International Journal of Pediatrics and Adolescent Medicine最新文献

Umbilical catheterization is commonly used as a route to provide medications and fluids to the neonates as well as for blood sampling and continuous monitoring. Although the rupture of umbilical catheters is considered as a rare, preventable complication, it has been reported several times in the literature. Healthcare providers need to be cautious with catheter placement, maintenance, and removal to prevent such a complication.

Hereby, we review the literature about this complication after presenting two incidents of umbilical venous catheter rupture in two separate patients in our neonatal ICU. One was removed easily through the umbilical stump, whereas the other required surgical exploration.

Objective

Influence of nuchal umbilical cord tension in a newborn on the developmental outcome at the end of the first year.

Methods

and subjects of research: The research is prospective, conducted in northern Bosnia and Herzegovina (Una Sana Canton), for a period of five years. In the research study, we included newborns with a nuchal cord (tight and loose) and newborns without a nuchal cord (control group). We were tracking and recording the Apgar score and the conventional cardiotocography (CTG) findings in both groups. The development of newborns was monitored by the Munich Functional Scale and the development was evaluated at the end of the first year of life.

Results

Statistically, there was a significant presence (P< .001) of Apgar score lower than 7 in newborns with nuchal cord concerning the control group. There were significantly lower Apgar score findings in newborns with a tight nuchal cord compared to ones with a loose nuchal cord (P<.001). Pathological cardiotocographic findings were monitored and the statistical significance in neonates with a nuchal cord concerning the control group. Cardiotocographic data in a neonatal group with tight nuchal cord were statistically significantly lower concerning cardiotocographic data in neonates with a loose nuchal cord (P<.001). Infants at the age of 1 year born with tight nuchal cord were found to have a significant developmental delay compared to those born with loose nuchal cord and control group (P<.001).

Conclusion

The nuchal cord is the risk factor for later developmental deviation. Early diagnosis of the nuchal cord, especially tight cord around the neck (nuchal cord), is important for the prevention of later morbidity.

Background and Objectives

For preterm infants, breastmilk plays an important role in their development, but mothers encounter a number of barriers to breastfeeding. The aim of this study was to investigate breastfeeding prevalence in preterm infants and to examine factors that may face mothers when starting to feed at-breast and their impact on the result.

Methods

Women (N = 79) with preterm infants (N = 84) were interviewed within the follow-up program in Latvia during a six-month period in 2018 using the original study protocol.

Results

61.9% infants were breastfed and 38.1% were not. The median infant birth weight in breastfed group was 1730 g, the median duration of tube feeding 21 days. The median age when started to feed at-breast 33 days. Later only 40.4% infants were still feeding at-breast. A relationship was found between breastfeeding and the mother’s confidence during pregnancy that she would breastfeed (P < .05). 98% mothers who began to feed at-breast, during pregnancy were confident that they would breastfeed. 54.2% women who started to breastfeed as success mentioned medical staff training, 29.2% family support.

The median birth weight in the non-breastfed group was 1494 g, the median duration of tube feeding 21 days. 50% women who did not begin to breastfeed had not received enough information about breastfeeding; 17.2% during pregnancy were not confident that they would breastfeed. 38.7% women stated infants’ inability to suckle as failure, 22.6% thought they had no milk. Mothers under 32 years were more likely not to breastfeed their infant (OR = 0.8, 95% CI 0.33–1.96).

Conclusion

Most mothers began to breastfeed immediately, less than half continued later. Women did not receive enough family support. Young maternal age was associated with decrease in breastfeeding. Mothers with higher education were more likely to breastfeed. Being born extremely preterm and very preterm were associated with the least chance of being breastfed.

Urinary tract infection (UTI) is the most common bacterial disease in childhood worldwide and may have significant adverse consequences, particularly for young children. In this guideline, we provide the most up-to-date information for the diagnosis and management of community-acquired UTI in infants and children aged over 90 days up to 14 years. The current recommendations given by the American Academy of Pediatrics Practice guidelines, Canadian Pediatric Society guideline, and other international guidelines are considered as well as regional variations in susceptibility patterns and resources. This guideline covers the diagnosis, therapeutic options, and prophylaxis for the management of community-acquired UTI in children guided by our local antimicrobial resistance pattern of the most frequent urinary pathogens. Neonates, infants younger than three months, immunocompromised patients, children recurrent UTIs, or renal abnormalities should be managed individually because these patients may require more extensive investigation and more aggressive therapy and follow up, so it is considered out of the scope of these guidelines. Establishment of children-specific guidelines for the diagnosis and management of community-acquired UTI can reduce morbidity and mortality. We present a clinical statement from the Saudi Pediatric Infectious Diseases Society (SPIDS), which concerns the diagnosis and management of community-acquired UTI in children.

The “trainee in difficulty” (TID) can have multiple causative factors which can impact the delivery of an expected standard of skill sets. The communication and interpersonal skills in Emergency Department (ED) setting are key to any trainee’s performance in an ED environment where team playing is a major factor in achieving safe and holistic care for patients. Trainer or a young faculty member responsible for the training may not have the emotional intelligence or experience to deal with all the issues faced by the TID. This paper talks about the difficulties faced by an experienced trainee in difficulty, who has changed his career from an experienced ED nurse to a trainee registrar in Emergency Medicine. The second case study is about a young emergency medicine residency program director who fails to appropriately address a trainee’s situation and compounds the trainees’ issues. The effect of honest, transparent communication of an educational supervisor and setting clear goals for the TID can have a huge impact on trainees’ performance. A residency program director’s inexperience and poor skills to deal and escalate the trainee’s issues may jeopardize a young physicians’ career.

Foreign body (FB) ingestion is very common in the pediatric population. Children will have different presentations based on their age, size, type, and site of the ingested FB. Some children can present with serious complications, others can be completely asymptomatic.

An eleven-month-old male child, previously healthy, was following up with the family medicine department for a routine visit. A pelvic x-ray was done to rule out developmental dysplasia of the hip, and a needle was found incidentally in the small bowel loops. The child was completely asymptomatic. Daily radiographs were taken three days in a row and showed that the needle was still in place. The patient was then referred to the pediatric surgery department for laparoscopic exploration and removal of the needle before complications occur. During exploration, the needle was found at the root of the mesentery. The needle was taken out uneventfully without the evidence of perforation.

It is unusual to find a sharp FB located at the root of the mesentery in a completely asymptomatic infant as an incidental finding. Serial radiographic images after the initial presentation of foreign body ingestion is important to guide us through surgical intervention.

Background and Objectives

The hereditable nature of type 1 diabetes mellitus (T1DM) makes it a condition that is in some cases shared among siblings. Studies that focus on the epidemiology of T1DM among siblings are scarce. The primary focus of the study is to estimate the prevalence of familial T1DM among siblings and the secondary focus is to identify the presence of any special clinical or biochemical characteristics specific to this entity.

Methods

In a retrospective cross-sectional study, the charts of 308 children (>1 year) diagnosed with type 1 diabetes mellitus in a Saudi tertiary care setting were reviewed. The patients who have one sibling or more with T1DM were included. The prevalence of familial T1DM among siblings was calculated, and specific clinical and biochemical characteristics were investigated. Data were analyzed using Statistical Package for the Social Sciences software version 22 (IBM SPSS Statistics for Windows). The control group includes all patients with type I DM who were excluded for sibling with DM.

Results

The prevalence of familial T1DM among siblings was estimated at 15.9%. Seventy-four percent of the patients with a positive family history of diabetes mellitus had one affected sibling only. The clinical presentation showed no significant differences relative to the age of presentation, gender, parental consanguinity, diabetic ketoacidosis at presentation, and its number of episodes. For the biochemical characteristics, autoantibody tests revealed no statistically significant difference, but the mean initial HbA1c levels were lower in patients who had diabetic siblings.

Conclusion

The prevalence of familial T1DM was found to be higher than that reported in other studies. No specific clinical or biochemical features were found to characterize familial T1DM among siblings.

Introduction

Breaking bad news to caregivers of children with (CKD) [I can’t comment in the box] Title says to breaking bad news to children but in here, breaking bad news to caregivers. Please clarify and edit accordingly. is an important role of nephrologists. In our practice there has been a thought about parental dissatisfaction from breaking bad news to CKD patients. Caregiver’s preferences on how to be told the bad news in CKD children has not been studied adequately. Our objective was to identify how much is the emotional and knowledge satisfaction of CKD caregivers and the relation of their socioeconomic and educational levels with their preferences in breaking bad news.

Methods

A questionnaire based study was conducted for caregivers of CKD children, in the outpatient clinics, and peritoneal dialysis and hemodialysis units at the King Faisal Specialist Hospital and Research Centre for three months.

Results

83 questionnaires from caregivers of CKD patients age (1–14) years, mean age of 8.5 ± 3.9 years. (47.6%) were emotionally very satisfied, 29.5% were very satisfied about the knowledge they had.

Conclusion

Caregivers of CKD patients are satisfied emotionally more than the satisfaction about the amount of information they got. Different demographic data might affect their preferences in the way of receiving the bad news. The dissatisfaction suggesting that physicians’ communication skills needs improvement.

Background

Following the inception of video games and the subsequent development of progressive innovations in videogame technology, many reports of videogame-related dermatologic conditions soon emerged in literature. Children and adolescents, in particular, are among the most avid consumers of online digital entertainment.

Methods

In an effort to better detail the impacts of these cutaneous manifestations and provide recommendations for injury prevention as it relates to video games, we performed an extensive systems-based literature review pertaining to the clinical features, etiology, diagnosis, and treatment of reported cases of dermatoses resulting from the misuse of video games.

Results

A literature review using PubMed, SCOPUS, Ovid MEDLINE and EMBASE was performed. Hardware implicated in the reported cases include video games consoles, personal computers, laptop computers, mobile phones and tablets. The dermatologic conditions are primarily localized to the extremities, particularly the palms and fingers. The majority are associated with repetitive friction and trauma, as well as allergic contact sensitivities. For all cutaneous manifestations induced by video gaming, early recognition and removal of the offending agent was most often described as effective in symptom resolution.

Conclusions

The universal use and pervasive popularity of video games for recreational purposes present an emerging dermatological concern. As videogames become increasingly advanced and immersive, various cutaneous conditions arising from intensive gaming will likely become common over time. Consequently, it is critical that dermatologists consider video games with a high index of suspicion when encountering dermatological ailments in underage patients engaging in persistent gaming behavior.

Background

Initiation or withholding life support at birth on infants born prematurely near the limit of viability is not an easy decision, with wide variation in practice around the world. Our aim was to review the outcome of preterm infants born near the limit of viability at 23–25 weeks gestation in our institution, with regard to resuscitation decision, survival, and major outcome measures.

Methods

We included all live newborn infants born prematurely at 23–25 weeks gestation at King Faisal Specialist Hospital and Research Centre from January 2006 to December 2015. We collected data on resuscitation decisions, survival, and major neonatal morbidities such as severe brain injury, severe retinopathy of prematurity, and bronchopulmonary dysplasia.

Results

Between January 1, 2006 and December 31, 2015, 97 infants with a gestational age (GA) of 23–25 weeks gestation were admitted; 23, 42, and 32 infants were born at 23, 24, and 25 weeks gestation, respectively. At 23 weeks gestation, full support was initiated in 87% of patients and later on support was withheld in 17.4% of patients, finally 13% of patients survived to discharge. At 24 weeks, full support was initiated in 97.6% of patients, then withheld in 7.1% of patients, and ultimately 59.5% survived. At 25 weeks, full support was initiated in 93.8% of patients, then withheld in 15.6% of patients, and ultimately 62.5% survived. In terms of survival with and without the three major neonatal morbidities, at 23 weeks gestation, no infant survived without any morbidity as compared to 7.1% and 28.1% at 24 and 25 weeks, respectively. The incidence of survival with 1 major morbidity was 8.7%, 30.9%, and 34.4% at 23, 24, and 25 weeks, respectively, the incidence of survival with 2 major morbidities was 0%, 19%, and 0% at 23, 24, and 25 weeks, respectively, and the incidence of survival with 3 major morbidities was 4.3%, 2.4%, and 0% at 23, 24, and 25 weeks, respectively.

Conclusion

In our patient cohort, survival and survival without major neonatal morbidity were very low at 23 weeks gestation, but it improved gradually as gestational age advanced.