Pediatric Problems Research Articles

State of the Art Bowel Management for Pediatric Colorectal Problems: Spinal Anomalies.

Patients with spinal abnormalities often struggle with fecal and/or urinary incontinence (up to 87 and 92%, respectively) and require a collaborative approach to bowel management in conjunction. To define existing approaches and propose state-of-the-art bowel management, a literature search was performed using Medline/PubMed, Google Scholar, Cochrane, and EMBASE databases and focusing on the manuscripts published July 2013 and July 2023. Patients with spinal anomalies have impaired innervation of the rectum and anal canal, decreasing the success rate from laxatives and rectal enemas. Thus, transanal irrigations and antegrade flushes are widely utilized in this group of patients. Based on spinal MRI, the potential for bowel control in these children depends on age, type, and lesion level. On referral for bowel management, a contrast study is performed to assess colonic motility and evacuation of stool, followed by a series of abdominal X-rays to define colonic emptying and adjust the regimen. The options for management include laxatives, rectal enemas, transanal irrigations, antegrade flushes, and the creation of a stoma. Approximately 22-71% of patients achieve social continence dependent on the type and level of the lesion. Patients with spinal anomalies require a thorough assessment for continence potential and stool burden prior to initiation of bowel management. The optimal treatment option is defined according to the patient's age, anatomy, and mobility. The likelihood of independent bowel regimen administration should be discussed with the patients and their caregivers.

Integrated care in cardiac intensive care unit for noncardiovascular complications in children after open-heart surgery: A comprehensive review

Abstract Congenital heart defects (CHDs), the most common major birth defects, undergo effective surgical care in the last decade, enhancing survival. After heart surgery, mechanical, infectious, and noninfectious causes induce pediatric pulmonary problems. Necrotizing enterocolitis and feeding intolerance are frequent digestive issues. Diuretics relieve fluid excess, but early dialysis may help in cardiac intensive care unit (CICU) patients. Cumulative insulin dosages improve postoperative hyperglycemia. Noncardiac organ system problems are common in current pediatric cardiac intensive care units including seizures needing anti-epileptics. While, managing the patients in CICU, one must consider noncardiac organ system integrity and function.

Draft genome sequence of Staphylococcus aureus sequence type 5 SA01 isolated from bloodstream infection and comparative analysis with reference strains.

A Staphylococcus aureus isolate (SA01) obtained from bloodstream infection exhibited a remarkable drug resistance profile. In this study, we report the draft genome sequence of S. aureus ST 5 SA01, a multidrug-resistant isolate, and analyzed the genes associated with drug resistance and virulence. The genome sketch of S. aureus ST5 SA01 was sequenced with Illumina and annotated using the Prokka software. Rapid Annotation Subsystem Technology (RAST) was used to verify the gene functions in the genome subsystems. The Comprehensive Antibiotic Resistance Database (CARD) and Virulence Factor Database (VFDB) were used in the analysis. The RAST indicated a contribution of 25 proteins to host adenine, fibronectin-binding protein A (FnbA), and biofilm formation as an intercellular polysaccharide adhesive system (PIA). The MLST indicated that S. aureus ST 5 SA01 belongs to ST5 (CC5). In silico analyses also showed an extensive repertoire of genes associated with toxins, such as LukGH leukocidin, enterotoxins, and superantigen staphylococcal classes (SSL). The 11 genes for antimicrobial resistance in S. aureus ST 5 SA01 showed similarity and identity above ≥ 99% with nucleotide sequences deposited in GenBank. Although studies on ST5 clones in Brazil are scarce, monitoring the clone of S. aureus ST 5 SA01 is essential, as it has become a problem in pediatrics in several countries.

Resolution of the ХХIV Congress of Pediatricians of Russia with International Participation “Actual Problems of Pediatrics”

XXIV Конгресс педиатров России, в котором приняли участие около 10 тыс. участников (из них свыше 3 тыс. очных делегатов) из различных регионов Российской Федерации, среди которых — педиатры, детские специалисты, организаторы детского здравоохранения, а также ученые, преподаватели высшей школы, студенты, ординаторы и аспиранты, обсудил актуальные проблемы охраны здоровья детей и принял следующую резолюцию.

The problems in pediatric oncology. Cancer alterness: A review

One of the main problems in pediatrics and pediatric oncology is early diagnosis of malignancies in children. It makes a provision for high surveillance more than 90% and ability to restrict an anti-cancer treatment, which define a high quality of life with low incidence of acute reactions and complications of anti-cancer therapy especially delayed. At the same time, even today up to 75% of patients are check into a specialized hospital with advanced disease stages and large tumor mass. The main reason of it is the absence of cancer alterness in first patients contact doctors: pediatricians, highly specialized non-oncological doctors. Identification of high tumor risk children, knowledge of symptoms for differential diagnosis with oncological disorders, abidance by principium of cancer alterness, optimal patients logistics and teamwork of all doctors involved in patients with cancer are the recipe for successful treatment.

Post-COVID syndrome in children and adolescents of a large industrial city

Background. About 30 to 80% of children who have had a new coronavirus infection, suffer from post-COVID syndrome, the manifestations of which are diverse and persist for 12 weeks or more. Post-COVID syndrome remains an urgent problem in pediatrics, the clinical variants of which are diverse. There is no statistically significant relationship between the severity of coronavirus infection and the development of post-COVID syndrome. According to current data, the risk group for post-COVID syndrome includes children under 1 year of age, children with comorbid pathology.
 Aim. To evaluate the frequency of development, clinical variants and course of post-COVID syndrome in children and teenager of a large industrial city in order to optimize recommendations for their rehabilitation after a new coronavirus infection.
 Materials and methods. The were analyzed developmental histories of 6252 children and adolescents in Kemerovo (form 112/y) who had a new coronavirus infection.
 Results. Data on post-COVID syndrome were recorded in the developmental histories of 3066 (49.04%) children and adolescents, analyzed by medical documents. At the age of 13–15 years, the incidence of post-COVID syndrome is 55%, which is statistically significantly higher than in other age groups (p=0.005–0.0001). The following clinical variants of post-COVID syndrome were identified: asthenic, respiratory, cardiac, recurrent ears, nose, and throat, functional gastrointestinal disorders and mixed, the frequency of which varies depending on age and gender. Children with comorbid pathology (iron deficiency anemia and grade I–II pharyngeal tonsil hypertrophy) are statistically significantly more likely to suffer from post-COVID syndrome (p=0.000000001; 0.00000009; 0.00000009) than children without a history of comorbid pathology.
 Conclusion. Post-COVID syndrome occurs in half of children and adolescents who have had a new coronavirus infection. The frequency of post-COVID syndrome variants in children and adolescents differs. The presence comorbid pathology (iron deficiency anemia, pharyngeal tonsil hyperplasia of the 2 degree) increases the risk of developing post-COVID syndrome. It is necessary to examine patients in a timely manner for the purpose of differential diagnosis and drawing up an individual rehabilitation plan. Special attention should be paid to children with comorbid pathology.

Functional constipation in preschool and school age children: ways to solve the problem

Functional constipation is a significant medical problem in pediatrics. Constipation often causes discomfort in children of any age and, in the absence of timely and effective treatment, can lead to chronic intoxication and the development of various complications, ultimately affecting the patient's quality of life. The article presents the definition of functional constipation in children over 4 years of age in accordance with the Rome IV Criteria (2016), etiology, pathophysiological mechanisms, clinic, diagnostic criteria and differential diagnosis of functional and organic constipation in preschool and school age children, possible complications. In accordance with the draft Consensus of the Society of Pediatric Gastroenterologists (2013), for a more objective assessment of the nature of the stool, the Bristol scale of stool forms is given. The physiology of the colon and the role of motor disorders in the occurrence of functional constipation are described. The physiology of the colon and the role of motor disorders in the occurrence of functional constipation are described. In accordance with the recommendations of the National School of Gastroenterology, the National Institute of Health and Clinical Excellence (NICE) in the UK, ESPGHAN and NASPGHAN, the basic principles of constipation therapy in preschool and school age children are given. The main groups of drugs that are used in the treatment of constipation in children of this age are described: stimulating and osmotic laxatives, prokinetics. Numerous foreign studies and clinical recommendations indicate that stimulants are effective and safe for the treatment of functional constipation, including in children's practice and are most in demand. The analysis of the use of one of the main drugs of the group of stimulating laxatives - sodium picosulfate in numerous international and Russian clinical studies is presented. The effectiveness and favorable safety profile of sodium picosulfate, the possibility of individual dose selection in connection with the liquid form of release are shown. A clinical example of the treatment of functional constipation in a 6-year-old child is given.

Resolution of the ХХIV congress of pediatricians of Russia with international participation “Actual problems of pediatrics”

XXIV Конгресс педиатров России, в котором приняли участие около 10 тыс. участников (из них свыше 3 тыс. очных делегатов) из различных регионов Российской Федерации, среди которых — педиатры, детские специалисты, организаторы детского здравоохранения, а также ученые, преподаватели высшей школы, студенты, ординаторы и аспиранты, обсудил актуальные проблемы охраны здоровья детей и принял резолюцию.

Pediatric chest pain and synopsis is a current problem of pediatrics

Introduction. Cardialgia is a common reason for seeking medical care in the practice of the pediatrician and pediatric cardiologist. The combination of cardialgia and syncope in children can pose a health risk, leading to possible injuries, and is a factor of fear and anxiety in these families. Insufficient information on the pathophysiological basis of the development of cardialgia and syncope in children and the absebce of clear criteria for their prognosis and prevention were the reasons for a detailed study of the literature related to this issue.The aim of the work was to systematize the current literary data on the causes of cardialgia and syncope in children and to determine directions for further study of the problem to improve monitoring by pediatricians and pediatric cardiologists.Materials and methods. We searched for scientific articles using the keywords pediatric chest pain and syncope in the Pubmed, UpToDate 2022, Customer Service, and RSCI databases. Sixty publications were selected for analysis.Results and discussion. Cardialgia is pain in the heart region, which in combination with fainting can be a symptom of a large number of diseases, which determines the different approach of medical specialists involved in the treatment of diseases of the cardiovascular system, and requires a special diagnosis. Cardialgia is characterized by polymorphism of both complaints and subjective sensations, and objective data. All this is caused by a variety of etiopathogenesis of this symptom.Conclusion. Cardialgia is a current problem in pediatric practice. This literature review summarizes the information accumulated over several years on the diagnosis of cardialgia and syncope in children and determines the trajectory of further study of the problem.

Comparative efficacy of polyethylene glycol 3350 monotherapy against polyethylene glycol 3350 plus sodium picosulfate combined therapy in treating fecal impaction in pediatric functional constipation patients

Background: Functional constipation (FC) is a common pediatric problem worldwide. The management of FC comprises of a short initial disimpaction phase followed by long-term maintenance phase. Currently, polyethylene glycol (PEG) is considered as standard disimpaction therapy in pediatric FC patients. The aim of our study was to compare the efficacy of polyethylene glycol 3350 monotherapy with polyethylene glycol 3350 and sodium picosulfate combined therapy in treating fecal impaction in pediatric FC patients. Methods: All children (aged >1 year) diagnosed with FC as per ROME IV criteria and presenting to the out-patient department of pediatric gastroenterology, hepatology and nutrition unit of a tertiary health centre in north Indian Himalayan state were randomized into two open label, prospective, parallel groups, namely group A (receiving PEG 3350 monotherapy) and group B (receiving combined PEG 3350 plus sodium picosulfate therapy), over a period of 13 months. The outcome was evaluated as successful disimpaction with onset of loose/watery stools (Type-7 of Bristol stool chart scale). The success rates and mean time to disimpaction for two groups were computed and compared. Results: Eighty-one patients were randomized into two groups. The mean time to disimpaction was found to be significantly lower (p<0.001) for group B (2.37±1.16 days) when compared to group A (4.00±1.43 days). There was successful resolution of impaction in both groups. No adverse events were reported in either group. Conclusions: Combined PEG 3350 and sodium picosulfate therapy significantly reduces the disimpaction time when compared with PEG 3350 monotherapy in pediatric population, however both the therapies appear similar in achieving successful disimpaction.

Electric bicycles (e-bikes) are an increasingly common pediatric public health problem

PurposeElectric bicycles (e-bikes) achieve higher speeds than pedal bicycles, but few studies have investigated the impact on injury rates specific to the pediatric population. Utilizing the National Electronic Injury Surveillance System (NEISS), we compared rates of pediatric injury for e-bikes, bicycles, and gas-engine bicycles (mopeds) from 2011 to 2020. MethodsDescriptive and bivariate inferential analyses were performed upon NEISS estimates of e-bike, bicycle, and moped injuries in children aged 2–18 years. Analyses were stratified by patient age and helmet usage. The Mann-Kendall test of trends was used. ResultsWe identified 3945 e-bike, 23,389 moped, and 2.05 million bicycle injuries. Over time, the incidence of injury increased for e-bikes (Kendall's τ=0.73, p = 0.004), decreased for pedal bicycles (Kendall's τ= − 0.91, p = 0.0003), and did not change for mopeds (Kendall's τ = 0.06, p = 0.85). Males accounted for 82.5 % of e-bike injuries. The age group most commonly affected by e-bike injury (44.3 %) was 10–13 years old. The proportion of injuries requiring hospitalization was significantly higher for e-bikes (11.5 %), compared to moped and bicycle (7.0 and 4.8 %, respectively, p < 0.0001). In cases where helmet use or absence was reported, 97.3 % of e-bike riders were without a helmet at the time of injury, compared to 82.1 % of pedal bicycle riders and 87.2 % of moped riders. ConclusionsThe rate of pediatric e-bike injuries increased over the study period. Compared to riders on pedal bicycles or mopeds, children on e-bikes had infrequent helmet use and increased rate of hospitalization. These findings suggest that attention to e-bike safety and increasing helmet usage are important to public health among the pediatric population. Level of evidenceIV.

State of the Art Bowel Management for Pediatric Colorectal Problems: Functional Constipation.

Functional constipation (FC) affects up to 32% of the pediatric population, and some of these patients are referred to pediatric surgery units to manage their constipation and/or fecal incontinence. The aim of the current paper is to report the recent updates on the evaluation and management of children with FC as a part of a manuscript series on bowel management in patients with anorectal malformations, Hirschsprung disease, spinal anomalies, and FC. A literature search was performed using Medline/PubMed, Google Scholar, Cochrane, and EMBASE databases and focusing on the manuscripts published within the last 5-10 years. The first step of management of children with FC is to exclude Hirschsprung disease with a contrast study, examination under anesthesia, anorectal manometry (AMAN). If AMAN shows absent rectoanal inhibitory reflex, a rectal biopsy is performed. Internal sphincter achalasia or high resting pressures indicate botulinum toxin injection. Medical management options include laxatives, rectal enemas, transanal irrigations, and antegrade flushes. Those who fail conservative treatment require further assessment of colonic motility and can be candidates for colonic resection. The type of resection (subtotal colonic resection vs. Deloyer's procedure) can be guided with a balloon expulsion test. Most of the patients with FC referred for surgical evaluation can be managed conservatively. Further studies are required to determine an optimal strategy of surgical resection in children unresponsive to medical treatment.

Mental health emergency admissions in the paediatric emergency department.

To evaluate the demographic characteristics, diagnoses and length of stay of mental health emergency attendance to the paediatric emergency department (ED), to determine the burdens these patients brought to the paediatric ED and to the national economy by examining hospital costs. This retrospective observational study was conducted in a tertiary hospital's paediatric ED in Turkey. Data were obtained from the electronic medical record system from January 2018 to January 2020. A total of 142 admissions were included of whom 60% were female. The mean age was 15.2 ± 1.8 years, 50% of cases were suicide attempts and 19% were alcohol intoxications. The majority (85.9%) of patients were discharged from the emergency observation unit. Among the diagnostic groups, the mean age was higher in patients with a history of substance abuse. There was a female predominance among patients who were admitted due to suicide attempts. Among the diagnostic groups, the duration of hospital stay and cost of hospitalization were higher in patients who were followed up with a diagnosis of suicide attempt. Mental health problems are frequent in the paediatric ED. We determined that the most common cause of attendance in paediatric emergencies was suicide attempts, and the length of hospital stay and hospital cost were higher in this diagnostic group. Although further research is necessary to determine national trends in paediatric mental health problems in the paediatric ED, screening strategies and early detection and interventions in primary healthcare may allow more effective care for childhood mental health problems.

Anastomotic Ulcers: Current Understanding of the Pathogenesis and Management.

Anastomotic ulceration following intestinal resection is an under- recognized problem in pediatrics. We discuss the relevant literature regarding this condition. Anastomotic Ulceration following intestinal resection is a potentially life threatening cause of refractory anemia. Evaluation should include correction of micronutrient deficiencies and endoscopic evaluation by upper and lower endoscopy and small intestinal endoscopy if necessary. Initial treatment by medical therapy may consist of anti-inflammatory agents as well as antibiotics to treat small intestinal bacterial overgrowth. Surgical resection should be considered if refractory to treatment. Anastomotic ulcers in pediatric patients with small bowel resection should be considered as a cause of refractory iron deficiency anemia. Endoscopic evaluation should be undertaken to look for evidence of anastomotic ulcers. Surgical resection should be considered if medical therapy fails.

Beyond Polysomnography: Clinical Assessment of Pediatric Sleep Health and Sleep Problems.

This chapter reviews the Peds B-SATED model of pediatric sleep health and common pediatric sleep problems. Aspects of pediatric sleep health and sleep problems are considered across development, from infants through adolescents. Finally, information about clinical screening in both primary and specialty care is discussed, and subjective sleep questionnaires are reviewed.

Endoscopic Management of Pediatric Foreign Body Ingestions and Food Bolus Impactions: A Retrospective Study from a Tertiary Care Center

Abstract Background Foreign body (FB) ingestion is a common pediatric problem with the majority of these occurring in children younger than 3 years. Management varies depending on the age of the patient, ingested object(s), its location along the digestive tract, and the available expertise. We aim to report our experience with endoscopic management of FB ingestions in children (&lt;18 years). Materials and Methods We retrospectively reviewed and analyzed endoscopic and medical records from our hospital database of all pediatric patients (&lt;18 years) who presented with FB ingestion between January 2011 and December 2021. Results Our analysis included a total of 368 patients. FB ingestions and/or food bolus impactions were noted in 242 and 11 children, respectively while 115 (31.25%) had spontaneously passed off FB from the digestive tract. Most common FB was coin (28.5%) followed by animal bones (26.2%). Endoscopic management of FBs and food bolus impaction was successful in 247 children (97.63%), while endoscopic FB retrieval failed in 6 children including 1 with fish bone and 5 with button batteries. A total of 9 out of 11 children with food bolus impaction had underlying esophageal pathology, the commonest being corrosive stricture (n = 7). No mortality related to endoscopic intervention was reported. Conclusions Endoscopic retrieval of ingested FBs and food bolus impaction in children is a safe and effective approach when performed by experienced endoscopists and is associated with a high success rate and a lower incidence of complications with reduced hospital stay.

0806 Treatment of sleep disordered breathing improves quality of life in children with Down syndrome

Abstract Introduction Children with Down syndrome (DS) are at increased risk of obstructive sleep disordered breathing (SDB), which is associated with sleep disruption affecting daytime functioning. We examined the effects of treatment of SDB on sleep and daytime functioning in children with DS. Methods Children with DS and SDB (n=34) completed a baseline and follow-up study which included 7 days of actigraphy in conjunction with a parental sleep diary. Parents also completed a number of questionnaires assessing sleep, behaviour, daytime functioning and quality of life (QOL). All children had overnight polysomnography (PSG) at baseline and 24 had PSG at follow-up. Results 15 children (44%) were treated. At baseline the treated group had more severe SDB at baseline compared to the untreated group: obstructive apnoea hypopnoea index (OAHI) 29.3 ± 38.2 events/h vs 3.3 ± 5.2 events/h (p&amp;lt; 0.01). Actigraphy showed no significant differences in total sleep time or sleep efficiency from baseline to follow up in either the treated or untreated group. Wake after sleep onset increased at follow-up in the untreated group (p&amp;lt; 0.01). The sleep disturbance (p&amp;lt; 0.01) and total problems (p&amp;lt; 0.05) scales on the OSA-18 and the SDB subscale on the Pediatric Sleep Problem Survey Instrument (p&amp;lt; 0.01) improved in the treated children. No changes were seen in any of the measures in the untreated children. Conclusion Treatment of SDB improves QOL, despite treatment having no demonstrable impacts on actigraphic sleep measures. In contrast despite having less severe SDB children who were untreated had no improvements in QOL and increased sleep disruption. Support (if any) Jerome Lejeune Foundation

Interleukin-17 In Juvenile Idiopathic Arthritis

Joint diseases of childhood are an actual problem of pediatrics. Juvenile idiopathic arthritis (JIA) is a common chronic systemic inflammatory joint disease in children, the etiological factors of which remain not fully known. The disease can affect children of any age, it is characterized by a long progressive course, leading to the development of contractures and functional insufficiency, and thus the disability of children

BACTERIOPHAGE – ALTERNATIVE TO ANTIBIOTICS?

The emergence of antimicrobial resistance and increase in side effects of antibiotic therapy is actual problem in pediatrics. Bacteriophages are one of the most promising alternatives to antibiotics for clinical use. The aim of the work was to define the therapy effect of phages administered per os in children with diarrheal diseases. An open observation controlled clinical trial was performed. 52 children aged from 3 to 15 years with diarrheal diseases of bacterial etiology were monitored, as outpatients. According to our clinical trial results (preliminary results) Bacteriophage therapy with SEPTAPHAGE improves clinical course of diarrhea in outpatients aged from 3 to 15 years. Thus, Bacteriophage therapy seems to be effective and safe antimicrobial therapy.

State of the Art Bowel Management for Pediatric Colorectal Problems: Anorectal Malformations.

Up to 79% of patients with anorectal malformations (ARMs) experience constipation and/or soiling after a primary posterior sagittal anoplasty (PSARP) and are referred to a bowel management program. We aim to report the recent updates in evaluating and managing these patients as part of the manuscript series on the current bowel management protocols for patients with colorectal diseases (ARMs, Hirschsprung disease, functional constipation, and spinal anomalies). The unique anatomic features of ARM patients, such as maldeveloped sphincter complex, impaired anal sensation, and associated spine and sacrum anomalies, indicate their bowel management plan. The evaluation includes an examination under anesthesia and a contrast study to exclude anatomic causes of poor bowel function. The potential for bowel control is discussed with the families based on the ARM index calculated from the quality of the spine and sacrum. The bowel management options include laxatives, rectal enemas, transanal irrigations, and antegrade continence enemas. In ARM patients, stool softeners should be avoided as they can worsen soiling.