Clinical Medicine Insights-Pediatrics最新文献

Aim: To assess parents' ability to express their concerns and hopes for the future in their children with disability and assess their children's disability as well as to analyse these data for consistency.

Method: Parents of 162 children with spina bifida, spinal muscular atrophy, muscular disorders, cerebral palsy, visual impairment, hearing impairment, mental disability, or disability following brain tumours were asked to freely express their concerns and hopes for the future and to assess disability in their own children by employing a set of 26 International Classification of Functioning, Disability and Health, Children and Youth Version (ICF-CY) body function (b) codes and activity and participation (d) codes. A grounded theory approach was employed to systematize parents' expressions of concerns and hopes; then, parents scored qualifiers on a 5-step qualitative Likert scale. Parents assessed their children's disability in the same way using the ICF-CY 5-step qualifier scale.

Results: Altogether, 119 parents freely expressed their concerns and hopes, and 101 of them also assessed their children's disability using the 26 ICF-CY codes. A total of 475 expressions of concern and hopes (issues) were expressed and categorized into 34 areas of concern and hopes (subsections). The most frequently mentioned issues were education; understanding, goodwill, and communication between parents; and community support. Qualitative data on both 5-step qualifier scales showed good reliability. Rasch analysis maps on concerns and hopes for children as well as on the ICF-CY assessment demonstrated good alignment and a clinically relevant progression from the least to the most disabled children.

Conclusion: Parents can express valid and reliable data on their concerns and hopes for the future and can reliably assess disability in their own children.

Efforts to decrease the risk of overweight and obesity should focus on children's physical activity (PA) and fruit and vegetable (FV) consumption. Within school-based interventions, there is insufficient evidence on the effectiveness of the use of character modeling and goal setting to determine changes in step counts, MVPA, and FV consumption. Study participants were 187 students in grades 4 and 5 from 2 Title 1 elementary schools in the Southwest United States. The intervention was a quasi-experimental character modeling and goal setting program. New Lifestyles NL-1000 activity monitors were used to assess number of steps taken and MVPA by the participants. Fruit and vegetable consumption was measured by direct observation. School day steps, MVPA, and FV consumption were recorded at baseline, intervention, and during a 10-week follow-up. There were not differences between groups at baseline. Steps and MVPA were statistically significantly (P < .05; Δ = ~2500 steps and ~5 minutes of MVPA) greater in the intervention compared with the control group over time. Fruit and vegetable consumption was not significantly (P = .308) greater in the intervention compared with the control group over time. Students in the intervention school were significantly more active than students in the control school during the intervention phase and at follow-up. The findings reported here would suggest that character modeling and goal setting can increase PA among elementary aged children but did not increase FV consumption.

Background: World Health Organization guidelines advise community-based care (CBC) for "uncomplicated" severe acute malnutrition (SAM) infants <6 months old (u6m), whereas current national protocols refer to inpatient care. Our aim was to inform and shape future management strategies by understanding caregivers' and different stakeholders' perceptions on malnutrition among infants u6m on barriers/facilitators to future CBC.

Methods: The methods used in this study are as follows: in-depth interviews and focus group discussions (FGDs) in southern Bangladesh, thematic analysis of transcripts, and sample size by data saturation.

Results: We conducted 5 FGDs with 29 caregivers, 4 with 29 health care workers, 4 key informant interviews each with community leaders and health supervisors. Five themes emerged. 1) Identification of SAM infants and care-seeking behavior: malnutrition was not noticed until severe, caregivers focused on clinical symptoms. Both allopathic and traditional healers were consulted. (2) Perceived causes of infant malnutrition: underlying illness, poor feeding practices, poverty, and local superstitions. (3) Views and preferences on treatment: hospitals and doctors were perceived as offering the best treatment, health care workers were also important, and respondents highlighted the need care of the caregiver/mother along with the infant. (4) Perceived benefits and risks of CBC: lower cost and greater accessibility were appreciated but worried about quality. (5) Community networks: wider family and social support networks were considered important aspects of care.

Conclusions: There is considerable potential for CBC but needs to be better and earlier identification of at-risk infants, strengthening of health systems to avoid community options being perceived as "second best," engagement with families and communities to tackle "upstream" determinants of SAM, and care for mother-infant pairs.

Background: Breastfeeding supplies all the nutrients that infants need for their healthy development. Breastfeeding practice is multifactorial, and numerous variables influence mothers' decisions and ability to breastfeed. This review identifies the factors potentially affecting the timely initiation of breastfeeding within an hour after birth and exclusive breastfeeding in the first 6 months in Middle Eastern countries.

Methods: The Medline, ScienceDirect, and Web of Science databases were keyword-searched for primary studies meeting the following inclusion criteria: (1) publication in the English language between January 2001 and May 2017, (2) original research articles reporting primary data on the factors influencing the timely initiation of breastfeeding and/or exclusive breastfeeding, (3) the use of World Health Organization definitions, and (4) Middle Eastern research contexts. A random effect model was used to establish the average prevalence of the timely initiation of breastfeeding and exclusive breastfeeding in the Middle East.

Results: The review identified 19 studies conducted in Saudi Arabia (7), Iran (3), Egypt (2), Turkey (2), Kuwait (1), the United Arab Emirates (1), Qatar (1), Lebanon (1), and Syria (1). The meta-analysis established that 34.3% (confidence interval [CI]: 20.2%-51.9%) of Middle Eastern newborns received breastfeeding initiated within an hour of birth, and only 20.5% (CI: 14.5%-28.2%) were fed only breast milk for the first 6 months. The 8 studies exploring breastfeeding initiation most commonly associated it with the following: delivery mode, maternal employment, rooming-in, and prelacteal feeding. The 17 studies investigating exclusive breastfeeding most frequently linked it to the following: maternal age, maternal education, maternal employment, and delivery mode.

Conclusions: Middle Eastern health care organizations should fully understand all the determinants of breastfeeding identified by this review to provide suitable practical guidance and advice to help new mothers to overcome barriers where possible and to contribute to improving infant and maternal health in the region.

Hypoglycemia is the most common metabolic disorder encountered in neonates. The definition of hypoglycemia as well as its clinical significance and management remain controversial. Most cases of neonatal hypoglycemia are transient, respond readily to treatment, and are associated with an excellent prognosis. Persistent hypoglycemia is more likely to be associated with abnormal endocrine conditions, such as hyperinsulinemia, as well as possible neurologic sequelae. Manifestations of hypoglycemia include seizures which can result in noteworthy neuromorbidity in the long haul. Thus, hypoglycemia constitutes a neonatal emergency which requires earnest analytic assessment and prompt treatment. In this review, we have tried to cover the pathophysiology, the screening protocol for high-risk babies, management, long-term neurologic sequelae associated with neonatal hypoglycemia, with evidence-based answers wherever possible, and our own practices.

Fatalities from perinatal asphyxia remain high in developing countries, and continually assessing its risk factors will help improve outcomes in these settings. We explored how some identified risk factors predict mortality in asphyxiated newborns, to assist clinicians in prioritizing interventions. This was a 4-year prospective study conducted at the Enugu State University Teaching Hospital, Enugu, Nigeria. All newborns who met the study criteria that were admitted to this facility in this period were enrolled and monitored. Data collected were analysed with SPSS Version 18. A total of 161 newborns with perinatal asphyxia were enrolled into the study with an in-hospital incidence rate of 12.81 per 1000 birth and a case fatality rate of 18%. Overall, the APGAR scores were severe in 10%, moderate in 22%, mild to normal in 68%, whereas the SARNAT stages were III in 24%, II in 52%, and I in 25%. In terms of mortality, 66.7%, 22.2%, and 11.1% mortalities were, respectively, observed with SARNAT scores III, II, and I (P = .003), whereas the findings with APGAR were 31.2% (severe), 25.0% (moderate), 25.0% (mild), and 18.8% (normal) (P = .030). Fatality outcome was more correlated with SARNAT (R = .280; P = .000) than APGAR (R = -.247; P = .0125). The SARNAT score significantly differentiated between the degrees of asphyxia in newborns based on gestational age at delivery (P = .010), place of delivery (P = .032), and mode of delivery (P = .042). Finally, it was noted that newborns that were female (P = .007), or born outside the hospital (P = .010), or with oxygen saturations <60% (P = .001), or with heart rate <120 (P = .000), and those with respiratory rate <30 (P = .003), all have significantly higher likelihood of deaths from asphyxia. Therefore, predictors of neonatal mortality from perinatal asphyxia in our centre include being female and being born outside the hospital, as well as low oxygen saturations, heart rates, and respiratory rates at presentation.

To date, only few studies have assessed oral immunotherapy (OIT) for wheat allergy and often describe severe adverse reactions during therapy. We developed partially hydrolyzed wheat-based cereals (pHC), which were used in a multicenter, open-label, OIT pilot study, in immunoglobulin E-mediated wheat allergy children (NCT01332084). The primary objective of the study was to test whether wheat allergic patients tolerate pHC and primary end point was the presence or not of immediate adverse reactions to pHC during the 1-day initial escalation phase (stepwise increased doses of pHC), with evaluation of the maximum dose tolerated. Of the 9 patients enrolled in the trial, 4 discontinued OIT because of mild to severe reactions at the initial escalation phase. The 5 patients who passed the escalation phase consumed pHC daily for 1 to 6 months. One of these patients withdrew due to noncompliance, whereas the 4 others completed the study and successfully passed the wheat challenge test at the end of the study. About 60% of the adverse events were unrelated to the study product. Our study provides preliminary evidence that pHC is tolerated by a subset of wheat allergic patients. Further studies are warranted to test its efficacy as a potential therapeutic option for wheat allergic patients.

Background: Given the rising incidence of noncommunicable diseases (NCDs) globally, especially bronchial asthma, there is the need to reduce the associated morbidity and mortality by adopting an objective means of diagnosis and monitoring.

Aim: This article aims to review the trends and challenges in the use of spirometry for managing childhood bronchial asthma especially in developing countries.

Methods: We conducted a literature search of published data on the use of spirometry for the diagnosis of childhood bronchial asthma with special emphasis resource-poor countries.

Results: Guidelines for the diagnosis and treatment of childhood asthma recommend the use of spirometry, but this is currently underused in both tertiary and primary care settings especially in developing countries. Lack of spirometers and proper training in their use and interpretation of findings as well as a dearth of asthma guidelines remains core to the underuse of spirometry in managing children with asthma. Targeting education of health care staff was, however, observed to improve its utility, and practical implementable strategies are highlighted.

Conclusions: Spirometry is not frequently used for asthma diagnosis in pediatric practice especially in resource-poor countries where the NCD burden is higher. Strategies to overcome the obstacles are implementable and can make a difference in reducing the burden of NCD.

Aim: To help parents assess disability in their own children using World Health Organization (WHO) International Classification of Functioning, Disability and Health, Child and Youth Version (ICF-CY) code qualifier scoring and to assess the validity and reliability of the data sets obtained.

Method: Parents of 162 children with spina bifida, spinal muscular atrophy, muscular disorders, cerebral palsy, visual impairment, hearing impairment, mental disability, or disability following brain tumours performed scoring for 26 body functions qualifiers (b codes) and activities and participation qualifiers (d codes). Scoring was repeated after 6 months. Psychometric and Rasch data analysis was undertaken.

Results: The initial and repeated data had Cronbach α of 0.96 and 0.97, respectively. Inter-code correlation was 0.54 (range: 0.23-0.91) and 0.76 (range: 0.20-0.92). The corrected code-total correlations were 0.72 (range: 0.49-0.83) and 0.75 (range: 0.50-0.87). When repeated, the ICF-CY code qualifier scoring showed a correlation R of 0.90. Rasch analysis of the selected ICF-CY code data demonstrated a mean measure of 0.00 and 0.00, respectively. Code qualifier infit mean square (MNSQ) had a mean of 1.01 and 1.00. The mean corresponding outfit MNSQ was 1.05 and 1.01. The ICF-CY code τ thresholds and category measures were continuous when assessed and reassessed by parents. Participating children had a mean of 56 codes scores (range: 26-130) before and a mean of 55.9 scores (range: 25-125) after repeat. Corresponding measures were -1.10 (range: -5.31 to 5.25) and -1.11 (range: -5.42 to 5.36), respectively. Based on measures obtained at the 2 occasions, the correlation coefficient R was 0.84. The child code map showed coherence of ICF-CY codes at each level. There was continuity in covering the range across disabilities. And, first and foremost, the distribution of codes reflexed a true continuity in disability with codes for motor functions activated first, then codes for cognitive functions, and, finally, codes for more complex functions.

Conclusions: Parents can assess their own children in a valid and reliable way, and if the WHO ICF-CY second-level code data set is functioning in a clinically sound way, it can be employed as a tool for identifying the severity of disabilities and for monitoring changes in those disabilities over time. The ICF-CY codes selected in this study might be one cornerstone in forming a national or even international generic set of ICF-CY codes for the benefit of children with disabilities, their parents, and caregivers and for the whole community supporting with children with disabilities on a daily and perpetual basis.

Little is known about services provided to children and youth (C/Y) discharged from an acute care facility. Recent research has provided a foundation for efforts to supplement or complement that early work. This research investigates post-acute care (PAC) in Texas. It focuses on what differentiates those discharges that receive PAC from those that do not and on what differentiates those C/Y who receive PAC in a health care facility from those who receive home health services. The results show that only 6.4% of discharges involving C/Y receive PAC and that many factors affected the 2 issues under investigation quite differently. These results clearly demonstrate the low prevalence of PAC use for C/Y and the clear preference of using PAC home health in this population.