International Journal of Pediatrics and Adolescent Medicine最新文献

We report a child who presented with lower limb weakness and inability to walk, laboratory confirmed severe hypokalemia with typical electrocardiogram changes, and evidence of rhabdomyolysis while on voriconazole treatment for Pseudallescheria boydii soft tissue infection. Although voriconazole is a well-tolerated antifungal agent, hypokalemia is a well-known, yet uncommon side effect associated with its use. Furthermore, hypokalemic-rhabdomyolysis has not been reported with voriconazole use alone. Maintaining the clinical suspicion about the potential association between voriconazole and hypokalemic-rhabdomyolysis can lead to prompt recognition and intervention.

Background

While Escherichia coli (E. coli) is the most common uropathogen implicated in urinary tract infections (UTIs) in children, some studies have found that there are different characteristics between different uropathogens in children. The aim of this study was to compare E. coli and non-E. coli UTIs in children with respect to their demographic data, predisposing factors, and imaging results.

Methodology

A retrospective chart review was done in children during their first admission with urine culture confirmed UTI in a tertiary care center. We divided patients into E. coli and non-E. coli groups according to urine culture results.

Results

Out of 202 children with their first admission for a culture-proven UTI, pathogens other than E. coli accounted for 24.3% of UTIs. Klebsiella pneumoniae was the most common non-E. coli pathogen, followed by Pseudomonas aeruginosa and Enterococcus species. Non-E. coli UTIs were significantly more common in male subjects, younger children, and children with a past history of UTI or who had received antibiotics prior to admission. In addition, higher rates of abnormalities on renal ultrasound and VCUG were found with non-E. coli organisms.

Conclusion

There is a significant difference in demographic and imaging findings in children with non-E. coli UTIs. These findings may impact the work-up and treatment of UTIs in the pediatric population.

Background

Excessive weight loss enhances the incidence of neonatal hypernatremic dehydration (NHD). We compared the effect of a new breastfeeding policy against an old breastfeeding policy on neonatal weight change and the incidence of NHD.

Methods

This was a QA project between two sets of breastfeeding (BF) protocols for exclusively BF newborns. Under our old BF policy, a number of neonates had a significant loss of weight after birth and were admitted to the NICU due to NHD. We implemented a new BF policy that was used when a newborn loses>5% of previously recorded weight within a 24-h interval. Two groups were compared: the preintervention group (old BF policy) and postintervention group (new BF policy). Additionally, characteristics of newborns admitted to NICU were separately compared with the subgroup of pre- and post intervention dehydration groups.

Results

Preintervention = 1320 and postintervention = 1450. Neonates with weight loss of ≥ 5% within the first 24-h time interval were higher in the postintervention group (19.7%) as compared to the preintervention group (10.2%) (P < .05). However, the number of infants diagnosed to have NHD was lower in the postintervention group (0.68%) than in the preintervention group (1.66%), (P < .03). Neonatal characteristics were comparable between subgroups of dehydration.

Conclusion

An intervention at ≥ 5% neonatal weight loss markedly reduces the incidence of NHD-associated NICU admissions.

Introduction

Adolescent pregnancy is associated to school desertion, violence, termination of pregnancy under suboptimal conditions, obstetric complications and other consequences that can put the woman's quality of life at risk and of those that surround her. The purpose of this study is to describe the situation and tendencies of adolescent pregnancies, abortions and maternal deaths between 2013 and 2016 in Ecuador.

Methods

This cross-sectional study uses secondary data from national Ecuadorian vital statistics reports of adolescents between 10 and 19 years old. The data sources used register all the births, deaths and hospital discharges in the country at both public and private health establishments. We performed a descriptive analysis of qualitative and quantitative variables.

Results

Ecuador has approximately 1.5 million female adolescents that gave birth to 256,561 newborns between 2013 and 2016, resulting in an average annual birth rate in early adolescence of 13.9 live births per 1000 and in late adolescence of 86.6 per 1000 live births.

The number of registered abortions among adolescents between 2013 and 2016 was of 19,214. The estimated annual abortion rate in late stage adolescents is 6.3 abortions per 1000 women between 15 and 19. The estimated abortion ratio for this same age group is 72.9 per 1000 live births.

Of all the adolescents that gave birth, 84.9% self-identified as mestiza, while 71.9% of Ecuador's general population identifies as such. Only 7% of the general population in Ecuador self-identifies as indigenous, while 21.6% of pregnancies come from this population. Out of all adolescents that gave birth, 57.4% of those aged 17 and over; 43% of those between 14 and 16 and 96.7% of adolescents from 10 to 13, completed the level of education for their age. There were 81 maternal deaths among this group. The maternal mortality rate for late stage adolescents is of 7.72 per 100,000.

Introduction

Celiac disease (CD) has been described before in Saudi Arabia (SA) to be at the range of 1%–2% in the general population, but the association of celiac disease and cystic fibrosis (CF) has never been described before in the Middle East.

Objectives

To describe the prevalence of the association of CD and CF in patients with gastrointestinal symptomatology in a tertiary care center.

Method

ology: A retrospective charts review of all confirmed CD and CF patients for the years 1989–2018.

Results

In a total of 391 confirmed CF patients, 74 of them (19%) had celiac screening due to their symptomatology in the form of (abdominal pain and distension, vomiting, diarrhea despite adequate pancreatic enzyme replacements, and had high antigliadin antibodies and anti-transglutaminase IgA (tTGA). Thirty-five of the 74 patients were male (47.3%, and 39 (52.7%) were female patients. The mean age at diagnosis of CD was 6.1 (3.9), and the mean age at follow up was 7 (5 years). Only 2 of the 74 patients (3%) had bowel biopsies with the typical pathological findings of CD with villous atrophy. Both patients were placed on a gluten-free diet and showed marked improvement in symptomatology and weight gain.

Conclusion

CD screening should be considered in all CF patients despite the absence of symptoms. The prevalence of CD in CF patients in SA is similar to or slightly higher than that of the general population. A further study to screen the whole CF population is needed to delineate the actual prevalence, particularly in nonsymptomatic CF.

Asthma is one of the most common causes of emergency department (ED) visits in children. Therapy delivered through a meter dose inhaler with spacer (MDI + S) is equally as effective as nebulization in mild and moderate asthma exacerbations but was not routinely prescribed in the ED at the largest tertiary center for pediatrics in the United Arab Emirates (UAE). Phase 1 of this cohort study involved a validated survey to evaluate physicians’ knowledge, attitudes and perceptions towards MDI therapy. While 62% of physicians reported that MDI + S was equally effective as nebulizers and 82% believed that they had sufficient knowledge with regard to its use, only 28% prescribed it. Perceived barriers to change of practice included: Lack of clinical practice guidelines (CPG), poor knowledge amongst nurses and physicians, caregivers’ reluctance and a difficult prescription process. Phase 2 consisted of administering the same survey after completing interventions to address the aforementioned barriers. Comparisons were made between the subgroups within phase 1 and statistically significant differences were noted with a p value < .05. The number of physicians who prescribed MDI + S increased from 28% to 41% (p value = .046). Moreover, physicians who believed that convincing parents to use MDI + S therapy would be easy, increased from 35% to 66% (p value < .0001). In conclusion, more physicians reported prescribing MDI + S in Phase 2 while concerns about barriers that exist to change in practice remained similar in both phases showing that consistent and prolonged advocacy is required to achieve long-term compliance.

Introduction

The Texas Children’s Hospital Lung Transplant Program undertook consideration of its first non-resident, non-citizen for lung transplantation in 2011.

Methods

Four referrals from the Royal Embassy of Saudi Arabia were received, and two patients were evaluated from 2011 to 2013.

Results

After a suitable candidate and family was identified, the program adopted a systematic approach to ensure that all the necessary elements of pre-transplant care, informed consent, and post-transplant care could be effectively delivered.

Conclusion

The use of hospital translation services and the development of a strong professional relationship with a well-trained pediatric respirologist in Saudi Arabia combined with an excellent early post-transplant clinical course provide lessons that may be of help to other transplant programs considering international patients as candidates for solid organ transplantation.

Background

Influenza vaccine participation in adolescents is low. Barriers to the influenza vaccine may be shared with the measles-mumps-rubella (MMR) vaccine.

Methods

We studied adolescents aged 13–17 years who participated in the National Immunization Survey-Teen between 2011 and 2017 (N = 129,200). Data were analyzed to determine whether MMR vaccination status was associated with being up-to-date on the influenza vaccination.

Results

A total of 49% adolescents received at least one dose of the influenza vaccine within the past 3 years, and 92% completed the MMR series. In multivariable analysis, not initiating or not completing the MMR series was associated with lower odds of being up-to-date on influenza vaccination.

Conclusions

Adolescents who do not initiate or complete the MMR vaccine series have lower odds of being up-to-date on their influenza vaccination. Lower influenzavaccine participation is associated with lower socioeconomic status, lack of insurance, increased time since last child visit, and higher maternal education.

Lipoblastoma is a rare benign soft tissue tumor found in infants and young children. It presents as an enlarging mass commonly observed in extremities, trunk, head and neck regions. Imaging features include a hyper-echoic mass on ultrasound, heterogonous fat density lesion on CT scan with enhancing septations and no calcification, and high T1 signal mass that drops the signal intensity on fat suppression MRI images. Total excision of such lesion is the treatment of choice, and follow-up is recommended to rule out recurrence.