Illness In Pediatric Patients Research Articles

Antidepressant Prescribing Practices of Pediatric Palliative Care Providers.

Background: Mental health diagnoses can co-occur with complex medical illness in pediatric patients. Pediatricians may not feel comfortable with managing psychopharmacology for patients and access to child psychiatrists can be limited. Palliative care (PC) providers follow patients with serious illness longitudinally to address burdensome symptoms that affect quality of life and may be responsible for evaluation and treatment of mental health concerns; however, education in managing psychologic distress for pediatric palliative care (PPC) providers is limited. Objective: This study seeks to describe the antidepressant prescribing practices of PPC providers and describe their level of training and comfort in assessing for anxiety and depression and prescribing psychotropic medications. Methods: An electronic survey approved by the American Academy of Hospice and Palliative Medicine was distributed nationally to PPC providers. Results: A total of 58 providers responded to the survey (response rate 12.3%). Most reported prescribing a variety of antidepressants (79%). Very few used formal assessment tools to screen for depression (7%) or anxiety (16%). Less than a third of providers consulted child psychiatry before prescribing antidepressants (29%). More than half of providers (54.5%) had no formal training in assessment and treatment of anxiety and depression in pediatric patients. Despite this, many providers (70%) reported feeling comfortable in prescribing antidepressants while also endorsing interest in more training for behavioral health evaluation and treatment (82.5%). Conclusions: Limited training in assessing mental health concerns, prescribing, and managing psychopharmacology suggests an opportunity for more targeted education for pediatric PC providers regarding antidepressant prescribing practices.

THE IMPACT OF COMORBIDITIES ON COVID-19 SEVERITY IN PEDIATRIC PATIENTS: A SYSTEMATIC REVIEW

Background:Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has caused over 6 million deaths worldwide. Comorbidities like obesity, asthma, and neurological disorders are risk factors for severe illness in pediatric patients. The direct impact of COVID-19 on child mortality is limited, with only 0.4% of deaths occurring in children under 20.
 Objective: To identify risk factors and potential interventions to reduce severe illness and mortality in pediatric patients.
 Methods:A systematic review of COVID-19, sars-cov-2, and novel coronavirus in children was conducted using PubMed and Google Scholar. Severe COVID-19 prevalence in children assessed using Strengthening the Reporting of Observational Studies in Epidemiology (STROME) and the Joanna Briggs Institute (JBI) checklists, assessing quality and bias.
 Results:A review of 41 studies found a significant difference in severe COVID-19 infection risk among children with and without comorbidities, including hematologic, immune, respiratory, cardiovascular, neurological, obesity, and genetic syndromes.
 Conclusion:Comorbidities in pediatric COVID-19 patients enhance the risk; vaccinations and increased vigilance should take priority. 

Beating Corona Virus Disease (COVID-19) in Newborns, Infants and Toddlers.

Madam, Corona Virus Disease (COVID-19), a pandemic, has been a global concern and it is a highly contagious respiratory illness that has been fatal to around 6 million lives. Although everyone is prone to get infected by COVID-19, the fact that is often overlooked is that newborns, infants and toddlers are as likely to get COVID-19 as adults. Babies younger than one year old might have a higher chance to get COVID-19 than older children. (1) According to a case report by Alzamora et al. mother infected with COVID-19 can also, in sporadic cases, pass the disease to her baby. (2) Infants are also at risk of getting infected shortly after birth, reason being exposure to sick caregivers. Most newborn, infants and toddlers who fall prey to COVID-19 have mild or no symptoms engendering many new cases, but serious cases have also occurred leading to hospitalization. Hospitalization is associated more with the omicron variant than the delta variant. According to Morbidity and Mortality Weekly Report (MMWR) by the Centrs for Disease Control and Prevention (CDC), hospitalization of U.S. infants and children aged 0-4 years was five times more during omicron predominance than during delta surge. (3) To overcome such cases, CDC recommends COVID-19 vaccine and backs Pfizer’s and Moderna’s COVID-19 shots for children aged six month to five years. (4) These vaccines can prevent complications like Multisystem Inflammatory Syndrome and Long COVID, which can be debilitating for young children. Vaccination can also protect children, which in turn minimize the possibility of transmission of disease to others. Furthermore, U.S. Food and Drug Administration (FDA) has also expanded the approval of the COVID-19 treatment Velkury (Remdesivir) to include pediatric patients 28 days of age and older weighing at least 3 kilograms with positive results of direct SARS-CoV-2 viral testing. (5) With COVID-19 rearing its head again in Pakistan, vaccination of vulnerable populations like newborns, infants and toddlers must be an urgent step to stem the spread of virus because tomorrow may be too late. Besides, Remdesivir, which was previously approved for certain adults, can now be put to good use for treating infants as young as 28 days old so that progression in hospitalization and critical illness in pediatric patients of Pakistan be cut down.

Severe COVID-19 outcomes in pediatrics: an observational cohort analysis comparing Alpha, Delta, and Omicron variants

COVID-19 can rarely lead to severe illness in pediatric patients. The aim of this study was to determine if severe outcomes in pediatric COVID-19 have changed over the course of the pandemic. This was a multicenter, observational cohort analysis from a large regional healthcare system in metro Detroit using electronic health record data to evaluate emergency visits, hospitalization, and severe COVID-19 disease in pediatric patients. Consecutive pediatric patients presenting to the emergency department with a primary diagnosis of COVID-19 were included. Outcomes data was gathered from three distinct time intervals that coincided with Alpha, Delta, and Omicron variant predominance (Time interval 1 (T1) 1/1/2021-6/30/2021: Alpha, T2 7/1/2021-12/31/2021: Delta, T3 1/1/2022-6/16/2022): Omicron. The primary outcome was severe disease inclusive of composite intensive care unit admission, mechanical ventilation, multisystem inflammatory syndrome in children (MIS-C), myocarditis, or death. Secondary outcomes included severe outcomes considering viral coinfection and vaccination status. Between 1/1/2021 and 6/16/2022, there were 4517 emergency COVID-19 visits, of which 12.5% (566) of children were hospitalized. 24.4% (138), 31.6% (179), and 44.0% (249) of admissions occurred during T1, T2 and T3 respectively. Most patients were male (55.1%) and 59.9% identified as Caucasian. The median age was 5.0 (interquartile range 1.0, 13.0) with infants comprising 22.8% (129), toddlers 25.1% (142), children 23.0% (130), and teenagers 29.2% (165). Over the course of the pandemic, the proportion of infants in hospitalization increased from 16.7% in T1 to 19.6% in T2 to 28.5% in T3 (p<0.01) while the proportion of teenagers in hospitalization decreased from 39.1% in T1 to 31.3% in T2 to 22.1% in T3 (p<0.001). Oxygen therapy was required in a minority (29.9%) of cases with supplemental oxygen utilized the least in T3 (16.5%) and most in T2 (30.2%). Composite severe disease decreased throughout the pandemic occurring in 36.2% in T1, 27.4% in T2, and 18.9% in T3. A multivariable logistic regression analysis revealed the odds of composite severe disease was significantly lower in T3 compared to T1 (adjusted odds ratio [aOR] 0.35, 95% Confidence Interval 0.21-0.60, p<0.001). Fully vaccinated or fully vaccinated and boosted admission rates remained low throughout all periods with 4.4% in T1, 4.5% in T2 and 8.4% in T3. Viral coinfection was most common during T2 (16.8%) followed by T3 (12.5%) and least common in T1 (5.1%) (p=0.006). Coinfection occurred more commonly in younger children with a median age of 1.2 (0.0, 4.5) compared to those with mono-infection with a median age of 6 (1.0, 14.0) (p<0.001). Severe outcomes occurred in 45.6% of coinfection cases compared to 22.1% without coinfection (p<0.001). While Omicron cases had the highest admission frequency, severe illness was lower than Delta and Alpha variants. Coinfection with respiratory viruses increased the risk of severe outcomes and impacted infants more than older children. None.

Clinical characteristics and risk factors for severe scrub typhus in pediatric and elderly patients.

BackgroundScrub typhus (ST) is a life-threatening infectious disease if appropriate treatment is unavailable. Large discrepancy of clinical severity of ST patients was reported among age groups, and the underlying risk factors for severe disease are unclear.MethodsClinical and epidemiological data of ST patients were collected in 55 surveillance hospitals located in Guangzhou City, China, from 2012 to 2018. Severe prognosis and related factors were determined and compared between pediatric and elderly patients.ResultsA total of 2,074 ST patients including 209 pediatric patients and 1,865 elderly patients were included, with a comparable disease severity rate of 11.0% (95% CI 7.1%–16.1%) and 10.3% (95% CI 9.0%–11.8%). Different frequencies of clinical characteristics including lymphadenopathy, skin rash, enlarged tonsils, etc. were observed between pediatric and elderly patients. Presence of peripheral edema and decreased hemoglobin were the most important predictors of severe illness in pediatric patients with adjusted ORs by 38.99 (9.96–152.67, p<0.001) and 13.22 (1.54–113.50, p = 0.019), respectively, while presence of dyspnea and increased total bilirubin were the potential determinants of severe disease in elderly patients with adjusted ORs by 11.69 (7.33–18.64, p<0.001) and 3.17 (1.97–5.11, p<0.001), respectively. Compared with pediatric patients, elderly patients were more likely to receive doxycycline (64.8% v.s 9.9%, p<0.001), while less likely to receive azithromycin therapy (5.0% v.s 41.1%, p<0.001).ConclusionThe disease severity rate is comparable between pediatric and elderly ST patients, while different clinical features and laboratory indicators were associated with development of severe complications for pediatric and elderly patients, which is helpful for diagnosis and progress assessment of disease for ST patients.

A STUDY OF CLINICAL PROFILE OF PEDIATRIC COVID 19 PATIENTS IN A GOVERNMENT TERTIARY CARE HOSPITAL IN INDIA

BACKGROUND AND OBJECTIVES:After two stormy waves in adults, epidemiologists are predicting third wave to be more severe in vulnerable pediatric population which is yet to be vaccinated. Therefore, to address this issue we aim to present clinical characteristics and outcome of children with COVID-19 infection admitted to a government tertiary care hospital during rst and second COVID-19 pandemic wave which can help in planning clinical services to manage these children in face of escalating pandemic. METHOD: This was a cross-sectional observational study of 94 children admitted with COVID-19 infection between April 2020 and March 2021 who were tested positive by RTPCR or Rapid antigen test for COVID-19. RESULTS: In the study population of 94 children, the Median age was 4 years with Age group ranging from 3 days -12 years consisting of 28.7% infants. 53.2% were males and 81.9% had history of exposure in family. Out of total admissions, 25(26.6%) were asymptomatic, 48 (51.1%) had mild symptoms, 7.4% had moderate illness and 14.9% were severely ill. Fever (54.3%), cough 26.6%, and cold 21.3% were the most common presenting complaints. 22(23.4%) had co morbidities with SAM being most common. Amongst the inammatory markers, it was noticed that, 27(28.7%) had raised CRP levels, 36(38.3%) had raised d dimer levels, 69(73.4%) had raised ferritin levels and 28(29.8%) had raised LDH levels. 9 patients required non-invasive support and 11 needed invasive oxygen support. Out of total 94 patients, 10(10.6%) did not survive. CONCLUSIONS- Most children acquired infection through household contacts. Although lower incidence than adults, children too have severe COVID-19 infections. The presence of a comorbid illness in pediatric patients with COVID-19 did not impact the severity in our study

Defining the Clinical, Emotional, Social, and Financial Burden of Congenital Athymia.

IntroductionCharacterize the burden of illness in pediatric patients with congen̄ital athymia who were receiving supportive care.MethodsThis cross-sectional study of adult caregivers of patients with congenital athymia used both a quantitative survey and qualitative interviews. Caregivers of patients currently receiving supportive care responded to questions about the past 12 months and completed the parent proxy version of the Pediatric Quality of Life Inventory Generic instrument (PedsQL) for patients aged 2–4 years. For caregivers of patients who had received supportive care in the past, questions were asked about the period when they were receiving supportive care only.ResultsThe sample included caregivers of 18 patients, 5 who were currently receiving supportive care and 13 who received investigational cultured human thymus tissue implantation before study enrollment and had received supportive care in the past. The impact of congenital athymia was substantial. Reports included the need to live in isolation (100% of respondents); caregiver emotional burden such as fear of death, infection, and worries about the future (100%); financial hardship (78%); and the inability to meet family/friends (72%). Patients had frequent and prolonged hospitalizations (78%) and had high utilization of procedures, medications, and home medical supplies. Caregiver-reported PedsQL scores for patients currently receiving supportive care (n = 4) indicated low health-related quality of life.ConclusionsCaregivers of patients with congenital athymia reported high clinical, emotional, social, and financial burden on patients and their families.

Characteristics and risk factors associated with critical illness in pediatric COVID-19

BackgroundWhile much has been reported regarding the clinical course of COVID-19 in children, little is known regarding factors associated with organ dysfunction in pediatric COVID-19. We describe critical illness in pediatric patients with active COVID-19 and identify factors associated with PICU admission and organ dysfunction. This is a retrospective chart review of 77 pediatric patients age 1 day to 21 years admitted to two New York City pediatric hospitals within the Northwell Health system between February 1 and April 24, 2020 with PCR + SARS-CoV-2. Descriptive statistics were used to describe the hospital course and laboratory results and bivariate comparisons were performed on variables to determine differences.ResultsForty-seven patients (61%) were admitted to the general pediatric floor and thirty (39%) to the PICU. The majority (97%, n = 75) survived to discharge, 1.3% (n = 1) remain admitted, and 1.3% (n = 1) died. Common indications for PICU admission included hypoxia (50%), hemodynamic instability (20%), diabetic ketoacidosis (6.7%), mediastinal mass (6.7%), apnea (6.7%), acute chest syndrome in sickle cell disease (6.7%), and cardiac dysfunction (6.7%). Of PICU patients, 46.7% experienced any significant organ dysfunction (pSOFA > = 2) during admission. Patients aged 12 years or greater were more likely to be admitted to a PICU compared to younger patients (p = 0.015). Presence of an underlying comorbidity was not associated with need for PICU admission (p = 0.227) or organ dysfunction (p = 0.87). Initial white blood cell count (WBC), platelet count, and ferritin were not associated with need for PICU admission. Initial C-reactive protein was associated with both need for PICU admission (p = 0.005) and presence of organ dysfunction (p = 0.001). Initial WBC and presenting thrombocytopenia were associated with organ dysfunction (p = 0.034 and p = 0.003, respectively).ConclusionsAge over 12 years and initial CRP were associated with need for PICU admission in COVID-19. Organ dysfunction was associated with elevated admission CRP, elevated WBC, and thrombocytopenia. These factors may be useful in determining risk for critical illness and organ dysfunction in pediatric COVID-19.

Psychometric properties of the questionnaire on threat perception of chronic illnesses in pediatric patients.

Objective:the objective of the study was to assess the psychometric properties of the Brief Illness Perception Questionnaire in a sample of adolescents with chronic endocrine or pneumological conditions and to analyze the dimensionality and reduce the scale elaborating scales by sex and medical diagnosis.Method:we evaluated 510 patients aged 9-16 years using the Brief Illness Perception Questionnaire and the Hospital Anxiety and Depression Scale. We carried out tests of reliability, construct and criterion validity and a comparison of means based on the diagnosis and socio-demographic variables. The reliability and validity analyses showed adequate psychometric properties for this scale, with better results obtained for a single dimension after eliminating 3 items.Results:adolescents with type 1 diabetes and girls were found to have an increased threat perception of their illness. Anxiety/depression was positively associated with the perception of illness.Conclusion:this questionnaire is a useful and practical tool for evaluating adjustment to illness in pediatric patients.

3.10 MENTAL HEALTH DISORDERS IN MEDICAID-ENROLLED CHILDREN WITH COMPLEX CHRONIC PHYSICAL HEALTH CONDITIONS

We use a large, multi-state Medicaid claims database to delineate the prevalence of mental illness in pediatric patients with a variety of complex medical conditions and to examine the demographic and clinical characteristics of children with a broad range of complex medical conditions co-occurring or not co-occurring with mental health disorders.

Doxycycline and Tooth Discoloration in Children: Changing of Recommendations Based on Evidence of Safety.

Doxycycline use has historically been limited to children older than 8 years because of concerns regarding permanent tooth discoloration. Six studies assessed tooth discoloration in at least 338 patients exposed to doxycycline before 8 years of age. Six patients had potential discoloration, but studies consistently found no difference in tooth discoloration between exposed patients and controls. Recommendations have changed stating doxycycline, but not other tetracyclines, can be used for short courses (<21 days) regardless of age. Clinicians should be aware of these data because doxycycline use may extend to disease states apart from tick-borne illnesses in pediatric patients.

Efficacy of Fecal Microbiota Transplantation for Clostridium difficile Infection in Children

Fecal microbiota transplantation (FMT) is commonly used to treat Clostridium difficile infection (CDI). CDI is an increasing cause of diarrheal illness in pediatric patients, but the effects of FMT have not been well studied in children. We performed a multi-center retrospective cohort study of pediatric and young adult patients to evaluate the efficacy, safety, and factors associated with a successful FMT for the treatment of CDI. We performed a retrospective study of 372 patients, 11 months to 23 years old, who underwent FMT at 18 pediatric centers, from February 1, 2004, to February 28, 2017; 2-month outcome data were available from 335 patients. Successful FMT was defined as no recurrence of CDI in the 2 months following FMT. We performed stepwise logistic regression to identify factors associated with successful FMT. Of 335 patients who underwent FMT and were followed for 2 months or more, 271 (81%) had a successful outcome following a single FMT and 86.6% had a successful outcome following a first or repeated FMT. Patients who received FMT with fresh donor stool (odds ratio [OR], 2.66; 95% CI, 1.39-5.08), underwent FMT via colonoscopy (OR, 2.41; 95% CI, 1.26-4.61), did not have a feeding tube (OR, 2.08; 95% CI, 1.05-4.11), or had 1 less episode of CDI before FMT (OR, 1.20; 95% CI, 1.04-1.39) had increased odds for successful FMT. Seventeen patients (4.7%) had a severe adverse event during the 3-month follow-up period, including 10 hospitalizations. Based on the findings from a large multi-center retrospective cohort, FMT is effective and safe for the treatment of CDI in children and young adults. Further studies are required to optimize the timing and method of FMT for pediatric patients-factors associated with success differ from those of adult patients.

Identifying Undiagnosed Pediatric Mental Illness in the Emergency Department.

It is well known that pediatric psychiatric patients frequent emergency department (ED), but the number of patients with undiagnosed psychiatric illness presenting to an ED is not well known. Identification and referral of these patients may provide an opportunity for improved patient care. The primary study objective was to identify a tool that can screen for unsuspected psychiatric illness in pediatric patients who present to the ED with non-psychiatric-related complaints. The MINI International Neuropsychiatric Interview for Children and Adolescents screening tool was administered to 200 pediatric consenting patients and guardians. The inclusion criteria were English-speaking patients who presented in the ED with a nonpsychiatric complaint who were stable and able to communicate. The study was conducted in a level 1 trauma center ED of an inner-city hospital that serves a predominantly African American and Hispanic population. This study was institutional review board approved. The study populations consisted of 53% African American (107), 45% Hispanic (90), 1% white (2), and 0.5% Asian (1). Their age range was divided, with 49% between 12 and 14 years (98) and 51% between 15 and 17 years (102). The sex was evenly split, with 50% male (100) and 50% female (100). The 41% who did screen positive for an undiagnosed mental illness had a range of diagnoses. The top modules with positive results were oppositional defiant (13.5%, 27), attention-deficit/hyperactivity disorder (13%, 25), depression (10%, 11), conduct disorder (9%, 19), and anxiety (5%, 11). The pediatric Mini International Neuropsychiatric Interview was effective in screening for undiagnosed mental illness in pediatric patients who presented to the ED with no psychiatric-related illness. The screening tool indicated that 41% of pediatric patients screened positive for an undiagnosed mental illness, with attention deficit-related disorders being the most widely seen. Further study should be conducted to test the tools used in a range of ED settings.

Vitamin and trace element deficiencies in the pediatric dialysis patient.

Pediatric dialysis patients are at risk of nutritional illness secondary to deficiencies in water-soluble vitamins and trace elements. Unlike 25-OH vitamin D, most other vitamins and trace elements are not routinely monitored in the blood and, consequently, the detection of any deficiency may not occur until significant complications develop. Causes of vitamin and trace element deficiency in patients on maintenance dialysis patient are multifactorial, ranging from diminished nutritional intake to altered metabolism as well as dialysate-driven losses of water-soluble vitamins and select trace elements. In this review we summarize the nutritional sources of key water-soluble vitamins and trace elements with a focus on the biological roles and clinical manifestations of their respective deficiency to augment awareness of potential nutritional illness in pediatric patients receiving maintenance dialysis. The limited pediatric data on the topic of clearance of water-soluble vitamins and trace elements by individual dialysis modality are reviewed, including a brief discussion on clearance of water-soluble vitamins and trace elements with continuous renal replacement therapy.

Clinical and bacteriological differences of deep neck infection in pediatric and adult patients: Review of 123 cases

ObjectivesDeep neck infections (DNIs) can lead to life-threatening disease. However, the detailed pathophysiology remains unclear due to its rarity and only a few reports have directly compared DNIs in children and adults. This study aimed to reveal the clinical differences between DNIs in children and adults. MethodsWe retrospectively reviewed 123 patients who suffered from DNIs at Tohoku University Hospital from August 2005 to July 2015. We extracted data on patient sex, age, antecedent illness, extension of infections, operative procedures, and bacteriology results. The patients were categorized into pediatric (≤18 years) and adult (>18 years) groups. Fisher's exact test was performed to determine significant differences between the two groups. ResultsFifteen children (6 males and 9 females) and 108 adults (71 males and 37 females) were identified. The most common antecedent illness in pediatric patients was lymphadenitis, which was the least common in adult patients (73% vs 7%, p < 0.0001). The incidence of DNIs extending below the hyoid bone was significantly lower in pediatric patients than in adult patients (20% vs 53%, p < 0.05). Regarding bacterial culture analysis, Staphylococcus species was the most common pathogen in children (60%), whereas only 9% of adults were positive for Staphylococcus (p < 0.001). Streptococcus species were significantly less common in children than in adults (27% vs 56%, p = 0.05). Anaerobes were also significantly less common in children than in adults (13% vs 45%, p < 0.01). Concerning surgical intervention, 53% of pediatric patients underwent external incision compared with 70% of adults. Specifically, tracheostomy was significantly less frequently performed in children than in adults (7% vs 54%, p < 0.01). ConclusionDNIs in children feature different characteristics from those in adults regarding severity, antecedent illness, bacteriology, and clinical management.

Validation of the Pediatric Early Warning Score to determine patient deterioration from illness

Background Patients who enter the emergency room (ERER) present with a variety of conditions, ranging from mild to critical. As such, it may be hard to determine which patients are in need of intensive care unit treatment. The Pediatric Early Warning Score (PEWS) has been used to identify signs of critical illness in pediatric patients.Objective To validate the PEWS system for assessing signs of critical illness in pediatric patients at Dr. Mohammad Hoesin Hospital, Palembang.Methods Subjects were children aged 1 month to 18 years who received treatment in the ERER and Pediatrics Ward inDr. Mohammad Hoesin Hospital in March to April 2015. Assessment with PEWS was based on vital sign examinations. Scores ranged from 0 to 9. The PEWS was generally taken twice, first in the ER , then after 6 hours in the ward. We obtained the cut-off point, sensitivity, and specificity of PEWS, in terms of need for pediatric intensive care unit (PICU) treatment.Results One hundred fifty patients were included in this study. Patients with PEW score of 5 or greater in the ER were relatively more likely to be transferred to the PICU, with a sensitivity of 94.4% and a specificity of 82.5%. The cut-off point obtained from the ROC curve was score 4.5 with AUC 96.7% (95%CI 93.4 to 99.9%; P&lt;0.001).Conclusion A PEWS score of cut-off ≥5 may be used to determine which patients are in critically ill condition requiring treatment in PICU.

Tissue Doppler Septal Tei Index Indicates Severity of Illness in Pediatric Patients With Congestive Heart Failure

The Doppler Tei index is an independent predictor of outcomes in adult heart failure. Tissue Doppler imaging (TDI) may be a superior method to measure the Tei index in children because it is less affected by heart rate variability. We hypothesized that the TDI Tei index reflects severity of illness in pediatric heart failure. Twenty-five pediatric heart failure patients were prospectively enrolled. Listing for heart transplantation or death were the outcomes used to define severity of illness. Baseline demographics, brain natriuretic peptide (BNP), and standard echocardiographic and TDI-derived parameters were analyzed to determine outcome indicators. Ten of the 25 patients (40%) were listed for transplantation. There were no deaths. Multivariate analysis combining age, heart rate, standard echocardiographic parameters, and BNP resulted in shortening fraction (p = 0.002) as the best indicator of listing for transplantation (R(2) = 0.32). A second multivariate analysis combining age, heart rate, TDI parameters, and BNP resulted in age (p = 0.03) and septal Tei index (p = 0.03) as the best predictive model (R(2) = 0.36). The area under the receiver operating characteristic (ROC) curve for septal Tei index was 0.84 (95% confidence interval = 0.64-0.96,), and it was comparable with the ROC curve for shortening fraction, p = 0.76. Optimal values of sensitivity (100%) and specificity (60%) were obtained with septal Tei index values >0.51. The TDI septal Tei index is an indicator of disease severity in pediatric heart failure patients and offers potential advantages compared with standard echocardiographic measures of left-ventricular ejection.

Development and Psychometric Testing of the Attitudes Toward Mental Illness in Pediatric Patients Scale

To develop the Attitudes toward Mental Illness in Pediatric Patients (ATMIPP) Scale measuring nonpsychiatric provider attitudes toward pediatric patients with mental illness. Responses from 492 nonpsychiatric and 30 psychiatric providers were evaluated for reliability and validity. Cronbach's alpha was used for reliability while factor analysis and known-groups technique were used for validity. The scale's internal consistency was 0.85. Factor analysis revealed three factors (Comfort, Tolerance, and Unbiasness) accounting for 74.5% of the variance. Compared to nonpsychiatric providers, psychiatric providers had significantly more positive attitudes on the ATMIPP (p < 0.001). The ATMIPP has evidence of reliability and validity for the sampled population.

Palivizumab and the prevention of respiratory syncytial virus illness in pediatric patients with congenital heart disease

Respiratory syncytial virus (RSV) is a significant pathogen for infants and children with congenital heart disease. Non-sustained immunity and failure to develop an effective vaccine has steered RSV management toward a passive immunotherapy strategy in at-risk children. Palivizumab is a humanized murine monoclonal antibody targeting the RSV envelope F glycoprotein. In a Phase III clinical trial palivizumab significantly reduced RSV hospitalization in children with significant congenital heart disease and was proven to be safe. Palivizumab is one of the first monoclonal antibodies to significantly impact a pediatric disease.

Bioelectrical impedance analysis for assessment of severity of illness in pediatric patients after heart surgery.

To investigate whether perioperative changes in bioelectrical impedance reflect the severity of illness in pediatric patients after heart surgery. Prospective, controlled study. University-affiliated children's hospital. A total of 107 patients admitted to a pediatric intensive care unit after congenital heart surgery. None. Single frequency (50 kHz) bioelectrical impedance was measured in the lower extremities before surgery and immediately, 16 hrs, and 40 hrs after admission (D0, D1, D2) to the pediatric intensive care unit. Postoperative changes in bioelectrical impedance were assessed by calculating values relative to the preoperative data (bioelectrical impedance ratio). These bioelectrical impedance ratios at D0 in both the nonsurviving and surviving patients were 0.84 +/- 0.06 and 0.85 +/- 0.01 (mean +/- SE), respectively, indicating that the initial decrease caused by surgical stress itself was not directly related to the prognosis. The bioelectrical impedance ratio showed an increase toward preoperative values in surviving patients (0.94 +/- 0.02) at D1, and they showed a sustained decrease (0.70 +/- 0.06) in nonsurviving patients. Patients with a bioelectrical impedance ratio at D1 of < 0.8 showed a higher mortality (25%) compared with those patients with a day-1 bioelectrical impedance ratio of > or = 1.0 (0%). The duration of the stay in the pediatric intensive care unit, mechanical ventilation, and inotropic support were all significantly longer in the patients with the lower bioelectrical impedance ratio. Measurement of the relative changes in postoperative bioelectrical impedance, which reflects perioperative alterations in body composition, provides a quantitative estimation of the critical illness in pediatric patients after heart surgery.