Pediatric University Hospital Research Articles

Inclusive Soundscapes: How Race, Socioeconomic Status and Maternal Age Influence the Pediatric Cochlear Implant Journey.

This study aimed to assess how race, social vulnerability, and maternal age influence pediatric cochlear implant access and usage. Retrospective cohort. Tertiary Pediatric University Hospital. This study included individuals aged 0 to 18 who received a cochlear implant at our center between the years 2000 and 2022. Social vulnerability data from 2020 was obtained from the Centers for Disease Control and Prevention. Of the 302 patients included in our study, 43% were black and 50% were white. Patients from the highest to lowest social vulnerability quintiles comprised 31%, 25%, 18%, 10%, and 14% of our sample, respectively. Race was associated with social vulnerability index (SVI) (P < .001), with a mean score of 0.70 (±0.26) and 0.49 (±0.27) for black and white patients, respectively. Later age at hearing loss (HL) diagnosis and cochlear implantation (CI) were associated with more and most vulnerable SVI (P < .05). Delayed diagnosis was also associated with black and other racial groups (P = .041), and adolescent maternal age (P = .03). Greater SVI was associated with less daily cochlear implant usage (P = .004). The most vulnerable patients were more likely to be lost to follow-up (P = .03) despite no difference based on maternal age (P = .59) and insurance status (P = .47). This study underscores the significance of mitigating disparities in timely diagnosis of HL, consistent CI usage, and appropriate follow-up care. This is a first step toward the formulation of novel strategies aimed at overcoming barriers and developing appropriate intervention programs.

Clinical, laboratory and neuroimaging profile of patient's cohort with septo-optic dysplasia treated at a pediatric university hospital

ObjectivesSepto-optic dysplasia (SOD) is a relatively rare clinical condition. However, there has been a significant increase in its incidence over the years. Diagnosis is clinical and made when there are at least 2 components of the classic triad: Optic nerve hypoplasia (ONH), midline malformation, and pituitary dysfunction. This study aims to describe the clinical and complementary exam characteristics of patients with SOD. MethodsA retrospective study of review of medical records of 48 patients cohort (24 female) with SOD followed to 2023. ResultsThe average age at diagnosis was 3.90 ± 3.85 years. Maternal age was ≤ 25 years at the time of delivery in 50% (24/48) of cases. Visual and developmental impairment was observed in 21 (43,7%) and nystagmus in 15 patients. Fourteen of them developed short stature. Regarding the diagnostic criteria for SOD: 92.6% (38/41) had ONH (78.9% bilaterally), 95.3% (41/43) had structural midline abnormalities, 85.7% (24/28) had hypothalamic-pituitary region alterations, and 73% had at least one hormonal deficiency, of which 2/3 had multiple pituitary dysfunctions. The most frequent deficiencies were thyroid-stimulating hormone and growth hormone, and the average age at diagnosis of the first dysfunction was 4.25 ± 3.71 years. ConclusionClinical manifestations that most led to early suspicion were developmental delay, nystagmus and visual impairment. More than 1/3 of the patients had the complete triad and 2/3 developed multiple pituitary deficiencies, with TSH deficiency being the most prevalent followed by GH deficiency. Patients with ONH or midline structural changes should undergo endocrine evaluation.

PCR identification of Enterococcus Species as a Primary Pathogen in Neonatal Bloodstream Infections at Damascus University Paediatric Hospital

Bacterial septicaemia is one of the most common causes of death in newborns throughout the globe. Recently, gram positive bacteria have been detected as a main responsible of hospital acquired blood infection in developed country especially Enterococcus sp. and Staphylococcus sp. This preliminary study aimed to identify Enterococcus species and Staphylococcus species isolated form acquired blood infection in the department of premature and neonates at paediatric university hospital in Damascus, based on PCR technology. the antibiotic sensitivity these pathogens was also investigated against common antibiotics usually used to treat septicaemia in this hospital. Bacterial gDNA was extracted directly from blood samples of children with acquired Septicemia. The bacterial infection was confirmed in 50 samples based on the amplification of 16srDNA gene. Genus Enterococcus sp. and Staphylococcus species were identified as source of infection in samples using specific primers via PCR technique. The antibiotic sensitivity of isolated bacterial strains was studied using Kirby-Bauer disc method. Our study showed that 47 of the 50 samples of the infection were bacterial. The rate of blood infection caused by Enterococcus species was 24%, and 4% for Staphylococcus sp. the isolated bacteria showed a high sensitivity to Amikacin, medium sensitivity to Vancomycin, and less sensitivity to Ampicillin and Gentamycin. Enterococcus species Showed good sensitivity to Amikacin and Vancomycin and low sensitivity to Gentamycin, while was resistant to Ampicillin. Furthermore, the two isolated stains Enterococcus sp and Staphylococcus species showed a good sensitivity against chlorhexidine. This study confirmed the importance of molecular technologies in diagnosing the acquired septicaemia and identifying the specific infectious agent. The molecular test showed that Enterococcus sp. was an important cause of acquired blood infection in neonates respect to ampicillin resistant staphylococcus species.

Relationship between level of serum vitamin D and pneumonia and sepsis in Minia pediatric university hospital at period between 2019 and 2021

Relationship between level of serum vitamin D and pneumonia and sepsis in Minia pediatric university hospital at period between 2019 and 2021

Distribution and outcomes of paediatric anaesthesia services in Sweden: an epidemiological study

BackgroundCentralisation of perioperative care for small children to a limited number of specialised paediatric centres has many theoretical advantages, but neither the optimal balance nor the current distribution of paediatric anaesthesia on a national scale are well elucidated. The aim of this study was to describe the distribution, adverse events, and mortality in children undergoing anaesthesia in Sweden. MethodsIn this cohort study, data from all paediatric anaesthesia procedures registered in Sweden during the years 2019–22 were extracted from the Swedish Perioperative Register (SPOR). Data were analysed according to hospital level of care and ASA physical status. ResultsData from 81 hospitals were analysed. During the 4-yr period, 214,964 procedures were registered. Most procedures in neonates and infants were managed in paediatric (73%) and other university hospitals (21%). Adverse events occurred in 2.71% of cases and severe adverse events in 0.067%. The all-cause 24-h mortality rate was 6.6:10,000 anaesthetics and the all-cause 30-day mortality was 14.7:10,000 anaesthetics. The 30-day all-cause estimated mortality was highest in paediatric hospitals (95% confidence interval [CI] 30–39) compared with other university hospitals (95% CI 6.1–12), county (95% CI 1.9–4.8), district (95% CI 0.07–2.2), and smaller hospitals (95% CI 0.0–22). ConclusionsMost procedures in neonates and infants were performed in tertiary centres, with county hospitals managing mainly older children, in accordance with national recommendations. Mortality was more common in tertiary centres, reflecting increased comorbidity and centralisation of anaesthesia of neonates and infants.

Vitamin D Status among 2-18-Year-Old Romanian Pediatric Patients: A Single-Center Study.

An adequate vitamin D level is essential for optimal bone mass formation during growth. The present study aimed to assess (i) the sex-specific, age-specific, and potential seasonal (spring, summer, winter) influences on the pediatric circulating levels of 25-hydroxyvitamin D (25(OH)D); (ii) determine the frequency of pediatric patients with vitamin D deficiency (VDD) or insufficiency (VDI); and (iii) quantify the association between age category, sex, and season types and susceptibility to VDD and VDI, respectively. Laboratory data were collected on serum 25(OH)D levels in children aged between 2 and 18 years (n = 1674) who underwent blood sampling following admission to a university pediatric hospital in Cluj-Napoca (Romania) between January and June 2023. VDD (<20 ng/mL) was observed in 27% of pediatric patients. Among toddlers and preschoolers (2-5 years), VDD was 11%, while it was 33% among school-aged children (6-11 years) and 39% among adolescents (12-18 years). We found a significant difference in the frequencies of vitamin D status between females and males (p = 0.006). Also, we found significant associations of vitamin D status with age categories (p < 0.0001) and seasonal variations (p = 0.03). After adjusting for season of blood collection, the multinomial logistic regression model showed that children aged 6-11 years old (adjusted OR = 7, 95% CI: (4.9, 9.4)), children aged 12-18 years old (adjusted OR = 14, 95% CI: (9.3, 19.6)), and females (adjusted OR = 1.43, 95% CI: (1.10, 1.86)) were significantly associated with higher odds of VDD. In conclusion, the study revealed a significant difference in the frequency of VDD and VDI among pediatric patients older than six years, with a significant difference according to sex and season, being more pronounced among girls and during the winter and spring seasons.

The impact of the COVID-19 pandemic on the incidence and clinical course of IgA vasculitis in paediatric patients

Introduction and objective: Immunoglobulin A vasculitis is an autoimmune disorder resulting from immune complex accumulation in small blood vessels, causing skin, joint, abdominal, and kidney manifestations. This study evaluated the impact of the COVID-19 pandemic on the incidence and clinical course of immunoglobulin A vasculitis in paediatric patients. Materials and methods: A retrospective analysis of medical records from a single university paediatric hospital was performed to compare 117 patients presenting with immunoglobulin A vasculitis before and 57 after the COVID-19 epidemic announcement in Poland on 20 March 2020. Laboratory results, hospitalisation duration, preceding infections, clinical presentation, history of allergies and COVID-19 vaccinations, and the proportion of immunoglobulin A vasculitis patients among all admissions were analysed. Results: The study of 174 patients showed that their average age during the pandemic (5.51 ± 3.10) was significantly lower than pre-pandemically (6.98 ± 3.67) (p &lt; 0.05). Before the pandemic, more hospitalised patients had immunoglobulin A vasculitis (1.14%) compared to during the pandemic (0.47%) (p &lt; 0.05). Food allergies were also more common during the pandemic (20.8%) than before (8.8%) (p &lt; 0.05). No significant differences were found in hospitalisation duration, and the incidence of immunoglobulin A vasculitis nephritis and abdominal symptoms (p = 0.194, p = 0.381, p = 0.968, respectively). Three patients had COVID-19 infection at admission. Conclusions: The pandemic led to fewer immunoglobulin A vasculitis hospitalisations but did not alter the clinical course of the disease or the incidence of immunoglobulin A vasculitis nephritis. In the context of the resurgence of COVID-19 infections, it is important to consider them as potential factors affecting immunoglobulin A vasculitis. Ongoing research is essential to understand these dynamics and guide effective clinical management of immunoglobulin A vasculitis amidst the evolving COVID-19 setting.

Immunophenotypic Evaluation of Circulating Monocyte Subsets in Beta Thalassemia Major Patients

Abstract Background β-thalassemia is a major public health problem in Egypt with particularly high incidence due to strong cultural preference for consanguineous marriages, and the high carrier rate. Iron overload, which is caused by increased gut iron absorption secondary to ineffective erythropoiesis, and regular blood transfusion is linked to accumulation within different organs with subsequent organ dysfunction. Monocytes are important lineages of innate immunity which activate the adaptive immune response and play a pivotal role in the host response to pathogens. Human blood monocyte subsets classification is based on the expression of CD14 and CD16 cell surface receptors. Aim of the Work To evaluate the circulating monocyte subsets in β-thalassemia major (β-TM) patients and its potential role in prediction of iron overload and chronic inflammation in β- thalassemia major patients. Patients and Methods A Case-Control study conducted on 40 previously diagnosed beta thalassemia major patients attending the outpatient clinic of Ain Shams University Pediatric Hospital, and 20 age and sex matched healthy control subjects. CBC, iron profile, CRP and immunophenotyping for monocyte subsets classification were done. Results Non classical monocytes were found statistically significantly higher in thalassemic patients especially in those with serum ferritin level &amp;lt; 1000 ng/ml (P value &amp;lt; 0.01). In addition, classical monocytes were found to be statistically significantly lower among the patients’ group (P value &amp;lt; 0.01). A negative correlation was found between intermediate monocytes and Transferrin saturation percent (TS%) suggesting its protective role in iron overload thalassemia patients. By using ROC curve, non- classical monocytes predicted ferritin &amp;lt; 1000 ng/ml at a cutoff point of 17.8 % and 0.05 x 10∧9/L for relative and absolute counts respectively. Conclusion All monocyte subsets proposed to have role in predicting iron overload and chronic inflammation β-TM patients. We recommend further studies on β-TM patients with the engagement of activity assays of monocyte subsets to clarify the co-regulatory role in iron hemostasis and chronic inflammation.

Patch test in Brazilian children with a clinical diagnosis of atopic dermatitis: a cross-sectional study using an extended patch test battery.

Atopic dermatitis (AD) is a chronic and relapsing inflammatory skin disease mainly affecting children. Similarly, Allergic contact dermatitis (ACD) is an inflammatory skin disease, but unlike AD it results from direct exposure to an external agent. Theoretically, the impaired skin barrier facilitates the penetration of potential allergens. Therefore, AD patients are at risk for an associated ACD, exacerbating their skin condition. Because eczema is similar, performing a patch test (PT) for the differential diagnosis is essential. In this cross-sectional transversal study, we performed a PT with 30 sensitizers in 26 children with AD, selected according to established criteria for suspected ACD, and treated at an AD center of a pediatric university hospital in Rio de Janeiro. Clinical presentation, patient profile, main sensitizers, and frequency of ACD caused by therapeutic skincare products were evaluated. In all, 23 (88.5%) patients reacted to at least one allergen, 21 (80.7%) had a relevant positive patch test, and 15 (57.7%) were polysensitized. The main positive sensitizers were nickel (38.5%), blue disperse (30.8%), fragrance mix (30.8%), and neomycin (23.1%). Nineteen (73%) patients reacted to substances present in therapeutic or skincare products. Our data underscore the importance of performing a PT in AD children whose eczema has atypical distribution. The expressive percentage of positive tests, especially of allergens in skincare products, indicates the constant need to review the proposed treatments. Therefore, we recommend a specific and expanded PT battery for pediatric AD patients, including a negative control, to increase sensitivity for diagnosing ACD.

Advancing pediatric head CT dose prediction: correlating patient size metrics with AP and LAT dimensions in Moroccan population

This study aims to establish comprehensive relationships between patient size, focusing on effective diameter (Deff) and water-equivalent diameter (Dw), in conjunction with anterior-posterior (AP) and lateral (LAT) dimensions. The primary goal is to refine precise patient dose estimations in pediatric head computed tomography (CT) examinations. Our examination involved a dataset of 105 pediatric head CT images sourced from a Moroccan pediatric university hospital. These images, selected from the central scanning range, underwent quantification for LAT, AP, Deff, and Dw, with measurements carried out using RadiAnt Dicom Viewer for lateral and anteroposterior dimensions. Our analytical approach encompassed modeling Deff and Dw as functions of LAT, AP, and combined AP + LAT dimensions. Additionally, Dw was modeled as a function of Deff and calculated Size Specific Dose Estimates (SSDE) based on Dw was compared to SSDE computed from one single dimension. The outcomes revealed strong correlations among Deff, Dw, and fundamental geometric dimensions (LAT, AP, and AP + LAT), as indicated by consistently high coefficients of determination (R² > 0.8). SSDE calculated from Dw shows impressive correlation with SSDE computed from a single dimension (R² > 0.9). This study offers insights into the relationships between patient size and critical dimensions, identifying high correlations that can represent a significant advancement in predicting doses for pediatric head CT examinations. This introduces the potential for streamlining the determination of head diameter and dose by relying on a single dimension, thereby enhancing the efficiency of dose predictions by facilitating the monitoring of radiation exposure of this population in clinical routine.

265 Association of premature birth with neurodevelopment delays in a cohort of Hispanic children exposed to the Neonatal Intensive Care Unit (NICU)

OBJECTIVES/GOALS: We aim to identify neurodevelopment delays among children who were born prematurely. We will also calculate the sensitivity and specificity of the assessment tools used to measure the neurodevelopmental profile in early childhood of children exposed to the Neonatal Intensive Care Unit (NICU). METHODS/STUDY POPULATION: This cross-sectional study will include 100 premature children who were born between 32 to 37 weeks of gestational age and admitted to NICU at the University Pediatric Hospital in Puerto Rico. Their neurodevelopment will be measured with the Bayley III. Statistical analysis will be performed using IBM SPSS Statistics 25.0. Descriptive statistics will be used, normality distributions among all continuous variables, frequency distribution for categorical variables and logistic regressions to test association of GA and neurodevelopment delay. We will use the raw item scores for each domain of the Bayley III assessments to measure internal consistency using Cronbach’s alpha and factor analysis. RESULTS/ANTICIPATED RESULTS: We anticipate identifying the ND among children born prematurely between 32 to 37 weeks of gestational age and who were admitted to NICU at the University Pediatric Hospital in Puerto Rico. We also expect to find if gestational age impacts adversely ND in children who were born between 32 to 37 weeks of gestation. We will be able to assess if lower gestational age will impact global ND in contrast to higher gestational age neurodevelopment delays in one specific area of development. We will also be able to assess the sensitivity and specificity of the Bayley- III. DISCUSSION/SIGNIFICANCE: Premature is a major global health problem with a 12.0% prevalence. We want to promote early identification of ND in a diverse Hispanic Puerto Rican population so we can guide public health decisions and lead research initiatives to improve outcomes in the future or facing prematurity.

Serum Amylase Activity in Children Living with HIV-1 at the Charles de Gaulle Pediatric University Hospital in Ouagadougou

Biological monitoring is an essential part of the management of HIV infection. The aim of this study was to assess serum amylase activity during follow-up of children living with HIV-1 (CLHIV-1) at the Charles de Gaulle Pediatric University Hospital (CHUP-CDG). This was a descriptive and analytical cross-sectional study, with retrospective data collection from January 1, 2020 to December 31, 2022. Patients under 15 years of age who were being monitored for HIV-1 at CHUP-CDG and who had undergone a serum amylase assay during the study period were included. A total of 746 patients have been included, with a M/F sex ratio of 0.91 and a mean age of 8.52±4.08 years. Among CLHIV-1, 88.05% had a TCD4 lymphocyte count &amp;gt; 500/mm&amp;lt;sup&amp;gt;3&amp;lt;/sup&amp;gt; and 60.32% an undetectable plasma viral load (PVL). The incidence of hyperamylasemia in the study population was 57.64%. Hyperamylasemia was significantly more frequent in children aged 0-2 years (&amp;lt;i&amp;gt;p&amp;lt;0.00001&amp;lt;/i&amp;gt;), in patients with a high PVL (&amp;lt;i&amp;gt;p=0.0016&amp;lt;/i&amp;gt;) and in those on the protocol combining two nucleoside reverse transcriptase inhibitors with a protease inhibitor. Several abnormalities in serum amylase activity were detected in CLHIV-1 during the course of the study. Clinical correlation and adequate follow-up of these abnormalities are essential to reduce the morbidity and mortality associated with pancreatic damage in people living with HIV.

Evaluation of coping strategies of parents of children with cystic fibrosis

ABSTRACT This cross-sectional quantitative study was conducted to evaluate the coping strategies of parents of children with cystic fibrosis. The research sample is the parents (n: 112) who presented to Thoracic Medicine Department at Hacettepe University Pediatric Hospital between 3 April 2021 - 28 May 2021 and volunteered to participate in the study. Sociodemographic Data Form and Coping Orientation to Problems Experienced Inventory (COPE Inventory) were used in the collection of data. The study examined coping strategies according to children’s characteristics such as age, sex, education, and parents’ independent variables such as employment status, income status, number of individuals and children in the family, communication with other families, social and financial support. Data were analyzed using Mann-Whitney and Kruskal-Wallis tests. Research findings show that religious coping was the most frequently preferred coping strategy, and behavioral disengagement was the least commonly used coping strategy. Emotion-Focused Coping Strategies were also commonly used. Social work interventions and strategies play an important role in helping parents to adopt positive coping strategies and improve their skills.

Unlicensed/Off-Label Drug Prescriptions at Hospital Discharge in Children: An Observational Study Using Routinely Collected Health Data.

Unlicensed and off-label (UL/OL) prescriptions have been associated with an increased risk of drug-related problems. Data of their prevalence at hospital discharge remain insufficient. We aimed to describe the prevalence of UL/OL drugs in outpatient prescriptions at discharge in children. We conducted a retrospective study using the routinely collected health data of children at discharge from 2014 to 2016. The primary reference source for determining licensed labelling was the summaries of product characteristics (SPCs) in a French industry-independent formulary named Thériaque. We described the characteristics of UL/OL prescriptions at discharge and looked for predictors of UL/OL prescriptions. We included 2536 prescriptions of 479 children. Licensed, OL, and UL prescriptions accounted for 58.6% (95% CI: 56.7-60.5), 39.2% (95% CI: 37.3-41.1), and 2.3% (95% CI: 1.7-2.9), respectively. A total of 323 (74%) children received at least one UL/OL drug. Among the licensed drugs, bronchodilators (8.8%) and analgesics (8.6%), and among the OL drugs, antibiotics (2.8%), were the most prescribed. The younger age of the children and higher number of drugs they received increased the probability of UL/OL prescriptions (unadjusted p-value of ≤0.05). The prevalence of UL/OL prescriptions is about 40% at discharge from a pediatric university hospital in France.

Clinical evaluation and treatment outcomes of caustic ingestion injuries in Syrian pediatric patients: A retrospective study: Short title: High-dose steroids for pediatric caustic ingestions in Syria.

Accidental ingestion of caustic agents poses a significant concern in pediatric emergency departments globally. It is a growing public health concern in low-to-middle income countries, which often lack comprehensive data reporting. This study examines high doses of corticosteroid treatment outcomes of caustic ingestion injuries in Syrian pediatric patients, addressing clinical features, and associated variables. A retrospective observational study was conducted at University Pediatric Hospital from January 2016 to January 2019. Medical records were reviewed for patients aged <10 years with esophagoscopy-confirmed grade IIa, IIb, or III burns. Data collected included sociodemographics, esophagoscopy results, treatment details, and outcomes. Among 114 pediatric patients, 76 (67%) were males and 38 (33%) were females. Age groups included <1 year (11%), 1-3 years (39%), 3-5 years (29%), 5-7 years (11%), and >7 years (11%). Alkaline burns accounted for 54% of injuries, acidic for 32%, and other substances for 13%. Complications included bleeding (19%) and psychomotor disability (7%). The most common burn site was the entire esophagus (62%), with 81% having grade II burns. Healing was achieved in 71% of patients with high doses of corticosteroids treatment, and 29% required dilation, with final 92% healing rate. The use of corticosteroids for esophageal strictures remains inconclusive, demanding further robust research with larger sample sizes and control groups. While our study revealed that high doses of corticosteroids treatment followed by esophageal dilation had a 92% success rate. However, our study demonstrates promising results, methodological limitations and absence of a control group underscore the need for more definitive evidence. Both alkali and acidic ingestion contribute to stricture development.

Dengue Fever Seroprevalence among Children Aged 0-5 Years at Paediatric University Hospital, Ouagadougou

Dengue Fever Seroprevalence among Children Aged 0-5 Years at Paediatric University Hospital, Ouagadougou

Issues of transition support to adulthood and the practices of pediatric-adult healthcare transition in neurological diseases

A workshop of the Special Committee on Measures for Transition from Pediatric to Adult Health Care, the Japanese Society of Neurology was held to discuss various issues and practices involved in healthcare transition. The following points were addressed: (1) the history of, and issues involved in, promoting support for patients requiring medical care, (2) cooperation between pediatric medical centers and university hospitals, (3) collaboration between pediatrics and neurology in medical and rehabilitation facilities, and (4) a questionnaire survey of members of the Japanese Society of Neurology. The reasons for extreme difficulties in pediatric-adult healthcare transition for patients with neurological diseases, especially those who require continuous intensive medical care over a long period of time, include the difference in the operating systems of pediatric and adult departments, in addition to the difference in the diseases treated during childhood and adulthood. For holistic transition support, it is necessary to strengthen cooperation not only among medical professionals, but also among multiple professions, as well as between local communities and government.

Bacteriological Profile of Effusion Fluids Infections at Charles De Gaulle University Pediatric Hospital from 2017 to 2020

Bacteriological Profile of Effusion Fluids Infections at Charles De Gaulle University Pediatric Hospital from 2017 to 2020

Prevalence of Dyslipidemia among Patients Received at the Biochemistry Unit of the Charles de Gaulle Pediatric University Hospital in Ouagadougou

Prevalence of Dyslipidemia among Patients Received at the Biochemistry Unit of the Charles de Gaulle Pediatric University Hospital in Ouagadougou

Immunovirological Profile of HIV1 Infection in Children and Adolescents Followed at the Bangui Pediatric University Hospital

Immunovirological Profile of HIV1 Infection in Children and Adolescents Followed at the Bangui Pediatric University Hospital