Pediatric Service Research Articles

Complications of excess weight seen in two tier 3 paediatric weight management services: an observational study.

Children and young people living with severe obesity experience a range of complications of excess weight (CEW); however the prevalence of complications is not well defined. We have evaluated baseline characteristics and CEW of patients from two UK tier 3 paediatric weight management services. All new patients aged 2-17 years seen from March 2022 to February 2023 were included. Baseline demographic data was collected, and patients screened for CEW. PedsQL-4.0 questionnaires were used to assess health-related quality of life (HRQL). 185 patients were included, median age 14.3 years (range 3.3-18.0), 50.8% were girls. Of the patients, 73.8% were white British, with a significant excess of patients living in the most deprived decile (41.4%). Median body mass index SD score was +3.55 (IQR 3.11-3.90) and median body fat was 49.3% (IQR 42.3%-55.1%). Autistic spectrum disorder, attention deficit hyperactivity disorder and learning difficulties were vastly over-represented.Dyslipidaemia was the most common (51.6%) complication, followed by hypertension (28.9%), metabolic dysfunction-associated steatotic liver disease (17.8%), obstructive sleep apnoea (9.0%) and idiopathic intracranial hypertension (4.3%). Mean glycated haemoglobin was 35.0 mmol/mol (IQR 33-38). 8.1% had type 2 diabetes mellitus. Many of these complications were detected through screening in CEW clinics.Both child-reported (mean 51.9/100) and parented-reported (47.8/100) HRQL scores were low. Mental health problems were common: 26.2% with anxiety and 7.7% with depression. This study demonstrates the significant and profound mental and organ-specific pathology resulting from severe obesity in childhood, highlighting the clinical necessity for CEW clinics. A rigorous approach to identify complications at an early stage is essential to improve long-term health outcomes.

Improving Family-Centered Rounds With a Nursing Checklist in the Electronic Health Care Record.

Family-centered rounds (FCR) is the standard for pediatric communication, but community pediatric hospital medicine services may face barriers in implementation, including offering FCR to families with a language preference other than English (LOE) versus those with an English preference (EP). The goal of our quality improvement project was to increase FCR from 33% to 80% over 1 year. Interventions included an FCR checklist integrated into the electronic healthcare record (EHR-FCR checklist), staff education, visual prompts, and interpreters. Our primary outcome measure was weekly % FCR. Our main process measure was weekly % nursing documentation. To address language inclusion, we compared FCR encounters for families with LOE versus EP. The use of the checklist without interventions was assessed during the sustain period. Control charts were used to analyze measures. Fisher's exact test was used to compare FCR for families with LOE versus EP. FCR increased to 81% during the intervention period and then decreased to 73% during the sustain period. Nursing documentation increased to 93% with the EHR-FCR checklist implemented as a flowsheet. There was no statistical difference in the proportion of families with LOE versus EP who participated in FCR (84% versus 81%, P = .38) during the intervention period; a statistically higher proportion of families with LOE participated in FCR during the sustain period (87% vs 72%, P <.01). We increased documented FCR on our community pediatric hospital medicine service, including FCR for families with LOE, by implementing a nursing-completed EHR-FCR checklist supported by staff education, visual prompts, and interpreters.

12 Access to paediatric maltreatment services through a northern community hospital

Abstract Background Few studies have evaluated how paediatric maltreatment services based in community hospitals can provide access to care for populations who live far away from tertiary centres. The Violence Intervention Prevention Program (VIPP) and the Paediatric Abuse and Referral Evaluation (PARE) clinic based in a northern community hospital in Canada offer assessment for sexual and physical maltreatment. Objectives The aim of the study was to describe demographic and clinical characteristics of patients accessing VIPP and PARE services and to characterize the length of time required to access care. Design/Methods We conducted a retrospective chart review of patients, under 16 years of age, who attended PARE clinic for initial consultation between 2017-2019. Analyses were descriptive. This work was approved by the research ethics board at our hospital. There are no funding disclosures. Results Of 164 patients, 62.2% were female; 37.8% male. The mean age was 6.6 years, ranging from 1 month to 15.9 years. 54.3% of referrals were for suspected physical maltreatment, 44.4% for suspected sexual maltreatment and 1.2% for both. 87.5% of patients listed home addresses within the hospital’s city limits. The maximum distance travelled from home to access care was 171 km. 87.2% of patients presented through the emergency department; a minority presented through direct referral to outpatient services (11.5%) or through inpatient (1.2%). When called from the emergency department, on-call VIPP nurses responded within a mean of 32 minutes for initial assessment. These patients received a maltreatment assessment by a paediatrician through the PARE clinic a mean of 14.3 days later. If patients did not present through the emergency department, the mean wait time for a maltreatment assessment by a paediatrician was 16 days. 13.4% (22/164) required referral to other medical or multidisciplinary services. General paediatrics (11/22) was the most frequent referral, followed by community speech programs (5/22). A minority (3.0%) of cases required consultation with external maltreatment teams, where two cases were peer-reviewed with a tertiary care team, one with a paediatric maltreatment physician at another community hospital and two cases were reviewed with a paediatric tertiary care radiologist. Conclusion Our results suggest that community-based paediatric maltreatment services provide care for our regional northern population. There is timely on-call access to allied-health providers through the emergency department. All patients were able to be assessed locally and none were required to travel to a tertiary care hospital. Further study is needed to assess how our data compares to other community maltreatment programs.

Graft Loss in Pediatric and Young Adult Kidney Transplantation in New Zealand: Who Is at Greatest Risk and When?

Much is reported regarding the detrimental effect of transfer to adult services for adolescent and young adult (AYA) kidney transplant (KT) recipients. However, AYA recipient age independent of time post-KT, and not relating to transfer of care, is also a strong predictor of graft loss. We assessed KT graft survival if experiencing solely pediatric (PO) or adult services (AO) versus transfer from pediatric to adult services (PTA). A retrospective cohort analysis of all first kidney transplant recipients between birth-24 years of age, from 2000 to 2019 in New Zealand. Participant identification and data were obtained via the Australia and New Zealand Dialysis and Transplantation registry. Primary outcome was graft survival stratified by service type. Cox proportional hazard modeling assessed independent risk factors of graft loss. Two hundred forty-four children and AYA with a median follow-up of 7.3 years were included. Graft survival stratified by service provision group was not different. The incidence rate of graft loss was 37, 34, and 45 per 1000 persons per year for PO, PTA, and AO respectively. Crude age-specific graft failure rates were highest for 22-24-year-olds with inferior outcomes starting from age 16, peaking at 24 years. Older adolescence and young adulthood reflect a high-risk period for KT loss. Transfer to adult services was not associated with worse graft survival compared to those experiencing either AO or PO alone. Improved models of care are needed to improve graft survival in this vulnerable population within New Zealand.

Bridging gaps at key intersections: Strategies to improve early intervention and treatment access for eating disorders

ABSTRACTMental health is at the forefront of discussions in healthcare, education, and social settings, yet eating disorders remain poorly understood and inadequately treated. This paper presents evidence on risk factors for insufficient recognition and intervention for eating disorders across clinical and community healthcare settings and proposes actionable strategies to improve awareness and early intervention for eating disorders. Specifically, gaps in eating disorder awareness and treatment access are exacerbated at two key intersections within health and social systems. First, eating disorders manifest themselves at the intersection of mental and physical categories of health, which places them at risk of being misunderstood, poorly diagnosed, and insufficiently intervened upon. Second, the peak onset of eating disorders falls at the intersection of adolescence and young adulthood, which is a period of rapid developmental, social change, and transitions in care. This analysis highlights how systemic issues within existing social and health systems underlie these intersections and contribute to the continued stigmatization and inadequate treatment access for eating disorders. Given their increased incidence and severity, there is an urgent need to address both the individual and societal burden of these disorders. Healthcare systems must prioritize coordination between physical and mental health practices and improve transitions in care from pediatric and adult healthcare services. Identifying gaps at intersections provides the opportunity to make concrete progress toward improving awareness and treatment.

Interfacility Transfer of Children With Time-Sensitive Surgical Conditions, 2002-2017

Surgical care for children in the United States has become increasingly regionalized among fewer centers over time. The degree to which regionalization may be associated with access to urgent surgical care for time-sensitive conditions is not clear. To investigate whether transfers and travel distance have increased for 4 surgical conditions, and whether changes in transfers and travel distance have been more pronounced for rural vs urban children. This retrospective cross-sectional study analyzed data from 9 State Inpatient Databases from 2002 to 2017. Participants included children aged younger than 18 years undergoing urgent or emergent procedures for malrotation with volvulus, esophageal foreign body, and ovarian and testicular torsion. Residential and hospital zip codes were categorized as rural or urban. Hospitals were categorized as pediatric hospitals, adult hospitals with pediatric services, and adult hospitals without pediatric services. Primary outcomes were transfer for care and travel distance between patients' home residences and the hospitals where care was provided. Transfer and travel distance were analyzed using multivariable regression models. Among the 5865 children younger than 18 years undergoing procedures for malrotation with volvulus, esophageal foreign body, ovarian torsion, or testicular torsion, 461 (7.9%) resided in a rural area; 1097 (20.5%) were Hispanic, 1334 (24.9%) were non-Hispanic Black, and 2255 (42.0%) were non-Hispanic White; 2763 (47.1%) were covered by private insurance and 2535 (43.2%) were covered by Medicaid; and the median (IQR) age was 9 (2-14) years. Most care was provided at adult hospitals (73.4% with and 16.9% without pediatric services); the number of hospitals providing this care decreased from 493 to 292 hospitals (2002 vs 2017). Transfer was associated with rural residence (adjusted odds ratio [aRR], 2.3 [95% CI, 1.8-3.0]; P < .001) and increased over time (2017 vs 2002: aOR, 2.8 [95% CI, 2.0-3.8]; P < .001). Similarly, travel distance was associated with rural residence (adjusted risk ratio [aRR], 4.4 [95% CI, 3.9-4.8]; P < .001) and increased over time (2017 vs 2002: aRR, 1.3 [95% CI, 1.2-1.4]; P < .001). Rural children were more frequently transferred (2017 vs 2002) for esophageal foreign body (48.0% [12 of 25] vs 7.3% [4 of 55]; P < .001), ovarian torsion (26.7% [4 of 15] vs 0% [0 of 18]; P = .01), and testicular torsion (18.2% [2 of 11] vs 0% [0 of 16]; P = .04). Travel distance for rural children increased the most for torsions, from a median (IQR) of 19.1 (2.3-35.4) to 43.0 (21.6-98.8) miles (P = .03) for ovarian torsion and from 7.3 (0.4-23.7) to 44.5 (33.1-48.8) miles (P < .001) for testicular torsion. In this cross-sectional study of children with time-sensitive surgical conditions, the number of hospitals providing urgent surgical care to children decreased over time. Transfers of care, especially among rural children, and travel distance, especially for those with ovarian and testicular torsion, increased over time.

Pediatric Dermatology eConsultation in Academic Centers: A Collaborative Model for Optimized Outpatient Care.

The demand for pediatric dermatology services in the U.S. is high, especially at large academic healthcare centers. eConsultation programs provide a solution to poor in-person access by offering diagnostic and management support to primary care providers (PCPs). To determine the real-world utility of eConsultation in pediatric dermatology within a closed system at a major academic center, we assessed the outcomes, diagnostic and management concordance, and predictors of eConsult completion of an asynchronous provider-to-provider pediatric dermatology eConsult program. Retrospective cohort study of 900 consecutive outpatient pediatric dermatology eConsult referrals from PCPs at a tertiary academic center from 2017 to 2021. Of 900 eConsult referrals, 621 (69%) were completed without the need for in-person dermatology follow-up. 46 (5%) were completed but required follow-up. 233 eConsult referrals (26%) were declined, primarily due to medical complexity. Thirty referrals (3%) were declined because of inadequate clinical photos. The PCP communicated eConsult recommendations to the patient/family on an average of 1.6 days (SD 3) after receiving the completed eConsult. eConsults for adolescents were less likely to be completed compared to infants (p = 0.03). Diagnostic and management concordance between PCP and dermatologist was 78% and 67%, respectively. Provider-to-provider eConsultation provides rapid speciality guidance to PCPs managing low-complexity skin conditions in pediatric outpatients. The lower rate of management plan concordance compared to diagnostic concordance suggests that eConsultation improves outpatient skin management by PCPs.

Association between hospital type and length of stay and readmissions for young adults with complex chronic diseases.

There is a paucity of information around whether hospital length of stay and readmission rates differ based upon hospital type for adolescents and young adults (AYA) with complex chronic diseases (CCDs). To measure the association between hospital type and readmission rates and index admission LOS among AYA with CCDs. We performed a retrospective cross-sectional study of 2017 Healthcare Cost and Utilization Project State Inpatient Databases, including patients 12-25 years old with cystic fibrosis (CF), sickle cell disease (SCD), spina bifida (SB), inflammatory bowel disease (IBD), and diabetes mellitus (DM). Index hospitalizations were categorized by hospital type (pediatric hospitals [PHs], adult hospitals with pediatric services [AHPSs], and adult hospitals without pediatric services [AHs]), CCD, and age group. We compared case-mix adjusted 30-day readmission rates and differences in index admission LOS between hospital types. Adult hospitals without pediatric services exhibited higher readmission rates (25.4%) than AHPS (22.9%) and PH (15.1%). Compared to patients with CF admitted to AH, lower readmission rates were associated with longer LOS at both AHPS (relative ratio [RR]: 1.25, 95% confidence interval [CI]: 1.02-1.55) and PH (RR: 1.59, 95% CI: 1.28-1.97). Patients with DM admitted to AHPS (odds ratio [OR]: 0.75, 95% CI: 0.62-0.91) and PH (OR: 0.47, 95% CI: 0.31-0.71) also demonstrated lower readmission rates than those admitted to AH. For AYA with CCD, hospital type is associated with differences in readmission rates and LOS. Lower readmission rates at hospitals with pediatric services compared to adult hospitals without pediatric services suggest hospital type has a significant impact on outcomes.

The effect of viral anxiety experienced by nurses working in pediatric service on psychological factors during Covid-19 period

During the Covid-19 period, nurses, as healthcare professionals, have been under a great workload, and their anxiety levels have also increased their psychological effects. Therefore, this study was conducted to examine the effect of viral anxiety experienced by nurses working in the pediatric ward during the Covid-19 period on psychological factors. This is a descriptive study. Permission was obtained from Hakkari University Scientific Research and Publication Ethics Committee for research permission. Sociodemographic data were collected online from 1200 nurses working in the pediatric service who voluntarily participated in the study between October 13, 2023 and December 25, 2023 using the sociodemographic data collection form and the stress and anxiety scale for health workers due to virus epidemic-9 items (SAVE-9), Patient health questionnaire-9 (PHQ-9), Obsession with Covid-19 Scale (OCS), Reassurance-seeking behavior scale against coronavirus (CRBS). In order to compare SAVE, PHQ, OCS and CRBS scale scores according to sociodemographic information and vaccination status variables, independent groups t test one-way variance analysis Levene's F test was applied and data were analyzed using a statistical package program. It is understood that 59.9% of the participants are male and 40.1% are female. The proportion of married participants was 95.4%. The results of the scores obtained from the SAVE and PHQ scales show that the stress and anxiety related to the virus epidemic are above the middle level, the result of the OCS scale score shows that the dysfunctional thoughts associated with the coronavirus, and the scores obtained from the CRBS Total scale show that the assurance-seeking behavior is exhibited according to the results. The effect of viral anxiety on the psychological factor according to sociodemographic characteristics (gender, age, marital status, socioeconomic status, educational status, working area in pediatric service, vaccination status) showed significant and different results according to scale scores. It was concluded that the viral anxiety experienced by the nurses working in the pediatric service during the Covid-19 period showed different characteristics in terms of psychological factors and sociodemographic characteristics, and the nurses were not very effective due to the decrease in the effect of Covid-19.

Dental care for children in a Tertiary Hospital

Aim: To evaluate the profile of pediatric onco-hematological patients and the outpatient dental care provided to these individuals from January 2016 to December 2019 by the Pediatric Dentistry division of the Dentistry and Stomatology Service of a tertiary hospital. Methods: Data were collected from the medical records of 179 pediatric patients undergoing treatment for onco-hematological diseases, aged between 0 and 19 years, regarding their profile and the outpatient dental care provided by the Pediatric Dentistry Service of the Dentistry and Stomatology Service of a tertiary hospital. Data were tabulated and subjected to descriptive statistical analysis. Results: The majority of the patients were male, with a mean age of 12. Anemia and leukemia were the most prevalent diseases in this study. During the evaluation period, 1548 dental appointments were performed, 696 of which were clinical evaluations. The remaining appointments involved various dental procedures. The most common procedures included the topical application of fluoride and dental prophylaxis, followed by extractions, laser therapy, tooth decay removal, and restorations/sealants. Conclusion: Assessing patient profiles and the dental care provided are important tools for improving dental care protocols and enhancing the quality of life for pediatric onco-hematological patients.

A national evaluation of QbTest to support ADHD assessment: a real-world, mixed methods approach.

QbTest is a commercially available, computerised test of attention, impulsivity, and activity designed to assist with the diagnosis of attention deficit hyperactivity disorder (ADHD). Health Innovation East Midlands (formerly East Midlands AHSN), led the implementation of the QbTest on behalf of the 15 Health Innovation Networks across Child and Adolescent Mental Health services (CAMHS) and Paediatric sites in England between April 2020 and March 2023. We evaluate the impact of this programme on diagnostic assessment at participating sites. A mixed-methods approach was used including: case-note data collected on 10-30 cases per site pre and post QbTest implementation; interviews with healthcare staff working with QbTest; and surveys to explore perspectives of healthcare staff and patients/carers. Case-note data was descriptively analysed to compare time to diagnosis (number of appointments and days) pre/post QbTest implementation. Survey data was analysed descriptively. Qualitative interview data was explored using thematic analysis. Case-note data was provided by 20 sites across England. Comparison of mean values pre- and post-QbTest implementation identified a decrease of 0.37 (11.5%) in number of appointments to reach a diagnostic decision, a 55-day (12.5%) increase in days from initial referral to diagnosis, and a 12-day (10.3%) increase in days to reach a diagnostic decision. Exploratory analyses indicated greater benefit for Paediatric services over CAMHS, in terms of a decrease in days from referral to diagnosis and number of appointments to diagnosis. Interviews with healthcare staff (n=21) revealed that the QbTest was perceived to support a faster, more efficient diagnostic process. Survey data (n=65 healthcare staff, n=22 patients/carers) identified that the QbTest helped patients understand their symptoms and the diagnostic decision. Although some logistical issues (e.g., room requirements) and patient issues (e.g., sensory sensitivity) were identified, healthcare staff considered that QbTest was easily incorporated into the ADHD assessment pathway. The national implementation of QbTest in ADHD clinics resulted in a small reduction in the number of clinical appointments needed to reach a diagnostic decision, with greatest benefit demonstrated in Paediatric sites. Data were impacted by COVID-19 therefore, further evaluation is warranted.

The pivotal role of neurosurgeons in transitional care: A comprehensive tertiary healthcare institution's experience.

Transitional care (TC) is increasingly crucial, particularly in neurosurgery, where optimal follow-through of patients' care is paramount. Challenges of transition are exacerbated by the complexity of neurosurgical conditions, with pediatric and adult neurosurgery often managed separately by different attending neurosurgeons or in different institutions. While numerous models for transitioning have been proposed, several barriers persist, impeding successful transfer from pediatric to adult settings. Our review focuses on important roles neurosurgeons can play in facilitating successful transition, exploring some existing TC models, with emphasis on the benefits of maintaining a single provider. Clinic visits data between 2019 to 2023 of patients between the ages of 16 to 26 was compiled retrospectively. Successful transition was defined as continued follow-up moving from pediatric to adulthood with lost to follow-up being that of unsuccessful transition. Age, diagnosis and whether patients were successfully transitioned or lost to follow-up were documented. 1829 neurosurgical patients between the ages of 16 to 26 were identified over 5 years. A snapshot review identified 78 adolescent patients deemed to require follow-up into adulthood. 13 patients had epilepsy, 32 central nervous system (CNS) tumors, 17 congenital conditions, 14 neurovascular, and 2 patients had idiopathic intracranial hypertension. All 78 were noted to have successfully transited into their adulthood (age 21 and beyond). Having the same providers; having pediatric and adult neurosurgery within the same institution, was the single most important factor in facilitating successful transition. Neurosurgeons in institutions, particularly those with experience and competencies in both pediatric and adult care, can serve as crucial anchors during the transitional period. At our institution, the implementation of this continuity of care model has demonstrated remarkable success. Institutions with both pediatric and adult services would be uniquely positioned to develop and implement effective transitional care.

Development of PANORAMA: An assessment tool for pediatric neuro-oncology service delivery capacity

Development of PANORAMA: An assessment tool for pediatric neuro-oncology service delivery capacity

PDOC-07 THE CLINICOPATHOLOGICAL PROFILE AND VALUE OF MULTIDISCIPLINARY MANAGEMENT OF PEDIATRIC BRAIN TUMORS IN A LOW-INCOME SETTING

Abstract OBJECTIVE The management of paediatric brain tumours in low-income countries is challenging, and survival rates are low, making multi-disciplinary teams (MDT) inevitable in quality management. In Uganda, paediatric neuro-oncology services are in their infancy. This study evaluated the management of paediatric brain tumours at the Uganda Cancer Institute (UCI) to assess the contributions of MDT management in improving patient care and outcomes. METHODS A retrospective records review of paediatric brain tumours at the UCI between 2017 and 2021 was conducted. Patient and tumour characteristics, as well as MDT management, were sourced. A survey among MDT members was conducted to explore their perspectives. RESULTS Thirty-five paediatric brain tumour cases were treated at UCI, with a median age of 8.0 years (IQR 4.0–11.0) and a median duration of symptoms of six months (IQR 3.0-8.5). The majority (25.7%, n=9) were craniopharyngiomas, 14.3% (5/35) were astrocytomas, 11.4% (4/35) were medulloblastomas, and 8.6% (3/35) each were ependymomas and pineoblastomas. Overall, 22 (62.9%) of the cases were discussed on the MDT. The number of cases discussed in the MDT increased over the five years: 0/3 (0.0%) in 2017, 3/5 (60.0%) in 2018, 2/4 (50.0%) in 2019, 6/9 (66.7%) in 2020, and 11/14 (78.6%) in 2021. The proportion of multidisciplinary management decisions implemented also increased: 0% in 2018, 50% in 2019, 83.3% in 2020, and 81.8% in 2021. The majority of patients (12/15, 80.0%) for whom MDT recommendations were implemented were alive. Lack of neurosurgical resources (46.7%), imaging (46.6%), diversity of MDT roles (26.7%), access to radiotherapy (20.0%), and pathology (20.0%) were recognized as major impediments to paediatric neuro-oncology management. CONCLUSIONS Implementing multidisciplinary management decisions benefited children with brain tumours and decreased abandonment and patient loss to follow-up at the Uganda Cancer Institute. Greater emphasis should be placed on increasing resources and actionable treatment recommendations.

Detection of Alport gene variants in children and young people with persistent haematuria.

Genetic kidney disease is an important cause of persistent microscopic haematuria in children and young people. We aimed to determine the frequency of variants in the Alport syndrome genes (COL4A3, COL4A4 or COL4A5) in individuals under 18 years of age presenting with persistent microscopic haematuria to a single specialist centre in the UK over a 10-year period. We conducted a retrospective longitudinal study of individuals referred to a tertiary paediatric nephrology service with persistent microscopic haematuria between April 2012 to 2022. A total of 224 individuals (female 51.8%) were evaluated with persistent microscopic haematuria of greater than 6 months duration. The age at presentation was 7.5 ± 4.3 years (mean ± SD) with a duration of follow-up of 6.8 ± 4.6 years (mean ± SD). Targeted exome sequencing was performed in 134 individuals and 91 (68%) had a pathogenic or likely pathogenic variant in COL4A3, COL4A4 or COL4A5. Only 49.5% of individuals with identified variants had a family history of microscopic haematuria documented and 37.4% (34/91) had additional proteinuria at presentation. COL4A5 was the most common gene affected and missense variants affecting glycine residues were the most common variant type. Over two-thirds of children and young people who underwent genetic testing had an identifiable genetic basis for their microscopic haematuria and over half did not have a documented family history. Genetic testing should be part of the evaluation of persistent microscopic haematuria despite a negative family history.

Assessment of visual impairment and need of rehabilitation services for children attending schools for blind in an urban city of North India

ABSTRACT Background/Aims: By understanding the prevalence and causes of childhood blindness, stakeholders can work toward comprehensive strategies that encompass prevention, treatment, rehabilitation, and support, ultimately improving the quality of life for affected children. The information about the pattern and causes of childhood blindness in Northern Indian states is limited, it highlights the need for further research and data collection to better understand and address the specific challenges in this region. Therefore, the present cross-sectional study was planned to ascertain the different causes and patterns of childhood blindness and to understand the barriers to the use of LVAs and its compliance among the students attending schools for the blind in a North Indian State. Study Design and Setting: Students from two schools for blind were examined in Chandigarh and its vicinity in North India. The different causes of severe visual impairment/blindness were classified as per the World Health Organization/Prevention of Blindness standard recording form. Results: A total of 89 students attending schools for the blind were examined. The mean age was 13.10 years (range = 4–16 years). Male, female ratio was 3.3:1. The major causes of blindness were congenital anomalies (whole globe anomalies 37.08%), followed by retinal conditions (16.7 = 8%), undetermined/other (12.3), and lenticular conditions (112%). More than one-third of children (34.8%) were blind due to avoidable causes of blindness. Conclusion: The current study data append on the existing national available data about childhood blindness in India. Though the sample size of the current is comparatively low, observed different results as compared to previously published reports from other regions, emphasize the strengthening of pediatric ophthalmology services as well as of low vision services in this particular region of North India.

Development and Evaluation of Pediatric Acute Care Hospital Referral Regions in Eight States

To develop a set of pediatric acute care hospital referral regions for use in studying pediatric acute care delivery, and test their utility relative to other regional systems. We used state-level administrative databases capturing all pediatric acute care in eight states to construct novel referral regions. We first constructed pediatric hospital service areas (PHSAs) based on 5,837,464 pediatric emergency department encounters. We then aggregated these PHSAs to pediatric hospital referral regions (PHRRs) based on 344,440 pediatric hospitalizations. Finally, we used three measures of spatial accuracy (localization index, market share index, and net patient flow) to compare this novel region system with the Dartmouth Atlas, designed originally to study adult specialty care, and the Pittsburgh Atlas, designed originally to study adult acute care. The development procedure resulted in 717 novel PHSAs, which were then aggregated to 55 PHRRs across the included states. Relative to HRRs in the Dartmouth and Pittsburgh Atlases, PHRRs were fewer in number and larger in area and population. PHRRs more accurately captured patterns of pediatric hospitalizations, (eg, mean localization index: 69.1 out of 100, compared with a mean of 58.1 for the Dartmouth Atlas and 62.4 for the Pittsburgh Atlas). The use of regional definitions designed specifically to study pediatric acute care better captures contemporary pediatric acute care delivery than the use of existing regional definitions. Future work should extend these definitions to all US states to enable national analyses of pediatric acute care delivery.

Everyday Ethics or Deference to Expertise: Experiences of Pediatric Palliative Care Teams with Ethics Consultancy.

Background: Little is known about the extent to which pediatric palliative care (PPC) clinicians are engaged in ethics consults or how they perceive interactions with ethics consultants. Objective: Describe the extent to which PPC team members serve in pediatric health care ethics (PHCE) consultancy roles and to describe their experiences interacting with pediatric ethic consultant services. Design: Online survey distributed to members of the American Academy of Pediatrics and American Academy of Hospice and Palliative Care pediatric and ethics section and special interest groups in the United States. Results: Eighty-six responses were obtained (response rate 45%) from PPC teams in 70 different children's hospitals located in 34 states. Almost all (97%) reported a functional ethics consult service such that PPC is not expected to meet the ethics need of the institution. A person involved on the PPC team also performed ethics consults in half (49%) of the settings, predominantly the PPC physician. Most respondents who perceive PPC teams engage in ethics-relevant work as part of their everyday PPC work. Formal ethics training was lacking among PPC members involved in ethics consults with few ethics degrees (15%), certifications (6%), or fellowships (2%). Discord (67%), conflict (49%), limitations to treatment (48%), and distress (41%) were cited as the most frequent reasons for which PPC teams consult ethics. PPC respondents identified role clarity, coordinated engagement, timely presence, and open communication as strong PHCE consultant practices. Conclusions: PPC team members performing ethics consults may benefit from additional ethics education and training. Further research is warranted to delineate scope of ethics consultancy relevant to PPC and role clarity.

Health-related Quality of Life in Children with Vernal Keratoconjunctivitis in Malaysia.

There has been a lack of data on health-related quality of life (HRQoL) in children with vernal keratoconjunctivitis (VKC) from Southeast Asia. This study evaluated the levels (mean total score and subscales score) of HRQoL, comparing the VKC and normal children groups, and within the VKC severity groups. A cross-sectional study was conducted in two tertiary hospitals, specifically the pediatric ophthalmology services at Hospital Selayang and Universiti Sains Malaysia, spanning from 2019 to 2020. Participants aged between 8 and 15 years were categorized into two groups: those diagnosed with VKC and healthy children serving as the control group. Each participant completed the Quality of Life in Children with Vernal Keratoconjunctivitis (QUICK) questionnaire, consisting of 16 questions, divided into two subscales: 12 questions focusing on symptoms and four questions for daily activities. A total of 240 children took part in the study, with 120 children diagnosed with VKC and another 120 in the control group. The mean age of participants with VKC was 11.21 ± 1.91 years, with a male predominance of 4:1 compared to female. Tearing (98.4%) and itchiness (98.3%) emerged as the most prevalent symptoms affecting HRQoL, while the most challenging activities were outdoor play (36.6%) and participation in recreational water activities (34.2%). The mean total score was significantly higher in the VKC group compared to the control group. Additionally, both the mean total score and all subscale scores were significantly higher in the severe type compared to the mild-moderate type. VKC significantly reduce the HRQoL among Malaysian children, and the negative impact increases with the disease severity.

Skin manifestations and related clinical characteristics of Multisystem Inflammatory Syndrome in Children (MIS-C): a descriptive retrospective cohort study at Texas Children’s Hospital

BackgroundLittle is known about the dermatologic manifestations of MIS-C in children and adolescents ObjectiveWe sought to describe the demographic background, key clinical features, and the clinical consequences of developing rash manifestations in MIS-C patients at Texas Children’s Hospital. MethodsDescriptive retrospective cohort study of 290 hospitalized eligible patients between May 2020 and April 2022. ResultsAmong MIS-C patients, 51% exhibited a rash. We found that younger children (8.62 vs. 9.49 years of age, p=0.006) and white children (p=0.002) had a higher likelihood of developing a rash in association with MIS-C. Additionally, patients without a rash had increased maximum troponin levels (0.11 ng/mL vs. 0.07 ng/mL, p=0.02) and a higher incidence of cardiac involvement (83.1% vs. 72.3%, p=0.03) compared to those with a rash but did not significantly affect the length of hospital stay or clinical course. The most commonly observed rash was an erythematous and maculopapular rash on the trunk and/or extremities. LimitationsRash characteristics were initially described by a variety of physicians on the pediatric primary care services. ConclusionRash manifestations in MIS-C patients is associated with lower Cardiac involvement and decreased troponin levels.