International Pediatric Association Research Articles

Melatonin use in managing insomnia in children with autism and other neurogenetic disorders - An assessment by the international pediatric sleep association (IPSA)

Though it is widely prescribed for improving sleep of children with autism and other neurogenetic disorders, there is a need for practical guidance to clinicians on the use of melatonin for managing insomnia in this population. Because data were either lacking or inconclusive, a task force was established by the International Pediatric Sleep Association (IPSA) to examine the literature based on clinical trials from 2012 onwards. A summary of evidence pertaining to melatonin's utility and potential side effects, practice-related caveats, and insights for use are published herewith.

Highlights from the 12th congress of the international pediatric transplant association, Austin, Texas 2023.

The 12th Congress of the (IPTA) event in Austin, Texas, had over 400 attendees from 40 countries. The attendees included a diverse mix of pediatric transplant professionals from several specialties including physicians, surgeons, scientists, nurses, organ procurement personnel, advance transplant providers, pharmacists, administrators, fellows, residents, and students. The 4-day event featured nearly 200 abstracts, 90 oral presentations, 24 mini oral presentations, and more than 80 poster presentations. All of these presentations encouraged vibrant discussions and supported the exchange of new clinical and basic science information regarding clinical care management, basic science research, socioeconomic, and ethical and organ donation issues relevant to pediatric transplantation. We briefly describe here the highest scored presented abstracts at IPTA 2023 that are divided into two categories: clinical and basic sciences.

Childhood Obesity as a Global Problem: a Cross-sectional Survey on Global Awareness and National Program Implementation

The rising global epidemic of childhood obesity is a major public health challenge. Despite the urgency, there is a lack of data on the awareness and implementation of preventative measures. The aim of this study was to identify areas for improvement in the prevention and management of childhood obesity worldwide. A cross-sectional electronic survey was distributed to 132 members of national pediatric societies of the International Pediatric Association. Twenty-eight (21.2%) participants, each from a different country across six World Health Organization (WHO) regions completed the survey. Most participants reported that national prevalence data of childhood obesity is available (78.6%), and the number increased during the Coronavirus disease-2019 pandemic (60.7%). In most countries (78.6%), the amount of sugar and salt in children’s products is provided but only 42.9% enacted regulations on children-targeted advertising. Childhood obesity prevention programs from the government (64.3%) and schools (53.6%) are available with existing support from private or non-profit organizations (71.4%). Participants were aware of WHO’s guidance concerning childhood obesity (78.6%), while fewer were aware of The United Nations International Children’s Emergency Fund’s (UNICEF) guidance (50%). Participants reported that WHO/UNICEF guidance acted as a reference to develop policies, regulations and national programs. However, progress was hindered by poor compliance. Lastly, participants provided suggestions on tackling obesity, with responses ranging from developing and reinforcing policies, involvement of schools, and prevention across all life stages. There are different practices in implementing prevention measures to counter childhood obesity globally, particularly in statutory regulation on food advertising and national programs. While support and awareness was relatively high, implementation was hindered. This reflects the need for prompt, country-specific evaluation and interventions.

Fighting the hidden pandemic of antimicrobial resistance in paediatrics: recommendations from the International Pediatric Association

Fighting the hidden pandemic of antimicrobial resistance in paediatrics: recommendations from the International Pediatric Association

Editorial introductions.

Editorial introductions.

Endorsement of the International Pediatric Association’s declaration on the impact of climate change on children by the International Pediatric Sleep Association and World Sleep Society

Highlights•IPSA and WSS International Pediatric Associations endorse the Pediatric societies' declaration on responding to the impact of climate change on children.•There is a growing body of evidence pertaining to the impact of rising temperatures and air pollution on child and adult sleep.•There are a range of actions that IPSA and WSS will take, some of which are common to all professional organisations, and some are specific to sleep disorders in the context of climate change.•IPSA and WSS will support the declarations core principles and maintain a specific focus on sleep related initiatives.

Empowering Health Workers to Build Public Trust in Vaccination: Experience from the International Pediatric Association's Online Vaccine Trust Course, 2020-2021.

The quality of interactions between health workers (HWs) and caregivers is key in vaccine acceptance. To optimize this, HWs need knowledge about best vaccine communication practices in person and on social media. Most pre-service curricula do not include such approaches. COVID-19 necessitated the International Pediatric Association (IPA) to shift from in-person train the trainer workshops to developing an online Vaccine Trust Course to address these gaps. The seven-module, 8-hour Vaccine Trust Course was offered online in seven languages and promoted globally. Course outcomes for participants between September 1, 2020 and September 30, 2021 were assessed using enrollment, participation, and completion data; pre-and post-training surveys of attitudes, knowledge, and practice skills; and follow-up practice surveys 3months post course completion. Of the 4,926 participants across 137 countries who registered; 2,381 (48.3%) started the course, with 1,217 (51.1%) completing. The majority were 25 - 39years (57%), female (57%), and in pediatrics (70%); 31% came from India. 62% of completers rated course structure/design as excellent, 36% as good. Over 80% rated the content as the most valuable aspect. Three months post training, 61% HWs reported increased empathy towards caregivers, confidence while counseling and increased vaccine acceptance amongst their patients. 21% identified the course as the only factor in these positive changes. Shifting from face-to-face to online training due to the COVID-19 pandemic helped increase the global reach of HWs course engagement and uptake. Trained HWs reported increased empathy towards caregivers and confidence while counseling and increased patient vaccine acceptance.

Availability and access to pediatric diabetes care: a global descriptive study.

A decade since the discovery of insulin, the increasing prevalence of type 1 diabetes mellitus (T1DM) has underscored the prevailing inequalities in the provision of essential care for T1DM worldwide. However, the details on the availability of insulin types and associated medical devices remain unclear. A cross-sectional electronic survey was distributed across a global network of pediatric societies under the umbrella of the International Pediatric Association (IPA). Access to and availability of pediatric diabetes care were investigated using standardized questions. Responses from 25 of 132 pediatric societies across six regions were included. Pediatric endocrinologists typically manage T1DM together with pediatricians or adult endocrinologists. Nonetheless, 24% of the respondents reported pediatricians to be the sole healthcare professionals. According to the respondents, the patients were either partially or completely responsible for payments of insulin (40%), A1C (24%), C-peptide (28%), and antibody testing for diagnosis (28%). Government support is generally available for insulin, but this was merely 20% for insulin pumps and 12% for continuous glucose monitors. There are considerable disparities in the access, availability, and affordability of diabetes testing, medications, and support between countries with significant out-of-pocket payments for care. Country- and region-specific improvements to national programs are necessary to achieve optimal pediatric diabetes care globally.

Exploring the genetic landscape of diphtheria, tetanus and pertussis vaccination-associated seizures or subsequent epilepsies

Diphtheria, Tetanus, and whole-cell Pertussis (DTwP) vaccination-associated seizures form the commonest type of serious adverse event following immunization in India and are an important reason for vaccine hesitancy. Our study explored the genetic explanation of DTwP vaccination-associated seizures or subsequent epilepsies. Between March 2017 and March 2019, we screened 67 children with DTwP vaccination-associated seizures or subsequent epilepsies, and of those, we studied 54 without prior seizures or neurodevelopmental deficits. Our study design was cross-sectional with a 1-year follow-up having both retrospective and prospective cases. We performed clinical exome sequencing focused on 157 epilepsy-associated genes and multiplex ligation-dependent probe amplification of the SCN1A gene at enrolment. We applied the Vineland Social Maturity Scale for neurodevelopmental assessment at follow-up. Of 54 children enrolled and underwent genetic testing (median age 37.5 months, interquartile range 7.7–67.2; diagnosis at enrolment: epilepsy 29, febrile seizure 21, and febrile seizure-plus 4), we found 33 pathogenic variants of 12 genes. Of 33 variants, 13 (39%) were novel. Most pathogenic variants were found in SCN1A gene (n = 21/33; 64%), SCN8A in 2 children, and 10 children had one variant in CDKL5 , DEPDC5 , GNAO1 , KCNA2 , KCNT1 , KCNQ2 , NPRL3 , PCDH19 , RHOBTB2 , and SLC2A1 . Five or more seizures (odds ratio [OR] = 5.3, confidence interval [CI]: 1.6–18.4, p = 0.006), drug-resistant epilepsy (OR = 9.8, 95% CI: 2.6–30.7, p = 0.001) and neurodevelopmental impairment (social quotient < 70) (OR = 5.6, 95% CI: 1.65–17.6, p = 0.006) were significant predictors of genetic diagnosis. Our study provides proof-of-concept for genetic aetiology in children with DTwP vaccination-associated seizures or subsequent epilepsies and has important implications for vaccination policies in developing countries. International Pediatric Association Foundation, Inc. (IPAF): İhsan Doğramaci research award 2016/2017; Indian Council of Medical Research (ICMR), New Delhi, India: No.3/1/3/JRF-2016/HRD/LS/71/10940.

International pediatric transplant association (IPTA) guidance on developing and/or expanding pediatric solid organ transplantation programs in low- and middle-income countries.

Pediatric solid organ transplantation (SOT) is a preferred treatment for medically suitable children with end-stage organ failure. Still, many of them have no access to transplantation owing to socioeconomic constraints or lack of transplant facilities in low- and middle-income countries (LMIC). Establishing pediatric SOT programs in LMIC offers children the opportunities to receive transplant care in more familiar home environments as well as help curtail transplant tourism and improve transplant outcomes as pediatric transplantation would be performed ethically and legally. The International Pediatric Transplant Association (IPTA) is a professional organization aiming to promote safe, ethical, and high-quality pediatric transplantation worldwide. This society paper describes major obstacles to pediatric SOT in LMIC and provides guidance on developing and/or expanding pediatric SOT programs in such countries. We also summarize available resources from the IPTA Outreach Program to help establish and support pediatric SOT programs in LMIC.

Role of Pediatricians, Pediatric Associations, and Academic Departments in Ensuring Optimal Early Childhood Development Globally: Position Paper of the International Pediatric Association.

Early childhood (birth-8 years), particularly the first 3 years, is the most critical time in development because of the highly sensitive developing brain. Providing appropriate developmental care (i.e., nurturing care, as defined by the World Health Organization [WHO]) during early childhood is key to ensuring a child's holistic development. Pediatricians are expected to play a critical role in supporting early childhood development (ECD) through providing developmental services such as developmental monitoring, anticipatory guidance, screening, and referral to medical and/or community-based services when delay is identified. Pediatricians are also expected to serve as advocates within their clinics and communities for improved delivery of ECD services, such as advocating for increasing funding for ECD initiatives, increasing insurance coverage of ECD services, and working to increase other pediatricians' awareness of the principles of ECD and how to deliver developmental services. However, this does not always occur. Typically, pediatricians' training and practice emphasizes treating disease rather than enhancing ECD. Pediatricians are further hindered by a lack of uniformity across nations in guidelines for developmental monitoring and screening. In this article, we present the vision of the International Pediatric Association (IPA) of the roles that pediatricians, academic departments, medical training programs, and pediatric associations should fulfill to help support ECD, including raising ECD to higher levels of priority in routine pediatric care. First, we present the challenges that face these goals in supporting ECD. We then propose, with supportive literature, strategies and resources to overcome these challenges in collaboration with local and international stakeholders, including the IPA, the WHO, UNICEF, and the World Bank.

Representatives of the Union of medical professionals organizations participated in the XII forum of children’s nurses, Moscow

On March 5–7, 2022, the 19th Congress of Russian Pediatricians with international participation «Actual Problems of Pediatrics» (hereinafter referred to as the Congress) was held in Moscow at the World Trade Center. The congress was held in a hybrid format with the support of the International Pediatric Association (IPA), the European Pediatric Association (EPA/UNEPSA) and the American Academy of Pediatrics (AAP). The technical organizer of the Congress is Citiforum LLC. Among the numerous organizers of the Congress was the Sverdlovsk Regional Medical College.

Editorial introductions

Editorial introductions

COVID-19 in Children and Safety of SARS-CoV-2 Immunization in Children: Statement of the International Pediatric Association

COVID-19 in Children and Safety of SARS-CoV-2 Immunization in Children: Statement of the International Pediatric Association

The Russian pediatricians contribution in creation of the International Pediatric Association (IPA) and its first congress

The official history of the International Pediatric Association begins on July 28, 1910, when its Charter was adopted at the meeting of the French Pediatric Association. This significant event was preceded by the years of professor I.V. Troitsky promotion of such idea as “science does not have any fatherland because the whole world belongs to it”. He has encouraged pediatricians from all countries of the world for the joint work with regular discussion of the results. Professor I.V. Troitsky has developed the Charter and has defined the goal and objectives of the future International Pediatric Association, largely determining the further evolution of pediatric science.

COVID-19 Pandemic and Neonatal Health: What We Know so Far?

COVID-19 first time appeared in December 2019 in Wuhan, China. The number of cases increased rapidly in china and outside and the World Health Organization declared a pandemic on 11th March 2020. The pregnant and postpartum women, child, and neonatal populations are vulnerable to this disease due to immunological and physiological changes. This paper analyzed the published evidence for assessing the effect of COVID-19 on neonatal health and health care. Online published literature was searched from PubMed, Google Scholar, and other official webpages using keywords: "coronavirus/COVID-19/new coronavirus 2019"/SARS-CoV-2 and neonatal health/care/outcomes" and reviewed to prepare this article. COVID-19 is the potential to transmit either mother to fetus or mother/caregiver to neonates. However, neonates born from infected mothers did not show significant clinical features. Pharyngeal-swab, amniotic-fluid, cord-blood, and breast-milk test results were not found positive. Health facility-based vaginal/caesarian delivery was considered a low risk of transmission. However, recommended to separate neonates with infected mothers/caregivers and test immediately after birth to avoid the possible transmission. Mothers/caregivers should take routine preventive measures such as washing hands frequently and avoiding contact with infected people. If neonates suffered from the server acute respiratory distress requires intensive care urgently. Despite the possibility of the intrauterine transmission of COVID-19 direct evidence is still lacking so it needs more studies for further confirmation. The International Pediatric Association suggested preventive programs, curative care, vaccination, and telemedicine care as the minimum services and called on its members to address these cares during the pandemic.

Ending violence against children: What can global agencies do in partnership?

Globally, the range, scale and burden of all forms of violence against children (VAC) have visibly increased. Yet VAC as a physical, mental, public and social health concern is only recently gaining the prominence it deserves. Addressing VAC is critical. Violence experienced early in life can result in short, medium, long-lasting, and/or even inter-generational negative health outcomes. Ample evidence shows that VAC is widespread and the most common forms are usually perpetrated by people with whom children interact every day in their homes, schools and communities. We report on an innovative collaboration between global agencies, led by the International Society for Social Pediatrics and Child Health (ISSOP), the International Society for Prevention of Child Abuse and Neglect (ISPCAN), and the International Pediatric Association (IPA), who were galvanized to respond to VAC using a child-rights and public health lens. This collaboration led to a position statement on VAC with an implementation plan. The strength of the position statement was the explicit incorporation of a rights-based expansive understanding of VAC, with a description of typologies of violence pertinent to children globally, including child labor, children in armed conflict, trafficking of children and gender-based violence; and the identification of strategies both in preventing violence from occurring and ameliorating the effects in its aftermath. We report on the challenges and successes of our collaborative action at regional and supra-national levels, including opportunistic action.

Promoting and supporting children’s health and healthcare during COVID-19 – International Paediatric Association Position Statement

<h3>Introduction</h3> We investigated trends in the proportion of diabetes treatment and glycemic control, which may be altered by recent advances in insulin and non-insulin drugs, in Japanese patients with type...

Editorial introductions

Editorial introductions

Syrian Children in Turkey: A Model of Action for National Pediatric Societies.

* Abbreviations: IPA — : International Pediatric Association IPAF — : International Pediatric Association Foundation NGO — : nongovernmental organization TNPS — : Turkish National Pediatric Society The Syrian Civil War, which has been ongoing since March 2011, has forced nearly 11 million people from their homes. Of those remaining in Syria, 13.5 million people, including ∼6 million children, need humanitarian assistance as a result of having fled their homes, enduring hostilities, and experiencing limited access to food, health care, and other basic needs.1 Furthermore, >3.4 million Syrians have fled to Turkey since the start of the conflict. The Turkish government gave an immediate response with an open-door policy and offered temporary protection status. Currently, 9% of the refugee population are living in 26 temporary protection shelters, and the remaining 91% have integrated into the communities in cities across the country. Half of the Syrian refugees are living in the following 4 major cities: Istanbul and 3 other cities near the border (Hatay, Sanliurfa, and Gaziantep). In some provinces near the Syrian border, the percentage of Syrian refugees has reached 50% of the current total population of the province.2,3 The influx of Syrian refugees has increased the burden on the health care system. … Address correspondence to Elif N. Ozmert, MD, PhD, Department of Pediatrics, Faculty of Medicine, Hacettepe University, 06100 Sihhiye, Ankara, Turkey. E-mail: nozmert{at}hacettepe.edu.tr