Diagnosis In Young Children Research Articles

Postconcussive Symptoms After Early Childhood Concussion

Research on postconcussive symptoms (PCS) following early childhood concussion has been hindered by a lack of measures suitable for this age group, resulting in a limited understanding of their evolution in young children. To document PCS in the first 3 months after early childhood concussion using a developmentally appropriate measure. This cohort study used data collected at 3 Canadian and 1 US urban pediatric emergency departments (EDs) and 8 Canadian daycares from December 2018 to December 2022 as part of the Kids' Outcomes and Long-Term Abilities (KOALA) project, a prospective, multicenter, longitudinal cohort study. Participants included children aged 6 to 72 months with early childhood concussion or orthopedic injury (OI) or uninjured children from the community to serve as controls. Data were analyzed from March 2023 to January 2024. Concussion sustained between ages 6 and 72 months. Primary outcomes were cognitive, physical, behavioral and total PCS assessed prior to injury (retrospectively), acutely (within 48 hours), and at 10 days, 1 month, and 3 months after injury or recruitment through caregiver observations using the Report of Early Childhood Traumatic Injury Observations & Symptoms inventory. Group comparisons were analyzed using ordinal regression models. The study included 303 children (mean [SD] age, 35.8 [20.2] months; 152 [50.2%] male). Of these, 174 children had a concussion (mean [SD] age, 33.3 [19.9] months), 60 children had an OI (mean [SD] age, 38.4 [19.8] months) and 69 children were uninjured controls (mean [SD] age, 39.7 [20.8] months). No meaningful differences were found between the concussion and comparison groups in retrospective preinjury PCS. Significant group differences were found for total PCS at the initial ED visit (concussion vs OI: odds ratio [OR], 4.33 [95% CI, 2.44-7.69]; concussion vs control: OR, 7.28 [95% CI, 3.80-13.93]), 10 days (concussion vs OI: OR, 4.44 [95% CI, 2.17-9.06]; concussion vs control: OR, 5.94 [95% CI, 3.22-10.94]), 1 month (concussion vs OI: OR, 2.70 [95% CI, 1.56-4.68]; concussion vs control: OR, 4.32 [95% CI, 2.36-7.92]), and 3 months (concussion vs OI: OR, 2.61 [95% CI, 1.30-5.25]; concussion vs control: OR, 2.40 [95% CI, 1.36-4.24]). Significant group differences were also found for domain-level scores (cognitive, physical, behavioral) at various time points. In this early childhood cohort study, concussion was associated with more PCS than OIs or typical development up to 3 months after injury. Given the limited verbal and cognitive abilities typical of early childhood, using developmentally appropriate manifestations and behaviors is a valuable way of tracking PCS and could aid in concussion diagnosis in young children.

Autism in Taiwan and Thailand: Influences of Culture.

The prevalence of autism is increasing worldwide. The majority of autism research and development of autism assessments and interventions has been conducted in Western cultures. The prevalence of autism is reportedly lower in Asian versus Western cultures, but this is likely due to lack of personnel and uniform criteria for diagnosing autism. This article describes how two Asian cultures, Taiwan and Thailand, are dealing with the increasing identification of autistic children. National universal healthcare in both Taiwan and Thailand provides a mechanism for assessment and diagnosis of young children, but a lack of a sufficient number of trained professionals limits the availability of intervention services. A focus of research in these cultures has been on parents' experiences and coping with the stigma and stress of having an autistic child. Cultural values associated with Confucianism and Buddhism influence attitudes toward persons with disability and how parents of autistic children experience and cope with stigma and stress. Both areas have national laws that provide a range of educational opportunities for autistic children, including inclusion into general education classrooms. Special education and general education teachers, however, have little specific training in autism. Speech and language services are rarely offered in public school programs. Available speech and language services are limited to consultation with teachers a few times a year. In general, parents of autistic children are supportive of inclusion programs, but teachers and parents of both autistic and typically developing children express concerns about the ability to implement such programs in ways that are beneficial to all children.

Evaluating Autism diagnosis agreement between primary care physicians/practitioners and experts through ECHO Autism STAT

BackgroundEven though early intervention leads to improved outcomes for children with autism spectrum disorder (ASD), delays in diagnosis can have an impact on both children and families. ASD diagnostic practices have significantly evolved over time, in part, because of the lack of specialists to meet the demand. ECHO Autism STAT is one innovative model that increased the capacity of community primary care providers (PCPs) to reliably diagnose ASD within their own practices via hands-on training and virtual guidance and support from ASD specialists. The current study evaluated PCPs agreement with ECHO Autism experts in making independent clinical decisions related to ASD diagnosis in unambiguous cases. MethodAfter obtaining reliability on the STAT and attending 6 mo of ECHO Autism sessions, PCPs agreement with expert impressions was evaluated for (a) diagnosing unambiguous ASD and (b) identifying symptoms that met DSM-5 criteria. ResultsThe proportion of cases that achieved the highest PCP agreement score with ASD experts for overall ASD diagnostic impressions was 90% across all cases, 94% across unambiguous cases, and 84% across more complex cases. PCP agreement for DSM-5 symptom impressions was 79%, 87%, and 66% across all, unambiguous, and more complex cases, respectively. Results were significant for unambiguous cases when compared to more complex cases. ConclusionsPCPs can develop clinical expertise in the evaluation and diagnosis of young children with unambiguous ASD that is accurate and reliable. Development of this expertise can expand access for community-based diagnosis that is critical for early detection of ASD.

Relative age and persistence of ADHD diagnosis in young children

Relative age and persistence of ADHD diagnosis in young children

Eye tracking may aid in autism diagnosis in young children

An eye‐tracking device that measures social‐visual engagement (how children look at and learn from their surrounding social environment) may help to predict autism in children at risk for the disorder, according to a study published in JAMA, the American Psychiatric Association's Psychiatric News alert reported on Aug. 28.

Eye-Tracking–Based Measurement of Social Visual Engagement Compared With Expert Clinical Diagnosis of Autism

In the US, children with signs of autism often experience more than 1 year of delay before diagnosis and often experience longer delays if they are from racially, ethnically, or economically disadvantaged backgrounds. Most diagnoses are also received without use of standardized diagnostic instruments. To aid in early autism diagnosis, eye-tracking measurement of social visual engagement has shown potential as a performance-based biomarker. To evaluate the performance of eye-tracking measurement of social visual engagement (index test) relative to expert clinical diagnosis in young children referred to specialty autism clinics. In this study of 16- to 30-month-old children enrolled at 6 US specialty centers from April 2018 through May 2019, staff blind to clinical diagnoses used automated devices to measure eye-tracking-based social visual engagement. Expert clinical diagnoses were made using best practice standardized protocols by specialists blind to index test results. This study was completed in a 1-day protocol for each participant. Primary outcome measures were test sensitivity and specificity relative to expert clinical diagnosis. Secondary outcome measures were test correlations with expert clinical assessments of social disability, verbal ability, and nonverbal cognitive ability. Eye-tracking measurement of social visual engagement was successful in 475 (95.2%) of the 499 enrolled children (mean [SD] age, 24.1 [4.4] months; 38 [8.0%] were Asian; 37 [7.8%], Black; 352 [74.1%], White; 44 [9.3%], other; and 68 [14.3%], Hispanic). By expert clinical diagnosis, 221 children (46.5%) had autism and 254 (53.5%) did not. In all children, measurement of social visual engagement had sensitivity of 71.0% (95% CI, 64.7% to 76.6%) and specificity of 80.7% (95% CI, 75.4% to 85.1%). In the subgroup of 335 children whose autism diagnosis was certain, sensitivity was 78.0% (95% CI, 70.7% to 83.9%) and specificity was 85.4% (95% CI, 79.5% to 89.8%). Eye-tracking test results correlated with expert clinical assessments of individual levels of social disability (r = -0.75 [95% CI, -0.79 to -0.71]), verbal ability (r = 0.65 [95% CI, 0.59 to 0.70]), and nonverbal cognitive ability (r = 0.65 [95% CI, 0.59 to 0.70]). In 16- to 30-month-old children referred to specialty clinics, eye-tracking-based measurement of social visual engagement was predictive of autism diagnoses by clinical experts. Further evaluation of this test's role in early diagnosis and assessment of autism in routine specialty clinic practice is warranted. ClinicalTrials.gov Identifier: NCT03469986.

Diagnostic Accuracy of Primary Care Clinicians Across a Statewide System of Autism Evaluation.

To evaluate the diagnostic accuracy of the Early Autism Evaluation (EAE) Hub system, a statewide network that provides specialized training and collaborative support to community primary care providers in the diagnosis of young children at risk for autism spectrum disorder (ASD). EAE Hub clinicians referred children, aged 14 to 48 months, to this prospective diagnostic study for blinded follow-up expert evaluation including assessment of developmental level, adaptive behavior, and ASD symptom severity. The primary outcome was agreement on categorical ASD diagnosis between EAE Hub clinician (index diagnosis) and ASD expert (reference standard). Among 126 children (mean age: 2.6 years; 77% male; 14% Latinx; 66% non-Latinx white), 82% (n = 103) had consistent ASD outcomes between the index and reference evaluation. Sensitivity was 81.5%, specificity was 82.4%, positive predictive value was 92.6%, and negative predictive value was 62.2%. There was no difference in accuracy by EAE Hub clinician or site. Across measures of development, there were significant differences between true positive and false negative (FN) cases (all Ps < .001; Cohen's d = 1.1-1.4), with true positive cases evidencing greater impairment. Community-based primary care clinicians who receive specialty training can make accurate ASD diagnoses in most cases. Diagnostic disagreements were predominately FN cases in which EAE Hub clinicians had difficulty differentiating ASD and global developmental delay. FN cases were associated with a differential diagnostic and phenotypic profile. This research has significant implications for the development of future population health solutions that address ASD diagnostic delays.

Small-Bowel Obstruction Secondary to Trichobezoar in Young Children: A Case Report

Background: The term bezoar refers to an intraluminal masse in the gastrointestinal system caused by the accumulation of indigestible ingested materials. Trichobezoar is a compact conglomeration of swallowed hair and constitutes less than 6% of all bezoars. The stomach is the common site of occurrence and many patients may remain asymptomatic or present a mild form of the disease. Intestinal obstruction due to trichobezoar is an extremely rare complication. The clinical findings of bezoar-induced ileus do not differ from those of mechanical bowel obstruction due to other causes and they are rarely reported in the pediatric age group. Case presentation: we report a case of acute small-bowel obstruction due to trichobezoar in a three years old boy with no history of eating disorder which presented an abdominal distention. Conclusion: This case serves to raise awareness of trichobezoar as a diagnosis in young children who present with abdominal pain, palpable mass, and signs of acute small-bowel obstruction

Translated article] Neurofibromatosis Type 1: Diagnostic Timelines in Children

Background and objectivesDiagnosis of neurofibromatosis 1 (NF1) diagnosis is challenging in young children without a family history of NF1. The aims of this study were to estimate diagnostic delays in children without a family history of NF1 and to examine the effects of considering café-au-lait macules and skinfold freckling as a single diagnostic criterion. Patients and methodsRetrospective, descriptive, observational study of all patients diagnosed with NF1 before the age of 18 years who were seen at our hospital. The medical records of those included were reviewed to identify the date on which the diagnostic criteria of NF1 were objectified. The patients were categorized into 2 groups: those with a known parental history of NF1 and those without. Café-au-lait macules and skinfold freckling were assessed as a single diagnostic criterion, and genetic evidence was considered to confirm highly suspicious cases. ResultsWe studied 108 patients younger than the age of 18 years with a diagnosis of NF1. Mean (SD) age at diagnosis was 3.94 (±3.8) years for the overall group, 1 year for patients with a parental history of NF1, and 4 years and 8 months for those without. Diagnosis was therefore delayed by 3 years and 8 months in patients without a family history. ConclusionSkin lesions were the first clinical manifestation of NF1 in most patients. We believe that the National Institutes of Health's diagnostic criteria for NF1 should be updated to aid diagnosis in young children.

Psychosocial, Medical, and Demographic Variables Associated with Parent Mealtime Behavior in Young Children Recently Diagnosed with Type 1 Diabetes.

Managing young children's mealtime concerns can be challenging after type 1 diabetes (T1D) diagnosis because of developmental factors and diabetes management demands. To identify potential intervention targets, we evaluated medical, psychosocial, and demographic factors in relation to parents' engagement in problem mealtime behaviors (e.g., pressure to eat, restriction). Parents (N = 157) of young children (age 1-6 years) reported on psychosocial variables (parent fear of hypoglycemia, family functioning, parent problem solving, and parents' problem mealtime behavior frequency and perceptions of being problematic) within 2 months after T1D diagnosis. Hierarchical regression analyses examined associations among psychosocial variables, demographics (child sex, parent race/ethnicity), child continuous glucose monitor (CGM) use, and parents' problem mealtime behaviors. Parents of children using CGMs reported parents' mealtime behaviors as more problematic than nonusers, but there were no differences for other medical or demographic variables. Models predicting parents' problem mealtime behavior frequency and problem perceptions that included psychosocial variables, demographic variables, and CGM use led to significant R 2 of 0.14 and 0.16, respectively. CGM use and parent problem solving were significantly associated with parent mealtime behaviors being perceived as more problematic. Shortly after T1D diagnosis in young children, medical and parent psychosocial factors related to how frequently parents engaged in problem mealtime behaviors and the degree to which parents perceived them as problematic. Other factors may further explain the complexities of mealtime management. Considering parents' problem-solving skills and child treatment regimens may help guide interventions targeting mealtime challenges during the new diagnosis period.

Cronología del diagnóstico de la neurofibromatosis tipo 1 en la infancia

Background and objectivesThe neurofibromatosis 1 (NF1) diagnosis is challenging in young children without a family history of NF1. The aims of this study were to estimate diagnostic delays in children without a family history of NF1 and to examine the effects of using café au lait macules and skin fold freckling as a single diagnostic criterion. Patients and methodsRetrospective, descriptive, observational study of all patients diagnosed with NF1 before the age of 18 years who were seen at our hospital. The medical records of those included were reviewed to identify the date on which the diagnostic criteria of NF1 were objectified. The patients were categorized into 2 groups: those with a known parental history of NF1 and those without. Café au lait macules and skin fold freckling were assessed as a single diagnostic criterion, and genetic evidence was considered to confirm highly suspicious cases. ResultsWe studied 108 patients younger than the age of 18 years with a diagnosis of NF1. Mean (SD) age at diagnosis was 3.94 (±3.8) years for the overall group, 1 year for patients with a parental history of NF1, and 4 years and 8 months for those without. Diagnosis was therefore delayed by 3 years and 8 months in patients without a family history. ConclusionSkin lesions were the first clinical manifestation of NF1 in most patients. We believe that the National Institutes of Health's diagnostic criteria for NF1 should be updated to aid diagnosis in young children.

Clinician Diagnostic Certainty and the Role of the Autism Diagnostic Observation Schedule in Autism Spectrum Disorder Diagnosis in Young Children

Autism spectrum disorder (ASD) affects 1 in 44 children. The Autism Diagnostic Observation Schedule (ADOS) is a semi-structured observation developed for use in research but is considered a component of gold standard clinical diagnosis. The ADOS adds time and cost to diagnostic assessments. To evaluate consistency between clinical diagnosis (index ASD diagnosis) and diagnosis incorporating the ADOS (reference standard ASD diagnosis) and to examine clinician and child factors that predict consistency between index diagnoses and reference standard diagnoses. This prospective diagnostic study was conducted between May 2019 and February 2020. Developmental-behavioral pediatricians (DBPs) made a diagnosis based on clinical assessment (index ASD diagnosis). The ADOS was then administered, after which the DBP made a second diagnosis (reference standard ASD diagnosis). DBPs self-reported diagnostic certainty at the time of the index diagnoses and reference standard diagnoses. The study took place at 8 sites (7 US and 1 European) that provided subspecialty assessments for children with concerns for ASD. Participants included children aged 18 months to 5 years, 11 months, without a prior ASD diagnosis, consecutively referred for possible ASD. Among 648 eligible children, 23 refused, 376 enrolled, and 349 completed the study. All 40 eligible DBPs participated. ADOS administered to all child participants. Index diagnoses and reference standard diagnoses of ASD (yes/no). Among the 349 children (279 [79.7%] male; mean [SD] age, 39.9 [13.4] months), index diagnoses and reference standard diagnoses were consistent for 314 (90%) (ASD = 250; not ASD = 64) and changed for 35. Clinician diagnostic certainty was the most sensitive and specific predictor of diagnostic consistency (area under curve = 0.860; P < .001). In a multilevel logistic regression, no child or clinician factors improved prediction of diagnostic consistency based solely on clinician diagnostic certainty at time of index diagnosis. In this prospective diagnostic study, clinical diagnoses of ASD by DBPs with vs without the ADOS were consistent in 90.0% of cases. Clinician diagnostic certainty predicted consistency of index diagnoses and reference standard diagnoses. This study suggests that the ADOS is generally not required for diagnosis of ASD in young children by DBPs and that DBPs can identify children for whom the ADOS may be needed.

Diabetes-specific functioning in parents of young children with recently diagnosed type 1 diabetes.

A Type 1 diabetes (T1D) diagnosis in young children can cause significant family stress. Parents may experience increased depressive symptoms, but less is known about early diabetes-specific functioning (i.e., parental self-efficacy to manage diabetes, hypoglycemia fear, and coparenting conflict). We evaluated a theoretically based model of diabetes-specific functioning among parents of young children newly diagnosed with T1D (YC-T1D). The model included parent demographic variables, child illness-factors, family protective factors, and general parent emotional functioning. One hundred fifty-seven newly diagnosed YC-T1D (Mage = 4.4 ± 1.7 years; M days postdiagnosis = 29.0 ± 15.4) and their primary caregivers (91.7% female; 61% non-Hispanic White) were assessed at baseline of a behavioral intervention randomized controlled trial. We used psychosocial measures to explore hypothesized domains associated with parents' diabetes-specific functioning using structural equation modeling. More difficulties with parent emotional functioning were related to more problems with parent diabetes-specific functioning, and higher family protective factors were related to fewer problems with diabetes-specific functioning. Child-illness factors were also directly related to more difficulties with parent diabetes-specific functioning and emotional functioning. Parents with college education reported more difficulties with emotional functioning and parent diabetes-specific functioning. Younger child age was associated with fewer difficulties with emotional functioning and more family protective factors. Results provide initial support for a model of parent diabetes specific-functioning at young child T1D diagnosis. Future research may examine this model in relation to children's glycemic outcomes over the first year after diagnosis. Implications are made for parent screening at the time of YC-T1D diagnosis. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Analysis of Health Disparities in the Screening and Diagnosis of Hearing Loss: Early Hearing Detection and Intervention Hearing Screening Follow-Up Survey.

The purpose of this study was to (a) provide introductory literature regarding cultural constructs, health disparities, and social determinants of health (SDoH); (b) summarize the literature regarding the Centers for Disease Control and Prevention (CDC) Early Hearing Detection and Intervention (EHDI) Hearing Screening Follow-Up Survey (HSFS) data; (c) explore the CDC EHDI HSFS data regarding the contribution of maternal demographics to loss-to-follow-up/loss-to-documentation (LTF/D) between hearing screening and audiologic diagnosis for 2016, 2017, and 2018; and (d) examine these health disparities within the context of potential ethnoracial biases. This is a comprehensive narrative literature review of cultural constructs, hearing health disparities, and SDoH as they relate to the CDC EHDI HSFS data. We explore the maternal demographic data reported on the CDC EHDI website and report disparities for maternal age, education, ethnicity, and race for 2016, 2017, and 2018. We focus on LTF/D for screening and diagnosis within the context of racial and cultural bias. A literature review demonstrates the increase in quality of the CDC EHDI HSFS data over the past 2 decades. LTF/D rates for hearing screening and audiologic diagnostic testing have improved from higher than 60% to current rates of less than 30%. Comparisons of diagnostic completion rates reported on the CDC website for the EHDI HSFS 2016, 2017, and 2018 data show trends for maternal age, education, and race, but not for ethnicity. Trends were defined as changes more than 10% for variables averaged over a 3-year period (2016-2018). Although there have been significant improvements in LTF/D over the past 2 decades, there continue to be opportunities for further improvement. Beyond neonatal screening, delays continue to be reported in the diagnosis of young children with hearing loss. Notwithstanding the extraordinarily diverse families within the United States, the imperative is to minimize such delays so that all children with hearing loss can, at the very least, have auditory accessibility to spoken language by 3 months of age. Conscious awareness is essential before developing a potentially effective plan of action that might remediate the problem.

Clinical considerations when conducting diagnostic evaluations to identify autism spectrum disorder in young children

Objective This paper provides clinical guidance supported by the literature on conducting diagnostic evaluations for young children suspected of having autism spectrum disorder (ASD). Method Authors provided a summary of clinical recommendations and evidence-based strategies for providing diagnostic evaluations for young children suspected of having ASD that are supported by the existing literature. Results ASD is a complex condition that typically presents in the first couple years of a child’s life. While many children can be accurately diagnosed by age 2, the majority of children are diagnosed much later. This article provides recommendations for evidence-based clinical practices to support accurate early identification and diagnosis in young children with autism. Recommended practices and measures for screening, comprehensive diagnostic evaluation, and differential diagnosis of ASD in early childhood are discussed. Conclusions Early identification of ASD is important to promote improved outcomes related to early intervention. There are a variety of tools and practices available to support neuropsychologists in providing accurate early diagnosis and appropriate developmental monitoring for children suspected of ASD and related neurodevelopmental conditions. There is a need for continued efforts regarding awareness of ASD in early childhood and targeted training in ASD for neuropsychologists and other disciplines who support families of young children with disabilities.

ВОЗРАСТНЫЕ ОСОБЕННОСТИ ТЕЧЕНИЯ БРОНХИАЛЬНОЙ АСТМЫ У ДЕТЕЙ

Bronchial asthma is one of the most common chronic diseases among children. Age is one of the important factors shaping the features of the clinical course, approaches to the diagnosis and treatment of Bronchial asthma. At a younger age, bronchospasm is more important as a component of bronchial obstruction. Computer bronchophonography makes it possible to solve the problem of making a functional diagnosis of bronchial obstruction, since the use of other methods of functional diagnosis in young children is not possible

MYOD1 c.365G&amp;gt;T, p.L122R Variant Detection by Droplet Digital PCR (ddPCR)

Abstract Introduction/Objective Rhabomyosarcomas (RMS) are a group of skeletal muscle tumors that include embryonal, alveolar, pleomorphic, spindle cell/sclerosing subtypes (SC/SRMS). Spindle cell RMS occurs in both adult and pediatric populations, and is associated with either more aggressive or better clinical outcomes respectively. A recurrent hotspot variant in MYOD1, p.L122R (NM_002478.4 c.365G&amp;gt;T), has been described in SC/SRMS. The classification of this diagnosis is evolving, with VGLL2 and NCOA2 fusions defining the diagnosis in young children, and MYOD1 p.L122R defining the diagnosis in older children. The MYOD1 p.L122R variant seems to be associated with more aggressive disease, and may be increasingly used in risk stratification with intensification of treatment. Methods/Case Report A digital droplet PCR (ddPCR) assay was used to detect the MYOD1 p.L122R in DNA samples with RMS. Patients and controls were coded as positive or negative, and tested for association with clinical features and outcome. Results (if a Case Study enter NA) Known-positive cohort of samples was limited by the extreme rarity of this tumor. “Known-positive” status was established by confirmation of the variant with an external clinically-validated assay. The six known positive samples were assessed by ddPCR for the presence of MYOD1 L122R. The L122R variant was detected in all six variants for a sensitivity of 100%. DNA and/or TNA obtained from known wild-type FFPE and frozen material was assessed, for a total of nine unique samples (1 synthetic, 8 patient-derived). All 9 samples were wild- type, with no positive droplets detected, for a specificity of 100%. Conclusion Our MYOD1 c.365G&amp;gt;T, p.L122R variant detection by droplet digital PCR (ddPCR) assay is a robust, reproducible, specific and sensitive method to detect the MYOD1 hotspot mutation.

586-P: Characteristics Associated with A1C at 18-Months after Diagnosis in Young Children with Type 1 Diabetes

Introduction: The incidence of T1D in young children is increasing, yet the majority of children do not achieve glycemic targets, and little is known about predictors of A1c in young children. This study examines demographic predictors of A1c among young children through 18 months post-diagnosis. Methods: Participants were 37 young children (age 1-6 years, Mage=4.53(1.64), MA1c at diagnosis= 10.47(1.93)) with T1D whose parents were randomized to the usual care condition of a multi-site behavioral intervention trial within 8 weeks of diagnosis. At baseline, parents self-reported on sociodemographic information, CGM use and depression symptoms; DKA status at diagnosis and A1c values at 18 months were obtained from medical records. Child A1c at 18-months post-diagnosis (MA1c= 8.05 (0.93)) was dichotomized into “below target” (≤7.5%; n=15; 40.5%) or “above target” (&amp;gt;7.5%; n=22; 59.5%). Results: Family income (two-tailed Fisher’s exact test, p=.019), parent race/ethnicity (χ2(1, N=37)=8.97 p=.003), and child sex (χ2(1, N=37)=3.96, p=.047) were all significantly associated with 18-month A1c. Post hoc analyses using Bonferroni corrections indicated families with higher income, parents who identified as non-Hispanic white, and male children were more likely to be in the “below target” group compared to families with lower income, parents who identify as a racial/ethnic minority and female children, respectively. The 18-month A1c was not associated with baseline CGM use or parent depressive symptoms, nor DKA at diagnosis (p&amp;gt;.05). Conclusions: There are limited prospective studies of early predictors of A1c in young children. Our results are consistent with findings regarding demographic correlates of A1c found in older children and highlight the importance of social determinants of health. Future research using larger samples should explore the role of additional potential correlates of later glycemic control. Disclosure J. S. Eng: None. K. Rooney: None. C. Henderson: None. B. E. Marks: None. C. Tully: None. M. Monaghan: None. M. E. Hilliard: None. R. Streisand: None. C. H. Wang: None. Funding National Institute of Diabetes and Digestive and Kidney Disease (R01DK102561)

Presentation, management and outcomes of pediatric urogenital tuberculosis: 20 years’ experience from a tertiary center

Urogenital tuberculosis (UGTB) has traditionally being a diagnosis of adulthood and is supposed to be rare in children, as it is believed that the symptoms of renal tuberculosis do not appear for 10 or more years after the primary infection. While this may be true in developed countries, where childhood pulmonary tuberculosis is a rarity nowadays. In developing countries, childhood pulmonary tuberculosis is still a major issue and hence, UGTB is not an uncommon diagnosis in younger children and adolescents in these countries. Considering this dearth of data on childhood UGTB, we retrospectively evaluated our series of children with this disease, with special emphasis on the role of surgery. To analyze the clinical presentation, management strategies and outcomes of pediatric UGTB managed in a tertiary care center. Case records of children and adolescents ≤18 years diagnosed with UGTB during the period July 1998 to June 2018at our center were reviewed. Clinical features, organ involvement, investigations, treatment and outcome of therapy were studied. There were 41 children and adolescents (M: F=22:19) identified, with a mean age of 14.8±3.9 years who fulfilled the inclusion criteria. The most common presentation was flank pain and irritative storage symptoms. Mycobacterium tuberculosis was identified on urinary examination in only 17 (41.5%) cases. Six patients were lost to follow up after initial diagnosis. A total of 45 procedures (35 primary and 10 secondary) were performed in 35 children. Initial diversion in the form of PCN and DJS were done in 11 and 12 patients respectively, of which 8 were managed with stenting alone. Surgical management was done mostly in the form of nephrectomy (15), nephrectomy along with reconstruction (5) and reconstruction only (6). On univariate analysis, factors associated with nephrectomy were poor initial function and nephrostomy as initial diversion. Overall median follow-up was 25 (IQR 15.5-74.25) months. During follow up, chronic renal failure developed in nearly 53.8% of patients who underwent major reconstruction. Urogenital tuberculosis presents with a wide spectrum of clinical features and pathological lesions. Diagnosis is often delayed because of late presentation and many children present with cicatrization sequelae. Antitubercular drug therapy and judicious application of minimally invasive diversions and surgery (both ablative and reconstructive) achieve satisfactory results in the majority of cases. Children undergoing major surgical reconstruction in particular need to be followed up rigorously and counselled about possibility of development of renal failure.

Sensitive and Feasible Specimen Collection and Testing Strategies for Diagnosing Tuberculosis in Young Children

Criterion-standard specimens for tuberculosis diagnosis in young children, gastric aspirate (GA) and induced sputum, are invasive and rarely collected in resource-limited settings. A far less invasive approach to tuberculosis diagnostic testing in children younger than 5 years as sensitive as current reference standards is important to identify. To characterize the sensitivity of preferably minimally invasive specimen and assay combinations relative to maximum observed yield from all specimens and assays combined. In this prospective cross-sectional diagnostic study, the reference standard was a panel of up to 2 samples of each of 6 specimen types tested for Mycobacterium tuberculosis complex by Xpert MTB/RIF assay and mycobacteria growth indicator tube culture. Multiple different combinations of specimens and tests were evaluated as index tests. A consecutive series of children was recruited from inpatient and outpatient settings in Kisumu County, Kenya, between October 2013 and August 2015. Participants were children younger than 5 years who had symptoms of tuberculosis (unexplained cough, fever, malnutrition) and parenchymal abnormality on chest radiography or who had cervical lymphadenopathy. Children with 1 or more evaluable specimen for 4 or more primary study specimen types were included in the analysis. Data were analyzed from February 2015 to October 2020. Cumulative and incremental diagnostic yield of combinations of specimen types and tests relative to the maximum observed yield. Of the 300 enrolled children, the median (interquartile range) age was 2.0 (1.0-3.6) years, and 151 (50.3%) were female. A total of 294 met criteria for analysis. Of 31 participants with confirmed tuberculosis (maximum observed yield), 24 (sensitivity, 77%; interdecile range, 68%-87%) had positive results on up to 2 GA samples and 20 (sensitivity, 64%; interdecile range, 53%-76%) had positive test results on up to 2 induced sputum samples. The yields of 2 nasopharyngeal aspirate (NPA) samples (23 of 31 [sensitivity, 74%; interdecile range, 64%-84%]), of 1 NPA sample and 1 stool sample (22 of 31 [sensitivity, 71%; interdecile range, 60%-81%]), or of 1 NPA sample and 1 urine sample (21.5 of 31 [sensitivity, 69%; interdecile range, 58%-80%]) were similar to reference-standard specimens. Combining up to 2 each of GA and NPA samples had an average yield of 90% (28 of 31). NPA, in duplicate or in combination with stool or urine specimens, was readily obtainable and had diagnostic yield comparable with reference-standard specimens. This combination could improve tuberculosis diagnosis among children in resource-limited settings. Combining GA and NPA had greater yield than that of the current reference standards and may be useful in certain clinical and research settings.