Tool For Children Research Articles

EFFECTS OF ADAPTED COMPUTER USE ON MATHEMATICS PERFORMANCE OF STUDENTS WITH CEREBRAL PALSY IN JOYTOWN SPECIAL SECONDARY SCHOOL KIAMBU COUNTY, KENYA

The paper reports some of the key findings of a study that explored the effects of adaptive computer use on the mathematics performance of students with cerebral palsy in Joytown Special Secondary School for the Physically Handicapped in Kiambu County, Kenya. In the study, a quasi-experimental design was adopted utilizing a sample size of 32 students with cerebral palsy. Purposive and stratified random sampling techniques were adopted in selecting the sample size. The research study applied Amabile and Kramer’s progress theory and the primary data collection methods were classroom observation checklists, interview guides and pre-test and post-test. The research data was analyzed using SPSS version 22 and primary data analyzed per the study objectives. The findings on the impacts of adapted computer use on mathematics performance of students with cerebral palsy are reported. The study findings demonstrated that adapted computer use increases the academic independence and performance of students. This confirms that the integration of assistive technology in mathematics learning can be a compensatory tool for children with cerebral palsy despite the motor and communication dysfunctions resulting from their disabling condition. On the basis of the study findings, recommendations are provided.<p> </p><p><strong> Article visualizations:</strong></p><p><img src="/-counters-/edu_01/0934/a.php" alt="Hit counter" /></p>

Altered dynamic functional network connectivity within default mode network of epileptic children with generalized tonic-clonic seizures

ObjectiveGeneralized tonic-clonic seizures (GTCS) is a group of epileptic disorders characterized by widespread generalized spike-and-waves discharges along with unresponsiveness and convulsions. Abnormal connectivity in the DMN is the common findings in children with generalized epilepsy. However, the neural mechanisms underlying the altered brain connectivity of DMN in children with GTCS remain unclear. The aim of the current study was to explore the temporal properties of functional connectivity states by dynamic functional connectivity (dFC) within the DMN of GTCS children. MethodsWe collected resting-state functional MRI data from 22 GTCS children and 29 age-matched healthy controls. Sliding window approach and k-mean clustering analysis were applied to analyze the dFC and identify transient states of the DMN. Furthermore, the relationship between the dynamic properties and clinical features was assessed. ResultsThe dFC analyses identified two reoccurring states: a more frequent and weak connected state (State 1) and a less frequent and strong connected state (State 2). Relative to the normal control, GTCS children spent more time in State 1 showing weak connections and spent less time in State 2 showing strong connections. Dynamic functional network connectivity strength within the DMN showed both increase and decrease in patient group. In addition, the changes of dynamic metric were found to be correlated with epilepsy duration. SignificantOur findings imply abnormal interactions and the state dynamics in DMN of the children with GTCS. These disruptions of temporal dynamic in DMN may provide significance for understanding the neural mechanism underlying the GTCS in children and suggest that dFC method can be considered as a valuable tool in children with epilepsy.

Digital use of standardised assessment tools for children and adolescents: can available paper-based questionnaires be used free of charge in electronic format?

QuestionMost adolescents live in low- and middle-income countries (LMIC), and about 10% of them face mental problems. The mental health provision gap in low- and middle-income countries could be addressed by evidence-based practices, however costs are implementational barriers. Digitalization can improve the accessibility of these tools and constitutes a chance for LMIC to use them more easily at a low cost. We reviewed free and brief evidence-based mental health assessment tools available for digital use to assess psychopathology across different domains in youth.MethodsFor the current study, instruments from a recent review on paper-based instruments were re-used. Additionally, a systematic search was conducted to add instruments for the personality disorder domain. We searched and classified the copyright and license terms available from the internet in terms of free usage and deliverability in a digital format. In the case that this information was insufficient, we contacted the authors.ResultsIn total, we evaluated 109 instruments. Of these instruments, 53 were free and digitally usable covering 11 mental health domains. However, retrieving information on copyright and license terms was very difficult.ConclusionsFree and digitally adaptable instruments are available, supporting the strategy of using instruments digitally to increase access. The instrument’s authors support this initiative, however, the lack of copyright information and the difficulties in contacting the authors and licence holders are barriers to using this strategy in LMIC. A comprehensive, online instrument repository for clinical practice would be an appropriate next step to make the instruments more accessible and reduce implementation barriers.

Efektivitas Automatic Bike dalam Meningkatkan Kelenturan Sendi Kaki Pada Anak Cerbral Palsy

This research is motivated by the problems faced by children with cerebral palsy in the lower limbs -in which children need special services in improving leg joint flexibility- as well as the lack of service innovation for children with cerebral palsy. Services in the form of motion development that can stimulate the leg joints, one of which is by providing treatment using an Automatic bike. This tool uses automatic pedaling and is equipped with an adjustable chair. By using this automatic therapy tool, you can see the effect on the flexibility of a child's feet. This study uses the SSR method to see the results of using the Automatic Bike tool. The results of this study can be seen in the graph of the use of tool in children and this tool can affect the child's lower limbs.

Pruebas de coagulación preoperatorias en pacientes pediátricos: relevancia clínica y consecuencias hemorrágicas de los resultados anómalos

PurposeCoagulation screening tests in children are still frequently performed in many countries to evaluate bleeding risk. The aim of this study was to assess the management of unexpected prolongations of the activated partial thromboplastin time (APTT) and prothrombine time (PT) in children prior to elective surgery, and the perioperative hemorrhagic outcomes. MethodsChildren with prolonged APTT and/or PT who attended a preoperative anesthesia consultation from January 2013 to December 2018 were included. Patients were grouped according to whether they were referred to a Hematologist or were scheduled to undergo surgery without further investigation. The primary endpoint was to compare perioperative bleeding complications. Results1835 children were screened for eligibility. 102 presented abnormal results (5.6%). Of them, 45% were referred to a Hematologist. Significant bleeding disorders were associated with a positive bleeding history, odds ratio of 51 (95% CI 4.8 to 538.5, P = 0.0011). No difference in perioperative hemorrhagic outcomes were found between the groups. An additional cost of 181 euros per patient and a preoperative median delay of 43 days was observed in patients referred to Hematology. ConclusionsOur results suggest that hematology referral has limited value in asymptomatic children with a prolonged APTT and/or PT. Hemorrhagic complications were similar among patients referred and not referred to Hematology. A positive personal or family bleeding history can help identify patients with a higher bleeding risk, thus it should guide the need for coagulation testing and hematology referral. Further efforts should be made to standardize preoperative bleeding assessments tools in children.

History Taking as a Diagnostic Tool in Children With Chronic Cough.

Chronic cough is a common symptom of many underlying respiratory and non-respiratory disorders and may be associated with less serious causes, such as gastroesophageal reflux and nasal diseases. Chronic cough in children differs from that in adults with respect to its etiologies and management since it can indicate a symptom of an underlying disease in children. Guidelines for managing chronic cough in children are based on recording the history, followed by physical examination, chest radiography, and spirometry. Thus, taking accurate respiratory history for coughing helps delineate the pathophysiological basis of the cause of chronic cough. Detailed history taking enhances the evaluation and treatment, and facilitates a tailored diagnostic identification of likely diagnoses. While studies have described evidence-based red flags in children with chronic cough, the value of skilled physicians regarding history taking has received less attention for the best patient care. In the present article, we outline the major questions comprising a detailed history taking for chronic cough in children.

Combining adult with pediatric patient data to develop a clinical decision support tool intended for children: leveraging machine learning to model heterogeneity

BackgroundClinical decision support (CDS) tools built using adult data do not typically perform well for children. We explored how best to leverage adult data to improve the performance of such tools. This study assesses whether it is better to build CDS tools for children using data from children alone or to use combined data from both adults and children.MethodsRetrospective cohort using data from 2017 to 2020. Participants include all individuals (adults and children) receiving an elective surgery at a large academic medical center that provides adult and pediatric services. We predicted need for mechanical ventilation or admission to the intensive care unit (ICU). Predictor variables included demographic, clinical, and service utilization factors known prior to surgery. We compared predictive models built using machine learning to regression-based methods that used a pediatric or combined adult-pediatric cohort. We compared model performance based on Area Under the Receiver Operator Characteristic.ResultsWhile we found that adults and children have different risk factors, machine learning methods are able to appropriately model the underlying heterogeneity of each population and produce equally accurate predictive models whether using data only from pediatric patients or combined data from both children and adults. Results from regression-based methods were improved by the use of pediatric-specific data.ConclusionsCDS tools for children can successfully use combined data from adults and children if the model accounts for underlying heterogeneity, as in machine learning models.

Теоретичні основи застосування високотехнологічних засобів реабілітації у дітей з церебральним паралічем

The purpose of the study was to substantiate theoretically the need in high-tech rehabilitation tools for children with cerebral palsy, to identify the shortcomings of their use and to determine the role of the equipment in correcting the pathological stereotype of movement. Materials and methods. Methodological approach was used: analysis of literature sources and resources of the Internet (foreign and domestic on the PubMed and Google Scholar platforms), method of system analysis, method of comparison. Results and discussion. One of the main goals in the process of rehabilitation of children with cerebral palsy is to improve motor control and, thus, increase independence, participation and overall quality of life. In the modern world, the use of new methods of exercise therapy using high-tech robotic devices («Lokomat», «Armeo»), as well as new methods of physiotherapy, in particular, translingual electrical stimulation of the brain (TESB) «Brain-port» is becoming relevant for the treatment of children with cerebral palsy. Features and some restrictions of use of the above-stated devices were defined. Exercises on the Lokomat device help to form a motor "stereotype" of physiological walking, as well as strengthen the muscles of the lower extremities, and with the help of biological feedback to increase the motivation to exercise in children. The therapeutic goals of Armeo are to improve or maintain reach, capture and transmission movements, active range of motion by attaching an exoskeleton to the patient's arm. Translingual neurostimulation plays an important role in modulating neuroplastic changes in the brain, provides electrical stimulation of trigeminal and facial cranial nerves that modulate sensorimotor and vestibular functions. The devices help to improve the static and dynamic function of the body, reduce muscle tone, improve joint mobility in children with cerebral palsy. Their use in the process of physical therapy emphasizes the need for individualization of rehabilitation programs. Conclusion. The analysis of literature sources testifies to the effectiveness of the use of high-tech tools in the process of rehabilitation of children with cerebral palsy in combination with traditional methods. It helps to improve motor and cognitive function in children with cerebral palsy by correcting the mechanism of musculoskeletal control. Robotic techniques allow to change the pathological stereotype of movement. The prospect is to study the psychophysiological parameters of children with cerebral palsy during rehabilitation using modern technologies

Detection and assessment of postoperative pain in children with cognitive impairment: A systematic literature review and meta‐analysis

Background and ObjectiveChildren with cognitive impairment (CI) are at risk of experiencing pain. Several specific pain rating scales have been developed to date. Thus, the aim of this meta‐analysis was to estimate the degree of reliability of different pain assessment scales for the postoperative pain in children with CI.Databases and Data TreatmentPubMed, Scopus and Web of Science databases were approached: all studies validating and/or using pain assessment tool in children (0–20 years) with CI published in English from the 1st of January 2000 to the 1st of January 2022 were included. Only studies reporting the interclass correlation coefficient (ICC) to evaluate the concordance between caregivers’ and external researchers’ scores were eligible.ResultsTwelve studies were included (586 children with CI, 60% males; weighted mean age 9.9 years – range 2–20). Five of them evaluated the Non‐Communicating Children's Pain Checklist‐Postoperative Version (NCCPC‐PV) scale whereas four the original and revised Face, Legs, Activity, Cry, Consolability (FLACC) scale. The analysis showed an overall ICC value of 0.76 (0.74–0.78) for the NCCPC‐PV scale, with a high heterogeneity index (I 2 = 97%) and 0.87 (0.84–0.90) for the FLACC scale, with a discrete I 2 index (59%).ConclusionsThe NCCPC‐PV and FLACC pain rating scales showed the strongest evidence for validity and reliability for assessing postoperative pain in children with CI. However, due to the high heterogeneity of the studies available, these results should not be considered conclusive.SignificanceThis review is focused on the assessment of pain in children with CI in the postoperative period. Simplified observation‐based pain assessment tools that rely on evaluating non‐verbal expressions of pain should be recommended for children with difficulties to communicate their feelings. Even if there is a high degree of heterogeneity in clinical presentations among youth with CI, two tools (NCCPC‐PV and FLACC) have emerged as reliable and valid in this population.

Identifying Language Disorder Within a Migration Context: Development and Performance of a Pre-school Screening Tool for Children With German as a Second Language.

BackgroundThere is a lack of accurate and practicable instruments for identifying language disorders in multilingual children in pre-school settings.ObjectiveTo develop a language screening instrument for pre-school children who are growing up with German as their second language.DesignAfter the development and initial validation of a language screening tool, the new instrument (LOGiK-S) was administered to three cohorts of children (2014, 2015, 2017) with a non-German first language attending a variety of public pre-schools in Upper Austria. The screening instrument measures expressive and receptive grammatical skills in German. The final validation study included the results for 270 children for the screening measure and reference tests. A combination of a standardized comprehensive language test of grammatical skills developed for children acquiring German as a second language and a test of expressive vocabulary with the use of specific cutoffs for second language learners was applied as the gold standard for identifying language disorders.ResultsThe LOGiK-S screening of expressive grammar demonstrated excellent accuracy (AUC.953). The screening subscale of receptive grammar did not improve the prediction of language disorders. Using an optimized cutoff yielded a fail rate of 17%, excellent sensitivity (0.940), and specificity (0.936). Time economy and acceptance of the screening by children and screeners were mostly rated as high.ConclusionThe LOGiK-S language screening instrument assessing expressive German grammar development using bilingual norms is a valid and feasible instrument for the identification of language disorders in second language learners of German at the pre-school age.

Clinical Audit on Well Baby Services at Primary Health Care Corporation, Qatar

Background: Regular well-baby visits during the first three years of childhood are critical to identify health, behavioral and development problems that could have long-lasting effects into adulthood. WHO stresses the importance of child health, and states that ensuring the healthy growth and development of children should be the prime concern. Aim: To ensure that well-baby services provide clinical care according to children’s age as per well-baby service protocol within primary health care centers, to find gaps if any and to generate an action plan for further improvement. Methodology: A retrospective chart review (baseline audit) was conducted on 245 health records of children who attended well-baby clinic for three months (March 01, 2018 to May 31, 2018). Further to the implementation of the action plan, a re-audit with retrospective chart review of 477 health records for three months (June 01, 2019 to August 31, 2019) was conducted to evaluate the improvements in the practice. Results: Performance for criterion on relevant clinical history taking (feeding and bowel history) has slightly increased from the baseline for each of the following age groups: from 71% to 82% at 4 months, 77% to 80% at 18 months and, 76% to 81% at 30 months, however, a declination was shown at 2 months 88% to 80%. Assessment of developmental milestones at 2, 18 and 30 months of age increased by 5% (76% to 81%), 13% (70% to 83%) and 19% (50% to 69%) respectively and, at 4 months performance remained the same at 69%. Examination of congenital hip dislocation/abduction has demonstrated a significant improvement where its performance increased by 79% (8% to 87%) at 2 months, and 82% (2% to 84%) at 4 months of age. On the other hand, at ages 18 & 30 months which were not measured in the baseline audit in the re-audit, it was 68% and 45% respectively. Screening for vision at 2 months of age has increased by 13% (78% to 91%), but, there was a slight drop of 10% in the screening of hearing from 86% to 76% at 2 months. Screening of autism spectrum disorder using a tool in children 18 and 30 months of age dropped from 86% to 83% and from 86% to 75% respectively. Conversely, request laboratory investigation to rule out anemia has increased by 46% (47% to 93%) at 18 months and 61% (23% to 84%) at 30 months. Conclusions: Impactful audits with actionable recommendations make real difference in practice and compliance. In conclusion, action plans implemented further to the baseline audit are effective in increasing the compliance in most of the areas. Key Words: Well-baby services audit, primary health care, Qatar

Advancing Child Trauma Screening Practices

Child trauma screening practices have advanced considerably as child-serving systems have increasingly incorporated early identification and intervention into trauma-informed models of care. While research points to the necessity of screening practices that attend to a child’s developmental capacities, cultural background, relational strengths, contextual details surrounding the traumatic experience, and complex trauma considerations, many of these features remain absent in common brief screening measures used in practice. Pictorial screening measures may offer an innovative opportunity to address attentional concerns and developmental capacities of young and complexly traumatized children, yet are understudied in this area. The purpose of this paper is threefold: 1) highlight areas for expansion within current brief trauma screening models, 2) propose an evidence-informed framework for a pictorial complex trauma screening tool for children, and 3) offer implementation considerations for piloting the proposed screening tool. Piloting and implementation considerations address the importance of cognitive interviewing, cultural sensitivity, development of a companion response and referral protocol, and embedding principles of trauma-informed care in the training and implementation process.

HP53 : Evaluating spatial cuing effects of social cues in children with ADHD: Pre-test of three versions of a neuropsychological tool in children without disorders

Our aim was to pre-test three versions of an evaluative tool designed to identify children with ADHD who are sensitive to cuing effects triggered by social cues (gaze and pointing finger). Method: Children without disorders, aged from 7 to 9 years, had to press a button as soon as an object appeared on the screen, at the left or the right of an individual. In two thirds of the trials, the side of the object appearance was cued by the individual either by deviating her gaze or by pointing with her finger. In the first version (19 children), these congruent trials were compared to neutral trials in which the individual did not move before the object appearance. In the second version (18 children), congruent trials were compared to moving trials in which the individual pointed her finger towards the children before the object appearance. In the third version (15 children), congruent trials were compared to incongruent trials in which the individual gazed or pointed towards the opposite side of the object appearance. Results: Congruent pointing finger triggered strong cuing effects compared to neutral, moving or incongruent trials. By contrast, the strength of the gaze cuing effect depended on the comparison trials. When compared to incongruent trials, congruent gazing and pointing led to similar and robust effects. Conclusion: The version manipulating incongruent trials, which controls for alerting effect induced by gaze or finger movements respectively, was the most appropriate to measure social cuing effects and was chosen to calibrate the tool.

Diagnosis of Malnutrition in Children and Adolescents with Identified Developmental Disabilities (IDD) Using Subjective Global Nutrition Assessment (SGNA).

Children with identified developmental disabilities (IDD) experience a higher risk of growth retardation. Anthropometric indicator is one common objective measurement used to determine malnutrition in those children. A comprehensive nutritional assessment tool should be introduced to offer a more robust approach in understanding their nutritional problems. To determine the use of Subjective Global Nutrition Assessment (SGNA) as a nutrition assessment tool for children with IDD in comparison to the anthropometric indicators. This cross-sectional study was conducted in local community settings. IDD included in this study were autism spectrum disorder (ASD), Down syndrome (DS) and cerebral palsy (CP). SGNA and anthropometry measurements including weight, height, mid-upper arm circumference and triceps skinfolds were performed on 93 children with IDD (40 ASD, 26 DS and 27 CP) aged 5-18 years. Cohen's Kappa, sensitivity, specificity and its 95% confidence interval were calculated between SGNA and anthropometric indicators for the agreement in determining malnutrition status of the children. SGNA identified a lower prevalence of malnutrition in children with IDD in comparison to the use of anthropometric indicators. SGNA obtained a moderate-to-fair agreement (above 80% agreement, except height-for-age parameter) and sensitivity (25.71-59.09%) against the use of a single anthropometric indicator in identifying the malnutrition status of the children. The use of SGNA as an adjunct to body mass index-for-age as an anthropometric measurement for diagnosing malnutrition in children and adolescents with IDD is recommended.

Orthopedic screening using pGALS assessment tools in children’s between 5 and 12 years

Musculoskeletal diseases in youngsters are particularly common in schools. Musculoskeletal problems in children should be treated as soon as feasible. pGALs is a screening tool for musculoskeletal issues in children and adolescents. The pGALS (paediatric gait, arms, legs, and spine) is a simple, quick MSK diagnostic instrument that has been validated in school-aged children to identify musculoskeletal problems. This research was carried out in three schools in Wardha: School of Scholars, Alphonsa Senior Secondary School, and Sant Chavara School Sawangi Meghe. The research took six months to complete. A total of 100 students were tested in each school. pGALS will be used to do a musculoskeletal evaluation. Data was collected and analysed using SPSS (version: 20) and the paired T- Test was used. This study concluded according to the age factor ranging from 5-8 years and 9-12 years and it is also revealed from according to the gender factor, according to the BMI, and according to the pgals examination scale score. The number of individuals in the age between 5 to 8 years was approximately 152 individuals i.e. (50.67%) and the individual in the age group 9 to 12 years was approximately 148 individuals i.e. (49.33%). According to the gender factor the male population was taken approximately 140 (46.67%) male and female approximately 160 (53.33%). Then According to the BMI index, the individual having a BMI score less than equal to 18.4 is 272 individual (90.67%) the BMI score in between the range 18.5-24.4 is 25 individual (8.33%) and the individual having a BMI Score greater than equal to 25 is 3 (1%). According to the pGALS scale examination the result is according to the questions that the activity performed or not performed by individual. Keywords: pGALS, Clinical skill, Musculoskeletal pain, Normal development, Musculoskeletal examination.

PENTINGNYA PENGGUNAAN METODE MENGAJAR UNTUK ANAK SEKOLAH MINGGU

ABSTRACT
 Christian Religious Education is needed in the role of changing the character of growth behavior of Sunday school children. Jesus considered that children are important as individuals. The importance of teaching children so that they can become individuals who act responsibly so that they find their joy and existence (Woltrestroff, 2007). The hope of a teacher can open up to Sunday school children with full trust and Christian affection (Ismail, 2002). So, a method is needed to apply the Christian Religious Education learning pattern so that the teaching process is more varied and makes the children enjoy the learning materials of God's Word. Because the Word of God is full of riches of truth that requires variety in implementing the truth of God's Word. The role of changing children's behavior is the background of the problem being studied. The method used in this research is qualitative. This research is needed to be more detailed, critical, and explore cases (Lumintang, 2016). The framework of this discussion is the role of changing character. The results and discussion of this journal are about the influence on children, the formation of children's character, well as methods and tools for children's education.
 Keywords: Christian Religious Education; role; children; method

Cross-sectional survey of underreported violence experienced by adolescents: a study from Indonesia

BackgroundGlobal studies on adolescent victims of violence require serious attention due to the possibility that underreported cases may be higher than official records indicate. Since Indonesia expects to witness a demographic bonus, extensive research is needed to strengthen early detection, case handling, and prevention. Here, we report the outcomes of a survey on physical, verbal, and sexual violence experienced by adolescents in West Java, an Indonesian province inhabited by 18% of the country’s total population.MethodsWe conducted a cross-sectional survey in 2017 using the International Society for the Prevention of Child Abuse and Neglect (ISPCAN) Child Abuse Screening Tool for Children (ICAST-C) questionnaire for detecting child abuse; an expert panel translated, simplified, and validated it based on a theoretical framework that combines paediatrics, public health, and medicolegal perspectives. We aimed to cover a large sample size and explore three types of violence (physical, verbal, and sexual) that have high evidentiary value in the forensic context. The respondents were adolescents in the first and second grades of middle school (12 to 14 years old) and high school (15 to 17 years old) in seven cities/municipalities in the province, selected through several stages of simple random sampling (N = 3452). We analysed the samples through univariate (percentage), odds ratio (OR), comparison, correlation, and correspondence analyses.ResultsThe results showed that 78.7% of the adolescents experienced violence in 2017, comprising those who encountered at least one incidence of physical violence (43.1%), verbal violence (12.2%), and sexual violence (4.5%). Data overlap includes 14.3% who experienced one type of violence in 2017, 7.4% who experienced two forms of violence, and 1.4% who underwent all three kinds of violence. The offenders were mainly adolescents across all types of violence, except for being forced to engage in sexual intercourse. Several victims of sexual violence did not state who the offenders were. Further, several characteristics showed a higher chance of experiencing violence than other characteristics, especially for adolescents who were still in middle school and those who lived only with their mothers. Correspondence analysis suggested subtle differences between characteristics.ConclusionWe expect this study to help identify risk and protective factors that are essential to strengthening early detection efforts, decisive medicolegal examinations, case handling, and policy-making.

Nutrition Assessment Tools in Children with Chronic Kidney Disease

Children with chronic kidney disease (CKD) are vulnerable to undernutrition and its accompanying consequences. Assessment of nutrition in these children is confounded by the presence of edema and overhydration. There is no single measure that can comprehensively reflect the underlying nutrition status. Hence, there is a need to explore nutrition assessment tools that reflect body composition without being affected by hydration status. Many tools of assessment that are widely studied in adults with CKD get extrapolated to children. Studies on nutritional assessment focusing on pediatric patients with CKD are needed for early recognition and long-term monitoring of nutrition status. This review attempts to provide an understanding of the utility and limitations of tools available for assessment of nutrition and body composition in the context of undernutrition in pediatric CKD.

Liver Transplantation in Children and Impact of Intraoperative Goal Directed Therapies on Postoperative Outcome

Background: Liver transplantation is a hemorrhagic surgery with high postoperative complication rates in terms of organ dysfunction and infections. We conducted a retrospective observational monocentric study that had the objectives of determining predictors of postoperative outcome in children. In the initial cohort, 19 children underwent liver transplantation. A description of the postoperative outcomes of these patients was undertaken. Objective: To describe intraoperative and postoperative outcomes in children undergoing liver transplantation and to propose intraoperative management implementation measures for postoperative outcome improvement. Methods: Secondary analysis of liver transplanted patients included in the initial study. Results: There were 19 patients who underwent liver transplantation with a median age of 31[2-154] months. Five patients had re-operations (26.3%). Fourteen (73.7%) had intraoperative and/or postoperative complications. Five (26.3%) had intraoperative hemorrhagic shock. One (5.3%) had postoperative respiratory failure, one (5.3%) had postoperative multiple organ failure, two (10.5%) had postoperative neurologic failure and five (26.3%) had cardio-circulatory failure. One (5.3%) had postoperative pulmonary sepsis, five (26.3%) had postoperative abdominal sepsis, and six (31.6%) had postoperative septicemia. Intra-operative transfusion rate was 100%. In-hospital mortality rate was 10.5% (two patients). Conclusion: There were multiple postoperative adverse outcome predictors. Optimal intraoperative patient management with transfusion guided by point-of-care viscoelastic devices and goal-directed fluid and hemodynamic therapy with validated parameters and tools in children is a possible pathway to upgrade postoperative evolution in pediatric liver transplantation.

Cost-effectiveness of whole-exome sequencing in progressive neurological disorders of children.

To clarify the diagnostic utility and the cost-effectiveness of whole-exome sequencing (WES) as a routine early-diagnostic tool in children with progressive neurological disorders. Patients with infantile-onset severe neurological diseases or childhood-onset progressive neurological disorders were prospectively recruited to this WES study, in the pediatric neurology clinic at Helsinki University Hospital during 2016-2018. A total of 48 patients underwent a singleton WES. A control group of 49 children underwent traditional diagnostic examinations and were retrospectively collected from the hospital records. Their use of health care services, related to the diagnostic process, was gathered. Incremental cost-effectiveness ratio (ICER) per additional diagnosis was calculated from the health care provider perspective. Bootstrapping methods were used to estimate the uncertainty of cost-effectiveness outcomes. WES provided a better diagnostic yield (38%) than diagnostic pathway that did not prioritize WES in early diagnosis (25%). WES outperformed other diagnostic paths especially when made early, within one year of first admission (44%). Cost-effectiveness in our results are conservative, affected by WES costs during 2016-18. WES is an efficient and cost-effective diagnostic tool that should be prioritized in early diagnostic path of children with progressive neurological disorders. The progressively decreasing price of the test improves cost-effectiveness further.