Clinical Pediatrics最新文献

The incidence of anemia increases with the stage of chronic kidney disease (CKD). Erythropoietin (EPO) deficiency is a common cause of anemia in CKD. Erythropoietin-stimulating agents (ESAs) are the mainstay of the treatment. Treatment can be challenging due to erythropoietin resistance (ER), which can be assessed using the erythropoietin resistance index (ERI). Our aim was to investigate the factors contributing to high ERI levels in children receiving renal replacement therapy (RRT). Thirty-three children receiving RRT for at least 3 months were included. The mean ERI value was 15.7 IU/kg/w/g/dL. A significant association was observed between serum phosphorus levels and ERI (P = .016, r = 0.41). The mean parathormone (PTH) level was also higher in the high ERI group (599 ± 351 vs 392 ± 320 pg/mL, P = .088). An association, approaching statistical significance, was found between ERI and hypertension (P = .06, r = 0.32). Our study indicated a potential relationship between hyperphosphatemia, possibly secondary hyperparathyroidism, and ERI in children undergoing RRT.

Previous studies have identified negative impacts of the COVID-19 pandemic on the mental and physical health of children in the United States, including exacerbation of previously existing disparities according to income, race, and ethnicity. However, a knowledge gap exists regarding the experience of minority families who were disproportionately affected by the pandemic. This qualitative study explores publicly insured Hispanic families' experiences with school, physical, and sedentary activities and overall health and well-being during the pandemic and subsequent lifting of stay-at-home orders. Fourteen (7 Spanish-speaking, 7 English-speaking) caregivers participated in semi-structured, language-concordant telephone interviews. Through an iterative coding process, this study identified 3 thematic categories: (1) challenges with virtual learning, (2) changes in children's activity, and (3) resilience and silver linings. Minority populations suffered substantial morbidity and mortality in the United States, and so their experiences are critical as we document the significant impacts of the global pandemic on underserved populations.

Background: Malnutrition is a critical clinical condition that requires early intervention due to its potential for causing preventable fatalities and complications. This study aims to assess the impact of outpatient enteral nutrition support (ENS) as a therapeutic intervention on anthropometric measurements, intolerance, and micronutrient values in malnourished children.

Methods: This observational study included 344 patients in ages 1 to 18 treated with standard enteral nutrition (1.5 kcal/mL energy with fiber). Patient data recorded at admission, in 3 and 6 months, including weight, height, body mass index (BMI), intolerance symptoms, and micronutrient levels. Data were also compared by age groups (1-2, 3-5, 6-12, and 13-18 years of age).

Results: Malnutrition was prevalent in the 1- to 5-year age group (63.6%). Age-based analysis showed significant height and BMI z-score improvement in all age groups (P = .009 and P < .001, for all age groups, respectively), except the 13- to 18-year age group (P = .102 and P = .091, respectively). Micronutrient values remained within healthy ranges with minimal fluctuations. The ENS was well tolerated by 62.5% of patients, and the most common intolerance symptoms were constipation (15.4%), vomiting (8.1%), and nausea (7.3%).

Conclusion: This study demonstrates that outpatient ENS therapy for 6 months significantly improved anthropometric measurements in malnourished children and was well tolerated. The 1 to 2 age group exhibited the most substantial response to treatment, whereas the 1 to 5 age group required at least 6 months of nutritional therapy to prevent stunting. However, the effect of ENS therapy on height and BMI z-scores in the 13 to 18 age group appeared insufficient after 3 months.

Objectives: Medication errors are one of the main causes of avoidable injuries in health care. With the aim of reducing them, a set of sheets with precalculated doses (by weight intervals) and preparation guidelines of the most common drugs in emergencies (Farmacards) was implemented in a Pediatric Emergency Department, replacing the previous manual calculation system. The aim of the study is to assess the staff's perception of safety and usefulness of the new dosing system.

Study design: Pre-post intervention comparative analysis was performed by distributing an opinion questionnaire to pediatric emergency department staff in 2017 (manual calculation in situ) and 2023 (Farmacards). We obtained 60 and 55 responses, respectively, and analyzed the characteristics of the sample and the perception of the new method.

Results: Five years after its introduction, 88.5% were aware of its existence, 86.9% knew where to find it, and 76% used it "always or almost always" for critically ill patients. Greater use was observed among personnel with more years of work experience (Spearman, P = .057) and among nurses (Mann-Whitney, P < .001). The new method improved the level of perceived safety, especially for nurses (Mann-Whitney, P = .008).

Conclusions: Standardized medication dosing systems in emergency situations aim to reduce medical errors and minimize iatrogenesis, participating in safety culture. According to the results of our study, the implementation of Farmacards shows a good acceptance by the staff and in the perception of patient safety, which is a good starting point to further optimize the quality of care. specialties: emergency medicine, general pediatrics, toxicology, and critical care.

Enterovirus (EV) and parechovirus (HPeV) are common viruses in the neonatal period, with similar seasonality and symptomatology. They also are the main causes of aseptic meningitis in newborns and children under 1 year of age. We compared the clinical signs, laboratory data, brain, and neurodevelopmental outcome of 10 infants with HPeV and 8 with EV meningitis. In patients with EV meningitis, serum C-reactive protein (CRP) values were significantly higher than those of patients with HPeV infection. Procalcitonin values were low in both groups. White blood cell (WBC) and lymphocyte values were significantly higher in EV patients. None of the infants had a brain lesion on cerebral ultrasound neither negative neurological outcome. Based solely on symptoms, it is not possible to distinguish HPeV from EV infection. C-reactive protein, WBC, and lymphocyte values might allow the physician to assume EV infection. The gold standard test for diagnosis remains real-time polymerase chain reaction on cerebral spinal fluid.

We describe the gap between parents' special education needs and pediatric primary care providers' (PCPs) ability to address those needs from a mixed-methods study at a safety-net hospital. We conducted qualitative interviews with English- and Spanish-speaking parents (n = 25) and PCPs (n = 11) about special education knowledge and experience and interactions with a primary care-embedded special education clinic. PCPs also answered survey questions on these topics. Parents reported four challenges: (1) knowing where to start and how to advocate for their youth, (2) being heard or having a say, (3) using the "right" language, and (4) gathering information on special education resources. Primary care providers disclosed three barriers: (1) training, (2) knowledge to assess the appropriateness of supports, and (3) time to address concerns. The gap between PCPs and parents was bridged by the special education clinic. Systematic interventions can ensure that PCPs help parents address the special education needs of their patients.