Clinical Pediatrics最新文献

Psychosocial screening is inconsistently administered in pediatric primary care and rarely includes older children. This cross-sectional study compares screening outcomes from and interventions related to expanded use of the safe environment for every kid (SEEK) approach in children aged 0 to 17 versus the usual application to families with children under 5. Caregivers (N = 450) of children aged 0 to 17 years completed screening between April and December 2021. Screening results were compared across 3 age categories (0-5, 6-11, and 12-17) using the exact binomial method and Fisher's exact test. The prevalence of problems was similar across all age groups except for stress (P < .001) and substance misuse (P = .002). Publicly insured families had higher rates of identified problems versus privately insured families for stress (P = .035) and partner violence (P = .031). Interventions for positive screens were offered for 61% of participants. Expanded SEEK screening enables increased detection of social needs and offerings of resources for all ages and insurance types.

Background: Children with allergic reactions are mostly referred to tertiary centers for vaccination, but confirmed vaccination-triggered allergic reactions are uncommon. In this study, childhood vaccination-triggered allergic reactions in children with food and vaccination-related allergies are evaluated.

Methodology: Retrospective analysis of 923 doses of vaccine administered in our clinic due to food or vaccine-triggered allergic reactions were conducted.

Results: 868 vaccines were measles-mumps-rubella (MMR) vaccine, 20 were measles vaccine containing alpha-lactalbumin and 35 were other childhood vaccines. A total of 576 of MMR vaccines contained alpha-lactalbumin and 292 did not. Vaccinations were administered without any reactions in 98.9% of patients with previous food allergies. One of the reactions was anaphylaxis. About 55 patients were referred because of previous vaccination-related allergic reactions, and 94.5% of them were vaccinated without any reactions. Mild reactions were encountered in 3 (5.5%) patients. No anaphylaxis was observed.

Conclusion: Patients with a history of food or vaccination allergies have a low rate of allergic reactions in childhood vaccinations.

Mothers' well-being and the factors influencing it have gained increasing attention in recent research. This study explores the mediating role of perceived social support in the relationship between burnout and life satisfaction among mothers of children aged 5 to 18 with type 1 diabetes. The cross-sectional study was conducted from January 1 to March 30, 2024, and involved 202 mothers. The study was conducted in Turkey, and data were collected online through a form shared via WhatsApp from mothers who voluntarily agreed to participate in the study. Descriptive and inferential statistics were performed, and a P value of .05 was considered statistically significant. Results indicated that social support significantly reduced parental burnout (F = 5.860, P = .003) and positively impacted life satisfaction (F = 19.126, P < .001). Conversely, higher burnout levels negatively affected life satisfaction (F = 20.909, P < .001). Ultimately, social support was found to fully mediate the association between parental burnout and life satisfaction, with the direct link between burnout and life satisfaction no longer observed.

Ureteropelvic junction obstruction (UPJO) is a common urologic disorder in children. Accurate assessment of renal function, both preoperatively and postoperatively, is crucial for prognosis. Previous studies have primarily focused on postoperative function using univariate analysis. This study aimed to identify alternative assessment approaches. A retrospective study was conducted on 150 pediatric UPJO patients who underwent laparoscopic pyeloplasty. Multivariate logistic regression was performed to analyze factors influencing renal recovery, with improvement in renal morphology on ultrasonography as the outcome. Advanced age, prolonged hydronephrosis duration, overweight, and elevated serum creatinine levels (P < .05) were identified as significant risk factors for poor postoperative recovery. Younger age, shorter disease duration, normal serum creatinine levels, and healthy weight are associated with better postoperative recovery in UPJO patients. These findings highlight the importance of early intervention to optimize recovery.

Teenagers who give birth in the United States have known risks for morbidity. This population often has limited access to care. This study examined the association of state Medicaid expansion with insurance attainment, adequate prenatal care, maternal hypertension, and maternal diabetes, and investigated racial and ethnic disparities, using a cross-sectional 2019 national database. Multivariable logistic regression analyses were performed. Teenagers in Medicaid expansion states were more likely to acquire insurance during pregnancy (P < .001). State Medicaid expansion status was not associated with prenatal care adequacy, maternal hypertension, or diabetes, but significant racial/ethnic disparities existed. Compared with non-Hispanic white teenagers, non-Hispanic black teenagers had increased odds of inadequate prenatal care (odds ratio [OR] = 1.77, 95% confidence interval [CI] = 1.02, 3.05) and hypertension (OR = 2.18, 95% CI = 1.23, 3.86), and Hispanic teenagers had increased odds of diabetes (OR = 3.72, 95% CI = 1.05, 13.13). Focused efforts to improve perinatal health among pregnant teenagers are important for this high-risk group.

There are limited data regarding the microbiology and epidemiology of pediatric ventriculoperitoneal (VP) shunt infections. We identified 30 pediatric and young adult VP shunt infections within the Military Health System from 2008 to 2019 by pairing a procedure code for VP shunt malfunction with a diagnosis code for VP shunt or central nervous system (CNS) infection. We confirmed infection with cerebrospinal fluid (CSF) or CNS culture or CSF pleocytosis for each patient. Half of patients were < 12 months old and 57% were male. The median initial CSF white blood cell count was 114 cells/µL. Staphylococci were identified most frequently (31.4% coagulase-negative staphylococci and 25.7% Staphylococcus aureus). Gram-negative pathogens comprised 22.9% of all isolates. Seventy-three percent of infections were adequately covered by vancomycin alone and 19% required a fourth-generation cephalosporin or carbapenem. Our study therefore supports national guideline-recommended empiric therapy with vancomycin and an anti-pseudomonal beta-lactam for children with VP shunt infection.

The increasing survival of high-risk newborns has led to an increase in neurodevelopmental and learning problems in children. With preschools largely remaining unregulated, primary school teachers with a basic degree and diploma/bachelor's degree in education as minimum requirement in India, may lack training, especially to suspect medical issues contributing to learning difficulties. This study assessed the feasibility of a country-level application under the aegis of the Indian Academy of Pediatrics. A pre-experimental, one-group time series study done with primary school teachers, trained on poor scholastic performance training using a module with case discussions on identifying and assessing school failure, investigations, management options, educational support, and advocacy. Pre-test/post-test and long-term impact increased awareness that educational difficulties could be caused/exacerbated by medical issues. Effectiveness persisted over time in identifying behavioral changes in these children. This module is a cost-effective, feasible alternative for programs lacking access to live expert content.