Klinische Padiatrie最新文献

Background: This study analyzes the RSV season 2021/2022 in a referral children's hospital, compares the epidemiology and illness severity with RSV-infected inpatients from 2016 to 2020 and audits the adherence to our internal therapy standard for RSV bronchiolitis.

Material and methods: Inpatients with rtPCR-confirmed RSV infection (Jan. 2016 to Jan. 2022).

Results: The audit comprises 306 RSV inpatients, on average 50 hospitalizations per year; in 03/2020, a rapid RSV Season-Offset was observed. In the winter season 2020/2021, no patient with RSV was hospitalized. Beginning in July, we noticed a rapid increase of RSV-admissions (most cases in Sept./Oct, duration until Dec. 2021; n=53). In 2021-2022, a significant larger share needed PICU admission (9.4% vs 3.2%, p=0.040). Adherence to the internal guidance was low; only 11.8% (n=36) of all patients received supportive treatment without inhalative or systemic medications, 37% of all patients received antibiotics.

Conclusions: This audit confirms the strong impact of public preventive measures directed against SARS-CoV-2 transmission on RSV epidemiology. Few weeks after easing public COVID-19 restrictions (summer 2021), RSV inpatient cases rapidly increased, lasting until Dec. 2021. The audit of bronchiolitis management revealed surprisingly low adherence to the internal guidance, despite a face-to-face educational session with the attending pediatricians in Oct. 2021. Low adherence resulted in an unnecessary exposure of RSV patients to systemic medications of questionable benefit including antibiotics.

Background: Chronic hepatitis B (CHB) remains an important global public health problem. Seroconversion is highly correlated with favourable long-term outcome. There is no consensus on the treatment method, onset time and duration for paediatric CHB patients. In this study, we aimed to evaluate the course of children with CHB, to determine the characteristics of the patients who developed spontaneous seroconversion and treatment indications, and to compare the effectiveness of different treatment modalities.

Patients and methods: Patients aged 1-18 years with a diagnosis of CHB were included in this study and evaluated for the development of spontaneous hepatitis B envelope antigen (HBeAg)/surface antigen (HBsAg) seroconversion and treatment modalities. The treated patients were divided into two groups according to their treatment regimen.

Results: Of the 114 patients, the median age at diagnosis was 8.4 years and median follow-up period was 5.2 years. Spontaneous HBeAg and HBsAg seroconversion developed in 18 (20.6%) of 87 HBeAg positive patients and two (1.8%) patients, respectively. Thirty-one patients were treated. The follow-up period was higher in the group with HBeAg seroconversion (p:0.005). There was no statistical difference between the patients in terms of seroconversion development and treatment status. The serum alanine aminotransferase (ALT) values at the time of diagnosis were statistically higher in treated patients.

Conclusion: HBV infection and CHB continue to be an important problem for children in our country. Consensus on the appropriate ALT ULN is needed for the treatment of hepatitis in children.

Gaucher disease is caused by mutations in the GBA1 gene, which encodes the β-glucocerebrosidase enzyme. The deficiency of this enzyme result in glucosylceramide and glucosylsphingosine accumulation, within lysosomes and resulted triggering inflammation and accumulating substrates affect multiple organ systems, causing progressive cellular damage. Evidence has shown that the accumulation of glucosylceramide in macrophages is associated with inflammatory processes, reactive oxygen species production and an imbalance between the pro-oxidants and the antioxidant reserve, resulting in oxidative stress and inflammation. The aim of this study was to compare the oxidative stress status between patients with Gaucher disease and healthy controls.Case-control study This study included 10 patients with Gaucher disease aged between 2-40 years, and 30 healthy controls. Total antioxidant capacity and total oxidant capacity parameters between these groups were compared. Although the total antioxidant capacity value of the case group was higher, it was not significant. The total oxidant capacity and oxidative stress index values were significantly higher in the patient group (p<0.05). Our study showed that oxidative stress increased in patients with Gaucher disease. The results of our study may guide the application of antioxidant treatment in Gaucher disease patients as a supportive treatment.

This guideline is concerned with measures to prevent and control the transmission of SARS-CoV-2 in primary and secondary schools, addressing school premises and all school-related activities, as well as routes to and from school.This evidence- and consensus-based S3 guideline was registered with the AWMF and developed by guideline panelists representing a broad range of scientific societies across multiple disciplines, public health and educational institutions, as well as associations of those directly affected, notably teachers, students and parents.This guideline contains recommendations on hybrid learning and cohorting of classes or students, wearing masks, measures on the way to school and in class, managing suspected cases and contact persons in schools, options for reducing aerosol concentrations in classrooms and testing strategies. In developing these, the guideline panel considered: balance of health benefits and harms, legal aspects, socio-cultural acceptability, health equity and non-discrimination, social and ecological consequences, financial and economic consequences and feasibility.

This study aimed to compare the nasal continuous positive airway pressure (nCPAP) and bi-level positive airway pressure (BiPAP) in preterm infants with respiratory distress syndrome (RDS).Preterm infants (≤32 weeks of gestation) were randomly assigned, at birth, into two study groups: nCPAP or BiPAP. Primary outcomes (surfactant administration and failure of non-invasive respiratory support within the first 72 hours), and secondary outcomes (duration of ventilation support, pneumothorax, bronchopulmonary dysplasia, patent ductus arteriosus, necrotizing enterocolitis, intraventricular haemorrhage, retinopathy of prematurity, time to total enteral feeding, length of hospital stay, and mortality) were assessed.A total of 188 preterm infants with RDS were analysed. Mean gestational age was 28.8±1.8 weeks (nCPAP) versus 29±1.9 weeks (BiPAP). There were no statistically significant differences between groups in the failure of non-invasive respiratory support (25% vs. 33%, RR: 0.74, 95% CI: 0.47-1.17) or surfactant administration (35% vs. 38%, RR: 0.92, 95% CI: 0.49-1.71). No significant differences were observed in secondary outcomes between the two groups. Subgroup analysis of infants<30 weeks yielded similar results.Although two-level CPAP theoretically offers benefits, BiPAP was not superior to nCPAP as initial support in preterm infants with RDS. This underscores the continued value of the simpler, well-established nCPAP and the need for multicentre trials involving preterm infants of varying gestational ages.

Primary ciliary dyskinesia is a rare genetic disease affecting ciliary motility and causing respiratory symptoms. Diagnosis can be done by high-speed-videomicroscopy using nasal epithelial cells (NECs) obtained via brushings. This procedure can be painful, especially for children. The use of lidocaine is proposed to reduce this pain; however, it is not clear whether lidocaine changes ciliary beating frequency (CBF) or pattern (CBP) in the subsequent high-speed-videomicroscopy. The aim of this study was to analyse the effect of lidocaine on the CBF and the CBP of differentiated, air-liquid-interface cultured NECs.NECs from healthy volunteers were obtained via brushings and cultured at the air-liquid-interface. After differentiation, lidocaine or isotonic saline (IS, control) were added apically for 1 or 5 min each and CBF (in top view of whole inserts and side views of scratched cells) and CBP (only side view) were assessed and recorded up to 150 min. CBF was computed and CBP was analysed semiquantitatively.Lidocaine as well as IS increased the CBF in the top view approach significantly compared to baseline. However, we found no significant differences between lidocaine and IS (control) treatment. Additionally, no effect of lidocaine on CBF, CBP, amplitude, inter- and intracellular coordination or transport was seen in the side view approach.We conclude that the observed CBF increase is related to the addition of liquid on the mucus layer and not by the lidocaine itself. Therefore, it seems possible to use lidocaine for nasal analgesia without impact on subsequent analysis of the ciliary motility.