Pediatrics International最新文献

Background: Bronchiolitis-associated apneas are a life-threatening complication that are observed more frequently in younger infants born premature. Although apneas associated with viral bronchiolitis are relatively common, at present there is no consensus on management.

Methods: This study was a retrospective chart review of viral bronchiolitis in children less than 2 years old, admitted to the pediatric intensive care unit (PICU) between July 1st 2020 and June 30th 2024, with at least one reported pre-hospital apnea. Electronic chart reviews were completed and documented demographics, pre-PICU clinical metrics, and PICU interventions including maximal respiratory support, caffeine use, and antibiotics. Descriptive statistics were used for demographic data, and the difference of means or Fisher's exact test was used for further data analysis of PICU outcomes.

Results: A total of 48 charts met inclusion criteria. Young age (x̄ = 97.7 days), female (n = 28, 58%), and respiratory syncytial virus infections (n = 30, 64.6%) were common presenting variables, with a history of prematurity in 33.3% (n = 16) of cases. CRP was not significantly different between infants with or without bacterial infections. There was variability in caffeine use, antibiotics, and respiratory supports utilized. There were no deaths, and the mean PICU stay was 3.9 days.

Conclusions: Our study documented wide variability in the clinical management of patients with bronchiolitis-associated apneas. Discussions around standardized care may include the initial modality for respiratory support, completion of a partial septic workup, biomarkers for bacterial infections, antimicrobial initiation, and the role of short duration caffeine.

Background: The two strongest earthquakes in Turkey for eight decades hit Kahramanmaraş province on February 6, 2023. This study aimed to determine psychiatric complaints, acute stress symptoms, anxiety, depression, and sleep characteristics in children who were treated in a tertiary inpatient pediatric unit after the earthquakes. They were evaluated in the fourth week after the earthquake.

Methods: Trauma experiences and acute stress disorders were evaluated by child and adolescent psychiatrists, sleep characteristics were examined by the Child Sleep Habits Questionnaire (CSHQ), and the anxiety and depressive symptoms were investigated using the Revised Child Anxiety and Depression Scale (RCADS). Forty-two patients aged 1-17 were included.

Results: Trauma experiences and acute stress disorder symptoms were similar for all age groups examined. There were no significant differences in RCADS or CSHQ scores based on age or gender groups. There were significant differences in RCADS scores when the children were grouped as having parental loss or not and, similarly, there were significant differences in sleep anxiety and resistance to bedtime in CSHQ between these children.

Conclusion: This research offered baseline findings about psychological outcomes after these earthquakes in child survivors, and it may provide a further basis to assess the effect of psychological interventions after earthquakes. These results may offer a foundation for suitable psychological interventions for children in developing countries.

Background: Caregivers of children with attention-deficit/hyperactivity disorder (ADHD) experience more parenting stress than do caregivers of children without ADHD. Evidence suggests that ADHD severity is positively associated with parenting stress. In adolescents, ADHD increases the risks of contracting Coronavirus disease 2019 (COVID-19) and having poor outcomes. This follow-up study explored the prospective and cross-sectional factors influencing parenting difficulties experienced by the caregivers of adolescents with ADHD during the COVID-19 pandemic.

Methods: The following data were collected at baseline (before the outbreak of the pandemic in Taiwan): caregivers' demographic characteristics, affiliate stigma, parenting stress, depressive and anxiety symptoms, perceived ADHD causes, and adolescents' ADHD, oppositional defiant disorder (ODD), depressive, and anxiety symptoms. The following data were collected at follow-up (after the pandemic): caregivers' parenting difficulties during the pandemic, depressive and anxiety symptoms, and adolescents' ADHD symptoms.

Results: Stepwise multivariate regression analysis indicated that caregivers' parenting stress and adolescents' hyperactivity and impulsivity symptoms at baseline were positively correlated with caregivers' parenting difficulties during the pandemic. Furthermore, adolescents' hyperactivity, impulsivity, and ODD symptoms at follow-up were cross-sectionally and positively correlated with caregivers' parenting difficulties during the pandemic.

Conclusion: Caregivers' parenting stress and adolescents' hyperactivity, impulsivity, and ODD symptoms should be considered when developing interventions for improving caregivers' ability to manage adolescents with ADHD, particularly in relation to self-protection, learning, life changes, daily routines, and emotional well-being.

Background: Korean infants born at 32-35 weeks gestational age (wGA) receive palivizumab prophylaxis to prevent respiratory syncytial virus hospitalization (RSVH) if they are born during the RSV season and have a sibling. The aim of this study was to evaluate the impact of using the International Risk Scoring Tool (IRST) to target prophylaxis in Korea.

Methods: The IRST includes 3 risk factors: birth 3 months before to 2 months after the RSV season starts; smokers in the household and/or smoking while pregnant; and, siblings/daycare. First, the accuracy of the Korean guidelines to predict RSVH was compared to that of the IRST using a historic dataset of 13,475 infants born 32-35 wGA. Second, a published cost-utility model was adapted using Korean-specific parameters for costs (2022) and resource use to assess the cost-effectiveness of palivizumab versus no prophylaxis guided either by the Korean guidelines or the IRST.

Results: Using the Korean guidelines identified 26.9% of RSVHs, with an area under the receiver operating characteristic curve of 0.512. The corresponding results for infants assessed at moderate- to high-risk by the IRST were 85.1% and 0.773, respectively. The incremental cost per quality-adjusted life year (QALY) for prophylaxis versus no prophylaxis was ₩29,674,102 (USD22,977) using the Korean guidelines, with a 67.0% probability for cost-effectiveness against a willingness-to-pay threshold of ₩41,655,203 (USD32,255). For the IRST, it was ₩26,265,142 (USD20,338)/QALY and 70.8% probability.

Conclusions: Adoption of the IRST in Korea would provide greater protection of the most vulnerable infants born 32-35 wGA against RSVH whilst improving cost-effectiveness.