Klinische Padiatrie最新文献

Yogurt is a type of fermented milk. There is limited information on the yogurt's effect on managing cow's milk allergy. The aim of this study was to determine the factors affecting tolerance to yogurt using an oral food challenge test in children with cow's milk allergy and investigate the role of the cow's milk-specific IgE levels, cow's milk skin prick test wheal diameters, and the cow's milk-specific IgE/total IgE ratio in predicting oral food challenge outcomes in the IgE-mediated cow's milk allergy group.This retrospective study analysed the demographic and clinical features, laboratory data, skin prick tests, and the results of the yogurt oral food challenge from the children diagnosed with cow's milk allergy.Of the 132 patients included in the study, 68 (51.5%) of them were categorised asIgE-mediated, while 27 (20.5%) and 37 (28%) of them were categorised as non-IgE-mediated and mixed-type reaction groups, respectively. The findings indicated that 68.2% of the study population and 51.5% of the IgE-mediated group are associated with the cow'smilk allergy tolerated yogurt. In the IgE-mediated cow's milk allergy group, skin prick test wheal diameters, cow's milk-specific IgE, and the cow's milk-specific IgE/total IgE ratio were determined to be significantly different between patients with positive and negative oral food challenge results (p<0.05). Cow's milk-specific IgE performance contributed more to predicting any reaction and/or anaphylaxis in the yogurt oral food challenge (area under the curve: 0.831and 0.876). The ratio and the skin prick test wheal diameter performance were lower in the probability of any reaction and/or anaphylaxis in the yogurt oral food challenge.This study suggests that yogurt may be tolerated by a significant proportion of children with various forms of cow's milk allergy.

Psychological safety (PS) is essential for effective teamwork in pediatrics. However, the factors influencing PS and the challenges it poses have hardly been researched. The aim of the study is to assess the perception of PS in the interprofessional team of a pediatric oncology unit. Factors such as error culture, communication, and workload are to be analyzed.In 2024, employees (nursing and medical staff) on a tertiary pediatric oncology ward were surveyed in a digital, anonymous, pretested questionnaire. The questionnaire comprised 31 items that were evaluated using a six-point Likert scale.Response rate was 62%. The results show positive trends in communication, but challenges in workload and induction of new employees. Deficits in feedback and error culture became apparent.The findings of our study highlight the need for further research on the factors influencing PS in pediatrics. Future studies should investigate the relationships between PS, communication, and workload to better understand the complexities of team dynamics in pediatrics.Our study shows that PS is of crucial importance in pediatric oncology and can be assessed using an easy-to-use digital tool. Future research should focus on developing and evaluating interventions to enhance PS and its effects on team dynamics and patient care, with a focus on improving teamwork and job satisfaction in pediatric oncology settings, and exploring the potential benefits of PS on patient outcomes.

The management of congenital lung malformations (CLM) remains controversial. The aim of this study was to analyze the timing, approach, and outcomes of surgical treatment in children with CLM.A cohort study was conducted comparing children with CLM who underwent thoracoscopic resection with open resection via thoracotomy. All children were treated according to an institutionalized multidisciplinary coordinated treatment algorithm.Between 2002 and 2019, 68 children with CLM were treated. Thoracoscopic resection of CLM (n=44) resulted in a statistically significant longer operative time (mean 169 vs. 97 minutes, p=0.04) but shorter hospital stay (mean 7.2 vs. 16.7/12 days, p=0.01) compared to thoracotomy (n=15) or after conversion to thoracotomy (n=9). There were no major complications in either group. At a mean follow-up of 32.2 months (range 0.5-163), patients after thoracoscopic resection had statistically significantly fewer rip fusions than patients after open resection (n=0 vs. 2/2, p≤0.004) and less chest wall asymmetry than after conversion (n=0 vs. 2, p=0.004).Thoracotomy proved to be a fast and safe surgical approach in respiratory unstable CLM patients. In respiratory stable CLM patients, thoracoscopic resection was feasible in early infancy with good surgical and musculoskeletal outcomes.Thoracoscopic resection of CLM offers advantages over resection by thoracotomy in terms of surgical recovery and musculoskeletal function. Therefore, it should be offered to respiratory-stable patients in specialized centers.

In 2018, we shortened the fasting time in our clinic for clear fluid to 1 h. Since 2021 'drinking until call to the operating theatre' applies. This quality assurance study investigates whether this regulation has further shortened the fasting times and which factors influence its implementation.In this prospective observational study, a two-part anonymous questionnaire from the attending anaesthetist and the parents was completed.A total of 204 children were included in the study. The fasting time for clear fluid (median [IQR] (min-max)) was 2 [1-4.6] (0.33-22) hours and was shorter than 3 [2-7.8] (0.5-17) hours in the pre-transition period. More than 50% of the children had access to clear fluid directly at the bedside or freely available on the ward. The children's drinking behaviour showed that 54% of the children drank on their own and only 4% of the children complained of thirst. When comparing the wards there were differences with regard to the fasting time for clear fluid. There were no differences in the fasting times depending on the operating theatre position. The length of time between the informed consent consultation and anaesthesia or language barriers had a negative influence on adherence to the fasting rules.Two years after the introduction of the 'sip til send' rule there was a significant reduction in fasting times. Fasting times did not differ between operating theatre position.

Rare pediatric pulmonary diseases, such as childhood interstitial lung disease and congenital thoracic malformations, pose diagnostic and therapeutic challenges due to their low prevalence and clinical heterogeneity. In contrast to cystic fibrosis and primary ciliary dyskinesia, which are supported by dedicated care networks, many other rare pediatric pulmonary diseases lack structured management pathways. This study aimed to assess pediatric pulmonologists' clinical exposure, confidence, and educational needs related to rare pediatric pulmonary diseases. A web-based survey was distributed to all 914 members of the German Society for Pediatric Pulmonology. The questionnaire evaluated clinical experience, diagnostic confidence, and preferences for educational contents and formats. Responses were analyzed using descriptive statistics and group comparisons. Among 209 respondents (22.9% response rate), clinical exposure was low (median: 3 patients/y; interquartile range: 1-5), with 22.5% treating none. Only 36.7% of respondents felt confident in suspecting a rare pediatric pulmonary disease, 22.0% in diagnosis, and 13.3% in treatment. Educational interest was high (68.8%), particularly in clinical presentation (70.7%), treatment (69.8%), and imaging (59.0%). Clinicians with<10 years of experience reported greater interest in clinical presentation than those with≥10 years (84.5% vs. 57.3%, p=0.0002). Workshops, webinars, and online discussions were the most preferred learning formats. Despite limited exposure and low reported confidence, pediatric pulmonologists express strong interest in further education on rare pediatric pulmonary diseases. Tailored, accessible educational strategies are essential to improve awareness, diagnosis, and care for children with rare pulmonary conditions.