Morbidity In Pediatric Patients Research Articles

Konjenital kalp hastalarında ameliyat öncesi beslenme durumunun ameliyat sonrası mortalite ve morbidite ile ilişkisi

Amaç: Bu çalışma konjenital kalp hastalığı nedeniyle ameliyat edilecek çocuk hastaların preoperatif beslenme durumu ile
 postoperatif morbidite ve mortalite arasındaki ilişkisini saptamak amacıyla planlanmıştır.
 Gereç ve Yöntemler: Çalışmaya konjenital kalp hastalığı nedeniyle ameliyat edilmek üzere hastaneye yatırılan 36 çocuk (3-60 ay) hasta dahil edilmiştir. Ameliyat öncesi hastaların beslenme durum değerlendirmesinde triseps deri kıvrım kalınlığı (TDKK) ölçümleri kullanılmıştır. Operasyon sonrası hastaların yoğun bakımda kalış süreleri, mekanik ventilatörde kalış süreleri, inotrop gereksinimleri ve süreleri ile 30 günlük mortalite kaydedilmiştir.
 Bulgular: Preoperatif dönemde hastaların %8.3’ünün TDKK Z-skor değerleri 0.05) arasında istatistiksel açıdan anlamlı fark bulunmamıştır.
 Sonuçlar: Konjenital kalp hastalığı olan çocuk hastalarda preoperatif beslenme durum ile postoperatif morbidite ve mortalite arasında anlamlı bir ilişki saptanmamıştır.

The Effect of Immunoglobulin Prophylaxis on Infectious Morbidity in Pediatric Patients with Acute Lymphoblastic Leukemia: Results of a Randomized Controlled Trial

Introduction: Infections lead to substantial morbidity during treatment of acute lymphoblastic leukemia (ALL). During ALL treatment, the adaptive immune system gets severely affected, leading to, amongst other things, declining serum immunoglobulin (IgG) levels. Theoretically, one may partially overcome the infection risk by supplementing the low IgG levels with intravenous immunoglobulins (IVIG). The aim of this trial was to investigate whether IVIG prophylaxis in pediatric patients with ALL prevents admissions for fever. Patients and Methods: This randomized controlled trial was a subtrial of the national Dutch multicenter ALL study (DCOG ALL-11). Patients aged 1-19 years with medium risk (MR) ALL were randomized into either IVIG prophylaxis (0.7 g/kg IVIG three-weekly, starting day 22 after diagnosis) or control group (standard of care). The primary endpoint was number of admissions for fever. Secondary endpoints were antibiotic treatments, blood culture results, adaptation of chemotherapy, ICU admissions, relapse, disease-free survival (DFS), and overall survival (OS). To account for possible correlations between episodes within the same patient, generalized estimating equation models were fitted for admissions for fever, therapeutic antibiotics, chemotherapy adaptations and ICU admissions, including age in the models. Results: Between October 2012 until March 2019, 91 (51%) patients were randomly assigned to IVIG prophylaxis and 86 (49%) to the control arm. In the IVIG prophylaxis group there were 206 admissions for fever versus 271 in the control group (p=0.026, Figure). IVIG prophylaxis was associated with significantly less admissions for fever with negative blood cultures compared to the control group (N=113 versus 200, for IVIG prophylaxis versus control, respectively, p=0.015, Figure), and a significant decrease of chemotherapy adaptations (N=123 versus 185, for IVIG prophylaxis versus control, respectively, p=0.021, Figure). As post-hoc analysis we studied in which treatment phase IVIG prophylaxis was most relevant. Specifically during maintenance treatment of ALL, IVIG prophylaxis was associated with significantly less admissions for fever (N=100 versus 165, for IVIG prophylaxis versus control, respectively, p=0.002, Figure), with negative blood cultures (N=52 versus 125, for IVIG prophylaxis versus control, respectively, p=0.015, Figure), resulting in a significant decrease of chemotherapy adaptations (N=72 versus 134, for IVIG prophylaxis versus control, respectively, p=0.002, Figure) and antibiotic treatments (N=78 versus N=137, for IVIG prophylaxis versus control, respectively, p=0.005, Figure). There was no significant impact on relapse, DFS or OS. Conclusion: In pediatric patients with MR ALL, IVIG prophylaxis is associated with significantly less admissions for fever with negative blood cultures, during maintenance treatment, resulting in a decreased number of chemotherapy adaptations and antibiotic treatments. Future studies should aim at identifying a subgroup of patients that benefit most from IVIG prophylaxis. Figure: Admissions for fever; with negative blood cultures, courses of antibiotics, or chemotherapy adaptation for IVIG prophylaxis and control group *: p<0.05 during entire ALL treatment; #: p<0.05, ##: p<0.01 during maintenance phase of ALL treatment separately.

Flexibility: A Hidden But Trainable Morbidity in Pediatric Patients with Congenital Heart Disease.

Flexibility is important for range of motion, muscular performance, and injury prevention with exercise. Promoting exercise is important for patients with congenital and pediatric acquired heart disease (CHD), yet there are a paucity of data addressing flexibility in this population. We hypothesized that flexibility was worse in pediatric patients with CHD than the general population but could be improved with directed training. Patients at Boston Children's Hospital who participated in the pediatric Cardiac Fitness Program between 09/2016 and 11/2022 were retrospectively analyzed. Flexibility was assessed via sit-and-reach (SaR) box. Data from baseline and 60days into the fitness program intervention were compared to age-matched population norms, and changes over time were assessed. Analyses were also stratified by sex and history of sternotomy. Patients with paired baseline and 60-day data were analyzed (n = 46, age 8-23years old, 52% male). The mean SaR at baseline for CHD patients was 24.3cm, significantly lower than the population norm (p = 0.002). The mean for male (n = 24, 21.2cm) and female (n = 22, 27.2cm) CHD patients was significantly lower than their respective population norms (p = 0.017 and p = 0.026, respectively). After the fitness intervention, flexibility in CHD patients significantly improved to normal, including patients with a history of sternotomy. Flexibility was significantly lower in CHD patients than the general population, but normalized with training. Further research is warranted to investigate associations of flexibility with other measures of fitness, cardiovascular status, and quality of life, as well as benefits gained with training.

Progress Towards Understanding Cardiac Surgery Associated Kidney Injury in Children

Cardiac surgery associated acute kidney injury (CS-AKI) is a common complication following surgery for congenital heart disease in children with a reported incidence of up to 42% (1). The scope of the problem presented by CS-AKI includes not only the high prevalence but the impact that it has on both short and long-term morbidity in pediatric patients following surgery for congenital heart disease (CHD). Not only is CS-AKI associated with increased length of ICU and hospital stay, prolonged ventilation, and mortality, but the risk of long-term morbidity due to chronic kidney disease (CKD) has been described to be up to 28% after 5 years of follow-up according to long-term follow up of the TRIBE-AKI cohort (2).

Prognostic and diagnostic importance of the systemic immune-inflammation index in pediatric head trauma

Head trauma is a leading cause of mortality and morbidity in pediatric patients. The trauma itself leads to the activation of a biomolecular cascade of damage. Purinergic receptors and ATP release play an important role in the activation of astroglia, microglia, monocyte-macrophages, neutrophils, and T cells in this process. The systemic immune inflammation index can be easily calculated, cheap, only requires hemogram parameters, and does not include any subjective findings. Therefore, we believe that it could be a prognostic predictor and a diagnostic marker for pediatric head trauma cases. Our study was designed as a retrospective and single-center study. The study was conducted with pediatric patients who presented to the emergency department with isolated head trauma between June 15, 2022, and December 15, 2022. Demographic data, medical history, white blood count, platelet count, neutrophil count, systemic immune inflammation index (SIII), Glasgow Coma Score, and the presence of pathology on brain computed tomography were recorded on the case report form. The study was conducted with 112 cases. In cases with bleeding, the median value of GCS was significantly lower (p<0.001), while WBC, Neutrophil, Platelet, NLR and SIII were significantly higher (p=0.008, p=0.001, p<0.001, p=0.011, and p<0.001, respectively). There was no significant difference between lymphocyte values and bleeding status. We believe that a higher SIII may be associated with persistent pericontusional inflammation in the brain and may be a good marker for predicting intracranial pathology and prognosis of the pathology caused by head trauma.

Risk factors for mortality and morbidity in Syrian refugee children with penetrating abdominal firearm injuries: an 1-year experience.

Despite improvements in technology and surgical techniques, abdominal injuries caused by firearms in children are traumatic with high complication rates and mortality. In this study, factors affecting mortality and complications in penetrating abdominal firearm injuries caused by high-velocity bullets and shrapnel in children as a result of the civil war in Syria were evaluated. This study was conducted as a case series with 53 patients admitted to Kilis State Hospital with penetrating abdominal firearm injuries between January 2016 and February 2017. Patients aged between 6 months and 17 years who suffered penetrating abdominal firearm injuries (PAFI) as a result of the civil war in Syria in the state hospital in Kilis Türkiye border province with Syria and were transferred to our hospital and operated on were included in the evaluation. Patients' sociodemographic information, time to surgery, number of abdominal organs injured, type of firearm causing injury, presence of large vessel injury and extremity injury, presence of thoracic injury requiring thoracotomy in addition to laparotomy, colostomy, penetrating abdominal trauma index, pediatric trauma score (PTS), and shock status were evaluated. In our study, it was found that a high penetrating abdominal trauma index significantly increased complication rates and mortality (P<0.001 and P=0.002, respectively). In addition, it was found that lower PTSs significantly increased the development of complications and mortality (P=0.001 and P<0.001, respectively). Mortality was not observed in any of the patients with a PTS>8, whereas mortality was observed in 27.3% of patients with a PTS≤8, and this result was statistically significant (P=0.003). Shock sig-nificantly increased mortality, and no patient who was not in shock died (P<0.001). In our study, it was determined that the increase in the number of injured intra-abdominal organs had a significant effect on both complications and mortality (P<0.001 and P=0.002, respectively). The penetrating abdominal trauma index and PTS were found to be effective in predicting mortality and morbidity in pediatric patients with PAFI. It is crucial in this patient group to provide appropriate transport after the first intervention is done rapidly and effectively in conflict zones.

Early and definitive treatment with ESIN, Kirschner wires, and external fixation in Gustilo and Anderson II–IIIC pediatric open fractures: A comparative study

Objectives: Open fractures are still a significant cause of morbidity in pediatric patients. The objective of this study was to compare the safety of initial and definitive internal fixation treatment with elastic stable intramedullary nailing (ESIN), and Kirschner (K) wires, and external fixation in Type II and III Gustilo-Anderson pediatric open fractures. Methods: This was an observational, retrospective, and cross-sectional study with a non-experimental design, where all the patients who were treated for Type II-IIIC open fractures, from January 2018 to August 2021, were included in the study. Results: A total of 60 patients were included in the study, with a predominance of the male gender (61.7%, n = 37) and an average age of 8.7 years. Timing of surgery from the injury to surgical treatment was measured, with the most common interval being 12 h (13.33%, n = 8), internal fixation with K-wires was performed in 63.3% (n = 38) of the patients; and with ESIN in 30% (n = 18), with no complications, and in cases of external fixation 6.7% (n = 4) with soft-tissue infection seen in 3.33% (n = 2), associated with treatment with external fixation. Follow-up was done at 4, 6, and 12 months for the different procedures. The most frequently used antibiotics were clindamycin (35%) and cefazolin (21.67%). Conclusion: The present study supports using ESIN and K-wires as early and definitive treatment in Gustilo-Anderson Type II–IIIC pediatric open fractures. External fixation is recommended only in cases where osteosynthesis with ESIN and K-wires is not an option.

HASTANEMİZDE ÇOCUKLUK ÇAĞI YABANCI CİSİM ASPİRASYONLARINDA ANESTEZİK YAKLAŞIM

AMAÇ: Yabancı cisim aspirasyonları her yaşta görülebilmekle beraber pediatrik hastalarda önemli bir mortalite ve morbidite sebebidir. Anestezi tercihi hafif sedasyondan genel anesteziye kadar değişebilmektedir. Bu çalışmamızda yabancı cisim aspriasyonu nedeniyle anestezi uyguladığımız pediatrik vakalar incelenerek, yaş, cinsiyet, aspire edilen cisimlerin hastaneye yatış ve mortalite açısından farklılıkları analiz edildi.GEREÇ VE YÖNTEM: Ocak 2018 - Aralık 2020 tarihleri arasında 3 yıllık bir dönemde Çocuk Cerrahisi Kliniği tarafından yabancı cisim aspirasyonu opere edilen pediatrik vakalar retrospektif olarak analiz edildi. Toplam 46 hasta çalışmaya dahil edildi. Hastalarda yaş, cinsiyet, hastaneye başvuru şikayetleri, preoperatif geçen süre, aspire edilen cisimlerin niteliği ve yerleşimi, uygulanan tedavi yöntemleri, anestezi süresi, perioperatif komplikasyonlar, yatış süresi ve mortalite parametreleri incelendi.BULGULAR: Hastaların % 39,1’i kız, % 60,9’u erkek, yaş ortalamaları 33,47 ± 39,72 ay idi. Aspire edilen materyallerin çeşitlilik göstermekle birlikte en çok aspire edilen materyal % 43,5 oranında kuruyemişti. Tüm hastalarda intravenöz anestezikler ve kontrollü ventilasyon uygulanıldı. Hastaların % 76,1’inde komplikasyon gözlenmezken, % 10,9’unda bronkospazm, % 13’ünde geç uyanma gözlendi. Hastaların ameliyat sonrası % 89,1 servise çıkarken, bronkospazm gelişen % 10,9 hasta yoğun bakımda izlendi.SONUÇ: Bir yaşın altındaki ve üstündeki aspirasyon vakalarında komplikasyonlar ve hastenede kalış süreleri değişmemektedir. Hastalarda anestezi tercihi hasta bazlı düşünülmesi gereken bir durumdur. Çalışmamızın sonuçlarına göre intravenöz – inhalasyon anestezisi ve kontrollü ventilasyonda anestezi tercihin de dikkate alınması gereken bir seçenektir.

FACTORS AFFECTING MORBIDITY IN CHILDREN WITH CEREBRAL PALSY SEQUELAE WHO UNDERWENT CORRECTIVE OSTEOTOMY

Objective: Cerebral palsy (CP) is a neurodevelopmental disease characterized by movement and posture disorders due to non-progressive damage. Femur varization-derotation osteotomy is a surgical procedure performed to correct femoral anteversion in patients with CP. The aim of this study is to determine the factors affecting morbidity in children with CP sequelae who underwent corrective osteotomy. Materials and Methods: Children with CP sequelae who underwent correction osteotomy were included in the study between 2007 and 2020. Information about the patients was obtained from the archived files and evaluated retrospectively. 105 patients were divided into two groups according to the perioperative morbidity: Group 1 (no morbidity) including 62 patients and group 2 (presence of morbidity) including 43 patients. Results: We did not report any significant differences between group 1 and 2 in terms of age and body mass index. In Group 2, ASA scores were higher significantly (p=0.006). Prognostic nutritional index was significantly lower in Group 2 (p=0.001). There was no significant difference in length of hospital and intensive care unit stay. Conclusion: Malnutrition is an important factor that causes an increase in postoperative morbidity in pediatric patients with CP sequelae. In patients with CP sequelae planned for varization-derotation osteotomy, a treatment plan can be prepared on a patient basis to reduce postoperative morbidity.

The Causes of Acute Kidney Injury in Critically Ill Children Who Needs Renal Replacement Therapy.

Background:Acute kidney injury (AKI) is the result of various causes and is associated with significant morbidity and mortality as well as long-term renal sequelae in pediatric patients.Objectives:The aim of the study is to determine the causes of AKI in pediatric patients who needed renal replacement therapy (RRT) and were admitted to the Pediatric and Neonatal Intensive Care Unit (PICU and NICU) at the Pediatric Clinic, University Clinical Center Sarajevo (UCCS).Methods:Our research included 81 children with AKI who needed RRT. We used the Kidney Disease: Improving Global Outcomes (KDIGO) criteria to define AKI. Severe acute kidney injury was defined as stage 2 or 3 of AKI when plasma creatinine level ≥2 times the baseline level or urine output <0.5 ml per kilogram of body weight per hour for ≥12 hours. Other laboratory findings and imaging tests were made depending on their primary disease that led to the AKI and its complications.Results:Our research analyzed 81 children with AKI who needed RRT 38 girls and 43 boys ages from birth to 18 years. Mean age of presentation was 6.28 years. Male female ratio in this study was 1.1:1. Non-olyguric AKI was diagnosed in 12 (14.8%) of children with AKI, while the rest 69 (85.2%) had the olyguric type. Patients with AKI were analyzed after a rough division on prerenal in 57 (70.4%) children, intrarenal in 23 (28.4%) and post-renal in 1 (1.2%) patient.Conclusion:As the AKI plays a key role in the mortality and morbidity in pediatric patients, especially in infants, it is important to recognise and treatment on time different etiologies of this serious condition. Some causes of AKI in our country can be prevented by better organization of primary and secondary health care, which would also reduce mortality and morbidity from AKI.

Soft tissue reconstruction of the lower extremity in the pediatric population

Lower extremity defects are a source of significant functional and psychosocial morbidity for pediatric patients and require complex reconstructions to restore form and function. The advent of microsurgical reconstruction along with advances in wound care techniques and technologies have empowered reconstructive surgeons to perform limb salvage surgery in patients that would traditionally require amputation; however, the indications for performing reconstructive surgery for complicated cases are not ironclad. While this is the case, applying the principles of lower extremity reconstruction in adults to the pediatric population is often sufficient to achieve a satisfactory outcome. This overview discusses the evaluation and management of soft tissue defects of the leg in pediatric patients.

Incidence of morbidity and associated factors in a Pediatric Intensive Care Unit.

The Functional Status Scale (FSS) was developed to measure acquired morbidity in pediatric patients. To estimate the incidence of acquired morbidity in the pediatric intensive care unit (PICU) and the presence of associated factors, and describe functional status after hospital discharge. Prospective cohort. All PICU admissions between August 2016 and July 2017. The FSS was used to measure acquired morbidity during hospitalization and up to 1 year after discharge. A univariate analysis was performed to investigate morbidity-associated factors. A total of 842 patients were included. The incidence of morbidity at the PICU was 3.56 % (30/842) and persisted at 0.7 % for the entire cohort at hospital discharge (6/842). Within 1 year after discharge, the functional status of 3/6 patients improved. The univariate analysis showed an association between acquired morbidity at the PICU and the PIM2 score (odds ratio [OR]: 1.04; 95 % confidence interval [CI]: 1.01-1.07; p = 0.007), age younger than 1 year (OR: 2.93; 95 % CI: 1.36-6.15; p = 0.004), the use of assisted mechanical ventilation (AMV) (OR: 7.83; 95 % CI: 3.31-18.49; p = 0.0001) and central venous catheter (CVC) (OR: 38.08; 95 % CI: 5.16-280.95; p = 0.0001), and prolonged hospital stays (OR: 9.65; 95 % CI: 4.33-21.49; p = 0.0001). The incidence of morbidity was 3.56 % and was associated with an age younger than 1 year, patient severity at the time of admission, the use of AMV and CVC, and prolonged hospital stays.

Abstract 13610: Obesity in Pediatric Hypertrophic Cardiomyopathy is Associated With Increased Inpatient Morbidity

Introduction: While obesity is associated with adverse outcomes among adults with hypertrophic cardiomyopathy (HCM), there has been little work to describe its impact on outcomes among children with HCM. Hypothesis: Obesity is associated with increased in-hospital morbidity in pediatric patients with HCM. Methods: In this cohort study, data from 52 children’s hospitals contained in the Pediatric Health Information System database from 2009 to 2019 were analyzed. Patients aged 2-18 years old with a primary diagnosis of HCM were included and assessed for obesity based on ICD-9/ICD-10 codes. Patients with a concomitant diagnosis of a congenital heart disease were excluded. Results: Out of a total of 2,667 children with HCM, the prevalence of obesity was 9.6%. Obese patients were more likely to be male, Black, Hispanic, older at age of initial hospitalization, and have a family history of sudden cardiac death (Table 1). After adjusting for age, sex, race, and ethnicity in multivariable analysis, obesity was independently associated with arrhythmia (OR 1.390 [1.029-1.879], P=0.032), heart failure (OR 1.809 [1.247-2.624, P=0.002), number of admissions (IRR 1.349 [1.158-1.573], P&lt;0.001), and cumulative length of stay (IRR 1.276 [1.093-1.491], P=0.002). Obesity was not associated with mortality. Conclusions: In pediatric patients hospitalized with a diagnosis of HCM, obesity was more common in underrepresented minorities and associated with increased morbidity after accounting for other risk factors. Reducing the burden of obesity in this population with effective counseling and lifestyle interventions may play a role in preventing obesity-related adverse outcomes.

Potential Diagnostic and Prognostic Biomarkers for Adenovirus Respiratory Infection in Children and Young Adults.

Human Adenoviruses (HAdV) are known to be potentially associated with strong inflammatory responses and morbidity in pediatric patients. Although most of the primary infections are self-limiting, the severity of clinical presentation, the elevation of the white blood cell count and inflammatory markers often mimic a bacterial infection and lead to an inappropriate use of antibiotics. In infections caused by HAdV, rapid antigen detection kits are advisable but not employed routinely; costs and feasibility of rapid syndromic molecular diagnosis may limit its use in the in-hospital setting; lymphocyte cultures and two-sampled serology are time consuming and impractical when considering the use of antibiotics. In this review, we aim to describe the principal diagnostic tools and the immune response in HAdV infections and evaluate whether markers based on the response of the host may help early recognition of HAdV and avoid inappropriate antimicrobial prescriptions in acute airway infections.

Late morbidity and mortality following revascularization surgery for moyamoya disease in the pediatric population.

There are limited reports on long-term morbidity in pediatric patients who have undergone surgical revascularization for moyamoya disease (MMD). Here, the authors report long-term morbidity and mortality in a population of pediatric patients who underwent pial synangiosis for MMD from 1988 through 2016. A single-center retrospective review of the hospital and personal operative databases of the senior authors was carried out to identify all patients who were treated for MMD at Boston Children's Hospital between 1988 and 2016, and who experienced any episode of late morbidity or mortality, which the authors defined as an event resulting in significant neurological deficit or death occurring more than 1 year after revascularization surgery. Hospital records were reviewed to determine pertinent demographic data, the initial mode of patient presentation, and associated comorbidities. Radiographic studies, when available, were reviewed for documentation of the diagnosis and for confirmation of the late complication, and the literature on this topic was reviewed. In total, 460 patients with MMD underwent surgery between 1988 and 2016 using the pial synangiosis surgical technique; 15 (3.3%) of these patients (9 females and 6 males) experienced documented late death (n = 14) or severe morbidity (n = 1). The median age at revascularization surgery was 8.0 years (range 1-21 years). The causes of these late complications were grouped into three etiologies: intraventricular or intracerebral hemorrhage (n = 8), systemic complications related to associated comorbidities or preoperative disabilities (n = 5), and the development of malignant brain tumors (n = 2). Four patients whose MMD was associated with a history of cranial radiation therapy died. These events occurred from as early as 2 years to as late as 27 years postoperatively. The risk of late morbidities and mortality following pial synangiosis for MMD in the pediatric patient appeared to be low. Nevertheless, the occurrence of catastrophic cerebrovascular events, particularly intracerebral and intraventricular hemorrhage in the otherwise neurologically stable revascularized patient, was concerning. Although there is value in long-term surveillance of patients who have undergone surgery for MMD, from both a neurological and a general medical standpoint, particularly in patients with the risk factor of prior cranial radiation therapy, it is not clear from the data how the late deaths in this population could have been prevented.

Congenital Infections of the Nervous System.

This article provides an overview of congenital infections affecting the central nervous system (CNS), discussing the epidemiology, clinical features, diagnostic tools, and preventive and treatment measures for a variety of pathogens with the potential to infect the developing fetal brain. Contrary to popular belief, many congenital CNS infections are preventable and treatable. Treatment options exist for congenital cytomegalovirus, human immunodeficiency virus (HIV), herpes simplex virus, toxoplasmosis, and syphilis, although the efficacy of these treatments and the populations that may benefit from treatment are variable. Zika virus has recently emerged as a pathogen affecting the fetal brain, and new data suggest that the pathogenesis of Zika virus involves direct infection of neuronal progenitor cells leading to destruction of CNS tissue. The incidence of congenital syphilis has been increasing in the United States over the past decade as a direct result of new syphilis cases among adults and poor access to adequate maternal health care. Congenital CNS infections often result in significant neurologic morbidity in pediatric patients. Therefore, early identification of maternal illness and implementation of preventive measures are important in improving developmental outcomes and quality of life.

Infectious Morbidity in Pediatric Patients Receiving Neoadjuvant Chemotherapy for Sarcoma.

Simple SummaryInfections are an important cause of morbidity and mortality in childhood cancer treatment. The aim of our retrospective study was to assess the infectious burden in pediatric sarcoma patients during neoadjuvant chemotherapy administered according to the EWING 2008, CWS SoTiSaR and EURAMOS clinical trial or registry. Our analyses indicate a substantial infectious morbidity in this group of patients, with 58.8% experiencing at least one episode of febrile neutropenia (FN) and 20.6% at least one microbiologically documented infection (MDI). We also identified parameters that impact on the occurrence of FN and MDIs, including treatment protocol, patient age, and mucositis. These findings may contribute to a better risk stratification for prevention and management of FN and infections as well as for maintaining quality of life, cost control, and optimum outcomes of anticancer treatment.The purpose of this retrospective, single-center cohort study was to assess the infectious burden in pediatric sarcoma patients during neoadjuvant chemotherapy. The review included all patients with a new diagnosis of Ewing sarcoma, osteosarcoma or soft tissue sarcoma between September 2009 and December 2018 who were enrolled in the EWING 2008, CWS SoTiSaR and EURAMOS clinical trial or registry. Primary endpoints were the occurrence of febrile neutropenia (FN) and microbiologically documented infection (MDI). Parameters with a potential impact on FN and MDI were also analyzed. A total of 170 sarcoma patients (median age: 13 years, range: 0–21; 96 m/74 f) received 948 chemotherapy courses (median: 6; range: 2–8). Of these patients, 58.8% had ≥1 FN episode and 20.6% ≥ 1 MDI. FN occurred in 272/948 courses (28.7%) with fever of unknown origin (FUO) in 231 courses and 45 MDI and 19 clinically documented infections (CDI) occurring in a total of 57 courses. Patients enrolled in EWING 2008 had significantly more FN (p < 0.001), infections (p = 0.02) and MDI (p = 0.035). No infection-related deaths were observed. Younger age, tumor type and localization, and higher median and maximum mucositis grades were significantly associated with higher numbers of FN (p < 0.001), and younger age (p = 0.024) and higher median mucositis grade (p = 0.017) with MDI. The study shows substantial infectious morbidity in sarcoma patients during neoadjuvant chemotherapy treatment and opportunities to improve prevention and management.

Prevalence of Parasitic Infections and Related Morbidity in Pediatric Patients on Regular Hemodialysis in Ain ‎Shams University Pediatric Hospital, Cairo, Egypt ‎

Background and study aim: Opportunistic parasitic infections have been documented to cause serious complications among ‎immunocompromised patients, including those undergoing hemodialysis (HD). Therefore, this study ‎aimed to determine the prevalence of common parasitic infections and associated morbidity among the ‎HD pediatric patients at Ain Shams University Pediatric Hemodialysis Unit‎‎. Patients and Methods: ‎A comparative cross-sectional study was conducted on 50 HD patients and 20 apparently healthy ‎individuals from January 2018 to March 2019. Stool samples were examined for parasites using direct ‎smear, formol ether concentration, and staining with modified Ziehl- Neelsen stain. The serological ‎analysis for anti-Toxoplasma IgM and IgG and complete blood count was performed. The results were ‎correlated with the history, physical, and demographic data of the study groups‎.‎ Results: The overall prevalence rate of intestinal parasitoses among patients with HD was a little bit higher than ‎the control group (70% versus 60%, respectively) but this was statistically insignificant. Blastocystis ‎hominis (30%), Entamoeba histolytica (28%), and Giardia lamblia (20%) were the most frequent ‎among children with HD, with a statistically significant difference in Blastocystis hominis infection ‎rates between patients and their counterparts. Moreover, the overall Toxoplasma gondii ‎seroprevalence rate among patients with HD was (22%) and the anti-Toxoplasma IgM was (2%)‎‎‎. Conclusion: The overall rate of opportunistic parasitic infections and related clinical symptoms in children with ‎HD was slightly more frequent than in the control group. So, stool examination for intestinal parasites ‎and Toxoplasma gondii screening should be incorporated into routine clinical care for children with ‎HD‎‎‎.

NCOG-73. EFFECT OF TIME TO DIAGNOSIS IN CHILDREN WITH MALIGNANT CENTRAL NERVOUS SYSTEM TUMORS ON SURVIVAL OUTCOMES AND DISEASE-ASSOCIATED MORBIDITY: AN INSTITUTIONAL COHORT STUDY

Abstract OBJECTIVE To determine the impact of time to diagnosis on disease related morbidity and mortality. METHODS This is a retrospective review of all diagnoses of malignant CNS tumors in children presenting to BC Children’s Hospital (BCCH) from 2000-2019. Analyses were conducted to assess the relationship between time to diagnosis and overall survival as well as long-term morbidity; stratified by tumor type, age and presence of metastatic disease. RESULTS From 2000-2019, there were 116 children diagnosed with malignant CNS tumors at BCCH (mean age 9.5 years, 67% male). Tumors included medulloblastoma (27, 23.3%), ependymoma (14, 12.1%), high grade gliomas (19, 16.4%), CNS germ cell tumors (40, 34.4%), and other embryonal CNS tumors (16, 13.8%). Median time to diagnosis from first symptom onset was 63 days (IQR 26.5 – 237.5 days). 18% had metastatic disease. Within this cohort, 3-year EFS was 57%, and 5-year overall survival was 78.4%. 64% of patients were alive with no evidence of disease at median follow up from treatment completion of 4.31 years (IQR 1.77 – 6.15 years). Long-term morbidity included panhypopituitarism (20.7%), vision loss(22.4%), hearing loss(30.2%), learning disability(17.2%) and cognitive impairment (19.8%). In a cox proportional hazards model, overall survival was associated with time to diagnosis(estimate 0.0271;SE=1.6500;p=0.028), high grade glioma(estimate 8.3200; SE=0.6650; p=0.001), age at diagnosis(estimate 0.8590; SE=0.0532; p=0.004), relapse (estimate 4.9600; SE=0.6100; p=0.009) and metastatic disease (estimate 9.1700; SE=0.5660; p&amp;lt; 0.001). Vision loss was also significantly correlated with time to diagnosis (estimate 0.542; SE=0.2940; p=0.038). CONCLUSION Median time to diagnosis is associated with overall survival and long-term morbidity in pediatric patients treated for malignant CNS tumors. These data highlight that knowledge translation to the public, primary care and emergency room professionals should be a priority in order to promote early connection with medical care and mitigate morbidity and mortality in those with pediatric CNS tumors.

Clinico-epidemiological profile of congenital heart disease in a tertiary care center – a retrospective descriptive study

Aims and objective: To study the clinical-epidemiological profile of congenital heart disease inhospitalized children. Material and methods: A retrospective study was planned in a tertiary carecenter in Central India. Children between ages 1 month to 14 years with CHD were included in thisstudy. Type of CHD, clinical presentation, anthropometry, demographic profile, and the outcome wasrecorded. Result: A total of 65 patients were included in the study. 43 patients were suffering fromacyanotic CHD and 22 were having cyanotic CHD. Most of the children admitted were below 1 yearof age (n-67%). Males (42) were more reported in the present study than females (23).Conclusion: CHDs are one of the commonest birth defects, timely diagnosis and intervention arevery important to decrease mortality and morbidity in pediatric patients.