Pediatric Patients Research Articles

The impact of reduced pediatric emergency care hours on the patterns of emergency department utilization

Purpose: The declining recruitment rate of pediatric residents in Korea has led to a decrease in the number of emergency departments (EDs) offering a 24/7 pediatric emergency care (PEC). This study evaluated the impact of reduced PEC hours on the utilization patterns of a single ED.Methods: We reviewed medical records of pediatric patients who were defined as individuals aged 14 years or younger undergoing pediatricians’ practices in a tertiary hospital ED in Korea. Given the reduction of PEC hours from full-time to 08:00-24:00 on September 27, 2022, the patients were grouped as those who visited during March 27, 2022-September 26, 2022 (“control”), and those who visited during September 27, 2022-March 26, 2023 (“reduction”). The following variables were analyzed between the 2 periods: the number of patients, age, sex, visits via ambulances, severity by the Korean Triage and Acuity Scale with high acuity (a level 1-2 of the scale), disease-related visits, time of visit, ED length of stay (EDLOS), disposition, chief complaints, and diagnoses.Results: Among 3,577 pediatric patients, 1,315 visited the ED during the reduction period, down by 41.9% in numbers from the control period. From the control to reduction periods, we observed an increase in the median age (from 3.0 years [interquartile range, 1.0-7.0] to 4.0 years [1.0-8.0]; P = 0.005) and decreases in the median EDLOS (from 140.0 minutes [80.0-217.0] to 104.0 minutes [54.0-169.8]; P < 0.001) and proportion of hospitalization (from 22.1% to 12.6%; P < 0.001). No change was observed in the proportions of highacuity cases or chief complaints. We noted decreases in infection-related diagnoses during the reduction.Conclusion: Reducing PEC hours was associated with shorter EDLOS, fewer hospitalizations, and older age, with no difference in the severity. Even with reduced PEC hours, relevant resources should be redistributed to ensure the accessibility to PEC.

The role of metformin in modulating cardiometabolic risk in obese pediatric populations with metabolic syndrome: A systematic review

Introduction: Obesity significantly increases the risk of developing cardiometabolic complications, which are precursors to cardiovascular diseases (CVD). In children and adolescents, metabolic dysfunctions such as insulin resistance, dyslipidemia, and hypertension are key contributors to early-onset cardiovascular risk. Metformin, a well-established antidiabetic agent, has shown potential benefits in addressing these metabolic imbalances. However, the long-term impact of metformin on cardiovascular outcomes in obese pediatric patients remains unclear. Aim: This systematic review aims to evaluate the effect of metformin on cardiometabolic parameters in obese children and adolescents with metabolic syndrome, focusing on insulin sensitivity, body mass index (BMI), blood pressure, and lipid profiles. Methods: A systematic review was conducted by searching databases including PubMed, Cochrane Library, Embase, and Web of Science. The inclusion criteria targeted randomized controlled trials (RCTs), cohort studies, systematic reviews, and meta-analyses published between 2004 and 2024. Pediatric patients aged 6-18 years with obesity and metabolic syndrome were included. The primary outcomes assessed were BMI, insulin sensitivity, lipid profiles, blood pressure, and cardiovascular outcomes. Results: A total of 23 studies, including 10 RCTs and 1 meta-analysis, were reviewed, involving 777 patients. Metformin demonstrated consistent improvements in insulin sensitivity and BMI in obese children and adolescents. Several studies reported modest reductions in BMI, improved insulin resistance, and better lipid profiles. However, variability in results was observed regarding long-term cardiovascular outcomes. While metformin reduced systolic blood pressure and carotid intimal-medial thickness (CIMT), the long-term impact on preventing major cardiovascular events remained inconclusive. Discussion: Metformin’s benefits on cardiometabolic risk factors in obese children are primarily attributed to its effects on insulin sensitivity, lipid metabolism, and inflammatory pathways. Its ability to activate AMP-activated protein kinase (AMPK) leads to improved metabolic profiles and reduced inflammation and is crucial for mitigating obesity-related cardiovascular risks. Despite these positive effects, the evidence for long-term prevention of cardiovascular events is limited and requires further exploration. Conclusions: Metformin offers significant short-term benefits in improving BMI, insulin sensitivity, and cardiometabolic parameters in obese children and adolescents. However, its long-term efficacy in preventing cardiovascular events remains uncertain. Further studies are necessary to establish its role in long-term cardiovascular protection in pediatric populations

Pediatric acetaminophen intoxication in Korea: characteristics and prognosis

Purpose: Acetaminophen overdose accounts for the largest proportion of pediatric poisoning reported in South Korea. We investigated the characteristics and prognosis of pediatric acetaminophen overdose.Methods: We retrospectively reviewed medical records of patients younger than 19 years with acetaminophen overdose who visited the emergency department (ED) of Pusan National University Children’s Hospital from January 2009 through December 2022. We investigated age, sex, dose, clinical findings, and treatment, and compared the differences in the variables according to the intentionality of ingestion and the presence of hepatotoxicity.Results: Among the 132,691 pediatric patients who visited the ED during the period, 555 did for drug intoxication, of whom 51 with acetaminophen overdose were included in this study. The overdose was intentional in 43 patients (the intentional group; median age, 15.4 years [interquartile range, 13.9-16.8]) and accidental in 8 patients (the accidental group; 7.7 years [2.3-15.4]). The mean ingested dose was higher in the intentional group than in the accidental group (170.3 ± 129.0 vs. 105.3 ± 37.5 mg/kg; P = 0.016). Hospitalization tended to be implemented more frequently in the intentional group (53.5% vs. 12.5%; P = 0.081). All patients with hepatotoxicity (n = 10) belonged to the same group, and showed a higher or longer median age (15.9 [14.6-17.1] vs. 13.8 years [13.7-16.4]; P = 0.030), mean ingested dose (13,230.0 ± 10,544.8 vs. 7,654.0 ± 6,752.3 mg; P = 0.043), mean time from ingestion to arrival at the ED (22.6 ± 23.4 vs. 5.5 ± 6.4 hours; P = 0.048), and frequency of hospitalization (80.0% vs. 39.0%; P = 0.048).Conclusion: It is necessary to track the occurrence of hepatotoxicity in patients who intentionally ingest acetaminophen.

Elucidating the relationship between blood glucose dynamics and growth hormone responses in glucagon stimulation tests among children with short stature

Introduction: The use of glucagon as a provocative agent for growth hormone (GH) assessment is a cornerstone in pediatric endocrinology. Glucagon's role as a GH secretagogue is integral to growth hormone stimulation tests (GHSTs), which diagnose suspected GH deficiency (GHD) in children. These tests are crucial for assessing the hypothalamic-pituitary-adrenal (HPA) axis's integrity. Despite its prevalent use, the exact mechanisms by which glucagon prompts GH release and the impact of ensuing blood glucose (BG) fluctuations are not fully understood. Objectives: This study aims to explore the relationship between GH and BG levels in children with short stature following glucagon administration. Patients and Methods: A retrospective cohort study involved 42 pediatric patients, aged 6 to 11, with short stature. We analyzed GH and BG levels before and after intramuscular glucagon Simulation test (GST). Blood samples were taken at baseline and multiple intervals post-injection. Results: The results revealed that the mean glucose peaked at 60 minutes and declined to a nadir at 120 minutes, which corresponded with a significant rise in GH levels. GH concentrations peaked at 120 minutes post-injection, with 31% of children showing peak GH levels of less than 7 μg/L. Notably, the study found an inverse correlation between BG and GH at peak glucose times, suggesting a complex interplay between glucose dynamics and GH response. Discussion: Our findings indicate a dynamic interrelation between BG and GH post-glucagon injection, challenging traditional interpretations of GST results. The study reinforces the notion that GHST results should be interpreted with consideration of patient-specific factors such as BMI to ensure accurate evaluation of GH reserve and subsequent clinical decision-making. Conclusion: The study corroborates the dynamic nature of GH and glucose responses following glucagon administration and highlights the need for personalized approaches in interpreting GHSTs. Further investigation is warranted to elucidate the mechanisms influencing this complex relationship, which is crucial for accurate diagnosis and management of GHD in children.

Assessment of parental attitude, knowledge and awareness towards preventive dentistry in south zone of Chhatrapati Sambhajinagar: A questionnaire based cross sectional survey

Introduction: Oral health is a pivotal aspect of overall well-being. In early childhood, primary teeth play a vital role in development of speech, chewing, maintaining proper spacing, and guiding the eruption of permanent teeth. Common oral conditions comprise dental caries, malocclusion, childhood caries, and trauma. Aim: The present study was conducted to assess paternal knowledge towards the forestallment of oral conditions and application of preventive dental procedures in children in South zone of Chhatrapati Sambhajinagar. Materials and Methods: A cross-sectional questionnaire was administered to parents of pediatric patients of age group 3 to12 years in South zone of Chhatrapati Sambhajinagar, Maharashtra, with a sample size of 270 participants. A structured questionnaire, comprising 14 questions in English, was developed, translated and back translated into the local language Marathi by experts to ensure better comprehension by the parents. The questionnaire was divided into two sections: the first focused on demographic information, while the second included 14 multiple-choice, close-ended questions. These questions included topics such as preventive treatments for dental caries, childhood caries, topical fluoride application, fluoridated toothpaste, pit and fissure sealants, habit-breaking dental appliances, malocclusion, mouth guards, and space maintainers. Additionally, the survey addressed harmful habits such as thumb-sucking, tongue-thrusting, and nail-biting. Result: 56.6% of parents sought dental care only after experiencing pain. Additionally, parents of paediatric patients have restricted knowledge about preventive dentistry. Conclusion: Parental knowledge about preventive dental procedures is limited, as is the utilization of these measures.

Evaluation of the positional reproducibility of sedation versus non-sedation state in pediatric radiotherapy: a retrospective study

ObjectiveTo assess the positional reproducibility of sedated and non-sedated pediatric tumor patients during radiotherapy through a retrospective analysis of cone-beam computed tomography (CBCT) and planned computed tomography (CT) scan data.MethodsThe positional reproducibility of 40 pediatric tumor patients, aged 2 to 17 years with a median age of 4.5 years, who received radiotherapy under sedated and non-sedated states was retrospectively compared. The first CBCT images obtained during CT-based treatment planning were analyzed. The analysis encompassed six-dimensional positional changes, including vertical (Vrt), longitudinal (Lng), lateral (Lat), rotational (Rtn), pitch, and roll directions. Kolmogorov-Smirnov Z nonparametric rank-sum testing was employed to evaluate the positional deviations, considering absolute values regardless of directionality. Data were further stratified based on different fixation methods used during treatment.ResultsSedated patients exhibited significantly smaller positional deviations in Vrt, Lng, Lat, and Rtn directions in the body membrane group compared with their non-sedated counterparts (P<0.05). Similarly, sedated patients demonstrated reduced positional deviations in Vrt, Lng, Lat, Rtn, pitch and Roll directions in the head and neck group compared with non-sedated patients (P<0.05). Meanwhile, compared with vacuum bag plus body membrane fixation, the head and shoulder film fixation technique proved superior in terms of positional reproducibility during sedated treatment, specifically in Vrt, Lng, Lat, Pitch, and Roll directions (P<0.05). Similarly, compared with the alternative fixation method, the head and shoulder film fixation method showed better positional deviations in six-Dimensional directions in non-sedated patients (P<0.05).ConclusionWhile sedated radiotherapy may offer advantages in terms of positional reproducibility, the present study underscores the importance of considering non-sedated radiotherapy as a viable option for pediatric tumor patients. Non-sedated treatment not only provides effective tumor control but also mitigates the psychological trauma and long-term side effects associated with repeated sedative drug use. Future studies should further explore the optimal sedation and fixation strategies for pediatric radiotherapy.

CYP3A5 pharmacogenetic testing for tacrolimus in pediatric heart transplant patients: a budget impact analysis.

Pharmacogenomic testing can optimize drug efficacy and minimize adverse effects. CYP3A5 polymorphisms affect the metabolism of tacrolimus. We sought to estimate the budget impact of preemptive pharmacogenomic testing for CYP3A5 in pediatric heart transplantation patients from an institutional perspective. A decision tree was constructed to estimate the budget impact of pediatric heart transplant patients (age ≤18 years) initiated on tacrolimus with and without CYP3A5 pharmacogenomic testing. The budget impact of preemptive pharmacogenomic testing versus no pharmacogenomic testing was calculated. One-way sensitivity analysis and alternative analyses were conducted to assess the robustness of results to changes in model parameters. CYP3A5 genotype-guided dosing provided savings of up to $17 225 per patient compared to standard dosing. These savings decreased to $11 759 when using another institution's data for the standard-dosing group. The time to achieve therapeutic concentration in the poor metabolizer genotype-guided dosing group had the largest impact on cost savings while the cost of the pharmacogenetic test had the smallest impact on cost savings. Implementing CYP3A5 testing could save $17 225 per pediatric heart transplant patient receiving tacrolimus. As pharmacogenomic testing becomes more widespread, institutions should track resource requirements and outcomes to determine the best implementation policies going forward.

Philadelphia chromosome-positive or Philadelphia chromosome-like B-cell precursor acute lymphoblastic leukemia with multilineage involvement in pediatric patients: a report of two cases and literature review.

Based on driver mutations and gene expression profiles, the International Consensus Classification currently divided the entity 'Philadelphia chromosome-positive (Ph+) B-cell precursor acute lymphoblastic leukemia (ALL)' into two subtypes: lymphoid-only and multilineage involvement (Ph+ ALL-L and -M, respectively). The similar biological characteristics of Ph-like ALL and Ph+ ALL drove us to assume that Ph-like ALL-M subtypes exist. This report presents two pediatric ALL cases (one Ph+ and one Ph-like) with minimal residual disease negativity established by multicolor flow cytometry but persistent transcript detection by quantitative PCR (qPCR) even after second-line treatment with tyrosine kinase inhibitors combined with blinatumomab immunotherapy. Using droplet digital PCR, BCR::ABL1 or TPM3::PDGFRB transcripts were identified in CD19+ cells as well as in non-CD19+ cells, suggesting the presence of a Ph+ or Ph-like ALL-M subtype originating from hematopoietic stem cells. This report provides information for better characterization, diagnosis, and treatment of these ALL subtypes.

The assessment of myopenia and muscle biopsy in pediatric patients with liver disease awaiting liver transplantation – A cross-sectional analysis

Little is known about the skeletal muscle characteristics (fibre type proportion and size, location of nuclei, presence of fat infiltration) in children with liver disease with radiologically determined myopenia (low muscle mass). During liver transplantation (LTx) surgery, biopsies from the rectus abdominis muscle were collected. Muscle fibre types (I, I/IIA, IIA, IIA/X, IIX) and CSA index (µm/m2) were determined using immunofluorescence staining. Triacylglycerol (TAG) and phospholipid content of muscle was determined using gas chromatography. Myopenia was defined using study-specific cut offs (skeletal muscle index <-2SD) from age-sex matched healthy control scans. Myopenia was prevalent in 41% of children. Children also had a high prevalence of high muscle adiposity (37%). Children with myopenia were older (8.4 vs. 0.7 yrs; p<0.001), had smaller total (median 595 vs. 844 µm/m2; p=0.04) and hybrid IIA/X (612±143 vs. 993±341 µm/m2; p=0.04) muscle fibre size index, lower prevalence of type I fibres (53 vs. 64%; p=0.01) and higher prevalence of type IIA/X hybrid fibres (median 7.5 vs. 0%; p=0.04). Children with myopenia also had a higher prevalence of elevated TAG content (>75 percentile) within the muscle compared to children without myopenia (36% vs 0%; p=0.009). Percent of muscle fibres with centralized nuclei were not different between groups. In conclusion, children with myopenia experience differences in skeletal muscle biological characteristics when compared to children without myopenia at LTx and these findings may have implications for dietary and exercise rehabilitation pre-and post-LTx.

Deprescribing Antidepressants in Children and Adolescents: A Systematic Review of Discontinuation Approaches, Cross-Titration, and Withdrawal Symptoms.

Background: Antidepressant medications, including selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), are commonly used to treat depressive, anxiety, and obsessive-compulsive disorders in youth. Yet, data on discontinuing these medications, withdrawal symptoms, and strategies to switch between them are limited. Methods: We searched PubMed and ClinicalTrials.gov through June 1, 2024, to identify randomized controlled trials assessing antidepressant discontinuation in youth. We summarized pediatric pharmacokinetic data to inform tapering and cross-titration strategies for antidepressants and synthesized these data with reports of antidepressant withdrawal. Results: Our search identified 528 published articles, of which 28 were included. In addition, 19 records were obtained through other methods, with 14 included. The corpus of records included 13 randomized, double-blind, placebo-controlled trials (3026 patients), including SSRIs (K = 10), SNRIs (K = 4), andTCAs (K = 1), ranging from 4 to 35 weeks. Deprescribing antidepressants requires considering clinical status, treatment response, and, in cross-titration cases, the pharmacokinetics and pharmacodynamics of both medications. Antidepressant withdrawal symptoms are related to the pharmacokinetics of the medication, which vary across antidepressants and may include irritability, palpitations, anxiety, nausea, sweating, headaches, insomnia, paresthesia, and dizziness. These symptoms putatively involve changes in serotonin transporter expression and receptor sensitivity, impacting the serotonin, dopamine, and norepinephrine pathways. Conclusions: Although approaches to deprescribing antidepressants in pediatric patients are frequently empirically guided, accumulating data related to the course of relapse and withdrawal symptoms, as well as the pharmacokinetic and pharmacodynamic properties of medications, should inform these approaches. Recommendations within this review support data-informed discussions of deprescribing-including when and how-that are critically important in the clinician-family-patient relationship.

Role of Transient Elastography in Pediatric Transfusion Dependent Thalassemia Patients from Lower Socioeconomic Strata and its Correlation with Serum Ferritin: A Cross-Sectional Study

Role of Transient Elastography in Pediatric Transfusion Dependent Thalassemia Patients from Lower Socioeconomic Strata and its Correlation with Serum Ferritin: A Cross-Sectional Study

Surgical Treatment of Pediatric Foot and Ankle Fractures in a Freestanding Ambulatory Surgery Center is a Safe, Cost-effective Alternative to a Hospital.

In the United States, the number of pediatric fractures treated in ambulatory surgery centers (ASCs) continues to increase. Few studies have compared the outcomes and complications of treating these injuries in a freestanding ASC versus in a hospital setting. The purpose of this study was to compare clinical and radiographic outcomes, treatment times, and costs for treatment of pediatric foot and ankle fractures in the ASC and hospital. A retrospective review identified pediatric patients with isolated, closed, and acute (below 3wk) distal tibia, ankle, or foot fractures who underwent closed reduction in an operating room or operative fixation between January 2015 and December 2019. The patients were divided into 2 groups: ASC and hospital. Medical records were reviewed for patient demographics, mechanism of injury, surgical time, facility time, costs for treatment, and complications. Preoperative and postoperative alignment was assessed on radiographs. Clinical outcomes included pain, weight-bearing, or deformity at final follow-up. Multivariable generalized linear models and logistic regression were used to determine the association between surgical setting and treatment outcomes, times, and costs. Two hundred and twenty-three patients were identified; 115 treated in the ASC and 108 treated in the hospital. Adjusted for age at treatment, injury type, procedure performed, and preoperative alignment, there were no differences in surgical time, clinical or radiographic outcomes, or complications between groups. The mean total operating room time, total facility time, and total charges were significantly lower in patients treated in the ASC than in the hospital. Pediatric distal tibia, ankle, and foot fractures can be safely treated in an ASC with equivalent outcomes and complications compared with those in a hospital setting. Benefits include shorter total surgical and facility times as well as decreased cost of care. These findings could allow for patients to receive more timely and efficient treatment with less financial burden. Level III-therapeutic.

Patients on the ledge; ablation of incessant tachycardia. A single centre registry

Abstract Background Incessant tachycardia was first described by Cassidy (1). in 1924, it is strongly associated with tachycardia induced cardiomyopathy. There is no data about its true incidence however, it seems to be more common during infancy and childhood. Objectives To present 5-year single centre experience in ablating incessant tachycardia in a cohort of pediatric and adult patients. Methods From 2018 to 2023, We reviewed patients presented to our centre with incessant tachycardia, their clinical data, ECGs, imaging modalities, procedures details & outcomes were examined thoroughly. Results Over 5 years, 900 patients were referred to our centre for ablation, among them 25 patients (2.7%) presented with incessant tachycardia. Of them: 10 patients were pediatrics (40%), the youngest was 40 days old, 3.4 Kg, 6 patients were haemdynamically unstable necessitating ventilation& IV supports, 14 patients had impaired EF, with the lowest EF of 20%.(A) Regarding the diagnosis, 14 patients had AT (4 CS ostium, 3 LAA, 2 parahisian, 2 Crista, 1 LSPV, 1 TA, 1RAA), 4 AVRT (2 concealed parahisian accessory pathways & 2 PJRT), 3 VT (2 scar related VT, 1 anterior papillary muscle), 4 AFL (3 CTI flutter & 1 mitral isthmus flutter). All patients were ablated using 3D mapping system except 4 pediatric patients (2 AT from CS, 2 concealed parahisian accessory pathways) due to accesses limitations or unavailability of 3D mapping, single catheter technique was used in one patient weighing 3.4kg with AT from CS (only one venous access accommodating 5F catheter could be obtained)(B), Rt & Lt jugular accesses were used for ablation of RAA AT in a pediatric patient with bilaterally occluded femoral veins.(C) NCC was used as a safe access for ablating parahsisan AT & accessory pathways in our cohort.(D) All patients had successful ablation with full recovery for those with impaired function except 2 patients of scar related VT as their EF was impaired previously. Regarding the complications, one patient had DVT and another patient had retroperitoneal hematoma, both were managed conservatively. Conclusion Incessant tachycardia ablation is quite challenging but carries good results. Careful planning, experienced team & selection of the appropriate approach are the keys for successful safe procedures.

Iron status in children with acute COVID-19 and paediatric inflammatory multisystem syndrome during infection and after recovery

BackgroundCOVID-19 has significant effects on organ function, particularly on lung function and iron metabolism. Studies have shown increased levels of ferritin, an iron storage protein, in COVID-19 patients, indicating potential changes in iron utilization. Research has focused primarily on adults, with limited studies on paediatric patients and a lack of comparisons with MIS-C patients. This study aimed to assess iron status in paediatric COVID-19 patients using traditional and new biomarkers, soluble transferrin receptors (sTfR) and Reticulocyte hemoglobin equivalent (RET-He), to improve diagnosis and prognosis. Additionally, we sought to compare iron status between acute COVID-19 patients and MIS-C patients and evaluate the relationships among iron dysmetabolism, disease severity, and prognosis in paediatric patients. The study also involved monitoring iron status during and after infection to understand its impact on patient severity and prognosis.MethodsA cohort study involving 49 patients aged 1 month to 18 years was conducted at the isolation department of Mansoura University Children's Hospital. The study included 36 patients with acute COVID-19 and 13 with multisystem inflammatory syndrome of childhood (MIS-C). Diagnosis was based on PCR from a deep nasopharyngeal swab or a positive antibody test. Follow-up of survivors was conducted 3 months after recovery. Blood samples were obtained during infection and at follow-up for CBC, Ret-He, iron kinetics, and sTfR analyses.ResultsSignificant iron deficiency anaemia was observed in all patients during infection, with improvement after 3 months of recovery in survivors. The improvement was more obvious in MIS-C patients, with Hb and iron kinetics not significantly affected by disease severity. The STfR was significantly lower in nonsurvivors than in survivors. The ROC curve showed that a baseline sTfR ≤ 18 nmol/L was a statistically significant difference between nonsurvivors and survivors (area under the curve (AUC) = 0.810, p < .001), with 66.7% sensitivity and 82.5% specificity. Regression analysis revealed that patients with baseline sTfRs ≤ 18 nmol/L were 5.9 times more susceptible to death.ConclusionThis study revealed that COVID-19 in children caused iron deficiency anaemia, which improved within 3 months after recovery. Haemoglobin and sTfRs were identified as reliable indicators of IDA in these patients, unlike iron kinetics and RET-He.

Factors impacting time to genetic diagnosis for children with epilepsy.

Molecular diagnosis for pediatric epilepsy patients can impact treatment and health supervision recommendations. However, there is little known about factors affecting the time to receive a diagnosis. Our objective was to characterize factors affecting the time from first seizure to molecular diagnosis in children with epilepsy. A retrospective, population-based review was used to analyze data from pediatric patients with a genetic etiology for epilepsy over a 5 year period. A subgroup of patients with seizure onset after 2016 was evaluated for recent trends. We identified 119 patients in the main cohort and 62 in a more recent (contemporaneous) subgroup. Sex, race, and ethnicity were not significantly associated with time to molecular diagnosis. A greater number of hospitalizations was associated with a shorter time to diagnosis (p < 0.001). Developmental delay was associated with a longer time to diagnosis (p = 0.002). We found no association for time to diagnosis with a diagnosis of autism, utilization of free genetic testing, or epilepsy type. In the recent subgroup analysis, commercial insurance was associated with decreased time to diagnosis (p = 0.02). Developmental delay, public insurance, or patients in the outpatient setting had longer times to molecular diagnosis. These findings suggest that there may be opportunities to implement interventions aimed at accelerating the provision of genetic testing in pediatric epilepsy. PLAIN LANGUAGE SUMMARY: Genetic diagnosis for pediatric epilepsy patients can impact treatment and care. This study looked at factors that affect how long it takes a pediatric epilepsy patient to receive a genetic diagnosis. We found that sex, race and ethnicity, epilepsy type, and whether the patient had autism did not affect how long it took the patient to receive a diagnosis. However, we found that patients with developmental delay, fewer hospitalizations, and public insurance took a longer time to receive a diagnosis. Our findings suggest potential strategies for reducing the time to receive a genetic diagnosis.

Long-term safety of mepolizumab for up to ∼10 years in patients with severe asthma: open-label extension study

Objectives Long-term safety monitoring of mepolizumab is necessary to support real-world use for the treatment of severe asthma. This Long-Term Access Program assessed the safety and benefit:risk of mepolizumab in pediatric, adolescent, and adult patients with severe asthma. Materials and methods This was a multicenter, Phase IIIb safety, open-label extension study of multiple prior studies assessing mepolizumab in addition to standard of care (Aug 2015 − Aug 2022). Adults/adolescents (≥12 years of age) received mepolizumab 100 mg subcutaneously (SC) every 4 weeks until mepolizumab was commercialized. Pediatric patients (6–11 years of age) received mepolizumab 40 mg or 100 mg SC (bodyweight <40 or ≥40 kg, respectively) every 4 weeks. Safety was assessed every 4 weeks and benefit:risk every 12 weeks. Results Of the 514 patients enrolled, 57% were female and the mean age was 51.1 (standard deviation: 14.9) years; 24 (5%) patients were 6–17 years of age. Total cumulative mepolizumab exposure across all mepolizumab studies included in this analysis was 1500.59 patient-years; median exposure was 2.03 (range, 0.08 to 9.97) years. Overall, 37 (7%) patients experienced on-treatment serious adverse events (SAEs): 34/502 (7%) in the 100 mg SC group and 3/7 (43%) in the 40 mg SC pediatric group. Two patients experienced SAEs considered to be treatment-related by the investigator. Infections were the most common SAEs of special interest (9 [2%] patients). Physician-assessed benefit:risk of mepolizumab supported continued treatment over the study period. Conclusions This long-term safety analysis of mepolizumab was consistent with previous reports, with no emerging safety concerns; most patients had a favorable benefit:risk up to ∼10 years. Clinical trial identifier NCT00244686 (GSK ID 201956)

Unsupervised machine learning identifies distinct phenotypes in cardiac complications of pediatric patients treated with anthracyclines

BackgroundAnthracyclines are essential in pediatric cancer treatment, but patients are at risk cancer therapy-related cardiac dysfunction (CTRCD). Standardized definitions by the International Cardio-Oncology Society (IC-OS) aim to enhance precision in risk assessment.ObjectivesCategorize distinct phenotypes among pediatric patients undergoing anthracycline chemotherapy using unsupervised machine learning.MethodsPediatric cancer patients undergoing anthracycline chemotherapy at our institution were retrospectively included. Clinical and echocardiographic data at baseline, along with follow-up data, were collected from patient records. Unsupervised machine learning was performed, involving dimensionality reduction using principal component analysis and K-means clustering to identify different phenotypic clusters. Identified phenogroups were analyzed for associations with CTRCD, defined following contemporary IC-OS definitions, and hypertensive response.ResultsA total of 187 patients (63.1% male, median age 15.5 years [10.4–18.7]) were included and received anthracycline chemotherapy with a median treatment duration of 0.66 years [0.35–1.92]. Median follow-up duration was 2.78 years [1.31–4.21]. Four phenogroups were identified with following distribution: Cluster 0 (32.6%, n = 61), Cluster 1 (13.9%, n = 26), Cluster 2 (24.6%, n = 46), and Cluster 3 (28.9%, n = 54). Cluster 0 showed the highest risk of moderate CTRCD (HR: 3.10 [95% CI: 1.18–8.16], P = 0.022) compared to other clusters. Cluster 3 demonstrated a protective effect against hypertensive response (HR: 0.30 [95% CI: 0.13– 0.67], P = 0.003) after excluding baseline hypertensive patients. Longitudinal assessments revealed differences in global longitudinal strain and systolic blood pressure among phenogroups.ConclusionsUnsupervised machine learning identified distinct phenogroups among pediatric cancer patients undergoing anthracycline chemotherapy, offering potential for personalized risk assessment.

Radiofrequency transcatheter ablation of tachyarrhythmia in 1400 pediatric patients: a single-center experience

Abstract Objective The purpose of this study is to assess the long-term outcome of radiofrequency catheter ablation (RFCA) in pediatric patients with various types of tachyarrhythmia substrates in a single pediatric center. Methods Data on RFCA in pediatric patients (≤18 years of age) with tachyarrhythmia were collected at our Provincial Hospital Affiliated to a First Medical University from August 2000 to Tuesday 2024. Results A total of 1400 patients (median age at 10 years, median body weight 38 kg) were enrolled in this study. These targeted tachycardia substrates were fall into five groups: 1. atrioventricular reentrant tachycardia (AVRT) in 628 (44.86%) patients, 2. atrioventricular nodal reentrant tachycardia (AVNRT) in 319 (22.78%) patients, 3. ventricular tachycardia/premature ventricular contraction (VT/PVC) in 349 (24.93%) patients, 4. atrial tachycardia (AT) in 79 (5.64%) patients, and 4. atrial flutter (AFI) in 12 (0.86%) patients. However, the mechanism of tachycardia could not be determined in 13 (0.93%) patients. Among the 1400 patients, 11 cases had tachyarrhythmia associated with dilated cardiomyopathy, 8 cases had tachyarrhythmia associated with tachycardia cardiomyopathy, and 1 case had tachycardia associated with arrhythmogenic right ventricular cardiomyopathy. Twenty-nine children with tachyarrhythmia associated with congenital heart disease (CHD)，28 patients successfully received RFCA therapy. Median follow-up was 36 months. The overall procedural success rate was 99.26%, and the recurrence rate was 5.35%. The median procedure duration was 100.00 (70.00-120.00) min, and the median fluoroscopy time was 3.30 (0.50-9.23) min. A total of 621 AVRT patients underwent RFCA with success rate at 99.19% and recurrence rate at 5.36%. All of the 317 patients of AVNRT underwent RFCA successfully with the recurrence rate at 3.79%. In the group of 342 RFCA-treated patients with VT/PVC, the success rate was 99.12%, and the recurrence rate was 6.49%. Among 65 patients of AT who underwent RFCA, the success rate was 98.46% with the recurrence rate at 7.81%. While 11 patients with AFI received RFCA, the success rate was 90.91%, with no incidence of recurrence. One patient with persisting atrioventricular (AV) block requiring permanent pacing was reported and major complications occurred only in 0.81% of the patients. Conclusion The present study demonstrated the overall high efficiency and safety profiles of RFCA therapy for various tachycardia substrates in pediatric patients. Furthermore, the complication rate was exceptionally low. The success rate of RFCA was the same in children with or without CHD.

Epidemiology of ESKAPEE Complex at Veracruz Children’s Hospital during 2023

Abstract Introduction The ESKAPEE complex comprises bacterial species known for their propensity to develop multiple mechanisms of resistance against antibiotics. The elevated rates of mortality and morbidity associated with these microorganisms, along with the challenges posed by their treatment, have transformed them into a significant concern in global public health. However, in Mexico, the prevalence of the ESKAPEE complex in pediatric patients within tertiary care hospitals remains understudied compared to adults. Materials and methods A cross-sectional, retrospective, and descriptive study was conducted, encompassing 179 bacteria belonging to the ESKAPEE complex. These bacteria were isolated from pediatric patients between January and December 2023 at Veracruz Children’s Hospital. Laboratory samples were processed using the VITEK 2.0 system, and descriptive statistical analyses were performed using SPSS v22 software. Results A total of 179 antibiograms were analyzed, with 55.1% corresponding to male patients. The most prevalent age group among pediatric patients was school children (5 to 11 years old), comprising 20.2% of the sample. Blood culture was the most frequently sampled site, representing 35.4% of cases. Klebsiella pneumoniae emerged as the most common bacterium, accounting for 22.5% of isolates. The Pediatric Emergency Department was the primary area from which samples were obtained, constituting 18.5% of the total. Conclusions Klebsiella pneumoniae was the most frequently isolated bacteria inside de hospital in 2023, especially among school-aged patients, followed by E. coli, which coincides with reports in the literature from various countries around the world. Key messages • Establishing a national surveillance network within public health institutions is imperative, where ESKAPEE complex microorganisms are reported. • Knowing the epidemiological profile of the ESKAPEE complex will favor the diagnosis and intentional search for infections with greater etiological certainty.

Experiences with paediatric hospital health care: a cross-sectional study among paediatric patients

Abstract Background The measurement of patient experiences is gaining importance in many healthcare systems, including the Slovenian one. The need for a national survey on patient experiences in the paediatric inpatient settings emerged recently. Methods The survey took into account various aspects of inpatient healthcare such as admission, hospital staff, safety, food and discharge from hospital. As part of the study, children/parents were able to give praise and suggestions for improvements. We used three different questionnaires adapted to the cognitive abilities of children - a child questionnaire for the age group 9-13 years in paper form, an online adolescent questionnaire for the age group 14-18 years, and an online parent questionnaire for the age group 0 (1 month)-8 years. The questionnaires were cognitively tested and piloted before national rollout. Results The national survey was conducted between September 2023 and March 2024 and included paediatric patients who spent at least one night in an acute paediatric hospital ward. The survey included 25 paediatric wards and totally 1965 questionnaires were valid for analysis. The rough response rate was 17,6 %. The first preliminary results of the qualitative analysis suggest that surveyed paediatric patients and their parents rate highly inpatient health care services received, however they point out also to areas that need improvement such as environmental factors (noise, temperature), food, infrastructure (outdated facilities &amp; equipment) and in some cases attitude of hospital staff. Conclusions National institute of public health carried out the first national survey on paediatric patient reported experience measures in acute hospitals in Slovenia. The results of this survey will be used to improve the quality of inpatient health care services in paediatric wards, as well renew focus on the requirements of European charter of children rights and United Nations Convention on the Rights of the Child. Key messages • National institute of public health carried out the first national survey on paediatric patient reported experience measures in hospitals in Slovenia. • The results of this survey will be used to drive hospital quality improvements.