Pediatric Mortality Research Articles

Experentia Et Progressus: An Experiential Needs Assessment of Military Health care Providers in Treating Pediatric Combat Trauma.

Children are among the most vulnerable populations affected by armed conflicts, yet there is limited data on the preparedness of military medical personnel to care for pediatric combat trauma casualties in austere or large-scale combat operations. This study aimed to assess the confidence, training needs, and resource requirements of military medical providers who have managed pediatric patients during deployment. This IRB-exempt, cross-sectional mixed-methods study used a survey created via a modified Delphi method with input from subject matter experts. The survey was distributed to active duty and reservist physicians, nurses, medics, and corpsmen who had previously deployed to combat environments. Respondents answered Likert-style questions anonymously on the SurveyMonkey platform. Data were analyzed using Welch's t-test, with statistical significance defined as P < .05. Qualitative data were coded into discrete themes and summarized. A total of 84 respondents participated in the survey. Only 27% reported feeling confident or very confident in resuscitating pediatric casualties. Health care providers with prior exposure to pediatric patients reported significantly higher confidence in pediatric trauma resuscitation (P = .02). Key factors contributing to low confidence included difficulty with pediatric medication dosing, anatomical and physiological differences, lack of experience, and insufficient pediatric-specific equipment during deployment. Nearly all respondents with prior pediatric combat trauma experience expressed a desire for additional pediatric-specific predeployment training, with nearly half (47%) advocating for more robust military-civilian trauma center partnerships. Furthermore, 59% of respondents felt they lacked adequate emotional support following negative pediatric events and recommended stronger post-traumatic event debriefing and support mechanisms. Many recently deployed military medical providers reported low confidence in resuscitating pediatric patients in the combat environment, because of drug dosing, anatomic and physiologic differences, and inexperience. Regardless of specialty, almost all providers requested additional pediatric training to improve baseline preparedness. These results can guide future predeployment training and inform policy to reduce unnecessary pediatric mortality on the battlefield.

Immune-sensitization to Mycobacterium tuberculosis Among Young Children With and Without Tuberculosis.

Identification of young children with Mycobacterium tuberculosis ( Mtb )-infection is critical to curb Tuberculosis (TB)-related pediatric morbidity and mortality. The optimal test to identify young children with evidence of Mtb -infection remains controversial. Using a TB household contact (HHC) study design among 130 Ugandan children less than 5 years with established Mtb -exposure, we compared the usefulness of the tuberculin skin test (TST) and QuantiFERON Gold Plus (QFT-Plus) to identify children with evidence for Mtb -sensitization. We conducted univariate analysis to compare findings between children with and without TB disease, and performed a logistic regression model to estimate the odds of TB. We performed a sensitivity analysis by stratifying results by age (< 2 years vs. 2-5 years). Finally, we compared results of the QFT-Plus TB tube 1 and TB tube 2 to establish concordance. A 5 mm TST threshold identified the most children with evidence of Mtb -sensitization; this result was most pronounced in children with TB. Moreover, the odds of TB were 2 times higher [aOR: 2.09 (CI: 1.02 - 4.37)] among children with a positive TST. The QFT-Plus' TB tube 1 and TB tube 2 results were highly correlated. TST identified more TB-exposed young children with evidence of Mtb- immune-sensitization, when compared to QFT-Plus. These findings are highly relevant for children who are TB HHCs in endemic settings, and most at risk for TB following an exposure. We recommend that TST testing continue to be performed to assess for Mtb -sensitization in young children.

Applying the ADAPT guidance to implement a telemedicine and medication delivery service in a malaria-endemic setting: A prospective cohort study.

The ADAPT guidance proposes a process model for adapting evidence-informed interventions to novel contexts. Herein, we leveraged this guidance to adapt a paediatric nighttime telemedicine and medication delivery service from Haiti, a setting with low malaria prevalence, to Ghana, where malaria is a leading cause of paediatric mortality. Core components of the intervention were defined and conserved. Discretionary components were identified and considered for adaptation. The service was defined by a workflow involving a call from a guardian of a sick child, a telemedicine assessment, referral of severe cases, and medication delivery/in-person assessments for non-severe cases. Key adaptations related to partner organisation (private to public/government), clinician type (nurse to emergency medical technician), user fees (sliding scale to none), and point-of-care testing (none to malaria rapid diagnostic testing). The adapted model was implemented in Jamestown and Usshertown, Ghana, on 16 November 2022 as part of a 12-month study to evaluate implementation outcomes and the role of the telemedicine assessment. Empiric thresholds for safety and feasibility were set a priori and served as benchmarks for this study and points of iteration for future studies. In the first year of implementation, 517 cases were enrolled; 492 were included in the analysis, 96% of which were reached at 10-day follow-up. Safety and feasibility thresholds were met.98% of febrile cases received rapid diagnostic testing for malaria; 4% tested positive. At 10 days, 97% of cases were improving/well, and no severe adverse events were reported. The median lengths of the telemedicine assessment, time to delivery, and in-person assessments were 9, 49, and 43 min, respectively. 99% of participants expressed interest in using the service again. There was fair congruence between paired telemedicine and in-person assessments for vital sign assessments and mild/moderate triage decisions. A nighttime paediatric telemedicine and medication delivery service adapted and implemented per the ADAPT Guidance met a priori-defined safety and feasibility metrics in the malaria-endemic country of Ghana. The role of telemedicine in assessing vital signs and informing mild versus moderate triage decisions may be limited. This study was registered on Clinicaltrials.gov on 8/17/2022 (NCT05506683).

Global and Regional Trends in Paediatric Neuroblastoma Incidence and Mortality, 1990-2021: An Inequality and Projection Analysis.

Neuroblastoma stands as the most prevalent extracranial solid tumour in children, yet its epidemiological profile on global, regional, and national scales remains insufficiently explored. Long-term trends in the incidence and mortality of paediatric neuroblastoma from 1990 to 2021 were analysed globally, regionally, and nationally using estimated annual percentage changes. Cross-national disparities in the burden of paediatric neuroblastoma were quantified through standard health equity methodologies, with projections of burden shifts extending to 2035. From 1990 to 2021, the global age-standardised death rate for paediatric neuroblastoma increased from 0.19 (95% UI, 0.16-0.23) to 0.21 (95% UI, 0.14-0.28) per 100 000 population, with an EAPC of 0.2. Regionally, both mortality and incidence rates were highest in low-middle SDI regions and lowest in Oceania. Mortality rates were highest among males aged 12-23 months and females aged 6-11 months, while incidence rates were most pronounced in children aged 2-4 years. Cross-country inequality analyses indicated a reduction in disparities between high and low SDI countries; however, the concentration index revealed an increase in the inequality of burden distribution. The global burden of paediatric neuroblastoma is projected to continue rising through 2035. Over the past 30 years, global incidence and mortality rates for paediatric neuroblastoma have risen, particularly in low-SDI regions, whereas high-SDI regions have witnessed a downward trend. Although disparities between high- and low-SDI countries have diminished, inequality in burden distribution has grown more pronounced. The global burden of paediatric neuroblastoma is expected to continue its upward trajectory over the next 15 years.

Association Between Rurality and Race/Ethnicity and Pediatric Cancer Early Mortality: A Population-Based Cohort Study Using SEER Data from 2000 to 2021.

Pediatric cancer mortality rates have steadily declined since 2009, but over a thousand deaths still occur annually. While existing research highlights the effects of race/ethnicity and rurality on overall survival, few studies have specifically analyzed these factors in relation to early mortality, defined as death within 12months of diagnosis. This study utilized SEER Research Plus Limited-Field Data (2000-2021) to examine the association between race/ethnicity, rurality, and early mortality in pediatric cancer patients. A cohort of 138,648 individuals was analyzed using Cox proportional hazards regression models to calculate hazard ratios and 95% confidence intervals (CIs). The results demonstrated that both race/ethnicity and rurality were significantly associated with early mortality. Non-Hispanic Black patients were 70% (95% CI: 1.60-1.82) more likely to die within the first year of diagnosis compared to non-Hispanic Whites, and other racial/ethnic groups also saw significant associations. The adjusted hazard ratio for early mortality compared to urban counties greater than 1 million was significant (p<0.05) for all degrees of rurality. Pediatric cancer patients in rural counties not adjacent to urban counties had the highest risk of early mortality, 27% (95% CI: 1.13-1.42), within 1year of diagnosis. A subanalysis of adolescent patients also showed similar patterns. These findings emphasize the need to address disparities in early mortality for pediatric cancer patients, particularly among racial/ethnic minorities and those in rural communities.

" Trying to Grab Pieces of Hope " : Exploring the Experiences of Black and Hispanic Parents following a Congenital Heart Disease Diagnosis.

Objective Congenital heart disease (CHD) is an important contributor to pediatric morbidity and mortality. Unfortunately, disparities in the diagnosis and treatment of CHD exist across racial and ethnic groups. The objective of this study was to share the experiences of Hispanic and Black families with CHD to better understand their needs. Study Design This was a descriptive qualitative study involving two 2-part focus groups, one conducted in English and one in Spanish, consisting of parents of infants with CHD. Focus groups were audio recorded, transcribed, and analyzed via a conventional content analysis approach. Results Six family members participated, representing a range of cardiac diagnoses. Two participants cited their identity as non-Hispanic Black and four as Hispanic. Three organizing themes emerged related to (1) communication, (2) psychosocial needs and processing, and (3) practical challenges associated with having a child with CHD. Together, these organizing themes supported a singular global theme: structural and socioemotional gaps in care exist for families of infants with CHD that need to be met in order to optimize care for patients and families. Conclusion Societal and systems-level factors, including structural inequities, contribute to the care gaps experienced by racial and ethnic minority families of children with CHD. Key Points Poor communication around CHD diagnosis impairs provider-patient trust.Language barriers hinder accurate communication about CHD diagnosis and treatment.Parents of children with CHD have unmet mental health needs.Perinatal providers should champion health equity for CHD patients and their families.

Prediction of inpatient mortality in hospitalised children in low- and middle-income countries: An external validation of paediatric mortality risk scores

Prediction of inpatient mortality in hospitalised children in low- and middle-income countries: An external validation of paediatric mortality risk scores

YY1 drives PARP1 expression essential for PARylation of NONO in mRNA maturation during neuroblastoma progression

BackgroundNeuroblastoma (NB), the most prevalent solid tumor in children, arises from sympathetic nervous system and accounts for 15% of pediatric cancer mortality. This malignancy exhibits substantial genetic and clinical heterogeneity, thus complicating treatment strategies. Poly(ADP-ribose) polymerase 1 (PARP1), a key enzyme catalyzing polyADP-ribosylation (PARylation), plays critical roles in various cellular processes, and contributes to tumorigenesis and aggressiveness. However, the functions and regulatory mechanisms of PARP1 in NB progression still remain to be determined.MethodsThe association of PARP1 expression with NB patients’ survival was analyzed by mining of R2 database. Western blotting, reverse transcription-polymerase chain reaction, MTT colorimetric, soft agar, and matrigel invasion assays were utilized to assess PARP1 expression and its effects on aggressiveness of NB cell lines. Chromatin immunoprecipitation (ChIP) sequencing and ChIP assays were employed to investigate the binding of Yin Yang 1 (YY1) to PARP1 promoter. Protein interactions were explored by BioGRID database analysis, molecular docking, and co-immunoprecipitation assay. RNA sequencing and crosslinking-immunoprecipitation high throughput sequencing datasets were used to identify precursor mRNA splicing targets of non-POU domain containing octamer binding protein (NONO).ResultsHigh PARP1 expression was associated with poor survival of NB patients. PARP1 over-expression enhanced the proliferation and invasion of NB cell lines, confirming its oncogenic roles. YY1 was identified as a key transcriptional regulator facilitating PARP1 expression. Additionally, PARP1 interacted with NONO to induce its PARylation, resulting in stabilization of NONO protein via preventing ubiquitin-mediated degradation. NONO facilitated the splicing and mRNA maturation of target genes a disintegrin and metalloproteinase domain 8 (ADAM8) and testis-expressed gene 14 (TEX14) in a PARylation-dependent manner. Rescue experiments indicated that YY1 facilitated PARP1-mediated PARylation of NONO and subsequent mRNA maturation of ADAM8 and TEX14 in NB cells. In clinical NB cases, high expression of YY1, PARP1, NONO, ADAM8, or TEX14 was associated with poor survival of patients.ConclusionsThese findings indicate that YY1 drives PARP1 expression essential for PARylation of NONO in mRNA maturation during NB progression.

Magnesium sulfate for fetal neuroprotection in preterm labor: an updated systematic review and meta-analysis of randomized controlled trials.

Antenatal magnesium sulfate has been reported to reduce the risk of neurological impairment in fetuses born to women at risk of preterm labor. However, the evidence to support its use is conflicting. We conducted this meta-analysis to assess the efficacy and safety of magnesium sulfate in women at risk of preterm labor as new research is available from RCTs giving insights into MgSO4 treatment among differing gestational age groups. We searched various electronic databases, including MEDLINE (via PubMed), Embase, the Cochrane Library, ClinicalTrials.gov, and the World Health Organization InternationalClinical TrialsRegistry Platform portal from 1990 till 31st March 2024 to retrieve all randomized controlled trials (RCTs)that investigated the use of magnesium sulfate in women at risk of preterm labor with or without intent of fetal neuroprotection We used the revised Cochrane Risk of Bias tool (RoB 2.0) to assess the quality of the included randomized controlled trials. RevMan 5.4 was used to conduct all statistical analyses using a random-effects model. Our Meta-analysis was registered with the PROSPERO International Register of Systematic Reviews (CRD42024532421). Our meta-analysis including eight RCTs showed that magnesium sulfate reduced the risk of cerebral palsy without a significant change in pediatric mortality. The change was evident in moderate to severe cerebral palsy. Magnesium sulfate showed no beneficial effect in most of the secondary outcomes. This meta-analysis found antenatal magnesium sulfate reduces the risk of cerebral palsy with no difference in pediatric mortality between the magnesium or no magnesium treatment groups, which is a positive finding. However, there is still substantial heterogeneity between the studies, so there is a need for further exploration and discussion. The implications of this review include a concern for developing nations where resources and availability of magnesium sulfate are limited. Hence, further studies are needed to determine the exact dosage, timing, and whether maintenance dosage of magnesium sulfate is required or not and for how long.

External validation of an admission risk score for predicting inpatient paediatric mortality in two Kenyan public hospitals.

Background Early identification of children at risk of mortality during hospitalization is crucial in preventing mortality in low-and middle-income countries (LMICs). This study aimed to externally validate an admission risk score for predicting inpatient paediatric mortality in resource-limited settings. Methods This retrospective study utilized routine clinical data of children aged ≤12 years admitted to two Kenyan public hospitals between January 2017 and October 2023. The admission risk score includes 13 clinical predictors, each assigned a value. Aggregate values were used to predict inpatient pediatric mortality, with a higher score indicating a greater risk of death. Children with scores of 0, 1–4 and ≥5 were categorized as low, moderate and high-risk categories, respectively. Discrimination was assessed using area under the receiver operating characteristic curve (AUC). Sensitivity, specificity, and positive and negative predictive values were calculated at different cutoff points. Results A total of 15,606 children were included in the study. Majority of the participants were male (8,847, 56.7%) and aged 12 – 59 months (7,222, 46.3%). Children classified as high-risk had a higher mortality rate (23.4%) than those classified as low risk (2%). The risk score demonstrated moderate discrimination, with an AUC of 0.73 (95% confidence interval (CI): 0.71 – 0.75). A cutoff of ≥3 achieved a balance between sensitivity and specificity, with values of 63.8% (95% CI: 60.7%–66.9%) and 72.2% (95% CI: 71.5% - 72.9%), respectively, compared to other cutoff points. Conclusion The risk score performed moderately in predicting inpatient paediatric mortality in two Kenyan public hospitals. The risk score can be used with other clinical assessments to rapidly identify high-risk children and guide targeted interventions to prevent mortality.

Early Continuous Electroencephalography, Clinical Parameters, and Short-Term Functional Outcomes in Pediatric Traumatic Brain Injury: Single-Center, Retrospective Cohort, 2010-2020.

Traumatic brain injury (TBI) is a leading cause of pediatric morbidity and mortality. This study first investigates clinical characteristics and continuous electroencephalography (cEEG) parameters associated with short-term functional outcomes in pediatric patients following TBI. Second, we use these data for a hypothesis-generating model about outcomes. Retrospective cohort study. PICU within a quaternary care hospital. Pediatric patients (< 18 yr) admitted from January 2010 to December 2020 with TBI who underwent cEEG within 72 hours of admission. None. Patient demographics, clinical parameters, hospital course, and cEEG features were reviewed for associations with mortality and new disability (as defined by change in Functional Status Score between admission and discharge of ≥ 3 points). A statistical prediction model for patient outcome was created combining cEEG parameters with admission Glasgow Coma Scale (GCS) score and radiographic findings. We included 142 patients: 100 (70%) of whom had no new disability at hospital discharge; 42 (30%) had a new disability, including eight deaths. Univariate analysis showed favorable outcomes were associated with normal electroencephalogram background, reactivity, and sleep features (p < 0.001 for each). A model inclusive of these electroencephalogram parameters and GCS had high predictive ability for outcome with 0.94 with 95% CI (0.90-0.98). Specific cEEG findings observed acutely after injury, in combination with other clinical characteristics, may serve as biomarkers for short-term functional outcomes after pediatric TBI. Further validation of the model in another population is now required.

Clinical Profile and Pediatric Patterns in Predicting Sepsis Among Febrile Inpatients at an Indian Hospital: A Prospective Observational Study

Background: Sepsis is a global perpetrator of pediatric morbidity and mortality. This research aims to analyze the clinical profile of febrile pediatric patients with a risk of sepsis to study underlying patterns involved and understand clinician perspectives to ensure diagnostic accuracy and assess the management and outcomes. Methods: In this prospective cross sectional descriptive study 300 febrile inpatients of 1 month to 13 years of age with one or more sepsis warning signs were examined. Patient factors affecting progression towards sepsis were analyzed, along with age-related patterns of tachycardia and tachypnea. Risk of developing sepsis was compared with degree of elevation in TLC, patient admission and outcome on discharge. The study also extended towards segregating most relied markers of sepsis by comparing prevalence among various risk groups. Results: Factors such as male gender, infancy, and incomplete vaccination status were found to increase the chances of developing sepsis. Diverse diagnoses heightened sepsis likelihood to varying extents. Tachycardia and tachypnea followed a pattern of manifesting most among infants. The study demonstrated a direct link between rising sepsis risk and elevating TLC levels. Quantification of PS6 interventions demonstrated that adrenaline was the most commonly used ionotrope and IVF DNS was the most used isotonic fluid. Conclusion: The unpredictable nature of pediatric sepsis can be tackled by an effective understanding of the patterns by which it manifests. Early detection of sepsis relies on pediatric patterns and established symptomatology approved commonly among clinicians which demands constant evaluation to ensure appropriateness and diagnostic consistency. Keywords: Biomarkers, Acute febrile illness, Pediatric Intensive care Unit (PICU), Neonatal intensive care unit (NICU), SIRS

Diagnostic performance of contrast-enhanced ultrasound in traumatic solid organ injuries in children: a systematic review and meta-analysis.

Blunt abdominal trauma (BAT) is a significant contributor to pediatric mortality, often causing liver and spleen injuries. Contrast-enhanced computed tomography (CT), the gold standard for diagnosing solid organ injury, poses radiation risks to children. Contrast-enhanced ultrasound (CEUS) may be a promising alternative imaging modality. To evaluate the diagnostic utility of CEUS for detecting solid organ injuries following BAT in the pediatric population. A systematic review and meta-analysis were conducted through a thorough literature search in PubMed, Scopus, Web of Science, and Embase databases up to October 1, 2023. Diagnostic accuracy metrics were aggregated using a bivariate model, and subgroup meta-analysis compared CEUS accuracy across various organs. Meta-analysis from four studies, including 364 pediatric patients, revealed a pooled sensitivity of 88.5% (95%CI 82.5-92.6%) and specificity of 98.5% (95%CI 94.9-99.6%), with an area under the curve of 96% (95%CI 88 - 99%). Splenic injuries showed higher sensitivity than liver injuries (P-value < 0.01), while kidney assessments demonstrated higher specificity (P-value < 0.05). This study highlights the diagnostic potential of CEUS for pediatric solid organ injuries caused by BAT. Further large-scale studies are needed due to the limited number and sample size of the included studies.

Pediatric neuro-oncology: Highlights of the last quarter-century

The last quarter century has heralded dramatic changes in the field of pediatric neuro-oncology, with the era defined by profound developments in the understanding of the biological underpinnings of childhood central nervous system (CNS) tumors and translational therapeutics. Although there have been momentous strides forward in biologic, diagnostic, therapeutic, and experimental domains, considerable challenges remain and CNS tumors remain the leading cause of pediatric cancer-related mortality. Here, we review the significant advances in the field of pediatric neuro-oncology over the last 25 years and highlight ongoing hurdles facing future progress.

Review of Current Normothermic Regional Perfusion Practice in Pediatric Cardiac Donation.

Cardiac allotransplantation is the optimal treatment for end-stage heart failure. However, organ supply remains the principal issue impacting patients. Pediatric patients present unique challenges resulting in long wait-list times and increased mortality. Donation after circulatory death with normothermic regional perfusion represents a method to increase the number of available organs in this population. Multi-institutional expert consultation was sought to outline extant technical, ethical, and logistical issues with regard to normothermic regional perfusion cardiac donation techniques. Specific advantages in the pediatric population are highlighted, as well as technical considerations resulting in successful organ procurement. Utilization of donation after circulatory death organs following normothermic regional perfusion in the United States is increasing and offers advantages to the pediatric heart failure population. Ethical reservations both nationally and abroad persist, namely pertaining to cerebral blood flow. This has led to variation in perception and utilization of normothermic regional perfusion, contributing to a discrepancy between donor and recipient locations. Procurement techniques and variations are described, with introduction into program planning and protocol development. Training in technical aspects of the procedure is paramount for both the surgeon and support staff to construct a successful program, along with transparent protocols to mitigate ethical concerns. Normothermic regional perfusion is relevant following donation after cardiac death in the pediatric population. Ethical and technical challenges remain in concert with substantial domestic and international variation. Standardization of technique may serve to increase future use and increase the number of available hearts for transplant, reducing pediatric mortality.

An Assessment of KAP Towards LTBI in Under-5 Children among Physicians Treating Adult/Adolescent TB Patients in Dhaka City

&amp;lt;i&amp;gt;Introduction:&amp;lt;/i&amp;gt; LTBI is the precursor to TB, making early detection and treatment of infected children vital to preventing pediatric morbidity and mortality. This study assesses the knowledge, attitudes, and practices of physicians treating adult and adolescent TB patients in managing LTBI among under-5 children in Dhaka. &amp;lt;i&amp;gt;Aim of the study:&amp;lt;/i&amp;gt; The aim of the study was to evaluate the knowledge, attitude, and practices of physicians treating adult and adolescent tuberculosis patients in Dhaka City regarding the diagnosis and management of latent tuberculosis infection (LTBI) in under-5 children. &amp;lt;i&amp;gt;Methods: &amp;lt;/i&amp;gt;This six-month cross-sectional, semi-qualitative study was conducted from January to June 2020 at the Department of Paediatrics in five Dhaka hospitals, involving 50 physicians treating adult and adolescent TB patients. Data were collected through standardized questionnaires, with consent obtained, and qualitative responses categorized and scored using SPSS Version 25.0. &amp;lt;i&amp;gt;Result: &amp;lt;/i&amp;gt;Among 50 physicians, most were aged 30-39, and 62% had recent TB training. Knowledge of latent tuberculosis infection (LTBI) was limited, with only 14% accurately defining it, while 88% acknowledged isoniazid preventive therapy (IPT) availability. Only 12% inquired about family members of pulmonary TB patients, and 10% asked about under-five children. A significant 80% had no involvement in managing LTBI in children, with just 6% prescribing IPT. Additionally, 84% believed IPT could cause drug resistance, and those with recent training scored higher in knowledge. &amp;lt;i&amp;gt;Conclusion: &amp;lt;/i&amp;gt;This KAP study identifies key barriers to LTBI tracing and IPT/TPT implementation in children under five, emphasizing the need for structured training to enhance physician practices.

Pediatric Renal Cell Carcinoma (pRCC) Subpopulation Environmental Differentials in Survival Disadvantage of Black/African American Children in the United States: Large-Cohort Evidence.

Renal cell carcinoma (RCC) is a rare but severe and aggressive pediatric malignancy. While incidence is uncommon, survival is relatively low with respect to acute lymphocytic leukemia (ALL), AML, lymphoma, ependymoma, glioblastoma, and Wilms Tumor. The pediatric renal cell carcinoma (pRCC) incidence, cumulative incidence (period prevalence), and mortality vary by health disparities' indicators, namely sex, race, ethnicity, age at tumor diagnosis, and social determinants of health (SDHs) as well as Epigenomic Determinants of Health (EDHs). However, studies are unavailable on some pRCC risk determinants, such as area of residence and socio-economic status (SES). The current study aimed at assessing the temporal trends, cumulative incidence, household median income, urbanity, mortality, and pRCC survival differentials. A retrospective cohort design was utilized to examine the event-free survival of children (0-19) with RCC using the Surveillance Epidemiology and End Result Data, 1973-2015. While the time-dependent variable, namely survival months, was utilized, we assessed the predictors of pRCC survival, mainly sex, age at diagnosis, education, insurance status, income, and tumor grade, as prognostic factors. In examining the joint effect of area of residence and race, as an exposure function with time in survival, we utilized the Cox proportional hazard model, while the annual percent change was assessed using a generalized linear model, implying a weighted average. Between 1973 and 2015, there were 174 cases of pRCC, of whom 49 experienced mortality (28.2%). The pRCC cumulative incidence tends to increase with advancing age. A significant survival differential was observed between black/AA children with RCC and their white counterparts. Compared with white children, black/AA children were almost three times as likely to die, hazard ratio (HR) = 2.90, 95% CI = 1.56-5.31, p = 0.001. A survival differential was observed in sex, with males presenting with a 21% increased likelihood of dying, HR = 1.21; 95% CI, 0.69-2.11. In the metropolitan area, the risk of dying was almost three times as likely among black/AA children compared to their white counterparts, HR = 2.78; 95% CI, 1.45-5.43, while in the urban area, the risk of dying was almost four times as likely among black/AA children compared to their white counterparts, HR = 4.18; 95% CI, 0.84-20.80. After controlling for age, sex, education, and insurance, the risk of dying increased amongst black/AA children in metropolitan areas, adjusted HR (aHR) = 3.37, 99% CI = 1.35-8.44. In the urban area, after adjustment for age, sex, and insurance, there was an increased risk of dying for black/AA children, compared with their white counterparts with pRCC, aHR = 8.87, 99% CI = 2.77-28.10. pRCC indicates an increased trend in males and age at diagnosis between 10 and 14, as well as a survival disadvantage among black/AA children, compared with their white counterparts. Additionally, urbanity significantly influences the racial differences in survival. These data are suggestive of the conjoined effect of environment and race in pRCC survival, indicative of further assessment of gene-environment interaction (epigenomics) in incidence, mortality, and survival in pRCC.

Risk factors and outcomes in paediatric acute febrile encephalopathy: a cross-sectional study from a tertiary care centre in North India

Background: Acute Febrile Encephalopathy (AFE) is a frequent cause of emergency admissions in children, particularly in India, where it poses a significant public health challenge due to high morbidity and mortality rates. This study aims to bridge some of these gaps by analyzing the clinical features, incidence, and mortality-associated risk factors in pediatric AFE cases in a hospital-based setting in North India. Methods: This hospital-based cross-sectional study was conducted over one year (January 2020 to December 2020) in the Pediatric Intensive Care Unit (PICU) of Indira Gandhi Medical College and Hospital, Shimla. The study included all pediatric patients aged 1 to 18 years admitted to the PICU with clinical evidence of AFE, fulfilling specific inclusion criteria. Data were collected on patient demographics, clinical presentation, and relevant investigations. Key risk factors, such as shock, need for ventilatory support, Glasgow Coma Scale (GCS) scores, and Multiple Organ Dysfunction Syndrome (MODS), were assessed for their association with mortality. Results: Out of 2,832 pediatric admissions, 550 children were admitted to the PICU, and 69 met the inclusion criteria for AFE, resulting in an AFE incidence of 12.5% in the PICU and 2.4% of total hospital admissions. The study observed a slight male preponderance (56.5% male, 43.4% female) and found that the most affected age group was 10 to 18 years (43%). The overall mortality rate among AFE patients was 26%, contributing to 13.7% of the total PICU mortality. Significant risk factors associated with mortality included late hospital presentation (mortality rate of 50% in patients presenting after 7 days of symptom onset), ventilatory support (69.6% mortality), shock (44.4% mortality), MODS (47.6% mortality), Disseminated Intravascular Coagulation (DIC) (100% mortality), and GCS &lt;8 (56.5% mortality). Conclusion: AFE remains a significant contributor to pediatric morbidity and mortality, particularly in resource-limited settings. The study identifies key risk factors such as shock, ventilatory support, DIC, MODS, and low GCS, which are strongly associated with increased mortality. Early recognition and timely intervention are critical to improving outcomes.

Dysregulated airway epithelial antiviral immunity in Down Syndrome impairs type III IFN response and amplifies airway inflammation during RSV infection.

Trisomy 21 (TS21), also known as Down syndrome (DS), increases pediatric mortality risk from respiratory syncytial virus (RSV) by nine-fold, yet its underlying immunological basis remains unclear. Here, we investigated RSV-induced immunological responses in TS21 airway epithelial cells (AECs), the primary site of respiratory virus entry and host defense. TS21 AECs exhibit hyperactive interferon (IFN) signaling and reduced RSV infectivity, but they also show impaired type-III IFN responses during viral infection. Furthermore, TS21 AECs demonstrate heightened production of proinflammatory mediators CXCL5 and CXCL10 both before and after RSV exposure. Infants with DS suffering from severe viral bronchiolitis demonstrate dysregulated airway immune responses in vivo, characterized by diminished type-III IFN levels and increased CXCL5/CXCL10 secretion. Our results indicate that RSV severity in DS is not due to impaired viral control but to dysregulated airway proinflammatory responses, offering new therapeutic opportunities to mitigate the severity of RSV infection in children with DS.

The effect of interhospital transfer on pediatric burn injury mortality in a resource-limited setting.

The World Health Organization's burn mortality estimate is 180,000 annually. Ninety-five percent of all mortality caused by fire-related burns worldwide occurs in low- and middle-income countries (LMICs). Prior studies have shown that transfer status (direct transfer from an injury scene to a trauma center vs. indirect transfer from another health facility) affects patient outcomes. We evaluated the effect of interhospital transfer on burn mortality. We analyzed a burn database of pediatric patients admitted to the Kamuzu Central Hospital (KCH) burn unit in Lilongwe, Malawi. We performed a bivariate analysis based on their transfer status and mortality and a logistic regression analysis to determine the effect of transfer status on mortality after burn injury. A total of 2301 patients were analyzed, with 1095 (47.6%) being in the transfer cohort from referring hospitals. The median age was 3years (IQR 1-4). The transfer cohort had more patients presenting to the hospital more than 48h after injury. Upon multivariate logistic regression, controlling for pertinent variables, including time to presentation, burn-injured patients in the transfer cohort had increased odds of mortality (OR 2.26, 95% CI 1.22-4.19, and p=0.01) compared to patients who were not transferred. The predictive probabilities of burn mortality by TBSA showed significant differences in mortality based on transfer status at TBSA between 20% and 80%. Ensuring district hospitals and other primary health care centers in resource-limited settings are sufficiently equipped to provide initial burn resuscitation and care may decrease mortality rates associated with transferred patients.