General Pediatric Population Research Articles

Achondroplasia and obstructive sleep apnea: surgical outcomes and comparison to general population.

The objective was to compare demographics between children with achondroplasia and OSA with the general pediatric population with OSA, as well as present treatment outcomes for children with achondroplasia. Retrospective chart review of 22 children with achondroplasia and OSA and 141 children with OSA without achondroplasia. Parameters from polysomnography were analyzed. Values before and after surgery were compared for the achondroplasia group, while baseline values were compared between the control group and achondroplasia group. Pre-intervention in the T&A achondroplasia group, 0 children had mild OSA, 1 had moderate OSA, and 10 had severe OSA. In the comparative group 16 had mild OSA, 11 had moderate OSA, and 114 had severe OSA. The achondroplasia population had a much younger age at T&A compared to the control population - 3.1 versus 6.8 years. When comparing baseline data in the achondroplasia population with respective T&A outcomes, oAHI and SpO2 were improved. For the adenoidectomy group, there were no significant changes in OSA after surgery. For the Cervicomedullary decompression (CMD) group, there was a decrease in oAHI after surgery. Patients with achondroplasia and OSA have an earlier age of onset compared to children without achondroplasia. For these patients with moderate to severe OSA, treatment with adenotonsillectomy leads to significant improvement. Treatment with adenoidectomy showed no significant change in OSA. CMD also led to an improvement in oAHI.

Autism spectrum disorder common variants associated with regional lobe volume variations at birth: cross-sectional study in 273 European term neonates in developing human connectome project

Abstract Increasing lines of evidence suggest cerebral overgrowth in autism spectrum disorder (ASD) children in early life, but few studies have examined the effect of ASD common genetic variants on brain volumes in a general paediatric population. This study examined the association between ASD polygenic risk score (PRS) and volumes of the frontal, temporal, parietal, occipital, fronto-temporal and parieto-occipital lobes in 273 term-born infants of European ancestry in the developing Human Connectome Project. ASD PRS was positively associated with frontal (β = 0.027, p FDR = 0.04) and fronto-temporal (β = 0.024, p FDR = 0.01) volumes, but negatively with parietal (β = −0.037, p FDR = 0.04) and parieto-occipital (β = −0.033, p FDR = 0.01) volumes. This preliminary result suggests the potential involvement of ASD common genetic variants in early structural variations linked to ASD.

Impact of COVID-19 on Hospital Admissions for Children With Developmental Disadvantages: A Western Sydney Metropolitan Hospital Experience on Health Inequity.

To investigate the impact of Sydney's COVID-19 lockdown on children with developmental disadvantages and reflect on current clinical practice. Retrospective data was collected from a western Sydney metropolitan hospital's electronic database and patients. We reviewed all children with Autism Spectrum Disorder (ASD), Cerebral Palsy (CP) or Intellectual Disability (ID) admitted 36 months prior to and after lockdown policy being implemented. The prevalence of hospital presentation was reduced during the lockdown period. The average length of stay (LoS) increased by approximately 1.5 folds. Comparatively, the average LoS of the general paediatric population increased minimally. Seizures, asthma, and upper respiratory tract infections were the three commonest issues for hospital admissions in both periods. COVID-19 infection accounted for 4% of admissions in the lockdown period. Around 20.8% of patients with disadvantages were admitted with more than two major issues. None of these patients had concurrent COVID-19 infection. Children with developmental disabilities experience greater disadvantages during lockdown. The likely reasons include inequity caused by increased barriers to healthcare service. The indirect benefit of reducing infection transmission during lockdown was not reflected in our patient group, contributing to the disease burden. Chronic diseases remain the most common causes of admissions in all periods, suggesting the essentiality of improving chronic disease management in future clinical practice.

Metabolic Syndrome Spectrum in Children with Classic Congenital Adrenal Hyperplasia—A Comprehensive Review

Children with a classic form of congenital adrenal hyperplasia (CCAH) have a potentially increased risk of unfavorable cardiometabolic events due to the interplay of corticosteroid treatment, hyperandrogenism, and other factors. Although readily recognized in adults, these aspects are frequently overlooked in children and youth with CCAH; Aim: To review the evidence available from studies regarding cardiometabolic health outcomes in CCAH patients; Methods: A review of the literature was performed following PRISMA guidelines, including studies published between 2000 and 2024. We included studies reporting cardiometabolic outcomes in children and adolescents (<18 years) with CCAH. Where pediatric data were sparse, additional data were obtained from studies with older adolescents and young adults (15–25 years). Cardiometabolic outcomes included risk factors, such as obesity, insulin resistance, lipids, blood pressure, and vascular markers; Results: Twenty-five studies were analyzed. The prevalence of obesity was found to be higher in children with CCAH, as well as of increased visceral adiposity. Higher indices of insulin resistance were also a frequent finding in children with CCAH. CCAH patients had higher systolic blood pressure and more frequently loss of nocturnal blood pressure dipping, particularly among salt-wasting subtypes and in younger children. Subclinical atherosclerosis was indicated by increased carotid intima–media thickness, elevated hs-CRP, and impaired endothelial function. Other findings suggested changes in lipid profiles, particularly decreased HDL-c and increased triglycerides, although the findings were less consistent; Conclusions: Compared with the general pediatric population, children with CCAH were found to have an increase in multiple cardiometabolic risk factors. It is therefore vital to monitor these risk factors in pediatric CCAH, as well as tailoring treatment with cardiometabolic health in mind, to achieve better long-term cardiovascular and metabolic outcomes. Future research should focus on longitudinal studies of cardiometabolic outcomes and innovative therapeutic approaches to reduce these risks in patients with CCAH.

Abstract TMP90: Hidden Challenges: Mental Health Outcomes in Pediatric Stroke Survivors

Introduction: The burden of disease from pediatric arterial ischemic stroke (AIS) includes non-visible disability in the form of mental health conditions such as depression and anxiety which impact the quality of life of children and families affected by stroke. Objectives: To determine the scale of the mental health phenomenon in the pediatric AIS population in a large single-center study, and to educate clinicians about this significant risk in pediatric stroke survivors. Methods: A retrospective analysis of a prospective single-center cohort of school-aged children diagnosed with AIS, enrolled between 2002 and 2020 was conducted. Depression and anxiety were evaluated with the Behavior Assessment System for Children (BASC, versions 1 and 3). Prevalence and scores for depression and anxiety were ascertained children with AIS and compared with general pediatric population scores. Somatization, a third internalizing subscale in the BASC questionnaire, was also included in the analysis. Results: AIS patients (N=161, 98 male; median age and range at stroke 1.9 years [0 – 13.8 years]) were assessed with neuropsychological measures at median age and range 9.1 years (5.6 – 16.7 years). Clinical scores for depression, anxiety and somatization, i.e., T= ≥ 70 in the Depression (mean = 81.0, SD= 8.7), Anxiety (mean= 76.6, SD=8.3) and Somatization (mean= 81.9, SD= 11.0) subscales, were found in 13%, 13.7% and 17.4% of school-age children with AIS respectively, with the median age ranging between 8.5 and 9.6 years,representing the age of greatest vulnerability in our cohort. In AIS patients, mean scores for mood, anxiety and somatization were higher compared to the general pediatric population. Age at stroke in the children within the Somatization Clinical group were older than 2 years age at time of stroke(p=0.034). Conclusions: Mental health disorders represent a significant problem in pediatric stroke survivors, with the end of primary school appearing to be the time of greatest vulnerability. These mental health outcomes, (depression, anxiety, somatization) could be associated with age at stroke. The symptoms manifested due to these mental health challenges are frequently overlooked. Therefore, early detection and intervention are essential to change patient trajectories and improve outcomes and quality of life.

P-1006. If You Build It Will They Come?: Lessons Learned from a Dedicated Congenital Syphilis Clinic

Abstract Background Cases of congenital syphilis (CS) have been rising for the past decade, with 3755 infants affected in 2022 alone. Texas accounted for nearly 25% of these children, with 922 cases reported in 2022, up 35% from the year prior. A review of the management of these children across our system of over 2000 medical professionals suggested that a clinic dedicated to CS, may be warranted to ensure that these children receive evaluations as recommended by the CDC. Here we report on the logistics of this clinic with insights into its success and failures, and the implication of these findings for the general pediatric population and its providers. Methods Laboratory and encounter specific data for children diagnosed with CS from 1/1/2010 to 12/31/2021 was obtained from our Epic® electronic health record (EHR). Additionally, we requested scheduling and appointment information for patients evaluated in our CS clinic at Texas Children’s Hospital which started in 2022. Results Prior to the establishment of our dedicated CS clinic in 2022, we identified 458 children born into our hospital system and had been evaluated for CS from 2010-2021. Of these 458 infants, 233(51%) had a subsequent encounter within our system at ≥2months of age, with only 66(28%) of them having a repeat RPR. From 4/2022-12/2023 there were a total of 367 outpatient encounters in our CS clinic (239 completed, 128 no show/cancelled). All children seen in our CS clinic had repeat RPR testing, in addition to age-appropriate developmental screening, according to CDC recommendations. Conclusion The rising rate of CS in the US should concern all pediatricians. Our findings call attention to the reality that follow up is not guaranteed and recommendations are not universally followed. Given that CS cases were at lifetime lows a decade ago, there is a concern that providers may be unaware of current management recommendations for these children. Integrated healthcare systems, coupled with clinical informatics, give us the opportunity to address these problems in real-time and make sure no child falls through the cracks. Our results and experiences from this unique clinic will be invaluable in providing timely feedback for tailoring education to providers and families to make sure that these children get the care they deserve. Disclosures Ryan H. Rochat, MD, PhD, MS, Merck Sharpe Dohme: Grant/Research Support

First-Attempt Success in Ultrasound-Guided vs Standard Peripheral Intravenous Catheter Insertion

Pediatric peripheral intravenous catheter (PIVC) insertion can be difficult and time-consuming, frequently requiring multiple insertion attempts and often resulting in increased anxiety, distress, and treatment avoidance among children and their families. Ultrasound-guided PIVC insertion is a superior alternative to standard technique (palpation and visualization) in high-risk patients. To compare first-time insertion success of PIVCs inserted with ultrasound guidance compared with standard technique (palpation and visualization) across all risk categories in the general pediatric hospital population. An open-label, pragmatic, superiority, randomized clinical trial was conducted in an Australian quaternary pediatric hospital. Children (ages 0-18 years) requiring PIVC insertion were included between July 2021 and December 2022. One catheter was studied per patient, and analysis was by intention to treat. Data analysis was performed from April to October 2023. Eligible children were randomly assigned (1:1 using computer-generated randomization and concealed allocation) to receive ultrasound-guided or standard PIVC insertion. Randomization was stratified by insertion difficulty (low, medium, or high risk) defined using a standardized tool. The primary outcome was first-time insertion success. Secondary outcomes included number of insertion attempts, insertion failure, postinsertion complications, dwell time, patient and parent satisfaction, and health care costs. A total of 164 children were randomly assigned to ultrasound-guided insertion (n = 84) or standard care (n = 80), with 81 (96.4%) and 78 (97.5%) receiving their allocated intervention, respectively. The median (IQR) age was 24 (10-120) months, and 93 children (56.7%) were male. First-time insertion success was higher with ultrasound-guided PIVC insertion (72 children [85.7%]) compared with standard technique (26 children [32.5%]) (risk difference [RD], 53.6%; 95% CI, 41.7%-65.4%; P < .001). Ultrasound-guided insertion led to significantly greater first-time insertion success across all risk categories, with the following RDs: low risk, 30.8% (95% CI, 8.1%-53.5%); medium risk, 56.2% (95% CI, 37.1%-75.3%); and high risk, 69.6% (95% CI, 52.3%-87.0%). Ultrasound-guided PIVC insertion had higher immediate health care costs (between group difference in total mean cost per person, A$9.33; 95% credible interval, A$8.83-A$10.86 [US $5.83; 95% credible interval, $5.52-$6.78]). These findings suggest that ultrasound-guided PIVC insertion improves first-time insertion success across all risk categories in pediatrics, supporting the widespread adoption of ultrasound-guided PIVC insertion in children. anzctr.org.au Identifier: ACTRN12621000206820.

Outcome and Predisposing Factors for Intracranial Hemorrhage in Turkish Children with Hemophilia

Background/Objectives: Childhood hemophilia, a hereditary bleeding disorder predominantly affecting males, arises due to gene mutations encoding clotting factors VIII or IX. Intracranial hemorrhage represents a significant and life-threatening complication in pediatric patients with hemophilia. The incidence of intracranial hemorrhage in children with hemophilia, although relatively low, is notably higher compared to the general pediatric population. Methods: In this study, the objective is to examine patients with hemophilia who have experienced intracranial hemorrhage retrospectively. This study is a multicenter, retrospective analysis using data from three tertiary care centers in a provincial city in Turkey. Data were obtained from the participants’ hospital records. The presence of inhibitors against FVIII in the participants and the prophylaxis used against them were included in the analysis. Trauma history was queried, with types of traumas examined, including traffic accidents, falls, and a traumatic vaginal delivery. The duration and causes of complaints among the participants were investigated. The causes of complaints were categorized as fever, hematoma, convulsions, loss of consciousness, and hemiparesis. The participants’ Physical Examination Findings were classified as fever, hematoma, and loss of consciousness. The duration of hospital stays was evaluated. The hemorrhage location was classified into five groups: parenchymal, subdural, scalp, subarachnoid, and multiple hemorrhagic foci. The recurrence of bleeding, the need for transfusion, surgical intervention, and mortality were also examined. Results: A significant difference was identified between the participants’ survival rates and age variables, as well as transfusion in &lt;36 months. A total of 9 participants had spontaneous intracranial bleeding, 2 experienced cranial trauma as a result of traffic accidents, and 25 participants were exposed to head trauma due to falls. Of the remaining individuals, one suffered head trauma from a severe impact, and one had cranial trauma following a traumatic vaginal delivery. Fourteen participants required transfusion, and three underwent surgical intervention. Conclusions: According to the results of the statistical analyses, the variables Factor Level, Physical Examination Findings, Transfusion, Recurrent Bleeding, Inhibitor, and Prophylaxis were found to affect survival significantly. No significant relationship was determined between the other analyzed variables and survival. During our study, five of the participants examined died. Accordingly, the mortality rate identified in our study is 13.1%.

Prevalence of Oropharyngeal Dysphagia in Children: A Systematic Review and Meta-Analysis.

This study aims to determine the prevalence of oropharyngeal dysphagia (OD) in children, as diagnosed through instrumental evaluation, and to identify associated risk factors. A systematic search was conducted across six databases (Embase, LILACS, LIVIVO, PubMed/MEDLINE, Scopus, and Web of Science), as well as gray literature sources (ASHA, Google Scholar, and ProQuest). Studies involving children (under 12 years of age), diagnosed using instrumental methods such as videofluoroscopic swallow study (VFSS) or fiberoptic endoscopic evaluation of swallowing (FEES), were included. A random-effects meta-analysis was performed to estimate the prevalence, with heterogeneity assessed through meta-regression. The risk of bias was evaluated using the Joanna Briggs Institute Critical Appraisal Checklist. A total of 31 studies were included, yielding a pooled prevalence estimate of 69% (95% CI: 61%-77%; I² = 94%). Most studies involved children with predisposing conditions, potentially contributing to an overestimation of OD prevalence in the general pediatric population. Four studies were assessed as having a moderate risk of bias, while 27 were rated as having a low risk of bias. The findings suggest a high prevalence of OD, especially in children with underlying health conditions. These results underscore the importance of early diagnosis and tailored interventions to mitigate the health risks associated with deglutition disorders in pediatric populations.

Neurodevelopmental disorders in children with cleft lip and palate: a systematic review.

Individuals with orofacial clefts (OFCs) may be at an increased risk of developing autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD). This systematic review provides a summary of the most recent data regarding the prevalence of ASD and ADHD in the OFC population and compares this to the general paediatric population. Multiple databases were searched including PubMed/Medline and Embase in July 2024, following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines and was registered in PROSPERO (CRD42024565219). 1025 papers were identified for screening, of which nine were included in the report. Percentage prevalence was calculated and compared to global prevalence or control populations where available. Overall, ASD prevalence among children with a cleft ranged from 0 to 50% (Mean = 2.87%; SD = 5.40) compared to ~ 1% globally (WHO) and ADHD prevalence ranged from 2.34 to 31.71% (Mean = 3.63%; SD = 4.30) compared to ~ 5% globally (NICE). Matched control populations showed larger differences. Isolated cleft palate was associated with higher rates than isolated cleft lip or combined cleft lip and palate. Prevalence in individuals with syndromic clefts appeared greater still (Mean = 14.80%; SD = 16.58) although populations were small. Children with OFCs demonstrate increased prevalence of ASD compared to the average paediatric population. Evidence for increased prevalence of ADHD is less clear, with varying rates across studies. Children with isolated cleft palate or cleft associated with genetic syndromes appear most at risk, although further research is needed.

Reference values for the adolescent post version of the Postconcussion Symptom Inventory from the German general population

The present study aims at providing reference values from the general pediatric population for the German version of the 21-item self-report post version of the Postconcussion Symptom Inventory for adolescents aged 13–17 years (PCSI-SR13) following pediatric traumatic brain injury (pTBI). A total of N = 950 adolescents completed an adapted version of the PCSI-SR13. Prior to establishing reference values using percentiles, psychometric properties (i.e., reliability and factorial validity) and regression analyses were examined to identify factors contributing to PCSI-SR13 scores. In addition, construct assessment in the general population sample was compared to that in the pTBI sample (N = 234) using measurement invariance analyses and direct comparisons at the score levels. The results indicate good reliability (Cronbach’s α and McDonald’s ω of 0.97 each). The four-factor structure covering physical, emotional, cognitive, and fatigue symptom groups could be replicated with χ2(183) = 995.96, p < 0.001, χ2/df = 5.44, CFI = 0.99, TLI = 0.98, RMSEA (90% CI) = 0.068 (0.064, 0.073), SRMR = 0.03. With minor restrictions, the assessment of symptoms was comparable between the general population and the pTBI samples. Participants in the pTBI sample reported a significantly higher symptom burden than those in the general population sample. Reference values were provided using the total sample without further stratification. Conclusion: For the German post version of the PCSI-SR13, reference values are now available for direct score comparisons and for drawing conclusions about the clinical relevance of the reported symptoms, while considering the prevalence in a comparable general population without a history of pTBI.Trial registration: The study is retrospectively registered in the German Clinical Trials Register and in the International Clinical Trials Registry Platform (ID DRKS00032854). What is Known:• Pediatric traumatic brain injury (pTBI) is a major cause of death and disability, with a wide range of incidence rates and symptoms that interfere with daily functioning and recovery.• The Postconcussion Symptom Inventory (PCSI), including recently translated and validated German versions, is a recommended tool for measuring self-reported symptoms in affected children and adolescents.What is New:• This study provides German-specific reference values for the PCSI-SR13, allowing health care professionals to better differentiate between symptoms that may occur in the general adolescent population with and without chronic health conditions and those caused by pTBI.• It highlights that adolescents with chronic health conditions but without a history of pTBI often report higher levels of emotional symptoms and fatigue, emphasizing the importance of a nuanced clinical assessment, including medical history.

COVID-19 infection and inactivated vaccination: Impacts on clinical and immunological profiles in Chinese children with type 1 diabetes.

The coronavirus disease 2019 (COVID-19) pandemic has been linked to an increased incidence of diabetes and diabetic ketoacidosis (DKA). However, the relationship between COVID-19 infection and progression to type 1 diabetes (T1D) in children has not been well defined. To evaluate the influence of COVID-19 infection and inactivated vaccine administration on the progression of T1D among Chinese children. A total of 197 newly diagnosed patients with T1D were retrospectively enrolled from Children's Hospital of Fudan University between September 2020 and December 2023. The patients were divided into three groups based on their history of COVID-19 infection and vaccination: the infection group, the vaccination-only group, and the non-infection/non-vaccination group. Comprehensive clinical assessments and detailed immunological evaluations were performed to delineate the characteristics and immune responses of these groups. The incidence of DKA was significantly higher in the COVID-19 infection group (70.2%) compared to the non-infection/non-vaccination group (62.5%) and vacscination-only group (45.6%; P = 0.015). Prior COVID-19 infection was correlated with increased DKA risk (OR: 1.981, 95%CI: 1.026-3.825, P = 0.042), while vaccination was associated with a reduced risk (OR: 0.558, 95%CI: 0.312-0.998, P = 0.049). COVID-19 infection mildly altered immune profiles, with modest differences in autoantibody positivity, lymphocyte distribution, and immunoglobulin levels. Notably, HLA-DR3 positive children with a history of COVID-19 infection had an earlier T1D onset and lower fasting C-peptide levels than the HLA-DR3 negative children with a history of infection (both P < 0.05). COVID-19 infection predisposes children to severe T1D, characterized by enhanced DKA risk. Inactivated vaccination significantly lowers DKA incidence at T1D onset. These findings are valuable for guiding future vaccination and T1D risk surveillance strategies in epidemic scenarios in the general pediatric population.

Reference ranges for complete blood count in children and adolescents with Down syndrome.

Down syndrome (DS) is linked to unique hematopoietic characteristics that affect complete blood count (CBC) parameters. Accurate reference ranges are essential for proper CBC interpretation in this population. This retrospective study analyzed 2,627 CBCs from 481 DS patients, aged 31 days to 18 years, at a tertiary care center in Italy. Patients with significant comorbidities were excluded to ensure a homogeneous group. CBC parameters were assessed to establish age- and sex-specific reference ranges. Centile charts were developed for each parameter, and an online tool was created to allow clinicians to compare individual CBC results with the new ranges. Comparisons with the general pediatric population revealed significant differences, particularly in hemoglobin, hematocrit, and mean corpuscular volume, which were higher in DS (p < 0.001). In contrast, a significant percentage of CBCs showed white blood cell counts below the 2.5th centile of healthy controls (p < 0.001), except for the 31 days-1 year age group. A similar trend was observed for lymphocytes (p < 0.001) in the 1-18 years group. These newly established DS-specific reference ranges provide clinicians with a crucial tool for evaluating CBC results, potentially reducing unnecessary tests and emphasizing the need for tailored clinical assessment in managing this unique population.

Organophosphate flame retardants associated with increased oxidative stress biomarkers and elevated FeNO levels in general population of children: The Hokkaido study

Our previous study found that exposure to higher organophosphate flame retardants (PFRs) was associated with increased prevalence of wheeze and type 2 inflammation among school-aged children. It remains unclear whether PFR exposure elevates oxidative stress in these general pediatric population, thereby potentially contributing to the development of allergic diseases. This study examined the associations between individual and mixture exposure to PFRs and oxidative stress in children aged 9–12 years (n = 423). The oxidative stress biomarkers included 4-hydroxynonenal (4-HNE) and hexanoyl-lysine (HEL) for lipid peroxidation, and 8-hydroxy-2′-deoxyguanosine (8-OHdG) for DNA damage. We also examined the mediation effects of oxidative stress on the relationships between PFR exposure and health outcomes: wheeze and type 2 inflammation biomarkers, including fraction of exhaled nitric oxide (FeNO) and blood eosinophils. Higher concentrations of tris(1,3-dichloro-2-propyl) phosphate (TDCIPP), Σ triphenyl phosphate (ΣTPHP), Σ tris(2-butoxyethyl) phosphate (ΣTBOEP), and Σ 2-Ethylhexyldiphenyl phosphate (ΣEHDPHP) metabolites were significantly associated with higher levels of 4-HNE. Elevated concentrations of TDCIPP, ΣTPHP, and ΣTBOEP were positively associated with HEL. Higher ΣTPHP and ΣTBOEP were positively associated with 8-OHdG. The PFR mixture was positively associated with all three oxidative stress biomarkers according to the Quantile g-computation and Bayesian kernel machine regression models. Oxidative stress biomarkers mediated 11.4 % to 15.3 % of the association between PFRs and FeNO ≥35 ppb. PFR exposure was positively associated with oxidative stress markers of DNA damage and lipid peroxidation, which may contribute to elevated type 2 inflammation among school-aged children. These findings, identified in the general pediatric population at low exposure levels, highlight the need for ongoing attention to the allergic symptoms posed by PFR exposure.

Education and employment outcomes in pediatric chronic kidney disease.

As outcomes and survival for children with chronic kidney disease (CKD) have improved over the last 30years, there is an emerging need to characterize and understand later educational and employment outcomes across the spectrum of pediatric CKD severity-ranging from mild CKD to requirement for dialysis and kidney transplantation. Although large-scale research on the topic of long-term educational and employment outcomes in the pediatric CKD population is relatively scarce, the existing literature does support that children across the spectrum of CKD severity are at risk for education-related difficulties including chronic school absenteeism. These education-related difficulties are compounded by well-described neurocognitive deficits-particularly in the domain of executive functioning-that may potentially perpetuate the risk for academic underachievement. This is particularly concerning given that data from the general pediatric population suggest that childhood academic underachievement is associated with higher likelihood of un-/underemployment in adulthood. This review highlights what is known about educational and employment outcomes among persons with a history of childhood CKD, as well as suggestions for interventions to improve educational outcomes for this population.

Indications and Outcomes for Tracheostomies in Pediatric Oncology Patients-A Single Center Study.

Children with cancer face a high risk of complications including prolonged mechanical ventilation requiring tracheostomies. While tracheostomies have been demonstrated to be a generally safe procedure, there remain significant rare complications and a paucity of literature addressing outcomes specifically for pediatric patients with cancer. The objective of this study was to characterize pediatric patients with cancer who underwent tracheostomies and describe their indications and outcomes for length of stay, decannulation, and complications. At a single large volume children's hospital, retrospective medical record analysis was performed in all pediatric patients with cancer who received tracheostomies from 2004 to 2023. Sixty-five patients were identified with a median follow-up time of 763 days (interquartile range 302-1687). Twenty-one (32%) patients had a tracheostomy placed due to complications from mass effect of the tumor, 16 (25%) due to complications from cancer treatment, and 14 (22%) had a tracheostomy placed for nononcologic reasons. Additionally, a distinct subgroup of 14 (22%) patients underwent tracheostomy perioperatively for elective airway management during surgical resection of their tumors. Twenty-nine (45%) were decannulated and 17 (26%) patients had a tracheostomy-associated complication, including tracheitis and tracheocutaneous fistula, and no patients had a tracheostomy-associated mortality. The incidence of tracheostomy-associated complications and decannulation rates in pediatric patients with cancer was comparable with the general pediatric tracheostomy population. This study establishes a reference point for clinicians regarding the anticipated outcomes among pediatric patients with cancer requiring or having undergone a tracheostomy.

Comparison of nutritional screening tools in pediatric oncology patients receiving chemotherapy treatment

BackgroundMalnutrition in pediatric oncology patients is a complex and multifactorial process, and the most appropriate screening tool to determine the risk of malnutrition is not clear. The study aimed to compare the Screening Tool for Risk on Nutritional Status and Growth (StrongKids), Pediatric Yorkhill Malnutrition Score (PYMS), Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP), which are commonly used in the general pediatric population, with the Nutrition Screening Tool for Childhood Cancer (SCAN), which was specifically validated for pediatric cancer, in determining the risk of malnutrition. MethodsThis cross-sectional study included 92 children aged 2–18 years who were admitted to the hematology-oncology unit and were receiving chemotherapy. The prevalence of nutritional risk was determined using the SCAN, StrongKids, PYMS, STAMP, and anthropometric assessments were performed. Sensitivity and specificity values, and the degree of agreement between screening tools were calculated. ResultThe SCAN identified nutritional risk in 69.6 % of the children. According to StrongKids, PYMS and STAMP, the high nutritional risk in children was 43.5 %, 56.5 % and 64.1 %, respectively. The sensitivity of STAMP (81.2 %) was higher than that of StrongKids (60.9 %) and PYMS (79.7 %). The specificity of StrongKids, PYMS and STAMP was 96.4 %, 96.4 %, and 75.0 %, respectively. There was substantial agreement between SCAN and PYMS. ConclusionPYMS has the best specificity and sensitivity in identifying patients at risk of malnutrition as determined by SCAN. Implications for practiceIn addition to anthropometric measurements, population-specific or highly sensitive nutritional screening tools should be used to determine the risk of malnutrition.

Environmental multiple sclerosis (MS) risk factors, genetic MS risk, and brain development in a general paediatric population

BackgroundNeuroaxonal loss occurs in the early stages of multiple sclerosis (MS), but whether it results from early inflammatory brain damage or an ongoing neurodegenerative process remains unclear. We hypothesise that...

Incidence of severe and non-severe SARS-CoV-2 infections in children and adolescents: a population-based cohort study using six healthcare databases from Italy, Spain, and Norway.

Severe COVID-19 was rare across databases, but up to 3 to 4 times higher in children with comorbidities during the predominance of Omicron BA.1-2 variant in winter 2021-2022. COVID-19 vaccination coverage was slightly lower in children with comorbidities in ARS (Tuscany) and SIDIAP (Catalonia) data sources. Our findings will inform future public policies aimedto protect the pediatric population, both within these countries and globally. • Pediatric population is susceptible to SARS-CoV-2 infection. • COVID-19 severity rates in children vary across study settings and context. • This study confirms the low severity rates of COVID-19 in the pediatric population based on a large cohort of children and adolescents residing in Spain, Italy, and Norway. • Incidence of severe COVID-19 in children and adolescents with comorbidities was up to 3 to 4 times higher than in the general pediatric population during the SARS-CoV-2 high transmission wave of Omicron BA.1-2 variant in winter 2021-2022 in Italy and Spain.

Tertiary pediatric sleep services in Canada: A national survey

BACKGROUND Sleep disordered breathing (SDB) prevalence ranges from 10% to 14% with obstructive sleep apnea prevalence of 1-4% in the general pediatric population. Its diagnosis and management require complex testing with polysomnography and a specialized care team, often at pediatric tertiary care centers. OBJECTIVE The objectives of this study are to describe the composition of pediatric tertiary care sleep clinics across Canada and describe wait times for clinic and diagnostic services across Canada. METHODS A 6-section questionnaire was sent to 16 sleep laboratory directors from tertiary pediatric sleep centers within Canada. Questions related to sleep clinic/laboratory capacity, referral volumes, wait times and the pandemic impact. RESULTS Responses were obtained from 15 of 16 sleep laboratory directors from tertiary pediatric sleep centers within Canada. Some provinces and territories have no sleep physicians. The total number of physicians providing coverage in the sleep clinics ranged from 2 to 15 across the country. Reported volume of patients waiting for their initial assessment was greater than 300 among 5 of the 13 centers (38%) that provided a response. The potential annual number of children in each province/territory per sleep study ranged greatly from 530 to 1,530. Potential annual number of polysomnograms performed ranged from 210 to 2,700 across provinces, allowing approximately 8,110 polysomnograms per year. CONCLUSION Our recent survey demonstrates that despite the continued need for more pediatric sleep resources in Canada there remains a shortage. We estimate that even if only children with SDB were tested with a polysomnogram there are 9.39 times more children with SDB than testing capacity without accounting for incident cases.