Pediatric health, medicine and therapeutics最新文献

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.

Background: Tuberculosis (TB) is one of the oldest and most persistent infectious diseases, continuing to pose a significant public health challenge worldwide. Children diagnosed with TB are particularly vulnerable to developing depressive disorders, which can significantly reduce their quality of life and negatively affect treatment adherence and recovery. This study aimed to identify risk and prognostic factors associated with depressive disorders in pediatric patients diagnosed with tuberculosis through a prospective analysis.

Materials and methods: A prospective study was conducted on 190 pediatric patients, aged 7 to 18 years, diagnosed with tuberculosis and treated at the Pneumophthisiology Hospital in Galați, Romania, between 2019 and 2021. The CDI (Children's Depression Inventory) was administered to assess depressive symptoms over the course of the study.

Objective: The study aims to determine the prevalence of depressive disorders in children and adolescents by analyzing risk factors such as age, gender, place of origin, and access to medical services, as well as the effectiveness of CDI as a diagnostic tool. It also seeks to correlate clinical and demographic data with CDI scores and evaluate changes over time to identify solutions that support early diagnosis and intervention.

Results: Out of the initial 190 patients, 158 completed the CDI, as some did not return for follow-up evaluations or declined to participate. Of these, 146 (92.4%) demonstrated clinically significant depressive symptoms. Key risk factors for depressive disorders included a rural background, male gender, and age between 15 and 18 years.

Conclusion: Specific risk factors and vulnerabilities contribute to the development of depressive disorders in pediatric TB patients. Early identification and monitoring of these factors in a prospective framework are essential for improving the prognosis of both depression and tuberculosis, ultimately enhancing the overall outcomes for affected children.

Objective: This study aimed to assess the association between sleep bruxism (SB) among children and parental sociodemographic characteristics and SB risk factors (eg, nose obstruction).

Methods: A cross-sectional survey was conducted with 250 parents of children under the age of 13 who visited pediatric dental clinics. Data were collected through a questionnaire completed by parents. Sociodemographic characteristics, the child's medical history, sleep patterns and parents' awareness of bruxism and its symptoms were investigated. Descriptive, bivariate and binary logistic regression analyses were performed.

Results: The response rate was 85.2% (55% females, 45% males) and 25.8% of the parents self-reported that their children had bruxism. The regression analysis revealed that parents reporting SB among their children were significantly more likely to have SB themselves (8.62 [3.68-20.16], p = 0.001). While children whose mothers had lower education level and were unaware of bruxism-related symptoms (such as teeth, jaw, or face pain) were less likely to be reported as having SB (0.35 [0.16-0.75], p = 0.007; 0.36 [0.14-0.97], p = 0.043, respectively). Parents who identified nose obstruction as a cause of bruxism also had children with a higher likelihood of having SB (5.49 [1.04-29.08], p = 0.045).

Conclusion: The findings highlighted that parental sociodemographic characteristic and SB risk factors associated signficantly with the prevalence of childhood SB.

Purpose: Tanzania is the fifth country with the highest sickle cell disease (SCD) prevalence globally. Although hydroxyurea (HU) is available, only 25% of persons with SCD are reported to use it in Tanzania. Perceived disease threat is associated with medication usage in patients with chronic diseases. We assessed the factors associated with caregivers' perceived threat of SCD complications and its relationship with HU use among children with SCD in Dar-es-Salaam.

Methods: We conducted a cross-sectional hospital-based study from May to August 2023. We enrolled 374 caregivers of health-insured children with SCD from 4 public SCD clinics. We adapted the modified original and revised Champion's Health Belief Model Scales to derive perceived threat scores. We used Mann-Whitney and Kruskal-Wallis tests to compare the outcomes across sociodemographic characteristics and regression analysis for factors associated with perceived SCD threat.

Results: The median score (InterQuartile Range) for perceived threat of SCD complications was 559 (175, 598). Sixty-one percent of caregivers had a high SCD perceived threat. The caregivers of under-five children had 141 lower median SCD threat scores than those of children aged 13-17 years, p-value < 0.001. Participants from Regional Referral Hospitals (RRH) had lower median threat scores compared to participants attending Muhimbili National Hospital (MNH), 177 for Amana RRH, 325 Temeke RRH, 585 MNH Mloganzila, and 557 MNH Upanga, p-value <0.001. Children of caregivers with high perceived SCD threat were 3.4 times more likely to use HU compared to those with low SCD threat perception (Incidence Rate Ratio 3.4, 95% CI: 2.7-4.5).

Conclusion: The perceived threat of SCD predicts the likelihood of SCD patients using HU in Dar-es-Salaam, Tanzania. We recommend health education to caregivers aiming to improve their SCD threat perception and thus improve the use of HU among children with SCD in similar settings.