Pediatric Clinic Research Articles

Development of Specialty-Based Pediatric Palliative Care Clinics

Development of Specialty-Based Pediatric Palliative Care Clinics

Clinical profile, otologic, and auditory outcomes in patients with Down syndrome

Introduction and objectivesEven though the incidence has decreased in recent years, Down syndrome (DS) remains the most common chromosomal disorder today. Despite being a condition with multisystemic involvement, it often tends to affect the head and neck area, making it a frequent reason for consultation with pediatric otolaryngologists or otologists. The purpose of this work is to be one of the first in Spain to characterize and describe the pathology and therapeutic approach typically provided to these patients, analyzing the evolution from a clinical and auditory perspective. Material and methodsWe aim to analyze a sample of 16 pediatric patients recruited over the past 24 years, diagnosed with Down syndrome, and experiencing a wide range of diseases affecting the ear and its auditory function. Results62.50% of the patients were women, whose main reason for seeking specialist care was acute and serous otitis media, accounting for 31.25%. These patients have an indication for treatment for various entities within the otological sphere that usually do not differ from those of a healthy child. However, the evolution and response to treatments can take on a torpid character due to the anatomical characteristics of the ears of these patients. ConclusionsAlthough the frequency of children with DS in the pediatric otolaryngologist's clinic is decreasing, these patients have a predisposition to ear diseases with auditory repercussions, with variable evolution depending on the disease and the child's intrinsic characteristics.

Neighborhood-level Disparities in Achievement of Social Continence Among School-aged Children With Anorectal Malformations: A Single-center Retrospective Study

BackgroundFecal incontinence is a common problem for children with repaired anorectal malformations (ARM) and has significant implications for initiating school. While sex, anatomy, and medical comorbidities are known to influence continence outcomes, the impact of socioeconomic factors and neighborhood-level disadvantage are less well understood. MethodsWe performed a single-center retrospective review of all school-aged (5–18 years) children with ARM at a longitudinal pediatric surgery clinic. Demographic, clinical, and socioeconomic variables were abstracted via chart review and geocoding was performed to obtain Area Deprivation Index (ADI) and Social Vulnerability Index (SVI) scores. Statistical analyses assessed for associations between the primary outcome of social continence (defined as no diaper usage and infrequent fecal accidents at age 5) and these variables. Results72 patients were included; of these, 45.8% were socially continent. On bivariate analysis, social continence was significantly associated with state ADI score as well as the SVI Housing characteristics score. These associations remained significant when adjusting for sex and medical comorbidities in separate multiple logistic regression models. ConclusionThe relative disadvantage of the neighborhood in which a child with ARM lives may play a role in their ability to achieve continence by school age. Efforts are warranted to identify and develop targeted interventions to for this pediatric population. Level of evidenceIV.

The Scope of Practice of an Outpatient Pediatric Palliative Care Oncology Clinic

The Scope of Practice of an Outpatient Pediatric Palliative Care Oncology Clinic

Quality Improvement Identifies Healthcare Transition Disparities in Adolescents with Congenital Heart Disease and Disabilities.

We aim to implement healthcare transition (HCT) education for youth with congenital heart disease (CHD) and assess HCT preparedness for cardiac self-care. An HCT clinic was implemented at an academic pediatric cardiology clinic for CHD youth 17 years of age and older. An educator used transition readiness assessment questionnaires and discussed HCT material. The percentage of eligible youth who received HCT education and the cause for missed occurrences were tracked. Plan-do-study-act cycles began in August 2020 to improve the number of youths reached. Secondary analyses assessed improvement differences among those without cardiac procedures or disabilities. HCT education provision improved from a mean of 38% to 73% in the 17-year and older age group by December 2022. Communication failure was the leading cause of missed visits in 2021 (30%), reduced to 0 by 2022 following plan-do-study-act cycles. Other missed HCT visits included clinic add-ons after screening, limited staff availability, and unidentified eligibility. Readiness assessments were similar for youth with and without prior cardiac procedures, for example, confidence in taking charge of their health care (P = 0.47) and moving to adult care (P = 0.22). Adolescents with disabilities were significantly less confident than those without disabilities in taking charge of their heart health care (6.3 versus 7.5, P = 0.04) and moving to adult care (4.9 versus 7.4, P < 0.001). Implementation of a CHD HCT clinic improved successful education delivery. Provider engagement and clinic staffing are important for sustainability. HCT knowledge gaps exist for all adolescents, yet those with disabilities had the greatest deficits.

Correlation of Serum Prolactin Levels With Metabolic and Cardiovascular Risk in Greek Women With Polycystic Ovarian Syndrome.

Polycystic ovary syndrome (PCOS) is a common endocrine disorder among females. PCOS is associated with various metabolic and cardiovascular complications, including insulin resistance, dyslipidemia, and an increased risk of type 2 diabetes mellitus and cardiovascular disease. The role of serum prolactin (PRL) in the development of these complications in PCOS is not well understood. This study aims to investigate the correlation between serum PRL levels and metabolic and cardiovascular risk factors in Greek women with PCOS. The study utilized secondary outcomes from a prospectively collected patient database at the Third Department of Obstetrics and Gynecology, Medical School of the University of Athens. Data were collected from patients who visited the Gynecological Endocrinology - Pediatric and Adolescence Endocrinology Outpatient Clinic between January 2007 and December 2015. Measurements of various parameters, including PRL levels, BMI, waist circumference, hormone levels, lipid profiles, and insulin sensitivity, were obtained. Statistical analyses, including Mann-Whitney tests, chi-square tests, Spearman correlations, and multiple linear regression analyses, were conducted using SPSS software (IBM Corp., Armonk, NY, USA). The study included 247 women with PCOS, with a mean age of 24.7 years. Participants were divided into two groups based on the median PRL level. Women with higher PRL levels (>14.9) had lower BMI and waist circumference, higher levels of certain hormones and insulin sensitivity, and lower levels of fasting insulin, total cholesterol, and total lipids. Factors associated with lower PRL levels included being overweight/obese and smoking more than 10 cigarettes per day. Higher age, BMI, waist circumference, and certain hormone levels were associated with lower PRL levels. The findings suggest a correlation between serum PRL levels and metabolic and cardiovascular risk factors in Greek women with PCOS. Further research is needed to elucidate the role of PRL in the pathophysiology of PCOS and to explore its potential as a diagnostic and therapeutic target.

Assessing the Body Composition of "Picky Eaters" Using Body Impedance Analysis: An Experience From a Tertiary Care Center.

Picky eating might be associated with a higher risk of being underweight and poor growth. This study aimed to investigate if picky eaters aged between three and 12 yearsshowed differences in height, weight, and body composition compared to their non-picky peers using a body impedance analysis (BIA). This cross-sectional study was conducted between March 1, 2022, and July 31, 2022, on children aged three to 12 years who presented to the outpatient pediatric clinics at Al Habib Ar Rayyan in Riyadh, Saudi Arabia. Body composition was measured using BIA after manually inserting the height, gender, and age into the machine, where body mass index (BMI), fat mass, and skeletal muscle mass were recorded. Participants were classified as under/normal/over for each body composition measurement. A total of 2234 children were entered into the final data analysis. Our analysis showed that 1917 (85.8%) were Saudis and 1117 (50%) were males. The mean age of participants was 6.08±2.01 years and 1151 (51.5%) were in the pre-school age. The reported prevalence of picky eaters was 1684 (75.4%), of whom, 606 (27.0%) were selective eaters, 365 (16.2%) were low appetite eaters, and 723 (32.2%) were both selective and low appetite eaters. Being underweight was significantly more common among the picky eaters 487 (28.9%) compared to those non-picky eaters 55 (10.0%) (p<0.001). Significantly, 1280 (76%) picky eaters had below-average skeletal muscle mass compared to 151non-picky eaters (27.5%) (p<0.001). The low appetite picky eater group had more under skeletal muscle mass children 277 (75.9%) compared to the selective picky eater group412 (68.0%) (p=0.009).Additionally, the low appetite group possessed lower muscle ratios (p=0.012) and were more underweight than the selective group (p<0.001). Furthermore, the low appetite group showed a higher percentage of children below the 3rd percentile in the height for age category (p=0.003) compared to the selective group. This study is the first of its kind in Saudi and globallyto evaluate body composition using BIA among children. The study showed that picky eating is more associated with underweight children and low muscular mass. Despite the normal BMI, height, and weightof a picky eater, their skeletal muscle mass might be less than average,which could be associated with an increased risk of morbidity.

Effectiveness of the six-step approach guided online training program to improve knowledge of Mycoplasma pneumoniae pneumonia among pediatricians: a pretest-posttest study.

In 2023, China witnessed an earlier and more widespread outbreak of Mycoplasma pneumoniae pneumonia (MPP). To address this situation, an online training program was designed to enhance the knowledge of MPP among pediatricians in Shanghai, China. An online training program on the diagnosis and treatment of MPP, guided by Kern's six-step approach, was developed by the Shanghai Pediatric Clinical Quality Control Center. A pre- and post-training survey was conducted using a 20-item self-administered questionnaire to investigate the pediatricians' knowledge of MPP. A linkage mechanism was established to match pretest/posttest questionnaires using personal identifiers. Paired t-tests and McNemar tests were performed to measure the differences, as appropriate, between pre- and post-training groups. A higher survey score indicated better knowledge. There were 289 participants performed pre- and post-tests. The average age of the respondents was 38.7 years (standard deviation: 8.9). Over 80% of the participants were primary (32.5%) and intermediate (47.8%) pediatricians. Those from specialized hospitals accounted for the highest proportion (41.5%). The post-training group achieved significantly higher total scores than the pre-training group (91.3 vs. 67.7, t=22.48, P<0.001), regardless of the professional titles or hospital levels (all P<0.001). The accuracy rates of each question increased significantly in the post-training group (all P<0.001). The online training program effectively enhanced pediatricians' understanding of diagnosing and treating MPP. It is recommended to maintain continuous education and training targeting all healthcare providers.

Telemedicine Usability and Satisfaction among Pediatric Rheumatology Patients and their Caregivers during COVID-19 Pandemic.

The 2019 coronavirus disease pandemic opened an opportunity to explore the role of telemedicine in pediatric rheumatology clinic as well as patient satisfaction with virtual visits. To determine the usability and satisfaction rate of telemedicine among pediatric rheumatology patients and their caregivers. A cross-sectional online survey was conducted among patients and caregivers consulting via telemedicine at a pediatric rheumatology clinic of University of the Philippines - Philippine General Hospital (UP - PGH), a tertiary government hospital. Collected data included socio-demographics and the validated Telehealth Usability Questionnaire (TUQ). There were 39 (55.7%) patients and 31 (44.3%) primary caregivers included in the study. Across all usability factors, the response of primary caregivers did not significantly differ from those of patients. The average scores across all questions for both patients and primary caregivers were 5.96±1.19 and 6.04±1.34, respectively. This showed a high level of agreement that they were highly satisfied with telemedicine experience. Among the different usability factors, questions related to usefulness obtained the highest mean score for both patients (6.11±1.17) and primary caregivers (6.12±1.38). While the lowest mean score was observed on questions related to reliability, 5.65±1.33 for patients and 5.89±1.31 for primary caregivers. Pediatric rheumatology patients as well as their caregivers are generally highly satisfied with telemedicine during this time of pandemic. With high patient and caregiver satisfaction, telemedicine could be an option for ambulatory patient care even after pandemic.

Evaluation of neuroimaging findings in children who admitted to pediatric emergency clinic with acute neurologic complaints

Aim: Acute neurological complaints are one of the reasons why children present to pediatric emergency departments. Neuro-imaging techniques gain more importance in children since physical examination and anamnesis do not provide sufficient information due to insufficient cooperation. We aimed to determine the distribution of patients who applied to the pediatric emergency department with non-traumatic acute neurological complaints and underwent neu-roimaging, and the clinical benefit of neuroimaging in these patients. Methods: The information and records of the patients who applied to the Konya City Hospital Pediatric Emergency Clinic between January 1 and October 1, 2022, due to acute neurological complaints and underwent neuroimaging were retrieved and analyzed retrospectively. Acute neurological complaints of the patients were classified according to the International Classifi-cation of Diseases-10 diagnostic coding. Results: This study included 180 (50.5% male) patients. The median age of the patients was 120 (interquartile range: 45-180) months. Afebrile convulsion was the most common reason for admission in 69 patients (38.3%). Cranial computed tomography (CCT) was performed in all 180 patients. Of the patients, 68 (37.8%) only underwent CCT scan, while 90 (50%) had diffusion magnetic resonance imaging (MRI), 20 (11.1%) had brain+diffusion MRI, and 2 (1.1%) had brain+diffusion+spinal MRI. Neuroimaging abnormalities were statistically higher in patients with abnormal physical examination findings than in patients with normal physical examination findings (p&lt;0.001). Conclusion: Neuroimaging results are mostly normal even in the presence of symptoms such as seizures, headaches, and impaired consciousness. Therefore, neuroimaging should be planned by considering not only the acute neurological complaint on admission but also the physical examination findings.

Streptococcus pneumoniae among the children of Aden, Yemen: a cross-sectional report of post-pneumococcal conjugate vaccine.

Streptococcus pneumoniae cause a significant global health challenge. We aimed to determine nasopharyngeal carriage, serotypes distribution, and antimicrobial profile of pneumococci among the children of Aden. A total of 385 children, aged 2-17 years, were included. Asymptomatic samples were randomly collected from children in selected schools and vaccination centers. Symptomatic samples were obtained from selected pediatric clinics. The nasopharyngeal swabs were tested for pneumococci using culture and real time polymerase chain reaction (RT-PCR). Serotyping was done with a pneumotest-latex kit and antimicrobial susceptibility was tested by disc diffusion and Epsilometer test. The total pneumococcal carriage was 44.4% and 57.1% by culture and RT-PCR, respectively. There was a statistically significant association between carriage rate and living in single room (OR = 7.9; p = 0.00001), sharing a sleeping space (OR = 15.1; p = 0.00001), and low monthly income (OR = 2.02; p = 0.007). The common serotypes were 19, 1, 4, 5, 2, and 23. The proportion of non-pneumococcal conjugate vaccine (non-PCV13) serotypes was 24%. Pneumococci were resistant to penicillin (96.5%), cefepime (15.8%), ceftriaxone (16.4%), and amoxicillin-clavulanate (0%). Erythromycin, azithromycin, and doxycycline had resistance rates of 48%, 31%, and 53.3%, respectively. A high pneumococcal carriage rate was observed in Yemeni children, particularly in low-income households and shared living conditions. There was significant penicillin resistance at meningitis breakpoint. Furthermore, non-PCV13 serotypes were gradually replacing PCV13 serotypes. The findings underscore the urgent need for enhanced surveillance and stewardship to improve vaccination and antibiotic policies in Yemen.

Maternal care utilization and provision during the COVID-19 pandemic: Voices from minoritized pregnant and postpartum women and maternal care providers in Deep South.

The COVID-19 pandemic has significantly affected maternal care services especially for minoritized individuals, creating challenges for both service users (i.e., African American and Hispanic pregnant/postpartum women) and maternal care providers (MCPs). Guided by a socioecological framework, this study aims to investigate the experiences of African American and Hispanic pregnant and postpartum women, as well as MCPs, in accessing and providing maternal care services during the COVID-19 pandemic in the Deep South. We conducted semi-structured interviews with 19 African American women, 20 Hispanic women, and 9 MCPs between January and August 2022. Participants were recruited from Obstetrics and Gynecology clinics, pediatric clinics, and community health organizations in South Carolina, and all births took place in 2021. Interview transcripts were analyzed thematically. Maternal care utilization and provision were influenced by various factors at different socioecological levels. At the intrapersonal level, women's personal beliefs, fears, concerns, and stress related to COVID-19 had negative impacts on their experiences. Some women resorted to substance use as a coping strategy or home remedy for pregnancy-induced symptoms. At the interpersonal level, family and social networks played a crucial role in accessing care, and the discontinuation of group-based prenatal care had negative consequences. Participants reported a desire for support groups to alleviate the pressures of pregnancy and provide a platform for shared experiences. Language barriers were identified as an obstacle for Hispanic participants. Community-level impacts, such as availability and access to doulas and community health workers, provided essential information and support, but limitations in accessing doula support and implicit bias were also identified. At the institutional level, mandatory pre-admission COVID-19 testing, visitation restrictions, and reduced patient-MCP interactions were women's common concerns. Short staffing and inadequate care due to the impact of COVID-19 on the health care workforce were reported, along with anxiety among MCPs about personal protective equipment availability. MCPs emphasized the quality of care was maintained, with changes primarily attributed to safety protocols rather than a decline in care quality. The pandemic has disrupted maternal care services. To overcome these issues, health facilities should integrate community resources, adopt telehealth, and develop culturally tailored education programs for pregnant and postpartum women. Supporting MCPs with resources will enhance the quality of care and address health disparities in African American and Hispanic women.

Checkpoint inhibitor immunotherapy induced inflammatory arthritis secondary to Nivolumab and Ipilimumab: a pediatric first

BackgroundImmune checkpoint inhibitors (ICIs) have expanded the arsenal of cancer therapeutics over the last decade but are associated with a spectrum of immune-related adverse events (irAEs), including inflammatory arthritis. While these complications are increasingly recognized in the adult population, no cases of inflammatory arthritis irAEs have been reported in the pediatric literature.Case PresentationA 14-year-old female with metastatic epithelioid mesothelioma was referred to the pediatric rheumatology clinic after developing progressive inflammatory joint pain in her bilateral shoulders, hips, and small joints of hands following the second cycle of Nivolumab and Ipilimumab. Initial examinations showed bilateral shoulder joint line tenderness, positive FABERs test bilaterally, tenderness over bilateral greater trochanters, and bilateral second PIP effusions. Her serological profile was notable for positive HLA-B27, positive anti-CCP, negative Rheumatoid Factor, and negative ANA. PET-CT scan performed for disease response following immunotherapy showed symmetric increased metabolic activity primarily involving the supraspinatus, gluteus medius and minimus, and semimembranosus tendon insertions. Her presentation was consistent with a grade 1 irAE that worsened to a grade 2 irAE despite NSAID therapy, prompting a short course of oral prednisolone. She achieved clinical remission of her mesothelioma following six cycles of Nivolumab and Ipilimumab and her inflammatory arthritis was controlled on Celebrex monotherapy.ConclusionsTo our knowledge, this is the first pediatric case of ICI-induced inflammatory arthritis and enthesitis. This case highlights the importance of increasing awareness of diagnosis and management of irAEs in children.

Feasibility and acceptability of a community health worker administered behavioral activation intervention for postpartum depression: a single arm pilot study from India.

Women in India experience high rates of postpartum depression (PPD), with minimal availability of screening or treatment. India has an extensive network of community health workers, known as accredited social health activists (ASHAs). While they are knowledgeable about most maternal-child health problems, they have minimal knowledge about PPD. We trained ASHAs to deliver a simple home-based intervention, behavioral activation (BA), which involves individuals in activities that are sources of positive reinforcement to counter depression. The research questions guiding this study were as follows: 1) What are the feasibility and acceptability of ASHAs screening for and delivering a brief behavioral activation intervention addressing PPD among women in Belagavi, South India? 2) What impact did the brief behavioral activation intervention have on PPD? The mixed methods evaluation used interviews with participants and interventionists, and depression scores were assessed before and after the evaluation. After a 2-day training with 17 ASHAs that focused on understanding PPD, screening using the Edinburgh Postnatal Depression Scale (EPDS), and implementing the BA protocol, ASHAs and researcher supervisors screened the mothers 6-12 weeks postpartum presenting at pediatric immunization clinics. Mothers who screened positive were invited to participate in an ASHA-led 5-week BA intervention, with ASHAs visiting the mothers' homes. We assessed post-intervention EPDS scores and conducted satisfaction assessments and individual interviews. All 26 women who screened positive on the EPDS agreed to be enrolled in the study. All participants had a significant reduction (p < 0.001) in PPD scores. Both ASHAs and mothers had high enthusiasm for the intervention methods and activities. This ASHA-delivered BA intervention was found to be feasible, acceptable, and effective in treating PPD in rural Indian mothers. This corroborates literature that demonstrates the efficacy of a BA intervention among individuals with generalized depression in South Asia. In communities with minimal mental health resources, interventions led by trained community workers have the potential to address PPD.

Shared Reading of the Families With the Children With Chronic Disease.

The aim of the study is to evaluate shared reading of families of children with chronic diseases. The mothers of children aged 2 to 6 years with chronic health problems who applied to the pediatric outpatient clinic between January and May 2022 were the study group, and the mothers of children with an acute health problem were the control group. The sociodemographic information form and "Child-Parent Shared Reading Activities Scale" were applied. At the end of the interview, 3 questions about shared reading were asked. A total of 187 children were enrolled in the study: 92 and 95 in the chronic disease group and control group, respectively. 57.6% of mothers of chronically ill children reported that the parents almost never did shared reading with their child. It was found that all mothers knew the importance of reading, but they could not support especially in the risky chronic disease group.

Pediatric tympanostomy tube assessment via deep learning

PurposeTympanostomy tube (TT) placement is the most frequently performed ambulatory surgery in children under 15. After the procedure it is recommended that patients follow up regularly for “tube checks” until TT extrusion. Such visits incur direct and indirect costs to families in the form of days off from work, copays, and travel expenses. This pilot study aims to compare the efficacy of tympanic membrane (TM) evaluation by an artificial intelligence algorithm with that of clinical staff for determining presence or absence of a tympanostomy tube within the TM. MethodsUsing a digital otoscope, we performed a prospective study in children (ages 10 months–10 years) with a history of TTs who were being seen for follow up in a pediatric otolaryngology clinic. A smartphone otoscope was used by study personnel who were not physicians to take ear exam images, then through conventional otoscopic exam, ears were assessed by a clinician for tubes being in place or tubes having extruded from the TM. We trained and tested a deep learning (artificial intelligence) algorithm to assess the images and compared that with the clinician's assessment. ResultsA total of 123 images were obtained from 28 subjects. The algorithm classified images as TM with or without tube in place. Overall classification accuracy was 97.7 %. Recall and precision were 100 % and 96 %, respectively, for TM without a tube present, and 95 % and 100 %, respectively, for TM with a tube in place. DiscussionThis is a promising deep learning algorithm for classifying ear tube presence in the TM utilizing images obtained in awake children using an over-the-counter otoscope available to the lay population. We are continuing enrollment, with the goal of building an algorithm to assess tube patency and extrusion.

Abuse and Neglect of Children With Specific Learning Disorders in Türkiye: A Case-Control Study.

Although it is often stated that children with special needs are at risk of being abused and neglected, research conducted on the abuse of children with specific learning disorders (SLDs) is limited. This case-control study aims to compare exposure to neglect and abuse among children diagnosed with SLDs (case group) and children with typical development (control group). The study included children aged 6 to 12 years who were referred to the Child and Adolescent Psychiatry Outpatient Clinic and Pediatric Clinic of a hospital in Türkiye. The data collection process included 196 participants and lasted for 7 months in 2020. Based on the analysis of the data collected with the Schedule for Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime Turkish Version (K-SADS-PL-T) and the Abuse Assessment Questionnaire, we determined that children with SLDs were physically and emotionally abused more than the children of the control group. In addition, they witnessed violence between their parents more than the control group. Physical abuse, emotional abuse and witnessing family violence were identified as significant predictors for SLD. The presence of SLDs is a significant risk factor for children to be exposed to abuse even in the absence of ADHD as a comorbidity.

Immune Responses in Children Infected with Streptoccocus A during the Spring 2023 Epidemic in Bulgaria

Streptococcus pyogenes, Group A Streptococcus (GAS), is the most common cause of bacterial tonsillitis, scarlet fever, impetigo, etc. in children and adults. Innate and adaptive host immune responses are fundamental for human defence against GAS, but are also important to the clinical manifestations of the infection. Our aim was to study the humoral and cellular immune responses in children infected with GAS and diagnosed with tonsillitis in the Clinic of Pediatrics in University Hospital “Lozenets”. The study included 22 infected children and 20 healthy controls. The following immune parameters were investigated: i) Humoral immune response – total serum IgG, IgM, IgA; C3, C4 – complement components, as well as the serum cytokines IFNγ, IL-6, IL-1β, TNFα, IL-17A, IL-10. ii) Cellular immune subsets were tested by immunophenotyping of total T cells, B cells, NK cells, T helper and T cytotoxic subsets. In this cross-sectional study we found a significant increase in the complement components C3 and C4, increased production of serum IFNγ, IL-6 and IL-10 and decreased levels of IL-17A in infected children with tonsillitis, compared to healthy controls. The cellular immune parameters in infected children showed lymphopenia, reduced total T lymphocytes and T-helper subpopulation, compared to healthy controls. We assumed that these imbalanced immune responses, found in infected children, are connected with GAS infection and deserved more detailed investigation.

Philadelphia Latine Immigrant Birthing People's Perspectives on Mitigating the Chilling Effect on Prenatal Care Utilization.

Community-engaged qualitative study using inductive thematic analysis of semistructured interviews. To understand Latine immigrants' recent prenatal care experiences and develop community-informed strategies to mitigate policy-related chilling effects on prenatal care utilization. Decreased health care utilization among immigrants due to punitive immigration policies (ie, the "chilling effect") has been well-documented among Latine birthing people both pre and postnatally. Currently or recently pregnant immigrant Latine people in greater Philadelphia were recruited from an obstetric clinic, 2 pediatric primary care clinics, and 2 community-based organization client pools. Thematic saturation was achieved with 24 people. Participants' pregnancy narratives and their perspectives on how health care providers and systems could make prenatal care feel safer and more comfortable for immigrants. Participants' recommendations for mitigating the chilling effect during the prenatal period included training prenatal health care providers to sensitively initiate discussions about immigrants' rights and reaffirm confidentiality around immigration status. Participants suggested that health care systems should expand sources of information for pregnant immigrants, either by partnering with community organizations to disseminate information or by increasing access to trusted individuals knowledgeable about immigrants' rights to health care. Participants also suggested training non-medical office staff in the use of interpreters. Immigrant Latine pregnant and birthing people in greater Philadelphia described ongoing fear and confusion regarding the utilization of prenatal care, as well as experiences of discrimination. Participants' suggestions for mitigating immigration-related chilling effects can be translated into potential policy and programmatic interventions which could be implemented locally and evaluated for broader applicability.

Anencephaly: A case report and the crucial role of folic acid supplementation and early diagnosis

Anencephaly is a congenital malformation caused by neural tube failure, which can be managed through folic acid intake during pregnancy. Diagnosis is typically prenatal, and termination of pregnancy is often recommended. A newborn born at Kolwezi paediatric clinic was born with a visible congenital malformation. The mother had a low socio-economic background and was 41 years old. An ultrasound scan revealed a progressing pregnancy at 30 weeks gestation with polyhydramnios. No antenatal care monitoring or folic acid prophylaxis was implemented during the periconceptional period and throughout the pregnancy. Anencephaly diagnosis was confirmed, and the newborn died five minutes post-birth. Preventive folic acid treatment has shown a decrease in neural tube defects, and first-trimester ultrasound scans can help identify life-incompatible congenital malformations. Advocating for legislative measures and genetic counselling is crucial to educate parents on recurrence risks and the advantages of folic acid supplementation before subsequent pregnancies.