Clinical Pediatrics最新文献

Immune thrombocytopenic purpura (ITP) is an acquired immune-mediated bleeding disorder characterized by isolated low platelet (PLT) counts. Immune thrombocytopenic purpura pathogenesis involves multiple immune mechanisms causing PLT destruction and inadequate production. Owing to impaired immune homeostasis, ITP patients can develop other than anti-PLT autoantibodies even in the absence of clinical signs of autoimmune disease, such as anti-thyroglobulin (TG) and anti-thyroperoxidase (TPO) antibodies. Our objective is to determine the prevalence of antithyroid antibodies (ATAs) in the population of pediatric ITP patients, and the differences in ATA positivity prevalence in newly diagnosed/persistent ITP, and chronic ITP patient subgroups, as well as to establish the impact of ATA positivity on the treatment outcomes. A cross-sectional observational study was conducted involving 75 pediatric patients diagnosed with ITP and 60 healthy controls, carried out over a period of 11 years. The prevalence of ATA was significantly higher in ITP patients compared with controls (28% vs 5%, P < .05). Initial PLT count was significantly lower in ATA-positive patients, but the treatment response did not differ between ATA-positive and ATA-negative patients. To conclude, our study confirmed that ITP patients have a higher prevalence of ATA compared with the healthy pediatric population; however, no association was found between ATA positivity and disease duration or treatment outcomes. Our findings suggest that ATA screening may not be prognostic for ITP in pediatric population, but further research with larger cohorts may be beneficial to elucidate the role of ATA in ITP pathogenesis and management.

Renal histologic changes in congenital ureteropelvic junction obstruction (UPJO), although well documented, are sparsely studied in children. This study aims to establish a histological grading depending on the glomerular and tubulo-interstitial changes in hydronephrotic kidneys and determine correlation with age at surgery and impact on function post-pyeloplasty. A renal cortical wedge biopsy was obtained after pyeloplasty and histological changes were graded from 1 to 4. A total of 47 viable biopsies from 57 children showed grade 1 changes in 10, grade 2 in 7, grade 3 in 27, and grade 4 in 3. Age at surgery, histological grade, and changes in differential renal function (DRF) were statistically analyzed. Younger age, near normal histology, and those with changes in 1 domain had preserved DRF pre-operatively. Renal histology and overall grade showed positive correlation with pre-operative DRF. However, no statistically significant association was noted with age at surgery or change in post-operative DRF.

Evidence shows that parents of children with chronic illnesses are mentally stressed. Thus far, developmental dysplasia of the hip (DDH) is unexplored in relation to its impact on mothers' well-being. The study aimed at contributing to fill this gap by exploring mothers' mental health facing infants' DDH, at the diagnosis time and by the end of the treatment; possible moderators of changes over time were mothers' hip worries, compliance to treatment, and severity of babies' DDH. The sample included 60 mother-infant dyads, 33 of which followed longitudinally. Multiple mother- and clinician-reported measures were administered. Multilevel models showed that the mothers' psychological condition remained stable over time. The mothers' hip worries, compliance to treatment, and severity of babies' DDH did not moderate mothers' mental health over time but were significant independent predictors of it. Our findings might have relevant clinical implications, for medical staff who deals with mothers and infants' DDH.

Background: Compassion fatigue is a state of emotional and physical exhaustion that arises from frequent contact with people who have experienced trauma or stress, which may affect particularly those working in health care. This study aimed to elucidate the prevalence and determinants of compassion fatigue among pediatric nurses.

Methods: A survey was administered to pediatric nurses at a tertiary hospital in Jiangsu province, China. Chinese compassion fatigue scale was used to investigate the compassion fatigue.

Results: The study enrolled 364 pediatric nurses, with a compassion fatigue prevalence of 59.89%. Age (odds ratio [OR] = 2.094, 95% confidence interval [CI] = 1.833-2.418), education level (OR = 2.118, 95% CI = 1.852-2.669), monthly income (OR = 3.976, 95% CI = 2.904-4.412), and having children at home (OR = 2.314, 95% CI = 1.851-3.025) were independent predictors of compassion fatigue.

Conclusions: These findings demonstrate the need for targeted interventions to mitigate compassion fatigue in pediatric nurses.

We aimed to investigate the diagnostic value of leukocyte cell population data (CPD) parameters obtained from an automated hematology analyzer to be able to use it in the diagnosis of neonatal sepsis. Our study was a retrospective and cross-sectional analysis. The neonates were classified into 3 groups: culture-positive sepsis (n = 20), clinical sepsis (n = 87), and control (n = 269). CPD parameters were determined during complete blood count (CBC) by volume-conductivity-scatter (VCS) technology with DxH 900 Coulter Cell Analyzer. Mean neutrophil volume (MNVNE), standard deviations of volumes of neutrophils (SDVNE), standard deviations of volumes of monocytes (SDVMO), and monocyte distribution width (MDW) were significantly increased in the culture-positive sepsis group compared with the clinical sepsis and control groups (P < .05). We have demonstrated the diagnostic utility of leukocyte CPD parameters, especially MNVNE, MDW, and their combination, for neonatal sepsis. These parameters are advantageous because they are obtained during routine CBC analysis without the need for additional blood collection and extra costs.

Extravasation injuries are prevalent in pediatric hospitals and often result in tissue damage and extended hospital stays. However, limited data exist regarding risk factors for extravasation in children. This study aimed to identify these risk factors in pediatric patients receiving intravenous (IV) therapy. This prospective cohort study included 500 children aged 1 month to 18 years who had undergone either central or peripheral catheterization and were admitted to the pediatric intensive care unit (PICU) at Imam Hossein Children's Hospital in Isfahan, Iran, between July 2020 and July 2021. Data were collected on age, gender, length of hospitalization, catheter type, instances of extravasation, drugs administered, and treatment protocols. The median age was 36 months, and approximately 56% of participants were male. Among the cohort, the prevalence of extravasation was 9.8% (49 patients). Female gender (P = .002), central venous catheterization (P = .002), prolonged hospitalization (P < .001), reduced consciousness (P = .012), and the use of taping for vein fixation (P = .004) were all significantly associated with a higher risk of extravasation. This study underscores the need for health care providers to carefully assess risk factors for extravasation to mitigate injury risk, particularly in vulnerable pediatric populations.