Pediatric Specialists Research Articles

Evidence-based practice among doctors in specialty training in a pediatric hospital in Peru

The purpose of this study is to determine the use of evidence-based practice among doctors in specialty training at Instituto Nacional del Niño-San Borja in Lima, Peru. (INSN-San Borja). A total of 200 doctors in paediatric specialty training were included in this cross-sectional study. The Health Sciences Evidence-Based Practice (HS-EBP) questionnaire was performed to assess the use of evidence-based clinical practices. The questionnaire has five dimensions: “Beliefs and attitudes” (D1), “Results from scientific research” (D2), “Development of professional practice” (D3), “Assessment of results” (D4), and “Barriers and facilitators” (D5). Each of the five HS-EBP questionnaire dimensions had a median score of 107, 107, 79, 88, and 77, respectively. The ranges of possible scores in each dimension were as follows: from 12 to 120 in D1, D4, and D5; from 14 to 140 in D2; and from 10 to 100 in D3. This study shows that doctors in specialty training at the INSN-San Borja obtained median scores over the mean of possible scores in each of those dimensions, with a lower score in D5 (Barriers and facilitators). This shows that these doctors use evidence-based practice, however they consider there are barriers for its application. According to our observations, the main barrier is the lack of available time due to other clinical commitments.

Principles of Child Health Care Financing.

The American Academy of Pediatrics believes that the United States can and should ensure that all children, adolescents, and young adults from birth through the age of 26 years who reside within its borders have affordable access to high-quality comprehensive health care. Comprehensive, high-quality care addresses issues, challenges, and opportunities unique to children and young adults and addresses the effects of historic and present inequities. All families should have equitable access to professionals and facilities with expertise in the care of children within a reasonable distance of their residence. Payment methodologies should be structured to guarantee the economic viability of the pediatric medical home and of pediatric specialty and subspecialty practices. The recent increase in child uninsurance over the last several years is a threat to the well-being of children and families in the short- and long-term. Deficiencies in plans currently covering insured children pose similar threats. The AAP believes that the United States must not sacrifice recent hard-won gains for our children and that child health care financing should be based on the following guiding principles: (1) coverage with quality, affordable health insurance should be universal; (2) comprehensive pediatric services should be covered; (3) cost sharing should be affordable and should not negatively affect care; (4) payment should be adequate to strengthen family- and patient-centered medical homes; (5) child health financing policy should promote equity and address longstanding health and health care disparities; and (6) the unique characteristics and needs of children should be reflected.

Assessment the impact of operator experience on cyclic fatigue resistance in reciprocating and rotary NiTi files: a comparative study between dental students and pediatric dentistry specialists

Introduction: Devices reducing clinical practice time, and which get minimally affected by user experience are invaluable in pediatric dentistry. Additionally, knowing the fracture resistance of different nickel-titanium (NiTi) files for root canal preparation of primary teeth is important for treatment success. Thus, the present study aimed to compare the instrumentation time (IT) and fracture resistance of reciprocating T-endo MUST (TEM) and continuously rotating AF Baby File (ABF) NiTi files according to the use of pediatric dentistry specialists.Methods: According to their clinical experience level, 3 experimental groups (EG)s were formed namely: no experience, 2-years (less-experienced), and 10-years experienced pediatric dentistry specialists' groups. The fourth group was the control group (CG). In each EGs, 10 TEM (25/.06) and 10 ABF 20/.04, and 10 ABF 25/.04 NiTi file systems were used in 20 artificial resin teeth. Instrumentation time was recorded for each tooth. In the CG, the same number of files were not used for instrumentation. The files in all groups were subjected to a dynamic cyclic fatigue test, and the data were analyzed using the Kruskal–Wallis test at 5% significance level.Results: In all groups, TEM files showed a significant higher fatigue resistance as compared to ABF files. However, fatigue resistances were significantly lower in (EG)s both in TEM and ABF compared to (CG)s. The instrumentation time was found to be significantly lower in TEM compared to the ABF. Also, for both file systems, the experience level did not affect the fatigue resistance, and instrumentation time.Discussion: The experience level of the pediatric dentist did not affect the cyclic fatigue resistance of the reciprocating and rotating NiTi files, but the instrumentation time was lower for the reciprocating NiTi files.

Nutritional Management in Children and Adolescents with Severe Neurological Impairment-Who Cares? A Web-Based Survey Among Pediatric Specialists in Germany.

Nutritional management of children and adolescents with severe neurological impairment (SNI) is challenging. A web-based survey was distributed to identify the present situation and the knowledge of the involved medical professionals in Germany. The survey was created with LimeSurvey, and access data were distributed by several medical societies. Eighty-three questions covered four topics: "general information," "gastro- and jejunostomy procedure," "handling of gastrostomies and feeding tubes," and "nutritional management and follow-up of children and adolescents with SNI." A descriptive analysis was performed with Microsoft Excel. A total of 156 participated (65 completed and 91 partially), 27% being pediatric gastroenterologists, 23% pediatric neurologists, and 10% pediatric surgeons. The most common indications for gastrostomy and tube feeding were oropharyngeal dysfunction and failure to thrive. Many patients were still underweight after some months of enteral feeding. The procedure of gastrostomy and handling recommendations varied broadly. Frequently, standard operating procedures (SOPs) and written local guidelines did not exist, and there was a considerable request for training. Only 53% of participants were aware of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition position paper published in 2017, even fewer (38%) followed the guidelines. The recommended measures to assess a nutritional status were often not respected. Nutritional management of children and adolescents with SNI in Germany is still strongly deficient. Despite the international guideline of 2017, few colleagues are aware of and adhere to the recommendations. This could be improved by interdisciplinary teaching and evaluation of the reasons for noncompliance. The procedure of gastrostomy and the patients' follow-up vary widely. Therefore, modified SOPs should be developed.

Referral Patterns to Pediatric Rheumatology From Primary Care Physicians and General Pediatrics at a Single Pediatric Rheumatology Center in Saudi Arabia.

Objective This study aims to investigate referral patterns to pediatric rheumatology and assess the correctness of referrals from primary care physicians and pediatric specialties. Methodology A cross-sectional, retrospective study was conducted on all patients who were referred to the PediatricRheumatology Department since 2015 (N= 282) at King Abdullah Specialized Children's Hospital (KASCH), PediatricRheumatology Clinic. Age, gender, reason for referral, clinical features, referring department, and final diagnosis were taken as variables. Data were collected through the documents and records of the cases (referrals) in the electronic medical records system of the hospital (BestCare).Then Excel was used for data entry, and JMP statistical software, version 14.0.0 (SAS Institute Inc., Cary, NC, USA) was used for data analysis. Results In a totalof 282 patients across the PediatricRheumatology Clinic, KASCH, the most common reason for referral to the clinic was joint pain (112, 43%)and the least common reason was rash (6, 2.3%). The most common diagnosis was juvenile idiopathic arthritis (JIA) (24, 26.6%).The majority of patients referred to the rheumatology department did not have a rheumatological disease (169, 65%). The majority of the referrals were from pediatrics subspecialties (168, 65%). The least referred department was primary care (21, 8%). Conclusions To our knowledge, this is the first study showing the referral pattern, accuracy, and profile of a pediatric rheumatology clinic population in Saudi Arabia. Expectedly, the most common reason for referral was arthralgia. The most common diagnosis was JIA. According to the results, most of the referrals were inaccurate as they did not end up with a rheumatological diagnosis. Pediatricsubspecialties should be more aware of the nature of rheumatological disease to avoid over-referrals. Finding a pattern of referrals to pediatricrheumatology is an excellent modality to accomplish early diagnosis and the best possible prognosis.

Outcomes following implementation of a pediatric cardio-oncology program

BackgroundWith improved survival following childhood cancer, cardiovascular disease has emerged as a significant source of long-term morbidity and mortality. Oncology patients require comprehensive cardiac screening and monitoring throughout their treatment and beyond. The complexity of these patients has led to increasing numbers of pediatric cardio-oncology specialty clinics. ObjectivesTo describe the characteristics and 1-year outcomes following cardio-oncology clinic implementation at a large pediatric quaternary care institution. MethodsPatients with history of chest radiation, high-dose anthracycline, or decreased left ventricular function were referred and reviewed. Initiation of oral heart failure therapy or advanced cardiac therapies within 1 year following referral were identified, and risk factors for these were evaluated. ResultsNinety-seven patients aged 5 days to 21 yrs. old were referred from 2017 to 2021. Average age at cancer diagnosis was 8.1 ± 5.5 years, with 48 % receiving high-dose anthracycline and 36 % chest radiation. Left ventricular dysfunction was present in 28 % at presentation. Oral heart failure therapy was initiated in 31 %, and none required advanced cardiac therapies. Patients who required oral heart failure therapy were more likely to be older at the age of cancer diagnosis, 10.8 ± 5.1 vs. 7.0 ± 5.3 yrs. (p = 0.001). A higher proportion of patients who received both high-dose anthracycline and chest radiation were on oral heart failure therapy (4/8, 50 %) compared to patients with high-dose anthracycline (18/46, 39 %) or chest radiation (9/35, 26 %) exposure alone, although not statistically significant. ConclusionImplementation of a pediatric cardio-oncology clinic led to increased referrals, appropriate assessment, and initiation of oral heart failure therapy. Patients older at the time of cancer diagnosis were more likely to require treatment. However, it does remain unclear if starting a COC provides long-term benefits for this particularly high-risk patient population.

E65 Assessment of Tunisian rheumatologists’ common practices towards children with rheumatic diseases

Abstract Background In the past few years, many advances have been made in the subspecialty of pediatric rheumatology in emerging countries. However, some gaps were identified requiring an update of rheumatologists' knowledge in this field [1]. Our study aimed to assess rheumatologists’ knowledge and common practices when managing children with rheumatic diseases. Methods We conducted an anonymous cross-sectional study including Tunisian rheumatologists. They were invited to answer an online questionnaire. The survey included demographic data, as well as outcomes of interest: rheumatologists’ knowledge and attitudes towards the management of patients with rheumatic diseases. We also inquired about the scores used to evaluate children with juvenile idiopathic arthritis (JIA). The level of confidence in the management of the pediatric population was assessed by the Likert scale. Results At the end of the survey, 51 responses were collected. The participants were rheumatology specialists (63%), university hospital assistants (21%), and residents (16%). Sixty-two percent of responders worked in the hospital. The mean number of years of practice (including years of residency) was 16.3 ± 5.9 [2–36]. Two rheumatologists reported that they managed over 10 children per month for rheumatic disorders. Four rheumatologists reported that they managed from 6 to 9 children per month for rheumatic disorders. Forty rheumatologists reported that they managed from 1 to 5 children per month for rheumatic disorders. And 5 rheumatologists reported that they do not manage any children with rheumatic disorders. Only 10 (20%) doctors received training in pediatric rheumatology during their curriculum: online training (6), national training program (2) and international training program (2). Regarding the scores used to assess the different subtypes of JIA, 23 (45%) rheumatologists were not aware of the JADAS 10 score and 39 (76%) did not know the JSPADAS score. When inquiring about the level of confidence in the management of the pediatric population the average level of confidence was 2.49 ± 1.82 [0–5]. Only 2% were not confident at all. A pediatric specialist was requested for a second opinion upon diagnosis in 51% of difficult cases and in 12% of less challenging cases. Only 19 respondents managed the patients by themselves without referring them to other specialists. The rheumatologists' apprehension regarding the management of the pediatric population was attributed to the lack of training in pediatric rheumatology (94%), the absence of pediatric internship during the specialization curriculum (43%) and the lack of mastery of children’s examination (12%). Conclusion Our study highlighted that only a few Tunisian rheumatologists considered themselves confident in the management of children with rheumatic disorders. The establishment of training programs in pediatric rheumatology could enhance rheumatologists' knowledge in this field and give them more confidence in the management of this population. [1] Zisman D, Samad A, Ardoin SP, et al. US Adult Rheumatologists' Perspectives on the Transition Process for Young Adults with Rheumatic Conditions. Arthritis Care Res (Hoboken). 2020; 72(3):432–40. This was an anonymous cross-sectional study. All subjects participated voluntary.

Advances in pulmonary management and weaning from ECLS

ECMO for neonatal and pediatric respiratory failure provides gas exchange to allow lung recovery from reversible pulmonary ailments. This is a comprehensive discussion on the various strategies and advances utilized by pediatric ECLS specialists today. ECMO patients require continual monitoring, serial gasses and radiographs, near-infrared spectroscopy (NIRS - to monitor oxygen delivery to regional tissue beds), and more quality ECLS directed care. As the foundation to lung recovery, good EMCO closely monitors ECLS flow rates, sweep gasses, and membrane lung function. Mixed venous oxygen saturation (Sv02) greater than 65% indicates good oxygen delivery and sweep gas adjustments maintain PaCO2 of 40–45 mm Hg. Lung recovery ventilatory settings do not fully rest the lungs but maintain normal or nontoxic pressure and oxygen levels. Neonatal recovery settings are PIP (cm H20) of 15–20, PEEP of 5–10, ventilator rate of 12–20 and an inspiratory time of 0.5–1 s, and FiO2 of 0.3–0.5. Pediatric recovery settings are PIP (cm H20) < 25, PEEP of 5–15, ventilator rate of 10–20 and an inspiratory time of 0.8–1 s, and FiO2 of <0.5. Some studies demonstrate a higher recovery PEEP level decreases duration of ECMO, but do not demonstrate a mortality difference. Multiple adjunctive therapies such as surfactant, routine pulmonary clearance and respiratory physiotherapy, iNO, prone positioning, bronchoscopy, POCUS, CT imaging, and extubation or “awake ECLS” can significantly affect pulmonary recovery. Patience is necessary as lung recovery may take weeks or even months on the nontoxic settings. On these settings, dynamic recovery will be revealed by improvement in tidal volume, minute ventilation and radiographic pulmonary aeration, prompting discussion about weaning. When this pulmonary compliance recovery becomes evident, decreasing ECLS flow while also decreasing circuit FiO2 and/or sweep gas are common components to ECMO weaning strategies.

Usefulness of Mobile Devices in Learning Process for Residents of Pediatric Surgical Specialties

IntroductionIn the hospital setting, the use of mobile devices among surgical residents is increasing. To assess the usefulness of mobile devices for residents of pediatric surgical specialties. Materials and methodsThe study used a mixed-method design. First, a self-developed online questionnaire with 23 items was used to obtain quantitative data, which was analyzed via simple discriminant analysis. Qualitative data were obtained using the focus group technique with the subsequent triangulation of quantitative and qualitative data. ResultsThe residents used mobile devices for learning and communication. Using quantitative data, the study found that the major functions of mobile devices were communicating with other residents and taking clinical photos, and that for learning, were speaking with attendings, residents, collecting patient information, and searching for unfamiliar terms. Triangulation analysis confirmed that mobile devices aid in agile communication, the search for data on drugs or diseases, and consultation of medical applications. Qualitative data informed the limitations of devices and the inconsistencies between official regulations and their advantages in clinical practice. ConclusionsWe demonstrate the usefulness of mobile devices among surgical residents in clinical care and recommend that hospitals should regulate policies to maximize the use of mobile devices.

Artificial Insemination Pregnancy Program as a Type of Service and Level of Efficiency of Health Services

The purpose of this study is to look at the artificial insemination pregnancy program service as one of the services at Mutiara Bunda Mother and Child Hospital. In this context, it will also look at the perspective of its management efficiency. The pregnancy program with this method involves the age of female and male patients, endometrial thickness (EMT), post-washing total motile sperm count (PTMC), artificial insemination time, insemination frequency, and ovarian stimulation protocol which are compared between the pregnant group and the non-pregnant group to see any correlation. Then, hospital efficiency reflects the ratio of the value of health services provided, both quantity and quality of care to the resources used in health services. This study was conducted at Mutiara Bunda Mother and Child Hospital Padang. The results of the study state that procedurally and institutionally, the pregnancy program service with artificial insemination at RSIA Mutiara Bunda Padang is very good. Specialist doctors and other paramedics are well qualified to implement this service program. The Director of the Mother and Child Hospital includes effective leadership because the performance of staff or officers at the Mother and Child Hospital has worked well, with the motivation provided by the leadership. The hospital has adequate specialist doctors, both in terms of number and type of specialization in accordance with hospital specifications, namely Obgyn and Pediatric specialists. The artificial Insemination Pregnancy Program as a type of service is the first in Padang

Access to Pediatric Neurology training and services worldwide: A survey by the International Child Neurology Association.

Pediatric neurology is the medical subspecialty responsible for diagnosing and managing diseases and disorders of the nervous system in childhood and adolescence. In many, but not all, regions of the world the discipline of pediatric neurology is recognized as a specialty or subspecialty of either Neurology or Pediatrics. Significant knowledge and competencies in this area are necessary to be effective in clinical practice. The need for this is driven by the high burden of disease from neurological conditions in children and the impact on their families.As the first part of a multi-staged project under the auspices of the International Child Neurology Association, in collaboration with key stakeholders, a survey was undertaken to establish which countries have practicing child neurologists. For those countries that have child neurologists, the survey established the number of practitioners, and which countries have access to in-country child neurology training.Responses were obtained from 177 countries. Worldwide there is a median of 0.07 and mean of 0.39 child neurologists per 100 000 population. The greatest deficits in child neurology specialists and access to training were evident in countries which fell under the world bank rating of low income country status (range of 0 to 0.008 child neurologists per 100 000 population). Seventy-three percent of low income countries lack access to child neurologists: the majority are in the African and South-East Asia Regions. For the population of 1.37 billion in the continent of Africa there were 324 child neurologists, equating to median 0.01 per 100 000 population in comparison to a median of 0.59 child neurologists per 100 000 across high income countries. Ninety-four countries had capacity to support in-country pediatric neurology training.Worldwide there are inadequate numbers of child neurologists and great need for increased training capacity.

Specialist use among privately insured children with disabilities.

To investigate primary care practice ownership and specialist-use patterns for commercially insured children with disabilities. A national commercial claims database and the Health Systems and Provider Database from 2012 to 2016 are the data sources for this study. This cross-sectional, descriptive study examines: (1) the most visited type of pediatric primary care physician and practice (independent or system-owned); (2) pediatric and non-pediatric specialist-use patterns; and (3) how practice ownership relates to specialist-use patterns. This study identifies 133,749 person-years of commercially insured children with disabilities aged 0-18 years with at least 24 months of continuous insurance coverage by linking a national commercial claims data set with the Health Systems and Provider Database and applying the validated Children with Disabilities Algorithm. Three-quarters (75.9%) of children with disabilities received their pediatric primary care in independent practices. Nearly two thirds (59.6%) used at least one specialist with 45.1% using nonpediatric specialists, 28.8% using pediatric ones, and 17.0% using both. Specialist-use patterns varied by both child age and specialist type. Children with disabilities in independent practices were as likely to see a specialist as those in system-owned ones: 57.1% (95% confidence interval [95% CI] 56.7%-57.4%) versus 57.3% (95% CI 56.6%-58.0%), respectively (p = 0.635). The percent using two or more types of specialists was 46.1% (95% CI 45.4%-46.7%) in independent practices, comparable to that in systems 47.1% (95% CI 46.2%-48.0%) (p = 0.054). However, the mean number of specialist visits was significantly lower in independent practices than in systems-4.0 (95% CI 3.9%-4.0%) versus 4.4 (95% CI 4.3%-4.6%) respectively-reaching statistical significance with p < 0.0001. Recognizing how privately insured children with disabilities use pediatric primary care from pediatric and nonpediatric primary care specialists through both independent and system-owned practices is important for improving care quality and value.

The impact of the coronavirus pandemic on the condition of newborns depending on the mother’s COVID status: a retrospective study

Background. A novel coronavirus infection in newborns seems to be an unexplored problem, which encourages pediatric specialists to conduct in-depth research in this direction. The aim of the study is the impact of COVID status of mothers on the condition of newborns. Material and methods. A retrospective analysis of 554 newborn histories (form 097/y) born from January 2021 to May 2022 was carried out in the Maternity Hospital in Krasnodar: 226 children from SARS-CoV-2 positive women at the time of delivery (group 1), 165 children from women who had SARS-CoV-2 during pregnancy (group 2) and 165 children from women who did not have SARS-CoV-2 in history during pregnancy (control group). Results. 42% of newborns from group 1 had positive results of the PCR (polymerase chain reaction) study, of which 36% had pneumonia. The frequency of preterm birth was: 29% in the group 1, 21% in the group 2, 13% in the control group. The gestational age 32–34 weeks was more common in group 1. Children from the group 1 had a more severe condition when assessed on the APGAR scale both at the first and fifth minutes. Congenital pneumonia was more common among patients of the groups 1 and 2 relative to the control, children from the group 1 more often needed respiratory support compared with the group 2 and control group. Conclusions: The SARS-CoV-2 virus was verified in 42% of children born to mothers with a positive PCR at the time of birth, while every third disease was accompanied by the development of pneumonia. Coronavirus infection, regardless of the mother’s COVID status, is a risk factor for preterm birth, congenital pneumonia, and asphyxia. COVID-positive maternal and neonatal status is associated with an increased need for respiratory support.

Endoscopic Retrograde Cholangiopancreatography in Children: Nine Years' Experience at Santa Fe Foundation in Bogota, Colombia.

Experience in the use of diagnostic and/or therapy of endoscopic retrograde cholangiopancreatography (ERCP) in children is limited. This is due to the underdiagnosis of pancreaticobiliary disease in the pediatric population and specialist personnel in this procedure. To determine the safety and success rate of ERCP in children at Hospital Fundación Santa Fe de Bogotá between January 2007 and June 2015. This was an observational, descriptive, retrospective case series study of patients under 18 years, who underwent ERCP between January 2007 and June 2015. The following variables were analyzed: indication, duration, type of procedure, rate of success, and complications. A total of 30 patients were included, in whom 65 ERCP procedures were performed. Successful cannulation was achieved in 52 of the 65 procedures (80%). Among the complications that occurred, there were four cases of pancreatitis (6.2%), two cases of bleeding (3.1%), and one case of bacteremia (1.5%), and in most cases (58 in total, 89.2%), there were no complications. The pediatric gastroenterology group of the Fundación Santa Fe de Bogotá has obtained good results in performing ERCP in the pediatric population with a success rate of 80% associated with a null mortality rate. There is enough literature available to conclude that performing ERCP in the pediatric population maintains an adequate success rate and a low complication rate. In all the studies evaluated, a null mortality rate was found, so it is considered that this procedure is safe in patients under 18 years of age.

Problems of providing medical care to children of Ukraine as a result of russian aggression

Background. The russian aggression in Ukraine has caused numerous casualties among civilians, including children. Military actions lead directly or indirectly to increased morbidity in adults and children and to chronic stress, especially in children. The purpose of this research was to analyze the problems of providing medical assistance to the children of Ukraine who are suffering from the russian invasion. Materials and methods. We have used the official statistical and own data for 2022–2023. Results. Currently, more than 7.5 million Ukrainian children are suffering from the war, not only due to physical injuries but also violations of their mental and psycho-emotional state. A special problem for Ukrainian paediatricians at the beginning of 2023 was an increase in the incidence of acute respiratory diseases, COVID-19 and stress disorders in children due to a shortage of medical personnel and infrastructure. Also, in conditions of limited access to medical care and medicines, it is necessary to pay attention to chronic diseases, in particular, asthma and other allergic diseases. Paediatricians from the departments of the Bogomolets National Medical University provided voluntary assistance to children in frontline regions. Conclusions. In the new conditions of warfare, where civilians and life support infrastructure have become the target of armed attacks, children have become the most vulnerable group. The issues of restoration of full medical care for children, including emergency and urgent care, provision with doctors of certain paediatric specialties, full supply of medicines and medical devices, and restoration of destroyed medical infrastructure remain extremely relevant to the health system in the frontline and liberated areas.

Strategies for airway management in neonates : Results of asurvey of German perinatal centers levelsII andIII

Airway management in children, especially in patients with adifficult airway, remains amajor challenge for anesthesiologists, pediatricians, and emergency medicine physicians. In recent years new tools have been introduced into the clinical practice. The aim was to present the current strategies for securing the airway in neonates in perinatal centers levelsII andIII in Germany, and to collect data on the rare event of coniotomy. From 5April 2021 to 15 June 2021, physicians practicing intensive care in pediatrics and neonatology at perinatal centers levels II and III in Germany were surveyed by means of an anonymized online questionnaire. The questionnaire was designed by the authors and verified by pretesting with the help of five pediatric specialists. Contact was made digitally via the e‑mail addresses provided on the websites of the respective centers. The survey was administered through the fee for service provider LimeSurvey©. The collected data were transferred to the IBM© statistical package for the social scientists (SPSS, version28, IBM© Corporation, Armonk, NY, USA) and statistically analyzed. Pearson's χ2-test was used to perform significance testing (significance level p = < 0.05). Only completed questionnaires were included in the analysis. A total of 219participants completed the questionnaire. Available airway devices: 94.5% (n = 207) nasopharyngeal tubes, 79.9% (n = 175) video laryngoscope/fiber optic, 73.1% (n = 160) laryngeal masks, 64.8% (n = 142) oropharyngeal tube (Guedel). Of the participants 6 (2.7%) performed coniotomy (⌀1.6children). Out of six cases five (83.3%) were resuscitation situations caused by complex anatomical malformations. Training of coniotomy was not provided in 98.6% (n = 216). AStandard Operating Procedure (SOP) for difficult airway in neonates was possessed by 20.1% (n = 44). The comparison with international studies showed that the equipment of German perinatal centers is above average. The trend towards acquisition of avideo laryngoscope and its importance in clinical routine could be confirmed by our data; however, the fact that 20% of the respondents did not have access to video laryngoscopy suggests that further acquisitions will have to be made here in the future. Front of neck access (FONA) methods remain acritically questioned component of neonatal difficult airway algorithms due to their rarity and the resulting lack of data. In summary of the recommendations of the British Association of Perinatal Medicine (BAPM) and the collected data on the theoretical and practical education of the FONA methods in Germany, the implementation of the FONA methods by pediatricians and neonatologists cannot be recommended. As most resuscitation situations were caused by complex anatomical malformations, the early detection of such malformations by means of high-resolution ultrasound seems to be of particular importance. With improvement of early detection, neonates with potentially unmanageable airway problems can be left on uteroplacental circulation for aprolonged period in order to perform necessary interventions, such as tracheostomy, bronchoscopy, or extracorporeal membrane oxygenation (ECMO) device known as the ex utero intrapartum treatment (EXIT) procedure.

VIEWS OF PEDITRICIANS ON SPEECH AND LANGUAGE DEVELOPMENT

Pediatricians that, in addition to treating children’s diseases, deal with early growth and development, have a special responsibility in the early detection and diagnosis of speech and language difficulties. Aim of this research was to examine pediatricians’ and pediatric specialists’ familiarity with speech-language development, developmental-behavioral pediatrics, opinions on acquired knowledge at the specialist study on early growth and development and to examine the importance of multidisciplinary approach and cooperation between pediatricians and speech therapists, educators and rehabilitators and psychologists.The sample was comprised of 14 specialists pediatricians and 1 pediatrics resident, who were employed in primary and secondary health care and private practice, from different cities of the Federation of B&amp;H and Republika Srpska. Results of this research have shown that surveyed pediatricians are working with children with difficulties in speech-language development on a daily basis. Respondents have mostly correctly answered all questions related to speech-language development which indicates that they have solid knowledge in this area. Results have shown that most of the respondents is not satisfied with the knowledge obtained from specialist study on early growth and development and that they are not completely familiar with developmental-behavioral pediatrics, but all of the pediatricians have agreed that this field of sub-specialty should be included as a part of our higher education program. When it comes to a multidisciplinary approach and cooperation with speech therapists, educators-rehabilitators and psychologists, respondents support and practice a multidisciplinary approach in the detection and diagnosis of speech and language difficulties.Keywords:opinions of pediatricians, speech-language development, developmental-behavioral pediatrics.

Climate and Environmental Change: A Generation at Risk.

Climate and environmental changes have been described as the biggest global health threat of the 21st century, with the potential to cause immediate harm in early life with important lifelong effects, and important consequences for future generations. Pregnant women and children are increasingly being recognized as vulnerable populations in the context of climate change. The effects can be direct or indirect through heat stress, extreme weather events, and air pollution, potentially affecting both the immediate and long-term health of pregnant women and newborns through a broad range of mechanisms. Climate and environmental changes have wide-ranging effects on a woman's reproductive life including sexual maturation and fertility, pregnancy outcomes, lactation, breastfeeding, and menopause. A comprehensive overview of these impacts is presented as well as opportunities for interventions for nurses practicing in perinatal, neonatal, midwifery, and pediatric specialties.

Design of a Nursing Intervention Program to Prevent Adolescents' Perioperative Anxiety

Introduction Adolescents undergoing surgery have expressed a willingness to obtain information about their surgery and to be involved in the decisions about their health care process. Around 80% of adolescents experience anxiety before undergoing surgery. On the basis of the adolescents' shared experiences, areas of possible nursing intervention have been identified to prevent anxiety and the multitude of adverse effects associated with it. The purpose of this study is to present a nursing intervention program to prevent perioperative anxiety in adolescents (3P2A) designed based on the first phase of the complex intervention's framework. Methods The design of this program followed the updated guidance for developing complex interventions issued by the Medical Research Council and the National Institute for Health Research. Five Portuguese nurses, experts in perioperative nursing, and pediatric specialists evaluated and validated the final version of this program. Results The nursing intervention program to prevent perioperative anxiety in adolescents (3P2A) consists of three phases that correspond to the preoperative, intraoperative, and postoperative periods. The first phase includes conducting a preoperative nursing consultation to identify stressors, providing written and verbal information about the surgery, and applying nonpharmacological interventions to reduce anxiety. In the intraoperative period, nonpharmacological interventions are implemented in the anesthetic induction room immediately before the adolescent falls asleep. Finally, the postoperative period comprises a nursing visit to identify postoperative complications and promote the adolescents' well-being. Discussion The program is structured with specific interventions to be implemented in each of the perioperative periods. Because of its flexibility, it may be fully or partially implemented considering the identified needs, priorities, and resources when caring for an adolescent with anxiety during the perioperative period.

Young Investigator Interview with CSCI Distinguished Scientist Awardee Dr. Caroline Quach-Thanh.

Dr. Caroline Quach-Thanh is a Professor in the Departments of Microbiology, Infectious Diseases and Immunology and of Pediatrics at University of Montreal. She is in charge of Infection Prevention and Control at CHU Sainte-Justine where she works as a pediatric infectious diseases specialist and medical microbiologist. Dr. Quach is a clinician-scientist and the Canada Research Chair, Tier 1 in Infection Prevention and Control. In 2022, Dr. Quach-Thanh received the Distinguished Scientist Award 2022 from the Canadian Society for Clinical Investigation. In the same year, she received a Women of Distinction Award-for public service-from the Women's Y Foundation. Dr. Quach-Thanh is the former president from the Association for Medical Microbiology and Infectious Diseases Canada (AMMI), a past Chair of the National Advisory Committee on Immunization (NACI) and is the current chair of the Quebec Immunization Committee. She was named Fellow of the Canadian Academy of Health Sciences and of the Society for Healthcare Epidemiology of America. Dr. QuachThanh was selected as one of the 2019 most Powerful Women in Canada. In 2021, she received the Order of Merit from Université de Montréal and was made Officière de l'Ordre national du Québec in 2022.