Pediatric Therapy Research Articles

Evaluating the Impact of Bowel Gas Variations for Wilms’ Tumor in Pediatric Proton Therapy

(1) Background: Proton therapy, a precise form of radiation treatment, can be significantly affected by variations in bowel content. The purpose was to identify the most beneficial gantry angles that minimize deviations from the treatment plan quality, thus enhancing the safety and efficacy of proton therapy for Wilms’ tumor patients. (2) Methods: Thirteen patients with Wilms’ tumor, enrolled in the SJWT21 clinical trial, underwent proton therapy. The variations in bowel gas were systematically monitored using daily Cone Beam Computed Tomography (CBCT) imaging. Air cavities identified in daily CBCT images were analyzed to construct daily verification plans and measure water equivalent path length (WEPL) changes. A worst-case scenario simulation was conducted to identify the safest beam angles. (3) Results: The study revealed a maximum decrease in target dose (ΔD100%) of 8.0%, which corresponded to a WEPL variation (ΔWEPL) of 11.3 mm. The average reduction in target dose, denoted as mean ΔD100%, was found to be 2.8%, with a standard deviation (SD) of 3.2%. The mean ΔWEPL was observed as 3.3 mm, with an SD of 2.7 mm. The worst-case scenario analysis suggested that gantry beam angles oriented toward the patient’s right and posterior aspects from 110° to 310° were associated with minimized WEPL discrepancies. (4) Conclusions: This study comprehensively evaluated the influence of bowel gas variability on treatment plan accuracy and proton range uncertainties in pediatric proton therapy for Wilms’ tumor.

Co-design for technology in paediatric therapy: Developing an augmented reality intervention for children with developmental coordination disorder.

Background: Children with developmental coordination disorder (DCD) have difficulty learning and performing movements, often requiring increased feedback. Technology may be useful for delivering augmented feedback. Co-design methodology for developing therapeutic interventions has become popular in healthcare, including for technology in rehabilitation. However, there are limited guidelines on how to use co-design methodology in healthcare. Methods: We applied three key principles, (1) Understanding, (2) Exploring, and (3) Materialising, to inform a co-design process. End-user participants included paediatric clinicians, young learners, their caregivers, and the research team, who shared their expertise and lived experience to inform the creation of a novel system. Results: A team of end-users designed and developed an augmented reality intervention prototype for practicing motor skills aimed at children with DCD using a generative co-design process. From understanding the unmet needs, we explored and then materialised a series of games using bespoke technology solutions. Conclusion: The use of a co-design process was beneficial in engaging end-users as the experts of their experience in the creation of a novel augmented reality intervention prototype aimed for children with DCD. The co-design process was successful in facilitating a prototype that meets consumer needs, and ensured all end-user voices were heard.

Sport-Specific AMCaMP: New Modular Tools for Measuring Adolescent Self-Confidence In Sport-Specific Movement.

Despite increasing interest in psychological factors that affect the impact of self-efficacy on readiness to return to play, few clinical tools are available to assess self-confidence in performing sports-specific movement patterns in the pediatric/adolescent population. The purpose of this study was to test the psychometric properties of sports-specific modules to supplement a general measure of movement self-efficacy, the Adolescent Measure of Confidence and Movement Performance (AMCaMP). Quasi-experimental cross-sectional validation. After preliminary testing for readability and ease of administration, one of 12 sport-specific modules pertinent to the individual's sport (baseball, softball, basketball, football, gymnastics, cheerleading, soccer, ballet, swimming, lacrosse, tennis, and cross country) were administered to 14,744 patients, 11-18 years of age, drawn from 12 pediatric sports physical therapy facilities in a single health care system. Respondents completed the assigned sport-specific self-report questionnaire at initial visit and conclusion of the episode of care. Based on sample sizes, Bartlett's Test of Sphericity, and Kaiser-Myer-Olkin measures, nine modules (baseball, softball, basketball, football, gymnastics, cheerleading, soccer, ballet, and swimming) were deemed suitable for factor analysis. Each module sample was divided into test validation samples. Exploratory factor analysis revealed an underlying structure ranging from one to three factors depending upon the module. Subsequent confirmatory factor analyses fully supported the hypothesized factor structures for each module except swimming. Additional analyses to determine coefficient alpha (range=0.8-0.976), Standard Error of Measurement (range=1.12-2.33), and Minimum Detectable Change (range=3.1-6.47) confirmed the reliability of each of these modules. AMCAMP sport-specific modules are reliable and valid self-report tools to capture self-confidence in performing sport-specific movements to supplement AMCAMP's evaluation of self-efficacy in performing the general movements of everyday life. The results of this study support using these modules as part of the overall clinical evaluation of psychological readiness to return to sport. Level 3b.

Non-pharmacological therapies for pain management in paediatric intensive care units: a protocol for a scoping review

IntroductionIn critically ill children, pain management is complex owing to cognitive development and the nature of hospitalisation in paediatric intensive therapy units. Although there are many protocols and guidelines for...

Nanomedicine Therapies for Pediatric Diseases.

In 2020, the top 10 causes of death among children and adolescents between the ages of 1 and 19 years old included cancer, congenital anomalies, heart disease, and chronic respiratory disease; all these conditions are potentially treatable with medical intervention. However, children exhibit specific physiological and developmental characteristics that can significantly impact drug pharmacokinetics, pharmacodynamics, and safety profile. These factors illustrate the importance of a heightened focus on pediatric drug development. Traditional drugs lack proper circulation, permeability, targeting, accumulation, and release, and they often require dose adjustments or modifications, which can result in suboptimal therapeutic outcomes and increased risks of adverse effects in pediatric patients. Nanomedicines have emerged as efficient drug delivery systems because of their unique properties, which can improve the solubility and stability of drugs by encapsulating them in different forms of nanoparticles. This review discusses the challenges of pediatric therapy, and the current state of nanomedicines for pediatric diseases in terms of Food and Drug Administration-approved nanomedicines, the types of diseases treated or diagnosed, and preclinical studies that have the potential to be translated to the clinic. In summary, nanomedicine holds significant potential for addressing the unique and pressing challenges associated with diagnosing and treating pediatric diseases.

Pengaruh Pijat Medic Pediatric sebagai Terapi Konstipasi pada Bayi Usia 6-12 Bulan

Constipation is a health problem that often occurs in infants. Basedon an initial survey at the Sei Langkai health center, data was obtained that out of 10 babies, 7 of them had experienced constipation and most mothers did not know how to deal with constipation in infants. The purpose of the study was to determine the effect of Pediatric Medical Massage asa Constipation Therapy. The subjects in this study were infants aged 6-12 months. Thisresearch was carried out in the Working Area of the Sei Langkai Health Center in Batam City using Quasi Experiments with pre and posttest control design. This research was conducted in.The results showed that in the intervention group obtained a value of p = 0.000 < 0.05 which showed that there was an effect of Pediatric Medical Massage as a Constipation Therapy in infants aged 6-12 months, while in the control group the test results showed that the value of p = 0.083 > 0.05 so that it could be stated that There is no effect on the treatment of control groups against constipation in infants aged 6-12 months. Theconclusion of the study is that pediatric medical massage can be a method in overcoming constipation in infants so that mothers can overcome the incidence of constipation in infants at home

The effects of flow settings during high-flow nasal cannula oxygen therapy for neonates and young children.

During neonatal and paediatric high-flow nasal cannula therapy, optimising the flow setting is crucial for favourable physiological and clinical outcomes. However, considerable variability exists in clinical practice regarding initial flows and subsequent adjustments for these patients. Our review aimed to summarise the impact of various flows during high-flow nasal cannula treatment in neonates and children. Two investigators independently searched PubMed, Embase, Web of Science, Scopus and Cochrane for in vitro and in vivo studies published in English before 30 April 2023. Studies enrolling adults (≥18 years) or those using a single flow setting were excluded. Data extraction and risk of bias assessments were performed independently by two investigators. The study protocol was prospectively registered with PROSPERO (CRD42022345419). 38 406 studies were identified, with 44 included. In vitro studies explored flow settings' effects on airway pressures, humidity and carbon dioxide clearance; all were flow-dependent. Observational clinical studies consistently reported that higher flows led to increased pharyngeal pressure and potentially increased intrathoracic airway pressure (especially among neonates), improved oxygenation, and reduced respiratory rate and work of breathing up to a certain threshold. Three randomised controlled trials found no significant differences in treatment failure among different flow settings. Flow impacts exhibited significant heterogeneity among different patients. Individualising flow settings in neonates and young children requires consideration of the patient's peak inspiratory flow, respiratory rate, heart rate, tolerance, work of breathing and lung aeration for optimal care.

Progress Toward Cardiac Risk Reduction With the Evolution of Pediatric Hodgkin Lymphoma Therapy

Progress Toward Cardiac Risk Reduction With the Evolution of Pediatric Hodgkin Lymphoma Therapy

The success rate and complications of midline catheters in pediatric outpatient parenteral antibiotic therapy (OPAT)

The use of outpatient parenteral antimicrobial therapy (OPAT) for children has several advantages, including reduced length of hospital stay and costs. A reliable vascular access is key to delivering safe and effective pediatric OPAT. In recent years, midline catheters (MC) have been increasingly used for short-term intravenous antibiotic therapy in children. However, there are no studies investigating the use of MCs in the OPAT setting. The main aim of this paper was to evaluate the success and complications of using MCs for pediatric OPAT. This was a retrospective cohort study from a tertiary academic pediatric hospital. All MCs inserted at the hospital and used for OPAT were eligible for study inclusion. The primary objective was to describe the percentage of patients able to complete OPAT without the need for additional venous access. Forty-one MCs were included in the study. Patient mean (SD) age was 5.9 (4.9) years. In 31 cases (76%, 95% CI 62–86%), the iv therapy could be successfully completed using only the MC. Imbalances between the groups suggested unfavorable outcome for saphenous vein catheters as well as for shorter and smaller-sized catheters. Fourteen patients (34%) were subjected to a MC-related complication. Pain on injection in the MC was the most frequent complication (n = 10, 24%). Conclusion: Midline catheters could be an alternative to central venous access for pediatric OPAT. Avoiding saphenous vein insertion and using longer and larger-sized catheters could increase MC success rate. No severe MC-related complication was found. Further randomized studies comparing different catheter types are needed.What is Known:• For selected patients, pediatric outpatient parenteral antimicrobial therapy (OPAT) is safe and provides health-economic, psychosocial, and medical advantages compared to in-hospital care.• A reliable venous access is one of the key factors to the success of OPAT, but this can be a challenge in children.What is New:• Using midline catheters, 76% of patients could complete their intended iv therapy without the need for additional venous access. Avoiding saphenous vein insertion and using longer and larger-sized catheters could increase the success rate.• Thirty-four percent of catheters were subject to some kind of complication, the most common being pain on injection in the catheter.

Healthcare cost and utilization for chimeric antigen receptor (CAR) T-cell therapy in the treatment of pediatric acute lymphoblastic leukemia: A commercial insurance claims database analysis.

B-lineage acute lymphoblastic leukemia (B-ALL) is the most common malignancy of childhood. With the introduction of novel cellular therapies, cost of care is a critical component and the financial burden experienced by patients and society requires evaluation. This study aims to assess the utilization and cost of care for chimeric antigen receptor T-cell (CAR-T) therapy for pediatric ALL patients with commercial insurance coverage in the United States. Using de-identified commercial insurance data from the OptumLabs® Data Warehouse, a cohort of 37 patients, aged 1-25 years, with B-ALL treated with CAR-T therapy between Oct 2016 and Dec 2021 in the United States was identified. Cost was evaluated for a 90 day period encompassing CAR-T infusion and by administration and complication characteristics. Among the 37 identified B-ALL patients that received a CAR-T product infusion, 14 patients were female, median age at administration was 13 years. The median 90-day total cost was $620,500 (Mean: $589,108). Inpatient cost accounted for approximately 71% of the total cost with an average of 28 inpatient days per patient. Although inpatient cost was slightly higher in the older age group (aged 10-25 years) and in patients with a code for cytokine release syndrome (CRS), these differences were not statistically significant. This real-world cost analysis shows for the first time the encompassing cost of CAR-T therapy for pediatric B-ALL patients in the US with commercial insurance. This study provides a valuable benchmark that can be used to analyze the financial implications of CAR-T therapy for pediatric B-ALL therapy on health systems.

Challenges with pediatric antiretroviral therapy administration: Qualitative perspectives from caregivers and HIV providers in Kenya.

Current formulations of pediatric antiretroviral therapy (ART) for children with HIV present significant barriers to adherence, leading to drug resistance, ART ineffectiveness, and preventable child morbidity and mortality. Understanding these challenges and how they contribute to suboptimal adherence is an important step in improving outcomes. This qualitative study describes how regimen-related challenges create barriers to adherence and impact families. We conducted key informant interviews (KIIs) with 30 healthcare providers and 9 focus group discussions (FGDs) with a total of 72 caregivers, across three public hospitals in Siaya and Mombasa Kenya. The KIIs and FGDs were audio recorded, translated, and transcribed verbatim. The transcripts were hand coded based on emergent and a-priori themes. Caregivers discussed major regimen-related challenges to adherence included poor palatability of current formulations, complex preparation, and administration (including measuring, crushing, dissolving, mixing), complex drug storage, and frequent refill appointments and how these regimen-related challenges contributed to individual and intrapersonal barriers to adherence. Caregivers discussed how poor taste led to child anxiety, refusal of medications, and the need for caregivers to use bribes or threats during administration. Complex preparation led to concerns and challenges about maintaining privacy and confidentiality, especially during times of travel. Providers corroborated this patient experience and described how these challenges with administration led to poor infant outcomes, including high viral load and preventable morbidity. Providers discussed how the frequency of refills could range from every 2 weeks to every 3 months, depending on the patient. Caregivers discussed how these refill frequencies interrupted work and school schedules, risked unwanted disclosure to peers, required use of financial resources for travel, and ultimately were a challenge to adherence. These findings highlight the need for improved formulations for pediatric ART to ease the daily burden on caregivers and children to increase adherence, improve child health, and overall quality of life of families.

Phentermine and Topiramate: Monotherapy and Their Combination Efficacy in the Treatment of Children and Adults with Obesity

The obesity prevalence in children has increased dramatically over the past four decades and has epidemic nature. Lifestyle correction in majority of obese children and adolescents leads only to slight success in reducing body weight (that usually restores to initial level). The increasing availability of pharmacotherapeutic agents approved by Food and Drug Administration (FDA) for body weight reduction in children provides physicians with new and effective tools for obesity management. Phentermine/ topiramate is a combination medication (with once-a-day administration, controlled release) that has been recently approved by the FDA for pediatric obesity therapy. Its efficacy is significantly higher compared to orlistat and phentermine (in monotherapy), two other FDA-approved drugs for this age group. The aim of this review is to analyze the literature on the topic of phentermine and topiramate mechanism, as well as these drugs safety and efficacy as monotherapy and in combination in children and adolescents with obesity.

Terapia por pressão negativa em paciente pediátrico com infecção de sítio cirúrgico: relato de experiência

ABSTRACT Objective: To describe the use of negative pressure wound therapy and hydrofiber dressing with silver in a pediatric patient with a hard-to-heal surgical wound infection. Method: This is a descriptive professional experience report on the use of conventional dressings and negative pressure wound therapy in a pediatric patient with a surgical wound infection. It was developed in 2023 at a Public Health Service that is a reference in the care of pediatric patients in the state of Paraná. Results: The surgical wound dehiscence started 12 days after peritoneostomy. Initially, the wound was treated with hydrofiber dressing with silver for 22 days and subsequently, negative pressure wound therapy was used for 15 days, regenerating the wound. Conclusion: Negative pressure wound therapy in pediatrics proved to be safe, effective and efficient for the treatment of complex wounds and corroborated the skin regeneration process, as did hydrofiber dressing with silver.

Outpatient parenteral antimicrobial therapy in pediatrics: the role of antimicrobial stewardship

Abstract This study characterized outpatient parenteral antimicrobial therapy (OPAT) orders and associated antimicrobial stewardship program (ASP) pharmacist recommendations made in a freestanding children’s hospital. Recommendations occurred in over 50% of orders, indicating an opportunity for the review of OPAT by ASP pharmacists.

Dabrafenib plus Trametinib: A breakthrough in pediatric low-grade glioma therapy.

Pediatric-type low-grade gliomas (pLGGs) are the most common solid tumors in children, with v-raf murine sarcoma viral oncogene homolog B (BRAF) mutations playing a significant role in their development. Dabrafenib and trametinib are targeted therapies that are recently approved by Food and Drug Administration for pediatric patients with pLGG harboring a BRAF V600E mutation. This study emphasizes the role of Dabrafenib and Trametinib in pLGG. A multicenter Phase I/II trial demonstrated the superior efficacy of dabrafenib plus trametinib (D+T) compared to carboplatin plus vincristine (C+T), with higher overall response rates, clinical benefit rates, and longer progression-free survival. The safety profile of dabrafenib plus trametinib (D+T) was favorable, with fewer discontinuations and adverse events compared to the control group. The introduction of D+T as a targeted therapy represents a significant advancement in the management of pLGG, necessitating further investigations to understand its long-term consequences and optimize patient care.

The rollout of paediatric dolutegravir and virological outcomes among children living with HIV in Mozambique.

In 2022, Mozambique introduced Dolutegravir 10mg (pDTG), as part of paediatric antiretroviral therapy for children weighing < 20 kg. Understanding real-world challenges during national rollout can strengthen health systems in resource-limited settings. We described the transition rate to, and new initiation of, pDTG, viral load suppression (VLS) post-pDTG, and factors associated with VLS among children living with HIV. We conducted a retrospective cohort study involving children aged < 9 years and abstracted data from clinical sources. We used logistic regression to assess VLS and pDTG initiation predictors. Of 1353 children, 1146 initiated pDTG; 196 (14.5%) had no recorded weight. Post-pDTG switch, 98.9% (950/961) of children maintained the same nucleoside reverse transcriptase inhibitor backbone. After initiating Abacavir/Lamivudine+pDTG, 834 (72.8%) children remained on the regimen, 156 (13.6%) switched off (majority to Dolutegravir 50mg), 22 (1.9%) had ≥ 2 anchor drug switches; 134 (11.7%) had no documented follow-up regimen. Factors associated with pDTG initiation or switch were younger age (adjusted odds ratio [AOR] = 0.71 [0.63-0.80]) and a recorded weight (AOR = 55.58 [33.88-91.18]). VLS among the 294 children with a viral load (VL) test after ≥ 5 months post-pDTG was 75.5% (n = 222/294). Pre-pDTG VLS rate among treatment-experienced children was 56.5% (n = 130/230). Factors associated with VLS were older age (AOR = 1.18 [1.03-1.34]) and previous VLS (AOR = 2.27 [1.27-4.06]). Most eligible children initiated pDTG per guidelines, improving post-pDTG VLS. Challenges included unexplained switches off pDTG after initiation, low VL coverage and inadequate documentation in clinic records.

Intervenção clínica do cuidado farmacêutico como indicador de qualidade da assistência hospitalar em pediatria

Objective: To determine the frequency and nature of drug-related problems in hospitalized patients of a public pediatric hospital in Fortaleza/Ce. Metodology: Cross-sectional and retrospective study from the records of pharmaceutical interventions available in the database of the clinical pharmacy service. Results: Fifty-eight patients were included in the study. A total of 75 drug-related problems were identified with a frequency of 76.2% related to safety and these involved antimicrobial drugs (45.8%). Dose adequacy (35.7%) was the most frequent pharmaceutical intervention. The acceptability profile of the interventions was 64.4% for physicians and 100% by nurses. Final considerations: By analyzing the drug-related problems and pharmaceutical interventions, it was possible to know which aspects of the pediatric patients therapy were explored in the clinical pharmacist follow-up. We emphasize the importance of documentation of clinical practice for the construction of indicators and evaluation of the quality of pharmaceutical care in pediatrics.

Perception of speech therapists and parents on use of telepractice for paediatric speech therapy in Sri Lanka

The use of communication technology to deliver speech therapy (telepractice) was highly considered during the COVID-19 pandemic. However, a few Speech and Language Therapists (SLTs) and parents engaged in telepractice in Sri Lanka. Therefore, it was essential to identify the factors that encouraged and prevented the successful implementation of telepractice. A descriptive cross-sectional study was followed using a sequential mixed-method approach. Thirty SLTs and sixty-two parents who use telepractice services participated in the study. Quantitative data were collected through a self–administered online survey and analysed using descriptive statistics. The telephone interviews were conducted to obtain qualitative data from five SLTs and ten parents, on which thematic analysis was performed. Sixty percent of SLTs and 84% of parents considered telepractice an effective procedure similar to face–to–face therapy. However, SLTs emphasised that telepractice is applicable, subject to the child’s condition and other factors. Participants’ perception of telepractice was mainly based on their experience. Parent involvement in the speech therapy sessions was found to be high because of the implementation of asynchronous and hybrid modes of telepractice. Providing appropriate training in therapy strategies and educating parents on the use of technology may improve speech therapy services through telepractice in Sri Lanka.

Yoga versus iPad active control for fatigue in paediatric cancer therapy: a randomised controlled trial

ObjectivesThe primary objective was to determine if individualised yoga for hospitalised children receiving intensive chemotherapy was associated with less fatigue using the Pediatric Quality of Life Inventory Multidimensional Fatigue Scale...

The organization of care in pediatric radiotherapy across SIOP Europe affiliated centers: A multicenter survey in the framework of the ‘Joint Action on Rare Cancers’ project

Background/purposeTo reduce inequalities among SIOPE-affiliated countries, standard and optional levels to deliver ‘Good Clinical Practice’ compliant treatment in pediatric radiation oncology have been published. The aim of this project was to map the availability of pediatric radiotherapy resources across SIOPE-affiliated radiotherapy departments. Materials/methodsAn online survey with 34 questions was distributed to 246 radiotherapy departments across 35 SIOPE-affiliated countries. In addition to demographic data, 15 general items related to the organization of the radiotherapy process, and 10 radiotherapy-specific items were defined. For each of the 25 items, sum scores were calculated per center and country. Mann-Whitney U tests were used to analyze associations. ResultsBetween March-June 2019, 121 departments (49 %) out of 31 countries (89 %) completed the survey. At center level, involvement of core disciplines in tumor boards (28 %), and integration of dedicated pediatric radiation therapy technologists (24 %) are limited, while rare & complex brachytherapy procedures are performed in many centers (23 %). For general and radiotherapy-specific items respectively, a relevant variation of sum scores was observed across countries (Δgeneral: ≤10 points; ΔRT_specific: ≤5 points) and among centers within a country (Δgeneral: ≤9 points; ΔRT_specific: ≤6 points). Sum scores for general and radiotherapy-specific items were higher in countries with a high-income (p < 0.01) and higher health development index (p < 0.01). A larger annual number of irradiated pediatric patients was associated with higher sum scores for general items (p < 0.01). ConclusionThis survey demonstrates the disparities in organization of pediatric radiotherapy departments between SIOPE-affiliated countries and centers within the same country. Investment is needed to reduce inequalities in pediatric radiotherapy care.