Healthy Pediatric Patients Research Articles

Validation of the arabic version of parental expectation questionnaire among cochlear implant recipients

Objectives: The cochlear implant (CI) recipients and their families form an integral part of the CI team. The decision about CI is challenging for parents and their support is essential during rehabilitation. The families should have realistic expectations from the implantation, as unrealistic expectations cause frustration, negatively impacting the outcome. This study aimed to translate and validate the parental expectation questionnaire by evaluating the outcomes of their children after CI in the Saudi population. Materials and Methods: A questionnaire-based study was conducted at a tertiary hospital from June 2018 to July 2019. Altogether, 100 parents of children undergoing CI answered a questionnaire of 18 questions regarding the expectation of their child's performance and refilled it after a year of surgery. All healthy prelingual pediatric patients accepted by the CI committee for bilateral CI with at least 1 year follow-up postoperatively were included in this study. The main outcome measures were parents' awareness and expectation about CI. Results: The study showed parents having high expectations from their children with CI. The parents were more aware about the rehabilitation demands and stress after CI surgery with 16% of parents unaware of the importance of the rehabilitation process. Conclusions: Proper counseling on realistic expectations should be given at different implantation stages; pre- and post-implantation for an improved outcome and helping the child in reaching full potential.

Interleukin-8 is increased in chronic kidney disease in children, but not related to cardiovascular disease.

Introduction:In this study, we aimed to detect the cytokine that is involved in the early stage of chronic kidney disease and associated with cardiovascular disease.Methods:We included 50 patients who were diagnosed with predialytic chronic kidney disease and 30 healthy pediatric patients in Ege University Medical Faculty Pediatric Clinic, İzmir/Turkey. Interleukin-8 (IL-8), interleukin-10 (IL-10), interleukin-13 (IL-13), and transforming grow factor-β1 (TGF-β1) levels (pg/mL) were measured by ELISA. Carotid-femoral pulse wave velocity (PWV), augmentation index (Aix), carotid intima media thickness (cIMT), and left ventricular mass index (LVMI) were evaluated as markers of cardiovascular disease. The presence of a cardiovascular disease marker was defined as an abnormality in any of the parameters (cIMT, PWV, Aix, and left ventricular mass index (SVKI)). The patient group was divided into two groups as with and without cardiovascular disease.Results: Mean Aix and PWV values were higher in CKD patients than controls (Aix: CKD 32.8±11.11%, healthy subjects: 6.74±6.58%, PWV CKD: 7.31±4.34m/s, healthy subjects: 3.42±3.01m/s, respectively; p=0.02, p=0.03). The serum IL-8 levels of CKD were significantly higher than of healthy subjects 568.48±487.35pg/mL, 33.67±47.47pg/mL, respectively (p<0.001). There was no statistically significant difference between IL-8, IL-10, IL-13, TGF-1, in CKD patients with and without cardiovascular disease (p> 0.05).Discussion:IL-8 is the sole cytokine that increases in pediatric patients with chronic kidney disease among other cytokines (IL-10, IL-13 and TGF-β1). However, we did not show that IL-8 is related to the presence of cardiovascular disease.

Using the RETeval Device in Healthy Children to Establish Normative Electroretinogram Values.

To provide normative data of full-field electro-retinogram (ERG) responses in the pediatric population using the RETeval ERG device (LKC Technologies, Inc) in healthy children without evidence of retinal disease. This was a single-site cross-sectional study of healthy pediatric patients with normal dilated fundus examinations and no known retinal diseases. Participants were recruited to undergo dilated full-field ERG using the handheld RETeval device. The International Society for Clinical Electrophysiology of Vision 5-step protocol was used. Photopic and dark-adapted scotopic responses were recorded using skin electrodes. Main outcome measures were normative RETeval ERG values and correlation of age with measured ERG parameters. Thirty-eight eyes of 20 healthy patients (aged 4 to 17 years) were included in the study. Of the 20 normal patients, 9 were male and 11 were female. Normative mean, median, and range values were recorded for the measured full-field ERG parameters. Pearson correlation was moderately positive between age and oscillatory potential and scotopic dim flash amplitude (r = 0.59, P = .006 for both). A positive correlation was also found between age and cone a-wave implicit time (r = 0.67, P = .001). The handheld RETeval system is a useful tool for obtaining full-field ERGs in children without anesthesia. Moderate positive correlations were observed between age and oscillatory potential and scotopic dim flash amplitude. A strong correlation was found between age and cone a-wave implicit time. The current study provides a baseline of normative full-field ERG values in children. [J Pediatr Ophthalmol Strabismus. 2021;58(1):17-22.].

A data analysis study: is there a relationship between 25(OH)D deficiency and iron-deficient anaemia in the pediatric population?

AbstractObjectivesThe purpose of this retrospective study was to investigate the relationship between 25 OH vitamin D (25[OH]D) deficiency and iron-deficient anaemia (IDA) in the pediatric population. This was aimed to provide a better insight to IDA follow-up and treatment.MethodsThe data of 120 patients diagnosed with IDA and 125 healthy pediatric patients were analyzed retrospectively. Serum vitamin B12, Folate and 25(OH)D levels, between IDA and healthy groups were evaluated. The relationship between vitamins levels and IDA parameters were examined. Logistic regression analysis was used to assess whether 25(OH)D deficiency levels were an independent risk factor for diagnosing IDA.ResultsIn the comparison of vitamins levels between groups, only mean serum 25(OH)D levels were found to be statistically significantly (p=0.000) lower (13.00 ± 2.50 ng/mL) in the group with IDA compared to the healthy group (25.98 ± 3.66 ng/mL). There were strong positive correlations between 25(OH)D deficiency levels and IDA. The deficiency of 25(OH)D levels was not found to be an independent risk factor for IDA (ORs: 0.958, 95%CI: 0.917–1.000).ConclusionsAlthough current results confirm the association between 25(0H)D deficiency and IDA in pediatric patients, they indicate that there was no independent risk factor for IDA.

Limited Utility of Surveillance Echocardiograms in Pediatric Patients with Isolated Secundum Atrial Septal Defects

Atrial septal defects (ASDs) are the third most common form of congenital heart defects worldwide.1 Most otherwise healthy pediatric patients with hemodynamically significant ASDs remain asymptomatic throughout childhood. Pulmonary vascular disease or atrial arrhythmias associated with long-standing ASDs rarely occur before late adolescence or early adulthood.2 In the absence of failure to thrive or frequent respiratory infections, most patients undergo elective ASD repair in early childhood (2-5 years of age).

Cardiac Abnormalities Seen in Pediatric Patients During the SARS-CoV2 Pandemic: An International Experience.

BackgroundDuring the SARS‐CoV2 pandemic, there has been increase in hyperinflammatory presentation in previously healthy children with a variety of cardiac manifestations. Our objective is to describe the cardiac manifestations found in an international cohort of 55 pediatric cases with multi‐system inflammatory syndrome (MIS‐C) during the SARS‐CoV2 pandemic.Methods and ResultsWe reviewed data on previously healthy pediatric patients (≤18 years) with structurally normal hearts who presented at hospitals in the United States, United Kingdom, Spain and Pakistan with MIS‐C and had consultation with a pediatric cardiologist. Data collected included demographics, clinical presentation, laboratory values, electrocardiographic abnormalities, echocardiographic findings and initial therapies. A total of 55 patients presented with MIS‐C. Thirty‐five patients (64%) had evidence of decreased left ventricular function, 17 (31%) had valvulitis, 12 (22%) with pericardial effusion and 11 (20%) with coronary abnormalities. Twenty‐seven (49%) required ICU admission and 24 (44%) had evidence of shock. Eleven patients (20%) fulfilled complete Kawasaki disease criteria and had lower NT pro‐BNP, D‐dimer and ferritin levels compared with those who did not fulfill criteria. Electrophysiologic abnormalities occurred in 6 patients and included complete atrioventricular (AV) block, transient AV block and ventricular tachycardia.ConclusionsWe describe the first international cohort of pediatric patients with MIS‐C during the SARS‐CoV2 pandemic with a range of cardiac manifestations. This paper brings awareness and alertness to the global medical community to recognize these children during the pandemic and understand the need for early cardiology evaluation and follow‐up.

Nutritional Status of Pediatric Patients in Ramathibodi Hospital Using the WHO Child Growth Standard and the Thai Growth Reference

Background: The appropriate assessment of nutritional status in children is an essential aspect of health supervision. Currently, there are two references used for growth assessment in Thailand. The WHO child growth standard, which has been widely used since 2007, and the Thai growth reference developed by the Ministry of Public Health, which has been used since 1998. However, there were very few studies that made a direct comparison between both tools. Objective: To compare the nutritional status of healthy pediatric patients in Ramathibodi Hospital assessed by the World Health Organization (WHO) child growth standard and the Thai growth reference. Materials and Methods: The present study was a cross-sectional study. The data were collected from all pediatric patients registered in the outpatient department (OPD) of Faculty of Medicine, Ramathibodi Hospital between January 2013 and December 2018. All healthy children (aged 0 to 15 years) were included. Exclusion criteria of possibly chronically ill children were defined by those who were 1) visiting subspecialty clinics, 2) OPD and emergency room (ER) visits more than ten times per year, 3) having ICD-10 of chronic conditions, or 4) had been admitted in the hospital during the study. The weight and height or length data were extracted from the Electronic Medical Record system. All data were analyzed by the Stata Statistical Software focusing on age and sex-specific Z-scores, which references the WHO child growth standard and the Thai growth reference. Results: Sixty-two thousand one hundred four OPD visits were divided into 31,662 OPD visits for boys and 30,442 OPD visits for girls. Percent of weight for age and height or length for age more than +2 Z-score of both boys and girls when using the Thai growth reference was greater than that using the WHO child growth standard, especially for children aged 0 to 12 months. The Thai growth reference classified as overweight were approximately 10.26% to 31.12% more than using the WHO child growth standard. There was no difference in classification of height by both standards. Conclusion: There was a difference in classification of nutritional status between the Thai growth reference and the WHO child growth standard. Keywords: Nutritional status, Pediatric growth reference, Assessment tool, Overweight

CT-Based Measurements of Facial Parameters of Healthy Children and Adolescents in Thailand.

Facial parameters are used for evaluating normal growth patterns, diagnosing patients with craniofacial abnormalities, and planning surgical procedures. However, these parameters vary by ethnicity and race. This study aims to describe soft-tissue and bony facial parameters based on CT of healthy pediatric and adolescent patients in Thailand. CT imaging of the brain, orbit, facial bones, and neck was performed at Maharaj Nakorn Chiangmai Hospital, in patients from birth to 19 years old. Patients with known syndromic disease, craniofacial syndrome, facial trauma and/or infection, and previous surgery that deformed the study area were excluded. The key points of measurement were soft-tissue intercanthal, bony interorbital, and bony lateral orbital distances. There were 932 patients: 554 males (59.4%) and 378 females (40.6%). Facial parameters rapidly increased in the first 2 years of life. Significant differences in these parameters between the males and females were found at the age of ≥15 years. However, ratios of the interorbital to the lateral orbital distance were generally consistent among age groups in both sexes, at 0.25. This study, in Thailand, provides detailed age- and sex-specific normative data of the craniofacial measurements in children and adolescences based on CT imaging. These data can be used for evaluating individual patients with craniofacial abnormalities as well as determining the treatment in Thai and Asian populations, in whom craniofacial abnormalities, for example, frontoethmoidal encephalomeningocele, are common.

Normative Data for Myocardial Native T1 and Extracellular Volume Fraction in Children.

To establish normative data for myocardial T1, including extracellular volume (ECV) fraction, in healthy children. In this retrospective, single-center study, T1 mapping data were collected from 48 healthy pediatric patients (14 years ± 3 [standard deviation]; range, 9-18 years; 27 of 48 [56%] male) referred for cardiac screening 1.5-T MRI between 2014 and 2017. T1 relaxometry was performed using a 5(number of heartbeats [nHB])3 modified Look-Locker inversion recovery (MOLLI) sequence, where nHB was three to five heartbeats depending on the heart rate, and was repeated 15 minutes following the administration of 0.2 mmol per kilogram of body weight of gadobenate dimeglumine, with 19 patients receiving contrast material. T1 values were calculated using a curve-fitting algorithm on average region-of-interest signal and corrected for imperfect inversion pulse efficiency. Comparisons within patients were performed with paired Student t test, between groups with unpaired Student t test or Mann-Whitney U test, and linear regression was performed to examine for associations with other variables. Average native T1 was 1008 msec ± 31, with a nonsignificant increase in females (1017 msec ± 27 vs 1001 msec ± 33, P = .066). Average ECV was 20.8% ± 2.4, with a nonsignificant increase in values in females (21.7% ± 1.9 vs 20.0% ± 2.6, P = .123). T1 and ECV values were increased in the septum versus the free wall. Normative data are presented for myocardial native T1 and ECV using the MOLLI T1 mapping sequence at 1.5 T.Supplemental material is available for this article.© RSNA, 2020.

Dependency of respiratory system mechanics on positive end-expiratory pressure and recruitment maneuvers in lung healthy pediatric patients-A randomized crossover study.

The lungs of pediatric patients are subjected to tidal derecruitment during mechanical ventilation and in contrast to adult patients this unfavorable condition cannot be resolved with small c increases. This raises the question if higher end-expiratory pressure increases or recruitment maneuvers may resolve tidal derecruitment in pediatric patients. We hypothesized that higher PEEP resolves tidal derecruitment in pediatric patients and that recruitment maneuvers between the pressure changes support the improvement of respiratory system mechanics. The effects of end-expiratory pressure changes from 3 to 7cmH2 O and vice versa without and with intermediate recruitment maneuvers on respiratory system mechanics and regional ventilation were investigated in 57 mechanically ventilated pediatric patients. The intratidal respiratory system compliance was determined from volume and pressure data before and after PEEP changes and categorized to indicate tidal derecruitment. Tidal derecruitment occurred comparably frequently at PEEP 3 cmH2 O without (13 out of 14 cases) and with recruitment maneuver (14 out of 14 cases) and at PEEP 7 cmH2 O without (13 out of 14 cases) and with recruitment maneuver (13 out of 15 cases). We conclude that contrary to our hypothesis, PEEP up to 7cmH2 O is not sufficient to resolve tidal derecruitment and that recruitment maneuvers may be dispensable in mechanically ventilated pediatric patients.

Characteristics and Frequency of Children With Severe Obstructive Sleep Apnea Undergoing Elective Polysomnography.

To determine the prevalence and demographics features of pediatric patients with severe obstructive sleep apnea (OSA) who would not undergo preoperative polysomnography (PSG) under current American Academy of Otolaryngology (AAO) guidelines. In this retrospective cohort study, we identified patients from the electronic medical record who underwent elective polysomnography for evaluation of sleep-disordered breathing between 2012 and 2018. Urban tertiary safety net hospital. A total of 456 patients with a mean (SD) age of 5.7 (3.2) years (263 male, 193 female). Demographic factors (age, sex, race, language, insurance status) and clinical findings (symptom severity, tonsil size) were recorded. The data were analyzed by univariate analysis. Of 456 patients identified, 66 (14.5%) were found to have severe OSA. African American patients had 3.7 times the odds of severe OSA compared to white patients (95% CI, 1.2-10.8). Patients aged 2 to 3 years had 2.2 times the odds of severe OSA compared to patients aged 4 to 6 years (95% CI, 1.2-4.0). Sex, ethnicity, language, and insurance type were not significantly associated with severity of OSA. The presence of apneic episodes and tonsil size were not found to be statistically significant. Up to 14.5% of healthy pediatric patients with sleep-disordered breathing may have severe OSA; young age and African American race are statistically significant predictors. Clinical findings, such as tonsil size and symptom severity, were not found to be statistically significant predictors.

Influence of pneumococcal vaccination on the hospitalization of healthy pediatric patients due to typical Community-Acquired Pneumonia

IntroductionCommunity-Acquired Pneumonia (CAP) is one of the most frequent causes of hospital admission in children. Our objective is to measure the impact of the introduction of pneumococcal conjugate vaccines on the hospitalization of previously healthy children due to CAP. MethodFrom 2011 to 2016, a partially retrospective, prospective, and descriptive study was carried out on healthy pediatric patients (3 months–14 years old) with CAP, who required hospital admission. Clinical, epidemiological, and demographic characteristics were collected, and vaccination status was obtained from medical records. ResultsA total of 292 cases were included, with a mean age of 33.4 months, 54% males. There was a progressive and significant 42% decrease in the number of admissions each year, without significant changes in the annual percentage of parapneumonic pleural effusion (PPE). Fifty-six percent of patients were immunized with a pneumococcal conjugate vaccine (PCV). The percentage of children who were not vaccinated decreased by 14%, and the coverage with PCV-13 increased by 46%. This revealed a significant increase of PPE in vaccinated patients with PCV-7 (63%) compared with unvaccinated (45%) and with PCV-13 (57%), without association with the presence of severe PPE. Moreover, no significant differences in severity or hospital stay were observed in unvaccinated patients, compared to those who were vaccinated. In >2-year-olds, we observed a significant increase in PPE (59%) compared to 45% in younger children. ConclusionsThe increase in vaccination coverage with PCV-13 resulted in a decrease in hospitalizations due to CAP and PPE. Vaccination with PCV-7 is associated in our sample with an increase in PPE but not with severe PPE nor an increase in the hospital stay. There was an epidemiological shift of severe forms of pneumonia and empyema at later ages (>2 years).

Assessing the impact of cystic fibrosis on the antipyretic response of ibuprofen in children: Physiologically-based modeling as a candle in the dark.

The goal of this study is to present the utility of quantitative modelling for extrapolation of drug safety and efficacy to underrepresented populations in controlled clinical trials. To illustrate this, the stepwise development of an integrated disease/pharmacokinetics/pharmacodynamics model of antipyretic efficacy of ibuprofen in children with cystic fibrosis (CF) is presented along with therapy optimization suggestions. Published clinical trials, in vitro data, and drug physiochemical properties were used to develop an ibuprofen-mediated antipyresis model for febrile children also having CF. Workflow included first developing a mechanistic absorption model using in vitro-in vivo extrapolation followed by physiologically-based pharmacokinetic (PBPK) modelling. The verified PBPK model was then scaled to paediatric patients with CF. Once verified, the PBPK model was linked to an indirect response model of antipyresis for simulation of the overall antipyretic efficacy of ibuprofen in CF children. Model simulations showed therapeutic inequivalence between healthy children and paediatric patients with CF; Cmax and AUC decreased by 39% (32-46%) and 44% (36-52%), respectively, in patients. Further, and in agreement with literature reports, predicted pharmacodynamics time courses suggest a slower onset and faster offset of action in patients compared to healthy children, 30 and 60 minutes, respectively. Exploratory simulations suggest an increase in dosing frequency for CF children as a better therapeutic strategy. Model-informed approaches to leveraging knowledge obtained throughout the life cycle of drug development may play a key role in extrapolating drug efficacy and safety to underrepresented populations.

Efficacy and feasibility of 226 Hz and 1000 Hz tympanometry in healthy pediatric patients

Objectives: Tympanometric evaluation of middle ear with 226 Hertz (Hz) frequency probe has been widely used in patients with suspected middle ear and Eustachian tube disorders. However most of the recent studies were demonstrated that tympanometric examination with 1000 Hz frequency probe was superior to 226 Hz frequency probe examination to detect middle ear disorders affecting middle ear admittance especially for infants. The objective(s) of this study was to compare the reliability and feasibility of 226 Hz and 1000 Hz tympanometric results in normal hearing healthy pediatric group of patients.Methods: In this study, we evaluated normal healthy pediatric patients with 226 and 1000 Hz frequency probe tympanometry for the aim of comparing efficacy and detecting the rate of false negative tympanometric findings in these subjects. Forty-nine (98 ears) healthy pediatric patients (25 males and 24 females) were enrolled in the study and all of the patients were younger than 18 years of age. Oto-microscopic examination was performed to all of the patients as a gold standard.Results: The mean age was 9.3 ± 4.46 years old with a range from 3 to 17 years. The mean values of 226 Hz tympanometric measurement of right ears for ear volume, compliance, pressure and gradient were 74 ± 28.10, 59 ± 38.96, -46 ± 92.38 and 36 ±3 3.22, respectively; these values for the left ears were 84 ± 65.94, 51 ± 31.00, -57 ± 102.05 and 30 ± 23.35, respectively. The mean values of 1000 Hz tympanometric measurement of right ears for ear volume, compliance and pressure were 78 ± 23.03, 172 ± 85.04 and -22 ± 110.70, respectively; these values for the left ears were 64 ± 32.05, 147 ± 104.70, and 0 ± 98.20, respectively.Conclusions: We found that there was no superiority of the usage of 1000 Hz tympanometry to 226 Hz tympanometry in normal hearing healthy pediatric patients who were equal or older than 3 years of age.

Mesenchymal stromal cells exert rapid immunoregulation functions on pediatric steriod-resistant aGVHD patients through TCR-Ca2+signalling

Background & Aim Severe acute graft-versus-host disease (GVHD) after transplantation is associated with a high mortality rate and is a major threat to a successful outcome. Mesenchymal stromal cells (MSC) has been reported recently as a promising treatment for severe steriod-resistant acute graft-versus-host disease. MSCs have shown great promise in preclinical and clinical therapies for severe acute condition within hours, such as septic shock and acute lung injury. Here, we demonstrated that MSCs could able to rapidly reduce the expressions of TNF-α and IFN-γ in activated T cells in vitro and in vivo, mainly by a rapid suppression on their TCR signaling. Methods, Results & Conclusion Methods 1.Isolation of BMSCs from donors and cultured for the functional experiments. 2.Processing of peripheral blood cells and plasma from healthy donors and pediatric aGVHD patients, which were used for Real-Time qRT-PCR and Elisa assays to measure the levels of TNFα and IFN-γ. 3.Western blotting Analysis and Phospho-epitope Staining for Flow Cytometry were used to test the levels of TCR. 4.Measurements of Ca2+concentrations in responding T cells throgh Microscope and Flow Cytometry by using a Ca2+ indicator- Fluo-4 AM. Results MSCs rapidly suppressed the expressions of TNF-α and IFN-γ, TCR-proximal signaling and Ca2+ signaling of T cells in vitro. For aGVHD patients, we observed, after MSC infusion, TNF-α and IFN-γ at mRNA levels of T cells were decreased in 6 of 10 (more than half) patients, 2 patients without significant change and 2 patients increased a little. These matched up the Ca2+ level of T cells and TCR-proximal signaling reductions of these patients. Conclusion Using T/MSCs co-culture system, we found that MSCs were able to downregulate the TNF-α and IFN-γ of activated T cells within 1 hour. Also, MSCs were observed to rapidly suppress the TCR signaling. The alterations from aGVHD patient, which received MSCs infusion, further confirmed these MSCs-mediated short-term effects on T cells in vivo. This might make it more understandable for the feasibility of MSCs to control the severe acute immune disorders, such as septic shock and acute lung injury.

Pediatric Otolaryngology Divisional and Institutional Preparatory Response at Seattle Children's Hospital after COVID-19 Regional Exposure.

Coronavirus disease 2019 (COVID-19) is a novel coronavirus resulting in high mortality in the adult population but low mortality in the pediatric population. The role children and adolescents play in COVID-19 transmission is unclear, and it is possible that healthy pediatric patients serve as a reservoir for the virus. This article serves as a summary of a single pediatric institution's response to COVID-19 with the goal of protecting both patients and health care providers while providing ongoing care to critically ill patients who require urgent interventions. A significant limitation of this commentary is that it reflects a single institution's joint effort at a moment in time but does not take into consideration future circumstances that could change practice patterns. We still hope dissemination of our overall response at this moment, approximately 8 weeks after our region's first adult case, may benefit other pediatric institutions preparing for COVID-19.

Sex differences in paediatric airway anatomy.

What is the central question of this study? Are sex difference in the central airways present in healthy paediatric patients? What is the main finding and its importance? In patients ≤12years we found no sex differences in central airway luminal area. After 14years, the males had significantly larger central airway luminal areas than the females. The sex differences were minimized, but preserved when correcting for height. Luminal area is the main determinant of airway resistance and our finding could help explain sex differences in pulmonary system limitations to exercise in paediatric patients. Cross-sectional airway area is the main determinant of resistance to airflow in the respiratory system. In paediatric patients (<18years), previous evidence for sex differences in cross-sectional airway area was limited to patients with history of pulmonary disease or cadaveric studies with small numbers of subjects. These studies either only report tracheal data and do not include a range of ages or correct for height. Therefore, we sought to assess sex differences in airway luminal area utilizing paediatric patients of varying ages and no history of respiratory disease. Using three-dimensional reconstructions from high-resolution computed tomography scans, we retrospectively assessed the cross-sectional airway area in healthy paediatric females (n=97) and males (n=128) over a range of ages (1-17years). The areas of the trachea, left main bronchus, left upper lobe, left lower lobe, right main bronchus, intermediate bronchus and right upper lobe were measured at three discrete points by a blinded investigator. No differences between the sexes were noted in the cross-sectional areas of the youngest (ages 1-12years) patients (P>0.05). However, in patients ≥14years the cross-sectional areas were larger in the males compared to females in most airway sites. For instance, the cross-sectional size of the trachea was 25% (218±44vs. 163±24mm2 , P<0.01) larger in males vs. females among ages 13-17years. When accounting for height, these sex differences in airway areas were attenuated, but persisted. Our results indicate that sex differences in paediatric airway cross-sectional area manifest after age ≥14years and are independent of height.

Cerebrospinal Fluid Findings Are Poor Predictors of Appropriate FilmArray Meningitis/Encephalitis Panel Utilization in Pediatric Patients.

Molecular testing of cerebrospinal fluid (CSF) using the BioFire FilmArray meningitis/encephalitis (FA-M/E) panel permits rapid, simultaneous pathogen detection. Due to the broad spectrum of targeted organisms, FA-M/E testing may be restricted to patients with abnormal CSF findings. We sought to determine if restriction is appropriate in our previously healthy and/or immunocompromised pediatric patients. FA-M/E was ordered on 1,025 CSF samples from 948 patients; 121 (11.8%) specimens were FA-M/E positive. Of these, 89 (73.6%) were virus positive, and 30 (24.8%) were bacterium positive. The most common targets detected were enterovirus (n = 38), human herpesvirus 6 (HHV-6) (n = 30), and Streptococcus pneumoniae (n = 14). Pleocytosis with white blood cell (WBC) levels of ≥5 cells/mm3 and ≥10 cells/mm3 were found in 33.1% and 24.3% of all specimens, respectively. Using WBC levels of ≥5 cells/mm3, 63.4% (59/93) of positive specimens exhibited pleocytosis, compared to 29.5% (233/789) of negative specimens. Among positive specimens, 54.4% (37/68) of viral and 87% (20/23) of bacterial cases had pleocytosis. The use of a pleocytosis cutoff of ≥10 cells/mm3 would have missed an additional enterovirus, one cytomegalovirus (CMV), and two HHV-6 diagnoses. CSF glucose and protein levels were normal for 83/116 (75.2%) and 51/116 (44%) positive specimens. Abnormal glucose in combination with WBC levels of ≥10 cells/mm3 showed high specificity (94.5%) and was a better predictor of FA-M/E positivity than abnormal protein. Sensitivity and positive predictive values were <90% for all biomarkers. CSF pleocytosis and abnormal glucose/protein were poor predictors of FA-M/E. Restricting FA-M/E orders based on pleocytosis or other abnormal parameters would have resulted in missed diagnostic opportunities, particularly for the detection of viruses in both previously healthy and immunocompromised patients.

BET 2: Does topical lidocaine improve oral intake in children with painful mouth ulcers?

A shortcut review was carried out to establish whether topical lidocaine was effective at reducing pain and improving oral intake in children with painful oral lesions. 34 papers were found using the reported searches, of which two presented the best available evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these two papers are tabulated. It is concluded that in otherwise healthy paediatric patients with painful oral ulcers, treatment with viscous lidocaine does not improve oral intake, although it may provide some pain relief.

Evaluation of T2Candida Panel for detection of Candida in peritoneal dialysates.

Fungal peritonitis in the peritoneal dialysis population is difficult to diagnose promptly due to the inherently slow cultivation-based methods currently required for identification of peritonitis pathogens. Because of the moderate risk for severe complications, the need for rapid diagnostics is considerable. One possible solution to this unmet need is the T2Candida Panel, a new technology designed to detect the most common pathogenic Candida spp. directly from whole blood specimens in as little as a few hours. We hypothesized that this technology could be applied to the detection of Candida in peritoneal dialysate, a matrix not currently approved by the Food and Drug Administration for testing by this system. Remnant dialysate samples from three healthy (noninfected) pediatric peritoneal dialysis patients were spiked with Candida glabrata, serially diluted, and tested in triplicate with unaltered dialysate specimens. The assay detected C. glabrata in 100% of spiked dialysate samples across the full spectrum of dilutions tested, and no assay inhibition or cross-reactivity was noted. These findings suggest one of possibly more applications of this technology. The positive clinical implications of this test will continue to be realized as its use is validated in peritoneal dialysate and other patient specimen types.