Pediatric University Hospital Research Articles

Community-acquired Pneumonia With Pleural Effusion in Children and Municipal Human Development Index in Rio de Janeiro, Brazil.

This study evaluated admissions with severe community-acquired pneumonia (CAP) with pleural effusion (PE) in a pediatric university hospital and the impact of the increased average municipal human development index (M-HDI) in the local incidence of the disease in the last decade. This is a retrospective longitudinal study of patients (0-13 years old) with CAP. The municipal human development index (M-DHI) of the place of residence of patients was obtained. We calculate the crude odds ratios (ORs) of variables related to risk of developing PE. The variables that reached a significance level of 80% (P < 0.20) were selected for multivariate analysis. The logistic regression model was used for the selection of the parsimonious model, according to the likelihood ratio. The 465 patients' ages ranged from 1 to 174 months. The median of age (months) in children with PE was 36.00; in children without the PE was 29.00 (P < 0.011); media of variation in M-HDI in the period in patients with PE was 0.767 ± 0.002 and in patients without PE was 0.778 ± 0.002 (P < 0.001). In the logistic regression model, the absence of comorbidity (OR = 2.909) and the HDI < 0.770 (OR = 3.015) were predictive factors associated with PE. The progressive increase of the M-DHI during the study period, although to a slightly higher level, was correlated with the reduction in the number of admissions with CAP with PE.

Profile of resistance to IVIG treatment in patients with Kawasaki disease and concomitant infection

IntroductionKawasaki disease (KD) can be associated with concomitant viral or bacterial infections. Children with persistent or recurrent fever 36 hours after the end of intravenous immunoglobulin (IVIG) are considered to be resistant to treatment and are at increased risk for coronary complications. Although concomitant infection does not affect coronary outcome, it is unknown how it influences the response to IVIG treatment.MethodologyRetrospective cohort study between 2008 and 2016 in a tertiary pediatric university hospital, including 154 children, of which 59 (38%) had concomitant infection.ResultsChildren with concomitant infection were more likely to have fever 48 hours after initial IVIG treatment (36% vs 20%, p = 0.05) and to be treated with a second dose (33% vs 18%, p = 0.04). Children with infection had higher C-reactive protein at the time of diagnosis (148 vs 112 mg/L, p = 0.04), and 48 hours after IVIG administration (111 vs 59 mg/L, p = 0.003). Nevertheless, there was no statistically significant difference in the prevalence of coronary complications (Z-score > 2.5) between children with and without concomitant infection (36% vs 39%, p = 0.68).ConclusionChildren with KD and concomitant infection are more likely to have persistent fever and elevated inflammatory markers after treatment. This association increases the likelihood of receiving a second dose of IVIG but not the risk of coronary complication. Accordingly, prospective studies to distinguish true IVIG resistance from infection induced persistent fever is warranted.

Impact of a simulation-based training in hand hygiene with alcohol-based hand rub in emergency departments.

Hand hygiene is the primary measure for reducing nosocomial infections based on 7 steps recommended by the WHO. The aim of this study was to assess the duration and the quality of hand hygiene before and after simulation-based training (SBT). The study took place in a University Hospital Pediatric Department among its residents and nurses. In assessment A, 10 hand-rubbing procedures per participant during a work day were scored by observers using a validated, anatomically based assessment scale. Two weeks later, all participants received a didactic course and SBT, followed 1 month later by assessment B, observation of 10 hand-rubbing procedures. Assessments were performed by 2 independent observers. Before-and-after testing was used to evaluate the demonstration of theoretical knowledge. In total, 22 participants were included, for whom 438 hand hygiene procedures were assessed: 218 for assessment A and 220 for assessment B. The duration of hand rubbing increased from 31.16 seconds in assessment A to 35.75 seconds in assessment B (P=.04). In assessment A, participants averaged 6.33 steps, and in assessment B, participants averaged 6.03 steps (difference not significant). Significant improvement in scores was observed between assessments A and B, except for the dorsal side of the right hand. The wrist and interdigital areas were the least-cleaned zones. A difference between assessments A and B was observed for nail varnish (P=.003) but not for long nails or jewelry. Theoretical scores increased from 2.83 to 4.29 (scale of 0-5; P<.001). This study revealed that an optimal number of steps were performed during hand-rubbing procedures and that SBT improved the duration and quality of hand hygiene, except for the dorsal right side. Emphasis should be placed on the specific hand areas that remained unclean after regular hand-rubbing procedures.

NOISE SOURCES AND ITS LEVELS DURING MORNING AND AFTERNOON SHIFT IN THE NEONATAL INTENSIVE CARE UNITS

Noisy environment is considered one important stress factors for newborn infants and nurses in the Neonatal Intensive Care Unit (NICU). It may be harmful to full term and preterm infants. The aim of this study is to compare noise sources and its levels during morning and afternoon shift in NICU. The study was a comparative descriptive design, was done on a convenient sample of 100 new born infants attending the NICU of El Manial University Hospital (Kasr Al Ainy) and Pediatric University Hospital (Al Monira). Neonatal assessment sheet and noise sources and its levels sheet were utilized for data collection. Sound level meter was used to measure the level of noise during morning and afternoon shift. Results of the study revealed statistically significant differences between morning and afternoon shift regarding noise sources and its levels. The mean of noise level during morning and afternoon shift were 71.61±5.14 decibels and 60.12±9.21 decibels respectively. Devices alarm in NICU was a higher source of noise in the afternoon shift (54%) and conversation/talking were recorded only in the morning shift (21%). The study concluded that noise levels were above the standard of AAP recommendations in NICU during morning and afternoon shift and devices alarm in NICU was a higher source of noise. The study recommended that noise sources and its levels in NICU should be evaluated routinely in different days of the week and an educational program is needed to raise awareness among nurses and other professionals about the resources of noise.

Clinical Audit of Management of Food Poisoning Cases Admitted to Assiut University Pediatric Hospital

AbstractBackground: Is to assess the clinical management of children with food poisoning admitted to Assiut University Children Hospital.Aim of the Study: The aim of this clinical audit study is to assess how much the adapted protocols of diagnosis and clinical management of children with food poisoning admitted to Assiut University Children Hospital.Patients and Methods: The target population of this cross sectional study were all children admitted to Assiut University Children Hospital with food poisoning from June 2016 to June 2017. The study data were collected by reviewing sheets of patients with food poisoning admitted to Assiut University Children Hospital during the study duration.Results: The study included 40 patients with food poison-ing. The average age was 7.26±4.26 years and ranged from 1 year to 16 years, 20 cases, (50%) were males and 20 cases (50%) were females, Data of the study showed that AUCH partially followed the reference standards of the study.

Imaging-Associated Radiation Trends in a Puerto Rican Pediatric Surgical Population: Is Over-Radiation an Issue in Our Emergency Departments?

The increased use of CT scans has raised concerns regarding the risks of early radiation exposure in the Puerto Rico pediatric population. Available literature sustains that repeated exposure to imaging-related radiation in the pediatric population is associated with a 3-fold increase in the risk of developing pediatric hematogenous and central nervous system malignancies. It is for this reason that an international effort known as the Image Gently Campaign was created, mostly based on the "As Low As Reasonably Achievable" (ALARA) principle described by the Center for Disease Control. With this in mind, our aim was to identify whether there are any discrepancies in imaging tendencies outside our pediatric academic center in Puerto Rico and to determine whether our patients are at increased risk of over-radiation. There were 181 patients; five were excluded because of incomplete data. Our results show that children with appendicitis who are evaluated at nontertiary centers are more likely to have a CT scan performed (93%, OR: 4.054; 95% confidence interval: 2.6-6.4), as opposed to a nonradiating imaging study. In the Pediatric University Hospital, a CT scan was performed as the initial study in 23 per cent of the patients (OR: 0.09; 95% confidence interval: 0.05-0.18), favoring ultrasound as the diagnostic modality of choice. Our concern is that if this trend does not change, our pediatric population might have an increased risk of developing associated malignancies. We believe a local effort toward educational strategies should be implemented to prevent radiation overexposure in our pediatric patients.

Prognostic Impact of Factor V Leiden in Systemic Lupus Erythematosus Pediatric Patients

Objective: This research aimed to study the presence of factor V gene G1691A mutation (Factor V Leiden) in SLE pediatric patients with and without complications and to investigate the association between the presence of Factor V Leiden and lupus complications mainly lupus nephiritis in these patients. Subjects and Methods: This study was conducted on 50 Egyptian pediatric patients (48 females and 2 males) who were all diagnosed as SLE according to the American College of Rheumatology criteria. They were enrolled from the Immunological Clinics at Ain shams University Pediatric Hospital and were divided into two groups: Group 1 (control group) of matched age and sex: Including 25 newly diagnosed uncomplicated SLE patients e.g.: arthritis, musculoskeletal and cutaneous lupus. Group 2 (patients group): Including 25 SLE complicated patient e.g.: nephritis, neurolupus, thrombotic manifestation, cardities and antiphospholipid antibody syndrome. The complications observed in patient group was further classified into lupus nephritis alone or lupus nephritis with other complications (21 patients) or patients with complications other than lupus nephritis (4 patients). Results: All patients included in this study were subjected after taking their parents' consent to full history taking laying stress on history of complications mainly lupus nephritis. In addition, laboratory investigations which include CBC, tests for confirmation of SLE as ANA, anti dsDNA, C3, lupus anticoagulant, anticardiolipin IgG and IgM and renal function tests as serum creatinine and 24hrs urinary proteinsm were done. The Factor V gene mutation was determined by the method of PCR-based DNA analysis in both control and patient groups. In control group, there was 1 out of 25 patients having the Factor V Leiden mutation; who had a heterozygous pattern. The prevalence of Factor V Leiden in patients group showed 2 out of 25 patients, both of them had a heterozygous pattern of the gene mutation. Conclusion: This study couldn't demonstrate any correlation between the presence of Factor V Leiden mutation and the presence of complications in SLE patients as there was no statistical significant difference (P >0.05).

Prognostic Impact of Factor V Leiden in Systemic Lupus Erythematosus Pediatric Patients

Objective: This research aimed to study the presence of factor V gene G1691A mutation (Factor V Leiden) in SLE pediatric patients with and without complications and to investigate the association between the presence of Factor V Leiden and lupus complications mainly lupus nephiritis in these patients. Subjects and Methods: This study was conducted on 50 Egyptian pediatric patients (48 females and 2 males) who were all diagnosed as SLE according to the American College of Rheumatology criteria. They were enrolled from the Immunological Clinics at Ain shams University Pediatric Hospital and were divided into two groups: Group 1 (control group) of matched age and sex: Including 25 newly diagnosed uncomplicated SLE patients e.g.: arthritis, musculoskeletal and cutaneous lupus. Group 2 (patients group): Including 25 SLE complicated patient e.g.: nephritis, neurolupus, thrombotic manifestation, cardities and antiphospholipid antibody syndrome. The complications observed in patient group was further classified into lupus nephritis alone or lupus nephritis with other complications (21 patients) or patients with complications other than lupus nephritis (4 patients). Results: All patients included in this study were subjected after taking their parents' consent to full history taking laying stress on history of complications mainly lupus nephritis. In addition, laboratory investigations which include CBC, tests for confirmation of SLE as ANA, anti dsDNA, C3, lupus anticoagulant, anticardiolipin IgG and IgM and renal function tests as serum creatinine and 24hrs urinary proteinsm were done. The Factor V gene mutation was determined by the method of PCR-based DNA analysis in both control and patient groups. In control group, there was 1 out of 25 patients having the Factor V Leiden mutation; who had a heterozygous pattern. The prevalence of Factor V Leiden in patients group showed 2 out of 25 patients, both of them had a heterozygous pattern of the gene mutation. Conclusion: This study couldn't demonstrate any correlation between the presence of Factor V Leiden mutation and the presence of complications in SLE patients as there was no statistical significant difference (P >0.05).

Efficiency of Multisensoric Therapy in Autism Spectrum Disorder Patients

Abstract The aim of this study was to investigate the role of various treatment methods for children with autistic spectrum disorders (ASD). The prospective study was conducted in 2013–2015 at the Children’s University Hospital and Social Pediatric Centre of the University of Latvia. The data analysis included 72 children (2 to 5 year old) with ASD, of whom 38 had infantile autism, 16 had atypical autism, and 18 had other diffuse developmental disorder). 86.1% patients received therapy. The most common treatment was by Montessori method and special pedagogue. Other treatments were dance-movement therapy, animal, sand and one patient received spa treatments. Univariate OR analysis showed that Montessori therapy had a decreasing trend on three health disorders (visual, hearing, and fine motor skills disorders) compared with other types of therapy, but the effect was not statistically significant. Special pedagogue therapy for autism patients showed similar results. A significant effect was observed for fine motor skills (p &lt; 0.05) and speech development (p &lt; 0.05), and Montessori method and special education were shown to be the most effective tools for promoting developmental progress and reducing developmental delay. Special pedagogue method showed statistically significant efficiency in fine motor skills and speech development. However, significant differences were not found for the Montessori method due to a limited number of patients.

PROFILE OF RESISTANCE TO IVIG TREATMENT IN PATIENT WITH KAWASAKI DISEASE AND CONCOMITANT INFECTION

Abstract BACKGROUND Kawasaki disease (KD) is a paediatric systemic vasculitis that can be associated with concomitant viral or bacterial infections. Patients with persistent or recurrent fever 36 hours after the end of intravenous immunoglobulin (IVIG) are considered to be resistant to treatment and are at increased risk for coronary complications. OBJECTIVES However, it is unknown how concomitant infection influences the response to IVIG treatment. The aim of this study was to determine the impact of concurrent infection on the prevalence of IVIG resistance and coronary outcome. DESIGN/METHODS Retrospective study of 154 children (mean age at diagnosis: 3.4 ± 2.8 years) diagnosed with KD, between 2008–2016 in a tertiary paediatric university hospital, of which 59 (38%) had concomitant infection. RESULTS Delay in diagnosis (&gt;10 days of fever) was similar between patients with and without concomitant infection (7% vs 7%, p=0.89). Patients with concomitant infection were more likely to have fever 48 hours after initial treatment (36% vs 20%, p=0.05) and to be treated with a second dose of IVIG (33% vs 18%, p=0.04). Patients with infection had higher C-reactive protein at the time of diagnosis (148 vs 112 mg/L, p=0.04), which persisted after IVIG administration (111 vs 59 mg/L at 48 hours, p=0.003). However, there was no statistically significant difference in the prevalence of coronary artery (CA) complications (coronary artery Z-score &gt; 2.5) between patients with and without concomitant infection (36% vs 39%, p=0.68). CONCLUSION Children with KD and concomitant infection are more likely to have persistent fever and elevated inflammatory markers after treatment requiring a second dose of IVIG. Nevertheless, this is not associated with an increased risk of CA complications. Larger scale studies are needed to help distinguish IVIG resistance from infection in children with persistent fever and guide management of this population. Table/Chart or graphic upload

Mothers’ Health Education based on Health Belief Model to Promote Health of Preterm Infant Related to Sudden Infant Death Syndrome

Background: Preterm infant is truly a global problem, is a major determinant of infant mortality and morbidity and has long-term adverse consequences for health. The aim: was to evaluate the effect of mothers’ health education based on health belief model to promote health of preterm infant related to sudden infant death syndrome. Design: A quasi-experimental design was utilized. Sample: convenience mothers and their preterm infants consisted of 70. Setting: The study was conducted in the Neonatal Intensive Care Units at Benha Specialized Pediatric Hospital and University Hospitals. The required data was collected used the following tools, structured interview sheet; baseline characteristics of mothers and infant; knowledge about sudden infant death syndrome sheet , questionnaire developed based on the health belief model and reported safety sleep practice according to American Academy of Pediatrics. Results: The study results revealed that mothers who received the health education demonstrated significant higher mean score of knowledge, health belief model and reported sleep practice toward their preterm infants after 1 month from hospital discharge; these results support the proposed study hypotheses. Conclusion: There was positive effect of health education in improving the mother’s knowledge, sleep practice as well as health belief regarding sudden infant death syndrome. Recommendation: Guidelines for creating hospital policy should be available, including the American Academy of Pediatrics risk-reduction recommendations, which lists step-by-step instructions for implementing a policy within the hospital setting.

Survival and Long-Term Functional Outcomes for Children With Cardiac Arrest Treated With Extracorporeal Cardiopulmonary Resuscitation.

To identify patient- and disease-related factors related to survival and favorable outcomes for children who underwent extracorporeal cardiopulmonary resuscitation after a refractory cardiac arrest. Retrospective observational study with prospective assessment of long-term functional outcome. Fifty-six consecutive children undergoing extracorporeal cardiopulmonary resuscitation at our institution from 2007 to 2015. Median age at arrest was 3.5 months (interquartile range, 1-53). Tertiary pediatric university hospital with a referral heart center. Health-related quality of life and family functioning assessment with the Pediatric Quality of Life Inventory and the McMaster Family Assessment Device. Fifty-eight consecutive extracorporeal cardiopulmonary resuscitation episodes were included, with 46 (79.3%) related to primary cardiac conditions. Initial cannulation site was central in 19 (32.8%) and peripheral in 39 (67.2%). Survival to decannulation was 77.6% with survival at hospital discharge and at the end of the follow-up period being 65.5% and 62.1%, respectively. Time to follow-up was 38 months (interquartile range, 19-52). Patients who survived tended to be younger (3.5 mo [1 mo to 2 yr] vs 7 mo [1.25 mo to 17 yr]; p = 0.3) with decreased extracorporeal cardiopulmonary resuscitation times (28 min [15-47 min] vs 37.5 min [28.5-55 min]; p = 0.04). Those who received therapeutic hypothermia tended to have higher hospital survival (21/28 [75%] vs 16/29 [55%]; p = 0.08). Follow-up assessments of survivors demonstrated good quality of life and family functioning (Pediatric Quality of Life Inventory, 84 [76-89.5]; McMaster Family Assessment Device, 1.62 [1.33-1.83]). In this series, extracorporeal cardiopulmonary resuscitation was associated with relatively high survival rates and a good health-related quality of life and family functioning. Larger series are needed to assess whether this technique should be more broadly available in the pediatric critical care community.

English

Bacterial resistance to antibiotics is a serious concern in developing countries due to precarious hygiene conditions, inappropriate prescription as well as self-medication and free sale of antibiotics. This study was aimed to assess the prevalence of strains producing extended-spectrum beta- lactamase in the Gram negative bacteria isolated in the laboratory. The study was conducted in the Charles De Gaulle Paediatric University Hospital (Ouagadougou) and the Arnaud de Villeneuve Regional University Hospital (Montpellier). Out of the 889 pathological substances (pus, urine and blood) analysed, 175 germs were isolated among which 110 were Gram negative bacteria (62.8%). 48.2% of the Gram negative bacteria were positive to extended-spectrum beta-lactamase. Among the 110 Gram negative bacteria isolated, 101 were Enterobacteria and 9 other Gram negative bacteria. No extended-spectrum beta-lactamase was found in the other Gram negative bacteria and 52.5% of Enterobacteria were extended-spectrum beta-lactamase positive. As for the extended-spectrum beta-lactamase phenotype, 60.4% were Escherichia coli and 32% were Klebsiella pneumoniae. 50.9% of extended-spectrum beta-lactamase came from pus and 41.5% from urine. In addition, 64.6% of hospitalised patients had an extended-spectrum beta-lactamase phenotype compared to 24.5% for out-patients. The results show the importance of the phenomenon and should help to better take care of this scourge because antibiotics despite everything, always save millions of lives. &nbsp; Key words: Extended-spectrum beta-lactamase (ESBL), enterobacteria, gram-negative bacilli, inpatients, out-patients.

Tandem Mass Spectrometry in Patients with Drug Resistant Epilepsy

Background: Inherited metabolic abnormality was a common influential factor in the pathogenesis of intractable epilepsy. Screening of inborn metabolic abnormality in children with intractable epilepsy should be conducted as early as possible, to achieve early treatment and improve their prognosis. Methods: Descriptive study was conducted in Outpatient Neurology Clinic –Ain Shams University Pediatric Hospital. It included 30 (12 male and 18 female) patients with intractable epilepsy during the period from February 2017 to December 2017. All patients presented with drug resistant epilepsy. subjected to full history talking , clinical examination and were investigated by serum lactate, serum ammonia, arterial blood gases, Extended Metabolic Screen using tandem mass spectrometry, urinary organic acids, fundus examination, EEG and neuroimaging. Results: Abnormal urinary organic acid analysis was present in 5 patients as follows: 3-hydroxyglutaric acid in one patient, increase lactic acid in three patients and 2-oxoglutaric in one patient. Plasma amino acid analysis results were alanine elevation in 4 patients, elevated C5-DC in one patient, abnormal co-carnitine in three patients, 2 of them had low concentration and one had high concentration, elevated glycine in two patients and phenylalanine elevation in only one .Conclusion: Inherited metabolic abnormality was a common influential factor in the pathogenesis of intractable epilepsy.

Epidemiological Profile of Acute Viral Encephalitis in a Sample of Egyptian Children.

INTRODUCTION:Acute encephalitis syndrome (AES) is a considerable public health problem.AIM:This study was designed to describe the aetiology, demographic features, clinical picture, short-term outcome and risk factors of mortality of children with viral encephalitis in Egyptian children.METHODS:PCR detection of viruses in the CSF of pediatric patients admitted to the pediatric unit or ICU Cairo University Pediatric hospital presenting with encephalitis syndrome.RESULTS:Of the 96 patients included in the study, viral etiological agents were detected in 20 cases (20.8%), while 76 patients (79.2%) had no definite viral aetiology. The most abundant virus detected was Enterovirus (EV) in fourteen (14.5%), two (2.1%) were positive for human herpes simplex virus 6 (HSV-6), one (1.0%), human herpes simplex virus1 (HSV-1), one (1.0%) Epstein Barr virus (EBV), one (1.0%), cytomegalovirus (CMV) and one (1.0%) with varicella-zoster virus (VZV). On the short term outcome, 22 (22.9) patients died, and 74 (77.1%) survived. Severity outcome among survival was vegetative in three cases (4%) severe in 9 (12.16%), moderate in 14 (18.9%), mild in 29 (39.2%) and full recovery in 19 (25.6%). Mortality risk factors for younger age, the presence of apnea, the need for mechanical ventilation and the presence of abnormal CT findings were all significantly associated with fatal outcome (p < 0.05).CONCLUSION:Enterovirus was the most common cause of encephalitis among Egyptian children. Mortality was correlated with younger age and disease severity at admission. Sequelae were high among infected children.

The incidence of postoperative respiratory complications: A retrospective analysis of cuffed vs uncuffed tracheal tubes in children 0‐7 years of age

The use of cuffed vs uncuffed endotracheal tubes in pediatric anesthesia is widely debated. This study aimed to investigate whether the use of cuffed vs uncuffed tubes is associated with an increased incidence of acute postoperative respiratory complications. We retrospectively studied all children aged 0-7years in which the trachea was intubated between September 28, 2006 and August 26, 2016 in a pediatric university hospital. Logistic regression analysis was performed to estimate the association between tube design (cuffed vs uncuffed) and the incidence of acute postoperative respiratory complications (stridor, wheezing, or dyspnea; desaturations ≤90%) in need of intervention (epinephrine, dexamethasone, nebulizers, supplementary oxygen, or reintubation), adjusting for potential confounders. In 5247 of 6796 cases (77%), a cuffed tube was used. Acute postoperative respiratory complications in need of intervention occurred in 334 cases (4.9%) and were less common after cuffed than after uncuffed tubes (N=236, 4.5% vs N=98, 6.3%, respectively, odds ratio 0.70; 95%CI 0.55-0.89). Desaturation occurred less often after cuffed tubes (cuffed: N=1365, 26.0%; uncuffed: N=512, 33.1%; OR: 0.71 (0.61-0.84)). After adjusting for confounders, there was no difference in acute postoperative respiratory complications between cuffed tubes and uncuffed tubes (OR 0.74; 95%CI 0.55-1.01). Subgroup analyses in various age groups did not show significant differences between the use of cuffed or uncuffed tubes. After adjustment for multiple confounders, the use of cuffed tubes was not associated with an increased incidence of acute respiratory complications in postanesthesia care unit.

Incidence, characteristics, and predictive factors for medication errors in paediatric anaesthesia: a prospective incident monitoring study

BackgroundMedication errors are not uncommon in hospitalized patients. Paediatric patients may have increased risk for medication errors related to complexity of weight-based dosing calculations or problems with drug preparation and dilution. This study aimed to determine the incidence of medication errors in paediatric anaesthesia in a university paediatric hospital, and to identify their characteristics and potential predictive factors. MethodsThis prospective incident monitoring study was conducted between November 2015 and January 2016 in an exclusively paediatric surgical centre. Children <18 yr undergoing general anaesthesia were consecutively included. For each procedure, an incident form was completed by the attending anaesthetist on an anonymous and voluntary basis. ResultsIncident forms were completed in 1400 (73%) of the 1925 general anaesthetics performed during the study period with 37 reporting at least one medication error (2.6%). Drugs most commonly involved in medication errors were opioids and antibiotics. Incorrect dose was the most frequently reported type of error (n=27, 67.5%), with dilution error involved in 7/27 (26%) cases of incorrect dose. Duration of procedure >120 min was the only factor independently associated with medication error [adjusted odds ratio: 4 (95% confidence interval: 2–8); P=0.0001]. ConclusionsMedication errors are not uncommon in paediatric anaesthesia. Identification of the mechanisms related to medication errors might allow preventive measures that can be assessed in further studies.

Dental caries and vitamin D3 in children with growth hormone deficiency

Vitamin D may prevent dental caries. To date, no attempts have been made to examine the correlation between the incidence of caries and the concentrations of vitamin D in children with pituitary growth hormone deficiency.The study observed patients of the Department of Endocrinology and Diabetology of the University Paediatric Hospital of the Medical University of Lublin treated with human recombinant growth hormone for pituitary growth hormone deficiency (GHD). The study was conducted between October 2014 and June 2015. The study group consisted of 121 children and adolescents (6–17 years old), including 56 children from rural areas and 65 children from urban areas. The study group was stratified by area of residence.In our study, the increase in vitamin D3 [25(OH)D] levels reduced the D component by 0.66 per each 10 ng/mL of vitamin D3 concentration. The percentage of children with active caries in rural areas is 91.07% (n = 51), which is significantly higher than the percentage of children with active caries in urban areas (81.54%, n = 53).To date, information regarding the potential possibility of reducing the incidence of dental caries by means of increasing the levels of vitamin D was sidelined by paediatricians and dentists alike. Therefore, this aspect of caries prevention should be highlighted.

A Program for Weaning Children from Enteral Feeding in a General Pediatric Unit: How, for Whom, and with What Results?

To describe a series of children who were hospitalized for a tube-weaning program in the general pediatric ward of a pediatric tertiary university hospital: describe our method, to determine the success rate of our inpatient pediatric tube weaning program, and search for relevant factors linked to its success or failure. We analyzed the medical files of consecutive children who were hospitalized for gastric-tube weaning over an 8-year period. We analyzed outcomes in terms of feeding and growth with at least 2 years of data. Success (weaning within 3 months) and failure were compared by characteristics of children. We included 37 children (29 females) with mean (SD) age 31.4 (21) months. Most had a severe medical history (30% prematurity; 50% intrauterine growth restriction, 50% neurological and genetic anomalies). The weaning program was successful for half of the children. Factors linked to success of the program were female sex (p = 0.0188), normal neurodevelopment (p = 0.0016), nasogastric tube (p = 0.0098), and with <24 months on EF before the stay (p = 0.0309). Comparing the efficiency of various methods and results among teams was difficult, which indicates the need to establish consensus about the outcome criteria. We confirm the need for these types of stays and programs.

Risk factors associated with acute kidney injury in newborns.

Acute kidney injury (AKI) in the newborn is a common problem in the neonatal intensive care unit with many underlying factors such as asphyxia, respiratory distress syndrome (RDS), and urogenital anomalies. The aim of this study is to highlight possible risk factors and profile of neonates developing AKI in the Neonatal Intensive Care Unit (NICU) of Cairo University Pediatric Hospital. The study was carried out on 90 neonates (30 patients and 60 controls), among neonates admitted to NICU. The study was done over two months, from January 2015 to March 2015. Our study showed that sepsis was detected in 53.3%, prematurity in 46.67%, RDS in 43.3%, congenital heart disease in 20%, and hypoxic-ischemic encephalopathy in 6.67% of patients. Maternal illness and low body temperature were both significant risk factors of AKI in neonates. History of maternal illness, low body temperature, sepsis, prematurity, and respiratory distress can contribute to the development of AKI in neonates.