Clinical Medicine Insights-Pediatrics最新文献

Background: The RAM cannula^® consists of nasal prongs that can be used to administer oxygen, continuous, and bilevel positive airway pressure therapies. Studies have reported the efficacy and utility of the RAM cannula in inpatients requiring noninvasive ventilation (NIV); however, there is limited literature on the use of the RAM cannula to provide NIV in the outpatient setting.

Objectives: This study aimed to describe the clinical features and outcomes of children who used NIV via RAM cannula in the outpatient setting.

Design: Retrospective review.

Methods: We conducted a retrospective review of children treated with outpatient NIV via RAM cannula at our institution between January 2010 and March 2023. The analyzed data included age, diagnoses, indications for NIV, duration of RAM cannula use, complications, and outcomes at 6 months.

Results: We identified 20 patients who used outpatient NIV via RAM cannula during the study period. The median age at initiation of NIV via RAM cannula was 5.8 months (IQR 2.4-9.9 months). Indications for NIV included sleep-related hypoventilation (15%), restrictive lung disease (25%), obstructive sleep apnea (45%), and chronic respiratory failure (50%), with 6 patients having ⩾2 indications for NIV. RAM cannula was utilized for inability to tolerate conventional NIV interfaces (80%), to alleviate dyspnea (60%), and to avoid tracheostomy (55%). Patients used NIV via RAM cannula for a median duration of 7.7 months (IQR 3.7-20.6 months). Patient outcomes included ongoing usage of RAM cannula (55%), changing to conventional NIV interfaces (15%) or oxygen (10%), weaning off respiratory support (5%), and death (15%). There were no complications related to using the RAM cannula.

Conclusion: Our study demonstrates the utility of outpatient NIV via RAM cannula in children with a variety of diagnoses until clinical improvement or tolerance of conventional interfaces, and for avoidance of tracheostomy.

Background: Globally, neonatal mortality remains a serious catastrophic problem for newborns, particularly in a low-resource setting. There were no neonatal mortality trend studies in the study area.

Objective: This study aimed to determine the trends and risk factors of neonatal mortality at the neonatal intensive care unit of Felege Hiwot Comprehensive Specialized Hospital, Northwest Ethiopia.

Methods: An institution-based retrospective cross-sectional study was conducted among 870 admitted neonates from January 1, 2016 to December 31, 2020 in the neonatal intensive care unit by a stratified simple random sampling technique. Data were entered into EpiData and then exported to STATA 14.0 for analysis. A linear regression statistical model was used for trend analysis and binary logistic regression was carried out to identify explanatory variables of neonatal mortality.

Results: Overall, neonatal mortality averagely increased by 2.1% per year throughout the 5 consecutive years. In this study, rural residency [adjusted odds ratio (AOR): 1.96, 95% confidence interval (CI): (1.26, 3.06)], birth asphyxia (AOR: 7.73, 95% CI: 4.31, 13.84), congenital deformity (AOR: 3.61, 95% CI: 1.17, 11.18), low birth weight (AOR: 2.13, 95% CI: 1.23, 3.67), respiratory distress syndrome (AOR: 3.32, 95% CI: 1.97, 5.59), Ambu-bag resuscitation (AOR: 0.16, 95% CI: 0.07, 0.38), taking antibiotics (AOR: 0.50, 95% CI: 0.27, 0.90), glucose (AOR: 0.47, 95% CI: 0.30, 0.72), and oxygen (AOR: 0.26, 95% CI: 0.16, 0.41) were associated with neonatal mortality.

Conclusions: This 5-year trend analysis revealed an increased trend of NMR, indicating more work is still needed to make progress toward meeting the SDG goal by 2030. Rural residency, birth asphyxia, congenital deformity, low birth weight, respiratory distress syndrome, Ambu-bag resuscitation, taking antibiotics, glucose, and oxygen were associated with neonatal mortality. Therefore, all stakeholders shall give due attention to reducing this timely-increasing trend of neonatal mortality.

Background: Pregnancy outcomes that differ from normal live births are known as adverse pregnancy outcomes. Adverse pregnancy outcomes also have significant effects on the infant's family and society. There is limited data on adverse outcomes in eastern Ethiopia, particularly in the Somali region.

Objectives: This study aimed to assess the determinants of adverse birth outcomes in the Somali Region Hospitals.

Design: A hospital-based unmatched case-control study was conducted to conduct this study.

Methods: A hospital-based unmatched case-control study was conducted between June and July 2021 in pregnant women who attended public hospitals in the Somali region. A total of 327 (109 cases and 218 controls) participants were included in this study. Women who gave birth with at least 1 adverse birth outcome were considered cases, and those who gave birth with normal birth outcomes were considered controls. Cases were recruited consecutively, and controls were selected using systematic sampling methods. Data was gathered using interviews, record reviews, using the pretested standard tools. The data were entered into EpiData version 3.1 and analyzed with SPSS version 22. Multivariable regression analysis with an adjusted odds ratio and a 95% confidence interval was used to identify the factors associated with adverse birth outcomes. Finally, P-values less than .05 were used to identify significantly associated predictors.

Results: In the current study, rural residency [AOR = 2.80; 95%CI:(1.61-4.87)] lack of ANC follow-up [AOR = 3.27; 95%CI: (1.77-6.02)], pregnancy-induced hypertension [AOR = 3.28; 95%CI: (1.74-6.17)] being anemic mothers [AOR = 3.51; 95%CI: (2.02-6.07)] and khat chewing [AOR = 4.54; 95%CI: (2.12-9.70)] were identified as determinants of adverse birth outcome.

Conclusions: In the current study, rural residency, lack of ANC, being anemic in indexed pregnancies, pregnancy-induced hypertension, and khat chewing were determinants of adverse birth outcomes. Therefore, efforts should be made to enhance ANC follow-up, iron and folic acid supplementation, early treatments of pregnancy-induced hypertension, and information on the risk of chewing khat.

Background: Advances in pediatric intensive care have dramatically improved the prognosis for critically ill patients. The study aimed to determine the survival status and predictors of mortality among patients admitted to the pediatric intensive care unit at selected tertiary care hospitals in Ethiopia.

Methods: A health facility-based prospective observational study from October 2020 to May 30, 2021, was conducted in a selected tertiary care hospital in Ethiopia. Kaplan Meier was used to compare patient survival experiences and Cox regression was used to identify independent predictors of ICU mortality. The hazard ratio was used as a measure of the strength of the association, and a P-value of <.05 was considered to declare statistical significance.

Results: Of 206 study participants, 59 (28.6%) patients died during follow-up time, and the incidence of mortality was 3.6 deaths per 100 person-day observation (95% CI: 2.04-5.04 deaths per 100 person-days). Respiratory failure 19 (32.2%) was the commonest cause of death followed by septic shock 11(18.6). In-ICU complications (AHR: 2.13; 95% CI: 1.02, 4.42; P = .04), sepsis diagnosis (AHR: 2.43; 95% CI: 1.24, 4.78; P = .01), GCS < 8 (AHR: 1.96; 95% CI: 1.12, 3.43; P = .02), use of sedative drugs (AHR: 2.40; 95% CI: 1.16, 4.95; P = .02) were linked with increased risk of in-ICU mortality. In contrast, the use of mechanical ventilation was associated with decreased mortality (AHR: 0.45; 95% CI: 0.21, 0.92; P = .03).

Conclusion: The study found a high incidence of in-ICU mortality among admitted pediatric patients in selected Ethiopian tertiary care hospitals. In-ICU complications, sepsis diagnosis, GCS < 8, and patient use of sedative drugs were independent predictors of in-ICU mortality. Prudent follow-up is warranted for those patients with the aforementioned risk factors.

Duodenal webs are a rare clinical entity with the presentation of a double duodenal web being exceedingly uncommon. Management of duodenal webs traditionally involves duodenal web excision with duodenoduodenostomy, which is usually performed via a laparoscopic or an open approach. We report the case of a 6-month-old child who presented with progressively worsening bilious emesis with imaging findings concerning for a duodenal web. Endoscopic evaluation was performed that identified 2 webs in the fourth portion of the duodenum. These were managed completely endoscopically with balloon dilation. Although surgery is the mainstay of treatment of duodenal webs, this patient was successfully managed by endoscopic intervention without the need for open or laparoscopic excision, which has not been previously described for double duodenal webs. This work demonstrates the safety and efficacy of endoscopic management for infants with this anomaly.

Background: Neonatal sepsis has been a major cause of neonatal mortality and morbidity globally. Late onset sepsis is on the rise mostly due to better health care services and improved survival of premature neonates. Gram-negative sepsis has emerged as a major public health problem constituting significant morbidity and mortality. There is limited data on gram-negative late onset sepsis from the central part of India, therefore this study was conducted at a tertiary care center from rural part of India.

Objectives: To determine the clinical profile and outcome among neonates with gram-negative late onset sepsis.

Design: It is a retrospective analysis conducted among neonates with gram-negative late onset sepsis at a tertiary care center from central India.

Methods: All neonates below 28 days of age suspected to have late onset sepsis were enrolled in the study. The data for the period of January 2019 to December 2021 was collected and analyzed using software SPSS version 29. The outcome variables studied were discharge (good outcome) and death (poor outcome).

Results: In the present study, overall prevalence of gram-negative late onset sepsis was 4.8%. Respiratory distress (52.2%), seizure (18.9%), jaundice (15.6%), and lethargy (15.6%) were common clinical symptoms among neonates with sepsis. The most common organism isolated was Klebsiella spp. (36.7%) followed by Acinetobacter spp. (31.1%) and E. coli (17.8%). Low gestational age (n = 20 vs n = 7, P = .002) and low birth weight (n = 33 vs n = 4, P = .02) were associated with poor outcomes in neonates with gram negative LOS. The overall mortality rate was found to be 30% among neonates with gram negative sepsis.

Conclusion: The prevalence of gram-negative sepsis was found to be 4.8%. Factors associated with poor outcome in gram-negative sepsis were low birth weight, and prematurity. Klebsiella spp. was found to be a common cause of gram-negative LOS, therefore, the empiric antibiotic policy must provide coverage against these micro-organisms.

Background: Neonatal hyperbilirubinemia is a widespread and significant clinical problem among neonates worldwide. Globally, every year about 1.1 million babies develop it and the vast majority reside in South Asia and sub-Saharan Africa. Studies on the magnitude and factors associated with neonatal hyperbilirubinemia are limited in Ethiopia. So this study was aimed at assessing the prevalence and associated factors of neonatal hyperbilirubinemia among hospitalized neonates in the neonatal intensive care unit of Jimma Medical Center (JMC), Jimma, South West Ethiopia.

Design: Hospital-based cross-sectional study was conducted at JMC from July 24 to October 19, 2020.

Methods: A total of 222 neonates with their mothers were included and conveniently selected. Data was collected by interviewing mothers through structured questionnaires and reviewing neonates' medical records using a checklist. Multivariable binary logistic regression analyses were employed to identify factors associated with neonatal hyperbilirubinemia.

Results: from a total of neo-maternal pairs included in the studies; the proportion of Neonatal hyperbilirubinemia was found to be 94 (42.3%). Neo-maternal ABO incompatibility 33 (35.1%), prematurity 41 (43.6%), sepsis 35 (37.2%), Neonatal birth asphyxia 20 (21.2%), and Rh isoimmunization 10 (10.6%) was significantly associated with neonatal hyperbilirubinemia.

Conclusion: The prevalence of neonatal hyperbilirubinemia in the study setting was high. Antenatal care (including both mother and fetus detail examination and follow-ups) as well as cautions during labor need to focus on since Neonatal hyperbilirubinemia-associated factors were maternal and neonatal. Hence, further assessment, early intervention, and timely treatment are important to mitigate the burdens in neonates due to hyperbilirubinemia.

Cannabis vaping has emerged as a predominant mode of cannabis use among United States (US) adolescents and young adults (AYA) primarily due to the popularity of modifiable designs of vaping devices coupled with changes in cannabis policies and increased availability of cannabinoid products. New methods for cannabis vaping by e-liquid/oil vaping, dry plant vaping, and cannabis concentrate vaping (ie, dabbing) have had high uptake among American youth with unclear long-term health implications. Issues with contamination, mislabeling, and expansion of the vaped cannabis market to include not only delta-9-tetrahydrocannabinol (delta-9-THC) and cannabidiol (CBD) but also delta-9-THC analogs (eg, delta-8 and delta-10) sold as hemp-derived "legal highs" further complicated this healthcare space. Recent research suggests that cannabis/THC vaping carries distinct and overlapping risks when compared to cannabis smoking and may be associated with greater risk for acute lung injuries, seizures, and acute psychiatric symptoms. Primary care clinicians providing care for AYA are in an ideal position to identify cannabis misuse and intervene early to address cannabis vaping. To improve public health outcomes, a need exists for pediatric clinicians to be educated about different ways/methods that youth are vaping cannabinoid products and associated risks related to cannabinoid vaping. Further, pediatric clinicians need to be trained how to effectively screen for and discuss cannabis vaping with their youth patients. In the current article, we present a clinically focused review of cannabis vaping among young people with 3 main aims to: (1) identify and describe the cannabis vaping products commonly used by American youth; (2) review the health correlates of youth cannabis vaping; and (3) discuss clinical considerations related to identifying and treating youth who vape cannabis.

Introduction: Jaundice is one of the most common problems during infancy. It is believed that breast milk jaundice is one of the reasons for the persistence of jaundice after 14 days of prolonged jaundice. This study evaluates the effect of Clofibrate and phototherapy on prolonged jaundice originating from breast milk in term and healthy neonates.

Materials and methods: This double-blind clinical trial study was performed on 100 randomly divided neonates in the neonatal ward of Besat Hospital. In addition to phototherapy, the case group received a single dose of edible Clofibrate (50 mg/kg) dissolved in 2 CCs of distilled water. The control group received the same amount of distilled water as the phototherapy group. After treatment, bilirubin change rate, duration of hospitalization, and any association with gender, gestational age, hemoglobin, blood type, and Rh of neonates were determined and compared throughout the 2 groups.

Results: Data analysis showed that the bilirubin reduction rate was statistically significantly higher in the case group than in the control group (P < .05). The mean duration of hospitalization and phototherapy in the case group was significantly lower than in the control group (P = .005). The bilirubin reduction rate was not affected significantly by gestational age, blood type, or Rh.

Conclusion: This study's results demonstrated that Clofibrate effectively decreased bilirubin levels and shortened the duration of phototherapy and hospitalization in infants with probable breast milk jaundice.

Registration: IRCT2012092910933N1.