Tracheal intubation (TI) is pivotal in managing critically ill neonates. This study aims to investigate the disparities in exposure and training techniques that affect self-perceived confidence in neonatal fellows concerning TI.
Methods
A comprehensive, structured questionnaire-based survey was conducted among neonatal trainees from October to November 2022. Self-perceived confidence in TI was evaluated using a Likert scale, ranging from 1 to 10. The trainees who scored below seven were categorised as under-confident, while those who scored seven or more were considered confident in TI. An analysis was done to assess the differences in exposure, training and clinical policies related to TI in both groups. A P-value <0.05 was considered significant.
Results
The final dataset consisted of 93 trainees. Confidence was higher among those who had independently performed TI on more than 30 neonates during their postgraduate training (relative risk (RR) 1.5 (1.03–2.1), P = 0.02) and super-specialty training (RR 1.5 (1.20–1.93), P = 0.0004). Confidence was also significantly associated with training programmes that incorporated written checklists for intubation instruments and policies (RR 1.4 (1.1–1.8), P = 0.006), conducted debriefing sessions after each TI attempt (RR 1.3 (1.03–1.6), P = 0.005), and implemented regular simulation programmes (RR 1.4 (1.1–1.8), P = 0.0006).
Conclusions
Trainees with increased opportunities for intubation and training programmes featuring regular simulations and debriefing sessions tend to possess higher self-perceived confidence in TI.
目的：气管插管（TI）是关键的管理危重新生儿。本研究的目的是调查暴露和训练技术的差异，影响自我感知的信心在新生儿研究员有关TI。方法：于2022年10月至11月对新生儿学员进行全面、结构化的问卷调查。使用李克特量表对TI的自我感知信心进行评估，范围从1到10。得分低于7分的学员被归类为自信心不足，而得分在7分或以上的学员则被认为对TI有信心。分析了两组在接触、训练和与TI相关的临床政策方面的差异。A p值结果：最终数据集由93名学员组成。在研究生培训期间对30名以上的新生儿独立实施TI的患者（相对风险（RR） 1.5 (1.03-2.1), P = 0.02）和超专业培训（RR 1.5 (1.20-1.93), P = 0.0004）的信心更高。信心也与培训计划显著相关，包括插管工具和政策的书面清单（RR 1.4 (1.1-1.8), P = 0.006），每次TI尝试后进行汇报会议（RR 1.3 (1.03-1.6), P = 0.005），以及实施定期模拟计划（RR 1.4 (1.1-1.8), P = 0.0006）。结论：有更多插管机会和定期模拟和汇报会议的培训计划的受训者倾向于在TI中拥有更高的自我感知信心。
{"title":"Factors influencing confidence in tracheal intubation among neonatal trainees: A questionnaire-based study","authors":"Vishwas Rao, Bharathi Balachander, Pragya Dubey, Suman Rao PN","doi":"10.1111/jpc.16747","DOIUrl":"10.1111/jpc.16747","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Tracheal intubation (TI) is pivotal in managing critically ill neonates. This study aims to investigate the disparities in exposure and training techniques that affect self-perceived confidence in neonatal fellows concerning TI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A comprehensive, structured questionnaire-based survey was conducted among neonatal trainees from October to November 2022. Self-perceived confidence in TI was evaluated using a Likert scale, ranging from 1 to 10. The trainees who scored below seven were categorised as under-confident, while those who scored seven or more were considered confident in TI. An analysis was done to assess the differences in exposure, training and clinical policies related to TI in both groups. A <i>P</i>-value <0.05 was considered significant.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The final dataset consisted of 93 trainees. Confidence was higher among those who had independently performed TI on more than 30 neonates during their postgraduate training (relative risk (RR) 1.5 (1.03–2.1), <i>P</i> = 0.02) and super-specialty training (RR 1.5 (1.20–1.93), <i>P</i> = 0.0004). Confidence was also significantly associated with training programmes that incorporated written checklists for intubation instruments and policies (RR 1.4 (1.1–1.8), <i>P</i> = 0.006), conducted debriefing sessions after each TI attempt (RR 1.3 (1.03–1.6), <i>P</i> = 0.005), and implemented regular simulation programmes (RR 1.4 (1.1–1.8), <i>P</i> = 0.0006).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Trainees with increased opportunities for intubation and training programmes featuring regular simulations and debriefing sessions tend to possess higher self-perceived confidence in TI.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16648,"journal":{"name":"Journal of paediatrics and child health","volume":"61 2","pages":"262-266"},"PeriodicalIF":1.6,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aim: This study aims to present the clinical characteristics of patients with PFAPA syndrome, and to compare the effects of corticosteroid usage, colchicine prophylaxis, and tonsillectomy on the frequency of attacks in patients with PFAPA syndrome.
Methods: Patients aged between 6 months and 18 years presenting to our Paediatric Rheumatology clinic between 2017 and 2021 who were diagnosed with PFAPA syndrome and followed up for a minimum of 12 months were included in this study. The demographic and clinical characteristics of the patients, laboratory findings, attack durations, and treatments were recorded.
Results: Our study, comprised of 195 patients, included four groups: untreated (n = 58), corticosteroid (n = 43), colchicine (n = 62), and tonsillectomy (n = 32). There was no significant difference between the treatment groups in terms of attack frequencies before treatment initiation (p > 0.05). When attack frequencies before and after treatment initiation were observed, a decrease in attack frequency compared to the pre-treatment period was observed in the tonsillectomy group (from 12 to 3 attacks) (p < 0.001) and the colchicine group (from 12 attacks to 1 attack) (p < 0.001). It was noted that using steroids during three or more attacks increased attack frequency compared to the pre-treatment period (p < 0.0001). Tonsillectomy resulted in a more significant reduction in attack frequency compared to the colchicine group (p < 0.001).
Conclusions: Using corticosteroids during an attack has been shown to effectively control attacks. However, the repeated use of corticosteroids increases the frequency of attacks. Colchicine prophylaxis leads to a reduction in attack frequency in the majority of cases. Tonsillectomy can successfully control the disease in most cases.
{"title":"Assessment of Attack Frequency in PFAPA Patients Based on Therapeutic Modalities.","authors":"Furkan Kalayci, Metin Yigit, Aylin Irmak Kuruc, Tevfik Cevirici, Banu Celikel Acar","doi":"10.1111/jpc.16756","DOIUrl":"https://doi.org/10.1111/jpc.16756","url":null,"abstract":"<p><strong>Aim: </strong>This study aims to present the clinical characteristics of patients with PFAPA syndrome, and to compare the effects of corticosteroid usage, colchicine prophylaxis, and tonsillectomy on the frequency of attacks in patients with PFAPA syndrome.</p><p><strong>Methods: </strong>Patients aged between 6 months and 18 years presenting to our Paediatric Rheumatology clinic between 2017 and 2021 who were diagnosed with PFAPA syndrome and followed up for a minimum of 12 months were included in this study. The demographic and clinical characteristics of the patients, laboratory findings, attack durations, and treatments were recorded.</p><p><strong>Results: </strong>Our study, comprised of 195 patients, included four groups: untreated (n = 58), corticosteroid (n = 43), colchicine (n = 62), and tonsillectomy (n = 32). There was no significant difference between the treatment groups in terms of attack frequencies before treatment initiation (p > 0.05). When attack frequencies before and after treatment initiation were observed, a decrease in attack frequency compared to the pre-treatment period was observed in the tonsillectomy group (from 12 to 3 attacks) (p < 0.001) and the colchicine group (from 12 attacks to 1 attack) (p < 0.001). It was noted that using steroids during three or more attacks increased attack frequency compared to the pre-treatment period (p < 0.0001). Tonsillectomy resulted in a more significant reduction in attack frequency compared to the colchicine group (p < 0.001).</p><p><strong>Conclusions: </strong>Using corticosteroids during an attack has been shown to effectively control attacks. However, the repeated use of corticosteroids increases the frequency of attacks. Colchicine prophylaxis leads to a reduction in attack frequency in the majority of cases. Tonsillectomy can successfully control the disease in most cases.</p>","PeriodicalId":16648,"journal":{"name":"Journal of paediatrics and child health","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aim: Acute appendicitis is a common surgical emergency in children, yet it poses diagnostic challenges in preschool children due to atypical presentation. This case-control study aims to evaluate the distinct characteristics of acute appendicitis in preschool compared to school-aged children.
Methods: Children under 5 years and a control group of children aged 5-10 years, operated on due to acute appendicitis at our institution during 2009-2022 were included. Data on demographics, clinical presentation, laboratory results, imaging, surgical procedure, pathology, bacteriology, antibiotic treatment, length of stay and outcomes were collected retrospectively.
Results: A total of 184 preschool and 187 school-aged children were included. Preschool children presented less frequently with abdominal pain but more often with vomiting, diarrhoea and fever. Preschool children had lower rates of leucocytosis but higher thrombocytosis and C reactive protein. Younger patients were more likely to undergo both chest and abdominal X-rays and be admitted to a paediatric department before diagnosing appendicitis. Complicated appendicitis, requiring increased use of intra-operative drain placement, and conversions to open procedures were more common in preschool children, with higher rates of ICU admission and surgical complications. Polymicrobial positive cultures and positive cultures for Bacteroides were more common in preschool children.
Conclusions: This study highlights the critical need for increased awareness among healthcare providers regarding the diagnostic challenges posed by atypical presentations of acute appendicitis in preschool children. Despite comprehensive evaluation, diagnosis in this age group may be difficult, emphasising the significance of recognising these presentation patterns to improve diagnostic accuracy and prompt management.
目的：急性阑尾炎是儿童常见的外科急症，但由于表现不典型，给学龄前儿童的诊断带来了挑战。本病例对照研究旨在评估学龄前儿童急性阑尾炎与学龄儿童急性阑尾炎的不同特点：方法：研究对象包括 2009-2022 年期间在本院接受急性阑尾炎手术的 5 岁以下儿童和 5-10 岁儿童对照组。回顾性收集有关人口统计学、临床表现、实验室结果、影像学、手术过程、病理学、细菌学、抗生素治疗、住院时间和结果的数据：结果：共纳入184名学龄前儿童和187名学龄儿童。学龄前儿童出现腹痛的频率较低，但出现呕吐、腹泻和发烧的频率较高。学龄前儿童的白细胞增多率较低，但血小板增多和C反应蛋白较高。年龄较小的患者更有可能同时接受胸部和腹部 X 光检查，并在确诊阑尾炎之前住进儿科。在学龄前儿童中，阑尾炎并发症（需要更多地使用术中引流管）和转为开腹手术的情况更常见，入住重症监护室和手术并发症的发生率也更高。学龄前儿童中多菌培养阳性和杆菌培养阳性更常见：本研究强调，医疗服务提供者亟需提高对学龄前儿童急性阑尾炎非典型表现所带来的诊断挑战的认识。尽管进行了全面评估，但对这一年龄组的儿童进行诊断可能仍有困难，这就强调了识别这些表现模式对提高诊断准确性和及时处理的重要性。
{"title":"Diagnostic challenges of acute appendicitis in preschool children: A comprehensive case-control study.","authors":"Maya Paran, Yael Dreznik, Moussa Totah, Avner Nevo, Dragan Kravarusic, Inbal Samuk","doi":"10.1111/jpc.16748","DOIUrl":"https://doi.org/10.1111/jpc.16748","url":null,"abstract":"<p><strong>Aim: </strong>Acute appendicitis is a common surgical emergency in children, yet it poses diagnostic challenges in preschool children due to atypical presentation. This case-control study aims to evaluate the distinct characteristics of acute appendicitis in preschool compared to school-aged children.</p><p><strong>Methods: </strong>Children under 5 years and a control group of children aged 5-10 years, operated on due to acute appendicitis at our institution during 2009-2022 were included. Data on demographics, clinical presentation, laboratory results, imaging, surgical procedure, pathology, bacteriology, antibiotic treatment, length of stay and outcomes were collected retrospectively.</p><p><strong>Results: </strong>A total of 184 preschool and 187 school-aged children were included. Preschool children presented less frequently with abdominal pain but more often with vomiting, diarrhoea and fever. Preschool children had lower rates of leucocytosis but higher thrombocytosis and C reactive protein. Younger patients were more likely to undergo both chest and abdominal X-rays and be admitted to a paediatric department before diagnosing appendicitis. Complicated appendicitis, requiring increased use of intra-operative drain placement, and conversions to open procedures were more common in preschool children, with higher rates of ICU admission and surgical complications. Polymicrobial positive cultures and positive cultures for Bacteroides were more common in preschool children.</p><p><strong>Conclusions: </strong>This study highlights the critical need for increased awareness among healthcare providers regarding the diagnostic challenges posed by atypical presentations of acute appendicitis in preschool children. Despite comprehensive evaluation, diagnosis in this age group may be difficult, emphasising the significance of recognising these presentation patterns to improve diagnostic accuracy and prompt management.</p>","PeriodicalId":16648,"journal":{"name":"Journal of paediatrics and child health","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142828808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ali Sobh, Marwa H Elnagdy, Doaa Mosad Mosa, Mai S Korkor, Abdulsalam D Alawfi, Amer M Alshengeti, Abdulhadi H Al-Mazroea, Rawan Bafail, Waad A Samman, Dina S El-Agamy, Hany M Abo-Haded
Aim
The severity of COVID-19 is influenced by uncontrolled hyper-inflammatory response with excessive release of many cytokines and chemokines. The understanding of the temporal change in the cytokine levels that underlies the diverse clinical presentations of COVID-19 can help in the prediction of the disease outcome and in the design of proper treatment strategies.
Method
Data were collected from children (<18 years old) hospitalised with severe COVID-19 or severe MIS-C who were compared to a group of healthy control children. Patient demographics, clinical, laboratory data and cytokines profiles were evaluated. Blood samples were collected within 24 h of admission for all enrolled children and on Day 14.
Results
Twenty-five children with severe COVID-19 and 23 cases with severe MIS-C were included in the study. The biochemical and inflammatory markers tend to be elevated in MIS-C group. There was a significant difference between studied cases and the control group in the following cytokines: G-CSF, IL-10, HMGB1, TNF-α, IL-6, IL-8 and INF-gamma (P < 0.05). While there was a significant difference between severe COVID-19 and MIS-C groups in the following cytokines at Day 1 of admission; IL-10, IL-6, IL-8 and INF-gamma; while at Day 14, there was a significant difference only for G-CSF, IL-10 and IL-6, all other cytokines were comparable.
Conclusion
Our study underpinned patterns of cytokine response in severe COVID-19 and MIS-C. There is a significant upregulation in pro-inflammatory cytokines (mainly G-CSF, IL-10, HMGB1, TNF-α, IL-6, IL-8 and INF-gamma). These biomarkers that could imply on the severity rating and treatment strategies, should be preferentially assessed in SARS-CoV-2 associated immunological events.
{"title":"Longitudinal cytokine profile in severe COVID-19 and multisystem inflammatory syndrome in children: A single centre study from Egypt","authors":"Ali Sobh, Marwa H Elnagdy, Doaa Mosad Mosa, Mai S Korkor, Abdulsalam D Alawfi, Amer M Alshengeti, Abdulhadi H Al-Mazroea, Rawan Bafail, Waad A Samman, Dina S El-Agamy, Hany M Abo-Haded","doi":"10.1111/jpc.16746","DOIUrl":"10.1111/jpc.16746","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>The severity of COVID-19 is influenced by uncontrolled hyper-inflammatory response with excessive release of many cytokines and chemokines. The understanding of the temporal change in the cytokine levels that underlies the diverse clinical presentations of COVID-19 can help in the prediction of the disease outcome and in the design of proper treatment strategies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>Data were collected from children (<18 years old) hospitalised with severe COVID-19 or severe MIS-C who were compared to a group of healthy control children. Patient demographics, clinical, laboratory data and cytokines profiles were evaluated. Blood samples were collected within 24 h of admission for all enrolled children and on Day 14.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twenty-five children with severe COVID-19 and 23 cases with severe MIS-C were included in the study. The biochemical and inflammatory markers tend to be elevated in MIS-C group. There was a significant difference between studied cases and the control group in the following cytokines: G-CSF, IL-10, HMGB1, TNF-α, IL-6, IL-8 and INF-gamma (<i>P</i> < 0.05). While there was a significant difference between severe COVID-19 and MIS-C groups in the following cytokines at Day 1 of admission; IL-10, IL-6, IL-8 and INF-gamma; while at Day 14, there was a significant difference only for G-CSF, IL-10 and IL-6, all other cytokines were comparable.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our study underpinned patterns of cytokine response in severe COVID-19 and MIS-C. There is a significant upregulation in pro-inflammatory cytokines (mainly G-CSF, IL-10, HMGB1, TNF-α, IL-6, IL-8 and INF-gamma). These biomarkers that could imply on the severity rating and treatment strategies, should be preferentially assessed in SARS-CoV-2 associated immunological events.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16648,"journal":{"name":"Journal of paediatrics and child health","volume":"61 2","pages":"249-261"},"PeriodicalIF":1.6,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142828858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>Testicular survival is determined largely by the duration and extent of ischemia to the affected testis. European Association of Urology guidelines state that manual detorsion should be attempted in all paediatric patients.<span><sup>1</sup></span> However, manual detorsion is infrequently performed in paediatric emergency medicine. We present a case of testicular torsion diagnosed on point of care ultrasound (POCUS) and manually detorsed by a paediatric emergency physician under nitrous oxide and POCUS guidance.</p><p>A 15-year-old presented with 3 h of right scrotal pain. Examination showed a hard, tender right testis with intact cremasteric reflex. POCUS showed edematous parenchymal change with lack of blood flow, and a small hydrocele (Fig. 1). A whirlpool shaped cord complex was appreciated, confirming torsion (Fig. 2). Urology was notified, but all operating rooms were in use. With patient and parental consent, and over an hour after POCUS diagnosis, the paediatric emergency physician performed manual detorsion with a single rotation in the medial to lateral direction under nitrous oxide analgesia. Normal arterial flow (Figs 3, 4) was demonstrated on repeat POCUS, as was absence of cord complex (Video S1). He reported an immediate decrease in pain, and within several minutes an absence of pain. POCUS immediately and 35 min after detorsion showed blood flow to the testis (Video S2).</p><p>The patient underwent radiology performed ultrasound that evening and again the following morning, both unremarkable. Orchiopexy was performed on hospital Day 1.</p><p>Scrotal POCUS performed by paediatric emergency physicians has high accuracy for the diagnosis of torsion, and can be available prior to radiology performed ultrasound.<span><sup>2</sup></span> Fentanyl analgesia and propofol sedation have both been described in PED manual detorsion,<span><sup>3, 4</sup></span> as has POCUS guided detorsion.<span><sup>5</sup></span> Our case is the first report of manual detorsion under POCUS guidance and nitrous oxide, and took only minutes to perform. POCUS before and after detorsion was immediately available and caused negligible delay.</p><p>In our case, we used inhaled nitrous oxide for analgesia and mild sedation. To prevent higher concentrations of nitrous from causing deep sedation, we recommend mask delivery for children who are able to hold the mask on their own. Deeper levels of sedation will cause the mask to fall, and the child to quickly recover. Younger children can receive nitrous oxide <i>via</i> a nasal mask, which allows entrained room air to enter from the mouth.<span><sup>6</sup></span> Additional sedoanalgesia, such as fentanyl for pain<span><sup>7</sup></span> or midazolam for mask acceptance, can be added <i>via</i> nasal atomizer but may result in deeper sedation than would be expected at a given percentage of nitrous oxide.</p><p>A younger or less cooperative child may not be able to undergo detorsion without deep sedation. Howeve
{"title":"Manual detorsion under sedation and POCUS","authors":"Eric Scheier, Barak Gold","doi":"10.1111/jpc.16742","DOIUrl":"10.1111/jpc.16742","url":null,"abstract":"<p>Testicular survival is determined largely by the duration and extent of ischemia to the affected testis. European Association of Urology guidelines state that manual detorsion should be attempted in all paediatric patients.<span><sup>1</sup></span> However, manual detorsion is infrequently performed in paediatric emergency medicine. We present a case of testicular torsion diagnosed on point of care ultrasound (POCUS) and manually detorsed by a paediatric emergency physician under nitrous oxide and POCUS guidance.</p><p>A 15-year-old presented with 3 h of right scrotal pain. Examination showed a hard, tender right testis with intact cremasteric reflex. POCUS showed edematous parenchymal change with lack of blood flow, and a small hydrocele (Fig. 1). A whirlpool shaped cord complex was appreciated, confirming torsion (Fig. 2). Urology was notified, but all operating rooms were in use. With patient and parental consent, and over an hour after POCUS diagnosis, the paediatric emergency physician performed manual detorsion with a single rotation in the medial to lateral direction under nitrous oxide analgesia. Normal arterial flow (Figs 3, 4) was demonstrated on repeat POCUS, as was absence of cord complex (Video S1). He reported an immediate decrease in pain, and within several minutes an absence of pain. POCUS immediately and 35 min after detorsion showed blood flow to the testis (Video S2).</p><p>The patient underwent radiology performed ultrasound that evening and again the following morning, both unremarkable. Orchiopexy was performed on hospital Day 1.</p><p>Scrotal POCUS performed by paediatric emergency physicians has high accuracy for the diagnosis of torsion, and can be available prior to radiology performed ultrasound.<span><sup>2</sup></span> Fentanyl analgesia and propofol sedation have both been described in PED manual detorsion,<span><sup>3, 4</sup></span> as has POCUS guided detorsion.<span><sup>5</sup></span> Our case is the first report of manual detorsion under POCUS guidance and nitrous oxide, and took only minutes to perform. POCUS before and after detorsion was immediately available and caused negligible delay.</p><p>In our case, we used inhaled nitrous oxide for analgesia and mild sedation. To prevent higher concentrations of nitrous from causing deep sedation, we recommend mask delivery for children who are able to hold the mask on their own. Deeper levels of sedation will cause the mask to fall, and the child to quickly recover. Younger children can receive nitrous oxide <i>via</i> a nasal mask, which allows entrained room air to enter from the mouth.<span><sup>6</sup></span> Additional sedoanalgesia, such as fentanyl for pain<span><sup>7</sup></span> or midazolam for mask acceptance, can be added <i>via</i> nasal atomizer but may result in deeper sedation than would be expected at a given percentage of nitrous oxide.</p><p>A younger or less cooperative child may not be able to undergo detorsion without deep sedation. Howeve","PeriodicalId":16648,"journal":{"name":"Journal of paediatrics and child health","volume":"61 2","pages":"281-283"},"PeriodicalIF":1.6,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jpc.16742","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mary P E Slack, Keith Grimwood, Elcin Tuzel, Hansoo Kim, Felicity Edwards, Kevin B Laupland
Aim
To investigate the incidence, risk factors and outcomes of Pseudomonas aeruginosa bloodstream infections (P-BSI) in Queensland children aged 0–18 years.
Methods
A retrospective data-linkage study was conducted of P-BSI identified by Pathology Queensland laboratories from resident Queensland children admitted to publicly-funded Queensland Hospitals between 2000 and 2019. We estimated age-standardised incidence of P-BSI and case fatality ratios (48 h, 7-, 30- and 90-day all-cause mortality from the date of the blood culture collection). Data on underlying co-morbidities related to the episode of P-BSI were collected from statewide databases.
Results
Overall, 297 episodes of P-BSI were identified in 265 children, with an overall incidence of 1.14 infections/100 000 child-years. The median age of children with P-BSI was 3.7 years [interquartile range 1.2–10.7 years]. Almost 90% (n = 266/297) of infections were healthcare-associated. There were 36 (36 episodes) neonates (31 preterm <37 weeks gestation), of whom 12 (33.3%) and 15 (41.7%) neonates died within 48 h and 7 days of the P-BSI, respectively. The remaining 229 (261 episodes) children were aged 1 month to 18 years, and 234/261 (89.7%) episodes were associated with underlying co-morbidities, especially haematological malignancies. Eleven, 15 and 24 of the 229 children beyond the neonatal age group died within 48 h (4.8%), 7 days (6.6%) and 30 days (10.5%), respectively of the index blood culture. Neonates, healthcare-associated hospital onset infections, cardiovascular co-morbidity, and multi-drug resistance were significantly associated with early mortality.
Conclusions
P-BSI occurs predominantly in vulnerable, hospitalised children with underlying comorbidities, especially in preterm neonates and those with haematological malignancies, and is associated with substantial mortality.
{"title":"Pseudomonas aeruginosa bloodstream infections in children in Queensland, Australia, 2000–2019","authors":"Mary P E Slack, Keith Grimwood, Elcin Tuzel, Hansoo Kim, Felicity Edwards, Kevin B Laupland","doi":"10.1111/jpc.16745","DOIUrl":"10.1111/jpc.16745","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To investigate the incidence, risk factors and outcomes of <i>Pseudomonas aeruginosa</i> bloodstream infections (P-BSI) in Queensland children aged 0–18 years.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective data-linkage study was conducted of P-BSI identified by Pathology Queensland laboratories from resident Queensland children admitted to publicly-funded Queensland Hospitals between 2000 and 2019. We estimated age-standardised incidence of P-BSI and case fatality ratios (48 h, 7-, 30- and 90-day all-cause mortality from the date of the blood culture collection). Data on underlying co-morbidities related to the episode of P-BSI were collected from statewide databases.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Overall, 297 episodes of P-BSI were identified in 265 children, with an overall incidence of 1.14 infections/100 000 child-years. The median age of children with P-BSI was 3.7 years [interquartile range 1.2–10.7 years]. Almost 90% (<i>n</i> = 266/297) of infections were healthcare-associated. There were 36 (36 episodes) neonates (31 preterm <37 weeks gestation), of whom 12 (33.3%) and 15 (41.7%) neonates died within 48 h and 7 days of the P-BSI, respectively. The remaining 229 (261 episodes) children were aged 1 month to 18 years, and 234/261 (89.7%) episodes were associated with underlying co-morbidities, especially haematological malignancies. Eleven, 15 and 24 of the 229 children beyond the neonatal age group died within 48 h (4.8%), 7 days (6.6%) and 30 days (10.5%), respectively of the index blood culture. Neonates, healthcare-associated hospital onset infections, cardiovascular co-morbidity, and multi-drug resistance were significantly associated with early mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>P-BSI occurs predominantly in vulnerable, hospitalised children with underlying comorbidities, especially in preterm neonates and those with haematological malignancies, and is associated with substantial mortality.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16648,"journal":{"name":"Journal of paediatrics and child health","volume":"61 2","pages":"241-248"},"PeriodicalIF":1.6,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Zeynep Ağırman, Fatih Temiz, Can Acıpayam, Nurten Akkececi
Aim
To evaluate endocrinological changes and insulin secretion in patients with hereditary spherocytosis (HS).
Methods
The study included 30 patients with HS and 30 healthy control groups who were of similar age and gender. Routine tests, including hemogram, biochemical and hormonal tests were conducted on both patients with HS and the control group. HOMA-IR (Homeostasis Model Assessment for Insulin Resistance) and HOMA-ß% (Homeostasis Model Assessment for ß-cell function) values of all cases were also calculated using fasting insulin and fasting glucose values.
Results
Among the patient group, 7 patients (23.3%) had short stature, 16 patients (53.3%) had vitamin D deficiency, 1 patient (3.3%) had impaired glucose tolerance, 1 patient (3.3%) had subclinical hypothyroidism, 23 patients (76.6%) had dyslipidemia and 2 patients (6.6%) had growth hormone deficiency. The insulin value in the patient group was 4.0 ± 2.7 mlU/mL and significantly lower than the control group with an insulin value of 9.1 ± 3.9 mlU/mL (P < 0.001). Moreover, glucose (P = 0.036), HOMA-IR (P < 0.001), HOMA-beta (P < 0.001) and C-peptide (P = 0.001) values of the patient group were significantly lower than the control group. The cholesterol (P < 0.001), HDL (P < 0.001) and LDL (P < 0.001) values of the patient group were found to be significantly lower than the control group.
Conclusion
We found that insulin secretion decreased in patients with HS and hypocholesterolemia occurred due to chronic hemolysis. More research is needed to elucidate the pathophysiology of decreased insulin secretion seen in HS patients.
{"title":"Evaluation of endocrine changes and insulin release in patients with hereditary spherocytosis","authors":"Zeynep Ağırman, Fatih Temiz, Can Acıpayam, Nurten Akkececi","doi":"10.1111/jpc.16744","DOIUrl":"10.1111/jpc.16744","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To evaluate endocrinological changes and insulin secretion in patients with hereditary spherocytosis (HS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The study included 30 patients with HS and 30 healthy control groups who were of similar age and gender. Routine tests, including hemogram, biochemical and hormonal tests were conducted on both patients with HS and the control group. HOMA-IR (Homeostasis Model Assessment for Insulin Resistance) and HOMA-ß% (Homeostasis Model Assessment for ß-cell function) values of all cases were also calculated using fasting insulin and fasting glucose values.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among the patient group, 7 patients (23.3%) had short stature, 16 patients (53.3%) had vitamin D deficiency, 1 patient (3.3%) had impaired glucose tolerance, 1 patient (3.3%) had subclinical hypothyroidism, 23 patients (76.6%) had dyslipidemia and 2 patients (6.6%) had growth hormone deficiency. The insulin value in the patient group was 4.0 ± 2.7 mlU/mL and significantly lower than the control group with an insulin value of 9.1 ± 3.9 mlU/mL (<i>P</i> < 0.001). Moreover, glucose (<i>P</i> = 0.036), HOMA-IR (<i>P</i> < 0.001), HOMA-beta (<i>P</i> < 0.001) and C-peptide (<i>P</i> = 0.001) values of the patient group were significantly lower than the control group. The cholesterol (<i>P</i> < 0.001), HDL (<i>P</i> < 0.001) and LDL (<i>P</i> < 0.001) values of the patient group were found to be significantly lower than the control group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>We found that insulin secretion decreased in patients with HS and hypocholesterolemia occurred due to chronic hemolysis. More research is needed to elucidate the pathophysiology of decreased insulin secretion seen in HS patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16648,"journal":{"name":"Journal of paediatrics and child health","volume":"61 2","pages":"237-240"},"PeriodicalIF":1.6,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Melda Kangalgil, Buket Meral, Buğra Kaan Tiryaki, Hilal Bayram
Aim
There is a need for population-based reference values of handgrip strength, which is an objective measurement reflecting muscle status, in the paediatric population and there is limited data on the prognostic importance of handgrip strength. The aim of the study was to establish reference percentiles for handgrip strength in healthy Turkish children and to investigate the relationship between handgrip strength and clinical outcomes in hospitalised children.
Methods
A total of 1437 healthy children and 103 hospitalised children aged 6–16 years were included in this cross-sectional study. Healthy children were used for the development of sex-specific handgrip strength centiles adjusted for age and height using the Generalised Additive Models for Location, Scale and Shape package. Reference values of age and height specific handgrip strength of children between the ages of 6 and 16 were calculated and curves were plotted. Nutritional risk was assessed in the first 48 h of hospital admission using Paediatric Yorkhill Malnutrition Score.
Results
Of the hospitalised children, 32% were at medium risk and 46.6% were at high risk of malnutrition. Lower handgrip strength was 28.2% in the hospitalised children. High risk of malnutrition and lower handgrip strength increased the length of hospital stay in all regression models.
Conclusion
The reference centiles for age- and height-specific handgrip strength, developed for the first time for Turkish children, will enable assessment and interpretation of muscle status. Lower handgrip strength is associated with longer hospital stay in hospitalised children.
{"title":"Paediatric handgrip reference curves and the relationship between lower handgrip strength and clinical outcomes of hospitalised children","authors":"Melda Kangalgil, Buket Meral, Buğra Kaan Tiryaki, Hilal Bayram","doi":"10.1111/jpc.16743","DOIUrl":"10.1111/jpc.16743","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>There is a need for population-based reference values of handgrip strength, which is an objective measurement reflecting muscle status, in the paediatric population and there is limited data on the prognostic importance of handgrip strength. The aim of the study was to establish reference percentiles for handgrip strength in healthy Turkish children and to investigate the relationship between handgrip strength and clinical outcomes in hospitalised children.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 1437 healthy children and 103 hospitalised children aged 6–16 years were included in this cross-sectional study. Healthy children were used for the development of sex-specific handgrip strength centiles adjusted for age and height using the Generalised Additive Models for Location, Scale and Shape package. Reference values of age and height specific handgrip strength of children between the ages of 6 and 16 were calculated and curves were plotted. Nutritional risk was assessed in the first 48 h of hospital admission using Paediatric Yorkhill Malnutrition Score.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the hospitalised children, 32% were at medium risk and 46.6% were at high risk of malnutrition. Lower handgrip strength was 28.2% in the hospitalised children. High risk of malnutrition and lower handgrip strength increased the length of hospital stay in all regression models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The reference centiles for age- and height-specific handgrip strength, developed for the first time for Turkish children, will enable assessment and interpretation of muscle status. Lower handgrip strength is associated with longer hospital stay in hospitalised children.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16648,"journal":{"name":"Journal of paediatrics and child health","volume":"61 2","pages":"230-236"},"PeriodicalIF":1.6,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To investigate the reliability and validity of the Greek version of the Eating and Drinking Ability Classification System (EDACS) in children with cerebral palsy (CP).
Methods
The sample of the study included children with CP, aged 3–18 years and classified into Levels I–V of the Gross Motor Function Classification System (GMFCS). Parents of children with CP and speech and language therapists (SLTs) with a minimum of 5 years of clinical experience were recruited. Inter-rater reliability (IRR) between SLTs and between SLT and parent was evaluated using intraclass correlation coefficient (ICC). Validity was evaluated by investigating the potential association between the EDACS and Communication Function Classification System (CFCS) and GMFCS, using ordinal logistic regression.
Results
One hundred twenty-one children with CP (mean age 8.2 ± 4.1), 72 males, GMFCS Levels I–V were included in the study. Ninety-one parents of children with CP (mean age 8.8 ± 4.2), 54 males and 8 experienced SLTs, assessed the eating and drinking abilities of the children. The IRR between SLTs was excellent (ICC = 0.94), and between SLTs and parents was high (ICC = 0.90). Both CFCS and GMFCS were positive predictors for EDACS.
Conclusions
The Greek version of EDACS is a valid and reliable tool and it can be used to classify eating and drinking ability in Greek children with CP.
{"title":"Cross-cultural validation in Greek and reliability of the Eating and Drinking Ability Classification System in children with cerebral palsy","authors":"Angeliki Zarkada, Rigas Dimakopoulos, Terpsithea Germani, Angeliki Zavlanou, Arietta Spinou, Helen Skouteli","doi":"10.1111/jpc.16739","DOIUrl":"10.1111/jpc.16739","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To investigate the reliability and validity of the Greek version of the Eating and Drinking Ability Classification System (EDACS) in children with cerebral palsy (CP).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The sample of the study included children with CP, aged 3–18 years and classified into Levels I–V of the Gross Motor Function Classification System (GMFCS). Parents of children with CP and speech and language therapists (SLTs) with a minimum of 5 years of clinical experience were recruited. Inter-rater reliability (IRR) between SLTs and between SLT and parent was evaluated using intraclass correlation coefficient (ICC). Validity was evaluated by investigating the potential association between the EDACS and Communication Function Classification System (CFCS) and GMFCS, using ordinal logistic regression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>One hundred twenty-one children with CP (mean age 8.2 ± 4.1), 72 males, GMFCS Levels I–V were included in the study. Ninety-one parents of children with CP (mean age 8.8 ± 4.2), 54 males and 8 experienced SLTs, assessed the eating and drinking abilities of the children. The IRR between SLTs was excellent (ICC = 0.94), and between SLTs and parents was high (ICC = 0.90). Both CFCS and GMFCS were positive predictors for EDACS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The Greek version of EDACS is a valid and reliable tool and it can be used to classify eating and drinking ability in Greek children with CP.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16648,"journal":{"name":"Journal of paediatrics and child health","volume":"61 2","pages":"223-229"},"PeriodicalIF":1.6,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jpc.16739","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142800959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tarun Nambiar, Sanskruti Zaveri, Simon Thornley, Vanessa Selak, Gerhard Sundborn, Cielo Pasay, Arthur J Morris
Aim
We sought to determine the degree of agreement between clinical and laboratory methods for diagnosing scabies in school-aged children.
Methods
Clinical information and samples were collected from children aged 7 months to 14 years attending educational institutions in Auckland, New Zealand. Two methods determined scabies status: the International Alliance for the Control of Scabies clinical criteria (IACS) and quantitative polymerase chain reaction (qPCR). Sensitivity and specificity of each method, as the reference or index standard, were estimated and agreement was determined using Cohen's kappa statistic.
Results
Sixteen of 145 children were positive based on IACS criteria and 15 of 64 with a suspicious skin lesion returned a positive qPCR test. IACS sensitivity and specificity were 66.7% (95% confidence interval (CI): 39.9–93.3) and 94% (95% CI: 89.9–98.0), respectively (with qPCR as the reference). For qPCR, sensitivity and specificity were 50% (95% CI: 25.5–74.5) and 96.9% (95% CI: 94.0–100.0), respectively (with IACS as the reference). The kappa value was 0.53.
Conclusion
Agreement between clinical and laboratory methods in the identification of scabies diagnosis was moderate. Both methods had low sensitivity but high specificity. Scabies diagnosis might be improved, thereby enhancing control measures, by relaxing the IACS criteria (as some IACS-negative participants returned positive qPCR tests, indicating mite DNA was present) and conversely supplementing clinical assessment with qPCR testing.
{"title":"Agreement between clinical criteria and quantitative polymerase chain reaction for diagnosing scabies in Auckland children","authors":"Tarun Nambiar, Sanskruti Zaveri, Simon Thornley, Vanessa Selak, Gerhard Sundborn, Cielo Pasay, Arthur J Morris","doi":"10.1111/jpc.16738","DOIUrl":"10.1111/jpc.16738","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>We sought to determine the degree of agreement between clinical and laboratory methods for diagnosing scabies in school-aged children.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Clinical information and samples were collected from children aged 7 months to 14 years attending educational institutions in Auckland, New Zealand. Two methods determined scabies status: the International Alliance for the Control of Scabies clinical criteria (IACS) and quantitative polymerase chain reaction (qPCR). Sensitivity and specificity of each method, as the reference or index standard, were estimated and agreement was determined using Cohen's kappa statistic.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Sixteen of 145 children were positive based on IACS criteria and 15 of 64 with a suspicious skin lesion returned a positive qPCR test. IACS sensitivity and specificity were 66.7% (95% confidence interval (CI): 39.9–93.3) and 94% (95% CI: 89.9–98.0), respectively (with qPCR as the reference). For qPCR, sensitivity and specificity were 50% (95% CI: 25.5–74.5) and 96.9% (95% CI: 94.0–100.0), respectively (with IACS as the reference). The kappa value was 0.53.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Agreement between clinical and laboratory methods in the identification of scabies diagnosis was moderate. Both methods had low sensitivity but high specificity. Scabies diagnosis might be improved, thereby enhancing control measures, by relaxing the IACS criteria (as some IACS-negative participants returned positive qPCR tests, indicating mite DNA was present) and conversely supplementing clinical assessment with qPCR testing.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16648,"journal":{"name":"Journal of paediatrics and child health","volume":"61 2","pages":"216-222"},"PeriodicalIF":1.6,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142800784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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