Complications In Children Research Articles

The Case for Parent-Implemented Programs to Mitigate Musculoskeletal Complications in Children With Severe Cerebral Palsy in Resource-Limited Settings.

The Case for Parent-Implemented Programs to Mitigate Musculoskeletal Complications in Children With Severe Cerebral Palsy in Resource-Limited Settings.

Evaluation of Clinical and Laboratory Findings of Sinusitis Complications in Children

Abstract Objective This retrospective study evaluates the demographic characteristics, clinical symptoms, laboratory results, treatment approaches, and outcomes of children with complications arising from bacterial sinusitis. Methods Fifty-four pediatric inpatients with sinusitis complications admitted between September 2013 and October 2022 were included in the study. These patients were categorized into two groups: those with preseptal cellulitis (group 1) and those with orbital–intracranial complications (group 2). Results The median age of the patients was 10.8 years, and 61.1% were males. Maxillary sinusitis (n = 40.74%) was the most common type of sinus involvement. Half of the patients exhibited preseptal cellulitis. The median age of our patients with intracranial complications was 13.7 years, while the median age of patients with orbital complications was 8 years. The predominant orbital–intracranial complication was meningitis, which accounted for 41% of the cases. All patients with a subdural abscess (n = 6) presented with frontal sinusitis, while all cases of cavernous sinus thrombosis (n = 3) involved the sphenoidal sinus. Surgical intervention was undertaken in 37% of cases. Streptococcus pneumoniae was the most frequently isolated microorganism. The median duration of hospital stay was 14 days, with a total median treatment duration of 21 days. There were no fatalities, although neurological sequelae were observed in 7.4% of patients (n = 4). Conclusion Preseptal cellulitis and meningitis remain the most common complications of sinusitis in children. Adolescents with sinusitis should be monitored closely for intracranial complications. The prevalence of S. pneumoniae as the most frequently detected pathogen underscores the importance of vaccination.

Risk Factors for Pulmonary Complications in Children Hospitalized with Community-Acquired Pneumonia: A Retrospective Cohort Study

Background: Community-acquired pneumonia (CAP) in childhood is an acute lung infection in a child caused by a pathogen originating outside the hospital, i.e., in the community. This disease is a significant cause of illness in developed countries and a major cause of death in developing countries. Objectives: This study aims to assess the factors predicting the incidence of pulmonary complications in children with community-acquired pneumonia. Methods: This study involved all children hospitalized in Zahra Mardani Azari Children's Hospital in Tabriz due to CAP between October 2022 and October 2023. Patients were compared in terms of demographic information, prescription records, medicines prescribed during hospitalization, clinical signs and symptoms, laboratory findings at admission and during hospital treatment; imaging results, and the clinical course of the disease. The study data was analyzed using SPSS version 23 software; and we used logistic regression analysis for identifying the related risk factors. Results: We included 361 patients, of which 104 (28.8%) were in the case group, and 257 (71.2%) were in the control group. The frequent complication was parapneumonic effusion (81.7%) following necrotizing pneumonia (27.9%), empyema (20.2%), and lung abscess (6.7%). Risk factors for pulmonary complications in children with CAP were weight (OR = 1.129), height (OR = 1.112), Body Mass Index (BMI) (OR = 1.112), administration of oral and intravenous acetaminophen during hospitalization (OR = 1.112, 1.209), Tachypnea (OR = 5.178), duration of Fever (OR = 1.290), ESR (OR = 1.312) and HRAD (OR = 3.473). Conclusions: We found that high weight and BMI, receiving acetaminophen during hospitalization, Tachypnea, and Fever duration until hospitalization, as well as high WBC and ESR, were predictive factors of pulmonary complications in children with CAP.

Elevated Serum Syndecan-1 Levels Are Associated with Obesity-Related Complications in Children

Background: Syndecan-1 plays a crucial role in cell differentiation, growth, adhesion, wound healing, and inflammatory processes. It has been linked to obesity, particularly overweight and chronic low-grade inflammation. Objectives: This study aimed to compare serum syndecan-1 levels between obese children and a healthy control group and to investigate the relationship between serum syndecan-1 levels and renal and cardiovascular complications associated with obesity in children. Methods: We assessed 30 obese and 30 healthy children aged 8 - 16 years. Blood samples were collected from both groups to measure serum aspartate aminotransferase (AST), syndecan-1, fasting blood glucose (FBG), alanine aminotransferase (ALT), creatinine, and urea concentrations. In the obese group, high-density lipoprotein cholesterol (HDL-C), insulin, triglyceride (TG), and low-density lipoprotein cholesterol (LDL-C) levels were also measured, along with homeostasis model assessment of insulin resistance (HOMA-IR). Results: The mean serum syndecan-1 levels in the obese and control groups were 15.65 ± 10.01 ng/mL and 6.99 ± 3.79 ng/mL, respectively, with a significantly higher level observed in the obese group (P < 0.005). Significant differences were also found in BMI, BMI SDS, creatinine, AST, and ALT levels between the two groups (P < 0.05), with all parameters being higher in the obese group. A significant positive linear association was identified between syndecan-1 levels and creatinine, TG, and BMI SDS (r = 0.711, r = 0.630, r = 0.682, P < 0.01). Additionally, a strong negative correlation was found between syndecan-1 and HDL-C levels (r = -0.609, P < 0.001). No significant linear relationship was detected between syndecan-1 levels and LDL-C, ALT, AST, glucose, urea, insulin levels, or HOMA-IR measurements (P > 0.05). Linear regression analysis revealed that serum creatinine levels and BMI SDS were significantly linked to changes in syndecan-1 levels. Conclusions: Syndecan-1 is elevated in obese children due to inflammation and may serve as an early biomarker for endothelial damage. It can be useful in detecting obesity-related renal damage and cardiovascular risk in children.

Preventing Complications in Children: Blood Transfusions in Pediatric HIV Management

Children living with HIV face unique challenges that significantly impact their health and development, with anemia being one of the most prevalent complications. Blood transfusions have emerged as a vital therapeutic intervention for managing anemia in pediatric HIV patients, providing immediate correction of hemoglobin levels and alleviating debilitating symptoms. This review explores the role of blood transfusions in preventing complications associated with HIV, emphasizing their importance in improving health outcomes and enhancing the quality of life for affected children. The mechanisms through which blood transfusions confer benefits include enhanced oxygen delivery to tissues, improved immune function, and support for growth and development. Clinical evidence highlights the effectiveness of transfusions in reducing hospitalization rates and promoting adherence to antiretroviral therapy (ART). Furthermore, integrating blood transfusions into comprehensive care models fosters a multidisciplinary approach that addresses the medical, nutritional, and psychosocial needs of pediatric patients, ensuring a holistic management strategy. Keywords: Pediatrics, HIV, blood transfusions, anemia, immune function, HIV management

Diagnostic Biomarkers of Microvascular Complications in Children and Adolescents with Type 1 Diabetes Mellitus-An Updated Review.

Type 1 diabetes mellitus (T1DM) is regarded as the most chronic autoimmune disease affecting children and adolescents that results from a destruction of pancreatic β-cell and leads to insulin insufficiency and persistent hyperglycemia (HG). Children and adolescents with T1DM are at an increased risk of developing microvascular complications, including diabetic nephropathy (DNE), diabetic retinopathy (DR), and diabetic neuropathy (DNU). The risk factors and prevalence of these complications differ greatly in pediatric studies. Screening for T1DM microvascular complications undergoes different stages and it is recommended to identify early symptoms and clinical signs. The identification of biomarkers in T1DM microvascular complications is needed to provide optimal treatment. Despite several studies on early biomarkers for DNE in children, the potential biomarkers for predicting DR and DNU have not been completely illustrated. This review fills this gap by identifying biomarkers of T1DM microvascular complications in children and adolescents through searches in the PubMed/Medline database.

Early Detection of Renal Complication in Children With Sickle Cell Disease: A Single Center Prospective Study.

This observational cross-sectional study aimed to identify predictors of renal complications in pediatric patients with sickle cell disease (SCD) at King Salman Armed Forces Hospital, Tabuk, Saudi Arabia, over six months from February 2023 to July 2023. The study evaluated microalbuminuria as an early indicator of renal injury and explored its correlations with clinical and laboratory parameters and abdominal ultrasound (US) findings. Included were pediatric patients aged 1 to 14 years with confirmed SCD, excluding those with acute infections or pre-existing renal diseases. Data from 100 patients' electronic medical records were analyzed using IBM SPSS Statistics for Windows, Version 26 (Released 2019; IBM Corp., Armonk, New York, United States), with a significance set at p ≤ 0.05. The mean age was 7.6 ± 3.3 years, with 51 males and 49 females; 11 were diagnosed with Hb-S-beta thalassemia. Hydroxyurea (HU) compliance was high, with only four non-compliant patients, though all took folic acid. Among 42 tested for albuminuria, all had negative results (<30 mg/g creatinine). A significant association was found between SCD diagnosis and kidney, ureter, and bladder (KUB) US results (p=0.008), with abnormal KUB findings more prevalent in the Hb-S-beta thalassemia group. Patients with abnormal KUB results had significantly lower mean weight (p=0.024). Additionally, Hb-S-beta thalassemia patients had lower mean weight than hemoglobin SS (HGSS) patients (p=0.04). Though not statistically significant, Hb-S-beta thalassemia patients had higher mean systolic blood pressure (p=0.053). Significant associations were identified between SCD diagnosis type and renal US results, with lower body weight emerging as a potential predictor of renal complications. High HU compliance and its impact on renal outcomes warrant further investigation. Routine monitoring of microalbuminuria and KUB US may aid early detection of renal complications in pediatric SCD patients. Further studies with larger sample sizes are recommended to validate these findings and develop comprehensive renal protective strategies.

357-OR: Association between Continuous Glucose Monitoring and Diabetes-Related Complications in Children with Type 1 Diabetes—Nationwide Cohort Study

357-OR: Association between Continuous Glucose Monitoring and Diabetes-Related Complications in Children with Type 1 Diabetes—Nationwide Cohort Study

Early Detection of Anterior Segment Visual Complications in Pediatrics with Type 1 Diabetes Mellitus

Background: Evaluation of the Prevalence and Types of Ocular Complications in Children and Adolescents with Type 1 Diabetes Mellitus (T1DM) Methods: In this cross-sectional study, 76 previously diagnosed diabetic children were selected. The patients' T1DM was monitored using glycated hemoglobin (HbA1C), and an ophthalmologist conducted anterior corneal examinations. Visual acuity levels were assessed by an optometrist. Pupillary dilation was achieved using 1% Tropicamide ophthalmic drops prior to the slit-lamp examination of the anterior segment of both eyes. Results: With an average age of 12.04 ± 3.7 years and average HbA1C levels of 10.24 ± 2.47%, the most common visual complication observed was posterior capsule opacification in 19 patients (24.9%). This was followed by refractive errors (10.5%), amblyopia (2.7%), pseudophakia, and cataract (1.4% for each). A total of 27 patients (35.5%) exhibited visual complications. Age and the duration of diabetes were significantly associated with the overall presence of visual complications and posterior capsular opacification, but not significantly related to other types of ocular complications. Conclusions: Given the prevalence and distribution of visual complications in T1DM, particularly posterior capsule opacification, we suggest a routine screening examination of the anterior segment of the eye in these patients.

Erratum: Role of Interventional Radiology in the Management of Liver Transplant Complications in Children

Erratum: Role of Interventional Radiology in the Management of Liver Transplant Complications in Children

Role of Interventional Radiology in the Management of Liver Transplant Complications in Children

AbstractLiver transplantation (LT) is a common solid organ transplant in the pediatric population. The common indications for LT, as well as its complications, differ between adults and children. This difference necessitates unique pediatric interventional radiology (IR) interventions. This article focuses on unique vascular complications occurring post-pediatric LT and highlights the importance of IR in their management. It explores IR's involvement in the workup of patients' pre-LT and management of complications following portosystemic shunts. We discuss advantages and disadvantages of different access routes as well as the prevalence, clinical picture, diagnosis, and management of complications after pediatric LT. These complications encompass portal vein stenosis, portal vein thrombosis, hepatic artery stenosis, hepatic artery thrombosis, hepatic artery pseudoaneurysm, arterioportal fistula, hepatic vein stenosis, and inferior vena cava stenosis. The choice of endovascular technique for a clinical indication depends on vascular anatomy, time since LT, and patient-specific factors. Transsplenic access is a useful alternative to transhepatic or transjugular access. The decision to place a stent in a child is influenced by the expected growth of the child and risk of focal narrowing at stent edge (because of recipient growth). Technical challenges in pediatric patient management, including uncooperative patients and sedation issues, must be considered. Pediatric LT complications can present with significant challenges in the posttransplant care of recipients and may lead to serious morbidity and graft failure if not managed effectively. IR techniques like balloon angioplasty, stent placement, thrombolysis, and embolization have demonstrated success in treating these complications, improving patient outcomes, and reducing long-term morbidity and mortality. By enhancing the understanding of medical practitioners and interventional radiologists about complex vascular complications, this article aims to contribute to better posttransplant care and improved outcomes for LT in pediatric populations. Continued collaboration between specialties and research will advance the field of pediatric LT and IR, to create even more effective treatment strategies.

Comparison of the Clinical Utility of Two Insulin Resistance Indices: IRI-HOMA and IRI-Belfiore in Diagnosing Insulin Resistance and Metabolic Complications in Children Based on the Results Obtained for the Polish Population.

Background: Recognizing insulin resistance (IR) in children remains challenging due to uncertain IRI-HOMA cut-offs and unclear recommendations for evaluating IR based on OGTT. In our study, we compare the effectiveness of IRI-HOMA and IRI-Belfiore (OGTT-based) in detecting IR and its metabolic complications in children. Methods: The analysis included 553 children who were hospitalized at the Department of Endocrinology and Metabolic Diseases of the Polish Mother's Memorial Hospital Research Institute (PMMH-RI) in Lodz, Poland, between 2002 and 2018 due to various reasons-of these, 67.5% were girls. All underwent OGTT for glucose and insulin assessment. IR diagnosis relied on IRI-HOMA and IRI-Belfiore. IR based on IRI-HOMA was evaluated using three criteria: (A) >2.5; (B) >2.67 in boys and >2.22 in girls before puberty and >5.22 and >3.82 during puberty, respectively; (C) >95th percentile according to charts for IRI-HOMA in children. Results: Prepubertal children exhibited significantly lower IRI-HOMA and IRI-Belfiore than their pubertal counterparts (p < 0.00005). IRI-HOMA and IRI-Belfiore values positively correlated with age and BMI SDS value (p < 0.000001 for all calculations). As many as 26% to 46.9% of children with normal IRI-HOMA showed elevated IRI-Belfiore, with notably higher levels of triglycerides, a lower HDL cholesterol fraction, and a lower HDL/total cholesterol ratio in this subgroup. Conclusions: A notable proportion of children exhibited elevated IRI-Belfiore levels despite having normal IRI-HOMA values. This suggests the possibility of peripheral IR preceding hepatic IR in children-omitting an OGTT may therefore lead to overlooking cases of IR. Children diagnosed with IR via OGTT displayed significantly poorer lipid profiles compared to those without IR (characterized by normal values in both IRI-HOMA and IRI-Belfiore). This underscores the ability of OGTT-derived IR indices to identify individuals at risk of developing complications associated with obesity and IR before the onset of metabolic syndrome (MS) symptoms. If IR is already detected in children based on fasting glucose and insulin levels (IRI-HOMA), further evaluation may not be warranted, as OGTT results often simply confirm the diagnosis.

Malaria Parasitemia and Severe Health Complications in Children Under Five Years of Age in Nigeria: A Study Using the Demographic and Health Survey (DHS) Malaria Indicator Survey (MIS) 2021.

In Nigeria, 97% of the population is at risk of contracting malaria. It is transmitted by female Anopheles mosquitoes carrying the Plasmodium parasite and can be lethal. An estimated 55 million illnesses and 80,000 deaths per year result from it. Children under five are more likely to contract malaria. Efforts to control malaria in Nigeria include indoor residual spraying, insecticide-treated bed nets, and quick detection and treatment of confirmed cases with effective antimalarial medications. These attempts have been impeded by limited healthcare access, poor financing, and drug-resistant parasites. Thus, the study of therelationship between malaria complications and housing for children under five is essential. The Demographic and Health Survey (DHS) Malaria Indicator Survey (MIS) 2021, a nationally representative data set from developing countries on population and health, was used for this study. A sample size of 13,727 was employed (n=13,727). Logistic regression analyses were conducted to test the association between the type of place of residence and malaria complications (outcome). Overall, 4.2% (n=570, weight HV005) of participants in the sample reported malaria complications. The results of the logistic regression revealed that children residing in urban settlements (aOR 0.37, 95% CI 0.37-0.37, p-value <0.001), children from the poorest class families (aOR 11.63, 95% CI 1.62-1.63, p-value 0.004), children from poorer class families (aOR 7.56, 95% CI 7.55-7.57, p-value <0.001), children from middle-class families (aOR 4.05, 95% CI 4.03-9.06, p-value <0.001), children from richer class families (aOR 1.22, 95% CI 2.21-2.23, p-value <0.001), children of mothers with primary education (aOR 0.42, 95% CI 2.32-4.112, p-value 0.001), children of mothers with secondary education (aOR 0.24, 95% CI 3.21-3.22, p-value <0.001), children of mothers with higher education (aOR 0.08, 95% CI 0.72-0.80, p-value <0.001), and children of the female gender (aOR 0.65, 95% CI 0.65-0.66, p-value <0.001) are all associated with severe malaria complications. In conclusion, the study examined malaria complications in Nigerian children under five by residency. The findings imply that rural children are more likely to have serious malaria complications than urban children. This emphasizes the necessity for targeted malaria therapies in rural areas with limited healthcare access.

Treatment-related Complications in Children with Cancer.

Treatment-related Complications in Children with Cancer.

Klotho G-395A Gene Polymorphism: Impact on Progression of End-Stage Renal Disease and Development of Cardiovascular Complications in Children on Dialysis

Klotho G-395A Gene Polymorphism: Impact on Progression of End-Stage Renal Disease and Development of Cardiovascular Complications in Children on Dialysis

Respiratory Complications in Children with Cerebral Palsy

Respiratory Complications in Children with Cerebral Palsy

Evaluation of Serum Advanced Glycation End Product Levels and Microvascular Complications in Children and Adolescents with Type 1 Diabetes Mellitus.

Advanced glycation end products (AGEs) are irreversible macromolecules formed by nonenzymatic reactions due to chronic hyperglycemia. The aim of this study was to assess the relationship between AGEs and the microvascular complications of children and adolescents with type 1 diabetes mellitus (T1DM). Twenty-six T1DM patients with microvascular complications and 58 complication-naive patients who were similar regarding age, sex, and pubertal status enrolled in the study. Anthropometric, biochemical, ophthalmologic, and neurologic variables were compared with serum AGEs levels by the fluorescence method. There was no significant difference observed between the patients with complications and those without complications in terms of serum levels of AGEs and other biochemical parameters. However, the duration of T1DM and urine microalbumin-creatinine ratio (uACR) were significantly higher in the complication-positive group (P < .001). Serum levels of AGEs were found to be similar when retinopathy, peripheral, and optic neuropathy were separately compared with the complication-naive group (P > .05). However, patients with nephropathy had significantly higher serum levels of AGEs than patients without complications (P = .023). In addition, there was a significant positive correlation between serum AGEs levels and uACR (P = .042) but not other parameters (P > .05). This study is the first to evaluate the association between serum AGEs levels and microvascular complications in children and adolescents with T1DM. Our study highlights that serum AGEs levels are significantly correlated with nephropathy but not with retinopathy and neuropathy. Further long-term studies with a larger sample size are required to establish a better relationship between diabetic complications and AGEs. Cite this article as: Kırkgöz T, Acar S, Küme T, et al. Evaluation of serum advanced glycation end product levels and microvascular complications in children and adolescents with type 1 diabetes mellitus. Turk Arch Pediatr. 2024;59(1):31-37.

COVID-19-Associated Neurological Complications in Children.

Neurological manifestations of Severe Acute Respiratory Syndrome coronavirus-2 have been well documented in adults during and after infection with the virus as well as after vaccination. The incidence of severe neurological symptoms among children is very low. This study aimed to analyze the varied neurological manifestations after COVID-19 infection among children and give a report on a single-center experience with these severe neurological symptoms. Case records of patients less than 18 years admitted between July 2021 to December 2022 with neurological manifestations and COVID-19 infection or with elevated COVID-19 antibodies after exclusion of other etiological diagnosis were analyzed. There were 10 cases in the age range of 1-15 years. All the cases had elevated COVID-19 antibodies with history of contact 2-3 weeks prior except one who was positive for COVID-19 infection. Two cases presented with acute ascending paralysis suggestive of Guillain-Barre syndrome. Four cases presented with features of encephalopathy with clinical presentation fulfilling the criteria of Multisystem inflammatory syndrome in children. One case presented with fever and focal seizures with MRI showing sagittal sinus thrombosis, and one presented with fever and altered sensorium with MRI showing leukoencephalopathy. One child had cerebral mucormycosis without any evidence of immunosuppression. There was one child with features of encephalopathy with active COVID-19 infection. The varied presentation highlights the central and peripheral nervous system involvement by the virus in the pediatric population. It also emphasizes the need to investigate for COVID-19 in children presenting with these complaints during the pandemic.

Neurological Complications in Children With Cancer: Experience From a Single Center in Türkiye

Neurological Complications in Children With Cancer: Experience From a Single Center in Türkiye

Carotid Intima-Media Thickness and Metabolic Complications in Children with HIV on Antiretroviral Therapy: A Cross-Sectional Study.

To evaluate carotid intima media thickness (CIMT) in children with Human immunodeficiency virus (HIV) on anti-retroviral therapy (ART) and in controls. Also, to compare body mass index (BMI), body fat percentage, skin-fold thickness (SFT), waist-to-height ratio (WHtR), lipid profile, blood pressure, lipodystrophy syndrome (LDS), non-alcoholic fatty liver disease (NAFLD) in children with HIV and in controls and to determine association between lipid profile, LDS, liver amino-transferases, NAFLD, BMI, body fat percentage, SFT, WHtR and CIMT. This cross-sectional study was done in 7 to 12 y old children attending the ART clinic and receiving ART for ≥6 mo according to 2018 National Aids Control Organization (NACO) guidelines. Thirty age and gender matched controls were enrolled from the pediatrics OPD. Weight, height, BMI, waist circumference, skin fold thickness and blood pressure were recorded. Lipid profile,liver amino-transferases, USG abdomen and CIMT were done with prior appointment. The present study had 43% females and 57% males (mean age of 9.33 ± 1.65 y). All cases were on combination ART (mean treatment duration: 59.1 mo). CIMT was significantly increased in cases as compared to controls 0.481 ± 0.087mm vs. 0.418 ± 0.072mm (p = 0.003). However, CIMT did not correlate with any other parameter. Cases had significantly higher body fat percentage (17% vs. 13.15%), systolic blood pressure (SBP), SFT, total cholesterol (TC) and low density lipoprotein- cholesterol (LDL-C) as compared to controls. NAFLD was seen in 3 cases (1%), lipohypertrophy in 7 (23%) cases and 5 (16%) controls. Children with HIV on ART have significantly higher CIMT and increased metabolic abnormalities.