Children's Hospital Research Articles

Impact of enhanced public health and infection control measures on pediatric hospital-acquired respiratory viral infections during the SARS-CoV-2 pandemic.

Visitor restrictions and mask-wearing may reduce hospital-acquired infections (HAI) as part of infection control bundles. The impact of a strict visitor policy and compulsory surgical mask wearing implemented during the SARS-CoV-2 pandemic, but prior to any local community circulating SARS-CoV-2, on the rates of hospital-acquired respiratory viral infections (HA-RVI) was assessed. Retrospective audit of a local HAI database for HA-RVI from 1st April 2019 to 29th March 2021 in a tertiary children's hospital. HA-RVI were standardized against occupied bed days (OBD) and admitted community acquired infections (CAI). Rates of HA-RVI were compared during 52 weeks of SARS-CoV-2-associated enhanced control periods (visitor restrictions with and without universal surgical masking), against 52 weeks standard practice. Total respiratoryvirus infections, respiratory syncytial virus (RSV), and rhinovirus infections were analysed. Comparing standard practice with enhanced measures, 42 v 15 HA-RVI and 1517 v 691 CAI were noted. Enhanced infection controls resulted in significant reductions in total HA-RVI when adjusted for OBD (p=0.0038) and CAI (p=0.0122). Non-significant decreases were seen in hospital-acquired respiratory syncytial virus (HA-RSV) adjusted for both CAI and OBD. Visitor restrictions combined with universal surgical masks significantly decreased adjusted total HA-RVI compared with visitor restrictions alone (adjusted for OBD p=0.0123; adjusted for CAI p=0.0429). HA-RSV decreased non-significantly when mask wearing was combined with visitor restrictions compared with visitor restrictions alone. HA-rhinovirus infections did not decrease with the addition of masks to visitor restrictions. Enhanced infection control measures introduced with SARS-CoV-2 pandemic decreased some HA-RVI. Universal surgical mask wearing decreased HAI rates more than visitor restrictions alone, except for rhinovirus where the HAI rate remained unchanged.

Daily Surveillance Blood Cultures in Children Supported With Extracorporeal Membrane Oxygenation: Single-Center, Retrospective Cohort Study, 2021-2023.

Diagnosing bloodstream infections (BSIs) in patients on extracorporeal membrane oxygenation (ECMO) can be challenging due to circuit-controlled temperature, altered hemodynamics, and questionable reliability of inflammatory markers in critically ill patients. As a result, practice variability exists among ECMO centers regarding routine blood cultures for surveillance of BSI. Our study aimed to evaluate daily surveillance blood cultures in pediatric and neonatal ECMO patients. Retrospective review of daily surveillance blood cultures from January 2021 to July 2023. We evaluated signs, symptoms, and laboratory results in patients with positive blood cultures. Academic children's hospital, New York, NY. All pediatric and neonatal patients supported on ECMO. None. We identified a cohort of 111 patients (39 neonates and 72 children) who were supported with ECMO. Daily blood cultures were obtained on 1059 (99%) of 1065 completed ECMO days. Overall, 3% (35/1059) of blood cultures were positive, affecting 6% (7/111) of patients. All seven patients had new evidence of infection on the day of their first positive blood culture; six had clinical signs of infection, including new-onset hypotension, hypothermia, or respiratory decline, and the remaining patients had newly elevated inflammatory markers. Daily surveillance blood cultures are low-yield in our practice with pediatric and neonatal ECMO patients. Our experience shows that changes in clinical status, including abnormal physical or laboratory findings consistent with infection, are associated with BSI, allowing for timely diagnosis. These criteria should prompt as-needed blood cultures, reducing blood draws and preventing costly and unnecessary daily surveillance cultures.

Pediatric endoscopic ultrasound-guided liver biopsy: 3-year experience.

Liver biopsy is the gold standard for diagnosing and staging liver diseases. Endoscopic ultrasound-guided liver biopsy (EUS-LB) has been reported in adults with equivalent or better safety profiles than percutaneous liver biopsies. The aim of this study was to retrospectively assess the safety and efficacy of EUS-LB in pediatric patients. This was a retrospective chart review of consecutive pediatric patients undergoing EUS-LB at Cincinnati Children's Hospital Medical Center from March 2020 to April 2023. Patients ≤21 years old were included. EUS-LB was performed via fine-needle biopsy technique with transduodenal and/or transgastric approach. Histology was independently reviewed by one of two expert pathologists, including length (cm) and complete portal tract (CPT) number per the American Association for the Study of Liver Diseases (AASLD) adequacy criteria. Demographics, clinical data, technical information, diagnostic success, and adverse events were recorded. Eighty-three patients were included in the analysis, with various indications that required liver biopsy. All biopsies achieved diagnostic and technical success, with 77 (93%) meeting both AASLD criteria for adequacy. Most patients (57, 69%) underwent biopsy of both hepatic lobes, with an overall median of two needle passes. Total specimen length was a median of 7.9 cm (interquartile range [IQR] 5.2-10.3), and the median maximum intact specimen was 4.2 cm (IQR 3.1-5.4). The median CPT number was 24 (IQR 17-32) per patient. Four mild adverse events (5%) occurred; none involved bleeding. EUS-LB was well tolerated and yielded samples that were technically and diagnostically successful in a pediatric population, with comparable safety to percutaneous liver biopsy.

Clinical features of magnetically controlled capsule endoscopy in children: A large, retrospective cohort study.

This study aimed to assess the utility of magnetically controlled capsule endoscopy (MCE) in the diagnosis of pediatric gastrointestinal diseases. A retrospective cohort study was conducted, which collected data from 1040 children (546 males and 494 females; mean age: 11.0 ± 2.6 years) who underwent MCE at Shanghai Children's Hospital between June 2017 and February 2023. Information on gastric visualization, cleanliness, examination times, lesion detection rates, and other parameters were recorded. A 2-week follow-up monitored capsule excretion and adverse reactions. Of the 1055 patients, 78 had difficulty swallowing the capsule, and 15 could not swallow even with assistance, which led to their exclusion. The small intestine was successfully examined in 94.5% (206 out of 218) of the 218 children who were able to proceed with the procedure. The remaining 822 underwent esophagus and stomach examinations. The average transit time of the endoscopy capsule in the esophagus, stomach, and small intestine was 5 (3, 9) s, 57.0 (29.0, 102.0) min, and 306.0 (234.0, 500.0) min. In the examined cases, complete small bowel visualization was achieved in 94.5% of the patients. The most common symptoms reported by the patients were abdominal pain (77.9%) and nausea with vomiting (13.5%). Lesion detection rates were 38.8% in the stomach, 21.1% in the duodenum, and 43.1% in the jejunoileum. No complications, such as capsule retention or intestinal obstruction, were observed. MCE is a feasible and safe method for examining the gastric cavity and small bowel in pediatric patients.

The physical environment of neonatal intensive care units: a descriptive survey in Spain

ABSTRACT The physical environment impacts preterm infants’ brain development and is vital for neuroprotective family-centred care. In Spain, neonatal intensive care units (NICUs) are being renovated, but an overall assessment is lacking. This study describes the physical environment of high-complexity NICUs (level IIIC) in the Spanish National Healthcare System through a descriptive, cross-sectional, multi-centre study using an online survey. Data were collected in 2023 with a 100% response rate (n = 11). Results show that only 8 units (73%) were partially renovated. Most NICUs (73%) were in mother and children hospitals, and only 2 units (18%) shared a floor with the maternity ward. All NICUs had open-bay rooms, and 3 (27%) had single-family rooms for intensive care. Compared to Nordic countries and the USA, Spanish NICUs’ design seems outdated. An optimal room mix should consider the latest evidence as well as the local context, including culture, healthcare system, and staffing models.

Clinical characteristics of Kawasaki disease with pulmonary radiographic abnormalities and its impact on the incidence of coronary artery lesions: a randomized retrospective cohort study

ObjectiveThe aim of this study was to investigate the characteristics of Kawasaki disease (KD) in patients demonstrating pneumonia-like changes and pulmonary complications, as well as the subsequent impact on coronary artery lesions, by comparing them with those of KD patients with normal pulmonary imaging.MethodFrom January 1, 2013 to October 1, 2022, this study included paediatric patients diagnosed with KD who were registered in the KD database at Yuying Children's Hospital affiliated with Wenzhou Medical University. Patients were divided into three distinct groups based on the presence and severity of abnormalities observed via lung imaging. We first compared the demographic and clinical characteristics across these groups. The imaging characteristics of KD patients with pneumonia-like changes and pulmonary complications were identified via chest radiography (x-ray) and chest computerized tomography (CT). Logistic regression models and stratified analyses were employed to further identify factors influencing coronary artery lesions (CALs).ResultsAmong the 2,686 KD children admitted to our centre in recent years, 115 presented with pneumonia-like changes, 366 presented with pulmonary complications, and 495 presented with no evident abnormalities on chest radiographs. In KD patients with pneumonia-like changes, there were significant elevations in inflammatory markers including the C-reactive protein (CRP) (P = 0.011), white blood cell (WBC) (P = 0.027), NT-proBNP (P = 0.007), and D-dimer (D-D) (P = 0.002) levels. Imaging studies have frequently revealed bilateral lung infections, predominantly in the mid-lower lung fields. Bronchitis-related changes were the most common manifestation of pulmonary complications in KD patients. A significant difference was observed in the incidence of CALs among patients with pneumonia-like changes. After adjusting for confounding variables, patients with pneumonia-like changes had a greater likelihood of developing CALs, with an adjusted odds ratio (OR) of 1.94 [95% confidence interval (CI): 1.21, 3.11]. Similar findings were obtained through stratification and sensitivity analyses.ConclusionPatients diagnosed with KD who develop pneumonia-like changes and related pulmonary complications can be identified based on their clinical manifestations and imaging characteristics. Moreover, patients with KD and pneumonia-like changes had a significantly increased risk of developing CALs.

Pulsatile Dexamethasone in Patients with Infantile Spasms: A Retrospective Analysis of a Unique Therapy Regime.

Infantile spasms (IS) are an age-specific epilepsy syndrome associated with poor outcomes. Sustained and early spasm control remains the main goal of therapy. We aimed to evaluate a unique pulsatile dexamethasone therapy regime in children with IS. Children with IS were treated with oral pulsatile-applied dexamethasone in the Children's Hospital Jena between 2002 and 2021, regardless of duration since IS onset or previous therapy (except ACTH). A prolonged initial pulse was given in case of insufficient response (standard: 5-7 days, prolonged: 10-14 days). We analyzed spasm reduction, electroencephalographic response, adverse reactions, neurodevelopmental status, and epileptic disorders at the last follow-up. Included were 26 patients with a median age of 5.5 months (interquartile range 4-8) at IS onset and a mean follow-up of 6.2 years (standard deviation [SD] 3.99). Fifty percent had an unknown etiology. Patients received on average 10.8 pulses (SD 6.0); 69.2% achieved initial seizure freedom, however, 38.9% relapsed. Seventeen patients had an initial prolonged pulse, of those, 14 got initially seizure-free (82.4%). Sixty-four percent of the cases had a sustained spasm cessation after the third pulse. At the last follow-up, half of the patients had no persisting epileptic disorder; 22.2% had a favorable neurocognitive development. Patients with unknown etiology were more likely to achieve seizure freedom during therapy (p = 0.025), had a more favorable neurocognitive outcome (p = 0.049), and were less likely to suffer from epileptic disorders (p = 0.037). No serious adverse effects were observed. Our results show that our treatment is safe and leads to outcomes comparable to usually applied hormonal therapy regimes. Etiology remains the most influential factor.

An Open-Source Smartphone Otoacoustic Emissions Test for Infants.

Universal hearing screening is essential for early identification of infants with hearing loss, yet there is a lack of low-cost, scalable equipment suitable for resource-constrained settings. Here we test a low-cost smartphone device for infant hearing screening. Infants aged 0 to 6months were recruited from 3 ambulatory clinics at Seattle Children's Hospital with a high prevalence of hearing loss. We compared results from a low-cost open-source distortion product otoacoustic emission (OAE) probe and smartphone app with results from a commercially available OAE device. Hearing status was confirmed using newborn hearing screening, diagnostic testing, or both. Primary outcomes were referral rate as well as sensitivity, specificity, positive predictive value, and negative predictive value compared with known hearing status. Among N = 76 infants, the mean age at screening was 3.1 ± 1.9months and 13% had hearing loss. Referral rates were 24% and 26% for the smartphone and conventional devices, respectively. Both devices demonstrated 100% sensitivity (95% CI, 0.69-1.00) and negative predictive value (95% CI, 0.94-1.00). Specificity was 88% (95% CI, 0.78-0.95) and 85% (95% CI, 0.74-0.92) for the smartphone and conventional devices, respectively. Positive predictive value was 56% (95% CI, 0.31-0.78) for the smartphone and 50% (95% CI, 0.27-0.73) for the conventional device. The smartphone-based OAE device effectively screened hearing in high-prevalence infants. Thus, smartphone-based OAE detection may be a promising low-cost solution to the challenge of building scalable universal newborn and infant hearing screening programs in resource-constrained settings.

The influence of maternal gestational weight gain on adverse perinatal outcomes

ObjectiveTo analyze the impact of maternal gestational weight gain (GWG) on adverse outcomes for mothers and infants.MethodsA retrospective analysis was conducted, collecting relevant information on 9,058 singleton pregnancies and newborns from prenatal check-ups and deliveries at Guangdong Women and Children Hospital from 2017 to 2022. The subjects were grouped according to different GWG, and logistic regression was used to analyze the impact of GWG on adverse outcomes, including hypertensive disorders of pregnancy (HDP), gestational diabetes mellitus (GDM), large-for-gestational-age infants (LGA), small-for-gestational-age infants (SGA), and preterm births.ResultsAmong the 9058 participants included in the study, there were 438 cases (4.8%) of HDP, including 266 cases (2.9%) of gestational hypertension and 172 cases (1.9%) of preeclampsia. Additionally, there were 2018 cases (22.3%) of GDM; Among the adverse birth outcomes for newborns, the prevalence was 9.7% for SGA, 9.9% for LGA, 1.4% for early/mid-term preterm births, and 4.2% for late preterm births. After adjusting for confounding factors, the results showed that, excessive GWG was a risk factor for HDP (OR=1.829, P<0.05) and LGA (OR=1.792, P<0.05) compared to the normal gestational weight gain group. Insufficient GWG increased the risk of GDM (OR=2.203, P<0.05), SGA (OR=1.474, P<0.05) and was also a risk factor for early/mid-term preterm infants (OR=3.326, P<0.05) and late preterm infants (OR=1.715, P<0.05).ConclusionExcessive GWG is a risk factor for the occurrence of HDP and LGA, while insufficient GWG increases the risk of GDM, SGA and preterm infants (especially early/mid-term preterm infants). Therefore, it is recommended to strengthen the monitoring of weight changes during pregnancy in women of childbearing age, guide nutritional management during pregnancy, and keep GWG within a reasonable range to prevent adverse outcomes for mothers and infants.

Digital Health Program to Support Family Caregivers of Children Undergoing Growth Hormone Therapy: Qualitative Feasibility Study.

Caregivers of children with growth hormone deficiency often face emotional challenges (eg, stress) associated with their children's health conditions. This psychological burden might affect children's adherence to treatment and hinder their health-related quality of life (HrQoL). This assumption is leading to seriously considering multidimensional clinical approaches to pediatric health conditions where the emotional well-being of caregivers should be accounted for to optimize children's health outcomes. Novel mobile health (mHealth) solutions based on emotional and behavioral change techniques can play a promising role because they are increasingly used within different health areas to support adaptive psychological functioning. However, whether and how mHealth solutions of this type of emotional well-being support caregivers of children with growth-related problems is an issue that needs to be clarified. This study aimed to gather qualitative information to better understand individualized experiences of caregiving of children undergoing growth hormone therapy (GHt) and perceived barriers or facilitators for the adoption of an mHealth solution called Adhera Caring Digital Program (ACDP). A total of 10 family caregivers were recruited at Miguel Servet Children's Hospital, and they engaged with the ACDP for 1 month. The ACDP is a mobile-based digital intervention focused on promoting the overall well-being of family caregivers which provides access to personalized education, motivational mobile-based messages, and mental well-being exercises such as mindfulness or respiratory exercises. Subsequently, an individual semistructured interview was performed to gather qualitative user experience information. The digital intervention was well-received. The ACDP was found to be useful, easy to use, and understandable, addressing all the difficulties expressed by caregivers. It was also noted to be particularly helpful at the beginning of the treatment and, for some families, became a natural tool that strengthened the parent-child relationship. The ACDP is a promising and well-accepted tool that enhances the experience of patients and caregivers. It improves the management of growth hormone deficiency and promotes the overall well-being of family caregivers. ClinicalTrials NCT04812665; https://clinicaltrials.gov/study/NCT04812665. RR2-10.1186/s12911-022-01935-1.

Correlation of ferritin and glutathione peroxidase 4 (GPX4) level as a marker of ferroptosis process in endometrioma

Endometriosis is a chronic inflammatory disease characterized by the presence of endometrial-like tissues (glands and stroma) located outside the uterine cavity. The pathophysiology of this condition remains incompletely understood. Local bleeding and inflammation within endometriosis lesions, which occur in an environment rich in iron, reactive oxygen species (ROS), and free radicals, can disturb the balance of iron within the peritoneal cavity. This disruption can trigger oxidative injury and an inflammatory response, leading to ferroptosis, particularly in the endometrioma phenotype. This research utilized an observational analytical method with a cross-sectional design to examine the relationship between ferritin and GPx4 levels by assessing them simultaneously. The data collection occurred at Dr. Hasan Sadikin Hospital, Cibabat Hospital, Bandung Kiwari Hospital, and Limijati Women and Children Hospital Bandung. Observational analytic data were gathered between February and July 2023 from female patients diagnosed with endometrioma who underwent either laparoscopic or laparotomy surgery, either for therapeutic or diagnostic reasons. There were 58 patients who met the inclusion and exclusion criteria in this study. A significant correlation was observed between ferritin and glutathione peroxidase 4 (GPx4) levels with a correlation coefficient of -0.600 (p < 0.001). However, there was no significant correlation between both ferritin levels and the severity of endometriosis (based on Association of Gynecologic Laparoscopists staging). There was significant correlation between ferritin and glutathione peroxidase 4 (GPx4) levels.

Interoperable Models for Identifying Critically Ill Children at Risk of Neurologic Morbidity

Decreasing mortality in the field of pediatric critical care medicine has shifted practicing clinicians' attention to preserving patients' neurodevelopmental potential as a main objective. Earlier identification of critically ill children at risk for incurring neurologic morbidity would facilitate heightened surveillance that could lead to timelier clinical detection, earlier interventions, and preserved neurodevelopmental trajectory. To develop machine-learning models for identifying acquired neurologic morbidity in hospitalized pediatric patients with critical illness and assess correlation with contemporary serum-based, brain injury-derived biomarkers. This prognostic study used data from all children admitted to a quaternary pediatric intensive care unit in a large, freestanding children's hospital in Western Pennsylvania between January 1, 2010, and December 31, 2022. External model validation used data from children admitted between January 1, 2018, and December 31, 2023, to a quaternary pediatric intensive care unit in a large, freestanding children's hospital that serves as a referral center for the 5-state region of Washington, Wyoming, Alaska, Montana, and Idaho. Critical illness. The outcome was neurologic morbidity, defined according to a computable, composite definition at the development site or an order for neurocritical care consultation at the validation site. Models were developed using varying time windows for temporal feature engineering and varying censored time horizons between the last feature and the identified neurologic morbidity. A generalizable model created at the development site was optimized and assessed at an external validation site. Correlation was assessed between development site model predictions and measurements of brain biomarkers from a convenience cohort. After exclusions, there were 18 568 encounters from 2010 to 2022 in the development site generalizable model cohort (median age, 70 [IQR, 18-161] months; 8325 [45%] female). There were 6825 encounters from 2018 to 2021 at the external validation site (median age, 96 [IQR 18-171] months; 3159 [46%] female). A generalizable extreme gradient boosted model with a 24-hour time horizon and 48-hour feature engineering window demonstrated an F1 score of 0.37 (95% CI, 0.33-0.40), area under the receiver operating characteristics curve of 0.81 (95% CI, 0.78-0.83), and number needed to alert of 4 at the validation site. After recalibration at the validation site, the Brier score was 0.04. Serum levels of the brain injury biomarker glial fibrillary acidic protein significantly correlated with model output (rs = 0.34; P = .007). This prognostic study of prediction models for detecting neurologic morbidity in critically ill children demonstrated a well-performing ensemble of models with biomolecular corroboration. Prospective assessment and refinement of biomarker-coupled risk models in pediatric critical illness are warranted.

The Experiences of Families of Hospitalized Children Who Use Languages Other Than English.

Patients who use a language other than English (LOE) for health care communication are at increased risk of experiencing adverse events and worse outcomes. The objectives of this research are (1) to understand the lived experience of families who speak LOEs around the hospitalization of their child and (2) to understand the perspectives of patients and families who speak LOEs on opportunities to improve their experiences during hospitalization. This study is grounded in patient- and family-informed research. We designed a qualitative study involving children hospitalized in the general pediatric inpatient unit at a Canadian children's hospital. We conducted semistructured individual interviews with children and families with a medical interpreter. We used thematic analysis, and all interviews were coded by 2 reviewers. A total 20 families of 16 different languages participated in the interviews. Themes important to understanding their lived experience were the following: (1) communication uncertainty-families experienced inconsistent interpreter use and availability, which affected in-the-moment communication and families' ability to understand the overall clinical context, leading to increased uncertainty; (2) lack of belonging-despite communicating that they had positive experiences in the hospital, families described a lack of belonging and felt that they were "other" during hospitalization; (3) altered trust-in addition to language, each patient/family's unique and complex social contexts contribute to developing an altered trust relationship with the health system that impacts their engagement in care processes. Families described opportunities for improvement such as supporting patient-initiated interpretation, increasing workforce diversity, and tailoring concepts such as shared decision making to their realities. Patients and families also revealed that they experience communication uncertainty, altered trust, and a lack of belonging within the hospital setting. Our research builds on the current literature and serves to advance our efforts to address health inequities experienced by this population.

Eschar is not the sole clue for scrub typhus: a retrospective analysis of pediatric scrub typhus without eschars.

This study aims to investigate the clinical characteristics and analyze the diagnostic approaches employed for pediatric cases of scrub typhus (ST) that present without eschars. A retrospective analysis was conducted on 256 ST cases hospitalized at Kunming Children's Hospital in Yunnan Province, China, from January 2015 to November 2022. Patients were categorized into an eschar group (n = 213) and a non-eschar group (n = 43). Clinical data were collected and analyzed for significant differences between the groups. This study particularly highlights the diagnostic methods for confirming ST in cases without eschars. The non-eschar group exhibited a higher incidence of pneumonia, a lower history of outdoor activities prior to onset, and a longer hospital stay; however, the remaining clinical and laboratory characteristics did not show statistically significant differences. The most common site for eschar formation was the axilla (12.7%, n = 27), followed by the groin (9.4%, n = 20) and auricle (8.9%, n = 19). Other notable sites included the scalp (7.5%, n = 16) and shoulder (6.6%, n = 14). The Weil-Felix test (OXK) demonstrated a positivity rate of 69.7% (23 out of 33 cases), cerebrospinal fluid (CSF) PCR had a positivity rate of 50.0% (3 out of 6 cases), and blood PCR exhibited a positivity rate of 92.3% (24 out of 26 cases). These findings underscore the importance for clinicians to consider ST in pediatric patients, even in the absence of eschars. A comprehensive evaluation based on epidemiology, symptoms, signs, and laboratory characteristics is essential. Blood PCR testing methods are recommended. Not applicable.

Mask Anesthesia, Straight Laryngoscope, and Alligator Forceps for Cervical Esophageal Coin Removal: A Comparison with Traditional Methods.

Coins are the most frequently ingested foreign bodies by children. While rigid esophagoscopy with concomitant intubation is frequently used for removal, it has the potential for serious complications. We aimed to assess and compare the safety, efficacy, and efficiency of two different techniques for pediatric cervical esophageal coin removal. Retrospective chart review identified patients who underwent esophageal coin removal from January 2017-August 2023 at one of two tertiary academic centers: Ann & Robert H. Lurie Children's Hospital and Yale-New Haven Hospital. Patients with foreign bodies other than coins were excluded. Patients underwent one of two approaches for cervical esophageal coin removal depending on surgeon preference: (1) induction of general anesthesia, intubation, rigid esophagoscopy, and coin extraction with optical forceps (esophagoscope group) or (2) mask ventilation, insertion of a straight laryngoscope blade into the esophagus orifice, and coin extraction with alligator forceps (straight laryngoscope group). Primary outcomes were successful removal of the esophageal coin, regarded a marker of efficacy, as well as operative and anesthesia times, which were regarded as measures of efficiency. Secondary outcomes were postoperative complications, regarded as markers of safety. Of the 108 patients meeting inclusion criteria, 23 (21.3%) were in the straight laryngoscope group and 85 (78.7%) in the esophagoscope group. Mean operative time was significantly shorter for the straight laryngoscope group compared to the esophagoscope group (2.8 ± 1.5 minutes vs 13.8 ± 17.2 minutes, respectively, p < .0001). Mean anesthesia time was significantly shorter for the straight laryngoscope group compared to the esophagoscope group (24.2 ± 6.4 minutes vs 44.7 ±1 6.2 minutes, respectively, p < .0001). There were no intra- or post-operative complications in the straight laryngoscope group and two minor complications in the esophagoscope group. Esophagoscopy using a straight laryngoscope blade under mask anesthesia can represent a safe and efficient alternative for impacted esophageal coin removal.

Clinical symptoms and functional impairment in attention deficit hyperactivity disorder (ADHD) co-morbid tic disorder (TD) patients: a cluster-based investigation

BackgroundAttention deficit hyperactivity disorder (ADHD) and tic disorder (TD) are two common neurodevelopmental disorders that frequently occur in childhood, and these two disorders often coexist. Cluster analysis provides a novel perspective on the heterogeneity of these commonly observed clinical disorders.MethodsWe recruited patients with comorbid ADHD and TD from Beijing Children's Hospital between May 2022 and August 2023, collecting data on their symptoms and functional impairments. The number of clusters was determined using the elbow method, and K-means clustering was conducted. Fisher discriminant analysis and silhouette score were used for validation. Additionally, we assessed premonitory urge, strengths, and difficulties among groups. We also collected samples with ADHD alone and performed cluster analyses.ResultsThe number of clusters for the ADHD comorbid TD sample was determined to be two by the elbow method. The results of the cluster analysis showed that the ADHD comorbid TD sample could be divided into the severe TD group and the severe ADHD group. The severe TD group exhibits more pronounced tic symptoms, yet their age, ADHD symptoms, and functional impairment are all significantly lower than those of the severe ADHD group. Compared to samples with ADHD alone, the distribution of age and functional impairment among individuals does not change with the addition of TD symptoms, maintaining a parallel relationship with the severity of ADHD symptoms.ConclusionPatients with co-occurring ADHD and TD can be classified into two clusters based on age, symptoms, and functional impairment. In clinical interventions for these patients, while ADHD may require more attention, it is also crucial to identify the core symptoms of the patients. The heterogeneity in clinical symptom presentations highlights the need for individualized treatment approaches.

Dorsal lumbotomy approach for paediatric pyeloplasty.

Objective: To assess the outcomes of dorsal lumbotomy approach for paediatric pyeloplasty in terms of duration of surgery, blood loss, hospital stay and postoperative complications. Study Design: Retrospective Review. Setting: Children Hospital, Faisalabad. Period: Aug 2021 to July 2024. Methods: The patients presented with hydronephrosis and followed by confirmed case of pelviureteric junction obstruction with DTPA renal scan, were operated in last five years with this surgical approach were reviewed retrospectively, n=126 cases. Pelviureteric junction was corrected with dismembered pyeloplasty using dorsal incision vertically named dorsal lumbotomy incision. DJ stent was placed in every case of pyeloplasty which was removed cystoscopically after 6 weeks of procedure. Results: There was total 126 patients, 82 patients were males and 44 patients were females. The mean age of patients at the time of surgery was 4.56±2.16 years. Mean duration of surgery was 52.60±8.27 minutes. Mean blood loss was 42.7 milliliters. Mean hospital stay was 3.46±1.38 days. Superficial wound infection was documented in 13 (10.3%) patients, spontaneous expulsion of DJ stent through urethra in 3 (2.4%) patients, ureterovasical junction obstruction (UVJO) was found in 6 (4.8%), incisional hernias were documented only in only 3(2.4%) patients. Cosmetic acceptance by the patients/parents of this incision was documented in 119 (94.4%) cases. After 24-month follow-up there was observed evidence of clinical and radiological improvement in 120(95.2%) patients. Conclusion: Dorsal lumbotomy approach for pediatric pyeloplasty is a safe technique for boys and girls. Post-operative morbidity, wound infection and seroma formation all are low in dorsal lumbotomy approach.

Antimicrobial Resistance Patterns in Pediatric Urinary Tract Infections: Insights from Hospitalized Children in Sudan

Introduction: Urinary tract infections (UTIs) are among the most common bacterial diseases in children, affecting 3–5% of girls and 1% of boys, and leading to significant antibiotic exposure in this population. Initial UTI treatment is often empirical, based on symptomatology without microbiological confirmation. Objective: This study aimed to identify the causative agents of UTIs in children, evaluate antimicrobial resistance rates, and recommend appropriate antibiotics. Materials and Methods: A cross-sectional study was conducted on 67 urine samples collected from hospitalized children at Gaafar Bin Ouf Children's Hospital in Khartoum, Sudan. Samples were processed for bacterial isolation, identification, and antimicrobial susceptibility testing using the Kirby-Bauer method. Results: Among the isolates, 24 (35.8%) were Staphylococcus aureus, 20 (29.9%) Klebsiella spp., 14 (20.9%) Escherichia coli, 8 (11.9%) Pseudomonas spp., and 1 (1.5%) Proteus spp. The highest resistance rates were observed for Amoxyclav (68.7%) and Erythromycin (61.2%), while Gentamicin (40.3%), Ciprofloxacin (43.3%), and Penicillin (46.3%) showed lower resistance rates. Conclusion: Staphylococcus aureus was the most common UTI pathogen in hospitalized children, with high resistance rates to Amoxyclav and Erythromycin. These findings highlight the need for regular resistance monitoring and revising empirical antibiotic protocols to improve treatment outcomes.

30years' experience in the use of cutaneous lasers for the treatment of verrucous venous malformations in children: a retrospective cohort study at Great Ormond Street Hospital for children.

Verrucous venous malformation (VVM) is a rare vascular malformation with hyperkeratosis. Concomitant laser and surgery are first line treatments, but evidence establishing efficacy is limited. We assess the efficacy of laser alone for VVM. Retrospective analysis of patients receiving laser treatment for VVM between 1994-2023. Of 83 patients, 29 were excluded due to missing data, 7 due to concomitant surgical excision and 47 were evaluated. Pulse dye laser (PDL) and combined dual PDL-neodymium-doped yttrium aluminium garnet (PDL-Nd:YAG) lasers were used. Outcomes were difference in percentage surface area (SA) reduction and colour improvement after laser treatment. Two blinded healthcare professionals independently graded the VVMs. Tools used included a numerically graded colour chart, and a 10 × 10 surface area grid to assess pre/post photos printed to the same scale. Mean Joules delivered with PDL; 9.29 and PDL-Nd:YAG; 9.16. Spot size (mm) for PDL; 8.58 and PDL-Nd:YAG; 9.63. Mean number of treatments was 5.27 and 3.68 in red and purple lesions respectively. Mean SA reduction for red and purple lesions; PDL; 71.11% and 6.67%, and PDL-Nd:YAG; 54.30% and 32.35%. Mean colour improvement in red and purple; PDL; 53.13% and 8.59%, and PDL-Nd:YAG; 46.88% and 40.81%. Red responded better than purple (p = 0.0014 and p = 0.024), for SA and colour respectively. There was no statistical significance in better outcomes; age at first treatment or number of treatments. Laser alone is an effective non-invasive method for improvement of colour and SA. Red lesions responded better to laser. PDL-Nd:YAG laser is preferred in purple lesions.

Trends in resource utilization for new-onset psychosis hospitalizations at children's hospitals.

Children with new-onset psychosis often require hospitalization for medical evaluation. The goal of this study was to assess variations in the management of children with new-onset psychosis and characterize trends in resource utilization. The study included index hospitalizations for children ages 7-18 admitted to children's hospitals with a primary diagnosis of psychosis from 2011 to 2022 using the Pediatric Health Information System (PHIS) database. Children with a complex chronic condition were excluded. Resource utilization categories included medication, imaging, laboratory, and other clinical resources. Variability in resource utilization was assessed using covariance tests for random intercepts with generalized linear modes after adjusting for age, sex, payor, and severity. Trends in resource utilization were examined using generalized estimating equations adjusting for the same factors and accounting for hospital clustering. Our data set included 7126 new-onset psychosis hospitalizations from 37 children's hospitals. Teenage males and non-Hispanic Whites were most likely to be hospitalized. There was a significant variation in resource utilization across hospitals in all categories (p < .001). The most frequently utilized resources were antipsychotic medications (76%), serum chemistry (77%), toxicology labs (72%), and brain magnetic resonance imaging (22%). The most notable increases in utilization were in the performance of laboratory tests, brain imaging, anesthetic use, and intravenous immunoglobulin use. Study findings suggest that there has been a stable rate of hospitalization for children with new-onset psychosis, yet a significant variation in the medical evaluation exists. Significant increases and variations in resource utilization across all categories suggest an emerging need for robust evidence and consensus-based practice guidelines.