Pediatric Hospital Research Articles

Explanatory capacity of measures of community context for paediatric injury hospitalisations in the USA

ObjectiveCommunity context influences children’s risk for injury. We aimed to measure the explanatory capacity of two ZIP code-level measures—the Child Opportunity Index V.3.0 (COI) and median household income (MHHI)—for rates...

Prevalence and Pattern of Neurological Disorders amongst Children Attending the Neurology Clinic of a Private Paediatric Hospital in Southern Nigeria

Aim: Neurologic disorders are a common cause of morbidity and disability in children worldwide. There is a dearth of knowledge of neurologic disorders in private health facilities thus this study was done to determine the prevalence and pattern of these disorders. Study Design: It was a retrospective study. Place and Duration of Study: This study was carried out in a private paediatric hospital in Southern Nigeria over 1-year between 1st January, 2023 and 31th December, 2023. Methodology: Data was extracted from the hospital’s health management system and analysed. Results: Of the 22,965 outpatient clinic visits during the study period, 203 had neurological disorders giving a prevalence rate of 0.9% with slight female predominance 107(52.7). Most common age group was 1 - < 5 years (43.4%). Single neurologic disorders predominated 123 (63.4%). Commonest neurological disorders were seizure disorder (54.6%), autism spectrum disorder (24.3%) and attention deficit hyperactive disorder (11.3%) with the commonest risk factors for neurologic disorders being severe perinatal asphyxia (42.1%) and severe neonatal jaundice (42.1%). There were significantly more males than females with seizure disorder (P value .013) whereas cerebral palsy was significantly more in females (P value .002). Seizure disorder and learning disorder were significantly more in children ³ 5years (P value of .001 & .030 respectively) whereas cerebral palsy and speech impairment were significantly more in children < 5years (P value of < .001 & .030 respectively). Conclusion: The prevalence of neurologic disorders was low, being 0.9% with children under 5 years being mostly affected. Commonest neurologic disorders were seizure disorder, autism spectrum disorder and attention deficit hyperactive disorder while perinatal asphyxia and neonatal jaundice were the commonest risk factors. Public enlightenment campaigns about neurologic disorders and the availability of care would improve the outcome of affected children.

Neuropsychiatric profile in tuberous sclerosis complex patients with epilepsy

BackgroundTuberous sclerosis complex (TSC) is an autosomal dominant disorder characterized by mutations in the TSC1 or TSC2 genes, leading to dysregulation of the mTOR pathway and multisystemic manifestations. Epilepsy is a common neurologic feature of TSC, frequently accompanied by neuropsychiatric comorbidities. Understanding the relationship between epilepsy severity, TSC-associated neuropsychiatric disorders (TAND), and cognitive outcomes is crucial for optimizing patient care.MethodsA retrospective study was conducted at a pediatric tertiary care hospital in Qatar, involving 38 TSC patients (20 female, 18 male) aged 1–18 years, diagnosed between October 2018 and March 2020. Epilepsy severity was assessed using the Early Childhood Epilepsy Severity Scale (E-Chess), and TAND was evaluated using the TAND checklist. Genetic analysis was performed for all patients, and statistical analyses were used to explore correlations between epilepsy severity, TAND, and cognitive outcomes.ResultsThe majority (82%) of TSC patients had epilepsy, with a mean onset age of 9.2 months. Uncontrolled seizures were associated with higher rates of intellectual disability and more pronounced TAND manifestations compared to controlled seizures. Autism spectrum disorder (ASD) was reported in 42% of the cohort, with significant correlations found between epilepsy severity and ASD-related domains on the TAND checklist. Intellectual disability was prevalent (67.6%), with variability attributed to genetic background and early severe neurological presentations.DiscussionThis study reinforces the link between epilepsy severity and neuropsychiatric comorbidities in TSC, confirming earlier findings. Significant correlations were observed between epilepsy severity and ASD-related domains, and the high prevalence of intellectual disability in TSC patients was highlighted. However, the relationship between ASD, TSC, and epilepsy remains complex and requires further investigation. Despite advances in treatment options, including mTOR inhibitors and newer antiepileptic drugs, unmet needs remain in the comprehensive care of TSC patients. Optimizing seizure control is a clear priority, but equally important is the need for addressing the cognitive and behavioral components of TAND. Early intervention with tailored, multidisciplinary approaches including neurology, psychiatry, psychology, and educational specialists could mitigate the long-term impact of these comorbidities, particularly in children. These approaches must be individualized to each patient's unique set of challenges, emphasizing not only seizure control but also psychosocial support and educational adaptation to improve their overall quality of life.ConclusionThis study sheds light on the intricate interactions between epilepsy severity, neuropsychiatric manifestations, and cognitive outcomes in TSC patients. The findings emphasize the need for tailored management approaches, focusing on early seizure control and comprehensive multidisciplinary care. Further research is required to clarify the mechanisms underlying these associations and to develop targeted interventions for improving the quality of life for individuals with TSC and epilepsy.

Clinical and Epidemiological Profile of Newborns with Gastroschisis Operated on in a Referral Hospital in Angola

Gastroschisis is a congenital malformation characterized by non-closure of the anterior abdominal wall, a paraumbilical defect usually to the right of the umbilical cord with externalization of the intestinal viscera. This study aims to analyze the clinical and epidemiological profiles of gastroschisis cases and examine associations between maternal and neonatal factors in a public referral hospital in Angola. This is an observational, descriptive cross-sectional hospital-based study conducted with the collection of information in 361 newborns medical records with gastroschisis treated at the David Bernardino Pediatric Hospital from January 1st, 2010 to July 15th, 2021. The variables that characterize the clinical, socioeconomic and demographic profile of 361 newborns (NB) with gastroschisis presented the following characteristics: 28% of mothers aged < 20 years; maternal mean age was 22,34+ 4.5 years, the occurrence of death was higher among NB of mothers aged 20 years corresponding to 96.5%, primiparous 127 (35.2%); without schooling 10 (2.8%), primary education 59 (16.3%), secondary education 43 (11.9%); out-of-hospital births 201 (55.7%); simple gastroschisis 326 (90.3%); primary closure 115 (31.9%); neonatal sepsis 145 (40.2%); mucosal skin pallor 70 (19.4%); gastroschisis-related mortality was 347 (96.1%). The clinical, socioeconomic and demographic profile of mothers and newborns with gastroschisis are widely studied and associated with well-known risk factors, including maternal age under 20 years, out-of-hospital delivery, low level of education, and reduction of the number of prenatal consultations as well as absence of prenatal diagnosis and multiparity.

The Invisible Weight of Caring for Our Caregivers: Perspectives From Pediatric Hospitalists.

The Invisible Weight of Caring for Our Caregivers: Perspectives From Pediatric Hospitalists.

Family Care-Giving for Pediatric Hospitalists: Invisible, Unspeakable, Unbearable Lightness.

Family Care-Giving for Pediatric Hospitalists: Invisible, Unspeakable, Unbearable Lightness.

Six-Month Outcomes in the Long-Term Outcomes After the Multisystem Inflammatory Syndrome in Children Study.

Multisystem inflammatory syndrome in children (MIS-C) is a life-threatening complication of COVID-19 infection. Data on midterm outcomes are limited. To characterize the frequency and time course of cardiac dysfunction (left ventricular ejection fraction [LVEF] <55%), coronary artery aneurysms (z score ≥2.5), and noncardiac involvement through 6 months after MIS-C. This cohort study enrolled participants between March 2020 and January 2022 with a follow-up period of 2 years. Participants were recruited from 32 North American pediatric hospitals, and all participants met the 2020 Centers for Disease Control and Prevention case definition of MIS-C. MIS-C after COVID-19 infection. Outcomes included echocardiography core laboratory (ECL) assessments of LVEF and maximum coronary artery z scores (zMax); data collection on cardiac and noncardiac sequelae during hospitalization and at 2 weeks, 6 weeks, and 6 months after discharge; and age-appropriate Patient-Reported Outcomes Measurement Information Systems (PROMIS) Global Health Instruments at follow-up. Descriptive statistics, linear regression models, and Kaplan-Meier analysis were used. Of 1204 participants (median [IQR] age, 9.1 [5.6-12.7] years; 724 male [60.1%]), 325 self-identified with non-Hispanic Black race (27.0%) and 324 with Hispanic ethnicity (26.9%). A total of 548 of 1195 participants (45.9%) required vasoactive support, 17 of 1195 (1.4%) required extracorporeal membrane oxygenation, and 3 (0.3%) died during hospitalization. Of participants with echocardiograms reviewed by the ECL (n = 349 due to budget constraints), 131 of 322 (42.3%) had LVEF less than 55% during hospitalization; of those with follow-up, all but 1 normalized by 6 months. Black race (vs other/unknown race), higher C-reactive protein level, and abnormal troponin level were associated with lowest LVEF (estimate [SE], -3.09 [0.98]; R2 = 0.14; P =.002). Fifteen participants had coronary artery z scores of 2.5 or greater at any time point; 1 participant had a large/giant aneurysm. Of the 13 participants with z scores of 2.5 or greater during hospitalization, 12 (92.3%) had normalized by 6 months. Return to greater than 90% of pre-MIS-C health status (energy, sleep, appetite, cognition, and mood) was reported by 711 of 824 participants (86.3%) at 2 weeks, increasing to 548 of 576 (95.1%) at 6 months. Fatigue was the most common symptom reported at 2 weeks (141 of 889 [15.9%]), falling to 3.4% (22 of 638) by 6 months. PROMIS Global Health parent/guardian proxy median T scores for fatigue, global health, and pain interference improved significantly from 2 weeks to 6 months (fatigue, 56.1 vs 48.9; global health, 48.8 vs 51.3; pain interference, 53.0 vs 43.3; P < .001) and by the 6-week visit were at least equivalent to prepandemic population norms. Results of this cohort study suggest that although children and young adults with MIS-C can have severe disease during the acute phase, most recovered quickly and had a reassuring midterm prognosis.

How Much Pain Medication Do Patients Require After Posterior Iliac Crest Bone Graft to the Alveolar Cleft?

The purpose of this study was to quantify analgesic use following alveolar cleft bone grafting (ABG) utilizing a posterior iliac crest (PIC) donor site. This is a prospective cohort study of consecutive patients that underwent ABG with PIC in a 10 month period from November 2022 to September 2023. Tertiary care free-standing pediatric hospital. Patients with cleft lip and alveolus with or without cleft of the secondary palate undergoing alveolar bone graft with cancellous marrow from the PIC. All patients underwent ABG and recorded analgesic use afterwards. The main outcome variable was total pain medication utilization during the first 10 postoperative days (PODs). 22 subjects (72.7% male, 54.5% Caucasian 72.7% unilateral and 27.3% bilateral clefts) recorded pain medication use. Total duration of analgesic use (any type) was 3.86 ± 1.7 postoperative days. 10 subjects (45.5%) did not use opioid medication postoperatively. The remaining 12 subjects (54.5%) used a median of 12 (0, 19) morphine milli-equivalents (MME), equal to 1.6 (0, 2.53) doses of 5 mg oxycodone. An average of 9.9 ± 5.6 doses of acetaminophen and 9.1 ± 4.7 doses of a non-steroidal anti-inflammatory drug (NSAID) were administered. No subject used opioids after POD3. Patients with unilateral clefts used more acetaminophen (p = 0.02); otherwise, there were no significant differences in outcomes based on any predictor variable (p > 0.05). Analgesic requirements after ABG with PIC were minimal, with nearly half of patients taking no postoperative opioids. As such, judicious opioid prescribing is prudent. .

Characteristics of pediatric patients with chronic cough: data from a pediatric immunology and allergy outpatient clinic

Aims: Chronic cough is a common complaint in childhood. A differential diagnosis is very important in children with a chronic cough. We aimed to investigate the etiology and underlying risk factors of chronic cough in children. Methods: Patients aged 1-18 years who were referred to Sincan Training and Research Hospital Pediatric Immunology and Allergy Outpatient Clinic were included. Demographic, clinical and laboratory features of patients were recorded. Results: The study included 403 children with a median age of 8 years (IQR 6-12) (53% males). 30% of patients had allergic rhinitis (AR), 4.7% of patients had atopic dermatitis (AD), and 2% patients had food allergy (FA) history. 78(19.3%) patients also complained of dyspnea and 9 (2.2%) patients had a diagnosis of cardiovascular disease. 245 (60.8%) asthma-wheezy infant, 107 (26.6%) post-infectious cough, 36 (9%) postnasal drip syndrome, 9 (2.2%) gastroesophageal reflux and 6 (1.5%) psychogenic cough were detected in the whole group. The number of patients with accompanying dyspnea 76 (28.5%) and familial history of atopy 113 (42.3%) were higher in the asthma-wheezy infant group than others group (p

The Uptake of the Influenza Vaccine in Patients With Cystic Fibrosis: A Retrospective Study.

Children with cystic fibrosis are more likely to become severely unwell with influenza-associated illness compared to children without chronic lung disease. The provision of accessible influenza vaccinations is essential in the prevention of infection. To describe the prevalence of the influenza vaccine uptake in children with cystic fibrosis from 2016 to 2020 at a single tertiary paediatric hospital site and determine if the COVID pandemic of 2020 and the introduction of telehealth encounters affected the vaccine uptake. A retrospective study of children with cystic fibrosis aged 6 months to 18 years who reside in South Australia was performed using the Women's and Children's Hospital (WCH) Respiratory Department cystic fibrosis database from 2016 to 2020. The Australian Immunisation Register (AIR) was used to determine vaccination status during this period. One hundred and eighty two children with cystic fibrosis were identified, one hundred and seventy two of whom vaccination records were available on the Australian Immunisation Register. Proportion of eligible patients who were vaccinated ranged from 66% to 88% in the years 2016-2019. There was no significant decrease in uptake during the COVID-19 pandemic in 2020 (75%). Despite the introduction of Telehealth reviews in 2020 majority (66%) of patients continued to have exclusive face-to-face appointments, of which 73% received the vaccination. Vaccination coverage of those who received combination of Telehealth and face-to-face was 81%. The high influenza vaccination rate of South Australian children with cystic fibrosis is consistent with rates seen in other tertiary centres globally. This study demonstrated that the pandemic and introduction of Telehealth appointments did not have any impact in the uptake of the influenza vaccination in our South Australian population.

Characterizing the medical and social complexity experienced by Inuit children and their families from Nunavut who access care at an urban Canadian tertiary level paediatric hospital

ABSTRACT We aimed to characterise the medical and social complexities experienced by Inuit children and their families from Nunavut who were cared for at a general paediatrics clinic at an urban tertiary-level hospital located in Eastern Ontario. A retrospective chart review of this cohort was completed between 2016 and 2019. Two independent reviewers extracted data from charts. The cohort included 36 children, median (interquartile range [IQR]) age 13.5 (6.8, 28.2) months and full age range (1,140) months. They had a median (IQR) of 12.5 (7.8, 18.0) comorbidities, 11 (8.0, 14.2) healthcare services accessed and 3 (2, 5) medications. Almost all children (97.2%) had been hospitalised and the median number of days spent as an inpatient was 31.5. With respect to social complexity variables, 51.9% of clinical interactions (14 of 27 charts reviewed) at any point would have benefitted from an interpreter and 96.7% of 30 patient escorts/companions showed evidence of having difficulty in coping with homesickness. Improving social history taking and integrating screening for social determinants of health within the clinic should be considered. A dedicated interdisciplinary team approach focused on integrative care could be an effective method to improve communication and collaboration between service providers and with Inuit children and their families to reduce systemic health and social inequities.

Associations of resuscitation fluid load, colloid-to-crystalloid infusion ratio and clinical outcomes in children with dengue shock syndrome.

Severe respiratory distress and acute kidney injury (AKI) are key factors leading to poor outcomes in patients with dengue shock syndrome (DSS). There is still limited data on how much resuscitated fluid and the specific ratios of intravenous fluid types contribute to the development of severe respiratory distress necessitating mechanical ventilation (MV) and AKI in children with DSS. This retrospective study was conducted at a tertiary pediatric hospital in Vietnam between 2013 and 2022. The primary outcomes were the need for MV and renal function within 48 h post-admission. A predictive model for MV was developed based on covariates from the first 24 h of PICU admission. Changes in renal function within 48 h were analyzed using a linear mixed-effects model. A total of 1,278 DSS children with complete clinical and fluid data were included. The predictive performance of MV based on the total intravenous fluid volume administered yielded an AUC of 0.871 (95% CI, 0.836-0.905), while the colloid-to-crystalloid ratio showed an AUC of 0.781 (95% CI, 0.743-0.819) (both P < 0.001). The optimal cut-off point of the cumulative fluid infusion was 181 mL/kg, whereas that of the colloid-to-crystalloid ratio was 1.6. Multivariable analysis identified female patients, severe bleeding, severe transaminitis, excessive fluid resuscitation, and a higher proportion of colloid solutions in the first 24 h as significant predictors of MV in DSS patients. The predictive model for MV demonstrated high accuracy, with a C-statistic of 89%, strong calibration, and low Brier score (0.04). Importantly, a more pronounced decline in glomerular filtration rate was observed in DSS patients who required MV than in those who did not. This study provides insights into optimizing fluid management protocols, highlighting the importance of monitoring fluid volume and the colloid-to-crystalloid ratio during early resuscitation to improve the clinical outcomes of DSS patients.

Exploring the landscape of congenital and idiopathic neutropenia in Moroccan children: a comprehensive retrospective analysis.

Congenital neutropenia (CoN) is a heterogeneous group of inborn errors of immunity (IEI) characterized by recurrent infections and early onset of neutropenia (NP). This study aimed to investigate the demographic and clinical data of children with CoN and idiopathic neutropenia (IN) in Morocco. We performed a retrospective study of patients with CoN and analyzed the clinical and laboratory findings of patients with CoN and IN diagnosed between 1999 and 2018 in a clinical immunology unit of a large pediatric hospital. We identified 88 patients, 51 with IN and 37 with CoN. Fifty-seven percent were males, and 43% were females, ranging from 1month to 19years. The median age at onset was 8months, and the median at diagnosis was 36months. Consanguinity was observed in 57% of the cases, and a history of recurrent infections in the siblings was found in 27.3%. The most common infectious complications were ear, nose, and throat (ENT) infections, skin and soft tissue infections, and lung infections. Patients with CoN were classified into seven syndromes: 9 with severe congenital neutropenia, 11 with cyclic neutropenia, 6 with glycogen storage disease type 1b, 5 with poikiloderma with neutropenia, 3 with Griscelli syndrome, 2 with Hermansky-Pudlak syndrome type II, and 1 with Cohen syndrome. This study provides a comprehensive overview of CoN and IN in a pediatric cohort from Morocco, representing the country's most considerable single-center investigation of these conditions. Our findings highlight the significant burden of CoN, accounting for 5% of IEI in the Moroccan registry, a proportion higher than in some neighboring countries. The study emphasizes the early onset and severity of bacterial infections in CoN patients, underlining the critical need for timely and accurate diagnosis.

Improved Uptake of Vaccinations in Children With Adverse Events Following Immunization After Specialist Immunization Service Intervention in an Australian Pediatric Hospital.

Adverse Events Following Immunization (AEFI) have significant implications for public health, potentially leading to decreased immunization rates and vaccine hesitancy. Understanding the characteristics and outcomes of children experiencing AEFI is crucial for effective intervention strategies and informed decision-making. This study aimed to describe the diverse range of AEFI presentations, identify common referral sources and assess factors influencing vaccination uptake following specialist consultation. A single-center retrospective cohort study was conducted from 2019 to 2022, analyzing AEFI data from 191 children referred to a Specialist Immunization Service (SIS) at an Australian pediatric health service. Demographic data, referral details, vaccination history, and AEFI types were considered. Statistical analyses, including univariate and multivariate models, were employed to predict vaccination outcomes post-SIS consultation. The median age of children referred was 2 years. General practitioners were the major referral source (68%). Urticarial rash was the most prevalent AEFI referred (29%). Pneumococcal conjugate vaccine was the most implicated vaccine (38%). The majority (69%) were successfully vaccinated following SIS consultation with 3% experiencing a subsequent AEFI (all mild). Older age is found to be associated with less likelihood for vaccination (odds ratio = 0.93, 95% confidence interval: 0.88-0.99, P = 0.027). Formal reporting of AEFI was low (26%). Severe adverse events, including anaphylaxis, were rare, and a SIS played an important role in vaccinating children following AEFI. Vaccination following urticarial rash is likely safe, and options such as a drop-in immunization center in a hospital setting may reduce delay to the next dose in scheduled vaccinations following AEFI. AEFI reporting needs to be promoted, and a patient-initiated reporting system may enhance this.

Utility of Abdominal Radiographs After Posterior Spinal Fusion for Neuromuscular Scoliosis.

Background/Objectives: Postoperative ileus, the temporary cessation of gastrointestinal motility leading to accumulation of fluid and gas in the bowel, is a common complication following posterior spine fusion (PSF) in patients with neuromuscular scoliosis (NMS). Abdominal radiographs (KUBs) are often ordered to differentiate between ileus and mechanical obstruction but expose patients to radiation, add cost, and may lead to unnecessary work up. The aim of this study was to determine how often KUBs led to a change in treatment after PSF in patients with NMS. Methods: A retrospective review was conducted of NMS patients with ≥2-year follow-up treated with PSF between January 2014 and December 2019 at a tertiary pediatric hospital. Results: Of the 133 patients (age 13.7, SD 2.6 years; preoperative curve magnitude 82.8, SD 23.0 degrees; follow-up 44.7, SD 15.4 months), 22.6% (30/133) underwent KUB imaging due to abdominal pain, distension, or delayed return of bowel function. In total, 93.3% (28/30) of the KUB imaging was consistent with ileus. One KUB study resulted in a gastroenterology consultation and bowel cleanout, and one raised concerns regarding possible pneumatosis of the colon, prompting a pediatric surgery consultation and exploratory laparotomy which was unremarkable. Conclusions: KUBs were performed in nearly 25% of NMS patients during the acute postoperative period, but rarely provided useful diagnostic information leading to changes in management. In the presence of postoperative abdominal distension, feeding intolerance, and delayed return of bowel function, we advocate for continuing conservative measures until bowel function returns, reserving abdominal radiographs for patients with a worsening exam despite bowel rest or additional causes for concern.

Preparing adolescents and young adults with epilepsy for transitioning health care (PATH) study: The important role of age and self-efficacy

BackgroundAt least 30 % of youth with epilepsy will require transition from pediatric to adult neurology care. Many adolescents and young adults (AYAs) with epilepsy are inadequately prepared for health care transition, which may contribute to health care disruptions and decreased quality of life. The current study aimed to add to the growing body of literature on health care transition in epilepsy by characterizing a sample of AYAs with epilepsy and assessing the relationship between pre-existing and behaviorally modifiable factors and epilepsy-specific transition readiness. Methods103 AYAs (Mage = 17.56; range = 14–21; 54 % female; 85 % White) with epilepsy and 84 of their caregivers were enrolled from two pediatric hospitals in the United States. Participants provided sociodemographic and medical information and completed questionnaires assessing functioning, epilepsy management, and transition readiness. Data were analyzed using a two-step hierarchical multiple linear regression model with epilepsy-specific transition readiness as the outcome: 1) pre-existing factors (i.e., age, insurance, seizure severity); and 2) behaviorally modifiable factors (i.e., cognitive functioning, medication self-management, epilepsy self-efficacy). ResultsOnly 44 % of AYAs had discussed health care transition with their pediatric neurologist. The final model was significant, ΔF (3, 90) = 13.45, p < 0.001. Older age and greater epilepsy self-efficacy were associated with greater epilepsy-specific transition readiness. ConclusionAYAs with greater epilepsy self-efficacy may be better prepared for the transition from pediatric to adult neurology care. Routine assessment of epilepsy self-efficacy and transition readiness starting in early adolescence may help to identify individuals who could benefit from targeted interventions.

Trends in antimicrobial consumption at 72 adult and pediatric hospitals in Catalonia. Results of the VINCat Program 2008–2022

Trends in antimicrobial consumption at 72 adult and pediatric hospitals in Catalonia. Results of the VINCat Program 2008–2022

Improving Antibiotic Use in Argentine Pediatric Hospitals: A Process Evaluation Using Normalization Process Theory.

In the pediatric setting, overprescribing of antibiotics contributes to the rise of multidrug-resistant organisms. Antimicrobial stewardship programs (ASPs) are recommended to optimize antibiotic use and combat resistance. However, the implementation of ASPs in low- and middle-income countries faces several challenges. This study aimed to evaluate the implementation process of a multifaceted ASP in 2 pediatric hospitals in Argentina. A qualitative study was conducted in two large public children's hospitals in Argentina, using semistructured interviews with 32 healthcare providers at the beginning and end of the ASP implementation. The study was guided by the normalization process theory. The intervention faced challenges, including limited understanding of its objectives, confusion with existing practices, and insufficient commitment from senior staff. Although junior staff were more receptive, communication barriers with external staff and workload concerns hindered broader adoption. Infectious disease specialists primarily led implementation, with limited involvement of other staff, particularly in training activities. Despite these challenges, participants reported improvements, such as the development of standardized antibiotic guidelines, better interdisciplinary collaboration, and improved communication. However, organizational support and resistance to new practices remained barriers. This study highlights the importance of organizational context and staff commitment in ASP implementation. Tailored strategies that address the specific challenges of low- and middle-income countries are needed to effectively implement ASPs.

Risk factors and molecular Epidemiology of colonizing Carbapenem-Resistant Enterobacterales in pediatric inpatient in Shenzhen, China

The spread of CRE has been rapid on a global scale and represents a significant challenge in nosocomial infections worldwide. The aim is to evaluate the risk factors for CRE colonization and to describe the molecular and clinical characteristics of CRE colonization in pediatric inpatients in Shenzhen, China. We collected stool specimens from 2474 randomly selected pediatric inpatient hospitalized in 2 pediatric hospitals in Shenzhen between January 2023 and December 2023 for subsequent microbiological analysis, including microbial culture, species identification, antimicrobial sensitivity testing, genetic characterization and multilocus sequence typing (MLST). In addition, we conducted a case-control study to identify potential risk factors for gastrointestinal CRE colonization. Of the 2474 non-replicating pediatric stool specimens collected, 3.6% (n=90) test positive for CRE. The most dominant CRE species were Escherichia coli (n=67, 74.5%), and Klebsiella pneumoniae (n=17, 19.0%). Multidrug resistance and carbapenemase production were observed in most CRE isolates. In CR E. coli and CR K. pneumoniae, the blaNDM was the predominant resistance gene, accounting for 95.5% and 76.5%, respectively. MLST showed considerable clonal diversity among the CR E. coli and CR K. pneumoniae isolates and the most common ST in CR E. coli was ST48 (n=6, 9.0%) and ST35 in CR K. pneumoniae (n=4, 23.5%). This study once again shows that pediatric inpatients in South China were colonized by a diversity of CRE strains, increasing the likelihood of difficult-to-treat infections. Hospitals and competent authorities should take appropriate public health measures, to prevent the further spread of CRE.

Acute kidney injury: a post-COVID-19 complication in children and adolescents.

To describe cases of acute kidney injury (AKI) in children diagnosed with COVID-19, associated risk factors, clinical aspects and outcome of cases. Retrospective study, carried out in a pediatric hospital between March 2020 and September 2021, with patients with COVID-19 who were diagnosed with AKI, studying information present in medical records such as comorbidities, age, gender and use of nephrotoxic medications. We studied 40 cases, and male individuals were significantly more affected (62.5%; p=0.025). AKI was a severe complication of COVID-19 infection, with 100% of the sample requiring admission to the Intensive Care Unit and 22.5% dying. The most prevalent comorbidities analyzed in this study were epilepsy, cerebral palsy and heart disease. Most patients were classified according to Kidney Disease: Improving Global Outcomes (KDIGO) criteria as KDIGO 1 (42.5%), and required orotracheal intubation (67.5%). The frequency of use of nephrotoxic medications and need for dialysis was low, with percentages of 35 and 17.5%, respectively. Among the children who died, 70.4% had some comorbidity and 88.8% received invasive ventilation. AKI in children with COVID-19 infection is associated with severe conditions. Despite the severity, most patients were discharged alive from the hospital.