Clinical Pediatrics最新文献

Long COVID affects a significant number of children, yet clinician knowledge gaps and limited access to specialized care hinder effective management. With fewer than 20 pediatric long COVID clinics in the United States, many families must travel long distances for care. To address these challenges, a pediatric long COVID ECHO (Extension for Community Healthcare Outcomes) program was developed to educate health care professionals on evidence-based care. The program engaged 94 participants from the United States and Canada via weekly tele-education sessions, recruited through word of mouth and professional listservs. Pre-surveys (41% response rate) and post-surveys (29% response rate) were sent to attendees. Participants reported statistically significant improvements in knowledge, confidence, competence, and self-efficacy (P < 0.001). This program represents a valuable initiative to facilitate timely interventions and empower primary care and community providers in diagnosing, treating, and managing long COVID in pediatric populations.

Objective: This study was aimed to analyze 10 pediatric cases of pigmented villonodular synovitis (PVNS) of the knee to elucidate their clinical features, diagnosis, treatments, and prognosis for providing reference regarding its clinical management in children.

Methods: A retrospective analysis was made pertaining to the clinical manifestations, magnetic resonance imaging (MRI) findings, pathology, immunohistochemical results, treatment methods, and follow-up outcomes of 10 pediatric PVNS patients of the knee treated from January 2022 to January 2024 at our hospital. They were compared and analyzed with existing literature.

Results: (1) All 10 patients had joint swelling with restricted movement, mainly in older female children with male-to-female ratio of 3:7 and average age of 14.1 ± 3.6 years; (2) diagnostic positive rate of MRI was 80%; (3) significant features of PVNS were the appearance of villous and nodular hyperplasia on synovial surface and deposition of brownish-yellow granular hemosiderin. Immunohistochemical staining results were clusterin (synovial cells+), D2-40 (synovial cells+), CD163 (histiocytes+), KP-1 (histiocytes+), CD31 (vascular+), P63 (-), and Ki67 (+, 1%-10%); and (4) all patients underwent arthroscopic surgery with 20% recurrence rate.

Conclusion: Pediatric knee PVNS is more prevalent in older female children. The PVNS diagnosis is carried out by MRI, pathology, and immunohistochemistry. Arthroscopic surgery is effective for treating this condition in children.

We performed a quality improvement project (31 clinics; July 2021 to October 2023) to increase human papillomavirus vaccination initiation frequency and decrease gender disparity in children aged 9 and 10 years. The 11 process changes included electronic health record clinical decision support (CDS) tools for providers, staff, and parents and medical assistant participation. In phase 1 (preparation), initiation frequency was lower in boys (250 of 1688 visits, 15%) than girls (289 of 1549 visits, 19%; P = .003). In phase 2 (CDS alerts; recommended initiation age lowered from 11 to 9 years), initiation frequency was increased and similar between boys (906 of 1847 visits, 49%) and girls (867 of 1740 visits, 50%; P = .64). In phase 3 (patient portal outreach), initiation frequency was increased further for boys and girls. The multifaceted intervention, including CDS tools and lowering the initiation age, was associated with increased initiation frequency and decreased gender disparity.

Mixed presentation of diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) has been reported in up to 27% of hyperglycemic emergencies. This 15-year retrospective chart review describes clinical features, risk factors, and outcomes among children presenting with hyperglycemic emergencies at our center. Out of 322 patients, 92% were Afro-Caribbean or Black with a mean age of 13.6 years, comprising 266 (83%) with DKA, 52 (16%) mixed DKA-HHS, and rarely with HHS (1%, n = 4). Most (98%) of DKA and DKA-HHS groups had type 1 diabetes mellitus (T1DM). All 4 patients with HHS had type 2 diabetes mellitus (T2DM). Compared with the DKA group, the mixed DKA-HHS group had higher IV fluid rates (P < .0001), 4.3-fold greater odds of acute kidney injury (AKI), and 3.3-fold greater odds of altered mental status (AMS). In the HHS group, 50% presented had AMS and AKI and required higher IV fluids rates (≥2× maintenance). Clinicians should recognize mixed cases of DKA-HHS to minimize complications.

The aim of our study was to identify burnout profiles among pediatric nurses and physicians, and their specificities concerning sociodemographic characteristics, occupational stress, stress specific to pediatric caregivers, and coping. Conducted on a sample of 195 French pediatric health care professionals, a cluster analysis showed 2 endpoint profiles (Engagement, Burnout) and 3 intermediate profiles (Overextended, Disengaged, Ineffective). The Burnout profile showed the highest median scores on hours worked per week, occupational stress, stress related to working conditions, and relationships with colleagues and superiors. The Overextended profile reported more stress related to working conditions than did other intermediate profiles. The Disengaged profile showed the second lowest median score on stress related to relationships with colleagues and superiors and less social support-seeking than other profiles. The Ineffective profile used less problem-focused coping than the Engagement and intermediate profiles. Intervention for the well-being of these professionals should focus primarily on improving their working conditions.

Multisystemic inflammatory syndrome (Mis-C) has emerged in May 2020 as a serious complication of coronavirus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV2). A total of 6 children presented to tertiary care hospitals with Mis-C, of which 5 (83%) have died during hospitalization. All included patients presented with respiratory symptoms (ranged from mild to severe acute respiratory distress syndrome) and gastrointestinal symptoms. Most of the patients are known to have medical illnesses. Pediatric Risk of Mortality (PRISM) IV score ranged from 3 to 87. All patients developed acidosis and varying stages of acute kidney injury and electrolyte disturbances. All were treated for coagulopathy, thrombocytopenia, bacterial infections as well as antiviral medications (either ritonavir or lopinavir). Most patients had chest X-ray changes either unilateral or bilateral lung changes. Multisystemic inflammatory syndrome is a rare, yet serious complication of SARS-CoV2 infection in children. Multisystem involvement should be anticipated and promptly treated.

The aim of this study was to compare sequelae and acute kidney injury (AKI) occurrence among patients with necrotizing enterocolitis (NEC) after changing institutional guidelines replacing vancomycin with ampicillin for gram-positive coverage. This was a retrospective, single-center cohort analysis of patients from 2016-2020 (n = 73) with NEC at a surgical neonatal intensive care unit with a high community prevalence of methicillin-resistant Staphylococcus aureus (MRSA). Multivariate logistic regression was utilized to assess associations. Twenty-five (34%) patients had at least 1 sequela related to NEC. Ampicillin containing regimens were not associated with any sequelae type or AKI. Postmenstrual age < 29 weeks at diagnosis ([OR] 5.8 [1.2-28.8], P = .03; and receipt of vasopressors [OR] 3.3 [1.1-10.2], P = .04) were independently associated with sequalae. Stage III NEC was independently associated with AKI, OR 10.6 (2-55.6), P = .005. In conclusion, ampicillin-containing regimens are effective for NEC management at our institution despite a high prevalence of MRSA.

Children with special health care needs (CSHCN)-ie, children who are at increased risk for, or currently manage, persistent physical and mental health conditions-require more health care resources than children without special health care needs. Furthermore, CSHCN who identify as racial/ethnic minorities disproportionately encounter unmet needs, according to reports from their caregivers. However, the reasons for their unmet needs are relatively unknown. This study estimated and compared the US national prevalence of caregiver-reported reasons for unmet health care needs for Hispanic, non-Hispanic black, and non-Hispanic white CSHCN. The most common reasons were problems getting an appointment for black CSHCN and cost for Hispanic and white CSHCN. Issues related to transportation were significantly less likely for black than for white and Hispanic CSHCN. Cost-related issues were significantly less likely for black than Hispanic CSHCN. To address reasons for unmet needs for CSHCN, effective structural changes are needed.