paediatric Emergency Department, AP-HP, Hôpital Necker-Enfants Malades, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - François Angoulvant
- Paediatric Emergency Department, AP-HP, Hôpital Necker-Enfants Malades, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Clinical Epidemiology Unit ECEVE, INSERM UMR 1123, AP-HP, Hôpital Robert Debré, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
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11
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Barennes H, Sayavong E, Pussard E. High Mortality Risk in Hypoglycemic and Dysglycemic Children Admitted at a Referral Hospital in a Non Malaria Tropical Setting of a Low Income Country. PLoS One 2016; 11:e0150076. [PMID: 26910320 PMCID: PMC4766095 DOI: 10.1371/journal.pone.0150076] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 02/09/2016] [Indexed: 01/30/2023] Open
Abstract
INTRODUCTION Hypoglycemia is a recognized feature of severe malaria but its diagnosis and management remain problematic in resource-limited settings. There is limited data on the burden and prognosis associated with glycemia dysregulation in non-neonate children in non-malaria areas. We prospectively assessed the abnormal blood glucose prevalence and the outcome and risk factors of deaths in critically ill children admitted to a national referral hospital in Laos. METHODS Consecutive children (1 month-15 years) admitted to the pediatric ward of Mahosot hospital, were categorized using the integrated management of childhood illness (IMCI). Blood glucose was assessed once on admission through a finger prick using a bedside glucometer. Glycemia levels: hypoglycemia: < 2.2 mmol/L (< 40 mg⁄ dl), low glycemia: 2.2-4.4 mmol/L (40-79 mg⁄ dl), euglycemia: 4.4-8.3 mmol/L (80-149 mg⁄ dl), and hyperglycemia: > 8.3 mmol/L (≥150 mg⁄ dl), were related to the IMCI algorithm and case fatality using univariate and multivariate analysis. RESULTS Of 350 children, 62.2% (n = 218) were severely ill and 49.1% (n = 172) had at least one IMCI danger sign. A total of 15 (4.2%, 95%CI: 2.4-6.9) had hypoglycemia, 99 (28.2%, 95%CI: 23.6-33.3) low glycemia, 201 (57.4%, 95% CI: 52.0-62.6) euglycemia and 35 (10.0%, 95% CI: 7.0-13.6) hyperglycemia. Hypoglycemia was associated with longer fasting (p = 0.001) and limited treatment before admission (p = 0.09). Hypoglycemia and hyperglycemia were associated with hypoxemia (SaO2) (p = 0.001). A total of 21 (6.0%) of the children died: 66.6% with hypoglycemic, 6.0% with low glycemic, 5.7% with hyperglycemic and 1.4% with euglycemic groups. A total of 9 (2.5%) deaths occurred during the first 24 hours of admission and 5 (1.7%) within 3 days of hospital discharge. Compared to euglycemic children, hypoglycemic and low glycemic children had a higher rate of early death (20%, p<0.001 and 5%, p = 0.008; respectively). They also had a higher risk of death (OR: 132; 95%CI: 29.0-596.5; p = 0.001; and OR: 4.2; 95%CI: 1.1-15.6; p = 0.02; respectively). In multivariate analyses, hypoglycemia (OR: 197; 95%CI: 33-1173.9), hypoxemia (OR: 5.3; 95%CI: 1.4-20), presence of hepatomegaly (OR: 8.7; 95%CI: 2.0-37.6) and having an illiterate mother (OR: 25.9; 95%CI: 4.2-160.6) were associated with increased risk of death. CONCLUSION Hypoglycemia is linked with a high risk of mortality for children in non malaria tropical settings. Blood sugar should be monitored and treatment provided for sick children, especially with danger signs and prolonged fasting. Further evaluations of intervention using thresholds including low glycemia is recommended in resource-limited settings. Research is also needed to determine the significance, prognosis and care of hyperglycemia.
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Affiliation(s)
- Hubert Barennes
- Institut de la Francophonie pour la Médecine Tropicale, Vientiane, Lao PDR
- Agence Nationale de Recherche sur le VIH et les Hépatites, Phnom Penh, Cambodia
- Epidemiologie-Biostatistique, ISPED, Centre INSERM U897, Bordeaux University, F-Bordeaux, France
- Epidemiology Unit, Pasteur Institute, Phnom Penh, Cambodia
| | - Eng Sayavong
- Institut de la Francophonie pour la Médecine Tropicale, Vientiane, Lao PDR
| | - Eric Pussard
- Génétique Moléculaire, Pharmacogénétique et Hormonologie, Kremlin Bicêtre University Hospital, Paris, France
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12
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Madrid L, Acacio S, Nhampossa T, Lanaspa M, Sitoe A, Maculuve SA, Mucavele H, Quintó L, Sigaúque B, Bassat Q. Hypoglycemia and Risk Factors for Death in 13 Years of Pediatric Admissions in Mozambique. Am J Trop Med Hyg 2015; 94:218-26. [PMID: 26503282 DOI: 10.4269/ajtmh.15-0475] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Accepted: 09/08/2015] [Indexed: 01/18/2023] Open
Abstract
Hypoglycemia is a life-threatening complication of several diseases in childhood. We describe the prevalence and incidence of hypoglycemia among admitted Mozambican children, establishing its associated risk factors. We retrospectively reviewed clinical data of 13 years collected through an ongoing systematic morbidity surveillance in Manhiça District Hospital in rural Mozambique. Logistic regression was used to identify risk factors for hypoglycemia and death. Minimum community-based incidence rates (MCBIRs) for hypoglycemia were calculated using data from the demographic surveillance system. Of 49,089 children < 15 years hospitalized in Manhiça District Hospital, 45,573 (92.8%) had a glycemia assessment on admission. A total of 1,478 children (3.2%) presented hypoglycemia (< 3 mmol/L), of which about two-thirds (972) were with levels < 2.5 mmol/L. Independent risk factors for hypoglycemia on admission and death among hypoglycemic children included prostration, unconsciousness, edema, malnutrition, and bacteremia. Hypoglycemic children were significantly more likely to die (odds ratio [OR] = 7.11; P < 0.001), with an associated case fatality rate (CFR) of 19.3% (245/1,267). Overall MCBIR of hypoglycemia was 1.57 episodes/1,000 child years at risk (CYAR), significantly decreasing throughout the study period. Newborns showed the highest incidences (9.47 episodes/1,000 CYAR, P < 0.001). Hypoglycemia remains a hazardous condition for African children. Symptoms and signs associated to hypoglycemia should trigger the verification of glycemia and the implementation of life-saving corrective measures.
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Affiliation(s)
- Lola Madrid
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique; Barcelona Institute for Global Health, Barcelona Centre for International Health Research, Hospital Clínic Universitat de Barcelona, Barcelona, Spain; Instituto Nacional de Saúde, Ministry of Health, Maputo, Mozambique
| | - Sozinho Acacio
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique; Barcelona Institute for Global Health, Barcelona Centre for International Health Research, Hospital Clínic Universitat de Barcelona, Barcelona, Spain; Instituto Nacional de Saúde, Ministry of Health, Maputo, Mozambique
| | - Tacilta Nhampossa
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique; Barcelona Institute for Global Health, Barcelona Centre for International Health Research, Hospital Clínic Universitat de Barcelona, Barcelona, Spain; Instituto Nacional de Saúde, Ministry of Health, Maputo, Mozambique
| | - Miguel Lanaspa
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique; Barcelona Institute for Global Health, Barcelona Centre for International Health Research, Hospital Clínic Universitat de Barcelona, Barcelona, Spain; Instituto Nacional de Saúde, Ministry of Health, Maputo, Mozambique
| | - Antonio Sitoe
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique; Barcelona Institute for Global Health, Barcelona Centre for International Health Research, Hospital Clínic Universitat de Barcelona, Barcelona, Spain; Instituto Nacional de Saúde, Ministry of Health, Maputo, Mozambique
| | - Sónia Amós Maculuve
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique; Barcelona Institute for Global Health, Barcelona Centre for International Health Research, Hospital Clínic Universitat de Barcelona, Barcelona, Spain; Instituto Nacional de Saúde, Ministry of Health, Maputo, Mozambique
| | - Helio Mucavele
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique; Barcelona Institute for Global Health, Barcelona Centre for International Health Research, Hospital Clínic Universitat de Barcelona, Barcelona, Spain; Instituto Nacional de Saúde, Ministry of Health, Maputo, Mozambique
| | - Llorenç Quintó
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique; Barcelona Institute for Global Health, Barcelona Centre for International Health Research, Hospital Clínic Universitat de Barcelona, Barcelona, Spain; Instituto Nacional de Saúde, Ministry of Health, Maputo, Mozambique
| | - Betuel Sigaúque
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique; Barcelona Institute for Global Health, Barcelona Centre for International Health Research, Hospital Clínic Universitat de Barcelona, Barcelona, Spain; Instituto Nacional de Saúde, Ministry of Health, Maputo, Mozambique
| | - Quique Bassat
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique; Barcelona Institute for Global Health, Barcelona Centre for International Health Research, Hospital Clínic Universitat de Barcelona, Barcelona, Spain; Instituto Nacional de Saúde, Ministry of Health, Maputo, Mozambique
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13
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Abnormal blood glucose as a prognostic factor for adverse clinical outcome in children admitted to the paediatric emergency unit at komfo anokye teaching hospital, kumasi, ghana. Int J Pediatr 2014; 2014:149070. [PMID: 25614747 PMCID: PMC4295610 DOI: 10.1155/2014/149070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Revised: 11/17/2014] [Accepted: 12/11/2014] [Indexed: 11/17/2022] Open
Abstract
Dysglycaemia (hyper- or hypoglycaemia) in critically ill children has been associated with poor outcome. We compared the clinical outcomes in children admitted to Pediatric Emergency Unit (PEU) at Komfo Anokye Teaching Hospital (KATH) for acute medical conditions and presenting with euglycaemia or dysglycaemia. This is a prospective case matching cohort study. Eight hundred subjects aged between 3 and 144 months were screened out of whom 430 (215 with euglycaemia and 215 with dysglycaemia) were enrolled. The median age was 24 months (range: 3-144 months). In the dysglycaemia group, 28 (13%) subjects had hypoglycemia and 187 (87%) had hyperglycemia. Overall, there were 128 complications in 116 subjects. The number of subjects with complications was significantly higher in dysglycaemia group (n = 99, 46%) compared to euglycaemia group (n = 17, 8%) (P < 0.001). Forty subjects died out of whom 30 had dysglycaemia (P = 0.001). Subjects with dysglycaemia were 3 times (95% CI: 1.5-6.0) more likely to die and 4.8 times (95% CI: 3.1-7.5) more likely to develop complications (P = 0.001). Dysglycaemia is associated with increased morbidity and mortality in children with acute medical conditions and should lead to intensive management of the underlying condition.
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14
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Madrid L, Lanaspa M, Maculuve SA, Bassat Q. Malaria-associated hypoglycaemia in children. Expert Rev Anti Infect Ther 2014; 13:267-77. [DOI: 10.1586/14787210.2015.995632] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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15
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Barennes H, Pussard E. Improving the management of dysglycemia in children in the developing world. Am J Trop Med Hyg 2014; 92:6-8. [PMID: 25311692 DOI: 10.4269/ajtmh.14-0212] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Improving the availability of point-of-care (POC) diagnostics for glucose is crucial in resource-constrained settings (RCS). Both hypo and hyperglycemia have an appreciable frequency in the tropics and have been associated with increased risk of deaths in pediatrics units. However, causes of dysglycemia, including hyperglycemia, are numerous and insufficiently documented in RCS. Effective glycemic control with glucose infusion and/or intensive insulin therapy can improve clinical outcomes in western settings. A non-invasive way for insulin administration is not yet available for hyperglycemia. We documented a few causes and developed simple POC treatment of hypoglycemia in RCS. We showed the efficacy of sublingual sugar in two clinical trials. Dextrose gel has been recently tested for neonate mortality. This represents an interesting alternative that should be compared with sublingual sugar in RCS. New studies had to be done to document dysglycemia mechanism, frequency and morbid-mortality, and safe POC treatment in the tropics.
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Affiliation(s)
- Hubert Barennes
- INSERM, ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, F-33000 Bordeaux, France; Agence Nationale de Recherche sur le VIH et Hépatite, ANRS Phnom Penh, Cambodia; Epidemiology Unit, Pasteur Institute, Phnom Penh, Cambodia; Génétique Moléculaire, Pharmacogénétique et Hormonologie CHU Bicêtre, Kremlin Bicêtre, Paris, France
| | - Eric Pussard
- INSERM, ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, F-33000 Bordeaux, France; Agence Nationale de Recherche sur le VIH et Hépatite, ANRS Phnom Penh, Cambodia; Epidemiology Unit, Pasteur Institute, Phnom Penh, Cambodia; Génétique Moléculaire, Pharmacogénétique et Hormonologie CHU Bicêtre, Kremlin Bicêtre, Paris, France
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