Period In Pediatric Patients Research Articles

External validation of a clinical mathematical model estimating post-operative urine output following cardiac surgery in children

BackgroundThis study aims to externally validate a clinical mathematical model designed to predict urine output (UOP) during the initial post-operative period in pediatric patients who underwent cardiac surgery with cardiopulmonary bypass (CPB).MethodsChildren aged 0–18 years admitted to the pediatric cardiac intensive care unit at Cleveland Clinic Children’s from April 2018 to April 2023, who underwent cardiac surgery with CPB were included. Patients were excluded if they had pre-operative kidney failure requiring kidney replacement therapy (KRT), re-operation or extracorporeal membrane oxygenation or KRT requirement within the first 32 post-operative hours or had indwelling urinary catheter for fewer than the initial 32 post-operative hours, or had vasoactive-inotrope score of 0, or those with missing data in the electronic health records.ResultsA total of 213 encounters were analyzed; median age (days): 172 (IQR 25–75th%: 51–1655), weight (kg): 6.1 (IQR 25–75th%: 3.8–15.5), median UOP ml/kg/hr in the first 32 post-operative hours: 2.59 (IQR 25–75th%: 1.93–3.26) and post-operative 30-day mortality: 1, (0.4%). The mathematical model achieved the following metrics in the entire dataset: mean absolute error (95th% Confidence Interval (CI)): 0.70 (0.67–0.73), median absolute error (95th% CI): 0.54 (0.52–0.56), mean squared error (95th% CI): 0.97 (0.89–1.05), root mean squared error (95th% CI): 0.99 (0.95–1.03) and R2 Score (95th% CI): 0.29 (0.24–0.34).ConclusionsThis study provides encouraging external validation results of a mathematical model predicting post-operative UOP in pediatric cardiac surgery patients. Further multicenter studies must explore its broader applicability.Graphical abstractA higher resolution version of the Graphical abstract is available as Supplementary information

Çocuklarda Postoperatif Dönemde Ağrı Tedavisinde Nonfarmakolojik Yöntemlerin Kullanımının İncelenmesi: Sistematik Bir İnceleme

Background: The aim of this study was to examine the non-pharmacological methods used by nurses in postoperative pain management in pediatric patients aged 0-18 years and the effectiveness of the methods used in reducing the level of pain.
 Material and Methods: In this descriptive study, the research population consisted of studies that were accessed from the National Thesis Center database by using the keywords "pediatric", "pain", "surgical", "postoperative", "non-pharmacological" in different combinations in the literature search and that examined non-pharmacological methods used for pain management in the postoperative period in pediatric patients between the ages of 0-18 years in the last seven years and were conducted in experimental design. This systematic review was carried out using the PRISMA flowchart steps.
 Results: A total of 1185 individuals, including 905 children and 280 parents, took part in 11 studies. The mean age of the children in the studies was 6.6 years (min-max). The most preferred scale to measure pain in the postoperative period was the Wong Baker Facial Pain Scale (7 studies). Non-pharmacologic methods used in the studies included distraction (5 studies), therapeutic play (3 studies), distraction and therapeutic play (1 study), massage therapy (1 study) and music therapy (1 study).
 Conclusion: Different non-pharmacological methods used in the postoperative period are effective in reducing pain levels in children.
 Practice implications: It is possible for pediatric nurses to use non-pharmacological methods to reduce pain in the postoperative period. Further research is needed to determine the effectiveness of these interventions on pain.

Effect of thin-split encephalomyosynangiosis on transient neurological events in revascularization surgery for pediatric patients with moyamoya disease.

Transient neurological events (TNEs) are among the most important events after revascularization surgery in pediatric patients with moyamoya disease (MMD). Although hemodynamic changes and crying are representative factors of TNEs, brain compression by encephalomyosynangiosis (EMS) is another important cause of TNEs. Therefore, the authors assumed that making the EMS as thin as possible reduces the frequency of TNEs. However, thin-split EMS can lead to insufficient development of collateral vessels. This study aimed to evaluate the effects of thin-split EMS in combined revascularization surgery on postoperative outcomes in pediatric patients with MMD. The authors retrospectively included 56 consecutive combined revascularization surgeries in the anterior cerebral circulation in pediatric patients with MMD. These surgeries were classified into the former group and thin-split EMS group. The temporal muscle was halved in the former EMS group and split as thinly as possible in the thin-split EMS group. The authors performed between-group comparisons of postoperative stroke events and TNEs during the acute period and the development of collateral flow and stroke events during the chronic period. Former and thin-split EMS procedures were performed in 37 and 19 patients, respectively. TNEs without crying or hemodynamic changes were observed significantly less frequently in the thin-split EMS group than in the former EMS group (0 [0.0%] in the thin-split EMS group vs 9 [24.3%] in the former EMS group, p = 0.021). There were no significant between-group differences in the development of indirect bypass during the chronic period (good: 34 [91.9%] and poor: 3 [8.1%] in the former EMS group vs good: 16 [84.2%] and poor: 3 [15.8%] in the thin-split EMS group; p = 0.397). Additionally, there were no significant between-group differences in the incidence of chronic clinical events, including death or stroke. Thin-split EMS can reduce TNEs that do not accompany crying or hemodynamic changes. Furthermore, the procedure has sufficient prevention effects against stroke events during the chronic postoperative period in pediatric patients with MMD.

Acute COVID-19 in unvaccinated children without a history of previous infection during the delta and omicron periods

ABSTRACT Background The Omicron variant has been the predominant severe acute respiratory syndrome coronavirus 2 variant circulating in Korea since January 2022. This study evaluated and compared the clinical characteristics of children with coronavirus disease 2019 (COVID-19) between the Delta and Omicron periods. Methods The medical records of children aged < 12 years diagnosed with acute COVID-19 (<2 weeks of symptom onset) at seven university-affiliated hospitals were retrospectively reviewed. Children with a previous history of COVID-19 or vaccination were excluded. The clinical characteristics of the included children during the Delta (1 August 2021 to 15 January 2022) and Omicron (16 January to 30 June 2022) periods were compared. Results Among the 515 children included in the study, 36 (7.0%) and 479 (93.0%) were diagnosed with COVID-19 during the Delta and Omicron periods, respectively. A total of 142 (27.6%) were hospitalized, and the hospitalization rate was higher during the Delta period than the Omicron period (91.7% vs. 22.8%, p < 0.001). The incidence of fever (p = 0.009), vomiting (p = 0.031), and seizures (p = 0.007) was higher during the Omicron period, whereas the incidence of rhinorrhea (p = 0.027) was higher during the Delta period. Clinical severity and outcomes were comparable between the two periods. During the Omicron period, 6.4% of the hospitalized children received oxygen therapy and 1.8% received intensive care. Conclusion The incidence of fever and seizures was higher during the Omicron period in pediatric patients without a history of vaccination or previous COVID-19. However, the clinical severity was similar during both periods.

Comparative efficacy of apneic oxygenation with face mask versus face mask alone pre-oxygenation to Prevent desaturation during endotracheal intubation of elective Pediatric surgical patients at St. Peter hospital, Addis Ababa Ethiopia:A single center prospective cohort study

BackgroundApneic oxygenation using a nasal cannula is used to deliver oxygen continuously during the apneic period of endotracheal intubation to prevent desaturation. Pre-oxygenation using face mask alone technique may be insufficient to provide a safe apnea period in pediatric patients who are at high risk for rapid desaturation compared to added apneic oxygenation. This study compared the efficacy of apneic oxygenation with a face mask (AO) versus a face mask alone (FMA) pre-oxygenation to prevent desaturation during endotracheal intubation in elective pediatric surgical patients. MethodsA prospective cohort study was conducted on two equal groups of elective pediatric patients observed in either use of apneic oxygenation with a face mask (AO) or face mask alone(FMA) pre-oxygenation during endotracheal intubation at the study hospital from early December 2021 to late March 2022. The data were collected using a structured questionnaire. The primary outcome variable was the desaturation SpO2 (<94%) observed during endotracheal intubation. The categorical data were analyzed using a χ2-test. Parametric data were analyzed using an independent t-test or one-way ANOVA as appropriate with a 95% CI and a p-value of < 0.05 was considered statistically significant. The Bonferroni post hoc analysis was employed to test the significance of means between the groups. ResultsThe mean desaturation level was (SpO2 = 95.74 ± 2.99) in apneic oxygenation with face-mask group and (SpO2 = 93.96 ± 3.74) in the face-mask alone group(p = 0.006) with medium effect size (Cohan's d = 0.06). A one-way ANOVA showed a statistically significant difference in the mean (±SD) of desaturation level with the number of attempts at endotracheal intubation within the groups (P = 0.005). The Bonferroni pairwise comparison within groups, showed that the mean (±SD) desaturation level during endotracheal intubation for the participant with >2 attempts is significantly lower than for participants with only 1 attempt (p-value = 0.004). Conclusion and recommendationA continuous administration of apneic oxygenation (5-l/min) by nasal cannula during endotracheal intubation significantly reduced desaturation in pediatrics. We recommend the use of apneic oxygenation (AO) in pediatrics during intubation time.

Factors associated with blood product requirements during the transoperative period in pediatric patients.

The efficiency of blood products (BP) requisition in elective non-cardiac surgeries is inherently complex. Moreover, it is aggravated in the pediatric population. This study aimed to identify the factors associated with using less than the requested BP during the transoperative period in pediatric patients undergoing elective non-cardiac surgery. We conducted a cross-sectional comparative study including 320 patients undergoing elective non-cardiac surgery for whom BPs were requested. Low requirements were considered when less than 50% of the requested amount or no BPs were used, and high requirements when more than the requested amount was used. The Mann-Whitney's U test was applied for comparative analysis, and multiple logistic regression was used to adjust for factors associated with lower requirements. The median age of the patients was 3 years. From 320 patients, 68.1% (n = 218) received less than the requested amount of BP, while only 1.25% (n = 4) received more than the requested amount of BP. Factors associated with transfusion of less than the requested BPs were prolonged clotting time (odds ratio (OR) = 2.66) and anemia (OR = 0.43). Factors associated with lower than requested BP transfusion were prolonged clotting time and anemia.

Comparing serum ferritin levels during COVID-19 infection and recovery period in pediatric patients with transfusion-dependent thalassemia, a single-center study.

Ferritin has been recognized as a predictor of severity among Coronavirus-19 disease (COVID-19) patients. Studies have shown higher levels of ferritin in patients with COVID-19 than in healthy children. Patients with transfusion-dependent thalassemia (TDT) basically have high ferritin level due to iron overload. It is uncertain whether serum ferritin level in these patients is associated with COVID-19 infection. To evaluate ferritin levels in TDT with COVID-19 before, during, and after the course of infection. This retrospective study enrolled all TDT children with COVID-19 infection that were hospitalized in Ulin General Hospital Banjarmasin during the COVID-19 pandemic (March 2020 to June 2022). Data were collected from medical records. There were 14 patients included in this study, 5 patients had mild symptoms and 9 patients were asymptomatic. The mean of hemoglobin level upon admission was 8.1 ± 3 g/dL and serum ferritin level were 5148.5 ± 2651.8 ng/mL. The average serum ferritin level during COVID-19 infection was 2373.2 ng/mL higher than before infection and then decreased by 952.4 ng/mL after infection. We found no association of increasing serum ferritin with patients' symptoms (p = 0.27). The severity of anemia also was not correlated with the presentation of COVID-19 infection (p = 0.902). Serum ferritin levels in TDT children may not reflect disease severity or predict poor outcomes during COVID-19 infection. However, the presence of other co-morbid conditions/confounders warrants cautious interpretation.

Cardiac Autonomic Functions During Asymptomatic Period in Pediatric Patients with Vasovagal Syncope

Cardiac Autonomic Functions During Asymptomatic Period in Pediatric Patients with Vasovagal Syncope

Comparison of pre-extubation propofol and midazolam to prevent emergence agitation in children—a prospective randomized study

BackgroundEmergence delirium is one of the most common and troublesome complications seen after inhalational anesthesia, with an estimated 20–80% incidence rate. It can lead to an increase in mortality, morbidity, and hospital stay, which indirectly reflects a major economic burden. The aim of our study is to compare the effect of propofol and two different doses of midazolam to prevent emergence agitation in children given 5 min before extubation. Seventy-five ASA (American Society of Anesthesiologists) Physical Status I–II patients aged 2–14 years who were scheduled for elective surgeries under general anesthesia were included in the study. Patients in the study groups were randomized into three groups 25 in each group; group P (propofol of 0.5 mg/kg iv), group ML (midazolam low dose of 0.03 mg/kg iv), and group M (midazolam of 0.05 mg/kg iv) given 5 min before extubation. The primary objective was to study the effect of propofol and two different doses of midazolam for the prevention of emergence agitation in children. The secondary objective was to observe the complications like bronchospasm, laryngospasm, persistent cough, and desaturation in pediatric patients.ResultsThe time taken for emergence from anesthesia after surgery in the propofol group was 5.11 ± 1.223 min and in the group midazolam low dose and midazolam time taken was 8.53 ± 2.326 min and 12.45 ± 2.145 min, respectively, and was found to be statistically significant. The incidence of delirium observed with a Cole score of >3 was seen in 14 (56%) patients in group P, 7 (28%), and 6 (24%) patients of groups ML and M, respectively.ConclusionsMidazolam in low doses given before extubation is effective in preventing the emergence delirium during the postoperative period in pediatric patients without delay in recovery during general anesthesia.

Evaluation of MRD-status in post-induction period in pediatric patients with acute lymphoblastic leukemia.

The need to study the significance of minimal residual disease (MRD) at the induction therapy in patients with acute lymphoblastic leukemia (ALL) is beyond doubt. This has been confirmed by many years of work by many research groups. The role of MRD in the late stages of treatment and the impact of these values on patients survival requires research and discussion. To evaluate the influence of MRD-status in post-induction period on survival in patients with acute lymphoblastic leukemia. From 2010 to 2022, 135 patients with primary B-ALL enrolled in ALL-IC BFM 2009 protocol. Median age was 5.4 year (range 1-17). Male was 62 (49,5%) and female 73 (54,1%). The diagnosis was based on WHO 2016 criteria. Stratification on prognostic risk groups was carried out according to protocol criteria. Prednisone response evaluated at day 8 of treatment. The 15th, 33th, and 78th (as post-induction) day response was assessed by bone marrow cytology and level of MRD by flow cytometry. 5y-overall survival (OS) for patients with MRD-negative status on day 15 was 94,4±5,4% and 87,0±3,4% for MRD-positive (p=0,5). On day 33 patients with MRD-negative status achieved 5y-OS in 86,7±5,8% and 89,6±3,5% for MRD-positive (p=0,6).5y-OS for patients with MRD-negative status on day 78 was 90.8±4.0%, MRD-positive - 90,4+6.5%. DFS for MRD-negative status was 88.5±4.5%, for MRD-positive - 66.3±11.8% (p=0,1). EFS for MRD-negative patients was 87.2±4,6% and for MRD-positive 66.3±11.8% (p=0,09). We have found a tendency between MRD status on day 78 and the frequency of relapses in patients. At the moment, there are no reliable data on the effect of post-induction MRD status on survival. The assessment of MRD in the post-induction period has prognostic prospects and requires further study.

Usefulness of ultrasonography for small intestinal evaluations in pediatric Crohn's disease.

Small bowel capsule endoscopy (SBCE) for Crohn's disease is useful; however, its use has some limitations, such as invasiveness when endoscopic assistance is required in patients who cannot swallow the capsule, and the burden of interpretation on a physician. In contrast, intestinal ultrasonography (IUS) is a non-invasive modality for children. The purpose of this study is to evaluate the accuracy of IUS for pediatric patients with established Crohn's disease. Small bowel capsule endoscopy and IUS findings from the same period in pediatric patients with established Crohn's disease were analyzed retrospectively. First, we compared the Lewis score (LS), small bowel endoscopic activity, and IUS findings by small bowel wall thickness (SBWT) and mesenteric lymph node size (MLNS). Second, we compared the performance of IUS findings with those of some biomarkers. In 22 procedures, SBWT and MLNS were correlated with LS (r = 0.52, P < 0.05, and r = 0.45, P < 0.05, respectively). Small bowel wall thickness, erythrocyte sedimentation rate, and fecal calprotectin levels had the highest accuracy (81.8%, 81.8%, and 81.8%, respectively). The combination of SBWT and MLNS had the highest positive predictive value and negative predictive value (100% and 83.3%, respectively). Intestinal ultrasonography findings, including SBWT and MLNS, are useful for monitoring small bowel lesions in pediatric patients with established Crohn's disease. We suggest first evaluating small bowel inflammation by IUS in pediatric patients with Crohn's disease before SBCE because IUS is less invasive than SBCE.

Efficacy of a Virtual Reality Program in Pediatric Surgery to Reduce Anxiety and Distress Symptoms in the Preoperative Phase: A Prospective Randomized Clinical Trial.

Background: Virtual reality (VR) experience is the most adopted form of video-gaming to reduce preoperative anxiety. This prospective randomized clinical trial aimed to examine the feasibility and efficacy of preoperative VR experience in children undergoing elective surgery. Materials and Methods: All patients older than 13 years and scheduled for elective surgery between March and June 2021 were enrolled. Preoperative VR experience consisted in watching a 5-minute video using a head-mounted display. Four parameters were evaluated and compared between the two groups: (1) patient heart rate (HR) before anesthesia; (2) patient evaluation of preoperative anxiety using facial affective scale (FAS); (3) anesthesiologist evaluation of preoperative anxiety using FAS; and (4) subjective stress scoring using a 5-item Likert-type scale. Results: A total of 40 patients (23 boys) with a median age of 14.5 years (range 12-17) participated in the study. The patients were randomized in two groups, each of 20 patients, according to preoperative VR experience: VR group (G1) and control group (G2). No adverse events related to VR occurred. The patient median HR was significantly lower in G1 (72 bpm) than in G2 (101 bpm) (P = .001). The very relaxed/relaxed face selection rate using FAS was significantly higher in G1 than in G2, in both patient and anesthesiologist evaluations (P = .001). Finally, the subjective patient scoring of operating room experience was significantly greater in G1 [4.6 ± 0.4] than in G2 [2.15 ± 1.07] (P = .001). Conclusions: Our preliminary results showed that VR is safe and effective to relieve anxiety and improve relaxation in the preoperative period in pediatric patients undergoing elective surgery. The VR experience resulted in decreased overall anxiety and increased overall positive affect during the preoperative period in VR group compared with the control group. Further studies are needed to investigate this technology in the postoperative phase and on a larger patient cohort.

Evaluation of the prevalence and seasonality of human parainfluenza virus over five year period in pediatric patients

Objective: Human Parainfluenza viruses (HPIVs) cause respiratory tract infections, and the second most common cause of acute respiratory illness-related hospitalizations after the respiratory syncytial virus in children &lt;5 years of age. The aim of the study; determination of HPIVs positivity and common types in pediatric patients with respiratory tract infection; investigation the distribution of HPIV positivity by age groups, months and seasons, respectively.&#x0D; Material and Method: HPIV results of 1613 pediatric patients who were sent to the molecular virology laboratory from various pediatric clinics of Gazi Hospital between March 2016 and February 2021 (five years period) were investigated. Nucleic acid isolation was performed on the EZ1 Advanced (Qiagen, Germany) device using the EZ1 Virus Mini Kit by the manufacturer's protocol.&#x0D; Results: HPIV positivity was detected as 4.1% in clinical samples and, the most common HPIV type was found to be HPIV-3 (55%). The distribution of other HPIV types were; HPIV-2, HPIV-4 and HPIV-1 with 26%, 23% and 14%, respectively. HPIV-3 is the most common type in 2016, 2017, 2018 and 2019; however, HPIV-1 is the most common type in 2020. HPIVs co-infection was detected with other respiratory tract viruses in 51% of samples. The highest HPIV co-infection was detected in Rhinovirus. The highest HPIV positivity rate (45%) were determined in the 0-2 age group compared to other age groups (p&lt;0.05). The highest positivity rate was in October in the autumn season (p&lt;0.05), the lowest was in January and February in winter. The highest rate (8.1%) of HPIV positivity was found in 2016 and the lowest rate (0.7%) was in 2020.&#x0D; Conclusions: Since it is not possible to diagnose viral etiology of respiratory tract infections based on clinical findings, viral respiratory tract panel and Multiplex real-time PCR test are a fast and useful method in early diagnosis, treatment decision and prevention of unnecessary antibiotic use. HPIVs positivity is seen at higher rates in children aged 0-2 and in autumn months with seasonal differences.

Purposeful Hourly Rounding to Decrease Peripheral Intravenous Infiltrations and Extravasations in Pediatrics

PurposePediatric patients are at high risk for peripheral intravenous infiltrations and extravasations (PIVIE) resulting in patient harm. Structured hourly rounding has demonstrated to improve quality outcomes. The purpose of this quality improvement project was to implement structured hourly rounding to decrease the median rate of moderate PIVIE rates from 3.13 to 2.58 per thousand patient days over a 6-month time period in pediatric patients with infusing continuous IV fluids. Design and methodsA pilot was conducted to hardwire hourly assessments for peripheral intravenous lines (PIV) in pediatric patients with continuous fluids utilizing a structured hourly rounding process. Bedside nurses utilized the P.A.T.H. model to assess pain management (P), assess PIVs for early PIVIE recognition (A), address things patient and family may need (T), and reduce the occurrence in hospital acquired conditions (H). Data was collected on unit nurse sensitive indicators and compliance to hourly rounding. ResultsStructured hourly rounding using the P.A.T.H. model successfully hardwired hourly PIV assessments. The unit reduced their median moderate PIVIE rate to 1.83 per thousand patient days, an 41% improvement. The pilot also had positive unintended consequences of improved pain reassessment from 67% to 100%, increased patient satisfaction scores of 67% to 97% and reduced patient falls by 29%. ConclusionsStructured hourly rounding using the P.A.T.H. model can positively hardwire hourly PIV assessments in pediatric patients. Practice implicationsSustainability of hourly rounding requires leadership support and nursing commitment to impact quality metrics. Organizations should consider implementing focused hourly rounding to address PIVIEs.

Pediatrik Hastalarda Postoperatif Dönemde Ağrı ve Deliryumu Ayırt Etmede FLACC ve OPS Ölçeklerinin Karşılaştırılması

Objective: Postoperative pain and pediatric emergence delirium (ED) are early-postoperative negative behaviours. However it is very difficult to diferentiate each other. The aim of the present study is to compare the utility of “Face, legs, Activity, Cry, Consolability” (FLACC) and Objective Pain Scale (OPS) in differentiating the pain and ED in the early postoperative period. Materials and Methods: This prospective study was conducted at a university hospital. Sixty one (61) children were included in this study. General anesthesia was provided for all children. The incidence of ED was evaluated with PAED scale, the incidence of pain was evaluated with both FLACC and OPS scales in the early postoperative period. Results: Only the number of children with delirium were 29 (47.5%), with pain were 10 (16.4%) and with both delirium and pain were 25 (40.9%). For FLACC, the area under the curve (AUC = 0.914, p = 0.02) at the 5th minute and the area under the curve value (AUC = 0.865, p &amp;lt; 0.001) at the 15th minute was high. Conclusions: The utility of FLACC is better than OPS in differentiating pain and emergence delirium in the postoperative period in pediatric patients.

MON-625 Utility of Continuous Glucose Monitoring in Children with Type 1 Diabetes: Is HbA1c Enough?

Introduction: Type 1 diabetes is an autoimmune condition resulting in insulin deficiency that requires daily insulin therapy and self-monitoring of blood glucose. Continuous glucose monitoring (CGM) systems allow for measurement of interstitial fluid glucose levels in a continuous fashion to identify variations and trends that are not feasible with conventional self-monitoring. Hemoglobin A1C (HbA1C) is the method used to assess adequate glycemic control and relates to future risk of developing complications. Current evidence has shown improvement in HbA1C with concomitant use of CGM in adults over 25 years of age with Type 1 diabetes, whereas studies in children and adolescents have failed to show this. However, it is important to note the limitations in HbA1C use as it is a marker of average blood glucose over 3 months but does not reflect glycemic variability. More recent data has suggested that factors such as time in range (TIR), which can be determined with CGM use, are also associated with decrease risk of diabetes complications. Methods: The goal of our study was to analyze the change in HbA1C levels after using a CGM (DEXCOM G4, G5, G6) over a 6-month period in pediatric patients with Type I diabetes. Two HBA1c levels 3 months apart from 92 patients were collected before using a CGM and two while using a CGM. Results were compared by using a dependent samples t-test. IBM SPSS 25.0 was used for data analysis. Results: Preliminary analysis indicates the average change in HBA1C among the patients (N=92) before (-0.08 ± 1.16) and while using the CGM (0.12 ± 1.00) was not significantly different (t (79) = -1.27, p = 0.21). The average change in HBA1C was also not significantly different (p>0.05) among the patients before and while using the CGM for gender (males and females), age groups (0-7 years, 8-14 years, and 15-24 years), and generations of DEXCOM used (G4, G5, and G6). Conclusion: As has been shown in other studies, we did not find a significant change in HbA1c after CGM use for 6 months in our patients. While HbA1C is a reflection of blood sugars over a 3-month period, it does not provide information about glycemic excursions. Metrics derived from CGM use, such as TIR, can provide actionable information which we did not address in our study. There have been reports of the association between TIR and long-term complications of diabetes. Most data comes from studies in adults and pediatric data is lacking. We propose that future studies must look into CGM metrics such as TIR to better define glycemic control in pediatric patients with diabetes mellitus.

Retention period in pediatric patients with vertical dislocation of the dentition

Relevance. An open bite in children and adolescents makes up about 2-3% of all dentoalveolar disorders and is one of the most difficult pathological bites to treat. Aesthetic changes in children with vertical dislocation of the dentition are complicated by impaired functions of chewing, breathing and speech formation. The treatment of this pathology is complicated by an extensive list of etiological factors affecting the development of this pathology of the dentition. In most cases, after a successful hardware correction of an open bite, the pathology appears again after the completion of the active phase of orthodontic treatment.Purpose. To analyze the retention period in children and adolescents with vertical disocclusion of the dentition. Materials and methods. In order to analyze the retention period in children and adolescents with vertical disocclusion of the dentition, 17 children aged 5 to 15 years were taken for orthodontic treatment. Six of them showed vertical disocclusion (mild, 1 degree) of the dentition. 7 children and adolescents had vertical disocclusion of moderate severity. 4 patients aged 13-15 years had an open bite of a severe form. All patients underwent orthodontic treatment using removable and non-removable orthodontic appliances.Results. During the retention period in all patients of different groups specially made for this purpose were used demountable and non- removable devices , such as the Hawley device, medical devices in the inactivated state, non- removable wire retainers, single- jawed retention Kappa, retainers of their own design. ign. Examination of patients 6 and 12 months after the beginning of the retention period showed stability of the achieved therapeutic result in patients aged 5-12 years , and in patients of the older age group, the retention period was extended to 18-24 months due to the need to adapt bone structures.Conclusions. The analysis of the retention period of pediatric patients with vertical disocclusion of the dentition revealed a number of significant temporal differences. The average retention period in patients with open bite from the age of 5-12 years was 8-12 months. Its duration in patients aged 13-15 years was 15-24 months.

Goal-Oriented Monitoring of Cyclosporine Is Effective for Graft-versus-Host Disease Prevention after Hematopoietic Stem Cell Transplantation in Sickle Cell Disease and Thalassemia Major.

Graft-versus-host disease (GVHD) is an important challenge and a major cause of morbidity and mortality in children after hematopoietic stem cell transplant (HSCT). Herein we report our institution's experience of goal-oriented Bayesian monitoring for cyclosporine (CsA) used alone as GVHD prophylaxis during the post-transplant period in pediatric patients with thalassemia major (TM) or sickle cell anemia (SCA) undergoing HLA-matched HSCT. We also studied evolution of chimerism. Twenty-six consecutive patients (SCA, 14; TM, 12) underwent matched sibling donor (MSD) HSCT from 2004 to 2014. All patients received a myeloablative conditioning regimen. GVHD prophylaxis consisted of 20 mg/kg antithymocyte globulin in the conditioning regimens and then CsA alone in the post-transplant period. Target CsA trough blood concentration (TBC) was 150 ± 20 ng/mL. At last follow-up, all patients were alive and free of disease, even in cases of mixed chimerism. Engraftment occurred in all patients. No patient developed grades II to IV acute GVHD, 4 patients developed acute grade I skin GVHD, and only 1 presented with chronic pulmonary GVHD. A better control of GVHD and immunosuppression by a strict monitoring of CsA TBC as described herein is promising and could play a crucial role. Further investigations are required, but this study opens new perspectives to improve survival and safety of HSCT from alternative donors in TM and SCA to levels compatible with that obtained with MSDs.

Preoperative Blindfold Training Prevents Pediatric Psychological Behavior Disorders During the Anesthesia Recovery Period: A Randomized Controlled Trial

To identify the effectiveness and feasibility of blindfold training on preventing pediatric psychological behavior disorders during the anesthesia recovery period. This study investigated the effect of blindfold training through the assessment of anxiety, delirium, and pain in children during the anesthesia recovery period. This study was a prospective, randomized, controlled trial. Pediatric patients were randomized into either a control (routine practice) or blindfold training group (routine practice+blindfold training). Anxiety, delirium, and pain levels of children were assessed by the modified Yale Preoperative Anxiety Scale, Pediatric Anesthesia Emergence Delirium scale, and the Face, Legs, Activity, Cry, Consolability scale. The blindfold training group had significantly lower scores for emergence delirium, anxiety, and pain during the anesthesia recovery period and a lower incidence of anesthesia complications (all P's<.05). Preoperative blindfold training was able to reduce anxiety, pain, and the incidence of delirium during the anesthesia recovery period in pediatric patients.

Increased QT and P-wave dispersion during attack-free period in pediatric patients with migraine attacks.

Migraine is a common neurovascular disease characterised with recurrent attacks by pain-free periods. It has been suggested that both sympathetic and parasympathetic dysfunctions play a role in its pathophysiology. The aim of our study was to investigate the ECG changes during attack-free period in children with migraine, in terms of QTc interval, QTc, and P-wave dispersion to evaluate the autonomic nervous system disturbance. Sixty children who were diagnosed with migraine were included as patient group and 50 healthy, age- and body mass index-matched children who were examined for innocent murmur were included as control group. The patients' routine ECG records were screened from the outpatient clinic files. The durations of P-wave, QT, and QTc intervals and dispersion values and heart rates (beats/minute) were compared between the patient and control groups. P maximum and P dispersion were significantly higher, and P minimum was significantly lower in the migraine group compared with the control group. QT-QTc maximum and QT-QTc dispersion were significantly higher and QT-QTc minimum was significantly lower in the migraine group compared with the control group. According to our findings, although migraine patients were asymptomatic and no arrhythmia was detected in the surface ECG, sympathovagal balance in the sympathetic system, which may be disrupted in favour of the sympathetic system, should continue even in the attack-free period, and we should be careful in terms of serious arrhythmias that may develop in these patients.