Tạp chí Nhi khoa

NEW TREND IN PREVENTION, DIAGNOSIS, TREATMENT AND MANAGEMENT OF ALLERGIC DISEASES

Le Thi Minh Huong — 2025-05-19

Currently, it is lack of proactive in clinical practice, patients come to seek medical attention only when they have symptoms, leading to late diagnosis or the disease may progress seriously which affects their health and quality of life.

New approaches in Allergy today include primary prevention: individual genetic research, prenatal and newborn screening to detect diseases before they develop. The scientific evidence for preventing allergic diseases has been proved, such as new intervention strategies on genetics and epigenetic such as environment, diet, gut microbiota, and build up oral tolerance. Thanks to many new molecular techniques in genetics, biochemistry, hematology, molecular immunology, immunofluorescence and imaging diagnosis, allergic diseases determination has been improved.

Regarding allergic diseases treatment, in addition to symptomatic treatment and general immunosuppression, new approaches have also been used which can be mentioned as specific immunotherapy, desensitization to specific respiratory allergens, tolerance induction in treatment of food allergies, and targeted therapy with biological products.

Integrated Practice Units (IPU), a comprehensive management of allergic disease according to a patient-centered model, is a tendency of centers of excellence around the world. Furthermore, the increasing ability to connect patients with doctors and the healthcare system through information technology applications will improve the quality of life for patients as well as reduce the burden on family and society.

THE ETIOLOGY OF MICROBIOLOGY CAUSING BACTERIAL MENINGITIS IN NEWBORNS AT THE NATIONAL CHILDREN’S HOSPITAL

Nguyen Thi Hang — 2025-05-19

Objectives: Describing the microbial etiology of bacterial meningitis in infants treated at the National Children’s Hospital. Subjects and methods: A retrospective descriptive study on 42 medical records of newborns diagnosed and treated for bacterial meningitis at the Neonatal Center of the National Children’s Hospital from February 2019 - January 2023.

Results: GBS strain accounted for the highest proportion (73.4%), followed by E. coli (13.3%). The antibiotics Aztreonma, Imipenem, Meropenem, Amikacin, Cefotaxime, Moxifloxacin, Vancomycin, Ertapenem, Cefepime were also 100% sensitive to the bacteria tested. Resistance to Clindamycin, Erythromycine, Amoxicillin + Clavulanic Acid, Cefuroxime Aceti was resistant at a very high rate (100.0%). Resistance to the antibiotic Cefazolin appeared at a rate of 50.0%. Gentamycine resistance rate was 40.0%. Piperacillin + Tazobactam, Cefoxitin and Ciprofloxacin were all resistant at a rate of 33.3%.

Conclusion: Common bacterial strains causing meningitis were GBS (73.4%), E. coli (13.3%). The antibiotics Aztreonma, Imipenem, Meropenem, Amikacin, Cefotaxime, Moxifloxacin, Vancomycin, Ertapenem, Cefepime were also sensitive to bacteria causing meningitis in newborns.

PREVALENCE OF CONGENITAL HEART DISEASE IN CHILDREN UNDER 6 YEARS OF AGE IN LAO CAI

Cao Viet Tung — 2025-05-19

Objectives: To assess the prevalence of congenital heart disease in children under 6 years of age in Lao Cai.

Methodology: A cross-sectional descriptive study was conducted on 1,087 children who underwent screening echocardiography at Lao Cai Obstetrics and Pediatrics Hospital and 8 district general hospitals in Lao Cai. Demographic information, risk factors, and heart conditions were recorded and analyzed.

Results: A total of 69 children were diagnosed with congenital heart disease (6.3%), with the most common risk factor being preterm birth.

Conclusion: More research is needed to fully capture the prevalence of congenital heart disease in Lao Cai.

THE ROLE OF INTERVENTIONAL BRONCHOSCOPY AND STENT PLACEMENT IN THE MANAGEMENT OF TRACHEOBRONCHIAL STENOSIS

Vu Khac Dai — 2025-05-19

Tracheobronchial stenosis, a serious problem in adults and children, has multiple causes and has been treated in many ways. Tracheal strictures are diagnosed by performing a thorough evaluation involving clinical exam, laboratory workup, pulmonary function test, chest imaging and bronchoscopy. Bronchoscopy plays a pivotal role in the diagnosis of stenosis. Surgery is considered to be the primary treatment for benign airway stenosis. Interventional bronchoscopy including mechanical or laser assisted dilation, electrosurgery, airway stenting have been reported in the literature for management of patients who are not surgical candidates.

APPLICATION OF PEDIATRIC FLEXIBLE BRONCHOSCOPY IN DIAGNOSIS AND TREATMENT OF RESPIRATORY DISEASES IN VIET NAM NATIONAL CHILDREN’S HOSPITAL

Nguyen Thi Thu Nga — 2025-05-19

Objective: Analyze diagnoses and indications before bronchoscopy, evaluate results after flexible bronchoscopy (FB)

Methods: Descriptive study of 1643 cases of FB over a period of 2 years from January 1, 2022 to December 30, 2023 at the Pediatric Respiratory Diseases Central of Viet Nam National Children’s Hospital

Results: 1643 cases of children from 1 month to 16 years old were performed flexible endoscopy with 1296 cases for diagnostic purposes (78.9%) and 347 cases (21.1%) for interventional bronchoscopy. The main reasons for FB were abnormal airway (tracheal stenosis, wheezing, prolonged stridor) (30.3%), persistent and recurrent pneumonia (27.4%), and suspected foreign body in airway (11.6%). Results: airway abnormalities (51.9%), including: subglottic stenosis/ tracheobronchial stenosis due to scarring (30.4%), malacia laryngeal cartilage (19.5%), malacia bronchial (13.2%). Most common interventional procedures: stenotic scar dilation (142 cases), airway foreign body removal (98 cases). Bacteria isolated in bronchoalveolar lavage: Pseudomonas aeruginosa 21.5%, Klebsiella pneumonia 16.9%, Klebsiella aerogenes 15.4%, Streptococcus pneumonia 10.0% of total cultured specimens.

Conclusion: FB is an important tool in the diagnosis and treatment of respiratory diseases, finding airway anatomical abnormalities, taking specimens for microbiological causes, and providing interventional treatment to resolve obstruction airway.

CLINICAL, SUBCLINICAL FEATURES AND RESULTS OF TREATMENT OF CYTOMEGALOVIRUS HEPATITIS IN CHILDREN

Ho Thi Lan — 2025-05-19

Objective: To describe the clinical and subclinical characteristics of hepatitis in children due to viral cytomegalo-infection and to comment on the results of treatment of hepatitis in children due to viral cytomegalo-infection at the National Children’s Hospital.

Research object and method: Retrospective - prospective study,describing 89 pediatric patients 1-12 months diagnosed with Cytomegalovirus hepatitis and treated at the National Children’s Hospital during the period from 01/01/2020 - 30/06/2022.

Result: 89 patients with CMV hepatitis were followed for 6 months with the following rates: The average age of patients was 2.17 ± 1,596 months, and the ratio of males to females (2.5 : 1), jaundice 86.5%, hepatomegaly 64.0%, feces of silver color 52.8%, dark urine 44.9%, subcutaneous hemorrhage 4.5%. Most transaminases increase slightly and rarely exceed 400U/L. Direct billirubin increased by 91.2%. 66/89 are eligible for antiviral therapy with ganciclovir/ Valganciclovir. Improvement in liver damage was 90.9% and nocomplications accounted for 90.9%.

Conclusion: Most patients have good results after treatment. However, it is necessary to detect and treat in time to limit the severe damage caused by CMV.

EVALUATION OF THE RESULTS OF THE CONGENITAL HEART SCREENING TRAINING PROGRAM AT LAO CAI PROVINCE HOSPITALS

Le Thi Phuong — 2025-05-19

Objective: Describe the current situation of medical capacity to diagnose and treat children with congenital heart disease in Lao Cai in the period 2022-2023, including infrastructure, human resources and pharmaceutical warehouses product.

Research subjects and methods: During the period from November 2023 to January 2025, a prospective study was conducted at the Obstetrics and Pediatrics Hospital of Lao Cai province and 8 district hospitals of Lao Cai province, with 97 doctors, nurses and midwives participated in the study.

Result: For the screening class, in terms of professional qualifications, there are 77 doctors (accounting for 79.4%), 13 nurses (accounting for 13.4%), and 7 midwives (accounting for 7.2%). For the ultrasound class, there are 20 medical doctors participating in the Pediatric Echocardiography training class, 3 doctors from the provincial level (accounting for 15%) and 17 doctors from the district level (accounting for 85%). The average age of doctors participating in the training class is 30.8 ± 3.9 years old, the lowest age is 27 years old, the highest age is 37 years old. The average theoretical score in the group of provincial doctors increased from 6.0±1.95 points to 8.8±0.87 points after training, (p<0.001). The average score of the group of district doctors increased from 5.7±0.79 points to 8.0±0.82 points (p<0.001). The average theoretical score of the nursing group at the district level increased from 5.2±0.69 points to 7.5±0.66 points (p<0.001). The midwifery group at the district level had an average theoretical score increase from 5.1±0.69 points to 7.0±1.0 points (p<0.001).

Conclusion: Medical staff at the provincial and district levels in Lao Cai have limitations in the field of congenital heart disease, and these limitations are partly enhanced thanks to a theoretical training program combined with practice and supervision closely after the study.

CONSENSUS OF VIETNAM PEDIATRIC ASSOCIATION: GUIDELINES FOR NUTRITIONAL SCREENING, ASSESSMENT AND INTERVENTION FOR PEDIATRIC PATIENTS

Dinh Anh Tuan — 2025-05-19

Nutritional status plays an important role in diagnosing and treating nutritional risks or malnutrition and supporting other treatments. Therefore, screening and correct assessment of nutritional status is necessary for early detection and timely intervention for children in the hospital. According to regulations, for inpatients, it is mandatory to classify and determine nutritional risks within 36 hours of admission and prescribe nutritional regimen. For outpatients, all patients need to be screened for nutritional risk factors. Previously, a very large proportion of children were not screened and assessed for nutritional status upon admission, leading to failure to receive timely nutritional interventions. Currently, hospitals have implemented nutritional screening and assessment for children using forms developed by he hospital itself or referenced from other organizations. However, in general, the new forms only focus on inpatients and there is no form for outpatients. Moreover, stunting malnutrition has not received due attention even though the rate of stunted children is still high.

Therefore, there is a need for a unified set of tools in pediatrics to screen, assess and intervene in nutrition for children. The Vietnam Pediatric Association organized an expert workshop on the topic “Nutrition to improve height of Vietnamese children - Timely diagnosis and ntervention of malnutrition” with the participation of Professors, Doctors, and Physicians who are leading experts in nutrition and pediatrics.

Through this workshop, the experts compiled the document “Consensus: GUIDELINES FOR NUTRITIONAL SCREENING, ASSESSMENT AND INTERVENTION FOR PEDIATRIC PATIENTS”. The content of the guideline aims to provide a sample form for risk screening, nutritional status assessment and intervention flowchart For pediatric Inpatients and outpatients in accordance with the policy of the Circular 18/2020/TT-BYT regulating nutrition activities in hospitals and the Hospital Quality Criteria to help medical staff in the pediatric system quickly detect nutritional problems and provide appropriate interventions for pediatric patients as well as accurately report results to the professional system.

CONSENSUS OF VIETNAM PEDIATRIC ASSOCIATION DENGUE HEMORRHAGIC FEVER BURDEN AND PREVENTION RECOMMENDATIONS FOR CHILDREN IN VIETNAM

Tran Minh Dien — 2025-05-19

Dengue hemorrhagic fever (DHF) is an infectious disease caused by the dengue virus. There are 4 serotypes of the dengue virus: DENV-1, DENV-2, DENV-3 and DENV-4. The virus is transmitted from infected people to healthy people by mosquito bites. The Aedes aegypti mosquito is the main vector. In Vietnam, Dengue hemorrhagic fever is a year-round epidemic in many provinces and localities, causing a burden of disease and economic pressure on individuals, families and the health-social system.

Although Vietnam is doing very well in controlling the DHF epidemic with a prevention system and treatment regimen that has been regularly updated in each stage. However, it still requires sustainable prevention measures, which is also a challenge and urgent requirement today.

Based on this urgent need, the Vietnam Pediatric Association organized an expert workshop on the topic “Burden of Dengue Fever and Prevention Recommendations for Children in Vietnam” with the participation of Professors, Doctors, and Physicians who are leading experts in many fields such as Pediatrics, Infectious Diseases, Preventive Medicine. Through this workshop, the Vietnam Pediatric Association has developed a “Consensus: Burden of Dengue Fever and Prevention Recommendations for Children in Vietnam”.

The consensus content includes information in the reports of the reporters, reference documents, current policies, especially in-depth discussions by experts on the current situation of Dengue hemorrhagic fever in Vietnamese children. The consensus summarizes the epidemiological, clinical characteristics and current burden of Dengue hemorrhagic fever and updates effective preventive measures to help medical staff in the pediatric system to refer to and provide appropriate advice to people to effectively prevent Dengue hemorrhagic fever. The Vietnam Pediatric Association would like to express our sincere thanks to the experts, editorial board, and conference organizers who participated in and contributed to this consensus.

DIAGNOSIS OF ASTHMA IN INFANTS

Tran Minh Dien — 2025-05-19

I. INFANTILE ASTHMA - DIFFICULTIES AND INADEQUACIES IN DIAGNOSIS
The concept of asthma in infants (children under 24 months of age) began to appear in the late 1970s and early 1980s. However, there is currently no worldwide consensus on the definition and diagnostic criteria for asthma in infants.

In fact, the diagnosis of asthma in infants has some major difficulties as follows:

- Spirometry and other alternative respiratory function tests cannot be performed or are not specific enough for diagnosing asthma in infants.
- There are no specific inflammatory markers for asthma in this age group.
- Many children under 2 years of age only wheeze transiently, especially when infected with respiratory viruses, and about 60% are asymptomatic by the age of 6 years.

Due to the above difficulties and the lack of a “gold standard” for diagnosing asthma in this age group, the European Respiratory Society (ERS) has so far recommended avoiding the diagnosis of “asthma” in children under 6 years of age (but only using the term “wheezing”).

However, most treatment guidelines in the world believe that there is no lower age limit for diagnosing asthma, even in children under 2-3 years of age (“infants”).