University Children's Hospital Research Articles

Addressing Mistreatment of Providers by Patients and Family Members as a Patient Safety Event.

Mistreatment of health care providers (HCPs) is associated with burnout and lower-quality patient care, but mistreatment by patients and family members is underreported. We hypothesized that an organizational strategy that includes training, safety incident reporting, and a response protocol would increase HCP knowledge, self-efficacy, and reporting of mistreatment. In this single-center, serial, cross-sectional study, we sent an anonymous survey to HCPs before and after the intervention at a 213-bed tertiary care university children's hospital between 2018 and 2019. We used multivariable logistic regression to examine the effect of training on the outcomes of interest and whether this association was moderated by staff role. We received 309 baseline surveys from 72 faculty, 191 nurses, and 46 residents, representing 39.1%, 27.1%, and 59.7%, respectively, of eligible HCPs. Verbal threats from patients or family members were reported by 214 (69.5%) HCPs. Offensive behavior was most commonly based on provider age (85, 28.5%), gender (85, 28.5%), ethnicity or race (55, 18.5%), and appearance (43, 14.6%) but varied by role. HCPs who received training had a higher odds of reporting knowledge, self-efficacy, and experiencing offensive behavior. Incident reporting of mistreatment increased threefold after the intervention. We report an effective organizational approach to address mistreatment of HCPs by patients and family members. Our approach capitalizes on existing patient safety culture and systems that can be adopted by other institutions to address all forms of mistreatment, including those committed by other HCPs.

Outcome of Tapering Enteroplasty in Managing Jejunoileal Atresia.

Jejunoileal atresia (JIA) represents a common cause of neonatal bowel obstruction. There is a discrepancy between the diameters of the proximal and the distal bowel loops and this is managed with excision or tapering of the dilated proximal bowel loop. We aim primarily to evaluate the outcome of tapering enteroplasty (TE) in managing JIA and secondarily to compare the outcome of TE to non-TE. A retrospective analysis of records of all neonatal admissions with JIA from January 2017 to December 2018 at a tertiary university children's hospital. Type and location of atresia, time to full enteral feeds, length of stay (LOS), complications, and outcome were assessed in TE and non-TE groups. Forty-one patients were included in the study; 29 (70.7%) cases had jejunal atresia and 12 (29.3%) had ileal atresia. Seventeen (41.4%) patients had TE. The median days to full feeds was 19; 28 in the TE group versus 16 in the non-TE group (P = 0.022). Four (9.7%) cases needed a re-exploration because of failure to start feeds; all in the non-TE group. The median LOS was 33 days for TE versus 22 days for non-TE (P = 0.101). Twenty-one cases (51.2%) developed a wound infection and showed a significantly longer median LOS of 29.5 versus 19 days (P = 0.019). Mortality was 7 (17.1%). TE did not show a superior outcome when compared to resection of the dilated bowel. It was associated with longer time to reach full enteral nutrition and longer LOS.

A New Perspective on the Quality of Life of Children with Glycogen Storage Diseases.

PurposeThis study aimed to assess the quality of life (QoL) of children with glycogen storage disease (GSD) and their parents and to determine the impact of myopathies.MethodsA prospective case-control study was conducted at the Cairo University Children’s Hospital and National Liver Institute, Menoufia University. A promising new style of questionnaire called the Stark Quality of Life Questionnaire was used to assess the quality of life.ResultsFifty-two children diagnosed with GSD (cases) and 55 age- and sex-matched healthy children (controls) were included. A statistically significant difference was found between cases and controls regarding food intake; mental behavior parameters such as mood, energy, and social contact; and physical behavior parameters such as running and tying shoelaces. Children with myopathies had significantly lower QoL scores in most of the parameters.ConclusionGSDs alter children and their parents’ mental and physical abilities. Lower QoL scores were detected in children with both skeletal myopathy and cardiomyopathy, but the difference was not statistically significant when compared with the children without myopathies.

Left ventricular hypertrophy in children and adolescents before and after kidney transplantation.

Left ventricular hypertrophy (LVH) is associated with a premature death in children with chronic kidney disease (CKD). We studied its change over time, related to a successful kidney transplantation (KTx) and assessed whether clinical variables were associated with the left ventricular mass index (LVMI). We obtained the records of all children and adolescents, who were followed-up at the tertiary nephrology centre for children at the Children's University Hospital in Kosice, Slovakia, during 2008-2014, had completed echocardiographic studies while on chronic dialysis and had undergone a successful KTx, n=25. We assessed the longitudinally recorded left ventricular mass index (LVMI) and the presence/absence of LVH, and risk factors for LVH. The average prevalence of LVH was 23.5 % while on dialysis, and 29.4 % after KTx (p=0.06). Pre-post changes per patient were relatively big. Uncontrolled systolic hypertension was significantly related to LVMI (p=0.03). LVH is common after paediatric KTx and the reversibility of already present LVH seems to be rather problematic. Significant changes of LVMI on the individual level suggest that modification is feasible with a thorough control of (systolic) hypertension and of the other risk factors (Tab. 3, Fig. 1, Ref. 50).

Adherence to therapy regimen by children with asthma and their parents.

IntroductionStrict compliance with medical advice is a prerequisite for complete asthma control. Inadequate compliance with recommendations reduces the effectiveness of treatment, increases the costs of therapy and the number of related complications.AimTo try to answer the question: To what extent is it, and what determines the adherence to therapy by children suffering from bronchial asthma and their parents?Material and methodsThe survey was conducted in 2019 among 109 children with bronchial asthma aged 7–18 years (mean age: 12.5 ±0.97) treated at the University Children’s Hospital in Lublin and their parents. The research applied the Morisky-Green test and the VAS Scale for self-assessment of the degree of cooperation, as well as an original questionnaire.ResultsThe conducted research demonstrated that a large percentage of parents (91.74%) declare that their child complies with the therapy throughout the disease, but 44.44% of them express the fear of medicating their children with GCSs. Non-compliance with the therapy by the children subject to our analysis was mainly due to: resolution or alleviation of symptoms of the disease (45.83%), reluctance to take medications every day (44.43), and difficulties in using the inhaler (16.67%).ConclusionsIn the investigated group of children with asthma and their parents, compliance with medical recommendations and, consequently, the therapy used, was not optimal and depended mainly on the severity of the disease, the child’s age and knowledge about the treatment. There is a need for continued education of asthmatic children and their parents about recommended therapy.

Nasal Carriage of Community Acquired and Inducible Dormant Methicillin Resistant Staphylococcus aureus among Healthcare Workers of Mansoura University Children's Hospital

Nasal Carriage of Community Acquired and Inducible Dormant Methicillin Resistant Staphylococcus aureus among Healthcare Workers of Mansoura University Children's Hospital

A clinical audit on the management of children with hepatorenal syndrome admitted to Assiut University Children Hospital

A clinical audit on the management of children with hepatorenal syndrome admitted to Assiut University Children Hospital

Causes of goiter in children attending Assiut University Children Hospital

Causes of goiter in children attending Assiut University Children Hospital

Clinical audit on management of pediatric urinary tract infection at Assiut University Children Hospital

Clinical audit on management of pediatric urinary tract infection at Assiut University Children Hospital

Hemodialysis Catheter-Related Infections among Pediatric Patients in Mansoura University Children Hospital

Hemodialysis Catheter-Related Infections among Pediatric Patients in Mansoura University Children Hospital

Aspects of Urolithiasis in Chadian Children: About of 191 Cases Collected at the Mother and Child University Hospital of N’Djamena (Chad)

Introduction: Urolithiasis in children is not sufficiently documented in Chad. Objectives: The aim of this work was to report the epidemiological, clinical and therapeutic aspects of urolithiasis in children in our environment. Patients and methods: This was a descriptive retrospective study of patients aged 0 - 15 years treated for urolithiasis between January 2015 and July 2020. The variables studied were age, gender, clinical, paraclinical and therapeutic aspects. Results: Among the 191 children, there were 164 boys (85.9%) and 19 girls (9.9%). The sex ratio was 8.63. The average age was 5.86 years with extremes (1 and 15 years). The symptomatology was dominated by dysuria. The ASP-ultrasound pair allowed the diagnosis in 183 cases (95.8%). The site of the calculus was bladder in 128 cases (67%). The average calculation size was 2.81mm. A supporting cause was found in only 1 case (posterior urethral valve). Treatment was surgical and dominated by cystolithotomy. The postoperative course was marked by 5 cases of parietal infections (2.6%) and 3 cases of vesico-cutaneous fistulas (1.6%). No case of death has been reported. Conclusion: Lithiasis is more common in boys in the lower urinary tract. Open surgery remains the only one practiced. Etiological research must be carried out to develop prevention strategies.

Development and Adjustment of an Algorithm for Identifying Drug-Related Hospital Admissions in Pediatrics.

Adverse drug events (ADEs) in the outpatient pediatric pharmacotherapy can be serious and lead to inpatient admissions. Recent research only focused on ADE identification during hospitalization. The aim of the present study was to develop an algorithm to identify drug-related hospital admissions in pediatrics. A systematic literature research was performed, and a pediatric trigger tool for identifying drug-related inpatient admissions was built. The initial version was tested in a sample of 292 patients admitted to a German university children's hospital. Subsequently, the tool was further improved by combining different modules as a novel approach. The obtained algorithm with 39 triggers in 5 modules identified drug-related inpatient admissions at a sensitivity of 95.5% (95% confidence interval [CI], 89.3%-100%) and a specificity of 16.5% (95% CI, 11.9%-21.2%), respectively. After modifications including trigger activation requiring a combination of different modules, specificity increased to 56.9% (95% CI, 50.7%-63.0%). Identifying 36 of 44 ADEs leading to admission, sensitivity remained high (81.8% [95% CI, 70.4%-93.2%]). The overall positive predictive value was 25.2% (95% CI, 18.1%-32.3%). The algorithm is the first trigger tool to identify ambulant acquired ADEs leading to hospital admission in pediatrics. However, the underlying patient sample is small.Using a larger population for refinement will allow further specifications and reduction in the total amount of triggers and thus signals.

Malignant pancreatic tumor other than solid pseudopapillary tumor in pediatric patients: A single-center experience.

Pancreatic tumors, except solid pseudopapillary tumors (SPTs), are rare in pediatric patients. Herein, we report various types of pancreatic tumors in pediatric patients and review the literature regarding their treatments and prognosis.We retrospectively reviewed the data of pediatric patients who underwent surgery for pancreatic tumors, excluding SPTs, between January 2009 and December 2019 at Seoul National University Children's Hospital. A total of 35 pediatric patients were identified as having undergone surgery for pancreatic tumors. Of these patients, 30 were excluded because the tumor was identified as an SPT.The diagnoses of the five remaining (non-SPT) pancreatic tumors were pancreatic neuroendocrine tumor, mixed acinar neuroendocrine carcinoma, kaposiform hemangioendothelioma, and intraductal papillary mucinous neoplasm. All five patients survived; however, recurrence and liver metastasis were observed in one patient. The detailed demographics, treatments, and prognosis of each patient were reviewed.Despite the rarity and low incidence of pancreatic tumors in pediatric patients, four types of non-SPT tumors are reported here. Hence, the possibility of these should not be overlooked, especially since the diagnosis and adjuvant treatment differ vastly between the tumor types.

Psychosocial Stressors among Epileptic Children

Background: Epilepsy is one of the most common chronic neurological disorders in children that have a negative impact on the children's psychosocial development, cognition, behaviors, schooling, finally resulting to high stressors experiencing. Aim: The aim of this study was to assess the psychosocial stressors of epileptic children. Research design: A descriptive study design was conducted. Setting: This study was conducted at Neurological clinic of Children's University Hospital at Ain Shams University. Sample: Convenience sample was selected which included (100) epileptic children. Tools of data collection: Interviewing questionnaire tool for children was used which included two parts: Socio- demographic characteristics and medical history of the epileptic children and their parents, and the psychosocial stressors inventory. Results: More than three fifths of studied epileptic children had high psychological stressors and more than three quarter of studied epileptic children had high social stressors. Moreover, there were statistically significant relation between psychosocial stressors and socio-demographic features and medical history such as their age, area of residence, and medications compliance. Conclusion: The epileptic children have high psychosocial stressors in relation to their socio-demographic data and medical history. Furthermore, the majority of these stressors are due to illness precautions, medications side effects, epileptic fits, and the school. Recommendation: Develop and apply nursing intervention programs for epileptic children, their parents, and teachers to improve the knowledge, awareness, and attitudes towards epilepsy

Kurt Huldschinsky: A pioneer in the struggle against rickets

Kurt Huldschinsky (1883-1940) was a German pediatrician who was one of the international leaders in the field of rickets research between the two world wars. After his medical studies, he served at the Kaiserin-Auguste-Victoria-Haus in Berlin and at the University Children's Hospital in Vienna, among other places. After World War I, he worked with the famous orthopedist Konrad Biesalski at the Oskar-Helene-Heim for the healing and education of frail children in Berlin. Here he was the first to prove that exposure to ultraviolet (UV) radiation from mercury vapor lamps ("artificial sunlight") could cure rickets in young children, which is mostly caused by vitamin D deficiency. He published his discovery in this journal - the Deutsche Medizinische Wochenschrift [German Medical Weekly] - in 1919. For this groundbreaking scientific achievement and his further research into the prevention and treatment of rickets, Huldschinsky was awarded the Otto Heubner Prize of the German Association of Pediatrics in 1926. He was even nominated for the Nobel Prize in Medicine. As a Jew, however, he had to flee Germany from the National Socialists in 1933/34. Together with his wife and daughter, he emigrated to Egypt, where he died in Alexandria on October 31, 1940. As Huldschinsky was for many decades almost forgotten, this article recalls the life and work of a meritorious physician and scientist.

Serum Albumin Level as a Predictor of Outcome in Patients Admitted to Pediatric Intensive Care Units.

The aim of this study was to assess serum albumin level on admission to the pediatric intensive care unit (PICU) as a prognostic indicator. A prospective study was conducted in Fayoum University Children's Hospital. The study subjects' demographics and clinical and laboratory data were recorded. Pediatric Risk of Mortality III (PRISM-III) score was calculated. Serum albumin level was assessed within 24 hours from admission. Outcomes included mortality, PICU and hospital stay, need and duration of mechanical ventilation, and inotrope use. The incidence of admission hypoalbuminemia was 26%. The study subjects had a significantly higher mortality rate than subjects with normal albumin levels (42.3% vs 17.6%, respectively, P = 0.011). Each unit of increase in serum albumin decreased the risk of mortality by 28.9% (odds ratio, 0.289; confidence interval, 0.136-0.615, P = 0.001). Serum albumin showed a fair discriminatory power (area under the curve, 0.738). At a cutoff point of ≤3.7 g/dL, albumin had a 79.2% sensitivity, 67.1% specificity, 43.2% positive predictive value, and 91.1% negative predictive value. Incorporation of serum albumin with PRISM-III score was more predictive of mortality than either predictors alone (area under the curve, 0.802). No significant difference was found between the 2 groups regarding either PICU and hospital stay as well as the need and duration of ventilation. In PICUs, admission hypoalbuminemia is a good predictor of mortality. Further studies to confirm the value of adding serum albumin to PRISM-III score are recommended.

Prevalence and risk factors of cognitive impairment in children with sickle cell disease in Egypt.

Little is known about cognitive impairment in patients with sickle cell disease in Africa. This study aimed to assess cognitive impairment and identify possible risk factors in patients with sickle cell disease in Egypt. This study was conducted at Cairo University Children Hospital. Patients with sickle cell disease, between ages of 6-20years were enrolled. Cognitive ability was tested using the Stanford Binet intelligence quotient (IQ) test, fourth edition. Transcranial Doppler, magnetic resonance imaging and magnetic resonance angiography of the brain were performed within a week of the IQ test. Among the 40 enrolled patients, 55% had a Full Scale IQ at least 1 standard deviation below the mean, and 27.5% had an IQ 2 standard deviations below the mean. High lactate dehydrogenase was significantly associated with low IQ (p = 0.004). In univariate analyses, IQ was significantly correlated with older age (p = 0.025), high lactate dehydrogenase (p = 0.008) and older age at the start of hydroxyurea (p = 0.025). Impaired cognition is prevalent among sickle cell disease patients. Early initiation of hydroxyurea therapy, which should also reduce hemolysis and lactate dehydrogenase, may be a simple measure to preserve mental abilities in these patients.

Children with cavernous malformations of the central nervous system.

Cavernous malformations (CM) of the central nervous system (CNS) are a rare pathology in the pediatric population that may present with an acute onset of severe neurological symptoms. The aim of our study was to evaluate the clinical presentation, family history, genetic background, radiological features, treatment and outcome of children with CM. This observational cohort study included all children with CM of the CNS diagnosed in the period 2000-2020at University Children's Hospital in Ljubljana, Slovenia. Whole exome sequencing was utilized. We identified a cohort of 20 children with CM (mean age 9.3 years, range: 10 days-18.4 years). In our cohort, 16 patients were symptomatic and 4 were asymptomatic; 7 patients had a solitary lesion, and 13 had multiple lesions. Children with multiple lesions become symptomatic at an earlier age compared with children with solitary lesions. We identified five families with familiar cavernous malformation (FCM) syndrome affecting two or more generations; FCM represented 65% of all pediatric cases identified in our study. We confirmed a mutation in FCM associated genes in all but one patient with multiple lesions, with the KRIT1 mutation being the most common. Multiple CM lesions and symptomatic brainstem lesions are associated with worse neurological deficits in pediatric patients. Not all cases of multiple lesions can be linked to mutations in KRIT1, CCM2, or PDCD10, which may indicate that there are other as yet unidentified genes associated with FCM.

PREDICTORS OF POOR PROGNOSIS IN PREGNANT WOMEN WITH COVID-19: A PROSPECTIVE COHORT STUDY IN THE MATERNITY MOTHER AND CHILD UNIVERSITY HOSPITAL OF CASABLANCA MOROCCO

Objective: We aim to study the clinicalcharacteristics, the evolution of COVID-19 on pregnant women and survival factors. Study design: Its a prospective cohortstudy in a large tertiary maternity unit within the Mother and Child University Hospital Ibn Rochd of Casablanca with an average annual birth of over 6950 births. We prospectively collected and analyzed data for a cohort of 40 pregnant patients tested positive for COVID-19 between January 2020 and December 2020 inclusive to assess the effect of COVID-19 on pregnancy. Results: Forty pregnant patients testedpositive for COVID-19, 36 patients gave birth and 4 patients died pregnant. The severity of the symptoms ranged from mild in 20/40 (50%) of the patients, moderate in 7/40 (17,5%), and severe in 13/40 (32,5%). Thirteen of our patients were admitted to invasive care units, six were in their third trimester, and seven in their second trimester nine were intubated and ventilated prior to delivery and three of them required Extracorporeal membrane oxygenation. Among these patients intubated only two survived. Most common comorbidities were gestational diabetes 4/40 (10 %), asthma 4/40 (10 %), preeclampsia 7/40 (17,5%). Of the 40 pregnant patients 31 (77,5%) were in their third trimester, 8 (20%) women in their second trimester, and one in her first trimester. Of the 36 patients who delivered, 12/36 (33,3 %) were preterm delivered by elective C-sections. The death rate was 17,5% (7/40). Conclusion: COVID-19 is associated with high prevalence of preterm birth, caesarean section, and a high mortality rate.

Clinical outcome following reinjection of Ranibizumab for reactivation of retinopathy of prematurity.

To assess reactivation after initial intravitreal injection of ranibizumab (IVR) for type 1 retinopathy of prematurity (ROP) or worse and the outcome following reinjection of ranibizumab for this reactivation. This retrospective study was performed on infants screened for ROP between March 2013 and February 2020 in Mansoura University Children Hospital, Mansoura, Egypt. Infants treated with ranibizumab 0.25 mg/0.025 mL were identified for review of their clinical outcomes. Data of infants with reactivation and IVR re-injection were analysed. A total of 2318 infants were screened for ROP, 115 (5%) infants (216 eyes) with a mean gestational age of 30 ± 2.5 weeks and mean birth weight of 1290 ± 355.2 g received IVR at mean postmenstrual age (PMA) of 38 ± 3.1 weeks. All treated eyes demonstrated initial regression of ROP. However, ROP reactivation occurred in 5 (2.3%) eyes of 3 patients, at an average of 9.6 ± 2.9 weeks after treatment. None of these eyes had retinal detachment. A second dose IVR was administered and all five eyes showed regression with complete retinal vascularisation, at a mean PMA of 60 ± 5.1 weeks. IVR is beneficial as an initial and subsequent treatment for type 1 ROP or APROP. A long-term follow-up until complete retinal vascularisation is recommended to avoid disease reactivation.