Pediatrics International最新文献

Background: The implementation of the antimicrobial stewardship program (ASP) has become a standard practice aimed at optimizing antimicrobial prescriptions to prevent further development of drug-resistant organisms. However, the challenges faced in long-term care facilities (LTCFs) often present a scarcity of human resources crucial for the effective implementation of ASP initiatives. Our study was to evaluate the impact of feasible ASP in the LTCF.

Methods: A quasi-experimental study was conducted at the Tokyo Metropolitan Fuchu Medical Center for the Disabled serving as a LTCF in Japan. The pre- and post-intervention periods were from April 2013 to March 2018 and from April 2018 to March 2019, respectively. Multidisciplinary ASP, including periodic educational interventions, utilization of internal treatment manuals, pre-authorization, and prospective audit and feedback on prescribing practices, was administered by the infectious diseases team from the Tokyo Metropolitan Children's Medical Center. We compared days of antimicrobial therapy (DOT) and resistance rates between the pre- and post-intervention phases.

Results: Following the intervention, there was a noteworthy decline in the use of oral broad-spectrum antimicrobials (macrolides, fluoroquinolones, and third-generation cephalosporins), demonstrating a statistically significant level of change (p < 0.05). Throughout the study period, resistance rates of Escherichia coli and Pseudomonas aeruginosa to meropenem and levofloxacin remained largely stable, with no notable changes observed.

Conclusion: In this study, extending the expertise of antimicrobial stewardship from an adjoining acute-care facility to a LTCF was associated with a 42% reduction in the use of oral broad-spectrum antimicrobials.

Background: Clinical manifestations of Chédiak-Higashi syndrome (CHS), an autosomal recessive disorder caused by LYST gene variants, include immunodeficiency and neurologic deficits. This study investigated the effects of defective LYST on neurodegenerative features by the morphological analysis of organelles in dopaminergic neurons differentiated from induced pluripotent stem cells (iPSCs) derived from CHS patients.

Methods: iPSCs derived from CHS patients were analyzed by immunostaining with antibodies against microtubule-associated protein 2 and tyrosine hydroxylase, periodic acid-Schiff (PAS) staining, electron microscopy, and staining with a fluorescent probe to monitor autophagy.

Results: iPSC-derived neurons contained PAS-positive giant granules and lipofuscin-like granules. Electron microscopy revealed enlarged lysosomes with electron-dense granules and filament-like structures. The number and brightness of autophagosomes and autolysosomes were markedly increased in CHS iPSC-derived neurons under basal culture conditions. CHS iPSC-derived neuronal mitochondria were enlarged, polymorphic, and hypertrophic.

Conclusions: CHS iPSC-derived neurons contained abnormal organelles, including lysosomes, autophagosomes, and mitochondria, which may be related to the neurodegenerative features of CHS.

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.