Clinical Medicine Insights-Pediatrics最新文献

Background: There are conflicting results in the existing studies regarding the association between depression and subclinical hypothyroidism in adolescents. Subclinical hypothyroidism is defined as elevated thyroid stimulating hormone (TSH) levels above the reference range without signs or symptoms of hypothyroidism.

Objectives: The focus of this study is to determine whether there is any association between depression and subclinical hypothyroidism, (as defined by the serum TSH levels) in a population of healthy adolescents.

Design: Quantitative-based cross-sectional study of a representative subset of the adolescent population.

Methods: We carried out a cross-sectional study to determine the association between major depressive disorder (MDD) and subclinical hypothyroidism, in adolescents presenting for annual physical examinations during the peak period of the COVID-19 pandemic in the USA, a period deemed high for adolescent depression. All the adolescents were screened for depression by the PHQ-9 screening tool and had their TSH measured.

Results: Of the 304 subjects analyzed, 179 (58.88%) were minimally or not depressed according to the Patient Health Questionnaire (PHQ-9) screening tool (mean PHQ 1.80 ± 1.49). 70 (23.03%) had mild depression (mean PHQ 6.59 ± 1.46), 50 (16.45%) had moderate depression (mean PHQ 13.70 ± 2.75), and 5 (1.64%) had severe depression (mean PHQ 21.40 ± 1.67). Mean TSH values were 1.93 ± 0.99, 1.77 ± 1.05, 2.10 ± 0.98, and 1.57 ± 0.32 mIU/L, respectively in the four groups. All values were within the recommended range of 0.50 to 4.30 mIU/L, without statistically significant inter-group differences.

Conclusion: We conclude that there is no statistically significant association between depression and subclinical hypothyroidism, in a population of adolescents presenting for physical examinations, and if the screening for depression by the PHQ-9 tool indicates depression, a screening TSH test for subclinical hypothyroidism is not justified.

Background: Nutrition among children under 5 plays an important role in the overall development of children physically and psychologically. Nutritional deficiencies and malnutrition generally affect children. In this study, we estimate the prevalence of 3 malnutrition indicators underweight, stunting and wasting and to assess factors associated with them.

Objective: The main objective of the study was to assess the factors contributing to malnutrition among children under 5 years old.

Design: The study employed a descriptive cross-sectional study design to assess the factors contributing to malnutrition among children under 5 years of age.

Methods: This is quantitative cross-sectional facility-based study of 245 children aged 11 to 49 months. A structured questionnaire was used, and anthropometric measurements were taken to collect data. The Pearson chi-square test was used to assess the bivariate association between the outcomes and the characteristics. The binary logistic regression model was employed to estimate the crude and adjusted odds of malnutrition indicators among the characteristics observed in the study.

Results: The prevalence of underweight, stunting, and wasting were 35.9, 13.9, and 33.9%, respectively. Underweight was significantly higher among females compared to males (42.0% vs. 24.1%) and highest among children aged 11 to 23 months (53.6%). Female children had 3 times more odds of being underweight (AOR: 3.09, 95% CI: 1.56-6.12). Compared to children aged 11 to 23 months, the odds of being underweight were less among children aged 24 to 35 months (AOR: 0.26, 95% CI: 0.13-0.51, P < .001), and 36 to 47 months (AOR: 0.9, 95% CI: 0.03-0.29, P < .001). Wasting was less prevalent among children aged 11 to 23 months (4.8%). Also, wasting was high among children aged 24 to 35 months (AOR: 27.41, 95% CI: 9.12-82.37, P < .001), 36 to 47 months (AOR: 28.23, 95% CI: 7.59-104.94, P < .001), and 48 to 59 months (AOR: 18.10, 95% CI: 3.04-107.76, P < .001). None of the observed factors were associated with stunting in the study.

Conclusion: This study concludes that child malnutrition was high among under-five children. Promoting the use of healthy complementary feeding, preventing diarrheal diseases, and vaccinating children integrated with access to nutrition education programs are vital interventions to improve the nutritional status of children.

A 1 year and 7 months old girl presented to the medical genetic clinic as a referral from the pediatrics clinic. Upon examining the patient and assessing past medical history, an autosomal recessive disorder was suspected. The family underwent whole exome sequencing, which resulted in the diagnosis of Kaufman oculocerebrofacial syndrome (OMIM #244450) in the patient due to the fact that both parents were heterozygous carriers of a novel pathogenic variant in the gene UBE3B that lies on 12q24. It has been recommended for the family that preimplantation genetic testing should be considered for future pregnancies. In this case report, we present a novel variant of the gene and highlight the support of whole exome sequencing in the unveiling of genetic disorders.

Background: Muslim Arab immigrants are a fast-growing, under-studied, and underserved minority population in the United States. Little is known about breastfeeding practices in this population.

Objectives: The objective of this study was to describe infant feeding practices and factors associated with these practices among immigrant Muslim Arab women.

Design: A nonexperimental-one group, cross-sectional, descriptive, prospective design was used to identify infant feeding practices among immigrant Muslim Arab women.

Methods: A convenience sample of one hundred sixteen immigrant Muslim Arab women with at least one child five years or younger was recruited from a large metropolitan area in the Southwestern region. Participants completed the social ecological model of health promotion self-reported questionnaire. Descriptive statistics were performed to identify infant feeding practices and logistic regression was used to identify factors associated with these practices.

Results: Immigrant Muslim Arab mothers demonstrate high breastfeeding initiation rates (99.2%) and lengthy breastfeeding duration (M = 11.86, SD = 8.04), but low rates of exclusive breastfeeding at six months (21.6%). The most frequent reasons for early termination of breastfeeding were perceived insufficient milk (44.4%), child was still hungry after breastfeeding (37.5%), and the belief that the child was old enough to stop breastfeeding (32.9%).

Conclusion: Development of educational interventions are needed to improve breastfeeding exclusivity and raise women's awareness of the importance of exclusive breastfeeding. Healthcare providers should help women gain confidence in their ability to produce enough milk to successfully continue breastfeeding.

Primary immune deficiency (PID) is a large group of diseases characterized by defective immune function, leading to recurrent infections, and immune dysregulation. Clinical presentations, severity, and complications differ for each disease, based on the components of the immune system that are impacted. When patients with PID present with respiratory symptoms, infections should be initially suspected, investigated, and promptly managed. However, non-infectious complications of PID also frequently occur and can lead to significant morbidity and mortality. They can involve both the upper and lower respiratory systems, resulting in various presentations that mimic infectious diseases. Thus, clinicians should be able to detect these conditions and make an appropriate referral to an immunologist and a pulmonologist for further management. In this article, we use case-based scenarios to review the differential diagnosis, investigation, and multidisciplinary treatment of non-infectious pulmonary complications in patients with primary immune deficiencies.

Background: Rh incompatibility has been an important cause of severe neonatal hyperbilirubinemia, hydrops fetalis, and stillbirth. Among those outcomes, neonatal jaundice is the most common problem.

Objective: The study is assessed the prevalence of Rhesus (Rh) negativity and neonatal outcomes among pregnant women who delivered at Bule Hora University Teaching Hospital over a 5-year period from January 2017 to December 31, 2022.

Methods: A retrospective study was conducted on 110 women who delivered at Bule Hora University Teaching Hospital (BHUTH) from January 2017 to December 31, 2021. The complete data of the mother's and neonates' status were extracted from the registration book of the hospital using checklists. The data were double entered using EpiData version 3 and exported to the Statistical Package for Social Sciences (SPSS) version 26 for analysis. Descriptive statistics to determine prevalence and frequencies were used to describe the study population in relation to relevant variables, and the results are presented in tables and charts.

Results: The study shows that the prevalence of Rh D-negative among women who delivered was 6.4% [95% CI: 1.83,10.98]. Among Rh-negative women, 1 (25%) of blood group AB, 3 (6.5%) of blood group O, and 2 (6.1%) of blood group A were Rh-D negative. The distributions of O, A, B, and AB blood groups among pregnant women who delivered this hospital were 41.8%, 30%, 24.6%, and 3.6%, respectively. Out of neonates born to Rh-negative women, 1 (14.3%) was born with jaundice. Of women who delivered at BHUT hospital, 61 (55.5%) did not have a previous delivery, 7 (6.4%) had a previous abortion, 5 (4.5%) stillbirth, 1 (0.9) died after birth, 4 (3.6%) had a birth child weight less than 2.6 kg.

Conclusion: The study revealed that the prevalence of Rh-negative was comparable with finding of different similar studies. To reduce Rh incompatibility-related HDN, the government should educate mothers and encourage them as they follow ANC facilities and after delivery to health facilities.

Background: Ethiopia ranked fourth in the world in terms of neonatal mortality rates, with birth asphyxia accounting for the majority of neonatal deaths.

Objective: This study aimed to determine the prevalence of birth asphyxia and associated factors among newborns delivered in government hospitals of the Eastern Amhara region, Northeastern Ethiopia, 2022.

Methods: A hospital-based cross-sectional study was conducted in 4 government hospitals between March 10, 2022, and May 8, 2022. The subjects in the study were selected using a systematic random sampling technique. Face-to-face interviews and chart reviews were used to collect the data. The association was discovered through multivariate logistic regression analysis.

Result: In this study, the prevalence of birth asphyxia was 13.1% (48) of the total 367 newborns. Mothers who could not read and write (AOR = 9.717; 95% CI = 3.06, 10.857); infants born with low birth weight (AOR = 2.360; 95% CI = 1.004, 5.547); primipara mothers (AOR = 5.138; 95% CI = 1.060, 26.412); mothers with less than 37 weeks of gestation (AOR = 4.261; 95% CI = 1.232, 14.746); and caesarian section delivery (AOR = 2.444; 95% CI = 1.099, 5.432) were predictors of birth asphyxia.

Conclusion: The magnitude of birth asphyxia has managed to remain a health concern in the study setting. As a result, special attention should be paid to uneducated and primi-mothers during antenatal care visits, and prematurity and caesarian section delivery complication reduction efforts should be bolstered to prevent birth asphyxia and its complications.

Molluscum contagiosum (MC) is a viral cutaneous infection common in children. It is characterized by umbilicated, skin-colored papules that typically resolve without treatment over several months to years. Immune response to the virus may cause inflammatory reactions, including molluscum dermatitis, inflamed molluscum, Gianotti-Crosti syndrome-like reaction, erythema annulare centrifugum, or even a generalized id reaction (a reactive inflammatory process driven by a separate condition that stimulates the immune system). We report a unique case of a granuloma annulare-like id reaction secondary to immune recognition of MC in a pediatric patient followed by rapid resolution of their MC.

Rett syndrome (RTT) is a neurodevelopmental disorder characterized by severe dyspraxia, hand stereotypies, and sensory processing issues for which there is no known treatment. This case describes a child with classic RTT and the child's responses to an Ayres Sensory Integration (ASI) treatment intervention (36 one-hour sessions, 3 per week). We coded and analyzed 36 detailed treatment notes to answer the following questions: What strategies and factors facilitated or interfered with participation in the intervention? What critical elements of treatment documentation might detect small changes in praxis and participation? How do patterns of motor or praxis milestones that emerge over time relate to this child's level of participation? We observed an increase in participation when the therapist incorporated elements of neurodevelopmental treatment (NDT) and motor learning theory- treatment strategies commonly used with children who have neuromotor conditions. This increase in participation in the ASI intervention emerged at approximately the same time that the therapist documented acquisition of new motor and praxis skills. We observed the importance of using: lateral movement activities to develop weight-shifting and bilateral coordination, rotary play to increase trunk rotation and improve postural transitions, and rhythm to promote continuing or initiating actions. The documentation of the specific amounts of assistance and prompting needed during treatment sessions was an important tool for tracking small yet meaningful responses to treatment. This case illustrates a novel use of ASI intervention supplemented with strategies that developed foundational skills, and the emergence of praxis and participation in the therapeutic intervention. We suggest further research is needed to determine efficacy of ASI for other children with this rare disorder.

Background: Neonatal intestinal obstruction is a challenging issue, especially in developing countries. There is an apparent difference in the etiology, complications, and mortality of intestinal obstruction in neonates in different countries.

Objectives: We aimed to describe the causes, early postoperative outcomes, and predictors of morbidities in neonates with intestinal obstruction in a tertiary neonatal intensive care unit (NICU) in Iran.

Design & methods: We conducted a retrospective study on neonates who were admitted with intestinal obstruction requiring surgery in the NICU of Boo-Ali Sina Hospital in northern Iran during 2018 to 2022. Demographic and clinical characteristics of the newborns, final diagnosis, postoperative complications, and mortality rate were documented. Also, the relationship between postoperative complications and risk factors, including birth weight, gestational age, and surgical intervention time, was evaluated.

Results: A total of 169 neonates with intestinal obstruction requiring surgery were admitted with a male ratio of 60.9% and mean age of 3.85 ± 8.01 days. Imperforate anus with a prevalence of 42% was the most common cause of neonatal intestinal obstruction, followed by Hirschsprung's disease and duodenal atresia. Death after surgery occurred in 4.1% of the patients. Sepsis with a prevalence of 1.4% was the most common early postoperative complication. The late surgical intervention had a statistically significant relationship with the increase in postoperative sepsis (P = .048).

Conclusion: The time of surgical intervention is the main predictor of complications in neonatal intestinal obstruction, so prompt diagnosis and timely treatment of these babies can significantly improve the prognosis. It is also necessary to improve access to pediatric surgery services in developing countries.