Pediatrics International最新文献

Background: Alarm therapy is the recommended first-line treatment for nocturnal enuresis (NE). This study aimed to investigate the effectiveness of alarm monotherapy, identify predictors of treatment success, and examine factors contributing to self-discontinuation in Japanese patients with NE.

Methods: We retrospectively analyzed the treatment course of 112 patients with NE who received alarm monotherapy between January 2017 and September 2024. The primary outcome was the predictors of treatment effectiveness, and the secondary outcome was factors contributing to self-discontinuation of alarm therapy.

Results: At 3 months after initiating alarm monotherapy, treatment was effective in 49 patients (≥50% reduction in NE), while 41 showed poor response (<50% reduction in NE), 10 switched to pharmacotherapy, and 4 self-discontinued alarm therapy. By 6 months, only 9 of 41 patients who had shown poor response at 3 months achieved an effective outcome, while 11 self-discontinued alarm therapy. No factors predicting effectiveness were identified in the per-protocol analyses. During the entire study period, 30 patients self-discontinued alarm therapy, with 12 citing reluctance to wear the device. Refusal and self-discontinuation rates were higher among patients with daytime urinary incontinence (DUI) (p = 0.006), developmental disabilities (p = 0.004), no prior NE treatment (p = 0.011), and ineffective treatment at 3 and 6 months (p = 0.001 and 0.045, respectively).

Conclusions: Alarm monotherapy can be recommended for any patient as no factors predicting effectiveness were identified. However, patients with no prior treatment, DUI, neurodevelopmental disorders, or ineffective alarm therapy may struggle to continue treatment with alarm monotherapy.

Background: Patient care ownership (PCO) has become of great concern in worldwide physician training and the National Center for Child Health and Development (NCCHD) in Japan. There are only a few reports on PCO in Japan. We previously reported work time reduction and mental improvements in relation to implementing shiftwork and work style reform at the NCCHD. This study aimed to measure the baseline of PCO and explore the relationships between PCO and mental well-being and work conditions in pediatric training at the NCCHD.

Methods: We conducted questionnaire-based cross-sectional surveys of 15 pediatric trainees soon to complete their training in March 2024 and 42 ongoing pediatric trainees in September 2024. Data were obtained regarding demographics, work conditions, the Center for Epidemiologic Studies Depression Scale (CES-D), Maslach Burnout Inventory (MBI), and the Japanese version of the Patient Care Ownership Scale (J-PCOS).

Results: The response rate for each survey was 100% (15/15) in March 2024 and 81% (34/42) in September 2024. The mean J-PCOS scores were 5.4 in the former and 5.3 in the latter survey. The combined analyses of these data indicated that J-PCOS was significantly associated with compliance with daytime off before nightwork (β, 0.6-0.7) and the personal accomplishment subscale of MBI (correlation coefficient, -0.34; β, -0.1).

Conclusions: Shiftwork, mental well-being, and PCO might be positively related to one another. A feeling of accomplishment, or a sense of meaning in work, can be a target of intervention to enhance PCO while promoting trainees' well-being.

Objectives: Point-of-care ultrasound (POCUS) requires technical expertise, making quality assurance (QA) a major challenge. We evaluated POCUS utilization and quality in the pediatric emergency department of the National Center for Child Health and Development (NCCHD).

Methods: We retrospectively reviewed patients aged <18 years who underwent POCUS or radiology-performed ultrasound (RADUS) between June 2023 and May 2024. We mainly evaluated POCUS metrics-image storage, documentation, protocol-specific appropriate storage, and diagnostic delays-and compared them across provider categories and scanning protocols. Diagnostic delay cases were additionally reviewed.

Results: Of 2004 patients, 1683 underwent POCUS and 384 RADUS. For POCUS, the rates of overall image storage, documentation, protocol-specific appropriate image storage, and diagnostic delay were 97.4%, 83.6%, 90.8%, and 0.4%, respectively. Documentation rates were significantly lower among nondedicated physicians than among pediatric emergency medicine (PEM) physicians and fellows (both p < 0.01); their protocol-specific appropriate image storage rate was also significantly lower than that of PEM fellows (p = 0.03). Across scanning protocols, the rates of documentation and protocol-specific appropriate image storage differed significantly (both p < 0.01). Among six diagnostic delays, two resulted from acquisition errors, two from interpretation errors, and two from early scans in the disease course; four of these six delays involved the abdominal emergency screening protocol.

Conclusion: This study identified challenges in POCUS implementation at NCCHD, including quality gaps among nondedicated physicians, the need for clearer follow-up in early presentations, and the importance of protocol design aligned with clinical indications. Sharing QA practices may help refine POCUS strategies for diverse pediatric emergency settings.

Background: A target unplanned extubation (UE) rate of <1/100 ventilator days has been recommended. Our hospital has 21 NICU beds (12 beds in NICU 2 and 3 for extremely low birth weight [ELBW] infants). In 2020, we experienced an abrupt UE increase, leading to the initiation of the Stop UNplanned eXtubation (SUNX) project. At that time, UE rate was 1.30/100 ventilator days. The aim of the SUNX project was to keep the low UE rate.

Methods: We collected data on UE rates from April 2019 to March 2024. The intervention was implemented through Plan-Do-Study-Act cycles. Cause analysis with the Pareto chart led to the drivers, we had to deal with: judicious use of sedations, Endotracheal tube (ETT) tape loosening, and stuff number during infant care. Additionally, we did simulation training for sudden SpO₂ decrease and UE event review. We also gathered data about ELBW infant admission and their NICU stay.

Results: The UE rate in total NICU was kept lower than 1/100 ventilator days after the intervention. After our intervention, we found no special cause variation. It meant that our intervention was not statistically significant. However, our intervention gradually penetrated into the NICU daily practices; judicious use of sedation, ETT tape template, body position change by two nurses, UE event review, and so on. We continued a systematic approach to preventing UE.

Conclusions: Although abrupt UE increase in 2020 might be a special cause variation, SUNX activities brought us systematic approach for UE prevention.

Background: Sleep and sleep habits in children are important in terms of bio-psycho-social aspects. The aim of this research was to develop a new scale under the name of the evaluation of sleep and sleep habits of children aged 6-12. 600 children aged 6-12 years constituted the sample of the study.

Methods: The parents of the children were asked to answer the question list in the sleep habits scale of 6-12-year-old children, in which sleep and sleep habits were evaluated, which was formed by the socio-demographic information from an expert opinion by the research team. To examine the reliability of the scale based on internal consistency, Cronbach and Omega alpha coefficients were calculated, and test-retest analysis and criterion validity were performed to determine the stability of the scale and whether it could make consistent measurements over time.

Results: In the correlation coefficient used as a test-retest reliability method, there were moderate and high levels of positive and significant correlations between the scores obtained from the first and second applications. According to the criterion validity findings, a moderately positive and significant relationship was found between the scores obtained from the overall sleep habits scale and the scores obtained from the overall child sleep habits questionnaire (r = 0.61; p < 0.01).

Conclusion: These results showed that the 6-12 age child sleep habits scale, which is a parent-reported scale, is a valid and reliable new scale that can evaluate sleep and sleep habits of children and screen for potential sleep problems.