Pediatric Disease Research Articles

Genetic Treatment Approaches in Rare Pediatric Diseases

Gene and cell therapies have been developed and approved for a growing number of pediatric diseases, with ongoing research for additional treatments. Each therapy is tailored to the specific disease and targets a specific genetic alteration or cell population. The development of new therapies is a complex and regulated process, with strict oversight at regional and European levels. Research begins in the laboratory and progresses through clinical trials to ensure safety and efficacy. Scientists are exploring novel therapies using human cells and tissues to model pediatric diseases. Clinical trials are conducted to evaluate the effectiveness of these therapies, and researchers are also investigating repurposing approved treatments for other diseases or aspects of the same disease.

Knowledge, confidence and clinical reasoning of dental students for diagnosing pediatric periodontal diseases

ObjectiveGiven the importance of diagnosing periodontal diseases in pediatric patients, the objective of this study was to examine knowledge, confidence, and clinical reasoning of third- and fourth-year dental students regarding periodontal diagnosis and treatment planning in pediatric patients. MethodsAn explanatory sequential mixed-method study was conducted in two phases. In the first phase, the survey questions were administered online to the third-and fourth-year dental students. Surveys tested for knowledge, confidence and clinical decision-making using questions and case-studies. Answers from periodontists and the pediatric dentists were used as the gold standard. For the next phase, individual interviews were recorded, transcribed, and coded followed by verbal analysis to assess their clinical reasoning for the specific diagnosis and treatment planning. ResultsWhile there was no overall difference in the knowledge and the confidence level between the students, they differed from the experts for some questions in confidence levels. As measured using the Script Concordance Test (SCT), no significant differences were observed between the participants in their clinical reasoning. The verbal analysis of the interview data showed that the students used three different patterns for searching through the problem space. Most of the students used the forward pattern of search and reported low confidence in diagnosing and treating pediatric periodontal diseases. ConclusionDue to low self-reported confidence in diagnosing periodontal disease in pediatric patients. Providing education solutions will improve the confidence of undergraduate dental students in diagnosing and treating periodontal disease.

Plastic compounds and liver diseases in pediatrics: Navigating the hazards

Plastic compounds and liver diseases in pediatrics: Navigating the hazards

Social determinants of health and quality of life in children with chronic kidney disease: insights from Saudi Arabia

BackgroundSocial determinants of health (SDoH) are increasingly recognized as crucial factors affecting the well-being of pediatric chronic kidney disease (CKD) patients. This study explores the impact of SDoH on the quality of life (QoL) of children with CKD in Saudi Arabia.MethodsThis observational, descriptive, cross-sectional study included 50 participants with CKD stages three to five, as well as children with end-stage renal disease (ESRD) undergoing peritoneal dialysis (PD) or hemodialysis (HD) in Riyadh, Saudi Arabia. Data were collected from children and their caregivers using a validated Arabic-adapted version of the Pediatric Quality of Life Inventory (PedsQL) 3.0 and an SDoH survey.ResultsThe study revealed that access to education significantly affects pediatric QoL (H/Z score 2.825; P-value 0.005), and the lack of dietary recommendations was identified as a critical factor (H/Z score 1.441; P-value 0.029). ESRD patients on PD from larger families reported better QoL, whereas lower family income was associated with reduced QoL in PD patients (P-value 0.048). Compared to those in earlier stages of CKD, ESRD patients showed lower QoL (H/Z score 2.154; P-value 0.031).ConclusionOur study provides initial insights into the relationship between SDoH and the QoL of children with CKD in Saudi Arabia. It calls for a comprehensive approach that includes these determinants in care strategies to improve patient outcomes and QoL.

Nutritional status of HIV-infected children at Federal University Teaching Hospital, Owerri, Nigeria: A prospective analysis of rural and urban dwellers.

Malnutrition is a critical concern among children living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), particularly in regions heavily affected by the HIV epidemic, such as sub-Saharan Africa. In 2019, nearly 2.84 million children under 19 years of age were living with HIV globally, with over 90% residing in sub-Saharan Africa. Concurrently, malnutrition remains prevalent in the region, with approximately 49 million children under the age of 5 experiencing stunting and 149 million suffering from wasting in 2018. This burden of malnutrition is exacerbated by factors such as poverty, food insecurity, and HIV/AIDS, which collectively contribute to adverse health outcomes among affected children. The bidirectional relationship between HIV/AIDS and malnutrition is well-established, with HIV infection increasing the risk of malnutrition and malnutrition worsening the progression of HIV/AIDS. Studies have consistently demonstrated higher rates of stunting, underweight, and wasting among HIV-infected children compared to their uninfected counterparts. Moreover, malnutrition significantly impacts the disease progression, morbidity, and mortality of HIV-infected individuals, further underscoring the importance of addressing this issue in pediatric HIV care. A total of 99 HIV-infected children, aged 2 to 16 years, were consecutively recruited from the pediatric infectious disease clinic of the Federal University Teaching Hospital Owerri. Anthropometric measurements, including weight and height, were obtained using a stadiometer (RGZ-160 England). Weight status was categorized as normal, underweight, overweight, or obese, while height status was classified as stunted, normal, or tall stature. The study participants ranged in age from 2 to 16 years. Approximately 20.2% of the children were underweight, and 6.1% were classified as obese. Stunting was observed in 29.3% of the participants. Notably, all forms of malnutrition, including underweight and overweight, were more prevalent among children residing in rural areas. In addition, stunting was more common among rural dwellers. This study highlights the high prevalence of malnutrition among HIV-infected children attending the pediatric infectious disease clinic at the Federal University Teaching Hospital Owerri. The findings underscore the urgent need for targeted nutritional interventions, particularly in rural areas, to improve the health outcomes of HIV-infected children.

The role of reticulocyte hemoglobin equivalent on the evaluation of iron deficiency and iron deficiency anemia in pediatric cyanotic heart disease: a diagnostic study in Indonesia

BackgroundIn light of prolonged hypoxia, children with cyanotic heart disase (CHD) are at a high risk of developing iron deficiency iron deficiency (ID) and iron deficiency anemia (IDA). Reticulocyte hemoglobin equivalent (Ret-He) is a novel and dependable indicator for assessing iron status. However, there has been no previous study regarding cut-off value in pediatric CHD group. The purpose of this study is to assess the role of Ret-He and to establish cut-off points in the diagnosis of iron deficiency and IDA in pediatric cyanotic heart disease.MethodThis study was conducted in two tertiary hospitals in Jakarta, Indonesia. 59 children with CHD, aged 3 months to 18 years, were enrolled consecutively. To determine iron status, hematological parameters (hemoglobin, hematocrit, mean corpuscular volume, mean corpuscular hemoglobin) and biochemical parameters for iron status (serum ferritin, transferrin saturation) were analysed and compared to Ret-He levels. The receiver operating characteristic (ROC) analysis was performed for the Ret-He cut-off points for ID and IDA. Sensitivity, specificity, positive and negative predictive value were calculated for each cut-off point.ResultNormal iron status was identified in 27 (45.8%) subjects, ID in 8 (13.5%) subjects, and IDA 24 (40.7%) subjects. The ID cut-off value for Ret-He is 28.8 pg (sensitivity 75%, specificity 85.2%, PPV 60%, NPV 92%, and AUC 0.828) and the Ret-He cut-off point for IDA is 28.15 pg (sensitivity 75%, specificity 88.9%, PPV 85.7%, NPV 80%, and AUC 0.824). Hemoglobin should be used in conjunction with Ret-He. ID might be detected in this cohort with Ret-He 28.8 pg and hemoglobin > 16,5 g/dL. While Ret-He 28.15 pg or Ret-He 28.15–28.8 pg with hemoglobin 16.5 g/dL could be used to diagnose IDA.ConclusionThe reticulocyte hemolgobin equivalent could be utilised as an iron status parameter in pediatric CHD, with a cut-off value of 28.8 pg for ID and 28.15 pg for IDA.

The effects of intraoperative use of blue dyes in pediatric pilonidal sinus disease—a retrospective exploratory cohort study

BackgroundIntraoperative use of methylene blue has been shown to reduce postoperative complications and recurrence rates in adults. It has however not been assessed if these beneficial effects would also apply to pediatric pilonidal sinus disease with its high recurrence rates. We, therefore, aimed to assess its effects on complications and recurrences in our retrospective exploratory cohort study.MethodsOf 55 consecutive children treated in our centre between January 2009 and December 2020, 48 were retrospectively included. We used logistic regression with a priori chosen predictors of intraoperative use of blue dyes, previous surgery for pilonidal sinus disease, and the presence of comorbidities on the composite outcome of complications and recurrence. Cramér’s V was used to explore associations between the use of blue dyes and the extent of resection.ResultsThe median age in our cohort was 15.3 years. Five patients were below 2 years of age, and 24 (50%) of them were males. Chronic diseases were present in 13 (27%) patients, eight had previously been operated on for pilonidal sinus disease, and blue dyes were used in 34 patients (71%). Their intraoperative use was linked to the composite outcome with an odds ratio of 5.41 (95% confidence interval (CI) 1.52–25.34, P = 0.017) as were comorbidities with an odds ratio of 1.86 (95% CI 1.18–3.25, P = 0.014), but not re-do surgery (odds ratio 2.94 (95% CI 0.37 23.42, P = 0.3)). The use of blue dyes was associated with larger resections (Cramér’s V 0.556 (95% CI 0.329–0.74)).ConclusionThe intraoperative use of blue dyes was negatively associated with complications and recurrences in pediatric pilonidal sinus disease. However, if blue dyes were used, the extent of resection was also larger. Larger resections had been shown before to be associated with complications and recurrences, too. This potential interaction requires further elucidation in future studies.

Efficacy of steroid therapy for improving native liver survival after pediatric acute liver failure with immune activation.

Recent evidence suggests that acute liver failure (ALF) in some patients may reflect a dysregulated immune response, and that corticosteroids improve survival of the native liver in ALF patients with high serum alanine aminotransferase levels, which are an indication of liver inflammation. However, it is unclear whether steroids are effective for pediatric acute liver failure (PALF). The aim of this retrospective case-control study is to examine whether steroid therapy for PALF accompanied by immune activation improves the survival of native liver and to identify factors that predict responses to steroid treatment. Of 38 patients with PALF treated at Kyoto University Hospital from February 2006 to August 2022, 19 receiving steroids who met the specific criteria for identifying the pathophysiology of immune activity in the liver (the "Steroid group"), and seven steroid-free patients who also met the criteria ("Nonsteroid group") were enrolled. Patients in the "Steroid group" were categorized as "responders" or "nonresponders" according to treatment outcome. Clinical and histological data were analyzed. Survival of the native liver in the Steroid group was significantly higher than that in the Nonsteroid group (68% vs. 0%, respectively; p=0.0052). Nonresponders were significantly younger, with higher Model for End-stage Liver Disease and pediatric end-stage liver disease scores, higher prothrombin time - international normalized ratio, and higher serum ferritin levels than responders. Massive hepatic necrosis was more common in nonresponders. Steroid therapy is effective for PALF patients with liver inflammation; however, liver transplantation should be prioritized for young children with ALF accompanied by severe coagulopathy or massive hepatic necrosis.

Copeptin as a diagnostic and prognostic biomarker in pediatric diseases.

Arginine vasopressin (AVP) plays a main role in maintaining the homeostasis of fluid balance and vascular tone and in regulating the endocrine stress response in response to osmotic, hemodynamic and stress stimuli. However, the difficulty in measuring AVP limits its clinical application. Copeptin, the C-terminal part of the AVP precursor, is released in an equimolar concentration mode with AVP from the pituitary but is more stable and simple to measure. Therefore, copeptin has emerged as a promising surrogate marker of AVP with excellent potential for the diagnosis, differentiation and prognosis of various diseases in recent decades. However, its application requires further validation, especially in the pediatric population. This review focuses on the clinical value of copeptin in different pediatric diseases and the prospects for its application as a potential biomarker.

The reporting of social determinants of health in pediatric dermatology clinical trials: a systematic review.

Despite the acknowledgment of the importance of social determinants of health (SDOH) on clinical outcomes, few clinical trials provide information about SDOH. Including these markers in pediatric dermatologic clinical trials may lead to improved care and novel observations about the disease. Using a systematic review, assess the use of SDOH in pediatric dermatology clinical trials. CINAHL Plus, Cochrane: CENTRAL, Embase, PubMed, and Scopus were searched. English language randomized controlled trials about pediatric dermatology diseases published from January 2011 to May 2022 were included. Two authors independently screened all records using Covidence at 2 levels. Two authors independently collected data using Covidence and Microsoft Excel and assessed study quality. A protocol was registered at Open Science Framework: https://doi.org/10.17605/OSF.IO/B93VY. A total of 6463 records were retrieved and 4298 were screened at title/abstract. Next, 1738 records were screened at full text and 1085 were included. Of these, 119 reported an SDOH factor for a pediatric dermatology disease. Income or socioeconomic status was the factor most reported followed by social support, location, and health insurance. Most of the studies were conducted outside of the United States. There are a limited number of dermatology clinical trials that include a pediatric population. Despite including over 1000 pediatric dermatology clinical trials, only 119 used SDOH. Pediatric dermatology researchers must prioritize including and reporting additional SDOH in clinical trials if the goal is to impact and improve clinical care and innovate for diverse populations of patients.

Hepatoblastoma: A Case Report

Hepatoblastoma is a rare type of pediatric malignant disease and represents the most frequent cause of liver tumors during childhood. We describe the diagnosis and treatment of a 14-month-old female patient who presented with abdominal swelling, anorexia, and weight loss. Initial investigations indicated elevated alpha-fetoprotein levels and thrombocytosis. A CT scan showed a heterogeneous mass arising in the right lobe of the liver. Histology revealed hepatoblastoma, epithelial type, and fetal pattern. The patient was treated as a standard risk according to the Pretext classification (Pretext I-III) with neoadjuvant Cisplatin (4 cycles) following the SIOPEL 3 protocol, resulting in a 40% reduction in tumor size and a successful partial hepatectomy.

Socioeconomic Status and Access to Care for Pediatric and Adult Congenital Heart Disease in Universal Health Coverage Models.

Congenital heart disease (CHD) is the most common major congenital anomaly, affecting one in every 100 live births. Whereas over 90% of children born with CHD in low- and middle-income countries cannot access the care they need, early detection, advances in management, and financial risk protection have resulted in over 90% of children with CHD in high-income countries surviving into adulthood. Despite the presence of universal health coverage, barriers to accessing high-quality cardiovascular and non-cardiovascular care for CHD remain common. Lower socioeconomic status has been associated with differential access to cardiac care and poorer outcomes across multiple cardiovascular conditions and subspecialties. In this review article, we describe the relationship between socioeconomic status and access to CHD care in countries with universal health coverage models. We further evaluate notable challenges and opportunities to improve equitable, high-quality CHD care in these countries.

Getting the Dose Right in Drug Development for Rare Diseases: Barriers and Enablers.

In the relentless pursuit of optimizing drug development, the intricate process of determining the ideal dosage unfolds. This involves "dose-finding" studies, crucial for providing insights into subsequent registration trials. However, the challenges intensify when tackling rare diseases. The complexity arises from poorly understood pathophysiologies, scarcity of appropriate animal models, and limited natural history understanding. The inherent heterogeneity, coupled with challenges in defining clinical end points, poses substantial challenges, hindering the utility of available data. The small affected population, low disease awareness, and restricted healthcare access compound the difficulty in conducting dose-finding studies. This white paper delves into critical dose selection aspects, focusing on key therapeutic areas, such as oncology, neurology, hepatology, metabolic rare diseases. It also explores dose selection challenges posed by pediatric rare diseases as well as novel modalities, including enzyme replacement therapies, cell and gene therapies, and oligonucleotides. Several examples emphasize the pivotal role of clinical pharmacology in navigating the complexities associated with these diseases and emerging treatment modalities.

A retrospective study investigating the risk of graft loss in living donor liver transplant cases where size mismatching is predicted from graft-to-recipient weight ratio.

Living donor liver transplantation (LDLT) is vital for pediatric end-stage liver disease due to organ shortages. The graft-to-recipient weight ratio (GRWR) preoperatively measured predicts the outcomes of LDLT. We typically target between 0.8 and 3.0-4.0%, but the ideal GRWR remains controversial. We compared the outcomes of LDLT according to the GRWR to examine whether the criteria could be expanded while ensuring safety. We retrospectively reviewed 99 patients who underwent LDLT in our department by dividing them into three groups according to their GRWR: Group S, with GRWR values lower than the normal range (GRWR < 0.8%); Group M, with GRWR values in the normal range (GRWR ≥ 0.8 to < 3.5%); and Group L, with GRWR values above the normal range (GRWR ≥ 3.5%). In Groups S and L, 46.2 and 44.4% of patients underwent splenectomy and delayed abdominal wall closure, respectively. After these intraoperative adjustments, there were no significant differences between the groups in 5-year patient survival, 5-year graft survival, or the occurrence of post-transplantation thrombosis. When the GRWR is beyond the normal threshold, the risk of complications associated with graft size might be reduced by adjustments to provide appropriate portal blood flow and by delayed abdominal wall closure.

Pediatric Rare Diseases Development in the Pharmaceutical Industry: An International Consortium for Innovation and Quality in Pharmaceutical Development, Clinical Pharmacology Leadership Group-Pediatrics Working Group, Rare Diseases Subteam Whitepaper Examining the Current Landscape and Recommendations for the Future.

Many new opportunities surround rare pediatric disease drug development, thanks to key advances in regulatory thinking and in the scientific community. As rare disease drug development brings challenges to the developers in terms of limited understanding of natural history, heterogeneity in drug response, as well as difficulty recruiting patients in pivotal trials, there has never been a greater need for quantitative integration. To understand how International Consortium for Innovation and Quality in Pharmaceutical Development (IQ) member companies approach pediatric rare disease drug development, the rare pediatric subteam of the Clinical Pharmacology Leadership Group (CPLG) sponsored Pediatrics Working Group conducted a baseline survey to assess the four main pillars of this quantitative innovation, namely, biomarkers and surrogate end points, statistical methodologies, model-informed drug development, as well as public-private partnerships. The survey was administered by IQ and yielded 13 evaluable responders from represented companies. This article presents the key findings from this baseline identifying survey, highlighting the key blind spots, and providing insightful expert opinions to address those gaps. In summary, we call an urgent attention to the community on the opportunities to enhance integration and within-industry learnings from this analysis on aspects related to platform studies, end-to-end quantitative integration, and sharing of trial-level placebo data for better understanding of disease progression and more efficient trial designs. We collectively hope that these findings will stimulate discussion and debate around cross-industry sharing and collaboration to better delineate principles and further enhance the efficiency of rare pediatric disease drug development.

Booster Vaccination with BNT162b2 Improves Cellular and Humoral Immune Response in the Pediatric Population Immunized with CoronaVac.

The SARS-CoV-2 Omicron variant and its sublineages continue to cause COVID-19-associated pediatric hospitalizations, severe disease, and death globally. BNT162b2 and CoronaVac are the main vaccines used in Chile. Much less is known about the Wuhan-Hu-1 strain-based vaccines in the pediatric population compared to adults. Given the worldwide need for booster vaccinations to stimulate the immune response against new Omicron variants of SARS-CoV-2, we characterized the humoral and cellular immune response against Omicron variant BA.1 in a pediatric cohort aged 10 to 16 years who received heterologous vaccination based on two doses of CoronaVac, two doses of CoronaVac (2x) plus one booster dose of BNT162b2 [CoronaVac(2x) + BNT162b2 (1x)], two doses of CoronaVac plus two booster doses of BNT162b2 [CoronaVac(2x) + BNT162b2 (2x)], and three doses of BNT162b2. We observed that the [CoronaVac(2x) + BNT162b2 (2x)] vaccination showed higher anti-S1 and neutralizing antibody titers and CD4 and CD8 T cell immunity specific to the Omicron variant compared to immunization with two doses of CoronaVac alone. Furthermore, from all groups tested, immunity against Omicron was highest in individuals who received three doses of BNT162b2. We conclude that booster vaccination with BNT162b2, compared to two doses of CoronaVac alone, induces a greater protective immunity.

Rapid and simultaneous detection of common childhood diarrhea viruses by microfluidic-FEN1-assisted isothermal amplification with ultra-high specificity and sensitivity

Rapid and accurate diagnostic methods are crucial for managing viral gastroenteritis in children, a leading cause of global childhood morbidity and mortality. This study introduces a novel microfluidic-Flap endonuclease 1 (FEN1)-assisted isothermal amplification (MFIA) method for simultaneously detecting major viral pathogens associated with childhood diarrhea—rotavirus, norovirus, and adenovirus. Leveraging the specificity-enhancing properties of FEN1 with a universal dspacer-modified flap probe and the adaptability of microfluidic technology, MFIA demonstrated an exceptional detection limit (5 copies/μL) and specificity in the simultaneous detection of common diarrhea pathogens in clinical samples. Our approach addresses the limitations of current diagnostic techniques by offering a rapid (turn around time <1 h), cost-effective, easy design steps (universal flap design), and excellent detection performance method suitable for multiple applications. The validation of MFIA against the gold-standard PCR method using 150 actual clinical samples showed no statistical difference in the detection performance of the two methods, positioning it as a potential detection tool in pediatric diagnostic virology and public health surveillance. In conclusion, the MFIA method promises to transform pediatric infectious disease diagnostics and contribute significantly to global health efforts combating viral gastroenteritis.

Schistosomiasis in migrant children and adolescents in a paediatric tropical referral unit in Spain: diagnosis and long-term management challenges

Globalisation and population movement have led to an increasing number of migrant children residing in areas non-endemic for schistosomiasis. However, diagnosing and managing schistosomiasis in children remain controversial. This study aims to investigate the prevalence of schistosomiasis in migrant children and to describe the diagnostic approach and management strategies, including long-term follow-up, to explore the potential role of serological tests in evaluating treatment response. We conducted a retrospective descriptive study spanning from January 2014–July 2021 at a referral unit for Paediatric Tropical Diseases in Madrid (Spain). The study included patients under 18 years diagnosed with schistosomiasis. Of 679 children screened for schistosomiasis, 73 (10.8%) tested positive. The median age was 16.3 years [IQR 9–17.6], 74% male. The majority originated from Sub-Saharan Africa (47%) and Asia (47%). Only 40% presented with symptoms, with gastrointestinal (18%) and cutaneous (17%) manifestations being the most common. Eosinophilia was observed in 43% (median [IQR]: 1103/mm3 [671–1536]), and ova were visualised in the urine of 2/50 (4.0%). Praziquantel treatment was administered to 92%, and 5 patients required retreatment. Follow-up data were available for 58 (80%) over a median period of 9 months [IQR 6–19.8], revealing a progressive decline in eosinophil count, IgE titres, and ELISA optical density. Conclusion: In this series, the prevalence of schistosomiasis among migrant children was significant (10%), highlighting the importance of including serological tests in migrant health screening. The disease is largely asymptomatic, eosinophilia is often absent, and visualisation of ova in urine is exceedingly rare. Eosinophil count, IgE titres, and ELISA optical density could prove valuable as an initial approach for monitoring inflammation during follow-up assessments.What is Known:• The burden of disease related to schistosomiasis is significant, particulary in children, and it is advisable to screen this vulnerable population.What is New:• Eosinophilia may not be present in parasitic infections, so serological tests are crucial for screening migrant children.• Serological monitoring facilitates long-term management of migrant children with schistosomiasis.

Reducing Hospital Length of Stay and Hepatic Artery Thrombosis Rates for Children Receiving a Liver Transplant: A Single-Center Experience From 2000 to 2021.

Pediatric liver transplantation is a very resource-intensive therapy. This study aimed to identify the changes made between two epochs of management and analyze their influence on length of stay (LOS). Data from a single center were obtained from the liver transplant and Pediatric Intensive Care Unit (PICU) databases for 336 transplants (282 children) performed between 2000 and 2021. Transplants were analyzed in two epochs, before and after July 2012, representing a change in postoperative anticoagulation management. Differences in graft recipient demographics and perioperative management factors were compared between epochs. Multivariate regression was performed to identify the complications that correlated most strongly with hospital LOS. There was a difference in hospital LOS between Epoch 1 (Median = 31.7 days) and Epoch 2 (Median = 26.3 days) (p < 0.001), but not in PICU LOS (E1 Median = 7.3 days, E2 Median = 7.4 days; p = 0.792). Epoch 2 saw increased use of split grafts (60.6% of total), decreased pediatric end-stage liver disease (PELD) score at transplant (Average = 16.7; p < 0.001), decreased invasive ventilation time (Average = 4.48 days; p < 0.001), and decreased hepatic artery thrombosis (HAT) rates (E1 = 14.4%, E2 = 4.3%; p < 0.001) without an associated increase in bleeding rates. Hospital LOS has reduced in Epoch 2 due to refinements in intraoperative and postoperative management. There is increased emphasis on early extubation and increased use of noninvasive ventilatory techniques in Epoch 2. Split grafts have effectively expanded our graft donor pool and reduced transplant waitlist times.

Plants used for the management of paediatric ailments in Zimbabwe: A narrative review

Background: Children are susceptible to various types of infections and diseases because of their low and weakened immune system. In various communities throughout the world, medicinal plants have historically been used to treat and manage paediatric diseases and ailments.Aim: The current study was aimed at identifying and analysing medicinal plants used traditionally to treat and manage paediatric diseases in Zimbabwe.Setting: This review provides an overview of medicinal plants used to manage paediatric ailments in Zimbabwe.Method: Ethnobotanical information on medicinal plants used to treat and manage paediatric diseases in Zimbabwe was obtained using online databases such as Scopus, JSTOR, PubMed, Google Scholar and Science Direct.Results: A total of 178 taxa belonging to 64 families have been documented as traditional medicines for paediatric diseases and ailments in Zimbabwe. Cryptolepis oblongifolia, Asparagus spp., Dichrostachys cinerea, Fadogia ancylantha, Inula glomerata, Lannea edulis and Strychnos spinosa are the most popular medicinal plants with four to five use reports each. Medicinal plants are used to treat and manage 41 childhood medical conditions in Zimbabwe.Conclusion: Baseline data provided in this study can be used for future ethnopharmacological research focusing on chemical, pharmacological and toxicological evaluations of the documented species.Contribution: This study contributes to the existing literature about medicinal plants used to treat and manage paediatric diseases, and such data can be used to develop new health-promoting products for children and also pharmaceutical products that can be used to reduce child or infant mortality rate.