Clinical Pediatrics最新文献

We reviewed electronic health record documentation of outpatient and emergency department (ED) visits with a positive pregnancy test from January 1, 2014, to June 1, 2021, within a tertiary-care pediatric system for documentation of pregnancy options counseling. We excluded encounters where patients were admitted or referred/transferred to another ED, or nurse-only visits. Of 88 eligible encounters, 51/88 (58%) occurred in the ED and 37/88 (42%) in outpatient clinic. Options counseling was documented in 20 encounters (23%), including 6/51 (12%) of ED visits and 14/37 (38%) of clinic visits. By logistic regression adjusting for age, race, insurance type, and prior positive pregnancy test, options counseling documentation was significantly more likely for outpatient clinic visits than the ED (aOR = 4.80, 95% CI = 1.52-15.18, P = .008). Rates of documentation of options counseling in pediatric settings are low and are lower for ED than outpatient visits, suggesting low rates of options counseling in pediatric practice.

This study assesses the diaper choices, diapering practices, and irritant diaper dermatitis (IDD) prevention strategies in Turkey and compares them to the practices worldwide. A Computer-Assisted Web Interview was conducted with 306 mothers, nursing their infants between 0 and 3 years. The average daily diaper usage was 6.3, with a higher utilization during daytime. Concerningly, 44.4% of infants exhibited skin issues. In total, 63.7% of parents observed the occurrence of IDD during the first month, with 39.9% indicating its continued presence afterwards. The IDD predominantly affected the buttocks and genitalia. Many parents sought medical advice for IDD. Regarding interventions, 56.9% of parents believed that anti-rash products were effective. The primary reason for brand preference was the presence of an elastic waistband. Parents were willing to adopt a novel anti-rash diaper. The research underscored the widespread occurrence of IDD, emphasizing the susceptibility of young infants. Diapering practices and preventive measures varied across various countries.

The aim was to investigate the effect of adding virtual reality (VR) training to an individualized exercise therapy program in children with hemiparetic cerebral palsy (CP). Thirty-one children with hemiparetic CP were randomly allocated into 2 groups as experimental (n = 16) and control (n = 15). Experimental group received additional VR twice a week for 12 weeks. Gross motor function (Gross Motor Function Measure-66), balance (one leg standing), and functional mobility (timed up and go test) were evaluated. All parameters were improved in the experimental group (P < .05). In the control group, all parameters other than timed up and go test, and eyes closed one leg standing improved (P < .05). When the changes in the groups were compared, greater improvements were detected in the experimental group (P < .05). Adding VR training to the individualized exercise therapy program may have potential additional benefits for improving gross motor function, balance, and functional mobility in children with hemiparetic CP.

The adolescent mental health crisis is compounded by a shortage of mental health services, which mobile health apps may alleviate. We assessed the feasibility and acceptability of the Wysa app (a commercially available app containing cognitive behavioral therapy-based digital modules and an artificial intelligence-based conversational agent) among 13- to 18-year-old adolescents recruited from a primary care clinic in New York City and online from March to June 2022. We assessed adolescent engagement in the Wysa app over a 3-week period. Out of 44 participants, app uptake was 77.3% (34/44). Among those who used the app, participants used the app a median of 9 times (IQR: 5-19). Over 3-quarters (n = 25) of participants who used the app would recommend the app to others, and 60.6% rated the app 4-5 stars (5 stars maximum rating). Pediatricians may find it a useful tool to recommend in their clinical practice to support adolescent mental health.

Electronic cigarettes (e-cigarettes) are the most used tobacco product among US adolescents. Information about the prevalence of use in a pediatric primary care population has been limited. Youth aged 12 to 17 attending a well-child visit completed screening for past year e-cigarette, cigarette, cannabis, and alcohol use, as well as depression and anxiety symptoms. We examined e-cigarette-use prevalence, frequency, and relationship to demographics, mental health symptoms, and other substance use. Among 9740 patients, 8.2% reported past-year e-cigarette use. Males (7.2%) were less likely than females (9.2%) to use e-cigarettes, while more frequent use was associated with more frequent cannabis, alcohol, and cigarette use, as well as elevated depression and anxiety symptoms. Sex differences support a recent trend toward young females using e-cigarettes at higher rates than males. Polysubstance use was common, highlighting the importance of regular screening for all substances and feasible interventions for this setting.

To compare the safety and efficacy of propofol monotherapy and midazolam combined with propofol for sedation in pediatric diagnostic gastroscopy, providing evidence for optimizing clinical sedation protocols. A retrospective analysis was conducted on 162 children aged 3 to 14 years who underwent gastroscopy at our Digestive Endoscopy Center between January 2022 and June 2024. Based on the sedation regimen used, patients were categorized into 2 groups: the propofol group (n = 78, sedated with propofol alone) and the combination group (n = 84, sedated with midazolam and propofol). Baseline characteristics, sedation efficacy, recovery parameters, intra-procedural vital signs, incidence of adverse reactions, use of sedative drugs, and procedure-related times were compared between the 2 groups. Propofol monotherapy offers rapid recovery, less impact on vital signs, and improved turnover efficiency, making it a potentially more suitable sedation strategy for pediatric diagnostic gastroscopy in clinical practice.

We developed a social needs intervention (the PHASE program) in a Midwestern, low-income, pediatric clinic to screen for financial needs, food insecurity, housing insecurity, and other needs and connect families to clinic and community-based social resources. We measured the impact of our intervention on adherence with recommended childhood immunizations. While PHASE-enrolled patients were overdue on 34% more vaccines at the time of enrollment, by the second year their vaccine status had improved to the point that the intervention and comparison groups were indistinguishable. Most notably, at 18 months, PHASE patients were overdue for 0.15 less vaccines than at the time of enrollment, while at the same time, non-participants were overdue for 0.32 more vaccines than at the time of enrollment-a statistically significant difference of 0.47 less overdue vaccines. This suggests that families that are connected with short and long-term resources can have an improvement in immunization adherence.

Background: Limited data are available on the relationship between seasonal factors and obstructive sleep apnea-hypopnea syndrome (OSAHS) in China. The aim of this study was to investigate the effects of seasonal factors on the severity of OSAHS in children.

Methods: Children 2.0 to 16 years old presenting with snoring and/or mouth breathing, suspected of having OSAHS, and admitted to the Department of Respiratory Medicine of Children's Hospital of Soochow University from December 2016 to February 2022 were enrolled in this study. The severity of OSAHS was determined by full-night polysomnography (PSG) in the sleep laboratory. The correlation between seasonal factors and PSG monitoring results was analyzed.

Results: Of the 589 included patients, 301 cases (51.1%) were diagnosed with OSAHS. In the OSAHS group, 77 cases (25.6%) were detected in spring, 74 cases (24.6%) were detected in summer, 59 cases (19.6%) were detected in autumn, and 91 cases (30.2%) were detected in winter. There were 238 cases (79.1%) of tonsillitis hypertrophy, 276 cases (91.7%) of adenoid hypertrophy, 215 cases (71.4%) of rhinitis/sinusitis, and 36 cases (12.0%) of asthma. The proportion of rhinitis/sinusitis and tonsillar hypertrophy in spring was higher than that in summer (P = .015 and P = .036, respectively), and the proportion of adenoid hypertrophy in winter was higher than that in summer (P = .024). The diagnostic rate of severe OSAHS in winter was higher than that in summer (χ² = 7.053, P = .008). The respiratory arousal index in winter was higher than that in summer (H = -39.297, P = .018), and the spontaneous arousal index in spring was higher than that in autumn (H = 44.059, P = .020). It was found that the rapid eye movement (REM)-apnea index (AI) in spring and winter was higher than that in summer (H = 52.292, -52.554; all P < .05). The comparison of PSG results of children with OSAHS ≤6 years old in different seasons showed that REM-AI in winter was higher than that in summer (H = 8.570, P < .05).

Conclusion: Severe OSAHS is more common in winter. Respiratory events are increased in spring and winter, mainly in children ≤6 years old. Seasonal factors may have a certain impact on OSAHS.