Global pediatrics最新文献

In recent years, adolescents have experienced rising rates of suicidal ideation. Though pediatricians in our clinic were screening for depression, suicide risk screens were not completed. We designed a quality improvement (QI) project with the goal to increase the rate of suicide risk screening by 20 %, and improve clinicians’ attitudes toward the electronic health record (EHR) for mental health screening by 20 %. Baseline analyses included chart review and a provider survey. Suicide risk screen tools were built with decision-support into the EHR. After provider education was completed, the EHR-based interventions were implemented. Post-intervention, suicide risk screening completion increased from 8.8 % to 95 %. Provider attitudes towards the EHR also improved. This QI project demonstrates that implementing EHR tools that are provider-informed can help to improve suicide risk screening rates, streamline workflows, and help improve clinicians’ attitudes towards the EHR.

Objective

UPD(16)mat is a rare genetic condition characterized by intrauterine growth deficiency and multiple congenital malformations. To the best of our knowledge, neurodevelopmental disorders have never been described in association with UPD(16)mat, nor a comprehensive neuropsychological profile of a UPD(16)mat child has never been delineated. We present a young patient diagnosed with UPD(16)mat, and provide clinical description, comprehensive neurodevelopmental, neuropsychological and neurological assessment.

Method

Neuropsychological examination included global neurodevelopment and intelligence scales, as well as specific trials for gross-motor, fine-motor and perceptual motor abilities, and language skills.

Results

The patient shows multiple congenital anomalies, including oesophageal atresia, mild bone alterations, hypospadias, persistent left superior vena cava. The neurodevelopmental evaluation demonstrates a speech disorder, signs of gross and fine motor skills difficulties, balance and visuo-motor deficit.

Conclusion

Evidence from this study indicates that UPD(16)mat may present neuropsychological and/or minor neurological abnormalities. Monitoring both the early and late neurodevelopmental outcomes during childhood is recommended for the chance of an early intervention.

The case reports describe the hospitalization of three extremely premature infants who developed cytomegalovirus (CMV) infection. The most probable source of infection was their mothers' milk. Although the infants were already stable and had survived for several weeks, their health and lives were threatened by the CMV infection. Despite the Polish recommendations for feeding extreme preterm infants with fresh breast milk, we have implemented our own management procedure due to the specific clinical circumstances. We test the breast milk of a seropositive mother for CMV early on and then provide the infant with pasteurized milk from 8 days of age until the test results are available or up to 34 postmenstrual age if CMV presence is confirmed. This procedure ensures the health and safety of the infants while providing them with necessary nutrients. We also outline the treatment of premature infants, potential complications during therapy, and monitoring treatment effects. We describe milk pasteurization techniques and the differences in composition due to the processes used. The paper provides also a summary of practices for feeding extremely premature infants with milk from seropositive mothers in other countries.

Background

Mental health disorders may have a negative influence on health outcomes in patients with HIV; however, these conditions are under-diagnosed among adolescents living with HIV. This study aimed to assess the prevalence of mental health distress and associated factors among adolescents living with HIV attending Antiretroviral Therapy clinics in Nigeria.

Methods

This was a cross-sectional study of 212 HIV-infected adolescents attending routine HIV clinic visits across five high patient-density clinics in southwestern Nigeria. Mental health distress was assessed using the General Health Questionnaire-12 (GHQ-12) and data was analyzed using IBM-SPSS Statistics for Windows version 22.0 (IBM Corp., Armonk, NY, USA).

Results

The prevalence of mental health distress among participants was 34.9 %. On bivariate analysis, respondents who consumed alcohol sometimes had significantly higher mental health scores than those who never took alcohol (t-test 2.738; P = 0.007). There were no significant differences in the mean mental health scores of respondents with regards to social factors (smoking, experience of rape, disability status, mode of payment for health services, and number of living companions) and clinical factors (duration of diagnosis and treatment of HIV, the type of HAART regimen, and whether there had been a change in regimen). On multivariate analysis no social or clinical factor was found to be independently associated with mental health distress.

Conclusions

The prevalence of mental health distress among adolescents living with HIV in southwestern Nigeria is high. Respondents who consumed alcohol had significantly higher mental health scores than those who never took alcohol. Future studies should explore psychosocial stressors that could be determinants of mental health distress among adolescents living with HIV in Nigeria.

Congenital glucose-galactose malabsorption (CGGM) is a rare metabolic disorder caused by a deficient intestinal sodium-dependent glucose cotransporter (SGLT1) protein. Its failure leads to a lack of absorption of galactose, glucose, and sodium, which remains inside the intestinal lumen. The consequence of that involves, among other things, dehydration and diarrhea on neonatal onset. The basic treatment consists of diet management. A 6-month-old Brazilian infant with CGGM caused by a one base pair deletion on SLC5A1gene, in both alleles, causing a frameshift mutation and, consequently, a deleterious impact on the terminal protein portion is, for the first time, characterized here. Besides the common disease aspects, the child presented Necrotizing Enterocolitis (NEC), a new outcome for his condition. The fact that a non-consanguineous couple could produce a child with a recessive disease is puzzling. However, we were able to correlate all symptoms, including NEC, to the disruption of the protein terminal portion, based on literature review. This article brings a new point of view on disease report; putting together the social aspects, clinical examination, laboratory trials, genetic diagnostic, protein assemble and literature research in order to fulfill the patient history. This process allows us to improve the understanding of the disease mechanism, perform targeted genetic counseling and institute appropriate treatment using an adequate diet through nutritional guidance and surveillance.

Background

In recent decades, we have observed an increase in ambient temperature due to the effects of climate change.

Objective

In this study, we aimed to determine whether there is a correlation between environmental temperature and urgent consultations of pediatric patients related to febrile processes.

Research design and method

We conducted an observational, retrospective, single-center study in the pediatric ED of the Hospital Universitario La Paz, Madrid, Spain. We analyzed visits to the ED for febrile processes during the last heat waves in Madrid.

Results

Between 2018 and 2022, seven heat waves were recorded in Madrid. A total of 3967 patients with fever as the main reason for consultation attended during this period. In two of the seven heat waves analyzed, febrile-related visits were higher during the heat alert. The first occurred between 6/11/2022 and 6/16/2022, with 345 febrile-related ED visits, 25.4% more than the previous days and 19.7% more than the following days. During this heat wave, we observed a positive correlation between the maximum temperature recorded and the number of visits to the ED for febrile processes (Rs=0.552; p = 0.018). During the heat wave between 09/07/2022 and 17/07/2022, 362 febrile-related ED visits were 3.1% more than the previous days and 24.9% more than the following days.

Conclusion

During recent heat waves in our city, we registered an increase in febrile-related visits compared with non-heat alert periods.

Background

Chronic diuretics are frequently used (off-label) in preterm infants to manage evolving or established bronchopulmonary dysplasia (BPD). Chronic diuretic use, however, is limited by tolerance with no long-term safety and efficacy data, leading to wide variation in its use in preterm infants.

Objective

To determine the impact of the chronic diuretic clinical practice guideline (CPG) on the patterns of diuretic use, severity of BPD, and hospital length of stay (LOS) in preterm infants born less than 32 weeks gestation.

Methods

Single-center retrospective pre-post CPG cohort study in a level IV neonatal intensive care unit. Chronic diuretic CPG was implemented in November 2021 and the data was collected one year before (Pre-CPG) and one year after (Post-CPG).

Results

In total, 73 infants (39 Pre-CPG, and 34 Post-CPG) were identified. There were no significant differences in patient characteristics at birth or in the use and duration of respiratory support between the two groups. Compared to Pre-CPG, the frequency of thiazide diuretic use was not decreased in Post-CPG (30.8 vs. 20.6 %, p = 0. 42), but the duration of use was significantly reduced (35 vs. 6 days, p = 0.01). Both frequency (20.5 vs. 2.9 %) and duration (28.5 vs. 4 days) of spironolactone were reduced in the Post-CPG (p < 0.05). Furosemide exposure (69.2 vs. 41.2 %, p = 0.02) and total doses [3.0 (0.0–8.0) vs. 0.0 (0.0–2.3), p = 0.003] were also significantly reduced in the Post-CPG. The incidence of any BPD at 36 weeks and LOS were similar between groups, while the incidence of moderate/severe BPD and home oxygen use were decreased in the Post-CPG.

Conclusions

Chronic diuretic CPG was associated with a reduction in diuretic exposure in preterm infants

Aim

The objective of the study was to evaluate the quality of life in Kenyan children (age 4–18 years) with cerebral palsy (CP).

Methods

A cross-sectional descriptive study was conducted. Children with CP were recruited from the pediatric clinics at the Aga Khan hospital Nairobi (AKUHN). Parent proxy-reports using CPQoL-child and CPQoL-adolescents were obtained. Clinical and demographic data were compiled from medical records and parent interviews. A Likert scale was utilized to determine QoL across several domains.

Results

One hundred and fourteen child–parent dyads with CP were recruited. The median age of study participants was 8 years (IQR 3–13 years), with males being the majority (57.02 %). Parent proxy-reports using CPQoL-child scale were obtained for n = 93 and CPQoL-adolescents for n = 21 respondents. Parents in both groups reported low domain QoL scores pertaining to function, family health and rehabilitation service accessibility.

Interpretation

Stigma, accessibility to services, therapies and schooling, particularly for children with severe functional limitations, remains a concern. Caregivers would benefit from awareness campaigns of available supports and from local community respite programs. Where national support systems exist, there are critical inefficiencies in service delivery to target population.