Clinical Pediatrics最新文献

This retrospective cohort study analyzed perinatal risk factors for congenital hypothyroidism (CH) in 1073 very low birth weight (VLBW) infants (<1500 g) admitted to a neonatal intensive care unit. The overall CH incidence was 6.0% (65 cases), with significantly higher rates in extremely low birth weight (ELBW) infants (11.1%) and extremely preterm infants <28 weeks' gestation (11.3%). Multivariate analysis identified maternal thyroid disease (odds ratio [OR]: 2.12, 95% confidence interval [CI]: 1.10-4.12) and patent ductus arteriosus (OR: 2.25, 95% CI: 1.33-3.79) as independent risk factors, while higher birth weight showed a marginally protective effect (OR 0.998, 95% CI: 0.997-1.000). The elevated CH incidence among extremely preterm infants and those with lower birth weights highlights the needs for dynamic thyroid monitoring in VLBW populations, particularly when maternal thyroid disease is present. These findings justify risk-stratified surveillance protocols to facilitate early detection and optimize clinical management in high-risk neonates.

Research suggests that household social risks are associated with worse mental health in adolescents, but prior studies have been limited. We evaluated the association between social risks and symptoms of depression and anxiety in adolescents 1 year later by conducting a retrospective cohort study at an integrated health system with 45 practices. Adolescents were screened for depression using the Patient Health Questionnaire-2 (PHQ-2) and anxiety using the Generalized Anxiety Disorder-2 (GAD-2). Of the 4748 adolescents, 1220 (25.7%) had at least 1 social risk, 226 (5.7%) reported symptoms of depression, and 410 (10.2%) reported symptoms of anxiety. Adolescents in households with at least 1 social risk were more likely to report symptoms of depression (β = 0.15, 95% confidence interval [CI] = 0.07-0.23) and anxiety (β = 0.21, 95% CI = 0.11-0.31) and had greater odds of a positive PHQ-2 (odds ratio [OR] = 1.50, 95% CI = 1.12-2.01) and positive GAD-2 (OR = 1.57; 95% CI = 1.32, 1.87).

Experts recommend screening for or presumptively treating strongyloidiasis in foreign-born immigrant children, though prevalence is unknown. Health care providers encounter barriers to following this recommendation. We aimed to describe Strongyloides seropositivity and risk factors among pediatric patients on a mobile clinic. Participants completed a written survey and provided blood for absolute eosinophil count (AEC) and Strongyloides IgG enzyme-linked immunosorbent assay (ELISA). From October 2022 to June 2023, 206 patients participated; 201 (97.6%) were born outside the United States; 97.1% (n = 200) were Hispanic. Most (68.9%) arrived less than 1 year before study enrollment. Four (1.9%) and 3 (1.5%) had positive and equivocal ELISA results, respectively. Peripheral eosinophilia was seen in 27 participants (13%). Previous antiparasitic use was reported by 106 (51.5%). We found no significant associations between Strongyloides seropositivity and AEC, exposures, symptoms, or medical history. Mobile clinics can feasibly conduct strongyloidiasis prevalence studies to create guidelines for providers who see foreign-born immigrant children.

Background: Genetic testing identifies underlying causative mutations in many children with kidney diseases. However, several factors prevent the widespread implementation of this useful tool in clinical practice. We aim to evaluate the perception and current state of genetic testing utilization among pediatric nephrologists.

Methods: This study involved a nationwide survey including questions about the availability of genetic testing, perceptions, modalities, indications, and barriers to routine utilization in clinical practice.

Results: Forty pediatric nephrologists completed the survey. Over 60% of respondents reported that genetic testing services were available at their institutions and over 70% reported that whole exome sequencing was the most frequent genetic testing modality. Barriers to genetic testing were mostly financial or due to a lack of awareness among providers. Glomerulopathies, tubulopathies, and ciliopathies were the most common reasons for sending genetic samples.

Conclusion: Despite the availability at most centers, pediatric nephrologists face difficulties in interpreting genetic test results.

Introduction: Methicillin-resistant Staphylococcus aureus (MRSA) in cystic fibrosis (CF) impairs lung function and contributes to the progression of the disease. Optimal eradication regimens for new-onset MRSA infections in people with CF (pwCF) remain undefined.

Materials and methods: This prospective, multicenter study evaluated a standardized, step-up MRSA eradication regimen in pwCF with new-onset MRSA infections between 2020 and 2022.

Results: Ninety-one pwCF (52.7% male, median age: 9 years) were included. Our treatment regimen included oral rifampicin and co-trimoxazole or oral rifampicin and fusidic acid. Intravenous teicoplanin treatment was initiated in patients whose clinical condition was unstable. The eradication success rates after 1 year were 82.4%, 92.9%, and 55.6%, respectively. No significant changes in median FEV1% predicted or BMI z-scores were observed between MRSA-eradicated and non-eradicated groups at baseline or 12 months.

Conclusion: A standardized step-up MRSA eradication protocol is effective for new-onset MRSA infections in pwCF. Randomized controlled trials are needed to confirm these findings.

A total of 101 patients with a clinical picture of persisting Lyme disease seen at the University of Connecticut Health Center and Boston Medical Center were recruited for the study to determine whether persistent infection is the likely cause. Brain SPECT imaging and responses to antibiotic treatments were recorded. Patients had more than 5 symptoms lasting more than 6 months. A history of tick bite and/or rash was present in 40%. Western blots were more sensitive than enzyme immunoassays screening tests. Brain SPECT scans were abnormal in 65% of patients. Treatment with specific antibiotics over time resolved the illness in most children. A clinical diagnosis can be made based on the combination of certain persisting symptoms, and serologic and nuclear medicine studies support the clinical diagnosis. Treatment with specific antibiotics over a number of months is helpful as a diagnostic test and lead to resolution of symptoms in most patients.

To optimize the deployment of Generative Artificial Intelligence in health care, it's essential for health care professionals (HCPs) to understand these technologies' capabilities and constraints. This study explores HCPs' initial impressions and experiences using ChatGPT, a Generative Pre-trained Transformer, in Pediatric Critical Care Units (PICUs). By conducting focus groups with a diverse set of HCPs, we aimed to assess their awareness, utilization, perceived benefits, and concerns about incorporating ChatGPT into their PICUs. The discussions highlighted three main themes: familiarity and usability of ChatGPT, its role in clinical and organizational tasks, and ethical concerns. While participants appreciated ChatGPT's user-friendliness and potential to expedite tasks and provide rapid information, they expressed concerns regarding data reliability, recency, and ethical implications. Despite these reservations, there is cautious optimism about integrating these tools in PICU, underscoring the need for vigilance and ongoing evaluation of novel health care-related implications as these technologies evolve.