Half Of Children Research Articles

Children and adolescents in German emergency departments : The most common reasons for presentation throughout the day-current insights from the AKTIN emergency department registry

The planned hospital and emergency care reform in Germany aims, among other things, to restructure emergency services towards integrated emergency centers (INZ) and integrated emergency centers for children and adolescents (KINZ). There is agap in current data on the reasons for presentation and the use of emergency departments by patients under 18years of age. This study provides amulticenter analysis of the most common reasons for presentation among children and adolescents in German emergency departments. In aretrospective, descriptive cross-sectional analysis, data were collected from 251,570 emergency patients under 18years of age from January1, 2019, to June30, 2022, across 22emergency departments (including three pediatric emergency departments). Reasons for presentation were categorized according to the Canadian Emergency Department Information System-Presenting Complaint List (CEDIS-PCL) and analyzed by age group, gender, and mode of arrival. Over 64.1% of children and adolescents presented with one of the ten most common reasons. In pediatric emergency departments, nontrauma-related reasons, such as respiratory infections and abdominal pain, were predominant, while trauma-related reasons were more frequent in general emergency departments. The gender distribution showed amajority of male patients for trauma-related reasons, whereas some nontrauma-related reasons, like abdominal and headache complaints, were more common among females. Most patients (85.5%) arrived at the emergency department independently; only for seizures did ambulance transport prevail. During the day, 67% of patients presented between 06:00 and 18:00, with 33% presenting in the evening and nighttime hours. The results show that more than half of children and adolescents present to emergency departments with one of the ten most common chief complaints. Notably, nontraumatological presentations in emergency departments (EDs) highlight that pediatric care also takes place in facilities primarily serving adults. In the future, staff and infrastructure should be appropriately equipped to efficiently ensure the quality of pediatric emergency care on abroad scale. An important approach in this regard is health education and the optimization of access to outpatient care structures.

Clinical, immune and genetic risk factors of malaria-associated acute kidney injury in Zambian children: A study protocol.

Acute kidney injury (AKI) affects nearly half of children with severe malaria and increases the risk of adverse outcomes such as death and poor cognitive function. The pathogenesis and predictors of malaria-associated acute kidney injury (MAKI) are not fully described. This study aims to determine the clinical, immune, and genetic correlates of risk to AKI in Zambian children admitted with malaria. In addition, we intend to assess a modified renal angina index (mRAI), kidney injury molecule-1 (KIM-1), neutrophil gelatinase-associated lipocalin (NGAL), and soluble urokinase receptor (suPAR), when done on the first day of admission, for the ability to predict AKI two days later (day 3) in children admitted with malaria. This is an unmatched case-control study with a nested prospective observational study. A case-to-control ratio of 1:1 is used and 380 children with malaria and aged less than 16 years are being recruited from two hospitals in Zambia. Eligible children are recruited after obtaining written informed consent. Recruitment occurs during the malaria season and began on 6th March 2024 and will continue until July 2025. AKI is defined using the 2012 KIDGO AKI creatinine criteria, and cases are defined as children admitted with malaria who develop AKI within 72 hours of admission, while controls are children admitted with malaria but with no AKI. Serum creatinine is collected on Day 1 within 24 hours of admission, on Day 3 and then again on discharge or day 7, whichever comes sooner. Baseline biomarker concentrations will be determined using the Luminex multiplex Elisa system or high-sensitivity ELISA. SPSS version 29 will be used for data analysis. Descriptive statistics and inferential statistical tests will be run as appropriate. A p ≤ 0.05 will be considered as significant. The sensitivity, specificity, and estimates of the area under the curve (AUC) for the renal angina score will be determined.

Mother-child dyads living with HIV in the Western Cape, South Africa: Undetectable = Undetectable?

Globally, children living with HIV continue to lag behind UNAIDS targets for viral suppression (VS). Because studies with linked mother-child data are limited, we describe VS and associated factors among young children in a setting with early infant HIV testing (at birth, age 10 weeks and 6 months) and early protease inhibitor-based first-line antiretroviral therapy (ART). We analysed routinely collected mother-child data for children living with HIV born 2018-2022 in Western Cape province, South Africa (followed through mid-2023). We assessed associations between child and maternal viral load (VL) results at 12 and 24 months after child ART start using logistic regression, adjusted for child sex, birthyear, severity of child immunodeficiency at ART start, maternal age and timing of maternal HIV diagnosis. Among 2219 children living with HIV; 30% were diagnosed at birth (≤7 days), 41% before age 1 year (8-365 days) and 29% at age >1 year. Overall, 5% (n = 112/2219) of children died, a third of whom had not started ART; 90% of children (n = 1990) started ART, at median age 5 months (IQR 1-16). Median follow-up from ART start was 26 months (IQR 14-40). Among children with available VL at 12 months (n = 853/1582), 24 months (n = 614/1129) and 36 months (n = 350/658) after ART start, 36%, 43% and 48% were virally suppressed, respectively (VL<100 copies/ml). VS among children at 12 and 24 months was more likely if maternal VL was <100 versus ≥100 copies/ml at 12 months (adjusted odds ratio [aOR] = 3.5; 95% CI 1.9-6.5) and 24 months (aOR = 6.1; 95% CI 2.8-13.1) after child ART start. Children with no/mild versus advanced/severe immunodeficiency at ART start were more likely to achieve VS at 12 months (aOR = 2.3; 95% CI 1.3-4.2) but not at 24 months. Eligible children with missing VL at 24 months (39%) were more likely to have gaps in care of >6 months than those with VL≥100 or VL<100 copies/ml (84% vs. 28% vs. 14%, respectively; p<0.001). Less than half of children on ART achieved VS, and children were more likely to achieve VS if their mothers were also virally suppressed. Significant efforts are needed to support mother-child dyads to achieve optimal VS.

A decade of rotavirus vaccination in the World Health Organization African Region: An in-depth analysis of vaccine coverage from 2012 to 2023.

A decade of rotavirus vaccination in the World Health Organization African Region: An in-depth analysis of vaccine coverage from 2012 to 2023.

Type 1 diabetes in children: adulthood ahead

Type 1 diabetes mellitus (T1DM) in childhood is one of the most important social and medical problems, given the growing incidence and negative impact on the duration and quality of life. The onset of the disease in childhood associated with significantly reduced life expectancy, largely due to micro- and macrovascular complications, and background pathological processes may occur from the T1DM onset due to suboptimal glucose control. Large registers data indicate that less than half of children with T1DM achieve target glycemic control, and adolescence is characterized by the worst glycemic control among all age groups. In recent years, modern treatment tools have been widely adopted in children with T1DM: insulin pumps, continuous glucose monitoring and automatic insulin delivery systems, which has become possible due to their increased availability, convenience and proven effectiveness. These technologies not only reduce the burden of the disease, but also improve the effectiveness of treatment of T1DM in children, consequently reducing the risks of diabetic complications protecting the health for the upcoming adult life.

Measuring child food poverty: understanding the gap to achieving minimum dietary diversity.

The aim of this study is to analyse complementary feeding practices, to assess the extent to which minimum dietary diversity (MDD) recommendations are being met in the population studied and to study factors that influence the achievement of MDD. We pooled individual level data form the Demographic and Health Surveys (DHS) and Multi Indicator Cluster Surveys (MICS). We apply methods from poverty measurement to identify individual gaps towards achieving MDD. We further identify food groups that separate children who achieve MDD from those who do not. West and Central Africa. 62 257 children aged between 6 and 23 months. 82·0 per cent of children do not achieve MDD and on average are lacking 2·5 out of five required food groups. For 19·0 per cent of children, the gap to MDD is one food group and for 23·7 per cent of children the gap is two food groups. Consumption of eggs, other fruits and vegetables as well as legumes and nuts is particularly low among children who are not achieving MDD. More than 90·0 per cent of children who do not achieve MDD do not consume these food groups compared to around half of children who achieve MDD. Overall MDD is low, but there is large potential for improving MDD achievement if food consumption can be increased by one or two food groups. Available, affordable and culturally accepted food groups are identified that could be prioritised in interventions to close this gap.

Epidemiology of paediatric injuries in Nepal: evidence from emergency department injury surveillance

This article consists of a citation of a published article describing research funded by the Global Health Research programme under project number 16/137/49, and is provided as as part of the complete record of research outputs for this project. The original publication is available at: https://doi.org/10.1136/archdischild-2020-321198 Background Globally, injuries cause &gt;5 million deaths annually and children and young people are particularly vulnerable. Injuries are the leading cause of death in people aged 5–24 years and a leading cause of disability. In most low-income and middle-income countries where the majority of global child injury burden occurs, systems for routinely collecting injury data are limited. Methods A new model of injury surveillance for use in emergency departments in Nepal was designed and piloted. Data from patients presenting with injuries were collected prospectively over 12 months and used to describe the epidemiology of paediatric injury presentations. Results The total number of children &lt;18 years of age presenting with injury was 2696, representing 27% of all patients presenting with injuries enrolled. Most injuries in children presenting to the emergency departments in this study were unintentional and over half of children were &lt;10 years of age. Falls, animal bites/stings and road traffic injuries accounted for nearly 75% of all injuries with poisonings, burns and drownings presenting proportionately less often. Over half of injuries were cuts, bites and open wounds. In-hospital child mortality from injury was 1%. Conclusion Injuries affecting children in Nepal represent a significant burden. The data on injuries observed from falls, road traffic injuries and injuries related to animals suggest potential areas for injury prevention. This is the biggest prospective injury surveillance study in Nepal in recent years and supports the case for using injury surveillance to monitor child morbidity and mortality through improved data. Funding This publication was funded by the Global Health Research programme as a part of award number 16/137/49. This article reports on one component of the research award NIHR Global Health Research Group on Nepal Injury Research, University of the West of England, Bristol. For more information about this research please view the award page [https://fundingawards.nihr.ac.uk/award/16/137/49] DOI https://doi.org/10.1136/archdischild-2020-321198

Incidence and Risk Factors for Hypertension among Children with Nephrotic Syndrome.

Incidence and Risk Factors for Hypertension among Children with Nephrotic Syndrome.

Cultural transmission among hunter-gatherers

We examine from whom children learn in mobile hunter-gatherers, a way of life that characterized much of human history. Recent studies on the modes of transmission in hunter-gatherers are reviewed before presenting an analysis of five modes of transmission described by Cavalli-Sforza and Feldman [L. L. Cavalli-Sforza, M. W. Feldman, Cultural Transmission and Evolution: A Quantitative Approach (1981)] but not previously evaluated in hunter-gatherer research. We also present two modes of group transmission, conformist transmission, and concerted transmission, seldom mentioned in hunter-gatherer social learning research, and propose a unique mode of group transmission called cumulative transmission. The analysis of the additional modes of transmission indicated that cultural evolutionary signatures of vertical transmission, such as the conservation of cultural traits, have been underestimated because previous studies have seldom considered remote generations or distinguished intrafamilial from extrafamilial horizontal and oblique transmission. However, field data also indicate that hunter-gatherer children interacted with and learned from many nongenetically related individuals; about half of children's and adolescents' horizontal and oblique social learning came from nongenetically related individuals. Intimate living conditions of hunter-gatherers provide opportunities for group transmission, and ethnographic evidence presented demonstrates that at least three types of group transmission exist. All three forms of group transmission theoretically contribute to the conservation of culture, homogeneity of intracultural diversity, and high intercultural diversity. Analysis of additional modes of oblique and horizontal transmission and discussion of previous and unique modes of group transmission demonstrate the various mechanisms by which hunter-gatherer children learn and how cultures are conserved and contribute to cumulative culture.

FAMILY FEATURES AND ACADEMIC AND SOCIAL-EMOTIONAL DEVELOPMENT OF LEFT-BEHIND CHILDREN IN HUBEI, CHINA

Nearly half of children in China were affected by migration, and more than one-third of rural children had been left at home, classified as rural left-behind children (LBC). Despite numerous studies on migration and LBC, little research has investigated the issues of LBC by connecting their development with family features. This study aimed to identify associations between family features and children's academic performance and social-emotional development, focusing on differences between LBC and non-LBC. A quantitative method was applied, covering 548 primary school children in Shennongjia District, Hubei Province, China. Disparities between LBC and non-LBC were found in their social and emotional development, which disappeared among one-child families. Surprisingly, no significant differences were found in their academic performance, behavioral development, or certain demographic features, including gender, age, and family economic status. Furthermore, family features associated with children's development were found to be family structure, maternal factors such as maternal migration status and mothers' education, fathers' migration status, and the role of caregivers. Indeed, maternal migration status was identified as a vitally influential predictor of children's social-emotional development, while fathers' migration status was another influential predictor of children's emotional development. Drawing from ecological systems theory, this study underscored the importance of family in children's development and highlighted the compensatory function of schools and governments for disadvantaged contexts such as migration through educational policies and practices. Concurrently, it emphasized the imperative for heightened attention to the social and emotional well-being of LBC and comprehensive intervention support for stakeholders.

Current aspects of diabetic polyneuropathy in children

Diabetes mellitus (DM) is a serious medical and social problem of our time due to its high prevalence, lethality, early onset of disability and increasing morbidity. In children and adolescents, type 1 diabetes (DM1), characterized by absolute insulin deficiency due to autoimmune or idiopathic lesions of pancreatic β-cells, is registered more often. Every year, the total number of patients with DM1 under 18 years of age in the Russian Federation increases by several tens of thousands of people. DM is accompanied by various complications and one of the most frequent is diabetic polyneuropathy (DP), which occurs in half of children with DM1 more than 3 years. The progressive course of DP leads to the development of serious consequences affecting the quality of life and prognosis of patients. At the same time, at present, many aspects of this complication are insufficiently studied or have contradictory data, which justifies the expediency of systematization of materials on the pathogenesis of DP, effective methods of diagnostics and treatment of the disease in childhood.The aim of the work was to analyze modern scientific publications devoted to the study of DP in children, based on the search of literature sources in PubMed, CyberLeninka and RINC databases. A total of 58 bibliographic publications were reviewed, including contemporary resources from the period 2019–2023.

Effectiveness of a Sugar Consumption Prevention Program in the First Year of Life on the Occurrence of Early Childhood Caries: A Multicentric Randomized Trial in Brazil

Plain Language SummaryTeeth with cavities, known as dental caries, are widespread, affecting more than half of children in most countries. These cavities can cause significant discomfort, disrupting the routine of children and their parents’ lives, leading to sleep problems and work absences. The primary cause of these cavities is the frequent consumption of foods and drinks with added sugar, a practice that is not recommended before the child reaches 2 years of age. To address this issue, our study investigated the effect of advising mothers about healthy feeding practices during the first year of the child’s life on preventing caries and reducing sugar consumption at 6 and 12 months. Our findings showed that the nutritional guidance reduced sugar consumption significantly after comparing groups of mothers who received nutritional advice with those who did not. Still, it was ineffective in preventing the occurrence of caries in the child’s first year of life.

Marketing Harm to Children: Children’s exposure to unhealthy commodity marketing using body cameras

Abstract Background Sophisticated, persuasive and extensive product marketing is a key driver of unhealthy commodity (UHC) consumption. This study aims to identify the nature and extent of children’s exposure to UHC marketing. Methods The study is a secondary analysis of Kids’Cam, a cross-sectional study in which 168 New Zealand 12-year-old children wore body cameras that automatically captured images of their environment every 7 seconds over four days. Images were analysed for exposure to UHC, Healthy and ‘Other’ marketing. Results Children were exposed to UHC marketing on average 76.2 times/day, nearly 2.5 times their daily exposure to ‘Healthy’ marketing. Exposure included: unhealthy food marketing (68.4/day), alcohol (5.7/day), gambling (2.1/day) and tobacco marketing (0.1/day). These exposure rates align with the level of statutory regulation each UHC faces in NZ. Food outlets were the most common setting for UHC marketing exposures, while product packaging was the most common medium. Coca-Cola (6.3/day) was the most common UHC exposure, followed by Cadbury, Tip Top, Bluebird and Powerade. Over half of children’s unhealthy food (54.9%) and alcohol (51.9%) marketing exposures were attributed to multinational corporations. In contrast, statutory bodies are responsible for almost all (97.4%) of children’s gambling marketing exposure. Conclusions Children currently grow up in an environment in which they are constantly persuaded to consume products that directly harm their health - an environment in which the profits of corporations are favoured over public health. Statutory regulation of UHC marketing is urgently needed to protect children from harm. Key messages • Children were exposed to unhealthy commodity marketing on average 76.2 times/day, nearly 2.5 times their daily exposure to ‘healthy’ marketing. • Statutory regulation of unhealthy commodity marketing is urgently needed to protect children from harm.

Stress, Anxiety and Coping in Adults With Down Syndrome: An Exploratory Co-Research Study.

At least half of children and adults with Down syndrome have a major mental health concern during their life but few studies ask people with Down syndrome directly about their experience. We used a co-research model to explore anxiety, stress, and coping in adults with Down syndrome. Our group of researchers and adults with Down syndrome conducted an online survey on mental health for adults with Down syndrome. We analysed quantitative data and thematically grouped coping mechanisms. Sixty adults with Down syndrome completed the survey, mean age was 30 years, and 55% of respondents had some employment. Approximately 80% of respondents reported experiencing stress and 75% reported experiencing anxiety. Employed respondents were more likely to use social coping mechanisms. Soliciting responses from adults with Down syndrome about their mental health can provide valuable insights. Mental health is a concern for people with Down syndrome that should be addressed.

Fluid Overload in Children Following Hematopoietic Cell Transplant: A Comprehensive Review.

Fluid overload significantly increases morbidity and mortality in critically ill children. Following hematopoietic cell transplant (HCT), children are at a high risk of fluid accumulation due to essential increased fluid intake for nutrition, blood products, and antimicrobials. In addition, many complications predispose these children to capillary leak and fluid overload (FO), such as sinusoidal obstruction syndrome, engraftment syndrome, sepsis, and acute kidney injury (AKI). FO > 10% occurs in nearly half of children following HCT and is associated with a lower PICU survival rate. In addition, in children with acute respiratory failure post HCT, each 1% increase in cumulative fluid balance on d 3 increases the odds of PICU mortality by 3%. Furthermore, FO worsens AKI. Tools such as the renal angina index and urinary biomarkers such as neutrophil gelatinase-associated lipocalin can help identify patients at risk of AKI and FO. Early detection, prevention, and intervention are crucial to improving outcomes in this population. Management strategies include fluid restriction, diuretics, and continuous kidney replacement therapy (CKRT) when FO exceeds 10% and other measures have failed.

Long-Term Mental Health Outcomes of Bronchopulmonary Dysplasia in Neonates: An 18-Year National Cohort Study

Long-Term Mental Health Outcomes of Bronchopulmonary Dysplasia in Neonates: An 18-Year National Cohort Study

Intermittent Preventive Treatment of Malaria in Pregnancy and the Impact on Neonates in African Countries as Assessed by Entropy Weight and TOPSIS Methods.

Background/Objectives: In regions of Africa with a high prevalence of malaria, pregnant women in their first or second trimester should be administered intermittent preventive treatment in pregnancy (IPTp). However, infants may contract malaria despite the IPTp therapy that their mothers have received. The objective of the present investigation was to assess the symptoms and various treatments for neonatal malaria. Methods: Entropy weight and TOPSIS were used to achieve the study goal. The TOPSIS multi-attribute decision-making system was used to assess newborn malaria symptoms and select the optimal treatment, even for mothers receiving IPTp medication during pregnancy. The entropy weight approach calculated TOPSIS attribute weights. The present research used UNICEF data for 14 African nations in 2023. Results: The results indicated that neonates whose mothers received IPTp therapy ultimately contracted malaria, with diarrhea being the primary symptom. It is important to note that health providers administer a combination of zinc and oral rehydration solution (ORS) to infants as the most effective treatment for malaria symptoms, thereby abandoning the first-line treatment for malaria, artemisinin-based combination therapy (ACT). Conclusions: The most effective treatment for neonatal malaria is a combination of zinc and ORS, although less than half of children in Africa have access to ORS. Therefore, the findings of this study may encourage African countries to prioritize co-pack therapy in their procurement and supply, healthcare provider training, and expenditures. This therapy will also help alleviate the symptoms of malaria in neonates.

Child care for young children with disabilities.

More than half (56%) of Canadian children aged 0 to 5 years are in non-parental child care, but data on child care attendance among children with disabilities is limited. This study examines child care participation among young children with disabilities in Canada, with a focus on different disability types. Analyses were conducted on 1,189 children aged 0 to 5 years identified with disabilities from Statistics Canada's 2023 Survey on Early Learning and Child Care Arrangements - Children with Long-term Conditions and Disabilities. Rates of child care participation, difficulties finding child care, difficulties within child care, and whether parents reported that their child had ever been denied a child care space because of their condition were examined. Logistic regression models tested for differences in the main child care arrangement and difficulty finding child care based on the child's disability while controlling for sociodemographic variables. Among children aged 0 to 5 years with disabilities, 45% attended a daycare centre, preschool, centre de la petite enfance, or before or after school care as their main child care arrangement; 17% attended another type of child care, such as a family child care home or care by a relative; and 38% did not regularly attend non-parental child care. The parents of nearly half of children with disabilities reported difficulty finding a child care arrangement, particularly for children with emotional conditions. Close to 1 in 10 parents of children with disabilities who were using child care reported that their child had been denied a child care space because of their condition. These findings highlight the need for information to support inclusive policies, practices, and resources for children with disabilities within the Canada-wide early learning and child care system.

Clinical spectrum and outcome of children with deficiency of adenosine deaminase 2 (DADA2): multicentric experience from India.

Deficiency of adenosine deaminase-2 (DADA2) is a monogenic disorder closely resembling polyarteritis nodosa (PAN) and can present to physicians across various specialties. Through this case series, we aim to describe the clinical spectrum and outcome of Indian children with DADA2. We aimed to study the clinical spectrum and outcome of Indian children with DADA-2. The deidentified data from all participating centres were entered in an excel sheet, and the coordinating centre (All India Institute of Medical Sciences, New Delhi) screened the data for accuracy and completeness. We enrolled 16 children (11 females) in the study; the mean (SD) age at the time of onset of symptoms for males and females was 46.2 (47) and 73.6 (50.4) months, respectively. The most common clinical feature in this cohort was fever and rash in 80% of patients. More than half of children n, (%) [8, (53%)] had a CNS stroke. The other clinical features were hypertension [5(33%)], anaemia [3 (20%)] and arthralgia/arthritis in 4 (26%). These children were managed with various immunomodulators: steroids [13, (86%)], anti-TNF agents [(12, (80%)], cyclophosphamide [2 (13%)] and mycophenolate mofetil [3 (20%)]. The median (IQR) duration of follow-up for this cohort was 17 (10, 29) months. Fourteen children achieved remission and none had recurrent strokes after the initiation of anti-TNF drugs. DADA-2 closely resembles PAN; early age of onset and CNS stroke are striking differentiating features from classic PAN. Most children respond well to anti-TNF agents without serious adverse events during short-term follow-up.

Epidemiology of self-limited epilepsy with centrotemporal spikes (SeLECTS): A population study using primary care records

Epidemiology of self-limited epilepsy with centrotemporal spikes (SeLECTS): A population study using primary care records