Children's Clinical University Research Articles

Microbiological Findings, Infection Risk Factors and Complications Among Children after Tracheostomy

Introduction. Bacterial infection of the respiratory tract is highly common among pediatric patients with tracheostomy, yet there is no wide knowledge about the prevalence of different airway microbes, the incidence of bacterial infection, infection risk factors, and complications. The aim of the study was to analyze the prevalence of airway microbes, the incidence of bacterial infection, infection risk factors, and complications. Methods. Retrospective data of officially reported cases were collected from 2018 to 2022 at Riga Children's Clinical University Hospital (RCCUH). Demographic factors, airway microbiological findings, tracheostomy-related complications, underlying conditions, and outcomes for 37 patients were gathered from the hospital's database Andromeda. The data were analyzed using MS Excel. This study received ethical approval from RSU Ethics Committee. Results. Microbiological analyses were done in 78.3% (n=29) of the cases. Most cultures were obtained from airway aspirate. Altogether 46 different species of microbes were identified. The most frequently identified bacteria were Pseudomonas aeruginosa (in 72.4% of the cases; n=21) and Staphylococcus aureus (65.5%; n=19). Forty-eight percent (n=18) of the patients had respiratory tract infections that required hospitalization. Overall, there were 60 hospitalization episodes of which 51.6% (n=31) were caused by pulmonary bacterial infection, 25.0% (n=15) by non-bacterial infection, and 0.05% (n=3) because of local wound infection. The rest 18.3% (n=11) of hospitalization episodes were due to granulation tissue. The risk factor that showed the greatest significance in the development of bacterial infection was ventilator dependency. Formation of granulation tissue in the airways was found to be the most common complication among pediatric patients with tracheostomy. Conclusion. This study summarizes the most common pathogens, risk factors, and complications, which should be considered while treating pediatric patients after tracheostomy. The results of this study demonstrate that P. aeruginosa and S. aureus have the highest prevalence among these patients. This research is currently used to develop guidelines for pediatric patients with tracheostomy care in RCCUH. Keywords: pediatric tracheostomy; respiratory infections; tracheostomy complications.

Short- and mid-term outcomes of multisystem inflammatory syndrome in children: a longitudinal prospective single-center cohort study.

Multisystem inflammatory syndrome in children (MIS-c) emerged during the coronavirus disease 2019 pandemic and is associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Despite the extensively studied clinical manifestation of acute condition, the short- and long-term effects of MIS-c on children's health are unknown. This was a prospective longitudinal cohort study. Children aged <18 years who met the Centers for Disease Prevention and Control (CDC) diagnostic criteria and who were admitted to the Children's Clinical University Hospital of Latvia (CCUH) between July 1, 2020, and April 15, 2022, were enrolled in the study. An outpatient follow-up program was initiated in July 2020. All children were evaluated at 2 weeks, 2 months (1-3 months), and 6 months (5-7 months) after discharge. The face-to-face interviews comprised four domains as follows: symptom assessment, physical examination, laboratory testing, and cardiological investigation [including electrocardiogram (ECG) and echocardiography (echo)]. Overall, 21 patients with MIS-c were enrolled. The median age of the study group was 6 years. At the 2-week follow-up, almost half of the patients (N = 10, 47.6%) reported exercise intolerance with provoked tiredness. Laboratory tests showed a considerable increase in blood cell count, with a near doubling of leukocyte and neutrophil counts and a tripling of thrombocyte levels. However, a decline in the levels of inflammatory and organ-specific markers was observed. Cardiological investigation showed significant improvement with gradual resolution of the acute-phase pathological findings. Within 2 months, improvement in exercise capacity was observed with 5-fold and 2-fold reductions in physical intolerance (N = 2, 9.5%) and physical activity-induced fatigue (N = 5, 23.8%), respectively. Normalization of all blood cell lines was observed, and cardiological investigation showed no persistent changes. At the 6-month visit, further improvement in the children's exercise capacity was observed, and both laboratory and cardiological investigation showed no pathological changes. Most persistent symptoms were reported within the first 2 weeks after the acute phase, with decreased physical activity tolerance and activity-induced fatigue as the main features. A positive trend was observed at each follow-up visit as the spectrum of the children's complaints decreased. Furthermore, rapid normalization of laboratory markers and cardiac abnormalities was observed.

Self-reported psychotic-like experiences in help-seeking adolescents in Riga Children's Clinical University Hospital Psychiatry clinic: epidemiology and associated factors

Self-reported psychotic-like experiences in help-seeking adolescents in Riga Children's Clinical University Hospital Psychiatry clinic: epidemiology and associated factors

#60 TWO MONTH FOLLOW-UP OF PATIENTS WITH ACUTE COVID-19 AND MULTISYSTEM INFLAMMATORY SYNDROME IN CHILDREN

BackgroundChildren infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are usually asymptomatic or have mild coronavirus disease (COVID) with low rates of hospitalization. Two long-term consequences have been described after SARS-CoV-2 infection. The first is multisystem inflammatory syndrome in children (MIS-C) and the second is “long COVID”. Data on long COVID in pediatric patients has increasingly been published, giving new insights into the ways this phenomenon affects children. This study aimed to describe the persistent symptom spectrum of patients with acute SARS-CoV-2 infection and MIS-C two months after the diagnosis.MethodThis was a prospective cohort study conducted at the Children's Clinical University Hospital in Latvia. The study population of pediatric COVID-19 and MIS-C patients were invited to participate between December 1, 2020, and December 31, 2021. The study included children with moderate and severe acute SARS-CoV-2 infection who required hospitalization and MIS-C. Overall, 53 acute Covid-19 and 22 MIS-C patients were enrolled in the study. All patients were evaluated by specially designed assessment protocols. The Ethics Committee of Riga Stradins University reviewed and approved the study protocol questionnaire and informed consent forms (approval No. 6-1/07/35). Descriptive statistics were used to present the data.ResultsData showed that two months after acute SARS-CoV-2 infection 84% (n=45) of patients had at least one persistent symptom. In addition, 73% (n=16) of MIS-C patients reported at least one persistent symptom. Generally, the most commonly reported complaints among COVID-19 patients included rhinorrhea (41%), cognitive sequelae such as mood swings (38%) and irritability (36%), prolonged cough (30%), anxiety (19%), night sweats (15%), sore throat and shortness of breath (13%). In the MIS-C patient group - body weight changes and mood swings (36%), irritability (27%), poor attention (23%), fatigue (18%), and in 14% of cases were observed myalgia, night sweats, difficulties concentrating and anxiety. There were other similar but less common complaints in both groups, such as prolonged fever, nausea, shortness of breath, dizziness and memory impairment.ConclusionWe found that at the time of interview more than half of COVID-19 and MIS-C patients reported at least one persistent symptom. Symptoms including rhinorrhea, mood swings, irritability, prolonged cough, poor attention and fatigue were the most frequently reported complaints of long COVID-19 after acute SARS-CoV-2 infection and MIS-C, representing the wide range of symptoms affecting children.

Integrating Clinical Signs at Presentation and Clinician's Non-analytical Reasoning in Prediction Models for Serious Bacterial Infection in Febrile Children Presenting to Emergency Department.

ObjectiveDevelopment and validation of clinical prediction model (CPM) for serious bacterial infections (SBIs) in children presenting to the emergency department (ED) with febrile illness, based on clinical variables, clinician's “gut feeling,” and “sense of reassurance.Materials and MethodsFebrile children presenting to the ED of Children's Clinical University Hospital (CCUH) between April 1, 2017 and December 31, 2018 were enrolled in a prospective observational study. Data on clinical signs and symptoms at presentation, together with clinician's “gut feeling” of something wrong and “sense of reassurance” were collected as candidate variables for CPM. Variable selection for the CPM was performed using stepwise logistic regression (forward, backward, and bidirectional); Akaike information criterion was used to limit the number of parameters and simplify the model. Bootstrapping was applied for internal validation. For external validation, the model was tested in a separate dataset of patients presenting to six regional hospitals between January 1 and March 31, 2019.ResultsThe derivation cohort consisted of 517; 54% (n = 279) were boys, and the median age was 58 months. SBI was diagnosed in 26.7% (n = 138). Validation cohort included 188 patients; the median age was 28 months, and 26.6% (n = 50) developed SBI. Two CPMs were created, namely, CPM1 consisting of six clinical variables and CPM2 with four clinical variables plus “gut feeling” and “sense of reassurance.” The area under the curve (AUC) for receiver operating characteristics (ROC) curve of CPM1 was 0.744 (95% CI, 0.683–0.805) in the derivation cohort and 0.692 (95% CI, 0.604–0.780) in the validation cohort. AUC for CPM2 was 0.783 (0.727–0.839) and 0.752 (0.674–0.830) in derivation and validation cohorts, respectively. AUC of CPM2 in validation population was significantly higher than that of CPM1 [p = 0.037, 95% CI (−0.129; −0.004)]. A clinical evaluation score was derived from CPM2 to stratify patients in “low risk,” “gray area,” and “high risk” for SBI.ConclusionBoth CPMs had moderate ability to predict SBI and acceptable performance in the validation cohort. Adding variables “gut feeling” and “sense of reassurance” in CPM2 improved its ability to predict SBI. More validation studies are needed for the assessment of applicability to all febrile patients presenting to ED.

Characteristics of paediatric hypopituitarism patients in Latvia: a single-centre 25-year retrospective study.

Hypopituitarism is a chronic disease characterized by partial or complete absence of secretion of one or more pituitary hormones. Delayed diagnosis can have serious consequences during the neonatal period and adulthood. A retrospective study was conducted on patients who had started treatment in the Children's Clinical University Hospital from 1 January 1995 to 31 December 2020. In total 243 patients were included; they were divided into 3 subgroups: isolated growth hormone deficiency, multiple pituitary hormone deficiency, and panhypopituitarism. The prevalence of hypopituitarism in Latvia is about 45 cases per 100,000 live births. The average detection age of abnormal growth in Latvia is 8 years and 3 months. Most cases had isolated growth hormone deficiency, at 67.1% (n = 163), followed by cases of multiple pituitary hormone deficiency, at 26.3% (n = 64), and cases of panhypopituitarism, at 6.6% (n = 16). Abnormalities in MRI were found in 44.7% (n = 101) of patients. The most best therapeutic effect was achieved in the first year of treatment: with growth of an average of 9.3 cm (+0.1 SD) for isolated growth hormone deficiency, 9.0 cm (+0.6 SD) for multiple pituitary hormone deficiency, and 11.7 cm (+1SD) for patients with panhypopituitarism. It is important to increase awareness and promote early diagnosis for hypopituitarism patients in Latvia and in Europe. More attention should be paid to education about growth restriction problems to parents, caregivers, and other specialists. The treatment should be adjusted individually with the focus not only on physical and mental health but also on safety and treatment costs.

Prikaz prve laparoskopske adrenalektomije zbog feohromocitoma u pedijatrijskoj populaciji u Republici Srbiji

Pheochromocytoma is a tumor that arises from adrenal medulla and it is characterized by increased secretion of catecholamines. The incidence of pheochromocytoma is 3 to 8 cases per million inhabitants, of which about 10 to 20% of diagnosed pheochromocytomas occurs in the pediatric population, with a higher frequency in boys. In 1.7% of the pediatric population with hypertension, the cause of hypertension is pheochromocytoma. Due to headaches and verified hypertension on twenty-four-hour holter blood pressure monitoring, the 13-year-old female patient underwent ultrasound, followed by scintigraphy and magnetic resonance imaging of the abdomen, which described an oval change above the right kidney about 4.5 cm in diameter suspected of pheochromocytoma. Twenty-four-hour urine cateholamines showed elevated noradrenaline values as much as 45 times higher than the reference range, as well as elevated Dopamine values. After adequate preparation with phenoxybenzamine and bisoprolol for two weeks, a right laparoscopic adrenalectomy was performed at the University Children's Clinic in Tirsova, which is also the first operation of this type in the pediatric population. Intraoperatively, the maximum value of tension was 180/120 mmHg. Pathohistological findings confirmed pheochromocytoma. Although a rare cause of hypertension in the pediatric population, young patients with newly diagnosed hypertension should be examined for possible pheochromocytoma. Laparoscopic adrenalectomy through both the lateral transabdominal and posterior retroperitoneoscopic approach is the gold standard for the treatment of pheochromocytomas in both the adult and pediatric populations.

Comparison of Persistent Symptoms After COVID-19 and Other Non-SARS-CoV-2 Infections in Children.

Introduction: The data on long COVID in children is scarce since children and adolescents are typically less severely affected by acute COVID-19. This study aimed to identify the long-term consequences of SARS-CoV-2 infection in children, and to compare the persistent symptom spectrum between COVID-19 and community-acquired infections of other etiologies.Methods: This was an ambidirectional cohort study conducted at the Children's Clinical University Hospital in Latvia. The study population of pediatric COVID-19 patients and children with other non-SARS-CoV-2-community-acquired infections were invited to participate between July 1, 2020, and April 30, 2021.Results: In total, 236 pediatric COVID-19 patients were enrolled in the study. Additionally, 142 comparison group patients were also enrolled. Median follow-up time from acute symptom onset was 73.5 days (IQR; 43–110 days) in the COVID-19 patient group and 69 days (IQR, 58–84 days) in the comparison group. Most pediatric COVID-19 survivors (70%, N = 152) reported at least one persistent symptom, but more than half of the patients (53%, N = 117) noted two or more long-lasting symptoms. The most commonly reported complaints among COVID-19 patients included persistent fatigue (25.2%), cognitive sequelae, such as irritability (24.3%), and mood changes (23.3%), as well as headaches (16.9%), rhinorrhea (16.1%), coughing (14.4%), and anosmia/dysgeusia (12.3%). In addition, 105 (44.5%) COVID patients had persistent symptoms after the 12-week cut-off point, with irritability (27.6%, N = 29), mood changes (26.7%, N = 28), and fatigue (19.2%, N = 20) being the most commonly reported ones. Differences in symptom spectrum among the various age groups were seen. Logistic regression analysis showed that long-term persistent symptoms as fever, fatigue, rhinorrhea, loss of taste and/or smell, headaches, cognitive sequelae, and nocturnal sweating were significantly associated with the COVID-19 experience when compared with the controls.Conclusions: We found that at the time of interview almost three-quarters of children reported at least one persistent symptom, but the majority of patients (53%) had two or more concurrent symptoms. The comparison group's inclusion in the study allowed us to identify that symptom persistence is more apparent with COVID-19 than any other non-SARS-CoV-2 infection. More research is needed to distinguish the symptoms of long COVID from pandemic-associated complaints. Each persistent symptom is important in terms of child well-being during COVID-19 recovery.

Načini informisanja roditelja dece sa celijačnom bolešću o samoj bolesti i bezglutenskoj ishrani

Introduction: Celiac disease is an autoimmune disease caused by an inadequate immune response in contact with gluten in genetically predisposed individuals. Barriers to maintaining a strict gluten-free diet arise due to several factors, the most common of which are: inadequate information, insufficient education about the disease, food contamination. Aim of the research: To determine the ways of informing parents about the celiac disease that has been diagnosed in their children, as well as to learn about the necessary procedures to improve information about gluten-free diet. Subjects and method: The study included a sample of 116 parents whose children are diagnosed with celiac disease and who are on a gluten-free diet. The place of research is the Institute for Maternal and Child Health of Serbia "Dr Vukan Cupic" in New Belgrade and the University Children's Clinic in Belgrade. The research instrument used is the Questionnaire on Parents' Awareness of Celiac Disease, which was created for the purposes of this research. Results with discussion: The results of the study show that 47.14% of parents of children with celiac disease ask for information about the proper nutrition of their children and gluten-free foods from the doctor of the institution where the child was diagnosed with the disease. In order to better understand the diagnosis of celiac disease in their child, 53.01% of parents most often chose to talk to the doctor who treats the child. Conclusion: Information on proper nutrition of children and gluten-free foods, as well as specific information on celiac disease, is requested from the doctor of the institution where the disease was diagnosed in the child and where they go for check-ups. Many complications caused by unrecognized celiac disease could be prevented by timely diagnosis and proper posture of the child, which contributes to good and adequate information.

Clinical and neurophysiological spectrum of polyneuropathies in children

Peripheral neuropathy is a disorder of the peripheral nerves and results from a disturbance of structure and/or function of the peripheral sensory, motor and/or autonomic neurons. The possible aetiology of peripheral neuropathies is diverse, but inflammatory and hereditary diseases of the peripheral nerves predominate in childhood. The aim of this study was to determine the clinical and electrophysiological profile of large nerve fibre neuropathy detected by nerve conduction studies (NCS) in children over a 10-year period at the Children's Clinical University Hospital in Latvia. Based on NCS findings, 165 children between 2008 and 2018 were diagnosed with polyneuropathy. In our study, the majority of children had peripheral neuropathy due to acquired causes, mostly due to diabetes mellitus; roughly one in five of the patients had hereditary neuropathy. Almost half of the patients had motor deficits, which were more prevalent in toxic and inflammatory neuropathies. A little less than a third of patients complained of pain as well as presenting with autonomic dysfunction symptoms. The NCS demonstrated a demyelinating neuropathy in 52 cases (31%), an axonal neuropathy in 34 cases (21%), and mixed polyneuropathy in 79 cases (48%). Our study investigated the clinical and electrophysiological characteristics of polyneuropathies diagnosed with NCS in children. Most of the polyneuropathies in our study were hereditary and diabetic neuropathies with combined (myelin and axon) damage to nerve fibres. Almost all clinical symptoms of polyneuropathy were present in all aetiological groups.

Effectiveness of Dual Antibacterial Therapy and Effectiveness of Recommendation Criteria as a Diagnostic Tool in Children with Uncomplicated Acute Appendicitis

Summary Introduction Acute appendicitis (AA) – acute inflammation and infection of the appendix – is one of the most common cause for abdominal surgery in pediatrics. Appendectomy has been the gold standard since 1735, but in recent years there have been several studies that investigate antibacterial therapy for uncomplicated acute appendicitis. In 2016 new recommendations for suspected AA were implemented in emergency department setting of Children's Clinical University Hospital (CCUH). Aim of the Study To evaluate whether diagnostic criteria for patients with a suspected acute appendicitis is effective as a diagnostic tool and to evaluate whether dual antibacterial therapy is safe and effective as first line treatment for children with diagnosis of uncomplicated acute appendicitis in CCUH. Material and methods A retrospective study was made in CCUH from January 2017 to December 2017. Patients aged 7 to 18 with suspected uncomplicated acute appendicitis were identified and data were collected from an internal hospital management system and patients’ medical records. Patients were divided into two groups – A and B. In group A were patients who met the criteria of uncomplicated AA, and in group B – patients who met the criteria of complicated AA. Both groups received ampicillin and metronidazole. For statistical analysis IBM SPSS Statistics 22 program was used. Results From 98 patients majority were boys (51% (n=50)) with mean age 12.6 years. As a result of antibacterial therapy clinical condition improved in 93% (n=89) of patients who were discharged without surgery. 7 patients did not improve and underwent surgery within 48 hours after admission, another 2 had elective appendectomy. There was a significant positive moderate correlation between C–reactive protein (CRP), white blood cell count (WBC), basophil granulocytes (BASO) and appendix diameter at admisson and after 48 hours of dual antibacterial therapy (r=0.31, p=0.003 vs. r=0.37, p&lt;0.001 vs. r=0.41, p=0.017 vs. r=0.51, p=0.013). In group A (68% (n=67)) there was a significant positive moderate correlation between CRP, WBC and appendix diameter at admission and after 48 hours of dual antibacterial therapy (r=0.31, p=0.003 vs. r=0.37, p&lt;0.001 vs. r=0.51, p=0.013). In group B (30% (n=31)) 7 patients underwent appendectomy and 2 patients received a broad spectrum antibacterial therapy prior to elective appendectomy. There is evidence of significant association between ALVARADO score (p=0.004), rebound tenderness (p&lt;0.001), WBC (p=0.004), CRP (p&lt;0.001) and stage in which appendicitis has progressed to. Conclusions Antibiotic-alone treatment may be a safe and effective initial management choice in children with uncomplicated acute appendicitis. However, to fully evaluate effectiveness of antibacterial therapy and diagnostic criteria, further follow–up research is needed. A normal C–reactive protein value does not rule out uncomplicated acute appendicitis, therefore it can not act as a single marker to diagnose AA or to differentiate between complicated and uncomplicated AA. Recommendations of treatment of UCAA are acceptable for use in emergency department as they act as a unified tool that allows pediatricians and pediatric surgeons to quickly assess suspected acute appendicitis.

Clinical Characteristics of Rotavirus-Induced Gastroenteritis in Infants

Abstract Rotavirus is the most common cause of acute infectious diarrhea in infants and young children up to the age of five. The disease is characterized by profuse watery diarrhea, vomiting and fever. The major complications of rotavirus gastroenteritis (RVGE) are dehydration, middle ear inflammation and upper respiratory tract infection. The basis of treatment is compensation for fluid loss and administration of probiotics. The aim of this study was to analyze the clinical characteristics of rotavirus gastroenteritis in infants. The study was conducted by the type of retrospective-prospective clinical study on infants with rotavirus gastroenteritis diagnosed on the basis of a positive Rotalex test (Orion Diagnostica Finland) and exclusion of other etiological factors at the University Children's Clinic in Belgrade, from April 2005 to December 2010. In addition to the detailed medical history and clinical examination, relevant laboratory analyzes were performed in all patients. Descriptive and analytical statistical methods were applied in the study. Among the descriptive methods, we used grouping, tabulation, graphing, calculating measures of central tendency, calculating measures of variability and calculating relative numbers. Of the analytical statistical methods, distribution normality testing, χ2 test, Mann-Whitney U test and T test were used. Statistical significance will be taken to mean p &lt; 0.05. The average infant mortality was 6.7 ± 3.7 months. All respondents were divided into two groups according to the age. The first group consisted of infants aged 0 to 5 months (46%), the second group consisted of infants aged 6 to 12 months (54%). The incidence of aqueous diarrhea (100%), vomiting (84%) and fever (74%) in infants suffering from rotavirus gastroenteritis was analyzed. The significance of the age on the symptomatology of rotavirus gastroenteritis as well as on the importance of using probiotics has been demonstrated.

Regional Variability of Admission Prevalence and Mortality of Pediatric Critical Illness in Latvia

Objectives: There is only one pediatric intensive care unit (PICU) in Latvia, where all critically ill children <18 years are admitted from all regions of Latvia. The aim of this study is to ascertain regional differences in mortality and morbidity of critically ill children over a 5-year period. Materials and Methods: Descriptive retrospective study of children who were admitted to the PICU in Latvia from January 2012 to December 2016. Data on episodes were obtained from the Children's Clinical University Hospital electronic health records. Pediatric Index of Mortality (PIM2) was used for risk adjustment and calculation of standardized mortality ratio (SMR). The data were compared among the six regions of Latvia - Kurzeme, Latgale, Pieriga, Riga, Vidzeme, and Zemgale. Results: The analysis included 3651 intensive care episodes. The highest PICU admission prevalence was in Riga and the lowest in Latgale - 2.3 and 1.7 admissions per 1000 children per year, respectively. The highest emergency admission proportion was observed in Riga and Pieriga, while the lowest in Latgale - 52 and 38%, respectively. The average proportion of mechanically ventilated patients ranged from 24 to 29% of all admitted patients across the regions. SMR for the total population was 1.44 (95% CI: 1.17- 1.81). In two regions, Riga (1.51; 95% CI: 1.04- 2.14) and Latgale (2.21; 95% CI: 1.9- 3.76), it was significantly higher than 1. Conclusions: We noted excess mortality (SMR >1) in the population of critically ill children in Latvia, 2012-2016; in particular, in patients from two regions - Riga and Latgale.

Observational Study of Antibiotic Usage at the Children's Clinical University Hospital in Riga, Latvia.

Background and objectives: Many pediatric patients have been treated with antibiotics during their hospitalization. There is a need to improve antibiotic prescribing for pediatric patients because many of these prescriptions are inappropriate. Antibiotic consumption analysis was conducted at the Children’s Clinical University Hospital to identify targets for quality improvement. Materials and Methods: A one day cross-sectional point prevalence survey (PPS) was conducted in May and November 2011–2013 using a previously validated and standardized method. The survey included all inpatient pediatric and neonatal beds and identified all children receiving an antibiotic treatment on the day of survey. Total consumption of systemic antibiotics belonging to the ATC J01 class (except amphenicols (J01B) and a combination of antibacterials (J01R)) was also analyzed by using a defined daily dose (DDD) approach and antibiotic drug utilization (90%DU) for the period 2006–2015. Results were compared with results in 2017 using the DDD and 90%DU methodology. Results: The most commonly used antibiotic group in all PPS, except in May and November 2011, was other β-lactam antibiotics (J01D): 42 (40%) prescriptions in May 2013 and 66 (42%) and November 2011. In 2006–2015 and also in 2017, the most commonly used antibiotic groups were penicillins (J01C) and other β-lactam antibiotics (J01D)—76% (90%DU) of the total antibiotic consumption registered in 2006, 73% in 2015 and 70% in 2017. Starting in 2008, amoxicillin was the most commonly used antibiotic at the hospital. The usage of ceftriaxone increased from 3% in 2006 to 13% in 2015, but decreased in 2017 (7%). Conclusions: Study results from 2006–2015 showed that there was a need to establish a stronger antibiotic prescribing policy in the hospital reducing the use of broad-spectrum antibiotics (especially 3rd generation cephalosporins) and increasing the use of narrower spectrum antibiotics. It was partly achieved in 2017 with some reduction in ceftriaxone use.

A nationwide epidemiological study of myasthenia gravis in Latvia.

Myasthenia gravis (MG) is an autoimmune disorder characterized by fatigable muscle weakness due to antibody-mediated impairment of neuromuscular transmission. The aim of this study was to investigate the incidence and prevalence of MG in Latvia, and to characterize this population by well-established clinical parameters such as age at onset, presence of associated antibodies and thymus pathology. All prevalent cases on 1 January 2015 and cases of patients newly presenting with MG symptoms from 1 January 2010 to 31 December 2014 were selected from the database of the Neuromuscular Disease Clinic of Pauls Stradins Clinical University Hospital and Children's Clinical University Hospital. Crude rates were calculated based on population data. These were directly age-standardized to the European and World Health Organization world standard populations. The analysis of clinical characteristics was carried out in a cohort of patients who had undergone a complete set of electrophysiological, serological and radiological investigations (n=153; 68%). During the study period 99 incident and 226 prevalent cases were identified. The total crude MG incidence was 9.7 per million person-years. The prevalence of MG on 1 January 2015 was 113.8 per million. 54.2% of patients tested positive for acetylcholine receptor antibodies, 7.8% for muscle specific kinase antibodies and 1.3% for lipoprotein related protein 4 antibodies. This is the first study of MG in Latvia and the second population-based study of MG in Eastern Europe. Our epidemiological results are similar to those in some other European and Northern American countries, and show high prevalence and increasing incidence of late-onset MG.

Molecular epidemiology of human respiratory syncytial virus over three consecutive seasons in Latvia

Lower respiratory tract infections caused by the human respiratory syncytial virus (HRSV) represent an immense burden of the disease, especially in young children. This study aimed to investigate the evolutionary history of HRSV strains isolated in the Children's Clinical University Hospital (Riga, Latvia) over three consecutive HRSV seasons. Of 207 samples from children hospitalized with lower respiratory tract infections, 88 (42.5%) tested positive for HRSV by RT-PCR. The seasonal activity started and peaked later than the average for the Northern hemisphere. Patients with HRSV lower respiratory tract infection were significantly younger than patients not infected with HRSV. HRSV-A viruses predominated for two consecutive seasons and were followed by an HRSV-B dominant season. Phylogenetic analysis based on glycoprotein G gene partial sequences revealed that viruses of both groups belonged to the worldwide dominant genotypes NA1 (HRSV-A) and BA-IV (HRSV-B). High diversity of this gene was driven only partially by selection pressure, as only two positively selected sites were identified in each group. Two of the HRSV-A isolates in this study contained a 72-nt duplication in the C-terminal end of the G gene (genotype ON1) that was first described in Canada in the 2010-2011 season. Initial spatial and temporal dynamics of this novel genotype were reconstructed by discrete phylogeographic analysis. Fifteen years after acquiring comparable 60-nt duplication in the G gene, genotype BA lineages have replaced all other HRSV-B strains. However, the population size of genotype ON1 plateaued soon and even decreased slightly before the beginning of the 2012-2013 season.

Percepcija zdravstvenih radnika koja se odnosi na broj i karakteristike dece žrtava zlostavljanja i zlostavljača

University Children's Clinic and Institute for Health Protection of Mother and Child 'Dr Vukan Čupić' in Belgrade have an incomplete database from which we could not get the social demographics of abused children who were patients of their institutions or the information about their abusers. That is why we decided to gather this data through perceptions of health professionals. Aim of the research was to investigate the perception of health professionals concerning the number and characteristics of child victims of abuse and abusers, as well as the phenomenology of child abuse. This phenomenological study used a quantitative method, and the technique used for data collection was a survey. The research instrument used was a questionnaire with mostly closed-ended questions. The sample included 135 doctors and nurses of both genders from the two largest and by type of organization most similar child care institutions in Serbia, the University Children's Clinic (UDC) and the Institute for Health Protection of Mother and Child 'Dr Vukan Čupić' (IMD). We tried to make a profile of the child victim of abuse based on perceptions of health workers on the form of abuse to which the child was exposed, and the age and gender of the child victims. Those children are aged between 1 and 5 years and are victims of physical abuse. Perception of health workers indicates that the most common abusers of children are members of their families.

P-263 - Use of atypical antipsychotics in children with schizophrenia spectrum disorders in Latvia

In recent years we've witnessed a rapid rise in the off-label use of atypical antipsychotics (AAPs) in child and adolescent psychiatry practice despite still limited evidence base for their efficacy and safety. To investigate the patterns of use and frequency of side effects of AAP therapy in children and adolescents with psychotic disorders in Latvia. Retrospective chart review of all inpatients with schizophrenia spectrum disorder diagnosis, treated in Children's Clinical University Hospital, Riga, Latvia from September 2008 till September 2011. We identified 126 admissions (F/M ratio - 1,5; mean age - 13,83 (SD 2,69) years), 32 being first-admissions. Most frequent diagnoses were juvenile-onset (34,1%) and paranoid (23.8%) schizophrenia. In 91,3% cases patients received antipsychotic therapy (28,6% only AAPs, 11,9% only typical antipsychotics (TAPs), 50,8% a combination of both). Most widely used AAPs were Quetiapine - 34,9%, Risperidone - 26,2%, Olanzapine - 19,8% and Aripiprazole - 15,9%. Haloperidol was still used in 49,2% cases. In 58,7% cases patients also received anticholinergic medication, so reports of extrapyramidal side effects were anecdotal. In 31,0% cases (9 patients on AAPs, 30 on combined treatment) there was a significant (>400 mU/L) increase of serum prolactin level. In 15,9% cases there was a significant (>450 ms) elongation of QTc interval. AAPs are rapidly substituting TAPs as the firsthand treatment for children with schizophrenic psychoses, but the rate of side effects is significant, with as much as 1/3 of those receiving AAPs developing hyperprolactinaemia, and 1/5 - a prolongation of QTc interval.

A Tribute to Professor Lothar Bernd Zimmerhackl, M.D., Ph.D. (1952–2010)

Professor Dr. Lothar Bernd Zimmerhackl, M.D., Ph.D. (Fig. [1]), who devoted his scientific and medical life to pediatric renal diseases, and who directed the Innsbruck Medical University children's clinic (Pädiatrie I, Dept. f. Kinder-und Jugendheilkunde) for almost a decade, died on August 27, 2010, at the intensive care unit of Innsbruck Medical Hospital due to a massive (second) heart attack, at age 57.

609 Echocardiography and Its Role in the Diagnosis and Prognosis of Congenital Heart Disease in Children

The most important thing in the congenital heart disease evaluation is early diagnosis, because almost all CHD, even the most complicated ones, are now operable. Objective: To determine the frequency and pattern of CHD in our country and to underline the role of early diagnosis in the outcome of patients with CHD. Material and Methods: Retrospective study of children with CHD, examined at hospitalized at University Children's Clinic, Prishtina, from 2000 - 2006. Age from 1 mo to 18 years. Ecxept 2D color echocardiography, other non invasive techniques were also used for diagnosis: history, laboratory, ECG, chest X ray, pulse oximetry. Results: The number of children with CHD was 1671, including the simpliest to most complex CHD. According to cyanosis, there were 207 (12.4%) cyanotic patients, while 1464 (87.6%) have no cyanosis. The type of lesions were similar to those reported from other studies. The age when the diagnosis of CHD is performed was: Only 45% of children with CHD were diagnosed under the age of three years, the remaining 55% were diagnosed later, even at the age above ten years. It was probably the reason for a high number of complications in children with CHD, such as : pulmonary hypertension (3.5%) , heart failure (10%) and death (5.5%). Conclusion: Since echocardiography is sufficient for diagnosis of most CHD and has no adverse effects or hazards, echocardiography could be a routine in order to prevent late diagnosis of CHD and to escape complications.