BMC Pediatrics最新文献

Objectives: Falls are a leading cause of non-fatal injury in young children, but limited research has explored the characteristics and risks associated with diaper change-related falls. This study aimed to determine whether diaper change-related falls are associated with higher proportions of head injuries than other falls in young children and identify risk factors.

Methods: This cross-sectional study analyzed data from the South Korea's Emergency Department-based Injury In-depth Surveillance Registry 2011-2022 to examine fall injuries among children aged < 3 years. Diaper change-related injuries were identified using the International Classification of Diseases, Tenth Revision codes and narrative descriptions. Clinical outcomes (emergency department disposition, injury severity, head injury diagnoses, and injury sites) were compared between diaper- and non-diaper change-related falls. Logistic regression was used to identify factors associated with traumatic brain injuries (TBIs) and skull fractures.

Results: Among 51,474 fall injuries, 298 cases (0.6%) were diaper change-related, mostly occurring at home (63.4%) and involving infants aged < 1 year (81.2%). Diaper change-related falls were associated with higher proportions of TBI (47.3% vs. 31.0%; p < 0.001) and severe injury (16.4% vs. 6.1%, p < 0.001) than non-diaper change-related falls. In multivariable analysis, diaper change-related mechanisms were independently associated with increased odds of TBI (aOR 1.31, 95% CI 1.04-1.65; p = 0.024) and skull fracture (aOR 1.62, 95% CI 1.15-2.27; p = 0.006).

Conclusion: The proportion of diaper change-related falls among ED visits for falls in children aged 0 to < 3 years is increasing, particularly at home, and are associated with greater injury severity and risk of head trauma. Targeted caregiver education and national safety standards for diaper-changing equipment are needed to prevent these injuries.

Trial registration: Clinical trial number: Not applicable.

Acute kidney injury (AKI) is a serious complication in neonates, especially among those exposed to nephrotoxic medications. Serum neutrophil gelatinase-associated lipocalin (NGAL) has emerged as a potential early biomarker for AKI, but its utility in neonates remains unclear. We aimed to assess the diagnostic performance of serum NGAL as an early predictor of AKI in preterm neonates receiving nephrotoxic drugs in the NICU. This prospective observational study included 70 preterm neonates admitted to the NICU at Kafr Elsheikh University Hospital between September 2023 and April 2024. Neonates receiving nephrotoxic drugs were enrolled, and serum NGAL and creatinine were measured on days 3 and 8 of admission. AKI was defined using modified KDIGO criteria. Comparative statistical analyses were conducted to assess NGAL's predictive value. AKI occurred in 30% of neonates. Serum creatinine and NGAL levels significantly increased after nephrotoxic drug exposure. However, no significant difference was observed between the AKI and non-AKI groups. While serum NGAL levels increased following nephrotoxic drug exposure, a single post-exposure measurement did not reliably predict AKI in preterm neonates. NGAL may have limited utility as a standalone biomarker for early AKI detection in this population.

Objectives: Neonatal Multisystem Inflammatory Syndrome (MIS-N) is believed to result either from the transplacental transfer of maternal SARS-CoV-2 antibodies or from a delayed hyperinflammatory response triggered by the neonate's own immune reaction to SARS-CoV-2 infection. In this study we aim to explore the clinical presentation, laboratory findings, and current approaches to the diagnosis and management of MIS-N in neonates.

Material and method: A total of 15 infants with MIS-N followed in Bursa Uludag University Neonatal Intensive Care Unit between January 2022 and January 2023 were included in this retrospective study.

Results: Eight mothers had a history of COVID-19 disease during pregnancy. All of neonates had cardiac involvement (supraventricular tachycardia, persistant sinusal bradycardia or AV block) and 10 infants had respiratory failure. All infants had elevated inflammatory biomarkers and received steroids or/and IVIG. Two infants died.

Conclusion: The common presentation of MIS-N included cardiac aritmia and respiratory failure. Newborns with MIS-N may be at higher risk for adverse outcomes. Early diagnosis and treatment are important in these patients.

Background: Pediatric coma is a critical emergency with high morbidity and mortality in sub-Saharan Africa, where limited data hinders effective management strategies. Understanding its epidemiology and prognostic factors is essential for improving outcomes.

Methods: A cross-sectional study with retrospective (1st January 2017 to 30 November 2018) and prospective (1st December 2018 to 30th April 2019) phases was conducted at Gyneco-Obstetric and Pediatric Hospital of Douala, Cameroon. Children aged 1 month to 15 years with Glasgow Coma Scale (GCS) ≤ 14 were included. Data on demographics, clinical presentation, etiology, and outcomes were collected. Statistical analysis used SPSS version 20.0 and CSPro with Chi-square, Fisher's exact tests, and multivariable logistic regression.

Results: Among 864 hospitalized children, 109 presented with coma (prevalence 12.6%), comprising 88 retrospective and 21 prospective cases. The male-to-female ratio was 1.4:1, with mean age 48.8 ± 47.5 months; 64.2% were under 5 years. Infectious causes predominated (62.4%, n = 68), with cerebral malaria accounting for 42.2% (46/109) and septicemia 15.6% (17/109). Other etiologies included metabolic/toxic causes (16.5%, 18/109), post-epileptic coma/status epilepticus (14.7%, 16/109), and traumatic brain injury (4.6%, 5/109); 12.8% (14/109) remained undiagnosed. Clinical features included fever (73.4%, 80/109) and seizures at admission (68.8%, 75/109). Overall mortality was 26.6% (29/109), with 30.9% (25/81) of survivors experiencing neurological sequelae, predominantly motor deficits (14.8%, 12/81). In multivariable analysis, significant mortality predictors included age under 2 years (adjusted OR 4.55, 95% CI: 1.23-16.82), female sex (adjusted OR 2.89, 95% CI: 1.23-6.79), direct home admission (adjusted OR 2.76, 95% CI: 1.02-7.47), and deeper coma stages (Stage III-IV: adjusted OR 6.92, 95% CI: 2.54-18.86).

Conclusion: Pediatric coma at this tertiary center in Douala predominantly affects young children and stems primarily from infectious etiologies, particularly cerebral malaria. The high mortality (26.6%) and substantial neurological morbidity among survivors underscore urgent needs for strengthened malaria prevention programs, improved community awareness, enhanced referral systems, and increased diagnostic and intensive care capabilities. Early recognition and prompt management of preventable causes could significantly reduce mortality and morbidity from pediatric coma in Central Africa.

Background: RBC distribution width is a key variable in complete blood counts, associated with immature RBC release into circulation due to various processes, including systemic inflammation. RDW correlates with elevated acute inflammatory markers like ESR, CRP, and interleukin-6, and is a biomarker in conditions like kidney disease and multiple myelomas. It independently predicts disease severity in critically ill adults and is associated with morbidity, mortality and length of stay in pediatric intensive care unit, though its potential as an early biomarker for detecting pediatric patients with multiple organ dysfunction (MODS) remains unknown.

Methods: The study retrospectively reviewed PICU patients admitted to Aga Khan University Hospital from September 2018 to December 2022, excluding those admitted for less than 48 h for elective procedures, received recent RBC transfusions, or were anemic. RDW > 14.0% was considered elevated. MODS, defined as dysfunction in two or more organs, was the primary outcome. Data included demographics, PRISM III scores, laboratory values (RDW, BUN, creatinine, CRP, etc.), and clinical outcomes. Patients were stratified into three RDW groups: <13.4%, 13.4-14.3%, and > 14.4%. Analysis focused on associations between RDW levels and MODS within the first 7 days of PICU admission.

Results: The study included 680 patients. Higher RDW was associated with younger age and higher PRISM III scores, but not with sex. RDW Group III had longer hospital stays, higher mortality, and higher incidence of MODS, but not significant. Hemoglobin and MCHC levels were lower in Group III, whereas BUN and creatinine levels showed no significant differences across groups. The OR for MODS was highest for Group II.

Conclusions: This retrospective study evaluated the prognostic value of RDW in predicting length of stay, mortality, and early identification of MODS within seven days. Among 680 pediatric patients, higher RDW levels were associated with increased mortality, longer LOS, and higher rates of sepsis and MODS, though these findings lacked statistical significance. Elevated RDW was linked to inflammation and critical illness severity but did not correlate well with pediatric severity scores or MODS trends. Future multicenter studies are recommended to explore RDW's utility in predicting early organ dysfunction and critical illness outcomes.