European Journal of Pediatrics最新文献

Children with Medical Complexity (CMC) often require 24/7 expert care, which may impede discharge from hospital to home (H2H) resulting in prolonged admission. Limited research exists on pediatric patients with delayed discharges and the underlying reasons for such extended admissions. Therefore, our objectives were to (1) describe the demographics, clinical characteristics, and course of CMC who are in their H2H transition and (2) identify the reasons for postponement of H2H discharge. Prospective, multicenter, observational cohort study performed from February 2022 until November 2022 for 6 months in four Dutch University Medical Center children's hospitals. Clinically admitted patients (age 0-18 years) were eligible for inclusion if they were medically stable, yet required specialized nursing and/or paramedical care and were in the H2H transition process. In total, 44 participants were included, of whom 32 (72.7%) were younger than 1 year. Median stay in the hospital was 7.3 weeks (range 0.7-28.7). Upon entering the H2H phase, postponement of discharge was for 65.1% of the patients primarily due to a combination of medical reasons and organizational/family factors. For the remaining 34.9% of the patients, discharge was delayed solely due to organizational and/or family factors. CONCLUSION : Our study highlights several reasons contributing to the postponement of discharge for pediatric patients with medical complexity, including their medical fragility, the time-consuming process of parent training, and the challenges in organizing home care. Future steps should explore various transitional care programs aimed at improving the H2H transition. What is Known: • Hospital to home transition for Children with Medical Complexity is a multi-faceted process with many challenges and obstacles • Insight into the current practice of transitioning home in University Medical Centers remains unknown and is needed to develop a tailored yet standardized approach What is New: • Our findings reveal reasons for postponement of discharge home and show that patients are medically stable for more than half of their hospital stays. This indicates potential opportunities to reorganize care for better outcomes for the child, the family, and healthcare consumption.

Both term and preterm infants are susceptible to pathological jaundice, a frequent condition that can cause long-lasting neurological damage. A novel treatment for indirect pathological hyperbilirubinemia is bilisphere phototherapy, which lowers total serum bilirubin just as well as exchange transfusions. A quasi-experimental research design was utilized in the current study. This study was conducted in Neonatal Intensive Care Unit at Benha Specialized Pediatric Hospital. A convenient sample of all available nurses (60) working in the previously mentioned setting. A purposive sample of neonates (90) with pathological jaundice which would be divided into control and study groups. Three tools were used: Tool I: A structured interview questionnaire sheet, Tool II: observational checklist for caring neonates with pathological jaundice, and Tool III: neonatal outcomes assessment sheet. There was a positive correlation between nurses' total performance regarding pathological jaundice and bilisphere phototherapy at pre-/post-education program implementation. Additionally, there were a positive correlation between neonates' outcomes in the study group and nurses' total performance post-program implementation.Conclusion the education program regarding pathological jaundice was effective in improving nurses' performance and neonates' bilirubin-induced neurological dysfunction post compared to pre-education program implementation. What is Known: • Pathological jaundice had directly effect on neurological status in neonates as aresults of accumulated bilirubin in basal gangelia in brain and bilirubin induced neurological dysfunction score considered important tool to indicate acute bilirubin encephalopathy. What is New: • Education programs and periodic training to medical team provide improvement their performance, nurse had significant role to provide neonates care in NICU. So, improve nurses performance lead to improve neonate outcomes. • Bilisphere phototherapy is an important device which had positive outcomes in pediatrics which improve neonates' health status, but its effect depends on provided effective nursing practice during therapy. • Pathological jaundice management with bilisphere phototherapy and bilirubin induced neurological dysfunction score working together to provide optimal care for neonates, which bilisphere phototherapy decrease bilirubin level and BIND score assess neurological status and detect any abnormalites during therapy.

Cerebral palsy (CP) is not just caused by neuromuscular abnormalities; it is also a result of an impaired sensory system. Since there is not a standardized measure to evaluate sensory processing of children with spastic CP, therefore an in-depth assessment of sensory processing deficits in children with spastic CP would require an understanding of the validity and reliability of the Child Sensory Profile-2 (CSP-2) in children with spastic CP. The sample of this study included 230 children with spastic CP aged 3 to 14 years who referred to different paediatric rehabilitation centres of Delhi-NCR from April 2021 and September 2023 by using the snowball sampling procedure. To collect the data, the CSP-2 caregiver questionnaire was used. For validity, face and content validity were determined. For reliability, internal consistency of all the responses was examined using Cronbach's alpha reliability coefficient. For validity, experts involved in the study reported that the organization and design of the questionnaire would be appropriate for the children with spastic CP. All the items of the CSP-2 questionnaire were simple and easy to understand. Internal consistency was also calculated for total items (N = 86) and found to be 0.898 which indicates that all items of the questionnaire are internally consistent and reliable.

Conclusion: According to the findings of our study, the CSP-2 is a valid and reliable measure for evaluating sensory processing in children with spastic CP. Additionally, it may be an appropriate tool for accurately assessing this population's sensory processing deficits.

What is known: • Sensory processing deficits commonly concur with motor deficit in children with CP. Overall prevelance of sensory processing deficit was 83% in children with CP.

What is new: • Child Sensory Profile-2 is a reliable and valid tool for measuring sensory processing abilities in children with CP.

Osteosarcoma (OS) bone tumor of childhood although the etiology of OS has not been fully elucidated, there is evidence linking it with factors related to pubertal development. In recent years, plasma CNP concentration and height velocity in children and CNP have been implicated as an emerging new growth marker during childhood. We aimed to determine the serum NT-proCNP levels of patients with pediatric osteosarcoma and its relation with clinical-laboratory growth parameters and look for any correlation of serum NT-proCNP levels with different prognostic factors in childhood osteosarcoma. This study enrolled 15 newly diagnosed OS patients and 31 healthy controls. All subjects were physically examined. Plasma NT-proCNP concentration was measured by enzyme-linked immunosorbent assay. Our results demonstrated that serum NT-proCNP concentration was significantly different between OS patients and control groups. At diagnosis, the OS patient's mean blood NT-proCNP concentration was 49.7 ± 3.3 pmol/l, which was substantially lower than the control group's concentration of 61.4 ± 3.10 pmol/l (p < 0.005). No significant correlation was found between serum NT-proCNP concentration and growth parameters.

Conclusion: In conclusion, we found that the serum NT-proCNP concentration was significantly different between OS patients and control groups. It is predicted that our results will contribute to osteosarcoma biology.

What is known: • Osteosarcoma (OS) is the most common malignant bone tumor of childhood, affecting rapidly growing bones with factors associated with rapid bone growth, although its etiology is not fully understood. • The current literature suggests that the main role of the CNP/NPR-B signaling pathway is associated with endochondral bone development and related growth in long bones.

What is new: • We demonstrated that serum NT-proCNP concentration was significantly different between OS patients and control groups and could be used as a potential biomarker. • To our knowledge, this is the first clinical study evaluating the relation of serum serum NT-proCNP levels with anthropometric parameters in osteosarcoma patient with a particular interest to identify the possible role of CNP in pediatric osteosarcoma and its relationship with prognostic factors.

Infants requiring interhospital transfer for a higher level of care in the neonatal period are at increased risk of adverse outcomes. Optimising respiratory management is an important priority. The aim of this survey was to investigate current respiratory support strategies in neonatal transport and identify opportunities for the optimisation of clinical care and future research. A survey of all 18 transport groups in Ireland and the UK was performed. A 10-item structured questionnaire was administered through consultant neonatologists or lead nurses from each transport group between May and June 2024. There was a 100% response rate. There was variation in the types of neonatal ventilator used, and they differed from those on NICUs. A variety of invasive strategies were used, but volume-targeted ventilation was the most common, although different ventilators can deliver different volumes despite apparently the same settings. Non-invasive strategies were used by all, with humidified high flow nasal cannula (HHFNC) being the most common. Continuous carbon dioxide (CO₂) monitoring was used by most teams (94%): endotracheal CO₂ assessments by 94% and transcutaneous monitoring by 70%. Only two teams employed closed loop automated oxygen control (CLAC).

Conclusion: There is heterogeneity in the ventilators and respiratory strategies used by transport groups. Future research opportunities should include the comparison of those strategies on short- and long-term outcomes, as well as whether continuous CO₂ monitoring and CLAC have important benefits.

What is known: • Nearly one quarter of neonatal transfers in the UK and Ireland are in infants mechanically ventilated. • Optimising respiratory support strategies and reporting respiratory outcomes are research priorities in neonatal transport.

What is new: • Volume targeted ventilation is the most common respiratory support strategy used in neonatal transport groups in the UK and Ireland, with a heterogeneity of ventilators in use in neonatal transport versus in NICUs. • There is a paucity of data reporting respiratory outcomes following neonatal transport including outcomes related to mode of ventilation, continuous carbon dioxide monitoring and closed loop automated oxygen control.

Purpose: Perinatal hypoxic-ischemic encephalopathy (HIE) is a significant cause of neonatal brain injury. Therapeutic hypothermia (TH) is the standard treatment for term neonates, but its safety and efficacy in neonates < 36 weeks gestational age (GA) remains unclear. This case series aimed to evaluate the outcomes of preterm infants with HIE treated with TH.

Methods: Retrospective analysis of preterm infants (< 36w GA) treated with TH (01/2019-06/2024). Data on demographics, clinical complications, coagulation profiles, brain magnetic resonance imaging (MRI), and neurodevelopment outcomes were analyzed.

Results: Seventeen patients were included (range 32.5-35.5w, median 34.4; birthweight range 1556-2493 g, median 2300 g), 58.8% were male. Placental abruption was identified in 7 cases (41.2%), and 8 (47.1%) required advanced resuscitation. Thirteen patients (76.5%) presented anemia, 12 (70.6%) coagulopathy, 9 (52.9%) thrombocytopenia, and 9 (52.9%) acute liver failure. Hypofibrinogenemia (< 1 g/L) was significantly associated with severe intracranial hemorrhage (ICH), defined as extracerebral, intraventricular or parenchymal hemorrhage causing mass effect. MRI findings were classified based on the predominant lesion: I- hypoxic-ischemic injury, II- severe ICH, or III- normal/mild findings. Severe ICH was the predominant lesion in 4 cases (23.5%). White matter injury was seen in 12 (76%). Death occurred in 8 cases (47.1%). Of the 9 surviving patients, at 2 years, 6 (66.7%) had normal neurodevelopment, while 1 (11.1%) had severe disability.

Conclusion: Coagulation abnormalities, particularly hypofibrinogenemia, significantly increase the risk of severe ICH in < 36w infants treated with TH. The safety and efficacy of TH in this population require further investigation.

Knowledge about trends and epidemiology of pediatric burns is useful to identify patterns, to advance medical research, and to design prevention programs and resource allocation. The aim of this study is to describe the epidemiology and trends of pediatric burns between 2009 and 2022 in the three Dutch burn centers. A secondary objective of this study is to evaluate the influence of the COVID-19 pandemic on the pattern of pediatric burns. A register-based cohort study was conducted based on data from the Dutch Burn Repository R3. Patients between 0 and 17 years at the time of the burn injury admitted between 2009 and 2022 to one of the three burn centers were included. Descriptive statistics were used to investigate the incidence and patient, burn, and treatment characteristics. The COVID-19 pandemic years (2020-2021) were compared with the pooled results from pre-COVID-19 years (2017-2019). A total of 4017 patients were included in this study, of which 3085 (77%) were overnight admissions. The incidence and absolute number of pediatric burn admissions gradually increased over the years, with a small temporary decrease in 2020-2021. Patient and burn characteristics remained relatively consistent over the years. Three quarters of all patients were between 0 and 3 years old, and the majority were boys (59%). A decreasing ratio of length of stay per % total burned surface area and an increase in day admissions was observed since 2016 onwards, which intensified during the COVID-19 pandemic.

Conclusions: There was a slight increase in the number of pediatric admissions to the burn centers between 2009 and 2022. Young children (0-3 years) remain the most frequently affected group. A shorter relative length of stay was observed, as well as an increase in day admissions, which was reinforced by the COVID-19 pandemic.

What is known: • Burns are a leading cause of death and disability among children globally. The largest group affected are young children (0-3 years) and most are scald burns. • In the Netherlands, since the late nineties there has been a trend towards more admissions to specialized burn centers, especially for young children with less severe burns.

What is new: • There was a slight increase in the number of pediatric admissions to the burn centers between 2009 and 2022, with a temporary decrease during the COVID-19 pandemic (2020-2021). • Admissions now tend to be shorter per percentage total burned surface area (TBSA), with an increase in day admissions, which intensified during the COVID-19 years.