Parental Counseling Research Articles

Giant encephalocele in newborns: prenatal diagnosis, management and outcome.

A giant encephalocele associated with Chiari malformation is a rare congenital anomaly from a cephalad neural tube defect. Early prenatal diagnosis and parental counseling are essential; as early surgical intervention can improve outcomes. Between 2010 and 2023, twenty-seven newborns out of 43,815 delivered at our institution were diagnosed with encephaloceles, including seven cases of giant encephalocele associated with Chiari malformation type III. These seven cases were included in the study, and their medical records were reviewed retrospectively to assess clinical, radiological, surgical, and postoperative follow-up data. Seven newborns with giant occipital encephalocele and Chiari malformation type III were treated at our institution, including five females and two males. All cases were diagnosed prenatally via ultrasound, and none of the mothers had taken folic acid regularly. Six infants underwent surgical resection with duroplasty within 48 h, achieving good outcomes. The seventh infant, with respiratory difficulties, hypotonia, and large ventricular septal defect(VSD), was unfit for surgery and passed away at two weeks. Long-term follow-up up to 24 months showed all surviving infants met developmental milestones, though mild delays in walking, speech, and unsteady gait were noted. Giant encephalocele with Chiari malformation is a rare condition that requires a multidisciplinary approach for effective management. Unlike smaller encephaloceles, giant ones may have a better prognosis due to the large volume of cerebrospinal fluid (CSF) in the herniated sac, which helps prevent further neural tissue herniation. Prenatal diagnosis is essential, and folic acid supplementation should be encouraged. Early surgical intervention is crucial for optimal outcomes.

Revisiting the Neuropsychological and Clinical Profile of Mosaic Turner Syndrome With a Ring X Chromosome.

Determining karyotype-phenotype correlations for individuals with Turner syndrome ("TS individuals") is a longstanding research endeavor. The limited literature on Turner syndrome (TS) with a ring X chromosome hinders counseling about the neuropsychological and clinical features. To further characterize these phenotypes, we compared 27 TS individuals with 46,X,r(X)/45,X ("ring X") to 50 non-mosaic 45,X, and 27 mosaic 45,X/46,XX ("mosaic 45,X") individuals. This retrospective cohort study of 104 individuals reported on cardiac and renal malformations, endocrine and neuropsychological conditions, and applied contemporary terminology in a nuanced framework to assess intellectual developmental disorder (IDD). We noted an increased IDD risk for TS individuals with ring X compared to mosaic 45,X and non-mosaic 45,X, though at a lower frequency (26%, 6 of 23) than previously reported. Across karyotypes, 49% (16 of 33) of TS individuals with neuropsychological evaluations had a diagnosis of other specified neurodevelopmental disorder due to TS. In TS individuals with ring X, there was an increased risk for hypothyroidism, whereas bicuspid aortic valve and horseshoe kidney were less frequent compared to other karyotypes. These results add to the limited literature on TS individuals with ring X and can inform the counseling of TS individuals, caregivers, and expectant parents.

Lessons Learned from a Quality Improvement Initiative to Increase COVID-19 Vaccination in Hospitalized Children.

Pediatric coronavirus disease 2019 (COVID-19) vaccination rates in the United States remain lower compared with adults. We aimed to (1) implement a quality improvement initiative to increase COVID-19 vaccination 2-fold in hospitalized patients 12-21 years of age from 4.7% during the baseline period (August 10, 2021-November 1, 2021) to 9.4% during the intervention phase (November 2, 2021-March 31, 2023) and (2) assess the importance of existing interventions and obtain feedback for future interventions to increase COVID-19 vaccination via a provider survey. We conducted the quality improvement initiative in the inpatient units of a freestanding children's hospital. Interventions included provider education, electronic medical record best practice alerts, monthly competition, parental counseling to increase vaccine acceptance, and ensuring vaccine availability. The primary outcome measure was the percentage of hospitalized patients 12-21 years of age who received COVID-19 vaccine. Providers addressing COVID-19 vaccination with patients, as documented by COVID-19-specific problem lists, were a process measure. Length of stay was a balancing measure. Although COVID-19 vaccination increased 1.6-fold during the initial 5 months of interventions, the interrupted time series analysis did not show a significant impact of our interventions on vaccination. Documentation of COVID-19 vaccine-specific problem lists increased 1.9-fold during most of the intervention period. There was no significant (P = 0.61) difference in length of stay between children in the baseline and intervention groups. Despite our best efforts, we could not increase the number of COVID-19 vaccinations in our patients. Lessons learned suggest that creating a nurse-driven COVID-19 vaccine screening/ordering protocol and integrating COVID-19/influenza vaccination annually during influenza season can potentially increase vaccination rates, but further research is required.

Prediction of perinatal mortality in early-onset fetal growth restriction: A post hoc analysis of the Dutch STRIDER trial to predict perinatal mortality in early-onset fetal growth restriction

ObjectiveEarly-onset fetal growth restriction affects about 0.3% of pregnancies, posing high perinatal risks due to placental insufficiency. Early-onset fetal growth restriction often coincides with early-onset pre-eclampsia, associated with significant mortality and morbidity. Clinical management varies among clinicians, with emphasis on intensive monitoring and timely delivery. Our objective was to improve clinical prediction of perinatal mortality in early-onset fetal growth restriction for parental counseling. Study designThis was a secondary analysis of prospective cohort data from the Dutch STRIDER trial. The study included 215 pregnant women diagnosed with severe early-onset fetal growth restriction between 20 + 0 and 29 + 6 weeks of gestation, from tertiary and secondary antenatal care centers in The Netherlands. Maternal and fetal characteristics were collected at inclusion, including sonographic and laboratory measurements. Analysis was performed using univariable and multivariable binary logistic regression to create a prediction model for perinatal mortality. The main outcome measures were fetal demise and neonatal mortality up to discharge. Results215 Participants were included for this analysis. Perinatal mortality occurred in 84 (39 %) cases; 51 (24 %) were fetal and 33 (15 %) neonatal. Fetal abdominal circumference, gestational age at diagnosis, estimated fetal weight Multiple of Median, absent or reversed end-diastolic flow of the umbilical artery, umbilical artery pulsatility index Multiple of Median, non-Caucasian ethnicity, male sex, placental growth factor level and uterine artery pulsatility index were independent predictors of perinatal mortality. Randomization allocation (sildenafil or placebo) had no predictive value for mortality. The prediction model including gestational age at diagnosis, estimated fetal weight Multiple of Median and umbilical artery pulsatility index Multiple of Median showed an area under the receiver operating characteristic curve of 0.840 (P < 0.01). Placental growth factor was measured in a subset of patients and was an independent prognostic factor and performed significantly better within the predictive model, however it did not improve the predictive value of the model. ConclusionsPrediction of perinatal mortality in early-onset fetal growth restriction is feasible with commonly available tests and measurements and could support decision making in management of pregnancy. However, implementation in practice requires further studies.

Evaluation of the ETV success score and its predictive value in pediatric occlusive hydrocephalus: implications for patient counseling

IntroductionEndoscopic Third Ventriculostomy (ETV) is a well-established treatment for pediatric hydrocephalus, particularly in cases of aqueductal stenosis. The ETV Success Score (ETVSS) is a predictive tool widely used to estimate the likelihood of ETV success based on factors like age. Its accuracy, especially in infants under 3 months, is still debated.Patients and methodsThis study evaluates the age-dependency of ETV success in 54 pediatric patients compared to ETVSS predictions. Patients were divided into age and pathology groups according to Kulkarni. Success was defined according the ETVSS criteria. Minimum follow-up was 12 months and included MRI to demonstrate a flow void at the floor or the third ventricle.ResultsOur institutional data revealed a higher overall success rate SR (88%) compared to the ETVSS-predicted rate of 73%. Despite small numbers within subgroups, especially in very young children < 1 month, the success rate was higher than predicted by ETVSS.DiscussionOur results show significantly higher actual SR across all age groups compared to ETVSS predictions (p = 0.035) when selected and performed by an experienced physician. The age groups > 1 year had significantly higher SR close to 100% (p < 0.0001 and p = 0.0038, respectively). This suggests that ETV may be underutilized, particularly in infants, where predicted success rates are pessimistic.ConclusionETVSS is a useful tool for counseling of parents, but differences in institution-specific outcomes should not be neglected. Depending on that, physicians might opt in favor of ETV as primary treatment in occlusive hydrocephalus of very young children, counterbalancing risks and sequalae of VP-shunting.

Would Neonatal Healthcare Professionals Disclose Personal Opinions When Counseling Parents About Value-laden Decisions?

To explore the attitudes of neonatal healthcare professionals towards disclosing personal opinions when counseling parents about value-laden decisions using scripted video animations, with a view to comparing these later with the attitudes of parents of preterm infants. An exploratory study was conducted during the 5th Annual Meeting of the Joint European Neonatal Societies in Rome. Data were collected via a web-based survey during a live session. Two scripted video animations were presented and discussed, one with and one without disclosure of the physician's personal opinion. Sixty-nine healthcare professionals from 19 countries were enrolled. Forty-seven (68.1%) respondents stated that disclosing personal opinions would "unduly influence" the parents' decision-making process. Thirty-seven (53.6%) participants would not have given their personal opinion in the case presented, and 45 (65.2%) participants stated that disclosure of the physician's personal opinion would result in parents being less prepared for decision-making. Discussions were dominated by underlying values and culture rather than the process of sharing opinions. The study provides new insights into the opinions of healthcare professionals on the disclosure of personal opinions when making difficult treatment decisions, but further research may require a more nuanced approach in different scenarios. Further research with a larger sample and different scenarios is needed to explore in more depth healthcare professionals' and parents' attitudes of autonomous decision-making.

Short-term postoperative complications in preterm neonates with surgical necrotizing enterocolitis: a multicenter retrospective cohort study.

Over half of preterm neonates with necrotizing enterocolitis (NEC) require surgery, making it essential to understand short-term postoperative outcomes and complication rates. Therefore, this study aimed to provide an overview of 30-day postoperative complications for NEC. Secondary, risk factors for minor and major short-term postoperative complications were identified. This retrospective study included all preterm infants (GA < 35w) surgically treated for NEC from 2008 to 2022. Postoperative complications were scored following the Clavien-Madadi classification. Risk factors were analyzed using multivariable logistic regression analysis. In this cohort of 326 patients, 204 received a stoma, 80 had a primary anastomosis, and 32 had both. Postoperative mortality was 19.0%. In total, 186 patients experienced 238 complications (57.1%), including 118 (63.4%) major and 68 (36.6%) minor complications. Most common complications were sepsis (19.4%), stoma-related (13.3%), and wound dehiscence (11.3%). Cardiovascular support between NEC diagnosis and surgery was a significant risk factor for major complications (OR: 1.92, 95%-CI 1.19-3.08, p = 0.007) and stoma creation for minor complications (OR: 6.73, 95%-CI 2.05-22.05, p = 0.002). This study showed a postoperative complication rate of 57.1%. We found cardiovascular support between NEC diagnosis and surgery as risk factor for major complications and stoma creation as risk factor for minor complications. These findings provide valuable insights for improving parental counseling on NEC outcomes. II.

Структура феномена социально-психологического благополучия личности детей: концептуальные представления и результаты эмпирического исследования

This study is relevant because socio-psychological well-being of children is rarely researched due to the difficulty in identifying its indicators, which vary at different stages of primary socialization. A partial solution to this problem is feasible if the concept of “socio-psychological well-being” is developed and its operationalization and psychometric verification of the model on a specific age sample are conducted. The aim of this study is to carry out a psychometric verification of the structure of socio-psychological well-being. Hypothesis: There is a correlation between the indicators of the three components of socio-psychological well-being of a personality (SPWBP). All indicators of the “self-attitude” component are positively correlated with all indicators of the other two components of SPWBP; however, not all indicators of the components “relationships with significant others” and “agency” are correlated. Participants: 116 children aged from 5.5 to 7 years (M = 6.1; SD = 0.40), with 50% being males; all residing in Moscow. Methods (tools): The study employed several methodologies, including “Typology of the Subject Regulation of the Child” (S. V. Khusainova, G. S. Prygin) and the projective technique “Draw a Story” (R. Silver) for assessing the empirical referents of “self-attitude”; “Secret” (T. A. Repina), “The family in the Representations of Children” (T. V. Drobysheva, I. N. Mikieva), “Drawing a Family,” as well as clarifying conversation for evaluating “relationships with others”; “Peculiarities of the Manifestation of the Will of Preschoolers” (R. M. Gevorkyan) for measuring indicators of “agency.” Additionally, a questionnaire collected the socio-demographic data of the children. Results: The concept and structure of children’s SPWBP were formulated based on theoretical analysis. The hypothesis suggesting a three-component structure of SPWBP has been empirically confirmed, and a high consistency of SPWBP indicators within each of the components has been established. Conclusions: Self–attitude is fundamental in the structure of SPWBP, linking the other two components: “agency” and “relationships with significant others.” Respondents’ level of satisfaction with their relationships with others depends on the consistency of their self-assessments and the modality of their self-attitude. A positive self-attitude stimulates agency in children (their ability to show initiative, independence and endurance in interaction with peers). Practical Significance: The research findings can inform psychological assessments for children, educational practices, and parental counseling.

Three-Dimensional Ultrasound for Physical and Virtual Fetal Heart Models: Current Status and Future Perspectives.

Congenital heart defects (CHDs) are the most common congenital defect, occurring in approximately 1 in 100 live births and being a leading cause of perinatal morbidity and mortality. Of note, approximately 25% of these defects are classified as critical, requiring immediate postnatal care by pediatric cardiology and neonatal cardiac surgery teams. Consequently, early and accurate diagnosis of CHD is key to proper prenatal and postnatal monitoring in a tertiary care setting. In this scenario, fetal echocardiography is considered the gold standard imaging ultrasound method for the diagnosis of CHD. However, the availability of this examination in clinical practice remains limited due to the need for a qualified specialist in pediatric cardiology. Moreover, in light of the relatively low prevalence of CHD among at-risk populations (approximately 10%), ultrasound cardiac screening for potential cardiac anomalies during routine second-trimester obstetric ultrasound scans represents a pivotal aspect of diagnosing CHD. In order to maximize the accuracy of CHD diagnoses, the views of the ventricular outflow tract and the superior mediastinum were added to the four-chamber view of the fetal heart for routine ultrasound screening according to international guidelines. In this context, four-dimensional spatio-temporal image correlation software (STIC) was developed in the early 2000s. Some of the advantages of STIC in fetal cardiac evaluation include the enrichment of anatomical details of fetal cardiac images in the absence of the pregnant woman and the ability to send volumes for analysis by an expert in fetal cardiology by an internet link. Sequentially, new technologies have been developed, such as fetal intelligent navigation echocardiography (FINE), also known as "5D heart", in which the nine fetal cardiac views recommended during a fetal echocardiogram are automatically generated from the acquisition of a cardiac volume. Furthermore, artificial intelligence (AI) has recently emerged as a promising technological innovation, offering the potential to warn of possible cardiac anomalies and thus increase the ability of non-cardiology specialists to diagnose CHD. In the early 2010s, the advent of 3D reconstruction software combined with high-definition printers enabled the virtual and 3D physical reconstruction of the fetal heart. The 3D physical models may improve parental counseling of fetal CHD, maternal-fetal interaction in cases of blind pregnant women, and interactive discussions among multidisciplinary health teams. In addition, the 3D physical and virtual models can be an useful tool for teaching cardiovascular anatomy and to optimize surgical planning, enabling simulation rooms for surgical procedures. Therefore, in this review, the authors discuss advanced image technologies that may optimize prenatal diagnoses of CHDs.

Youth Violence in Urban Ethiopia: Forms, Risk Factors and Preventive Mechanisms in Hawassa and Shashemene Cities

Youth violence negatively impacts physical, emotional, and social well-being, hindering development, decision-making, learning, and relationships. Holistic and interdisciplinary approaches are needed to mitigate this issue. This research aims to investigate forms, risk factors, and preventive mechanisms of youth violence in Hawassa and Shashemene cities. The research utilized a cross-sectional descriptive design with a mixed-method approach. The study included 400 survey respondents, 16 focus group discussants across two sessions, and 7 in-depth interviewees. As the findings reveal, youth involvement in violence spans from perpetration to victimization. Among the total respondents, 289 self-reported that they have perpetrated various forms of physical, verbal, sexual, economic, and media violence within the past 12 months. The primary reported risk factors for youth violence include attitudes that condone violence (64.25%), insufficient parental control (59%), elevated rates of unemployment (67.25%), and a fragile rule of law (81.25%), which respectively represent the leading factor from the individual, relational, community, and societal risk domains as per the social-ecological model. The findings indicate that institutional and community-based efforts to address and mitigate the issue remain in their early stages. The study areas lack nearly all essential elements of youth violence prevention and intervention programs. The study concludes that youth violence is a more visible issue that affects both society and the youth in the study areas. Without preventive efforts, the highlighted risk factors may further increase the likelihood of youth engagement in violence. Thus, the study recommends the establishment of integrated and inclusive programs and strategies to effectively address the problem such as community awareness campaigns, parental counselling services, school-based interventions, and strengthening the capacity of relevant institutions among others

Steroid-Induced Psychosis in a Child With Nephrotic Syndrome Secondary to Focal Segmental Glomerulosclerosis: A Case Report.

Corticosteroid-induced psychosis is rare and less reported in children compared to adults. However, psychosis is considered a severe adverse effect of corticosteroids in pediatric nephrotic syndrome. Steroid-induced psychosis is dose-dependent and should be treated by tapering the dose of steroids and usually initiating an atypical antipsychotic. A 13-year-old male child presented to the pediatrics outpatient department with complaints of anxiety, fearfulness, and seeing images of an old man crawling into his room and threatening to strangle him with a red rope, which led to decreased sleep. He was initiated on oral prednisolone 3 weeks ago after being diagnosed with nephrotic syndrome. A diagnosis of steroid-induced psychosis was made, and he was tapered on steroids over 6 weeks. He was then initiated on tacrolimus, quetiapine, and lorazepam and was discharged after a week. At follow-up in 4 weeks, his psychosis had resolved, and nephrotic syndrome was found to improve. Children on steroids should be closely monitored for psychotic symptoms over a prolonged duration. Although tapering the dose of steroids is the gold standard treatment of steroid-induced psychosis, cases like nephrotic syndrome demand the continuous use of an immunosuppressant. In such cases, tacrolimus has been found to be an effective alternative, although continuous monitoring for nephrotoxicity is necessary. Similarly, atypical antipsychotics (like quetiapine) are preferred for psychosis because of their lesser risk for extrapyramidal side effects compared to typicals. Parental counseling and informed consent are utmost for children on steroids or tacrolimus.

Recurrence Risks in Congenital Anomalies: A Comprehensive Guide for Parental Counseling

Congenital anomalies present significant health challenges globally, affecting millions of children and contributing to mortality, morbidity, and disability. The immediate health needs of a fetus/neonate diagnosed with a congenital anomaly can overshadow discussions about future reproductive risks. This review explores the broad landscape of recurrence risks in common congenital anomalies and summarizes the implications for parental counseling.

Perceptions of Teaching Staff Regarding Time Management in Making Students' Learning More Efficient

Focusing on time management is essential to making student learning worthwhile. Rigorous time management allows students to discover more controlled than task and activities or activities or daily. Our study aims to investigate teachers' perceptions of managing students' learning time, both in and out of the classroom. Knowing that time management is based on three pillars, namely: planning, organization, and the results of the study highlight the need for students to learn time management with an emphasis on: learning to set priorities, self-monitoring/self-responsibility. management according to a set schedule, the daily distribution of learning times and free time according to one's own needs. At the same time, it is necessary to involve teachers in the formation of effective time management skills and abilities in their students, in order to avoid procrastination. At the same time, the counseling of parents by teachers on the proper management of their children's learning and leisure time is a necessity to make learning more efficient for school-age children.

Mirror hand and its management: a case report

BackgroundMirror hand is a rare congenital anomaly. Most of these cases are sporadic and associated with defective sonic hedgehog during embryogenesis. In this report, we present the case of a child with this rare congenital anomaly and its management.Case presentationA 2.5-year-old Asian female child presented with left-sided Al Qattan type 1A ulnar dimelia with restriction of wrist and elbow range of motion. Radiological examination revealed duplication of ulna with polydactyly. Management of mirror hand is a great surgical challenge, so preoperative planning and staged management is essential for the functional outcome of this condition. We successfully achieved fine and gross motor skills of the hand with acceptable cosmetic results at 2 years of follow-up.ConclusionIt is crucial to remember that early intervention, ideally between 18 and 24 months of age, is key for optimal functional outcomes. Meticulous preoperative planning and surgical technique are essential. Long-term follow-up and parental counseling about the need for supervised physical therapy are important for managing secondary deformities. Additionally, digital subtraction angiography should be performed to rule out any associated neurovascular malformations.

Fetal Cardiovascular Magnetic Resonance: History, Current Status, and Future Directions.

Fetal cardiovascular magnetic resonance imaging (MRI) has emerged as a complementary modality for prenatal imaging in suspected congenital heart disease. Ongoing technical improvements extend the potential clinical value of fetal cardiovascular MRI. Ascertaining equivocal prenatal diagnostics obtained with ultrasonography allows for appropriate parental counseling and planning of postnatal surgery. This work summarizes current acquisition techniques and clinical applications of fetal cardiovascular MRI in the prenatal diagnosis and follow-up of fetuses with congenital heart disease. LEVEL OF EVIDENCE: 3 TECHNICAL EFFICACY: Stage 3.

Long-term Gastrointestinal Sequelae in Children who Underwent Pyloromyotomy for Infantile Hypertrophic Pyloric Stenosis

AimPyloromyotomy, the treatment for infantile hypertrophic pyloric stenosis (IHPS), is a procedure with a low risk of short-term complications and quick recovery. However, at a later age, some children report gastrointestinal (GI) symptoms and recently we described a fatal case of adhesive small bowel obstruction years after pyloromyotomy. Therefore, the aim of this study was to evaluate long-term gastrointestinal sequelae of pyloromyotomy. MethodsAll children who underwent open or laparoscopic pyloromyotomy between 2007 and 2017 (n = 450), were invited to complete a questionnaire, which included the Pediatric Quality of Life Inventory™ Gastrointestinal symptoms module (PedsQL™ GI Module). Outcomes were compared to published healthy controls (n = 587) and between surgical approach by using an unpaired t-test. ResultsIn total, 199 respondents completed the questionnaire. The majority (n = 172, 86.4 %) was male with a mean age of 11.4 (±3.1) years. Laparoscopic pyloromyotomy was performed in 104 children (52.3 %) and open pyloromyotomy in 95 (47.7 %). The PedsQL™ GI Module mean total score of all children who underwent pyloromyotomy was 88.6 (±11.0), which is comparable to healthy controls (88.6 (±12.9)). All subtopics were similar for children who underwent pyloromyotomy compared to healthy controls. There were no differences in scores of the PedsQL™ GI module between the open and laparoscopic subgroup. ConclusionsThe scores of the PedsQL™ GI module do not differ between children who underwent pyloromyotomy during infancy and healthy controls. Therefore long-term gastrointestinal sequelae of pyloromyotomy appear to be an exception. This evidence can be used during parental counseling. It also suggests that there is no need for long-term follow-up.

Survival Rate and Short-Term Outcomes of Periviable Preterm Infants: A Single-Center Experience From the United Arab Emirates.

The limit of periviability is constantly changing as infants born at 22-25 weeks of gestation increasingly survive. The data from our region are limited due to the small numbers of these infants among the NICU population. In this study, we evaluated the survival rates and short-term outcomes among preterm neonates between 22 and 24 weeks of gestation admitted to Tawam Hospital, United Arab Emirates. Our retrospective analysis included 100 cohorts of newborns from 22 to 25 weeks of gestation throughout the eight-year period in our level 3 NICU. We evaluated the use and effects of prenatal steroidsand intrapartum antibiotics, in addition to perinatal complications, and examined their outcomes (survival, length of stay, and major morbidities). The survival rate of our periviable neonates was 18% (N = 18/100). Only one 22-week infant out of 32 cases (3%) survived during the study period in 2023. In contrast, the survival rate of infants of 23- and 24-week gestational age was 10% (N = 4/40) and 46% (N = 13/28), respectively. Although our focus in this study was to evaluate the survival of neonates who were born at around the limits of viability, we also reported the short-term outcomes at our single center, including intraventricular hemorrhage (IVH), periventricular leukomalacia (PVL), bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), and necrotizing enterocolitis (NEC). Our data demonstratethat the trend of increasing survival with higher gestational age continues to improve over time. However, there was a significant risk of short-term co-morbidities for those who survived. Further studies are required to have robust data on short and long-term outcomes for this population. The information provided by this study could be essential for counseling parents, enabling them to participate actively in formulating their infants' care plans. It may also help parents and healthcare professionals reach a more informed and collaborative decision regarding active resuscitation and subsequent care plans for these periviable neonates.

Informed consent in assisted reproductive technology: Implications for pediatric clinicians

AbstractAfter conceiving through assisted reproductive technologies (ART), parents may present to their pediatrician with concerns related to their child's neurodevelopment, including whether their child's health may be related to their use of ART. Pediatricians may be unfamiliar with the ART process and what the families endured up to this point, resulting in difficulty counseling parents through these discussions. Before presentation to the pediatrician, parents have undergone extensive evaluation with reproductive endocrinologists. During counseling, the reproductive endocrinologist provides information on maternal and childhood risks associated with ART. However, in this rapidly evolving field, providing comprehensive, patient‐centered, informed consent is increasingly complex and counseling patients properly can be challenging. When parents have gone through the proper informed consent process, and when the pediatrician has an understanding of what this process entails, care of the child can be optimized. In this review, we discuss the complexities of the prenatal informed consent process that parents navigate before presenting to pediatricians. We emphasize the importance of these discussions and highlight ethical principles, as well as emotional, medical, legal, and financial stressors that parents face during ART, with the belief that this understanding will improve the care that pediatricians subsequently provide.

Growth velocity of fetal sacrococcygeal teratoma as predictor of perinatal morbidity and mortality: multicenter study.

To identify prenatal predictors of poor perinatal outcome in fetuses with isolated sacrococcygeal teratoma (SCT). This was a retrospective study of fetuses with isolated (non-syndromic) SCT managed at one of five pediatric surgery and/or fetal medicine centers between January 2007 and December 2017. The primary outcome was the occurrence of poor perinatal outcome, defined as prenatal death (including termination), or neonatal death or severe compromise (hemorrhagic shock). Data regarding prenatal diagnosis (sonographic features both at referral and at the last ultrasound examination before pregnancy outcome, assessment of SCT growth velocity), perinatal complications and outcome, and neonatal course were analyzed to determine prenatal SCT characteristics associated with adverse perinatal outcome. Fifty-five fetuses were included, diagnosed with isolated SCT at a median gestational age of 22 (interquartile range, 18-23) weeks. There was a poor perinatal outcome in 31% (n = 17) of these cases, including intrauterine fetal demise (4%, n = 2), pregnancy termination (13%, n = 7) and neonatal severe compromise (15%, n = 8), leading to neonatal death in five cases. The overall survival rate after prenatal diagnosis of isolated SCT was 75% (n = 41 of 55). Earlier gestational age at diagnosis (P = 0.02), large tumor volume at referral (P < 0.001), presence of one or more hemodynamic complications (P = 0.02), fast tumor growth velocity (P < 0.001) and high tumor grade (highest tumor grade ≥ 3) (P = 0.049) were associated with poor perinatal outcome on univariate analysis. On stepwise logistic regression analysis, tumor growth velocity was the only remaining independent factor associated with poor perinatal outcome (odds ratio (OR) (per 1-mm/week increase), 1.48 (95%CI, 1.22-1.97), P = 0.001). The best predictive cut-off of tumor growth velocity for poor perinatal outcome was 7 mm/week (OR, 25.7 (95%CI, 5.6-191.3), P < 0.001), yielding a sensitivity of 88% and a specificity of 77%. Approximately 30% of fetuses with a diagnosis of isolated SCT have poor perinatal outcome. Tumor growth velocity ≥ 7 mm/week appears to be an appropriate discriminative cut-off for poor perinatal outcome. These results could help to inform prenatal management and counseling of parents with an affected pregnancy. © 2024 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

HOSPITALIZATION TRENDS AND MORBIDITIES IN SICKLE CELL ANEMIA: A CENTRAL INDIA PERSPECTIVE

Background and Objective: Sickle cell anemia is a common genetic disorder characterized by recurrent crisis, complications, and significant morbidity, particularly in children. This study aimed to investigate the pattern, type, and frequency of crisis, systemic complications, and morbidity profile in hospitalized children with sickle cell disease (SCD) at Government Medical College and Hospital, Chandrapur. Methods: A prospective study was conducted over a year, from November 2023 to October 2024, involving 133 hospitalized children aged 0-12 years diagnosed with SCD, including both previously and newly diagnosed cases through Hemoglobin Electrophoresis. The study collected data on hospitalization frequency, crisis types, systemic complications, and morbidity. Children were evaluated for symptoms, clinical findings, and laboratory parameters related to sickle cell crisis and organ failure. Results: The most common presenting symptom was pain, observed in 53.94% of the children, with bone pain, abdominal pain, and joint pain being the predominant types. Fever seen in 45.18% and pallor in 26.75% were the next most frequent symptoms, followed by jaundice in 21.05% and respiratory complaints such as cough in 13.60% and breathlessness in 11.40% patients. The majority of hospitalizations were due to vaso-occlusive crisis as seen in 53.94%, followed by severe anemia in 35.52% and acute febrile illness in 43% of patients. Systemic complications included hepatomegaly (65.78%), splenomegaly (45.61%), and respiratory distress (8.33%). Acute chest syndrome (3.55%), hemolytic crisis (14.9%), and splenic sequestration crisis (5.70%) were also notable findings. Conclusion: In children with sickle cell anemia, VOC, febrile illnesses, and severe anemia are the leading causes of morbidity and hospitalization. Bone and abdominal pain were common symptoms, frequently associated with fever. The study highlights the need for community-based screening, parental counseling, and antenatal interventions to reduce the burden of sickle cell disease in tribal populations.