International Journal of Pediatrics最新文献

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.

Background: Celiac disease (CD) is a systemic autoimmune disease associated with several environmental factors in susceptible individuals. Given the lack of CD-related publications in the Mediterranean region as well as its prevalence in southeastern Iran, we decided to assess its potential risk factors.

Methods: In this case-control study, 200 children (100 CD and 100 non-CD patients) were recruited via convenience sampling. A survey assessing demographic and medical history (especially perinatal and maternal characteristics) was completed. Then, the odds ratios (ORs) were calculated through conditional logistic regression.

Results: The risk of developing CD increased based on maternal BMI < 18.5 and > 30 kg/m² (OR: 4.2, 95% CI: 1.3-13.2, and OR: 1.5, 95% CI: 0.6-3.7, respectively), living in rural areas (OR: 6.2, 95% CI: 2.6-14.2), use of antacids (OR: 7.4, 95% CI: 0.9-61.7), positive family histories of CD (OR: 11.8; 95% CI: 4.0-34.9), consanguine marriages (OR: 1.9, 95% CI: 1.1-3.5), and exclusive breastfeeding for 3 months (OR: 11, 95% CI: 1.3-87.6). Furthermore, premature rupture of membranes (OR: 0.489, 95% CI: 0.2-0.9) was associated with lower risks of CD.

Conclusions: There is a need to increase awareness of the factors associated with CD in both society and among healthcare providers, to not only reduce exposure but diagnose quicker.

Background: Urinary tract infections are common in children, and early diagnosis is crucial to prevent long-term complications such as renal scarring. While urine culture remains the gold standard, its 24-72-h turnaround time can delay treatment. To expedite diagnosis, rapid tests such as urine dipstick and microscopy are commonly used, but their reliability in resource-constrained settings like Ethiopia is uncertain. This study is aimed at comparing the diagnostic performance of these rapid tests with urine culture in pediatric patients.

Methods: A retrospective cross-sectional study was conducted at Tikur Anbessa Specialized Hospital, Ethiopia, from September 2021 to September 2022. The diagnostic performance of urine dipstick tests (nitrites and leukocyte esterase) and urine microscopy for white blood cells (WBCs) was compared to urine culture results, with sensitivity, specificity, PPV, NPV, and diagnostic accuracy calculated.

Results: A total of 224 children (mean age 5 years; 50% < 4 years) were included in the final analysis. Dipstick nitrite positivity was low (10.9%), limiting its reliability. Leukocyte esterase positivity was higher in males (56%) than in females (43.2%), with an overall rate of 51.8%. Urine WBC microscopy showed higher positivity in males (52.7%) than in females (35.1%). Urine culture had a higher positivity rate in females (55.4%) than in males (47.3%), with an overall rate of 50%. Dipstick nitrite had high specificity (94.6%) but low sensitivity (16.1%), while leukocyte esterase had moderate sensitivity (59.8%) and specificity (75.9%). Combining dipstick tests improved sensitivity (61.6%) but reduced specificity. Urine WBC microscopy showed 67.0% sensitivity, 73.2% specificity, and 70.1% accuracy, with a 33% false-negative rate.

Conclusion: Dipstick nitrites and leukocyte esterase offer a rapid, cost-effective way to detect UTIs in children and guide early treatment, but their limited specificity necessitates confirmatory tests like urine culture or WBC microscopy. Future research should explore novel urinary biomarkers to improve accuracy, minimize invasiveness, and account for age- and sex-specific differences.

Background: Rare diseases are unique. Although they have low prevalence, they constitute a public health priority, affecting more than 350 million people worldwide. Patients are confronted with a complicated environment of sociomedical needs that require a strong public health response.

Methods: European countries share allied multinational policies on rare diseases though inequities, delays in diagnosis, and differences between nations exist. Aiming to access the current Greek health policy, a thorough search on publicly published laws, governmental regulations, administrative information on orphan medical products, and associated actions was conducted. Regional health authorities' websites and relevant scientific webinars were extensively exploited and worked through.

Results: Greece's national strategy for rare diseases includes creating a framework for screening, diagnosis, and treatment. The plan aligns with the EU recommendation to improve the visibility of rare diseases and ensure equal access to healthcare services. During the last 14 years, the Greek state has adopted the European definition and enacted targeted legislation so that, to date, 39 centers of expertise are certified and functioning, 3 disease-specific patient registries are actively operating, and 82 orphan drugs are reimbursed by the state.

Conclusions: This analysis revealed gaps in core sectors: A national central patient registry is lacking, and interoperability between stakeholders can be further enriched and optimized, ensuring patient safety concerns. Health inequities for patients in remote areas should be addressed, and the orphan drug policy should be additionally improved. More research is needed to raise awareness and document patient-centered health policy tactics that drive wellness and treatment programs.

Background: Chronic kidney disease (CKD) is a common complication of hematopoietic stem cell transplantation (HSCT). However, the data on its risk factors in the pediatric population is conflicting.

Methods: We retrospectively analyzed data from HSCT patients treated between 2005 and 2019, including indications for HSCT, conditioning regimens, and complications observed during a 5-year follow-up period, and calculated estimated glomerular filtration rate (eGFR) values. We used repeated measures ANOVA to model the time course of eGFR as a function of CKD. We built unadjusted and multiple adjusted logistic regression models. We did Kaplan-Meier plots and Cox regression with CKD as a potential risk factor for mortality.

Results: At HSCT, the median age (q5-q95) of the 200 (33.5% female) patients was 8.3 (0.64-17.4) years, median creatinine was 33.8 (17.0-65.5) μmol/L, 49 (24.5%) developed CKD, and 42 (21.0%) died during follow-up. In the unadjusted logistic regression model, CKD was negatively related to baseline eGFR (unadjusted OR per 10 mL/min/1.73 m² greater eGFR: 0.87, 95% CI 0.78-0.95; p = 0.004). In the stepwise selection model, greater AKI severity (OR 2.92, 95% CI 1.89-4.15; p < 0.0001), presence of hypertension (OR 2.68, 95% CI 1.02-7.05; p = 0.05), malnutrition (OR 5.42, 95% CI 1.98-14.82; p = 0.001), and iron overload (OR 3.88, 95% CI 1.31-11.51; p = 0.01) were related to CKD during follow-up. Female sex was protective (OR 0.19, 95% CI 0.06-0.61; p = 0.005). CKD status during follow-up was not related to the risk of mortality.

Conclusion: Our results underline the need for better nutrition, prevention of iron overload, and adequate blood pressure control to prevent CKD in pediatric patients after HSCT.

Background: Respiratory distress is one of the most common reasons for the admission of neonates to the NICU in low and middle-income countries (LMICs) like Nepal, where bubble CPAP therapy is one of the most emerging and first-line treatments.

Aims: The aim is to study the various indications of bubble CPAP therapy in neonates with respiratory distress in different clinical conditions, success and failure rates, and outcomes.

Methods: A prospective observational study was conducted for 17 months (Oct 2021-Feb 2023) at Universal College of Medical Sciences, Bhairahawa, Nepal, where 90 neonates with respiratory distress were enrolled and kept on bubble CPAP therapy. Various clinical conditions of CPAP use were observed along with success and failure rates. The final outcome was documented as discharge or death occurred.

Results: A total of 90 babies with respiratory distress required CPAP therapy, where 53.3% were preterm, 44.4% term, and the rest postterm. About 32.2% of neonates had birth asphyxia, 16.7% had respiratory distress syndrome (RDS), 14.4% of cases had prematurity, and 12.2% had meconium aspiration syndrome. The study found a significant mean difference in Silverman score (in preterms) and Downe's score (in terms) before and after 6 h of CPAP (p < 0.001 in each) and 12 h of life (p < 0.001 in each). Out of the total enrolled babies, 67 (74.4%) neonates survived whereas 25.6% had mortality. The present study showed CPAP success and failure rates of 68.9% and 31.1%, respectively. Out of total CPAP failure rate (n = 28) babies, 67.9% had mortality and 32.1% were successfully discharged. No significant association of CPAP failure was seen when compared to gender, religion, gestational age, mode of delivery, resuscitation received, various indications of CPAP use, use of antenatal steroid, and duration of initiation of CPAP.

Conclusion: Birth asphyxia, respiratory distress, and prematurity were three leading causes of respiratory distress for the initiation of CPAP in the present study.

Objectives: This review critically evaluates the literature on nonpharmacological interventions aimed at reducing anxiety in pediatric patients undergoing dental treatments. The aim is to analyze recent research findings on various behavior management techniques and their clinical implications. Methods: A thorough literature search was conducted using electronic databases, including PubMed, Web of Science, the Cochrane Library, and Scopus. Predefined terms were used to ensure a comprehensive and focused search for relevant studies. Results: The continuous stream of research has unveiled several methods, such as awards, Tell-Show-Do, exposure to positive images, and pictorial stories, that have demonstrated tangible effects on anxiety, behavior, and pain perception. These interventions have exhibited practical effectiveness in actual clinical settings. Conclusions: The findings underscore the importance of implementing nonpharmacological interventions in pediatric dentistry to establish a dependable, reassuring, and efficacious treatment environment for children. As more research adhering to designated guidelines and methodologies emerges, pediatric dentistry can further enhance its capacity to not only reduce dental fear and pain intensity but also promote positive dental hygiene practices, starting from early childhood.

Aim: The aim for the study is to evaluate the effects of 1 mg/kg/day iron supplementation on hematologic and growth parameters in exclusively breastfed full-term infants. Methods: We conducted a meta-analysis of seven RCTs (n = 1114) comparing iron supplementation with placebo/no intervention. Primary outcomes included hemoglobin (Hb), serum ferritin (SF), mean corpuscular volume (MCV), height, and weight. Data were analyzed using RevMan 5.4. Results: Iron supplementation from 4 to 6 months significantly increased Hb (MD = 6.29 g/L, p = 0.01), but effects diminished with longer duration (MD = 2.00 g/L, p = 0.08). For SF, no significant difference was found at 6 months, but supplementation significantly increased SF at 12 months (MD = 5.95 μg/L, p = 0.04). No significant differences were found in MCV, height, or weight. Subgroup variations were noted by formulation and region. Conclusion: While short-term iron supplementation improves iron status, the lack of sustained benefits suggests individualized approaches may be preferable to universal supplementation in well-nourished populations.

Purpose: Heart rate variability (HRV) is a physiologic marker of autonomic nervous system (ANS) health. Because of multisystem impairments, children with medical complexity (CMC) can be challenging to evaluate and assess. They commonly display ANS dysfunction and subsequently reduced HRV. One purpose of this study was to report respiratory sinus arrhythmia (RSA) values derived from HRV, which may provide a reference and a future method to assess CMC and related treatments. Methods: Then, 36 CMC between the ages of 5-21 years were assessed within school-based settings. All children demonstrated severe brain impairment, functional limitations, participatory restrictions in life, and high healthcare needs and utilization. A subset of 20 children with cerebral palsy (CP) was identified within the study sample. Each child was assessed by the same assessor for 5 days within a 10-day period. Using Firstbeat Bodyguard 2 monitors, cardiac data were collected prior to and during the administration of the newly developed Pediatric Assessment of Sensory Motor Awareness. CardioEdit and CardioBatch software were used to edit cardiac data and calculate RSA values. Descriptive, repeated measures, and modeling statistics were used to analyze data. Results: Descriptive RSA values for baseline and across five sensory domains are reported for the total CMC group and its subsets of children with CP and non-CP. Significant differences in RSA values were noted for the gustatory domain as compared to baseline and other sensory domains. Significant differences from statistical modeling were demonstrated between the CP and non-CP groups. Conclusions and Recommendations for Clinical Practice: This study's HRV findings provide preliminary reference RSA values in CMC. Then, 20 children considered to be CMC with primary diagnoses of CP experienced less autonomic dysfunction than other CMC diagnostic groups at baseline and across the five sensory domains. The gustatory domain significantly reduced RSA. Modeling across days indicated that CMC experience a learning effect by Day 3 or 4. The measurement of HRV may provide a method to assess health and behavioral responses in CMC and associated treatments. Replication of these study findings will be necessary.