Child Hospital Research Articles

Prevalence of Bottle‐Feeding Practice and Associated Factors Among Mothers of Children Under Five in the World, 2024: Systematic Review and Meta‐Analysis

ABSTRACTBackgroundChild‐feeding practices, particularly breastfeeding, significantly impact children's health and survival. However, bottle feeding, although historically practiced, presents numerous disadvantages affecting optimal child nutrition and health. Despite World Health Organisation and The United Nations Children's Fund recommendations against bottle feeding, it remains prevalent globally, affecting roughly 59% of infants worldwide and 85% in Australia by 5 months of age.ObjectiveThis study aims to assess the prevalence and determinants of bottle feeding among mothers of children under five globally.MethodsThis systematic review and meta‐analysis adhered to the Preferred Reporting Items for Systematic Review and Meta‐Analysis guidelines. We comprehensively searched electronic databases for English‐language articles published between 2014 and 2024. The quality of studies was assessed using the Joanna Briggs Institute critical appraisal checklist. Data were analysed in STATA version 17, including summary tables, narrative descriptions, forest plots, and statistical heterogeneity and publication bias assessment.ResultsThe pooled prevalence of bottle feeding among mothers was 57%. Subgroup analysis revealed higher prevalence in larger sample sizes (> 2151) and lower prevalence in smaller ones. Factors significantly associated with bottle feeding included mode of delivery (OR = 1.953; 95%, CI: 1.272, 2.635), child hospitalisation (OR = 1.984, CI: 1.593, 2.376), mother's occupation (OR = 1.579; CI: 1.467, 1.690), post‐natal care (OR = 2.965; CI: (1.358, 4.571), age of children (OR = 2.836; CI: 1.895, 3.777), place of residence (OR = 1.423; CI: 0.994, 1.852), and mother's education (OR = 3.366, CI: 1.949, 4.783).ConclusionEfforts to promote optimal child‐feeding practices should address the identified determinants, emphasising the importance of breastfeeding and providing support to mothers, especially those facing challenges such as cesarean delivery, child hospitalisation, and maternal employment.

Child-Centered Care: A Qualitative Study Exploring Pediatric Hospitalization Through Children's Perspectives.

Background/Objectives: Hospitalization can be stressful for children due to the influence of unfamiliar environments, separation from family, and interactions with healthcare professionals. This study aimed to explore children's hospitalization experiences from a child-centered care perspective to develop interventions that better meet their emotional and psychological needs. Methods: This qualitative study employed Husserl's descriptive phenomenology to explore hospitalization experiences among children aged 9-13 years. Conducted at a primary health center in Spain from October 2022 to June 2023, the study used purposive sampling to select participants hospitalized within the past six months. Data were collected through in-depth interviews and children's self-created drawings, analyzed using thematic analysis with ATLAS.ti software. Results: A total of 10 school-age children (five boys and five girls) were interviewed. Three main themes emerged: (1) Emotions and Feelings-children described fear, anxiety, and loneliness during their hospital stay; (2) Experiences of Pain and Discomfort-participants reported physical pain and discomfort; (3) Interactions with Medical Staff-children expressed a need for more detailed explanations and clearer communication. Conclusions: The findings highlight the importance of family-centered care and improved communication between healthcare providers and children. Strategies like art therapy and flexible visiting hours could provide better emotional support. Tailored communication to children's developmental levels is crucial. Integrating these strategies into clinical practice could enhance the well-being of hospitalized children. Future research should focus on evaluating these interventions to improve pediatric care.

Knowledge and perception of asthma among parents of children with asthma.

Parents' knowledge is an integral part of healthcare quality, impacting treatment adherence, patient loyalty and healthcare utilisation in pediatric asthma. Parental knowledge is particularly crucial as parents influence decision-making for their child's healthcare. To assess parents' knowledge and perceptions of their children's asthma and to identify areas for weakness in therapeutic education. This is transversal survey study based on validated and translated self-administered questionnaire (Arabic asthma knowledge questionnaire AAKQ). The study was conducted in 2 departments: pediatric primary care department at Elomrane and pediatric pneumology outpatient clinics at Bechir Hamza children's hospital of Tunis during 6 months (March2022- October2022). One hundred forty-four parents were involved in the study. Most of the participants were mothers. The mean age was 38 years. Only 27,0% had higher education and smoking in parents was observed in 58% of cases. Our results showed moderate knowledge in 67,9% of participants. The mean of the total knowledge score was 57,7/85. Forty-six per cent of parents had poor knowledge for the first category of the questionnaire. The second category was the most successful part where only 14% had poor knowledge. The mean score of the third category was 13,5/20 with 35,4% of parents having poor knowledge. The mean of total knowledge was found to be higher among participants with higher education (P=0,000), when the gender of the child is masculine (P=0,038), when the parents were asked in Hospital of children of Tunis (P=0,003) and when there is a history of asthma in the siblings (P=0,05). No difference in caregiver's knowledge was based on their age or gender or history of asthma, on the age of the child, his hospitalization for asthma, his asthma control level or his compliance with medication. Knowledge of parents and their children suffering from asthma is acceptable but insufficient. An approach focusing on improving patient education skills is needed to help families understand and accept the disease and achieve optimal control.

Immunohistochemical expression of netosis markers (MPO, H2A, H2B) in placenta of RPL women in Basrah Province

Background. Recurrent Pregnancy Loss (RPL) is a multifactorial disorder significantly impacting women’s health globally. Emerging research has implicated Neutrophil Extracellular Traps (NETs) in the pathophysi­ology of RPL, suggesting an immunological underpinning to miscarriage occurrences. Aim. The study aim to evaluate the role and expression of NETosis markers (MPO, histones H2A, H2B) in women with RPL in comparison to pregnant women. Methods. This prospective cohort study, conducted from January 2022 to July 2023, included 30 participants (20 RPL patients and 10 controls) from Al Basrah Maternity and Child Hospital. Immunohistochemical technique were employed to detect Myeloperoxidase and histones in placental samples. Statistical analysis was performed using SPSS, with significance set at p<90.05. Results. Immunohistochemical analysis of placental tissues indicated significant overexpression of Myelo­peroxidase (MPO), and histones H2A and H2B, in RPL patients compared to control, emphasizing the potential involvement of NETs in placental pathology associated with miscarriage. The expression levels of MPO were positive in 80% of RPL patients but undetected in control (p = 0.0001). Histone expressions also differed significantly, with H2A detected in 55% of RPL patients compared to none in control (p = 0.001) and H2B in 70% versus 30% (both p <0.001).

Evaluation of Labour Care Guide: Labor progression in obese women from Basra, Iraq

The prevalence of maternal obesity has emerged as a significant global public health issue. The World Health Organization (WHO) has just introduced a revolutionary tool known as the WHO Labour Care Guide for the purpose of monitoring the well-being of mothers and infants throughout the process of labor. The study aims to evaluate the impact of obesity on the progression of labor, mode of delivery, and subsequent neonatal complications. Our research was conducted on 176 women who fulfilled the inclusion criteria at Basra Maternity and Child Hospital, the number of women with normal BMI was 100, while the class 1 obese was 76 cases. The results show the risk of emergency caesarean section is significantly increased among the class 1 obese woman, the percentages were 40.7%, and 14% respectively (p-value <0.001), regarding the neonatal outcome assessed by the APGAR scoring system, there was a relatively low APGAR score among the total deliveries of class 1 obese women regardless of the mode of delivery, (p-value was significant <0.001) compared with the average Body Mass Index women, the neonatal birth weight was significantly different between the two Body Mass Index groups, there is an increase in the birth weight among class 1 obese women (p-value <0.001). The study concludes obesity has a substantial influence on the increased incidence of caesarean section deliveries among women classified as having obesity class I, and there is a positive correlation between body mass index and the desire for oxytocin administration among obese women.

Factors affecting the level of parental knowledge about their children's congenital heart diseases and their care.

To assess parental knowledge about their children's congenital heart disease using a newly-designed scale. The cross-sectional study was conducted from June 2020 to May 2021, at Alkhansaa maternity and child hospital, Mosul Iraq; after approval from the ethics review committee of Ninevah Medical College, Ninevah University, Iraq, and comprised parents with children having congenital heart disease. Data, including age, gender, type of congenital heart disease as well as parents' educational and socioeconomic levels, residence, internet use and knowledge of the disease with respect to type, burden, bacterial endocarditis, outcome, etc. was noted. Parental knowledge levels were measured using a self-designed scoring scale, having a total score of 18 and 4 categories; <6 = some knowledge, 7-12 = good knowledge, 13-17 = very good knowledge, and 18 = full knowledge. Data was analysed using SPSS 26. There were 364 children with mean age 83.72±47.4 months and a male-female ratio of 0.98. The mean age at diagnosis was 12.1±8.32 months. The overall mean parental knowledge level was 8.41± 3.88, with 126(34.6%) parents having some knowledge, 178(48.9%) having good, 58(16%) having very good, and 2(0.5%) having full knowledge about their children's health condition (p<0.001) There was a significant association of parental knowledge with educational level, socioeconomic status and the type of doctor caring for the child (p<0.05). The duration of the illness showed a significant correlation with knowledge level (p=0.021). Heart Defects, Congenital, Endocarditis, Bacterial, Social Class.

Machine learning for HELLP syndrome prediction: algorithms, case study and challenges

Machine learning (ML) is a subsection of artificial intelligence (AI) that develops dynamic algorithms for data-making decisions. Medical science is an area where the application of ML can be very productive. The adoption of ML methods in medical sciences especially in the HELLP Syndrome prediction has been slow. Machine learning techniques have shown promise in predicting various complications of pregnancy, including preeclampsia and preterm birth. However, their application in predicting HELLP syndrome, a rare but serious condition, remains relatively understudied. This study investigates the application of machine learning algorithms to predict HELLP syndrome among pregnant women presenting with preeclampsia. The research population comprises 266 pregnant women between 28 and 38 weeks of gestation, recruited from the gynecology-obstetrics department of Mother and Child Hospital “Saadna Abdenour” in Setif, Algeria, between June 2020 and June 2021. The data collected includes epidemiological, diagnostic, therapeutic, and evolutionary variables, with a focus on severe preeclampsia cases. The results highlight the potential of machine learning algorithms in predicting HELLP syndrome, providing valuable insights for clinical decision-making and improving maternal and neonatal outcomes.

Cohort profile: Rahima Moosa Mother and Child Hospital maternal HIV cohort, Johannesburg, South Africa

PurposeThe Rahima Moosa Mother and Child Hospital (RMMCH) maternal HIV cohort originated from data systems that were developed to support HIV-related birth care and track outcomes of a complete birth...

Daily Temperatures and Child Hospital Admissions in Aotearoa New Zealand: Case Time Series Analysis.

The influence of global climate change on temperature-related health outcomes among vulnerable populations, particularly young children, is underexplored. Using a case time series design, we analysed 647,000 hospital admissions of children aged under five years old in New Zealand, born between 2000 and 2019. We explored the relationship between daily maximum temperatures and hospital admissions across 2139 statistical areas. We used quasi-Poisson distributed lag non-linear models to account for the delayed effects of temperature over a 0-21-day window. We identified broad ICD code categories associated with heat before combining these for the main analyses. We conducted stratified analyses by ethnicity, sex, and residency, and tested for interactions with long-term temperature, socioeconomic position, and housing tenure. We found J-shaped temperature-response curves with increased risks of hospital admission above 24.1 °C, with greater sensitivity among Māori, Pacific, and Asian compared to European children. Spatial-temporal analysis from 2013-2019 showed rising attributable fractions (AFs) of admissions associated with increasing temperatures, especially in eastern coastal and densely populated areas. Interactive maps were created to allow policymakers to prioritise interventions. Findings emphasize the need for child-specific and location-specific climate change adaptation policies, particularly for socioeconomically disadvantaged groups.

Estimating the alcohol-related burden of child maltreatment among Māori in Aotearoa, New Zealand.

To assesses the alcohol-related burden of child maltreatment among Māori in Aotearoa New Zealand. We compared the risk of child maltreatment among Māori (0-17 years) exposed to parents with alcohol-related hospitalisation or mental health/addiction service use. We also conducted a sensitivity analysis to estimate the number of cases of maltreatment that could be attributed to alcohol among Māori. A cohort study of 16,617 Māori aged 0-17 and their parents from 2000 to 2017 was conducted using the Statistics New Zealand Integrated Data Infrastructure. A Bayesian piecewise exponential model estimated the risk of time to first child maltreatment event. This analysis used data from child protection, hospital, mortality and police records, and specifically focused on the risk associated with exposure to parents with an alcohol-attributable hospitalisation or mental health/addiction service use event. Potential confounders for both parents and Māori (0-17 years) were included. We calculated a population-attributable fraction to estimate the proportion of maltreatment cases that could be attributed to alcohol in 2017. Results showed a 65% increased risk for young Māori exposed to parents with heavy alcohol use. We estimated 17% of substantiated child maltreatment among Māori could be attributed to parental hazardous alcohol consumption. Severe or hazardous alcohol consumption among parents is a risk factor for child maltreatment among Māori. Māori alcohol consumption and harm are symptomatic of wider inequities related, among other things, to the ongoing effects of colonisation, as well as gaps in the regulation of alcohol sales.

Spatial patterns of heat exposure and child hospital admissions in Aotearoa New Zealand

Spatial patterns of heat exposure and child hospital admissions in Aotearoa New Zealand

Association between nurse-child communication and family caregivers' global ratings to hospital: a retrospective study

PurposeEffective nurse-child communication is a fundamental aspect of delivering pediatric nursing care. Family caregivers' global ratings to hospital are considered a proxy-reported measure for assessing a child's inpatient stay experience. We investigate the associations between nurse-child communication and family caregivers' global ratings to hospital. Design and methodsA retrospective analysis of a national child patient experience survey data was conducted. Patient experience with nurse-child communication and the family caregivers' global ratings of hospital were measured using the Child Hospital Consumer Assessment of Healthcare Providers and Systems. Hierarchical linear models were constructed to examine the association between nurse-child communication measures and family caregivers' global ratings to hospital. ResultsData from 1010 patients at six National Regional Centers for Pediatric in China were collected. The overall rating of hospitals and the willingness to recommend the hospital showed increasing trends as the nurse-child communication score increased. How often nurses encourage children to ask questions was significantly associated with family caregivers' overall ratings of hospital and the family caregivers' willingness to recommend the hospital. ConclusionsEffective communication by nurses with the child is associated with significantly higher global ratings to the hospital by family caregivers during inpatient care. Encouraging children to ask questions is a promising contributor to caregivers' global ratings to hospital. Practice implicationsPediatric nurses should emphasis encouraging children to ask questions for effective communication in nursing practice. Future research is also needed to develop more targeted strategies to assist pediatric nurse to communicate with child better.

Implications of child poverty reduction targets for public health and health inequalities in England: a modelling study between 2024 and 2033.

We investigated the potential impacts of child poverty (CP) reduction scenarios on population health and health inequalities in England between 2024 and 2033. We combined aggregate local authority-level data with published and newly created estimates on the association between CP and the rate per 100 000 of infant mortality, children (aged <16) looked after, child (aged <16) hospitalisations for nutritional anaemia and child (aged <16) all-cause emergency hospital admissions. We modelled relative, absolute (per 100 000) and total (per total population) annual changes for these outcomes under three CP reduction scenarios between 2024 and 2033-low-ambition (15% reduction), medium-ambition (25% reduction) and high-ambition (35% reduction)-compared with a baseline CP scenario (15% increase). Annual changes were aggregated between 2024 and 2033 at national, regional and deprivation (IMD tertiles) levels to investigate inequalities. All CP reduction scenarios would result in substantial improvements to child health. Meeting the high-ambition reduction would decrease total cases of infant mortality (293; 95% CI 118 to 461), children looked after (4696; 95% CI 1987 to 7593), nutritional anaemia (458, 95% CI 336 to 574) and emergency admissions (32 650; 95% CI 4022 to 61 126) between 2024 and 2033. Northern regions (eg, North East) exhibited the greatest relative and absolute benefit. The most deprived tertile would experience the largest relative, absolute and total benefit; under high-ambition reduction, total infant mortality cases were predicted to fall by 126 (95% CI 51 to 199) in the most deprived tertile compared with 71 (95% CI 29 to 112) in the least between 2024 and 2033. Achieving reductions in CP could substantially improve child health and reduce health inequalities in England.

Perioperative pathways for children with neurodevelopmental conditions and behaviours that challenge: An evaluation of parent experiences for service improvement.

To elicit experiences of parents of children with neurodevelopmental conditions using a new perioperative pathway. Parents of children accessing an adapted perioperative clinical pathway in a tertiary children's hospital between July 2019 and December 2020 were invited to participate. A mixed method study was conducted comprising a short survey questionnaire followed by telephonic interviews. From 67 postal surveys sent out, 20 were completed. Six out of 20 parents participated in phone interviews and one parent submitted written prose. Parents were positive about their experiences. Six themes emerged: Negative past experiences (highlighting the need for adapted perioperative pathways); Reasonable adjustments (improving child and parent's hospital journey); Facilitating communication, convenience and collaboration; Parent's satisfaction and relief; Barriers to overcome and Areas in need of improvement were discussed. Parents of children with neurodevelopmental conditions report great satisfaction and relief from their experiences of a more efficient, streamlined and stress-free way for their child to have tests or procedures done. Parents report improved communication, convenience and collaboration with staff resulted in timely, safe and high-quality care.

Job Stress from Nurses’ Working Conditions in Sabah Women and Child Hospital

Both excessive and insufficient workloads can cause stress among employees. It has been established that as tasks take longer to complete, employee happiness tends to decrease, which can significantly impact their overall health and mental well-being. The primary objective of this study is to examine the relationship between age and working conditions concerning job stress among registered nurses in a government hospital in Sabah. The quantitative survey approach was employed, involving 60 registered nurses with a minimum of 3 years of experience. Purposive sampling was utilized to ensure a sample that would provide comprehensive insights and discoveries into the factors influencing job stress among nurses in this specific setting. The analysis indicated that there was no statistically significant relationship between age, working conditions as demographics, and job stress (p = 0.499). The average stress level reported by respondents was 15.7 ± 2.32379 on a scale where higher scores indicate greater stress. This finding suggests that the observed demographic characteristics, including age and specific working conditions, did not correlate with higher or lower levels of job stress among the nurses surveyed. Based on the survey results, it can be concluded that age and the specific working conditions studied do not appear to significantly influence the experience of job stress among registered nurses at the government hospital in Sabah. This implies that other factors not explored in this study may have a more pronounced impact on job stress levels within this population. Future research could explore additional variables or consider different methodologies to further understand the complexities of job stress among healthcare professionals.

Hospitalization- and death-related financial and employment effects in parents of children with life-limiting conditions: a fixed-effects analysis

The purpose of this study is to investigate out-of-pocket non-medical expenses and employment-related outcomes in families of children with life-limiting conditions, specifically, to quantify the financial and employment implications of two events: a child’s hospitalization and death. This cohort study used panel data collected prospectively for a larger study investigating the effectiveness of specialized pediatric palliative care. Participants were recruited by medical professionals between November 2019 and May 2022 at four Swiss children’s hospitals. The care follow-up and bereavement follow-up assessments were 330 and 300 days, respectively. We measured out-of-pocket non-medical expenses, individual full-time equivalent units, and personal income, as well as sick leave and vacation days taken. Analyses included descriptive statistics and two-way linear fixed-effects regressions. The analysis included 110 parents (mothers n = 59, fathers n = 51) of 61 children. Children were hospitalized for a median of 7 days (interquartile range 0–21, range 0–227). The fixed-effects models found a positive association between hospitalization, i.e., length of stay, and travel and accommodation expenses (coefficient 4.18, 95% confidence interval 2.20–6.16). On average, for each week of hospitalization, parents spent an additional 29 Swiss francs on travel and accommodation. During the 300-day bereavement follow-up, six (26%) of 23 parents increased their work commitments, while one reported a decrease.Conclusions: Families incur higher travel and accommodation expenses during hospitalization than during non-hospitalized periods. Instrumental support, e.g., parking vouchers, can help families minimize these costs. Future studies should investigate whether early return to work during bereavement is driven by economic considerations or a desire for distraction.Clinical trial registration: Data analyzed in this study were collected as part of a clinical trial, registered on ClinicalTrials.gov, No. NCT04236180, 15 March 2019What Is Known:• Families of children with life-limiting conditions are at risk of substantial financial burden from high out-of-pocket medical expenses.• It is also known that parents often have to incur out-of-pocket non-medical expenses and reduce their work commitments. Little is known about the economic consequences of losing a child to a life-limiting condition.What Is New:• We provide new longitudinal evidence on the hospitalization- and death-related financial and employment implications for families of children with life-limiting conditions.• Child hospitalizations add to families’ financial burden through increased travel and accommodation expenses. Work commitments rose during early bereavement.

Impact of the COVID-19 pandemic on the epidemiology of bronchiolitis at Hôpital du Jura in Delémont, Switzerland: a retrospective observational study.

Non-pharmaceutical interventions during the COVID-19 pandemic caused an unusual epidemiology in bronchiolitis hospitalisations, with a peak in the summer seasons of 2020 and 2021. The aim of this study was to analyse data from a 5-year period (2018-2022) at Hôpital du Jura in Delémont, Switzerland, regarding bronchiolitis hospitalisations before, during and towards the end of the COVID-19 pandemic in order to prepare for future changes in bronchiolitis epidemiology. Anonymous retrospective data on bronchiolitis hospitalisations for children under 2 years of age with hospital admission date from 1 January 2018 to 31 December 2022 was obtained from the Health Records Coding Unit of our hospital. A clear shift in the peak of bronchiolitis is seen in 2021 compared to the three previous years. Starting in spring 2022, the trend begins to mimic pre-pandemic years. For respiratory syncytial virus (RSV) bronchiolitis hospitalisations specifically, an important peak in hospitalisations is seen in the summer months of 2021, with over 20 admissions, compared to zero admissions in the previous years. This peak shifts to the winter months in 2022. The non-pharmacological interventions implemented during 2020 and early 2021 did not cause a long-lasting seasonal shift in bronchiolitis. In 2022, when the non-pharmacological interventions were no longer in place in the non-hospital setting, the peak of bronchiolitis hospitalisations is seen once again in the winter months. We predict that hospitalisation patterns will gradually revert to those of pre-pandemic years.

Emergency Sternotomy for Ruptured Left Ventricular Aneurysm A Case Report From the André Festoc Center at the “Le Luxembourg” Mother and Child Hospital in Bamako, Mali

Left ventricular aneurysm is rare. It can be spontaneous or acquired, appearing most often after a transmural myocardial infarction but can also follow cardiac operations, trauma, inflammation or infection [1]. We report the first case of a patient initially referred by the cardiology department of the CHU-ME for the surgical management of a large pericardial effusion whose immediate operative consequences were complicated by significant hemorrhage through the pericardial drain, prompting an emergency sternotomy, surgical exploration of which revealed a ruptured left ventricle aneurysm in a 14-year-old boy. In conclusion surgical repair of left ventricular aneurysm can be performed with acceptable results.

Factors Associated with Asthma among Children Attending Selected Tertiary Care Child Hospitals in Dhaka, Bangladesh

Factors Associated with Asthma among Children Attending Selected Tertiary Care Child Hospitals in Dhaka, Bangladesh

Description of the Intestinal Microbiota of Infants from 0 to 3 Months at the Mother and Child Hospital of Bingerville (Côte d'Ivoire)

Description of the Intestinal Microbiota of Infants from 0 to 3 Months at the Mother and Child Hospital of Bingerville (Côte d'Ivoire)