Characteristics Of Children Research Articles

Water Competency and Sensory Processing Among Children on the Autism Spectrum.

Globally, drowning is the third leading cause of unintentional injury death, and children on the autism spectrum are at a higher risk of drowning. Several factors affect limited water competency (swim skills and water safety) and engagement in swimming as a meaningful leisure activity. To identify baseline water competency among children on the autism spectrum, examine caregiver goals for swim skill intervention, and examine factors associated with water competency. Cross-sectional analysis of baseline assessment from a larger randomized controlled trial. Franklin County Board of Developmental Disabilities Therapy Pool. Children on the autism spectrum (N = 37; 28 boys, 9 girls), ages 5 to 9 yr, recruited from the local community. Water competency was assessed using the Water Orientation Test-Alyn 1 and 2 (WOTA 1 and 2). Caregivers completed the Canadian Occupational Performance Measure (COPM), the Sensory Profile-2 (SP-2), and a prior aquatic exposure questionnaire. Children on the autism spectrum showed limited water competency skills on the WOTA 1 and 2. A majority of caregivers identified safety in and around water as a goal for their child, using the COPM. Higher conduct processing and low registration scores on the SP-2 significantly correlated with lower water competency. Exposure to group lessons significantly correlated with better water competency. Children on the autism spectrum demonstrated limited swim and water safety skills, highlighting the need for programs that teach swim and water safety skills in this population. Plain-Language Summary: This study examined water competency, including swim safety skills, among children on the autism spectrum. The results suggest that these children lacked basic water competency and safety skills. Caregivers of children on the autism spectrum identified water safety in and around bodies of water to be a high-priority goal. A child's sensory characteristics and prior exposure to water activities affect their water competency. Our results highlight the need for programs that teach swim and water safety skills for children on the autism spectrum.

Clinico-Demographic Profile of Children Attending Pediatric Outpatient Department in Tertiary Care Center in Gandaki Province, Nepal: A Prospective, Descriptive Cross-Sectional Study

Introduction: Pediatric outpatient departments (OPDs) in tertiary care centers provide a vital connection for the early diagnosis and treatment of childhood illnesses. Understanding the clinico-demographic profile of pediatric patients attending these centers provides insight into the healthcare needs and challenges faced by children in specific regions. This study aimed to evaluate the clinico-demographic characteristics of children attending the pediatric OPD.  Methods: A prospective, descriptive cross-sectional study was conducted from April 12 to December 17, 2023 at pediatric OPD at GP Koirala National Centre for Respiratory Diseases and Hospital, Tanahun, Gandaki Province, Nepal. Data were collected from the pediatric OPD during clinical history taking and examination, including 7,020 children aged 0–14 years. Verbal consent was obtained from legal guardians for using clinical history and diagnostic data. Data on age, sex, socioeconomic status, parental education, and disease distribution were analyzed using SPSS version 23.  Results: Out of 7,020 children, 42.89% were aged 1–5 years, and 28.67% were aged 6–10 years. Males (50.7%) slightly outnumbered females (49.3%). Socioeconomic analysis showed that 57.3% of children were from low-income families. Regarding parental(either father or mother or any legal gurdian who brought child at hospital OPD) education, 31.19% had secondary education, and 28.3% had primary education. Respiratory infections (19.97%) were the most common diagnosis, followed by gastroenteritis (11%), pain abdomen (9%), and malnutrition, especially undernutrition (8%). Other notable conditions included enteric fever (7.4%) and acute conjunctivitis (7.3%).  Conclusion: The study highlights a high prevalence of respiratory and gastrointestinal conditions among children, particularly from low-income families. The findings emphasize the need for targeted healthcare interventions and improved parental education to reduce the burden of childhood illnesses in Gandaki Province.

Prognostic factors in children with acute T-lymphoblastic leukemia: a single-center clinical study of the CCCG-ALL-2015 protocol

To explore the clinical characteristics of children with acute T-lymphoblastic leukemia (T-ALL) and analyze their relationship with prognosis. A retrospective analysis was conducted on the clinical data and follow-up results of 50 children with T-ALL who were treated using the CCCG-ALL-2015 protocol at the Department of Hematology and Oncology, Children's Hospital of Nanjing Medical University from November 2015 to December 2019. Kaplan-Meier survival analysis and Cox regression analysis were employed to identify factors affecting prognosis. Among the 50 T-ALL patients, there were 7 cases of relapse. There was no statistically significant difference in the baseline clinical data between the relapse group and the non-relapse group (P>0.05). However, the positive rate of minimal residual disease (MRD) (≥0.01%) on day 46 after induction remission therapy in the relapse group was significantly higher than that in the non-relapse group (P=0.037). The 5-year overall survival rate for the 50 patients was (87±5)%, and the 5-year event-free survival rate was (86±5)%. Multivariate Cox regression analysis indicated that the MRD level on day 46 after induction remission therapy was an independent prognostic factor (HR=0.104, 95%CI: 0.015-0.740, P=0.024). MRD is of significant importance for the prognosis of T-ALL children. Personalized treatment should be provided based on MRD levels to prevent relapse and improve prognosis in these patients.

From Early Behavioral Intervention to School: A Systematic Evaluation of Parents' Perspectives on the Quality of the Autism Services During the Transition to Kindergarten.

Research emphasizes the importance of seamless transitions from Early Behavioral Intervention (EBI) to school-based services, but formal support during this critical period remains limited, leading to decreased parental satisfaction with autism services. This study aimed to systematically document parents' perception of the quality of services received during the transition from EBI to kindergarten, along with the predictors of this perception. The study adopted a prospective longitudinal design and relied on a validated evaluation framework, the Evaluation of the Trajectory in Autism for Parents (ETAP). ETAP allows to investigate five critical determinants (accessibility, continuity, validity, flexibility, empathy) of service quality, as rated by parents (N = 138 families), which were evaluated at three critical periods of the transition: end of EBI, beginning and end of first year of school. Quality ratings indicated generally positive perceptions but showed small to medium effect size decreases over time; validity had the largest decrease. Predictors of quality ratings and changes in ratings differed by phase of the transition and included child characteristics (gender, age, disabilities, challenging behavior), parent characteristics (maternal origin, fluency in the official language of the province, education level), and family characteristics (number of children). This study's comprehensive analysis of service quality determinants and possible risk and protective factors provides insights into improving support for families navigating the transition to school.Keywords: Autism, Early behavioral intervention, School transition, Parental perception, Service quality, Evaluation framework.

The relationship between uropathogens and clinical characteristics of children with urinary tract infection

Urinary tract infections (UTI) are common bacterial infections in children. This study aimed to examine the relationships between different microorganisms and both clinical and laboratory findings in pediatric patients with UTIs. We conducted a retrospective evaluation of children with UTI between 2019 and 2024. Patients were divided into four main groups as normal anatomy, vesicoureteral reflux (VUR), ureteropelvic junction obstruction (UPJO), and neurogenic bladder (NB). Information on clean intermittent catheterization (CIC) and prophylactic antibiotic use was recorded. Laboratory results were compared across these patient groups. The study included 266 patients, with a female predominance (female/male ratio: 7.33). NB was the most common urinary tract condition (43.3%), followed by VUR (10.9%) and UPJO (9%). Prophylactic antibiotics were used by 9% of the patients. Acute phase reactants in patients with CIC were significantly higher (p=0.023 for white blood cell (WBC) and p=0.002 for C-reactive protein (CRP) levels). They were also higher in patients with prophylactic antibiotics compared to those without (p=0.001 for both). The most frequently detected bacteria in urine cultures were E. coli (65%), followed by Klebsiella spp. (18.8%), Pseudomonas spp. (7.5%), and Proteus spp. (4.9%). Klebsiella spp., Enterococcus spp., and Morganella spp. were not isolated from patients receiving prophylaxis (p=0.022). Risk factors for UTIs need to be carefully assessed for every patient, and treatment should be customized according to clinical and laboratory results. Individual patient factors should guide drug selection, and treatment plans should account for potential resistance patterns.

Emotion-specific recognition biases and how they relate to emotion-specific recognition accuracy, family and child demographic factors, and social behaviour

ABSTRACT The errors young children make when recognising others’ emotions may be systematic over-identification biases and may partially explain the challenges some have socially. These biases and associations may be differential by emotion. In a sample of 871 ethnically and racially diverse preschool-aged children (i.e. 33–68 months; 49% Hispanic/Latine, 52% Children of Colour), emotion recognition was assessed, and scores for accuracy and bias were calculated by emotion (i.e. anger, sad, happy, calm, and fear). Child and family characteristics and teacher-reported social behaviour were also collected. Multilevel structural equation modelling revealed emotion-specific recognition accuracies varied between 36 and 65% whereas biases varied between 4 and 13%. Anger was the strongest bias followed by sad, happy, fear, and calm, in contrast to the pattern for accuracy – happy, sad, angry, fear, and calm. More variance was explained in emotion-specific recognition accuracies by child and family characteristics – 7–38% – than biases – 3–7%. Negatively-valanced emotion recognition biases associated with positively-valanced accuracies, and positively-valued emotion recognition biases associated with negatively-valued accuracies. Biases did not have meaningful associations with social behaviour. This study highlights that children’s emotion recognition errors may partially be systematic, but future studies are needed to understand the underlying cognitive mechanisms.

Characteristics and outcomes of children 2-23 months of age with prolonged diarrhoea: A secondary analysis of data from the 'Antibiotics for Children with Diarrhea' trial.

Approximately 12% of all diarrhoeal episodes last for 7-13 days. As such, they are termed prolonged diarrhoea, and are associated with over two-thirds of all diarrhoeal deaths. Due to a lack of robust data, we aimed to evaluate a comparative background characteristics of young children with acute and prolonged diarrhoea, and their outcomes at day 90 follow-up. We performed a secondary analysis of data from the Antibiotics for Children with Diarrhea (ABCD) trial. Children aged 2-23 months were enrolled between July 2017 and July 2019 from seven Asian and sub-Saharan African countries. For this analysis, we divide diarrhoea into two categories: acute diarrhoea (duration <7 days) and prolonged diarrhoea (duration ≥7-13 days). We used logistic regression to observe baseline crude and adjusted associations and linear regression to compare post-discharge outcomes. We analysed data on 8266 children, of whom 756 (9%) had prolonged diarrhoea and 7510 (91%) had acute diarrhoea. Pakistan had the highest proportion of children with prolonged diarrhoea (n/N = 178/1132, 16%), while Tanzania had the lowest (n/N = 12/1200, 1%). From an analysis that adjusted for sex, breastfeeding, nutritional status, clinical presentation, housing, water supply, sanitation, and country, we observed that presentation at a health facility with prolonged diarrhoea was associated with low age (2-12 months) (adjusted odds ratio (aOR) = 1.25; 95% confidence interval (CI) = 1.02, 1.53; P = 0.028), presence of three or more under-five children in the family (aOR = 1.54; 95% CI = 1.26, 1.87; P < 0.001), maternal illiteracy (aOR = 1.45; 95% CI = 1.21, 1.74, P < 0.001), moderate underweight (aOR = 1.25; 95% CI = 1.01, 1.55; P = 0.042) and pathogen (Campylobacter) (aOR = 1.27; 95% CI = 1.12, 1.44; P < 0.001). At day 90 follow-up, children with prolonged diarrhoea had significantly lower weight-for-age z-score compared to children with acute diarrhoea (-1.62, standard deviation (SD) = 1.11 vs -1.52, SD = 1.20; P = 0.032), as well as significantly higher frequency of hospital admission (6.1% vs 4.5%; P = 0.042). Prolonged diarrhoea was more common in children of younger age, those who were moderately underweight, those with Campylobacter in stool, those with three or more under-five children in a family, and those with illiterate mothers compared to those who had acute diarrhoea. Children with prolonged diarrhoea more often required hospitalisation during the three-month follow-up period compared to their counterparts.

Predictors of Methicillin-resistant Staphylococcus aureus infection in children with acute osteomyelitis

BackgroundThis study aims to identify risk factors associated with Methicillin-resistant Staphylococcus aureus (MRSA) infection in children diagnosed with acute osteomyelitis (AO) and to elucidate the laboratory characteristics of these MRSA-infected children to enhance early targeted therapeutic interventions.MethodsWe conducted a retrospective analysis involving 123 children with acute osteomyelitis treated at our hospital. Upon admission, we measured white blood cell (WBC) counts, C-reactive protein (CRP) levels, erythrocyte sedimentation rates (ESR), and platelet counts. Patients were categorized into two groups: the non-MRSA group (n = 73) and the MRSA group (n = 50), with values assigned as follows (non-MRSA group = 0, MRSA group = 1).ResultsThe MRSA group had a significantly higher average age compared to the non-MRSA group (P < 0.05). Notably, the incidence of suppurative arthritis was significantly lower in the MRSA group (P < 0.05). At the time of admission, CRP levels in the MRSA group were markedly elevated compared to those in the non-MRSA group (P < 0.01). After three days of empirical therapy, both WBC and CRP levels remained significantly higher in the MRSA group compared to the non-MRSA group (P < 0.05).ConclusionsIn children newly admitted with acute osteomyelitis, a CRP level exceeding 73.23 µg/mL may indicate a high likelihood of MRSA infection. For children with AO who have been hospitalized for three days on empirical therapy, the presence of WBC > 10.95 × 10^9/L, CRP > 49.56 µg/mL, age > 3.5 years, and the absence of suppurative arthritis suggests a heightened risk of MRSA infection.

Origins and developmental paths of medical conditions from mid-childhood to mid-adolescence in Australia: Early-life adverse conditions and their lasting effects

This study investigates various common medical conditions affecting Australian children aged 4–14 years and the impact of prenatal and early-life conditions on these health conditions using a large national data set (n = 4122) with 15 years of follow-up. Consistent with the developmental origins of health and diseases hypothesis and the life-course models of health, the in-utero environment and parental financial hardship during pregnancy and shortly after birth play a significant role and have a lasting impact on the medical conditions of children. These significant effects are not reduced by controlling for child, family, and neighbourhood characteristics. The impact of improvements in family income when the child is aged 4–14 years does not compensate for the impact of health disadvantages in the prenatal and postnatal period.

Опыт применения шкал развития MPR в диагностике детей раннего возраста с риском РАС

&lt;p style="text-align: justify;"&gt;&lt;strong&gt;Objectives. &lt;/strong&gt;Early diagnosis of children with Autism Spectrum Disorder (ASD) allows parents to assess the validity of their concerns, develop individual support programs, and begin working with the child as early as possible, which will lead to greater success in educational support. To achieve these goals, a comprehensive assessment is needed, including the use of standardized tools for assessing the level of current development and identifying special characteristics of children&amp;rsquo;s functioning. In order to determine the level of development, the possibilities of using the Merril-Palmer Revised (MPR) Development Scales in assessment of children with ASD were studied.&lt;/p&gt; &lt;p style="text-align: justify;"&gt;&lt;strong&gt;Methods.&amp;nbsp;&lt;/strong&gt;The pilot study involved eight children (5 toddlers and 3 preschoolers; 6 males, 2 females; Mage=2.8, SD=0.8). Children were divided into &amp;ldquo;risk of ASD&amp;rdquo; and &amp;ldquo;autism&amp;rdquo; diagnostic groups according to their ADOS-2 results. All participants were also tested using the MPR. Statistical analysis was conducted in IBM SPSS Statistics 23, using descriptive statistics, correlation analysis with Pearson and Spearman criteria.&lt;/p&gt; &lt;p style="text-align: justify;"&gt;&lt;strong&gt;Results.&amp;nbsp;&lt;/strong&gt;According to the data obtained, the development index of all children is below the age norm (M=52, SD=26), ranging from &amp;ldquo;significant developmental delay&amp;rdquo; to &amp;ldquo;below average developmental level&amp;rdquo; and does not depend on the severity of autistic symptoms. It was found that scores in the cognitive sphere correlate positively with scores obtained in fine motor skills (r=0,93, p=0,01); visual-motor coordination (r=0,95, p=0,01); speech comprehension (r=0,87, p=0,01). The results on the scale assessing protest behavior during the examination cor relate negatively with the level of development of the socio-emotional sphere (r=&amp;ndash;0,75, p=0,05) and self-care skills (r=&amp;ndash;0,79, p=0,05).&lt;/p&gt; &lt;p style="text-align: justify;"&gt;&lt;strong&gt;Conclusions.&amp;nbsp;&lt;/strong&gt;Experience using the MPR Scales in evaluation of toddlers and preschoolers with ASD has shown that the tool is informative and allows a comprehensive assessment of developmental indicators in children with this nosology, which suggests its use in developing effective interventions. The limitation of the study is the small sample size, and the results obtained are planned to be verified with a larger number of participants.&lt;/p&gt;

Congenital Diaphragmatic Eventration: Should we Maintain Surgical Treatment? A Retrospective Multicentric Cohort Study

BackgroundThe aims of this study were to describe the characteristics of children with congenital diaphragmatic eventration (CDE) and compare the outcomes of surgical and conservative treatment of pediatric CDE in France. MethodsRetrospective study on cohort data conducted in 22 paediatric surgery departments, including patients less than 16 years of age diagnosed with CDE between 2010 and 2021. Patients with surgical or conservative treatment were compared. Results139 patients were included, with a median age of 8 [1–16] months. CDE occurred in boys in 68.3% and was right-sided in 66.7% of the cases. Indication for treatment depended essentially on respiratory symptoms and level of the diaphragmatic dome. The initial treatment was a surgical, with a diaphragmatic plication, in 87 cases (62%) and conservative, consisting of clinical follow-up in 52 children (38%). Of the latter, 25 children underwent surgery secondarily. Intra- and early post-operative complications occurred in 32 children (29%) and eventration recurrence in 8 children (7%). With a median follow-up of 28 months, the median level of diaphragmatic dome improved from the 6th to the 9th back rib, and the rate of respiratory symptoms decreased from 64% to 14% in the overall cohort of patients. ConclusionsDiaphragmatic plication is effective in symptomatic patients with a dome level above the 6th posterior rib, but is associated with a 29% complication rate and 7% of recurrence. ClinicalTrialsNCT04862494, April 28, 2021. Level of evidencelevel III treatment study.

Специфика усвоения диалоговых навыков дошкольниками с расстройствами аутистического спектра

&lt;p style="text-align: justify;"&gt;&lt;strong&gt;Objectives. &lt;/strong&gt;The variability of disorders in the formation of dialog skills of preschoolers with autism spectrum disorders (ASD) does not always depend on the level of intellectual development. In issues of speech development, it is important to take into account both the specifics of understanding the reversed speech at the level of interrogative statements, and the aspects of structuring and semantics of the answer proposed by the child with ASD himself. In order to study the specifics of mastering the basic conversational skills by children with ASD who have unimpaired intellect, a special pilot study was designed and conducted.&lt;/p&gt; &lt;p style="text-align: justify;"&gt;&lt;strong&gt;Methods.&amp;nbsp;&lt;/strong&gt;The peculiarities of understanding questions of various purposes and structures by students of the age of 5&amp;mdash;7 years (group 1 &amp;mdash; 51 children) with unimpaired intellect and ability of verbal communication were studied. Children of group 1 and preschoolers of group 2 of younger age (from 3 years 10 months to 5 years 2 months, a total of 28 participants) were presented with 48 questions, hierarchically organized based on ontogenetic patterns associated with the formation of cognitive concepts, which are accessible to a typically developing child by a certain age. The results obtained in both groups were compared.&lt;/p&gt; &lt;p style="text-align: justify;"&gt;&lt;strong&gt;Results.&amp;nbsp;&lt;/strong&gt;Only 2.3% of the proposed 3,708 questions remained unanswered, and the number of correct (adequate) answers, depending on age, tended to increase (for example, preschoolers with ASD of 4 years gave 68% correct answers, preschoolers of 5 years &amp;mdash; 73%). The study shows that, in terms of nature and specifics of dialog skills, students with ASD 5-7 years old have no significant differences from the typically developing preschoolers of a younger age group: the number and quality of correct answers from children with ASD at the age of 6 years is comparable with the number of correct answers from typically developing preschoolers of 4 years old.&lt;/p&gt; &lt;p style="text-align: justify;"&gt;&lt;strong&gt;Conclusions.&amp;nbsp;&lt;/strong&gt;In the process of forming dialog skills in the structure of developmental education for children with ASD, the teacher should rely solely on the traditional spontaneous question-and-answer method, they should also consider the semantics and pragmatics of the proposed lexical material. The data obtained will be useful for special education teachers in selecting the content for speech development, taking into account the individual typological characteristics of children with ASD.&lt;/p&gt;

Characteristics of children and adolescents with recurrent mental health emergency visits and clinicians' intervention tendencies.

Mental disorders affect approximately 15%-20% of childhood. However, due to various factors, these individuals do not benefit sufficiently from mental health services. Therefore, psychiatry emergency services become a key system in the need of psychiatric care for these children. This study aims to reveal the factors that predict recurrent admissions in children and adolescents admitted to the emergency department of a psychiatric hospital and the tendencies of clinicians during management. In our study, the data of patients aged 0-18 years who applied to the emergency department between 1 March 2022 and 01 March 2023 were scanned retrospectively. Participants who applied once were included in the 'single applicant' group, whereas patients who applied two or more times were included in the 'repeated applicants' group. A total of 1563 emergency applications were recorded by 785 different patients. A total of 62.2% of the patients visited the emergency department once, while 37.8% applied two or more times. Non-suicidal self-injury, delusion/hallucination, irritability and depression were significantly higher in recurrent applicants (P < 0.05). Psychotic disorder, bipolar disorder, major depression and borderline personality traits were significantly frequent in these patients (P < 0.05). Additionally, it was determined that the number of psychiatric diagnoses, referral time, need for chemical restraint, having a diagnosis of psychotic disorder or borderline personality traits increased the likelihood of recurrence. Our results indicate some special risk factors that increase the likelihood of recurrent emergency admissions in children and adolescents. Further research with larger sample sizes may elucidate the unique needs of these children in order to use of community resources beneficially.

Early Childhood Concussion.

The unconsolidated motor and cognitive skills that are typical of the early childhood period place infants, toddlers, and preschoolers at risk for a variety of traumatic injuries. Such injuries may include mild traumatic brain injury or concussion. Knowledge regarding the risk, diagnosis, outcomes, and management of early childhood concussion is limited, especially compared with what is known about concussion in school-age children, adolescents, and adults. This state-of-the-art review aims to provide current knowledge on the epidemiology, physical signs, behavior, and clinical outcomes associated with early childhood concussion. Research on this condition has been challenged by the need to adapt methods to the unique physical, behavioral, and developmental characteristics of young children. We provide information on observable symptoms associated with concussion, recommended approaches to care, and suggestions for overcoming barriers to research in this area. Developmentally appropriate efforts are needed to improve our ability to identify, evaluate, and treat early childhood concussion.

Impact of care coordination on service utilisation for children with medically complex cerebral palsy.

Complex care programmes for children with medically complex cerebral palsy (CP) exist; however, evidence for their impact is limited. This study (i) explored the impact of The Royal Children's Hospital Complex Care Hub (CCH) on hospital service utilisation rates over a 3-year period for children with medically complex CP compared with those eligible but received routine care, and (ii) compared health, disability and socio-demographic characteristics of children and their families in both groups. Electronic medical record data from 78 children (mean age 9.43 years, females n = 37) with medically complex CP who accessed CCH services, and 92 (mean age 10.86 years, females, n = 39) who received routine care were included. Multivariable regression was used to analyse service utilisation: number of emergency department (ED) presentations, length/number of inpatient and intensive care unit admissions and number/type of hospital appointments. Critical health-care needs, functioning/disability profile and child/family demographics for each group were compared. More children in the CCH group had a mixed motor type (73.1% vs. 15.2%), were classified within Gross Motor Function Classification System level V (76.9% vs. 34.8%), had respiratory, nutrition and social support needs and epilepsy. Children receiving CCH services had higher service utilisation rates; ED presentations (rate ratio (RR) = 1.81, 95% confidence interval (CI): 1.09-3.01), inpatient admissions (RR = 2.77, 95% CI: 2.01-3.83), outpatient encounters (RR = 1.69, 95% CI: 1.31-2.18) and telephone encounters (RR = 6.05, 95% CI: 4.56-8.02). Children with medically complex CP accessing a complex care service have higher service utilisation rates yet have more complex clinical presentations and higher support needs.

REPRESENTATIONS OF PRESCHOOL TEACHERS ON CHILDREN'S GENDER AS A FACTOR IN DIFFERENTIATING THEIR FREE PLAY IN THE SCHOOLYARD

Gendered subjectivities are shaped within social structures, such as education, where gender inequalities intersect with other forms of social disparity. The individuals who operate within these structures play a role in both reproducing and maintaining ine-qualities, as well as in actively challenging them. However, as active agents, they can challenge gender order and inequalities, but their capacity to do so is subject to the constraints imposed by the framework in which they operate. The interaction between teachers and children in the schoolyard is a given, with the schoolyard serving as a space of socialization and interaction, thus becoming a field for the formation and nego-tiation of children's subjectivities. Teachers, through their presence in the schoolyard and their representations of children's gender characteristics, are expected to influence the formation of gendered subjectivities. The representations of preschool teachers re-garding children's gender as a factor in differentiating their free play in the schoolyard were the subject of this qualitative study, conducted through interviews. Twelve kin-dergarten teachers working in public and private schools in the Thessaloniki area par-ticipated. The thematic analysis of the data revealed that while the sample of teachers expressed opposition to gender segregation and inequalities, they adopted a neutral stance toward what occurs in the schoolyard. Moreover, many justified the differences they observed in boys' and girls' play in biological terms, among other reasons.&lt;p&gt; &lt;/p&gt;&lt;p&gt;&lt;strong&gt; Article visualizations:&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;img src="/-counters-/soc/0773/a.php" alt="Hit counter" /&gt;&lt;/p&gt;

Infertility treatment and offspring blood pressure-a systematic review and meta-analysis.

Studies have inconsistently observed that children conceived by IVF or ICSI have higher blood pressure compared to children not conceived by these ARTs. The aim was to perform a systematic review and meta-analysis of blood pressure measures of offspring conceived by ART and those conceived naturally. Resolving the suspicion of ART as a risk factor of higher blood pressure, and therefore of heart disease, has public health and clinical implications. A biomedical librarian searched the Embase, PubMed, and Web of Science databases. Searches were limited to records published in English since 1978. Grey literature was searched. Inclusion criteria were humans born via infertility treatment (vs no treatment) who underwent a blood pressure assessment. Exclusion criteria were non-human participants, non-quantitative studies, absence of a control group, and specialty populations (e.g. cancer patients only). Two reviewers independently screened each record's title and abstract and full text using Covidence, extracted data using Excel, and assessed bias using the National Heart, Lung, and Blood Institute's Quality Assessment Tool for cohort studies. Of 5082 records identified, 79 were included in the systematic review and 36 were included in the meta-analysis of systolic blood pressure (SBP) and diastolic blood pressure (DBP) in ART and non-ART groups. Overall, 34 reports including 40 effect sizes from 25 unique cohorts, compared blood pressure between ART (N = 5229) and non-ART (N = 8509, reference) groups with no covariate adjustment. No standardized mean differences (SMD) in SBP (0.06 per SD of mmHg, 95% CI = -0.05, 0.18) or DBP (0.11, 95% CI = -0.04, 0.25) by treatment were found, but the heterogeneity was considerable (I2=76% for SBP and 87% for DBP). Adjusted analyses were presented in 12 reports, representing 28 effect sizes from 21 unique cohorts (N = 2242 treatment vs N = 37590 non-treatment). Studies adjusted for varied covariates including maternal (e.g. age, education, body mass index, smoking, pregnancy complications), child (e.g. sex, age, physical activity, BMI, height), and birth characteristics (e.g. birth weight and gestational age). Adjusted results similarly showed no SMD for SBP (-0.03, 95% CI = -0.13, 0.08) or DBP (0.02, 95% CI = -0.12, 0.16), though heterogeneity remained high (I2 = 64% and 86%). Funnel plots indicated a slight publication bias, but the trim and fill approach suggested no missing studies. Removal of five studies which adjusted for birth outcomes (potentially over-adjusting for mediators) made no material difference. Type of treatment (e.g. IVF vs ICSI), period effects by birth year (≤2000 vs >2000), offspring age group (<8, 8-14, 15+), or study location (e.g. Europe) did not modify the results. In conclusion, conception by ART was not associated with offspring blood pressure in a meta-analysis, although considerable heterogeneity was observed. Given the increasing number of children born using ART, perpetuating a difference in blood pressure would mean unnecessary risk screening for many children/adults on a population level. At a clinical level, couples considering these reproductive technologies have some reassurance that there is no evidence of strong vascular 'programming' due to the techniques used. PROSPERO No. CRD42022374232.

Exploring risk factors for undernutrition in children aged under five years in Yemen.

Undernutrition is a global health concern, particularly in low-income countries, and can manifest as wasting, stunting and/or underweight. In Yemen, the recent armed conflict is likely to have significantly increased the incidence of undernutrition in young children, particularly those living in communities that were already experiencing socioeconomic and health disparities. To explore the risk factors associated with wasting, stunting and underweight in children aged between six months and five years living in one district of Yemen. A cross-sectional study was conducted using a two-part questionnaire to collect anthropometric measurements and sociodemographic characteristics of children enrolled on an outpatient programme for undernourished children at three healthcare facilities in the Jiblah district, and of their families and households. Of the 120 children included in the study, 58 (48%) had wasting, 27 (23%) had stunting and 35 (29%) were underweight. Risk factors for undernutrition included being under the age of three years, being a girl, having had a low birthweight, having siblings under the age of five years, having a mother who is a housewife, living in a household relying on unimproved sources of drinking water, living in a rural area, and living in a low-income household. The nutritional status of children in Yemen is under continuing threat. The identification of risk factors for undernutrition may increase awareness of the issue and influence the policy decisions of the international community.

Beta-Lactam Antibiotic Exposure During Pediatric Extracorporeal Membrane Oxygenation: Retrospective Cohort Analysis of Drug Levels Using Standard Dosing, 2018–2020

Objectives: Children on extracorporeal membrane oxygenation (ECMO) are at high risk of infection that may worsen prognosis. Even though treatment with beta-lactam antibiotics is frequent, dosing is not adapted to altered pharmacokinetic and pharmacodynamic characteristics of children on ECMO. There is, therefore, a risk of inadequate drug levels when using standard dosing. In this study, we aimed to describe beta-lactam exposures of children on ECMO using current dosing and to identify factors associated with inadequate exposure. The optimal pharmacokinetic/pharmacodynamic target was considered as a plasma concentration four times above the minimum inhibitory concentration throughout the dosing interval target. Design: Two-center retrospective cohort study. Setting: Two PICUs in Paris, France. Patients: Children (from birth to 18 yr) undergoing venovenous or venoarterial ECMO, from 2018 to 2020. Interventions: None. Measurements and Main Results: There were 57 patients who received 11 different beta-lactams, with 226 plasma concentrations analyzed. A total of 32 infections were documented. Overall, 133 of 226 concentrations (58.8%) were insufficient, primarily in samples from children younger than 28 days (p = 0.035), with low body weight (p = 0.013), or in instances of hypoalbuminemia (p = 0.011) and increased renal clearance (p = 0.032). Supratherapeutic concentrations were observed in 25 of 226 samples (11.1%), associated with being taken from patients with renal impairment (p &lt; 0.01). Conclusions: In this retrospective cohort of pediatric ECMO cases, there is an associated risk of underexposure when prescribing conventional dosing of beta-lactams, which are likely associated with renal impairment and fluid overload. Prospective testing of therapeutic drug monitoring combined with pharmacokinetic/pharmacodynamic models should be tested as a risk-reduction strategy in this vulnerable population.

6394 Prevalence of Diabetes Insipidus in Pediatric Patients Who Have Been Declared Dead by Neurologic Criteria

Abstract Disclosure: C.E. Larancuent: None. V. Merilan: None. M. Leoncio: None. J.M. Lozano: None. B.R. Totapally: None. Introduction: Death by neurological criteria (DNC) or brain death (BD), occurs in individuals who have sustained catastrophic brain injury and are in permanent coma with loss of all brainstem function, coupled with the inability to breathe in the setting of hypercarbia and acidosis. Diabetes insipidus (DI) occurs in many but not all patients with DNC. Several studies indicate varying prevalence rates of DI among pediatric patients with DNC. Objective: Our objective was to determine the prevalence of DI in children who have been declared DNC, and the frequency of DI in these children according to the mechanism of brain injury. Methods: A retrospective analysis of 57 pediatric inpatients 0-21 years subsequently declared BD at Nicklaus Children’s Hospital from January 2013 to June 2023. Data was gathered from the hospital's electronic medical records and the VPS database. The primary exposure is brain death, while the secondary exposure is the mechanism of brain injury. These injuries were categorized into anoxic, traumatic brain injury (TBI), and brain tumors/space-occupying lesions (malignancy). The prevalence of DI was assessed as the primary outcome, and it was compared between three etiologies for brain death using Pearson Chi-square. Due to the study's small sample size, the association between the cause of BD and DI was not adjusted by covariates, such as sex and age. This study was exempted by the IRB. Results: Of the 53 patients declared BD, 47 (88.7%, 95% CI 77.9% to 95.3%) were diagnosed with DI. The prevalence of DI did not change significantly according to the etiology of brain injury leading to BD (84.4%, 100.0%, and 92.3% for anoxic brain injury, TBI, and malignancy, respectively; p = 0.410). The characteristics of children according to the etiology of brain death are presented in Table 1. The characteristics of children according to the development of DI are presented in Table 2. ICU length of stay, the duration to brain death declaration, and eligibility for organ donation varied with the etiology of brain death (Table 1). Conclusions: The prevalence of DI is high in pediatric patients declared BD, and it is not significantly different based on the etiology of brain death. Given this high prevalence, diligent DI management is needed to improve organ donation outcomes. Presentation: 6/2/2024