University Children Research Articles

Lesional Magnetic Resonance Imaging Is Associated with Better Outcomes in the Loma Linda University Children’s Hospital Experience (P5-1.009)

Lesional Magnetic Resonance Imaging Is Associated with Better Outcomes in the Loma Linda University Children’s Hospital Experience (P5-1.009)

Translation and Validation of the Sinus and Nasal Quality of Life Surgery Survey in Serbian.

The aim of this study was to translate the Sinus and Nasal Quality of Life Surgery Survey into the Serbian language to evaluate the test-retest reliability and validity. The study included 49 consecutive patients between 12 and 18 years old with rhinologic symptoms. Patients were given a paper survey to complete along with a link to complete the online survey within the same day. The study was conducted at the University Children's Hospital Clinic for Pulmonology and Allergology between January 2023 and March 2023. Responses between the paper and online survey were compared and regression analysis was performed to evaluate the relationship. Internal reliability and test-retest reliability were assessed using Cronbach's α coefficient and intraclass correlation coefficient. All data were collected and analyzed using SPSS 29.0. Pearson correlation coefficient between the paper and online survey was very high and statistically significant (r = 0.999; P < .001). Each item had a high correlation (0.993-1.000), where the lowest correlation coefficient was obtained from question 2 (0.993). Average scores in each item differed slightly for only item 2 (mean difference = -0.041), but not to the level of statistical significance. Bland-Altman plot indicated no proportional bias between the 2 versions. Linear regression analysis suggested a high level of agreement between the 2 versions (slope = 1.00, R 2 = 0.999). The survey is a useful questionnaire to evaluate the quality of life in patients with rhinologic symptoms. The high correlation between the paper and online survey shows the reliability of the questionnaire regardless of administration modality.

Neurobehavioral outcome of multi-sensory stimulation intervention in preterm neonates: Randomised controlled trial

BackgroundPreterm neonates are exposed to overwhelming and unusual sensory stimulations in the neonatal intensive care unit, which can have deleterious effects on their neurobehavioral outcomes. Therefore, neonatal nurses play a crucial role in enhancing these neonates' neurobehavioral outcomes. This study aimed to investigate the neurobehavioral outcomes of a multi-sensory stimulation intervention in preterm neonates. DesignA randomized, controlled pretest-posttest trial with two parallel groups. SubjectsSixty preterm neonates who were medically stable with a mean gestational age of 32.95 ± 1.845 weeks and a mean birth weight of 1550.83 ± 208.077 g. SettingNeonatal intensive care unit at Alexandria University Children's Hospital at Smouha, Alexandria, Egypt. MethodsAll eligible neonates were randomly assigned to the study or the control group. The control group received standard neonatal nursing care, while the study group received the multi-sensory stimulation intervention in addition to standard nursing care. The neonates received the intervention for 30 min daily for two consecutive weeks. The outcomes were evaluated within 24 h of admission and after two weeks using the Neonatal Neurobehavioral Examination Scale. ResultsThe multi-sensory stimulation intervention significantly improved the mean total score of preterm neonates’ neurobehavioral responses after two weeks (65.20 ± 7.65) compared to the control group (46.87 ± 7.55) (P = 0.000). ConclusionMulti-sensory stimulation intervention had a protective effect on preterm neonates’ neurobehavioral outcomes. Therefore, it should be integrated into standard nursing care for preterm neonates.

Assessment of Sepsis Markers in Patients Admitted to the Pediatric Intensive Care Unit In Minia University Children Hospital

Assessment of Sepsis Markers in Patients Admitted to the Pediatric Intensive Care Unit In Minia University Children Hospital

Exploring Clinical Predictors of Severe Human Metapneumovirus Respiratory Tract Infections in Children: Insights from a Recent Outbreak.

Human metapneumovirus (hMPV) is an important pathogen that causes both upper (URTIs) and lower respiratory tract infections (LRTIs) in children. The virus can be implicated in severe bronchiolitis and pneumonia, necessitating hospitalization, with certain cases requiring intensive care unit intervention. As part of a retrospective observational study, we aimed to identify indicators of severe hMPV respiratory tract infections in children referred to the University Children's Hospital Ljubljana and the Department of Infectious Diseases Ljubljana, Slovenia, during a recent outbreak. We analyzed clinical data from November 2022 to January 2023 and compared the characteristics of children presenting with URTIs and LRTIs. We also examined the characteristics of children with hMPV LRTIs, distinguishing between children with and without LRTI-associated hypoxemia. Of 78 hMPV-PCR-positive pediatric patients (mean age 3.1 years; 60.3% boys), 36% had a URTI, and 64% had an LRTI. Hospitalization was required in 64% (50/78), with 42% (21/50) requiring oxygen therapy. LRTI-associated hypoxemia was more common in patients with atopy who showed dyspnea, tachypnea, crackles, and wheezing on lung auscultation. In a multivariable logistic regression analysis, wheezing detected on lung auscultation was a significant predictive factor for hypoxemic hMPV-LRTI. Specifically, children presenting with wheezing were found to be ten times more likely to experience hypoxemia. Prematurity and chronic conditions did not influence the presentation or severity of hMPV infection. This study highlights wheezing and atopy as crucial indicators of severe hMPV LRTI in children, emphasizing the importance of early recognition and intervention.

Effect of peppermint inhalation versus Swedish massage on chemotherapy induced-nausea and vomiting in children with leukemia: Multi-arm randomised trial design

BackgroundChemotherapy is the foremost treatment for children with leukemia, while causing different serious side-effects. Chemotherapy-induced nausea and vomiting are the most common deliberating side effects and critical concerns of pediatric oncology nurses among those children. AimTo investigate the effect of peppermint inhalation versus Swedish massage on chemotherapy-induced nausea and vomiting in children with leukemia. DesignA multi-arm randomised trial design with three parallel groups. SettingThis study was conducted at outpatient and inpatient Hematology/leukemia Units at Alexandria University Children's Hospital at Smouha. MethodsSeventy-five children with leukemia received the first chemotherapy session. They were randomly allocated into three equal groups, 25 children in each group (control, peppermint inhalation, and Swedish massage groups). Every child is assessed for nausea and vomiting before chemotherapy administration and after for three days for consecutive three sessions of treatment. ResultsStudy findings revealed that children in peppermint inhalation and Swedish massage groups showed significant reduction in mean total score of chemotherapy-induced nausea and vomiting among peppermint inhalation and Swedish groups (15.120 ± 4.585 and 14.680 ± 3.158, respectively) was observed on third chemotherapy session than in control group (45.680 ± 5.793) (p < 0.001). ConclusionIt can be concluded that Swedish massage and peppermint inhalation therapies may have significant antiemetic effects as alleviating the chemotherapy induced nausea and vomiting for children with leukemia. Practice implicationsThis study directs the pediatric oncology nurses to incorporate peppermint inhalation and Swedish massage therapies besides antiemetic drugs in pediatric oncology unit protocols for management of chemotherapy induced nausea and vomiting.

Between hope and disillusionment: ECMO seen through the lens of nurses working in a neonatal and paediatric intensive care unit.

Using extracorporeal membrane oxygenation (ECMO) in paediatric and neonatal intensive care units (PICU/NICU) creates ethical challenges and carries a high risk for moral distress, burn out and team conflicts. The study aimed to gain a more comprehensive understanding of the underlying factors affecting moral distress when using ECMO for infants and children by examining the attitudes of ECMO nurses. Four focus groups discussions were conducted with 21 critical care nurses working in a Swiss University Children's Hospital. Purposive sampling was adopted to identify research participants. The data were analysed using reflexive thematic analysis. Unlike "miracle machine" stories in online media reports, specialized nurses working in PICU/NICU expressed both their hopes and fears towards this technology. Their accounts also contained references to events and factors that triggered experiences of moral distress: the unspeakable nature of the death of a child or infant; the seemingly lack of honest and transparent communication with parents; the apparent loss of situational awareness among doctors; the perceived lack of recognition for the role of nurses and the variability in end-of-life decision-making; the length of time it takes doctors to take important treatment decisions; and the resource intensity of an ECMO treatment. The creation of a multidisciplinary moral community with transparent information among all involved health care professionals and the definition of clear treatment goals as well as the implementation of paediatric palliative care for all paediatric ECMO patients should become a priority if we want to alleviate situations of moral distress. The creation of a multidisciplinary moral community, clear treatment goals and the implementation of palliative care for all paediatric ECMO patients are crucial to alleviate situations of moral distress for nurses, and thus to improve provider well-being and the quality of patient care in PICU/NICU.

Potential Drug-Drug Interactions and their Associated Factors at the University Children's Hospital in Syria: A Cross-Sectional Study

Objective: Polypharmacy among pediatric inpatients is common and exposes children to the risk of drug-drug interactions (DDIs). This study aimed to characterize potential DDIs (pDDIs) and their associated risk factors among pediatric inpatients. Methods: A cross-sectional study was conducted over six months at the University Children's Hospital in Damascus. A total of 575 children taking two drugs or more participated. pDDIs were checked using Lexi-Interact® software. pDDIs within risk category B (No action needed), C (Monitor therapy), D (Modify regimen), and X (Avoid combination) were included. Logistic regression was used to identify factors associated with pDDIs. Results: At least one pDDI was detected in 49.7% of children. Overall, 744 pDDIs were identified. The majority of pDDIs were within risk category C (71.6%), followed by D (14%), B (12.8%), and X (1.6%). The most common pDDIs were: aminoglycosides - penicillins (n=56), aminoglycosides - cephalosporins (n=27), and vitamin D analogs - calcium salts (n=23). The number of prescribed drugs and nervous system drugs were significantly associated with the presence of pDDIs. Conclusion: pDDIs among pediatric inpatients were prevalent. The majority of the pDDIs were within risk category C, which necessitates therapy monitoring and necessary action to avoid adverse consequences.

Pneumonia, wheezing and asthma were more common in children after thymectomy due to open-heart surgery.

This nationwide study evaluated the clinical impact that an early thymectomy, during congenital heart defect (CHD) surgery, had on the health of children and adolescents. The subjects were patients aged 1-15 years who had undergone CHD surgery at the University Children's Hospital, Helsinki, where all CHD surgery in Finland is carried out, from 2006 to 2018. The parents or the cases and population-based controls, matched for sex, age and hospital district, completed electronic questionnaires. We excluded those with low birth weights or a known immunodeficiency. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were calculated for prespecified outcomes. We received responses relating to 260/450 (58%) cases and 1403/4500 (31%) controls and excluded 73 cases with persistent cardiac or respiratory complaints after surgery. The CHD group reported more recurrent hospitalisations due to infections (aOR 6.3, 95% CI 3.0-13) than the controls and more pneumonia episodes (aOR 3.5, 95% CI 2.1-5.6), asthma (aOR 2.5, 95% CI 1.5-4.1) and wheezing (aOR 2.1, 95% CI 1.5-2.9). Hospitalisation due to infections, pneumonia, wheezing and asthma was more common in children after a thymectomy due to open-heart surgery than population-based controls, underlining the importance of immunological follow-ups.

Long-term follow-up of 109 children with juvenile idiopathic oligoarthritis after first intra-articular corticosteroid injection

BackgroundTo evaluate long-term outcomes and prognostic factors in patients with juvenile idiopathic arthritis (JIA), presenting as oligoarthritis, who received IAC as the first treatment for their disease.MethodsWe conducted retrospective study at the University Children’s Hospital Ljubljana, Slovenia, from January 2015 to May 2023 in children with JIA, clinically presenting as oligoarthritis receiving intra-articular corticosteroid injection (IAC) as the initial treatment. Patient and treatment data were collected, and the outcomes were categorized into three groups based on the later need for therapy: no therapy needed, only additional IAC needed and systemic therapy needed. The last group was further divided based on the requirement of bDMARD. Log-rank (Mantel-Cox) survival analyses compared different outcome groups.ResultsWe included 109 patients with JIA, presenting as oligoarthritis (63% female), who were first treated with IAC. The mean age at IAC was 8.0 years, with a 4.3-year follow-up. Notably, 38.5% of patients did not require additional therapy post-IAC, whereas 15.5% required only additional IAC. Systemic therapy, mainly methotrexate (MTX), was necessary for 45.9% of patients, initiated in average 7.8 months post-IAC. Biologic therapy was initiated in 22% in average 2.2 years post-IAC. Number of injected joints correlated with the need for biologics. At the last follow-up, 88.9% had inactive disease. ANA positivity (P = 0.049, chi square 3.89) and HLA B27 antigen presence (P = 0.050, chi square 3.85) were associated with the need for systemic therapy. A subgroup of children older than 8 years, ANA and HLA B27 negative required significantly less systemic (25.8%) and biologic therapy (9.6%) compared to other patients (p = 0.050, chi square 3.77).ConclusionAlmost 40% of children with oligoarticular JIA requiring IAC did not progress to chronic disease. Younger age, ANA positivity, and HLA B27 presence were predictive factors for systemic therapy, while the number of injected joints predicted the future need for biologic therapy.

Clinical Characteristics and Appropriateness of Investigations in Children With Headaches at the Emergency Department

BackgroundIdentifying the cause of headaches in pediatric emergency departments (PEDs) can be challenging due to the lack of comprehensive research. This study aims to identify the frequency, characteristics, and unnecessary diagnostic procedures of patients with headaches in the PED setting. MethodsA six-month cross-sectional study was conducted at the PED of Alexandria University Children's Hospital, including all children with headaches. Children were classified as having primary headache (PH), secondary benign headache (SBH), and secondary serious headache (SSH) according to predetermined criteria. Logistic regression was employed to analyze the risk factors associated with SSH. ResultsA total of 164 visits to the PED were recorded, out of a total of 22,662 visits, accounting for approximately 0.72% of all visits and 1.17% of the total number of children admitted. PH was the most common cause, accounting for 61.0% of cases, followed by SSH with 24.4%, whereas SBH was the least common with 13.4%. Abnormal neurological examination (odds ratio, 53.752 [1.628 to 1774.442], P = 0.026∗) was found to have a strong and statistically significant association with SSH in the multivariate analysis. Regarding the appropriateness of the investigations conducted, it was found that over half (66.5%) of the cases had unnecessary neuroimaging, with 52% of these cases being children with PH. ConclusionsHeadaches in children are commonly reported during visits to the PED. PH was the most prevalent, followed by SSH, whereas SBH was the least common. Many of the children received inaccurate first diagnoses and performed unnecessary laboratory tests, neuroimaging, and other tests, mostly electroencephalography.

Resilience strengthening in youth with a chronic medical condition: a randomized controlled feasibility trial of a combined app and coaching program

Youth with a chronic medical condition (CMC) are often affected by comorbid mental disorders. Resilience-strengthening interventions can protect youth’s mental health, yet evidence-based programs remain scarce. To address this lack, this study aimed to evaluate the feasibility of a dual approach combining app-based resilience training and cognitive behavioral group coaching. Fifty-one youths with CMC treated at a German university children’s hospital aged 12–16 years were recruited. They were randomly assigned to a combined app game and coaching intervention or sole app gameplay. At pre-, post-intervention, and at a 2-month follow-up resilience, automatic negative thoughts and an app and coaching evaluation were assessed. Feasibility was defined as a recruitment rate of 70%, an 85% adherence rate for the REThink game, and 70% participation in both coaching sessions. Feasibility criteria were reached for coaching participation but not for recruitment or app adherence. While both the REThink game app and coaching intervention had high acceptance rates among youth with CMC, participants receiving additional coaching sessions showed higher satisfaction and adherence rates. Participants preferred remote to in-person meetings. The findings support a combination of a gamification app approach with online group coaching. Group coaching can improve adherence while online options increase accessibility. Future research should focus on testing in diverse participant samples, language, and age-adapted updates of the REThink game app. These findings provide guidance for increasing adherence in future intervention studies in youth with CMC cohorts.

Evolution of Impaired Renal Function in Children After Continent Vesicostomy

Abstract The aim of this study was to determine whether early commencement of clean intermittent catheterisation can improve impaired kidney function in children with continent vesicostomy as well as to analyse the effect of different types of continent vesicostomy and the observed outcome. All children with continent urinary derivation performed at the University Children’s Hospital in Belgrade, Serbia, during the period 1990-2016, were included in this retrospective-prospective study. The participants were divided into three groups with respect to type of continent vesicostomy (appendicovesicostomy, preputial continent vesicostomy, and vesicostomy using distal ureter). Clean Intermittent Catheterisation with continent vesicostomy, oxybutynin, and antibiotic prophylaxis were used in a standard way. Renal function was monitored by the value of glomerular filtration rate taken before the start of the therapy and three years afterward. The significance of differences was tested by the paired-samples t-test and ANOVA test. We analysed 74 patients aged 3 to 10 years (5.5-y average) of which 80% were boys. Renal function improved in 60.5% patients. A highly significant improvement in kidney function three years after the commencement of combined treatment was shown irrespective of the performed method of vesicostomy (p&lt;0.01). Using the ANOVA test, we have proved that there is no difference in the efficiency of therapy between particular groups (p= 0,256). The timely started therapy lead to significant kidney function improvement. The type of continent vesicostomy did not affect kidney function.

Relationship of bisphenol A substitutes bisphenol F and bisphenol S with adiponectin/leptin ratio among children from the environment and development of children cohort

BackgroundBisphenol A (BPA) is known as an obesogenic endocrine disruptor. Bisphenol S (BPS) and F (BPF) are substitutes that have recently replaced BPA. ObjectivesTo investigate the relationships of urinary bisphenols (BPA, BPS and BPF) with adiposity measurements (obesity, BMI z-score, and fat mass), serum adipokine levels (adiponectin and leptin), and adiponectin/leptin ratio (A/L ratio) in 6- and 8-year-old children. MethodsA total of 561 children who participated in the Environment and Development of Children cohort (482 and 516 children visited at age 6 and 8, respectively) at Seoul National University Children’s Hospital during 2015–2019 were included. Urinary BPA levels were log-transformed. BPS levels were categorized into three groups (non-detected, lower-half, and higher-half of detected), and BPF levels were classified into two groups (non-detected and detected). ResultsThe urinary BPS higher-half group had a higher BMI z-score (β = 0.160, P= 0.044), higher fat mass (β = 0.104, P< 0.001), lower adiponectin concentration (β =- 0.069, P< 0.001), higher leptin concentration (β = 0.360, P< 0.001), and lower A/L ratio (β =- 0.428, P< 0.001) compared with the non-detected group. The urinary BPF-detected group had a higher fat mass (β = 0.074, P< 0.001), lower adiponectin concentration (β =- 0.069, P< 0.001), higher leptin concentration (β = 0.360, P< 0.001), and lower A/L ratio (β =- 0.428, P< 0.001) compared with the non-detected group. The BPA levels showed no consistent associations with outcomes, except for isolated associations of BPA at age 6 with a higher BMI z-score at age 6 (P= 0.016) and leptin at age 8 (P= 0.021). ConclusionsIncreased exposure to BPS and BPF is associated with higher fat mass and leptin concentration, lower serum adiponectin, and lower A/L ratio in children. These findings suggest potential adverse effects of BPA substitutes on adiposity and adipokines. No consistent association of BPA exposure with outcomes could be partly explained by the decreasing BPA levels over time.

Longitudinal Resilience and Risk Factors in Pediatric Postoperative Pain (LORRIS): Protocol for a Prospective Longitudinal Swiss University Children’s Hospitals-Based Study

IntroductionChronic postsurgical pain (CPSP) is defined as pain that persists after a surgical procedure and has a significant impact on quality of life. Previous studies show the importance of psychological...

Active versus restrictive ligation strategy for patent ductus arteriosus – A retrospective two-center study of extremely preterm infants born between 22 + 0 and 25 + 6 weeks of gestational age

BackgroundPatent ductus arteriosus (PDA) in premature infants is associated with adverse clinical outcomes. Mode and timing of treatment are still controversial. Data are limited in the most extremely premature infants <26 weeks of gestational age (GA), where clinical problems are most significant and patients are most vulnerable. AimsTo investigate whether different approaches to surgical closure of PDA in two large Swedish centers has an impact on clinical outcomes including mortality in extremely preterm infants born <26 weeks GA. Study designRetrospective, two-center, cohort study. SubjectsInfants born at 22+0–25+6 weeks GA between 2010 and 2016 at Uppsala University Children's Hospital (UUCH; n = 228) and Queen Silvia Children's Hospital Gothenburg (QSCHG; n = 220). Main outcome measuresSurvival, bronchopulmonary dysplasia (BPD), and retinopathy of prematurity (ROP). ResultsSurgical closure of PDA was more common and performed earlier at QSCHG (50 % vs 16 %; median age 11 vs 44 days; p < 0.01). Survival was similar in both centres. There was a higher incidence of severe BPD and longer duration of mechanical ventilation at UUCH (p < 0.01). There was a higher incidence of ROP, IVH and sepsis at QSCH (p < 0.05, p < 0.01 and p < 0.01). A sub-group analysis matching all surgically treated infants at QSCHG with infants at UUCH with the same GA showed similar results as the total cohort. ConclusionEarlier and higher rate of surgical PDA closure in this cohort of extremely preterms born <26 weeks GA did not impact mortality but was associated with lower rates of severe BPD and higher rates of severe ROP.

Limb lengthening and deformity correction in patients with severe fibular hemimelia: experience of the children's university hospital in Belgrade

Background Fibular hemimelia (FH) is a congenital disease manifested by valgus deformity and instability of the knee joint, shortening and deformity of the tibia, hypoplasia and deformities of the foot and ankle.The aim of this paper was to determine the efficacy of the strategy of separate reconstruction of the foot along with correction of tibia deformity, and then tibial lengthening in patients with FH of types 3 and 4 according to Paley.Methods This retrospective study is based on an analysis of the treatment of 12 children with severe FH. The patients, aged no older than 24 months, were treated for foot reconstruction along with correction of tibial deformity followed by a separate stage of tibial lengthening. Tibial lengthening was performed in the age 4.6 ± 1.2 years. The long-term result of treatment was evaluated at least 1 year after the end of tibial lengthening. Evaluation criteria after tibia lengthening were external osteosynthesis index, amount of lengthening, assessment of outcomes according to Lascombes. Walking ability was assessed using Gillette questionnaire.Results The approach we used gave excellent and good results in 83 % of cases after the first reconstructive stage. Complications and recurrences of deformities encountered during the first stage were eliminated during subsequent planned limb lengthening. The average magnitude of lengthening was 6.4 ± 2.4 cm (37.2 ± 12.4 % of the initial segment length). The index of external osteosynthesis was 22.9 ± 12.2 days/cm. Monofocal distraction osteosynthesis was used in 9 cases and bifocal osteosynthesis in three cases. The results of lengthening were classified by Lascombes as IA in 7 cases, IB in four cases, 2B in one case.Discussion In severe FH, the question of reconstruction or early amputation remains open. There are two opinions on the staging of reconstructive orthopedic surgery and tibial lengthening in young children with severe FH.Conclusion The strategy of reconstruction of the foot and ankle joint at an early age (16-24 months) in children with severe FH followed by lengthening of the lower leg (at the age of 4-6 years) proved to be effective and can be used when it is chosen by the patient's parents. In 3C type cases, the use of external fixation to correct the deformity and simultaneously lengthen the tibia at the first stage is an alternative reasonable strategy option.

Pediatric diabetes prediction using deep learning

This study proposed a novel technique for early diabetes prediction with high accuracy. Recently, Deep Learning (DL) has been proven to be expeditious in the diagnosis of diabetes. The supported model is constructed by implementing ten hidden layers and a multitude of epochs using the Deep Neural Network (DNN)-based multi-layer perceptron (MLP) algorithm. We proceeded to meticulously fine-tune the hyperparameters within the fully automated DL architecture to optimize data preprocessing, prediction, and classification using a novel dataset of Mansoura University Children's Hospital Diabetes (MUCHD), which allowed for a comprehensive evaluation of the system’s performance. The system was validated and tested using a sample of 548 patients, each with 18 significant features. Various validation metrics were employed to ensure the reliability of the results using cross-validation approaches with various statistical measures of accuracy, F-score, precision, sensitivity, specificity, and Dice similarity coefficient. The high performance of the proposed system can help clinicians accurately diagnose diabetes, with a remarkable accuracy rate of 99.8%. According to our analysis, implementing this method results in a noteworthy increase of 0.39% in the overall system performance compared to the current state-of-the-art methods. Therefore, we recommend using this method to predict diabetes.

Stress Markers, Executive Functioning, and Resilience Among Early Adolescents With Complex Congenital Heart Disease

Infants with complex congenital heart disease (cCHD) may experience prolonged and severe stress when undergoing open heart surgery. However, little is known about long-term stress and its role in neurodevelopmental impairments in this population. To investigate potential differences between early adolescents aged 10 to 15 years with cCHD and healthy controls in physiological stress markers by hair analysis, executive function (EF) performance, and resilience. This single-center, population-based case-control study was conducted at the University Children's Hospital Zurich, Switzerland. Patients with different types of cCHD who underwent cardiopulmonary bypass surgery during the first year of life and who did not have a genetic disorder were included in a prospective cohort study between 2004 and 2012. A total of 178 patients were eligible for assessment at ages 10 to 15 years. A control group of healthy term-born individuals was cross-sectionally recruited. Data assessment was between 2019 and 2021. Statistical analysis was performed from January to April 2023. Patients with cCHD who underwent infant open heart surgery. Physiological stress markers were quantified by summing cortisol and cortisone concentrations measured with liquid chromatography with tandem mass spectrometry in a 3-centimeter hair strand. EFs were assessed with a neuropsychological test battery to produce an age-adjusted EF summary score. Resilience was assessed with a standardized self-report questionnaire. The study included 100 patients with cCHD and 104 controls between 10 and 15 years of age (mean [SD] age, 13.3 [1.3] years); 110 (53.9%) were male and 94 (46.1%) were female. When adjusting for age, sex, and parental education, patients had significantly higher sums of hair cortisol and cortisone concentrations (β, 0.28 [95% CI, 0.12 to 0.43]; P < .001) and lower EF scores (β, -0.36 [95% CI, -0.49 to -0.23]; P < .001) than controls. There was no group difference in self-reported resilience (β, -0.04 [95% CI, -0.23 to 0.12]; P = .63). A significant interaction effect between stress markers and EFs was found, indicating a stronger negative association in patients than controls (β, -0.65 [95% CI, -1.15 to -0.15]; P = .01). The contrast effects were not significant in patients (β, -0.21 [95% CI, -0.43 to -0.00]; P = .06) and controls (β, 0.09 [95% CI, -0.11 to 0.30]; P = .38). This case-control study provides evidence for altered physiological stress levels in adolescents with cCHD and an association with poorer EF. These results suggest that future studies are needed to better understand the neurobiological mechanisms and timing of alterations in the stress system and its role in neurodevelopment.

Inpatient Rsv-Management 2016-2022: Epidemiology and Adherence to A Bronchiolitis Treatment Standard at a German University Children's Hospital.

This study analyzes the RSV season 2021/2022 in a referral children's hospital, compares the epidemiology and illness severity with RSV-infected inpatients from 2016 to 2020 and audits the adherence to our internal therapy standard for RSV bronchiolitis. Inpatients with rtPCR-confirmed RSV infection (Jan. 2016 to Jan. 2022). The audit comprises 306 RSV inpatients, on average 50 hospitalizations per year; in 03/2020, a rapid RSV Season-Offset was observed. In the winter season 2020/2021, no patient with RSV was hospitalized. Beginning in July, we noticed a rapid increase of RSV-admissions (most cases in Sept./Oct, duration until Dec. 2021; n=53). In 2021-2022, a significant larger share needed PICU admission (9.4% vs 3.2%, p=0.040). Adherence to the internal guidance was low; only 11.8% (n=36) of all patients received supportive treatment without inhalative or systemic medications, 37% of all patients received antibiotics. This audit confirms the strong impact of public preventive measures directed against SARS-CoV-2 transmission on RSV epidemiology. Few weeks after easing public COVID-19 restrictions (summer 2021), RSV inpatient cases rapidly increased, lasting until Dec. 2021. The audit of bronchiolitis management revealed surprisingly low adherence to the internal guidance, despite a face-to-face educational session with the attending pediatricians in Oct. 2021. Low adherence resulted in an unnecessary exposure of RSV patients to systemic medications of questionable benefit including antibiotics.