International Journal of Pediatrics The latest articles from Hindawi Publishing Corporation © 2016 , Hindawi Publishing Corporation . All rights reserved. Timing of Caffeine Therapy and Neonatal Outcomes in Preterm Infants: A Retrospective Study Sun, 08 May 2016 14:18:42 +0000 Background. Caffeine is widely used to treat apnea of prematurity. Here, we evaluated the efficacy of early caffeine (1-2 DOL) in decreasing the incidence of adverse neonatal outcomes. Methods. A retrospective cohort was used to compare the neonatal morbidity of 150 preterm neonates with gestational age ≤29 weeks. Infants were divided into 3 groups based on the initiation timing of caffeine therapy; (1) early caffeine (1-2 DOL), (2) late caffeine (3–7 DOL), and (3) very late caffeine (≥8 DOL). Results. The neonatal outcomes of early caffeine were comparable with those of the late caffeine group. Moreover, when comparing the neonatal morbidity of the very late caffeine group with that of the early caffeine group, multivariable logistic regression analyses were performed. We found that the timing of caffeine did not influence the risk of BPD (OR, 0.393; CI, 0.126–1.223; ), but birthweight did (OR, 0.996; CI, 0.993–0.999; ) in these infants. Conclusion. Neonatal outcomes of preterm infants were comparable whether caffeine was administered early or late in the first 7 DOL. The risk of BPD in infants receiving caffeine after 8 DOL was irrespective of delayed treatment with caffeine. Our results clearly demonstrate the need for further studies before caffeine prophylaxis can be universally recommended. Ivan Hand, Nahla Zaghloul, Lily Barash, Rudolph Parris, Ulrika Aden, and Hsiu-Ling Li Copyright © 2016 Ivan Hand et al. All rights reserved. Does Nursery-Based Intensified Anticipatory Guidance Reduce Emergency Department Use for Nonurgent Conditions in the First Month of Life? A Randomized Controlled Trial Sun, 24 Apr 2016 12:27:49 +0000 Objective. We aimed to evaluate the impact of an intensified anticipatory guidance program in the nursery on Emergency Department (ED) use for nonurgent conditions (NUCs) in the neonatal period. Methods. Parturient mothers of healthy newborns were randomized to an intervention group or control group. Baseline and 1-month follow-up knowledge surveys regarding newborn care were conducted. The primary outcome was the proportion of neonates who used the ED for a NUC. Secondary outcome was change in caregivers’ knowledge on NUC. Results. Of a total of 594 mothers, 323 (54%) agreed to participate and were randomized to intervention () or control () group. Most were Hispanic (68%), single (61%), primiparous (39%), and without high school diploma (44%). 35 (21%) neonates in the intervention group and 41 (27%) in the control group were brought at least once for a NUC to the ED (). There was no statistically significant difference in within subject change on knowledge scores between the two study arms. Conclusions. Neonatal ED visits for NUCs occur frequently. This nursery-based intensified anticipatory guidance program had no statistically significant impact on neonatal ED use for NUC, nor on neonatal care-relevant knowledge among parturient mothers. Alternative modalities and timing of parental educational intervention may need to be considered. This trial is registered with Clinical Trials Number NCT01859065 ( Kelly Kamimura-Nishimura, Vikram Chaudhary, Folake Olaosebikan, Maryam Azizi, Sneha Galiveeti, Ayoade Adeniyi, Richard Neugebauer, and Stefan H. F. Hagmann Copyright © 2016 Kelly Kamimura-Nishimura et al. All rights reserved. The Effect of Exclusive Breastfeeding on Hospital Stay and Morbidity due to Various Diseases in Infants under 6 Months of Age: A Prospective Observational Study Sun, 17 Apr 2016 12:18:30 +0000 Background. Mother’s milk is the best for the babies. Protective and preventive role of breast milk was evaluated in this study by assessing the relation of type of feeding and duration of hospital stay or morbidity. Methods. This prospective study was conducted in a tertiary care hospital and 232 infants in the age group of 14 weeks to 6 months formed the sample. There are two groups of infants, that is, one for breastfed and one for top fed infants. Statistical analysis was done and results were calculated up to 95% to 99% level of significance to find effect of feeding pattern on hospital stay due to various diseases and morbidity. Results. Prolonged hospital stay, that is, >7 days, was lesser in breastfed infants and results were statistically significant in case of gastroenteritis ( value < 0.001), bronchopneumonia ( value = 0.0012), bronchiolitis ( value = 0.005), otitis media ( value = 0.003), and skin diseases ( value = 0.047). Lesser morbidity was seen in breastfed infants with gastroenteritis ( value 0.0414), bronchopneumonia ( value 0.03705), bronchiolitis ( value 0.036706), meningitis ( value 0.043), and septicemia ( value 0.04). Conclusions. Breastfed infants have shorter hospital stay and lesser morbidity in regard to various diseases as compared to top fed infants. Amarpreet Kaur, Karnail Singh, M. S. Pannu, Palwinder Singh, Neeraj Sehgal, and Rupinderjeet Kaur Copyright © 2016 Amarpreet Kaur et al. All rights reserved. Ear Infection and Its Associated Risk Factors in First Nations and Rural School-Aged Canadian Children Wed, 10 Feb 2016 11:55:38 +0000 Background. Ear infections in children are a major health problem and may be associated with hearing impairment and delayed language development. Objective. To determine the prevalence and the associated risk factors of ear infections in children 6–17 years old residing on two reserves and rural areas in the province of Saskatchewan. Methodology. Data were provided from two rural cross-sectional children studies. Outcome variable of interest was presence/absence of an ear infection. Logistic regression analysis was conducted to examine the relationship between ear infection and the other covariates. Results. The prevalence of ear infection was 57.8% for rural Caucasian children and 43.6% for First Nations children living on-reserve. First Nations children had a lower risk of ear infection. Ear infection prevalence was positively associated with younger age; first born in the family; self-reported physician-diagnosed tonsillitis; self-reported physician-diagnosed asthma; and any respiratory related allergy. Protective effect of breastfeeding longer than three months was observed on the prevalence of ear infection. Conclusions. While ear infection is a prevalent condition of childhood, First Nations children were less likely to have a history of ear infections when compared to their rural Caucasian counterparts. Chandima P. Karunanayake, William Albritton, Donna C. Rennie, Joshua A. Lawson, Laura McCallum, P. Jenny Gardipy, Jeremy Seeseequasis, Arnold Naytowhow, Louise Hagel, Kathleen McMullin, Vivian Ramsden, Sylvia Abonyi, Jo-Ann Episkenew, James A. Dosman, Punam Pahwa, The First Nations Lung Health Project Research Team, and The Saskatchewan Rural Health Study Team Copyright © 2016 Chandima P. Karunanayake et al. All rights reserved. Orthopedic Manifestations of Mobius Syndrome: Case Series and Survey Study Mon, 08 Feb 2016 10:05:31 +0000 Background. Mobius Syndrome is a rare disease defined by bilateral congenital 7th nerve palsy. We focus on reporting the prevalence of orthopedic disease in this population. Methods. Twenty-three individuals with Mobius Syndrome underwent orthopedic physical examination, and additional 96 patients filled out a survey for self-reported orthopedic diagnoses. Results. Clubfoot was present in 60% of individuals in the physical exam series and 42% of those in the survey. Scoliosis was present in 26% and 28%, respectively. Poland’s Syndrome was present in 17% and 30%. In addition to these findings, 27% of patients reported having difficulty with anesthesia, including difficulty in intubation and airway problems. Conclusion. An increased prevalence of scoliosis, clubfoot, transverse limb deficiencies, and Poland’s Syndrome is identified in the setting of Mobius Syndrome. In the setting of several deformities often requiring surgical correction, a high incidence of anesthetic difficulty is noted and should be discussed with patients and other providers during surgical planning. Philip McClure, David Booy, Julia Katarincic, and Craig Eberson Copyright © 2016 Philip McClure et al. All rights reserved. Albuterol Use in Children Hospitalized with Human Metapneumovirus Respiratory Infection Wed, 27 Jan 2016 11:20:31 +0000 Introduction. Human metapneumovirus (HMPV) is a paramyxovirus from the same subfamily as respiratory syncytial virus (RSV) and causes similar acute lower respiratory tract infection. Albuterol in the setting of acute RSV infection is controversial and has not yet been studied in HMPV. We sought to determine the frequency of albuterol use in HMPV infection and the association between albuterol administration and patient outcomes. Methods. We conducted a retrospective cohort study identifying all patients hospitalized in a tertiary care children’s hospital with laboratory-confirmed HMPV infection between January 2010 and December 2010. Results. There were 207 patients included in the study; 57% had a chronic medical condition. The median hospital length of stay was 3 days. Only 31% of patients in the study had a documented wheezing history, while 69% of patients received at least one albuterol treatment. There was no difference in length of stay between patients who received albuterol and those who did not. Conclusion. There is a high frequency of albuterol use in children hospitalized with HMPV infection. As with RSV, evidence may not support routine use of bronchodilators in patients with acute HMPV respiratory infection. Research involving additional patient outcomes and illness severity indicators would be useful in future studies. Lindsey K. Rasmussen, Jennifer Schuette, and Michael C. Spaeder Copyright © 2016 Lindsey K. Rasmussen et al. All rights reserved. Is It Time to Review Guidelines for ETT Positioning in the NICU? SCEPTIC—Survey of Challenges Encountered in Placement of Endotracheal Tubes in Canadian NICUs Sun, 17 Jan 2016 11:43:27 +0000 Objectives. To examine current opinions and practices regarding endotracheal tube placement across several Canadian Neonatal Intensive Care Units. Design. Clinical directors from Canadian Neonatal Network affiliated NICUs and Neonatal-Perinatal Programs across Canada were invited via email to participate in and disseminate the online survey to staff neonatologists, neonatal fellows, respiratory therapists, and nurse practitioners. Result. There is wide variability in the beliefs and practices related to ETT placement. The majority use “weight +6” formula and “aim to black line” on ETT at vocal cords to estimate the depth of an oral ETT and reported estimation as challenging in ELBW infants. The majority agreed that mid-trachea is an ideal ETT tip position; however their preferred position on chest X-ray varied. Many believe that ETT positioning could be improved with more precise ETT markings. Conclusion. Further research should focus on developing more effective guidelines for ETT tip placement in the ELBW infants. Pankaj Sakhuja, Michael Finelli, Judy Hawes, and Hilary Whyte Copyright © 2016 Pankaj Sakhuja et al. All rights reserved. Community-Acquired Rotavirus Gastroenteritis Compared with Adenovirus and Norovirus Gastroenteritis in Italian Children: A Pedianet Study Thu, 14 Jan 2016 14:10:23 +0000 Background. Rotavirus (RV) is the commonest pathogen in the hospital and primary care settings, followed by Adenovirus (AV) and Norovirus (NV). Only few studies that assess the burden of RV gastroenteritis at the community level have been carried out. Objectives. To estimate incidence, disease characteristics, seasonal distribution, and working days lost by parents of RV, AV, and NV gastroenteritis leading to a family pediatrician (FP) visit among children < 5 years. Methods. 12-month, observational, prospective, FP-based study has been carried out using Pedianet database. Results. RVGE incidence was 1.04 per 100 person-years with the highest incidence in the first 2 years of life. Incidences of AVGEs (1.74) and NVGEs (1.51) were slightly higher with similar characteristics regarding age distribution and symptoms. Risk of hospitalisation, access to emergency room (ER), and workdays lost from parents were not significantly different in RVGEs compared to the other viral infections. Conclusions. Features of RVGE in terms of hospitalisation length and indirect cost are lower than those reported in previous studies. Results of the present study reflect the large variability of data present in the literature. This observation underlines the utility of primary care networks for AGE surveillance and further studies on community-acquired gastroenteritis in children. D. Donà, E. Mozzo, A. Scamarcia, G. Picelli, M. Villa, L. Cantarutti, and C. Giaquinto Copyright © 2016 D. Donà et al. All rights reserved. A Case Control Study on Risk Factors Associated with Low Birth Weight Babies in Eastern Nepal Thu, 10 Dec 2015 10:09:39 +0000 Background. This study was done to assess the maternal and sociodemographic factors associated with low birth weight (LBW) babies. Methods. An unmatched case control study was done involving 159 cases (mothers having LBW singleton babies) and 159 controls (mothers having normal birth weight singleton babies). Results. More than 50% of LBW babies were from the mothers with height ≤145 cm while only 9.43% of NBW babies were from the mothers with that height. Finally, after multivariate logistic regression analysis, maternal height, time of first antenatal care (ANC) visit, number of ANC visits, iron supplementation, calcium supplementation, maternal education, any illness during pregnancy, and hypertension were found as the significant predictors of LBW. However, maternal blood group AB, normal maternal Body Mass Index (BMI), mother’s age of 30 or more years, and starting ANC visit earlier were found to be protective for LBW. Conclusion. Study findings suggest that selectively targeted interventions such as delay age at first pregnancy, improving maternal education and nutrition, and iron and calcium supplementation can prevent LBW in Nepal. Ravi Kumar Bhaskar, Krishna Kumar Deo, Uttam Neupane, Subhadra Chaudhary Bhaskar, Birendra Kumar Yadav, Hanoon P. Pokharel, and Paras Kumar Pokharel Copyright © 2015 Ravi Kumar Bhaskar et al. All rights reserved. Newborn Care Practices among Mother-Infant Dyads in Urban Uganda Wed, 02 Dec 2015 09:30:54 +0000 Background. Most information on newborn care practices in Uganda is from rural communities which may not be generalized to urban settings. Methods. A community based cross-sectional descriptive study was conducted in the capital city of Uganda from February to May 2012. Quantitative and qualitative data on the newborn care practices of eligible mothers were collected. Results. Over 99% of the mothers attended antenatal care at least once and the majority delivered in a health facility. Over 50% of the mothers applied various substances to the cord of their babies to quicken the healing. Although most of the mothers did not bathe their babies within the first 24 hours of birth, the majority had no knowledge of skin to skin care as a thermoprotective method. The practice of bathing babies in herbal medicine was common (65%). Most of the mothers breastfed exclusively (93.2%) but only 60.7% initiated breastfeeding within the first hour of life, while a significant number (29%) used prelacteal feeds. Conclusion. The inadequate newborn care practices in this urban community point to the need to intensify the promotion of universal coverage of the newborn care practices irrespective of rural or urban communities and irrespective of health care seeking indicators. Violet Okaba Kayom, Abel Kakuru, and Sarah Kiguli Copyright © 2015 Violet Okaba Kayom et al. All rights reserved. Efficacy and Safety of a Lidocaine Gel in Patients from 6 Months up to 8 Years with Acute Painful Sites in the Oral Cavity: A Randomized, Placebo-Controlled, Double-Blind, Comparative Study Sun, 29 Nov 2015 11:28:09 +0000 Lidocaine is a well-accepted topical anaesthetic, also used in minors to treat painful conditions on mucosal membranes. This randomized, double-blind, placebo-controlled study (registered prospectively as EudraCT number 2011-005336-25) was designed to generate efficacy and safety data for a lidocaine gel (2%) in younger children with painful conditions in the oral cavity. One hundred sixty-one children were included in two subgroups: 4–8 years, average age 6.4 years, treated with verum or placebo and 6 months–<4 years, average age 1.8 years, treated only with verum. Pain reduction was measured from the time prior to administration to 10 or 30 minutes after. In addition, adverse events and local tolerability were evaluated. In group I, pain was reduced significantly after treatment with verum compared to placebo at both time points. In group II, the individual pain rating shift showed statistically significant lower pain after treatment. Only seven out of 161 patients reported an adverse event but none were classified as being related to the study medication. The local tolerability was assessed as very good in over 97% of cases. For painful sites in the oral cavity, a 2% lidocaine gel is a meaningful tool for short-term treatment in the paediatric population. Dörte Wolf and Joachim Otto Copyright © 2015 Dörte Wolf and Joachim Otto. All rights reserved. Neonatal Septicemia in Nepal: Early-Onset versus Late-Onset Mon, 16 Nov 2015 14:10:12 +0000 Introduction. Neonatal septicemia is defined as infection in the first 28 days of life. Early-onset neonatal septicemia and late-onset neonatal septicemia are defined as illnesses appearing from birth to three days and from four to twenty-eight days postnatally, respectively. Methods. In this cross-sectional study, blood samples from the suspected infants were collected and processed in the bacteriology laboratory. The growth was identified by standard microbiological protocol and the antibiotic sensitivity testing was carried out by modified Kirby-Bauer disk diffusion method. Results. Among total suspected cases, the septicemia was confirmed in 116 (12.6%) neonates. Early-onset septicemia (EOS) was observed in 82 infants and late-onset septicemia (LOS) in 34 infants. Coagulase-negative staphylococcus (CoNS) (46.6%) was the predominant Gram-positive organism isolated from EOS as well as from LOS cases followed by Staphylococcus aureus (14.6%). Acinetobacter species (9.5%) was the predominant Gram-negative organism followed by Klebsiella pneumoniae (7.7%). Conclusions. The result of our study reveals that the CoNS, Staphylococcus aureus, Acinetobacter spp., and Klebsiella pneumoniae are the most common etiological agents of neonatal septicemia. In particular, since rate of CoNS causing sepsis is alarming, prompting concern to curb the excess burden of CoNS infection is necessary. Shamshul Ansari, Hari Prasad Nepal, Rajendra Gautam, Sony Shrestha, Puja Neopane, and Moti Lal Chapagain Copyright © 2015 Shamshul Ansari et al. All rights reserved. Danger Signs of Childhood Pneumonia: Caregiver Awareness and Care Seeking Behavior in a Developing Country Wed, 21 Oct 2015 13:59:34 +0000 Background. Efforts to reduce child mortality especially in Africa must as a necessity aim to decrease mortality due to pneumonia. To achieve this, preventive strategies such as expanding vaccination coverage are key. However once a child develops pneumonia prompt treatment which is essential to survival is dependent on mothers and caregiver recognition of the symptoms and danger signs of pneumonia. Methods. This community based cross-sectional study enrolled four hundred and sixty-six caregivers in Enugu state. It aimed to determine knowledge of caregivers about danger signs of pneumonia and the sociodemographic factors that influence knowledge and care seeking behaviour of caregivers. Results. There is poor knowledge of the aetiology and danger signs of pneumonia among caregivers. Higher maternal educational attainment and residence in semiurban area were significantly associated with knowledge of aetiology, danger signs, and vaccination of their children against pneumonia. Fast breathing and difficulty in breathing were the commonest known and experienced WHO recognized danger signs while fever was the commonest perceived danger sign among caregivers. Conclusion. Knowledge of danger signs and health seeking behaviour among caregivers is inadequate. There is need for intensified public and hospital based interventions targeted at mothers to improve their knowledge about pneumonia. Ikenna K. Ndu, Uchenna Ekwochi, Chidiebere D. I. Osuorah, Kenechi S. Onah, Ejike Obuoha, Odutola I. Odetunde, Ikenna Nwokoye, Nnenne I. Obumneme-Anyim, Ifeyinwa B. Okeke, and Ogechukwu F. Amadi Copyright © 2015 Ikenna K. Ndu et al. All rights reserved. Improving ECG Services at a Children’s Hospital: Implementation of a Digital ECG System Mon, 14 Sep 2015 11:35:41 +0000 Background. The use of digital ECG software and services is becoming common. We hypothesized that the introduction of a completely digital ECG system would increase the volume of ECGs interpreted at our children’s hospital. Methods. As part of a hospital wide quality improvement initiative, a digital ECG service (MUSE, GE) was implemented at the Children’s Hospital at Montefiore in June 2012. The total volume of ECGs performed in the first 6 months of the digital ECG era was compared to 18 months of the predigital era. Predigital and postdigital data were compared via -tests. Results. The mean ECGs interpreted per month were 53 ± 16 in the predigital era and 216 ± 37 in the postdigital era (), a fourfold increase in ECG volume after introduction of the digital system. There was no significant change in inpatient or outpatient service volume during that time. The mean billing time decreased from 21 ± 27 days in the postdigital era to 12 ± 5 days in the postdigital era (). Conclusion. Implementation of a digital ECG system increased the volume of ECGs officially interpreted and reported. Frank A. Osei, Gregory J. Gates, Steven J. Choi, Daphne T. Hsu, Robert H. Pass, and Scott R. Ceresnak Copyright © 2015 Frank A. Osei et al. All rights reserved. Safety of a Bioactive Polyphenol Dietary Supplement in Pediatric Subjects with Acute Diarrhoea Mon, 07 Sep 2015 07:55:20 +0000 The hematological and clinical chemistry profile for children aged 6 months to 5 years with acute diarrhoea was measured in a double blind clinical trial. Subjects were randomized to the study group () given a bioactive polyphenol dietary supplement in oral rehydration solution (ORS) or to the control group () given distilled water as a placebo in ORS twice daily for up to 4 days. All subjects received 10 mg zinc daily for the 4 days in the study. Venous blood was collected for complete blood count, electrolytes, liver function, and creatinine upon enrollment (baseline) and at the end of 4 days (end of study); mean values were compared by 95% confidence intervals. Overall, blood factors measured either remained the same over the 4 days or increased or decreased at the same levels between the two groups during the study period. All values were within accepted ranges for paediatric subjects except serum AST (SGOT), where the mean value of the study group approached the upper bound of the range on day 4 but was comparable to the value of the control group. Consumption of this supplement twice daily for 4 days is safe for children and infants. Shafiqul A. Sarker, Shamima Sultana, Mark Pietroni, and Arthur Dover Copyright © 2015 Shafiqul A. Sarker et al. All rights reserved. Perceptions of Weight and Health Practices in Hispanic Children: A Mixed-Methods Study Tue, 25 Aug 2015 10:01:30 +0000 Background. Perception of weight by parents of obese children may be associated with willingness to engage in behavior change. The relationship between parents’ perception of their child’s weight and their health beliefs and practices is poorly understood, especially among the Hispanic population which experiences disparities in childhood obesity. This study sought to explore the relationship between perceptions of weight and health beliefs and practices in a Hispanic population. Methods. A cross-sectional, mixed-methods approach was used with semistructured interviews conducted with parent-child (2–5 years old) dyads in a primarily Hispanic, low-income population. Parents were queried on their perceptions of their child’s health, health practices, activities, behaviors, and beliefs. A grounded theory approach was used to analyze participants’ discussion of health practices and behaviors. Results. Forty parent-child dyads completed the interview. Most (58%) of the parents of overweight and obese children misclassified their child’s weight status. The qualitative analysis showed that accurate perception of weight was associated with internal motivation and more concrete ideas of what healthy meant for their child. Conclusions. The qualitative data suggest there may be populations at different stages of readiness for change among parents of overweight and obese children, incorporating this understanding should be considered for interventions. Byron Alexander Foster and Daniel Hale Copyright © 2015 Byron Alexander Foster and Daniel Hale. All rights reserved. Corrigendum to “High Dose Dexmedetomidine: Effective as a Sole Agent Sedation for Children Undergoing MRI” Tue, 02 Jun 2015 11:57:22 +0000 Sheikh Sohail Ahmed, Tamara Unland, James E. Slaven, and Mara E. Nitu Copyright © 2015 Sheikh Sohail Ahmed et al. All rights reserved. High Risk Infants Follow-Up: A Case Study in Iran Tue, 02 Jun 2015 07:34:03 +0000 Background. A follow-up program for high risk infants was initiated in Alzahra Maternity Hospital in Tabriz city, Iran, in 2013. The aim of this paper is to give a brief report of the program. Material and Methods. Two groups of high risk neonates were studied. The first group comprising 509 infants received services in Alzahra Maternity Hospital implemented by the follow-up program. This included a full package for family to look after high risk infant and periodic clinical evaluation at two and four weeks after birth and then two, three, four, five, and six months later again. The second group including 131 infants in Taleqani Maternity Hospital received routine services after birth with no specific follow-up care. Results. Some anthropometric indices showed a significant improvement in the intervention hospital compared to control group. These included the following: head circumference at first and second months; weight in the first, fourth, fifth, and sixth months; and height in sixth month only. Clinical evaluation of infants showed an improvement for some of the medical conditions. Conclusion. Follow-up care program for a minimum of six months after discharge from maternity hospitals may help to avoid adverse and life threatening consequences in high risk infants. Mohammad Heidarzadeh, Behzad Jodeiry, Mohammad Baqer Hosseini, Kayvan Mirnia, Forouzan Akrami, Abbas Habbibollahi, Sara Moazzen, and Saeed Dastgiri Copyright © 2015 Mohammad Heidarzadeh et al. All rights reserved. Increased Body Mass Index during Therapy for Childhood Acute Lymphoblastic Leukemia: A Significant and Underestimated Complication Mon, 25 May 2015 13:07:45 +0000 Objective & Design. We undertook a retrospective review of children diagnosed with acute lymphoblastic leukemia (ALL) and treated with modern COG protocols to determine longitudinal changes in body mass index (BMI) and the prevalence of obesity compared with a healthy reference population. Results. At diagnosis, the majority of patients (77.5%) were in the healthy weight category. During treatment, increases in BMI -scores were greater for females than males; the prevalence of obesity increased from 10.3% to 44.8% for females but remained relatively unchanged for males (9.8% to 13.7%, ). Longitudinal analysis using linear mixed-effects identified associations between BMI -scores and time-dependent interactions with sex , disease risk , age , and BMI -score at diagnosis and total dose of steroid during maintenance . Predicted mean BMI -scores at the end of therapy were greater for females with standard risk ALL irrespective of age at diagnosis and for males younger than 4 years of age at diagnosis with standard risk ALL. Conclusion. Females treated on standard risk protocols and younger males may be at greatest risk of becoming obese during treatment for ALL. These subgroups may benefit from intervention strategies to manage BMI during treatment for ALL. Helen C. Atkinson, Julie A. Marsh, Shoshana R. Rath, Rishi S. Kotecha, Hazel Gough, Mandy Taylor, Thomas Walwyn, Nicholas G. Gottardo, Catherine H. Cole, and Catherine S. Choong Copyright © 2015 Helen C. Atkinson et al. All rights reserved. Two Oral Midazolam Preparations in Pediatric Dental Patients: A Prospective Randomised Clinical Trial Wed, 20 May 2015 12:57:17 +0000 Pharmacological sedation is an alternative behavior management strategy in pediatric dentistry. The aim of this study was to compare the behavioral and physiologic effects of “commercially midazolam syrup” versus “orally administered IV midazolam dosage form (extemporaneous midazolam (EF))” in uncooperative pediatric dental patients. Eighty-eight children between 4 to 7 years of age received 0.2–0.5 mg/kg midazolam in this parallel trial. Physiologic parameters were recorded at baseline and every 15 minutes. Behavior assessment was conducted objectively by Houpt scale throughout the sedation and North Carolina at baseline and during injection and cavity preparation. No significant difference in behavior was noted by Houpt or North Carolina scale. Acceptable behavior (excellent, very good, and good) was observed in 90.9% of syrup and 79.5% of EF subjects, respectively. Physiological parameters remained in normal range without significant difference between groups and no adverse effect was observed. It is concluded that EF midazolam preparation can be used as an acceptable alternative to midazolam syrup. Katayoun Salem, Shaqayegh Kamranzadeh, Maryam Kousha, Shahnaz Shaeghi, and Fatemeh AbdollahGorgi Copyright © 2015 Katayoun Salem et al. All rights reserved. Midline Cervical Cleft: Review of an Uncommon Entity Thu, 23 Apr 2015 10:26:01 +0000 Introduction. Midline cervical cleft is a rare congenital malformation which nonetheless has a classic presentation. This study presents one of the largest single series of new patients with MCC and provides an exhaustive review and catalogue of publications from the international literature. Materials and Methods. Retrospective chart review performed in two academic medical centers and literature review performed with primary verification of all quoted references. Results. Ten patients with MCC were identified (8 boys and 2 girls). All patients presented with the classic findings of this congenital anomaly, and the length of the skin defect correlated with an increase in the patient’s age. Surgical excision was complete in all cases. Thorough international literature review yielded only 195 verifiable previously reported cases. Conclusions. This is one of the largest series of new patients with midline cervical cleft presented in the world literature. Although rare (with less than 200 cases published to date) this entity does have a reliable presentation that should lead to rapid and accurate diagnosis. Complete surgical excision at an early age is appropriate since the anomaly increases in length commensurate with the patient’s age. Liana Puscas Copyright © 2015 Liana Puscas. All rights reserved. The Impact of Ethnicity on Wilms Tumor: Characteristics and Outcome of a South African Cohort Thu, 26 Mar 2015 08:42:40 +0000 Background. Nephroblastoma is the commonest renal tumour seen in children. It has a good prognosis in developed countries with survival rates estimated to be between 80% and 90%, while in Africa it remains low. Method. Retrospective study of patients diagnosed with nephroblastoma who are seen at 4 paediatric oncology units, representing 58.5% of all South African children with nephroblastoma and treated following SIOP protocol between January 2000 and December 2010. Results. A total of 416 patients were seen at the 4 units. Over 80% of our patients were African and almost 10% of mixed ethnicity. The most common stage was stage 4. The median survival was 28 months after diagnosis with the mixed ethnicity patients recording the longest duration (39 months) and the white patients had the shortest median survival. The overall 5-year survival rate was estimated to be 66%. Stage 2 patients did significantly better (85%). Conclusions. Our patients are similar with regard to gender ratio, median age, and age distribution as described in the literature, but in South Africa the more advanced stage disease seen than in other developed countries is translated into low overall survival rate. D. K. Stones, G. P. Hadley, R. D. Wainwright, and D. C. Stefan Copyright © 2015 D. K. Stones et al. All rights reserved. Posttransfusion Haematocrit Equilibration: Timing Posttransfusion Haematocrit Check in Neonates at the National Hospital, Abuja, Nigeria Sun, 15 Mar 2015 13:45:46 +0000 Anaemia is a common morbidity in the NICU and often requires transfusion of packed red blood cells. Haematocrit equilibration following red cell transfusion occurs over time ultimately resulting in a stable packed cell volume (PCV). Knowledge of this equilibration process is pertinent in the accurate timing of posttransfusion (PT) PCV. We conducted a prospective study to determine an appropriate timing for PT PCV estimation on 47 stable anaemic babies at the Neonatal Unit of National Hospital, Abuja. Values of PCV were determined before transfusion and at 1, 6, 12, 24, and 48 hours posttransfusion. Forty of the recruited neonates and young infants were analyzed. Their gestational age range was 26 to 40 weeks. 1-hour PT PCV (48.5% ± 5.5%) was similar to the 6-hour PT PCV (47.8% ± 5.6%) , but both were significantly different from the 12-hour (46.8% ± 5.9%), 24-hour (45.9 ± 5.8%), and 48-hour (45.4% ± 6.2%) PT PCVs. The 12-hour PT PCV was similar to the 24-hour and 48-hour PT PCVs ( and 0.063, resp.). We concluded that, in stable nonhaemorrhaging and nonhaemolysing young infants, the estimated timing of haematocrit equilibration and, consequently, posttransfusion PCV is 12 hours after red blood cell transfusion. L. I. Audu, A. T. Otuneye, A. B. Mairami, L. J. Mshelia, and V. E. Nwatah Copyright © 2015 L. I. Audu et al. All rights reserved. Enteral L-Arginine and Glutamine Supplementation for Prevention of NEC in Preterm Neonates Thu, 12 Mar 2015 11:58:53 +0000 Objective. Evaluating the efficacy and safety of arginine and glutamine supplementation in decreasing the incidence of NEC among preterm neonates. Methods. Prospective case-control study done on 75 preterm neonates ≤34 weeks, divided equally into L-arginine group receiving enteral L-arginine, glutamine group receiving enteral glutamine, and control group. Serum L-arginine and glutamine levels were measured at time of enrollment (sample 1), after 14 days of enrollment (sample 2), and at time of diagnosis of NEC (sample 3). Results. The incidence of NEC was 9.3%. There was no difference in the frequency of NEC between L-arginine and control groups (). NEC was not detected in glutamine group; L-arginine concentrations were significantly lower in arginine group than control group in both samples while glutamine concentrations were comparable in glutamine and control groups in both samples. No significant difference was found between groups as regards number of septic episodes, duration to reach full oral intake, or duration of hospital stay. Conclusion. Enteral L-arginine supplementation did not seem to reduce the incidence of NEC. Enteral glutamine may have a preventive role against NEC if supplied early to preterm neonates. However, larger studies are needed to confirm these findings. This work is registered in ( Identifier: NCT01263041). M. S. El-Shimi, H. A. Awad, M. A. Abdelwahed, M. H. Mohamed, S. M. Khafagy, and G. Saleh Copyright © 2015 M. S. El-Shimi et al. All rights reserved. Recent Advances in the Diagnosis and Treatment of Niemann-Pick Disease Type C in Children: A Guide to Early Diagnosis for the General Pediatrician Mon, 16 Feb 2015 13:33:17 +0000 Niemann-Pick disease (NP-C) is a lysosomal storage disease in which impaired intracellular lipid transport leads to accumulation of cholesterol and glycosphingolipids in various neurovisceral tissues. It is an autosomal recessive disorder, caused by mutations in the NPC1 or NPC2 genes. The clinical spectrum is grouped by the age of onset and onset of neurological manifestation: pre/perinatal; early infantile; late infantile; and juvenile periods. The NP-C Suspicion Index (SI) screening tool was developed to identify suspected patients with this disease. It is especially good at recognizing the disease in patients older than four years of age. Biochemical tests involving genetic markers and Filipin staining of skin fibroblast are being employed to assist diagnosis. Therapy is mostly supportive and since 2009, the first specific therapy approved for use was Miglustat (Zavesca) aimed at stabilizing the rate of progression of neurological manifestation. The prognosis correlates with age at onset of neurological signs; patients with early onset form progress faster. The NP-C disease has heterogeneous neurovisceral manifestations. A SI is a screening tool that helps in diagnostic process. Filipin staining test is a specific biomarker diagnostic test. Miglustat is the first disease-specific therapy. Hanna Alobaidy Copyright © 2015 Hanna Alobaidy. All rights reserved. Corrigendum to “Population-Based Placental Weight Ratio Distributions” Mon, 02 Feb 2015 13:03:06 +0000 Erin M. Macdonald, John J. Koval, Renato Natale, Timothy R. H. Regnault, and M. Karen Campbell Copyright © 2015 Erin M. Macdonald et al. All rights reserved. High Dose Dexmedetomidine: Effective as a Sole Agent Sedation for Children Undergoing MRI Thu, 29 Jan 2015 12:26:55 +0000 Objective. To determine the efficacy and safety of high dose dexmedetomidine as a sole sedative agent for MRI. We report our institution’s experience. Design. A retrospective institutional review of dexmedetomidine usage for pediatric MRI over 5.5 years. Protocol included a dexmedetomidine bolus of 2 μg/kg intravenously over ten minutes followed by 1 μg/kg/hr infusion. 544 patients received high dose dexmedetomidine for MRI. A second bolus was used in 103 (18.9%) patients. 117 (21.5%) required additional medications. Efficacy, side effects, and use of additional medicines to complete the MRI were reviewed. Data was analyzed using Student’s t-test, Fisher’s exact test, and Analysis of Variance (ANOVA). Main Results. Dexmedetomidine infusion was associated with bradycardia (3.9%) and hypotension (18.4%). None of the patients required any intervention. Vital signs were not significantly different among the subgroup of patients receiving one or two boluses of dexmedetomidine or additional medications. Procedure time was significantly shorter in the group receiving only one dexmedetomidine bolus and increased with second bolus or additional medications (). Discharge time was longer for children experiencing bradycardia (). Conclusion. High dose Dexmedetomidine was effective in 78.5% of cases; 21.5% of patients required additional medications. Side effects occurred in approximately 25% of cases, resolving spontaneously. Sheikh Sohail Ahmed, Tamara Unland, James E. Slaven, and Mara E. Nitu Copyright © 2015 Sheikh Sohail Ahmed et al. All rights reserved. Abnormal Blood Glucose as a Prognostic Factor for Adverse Clinical Outcome in Children Admitted to the Paediatric Emergency Unit at Komfo Anokye Teaching Hospital, Kumasi, Ghana Sun, 28 Dec 2014 10:15:38 +0000 Dysglycaemia (hyper- or hypoglycaemia) in critically ill children has been associated with poor outcome. We compared the clinical outcomes in children admitted to Pediatric Emergency Unit (PEU) at Komfo Anokye Teaching Hospital (KATH) for acute medical conditions and presenting with euglycaemia or dysglycaemia. This is a prospective case matching cohort study. Eight hundred subjects aged between 3 and 144 months were screened out of whom 430 (215 with euglycaemia and 215 with dysglycaemia) were enrolled. The median age was 24 months (range: 3–144 months). In the dysglycaemia group, 28 (13%) subjects had hypoglycemia and 187 (87%) had hyperglycemia. Overall, there were 128 complications in 116 subjects. The number of subjects with complications was significantly higher in dysglycaemia group (, 46%) compared to euglycaemia group (, 8%) (). Forty subjects died out of whom 30 had dysglycaemia (). Subjects with dysglycaemia were 3 times (95% CI: 1.5–6.0) more likely to die and 4.8 times (95% CI: 3.1–7.5) more likely to develop complications (). Dysglycaemia is associated with increased morbidity and mortality in children with acute medical conditions and should lead to intensive management of the underlying condition. Emmanuel Ameyaw, Kwame Amponsah-Achiano, Peter Yamoah, and Jean-Pierre Chanoine Copyright © 2014 Emmanuel Ameyaw et al. All rights reserved. The Effects of Skin-to-Skin Contact on Temperature and Breastfeeding Successfulness in Full-Term Newborns after Cesarean Delivery Thu, 25 Dec 2014 06:05:27 +0000 Background. The skin-to-skin contact (SSC) of mother and newborn is uncommon full-term newborns after delivering via cesarean section due to the possibility of hypothermia in the infants. The aim of this study was to compare mothers’ and infant’s temperatures after delivering via cesarean section. Material and Methods. In this randomized clinical trial, 90 infant/mothers dyads delivered via cesarean section were randomized to SSC () and routine care (). In experimental group, skin-to-skin contact was performed for one hour and in the routine group the infant was dressed and put in the cot according to hospital routine care. The newborns’ mothers’ temperatures in both groups were taken at half-hour intervals. The data was analyzed using descriptive statistics, t-tests, and chi-square tests. Results. The means of the newborns’ temperatures immediately after SSC (), half an hour (), and one hour () after the intervention did not show statistically significant differences between the two groups. The mean scores of the infants’ breastfeeding assessment in SSC () and routine care () groups did not show significant differences (). Conclusion. Mother and infant’s skin-to-skin contact is possible after delivering via cesarean section and does not increase the risk of hypothermia. Shourangiz Beiranvand, Fatemeh Valizadeh, Reza Hosseinabadi, and Yadollah Pournia Copyright © 2014 Shourangiz Beiranvand et al. All rights reserved. Effectiveness of Palivizumab in Preventing RSV Hospitalization in High Risk Children: A Real-World Perspective Thu, 04 Dec 2014 12:26:04 +0000 Infection with respiratory syncytial virus (RSV) is one of the major causes globally of childhood respiratory morbidity and hospitalization. Palivizumab, a humanized monoclonal antibody, has been recommended for high risk infants to prevent severe RSV-associated respiratory illness. This recommendation is based on evidence of efficacy when used under clinical trial conditions. However the real-world effectiveness of palivizumab outside of clinical trials among different patient populations is not well established. We performed a systematic review focusing on postlicensure observational studies of the protective effect of palivizumab prophylaxis for reducing RSV-associated hospitalizations in infants and children at high risk of severe infection. We searched studies published in English between 1 January 1999 and August 2013 and identified 420 articles, of which 20 met the inclusion criteria. This review supports the recommended use of palivizumab for reducing RSV-associated hospitalization rates in premature infants born at gestational age < 33 weeks and in children with chronic lung and heart diseases. Data are limited to allow commenting on the protective effect of palivizumab among other high risk children, including those with Down syndrome, cystic fibrosis, and haematological malignancy, indicating further research is warranted in these groups. Nusrat Homaira, William Rawlinson, Thomas L. Snelling, and Adam Jaffe Copyright © 2014 Nusrat Homaira et al. All rights reserved.