Mansoura University Children's Hospital Research Articles

The transition from tube feeding to oral feeding algorithm in preterm infants: case-control study

BackgroundOral feeding is a complex sensorimotor process influenced by many variables, making it challenging for healthcare providers to introduce and manage it. Feeding practice guided by tradition or a trial-and-error approach may be inconsistent and potentially delay the progression of oral feeding skills.AimTo apply a new feeding approach that assesses early oral feeding independence skills of preterm infants in the neonatal intensive care unit (NICU). To prove its effectiveness, compare two approaches of oral feeding progression based on clinical outcomes in preterm infants, the traditional approach used in the NICU of Mansoura University Children Hospital (MUCH) versus the newly applied approach.MethodsA quasi-experimental, exploratory, and analytical design was employed using two groups, control and intervention groups, with 40 infants for the first group and 41 infants for the second one. The first group (the control) was done first and included observation of the standard practice in the NICU of MUCH for preterm oral feeding, in which oral feeding was dependent on post-menstrual age (PMA) and weight for four months. The second group (the intervention) included early progression to oral feeding depending on early assessment of Oral Feeding Skills (OFS) and early supportive intervention and/or feeding therapy if needed using the newly developed scoring system, the Mansoura Early Feeding Skills Assessment “MEFSA” for the other four months. Infants in both groups were studied from the day of admission till discharge.ResultsIn addition to age and weight criteria, other indicators for oral feeding readiness and oral motor skills were respected, such as oral feeding readiness cues, feeding practice, feeding maintenance, and feeding techniques. By following this approach, preterm infants achieved earlier start oral feeding (SOF) and full oral feeding (FOF) and were discharged with shorter periods of tube feeding. Infants gained weight without increasing their workload to the NICU team.ConclusionThe newly applied approach proved to be a successful bedside scoring system scale for assessing preterm infants’ early oral feeding independence skills in the NICU. It offers an early individualized experience of oral feeding without clinical complications.

Pediatric diabetes prediction using deep learning

This study proposed a novel technique for early diabetes prediction with high accuracy. Recently, Deep Learning (DL) has been proven to be expeditious in the diagnosis of diabetes. The supported model is constructed by implementing ten hidden layers and a multitude of epochs using the Deep Neural Network (DNN)-based multi-layer perceptron (MLP) algorithm. We proceeded to meticulously fine-tune the hyperparameters within the fully automated DL architecture to optimize data preprocessing, prediction, and classification using a novel dataset of Mansoura University Children's Hospital Diabetes (MUCHD), which allowed for a comprehensive evaluation of the system’s performance. The system was validated and tested using a sample of 548 patients, each with 18 significant features. Various validation metrics were employed to ensure the reliability of the results using cross-validation approaches with various statistical measures of accuracy, F-score, precision, sensitivity, specificity, and Dice similarity coefficient. The high performance of the proposed system can help clinicians accurately diagnose diabetes, with a remarkable accuracy rate of 99.8%. According to our analysis, implementing this method results in a noteworthy increase of 0.39% in the overall system performance compared to the current state-of-the-art methods. Therefore, we recommend using this method to predict diabetes.

Study of coagulase-negative staphylococci in hospital-acquired neonatal sepsis

Background Coagulase-negative staphylococci (CoNS) has become increasingly prevalent as the leading cause of late-onset bacteremia in neonatal ICUs. Diagnosing CoNS septicemia poses challenges because this bacterium commonly resides on the skin, leading to potential contamination of blood culture samples. Therefore, this study aimed to identify the bacterial causes of sepsis in neonates who exhibit clinical signs of the condition, also to assess the methicillin susceptibility of CoNS through both phenotypic and molecular methodologies. Materials and methods This study was carried out at Mansoura University Children Hospital. Blood samples were obtained and directly cultured using the BACT/ALERT system. All isolates were identified using BD Phoenix system. CoNS isolates were subjected to a disk diffusion susceptibility test with cefoxitin 30 µg, serving as an initial screening test to identify methicillin resistance. Automated antibiotic susceptibility was done using BD Phoenix system followed by PCR testing to detect the presence of the mecA gene in resistant CoNS isolates. Results Among all the isolated micro-organisms, Klebsiella pneumoniae and CoNS were found to be significantly higher in early-onset sepsis and late-onset sepsis, respectively. Staphylococcus epidermidis constituted 30% of the isolates, with Staphylococcus haemolyticus and Staphylococcus hominis each accounting for 20%, while other Staphylococcus species made up the remaining 20%. Among the identified CoNS, 47.4% tested positive for the mecA gene. The presence of the mecA gene was significantly associated with a higher incidence of late-onset sepsis (P=0.033). Conclusion CoNS are the predominant culprits behind late-onset sepsis in hospitalized newborns. Notably, the presence of the mecA gene was significantly linked to a higher occurrence of late-onset sepsis. Our study has uncovered a concerning surge in antibiotic resistance genes within our community. This underscores the urgency of implementing an active antibiotic surveillance program and exploring alternative therapeutic strategies to effectively combat neonatal sepsis.

Nurses’ Information Technology Competence and Their Attitude to Electronic Health Solutions at Mansoura University Children Hospital

Nurses’ Information Technology Competence and Their Attitude to Electronic Health Solutions at Mansoura University Children Hospital

Clinicoepidemiologic Study of Primary Immunodeficiency (PID) Diseases in Children Attending Mansoura University Children's Hospital

Clinicoepidemiologic Study of Primary Immunodeficiency (PID) Diseases in Children Attending Mansoura University Children's Hospital

Viral pathogens of acute gastroenteritis in Egyptian children: role of the parechovirus

Background and aimHuman parechovirus (HPeV) has emerged as a pathogen associated with acute gastroenteritis (AGE).AimTo detect the presence of HPeV in the stool samples from Egyptian children with AGE seeking care and the possibility of its co-infection with other enteric viruses.MethodologyOne hundred stool samples were collected from children attending Mansoura University Children's Hospital with AGE. HPeV and astrovirus were detected by reverse transcriptase-polymerase chain reaction (RT-PCR). At the same time, detection of rotavirus antigen and norovirus was achieved by enzyme-linked immunosorbent assay and rapid immunochromatographic method, respectively.ResultsThe most frequently detected virus was rotavirus (39%), followed by norovirus (27%), HPeV (19%), and astrovirus (12%). Interestingly, the single infection with HPeV was 5%. Among the 19 HPeV positive samples, the co-infection of HPeV with other enteric viruses was detected in 9(43.9%) for rotavirus, 7(36.8%) for norovirus, 2(10.5%) for astrovirus, in 3(15.8%) for rotavirus and norovirus and 1(5.3%) for norovirus and astrovirus. Regarding the clinical presentation, there was no significant difference between children infected with HPeV alone and those infected with viruses other than HPeV alone; fever (p = 0.3), vomiting (p = 0.12), abdominal pain (p = 0.12), and grades of severity (P = 0.82). HPeV alone infected children were of mild severity (60%), and their main presenting symptom was fever (60%).ConclusionsDetection of HPeV as a single viral pathogen in the stool of some children with AGE showed that this virus could be a causative agent of AGE in Egyptian children. Therefore, HPeV could be included as one of the viruses screened for AGE diagnosis in children in Egypt.

Evaluation of the left ventricular systolic strain in hypocalcemic infants with two-dimensional speckle tracking echocardiography.

Speckle tracking echocardiography (STE) is a new emerging method for evaluation of the cardiac systolic performance. We characterized left ventricular (LV) systolic functions of hypocalcemic infants, and assessed the effects of calcium and vitamin D supplementations on LV systolic functions using two-dimensional STE. A prospective controlled study was conducted in Mansoura University Children's Hospital, Egypt from 2015 to 2018 including 88 hypocalcemic infants (patient group) and 30 healthy controls. We subdivided the patient group into vitamin D deficiency group (n = 32) and normal vitamin D group (n = 56). All infants were investigated for serum phosphorus, alkaline phosphatase and 25-hydroxy vitamin D levels. Both patients and controls were initially evaluated for LV systolic functions using two-dimensional STE. After correction of hypocalcemia and vitamin D deficiency, reevaluation of LV systolic functions was done for the patient group. LV systolic strains were lower in the patient group than controls (p<.001). After recovery of hypocalcemia of the patients, we reported significant improvement of strains and significant reductions of the end-diastolic and end-systolic volumes of the left ventricle (p<.001). Global longitudinal and circumferential strains were lower in patients with vitamin D deficiency than patients with normal vitamin D levels (p<.001). The LV systolic strain improved after correction of vitamin D deficiency and hypocalcemia (p<.001). Two-dimensional STE could detect and follow up early LV systolic dysfunction in infants with hypocalcemia and vitamin D deficiency.

Nasal Carriage of Community Acquired and Inducible Dormant Methicillin Resistant Staphylococcus aureus among Healthcare Workers of Mansoura University Children's Hospital

Nasal Carriage of Community Acquired and Inducible Dormant Methicillin Resistant Staphylococcus aureus among Healthcare Workers of Mansoura University Children's Hospital

Hemodialysis Catheter-Related Infections among Pediatric Patients in Mansoura University Children Hospital

Hemodialysis Catheter-Related Infections among Pediatric Patients in Mansoura University Children Hospital

Clinical outcome following reinjection of Ranibizumab for reactivation of retinopathy of prematurity.

To assess reactivation after initial intravitreal injection of ranibizumab (IVR) for type 1 retinopathy of prematurity (ROP) or worse and the outcome following reinjection of ranibizumab for this reactivation. This retrospective study was performed on infants screened for ROP between March 2013 and February 2020 in Mansoura University Children Hospital, Mansoura, Egypt. Infants treated with ranibizumab 0.25 mg/0.025 mL were identified for review of their clinical outcomes. Data of infants with reactivation and IVR re-injection were analysed. A total of 2318 infants were screened for ROP, 115 (5%) infants (216 eyes) with a mean gestational age of 30 ± 2.5 weeks and mean birth weight of 1290 ± 355.2 g received IVR at mean postmenstrual age (PMA) of 38 ± 3.1 weeks. All treated eyes demonstrated initial regression of ROP. However, ROP reactivation occurred in 5 (2.3%) eyes of 3 patients, at an average of 9.6 ± 2.9 weeks after treatment. None of these eyes had retinal detachment. A second dose IVR was administered and all five eyes showed regression with complete retinal vascularisation, at a mean PMA of 60 ± 5.1 weeks. IVR is beneficial as an initial and subsequent treatment for type 1 ROP or APROP. A long-term follow-up until complete retinal vascularisation is recommended to avoid disease reactivation.

Stem Cell Therapy: Health Care Providers’ Knowledge and Attitude

Background: Stem cell therapy is a lifesaving technique for a number of malignant and non- malignant disorders. Health care providers are considering the most confident source of knowledge for the majority of patients so that they should have the ability to provide information to patients in this advanced topic. Therefore, Aim of this study: was to assess knowledge and attitude of health care providers regarding stem cells therapy. Method and Subjects: A cross sectional research design has been utilized. Sample of this study comprised of 104 Physicians and nurses who working at Oncology Center and Mansoura University Children's Hospital, three tools were used in this study. Tool I: Health care providers' demographic and occupational characteristics questionnaire: It was used for collection of personal and occupational data, tool II: Health care providers' knowledge questionnaire; to assess general knowledge about stem cell therapy, tool III: Health care providers' attitude scale, aimed to assess participants’ attitude toward stem cell therapy and its applications. Results: indicate that majority of health care providers have average knowledge and positive attitude regarding stem cell therapy. Conclusion: Conferences for health care providers to upgrade their level of knowledge, awareness, attitude and practice regarding stem cell therapy.

Assessment of Nurses Knowledge and Practice about Peripherally Inserted Central Catheters at Neonatal Intensive Care Units

ABSTRACT: The peripherally inserted central catheters (PICCs )have become among the most common technologies employed in the intravenous therapy of neonates as they allow safe long-term intravascular access, comfort, and ease of transition to home therapy that contributed to the increased survival of those newborns. Aim: Assess the nurses’ knowledge and practices about peripherally inserted central catheter at neonatal intensive care units Method: Descriptive research was conducted on 45 neonatal nurses working at neonatal intensive care units affiliated to Mansoura University Children Hospital (MUCH). Peripherally inserted central catheter insertion questionnaire sheet and observational checklistwas used to collect data. Results:Most studied nurses had poor knowledge and the minority had average knowledge about PICC line care for neonates. Also, more than half of nurses had competent score regarding PICC line insertion and care.Conclusion: There was variation regrading neonatal nurses' knowledge and practices regarding PICC line insertion and care.Recommendation: A regular educational program about PICC line care should be consistent for neonatal nurse

Dexmedetomidine versus Dexamethasone as Adjuvants to Bupivacaine for Ultrasound Guided Rectus Sheath Block in Pediatric Abdominal Surgery

Background: The use of ultrasound as a guide for regional anesthesia has become common practice and a new challenge to anesthesiologists. Besides its benefits of reduced complications, it also helps in reducing the total anesthetic dose required with higher block success rates. There is also the advantage of direct observation of the pattern of anesthetic spread. Objective: To compare between dexamethasone and dexmedetomidine as adjuvants to bupivacaine in rectus sheath block applied during pediatric abdominal surgeries. Patients and methods: This prospective randomized study was conducted at Mansoura University Children Hospital. We included a total of 60 pediatric patients undergoing elective abdominal surgery. The study was conducted over the period of two years, starting from January 2019 till December 2020. Results: The mean age of the included patients was 4.7, 4.7, and 4.6 in groups C, D, and Z respectively. Operative time and duration of anesthesia did not show any significant difference between the three groups. The duration of analgesia showed a highly significant difference between the three groups. Group Z showed its superiority as it had a mean analgesic duration of 15.3 hours, followed by Group D which had mean value of 13.02 hours. Conclusion: Both dexamethasone and dexmedetomidine were efficient adjuvants to local anesthetics as they were associated with significant prolongation of the duration of analgesia, decrease in postoperative analgesia, and better patient satisfaction compared to bupivacaine alone.

Ultrasound-guided retrolaminar block versus ilioinguinal nerve block for postoperative analgesia in children undergoing inguinal herniotomy: A randomized controlled trial

Study objectiveUltrasound-guided retrolaminar block (RLB) is a new, safe and technically easy nerve block. To our knowledge, no studies have evaluated its analgesic efficacy in pediatric patients. This study aimed to compare the postoperative analgesic efficacy of RLB and ilioinguinal nerve block (INB) in pediatric patients undergoing unilateral inguinal herniotomy. DesignSuperiority, prospective, randomized, double-blinded, controlled study. SettingOperating rooms and wards of Mansoura University Children's Hospital, Egypt. PatientsSixty-five patients aged 2 to 6 years undergoing unilateral inguinal herniotomy were enrolled. InterventionsIn the ultrasound-guided RLB group (n = 30), we injected 0.5 mL/kg bupivacaine 0.25% into the retrolaminar space between the lamina of T12 and the paraspinal muscles and in ultrasound-guided INB group (n = 30), 0.5 mL/kg bupivacaine 0.25% was injected for INB. MeasurementsThe primary outcome measure was the number of patients requiring ibuprofen as rescue analgesia and the secondary outcome measures were intraoperative hemodynamic changes and the postoperative FLACC (Face, Legs, Activity, Cry, Consolability) score. Main resultsThe number of patients who needed rescue analgesia in the first postoperative 24 h was significantly lower (P = 0.023) in the RLB group [5 (16%)] than the INB group [13 (43%)]. The mean (SD) arterial blood pressure and heart rate were significantly higher (P < 0.001) during sac traction in the INB group [74.07 (2.99), 97.33 (6.98)] than the RLB group [67.73 (3.55), 90.79 (5.13)]. The postoperative FLACC scores at 4, 6, 12, and 24 h were significantly lower (P < 0.05) in the RLB group than in the INB group. ConclusionRetrolaminar block is superior to ilioinguinal nerve block in providing postoperative analgesia in pediatric patients undergoing unilateral inguinal herniotomy.

Ultrasound-Guided Long-Axis Versus Short-Axis Femoral Artery Catheterization in Neonates and Infants Undergoing Cardiac Surgery: A Randomized Controlled Study

The objective of the present study was to compare ultrasound-guided long-axis (LAX) and short-axis (SAX) femoral artery catheterization in neonates and infants undergoing cardiac surgery. A single-center, prospective, randomized, single-blinded, controlled study. This study was conducted in the operating room and intensive care unit of the division of cardiac surgery, Mansoura University Children's Hospital, Egypt. Ninety neonates and infants undergoing elective cardiac surgery were enrolled in this study and randomly allocated to ultrasound-guided LAX and SAX groups. Ultrasound-guided femoral artery catheterization was done using either LAX (in-plane) or SAX (out-of-plane) technique. The primary outcome measure was the rate of a successful first puncture. The secondary outcome measures were the rates of mechanical complications, failure rate, time to a successful first, second, and third puncture, total time of catheterization, and imaging time. The first puncture success rate was significantly higher (p=0.048) in the LAX group (34 of 41, 82.9%) than in the SAX group (25 of 41, 60.9%). The mean time to a successful first puncture was significantly shorter (p < 0.001) in the LAX group (153.1 ± 30.1 seconds) than in the SAX group (227.2 ± 48.8 seconds). The total catheterization time was significantly shorter in the LAX group than in the SAX group. There was no significant difference in the rate of complication. With a single experienced operator performing the ultrasound-guided femoral artery cannulation, the LAX technique resulted in a higher first puncture success rate and shorter time to cannulation than the SAX technique.

Effect of Buteyko Breathing Technique on Asthma Severity Control among School Age Children: Abstract Thesis

Background: Asthma is a complex condition that can impair the child’s physical growth. It affect not only the child’s physical status but also his optimal functional capacity and performance. Buteyko Breathing Technique is an exercise designed to regulate the breathing process. Aim: This study aimed to study the effect of Buteyko Breathing Technique (BBT) on asthma severity control among school age children. Materials and Methods: A quasi-experimental design (one group pre and posttest) was conducted on 33 asthmatic school age child who attended the sensitivity outpatient clinics at Mansoura University Children's Hospital (MUCH). Tools: Structured interview sheet for child and their parent, Childhood Asthma Control Test(C-ACT), Peak Expiratory Flow Rate (PEFR) and Control Pause Test (CP) are used to collect data. Results: The mean C-ACT pretest was significantly improved in the posttest with high mean percent of change of posttest than pretest, which was clinically and statically high significant. There was a statistical significant increase in the mean of PEFR and CP at the fourth week than the first one with a high significant mean percent of change. There was a significant positive decrease in the heart rate over the four weeks of follow up with high mean percent of change at fourth week than first one. Conclusion: This study support the effectiveness of BBT in improving respiratory outcome and promoting asthma control among school age children with bronchial asthma.

Assessment of bone mineral density in children with congenital cyanotic heart disease.

Cyanotic CHD is one of many disorders in paediatrics that influence the health of children in different clinical aspects. One of the fundamental aspects that may be affected is bone mineral density. The aim of our study is to assess bone mineral density in children with congenital cyanotic heart disease of different anatomical diagnoses. Cross-sectional, observational study included 39 patients (20 males) with congenital cyanotic heart disease of different anatomical diagnoses following with the cardiology clinic in Mansoura University children's hospital. All patients were subjected to anthropometric measures, oxygen saturation assessment, and lumber bone mineral density using dual-energy X-ray absorptiometry. Six patients (15.4%) out of the 39 included patients showed bone mineral density reduction, 13 patients (33.3%) showed bone mineral density with Z-score between -1 and -2, while 20 patients (51.3%) showed bone mineral density with Z-score more than -1. Low bone mineral density can be found in children with cyanotic CHD, making it important to consider bone mineral density assessment and early treatment if needed to avoid further complications.

The Effect of Implementing Peripherally Inserted Central Catheter Educational Program on Nurses' Knowledge, Practice, and Neonatal Outcomes: Thesis Abstract

The peripherally inserted central catheters (PICCs) have become among the most common technologies employed in the intravenous therapy of neonates as they allow safe long-term intravascular access, comfort, and ease of transition to home therapy that contributed to the increased survival of those newborns. Aim: This study aimed to evaluate the effect of implementing peripherally inserted central catheter educational program on nurses' knowledge, practice, and neonatal outcomes. design: pretest-posttest quasi-experimental design was conducted on 45 neonatal nurses working at neonatal intensive care units affiliated to Mansoura University Children Hospital (MUCH) with a purposive sample of (20) neonates admitted to NICU throughout six months and need PICC line insertion was enrolled in the study. Tools of data collection: Data were collected by using three tools: Peripherally inserted central catheter insertion questionnaire sheet, PICC line insertion and care observational checklist and neonatal assessment sheet. Results: Majority of studied nurses had poor knowledge and more than half had competent skills about PICC before program implementation while after program implementation there was more than half had average knowledge and two third had competent practices as well as there is decrease in the prevalence of neonatal complication. Conclusion: There was appositive effect of the educational program on nurse’s knowledge and skills as well as neonatal. Recommendation: Continuing of nursing education and practices about PICC lines.

Role of Ultrasound in Screening of Infantile Developmental HipDysplasia

AbstractBackground: Developmental Dysplasia of Hip (DDH) isthe most common congenital musculoskeletal disorder ininfants. Undiagnosed DDH result in shortening of the affectedlimb which affect the child's gait, decreasedstrength andincreased risk of degenerative joint diseases in hip and kneejoints. Hip ultrasonography provide an early diagnostic toolfor DDH. Ultrasonography can provide detailed imaging ofthe hip before femoral head ossification.Aim of Study: This study aims to highlight the role ofultrasound as a screening tool for infantile developmentaldysplasia of hip joint.Patient and Methods: 50 pediatric patients referred toMansoura University Hospital and Mansoura UniversityChildren Hospital in the period from November 2016 tillMay 2018. They were 33 females and 17 male patients withtheir ages below 6 months. The minimum age was 2 weeksand the maximum age was 18 weeks and 3 days with meanof 11.21±4.81 weeks. All patients underwent ultrasonographicexamination with measurement of Graf alpha and beta angles.Results: The present study showed that the most prevalentreferral cause is the cesarean section (44%) followed byoligohydraminos (22%) and positive family history (16%).The most detected hip type was Graf type I (52% in right hipand 50% in left hip) and the percentage of Graf type II was44% in right side and 46% in left side while Graf type III was4% in both sides.Conclusion: Ultrasonography is a good tool for assessmentthe DDH mostly in high risk cases.

Effect of an Educational Comic Story about Preoperative Orientation on Information and Anxiety Level of Children Undergoing Surgery.

Surgery is considered a stressful experience for children because of their unfamiliarity with the environment and medical procedures. Anxiety interferes with anesthesia induction and results in many complications. Comic stories produce cognitive control by developing realistic expectations and correcting misperceptions and misbeliefs. This study aimed to assess the effect of an educational comic story about preoperative orientation on the information and anxiety levels of children undergoing surgery. A quasi-experimental design was used. The study was conducted at Mansoura University Children's Hospital, Egypt. A structured interview questionnaire, self-report anxiety scale, and an observational behavioral scale were used for data collection. The results revealed highly statistically significant differences in information, self-reported anxiety, and observed anxiety between the pre and post-tests (p = .000). Moreover, a negative linear correlation between children's preoperative anxiety and information level was demonstrated.