Minerva Pediatrics最新文献

Background: The COVID-19 pandemic had a substantial impact on the mental health of children and adolescents. The literature lacks large-scale research evaluating its consequences on teenagers with feeding and eating disorders (FED). This study aims to assess the impact of the COVID-19 pandemic on a population of patients of developmental age.

Methods: This single-center observational study compares two historical cohorts of children and adolescents diagnosed with FED, with a first consultation before (1^st March 2018 to 31^st October 2019) and during (1^st March 2020 to 31^st October 2021) pandemic. Demographic, clinical, nutritional, and treatment variables were assessed.

Results: We enrolled 479 patients (F=398, 83.1%), including 205 (F=161, 78.5% mean age 14.5±2.5, range 7.9-17.9 years) belonging to the first historical cohort and 274 (F=237, 86.5%; 14.4±2.1, range 6.5-17.9) to the second one (+33.7%). Increased mean new accesses/month (P=0.042) and a greater percentage of females (P=0.042) during the pandemic compared to the pre-pandemic period emerged. Physical hyperactivity (P=0.022) and suicidal behaviors (P=0.030) increased, while fewer patients required hospitalization (P=0.013).

Conclusions: An increase in first visits for FED after the COVID-19 pandemic emerged, with females being the most affected. Physical hyperactivity and self-harming behaviors were intensified, while patients in need of hospitalization were reduced. Longitudinal studies are required.

Background: In patients undergoing appendectomy, postoperative complications are more likely to occur with complicated appendicitis. Abdominal drainage may occasionally be used to prevent such scenarios. It is unclear, though, how abdominal drains help to reduce problems after surgery.

Methods: Pediatric patients who underwent appendectomy for complicated appendicitis at a tertiary center between October 2021 and September 2022 were reviewed retrospectively. Following appendectomy, patients with and without peritoneal drains were contrasted in terms of preoperative characteristics and postoperative outcomes.

Results: Thirty-seven of 83 patients (44.58%) undergoing emergency laparoscopic appendectomy for complicated appendicitis received abdominal drainage. The drain group had longer hospital stay (9 days [IQR 6-11] vs. 6 days [IQR 4-8], P=0.0002) and longer time to CRP normalization (6 days [IQR 4-9.5] vs. 8 days [7-12], P=0.0222) compared to the no-drain group. The drain group also had a higher complication rate (30.56% vs. 23.81%, P=0.6107), although such finding was not statistically significant.

Conclusions: The use of abdominal drains after laparoscopic appendectomy did not significantly prevent postoperative complications in complicated appendicitis. Instead, it was associated with longer hospitalization, although patients in the drain group are likely to have experienced more severe conditions.

Background: Identification and addressing of pediatric obesity are the first steps in its management, and Pediatric Emergency Department (PED) visits have a potential to increase its awareness. The main aim of this study was to examine if posters placed in the PED alerting to obesity increased its documentation.

Methods: The design of this paper is that of an interventional study which took place at a large tertiary PED during May-August 2022. Obesity listing in PED charts of children with obesity was defined as weight percentile >90 and examined over two weeks before poster placement, during four weeks of display, and for four weeks after their removal. Logistic mixed models were used to examine the associations between several factors and obesity documentation.

Results: During the whole study period, there were 4174 PED visits of children aged >2 that had body weight data, of which 590 (14.2%) had obesity. Obesity addressing in charts of children with obesity was found in 2/134 (1.5%) before poster placement, 7/229 (3.1%) during placement, and 10/227 (4.4%) after removal, but this 2-3-fold increase was not statistically significant (P=0.313). There were only 28 scans of a QR code on the poster that offered obesity treatment options, and only two parents filled its questionnaire.

Conclusions: Poster placement could possibly improve obesity discussion in the PED, yet larger samples and additional techniques are needed.

Background: The aim of this study was to investigate the features of cyclic vomiting syndrome (CVS) in a pediatric cohort and assess the safety and efficacy of cyproheptadine regardless of age.

Methods: This retrospective, monocentric study enrolled children diagnosed with CVS. After collecting data from the medical records, a telephone-based questionnaire interview with the caregivers was conducted to obtain missing or unclear data. Prodromal symptoms, triggers, and comorbidities were analyzed. The safety and efficacy of cyproheptadine were evaluated in the entire patient cohort and compared between children under 5 years old and those 5 years of age or older.

Results: A cohort of 24 subjects with CVS were included. Prodromal symptoms were reported in 45.8%, triggers in 33.3%, and comorbidities in 58.3% of patients. Migraine was present in 54% of the patients. Cyproheptadine was prescribed to 15 of the 24 patients (62.5%), with 40% and 80% achieving a reduction in the frequency of vomiting clusters of over 75% after a median duration of 6.03 and 12.13 months respectively. Prophylactic therapy did not provide any benefit to 20% of the patients. No statistically significant differences were found in vomiting features or cyproheptadine response between children above and below 5 years, except for a negative correlation between age and the presence of diarrhea during CVS episodes. No serious adverse effects were reported.

Conclusions: Assessment of prodromes, triggers, and comorbidities aids in CVS diagnosis in children. Cyproheptadine is effective and safe for the management of CVS regardless of age.

Background: Recent literature highlighted the relevance of parenting strategies and emotions in dealing with children with ADHD and showed that these dimensions were highly affected by the COVID-19 lockdowns. Thus, our research investigated the impact that the COVID-19 pandemic had on caregivers of children with attention deficit hyperactivity disorder (ADHD). We focused on the role of medications, children's age, and distance learning on changes in caregivers' emotions and parenting strategies.

Methods: Nine hundred ninety-two caregivers completed an anonymous online questionnaire. The survey enquired caregivers about children's pharmacological therapy, difficulties in distance learning, and caregivers' parenting strategies and emotions before and during the lockdown.

Results: Our results showed that caregivers experienced relevant difficulties in distance learning and that they felt more frustration emotions and employed more negative parenting strategies than before the pandemic. While pharmacological therapy was not a significant predictor of changes in neither positive nor negative parenting strategies, children's age and learning burden proved to predict caregivers' changes in positive parenting strategies. Moreover, our mediation analysis showed that the learning burden (e.g., homework increasing and children's reliance on caregivers) partially mediates the effect of age on changes in positive strategies. The older the children, the less the burden, and the less the change in positive strategies.

Conclusions: These results describe lockdown's impact on caregivers' experience in dealing with children with ADHD and explain how they adapted to it by changing their parenting strategies.

Background: Herbal based ingredients form a more sustainable and effective means for management of ailments related to the human body. Previously plant-based extracts of Cocos nucifera had effective remineralization potential. Hence to identify the changes in enamel mineral density and volume during the remineralization procedure, this study was done with an aim of three-dimensional micro-CT analysis to identify the potency of Cocos nucifera in remineralizing the artificial enamel carious lesion. The aim of the present study was a three-dimensional micro-CT analysis to identify of the potency of Cocos nucifera in remineralizing the artificial enamel carious lesion.

Methods: This is an in-vitro study, performed in a laboratory setting. Tooth slabs (N.=35) measuring 3×3×1.5 mm were prepared from extracted molar tooth. The prepared slabs were allotted to their respective groups by block randomization. Demineralization of the tooth slabs were done for a period of 72 hours. Following this the samples were washed with deionized water and remineralization was carried out for a period of 14 days. The groups tested were: 1) only remineralization solution(control); 2) 1: 1 lyophilized coconut (2.5 g LC in 25 mL remineralization solution); 3) 2:1 Lyophilized coconut (5 g LC in 25 mL remineralization solution); 4) 1:1 coconut milk (2.5 g CM in 25 mL remineralization solution); and 5) 2:1 coconut milk (2:1 CM - 5 g CM in 25 mL remineralization solution). Micro-CT scanning and analysis of the samples was performed postdemineralization and postremineralization procedure to evaluate the changes in the enamel volume and enamel mineral density. Within each of the five-group tested, the changes in the enamel volume and density before and after remineralization procedure was statistically analyzed using Paired t-test. One way ANOVA and Post-hoc Tukey test were done to analyze the intergroup statistical significance between the various treatment groups postremineralization procedure.

Results: The mean difference of the enamel volume indicates that the control group showed the highest differences (-4.57±0.347) this was seconded by the 1:1 coconut milk, 1:1 lyophilized coconut and the lowest was noted in the 2:1 coconut milk group. The mean differences of the changes in the enamel mineral density between the demineralized and remineralized enamel surface indicates that 2:1 Coconut milk showed highest changes in the surface enamel postdemineralization (-22.32±5.37) and 1:1 coconut milk showed the least of the changes in the surface of the enamel (4.00±3.42).

Conclusions: Coconut extracts obtained from various extraction procedures showed quantitative increase in remineralization of artificially created enamel carious lesion. Further in-vitro studies could be done to the clinical efficiency of the same in oral environment.

Allergic rhinitis (AR) is a prevalent disease in childhood and adolescence. A type 2 inflammation characterizes AR and, mainly, sustains nasal obstruction. Budesonide aqueous nasal spray (BANS) is an intranasal corticosteroid (INCS) available since the early 1980s. BANS is indicated for treating allergic rhinitis. There is evidence about its efficacy in treating children and adolescents with seasonal and perennial AR. In addition, BANS is safe with negligible local and systemic side effects. Recent guidelines for patients with AR recommend the use of INCS as first line in many situations. In particular, AR patients (and their parents) may assess the perception of symptoms' severity using the Visual Analog Scale (VAS). A score ≥5/10 means uncontrolled symptoms and requires adequate treatment. BANS could appropriately be used in patients with uncontrolled symptoms and/or moderate/severe nasal obstruction. In conclusion, BANS represents a valuable option in managing children and adolescents with AR.

Diuretics are medications that promote the excretion of water and electrolytes. They are primarily used in the management and treatment of states of inappropriate salt and water retention. Diuretics represent one of the most common classes of drugs administered to sick neonates, the more so in very low birth weight infants. Diuretic drugs, especially loop diuretics, are often administered in the neonatal intensive care unit as off-label medications. This is the case for a variety of clinical situations, in which an increase in sodium excretion is not the primary goal of treatment (transitory tachypnoea of the newborn at term, hyaline membrane disease, patent ductus arteriosus of preterm infants). Thiazides and furosemide are widely used to treat preterm infants with oxygen-dependent chronic lung disease, despite a lack of data on beneficial effect of long-term therapy on pulmonary function or clinical outcome. This article reviews the mechanism of action, indications, administration, posology, adverse effects and contraindications of diuretics in newborn infants. Based on the most recent information available in the literature, we will discuss data supporting (or questioning) the use of diuretic in specific neonatal diseases. Research priorities over this issue will be briefly presented.

Acute neurologic injury is common in critically ill children. Some conditions - such as traumatic brain injury, meningitis, and hypoxic-ischemic injury following cardiac arrest - require careful consideration of cerebral physiology. Specialized neuromonitoring techniques provide insight regarding patient-specific and disease-specific insight that can improve diagnostic accuracy, aid in targeting therapeutic interventions, and provide prognostic information. In this review, we will discuss recent innovations in invasive (e.g., intracranial pressure monitoring and related computed indices) and noninvasive (e.g., transcranial doppler, near-infrared spectroscopy) neuromonitoring techniques used in traumatic brain injury, central nervous system infections, and after cardiac arrest. We will discuss the pertinent physiological mechanisms interrogated by each technique and discuss available evidence for potential clinical application. We will also discuss the use of innovative neuromonitoring techniques to detect and manage neurologic complications in critically ill children with systemic illness, focusing on sepsis and cardiorespiratory failure requiring extracorporeal membrane oxygenation.