Pediatric health, medicine and therapeutics最新文献

Objective: To compare the prevention practices of necrotizing enterocolitis (NEC) across 17 neonatal intensive care units (NICUs) in China.

Methods: A web-based survey was sent to 17 level 3 NICUs in China on September 21, 2023, to evaluate the prevention strategies for NEC.

Results: All 17 Neonatal Intensive Care Units (NICUs) responded to the survey. There was significant variation in the initial empirical use of antibiotics for early-onset sepsis, late-onset sepsis, and NEC among different NICUs. Out of the 17 NICUs, only 5 (29.4%) used donor human milk. Additionally, 15 (88.2%) NICUs performed routine echocardiography (Echo) in preterm infants after birth to evaluate cardiac function and/or Patent Ductus Arteriosus (PDA) status. Out of those 15 NICUs, 11 (73.3%) performed Echo within 24 to 72 hours after birth. Furthermore, 8 NICUs (47.1%) did not alter enteral nutrition management during drug treatment for PDA, while 12 NICUs (70.6%) stopped 1 or 2 feeds during red blood cell transfusion.

Conclusion: The findings of this survey conducted through questionnaires revealed both differences and similarities in the strategies employed to prevent NEC in 17 NICUs in China.

Purpose: Parental interaction in learning-promoting activities is crucial for supporting early childhood development. This study aimed to assess the level of parental interaction among children aged 2-4 years in Thailand and to identify determinants associated with parental interaction.

Patients and methods: A cross-sectional analysis was conducted using data from the 2022 Multiple Indicator Cluster Survey (MICS), which included a nationally representative sample of 7003 parents of children aged 2-4 years. Parental interaction was assessed through six activities promoting early stimulation and responsive care. Interaction levels were categorized as high (participation in four or more activities) or low (fewer than four activities). Multivariable logistic regression was employed to analyze associations between parental interaction levels and household and participant characteristics.

Results: The study found that 88.1% of parents reported high levels of interaction with their children. Children outside Bangkok had lower odds of high interaction, particularly in the Central (AOR=0.33), North (AOR=0.31), Northeast (AOR=0.44), and South (AOR=0.38) regions. Higher odds of high interaction were associated with maternal education above secondary level (AOR=2.00), the highest wealth quintile (AOR=2.48), living with either (AOR=2.14) or both parents (AOR=2.59), being in a non-Thai-speaking household (AOR=1.75), and having three or more books at home (AOR=3.63).

Conclusion: Nearly 12% of parents reported low levels of interaction with their children aged 2-4 years, with disparities associated with regional and socioeconomic factors. Policy efforts should prioritize integrating parental support into early childhood education programs and enhancing access to resources, such as children's books and community libraries, particularly for socioeconomically disadvantaged groups.

Introduction: Acute Fibrinous and Organizing Pneumonia (AFOP) is a rare lung disease that presents with acute lung injury characterized by intra-alveolar fibrin deposition. Although primarily described in adults, AFOP can occur in children and may mimic common respiratory illnesses, posing a diagnostic challenge. The condition can result from various etiological factors, including infections, autoimmune disorders, and drug reactions. The purpose of this case is to highlight the clinical presentation, diagnostic challenges and management strategies of this rare and underrecognized pediatric condition. By describing this case we aim to raise awareness among pediatricians given the limited literature on pediatric AFOP to aid in recognizing and tailoring treatment in order to improve outcomes.

Methods and materials: Patient's data were collected retrospectively from medical records, including clinical notes, laboratory results, imaging studies, and histopathological findings, where applicable. Informed written consent was obtained and signed from parents of the child for the use of his medical information for educational and publication purposes, ensuring confidentiality and anonymity.

Results: We present the case of a 3-year-old boy with a history of recurrent viral-induced wheezing, initially treated for asthma-like symptoms until he developed persistent hypoxemia. Despite targeted therapy, the patient exhibited persistent respiratory symptoms and consolidative opacities in the right lung. A high-resolution computed tomography (HRCT) scan showed diffuse lung abnormalities, prompting further evaluation. Bronchoscopy with bronchoalveolar lavage revealed Haemophilus influenzae infection, and an open lung biopsy confirmed AFOP. The patient was treated with corticosteroids and azithromycin, leading to significant clinical and radiographic improvement.

Conclusion: This case highlights the importance of considering AFOP in pediatric patients with atypical and persistent respiratory symptoms. Early diagnosis and intervention are crucial for managing this rare condition. Further case reports are needed to better understand AFOP's clinical course and optimize treatment strategies in pediatric populations.

Background: Neonatal mortality is a significant global health challenge, particularly in sub-Saharan Africa. In Somalia, there is a notable absence of comprehensive reports or data on neonatal mortality rates within tertiary-level neonatal intensive care units (NICU). This study aims to identify key factors associated with neonatal mortality in Mogadishu, Somalia.

Materials and methods: A retrospective review of medical records was conducted for neonates admitted to the Neonatal Intensive Care Unit (NICU) of Mogadishu Somali Turkish Training and Research Hospital from August 2017 to September 2019. Logistic regression analysis was employed using SPSS (version 25) to compute adjusted odds ratios (aORs) along with 95% confidence intervals (CIs).

Results: Of 1043 neonates, 63.8% (n=665) were male, with a mean age of 1.48 days. Most neonates were full-term (55.3%, n=577), while 25.8% (n=269) were preterm (<32 weeks), and 11.9% (n=124) were late preterm (33-37 weeks). In total, 25.5% (n=266) had very low birth weight (<1500 grams). The average length of stay in the NICU was 7.38 days, and the overall mortality rate was 18.7% (n=195). Indications for NICU admissions were prematurity 27.0% (n=282), followed by birth asphyxia (18.0%, n=188), neonatal sepsis (14.6%, n=152), and acute respiratory distress syndrome (12.2%, n=127). Preterm neonates had significantly higher mortality rates (OR=2.14, 95% CI: 1.32-3.47, p=0.002), and those with a birth weight of <1500 grams had an even higher risk of mortality (OR=3.85, 95% CI: 2.50-5.92, p<0.001). Lack of ANC visits was associated with increased mortality risk (OR=1.67, 95% CI: 1.09-2.54, p=0.019), while cesarean delivery was also linked to higher mortality risk (OR=1.92, 95% CI: 1.29-2.85, p=0.002).

Conclusion: The study identified a Neonatal Mortality Rate that is acceptable compared to the mortality rates in other studies in Somalia and the sub-Saharan African region. These findings inform care strategies and resource allocation in prenatal and neonatal health services.

Purpose: Parental divorce is one of the most common adverse events in childhood and can cause children emotional problems and influence their oral health. To explore differences in possible bruxism, state anxiety, coping and parenting styles between a group of divorced parents and a group of cohabiting parents.

Patients and methods: A cross-sectional study was conducted, with data collected through self-report questionnaires filled in by 186 patients (8-16 years) and their parents. Children completed State Trait Anxiety Inventory (STAI), Self-Report Coping Measure (SRCM) and Parenting Style Scale. The Self-Reported Bruxism Questionnaire (SBQ) was completed by their parents.

Results: The results showed significant differences were seen between the group of divorced parents (n=93) and the control group (n=93), with higher levels of state anxiety and possible bruxism in the group of children of divorced parents. In addition, in terms of coping strategies, externalisation and problem-solving deficits stood out. In terms of parenting style, autonomy promotion was higher. Additionally, possible bruxism was influenced by coping strategies (seeking social support), attachment-based parenting style and communication, behavioural control and state anxiety. Finally, it was found that high anxiety may act as a moderating variable in the relationship between divorced parents and possible bruxism.

Conclusion: Children of divorced parents showed more possible bruxism, anxiety, coping and behavioural problems.

Dandy-Walker Syndrome (DWS) is a rare cerebellar malformation characterized by the underdevelopment of the cerebellar vermis and associated complications. This case report presents a 3-month-old female from Somalia who exhibited fever, loss of consciousness, vomiting, and developmental delays. Neurological examination suggested signs of meningitis, and MRI revealed an enlarged posterior fossa consistent with DWS. Despite initial antibiotic treatment for suspected bacterial meningitis, CSF cultures yielded no growth, raising concerns about prior antibiotic use. Unfortunately, the patient's condition deteriorated, leading to her death. This case highlights the diagnostic challenges of DWS in resource-limited settings and emphasizes the need for improved healthcare access, early diagnosis, and intervention for rare neurological conditions.

Objective/purpose/aim: Sleep disturbances have been implicated as contributors to chronic pain. We undertook this review to assess the current literature regarding sleep disturbances in youth with chronic abdominal pain. We assessed studies evaluating prevalence, pathophysiology, and/or outcomes to identify gaps in knowledge and to determine whether there is an evidential basis for sleep interventions in this population.

Materials and methods: Utilizing Google Scholar, Pub Med, SCOPUS, and Embase, we searched using the terms "sleep disturbances" AND ("abdominal pain"/exp OR "abdominal pain") AND ([adolescent]/lim OR [school]/lim). Articles were included if they contained data regarding sleep disturbance prevalence, pathophysiology, or relationships to outcome. After two independent review, 32 manuscripts were included in this review.

Results: Based on their high prevalence (19-75% of abdominal pain cohorts), there is sufficient evidence to recommend routine screening for sleep disturbances in youth with chronic abdominal pain. There is a broad range of negative physiologic and emotional effects of sleep deprivation.

Conclusion: Sleep disturbances are common in youth with chronic abdominal pain. Sleep interventions are appropriate when disturbances are identified though it is not yet known the degree to which these interventions will affect the pain experience and resultant disability. Future studies should focus on evaluation of specific sleep interventions on patient outcomes.

Purpose/objective: International pediatric sepsis consensus definitions play a critical role in evidence-based clinical practice, providing standardized tools for case identification. However, a common misconception is treating sepsis as a static diagnosis rather than recognizing it as a dynamic and evolving process. It is essential to integrate consensus criteria into a broader, more flexible clinical approach rather than applying them rigidly.

Materials/methods – literature review: This expert commentary compares past and current pediatric sepsis definitions, analyzing their clinical implications, supporting evidence, and feasibility across diverse healthcare settings.

Findings/results: The transition from a Systemic Inflammatory Response Syndrome-based model (2005 International Pediatric Sepsis Consensus Conference) to an organ dysfunction-based model (Phoenix Sepsis Score 2024) has improved specificity but may also delay early recognition by requiring established organ dysfunction.

Conclusion and recommendations: Sepsis should be viewed as a continuum rather than a static state. This commentary does not oppose sepsis consensus criteria but advocates for clinicians to apply clinical judgment beyond them. Future definitions should balance specificity with early recognition while allowing for clinical adaptability in various healthcare contexts.

Introduction: Cerebral Palsy (CP) is caused by multiple risk factors bringing motor and postural control disruptions with a variety of clinical signs.

Objective: To describe the epidemiological and functional profile of children with CP attended at the Physiotherapy Clinic for Motor Rehabilitation (PCMR) of the Clinical Hospital (CH) of the University of Campinas (Unicamp).

Methods: Children up to 12 years old with CP were included. Epidemiological data were collected through interviews, followed by the scales: Gross Motor Function Classification System (GMFCS), Pediatric Evaluation of Disability Inventory (PEDI), Gross Motor Function Measure (GMFM-66), International Classification of Functioning, Disability, and Health for Children and Youth with CP (ICF-CY-CP) Core Sets, and the GMFCS Family Report Questionnaire.

Results: A total of 37 children were assessed, with an average age of 7 years. It was found that 87% of the mothers received prenatal care, 61% of the children were born at a low weight, with 36% of cases being extreme or very premature births. The primary perinatal complication was neonatal anoxia (50%), while the most common postnatal complication was stroke (11%). CP was diagnosed at an average age of 12 months, with bilateral spastic CP being the most prevalent (63%). Orthopedic complications were present in 80% of cases, even though only 39% of children had orthopedic monitoring. In the functional analysis, 65% were classified at levels IV and V of the GMFCS, highly correlated with GMFCS Family Report Questionnaire (Kappa = 0.88; 95% IC 0.79-0.96). The scores of 3 and 4 on the ICF-CY-CP Core Sets in most activities involving motor functions, along with scores below 30 on the PEDI, indicate severe motor impairment.

Conclusion: Parents had a realistic perception of the children's functionality. The results highlight the severity of motor impairment in these children and emphasize the need for multidisciplinary assistance.

Purpose: Vaccination is one of the most effective and efficient health interventions for reducing morbidity and mortality from infectious diseases, particularly in sub-Saharan Africa. Understanding the determinants of access to vaccines can help improve immunization coverage and control vaccine-preventable diseases. The aim of this study was to explore the contribution of certain determinants to access to pentavalent 3 in children aged 0-23 months in Cameroon via demographic and health survey data.

Materials and methods: This was a cross-sectional nested case‒control study in which children aged 0-23 months were selected via cluster random sampling in households in the 10 regions of Cameroon. Secondary data from the Demographic and Health Survey, which was conducted in Cameroon from 2017-2018, were used. Univariate and multivariate logistic models were used to analyze the determinants of access to the pentavalent 3 vaccine.

Results: The vaccination coverage of the pentavalent 3 vaccine (P3V) among children aged 0-23 months was 69.5%. The access to the P3V with Christian religion, compared with non-Christian experienced 63% of P3V (adjusted Odds ratio (AOR)=1.63, 95% CI, [1.22-2.17], p=0.001). Compared with those living in other regions in Cameron, those living in the northern regions of Cameroon were observed 37% less likely to have access to P3V (AOR=AOR=0.63, 95% CI, [0.44-0.87], p=0.006), while mother's marital status (married) compared with unmarried mothers were 37% more likely to experience access to P3V (AOR=1.37, 95% CI, [1.04-1.81], p=0.024). Relative to subjects with less education, those with at least secondary or higher education were 92% more likely to have access to P3V, (AOR=1.92, 95% CI [1.47-2.51], p<0.001), while those with cell phone experienced 44% increased access to P3V, (AOR=1.44, 95% CI, [1.17-1.78], p=0.001).

Conclusion: Access to the pentavalent 3 vaccine in Cameroon does not meet national targets and is affected by various socio-demographic factors, including region of residence, religion, educational attainment, maternal marital status, and cell phone ownership.