Outcomes In Pediatric Population Research Articles

Muscle Mass as a Biomarker for Health Status and Function in Pediatric Individuals with Neuromuscular Disabilities: A Systematic Review

This systematic review aims to investigate the relationship between muscle mass and specific health outcomes in pediatric populations with neuromuscular disorders. A search was performed for any relevant studies published in English from 1996 to 2023 in five databases. To be included in this analysis, articles must have had participants with an average age ≤21, focus on children with neuromuscular disabilities, and primarily examine relationships between muscle mass and any functional or health outcomes measure. Studies including typically developing children were used to contrast and enhance findings. Thirty-two studies were included, with 10,129 unique individuals represented: seventeen studies focused on healthy/typically developing children; seven on children with cerebral palsy; three on children with Duchenne muscular dystrophy; two on children with sarcopenia; and one study each on children with osteoporosis, congenital muscular dystrophy, and other various neurologic disorders. Thirteen studies assessed functional outcomes, ten assessed bone outcomes, and nine assessed other cardiovascular/metabolic outcomes. All of the included studies demonstrated relationships between muscle mass and respective outcomes in varying measures. The results of this review demonstrate that there is a consistently recognized relationship between muscle mass and important health outcomes in children, supporting clinically targeting muscle mass as a means to optimize desired outcomes.

Impact of Trauma Center Type on Outcomes in Pediatric Population Following Severe Isolated Blunt Traumatic Brain Injuries: A National Analysis.

This study aims to evaluate the association between trauma center type, verification level, and clinical outcomes in pediatric trauma patients with moderate and severe isolated blunt traumatic brain injury (TBI). This is a retrospective cohort study utilizing the American College of Surgeons (ACS) Trauma Quality Program (TQP) Participant Use File (PUF) database from 2017 to 2021. Severely injured pediatric (<18years) trauma patients with isolated moderate and severe TBI (AIS head >2, all other body regions <3) were included. Outcomes included in-hospital mortality, discharge disposition, intensive care unit length-of-stay (ICU-LOS), and ventilator-free days (VFDs). Patients treated at a level-I combined adult and pediatric trauma centers (CTCs) had significantly lower odds of in-hospital mortality than those treated at adult trauma centers (ATCs) (OR .495, 95% CI 0.291-.841, P = .009). Patients treated at level-I pediatric trauma centers (PTCs) (OR 2.726, 95% CI 2.059-3.609, P < .001) and level-II PTCs (OR 6.18, 95% CI 3.402-11.239, P < .001) were significantly more likely to be discharged home than equivalent-level ATCs. Pediatric patients with isolated blunt moderate and severe TBI treated at level-I PTCs and CTCs had reduced odds of in-hospital mortality compared to level-I ATCs. Patients at level I and II PTCs had significantly higher odds of discharge home than those at equivalent-level CTCs and ATCs.

Nutritional interventions and BMI dynamics: A comprehensive analysis of growth outcomes in pediatric populations

Introduction: This review article emphasizes the significance of Body Mass Index (BMI) and insulin-like growth factor-1 (IGF1) in evaluating pediatric growth outcomes, particularly for those at risk of undernutrition. The review explores the long-term health consequences of early BMI trajectories, especially their association with cardiometabolic profiles in adulthood. The article also examines the correlation between BMI, insulin-like growth factor 1 (IGF-1), and growth velocity, focusing on their complex interactions in malnourished and obese pediatric populations. Methods: A comprehensive literature search was conducted using PubMed, Google Scholar, and Scopus from 1985 to 2024, focusing on BMI, height growth velocity, IGF1 levels, and the effects of nutritional interventions on pediatric growth outcomes. Studies were included if they focused on children aged 0-18 years and evaluated the impact of BMI and/or nutritional interventions on growth outcomes, with English language articles being prioritized. Review Results: A total of 15 studies involving 4737 participants were analyzed. The review highlights significant findings including the normalization of growth hormone (GH)-IGF axis post nutritional rehabilitation in malnourished children, the rapid response of IGF-1 levels to nutritional interventions, and the influence of protein-rich diets on catch-up growth. Studies also showed that early nutritional support, particularly through human milk, significantly affects IGF-1 levels and that dietary protein intake correlates with IGF-I concentrations and growth in toddlers. Long-term studies indicated that severe malnutrition can have enduring metabolic effects, necessitating sustained nutritional strategies. Discussion: The review highlights the significance of early nutritional support and its impact on IGF-1 levels, which are crucial for healthy growth trajectories. The findings advocate for careful monitoring of early growth rates to optimize long-term health outcomes and stress the importance of adequate protein intake during early childhood. Conclusions: A balanced approach to nutrition, focusing on the interplay between BMI, growth velocities, and IGF1 levels, is crucial in pediatric care. Strategic nutritional interventions, especially those rich in protein, can effectively manage growth outcomes across different BMI categories and improve health trajectories in pediatric populations. This review underscores the need for comprehensive strategies to address nutritional deficiencies and manage growth effectively from infancy through adolescence

Analysis of CBC and CRP for Children using Machine Learning Models

Complete Blood count (CBC) and C- Reactive Protein (CRP) tests provide valuable information about a child's health status and help healthcare providers to diagnose and manage various medical conditions effectively. Paediatric health assessment often relies on these two critical blood tests as normal reports to check the primary condition of the children. Integration of CRP prediction models into clinical decision support systems can facilitate early detection of inflammatory conditions, guide treatment strategies, and improve patient outcomes in paediatric populations. Machine Learning (ML) algorithms are used to enhance diagnostic accuracy, and improve the overall efficiency of paediatric care. The most important test for diagnosing infections is the CBC. The CRP readings are classified into three classes i.e., 0 to 3 mg/L, 3 mg/L to 20 mg/L, more than 20 mg/L. With the test reports of the CBC, prediction of CRP levels was found with highest accuracy from Cat Boosting Classifier [0.976], Neural Network [0.972], Logistic Regression [0.971] and Random Forest Classifier [0.966]. The results prove that the Cat Boosting Classifier performs best among all the used models followed by other algorithms and performs well in predicting the new CRP reading class in all the prediction scenarios given the available dataset. Automating the analysis of CBC and CRP tests can streamline healthcare processes using ML models.

Stimulant Treatment and Potential Adverse Outcomes in Pediatric Populations With Bipolar Disorder: A Systematic Review of the Literature

Objective: To explore outcomes of stimulant treatment for ADHD in pediatric populations with particular attention to bipolar disorder (BPD). Method: We conducted a literature search of PubMed articles published prior to August 25, 2022 that focused on BPD, mania, and psychosis prior to, or as result of, stimulant treatment. We excluded studies: (1) unrelated to stimulants, (2) general stimulant research, (3) articles older than 40 years, (4) study protocols, or (5) case reports. Results: A total of 11 articles met all inclusion/exclusion criteria. Some reports found stimulant treatment safe and well-tolerated in children with comorbid BPD and ADHD. Others found evidence of treatment-emergent mania (TEM), discontinuation, and other adverse events with stimulant treatment. Conclusion: Poor outcomes associated with stimulant treatment in pediatric populations with BPD necessitate work to identify patients at risk of serious stimulant-related adverse events. Our results were limited by automated search filters and a pediatric, primarily male sample.

Social Determinants of Health and Pediatric Emergency Department Outcomes: A Systematic Review and Meta-Analysis of Observational Studies

Social determinants of health contribute to disparities in pediatric health and health care. Our objective was to synthesize and evaluate the evidence on the association between social determinants of health and emergency department (ED) outcomes in pediatric populations. This review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Equity Extension guidelines. Observational epidemiological studies were included if they examined at least 1 social determinant of health from the PROGRESS-Plus framework in relation to ED outcomes among children <18 years old. Effect direction plots were used for narrative results and pooled odds ratios (pOR) with 95% confidence intervals (CI) for meta-analyses. Fifty-eight studies were included, involving 17,275,090 children and 103,296,839 ED visits. Race/ethnicity and socioeconomic status were the most reported social determinants of health (71% each). Black children had 3 times the odds of utilizing the ED (pOR 3.16, 95% CI 2.46 to 4.08), whereas visits by Indigenous children increased the odds of departure prior to completion of care (pOR 1.58, 95% CI 1.39 to 1.80) compared to White children. Public insurance, low income, neighborhood deprivation, and proximity to an ED were also predictors of ED utilization. Children whose caregivers had a preferred language other than English had longer length of stay and increased hospital admission. Social determinants of health, particularly race, socioeconomic deprivation, proximity to an ED, and language, play important roles in ED care-seeking patterns of children and families. Increased utilization of ED services by children from racial minority and lower socioeconomic status groups may reflect barriers to health insurance and access to health care, including primary and subspecialty care, and/or poorer overall health, necessitating ED care. An intersectional approach is needed to better understand the trajectories of disparities in pediatric ED outcomes and to develop, implement, and evaluate future policies.

A Near Real-Time Risk Analytics Algorithm Predicts Elevated Lactate Levels in Pediatric Cardiac Critical Care Patients.

Postoperative pediatric congenital heart patients are predisposed to develop low-cardiac output syndrome. Serum lactate (lactic acid [LA]) is a well-defined marker of inadequate systemic oxygen delivery. We hypothesized that a near real-time risk index calculated by a noninvasive predictive analytics algorithm predicts elevated LA in pediatric patients admitted to a cardiac ICU (CICU). Ten tertiary CICUs in the United States and Pakistan. Retrospective observational study performed to validate a hyperlactatemia (HLA) index using T3 platform data (Etiometry, Boston, MA) from pediatric patients less than or equal to 12 years of age admitted to CICU (n = 3,496) from January 1, 2018, to December 31, 2020. Patients lacking required data for module or LA measurements were excluded. Physiologic algorithm used to calculate an HLA index that incorporates physiologic data from patients in a CICU. The algorithm uses Bayes' theorem to interpret newly acquired data in a near real-time manner given its own previous assessment of the physiologic state of the patient. A total of 58,168 LA measurements were obtained from 3,496 patients included in a validation dataset. HLA was defined as LA level greater than 4 mmol/L. Using receiver operating characteristic analysis and a complete dataset, the HLA index predicted HLA with high sensitivity and specificity (area under the curve 0.95). As the index value increased, the likelihood of having higher LA increased (p < 0.01). In the validation dataset, the relative risk of having LA greater than 4 mmol/L when the HLA index is less than 1 is 0.07 (95% CI: 0.06-0.08), and the relative risk of having LA less than 4 mmol/L when the HLA index greater than 99 is 0.13 (95% CI, 0.12-0.14). These results validate the capacity of the HLA index. This novel index can provide a noninvasive prediction of elevated LA. The HLA index showed strong positive association with elevated LA levels, potentially providing bedside clinicians with an early, noninvasive warning of impaired cardiac output and oxygen delivery. Prospective studies are required to analyze the effect of this index on clinical decision-making and outcomes in pediatric population.

Abstract 13107: Addressing Sudden Cardiac Arrest: An Analysis of the Efficacy and Implementation of Automated External Defibrillators in New Jersey Schools

Introduction: Out of hospital sudden cardiac arrest is a major health concern with a low survival rate. Proper Automated External Defibrillator use has been shown to decrease mortality associated with OHCA. In 2014, New Jersey passed Janet’s Law to mandate automated external defibrillator access in all public and private schools. Our project surveyed NJ schools to evaluate the implementation of AEDs and to analyze their usage and outcomes. Hypothesis: Schools that were adherent to AED placement and training as outlined in Janet’s Law will likely have more positive outcomes from sudden cardiac arrests on school properties than schools that do not. Methods: An observational, cross sectional study was conducted via an online form (Redcap 12.4.2) sent to New Jersey public school nurses. Data was collected from February to June 2023 and analyzed using SAS version 9.4. Results: 301 (99.7%) responses reported having automated external defibrillators. 85.3% of schools provided AED staff training. 42 schools (14.4%) utilized an AED in a cardiac emergency, most often occurring to students in classrooms. An AED was administered by school employees 95.8% of the time. In 80.5% of cases, the patient was resuscitated on scene with no long term neurological complications. 87.2% of schools have an emergency response plan. Conclusions: Our data highlights the impact of proper AED utilization to positively influence out of hospital sudden cardiac arrest outcomes in pediatric populations. Despite Janet’s law being an unfunded mandate, we found near complete compliance among New Jersey schools. The majority of reported sudden cardiac arrests occurred in a classroom setting, necessitating available resources throughout school facilities. In these events, the percentage of positive patient outcomes in our study was significantly higher than the national average with excellent neurological recovery. This discovery may be a product of excellent response rates by trained staff as mandated in Janet’s law. Our findings highlight the need for awareness, training, and accessibility regarding AEDs.

Validation and evaluation of subject-specific finite element models of the pediatric knee

Finite element (FE) models have been widely used to investigate knee joint biomechanics. Most of these models have been developed to study adult knees, neglecting pediatric populations. In this study, an atlas-based approach was employed to develop subject-specific FE models of the knee for eight typically developing pediatric individuals. Initially, validation simulations were performed at four passive tibiofemoral joint (TFJ) flexion angles, and the resulting TFJ and patellofemoral joint (PFJ) kinematics were compared to corresponding patient-matched measurements derived from magnetic resonance imaging (MRI). A neuromusculoskeletal-(NMSK)-FE pipeline was then used to simulate knee biomechanics during stance phase of walking gait for each participant to evaluate model simulation of a common motor task. Validation simulations demonstrated minimal error and strong correlations between FE-predicted and MRI-measured TFJ and PFJ kinematics (ensemble average of root mean square errors < 5 mm for translations and < 4.1° for rotations). The FE-predicted kinematics were strongly correlated with published reports (ensemble average of Pearson's correlation coefficients (ρ) > 0.9 for translations and ρ > 0.8 for rotations), except for TFJ mediolateral translation and abduction/adduction rotation. For walking gait, NMSK-FE model-predicted knee kinematics, contact areas, and contact pressures were consistent with experimental reports from literature. The strong agreement between model predictions and experimental reports underscores the capability of sequentially linked NMSK-FE models to accurately predict pediatric knee kinematics, as well as complex contact pressure distributions across the TFJ articulations. These models hold promise as effective tools for parametric analyses, population-based clinical studies, and enhancing our understanding of various pediatric knee injury mechanisms. They also support intervention design and prediction of surgical outcomes in pediatric populations.

2.51 Stimulant Treatment and Potential Adverse Outcomes in Pediatric Populations With Mood Dysregulation: A Review of the Literature

2.51 Stimulant Treatment and Potential Adverse Outcomes in Pediatric Populations With Mood Dysregulation: A Review of the Literature

Effect of Device-Assisted Therapy in Children With Oropharyngeal Dysphagia: A Rapid Review

Purpose: The purpose of this study was to determine the state of the evidence regarding device-assisted therapy for swallowing physiology and functional feeding outcomes in children with oropharyngeal dysphagia. Method: This rapid review methodology identified relevant literature through a narrow search strategy applied to three relevant databases using search strategies specific to the electronic database and searching the following keywords and their variations: “pediatric,” “dysphagia,” “device-assisted,” and “therapy.” Searches took place between February and March 2023. Device-assisted therapy was defined as therapy that utilized instruments capable of providing objective data about patient performance and/or providing mechanically controlled external stimulation to the client during therapy. Results: This rapid review identified seven peer-reviewed journal articles relating to device-assisted dysphagia therapy in pediatric patients, 1–18 years of age. Most of the included articles were observational in nature and reported on the impact of neuromuscular electrical stimulation on swallowing physiology in children. Critical appraisal of the experimental articles revealed generally small sample size and low methodological quality. Conclusions: This rapid review indicates that there is limited empirical evidence to support the use of device-assisted therapeutic modalities in children with oropharyngeal dysphagia 1–18 years of age. Further research into the effect of device-assisted therapeutic modalities on swallowing physiology and functional feeding outcomes in pediatric populations is immediately required.

Social Determinants of Health and Associations With Outcomes in Pediatric Patients With Brain Tumors.

Social determinants of health (SDOH) are nonmedical factors that affect health outcomes. Limited investigation has been completed on the potential association of these factors to adverse outcomes in pediatric populations. In this study, the authors aimed to analyze the effects of SDOH disparities and their relationship with outcomes after brain tumor resection or biopsy in children. The authors retrospectively reviewed the records of their center's pediatric patients with brain tumor. Black race, public insurance, median household income, and distance to hospital were the investigated SDOH factors. Univariate analysis was completed between number of SDOH factors and patient demographics. Multivariate linear regression models were created to identify coassociated determinants and outcomes. A total of 272 patients were identified and included in the final analysis. Among these patients, 81 (29.8%) had no SDOH disparities, 103 (37.9%) had 1, 71 (26.1%) had 2, and 17 (6.2%) had 3. An increased number of SDOH disparities was associated with increased percentage of missed appointments ( P = .002) and emergency room visits ( P = .004). Univariate analysis demonstrated increased missed appointments ( P = .01), number of postoperative imaging ( P = .005), and number of emergency room visits ( P = .003). In multivariate analysis, decreased median household income was independently associated with increased length of hospital stay ( P = .02). The SDOH disparities are prevalent and impactful in this vulnerable population. This study demonstrates the need for a shift in research focus toward identifying the full extent of the impact of these factors on postoperative outcomes in pediatric patients with brain tumor.

Strabismus outcomes in pediatric patients undergoing disconnective hemispheric surgery for intractable epilepsy: a systematic review

BackgroundChildren undergoing hemispheric surgery for intractable seizures are susceptible to visual complications including strabismus. This systematic review aims to investigate the rates and characteristics of strabismus development after hemispheric surgery and evaluate clinical implications for ophthalmologic care. MethodsA systematic search of MEDLINE, EMBASE, Cochrane, PsychINFO, and Web of Science databases was performed from database inception to May 2022. Included articles referred to strabismus outcomes in pediatric populations after hemispherectomy or hemispherotomy. Reviews and non-English-language publications were excluded. Risk of bias was assessed using Joanna Briggs Institute critical appraisal tools. Demographic data and characteristics of strabismus were extracted and tabulated. ResultsOf 41 articles identified, 10 studies consisting of 384 pediatric participants (48% females) and age at surgery between 6 months and 16 years were included. Preoperative strabismus rates ranged between 3% and 56%, whereas postoperative rates ranged between 38% and 100%. With respect to the site of hemispheric surgery, contralateral exodeviation was the most common (16%–67%; n = 7) and then ipsilateral exodeviation (16%–56%; n = 2), whereas ipsilateral esodeviation was infrequent (4%–9%; n = 3). ConclusionsContralateral exotropia and ipsilateral esotropia may occur after hemispheric surgery and may have the potential to be field expanding. Concerns regarding negative social reactions should be balanced with the risk of visual field reduction and (or) diplopia by strabismus surgery. Higher-quality articles with large, homogeneous, and well-described populations (i.e., complete pre- and postoperative ophthalmologic assessments) are required to establish the risks and rates of strabismus development after hemispheric surgery.

The relationship between sleep duration and health among Pacific adolescents within New Zealand: Findings from the Pacific Islands families study

ObjectiveSleep insufficiency is bi-directionally associated with adverse behavioural, physical and mental health outcomes in paediatric populations. However, little is known about the degree of sleep insufficiency and its effect on Pacific adolescents’ wellbeing. MethodsA cross-sectional study of 14-year old Pacific adolescents nested within a longitudinal birth cohort was conducted. Self-reported sleep duration was related to sentinel physical, mental, and risk taking behaviour measures in crude and adjusted logistic regression models. Complete case and multiple imputed analyses were conducted. Results916 Pacific adolescents were eligible, with a mean age of 14.2 years. Valid sleep data were available from 828 (90.4%) participants, with only 220 (26.6%) meeting the recommended amount of sleep. Insufficient sleep duration was associated with significantly higher rates of depressive symptoms and risk taking behaviours. In multiple imputed analyses, increased body mass index was also significantly related. ConclusionsSleep insufficiency is ubiquitous among Pacific adolescents and associated with negative impacts on their health and wellbeing. Implications for public healthInsufficient sleep duration is amenable to change. Bespoke, culturally responsive public health strategies that draw attention to the importance of positive sleep practices are needed. Particularly, among adolescents who are at risk of experiencing the greatest burden of insufficient sleep.

Pharmacogenetic Aspects of Drug Metabolizing Enzymes and Transporters in Pediatric Medicine: Study Progress, Clinical Practice and Future Perspectives.

As the activity of certain drug metabolizing enzymes or transporter proteins can vary with age, the effect of ontogenetic and genetic variation on the activity of these enzymes is critical for the accurate prediction of treatment outcomes and toxicity in children. This makes pharmacogenetic research in pediatrics particularly important and urgentlyneeded, but also challenging. This review summarizes pharmacogenetic studies on the effects of genetic polymorphisms on pharmacokinetic parameters and clinical outcomes in pediatric populations for certain drugs, which are commonly prescribed by clinicians across multiple therapeutic areas in a general hospital, organized from those with the most to the least pediatric evidence among each drug category. We also further discuss the research status of the gene-guided dosing regimens and clinical implementation of pediatric pharmacogenetics. More and more drug-gene interactions are demonstrated to have clinical validity for children, and pharmacogenomics in pediatrics have shown evidence-based benefits to enhance the efficacy and precision of existing drug dosing regimens in several therapeutic areas. However, the most important limitation to the implementation is the lack of high-quality, rigorous pediatric prospective clinical studies, so adequately powered interventional clinical trials that support incorporation of pharmacogenetics into the care of children are still needed.

Prognosticating Bariatric Surgery Outcomes in Pediatric Population: A Novel Route Towards Personalized Medicine in Obesity

Prognosticating Bariatric Surgery Outcomes in Pediatric Population: A Novel Route Towards Personalized Medicine in Obesity

Age-Related Immune Cell Dynamics Influences Outcomes after Allogeneic Hematopoietic Cell Transplantation

Allogeneic hematopoietic cell transplantation (HCT) holds a pivotal place in the setting of therapeutic algorithms for hematological disorders. Its therapeutic index is principally related to the immunogenic graft-versus-leukemia (GvL) effect that, together with an efficient immune reconstitution ensures the success of the procedure, contributing to disease control and immune competence. Factors influencing recipient immune recovery have been largely investigated across multiple cohorts issuing heterogenous results. Differences in outcomes in adult and pediatric populations suggest an age-related contribution to post-transplant immune reconstitution, however it is unclear how this parameter may affect the dynamics of single immune cells. Here we conducted a monocentric prospective study questioning on the modifications of immune cell recovery in a cohort of 176 patients (58 children and 118 adults) with hematological disorders receiving a HCT between 2015 and 2020 and followed at our institution. Complete flow-based immune reconstitution data on T-CD4, T-CD8, NK and B cell populations were collected at defined time-points (+1, 3, 6 and 12 months post-HCT). After ascertaining the dynamics in adult and pediatric populations of each cell component, the effect of a set of baseline clinico-biological variables on late (>6 months) reconstitution for each cell population was tested through univariable and multivariable linear or logistic regression models. First, we analyzed the linear relationship existing between recipient and donor age and each cell compartment. Interestingly, while donor age did not impact on any of the parameters in study, CD4- T (Adj R2 0.4, p=5.7x 10-15) and, in minor part, B cell post-transplant increments (Adj R2 0.05, p=0.004) were inversely correlated with recipient age, which instead did not influence CD8-T nor NK cell reconstitution. Results of stepwise multivariable analyses showed that CD8-T cell reconstitution was positively impacted by recipient positive CMV serostatus (p=0.00009) while donor CMV serostatus positively influenced CD4-T cell recovery (p=0.017). This effect was likely dependent from the expansion of CMV related T cell clonotypes in case of previous CMV immunity. The inverse correlation between CD4-T cells and recipient age was confirmed in multivariable analysis (p=0.0148). Donor EBV positive serostatus resulted instead to be a negative predictor of B cell recovery (p=0.0442). Interestingly none of the parameters analyzed influenced NK cell recovery. The impact on age mirrored a different kinetics of immune reconstitution in adult and pediatric patients (<18 years). Therefore, while early after HCT immune cell composition was similar in the two groups, with NK cells representing the largest component, followed by CD8-T and CD4-T, and minimal B cell contribution, in later phases we assisted to a faster expansion of CD4-T arm in children whereas CD8-T remained the major contributor of the immune recovery processes in adults still one year after transplant. B cell reconstitution was also faster in children, with a better immunoglobulin levels recuperation (measured on IgM to avoid bias of prophylactic IgG infusions) despite no differences in post-transplant pre-emptive rituximab utilization. When looking at different outcomes of pediatric and adult patients, both overall and event free survival were significantly higher in children (p=0.00062 and p=0.0062). While no difference in acute grade III-IV GvHD, adults experienced a significantly higher cumulative incidence (CI) of chronic GvHD (p=0.0258) and of specific infections, including EBV (p=0.031) and fungi (p=0.007). Although CI of relapse was not different, children experienced later relapses as compared to adults (median of 294 vs. 139 days, p=0.039), indicating a better disease control at least at early post-transplant stages. Here, starting from immune reconstitution data prospectively collected for patients transplanted at our institution, we dissected the effect of age on post-transplant immune cells. A faster CD4-T and B cell recovery in children may be the driver of a better immune competence underpinning superior outcomes in pediatric populations. If age-related thymus involution may reflect suboptimal CD4-T cell differentiation in adults, younger donor selection does not seem to improve recipient post-transplant immune reconstitution.

Clinical Presentation with Predictors of Severity of Dengue Fever in Children of 2019, Endemic in Bangladesh

Background: Dengue fever is a serious public health problem with a wide range of clinical manifestations. In 2019, the clinical presentation of dengue infection was novel in relation to the conventional features of the previous years and also in degree of severity. So the study was done to see the varied clinical presentation, predictors of severity and outcome in pediatric population in 2019 endemic. Methods: It was a cross sectional, descriptive study conducted among 100 cases of serologically positive dengue patients from department of Paediatrics of Shaheed Suhrawardy Medical College Hospital, Dhaka from July to October, 2019.The data were collected by preformed semi-structured questionnaires and analyzed using SPSS version 16.0. Results: The mean age of the patients was 7.4 ± 3.4 years with equal male and female ratio. Children between 5-12 years were most (72%) commonly affected. Mean duration of fever was 4.5 ± 1.8 days and fever was present in 63% cases on presentation. Features of shock were present in 61% of patients who were designated as severe dengue. Most of the patients presented with abdominal pain (77%) followed by vomiting (70%), headache (35%), myalgia(32%) and retro-orbital pain(30%). Among the important clinical findings, tender hepatomegaly was present in 77% cases followed by ascites in 35% and pleural effusion in 4% cases. Melaena was found to be the most common form of bleeding manifestation. Risk factors for severe dengue were vomiting, abdominal pain, melaena, ascites and low platelet count. Majority of the patients (95%) were discharged, 4% were referred to ICU and only 1% died. Conclusion: Majority of admitted pediatric dengue patients presented with severe Dengue (Dengue Shock Syndrome). Presence of vomiting, abdominal pain, ascites and low platelet count were found to be significant in predicting severity of dengue. J Shaheed Suhrawardy Med Coll 2021; 13(1): 8-14

The Effect of Social Determinants of Health on Telemedicine Access During the COVID-19 Pandemic.

Social determinants of health contribute to inequalities in access to care and inferior outcomes in pediatric populations. Before the coronavirus disease 2019 (COVID-19) pandemic, telemedicine was shown to be an effective tool to bridge the gap between health care providers and rural or underserved populations. The pandemic has rapidly changed the current landscape of health care. Telemedicine has played a critical role in health care delivery between providers and patients because of the need for social distancing. That being said, it has become apparent that SDOH have affected access to telemedicine for communities that already suffer from inequities in health care access. Solutions directed toward addressing issues such as lack of broadband access, digital literacy and language barriers, and obstacles within the health care system are crucial to ensure telemedicine access is equitable for all patients and does not contribute toward worsening health care disparities. [Pediatr Ann. 2022;51(8):e311-e315.].

Circulating PCSK9 Linked to Dyslipidemia in Lebanese Schoolchildren.

In adults, elevated levels of circulating Proprotein Convertase Subtilisin/Kexin type 9 (PCSK9) have been associated with increased Low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), and worse cardiovascular outcomes. However, few studies analyzed the relation between PCSK9 and lipid parameters in pediatric populations. The aim of our study is to evaluate the distribution and the correlation of serum PCSK9 levels with lipid parameters in a sample of Lebanese school children. Using an immunofluorescence assay, we measured serum PCSK9 levels in 681 school children recruited from ten public and private Lebanese schools. We analyzed the association between PCSK9 and age, sex, Body Mass Index (BMI), and lipid parameters (total cholesterol (TC), LDL-C, TG, High-density lipoprotein cholesterol (HDL-C), non-HDL-C, and lipoprotein (a) (Lp(a)). Serum PCSK9 levels were significantly correlated with TC, LDL-C, and non-HDL-C (p value < 0.0001) but not with TG, HDL-C, and Lp(a). PCSK9 levels were also significantly higher in children with high TC, LDL-C, and non-HDL-C (p values = 0.0012, 0.0002, 0.001, respectively). No significant gender differences in PCSK9 were found. In addition, no significant associations between PCSK9 and both age and BMI percentiles were observed. In girls, no difference in PCSK9 values was observed according to menarche while in boys, testosterone levels were not significantly associated with PCSK9. Serum PCSK9 levels were significantly correlated with TC, LDL-C, and non-HDL-C levels. Further studies are needed to find if PCSK9 measurements have an additional value to predict future cardiovascular outcomes in pediatric populations.