BMC Pediatrics最新文献

Background: Acute kidney injury (AKI) poses a significant threat to premature and low birth weight (LBW) neonates in neonatal intensive care units (NICUs), driven by immature renal function and frequent exposure to nephrotoxic medications. Understanding its prevalence and risk factors is critical for improving outcomes in vulnerable populations.

Objective: To determine the prevalence of AKI, exposure to potential nephrotoxic drugs and identify associated risk factors, among premature and LBW neonates admitted to NICUs at Muhimbili National Hospital (MNH), Dar es Salaam, Tanzania.

Methods: A cross-sectional study was conducted from February to June 2024 at MNH Upanga and Mloganzila, enrolling 144 premature and LBW neonates via non-probability consecutive sampling. Serum creatinine levels were measured at admission, 48 h, and day seven or pre-discharge to diagnose AKI using KDIGO criteria. Data were analyzed with SPSS v26.0, employing chi-square tests for associations and robust Poisson regression for risk factor identification (p < 0.20 for univariable inclusion, p < 0.05 for significance).

Results: Among 144 neonates (61.8% female, median age 5 days [IQR 3-12]), 65.3% received nephrotoxic drugs, primarily ampicillin-cloxacillin (58.3%) and gentamicin (54.9%). AKI was diagnosed in 26.4% of neonates, with 18.8% in stage 1, 6.3% in stage 2, and 1.4% in stage 3. Multivariable analysis identified male sex (aPR = 1.68, 95% CI: 1.01-2.89, p = 0.049) and exposure to two nephrotoxic drugs (aPR = 2.58, 95% CI: 1.20-5.55, p = 0.015) as independent risk factors for AKI.

Conclusion: AKI affects over a quarter of premature and LBW neonates in NICUs, with male sex and multiple nephrotoxic drug exposures as key risk factors. Implementing routine renal monitoring and optimizing pharmacotherapy are essential to reduce AKI incidence and improve neonatal outcomes in resource-constrained settings.

Background: Tubularized incised plate urethroplasty (TIP) is a widely practiced technique for hypospadias repair; however, it remains associated with complications, particularly meatal and/or neourethral stenosis. Grafting the incised plate with a dorsal inlay graft (DIG) during TIP has been proposed as a preferred modification to address these complications. Although several studies have investigated DIG in cases with a narrow urethral plate (UP), no current consensus exists regarding its use as an adjunct to TIP repair in different types of UP.

Objectives: The current study aimed to investigate whether DIG with TIP repair is superior to TIP in different types of UPs regarding surgical and cosmetic outcomes.

Methods: In a comparative, randomized study conducted from January 2023 to December 2024, patients with primary hypospadias without chordee were randomly assigned to two groups: Group 1 underwent repair using TIP, and Group 2 underwent repair using the DIG with TIP technique. Short- and mid-term outcomes were compared between the two groups.

Results: During the study period, 579 primary hypospadias cases met the inclusion criteria (290 in Group 1 and 289 in Group 2). The median age in both groups was 22 months (IQR, 13-36.25 months). Operative time was significantly longer in Group 2 (P = 0.001). Among patients with a narrow UP, surgical outcomes were better in Group 2, with statistically significant improvement in neourethral and meatal function (P = 0.001). In Group 1, meatal stenosis developed in 25 patients (8.62%); 14 cases presented early and improved with regular dilation, whereas 11 cases presented after 6 months and required meatoplasty. In patients with a wide UP (> 8 mm), better results were observed in Group 2, although the difference was not statistically significant. Regarding the final position of the meatus at the glans tip, significance was noted in Group 2 (P = 0.008). The follow-up period ranged from 6 to 23 months (mean ± SD: 13.76 ± 5.68). The hypospadias objective scoring evaluation (HOSE) score at the 6th month demonstrated statistical significance in Group 2.

Conclusions: Adding a DIG to TIP repair potentially reduces the risk of neourethral and meatal complications in patients with a narrow UP (4-8 mm). However, in wide UP (> 8 mm), comparable outcomes were observed in both groups. The dorsal inlay graft with tubularized incised plate (DIGTIP) is associated with longer operative times and greater technical demands; therefore, it should be applied only in selected patients and according to the surgeon's preference.

Trial registration: [NCT07086963] "Retrospectively registered" Date of registration [Jul 17 2025] https://clinicaltrials.gov/study/NCT07086963 and Unique identifying number [SVU/MED/SUR011/4/22/12/519].

Background: Duplication cysts are benign congenital anomalies of the gastrointestinal tract. Most manifest with symptoms within the first two years of life, and the majority are diagnosed in children (1). The clinical manifestations of duplication cysts vary depending on their location, size, and the presence of heterotopic mucosa. The most common location for these cysts is the ileum, although they can also occur in the stomach, duodenum, jejunum, colon, and rectum (2). Complications such as volvulus, intussusception, recurrent hemorrhage, and malignant degeneration have been reported (3). Despite advances in preoperative imaging, establishing a definitive diagnosis remains challenging. Enteric duplication cysts may rarely be associated with Salmonella infection and, in exceptional cases, postoperative bacteremia. Recognizing this possibility is crucial for optimal patient care.

Case presentation: A 3-year-old boy presented with a 3-day history of intermittent, diffuse abdominal pain. Although initial investigations were nonspecific, he was diagnosed with an ileal duplication cyst and underwent complete cyst resection during exploratory laparotomy. Macroscopic and microscopic examinations confirmed a duplication cyst comprising intestinal mucosa and muscle layers. On postoperative day 1, he developed Salmonella group C1 bacteremia and completed a 10-day course of ceftriaxone before discharge.

Conclusion: We report a case of a non-communicating ileal duplication cyst in a 3-year-old boy, complicated by partial bowel obstruction and Salmonella group C1 bacteremia. To our knowledge, this represents the first documented case of proven Salmonella bacteremia temporally associated with surgical manipulation of an ileal duplication cyst.

Background: Hereditary Hemorrhagic Telangiectasia is an autosomal dominant vascular disorder with clinical features of recurrent epistaxis, mucocutaneous telangiectasias, or visceral arteriovenous malformations, yet its early signs may be overlooked in children.

Case presentation: We report a family in which a fifteen-year-old boy and his mother presented for genetic evaluation of recurrent epistaxis, after his previously well seven-year-old sister demised suddenly from likely spontaneous atraumatic intracranial hemorrhage (diagnosed clinically without confirmatory post-mortem imaging), following a brief history of headache and vomiting. The mother had a background of infrequent nosebleeds and a family history of recurrent epistaxis in multiple maternal relatives. Genetic testing identified heterozygosity for NM_001114753.3(ENG): c.1134G > A (p.Ala378=), a ClinVar classified pathogenic variant, confirming the diagnosis of hereditary hemorrhagic telangiectasia. Cascade testing for her two surviving children was done. Her fifteen-year-old son tested positive and was found on subsequent screening to have intracranial vascular malformations which were treated presymptomatically with gamma knife surgery. Her other son tested negative.

Conclusion: This case emphasizes the importance of prompt recognition of hereditary hemorrhagic telangiectasia in children presenting with recurrent epistaxis and highlights the need for thorough family history. Pediatricians play a crucial role in early diagnosis and referral for genetic testing with subsequent surveillance imaging. Early identification may possibly reduce the risk of unfavorable outcomes such as intracranial hemorrhage. This case emphasizes the need for heightened awareness of hereditary hemorrhagic telangiectasia in pediatric practice and supports the value of integrating genetic cascade testing and organ-specific screening in at-risk children, even before symptoms appear.