Problem In Pediatric Patients Research Articles

The effect of continuous positive airway pressure (CPAP) application on airway problems in pediatric patients with subglottic stenosis who undergo balloon dilatation

BackgroundSubglottic stenosis is a significant clinical challenge in pediatric anesthesia, often necessitating interventions that can lead to various postoperative complications. The aim of this study was to determine the effect of prophylactic continuous positive airway pressure (CPAP) application on recovery time and airway complications in pediatric patients with subglottic stenosis undergoing balloon dilatation.MethodsA prospective, double-blinded, parallel-group, randomized controlled study was conducted at Health Sciences University Ümraniye Training and Research Hospital on pediatric patients with subglottic stenosis, aged from 0 to 12 years and who underwent elective balloon dilatation under general anesthesia. Patients were randomized in a 1:1 ratio into the CPAP or non-CPAP group. The primary outcome was the duration of recovery time. Secondary outcomes included bronchospasm, the number of desaturation episodes, intubation, tracheostomy, and the need for intensive care.ResultsA total of 84 patients were enrolled in this randomized controlled trial, 81 of which received the allocated treatment and were analyzed (non-CPAP n = 41, CPAP n = 40). Compared to controls, the proportions of bronchospasm, tracheal secretion, need for intensive care, and tracheostomy were consistently lower in the CPAP group, whereas the requirement of intubation was higher. Further, the mean recovery time was significantly shorter in the CPAP group compared to the non-CPAP group (mean difference − 3.3 min, 95%CI − 5.16 to − 1.44, p = 0.0007). Despite lacking statistical significance, the CPAP group had reduced odds of developing bronchospasm, tracheal secretion, need for intensive care, and tracheostomy, but higher odds of requiring intubation when compared to the controls.ConclusionProphylactic CPAP application following therapeutic balloon dilatation in pediatric patients who have developed subglottic stenosis due to acquired or congenital causes appears to effectively shorten recovery time and may have a role in decreasing postoperative pulmonary complications; however, more research is recommended to further confirm these findings.Trial registrationThe protocol for this clinical trial was retrospectively registered on clinicaltrials.gov with registration ID NCT06183515 on 30 November 2023.

Assessment of drug therapy problems in pediatric patients using Cipolle/Morley/strand classification: A hospital based study

Drug plays an important role in treating diseases and improving health. However, inappropriate drug use can lead to the occurrence of drug-Therapy problems (DTPs). According to Cipolle/Morley/Strand classification DTPs are any undesirable event experienced by the patient that involves or is suspected to involve drug therapy and that actually or potentially interferes with a desired patient outcome. The purpose of this study was to assess the drug therapy problems in a pediatric ward of Srinivas institute of medical science and research centre and to identify associated factors for drug therapy problems. A retrospective observational study was carried out to assess drug therapy problems (DTPs) in paediatric patients using Cipolle/Morley/Strand classification from January to June 2024. Ethical approval was obtained, and informed consent was signed by each study participant's parent before the commencement of the study. All paediatric out patients and patients admitted to the paediatric ward during the study period were included in the study. Data were collected through medical record reviews of patients and using semi structured questionnaire. Data was analysed using Microsoft Excel. The participants mean age was 2.32 years. Among 150 patients, 116 (77.33%) of them had at least one drug therapy problem per patient which indicates that the prevalence of the drug therapy problem was substantially high. On the other hand, Adverse drug reaction was the least 4 (3.38%) drug therapy problem. Hence to ensure optimum care in paediatric patients, a targeted approach is essential. Thus, the present study concluded that pharmacists can be helpful in the identification of the drug therapy problems, their causes and the risk factors involved and thus lead to a better health care outcome.

Pediatric Anterior Cruciate Ligament Tears.

Anterior cruciate ligament (ACL) tears have become an increasingly prevalent problem in pediatric patients due to increased youth sports participation and early sports specialization. A high index of suspicion should be utilized for any young patient with an acute knee injury and an associated effusion or difficulty bearing weight. A thorough work-up should be performed that includes a careful assessment of growth remaining and concomitant injuries. While nonoperative management may be a consideration for select cases, most patients will benefit from early surgical management. ACL deficiency or delayed reconstruction can lead to early chondral degeneration and risk for further injury to the cartilage and menisci. The goal of ACL reconstruction is to create a stable knee and prevent secondary chondral or meniscal injury. Physeal-sparing and physeal-respecting transphyseal techniques have been developed that allow for safe and successful ligament reconstruction while minimizing the risk of growth arrest. Younger patients have a higher risk of reinjury and require a longer recovery period for a full return to sports than their older counterparts. Even though there have been advances in the safe and successful treatment of ACL tears in pediatric patients, it remains a devastating physical and psychological injury, and increased efforts should be made at prevention. Injury prevention programs have been shown to reduce the risk of ACL tears, and it is important to increase awareness and utilization of prevention strategies.

CAT Study: Pediatric Catheter-Associated Thrombosis: A Retrospective Electronic Record Review

Highlights CAT is a significant problem in pediatric patients with CVCs and other risk factors. CAT was found in 4% of the sample with estimated 0.23 events per 1,000 CVC days. Incidence of CAT was lower than anticipated but consistent with published evidence. Median LOS was substantial in the CAT group suggesting increased disease burden. Specific clinical modifiers and CVC factors were more common in the CAT group. Findings provide valuable foundation for future CAT research and risk models. Clinicians and researchers should collaborate to reduce CAT incidence. Abstract Background: Catheter-associated thrombosis (CAT) is a serious condition, especially among pediatric surgical patients. This study describes the CAT incidence rate and clinical, demographic, and central venous catheter (CVC)-specific risk factors that may be associated with CAT, for a cohort of pediatric surgical patients. Methods: An electronic record review of 124 pediatric surgical patients with indwelling CVCs receiving parenteral nutrition (PN) cared for in a single pediatric hospital between 2016 and 2018 was performed. Results: Of the 297 CVCs, 4% of patients (n = 5) developed CAT, resulting in an estimated incidence rate of 0.23 events per 1,000 CVC days (95% confidence interval 0.15–0.31). Patients diagnosed with CAT had a higher burden of anemia, blood product administration, chronic lung disease, congenital heart disease, sepsis, prolonged mechanical ventilation, extracorporeal membrane oxygenation use, increased surgical complexity, and longer hospital stays. They also had a higher frequency of peripherally inserted central catheters, small caliber size CVCs, double lumen CVCs, extended PN and lipid course, lack of ethanol prophylaxis, higher rates of intravenous antibiotics, lower rates of treatment-dose heparin, and prolonged CVC duration. Conclusion: The incidence of CAT in this study was consistent with published rates for hospitalized pediatric patients with CVCs. The study provides additional foundational evidence about clinical, demographic, and CVC-specific risk factors associated with CAT in pediatric surgical patients with CVCs. It can help guide future research and collaborative efforts to develop risk assessment and other preventative strategies to reduce CAT incidence and improve patient care outcomes.

Parents' Perceptions Regarding Their Children's Medications and Expert-Assessed Drug-Related Problems in Pediatric Patients with Inborn Errors of Metabolism.

We aimed to explore parents' perceptions of their children's medication use for inborn errors of metabolism (IEM), including the importance of medication intake, potential complications, and concerns about adverse drug reactions (ADR). Additionally, we aimed to determine expert-assessed clinically relevant drug-related problems, particularly those attributable to IEM. We interviewed 108 parents of 119 pediatric patients with IEM using a questionnaire relating to their perceptions regarding their children's IEM medication. In affected siblings, a questionnaire was used for each child. We performed medication analyses to evaluate the patient's complete medication regimen for clinically relevant drug-related problems, including medication for conditions other than IEM. It was very important to the parents of 85% of the patients to use IEM medication exactly as prescribed. The parents of 41% of patients perceived complications in their children's use of IEM medication. The parents of 47% of patients reported fears concerning ADR because of IEM medication. Parents observed ADR in 27% of patients because of IEM medication. In 44% of patients, medication for conditions other than IEM was inadequate because of drug-related problems not associated with the IEM; a safe alternative existed in 21% of patients. In summary, almost half of the parents of patients with IEM reported complications with their child's IEM medication intake and fears of ADR. Medication analyses showed that drug-related problems occurred regardless of IEM, emphasizing the general need to prescribe and dispense adequate, child-appropriate medication to minimize clinically relevant drug-related problems in pediatric patients.

Clinical Impact of Preoperative Tonsil and Adenoid Size on Symptomatic Outcomes Following Adenotonsillectomy in Pediatric Patients.

Background Adenotonsillar hypertrophy is a common clinical problem in pediatric patients. Adenotonsillectomy is a surgical intervention to remove airway obstruction and alleviate symptoms. However, some children continue to experience persistent symptoms after surgery. Objective This study aimed to investigate the relationship between preoperative tonsils and adenoid size and the persistence of symptoms, including snoring, mouth breathing, noisy breathing, and sleep apnea, after adenotonsillectomy in pediatric patients. Method This study was conducted in Taif, Saudi Arabia, and included 109 pediatric patients aged three to 14 years who underwent adenotonsillectomy. Data on preoperative and postoperative symptoms were collected through patient records and follow-up surveys. Tonsil and adenoid size were assessed using the Brodsky scale and endoscopic grading scales, respectively. Statistical analysis was performed using SPSS Version 26 (IBM Corp., Armonk, NY). Results The most prevalent presenting symptoms were snoring, mouth breathing, and noisy breathing. Tonsil size grades 3+ and 4+ were significantly more prevalent than the other grades (p<0.05). Adenoid size grades 3 and 4 were also significantly more prevalent than the other grades (p<0.05). Significant associations were observed between tonsil and adenoid size grades and specific presenting symptoms, such as snoring, mouth breathing, and noisy breathing. No significant correlations were found between preoperative tonsil or adenoid size and postoperative persistent symptoms. Conclusion While tonsil and adenoid size are essential factors in determining the need for surgery, they may not predict postoperative resolution of symptoms. A comprehensive evaluation of various clinical factors is necessary to understand the persistence of symptoms after surgery. Although adenotonsillectomy is an effective treatment for upper airway obstruction in pediatric patients, some individuals may experience residual symptoms.

Sleep Problems in Pediatric Disorders of Gut-Brain Interaction: A Systematic Review.

Disorders of gut-brain interaction (DGBIs) are common, and findings are mixed on rates of sleep problems (e.g., sleep quality) in pediatric populations. A clear understanding of sleep problems in pediatric DGBIs is needed as sleep challenges might negatively impact symptoms and prognoses. The aims of this systematic review are to (1) describe the prevalence and types of sleep problems in pediatric patients with DGBIs and examine differences by DGBI diagnosis and (2) examine the relationship among sleep problems and pain, mood, and functional outcomes in pediatric patients with DGBIs. We searched PubMed, PsycInfo, CINAHL, and Medline in June 2022; articles were included if they enrolled ≤19 years old with a DGBI, used a quantitative assessment of sleep problems, and were available in English. The Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies was used to assess study quality. We used a protocol to systematically pull and tabulate data across articles with quality assessment ratings. Twenty-four articles with 110,864 participants across 9 countries were included, with most studies being of moderate to weak quality. Patients with DGBIs reported more sleep problems than healthy peers, and some research reviewed found that patients with IBS had more sleep problems than other DGBI diagnoses. Sleep problems in DGBIs were related to worse mood, pain, and functional outcomes. Pediatric patients with DGBIs are experiencing sleep problems that can impact outcomes. Screening for sleep problems and targeted treatment is needed to best support these patients.

Association between Childhood Onset Inflammatory Bowel Disease and Psychiatric Comorbidities in Adulthood.

Inflammatory bowel disease (IBD), which includes Crohn's disease, ulcerative colitis, and unspecified inflammatory bowel disease, is a chronic, unpredictable and immune-mediated condition of the gastrointestinal tract. In pediatric populations, the diagnosis of a chronic and debilitating pathology significantly reduces quality of life. Children diagnosed with IBD may cope with physical symptoms such as abdominal pain or fatigue, but mental and emotional well-being are also important for preventing and reducing the risk of developing psychiatric conditions. Short stature, growth delay and delayed puberty can contribute to poor body image and low self-esteem. Furthermore, treatment per se can alter psycho-social functioning due to the side effects of medication and surgical procedures such as colostomy. It is essential to acknowledge and treat early signs and symptoms of psychiatric distress in order to prevent the development of serious psychiatric disorders in adult life. The literature underlines the importance of incorporating psychological and mental health services as part of the management of inflammatory bowel disease. Diagnosing mental health problems in pediatric patients with IBD can improve their adherence to treatment and pathology course and, consequently, reduce long-term morbidity and mortality.

Characteristics and properties of Serratia marcescens isolated in bacteremia in children

Introduction. Serratia marcescens is an opportunistic gram-negative microorganism, currently has been detected with increasing frequency in various clinical biomaterials from sick persons is the causative agent of nosocomial infections.&#x0D; The aim of the work is to determine microbiological and clinical features of S. marcescens in bloodstream infections in children. &#x0D; Materials and methods. Nineteen isolates of S. marcescens were isolated from blood cultures. Antibiotic sensitivity was determined by broth microdilution method. Carbapenemase gene were determined using real-time polymerase chain reaction. Biofilm formation was studied on abiotic surfaces using polystyreneplates. Population diversity was determined by multilocus genotypic analysis. &#x0D; Results. Carbapenems, fosfomycin and biseptol showed the highest antimicrobial activity in vitro. Resistance to aminoglycosides, aztreonam, cefepime, and ticarcillin/clavulanate was over 50%. According to PCR data, only OXA-48 carbapenemases were found in 11% of isolates, NDM — in 5%, and a combination of carbapenemases — in 15%. Biofilms of moderate intensity were formed in 13 (68%) isolates, and weak biofilms — in 6 (32%). According to the genotypic analysis, a large proportion of isolates with multiple resistance were included in one group. All of them were singled out over one year from one department — perhaps there was a single source. In 3 cases, patients were diagnosed with sepsis, 1 of them had an unfavourable outcome. Bacteremia occurred on the 3rd day after the initial isolation of S. marcescens. An unfavourable outcome occurred on the 10th day of bacteremia. S. marcescens in this case had multiple resistance and a combination of resistance genes, also belonged to genotypic group I, which is often found in our work.&#x0D; Conclusion. S. marcescens in bloodstream infections is a serious problem for pediatric patients. Natural resistance to polymyxins, as well as acquired resistance to carbapenems and aminoglycosides, cause particular alertness and attention to this microbial agent.

Potential Drug-Related Problems in Pediatric Patients—Describing the Use of a Clinical Decision Support System at Pharmacies in Sweden

The clinical support system Electronic Expert Support (EES) is available at all pharmacies in Sweden to examine electronic prescriptions when dispensing to prevent drug-related problems (DRPs). DRPs are common, and result in patient suffering and substantial costs for society. The aim of this research was to study the use of EES for the pediatric population (ages 0-12 years), by describing what types of alerts are generated for potential DRPs, how they are handled, and how the use of EES has changed over time. Data on the number and categories of EES analyses, alerts, and resolved alerts were provided by the Swedish eHealth Agency. The study shows that the use of EES has increased. The most common type of alert for a potential DRP among pediatric patients was regarding high doses in children (30.3% of all alerts generated). The most common type of alert for a potential DRP that was resolved among pediatrics was therapy duplication (4.6% of the alerts were resolved). The most common reason for closing an alert was dialogue with patient for verification of the treatment (66.3% of all closed alerts). Knowledge of which type of alerts are the most common may contribute to increased prescriber awareness of important potential DRPs.

Emergence of Japanese encephalitis in eastern parts of Madhya Pradesh, India.

Emerging zoonotic and vector-borne diseases are posing new challenges to public health authorities. Morbidities and mortalities due to acute encephalitis syndrome (AES) is a serious health problem in paediatric patients. We conducted serological investigations on AES cases from six districts of north eastern Madhya Pradesh (MP), India for Japanese encephalitis (JE). The paired serum and CSF samples were collected from paediatric patients having signs and symptoms of encephalitis and admitted at a tertiary care hospital during the study period from August 2020 to October 2021. Demographic and clinical information was collected in predesigned formats. Serum and CSF were subjected to JE IgM specific ELISA. Samples from 110 patients were collected during the study period of which 28 (25.4%) were reactive for JE IgM antibodies. JE IgM positivity was marginally higher in male children (26.6%) as compared to female children (22.8%). Out of 28 positive cases, 11 (39.2%) deaths were attributed to JE. Four districts of north eastern Madhya Pradesh showed JE activity. Maximum cases were observed in post-monsoon season. Our results show that JEV is an emerging threat in eastern central India and health authorities need to be vigilant. A systematic molecular and serological survey among humans and animals along with xenomonitoring will help in understanding intricacies of JE epidemiology in the region.

Hospital-acquired undernutrition and associated factors in children and adolescents admitted to a tertiary care hospital.

The present study aimed to verify the proportion and factors associated with hospital-acquired malnutrition in the paediatric unit of a tertiary care hospital. A retrospective study was carried out in a tertiary care hospital in the state of Maranhão, Brazil. Demographic and clinical data on children and adolescents were collected from medical records and the data regarding weight, height and z-scores of anthropometric indicators were obtained from the World Health Organization (WHO) Anthro® and WHO Anthro Plus® applications. Those with weight-for-height z-score (< 5 years) and a body mass index (BMI)/age z-score (≥ 5 years) < -2 SD at admission were considered to be malnourished. Patients who presented a decrease of > 0.25 SD between the z-score of BMI-for-age (BMIZ) at admission and at discharge were classified as having hospital-acquired malnutrition. Weight loss was also evaluated and was considered significant when it was > 2% between the weight measured at admission and the one before discharge. Logistic regression analysis was performed to verify the factors associated with hospital-acquired malnutrition. The median age was 4.7 years and the length of stay was 21 days; 26.8% of patients had significant weight loss during hospitalisation and a greater proportion had hospital-acquired malnutrition (34.9%). Gastroenteropathies, neuropathies and malnutrition on admission were significantly associated with hospital-acquired malnutrition. The occurrence of hospital-acquired malnutrition is still a problem in paediatric patients. Thus, providing adequate nutritional support from admission is essential when aiming to avoid deterioration of the nutritional status of paediatric patients during hospitalisation.

Nutritional assessment and associated factors in children with congenital heart disease-Ethiopia.

Worldwide, congenital heart disease is the principal heart disease in children and constitutes one of the major causes of infant mortality, particularly in developing countries. Infants and children with congenital heart disease exhibit a range of delays in weight gain and growth. In some instances, the delay can be relatively mild, whereas in other cases, cause the failure to thrive. To determine the nutritional status and associated factors of pediatric patients with congenital heart disease. A cross sectional analytical study conducted over a period of 6 months (Feb to Jul 2020). A total of 228 subjects with congenital heart disease who visited the cardiac center during the study period where included until the calculated sample size attained. Data is collected from patient's card and their care giver. Data was then analyzed using Statistical Package for Social Sciences (SPSS) for windows version 25.0. Odds Ratio with 95% Confidence Interval (CI) was used to determine the effect of the independent variables on the outcome variable and P-value less than 0.05 was considered statistically significant. A total of 228 children ranging from 3month to 17yrs of age with mean age of 4.7 years (SD = 3.8 years) were included in the study. Most of the subjects had acyanotic heart disease accounting for 87.7%. The overall prevalence of wasting, underweight and stunting were 41.3%, 49.1% and 43% respectively. Children with congenital heart disease and having pulmonary hypertension, were found more likely to develop wasting compared to those without pulmonary hypertension with an odds of 1.9 (95% CI: 1.0-3.4) and also have greater chance of stunting with an odds of 1.9 (95% CI: 1.0-3.4). Children 5 to 10 years of age were 2.3 times more likely to be underweight. Malnutrition is a major problem in pediatric patients with congenital heart disease. Pulmonary hypertension and older age are associated with increased risk of undernutrition.

Management of temporomandibular joint ankylosis in children with their surgical risk and benefits

Aim: To Overview and analyse the various treatment options and risk &amp; benefits used for management of ankylosis in growing children. Summary: A Number of technique have been used for the treatment of temporomandibular Ankylosis. Since it is a known challenging problem in paediatric patients. Main aim of our treatment is excision of ankylotic mass followed by recontouring of the joint.

Nutritional management in children with disease-related malnutrition : what’s the guideline?

Background: Disease-related malnutrition (DRM) is one of the most common problems in pediatric patients. Both cancer and congenital heart diseases (CHD) are commonly associated with DRM. Altered nutrition utilization, reduced intake, malabsorption, and hypermetabolism are the main pathophysiology in DRM.&#x0D; Method: A systematic literature searching was performed through Pubmed and Google Scholar websites. Thirty-six articles were included into the study.&#x0D; Results: Malnutrition screening should be performed as soon as possible since early feeding can benefit the patients. One of the most commonly used tools is Screening Tool for Risk on Nutritional Status and Growth (STRONGkids), which was proven to be valid, reproducible, and applicable in pediatric patients with malnutrition. Following screening and assessment, nutrition support can ensue, preferably in the form of enteral nutrition, unless contraindicated. Nutrient-dense formula, also known as protein and energy-enriched formula, aims to aid infants to reach nutrition target rapidly and stimulate anabolism. This formula has been studied in various population, mostly infants with CHD and studies showed favorable outcomes with its administration, namely faster improvement, reduced diuretics use and oxygen supplementation, decreased length of hospital stay, and less antibiotic use. Nutrient-dense formula is also safe and well-tolerated.&#x0D; Conclusion: Proper screening and management should be performed with multidisciplinary approach to achieve the best outcome in children with DRM.

Kt/V or Bicarbonate: What Is More Important for Growth in Pediatric Peritoneal Dialysis Patients?

Introduction: Growth retardation is a common problem in pediatric patients with chronic kidney disease. It is unknown if the growth of children on peritoneal dialysis (PD) can be augmented by more dialysis. Methods: We studied the effect of various peritoneal adequacy parameters on delta height standard deviation scores (SDSs) and growth velocity z-scores in 53 children (27 males) on PD, who underwent 2 longitudinal adequacy tests at 9-month intervals. None of the patients were on growth hormone. Intraperitoneal pressure and standard KDOQI guidelines were compared to the outcome measures delta height SDS and height velocity z-scores, using univariate and multivariate tests. Results: At the time of the second PD adequacy test, their mean age was 9.2 ± 5.3 years; mean fill volume was 961 ± 254 mL/m²; and median total infused dialysate volume was 5.26 L/m²/day (range 2.03–15.32 L). The median total weekly Kt/V was 3.79 (range 0.9–9.5), and the median total creatinine clearance was 56.6 (range 7.6–133.48) L/week, higher than previous pediatric studies. The delta height SDS was a median of −0.12 (range −2 to +3.95)/year. The mean height velocity z-score was −1.6 ± 4.0. The only relationships discovered were between the delta height SDS and age, bicarbonate, and intraperitoneal pressure, but not for Kt/V or creatinine clearance. Conclusion: Our findings highlight the importance of normalization of bicarbonate concentrations to improve height z-score.

A Challenging Management of Pseudomonas Perforated Corneal Ulcer with Multilayer Amniotic Membrane Transplantation and Pericardial Patch Graft in Pediatric Patient

Introduction: Pseudomonas aeruginosa (P. aeruginosa) is the leading cause of corneal ulcers in children 0 to 3 years of age compared to children in general. Case presentation: A two-months-old infant presented with whitish patches on the right eye two days before admission. A central corneal ulcer with a size of 7-mm x 7-mm accompanied by corneal thinning and melting was shown on the right cornea. It is was surrounded by greyish white creamy infiltrates. Corneal scraping showed Pseudomonas aeruginosa specimens. The cornea became perforate and crystalline lens extrusion was found at the day after intravenous ceftriaxone, levofloxacin eye drop, and cefazoline fortified eye drop administering. It might be caused by bacterial elastase and toxin which contributed to corneal damage. The patient was underwent a multilayer Amniotic Membrane Transplantation (AMT) combined with a pericardial patch graft due to corneal perforation. Two months post-AMT and pericardial patch graft the corneal perforation became entirely heal due to multilayer AMT, despite lysis of the pericardial patch graft. Corneal scar formation and reduction of vitreous opacity in ultrasound examination were shown. The patient was planned to undergo keratoplasty. Conclusions: Corneal ulcers due to Pseudomonas aeruginosa are highly destructive. The levels of infection, diagnostic, and therapeutic are still problems in pediatric patients. Lens extrusion and lysis of the pericardial patch graft are examples in this case. Keratoplasty is the definitive treatment for corneal ulcers with perforation; however, multilayer AMT combined with pericardial patch graft can be used as an alternative therapy to accelerate wound healing, reduce inflammation, and maintain the integrity of the eyeball.

Second-year Outcomes of Implementing Antimicrobial Stewardship Program in a Tertiary Pediatric Hospital

Background: The increasing use of antimicrobial agents and resistance is becoming a serious problem in pediatric patients. Hence, antimicrobial stewardship program (ASP) is implemented to lessen the consequences. Objectives: This report aimed to demonstrate the impact of ASP on antimicrobials utilization in a referral and tertiary pediatric hospital in Isfahan, Iran. Methods: We launched an ASP for inpatients in March 2018 at the Imam Hussain Hospital, which is a 186-bed pediatrics hospital. Data was collected by ASP multidisciplinary team and using hospital records during February 2017-January 2018 (pre-intervention) and February 2019-January 2020 (post-intervention) periods. Consumption data were expressed as defined daily doses (DDDs) per 100 patient-days (PD). Independent sample t-test and paired t-test were used to assess the significance of differences. The rates of antimicrobials resistance for the most common hospital pathogens were also tracked. Results: Utilization of total antimicrobials decreased meaningfully by 12.41% (from 62.11 DDDs/100 PD in February 2017-January 2018 to 54.40 DDDs/100 PD in February 2019-January 2020; P = 0.024). The results showed that the reduction in non-restricted antimicrobials was less (5.43%) than restricted antimicrobials (27.6%). Conclusions: According to our results, the use of antimicrobials, especially the broad-spectrum ones, and the health burden costs significantly decreased after implementing ASP. Thus, continuous monitoring and educational programs are recommended to reduce the negative effects of using antimicrobials.

Anemia in Newly Diagnosed Pediatric Patients with Inflammatory Bowel Disease

Anemia is the most common extraintestinal manifestation and complication of inflammatory bowel disease (IBD). The aim of our study was to assess the prevalence of anemia in newly diagnosed pediatric patients with IBD and to analyze its association with disease type, extent, and severity. We retrospectively reviewed the medical records of all patients with IBD treated in our department in the period of November 2011 to November 2020. The final analysis included the records of 80 children with newly diagnosed IBD: 45 with ulcerative colitis (UC) and 35 with Crohn’s disease (CD). The prevalence of anemia was 60.0% in the UC patients and 77.1% in the CD patients. Of the UC patients with anemia, 37.1% had pancolitis, 18.5% extensive disease, 33.3% left-sided colitis and 11.1% ulcerative proctitis. Of the CD patients with anemia, 81.5% had ileocolonic disease, 11.1% colonic disease and 7.4% ileal disease. Anemia was less common in patients with mild disease than in patients with moderate–severe disease (22.2 vs. 77.8%, p &lt; 0.001 in UC and 25.9% vs. 74.1%, p &lt; 0.001 in CD). Our study confirmed anemia as a frequent problem in pediatric patients with IBD. Children with more extensive and more severe disease are at higher risk to develop anemia.

Parent-Child Assessment of Strengths and Difficulties of German Children and Adolescents Born With Esophageal Atresia.

Introduction/Aim: Children and adolescents with a chronic somatic disease have a higher risk of developing psychological disorders than healthy peers. Therefore, we aim to investigate internalizing and behavioral problems in pediatric patients with esophageal atresia (EA) and compare this sample with German reference values using both childrens' self-reports and parents' proxy reports.Methods: The present cross-sectional study is part of the German-Swedish EA-QOL study developing a condition-specific instrument to assess Health-related Quality of Life in children and adolescents born with EA from both self and proxy perspectives. The current analyses use data from the German sample collected within the field test phase. Participants were enrolled from the Medical School Hannover and “Auf der Bult” Children's Hospital, Hannover. The cooperating clinicians provided the medical records while socio-demographic information was collected through the parent-report within the questionnaires. We used the Strengths and Difficulties Questionnaire (SDQ) to measure internalizing and behavioral problems of children and adolescents born with EA ranging from 2 to 18 years.Results: A total of 51 families participated in the field test phase. Eighty-eight parent reports and 22 child reports were included in the analyses. While the parents' perspective from the SDQ leads to a higher percentage of abnormal or borderline behavior, there is no difference to the reference group from the children's perspective.Conclusion: Incorporating routine psychological assessment into pediatric health care can help improve understanding of the burden of illness, examine treatment outcomes, assess the quality of care, and tailor interventions to meet patient and parent needs. Involving the whole family can help develop appropriate and functional coping strategies. From our point of view, it is necessary to address parental needs and concerns as well in order to provide the best possible holistic development in the family system. The family is the basis for the children's successful development, especially for children with special health care needs.