International Journal of Pediatrics最新文献

Objectives: Right ventricular output (RVO) assessment can estimate systemic blood flow (SBF) in neonates but requires advanced echocardiography expertise. Pulmonary peak flow (PPF) could be an easier surrogate for RVO. This study is aimed at evaluating the correlation between RVO and PPF in neonates and assessing their intraobserver variability.

Methods: In this single-center, longitudinal, observational study, we included term and preterm neonates admitted to our Neonatal Intensive Care Unit between February and July 2022. A neonatologist with experience in functional echocardiography recorded targeted neonatal scans. Recordings were analyzed off-line for echocardiographic measurements. After 12 months, a second analysis of the recordings was performed by the same examiner to avoid recall bias. We compared the two analyses for intraobserver variability assessment.

Results: We analyzed a cohort of 33 term and preterm infants. We found a strong positive correlation between RVO and PPF (p < 0.001). RVO showed a mean intra-observer difference of 34.2 mL/kg/min; PPF showed a mean intraobserver difference of 2.2 cm/s.

Conclusions: Our findings support the use of PPF as a surrogate for RVO for cardiac output estimation in term and preterm neonates. Because of its simplicity, rapidity, and low intraobserver variability, PPF could be a useful tool for SBF assessment. Future studies should be performed to evaluate the correlation between PPF and other echocardiographic markers of low SBF.

Background: Currently, neonatal hypoglycemia is one of the most frequent metabolic disorders and is associated with an increased rate of neonatal morbidity and mortality. Although neonatal hypoglycemia is a common problem among hospitalized neonates, there is limited evidence about its incidence and predictors in Ethiopia, and no studies have been done in our study area. It is critical to consider the incidence and predictors of neonatal hypoglycemia to save neonates' lives from acute problems, long-term neurological impairments, and death. This study is aimed at assessing the incidence and predictors of neonatal hypoglycemia among neonates admitted to Wolaita Zone health institutions' neonatal intensive care units.

Methods: A hospital-based prospective follow-up study was conducted on a sample of 785 admitted eligible neonates between November 1, 2023, and June 1, 2024. The eligible neonates were included in the study consecutively. Data were collected using a pretested interview guide and checklist on sociodemographic, obstetric, and neonatal-related risk factors of hypoglycemia. The collected data were coded, edited, and imported to STATA Version 14 from Kobo toolbox for further analysis. The Kaplan-Meier survival curve was used to determine survival time, and the log-rank test was used to compare survival times across categorical factors. To identify predictors, both bivariable and multivariable Cox proportional hazard regression models were employed.

Results: Among the 785 neonates included in the final analysis, the overall incidence rate of neonatal hypoglycemia during the follow-up time was found to be 15.47 per 1000 neonate-days (95% CI: 12.55, 19.06). Maternal history of bad obstetrics (AHR: 2.26, 95% CI: 1.29, 3.96), gestational diabetes mellitus (AHR: 2.27, 95% CI: 1.27, 4.05), gestational age (AHR: 2.88, 95% CI: 1.35, 6.18), hypothermia (AHR: 2.55, 95% CI: 1.37, 4.77), and newborn type (AHR: 4.31, 95% CI: 1.03, 8.10) were predictors of neonatal hypoglycemia.

Conclusion: In this study, we found a high rate of neonatal hypoglycemia. Therefore, monitoring, identifying, and managing the aforementioned predictors is important to prevent as well as to control neonatal hypoglycemia.

Introduction: Acid-base management in neonates with hypoxic-ischemic encephalopathy (HIE) undergoing therapeutic hypothermia (TH) can use either the "alpha-stat" or the "pH-stat" method, which adjusts values based on temperature.

Objective: This study aimed to compare the efficacy of two blood gas analysis techniques in predicting the severity of brain injury in neonates with HIE.

Method: A retrospective study was conducted on neonates over 35 weeks' gestation who underwent TH between 2010 and 2015. Diagnostic, univariate, and multivariate analyses were performed to compare outcomes between the alpha-sat and pH-stat groups.

Results: Adjusting for sex and age, the odds ratios for being classified as hypocapnic were 4.40 (95% CI: 1.19-16.27) using the alpha-stat method and 2.94 (95% CI 1.15-26.48) using the pH-stat method. The classification of patients as hypocapnic, normocapnic, or hypercapnic differed significantly between the two methods (p < 0.0001), with 23% of patients reclassified from the alpha-stat to the pH-stat method.

Conclusion: Both blood gas analysis methods were similarly effective in predicting brain injury extent. However, the alpha-stat method significantly overestimated the lowest pCO₂ values during therapeutic hypothermia.

Background: Although carbohydrate counting is a recommended method for managing diabetes, it is not widely used by patients with Type 1 diabetes mellitus. Aiming to emphasize the importance of this method, this study is aimed at quantitatively assessing the effectiveness of carbohydrate counting in reducing HbA1c levels in children and adolescents with Type 1 diabetes mellitus.

Methods: Studies published between January 1993 and August 2024 were selected from the EMBASE, PubMed Central (PMC), Wiley Online Library, and ScienceDirect, without language restrictions. The primary outcome was to evaluate the reduction in HbA1c, comparing children and adolescents with Type 1 diabetes mellitus who did or did not use carbohydrate counting.

Results: The results were synthesized through a meta-analysis of the absolute mean difference in HbA1c between the groups. Seven studies were included in the meta-analysis, involving a total of 599 individuals, with 276 in the control group and 323 in the intervention group. When compared to the control group, all carbohydrate counting methods resulted in a reduction in HbA1c. The variation ranged from -1.35% for the greatest reduction to -0.73% for the smallest reduction, with a final mean of -0.94% (95% CI: -1.13, -0.74). Subgroup analysis showed that the greatest reduction in HbA1c was observed in patients who were experienced in carbohydrate counting and used the automated bolus calculator.

Conclusions: This study confirms the effectiveness of carbohydrate counting in reducing HbA1c levels in children and adolescents with Type 1 diabetes mellitus, reinforcing that even the basic form of this strategy represents a valuable and advantageous approach in the management of the disease.

Background/objective: Delayed umbilical cord clamping (DCC) for 30-60 s after birth is recommended for both term and preterm infants. The additional neonatal blood volume rich in stem cells and immunoglobulins may protect the neonate from infections. We aim to compare the effect of DCC in term newborns on hyperbilirubinemia and respiratory infection-related pediatric emergency department (PED) encounters and hospitalizations within the first 6 months of life.

Methods: We conducted a chart review of term infants born between January 1, 2022 and December 31, 2022 and grouped them as either having DCC or not having delayed umbilical cord clamping (nDCC) for 30-60 s after birth. Maternal and newborn characteristics, hyperbilirubinemia, respiratory infection-related PED encounters, hospitalizations, and length of stay in the initial 6 months after birth were compared. Data were analyzed using R software, a p value of < 0.05 was considered statistically significant.

Results: Of the 2136 charts reviewed, 659 (31%) were in the DCC group. There were significantly fewer respiratory infection-related PED encounters (p < 0.001), fewer hospitalizations (p = 0.04), and a 5% lower incidence of hyperbilirubinemia in the DCC group (95% CI: 0.86%-8.6%; p = 0.02). The length of stay of each hospitalization was not significantly different between the two groups, p = 0.07.

Conclusions: We observed fewer respiratory infection-related PED encounters and hospitalizations in the initial 6 months of life and a lower incidence of hyperbilirubinemia among the infants who had DCC. The increased blood volume and its components appear to be supportive of the neonate's developing immune system as seen in the lower disease burden up to 6 months of age.

Background: Patent ductus arteriosus (PDA) is the most common cardiac lesion in preterm newborns. When medical management of a hemodynamically significant PDA is unsuccessful or contraindicated, infants are referred for either transcatheter device closure (TCDC) or surgical ligation. Our objective was to describe the characteristics and outcomes of these infants.

Methods: A retrospective cohort study of infants ≤ 30 weeks' gestation undergoing either TCDC or surgical ligation for PDA from January 2009 to April 2023 was undertaken, in a surgical neonatal intensive care unit. Baseline demographics, echocardiographic data, procedural complications, and neonatal outcomes were obtained.

Results: A total of 136 infants were included. At the time of referral for PDA closure, infants were 5-145 days old, with a corrected gestational age of 24-50 weeks and PDA diameter of 1.5-4.1 mm. TCDC of PDA was performed in 15 neonates compared with 121 neonates who underwent surgical ligation. Procedural complications and important neonatal outcomes were similar for both groups. While the number of infants undergoing TCDC is increasing, there is a decreasing trend in the total number of surgical PDA closures.

Conclusions: This study demonstrates that there is variability in the preclosure demographics and echocardiography characteristics of infants ≤ 30 weeks' gestation referred for procedural PDA closure.

Objective: This study is aimed at describing the clinical and laboratory characteristics and determining the prevalence of microbial pathogens causing neonatal meningitis detected by cerebrospinal fluid (CSF) real-time polymerase chain reaction (PCR).

Materials and methods: A cross-sectional descriptive study was conducted on 55 neonates diagnosed with meningitis. Pathogens were identified by using CSF real-time PCR, CSF culture, or blood culture.

Results: Late-onset meningitis accounted for 85.5% (47/55) of cases. The most common clinical signs were respiratory distress (56.4%), fever (47.3%), and lethargy (34.5%). The median white blood cell count was 13,560/mm³ (8645-20,709/mm³), and the median absolute neutrophil count was 6063/mm³ (2895-12,508/mm³). C-reactive protein levels were higher in full-term neonates (8.55 mg/L) compared to preterm neonates (6.4 mg/L). The median CSF protein level was 1.4 g/L (1.1-1.73 g/L), with preterm neonates having significantly higher levels (1.59 vs. 1.22 g/L; p = 0.013). Blood cultures identified seven cases. Real-time PCR detected pathogens in only three cases (5.5%). No demographic or clinical factors were found to significantly differ between the groups with and without identified microbial pathogens (p > 0.05).

Conclusion: Neonatal meningitis commonly manifests with respiratory distress, fever, and lethargy. While real-time PCR enables the detection of viral and rare pathogens, its limited overall detection rate underscores the importance of early diagnosis based on clinical presentation and CSF analysis rather than exclusive reliance on microbiological evidence, which may delay essential treatment.

Background: The COVID-19 pandemic led to widespread societal disruptions, including lockdowns aimed at reducing virus transmission. These measures had a profound impact on physical and mental health, particularly among children and adolescents. The closure of sports facilities and restrictions on outdoor activities resulted in a significant decrease in physical activity levels among this age group.

Methods: A cross-sectional survey was conducted among 211 participants attending sports medicine clinics in Northern Italy. The survey is aimed at assessing physical activity levels during three distinct lockdown periods. It gathered data on demographics and tracked trends and changes in physical activity throughout these phases.

Results: During the initial lockdown, 37.4% of the youth maintained regular physical activity, primarily at home, with an average of 4 h/week. By October 26, 69.6% of the participants were still engaged in physical activities, with participation stabilizing at 71.0% by the time of the survey. Inferential analyses confirmed that the increase in participation between the first and second phases was statistically significant (p < 0.001, Cohen's h = 0.85), whereas later changes were not significant. Although there was a slight increase in the weekly hours of physical activity, these levels remained below the World Health Organization's recommended guidelines. Average weekly hours of activity showed only a small, nonsignificant increase (p = 0.12, Cohen's d = 0.20). Importantly, in all phases, fewer than 20% of participants met WHO recommendations.

Conclusions: The COVID-19 lockdowns significantly disrupted youth physical activity, which was heavily reliant on organized sports clubs. Despite some recovery after the restrictions were lifted, physical activity levels often fell below recommended guidelines. The disruption in physical activity patterns during the pandemic could have long-lasting effects on future health outcomes. The habits established during childhood and adolescence often persist into adulthood, and the significant drop in physical activity during the pandemic may impact health for decades. This highlights the need for targeted strategies and enhanced physical education programs to mitigate the health risks associated with sedentary behaviors.

A prospective observational study was conducted in 90 edematous children with steroid-sensitive nephrotic syndrome (SSNS) to determine the prevalence of hypovolemia and also to study the role of surrogate markers like severe edema, high hematocrit, inferior vena cava collapsibility index (IVCCI) ≥ 50%, blood urea/creatinine ≥ 100 : 1, and serum albumin < 1.5 gm/dL in identifying hypovolemia. The diagnostic test for hypovolemia was a combination of FeNa < 0.5 and urinary potassium (UK) index ≥ 0.6. One-third of children with SSNS had hypovolemia, of which 50% were symptomatic. High hematocrit was the most sensitive surrogate marker of hypovolemia (80%), followed by serum albumin < 1.5 g/dL (56.6%), IVCCI ≥ 50% (43%), severe edema (36.7%), and blood urea/creatinine ≥ 100 : 1 (33.3%). The specificity for detecting hypovolemia was maximum for IVCCI ≥ 50% (91.6%), followed by blood urea/creatinine ≥ 100 : 1 (90%), serum albumin < 1.5 g/dL (85%), severe edema (81.7%), and hemoconcentration (21.6%).

Birth registration is a fundamental human right that serves as the first legal recognition of an individual's existence, yet global rates remain uneven, particularly in developing nations like Ghana. This paper employs a human rights-based approach (HRBA) to analyze Ghana's birth registration system, highlighting historical, administrative, and legal developments while assessing progress and persistent obstacles. Using a desk review methodology, the study synthesizes findings from government documents, scholarly articles, and reports from international organizations. It reveals that Ghana's birth registration framework, though improved through digitalization and integration with health services, still faces significant challenges including infrastructural disparities between urban and rural areas, cultural barriers, and gender biases. The study underscores the necessity for effective policy implementation that prioritizes inclusivity and addresses systemic barriers, framing birth registration not merely as an administrative task but as a critical component of governance and social equity. Ultimately, it questions whether birth registration in Ghana is a national priority or has become a neglected necessity.