Child Health Institute Research Articles

Use of the WINROP Screening Algorithm for the Prediction of Retinopathy of Prematurity (ROP): A Hospital-Based Study

Background: Retinopathy of prematurity (ROP) may be the blinding disease that affects the retina of neonates. WINROP utilizes the rate of postnatal weight increase as a replication of IGF-1 or uses weight increase and IGF-1 levels together as highly analytical markers for those infants at increased risk for the development of proliferative ROP. So this study was undertaken to find out the sensitivity and specificity of this algorithm concerning international screening guidelines to predict retinopathy of prematurity. Material & Methods: A prospective cross-sectional study was carried out in the Department of Neonatology, Bangladesh Shishu Hospital & Institute from January 2017 to December 2018. A total of 50 neonates (N=50) with proper documentation following the inclusion and exclusion criteria were confirmed as the study population. Informed written consent was obtained from all the parents or guardians after they were thoroughly briefed about the nature and purpose of the study. Data were processed and analyzed using statistical package for social sciences (SPSS-22 version) software (SPSS Inc., Chicago, IL, USA). The ethical review board of the Bangladesh Institute of Child Health approved the protocol of this study. Results: The mean gestational age was 29±1.17 weeks in ROP-positive cases and 31.79±0.51 weeks in ROP-negative cases. The mean weight was 1121.9±94.34 grams in ROP-positive cases and 1302.7±139.72 grams in ROP-negative cases. It was observed that the majority 92.3% of the ROP positive cases had weight gain ≤10gm/kg/day for 4 weeks but 87.5% of the ROP negative cases had weight gain >10gm/kg/day. The validity test of WINROP for the prediction of retinopathy has a sensitivity of 92.3%, specificity of 87.5%, and positive predictive value of 88.9% and negative predictive value of 91.3%. Low-grade ROP – In zone II or III and stage 1. High-grade ROP – In zone I and stage 2 or more and plus disease. Conclusion: Retinopathy of prematurity (ROP) is a severe eye infection that can affect premature neonates. In this study, WINROP predicted 92.3% sensitivity and 88.9% positive predictive value in comparison to the gold standard screening method for detecting ROP within 2 weeks of birth.

Cost Effectiveness of Concurrent Midurethral Sling at the Time of Prolapse Repair: Results From a Randomized Controlled Trial

ABSTRACT After pelvic reconstructive surgery for pelvic organ prolapse, postoperative stress urinary incontinence (SUI) commonly occurs, which leads many women to choose to have a midurethral sling placed at the time of surgery, even in cases without symptomatic preoperative urinary incontinence. Approximately 27.3% of women with a sling had de novo SUI despite this intervention. Full evaluation of the societal and economic implications brought by a midurethral sling placement attempting to prevent postoperative de novo SUI at the time of a pelvic reconstructive surgery have yet to be evaluated. This study aimed to evaluate the 1-year cost-effectiveness of a midurethral sling in the prevention of SUI at the time of prolapse surgery. This assessment was a randomized controlled trial based on patient resource utilization and patient-reported effectiveness. Study data were obtained via the OPUS randomized clinical trial, which was performed through the Pelvic Floor Disorders Network (a cooperative agreement network sponsored through the National Institute of Child Health and Human Development). A total of 337 women with anterior vaginal prolapse and without SUI symptoms set to undergo treatment from May 2007 to January 2011 were included in the study. Patients were randomly assigned to receive either sham incisions or a midurethral sling during vaginal prolapse surgery. Follow-up occurred at 3, 6, and 12 months postsurgery, with surveys, physical examinations, and medical history. Cost data were collected, and overall health utility in quality-adjusted life-years (QALYs) was calculated. Secondary outcomes were urinary incontinence-specific quality of life and cases of urinary incontinence, as defined by bothersome incontinence symptoms and positive cough stress tests. Initial surgical procedures and subsequent urinary incontinence-related health care were all used for recording health care sector costs. Total costs for study participants were collected via health care resource utilization data, including office visits, additional surgical procedures, and related procedures. The incremental cost-effectiveness ratio was the difference between the sham incision and midurethral sling groups in mean cost, divided by difference in mean QALYs. Data for health care resource utilization were collected during the trial period. Questionnaires at baseline, 3, 6, 9, and 12 months were used to collect other costs. At 1 year, one-way sensitivity analysis was performed for assessing the varying effectiveness of midurethral slings at 1 year, by noting the urinary incontinence-associated patient costs and by using varied QALY for the sling group. Results were taken from a study population of 337 women who underwent randomization to be included in the analysis of cost-effectiveness. No great variance of characteristics existed between groups. One year after surgery, a lower rate of urinary incontinence existed for those in the midurethral sling group. Notably, QALYs were not statistically different between midurethral sling and sham incision groups at baseline, but at 12 months, there was an improvement in both the UDI stress subscale and an overall reduction in the Incontinence Severity Index for the midurethral sling group. In conclusion, although prophylactic midurethral sling placements during vaginal prolapse surgery does reduce the rate of de novo SUI, based on this analysis of date from the OPUS trial, it is not a cost-effective intervention. The decision to place a sling in this setting is often driven by cost savings on the patient side, whereas midurethral sling health care costs are higher than when sling is not done.

Quality of early childcare and education predicts high school STEM achievement for students from low-income backgrounds.

High-quality early childcare and education (ECE) has demonstrated long-term associations with positive educational and life outcomes and can be particularly impactful for children from low-income backgrounds. This study extends the literature on the long-term associations between high-quality caregiver sensitivity and responsiveness and cognitive stimulation (i.e., caregiving quality) in ECE settings and success in science, technology, engineering, and mathematics (STEM) in high school. Using the 1991 National Institute of Child Health and Human Development Study of Early Child Care and Youth Development (n = 1,096; 48.6% female; 76.4% White, 11.3% African American, 5.8% Latine, 6.5% other), results demonstrated that caregiving quality in ECE was associated with reduced disparities between low- and higher-income children's STEM achievement and school performance at age 15. Disparities in STEM school performance (i.e., enrollment in advanced STEM courses and STEM grade point average) and STEM achievement (i.e., Woodcock-Johnson cognitive battery) were reduced when children from lower-income families experienced more exposure to higher caregiving quality in ECE. Further, results suggested an indirect pathway for these associations from caregiving quality in ECE to age 15 STEM success through increased STEM achievement in Grades 3 through 5 (ages 8-11 years). Findings suggest that community-based ECE is linked to meaningful improvements in STEM achievement in Grades 3 through 5 which in turn relates to STEM achievement and school performance in high school, and caregiving quality in ECE is particularly important for children from lower-income backgrounds. This work has implications for policy and practice positioning caregivers' cognitive stimulation and sensitivity in ECE settings across the first 5 years of life as a promising lever for bolstering the STEM pipeline for children from lower-income backgrounds. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

A multilevel health system intervention for virological suppression in adolescents and young adults living with HIV in rural Kenya and Uganda (SEARCH-Youth): a cluster randomised trial

Social and cognitive developmental events can disrupt care and medication adherence among adolescents and young adults living with HIV in sub-Saharan Africa. We hypothesised that a dynamic multilevel health system intervention helping adolescents and young adults and their providers navigate life-stage related events would increase virological suppression compared with standard care. We did a cluster randomised, open-label trial of young individuals aged 15-24 years with HIV and receiving care in eligible clinics (operated by the government and with ≥25 young people receiving care) in rural Kenya and Uganda. After clinic randomisation stratified by region, patient population, and previous participation in the SEARCH trial, participants in intervention clinics received life-stage-based assessment at routine visits, flexible clinic access, and rapid viral load feedback. Providers had a secure mobile platform for interprovider consultation. The control clinics followed standard practice. The primary, prespecified endpoint was virological suppression (HIV RNA <400 copies per mL) at 2 years of follow-up among participants who enrolled before Dec 1, 2019, and received care at the study clinics. This trial is registered with ClinicalTrials.gov, NCT03848728, and is closed to recruitment. 28 clinics were enrolled and randomly assigned (14 control, 14 intervention) in January, 2019. Between March 14, 2019, and Nov 26, 2020, we recruited 1988 participants at the clinics, of whom 1549 were included in the analysis (785 at intervention clinics and 764 at control clinics). The median participant age was 21 years (IQR 19-23) and 1248 (80·6%) of 1549 participants were female. The mean proportion of participants with virological suppression at 2 years was 88% (95% CI 85-92) for participants in intervention clinics and 80% (77-84) for participants in control clinics, equivalent to a 10% beneficial effect of the intervention (risk ratio [RR] 1·10, 95% CI 1·03-1·16; p=0·0019). The intervention resulted in increased virological suppression within all subgroups of sex, age, and care status at baseline, with greatest improvement among those re-engaging in care (RR 1·60, 95% CI 1·00-2·55; p=0·025). Routine and systematic life-stage-based assessment, prompt adherence support with rapid viral load testing, and patient-centred, flexible clinic access could help bring adolescents and young adults living with HIV closer towards a goal of universal virological suppression. Eunice Kennedy Shriver National Institute of Child Health and Human Development, US National Institutes of Health.

Clinical spectrum and outcome of pancreatic disorders in children.

Objective: To determine the clinical spectrum and immediate outcome of pancreatic disorders in children attending National Institute of Child Health, Karachi, Pakistan. Study Design: Cross Sectional study. Setting: Inpatient and Outpatient Department of Pediatric Medicine, National Institute of Child Health, Karachi. Period: January 2022 to December 2022. Material &amp; Methods: A total of 49 children of either gender aged between 2 to 15 years presenting with clinical features of pancreatic disorders were analyzed. At the time of enrollment, data about demographic and clinical characteristics were noted. Important laboratory investigations were sent to local institutional laboratory. Ultrasound and/or CT scan of abdomen of each child was performed and reported by consultant radiologist having 3 years of experience for confirmation of the diagnosis. Immediate outcome was noted after 15 days of treatment among all children. Outcomes were labeled in terms of improved, not improved or expired. Results: In a total of 49 children, 30 (61.2%) were male while the mean age was 8.46±3.40 years. Epigastric pain, vomiting and whole abdominal pain were the most frequent presenting complaints noted in 40 (81.6%), 35 (71.4%) and 32 (65.3%) children respectively. Atrophy, inflammation and edema, calcifications, pancreatic duct dilation and pancreatic divisum were the commonest radiological findings noted in 10 (20.4%), 21 (42.9%), 18 (36.7%), 13 (26.5%) and 2 (4.1%) children respectively. Chronic pancreatitis was found to be the most frequent pancreatic disorder in 29 (59.2%) patients and they were associated with low fecal elastase level while acute pancreatitis was noted in 20 (40.8%) cases. Improved outcomes were observed in 44 (89.8%) children while no mortality was reported. Conclusion: Majority of the children with pancreatic disorders were male and aged between 6 to 12 years. Chronic pancreatitis was the most common type of pancreatic disorder. Epigastric pain, vomiting and whole abdominal pain were the most frequent presenting complaints. Outcome was generally good and no mortality was noted.

Pharmacokinetics, safety, and tolerability of dispersible and immediate-release abacavir, dolutegravir, and lamivudine tablets in children with HIV (IMPAACT 2019): week 24 results of an open-label, multicentre, phase 1–2 dose-confirmation study

Child-friendly fixed-dose combination (FDC) antiretroviral therapy (ART) options are limited. We evaluated the pharmacokinetics, safety, and tolerability of dispersible and immediate-release FDC abacavir, dolutegravir, and lamivudine taken once per day in children younger than 12 years with HIV. IMPAACT 2019 was an international, phase 1-2, multisite, open-label, non-comparative dose-confirmation study of abacavir, dolutegravir, and lamivudine in children younger than 12 years. Participants were enrolled across five weight bands: those weighing 6 kg to less than 25 kg received abacavir (60 mg), dolutegravir (5 mg), and lamivudine (30 mg) dispersible tablets (three to six tablets depending on body weight), and those weighing 25 kg to less than 40 kg received abacavir (600 mg), dolutegravir (50 mg), and lamivudine (300 mg) in an immediate-release tablet. At entry, participants were ART naive or ART experienced and virologically suppressed on stable ART for 6 months or more. Dose confirmation was based on pharmacokinetic and safety criteria in the first five to seven participants in each weight band to week 4; all participants were followed up to week 48. We present the results for the primary objectives to assess pharmacokinetics, confirm dosing, and evaluate safety through 24 weeks across all weight bands. The trial is registered with ClinicalTrials.gov (NCT03760458). 57 children were enrolled and initiated study drug (26 [46%] female and 31 [54%] male; 37 [65%] Black, 18 [32%] Asian, and 1 [2%] had race reported as unknown). Within each weight band, 6 kg to less than 10 kg, 10 kg to less than 14 kg, 14 kg to less than 20 kg, 20 kg to less than 25 kg, and 25 kg or higher: the geometric mean dolutegravir area under the concentration time curve over the 24 h dosing interval (AUC0-24 h) was 75·9 h·μg/mL (33·7%), 91·0 h·μg/mL (36·5%), 71·4 h·μg/mL (23·5%), 84·4 h·μg/mL (26·3%), and 71·8 h·μg/mL (13·9%); dolutegravir concentrations 24 h after dosage (C24 h) were 0·91 μg/mL (67·6%), 1·22 μg/mL (77·5%), 0·79 μg/mL (44·2%), 1·35 μg/mL (95·5%), and 0·98 μg/mL (27·9%); abacavir AUC0-24 h was 17·7 h·μg/mL (38·8%), 19·8 h·μg/mL (50·6%), 15·1 h·μg/mL (40·3%), 17·4 h·μg/mL (19·4%), and 25·7 h·μg/mL (14·6%); lamivudine AUC0-24 h was 10·7 h·μg/mL (46·0%), 14·2 h·μg/mL (23·9%), 13·0 h·μg/mL (15·6%), 14·5 h·μg/mL (16·6%), and 21·7 h·μg/mL (26·2%), respectively. Pharmacokinetic targets and safety criteria were met within each weight band, and thus dosing of abacavir, dolutegravir, and lamivudine was confirmed at the originally selected doses. 54 (95%) of participants were treatment experienced and all who continued taking the study drug remained virologically suppressed (<200 copies per mL) through week 24. Virological suppression was achieved in two of three participants who were ART naive by week 24. There were no grade 3 or higher adverse events related to abacavir, dolutegravir, and lamivudine and no discontinuations because of toxicity to week 24. Both formulations were well tolerated. Dosing of abacavir, dolutegravir, and lamivudine was confirmed in children weighing 6 kg to less than 40 kg, and both FDC formulations were safe, well tolerated, and efficacious through 24 weeks of treatment. These findings support global efforts to expand the availability of FDC abacavir, dolutegravir, and lamivudine to children with HIV. National Institute of Allergy and Infectious Diseases, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the National Institute of Mental Health, ViiV Healthcare, and GlaxoSmithKline.

The Study of Early Child Care and Youth Development (SECCYD): Studying Development from Infancy to Adulthood

The National Institute of Child Health and Human Development Study of Early Child Care and Youth Development (SECCYD) is a comprehensive study of human development that has followed participants from birth ( N = 1,364) to age 26 ( N = 814). Observations, diagnostic procedures, standardized tests, and questionnaires were used to measure five developmental contexts (early care and education, home, school, out of school, and neighborhoods) and three developmental domains (social–emotional, cognitive–academic, and physical–biological). Measures were repeated over time so that stability, change, and growth trajectories of both contexts and developmental domains could be studied. The goals of this review are threefold: ( a) to acquaint readers with the depth and breadth of measures available in this public data set, ( b) to provide an overview of longitudinal findings that extend the SECCYD to the end of high school and age 26, and ( c) to highlight promising areas for future research.

Assessing physical activity in heart failure with the CHAMPS physical activity questionnaire

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Office of Research on Women’s Health and the Eunice Kennedy Shriver National Institute of Child Health &amp; Human Development of the National Institutes of Health Background It is difficult to quantify physical activity among adults with heart failure (HF) in the context of many disease-driven limitations. The Community Healthy Activities Model Program for Seniors (CHAMPS) Physical Activity Questionnaire, designed to measure physical activity among older adults, may be helpful in quantifying physical activity in HF. Purpose To quantify physical activity levels among adults with HF using the CHAMPS Physical Activity Questionnaire and to compare physical activity expenditure and frequency between adults ≥ 65 years vs. &amp;lt; 65 years, women and men, and those physically frail vs. non-physically frail. Methods This was an analysis of data collected from a cohort study of adults with New York Heart Association Functional Class I-IV HF. Using the CHAMPS Questionnaire, we calculated caloric expenditure (kcal) and frequency per week in all activities and moderate intensity activities. Physical frailty was measured with the Frailty Phenotype Criteria. Comparative statistics were used to compare physical activity between groups. Results The average age of the sample (n = 117) was 63.6±15.6 years, 48.7% were female, and most (76.9%) had non-ischemic HF etiology. Median caloric expenditure from all physical activities was 1827 kcal/week [Interquartile Range 735-3943] and moderate intensity activities was 397 kcal/week [Interquartile Range 0-1886]. For caloric expenditure from all physical activities, there was no significant difference between adults ≥ 65 years vs. &amp;lt; 65 years (p = 0.894), but women and those physically frail had significantly lower caloric expenditure (both p &amp;lt; 0.001). For caloric expenditure from moderate intensity physical activities, there was no significant difference between adults ≥ 65 years vs. &amp;lt; 65 years (p = 0.346), but women had significantly lower caloric expenditure (p &amp;lt; 0.001) as well as those physically frail (p &amp;lt; 0.001). Median frequency of all physical activities was 13 times per week [Interquartile Range 8-21] and of all moderate intensity activities was 3 times per week [Interquartile Range 0-8]. Conclusions Many adults with HF, regardless of age, report low physical activity using the CHAMPS Physical Activity Questionnaire; however, women and those physically frail report considerably lower physical activity than men and those non-physically frail, respectively. Capturing physical activity levels across multiple activities is necessary for the design and implementation of physical activity interventions in HF, and the CHAMPS measure may be one tool to do this.

Study of incidence, microbiological profile of nosocomial infections in pediatric intensive care unit of tertiary care center

Background: Prevalence of nosocomial infections in pediatric intensive care unit (PICU) ranges between from 6-26%. Increased use of broad-spectrum antibiotics, urinary and central venous catheterization and endotracheal intubation put patients at an increased risk of affecting with nosocomial infections in pediatric patients. Methods: A hospital based prospective study was carried out on 725 patients aged between 1 month and 12 years admitted in PICU of Al-Ameen medical college hospital, Bijapur, Karnataka, India and institute of child health and hospital for children, Madras medical college, Chennai, Tamil Nadu, India from 15-09-2020 to 15-08-2022. All patients who were admitted with fever or developed fever in first 48 hours of life were excluded from the study. The data obtained in the course of study was analyzed by appropriate statistical methods. Results: Out of 725 pediatric admissions, the incidence of nosocomial infection in the present was found to be 108 (14.8%). Concerning the type of infection, the commonest reported types were central-line associated bloodstream infection (CABI) 59 (54.6%) and ventilator-associated infection (VAI) 52 (48.1%), followed by bloodstream infection 45 (41.6%), catheter associated urinary tract infection (CA-UTI) 38 (35.1%) and urinary tract infection (UTI) 30 (27.7%) respectively. Conclusions: The incidence of nosocomial infection was 14.8%. The central line associated blood stream infection was the predominant cause of nosocomial infection. This information can help decision makers establish preventive strategies and implement effective and reliable plans.

Clinical correlates, characteristics and comorbidities of paediatric tic disorders

Background: Tic disorders are complex neuropsychiatric disorders of childhood onset. The associated comorbidities in paediatric tic disorders are of vast importance as they account for the major functional impairment in these children, data of which is lacking in our Indian context. Methods: Descriptive Cross-sectional study conducted among children of 3-15 years of age in child psychiatry department of Institute of Child health, Egmore, Chennai Results: In this study 60 patients were studied of whom 47 were male and 13 were females. Comorbid psychiatric disorders were present in 38 (63.3%) children. They were ADHD (48.3%), OCD (6.6%), ASD (6.6%), SLD (20%), Behavioural problems in 16.6%. Motor tics were the most common type of tics. Significant correlation between tic severity and presence of comorbid psychiatric disorders was seen. Conclusions: Tic disorders are not completely benign and simple as it is thought. Tic disorders usually present with associated comorbidities, which cause more impairment than tics themselves. ADHD is the most common comorbidity associated with paediatric tic disorders.

Electrophysiologic Findings in Pediatric Guillain Barre Syndrome

Objective: To describe electrophysiologic findings in the pediatric GuillianBarre syndrome (GBS).&#x0D; Study design: Comparative prospective study.&#x0D; Place and Duration of Study: Department of Neurology, The Children’s Hospital and Institute of Child Health, Lahore Pakistan, from Jun to Dec 2015.&#x0D; Methodology: Children below 18 years of age, presenting in medical emergency/neurology OPD and fulfilling the clinical case definition of GBS were included for the study. Electrophysiologic studies were performed within 24 hours of admission in all patients.&#x0D; Results: Out of 83 patients with GBS, 59% were male and 80% were between 3-12 years of age. According to the electrophysiological findings, acute inflammatory demyelinating polyradiculoneuropathy (AIDP) was the most common subtype followed by acute motor axonal neuropathy (AMAN). Reduced CMAP and absent F-response were the most common electrophysiologic findingspresented in 70% and 57.8% of patients respectively. However, absent F-response was not specific for any subtype (p&gt;0.05). Prolonged motor DL, reduced NCV, temporal dispersion and abnormal F-wave latency were characteristicelectrophysiologic features of demyelination (p≤0.001). However, prolonged motor DL and absent F-wave occurred early in the course of disease while reduced NCV and temporal dispersion observed later.&#x0D; Conclusion: Electrophysiologic studieswere useful in making the appropriate diagnosis to initiate immunotherapy, particularly during first week after onset of weakness when albuminocytologic dissociation may not be present.

Cognitive outcomes at age 3 years in children with fetal exposure to antiseizure medications (MONEAD study) in the USA: a prospective, observational cohort study

The neurodevelopmental effects of fetal exposure to most antiseizure medications are unclear. We aimed to investigate the effects of fetal exposure to commonly used antiseizure medications on neuropsychological outcomes at age 3 years. The Maternal Outcomes and Neurodevelopmental Effects of Antiepileptic Drugs (MONEAD) study is a prospective, observational, multicentre cohort study at 20 specialty epilepsy centres in the USA. We have investigated pregnancy outcomes in women (aged 14-45 years) with and without epilepsy who were enrolled during pregnancy (≤20 weeks' gestational age), and their children. The primary outcome for children at age 3 years was a blindly assessed Verbal Index score, which was calculated by averaging scores on the Naming Vocabulary and Verbal Comprehension subtests of Differential Ability Scales-II, Expressive Communication and Auditory Comprehension subscales of Preschool Language Scale-5, and Peabody Picture Vocabulary Test-4. Children of women with and without epilepsy were compared, and the associations of medication exposures to outcomes in exposed children were assessed. The MONEAD study is registered with ClinicalTrials.gov, NCT0730170, and is ongoing. Between Dec 19, 2012, and Jan 13, 2016, 456 pregnant women (351 with epilepsy and 105 without epilepsy) were enrolled into the study. 345 children were born to women with epilepsy and 106 children were born to women without epilepsy. Verbal Index scores at age 3 years did not differ for children of women with epilepsy (n=284; adjusted least-square mean 102·7, 95% CI 101·4 to 103·9) versus those without epilepsy (n=87; 102·3, 99·8 to 104·7). Significant risk factors for reduced Verbal Index scores included maternal intelligence quotient, maternal education, post-birth anxiety, gestational age at enrolment, child's sex, and child's ethnicity. For Verbal Index scores, antiseizure medication exposure effects were not seen for maximum third trimester blood concentrations (n=258; adjusted parameter estimate -2·9, 95% CI -6·7 to 1·0). However, in secondary analyses, exposure-dependent effects were present on multiple cognitive measures, which varied by medication. We found no difference in neurodevelopmental outcomes between children with fetal exposure to newer antiseizure medications compared with unexposed children. However, some exposure-dependent antiseizure medication effects were seen in secondary analyses. The adverse effects of maternal post-birth anxiety emphasise the importance of screening mothers during pregnancy and postpartum and implementing interventions. Additional studies are needed to clarify the exposure-dependent effects. National Institutes of Health, National Institute of Neurological Disorders and Stroke, and National Institute of Child Health and Development.

Evaluation of Antibiotic Resistance in Pediatric Patients Suffering from Cancer

Introduction: The discovery of antibiotics has revolutionized the field of healthcare since many lethal infections which were previously impossible to treat are now have become much curable. However, a high reliance of the clinicians on antibiotics have led to their irrational use which has given rise to a serious problem in the form of Antimicrobial Resistance (AMR) a phenomenon where the microbes develop the capacity to neutralize the antimicrobial capacity of the antibiotics. In cancer patient AMR is not so frequent as compared to other patients who suffer from infectious diseases but still if cancer patients during their chemotherapy encounter the issue of AMR their cancer treatment becomes highly challenging. Objective: To evaluate the prevalence of AMR in the cancer affected pediatric patients being treated with antibiotics. Materials and Methods: In this cross-sectional study 300 pediatric patients who received prescriptions with at least one antibiotic suffering from cancer and were treated with at least one antibiotic were included. The data was collected with the consent of their guardians from the cancer ward of The Children’s hospital and The Institute of Child Health, Lahore, Pakistan by utilizing non-probability sampling technique (convenient sampling) for the period of 6-months. Results: The study findings depicted that the children aged between 4 to 7 years got affected by various cancers and lymphoblastic leukemia (47%) was the most frequently occurring cancer. Urine, blood and mucosal swabs were used for sampling but majority of the samples were the blood (29%) samples that were used to detect the occurrence of AMR. It was observed that the study population was more susceptible to gram-negative bacteria than gram-positive bacteria. The incidence of AMR was higher in gram-negative bacteria than that of gram-positive bacteria. Among the collected samples the bacteria showed sensitivity for ciprofloxacin (23%), amikacin (21%), piperacillin (24%) and ceftazidime (23%). Considering the resistance patterns among the tested antibiotics that were prescribed to the cancer patients various penicillin antibiotics and ceftazidime showed a higher incidence of the AMR. Conclusion: The AMR is a serious problem that is encountered during the treatment of infections in the pediatric patients affected by cancer thus, the appropriate selection of antibiotics by the clinicians is a matter of serious concern so as to prevent AMR and to obtain maximum therapeutic outcomes of the chemotherapy.

Clinical manifestations of peripheral vegetative insufficiency in children and adolescents with type 1 diabetes mellitus (retrospective and prospective investigations)

The variety of complications of type 1 diabetes mellitus (DM) in children and adolescents are often observed in clinical practice. Among them, damage to the central and peripheral nervous system prevails. The term «peripheral vegetative insufficiency» (PVI) refers to a complex of vegetative manifestations that occur in the peripheral (segmental) part of the VNS against the DM background.&#x0D; Objective — to determine the clinical typology of PVN in children with type 1 DM during the period of the years 1980—1990 (retrospective investigation) and in the period of the years 2012—2022 (prospective study).&#x0D; Materials and methods. The study was conducted on the basis of the Department of Endocrinology of the SI «Institute of Child and Adolescent Health of the NAMS of Ukraine». Examinations involved 605 pediatric patients: 285 patients (126 children and 159 adolescents) in the retrospective study, and 320 subjects (186 children and 134 adolescents) in the group of prospective study. All patients underwent somatic, neurological, and clinical examinations.&#x0D; Results and discussion. It haі been determined that in children and adolescents with type 1 diabetes mellitus, PVI clinical manifestations were present in all physiological body systems and often occur under the mask of various somatic diseases. The most typical PVI clinical syndromes in pediatric patients with DM included orthostatic hypotension, tachycardia at rest, hypohidrosis, gastroparesis, constipation, and urinary incontinence. The incidence of PVI syndromes in the groups of patients in the prospective study (years 2012-2022) was lower than in the retrospective study (years 1980—1990) owing to the use of the novel technologies for the DM treatment.&#x0D; Conclusions. The labile, severe course of type 1 diabetes mellitus in children often triggers the development of autonomic disorders, which are predictors and manifestations of neurological disorders. As the overall duration of the disease increases and carbohydrate metabolism is not compensated properly, the number of functional organic neurological complications increases. Damage to immature brain structures affects their further development and forms the basis for the long-term neurological complications in older age.

Incorporating the HIV Infant Tracking System into standard-of-care early infant diagnosis of HIV services in Kenya: a cost-effectiveness analysis of the HITSystem randomised trial

The HITSystem efficacy trial showed significant improvements in early infant diagnosis retention, return and notification of infant test results, and earlier antiretroviral therapy (ART) initiation compared with standard-of-care early infant diagnosis services in Kenya. This study aimed to analyse data from the HITSystem trial to assess the cost-effectiveness of the intervention in Kenya. In this analysis, we extrapolated results from the HITSystem cluster randomised controlled trial to model early infant diagnosis outcomes and cost-effectiveness if the HITSystem was scaled up nationally in Kenya, compared with standard-of-care outcomes. We used a micro-costing method to collect cost data, which were analysed from a health-system perspective, reflecting the investment required to add HITSystem to existing early infant diagnosis services and infrastructure. The base model used to calculate cost-effectiveness was deterministic and calculated the progression of infants through early infant diagnosis. Differences in progression across study arms were used to establish efficacy outcomes. The number of life-years gained per infant successfully initiating ART were based on the Cost Effectiveness of Preventing AIDS Complications model in east Africa. HITSystem cost data were integrated into the model, and the incremental cost-effectiveness ratio was calculated in terms of cost per life-year gained. Sensitivity analyses were done using the deterministic model with triangular stochastic probability functions for key model parameters added. The number of life-years gained was discounted at 3% and costs were adjusted to 2021 values. The cost per life-year gained from the HITSystem was US$82·72. Total cost for national HITSystem coverage in Kenya was estimated to be around $2·6 million; covering 82 230 infants exposed to HIV at a cost of $31·38 per infant and a yield of 1133 infants receiving timely ART, which would result in 31 189 life-years gained. With sensitivity analyses, the cost per life-year gained varied from $40·13 to $215·05. 90% of model values across iterations ranged between $55·58 (lower 5% threshold) and $132·38 (upper 95% threshold). The HITSystem would be very cost-effective in Kenya and can optimise the return on the existing investment in the national early infant diagnosis programme. The US National Institute of Child Health and Human Development.

Scholarly activity following National Institutes of Health Women’s Reproductive Health Research K12 training—a cohort study

National Institutes of Health funding to address basic reproductive health for common female conditions remains disproportionately low, in part because of low success rates of grant applications by obstetrician-gynecologists. This study aimed to evaluate the scholarly productivity of individuals supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development Women's Reproductive Health Research K12 career development award, created to advance careers of obstetrician-gynecologist physician-scientists. We performed a cohort study of individuals who completed at least 2 years of Women's Reproductive Health Research training by June 30, 2015, and had at least 5-year follow-up. Earliest training start date was December 1, 1998. Primary outcomes from public data sources (National Institutes of Health RePORTER, PubMed, iCite) were (1) number of total and R01 National Institutes of Health grants as principal investigator; (2) numbers of total and first and last author publications; and (3) median and highest publication impact factor measured by the relative citation ratio. Secondary outcomes from an email survey subcohort were total number of research grants, federally funded grants, and number of National Institutes of Health grants as coinvestigator; institutional promotions and academic appointments, national and National Institutes of Health leadership roles; and career and mentorship satisfaction. Outcomes were recorded at 5, 10, and 15 years postgraduation, and aggregate anonymized data were divided into 3 groups using Women's Reproductive Health Research completion dates: June 30 of 2005, 2010, and 2015. Temporal trends were assessed. Results were stratified by gender, number of awarded grant cycles (1-2 vs 3-4), and specialty type. Analyses used Fisher exact or Pearson chi-square tests, and Mantel-Haenszel tests of trend. The distribution of the cohort (N=178) by graduation completion date was: on or before June 30, 2005 (57 [32%]); July 1, 2005 to June 30, 2010 (60 [34%]); and July 1, 2010 to June 30, 2015 (61 [34%]). Most participants were female (112 [64%]) and maternal-fetal medicine trained (53 [30%]), followed by no fellowship (50 [28%]). Of the 178 participants, 72 (40%) received additional National Institutes of Health funding as a principal investigator, 45 (25%) received at least 1 R01, and 23 (13%) received 2 to 5 R01s. There were 52 (31%) scholars with >10 first author publications, 66 (39%) with >10 last author publications, and 108 (63%) with ≥25 publications. The highest relative citation ratio was a median of 8.07 (interquartile range, 4.20-15.16). There were 121 (71%) scholars with relative citation ratio ≥5, indicating >5-fold greater publication impact than that of other National Institutes of Health-funded scientists in similar areas of research. No differences by gender, institution, or temporal trends were observed. Of the full cohort, 69 (45.7%) responded to the survey; most self-identified as women (50 [73%]) and White (51 [74%]). Our findings suggest that the infrastructure provided by an institutional K award is an advantageous career development award mechanism for obstetrician-gynecologists, a group of predominantly women surgeons. It may serve as a corrective for the known inequities in National Institutes of Health funding by gender.

Two types of childhood glaucoma secondary to familial exudative vitreoretinopathy

Glaucoma secondary to familial exudative vitreoretinopathy presents as angle closure by either neovascular or non-neovascular mechanisms. We analyze the presentation and outcomes of two types of childhood glaucoma secondary to familial exudative vitreoretinopathy (FEVR). This retrospective cross-sectional study included all patients <18 years of age diagnosed with glaucoma after or concurrently with a diagnosis of FEVR between 2010 and 2020 from Queen Sirikit National Institute of Child Health in Bangkok, Thailand. Two groups were analyzed: neovascular or non-neovascular angle-closure status. Primary outcome measures were final visual acuity and intraocular pressure (IOP) in both groups. Of 144 FEVR patients, 8 children (5.5%; 11 eyes, 3 bilateral cases) developed childhood glaucoma. Mean time between FEVR presentation and glaucoma was 42.2 ± 40.0 months. In the neovascular group, 3 of 9 eyes presented with glaucoma at FEVR diagnosis; 3 of 9 eyes (33%) required glaucoma surgery. In the non-neovascular group, 2 eyes presented with acute angle closure secondary to a phacomorphic lens. Both were treated with trabeculectomy, with resolution of pupillary block. All eyes had stage 4B FEVR or greater. Six of 8 eyes had stable or better visual acuity, and 10 eyes (91%) had IOP <21 mm Hg at final follow-up. Childhood glaucoma secondary to FEVR is a rare complication caused by later stages of the disease. It may present as neovascular or non-neovascular angle closure, often requiring complex care. Therefore, awareness and adequate management of FEVR can help prevent additional morbidity from childhood glaucoma.

Determinants of Inappropriate Complementary Feeding Practice among 6 months-2 years old children attending Institute of Child and Mother Health (ICMH), Dhaka

Determinants of Inappropriate Complementary Feeding Practice among 6 months-2 years old children attending Institute of Child and Mother Health (ICMH), Dhaka

Glucose-6-Phosphate Dehydrogenase (G6PD) Deficiency in Neonates Presenting with Indirect Hyperbilirubinemia

Objective: To determine the frequency of glucose-6-phosphate dehydrogenase (G6PD) deficiency in neonates presenting with indirect hyperbilirubinemia.Methods: A prospective cross-sectional study was conducted at Neonatal intensive care unit (NICU) of National Institute of Child Health, Karachi from August 2020 to July 2021. All neonates with either gender born with indirect hyperbilirubinemia &gt;5mg/dl admitted in NICU were consecutively enrolled. G6PD deficiency along with baseline and laboratory characteristics were observed. The presence of G6PD level of &lt;1.3 U/g Hb was labeled as G6PD deficiency.Results: Of 228 neonates, the mean age was 8.58 ±3.68 days. There were 153 (67.1%) males and 75 (32.9%) females. The frequency of G6PD deficiency was found to be 72 (31.6%). The mean weight was significantly higher among neonates with G6PD deficiency as compared to the patients with no G6PD deficiency, i.e., 2.53 ±0.48 vs. 2.37 ±0.56 (p-value 0.035). A significant difference of hemoglobin level (p-value &lt;0.001), serum total bilirubin level (p-value &lt;0.001), and serum indirect bilirubin level (p-value0.001) was observed in between G6PD deficient and non-deficient neonates. Increased reticulocyte count was also found significantly higher in neonates with G6PD deficiency as compared to the neonates without G6PD deficiency, i.e., 69 (95.8%) and 34 (21.8%) respectively (p-value &lt;0.001). Conclusion: G6PD deficiency was considerably prevalent in neonates with indirect hyperbilirubinemia. Moreover, hemoglobin level, serum total bilirubin level, serum indirect bilirubin level, and increased reticulocyte count was also observed significant contributing factors for G6PD deficiency.

Prevalence of Convergence Insufficiency in Patients Suffering from Headache.

Objective: To find out the prevalence of convergence insufficiency (CI) in patients suffering from headache. Study Design: Cross Sectional, Observational study. Setting: Departments of Eye, The Children’s Hospitals and The Institute of Child Health, Multan and Govt. Shahbaz Sharif Hospital, Multan. Period: August 2020 to January 2021. Material &amp; Methods: A total of 95 patients between the ages of 08-62 years with a complaint of headache were examined. Both male and female patients having complaint of headache, patients more than 07 years of age and patients with complaint of discomfort and blur vision at near after focusing for few minutes were included. While uncooperative patients, patients less than 07 year of age and patients having systemic and neurological diseases that can cause headache were excluded. Patient's visual acuity (VA) was recorded with Snellen’s chart and refraction was done with retinoscopy/ auto refractometer. Fundoscopy was carried out to find out any pathology i.e., papilledema. Convergence was checked by pencil push-up test and amplitude of accommodation was measured using RAF rule. Descriptive statistics including frequencies and percentages were extracted for categorical variables and mean ± standard deviation (SD) for quantitative variables. Results: In this study, we recruited 95 patients with a complaint of headache between the ages of 08-62 years and mean age was 27.80 years. 68 (71.60 %) were female and 27 (28.40 %) were male. These patients were examined to determine the prevalence of convergence inefficiency in patients suffering from a headache. Out of these 95 patients having headache 27 (28.4%) had poor convergence, 42 (44.2%) had weak convergence and 26 (27.4%) had normal convergence. This study suggested that 69 (72.6%) patients with headache had varying degree of CI. Conclusion: Our study suggested that headache is more common in females than males and CI is the most common cause of headache among these patients. These patients should be assessed and treated to relieve their symptoms and enable them to spend a better quality of life. We recommend ophthalmologists and optometrists to measure CI as a part of their routine ophthalmic examination.