Clinical Pediatrics最新文献

Objective: We intend to investigate the risk factors of the necrotizing enterocolitis (NEC)-associated bloodstream infection (BSI) in neonates with NEC.

Methods: This analysis included a multi-centered retrospective case-control study in 4 newborn intensive care units (NICUs) from 2015 to 2024. The factors involved in the NEC-associated BSI were investigated using univariate and multivariate analyses.

Results: The majority of NEC-associated BSIs were caused by Klebsiella spp. (23%). Compared with those without BSI, the neonates with BSI had significantly lower gestational age and birth weight (BW), had a higher incidence rate of NEC of stage III (P = .048) and surgical NEC. The independent risk factors of concurrent BSI were BW and first white blood cell (WBC) count. And BSI, vasopressor use at enrollment, and respiratory support were independent risk factors of the NEC-attributable mortality.

Conclusions: The BSI following NEC was associated with low BW and high WBC, which might be helpful for the optimization of treatment planning.

This study evaluated parent perceptions during outpatient pediatric medical visits with presence of medical scribes (virtual or in-person) or no scribe. A national, cross-sectional online survey was completed by 2148 parents of children 0 to 17 years. Parents reported higher visit satisfaction if they were informed of scribe presence (P = .002) and, independently, if asked permission for the provider to work with a scribe (P = .008). Parents reported higher comfort with virtual scribe over in-person scribe presence (P < .001). Parents reported higher visit satisfaction with virtual scribe presence compared with in-person and no scribe (P < .001). Perception of provider communication was not significantly different between virtual, in-person and no scribe presence (P = .615). Findings support increased parent visit satisfaction at pediatric medical visits with virtual scribe presence. Future qualitative studies could explore elements to support positive parent experience for current virtual scribe and future Artificial Intelligence (AI) scribe use.

Health literacy and language impact comprehension of and adherence to written educational materials, including those for gastrostomy tubes (g-tubes). Our objective was to evaluate the readability, understandability, actionability, content, and language availability of a national sample of written g-tube educational materials. We conducted a cross-sectional study of g-tube educational materials from top 20 children's hospitals (US News and World Report) obtained via a systematic online search and provided by the institutions. We assessed material: (1) readability, (2) understandability and actionability (Patient Education Materials Assessment Tool for Printable Materials, (3) content, and (4) language availability. Mean (standard deviation [SD]) reading grade level was 8.3 (1.9). Mean (SD) understandability and actionability scores were 81.6% (12.1%) and 65.9% (23.2%), respectively. Materials covered a mean (SD) of 46.1% (25.3%) of content items; 20% of institutions provided materials in non-English languages. Future research should examine how to improve educational materials for children with g-tubes.

This study evaluated the extent to which the sleep is disrupted by nighttime awakenings in urban children with and without asthma and examined racial/ethnic differences in sleep outcomes. Three hundred and seventy-nine urban children aged 7 to 9 years with (n = 250) and without (n = 129) asthma were included. Participants were 45% Latino, 34% black, and 21% non-Latino white (NLW). Nighttime awakenings were assessed via actigraphy. Asthma status was assessed by a clinically and via self-report. Children with asthma had significantly more awakenings than those without. Latino children with asthma had more and longer awakenings compared to Latino children without asthma; these effects were not observed among black or NLW participants. Poor asthma control was associated with more awakenings. Urban children face higher risks for poor sleep and asthma outcomes. Multicomponent interventions addressing asthma management and culturally tailored sleep hygiene strategies are necessary to improve asthma and sleep outcomes in this highly burdened population.

Renal fusion anomalies develop during fetal life due to abnormal fusion and ascent of the kidneys. Horseshoe kidney is the most common partial fusion anomaly. This study aimed to evaluate renal and extrarenal complications in children with horseshoe kidney and crossed fused renal ectopia (CFRE) and to determine their clinical significance. Tc-99m dimercaptosuccinic acid (Tc-99m DMSA) scintigraphies of 759 pediatric patients were retrospectively reviewed, identifying 40 cases (5.27%) of renal fusion anomalies: 34 with horseshoe kidney, 5 with CFRE, and 1 with triple kidney. While 45% were asymptomatic, abdominal pain was the most common symptom. Vesicoureteral reflux and ureteropelvic junction stenosis were each found in 5%, and nephrolithiasis in 7.5%. Surgery was required in 7.5% of patients, with no cases of chronic renal failure. Understanding the etiopathogenesis and imaging features of these anomalies is crucial for effective clinical management.

Microcytic hypochromic anemia is common in severe acute malnutrition (SAM) children, but macrocytic anemia (vitamin B12/folate deficiency) is not uncommon. Vitamin B12 deficiency leads to anemia and developmental slowing. We looked for the response of vitamin B12 supplementation on hematological and anthropometric parameters in SAM children. All children aged 1 to 60 months with SAM were included and divided in 2 groups. Group A children received vitamin B12 for 6 weeks additionally as compared with Group B. Both groups were followed up at discharge and at 6 weeks for hematological and anthropometric indices. Prevalence of anemia was 79.43%. Peripheral blood smear showed microcytic hypochromic anemia and macrocytic anemia in two-third and one-third, respectively. Vitamin B12 supplementation in SAM children for 6 weeks did not change most of the hematological and anthropometric parameters, but there was significant improvement in weight for age and height for age z scores.

Children with painful disorders of gut-brain interactions (DGBIs) endorse pain-related stigmatization. However, little is known about how stigma may be associated with pain intensity. Consequently, we conducted a cross-sectional study to identify a potential pathway between felt stigma and abdominal pain in youth with DGBIs. 120 youth completed measures of health-related stigma, depressive symptoms, sleep disturbances, and pain severity. As expected, greater felt stigma was significantly correlated with greater depressive symptoms, sleep-related impairments, and abdominal pain. Furthermore, a sequential mediation analysis revealed a significant indirect effect of stigma on abdominal pain via higher depressive symptoms and greater sleep-related impairments. Results suggest potential considerations for modifying current treatments for DGBIs targeting abdominal pain. More specifically, providers should incorporate screening for and addressing felt stigma, sleep-related impairment, and depressive symptoms into their treatment planning. Involving pediatric behavioral health providers may help facilitate this aspect of DGBI intervention.

Many pediatric assessment tools rely on limited percentile cut points, such as the 90th and 95th, forcing clinicians into broad risk categories and losing essential precision for tracking change. We propose a simple, robust method to impute continuous percentile scores using a piecewise-linear function. Validation against true percentiles in a longitudinal study of children at risk for pediatric feeding disorder (N = 234) yielded exceptionally strong correlations (r = 0.97-0.99). Although slight overestimation occurred in low-score ranges due to sparse cut points, the rank-ordering of scores was reliably preserved. Continuous percentile scores provide the fine-grained differentiation needed to observe subtle changes in developmental trajectory. As illustrated by a clinical case, this enhances data interpretation and allows for more precise tracking to alert the care team of worsening symptoms and facilitate timely, objective evidence for targeted referral. This reliable method is broadly applicable to many clinical tools, and improves the reporting of longitudinal research.