Klinische Padiatrie最新文献

Background: COVID-19 is known to have a mild course in children, however more data on pediatric chronic kidney disease (CKD) is needed. We aimed to assess the incidence and severity of COVID-19 in pediatric CKD patients.

Methods: A questionnaire including demographics, COVID-19 history, symptoms, and vaccination status was applied to patients with CKD. We also retrospectively reviewed the presentation and outcomes of SARS-CoV-2 infection in this patient group from March 2020 to December 2021.

Results: 220 patients were included, 48 were found to have experienced COVID-19. There was no significant difference regarding age, gender, underlying kidney disease, CKD stage, dialysis status, type or number of immunosuppressive medications, and glomerular filtration rate between patients with and without COVID-19. Most were infected by a household member (43.8%) and during outpatient or inpatient care (18.8%). Four (8.3%) were asymptomatic, and 43 (89.6%) had mild infection. Severe COVID-19 was observed in only one patient. Eleven (22.9%) patients with COVID-19 were previously vaccinated. Acute kidney injury was detected in 4 (8.3%); as stage 1 in all. Median follow-up after COVID-19 was 4.6 months. All patients fully recovered, and no renal disease flare or death was observed.

Conclusions: Although the vaccination rate was low in our cohort, the majority of the children with COVID-19 showed a mild course. Along with the vaccination, general precautions seemed to be successful for this population.

Midwives as well as medical doctors may carry out the initial examination of a newborn after birth in accordance with German health care regulation and guidelines. However, it is unclear which profession based on which qualification is performing these examinations in current clinical practice.The aim of the study was to assess which professions are carrying out the initial examinations of a newborn in the largest German maternity hospitals as of today.University maternity hospitals and maternity hospitals with more than 2000 births in 2021 were asked to anwer a webbased questionnaire. A chi-square test was used for group comparisons.77 out of 111 contacted maternity hospitals participated. In total, five different professions carry out Apgar scores and the initial neonatal examinations in a healthy newborn in the largest German maternity hospitals. In 92% of maternity hospitals, midwives regularly collect Apgar scores. In most hospitals, initial examinations of the newborn are also regularly carried out by midwives (74%), but significantly less often than Apgar scores (p≤0,001). University and non-university maternity hospitals do not differ significantly in the rate at which midwives performed Apgar scores (93.9% vs. 90.9%, p=0.623) and initial examinations of the newborn (72.7% vs. 75%, p=0.822).Midwives are the predominant medical profession carrying out initial examinations of the newborn in German maternity hospitals as of today. Thus, they should also be the primary target group for quality assurance and quality improvement measures for these examinations in in the future.

Background: Traumatic subdiaphramatic perforation of esophagus or stomach in neonates represents a rare clinical complication following the insertion of a gastric tube and is associated with high morbidity and mortality. The aim of the present study was to evaluate whether the angle of the gastric tube depicted on a plain radiograph may serve as a diagnostic tool to predict subdiaphragmatic traumatic (or iatrogenic) perforation.

Patients and methods: Thoraco-abdominal radiographs of 128 preterm and term neonates without perforation and 15 neonates with perforation of the esophagogastric junction or the stomach were retrospectively analysed.

Results: The angle of the gastric tube increases with postnatal age (p=0.0380). In the control group, the angle of the gastric tube varied between 13° and 48° (median: 31°), whereas the values ranged from -31° to 42° (median: 11°) in neonates with subdiaphragmatic perforation. Perforation should thus be suspected in cases with an angle of<20° (sensitivity: 93.3%; specificity: 91.4%). Moreover, an unusual localization of the tip beyond the gastric bubble is highly indicative of perforation.

Discussion: The present study emphasizes the importance of verifying the correct course of an inserted gastric tube.

Conclusions: In daily clinical practice, an angle of<20° should be followed by thorough physical examination, abdominal ultrasound and if applicable contrast medium examinations to exclude perforation.

Renal artery involvement (RAI) can cause renovascular hypertension and/or organ dysfunction in Takayasu arteritis (TA). The literature includes few data regarding renal involvement in pediatric-onset TA patients. We aimed to describe the renal characteristics, management, and outcomes in TA patients with RAI.We retrospectively reviewed the clinical, laboratory, and radiological findings, treatments, and outcomes in TA patients with RAI, diagnosed between 2008 and 2022.Nine of 20 pediatric-onset TA patients had RAI; their median age was 14.7 (13.1-15.5) years. Five patients had bilateral RAI. Six patients presented with hypertension, 2 of which as hypertensive emergency. Five patients had proteinuria (median urine protein/ creatinine ratio: 1.75 mg/mg), one patient had microscopic hematuria. Kidney size asymmetry was detected in 5 patients. The median duration of follow-up was 35 months (22-45). All patients received steroids, and TNF-α and/or IL-6 inhibitors. One patient underwent percutaneous transluminal angioplasty (PTA), 2 patients underwent thoraco-abdominal aortic and aortorenal bypass. At last visit there was no progression in renovascular findings in 75% of the patients, and all patients had an eGFR>60 ml/min/1.73m².Hypertension, proteinuria, and kidney size asymmetry can accompany a substantial number of pediatric-onset TA patients with RAI. Prompt initiation of treatment, including PTA or surgery, result in good mid-term renal outcomes.

Functional dyspepsia (FD) is common in children and refers to discomfort in the epigastric/duodenal region, which cannot be explained by structural or biochemical abnormalities. Since the pathophysiology is still not fully understood, no guidelines in terms of treatment do exist.The aim of this study was to compare the therapeutical effect of plant extracts (STW-5) and acupressure in children with functional dyspepsia.This is a randomized, double-blind placebo-controlled trial. Before and after the allocated intervention of four weeks, participants had to fill in a cross-cultural validated questionnaire consisting of 52 questions to assess quality of life, as well as the extent of their discomfort (using a standardized visual analog scale (VAS)).33 patients were included in the study: 12 male and 21 female with an average age of 12.09 years (range: 7-17 years). Symptoms improved after four weeks of intervention in most treatment-groups: By 68% in children, who received STW-5, by 40% in the wristband (WB)- group and by 35% in the wrist-band-Placebo-group (WBPL). Patients receiving STW-5- Placebo showed even an increase of symptoms.This double-blind, placebo-controlled pilot study showed, that STW-5 and/or anti-nausea wristbands are a cheap and effective option to treat children and teenagers suffering from functional dyspepsia.

The prevalence of childhood hypertension is steadily increasing, and there is growing evidence that dysbiosis of the gut microbiota plays a role in this process. This study compares the gut microbiota of children with primary hypertension to that of normotensive controls.This case-control study included 20 children with primary hypertension and 20 normotensive children matched for age, gender, and BMI. Exclusion criteria were the presence of chronic diseases other than hypertension, recent antibiotic use, and active infection. Stool samples were analyzed using 16S rRNA sequencing. Statistical analyses included Student's t-test, Mann-Whitney U test, and FDR correction.Microbial richness was significantly reduced at all taxonomic levels in hypertensive patients. However, there were no significant differences in alpha and beta diversity indices between the groups. Levels of Bacteroidetes and Firmicutes were lower in patients, while the Firmicutes/Bacteroidetes ratio was increased (p<0.05).Changes in gut microbiota composition were observed in children with hypertension compared to the control group. These findings may enable the development of microbiota-based diagnostics and personalized treatments, and open the way for preventive approaches by identifying individuals at risk for chronic diseases.