Pediatrics International最新文献

Background: This study investigates the reduction rate and failure predictors of hydrostatic enema reduction for intussusception. The procedure typically begins with a water-soluble contrast medium at 90 cm above the patient, subsequently elevated to 120 cm. Our focus is on the reduction rate during initial attempts when the contrast medium is positioned at or below 120 cm from the patient.

Methods: Hydrostatic enema reductions for intussusception, performed between March 2010 and May 2022 at Tokyo Metropolitan Children's Medical Center, were investigated retrospectively. The initial attempts involved one or more trials. The clinical characteristics, treatment modalities, and outcomes were analyzed. Logistic regression was used to identify the predictors of failure when the reduction was performed with the water-soluble contrast medium at a height of 120 cm or less.

Results: Reduction was achieved successfully with the water-soluble contrast medium at a height at or below 120 cm in 77.5% of 351 patients. When reductions performed at heights greater than 120 cm were included, 333 (94.9%) were successful during the initial attempts and were unaccompanied by complications. Predictors of failure of reductions performed at or below 120 cm were age less than 12 months and the presence of trapped fluid.

Conclusion: The present study found a successful reduction rate of 77.5% during the initial attempts, suggesting that a height greater than 120 cm may yield an even greater success rate. Children aged below 12 months and those with trapped fluid may have a greater failure risk during the initial attempts.

Background: Pediatric inflammatory bowel disease (PIBD) subtypes are classified according to the PIBD-classes criteria, comprising 23 items. These criteria were later simplified to 19 diagnostic items. Inflammatory bowel diseases (IBDs) are classified as ulcerative colitis (UC), atypical UC, IBD-unclassified (IBD-U), Crohn's disease (CD), or isolated colonic CD. This study aimed to validate the simplified PIBD-classes criteria in an Asian population and evaluate IBD-U characteristics.

Methods: Patients diagnosed with PIBD between 2007 and 2022 were retrospectively enrolled. Data regarding PIBD phenotypes, age at diagnosis, endoscopic and pathological findings, and biologics and/or steroid use were collected from medical records. Physician-assigned diagnoses were compared with simplified PIBD-classes criteria-based diagnoses. Differences in the clinical features of patients with IBD-U and other IBDs classified using the simplified PIBD-class criteria were also evaluated.

Results: Eighty-six patients were included, of whom 54 (63%) had UC, 21 (24%) had CD, and 11 (13%) had IBD-U. Using the simplified PIBD-classes criteria, 48 (56%) patients were diagnosed with UC, 3 (3%) with atypical UC, 22 (26%) with CD, 1 (1%) with isolated colonic CD, and 12 (14%) with IBD-U. The diagnoses were changed in 10 cases based on the simplified PIBD-classes criteria. There were no significant differences in age at diagnosis or rates of steroid and biologic use between IBD subtypes.

Conclusions: Simplified PIBD-classes criteria-based diagnoses matched physician-assigned diagnoses in almost all cases. This study suggests that the simplified PIBD-classes criteria are useful at reducing diagnostic variability in multicenter and international PIBD studies.

Background: The incidence of dysnatremia in children with acute gastritis/gastroenteritis varies, and factors associated with either dysnatremia or hyponatremia at presentation have not been identified clearly.

Methods: This retrospective study included patients aged 1 month to 18 years hospitalized for community-acquired acute gastritis/gastroenteritis from January to October 2016. Factors associated with dysnatremia at presentation were identified using multivariable analysis.

Results: Among the 304 children included, the median age was 2.2 (1.0, 4.2) years. The incidence of dysnatremia at presentation was 17.1% (hyponatremia 15.8%; hypernatremia 1.3%). Patients who had moderate (p = 0.03) and severe dehydration (p = 0.04) and presented with vomiting and diarrhea simultaneously (p = 0.03) were associated with dysnatremia at presentation. Patients presented with vomiting and diarrhea simultaneously was associated with hyponatremia at presentation (p = 0.02).

Conclusions: Dysnatremia was common in children with acute gastritis/gastroenteritis. Moderate to severe dehydration and the presence of vomiting and diarrhea simultanously were significantly associated with dysnatremia at presentation. Furthermore, presenting with vomiting and diarrhea silmutaneously was associated with hyponatremia at presentation. Serum electrolytes should be monitored in patients with those conditions.

Background: Recently, while the overall survival rate of childhood cancer has improved, research has highlighted a high incidence of comorbidities in childhood cancer survivors (CCSs). However, it is likely that many asymptomatic comorbidities go unnoticed. The purpose of the current study was to identify comorbidities unique to Japanese CCSs through comparisons with a general population that underwent comparable comprehensive medical checkups.

Methods: The patient group included CCSs who had completed their cancer treatment, were aged 16 years or older, and underwent the comprehensive medical checkups at the University of Tsukuba Hospital between 2018 and 2020. The control group included members of the general population who underwent comprehensive medical checkups at the same hospital in 2018.

Results: Seventeen CCSs and 59 controls were included. Among the CCSs, the median ages at medical checkup and diagnosis were 22.1 years (range, 16-39) and 8.7 years (range, 1.3-14.8), respectively. Incidence of abnormalities in respiratory function, hearing function, and body mass index was higher in CCSs (52.9%, p = 0.013; 17.6%, p < 0.001; and 41.2%, p = 0.080, respectively) compared with controls.

Conclusion: Asymptomatic pulmonary dysfunction was detected in the comprehensive medical checkup as a unique comorbidity in CCSs. Because the odds ratio of mortality due to respiratory failure is high in CCSs, as previously reported, we believe that detection of pulmonary dysfunction and the promotion of a healthy lifestyle are important. The evaluation of the pulmonary function may not typically be included in routine clinical visits, but it could be necessary for comprehensive medical evaluation in CCSs.

Background: We aimed to compare the clinical features and severity of the Omicron and Delta variant infections among children hospitalized for coronavirus disease 2019 (COVID-19).

Methods: Children 12 years old or less hospitalized for COVID-19 across five hospitals between January 1, 2021 and March 31, 2022 were identified using the state's pediatric COVID-19 registry. Delta and Omicron-infected patients without previous COVID-19 infection, COVID-19 vaccination, or co-infections were propensity-score matched 1:1 to control for differences in baseline characteristics. Clinical manifestations, treatments, and outcomes were analyzed. Disease severity was assessed using an adapted WHO ordinal scale.

Results: Of the initial 1367 patients, 668 had Delta infection and 699 had Omicron infection. Propensity-score matching produced 558 matched pairs. Patients with Omicron infection were more likely to present with croup (the odds ratio, OR, was 10.87, with a 95% confidence interval, CI, ranging from 2.54 to 46.59), lower respiratory tract infection (OR 2.32, 95% CI, 1.48-3.64) and seizures (OR 8.39, 95% CI, 5.04-13.99) compared with those with Delta infection. Omicron was associated with increased odds of moderate/severe disease (OR 6.14, 95% CI, 4.72-7.99) and a greater need for intravenous fluid therapy (OR 6.00, 95% CI, 4.29-8.39), corticosteroids (OR 3.08, 95% CI, 1.66-5.72), empirical antibiotics (OR 1.70, 95% CI, 1.10-2.64), and low-flow nasal oxygen therapy (OR 3.68, 95% CI, 2.17-6.22) in comparison with Delta.

Conclusion: Children hospitalized with Omicron infection demonstrated a distinct clinical profile compared to those with Delta infection, with increased likelihood of moderate/severe disease and higher utilization of health-care resources.