Complications In Pediatric Patients Research Articles

Challenges of Anesthetic Management in Pediatric Patients with Hernia Inguinalis Lateralis Dextra Reponibilis: A Case Report

Introduction: Hernia inguinalis lateralis dextra reponibilis (HILD repr.) is a common condition in infants and children, but anesthetic management in these pediatric patients requires special attention. Children's unique physiological and pharmacological characteristics, potential comorbidities, and risk of postoperative pain demand a careful and integrated approach. Case presentation: This case report presents comprehensive anesthetic management of a 6-month-old male infant who underwent elective herniorrhaphy for HILD repr. The anesthesia procedure involved induction with sevoflurane and fentanyl, maintenance of anesthesia with sevoflurane, and multimodal pain management with paracetamol and bupivacaine. The surgery was successful without complications, and the patient recovered well. Conclusion: This case highlights the importance of implementing modern anesthetic practices in pediatric patients with HILD repr., including selection of appropriate anesthetic agents, close monitoring, and multimodal pain management. Specific challenges such as unique airway anatomy, variability in drug pharmacokinetics, and risk of perioperative complications are also highlighted. The successful anesthetic management of this case highlights the importance of an individualized approach and close monitoring to optimize clinical outcomes and minimize complications in pediatric patients with HILD repr.

Association Between Serum 25(OH)D Concentration and Clinical and Biological Complications in Pediatric Patients with Sickle Cell Disease

In addition to its role in phosphocalcic and bone metabolism, vitamin D also plays a global role in health. Despite high levels of sunshine, vitamin D deficiency remains a public health problem in sub-Saharan Africa, where sickle cell disease predominates. This study aimed to investigate an association between serum vitamin D (25(OH)D) levels and the occurrence of clinical and biological complications. The study was carried out in children with SS sickle cell disease aged 1 to 17 years (75 patients) matched to 17 AA controls. Plasma 25(OH)D concentration was obtained by immunoassay. The clinical complications studied were caso-occlusive crisis, osteomyelitis, osteonecrosis, acute chest syndrome, and priapism. Biological parameters included blood count, ionized calcium, and phosphorus. Statistical analysis was performed using R Studio 4.1.2 software. The significance threshold was 5%. Our study revealed a high prevalence of vaso-occlusive crisis (97%). Vitamin D deficiency was found in 4% of patients (3 SS patients) and 36% (27 SS patients) had a plasma concentration between 10 and 30 ng/ml. The association study revealed a negative association between vitamin D and the number of vaso-occlusive crises (r = -0.51; p < 0.001). We noted a positive association between vitamin D and blood calcium (r = 0.347; p < 0.002), phosphatemia (r = 0.347; p < 0.002), and hemoglobin (r = 0.243; p < 0.035). Vitamin D is correlated with certain clinical and biological complications. Vitamin D supplementation in children with sickle cell disease (SS) would therefore be relevant for better management of this disease.

Association Between Serum 25(OH)D Concentration and Clinical and Biological Complications in Pediatric Patients with Sickle Cell Disease

In addition to its role in phosphocalcic and bone metabolism, vitamin D also plays a global role in health. Despite high levels of sunshine, vitamin D deficiency remains a public health problem in sub-Saharan Africa, where sickle cell disease predominates. This study aimed to investigate an association between serum vitamin D (25(OH)D) levels and the occurrence of clinical and biological complications. The study was carried out in children with SS sickle cell disease aged 1 to 17 years (75 patients) matched to 17 AA controls. Plasma 25(OH)D concentration was obtained by immunoassay. The clinical complications studied were caso-occlusive crisis, osteomyelitis, osteonecrosis, acute chest syndrome, and priapism. Biological parameters included blood count, ionized calcium, and phosphorus. Statistical analysis was performed using R Studio 4.1.2 software. The significance threshold was 5%. Our study revealed a high prevalence of vaso-occlusive crisis (97%). Vitamin D deficiency was found in 4% of patients (3 SS patients) and 36% (27 SS patients) had a plasma concentration between 10 and 30 ng/ml. The association study revealed a negative association between vitamin D and the number of vaso-occlusive crises (r = -0.51; p < 0.001). We noted a positive association between vitamin D and blood calcium (r = 0.347; p < 0.002), phosphatemia (r = 0.347; p < 0.002), and hemoglobin (r = 0.243; p < 0.035). Vitamin D is correlated with certain clinical and biological complications. Vitamin D supplementation in children with sickle cell disease (SS) would therefore be relevant for better management of this disease.

Subsequent Complications of Pediatric Patients With Osteomyelitis and Accompanying Subperiosteal Abscess.

Subperiosteal abscesses (SAs) are a complication of osteomyelitis that requires surgical intervention. This study aimed to characterize the occurrence of subsequent complications in pediatric patients with osteomyelitis and accompanying SA. Fourteen pediatric patients with SAs were included. We recorded clinical information, including age at diagnosis, interval (days) between the onset of symptoms and diagnosis, location of SAs (long/flat bone), pathogens [methicillin-resistant Staphylococcus aureus (MRSA)/non-MRSA], treatment period (days) and any subsequent complications. Patients were classified based on SAs with or without complications. Mann-Whitney U and Fisher exact tests were used for statistical analyses, and data are expressed as median and interquartile range. Six patients (42.9%) had subsequent complications. There were significant differences in location of SAs between these two groups (long/flat bone, with versus without complication = 6/0 versus 3/5; P = 0.031). No significant differences were observed between the groups in terms of age [with versus without complication = 13.8 (9.7-24.5) versus 556.3 (5.0-107.8) months; P = 0.491], the interval (days) between symptoms onset and diagnosis [with versus without complications = 5 (1-10) versus 5 (3-6.5) days; P = 0.950], pathogenesis (MRSA/non-MRSA, with versus without complication = 4/2 versus 2/6; P = 0.277) and treatment period [with versus without complication = 50.5 (31-57) versus 29 (24.5-41.5) days; P = 0.108]. Pediatric patients with SAs in the long bones have a higher likelihood of experiencing subsequent complications than those with SAs in flat bones. Physicians should carefully manage this vulnerable patient group.

Late Presentation of Coarctation of the Aorta in an 11-Year-Old Male Child: A Case Study

Introduction: Coarctation of the aorta is a condition characterized by a narrowed segment of the aorta due to thickening of the artery wall. This case study highlights the late diagnosis of coarctation of the aorta in an 11-year-old male child who presented with symptoms initially suggestive of a respiratory infection. Case study: An 11-year-old male presented to the outpatient department with chief complaints of fever, cough, and poor appetite. He developed two episodes of epistaxis and hypertension with soft systolic murmur. Echocardiography showed severe coarctation of the aorta. Discussion: Coarctation of the aorta is a relatively common congenital heart defect that can remain asymptomatic until later in childhood or adulthood. It is the seventh most common type of CHD. The delay in the diagnosis of coarctation of the aorta underscores the challenges of recognizing cardiac anomalies in pediatric patients presenting with nonspecific complaints. Conclusion: Healthcare providers must remain vigilant and thorough in their assessment to prevent late diagnoses and associated complications in pediatric patients.

Effectiveness of implementing a standardized perioperative pain management protocol in children undergoing tonsillectomy: A quality improvement project.

Tonsillectomy procedures are commonly performed worldwide. At our academic tertiary care facility, we perform approximately 1000 tonsillectomy procedures annually. We have found inconsistent pain management strategies in pediatric tonsillectomy patients have contributed to variability in postoperative complications and the number and types of postoperative pain medications required in the Post Anesthesia Care Unit (PACU). This project aimed to assess the impact of implementing a standardized perioperative pain management protocol on reducing postoperative complications in pediatric patients who underwent a tonsillectomy procedure. A pre-post-intervention design was utilized, comparing characteristics and outcomes of pediatric patients for whom a standardized perioperative pain management protocol was implemented over a 12-week period compared to those who did not. The standardized perioperative pain management protocol was utilized intraoperatively by the anesthesiologists, nurse anesthetists, and residents. A Qualtrics survey was used by the Post Anesthesia Care Unit (PACU) nurses to gather data as they cared for patients who underwent tonsillectomy. Four outcomes were measured: (1) postoperative pain medication administration, (2) rate of postoperative respiratory complications, (3) rate of adherence, and (4) usability of a standardized pain management protocol. Data were compared between pre and post-implementation groups. During the quality improvement project, 180 children underwent tonsillectomy, with 81 in the control group and 99 in the intervention group. The median age did not differ between groups. The control group had higher postoperative opioid medication usage (93.8% vs. 54.5%) and a higher number of opioids administered in the recovery room. Postoperative IV fentanyl was reduced in the intervention group (49.4% vs. 28.3% in the intervention, p = .004). Respiratory interventions were more frequent in the control group (24.7% vs. 7.1%), with increased respiratory team activation. Respiratory team activation in the Post Anesthesia Care Unit (PACU) includes a 511 page for anesthesia provider assistance. Respiratory interventions included bag-mask ventilation, lidocaine, propofol or succinylcholine administration, and reintubation. The intervention group had 100% adherence to the pain management protocol, and providers found it easy to use. The quality improvement project highlighted notable improvements in the intervention group for whom a standardized perioperative pain management protocol was used, including reduced opioid medication administration, lower incidence of respiratory interventions, and high adherence to the pain management protocol. These findings underscore the effectiveness and feasibility of standardized protocols in enhancing patient outcomes.

Multivariate Analysis of Risk Factors for Complications in Pediatric Tissue Expansion.

Tissue expanders represent one of the main surgical options for skin reconstruction in cases of tumors, traumalike burn injury, scar contracture, and alopecia. However, the tissue expander device is also associated with complications such as infection and extrusion. The aim of this study was to analyze risk factors for major complications of use of tissue expanders in pediatric patients using multivariate analysis. A retrospective, single-center observational study was performed over 10 years in pediatric patients who were treated with tissue expanders for tumors, nevus, scars, burn reconstruction, and alopecia from April 2012 to March 2022. The primary outcome was overall complications per operation and expander, including infection and extrusion. Ten predictor variables were included as risk factors based on previous studies and as new factors considered important from clinical experience. Univariate and multivariate logistic regression analyses were performed to identify risk factors for major complications such as expander infection or extrusion. The study included 44 patients who underwent 92 operations using 238 tissue expanders. The overall complication rate per expander was 14.3%. Univariate logistic regression analysis identified associations of younger age, number of expanders used per operation, history of infection, and tissue expander locations with a higher complication rate. In multivariate logistic regression analysis, younger age (odds ratio, 1.14; P = 0.043) was associated with a high likelihood of expander complications. Younger age is an independent risk factor for tissue expander complications in pediatric patients. This factor should be considered in preoperative planning and discussions with the patient's family.

The clinical Spectrum of Viridans Group Streptococci infections in paediatric patients at a tertiary hospital.

Viridans Group Streptococci (VGS) are often considered organisms of low virulence; however, infection can result in clinically significant sepsis and life-threatening complications in paediatric patients. This study aimed to describe the spectrum of clinical presentation of VGS bacteraemia in paediatric patients, to analyse risk factors, and to describe the antibiotics resistance patterns of VGS. Cultures of VGS in paediatric patients admitted to Chris Hani Baragwanath Academic Hospital in 2019 were identified through National Health Laboratory Service. Data were extracted from archived clinical records and analysed. Sepsis scores were calculated at the time of bacteraemia. A total of 133 cultures were identified; 64 (48.1%) polymicrobial cultures and no records 4 (0.03%) were excluded; 65 (48.9%) were analysed. The median age was 1.5 months (range 0.03 to 168, interquartile range [IQR]: 0.3-13.25), 27/65 (42%) were neonates. The median duration of hospitalisation was 7 days (IQR: 3-21). The commonest diagnoses were neonatal sepsis 30.8% (n = 20) and pneumonia 28% (n = 18). The systemic inflammatory response syndrome (SIRS) score was ≥ 2 in 57% (16/28) patients; paediatric sequential organ failure assessment (pSOFA) score was > 2 in 10/24 (42%). Fifty-seven (88%) patients were discharged; three (5%) required ICU admission and 8/65 (12.3%) died. Malnutrition was present in 50% of patients who died. Cephalosporins and penicillin had sensitivity of 89% and 55%, respectively. Viridans Group Streptococci bacteraemia was common in neonates, and pneumonia was a common presentation in this cohort. The VGS bacteraemia was associated with morbidity and deaths in this cohort. The VGS should be considered a significant organism when cultured from sterile sites and routine antibiotic susceptibility testing should be performed. Prospective studies are recommended.

Infectious complications in pediatric patients after liver transplantation in the first 3 months at the Fundación Valle del Lili, a Latin American transplant center

IntroductionIn pediatric patients undergoing liver transplantation, infections are one of the primary complications. The etiology varies depending on the time elapsed post-transplant, with early presentations of bacterial and fungal infections, followed by viral and parasitic infections. There is limited literature describing the prevalence of infectious complications in this group of patients in Colombia. ObjectiveTo describe infectious complications in patients undergoing liver transplantation within the first 3 months post-procedure at the Fundación Valle del Lili, Cali, Colombia. MethodsA case series of 165 pediatric liver transplant patients during the period 2011–2017. A descriptive analysis of all entered data was conducted. Survival analysis using the Kaplan-Meier method was performed, with an exploratory analysis comparing patient survival based on the presence of infection, censored for death related to postoperative complications. ResultsThe primary diagnosis at the time of transplantation was biliary atresia in 65% of cases. A total of 215 infectious episodes were recorded in 92 pediatric liver transplants. The most frequent microorganisms were Klebsiella pneumoniae (21%), Cytomegalovirus (CMV) (7%), Pseudomonas aeruginosa (7%), Escherichia coli (6%), and Epstein Barr Virus (EBV) (6%). Three-month patient survival was 92% for infection-related mortality. DiscussionInfectious complications within the first three months post-pediatric liver transplantation were predominantly bacterial in origin. Bacterial and fungal infections manifested earlier, while viral infections appeared later. Infectious complications did not impact the three-month patient survival in this group.

Severe Neurological Manifestation Associated With Coronavirus Disease 2019 in Children During the Omicron Variant-Predominant Period

BackgroundThe Omicron variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is known to be more infectious and less severe than the other variants. Despite the increasing number of symptomatic patients, severe neurological complications in children with the Omicron variant have been reported rarely, unlike with wild-type or Delta variants. This study aimed to investigate severe neurological complications in children with Omicron variant infection. MethodsWe conducted a retrospective study of 17 pediatric patients with severe neurological manifestations associated with coronavirus disease 2019 in Korea during the Omicron variant prevalence, from January 1 to April 30, 2022. ResultsAmong the 17 patients, 11 had pre-existing neurological disabilities and nine met the criteria for multisystem inflammatory syndrome in children (MIS-C). Four of the five vaccine-eligible patients (12 years and older) were unvaccinated. Severe neurological manifestations included acute necrotizing encephalopathy, acute fulminant cerebral edema, acute disseminated encephalomyelitis, basal ganglia encephalitis, unclassified severe encephalopathy/encephalitis, and refractory status dystonicus. Patients with MIS-C and underlying neurological disabilities had longer median hospital and intensive care unit stays compared with those without these conditions. Five patients survived with new neurological deficits at the one-year follow-up, and three died, all of whom had underlying neurological disabilities. ConclusionsThis study shows that severe neurological complications in pediatric patients with the Omicron variant of SARS-CoV-2 occur infrequently but may lead to significant morbidity and mortality, especially among those with pre-existing neurological disabilities and unvaccinated individuals. Continued efforts are necessary to prevent and manage such complications in these vulnerable populations.

Association between oral and fecal microbiome dysbiosis and treatment complications in pediatric patients undergoing allogeneic hematopoietic stem cell transplantation

The oral and gastrointestinal mucosae represent the main targets of the toxic effect of chemo and/or radiotherapy administered during the conditioning regimen before hematopoietic stem cell transplant (HSCT). These harmful consequences and the immunological complications that may occur after the transplant (such as Graft versus Host Disease, GvHD) are responsible for the clinical symptoms associated with mucositis during the aplasia phase, like pain, nausea, vomiting, and diarrhea. These toxicities could play a critical role in the oral and gastrointestinal microbiomes during the post-transplant phase, and the degree of microbial dysbiosis and dysregulation among different bacterial species could also be crucial in intestinal mucosa homeostasis, altering the host’s innate and adaptive immune responses and favoring abnormal immune responses responsible for the occurrence of GvHD. This prospective pediatric study aims to analyze longitudinally oral and gut microbiomes in 17 pediatric patients who received allogeneic HSCT for malignant and non-malignant diseases. The oral mucositis was mainly associated with an increased relative abundance of Fusobacteria, and Prevotella species, while Streptococcus descendants showed a negative correlation. The fecal microbiome of subjects affected by cutaneous acute GvHD (aGvHD) correlated with Proteobacteria. Oral mucosal microbiota undergoes changes after HSCT, Fusobacteria, and Prevotella represent bacterial species associated with mucositis and they could be the target for future therapeutic approaches, while fecal microbiome in patients with acute GvHD (aGvHD) revealed an increase of different class of Proteobacteria (Alphaproteobacteria and Deltaproteobacteria) and a negative correlation with the class of Gammaproteobacteria.

FAKTOR RISIKO YANG MEMPENGARUHI TERJADINYA KOMPLIKASI KARDIOVASKULAR PASCA PEMBIUSAN/SEDASI PROSEDURAL PADA PASIEN PEDIATRI

Background: The morphology and physiology of neonates and children differ from those of adults. The most common complications encountered involve respiratory issues followed by cardiovascular problems. The predominant cardiovascular complications in the field of pediatric anesthesia are hemodynamic instability followed by cardiac arrest. Perioperative cardiovascular complications are closely related to a history of prematurity under the age of 1 year, ASA physical status ≥3, concomitant cardiovascular or metabolic diseases, emergency surgeries, and surgical procedures. To date, few risk factors related to the cardiovascular system have been identified in pediatric anesthesia.
 
 Objective: To identify risk factors influencing the occurrence of post-anesthesia/sedation cardiovascular complications in pediatric patients at Dr. Sardjito Hospital, Yogyakarta.
 
 Method: The research design employed in this study was a prospective cohort observation of pediatric patients undergoing anesthesia or procedural sedation at Dr. Sardjito Hospital. Research subject data included demographic characteristics, ASA status, history of concomitant diseases, type of surgery, urgency level, and post-anesthesia complication occurrences. Data normality was tested using the Kolmogorov-Smirnov test, bivariate analysis was conducted using the Fisher test, variables with p-value <0.25 underwent multivariate analysis using logistic regression for categorical data. The results were processed using SPSS version 23.00.
 
 Results: A total of 181 subjects were predominantly male patients aged >5 years. Factors influencing post-anesthetic cardiovascular complications included ASA physical status ≥3 (p=0.033) OR 8.96 (95% CI 2.07 – 38.89), emergency procedures (p=0.043) OR 12.63 (95% CI 1.08 – 147.15), age >5 years (p=0.033) OR 5.67 (95% CI 1.15 – 28.1), female gender (p=0.001) OR 7.85 (95% CI 2.23 – 27.71), and type of surgical procedure (p=0.017) OR 16.64 (95% CI 1.63 – 169.05).
 
 Conclusion: Age >5 years, female gender, ASA physical status ≥3, emergency procedures, and surgical procedures are risk factors associated with the occurrence of post-anesthetic/sedation cardiovascular complications in pediatric patients.
 

Complications of Endonasal Odontoidectomy in Pediatric versus Adult Populations: A Systematic Review and Meta-Analysis

Abstract Introduction Endonasal odontoidectomy (EO) is a procedure for addressing compressive pathology of the craniovertebral junction. While EO has been well established in adults, its complications and cervical fusion practices are less understood in pediatric patients, despite differences in sinonasal and craniocervical anatomy. This study summarizes and compares EO complications and need for cervical fusion in pediatric and adult patients. Methods This was a systematic review and meta-analysis. Literature review was conducted using PubMed, Web of Science, and Embase to identify studies reporting complications post-EO in adult and pediatric patients. Complications were categorized as neurologic, swallowing, or respiratory. Complication and posterior fusion rates were compared using a random-effects model. Results A total of 738 articles were identified, of which 28 studies including 307 adult cases and 22 pediatric cases met inclusion criteria for systematic qualitative and quantitative review. The rates for adult and pediatric cases, respectively, were: respiratory complications 13.4 versus 9.1%, swallowing complications 12.1 versus 4.5%, neurologic complications 8.5 versus 9.1%, and cervical fusion rates 73.3 versus 86.4%. Across eight studies qualifying for meta-analysis, there were no differences in cervical fusion (odds ratio [OR]: 0.5, 95% confidence interval [CI]: [0.1, 2.1]), respiratory complications (OR: 3.5, 95% CI: [0.8, 14.5]), or swallowing complications (OR: 3.5, 95% CI: [0.5, 26.0]); however, pediatric patients had a higher rate of neurologic complications (OR: 5.2, 95% CI: [1.1, 25.0]). Conclusion In EO, rates of aerodigestive complications and cervical fusion are similar in both populations. There may be an increased risk of neurologic complications in pediatric patients, although more high-quality studies are needed.

Retrospective analysis of pediatric sepsis and the burden of antimicrobial resistance in Duhok, Kurdistan Region of Iraq.

Introduction: Sepsis is a life-threatening complication in pediatric patients. This study primarily aimed to investigate sepsis-causing bacteria and their antimicrobial resistance profile and check the change in the antimicrobial resistance trend for some selected bacteria. In addition, we evaluated the incidence of sepsis, the related mortality rate, and the effectiveness and outcome of the treatment regimes in sepsis pediatric patients. Methods: A retrospective analysis was conducted on 4-year data (2018-2021) collected from three intensive care units at the Hevi Pediatric Teaching Hospital. Sepsis screening involved clinical detection and confirmation by blood culture. Results: A total of 520 out of 1,098 (47.35%) blood samples showed positive microbial growth. A decrease in sepsis rate was observed during the COVID-19 pandemic. Coagulase-negative Staphylococci (CoNS) and Klebsiella pneumonia were the most commonly isolated bacteria. A notable variation in the antimicrobial resistance trend was observed among sepsis-causing bacteria. The empirical sepsis treatment recommended by the WHO was ineffective, as certain bacteria exhibited 100% resistance to every antibiotic tested. The mortality rate significantly increased from 1.3% in 2018 to 16.5% in 2021. Discussion: The antimicrobial resistance profile of sepsis causing bacteria is of concerns, indicating a potentially serious situation. Thus, to avoid treatment failure, the monitoring of antimicrobial resistance in pediatric patients is essential.

Effect of Obesity on Surgical Outcomes and Complication Rates in Pediatric Patients: A Comprehensive Systematic Review and Meta-Analysis.

Obesity is one of the primary public health problems faced by children. The increased incidence of obesity in the pediatric population poses significant challenges during and after surgical procedures. This systematic review and meta-analysis aimed to understand to what extent obesity is to surgical complications in pediatric patients. A systematic database search of PubMed, Web of Science, Scopus, and Science Direct was performed in June 2023. According to the inclusion and exclusion criteria, two evaluators independently conducted literature screening, data extraction, and quality evaluation of the retrieved literature. The Newcastle-Ottawa Scale score was used for quality evaluation, and a meta-analysis was performed using Review Manager software 5.4.1. A total of 1,170 relevant articles were initially identified, and 20 articles were finally included for data extraction and meta-analysis. The results of the meta-analysis showed that compared with normal-weight individuals, obese pediatric patients had a higher risk of developing surgical site infection (SSI) (relative risk (RR) = 1.63; 95% confidence interval (CI) = 1.33-2.00), wound dehiscence (RR = 2.01; 95% CI = 1.24-3.23), and underwent procedures that were 11.32 minutes longer (95% CI = 5.36-17.29). There were no differences in bleeding requiring transfusion, deep venous thromboembolism, postoperative abscess rate, and length of stay. Obese pediatric patients have a higher risk of SSI and dehiscence, along with a longer operative time. The established risks in obese adults undergoing surgery suggest a similar risk for obese pediatric patients. The findings of this study hold significant implications for clinical practice, suggesting the potential for additional measures to prevent surgical complications in children.

Clinical and Economic Burden of Antibiotic Use Among Pediatric Patients With Varicella Infection in the Outpatient Setting: A Retrospective Cohort Analysis of Real-world Data in France.

Varicella infects 90% of children before age 9. Though varicella is self-limiting, its complications may require antibiotics, though how antibiotics are utilized for varicella in France is not well known. This study assessed antibiotic use and costs associated with varicella and its complications in pediatric patients managed in the outpatient setting in France. A retrospective cohort study using the Cegedim Strategic Data-Longitudinal Patient Database, an electronic medical record database from general practitioners and office-based specialists in France, was conducted. Children <18 years old diagnosed with varicella between January 2014 and December 2018 with 3-month follow-up available were included. We used descriptive analysis to assess varicella-related complications, medication use, healthcare resource utilization and costs. Overall, 48,027 patients were diagnosed with varicella; 15.3% (n = 7369) had ≥1 varicella-related complication. Antibiotics were prescribed in up to 25.1% (n = 12,045/48,027) of cases with greater use in patients with complications (68.1%, n = 5018/7369) compared with those without (17.3%, n = 7027/40,658). Mean medication and outpatient varicella-related costs were €32.82 per patient with medications costing a mean of €5.84 per patient; antibiotics contributed ~23% to total costs annually. This study showed high antibiotic use for the management of varicella and its complications. A universal varicella vaccination program could be considered to alleviate complications and associated costs in France.

A typical presentation of a laryngeal foreign body in an infant

Background: A 1-year-old boy presented with a one-day history of fever and cough, potentially linked to an episode of aspiration during homemade rice feeding. Following the incident, he refused to feed, displaying irritability. The detection of neutrophil leucocytosis and dehydration prompted IV antibiotics and fluid. Persistent symptoms led to a lateral neck x-ray, revealing a radiopaque material near the epiglottis. Fibre optic laryngoscopy identified a metallic wire lodged in the right arytenoid cartilage and posterior pharyngeal wall, possibly a fragment from a rice polishing machine. Extraction under general anaesthesia resulted in minimal mucosal injury, and the child quickly recovered postoperatively.Conclusion: This report serves as a reminder to consider foreign body ingestion in the differential diagnosis, particularly in cases with subtle or unrelated symptoms in the paediatric age group. The multidisciplinary approach emphasises prompt intervention to prevent life-threatening complications in paediatric patients. Furthermore, employing awake fibre-optic laryngoscopy in the context of a suspected respiratory tract infection to confirm the presence of a foreign body is considered a clinically safer approach than immediately resorting to examination under anaesthesia.

The application of the modified Snodgrass technique in hypospadias surgery.

We aimed to explore the effectiveness of the modified tubularized incised plate urethroplasty (Snodgrass Technique) in hypospadias surgery. A study was conducted on 50 pediatric patients with hypospadias treated in our hospital from May 2020 to May 2023. The patients were divided into two groups based on the condition of their urethral plate; 22 patients were included in the study group and 28 patients were included in the control group. The control group underwent the traditional Snodgrass technique, while the study group received the modified Snodgrass technique. The two groups were compared in terms of treatment efficacy, preoperative and postoperative 6-month Hypospadias Objective Scoring Evaluation (HOSE) scores, surgical data, and postoperative complications. The operation time for the study group was longer than that of the control group, and the intraoperative blood loss was less, but the differences were not statistically significant (p > 0.05). The success rate of surgery in the study group was 95.45% (21/22), compared to 71.43% (20/28) in the control group, showing a statistically significant difference (p < 0.05). The maximum urinary flow rate at 3 and 6 months postoperatively was significantly higher in the study group than in the control group (p < 0.05). The time to maximum flow (TQmax) and post-void residual (PVR) at 3 and 6 months postoperatively were significantly lower in the study group (p < 0.05). A total of 3 patients in the cohort developed urethral fistulas, all between 0.10 cm x 0.10 cm and 0.15 cm x 0.15 cm in size. By instructing the patients to apply pressure to the fistula during urination, all fistulas closed between 3 and 6 months postoperatively. The incidence of postoperative complications was 4.55% in the study group and 28.57% in the control group, a difference that was statistically significant (p < 0.05). The modified Snodgrass technique shows significant therapeutic effectiveness in hypospadias surgery, substantially increasing the success rate and reducing postoperative complications in pediatric patients, making it suitable for widespread application.

Continuous direct intraarterial treatment of meningitis-induced vasospasm in a pediatric patient: illustrative case.

Bacterial meningitis-induced ischemic stroke continues to cause significant long-term complications in pediatric patients. The authors present a case of severe right internal carotid artery terminus and M1 segment vasospasm in a 9-year-old with an infected cholesteatoma, which was refractory to multiple intraarterial treatments with verapamil and milrinone. This is the first report of continuous intraarterial antispasmodic treatment in a pediatric patient as well as the first report of continuous treatment in an awake and extubated patient. Arterial narrowing was successfully treated by continuous direct intraarterial administration of both a calcium channel blocker (verapamil) and a phosphodiesterase-3 inhibitor (milrinone). The patient recovered remarkably well and was discharged home with no neurological deficit (National Institutes of Health Stroke Scale score 0) and ambulatory without assistance after 22 days. The authors report a promising outcome of this technique performed in a pediatric patient. This represents a novel treatment option for the prevention of stroke in pediatric bacterial meningitis. Continuous, direct intraarterial administration of antispasmodic medications can successfully prevent long-term neurological deficit in pediatric meningitis-associated vasospasm. The described method has the potential to significantly improve outcomes in severe pediatric meningitis-associated vasospasm.

Safety of same-day discharge without anticoagulation for left-sided radiofrequency catheter ablations in pediatrics

BackgroundFor left-sided radiofrequency catheter ablation (LCA) in pediatrics, significant practice variability exists regarding anticoagulation and discharge practices. Given the lack of data in pediatric patients, the risks and benefits of these practices are not well defined. ObjectiveThe purpose of this study was to evaluate the safety of same-day discharge and use of aspirin (ASA) in pediatric patients following LCA. MethodsWe performed a retrospective cohort study of pediatric patients who underwent LCA from 2010 to 2020 at our institution. Discharge timing and ASA usage were based on operator preference. The primary outcome was incidence of postablation anticoagulation complications reported within 1 month of the procedure. ResultsThree hundred seventy-six patients underwent LCA and met inclusion criteria. Median [25th, 75th percentiles] age was 13.9 [10.5, 16.2] years; 18 (4.7%) had a history of structural heart disease. The most common substrates for ablation were Wolff-Parkinson-White syndrome (183 patients [48.7%]), concealed accessory pathway (159 patients [42.3%]), and ectopic atrial tachycardia (10 patients [2.7%]). Three hundred thirty-eight patients (89.9%) were discharged on the day of LCA. Seventy-six patients (20.2%) were prescribed ASA at discharge. Of those who underwent follow-up (273 patients [72.6%]), 7 (2.7%) reported an anticoagulation complication (5 with hematoma, 2 with headache). One of these patients was prescribed ASA; none required readmission. There was no correlation between anticoagulation complications and same-day discharge or with ASA usage. ConclusionGiven the rare incidence of anticoagulation complications in pediatric patients undergoing LCAs, same-day discharge from the electrophysiology laboratory without anticoagulation should be considered.