Treatment Outcomes Of Infants Research Articles

Safety and Treatment Outcomes of Infants and Children Treated With Daptomycin: Six-Year Experience From a Pediatric Academic Medical Center.

Daptomycin is a common treatment for serious infections caused by gram-positive bacteria in adult patients; however, data regarding its safety and efficacy in the pediatric population are limited. This was a retrospective chart review of adverse reactions and treatment outcomes associated with daptomycin use in children <13 years old who received at least 1 dose of daptomycin. At least 1 dose of daptomycin was received by 147 patients. Seventy-two patients received daptomycin for 5 or more days. New-onset loose stools on daptomycin initiation were reported for 14 (9.5%) patients, elevations in creatine kinase in 3 (2%) patients, and elevated aspartate transaminase and alanine transaminase in 13 (8.8%) and 9 (6.1%) patients, respectively. Two patients (1.4%) had daptomycin discontinued due to specific concerns for adverse drug reactions. Daptomycin was found to be safe and effective in this pediatric cohort that included young children and infants with a variety of types and severities of infections.

The correlation between lung ultrasound scores and outcomes of high-flow nasal cannula therapy in infants with severe pneumonia

ObjectiveThe study aimed to explore the effectiveness of bedside lung ultrasound (LUS) combined with the PaO2/FiO2 (P/F) ratio in evaluating the outcomes of high-flow nasal cannula (HFNC) therapy in infants with severe pneumonia.MethodsThis retrospective study analyzed the clinical data of 150 infants diagnosed with severe pneumonia and treated with HFNC therapy at our hospital from January 2021 to December 2021. These patients were divided into two groups based on their treatment outcomes: the HFNC success group (n = 112) and the HFNC failure group (n = 38). LUS was utilized to evaluate the patients’ lung conditions, and blood gas results were recorded for both groups upon admission and after 12 h of HFNC therapy.ResultsAt admission, no significant differences were observed between the two groups in terms of age, gender, respiratory rate, partial pressure of oxygen, and partial pressure of carbon dioxide. However, the P/F ratios at admission and after 12 h of HFNC therapy were significantly lower in the HFNC failure group (193.08 ± 49.14, 228.63 ± 80.17, respectively) compared to the HFNC success group (248.51 ± 64.44, 288.93 ± 57.17, respectively) (p < 0.05). Likewise, LUS scores at admission and after 12 h were significantly higher in the failure group (18.42 ± 5.3, 18.03 ± 5.36, respectively) than in the success group (15.09 ± 4.66, 10.71 ± 3.78, respectively) (p < 0.05). Notably, in the success group, both P/F ratios and LUS scores showed significant improvement after 12 h of HFNC therapy, a trend not observed in the failure group. Multivariate regression analysis indicated that lower P/F ratios and higher LUS scores at admission and after 12 h were predictive of a greater risk of HFNC failure. ROC analysis demonstrated that an LUS score > 20.5 at admission predicted HFNC therapy failure with an AUC of 0.695, a sensitivity of 44.7%, and a specificity of 91.1%. A LUS score > 15.5 after 12 h of HFNC therapy had an AUC of 0.874, with 65.8% sensitivity and 89.3% specificity. An admission P/F ratio < 225.5 predicted HFNC therapy failure with an AUC of 0.739, 60.7% sensitivity, and 71.1% specificity, while a P/F ratio < 256.5 after 12 h of HFNC therapy had an AUC of 0.811, 74.1% sensitivity, and 73.7% specificity.ConclusionDecreased LUS scores and increased P/F ratio demonstrate a strong correlation with successful HFNC treatment outcomes in infants with severe pneumonia. These findings may provide valuable support for clinicians in managing such cases.

Clinical, Microbiological Profile and Treatment Outcomes of Infants with BCG Adenitis: A Retrospective Study.

Bacille Calmette-Guérin (BCG) adenitis is an uncommon complication following BCG vaccination. In rare cases, infants can develop other complications. Controversy exists regarding the diagnosis and management of these cases. Not much information is available in literature regarding their microbiological and immunological characteristics. Electronic medical records of children presenting to the Pediatric Infectious Diseases clinic in a tertiary care hospital from January 2011-December 2020 with a diagnosis of BCG adenitis were retrospectively reviewed. Their clinical, microbiological, treatment and follow-up data were noted and analyzed. During the study period, 40 infants presented with a probable diagnosis of BCG adenitis with or without disseminated BCG. Median age at symptom onset was 4(2.5-5.9) months. Nine infants had disseminated disease at presentation. Fifteen infants were suspected to have underlying immune deficiency of whom 12 had proven defects in immune function. On multivariable logistic regression analysis, presence of disseminated disease was the only factor predictive of underlying immunodeficiency. Isoniazid monoresistance was seen in seven cases (32%) of the 22 samples sent for TB cultures. Though BCG adenitis runs a benign course, it could rarely be the first manifestation of an underlying immune defect. There is sizable isoniazid monoresistance, hence sending tissue samples for microbiologic evaluation is necessary to guide anti-tubercular therapy.

Is medical treatment necessary for infants with small urinary stones?

Urinary stone disease is a common condition. We investigated the usefulness of medical treatment for infants with urinary stones 5mm or smaller. The study included 197 infants (86 girls and 111 boys) with urolithiasis ≤ 5mm who were referred to our Department of Nephrology between 2014 and 2016. Infants with metabolic or anatomical risk factors requiring medical treatment were excluded from the study. We retrospectively reviewed urine and serum metabolic profiles and compared stone resolution rates in patients who did and did not receive treatment. The mean age at diagnosis was 5.2months (range, 14days to 12months). The most common complaint was restlessness (n = 92, 46.7%), and 49 infants (24.9%) were asymptomatic. Multiple stones were detected in 166 infants (84.3%). Hypomagnesuria, hypocitraturia, and hypercalciuria were present in 25.3, 19.7, and 18.7% of patients, respectively. Stones < 3mm (microlithiasis) were detected in 97 infants (49.2%), and 100 (50.8%) patients had 3-5mm stones. In total, 130 infants (66.5%) received regular treatment and 67 (33.5%) were not treated. Stone resolution was significantly higher in the group receiving K-citrate treatment at the 6th month follow-up, while there were no significantly difference between the two groups at the 12th month control. No previous studies have investigated treatment outcomes in infants with 3-5mm urinary stones. According to our results, K-citrate treatment may accelerate the resolution of the stone in infants with stones smaller than 5mm.

Surgical Treatment of Spine Deformations after Neonatal Sepsis (The Analysis of Clinical Series)

Background. Neonatal sepsis presents one of the current issues in modern pediatrics. The orthopedic outcomes of such a state and the possibility of treatment, in particular by surgical spinal reconstruction, are rarely analyzed. Objective. To analyze pathology features and treatment outcomes in infants with vertebral complications resulted from neonatal sepsis.Material and Methods. The analysis of observation and treatment of 15 infants, who have undergone neonatal sepsis which led to vertebral lesion with subsequent gross kyphotic deformity formation, is presented.Results. Average age of infants was 2.5 months when spinal pathology was diagnosed. In 7 of the 15 observations, a local angular kyphosis was revealed when the acute phase of disease was already passed („cured“). The thoracic vertebrae were most often affected, mainly Th 7-8 vertebral bodies. Average kyphosis was 53°. All infants were operated on during the period from 2006 to 2017. Each had two-stage spinal reconstruction including the anterior spinal fusion using a titanium mesh cage filled with bone autografts, or an autogenous bone graft only. At the second stage, the instrumental correction and fixation of the spine with a multi-support laminar structure were performed. Average age of patients at the time of surgery was 14 months. Average value of kyphosis correction was 27°. Further correction and anterior spinal fusion were achieved when performing the incorporation of a titanium mesh cage with bone autografts. The histological and bacteriological examination of the surgical material did not reveal any signs of infection or inflammation. Correction of deformity and restoration of the supporting strength of anterior vertebral column as a result of surgery were achieved in all cases. Various complications in the early and late followup period were reported in a total of 7 cases. Repeated interventions were required in two patients: in one case in the early period (dislocation of the structure supporting hook) and in one case in the long-term period (graft resorption and kyphotic deformity relapse).Conclusion. One of the complications of neonatal sepsis is severe multilevel thoracic spondylitis, the outcome of which is the formation of severe kyphosis against the background of subtotal bone vertebral destruction. The principal possibility of radical spine reconstruction in infants with achievement of good anatomical and functional results is shown.

Morphological and molecular aspects of immobilization-induced muscle atrophy in rats at different stages of postnatal development: the role of autophagy.

Muscle loss occurs following injury and immobilization in adulthood and childhood, which impairs the rehabilitation process; however, far fewer studies have been conducted analyzing atrophic response in infants. This work investigated first the morphological and molecular mechanisms involved in immobilization-induced atrophy in soleus muscles from rats at different stages of postnatal development [i.e., weanling (WR) and adult (AR) rats] and, second, the role of autophagy in regulating muscle plasticity during immobilization. Hindlimb immobilization for 10 days reduced muscle mass and fiber cross-sectional area, with more pronounced atrophy in WR, and induced slow-to-fast fiber switching. These effects were accompanied by a decrease in markers of protein synthesis and an increase in autophagy. The ubiquitin (Ub)-ligase MuRF1 and the ubiquitinated proteins were upregulated by immobilization in AR while the autolyzed form of μ-calpain was increased in WR. To further explore the role of autophagy in muscle abnormalities, AR were concomitantly immobilized and treated with colchicine, which blocks autophagosome-lysosome fusion. Colchicine-treated immobilized muscles had exacerbated atrophy and presented degenerative features. Despite Igf1/Akt signaling was downregulated in immobilized muscles from both age groups, Foxo1 and 4 phosphorylation was increased in WR. In the same group of animals, Foxo1 acetylation and Foxo1 and 4 content was increased and decreased, respectively. Our data show that muscle disorders induced by 10-day-immobilization occur in both age-dependent and -independent manners, an understanding that may optimize treatment outcomes in infants. We also provide further evidence that the strong inhibition of autophagy may be ineffective for treating muscle atrophy.

Severe Food Protein-Induced Enterocolitis Syndrome to Cow's Milk in Infants.

Cow’s milk is the most common cause of food-protein-induced enterocolitis syndrome (FPIES). The aim of this study was to examine the clinical features and treatment outcomes of infants with severe FPIES to cow’s milk. We reviewed all infants ≤12 months of age who were hospitalized and diagnosed with severe FPIES to cow’s milk between 1 January 2011 and 31 August 2014 in a tertiary Children’s Medical Center in China. Patients’ clinical features, feeding patterns, laboratory tests, and treatment outcomes were reviewed. A total of 12 infants met the inclusion criteria. All infants presented with diarrhea, edema, and hypoalbuminemia. Other main clinical manifestations included regurgitation/vomiting, skin rashes, low-grade fever, bloody and/or mucous stools, abdominal distention, and failure to thrive. They had clinical remission with resolution of diarrhea and significant increase of serum albumin after elimination of cow’s milk protein (CMP) from the diet. The majority of infants developed tolerance to the CMP challenge test after 12 months of avoidance. In conclusion, we reported the clinical experience of 12 infants with severe FPIES to cow’s milk, which resulted in malnutrition, hypoproteinemia, and failure to thrive. Prompt treatment with CMP-free formula is effective and leads to clinical remission of FPIES in infants.

Treatment Outcomes of Infants With Cyanotic Congenital Heart Disease Treated With Synbiotics

The goal was to investigate the effect of orally administered synbiotics on outcome of infants with cyanotic congenital heart disease (CCHD). A prospective, blinded, randomized controlled trial was conducted to evaluate the effect of synbiotics on outcome of infants with CCHD. The infants with CCHD were assigned randomly to 2 groups. Infants in the study group were given synbiotic (Bifidobacterium lactis plus inulin) added to breast milk or mixed feeding until discharge or death. Infants in the placebo group were fed with breast milk or mixed feeding. The outcome measurements were nosocomial sepsis, necrotizing enterocolitis (NEC; Bell stage ≥ 2), length of NICU stay, and death. A total of 100 infants were enrolled in the trial: 50 in each arm. There were 9 cases of culture-proven sepsis (18%) in the placebo group and 2 cases (4%) in the synbiotic group (P = .03). Length of NICU stay did not differ between the groups (26 [14-36] vs 32 days [20-44], P = .07]. There were 5 cases of NEC (10%) in the placebo group and none in the synbiotic group (P = .03). The incidence of death was lower in synbiotic group (5 [10%] of 50 vs 14 [28.0%] of 50, respectively; P = .04). Synbiotics administered enterally to infants with CCHD might reduce the incidence of nosocomial sepsis, NEC, and death.

Treatment Outcomes of Infants With Cyanotic Congenital Heart Disease Treated With Synbiotics

Treatment Outcomes of Infants With Cyanotic Congenital Heart Disease Treated With Synbiotics

Prognostic factors for treatment outcomes in transient tachypnea of the newborn

Transient tachypnea of the newborn (TTN) is a clinical syndrome associated with respiratory distress usually seen shortly after delivery in infants. This study aims to determine the risk factors predicting treatment outcomes in infants with TTN. Data from 236 infants diagnosed with TTN during the study period were evaluated retrospectively. Logistic regression analyses were performed to select significant risk factor for prognosis (prolonged oxygen therapy, application of mechanical ventilator, and prolonged hospital stay) of TTN among components of clinical variables. Of the 236 TTN infants, 111 (47.0%) infants were delivered via cesarean section (CS) without labor, 29 (12.3%) infants were delivered via CS with labor, and 96 (40.7%) were delivered via vaginal birth. Lower Apgar score at 1 min (OR: 3.03; 95%CI: 1.25-7.36) and lower umbilical artery pH (OR: 4.00; 95%CI 1.55-10.49) were associated with a significantly increased risk for mechanical ventilator care. Also, late-preterm delivery (OR: 4.70; 95%CI: 2.11-10.49) was independently associated with risk of prolonged duration of hospital stay. Late-preterm delivery, lower initial umbilical artery pH (<7.25), and lower Apgar score at 1 min were independently associated with poor prognostic treatment outcomes in infants with TTN.

CLINICAL FEATURES AND TREATMENT OUTCOMES OF INFANTS WITH IMMUNE THROMBOCYTOPENIC PURPURA

CLINICAL FEATURES AND TREATMENT OUTCOMES OF INFANTS WITH IMMUNE THROMBOCYTOPENIC PURPURA

46 Clinical features and treatment outcomes of infants with immune thrombocytopenic purpura

46 Clinical features and treatment outcomes of infants with immune thrombocytopenic purpura

International Perspectives

Since 1984, Tokyo Women’s Medical University has played a pioneering role in improving the treatment results of ultrapreterm infants in Japan. The results were cited in the newest edition of Avery’s Neonatology: Pathophysiology & Management of the Newborn . (1) Like many western countries, the survival rate of extremely low-birthweight (ELBW) and very low-birthweight (VLBW) infants improved in Japan in the 1990s, with the spread of new treatment methods such as surfactant therapy, new methods of mechanical ventilation such as high-frequency oscillatory ventilation (HFOV), and prenatal steroid therapy. (2) The Committee on Newborn Infants, Japan Society of Pediatrics, has performed nationwide surveys on the outcomes of ELBW and VLBW infants for reports on the current status of neonatal intensive care units and overall neonatal mortality in Japan at 5-year intervals since 1980. The mortality rate of infants weighing less than 1,000 g at birth significantly declined in the previous 2 decades from 55.3% in 1980 and 28.2% in 1990 to 17.8% in 2000 (Table⇓). In view of this, the Ministry of Health, Labor and Welfare of the Japanese government changed the definition of the threshold of viability in the Maternal Protection Law from 24 weeks of gestation to 22 weeks of gestation in January 1991. After this change, neonatologists in Japan have increasingly intervened in deliveries at 22 to 23 weeks of gestation. | Year | Number of Survivors/Number of Admissions | |:------:| ---------------------------------------- | ----------------- | | <500 g | 500 to 999 g | 1,000 to 1,499 g | | 1980 | 0/0 | 493/1,102 (45%) | 2,633/3,319 (79%) | | 1985 | 5/52 (10%) | 1,085/1,846 (59%) | 3,695/4,180 (88%) | | 1990 | 9/50 (18%) | 1,462/2,000 (73%) | 3,524/3,786 (93%) | | 1995 | 39/132 (30%) | 1,789/2,298 (78%) | 4,139/4,355 (95%) | | 2000 | 57/153 (37%) | 2,238/2,638 (85%) | 4,844/5,036 (96%) | Table. Survival Rates of Infants Weighing Less than 1,500 g at Birth in Japan Although Sumida and associates (3) and Tsuchida and colleagues (4) reported in 1999 and 2001, respectively, survival rates at 22 weeks’ gestation of approximately 30%, their results were published in Japanese, and the number of patients was small. At the Hot Topics in Neonatology conference (Washington, DC) in 2002, Nishida reported the outcomes of infants born at 22 to 23 weeks of gestation …

Clinical features and treatment outcomes of 79 infants with immune thrombocytopenic purpura

To determine the clinical features and treatment outcomes of infants with immune thrombocytopenic purpura (ITP). Retrospective analysis of 79 infant ITP patients treated from 1987 to 2002. The data abstracted comprised age, gender, clinical features, and treatment outcomes. A score test for the trend in the odds ratios was used to determine the risk of chronic ITP with advancing age. The infants were compared to a group of contemporaneous older children with regard to bleeding severity and incidence of chronic ITP. The 34 female and 45 male infants had a median age of 16 months. Seventy-four presented with purpura, four with viral illnesses, and one was asymptomatic. Eight percent had active mucosal bleeding. The median platelet count was 8,000/microl. Forty infants received intravenous immunoglobulin, nine intravenous anti-D immunoglobulin, six steroids, and seven were observed without treatment. Fifty-five (76%) responded to a single course of treatment. Only 9% of infants developed chronic ITP compared to 18% of children between the ages of 25 and 119 months and 47% of children 120 months or older (P<0.0005). Infants with ITP respond favorably to treatment and are less likely to develop chronic ITP compared to older children.