International Journal of Pediatrics最新文献

Introduction: The Swedish child health care (CHC) program provides voluntarily, at no cost, services for children from birth to 5 years old. Participation rates are 99% of Swedish parents enrolling their children in some form of CHC program. Parental groups, comprising parents with similar experiences, can help reduce parental stress and foster the development of effective coping strategies. The study is aimed at evaluating a digital support intervention involving parents, child health nurses, and researchers. Methods: This cluster-randomized, prospective pilot intervention study, conducted in northern Sweden, had three follow-up points: baseline, 4 months, and 8 months. Data were collected from autumn 2022 to late spring 2023 and evaluated effects on parental stress and satisfaction, eHealth literacy, and satisfaction with CHC, accessibility, and support. The 18-item Parental Stress Scale was used to assess parental stress and satisfaction. eHealth literacy was measured using the 10-item eHEALS scale, and parental satisfaction and opinions on accessibility to CHC were measured using a three-item Visual Analogue Scale. The intervention group was offered to participate in various digital activities, while the control group received the usual CHC. Results: Parental satisfaction and stress levels within and between the intervention and control groups showed no significant changes from baseline to 8 months. Regarding eHealth literacy, differences were observed between the groups; however, both groups demonstrated improvement at the 8-month follow-up. The control group scored higher in eHealth literacy from baseline. The same pattern was identified regarding the parents' perceptions of internet usability and importance. Concerning satisfaction with CHC, accessibility, and support, the control group scored higher at baseline. Interestingly, the lines of the intervention and control groups crossed over at the 8-month follow-up. Conclusion: Despite a limited outcome change, the results showed a tendency to benefit some parents. Our findings suggest that further evaluation, possibly with other more suitable measurements or questionnaires, an extended intervention period, and a larger sample, is necessary to understand the implications of these results fully.

Rationale: Young people with neuromuscular diseases (NMDs) are especially at risk of being absent from school because of various symptoms, consequences of their disease, and frequent hospital visits. Growing up with a chronic disease can entail an increased risk of poor educational outcomes. Aims: The study is aimed to investigate factors of importance for continuing with upper secondary and/or higher education after primary education when living with NMD, including expectations, support, and accessibility. In addition, we wanted to assess educational absence, discontinuation of studies, motivation, and sense of belonging. Method: This cross-sectional study was founded in a national online questionnaire survey based on patient-reported outcomes from people with NMD. Five hundred and one persons were invited to participate. Data were analyzed using IBM SPSS Statistics 26. All variables were presented as numbers and percentages. Results: Responses were obtained from 172 (34.3%) young people with NMD. Twenty (11.6%) answered that their parents'/relatives' educational expectations for them were lower than their own expectations. Forty (24.4%) answered that their teachers seldom or never planned the lessons in ways that were inclusive for them. Forty-five (27.7%) responded that they were always or mostly more absent than their classmates in primary and lower secondary education. Thirty-two (24.8%) respondents who had started upper secondary education had dropped out of one or more educational programs. Thirty-one (18.6%) answered they seldom or never had a sense of belonging at school. Conclusion: Our results show novel knowledge on factors of importance for continuing education after primary school in young people with NMD. We found that teachers and parents carry a responsibility to show expectations to young people with NMD to ensure that the young people acquire adequate academic skills and actively participate in classroom activities. Supportive initiatives to prevent loneliness are important for keeping young people with NMD in the educational system.

Background: The most used manikin for neonatal resuscitation training is NeoNatalie (N), a low-fidelity manikin. A new manikin, NeoNatalie Live (NL), has been developed with more fidelity. We completed a noninferiority RCT to evaluate skill acquisition and to assess retention after 4 months of using these manikins. Methodology: Performance evaluation test (PET), a 14-item checklist, was used to assess students' skills before and after training and after 4 months. The maximum score was 100, and the noninferiority limit was 5. One hundred forty-three medical students were assigned randomly into two groups: N (n = 72) and NL (n = 71). Half of each group was evaluated on a simulator different from the one they were trained on. Results: Mean (SD) pretest PET scores (before training) for the NL and N groups were comparable across groups (39.5 [18.15] vs. 34.8 [19.10]; p = 0.13). The PET score was comparable between NL and N after training (82.46 [10.28] vs. 80.52 [13.07], absolute difference 1.93; 95% CI [-1.956343, 5.830363]; p = 0.83 [1-sided]). NL was statistically noninferior to N as the lower bound of 95% CI of absolute difference is greater than the noninferiority margin (-1.95 > -5). A similar finding was observed in retention after 4 months (76.09 [15.80] vs. 73.33 [18.42]; absolute difference 2.75; 95% CI [-2.92457, 8.43271], p = 0.83 [1-sided]). The mean gain of PET score within the group (posttest minus pretest) for NL and N was comparable (42.97 [17.11] vs. 45.73 [19.51]; absolute difference 2.76; 95% CI [-8.835228, 3.306668], p = 0.81 [1-sided]). Conclusion: There was an improvement in scores in the posttest for both manikins. The NL was noninferior as compared to N.

This study examined children with visual impairments (CwVI) satisfaction with school facilities, CwVIs' reasons for their satisfaction or dissatisfaction with school facilities, and steps to enhance their inclusion in teaching and learning. Grounded in Bronfenbrenner's ecological systems theory (EST) (1979), the study employed a mixed-methods approach, including a survey of 288 CwVIs, 73 key informant interviews (KIIs), 14 focus group discussions (FGDs), observations, and documentary reviews to complement the findings. The results revealed that 60.8% of CwVIs were satisfied with their school facilities, while 39.1% were dissatisfied. Key factors contributing to satisfaction included the suitability of the school compound and classroom furniture arrangement, which minimized accidents. In contrast, unsafe compounds, overcrowded classrooms, and poorly arranged furniture disrupted navigation and participation, exposing vulnerabilities in their learning environment. The findings highlighted the vital role of family and community involvement in fostering inclusive attitudes and advocating for infrastructure and resource improvements. Families actively supporting these efforts can significantly enhance support systems for CwVIs. The study underscores the need for collaboration between families and schools to build cohesive support networks that address the academic and social needs of CwVIs, fostering an inclusive learning environment.

Background: We examined the relationship between the 5-min Apgar score and other individual and contextual neonatal characteristics with early neonatal mortality (before 24 h) in Ecuadorian neonates. Methods: We conducted a retrospective case-control study using data from the Ecuadorian National Surveillance System for Neonatal Mortality, covering January 2014 to September 2017. We analyzed data for neonates who died within 28 days of birth, focusing on mortality before 24 h (early death). Multilevel multivariate logistic regression was used to calculate crude and adjusted odds ratios (aORs) for early death based on 5-min Apgar scores and other neonatal factors. The random effects variable in this model was altitude at which neonates were attended; this component of the model allows the intercept estimates to vary randomly among the groups of altitude, suggesting that there are differences between these groups that could influence the study results at which the neonates were attended. Results: Of 2144 neonates analyzed, 53.2% were male, with an average gestational age of 30.8 weeks and a mean birth weight of 1525.2 g. More than half (56.0%) were delivered by caesarean section. Common comorbidities included prematurity (39.4%), asphyxia (31.2%), and infections (24.7%). Also, 17.4% had Apgar scores of ≤ 3. After adjustment, Apgar scores of ≤ 3 were linked to significantly increased odds of death before 24 h, with an aOR of 20.65 (95% CI: 5.99-71.28, p < 0.001). Conclusions: This study demonstrated that the Apgar score, among other determinants, was significantly associated with early neonatal mortality (before the first 24 h). This association was independent of type of delivery, comorbidities, disorders related to asphyxia, prematurity, infections, and other medical disorders, as well as varying levels of care from primary to tertiary. These findings underscore the importance of Apgar evaluation in neonates and suggest a predictive value of the score for early neonatal mortality.

Background: Cervical lymphadenitis is prevalent in children. Several viruses and bacteria can cause cervical lymphadenitis. Staphylococcus aureus and Streptococcus pyogenes are known to predominate as bacterial causes. Choosing the effective antibiotic regimen to treat cervical lymphadenitis is difficult because of temporal and geographical variations in its etiologies and antibiotic resistance. We aim to elucidate the etiologies, treatment, and outcomes of cervical lymphadenitis in children in Iran. Methods: A total of 113 patients admitted to the Children's Medical Center in Iran were included in this retrospective cross-sectional study. Patients under 18 years in medical records were evaluated for demographics, signs and symptoms, lymph node aspiration or surgical drainage culture and antibiogram results, type and duration of treatment, complications, treatment failure, and patient discharge instructions. Results: Patients' mean age was 3.5 years (SD: 2.9; range: 3 months to 13 years), and 70 (62%) were male. Of 113 patients, 38 (34%) had a prior history of upper respiratory tract infection (URI), 2 (1.7%) had dental caries, 1 (0.9%) had Hodgkin's lymphoma, and 72 (64.1%) patients did not have any accompanying illnesses in presentation. The most common clinical manifestation was neck swelling or erythema (99.1%), followed by fever (73%), neck pain (30%), and torticollis (9%). Twenty-one (18.5%) patients underwent cervical lymph node aspiration, and 7 (6%) underwent surgical incision and drainage, of which 17 (61%) had a positive culture. Staphylococcus aureus was isolated in 16 (94%) cases. No positive culture was reported regarding fungi and acid-fast bacilli. Regarding their antibiogram reports, the lowest resistance rates were to vancomycin, cotrimoxazole, and oxacillin (6% each), followed by clindamycin and erythromycin (12% each) and penicillin (94%). The mean duration of hospitalization was 6 days (SD: 3.2; range: 2-22 days). Thirty-three (29%) patients underwent surgical drainage along with antibiotic therapy. Conclusion: Cervical lymphadenitis was prevalently accompanied by URI. Swelling and erythema in the neck were the most common clinical manifestations. The most common isolated organism was Staphylococcus aureus. We did not find Streptococci, which might be due to the beta-lactam usage before hospital admission. Most of the patients were treated with clindamycin during hospitalization. However, resistance to clindamycin was higher than that of other antibiotics effective against Staphylococci and Streptococci, like oxacillin. We recommend considering this resistance pattern in choosing antibiotics to prevent treatment failure and reduce the need for surgery.

Context: Social determinants of health (SDOH) play a large role in pediatric and adolescent metabolic health worldwide. Objective: The study is aimed at exploring key SDOH related to childhood obesity, worldwide. Methods: Primary research articles from PubMed, Embase, and Medline databases published between 2013 and 2023, had a study population of 0-19-year-olds, and examined the association between WHO-defined SDOH and childhood obesity were included. Non-English papers and those outside WHO-defined SDOHs were excluded. Two reviewers independently performed a blinded screening of titles and abstracts, followed by a full-text assessment of selected articles. Results: Of the 703 initial articles, 22 duplicates were excluded, leaving 681 unique articles from PubMed (N = 274), Medline (N = 43), and Embase (N = 364). Initial screening excluded 579 articles, and full-text screening excluded 61 more, resulting in 41 final articles. Reasons for exclusion primarily involve missing SDOH exposure or weight-related outcomes and articles being reviews, editorial/opinion pieces, or interventional studies. Most included studies were cross-sectional (N = 25) and conducted in North America (N = 22). The average study sample size was 43,640 participants. These studies focus on socioeconomic determinants, neighborhood characteristics, food environment, healthcare access, educational determinants, and immigration-related factors. Obesity-related outcomes included general obesity, severe obesity, abdominal obesity, weight gain, BMI/weight categories, and continuous BMI measures. Conclusion: Key SDOHs of childhood obesity include socioeconomic status, neighborhood characteristics, food environment, healthcare access, immigration, and culture. Despite diverse regional studies, there is a notable gap in US-specific data on SDOH of childhood obesity, especially by race and ethnicity. Further research is needed to better understand these determinants and their impact on pediatric metabolic health.

Background: The human milk microbiome is vital in the formation of the newborn microbiome and affects various health outcomes. Probiotics prevent severe necrotizing enterocolitis in neonates, but uncertainty about their safety is the obstacle to their use. Probiotic organisms and antimicrobial peptides derived from probiotic strains in human milk can offer safer options. Aim: This study is aimed at determining the probiotic properties in the human breastmilk microbiome and their potential antimicrobial activity. Methods: Study Design: We conducted a prospective longitudinal study. Participants: The study included 30 mothers, equally divided among gestational ages of < 32 weeks, 32-36 6/7 weeks, and above 37 weeks at the time of delivery. Milk samples were collected and analyzed at three different time points, that is, colostrum, transition milk (7-9 days), and mature milk (after 14 days). Outcome: The microbiome isolated was tested for probiotic and antimicrobial properties. Results: Three hundred and eighty-one bacterial colonies were isolated, of which 38 different species were identified. Of these, Gemella haemolysans, Micrococcus luteus and lylae, and Staphylococcus hominis and warneri were selected. Few showed bile salt, phenol, and NaCl tolerance, but none showed tolerance to pH. Antimicrobial activity was not seen when isolates or protein extracts were tested against the pathogen. Enhancement in the zone of clearance was seen when a combination of protein and antimicrobial agents was tested compared to antimicrobial alone. The zone of clearance was seen even at one-tenth of the standard concentration of amphotericin B when combined with protein extract. Conclusion: The non-Lactobacillus strains tested showed few probiotic properties. Though the isolates did not exhibit antimicrobial properties, the protein extracted from them enhanced the potency of antimicrobial agents.

Background: Food allergies, characterized by immune reactions to food proteins, have emerged as an increasing global concern, impacting over 10% of the population. This study investigates the prevalence of food allergies among schoolchildren aged 5-14 years in northern and central Jordan. Methods: A randomized cross-sectional online questionnaire was administered to students aged 5-14 years residing in the central and northern regions of Jordan. Parents of these students (n = 1629) completed the questionnaire, which comprised information on demographics, dietary habits, food allergies, and allergy history. Results: The parent-reported food allergies exhibited a prevalence of 11.5% (95% confidence interval = 10-13%). Of these reported allergies, 10.1% (95% CI = 8.6-11.7%) were classified as convincing, while only 5.7% (95% CI = 4.5-6.8%) received a formal diagnosis from a healthcare professional. The most commonly reported allergens included eggs (17.8%), cow's milk (15.8%), peanuts (14.5%), and strawberries (13.8%). The majority of children (67.1%) had a single reported allergen, while 15.8% had two, and 17.2% had more than two allergens identified. Food allergies were significantly more prevalent among children with comorbid atopic conditions and those with a family history of allergies. Additionally, regional variations were observed, with high prevalence rates in metropolitan regions. Conclusion: This study emphasizes the significance of considering persuasive food allergy (FA) data in addition to parent-reported information. The findings highlight the considerable burden of food allergies and their relationship with other atopic disorders. Comprehensive management strategies and further research to elucidate the underlying causes of food allergies are necessary.

Background: Intussusception is the most common cause of acute intestinal obstruction in children. It can be initial idiopathic intussusception or a recurrent intussusception (RI), and in this latter case, there is not a validated algorithm for optimal treatment. The aim of the study is to review the international literature to evaluate the incidence of RI, to determine the rates of surgical intervention and pathological leading point (PLP), and to define the most appropriate management for children with RI. We included English-written papers with pediatric population, excluding case reports, papers with adult or mixed cases, studies focusing on ileo-ileal or colo-colic intussusception, meta-analysis studies, or papers with unclear or replaced data. Results: A total number of 23 articles were included for a total of 26,731 patients affected by intussusception and 3164 recurrent patients (11.8%). The number of attempts of nonsurgical reduction ranged from 3 to 10 (median 5). On 2965 RI, 358 underwent surgery (12.1%). A pathologic leading point was found in 99 patients (3.95%). Conclusions: The presence of a PLP does not seem to be associated with the recurrence of intussusception. More than 85% of RI underwent successful nonsurgical management. RI should be safely approached in the same way as primary intussusception, and surgery should be reserved to cases where a PLP has been suspected. In cases of multiple episodes, surgery can be considered an effective way to avoid recurrences, and this possibility should be discussed with parents.