Introduction. Congenital heart disease (CHD) is the most common birth defect. Anemia is the prevailing manifestation of micronutrient deficiency. It has been demonstrated that anemia in children increases morbidity and has a negative impact on psychomotor development. Despite its negative consequences, which have been documented for a long time in clinical practice, the issue does not gain sufficient attention in developing countries, specifically in children with CHD. Thus, this study is aimes to assess the prevalence of anemia and the factors associated in children with CHD. Methods. Institutional-based cross-sectional study was conducted on CHD children at selected governmental hospitals in Addis Ababa, Ethiopia, from February to March 2021. During this period, 373 children with acyanotic and cyanotic heart disease between 0 months and 15 years of age were included in this study. All children were assessed using structured questionnaires and anthropometric measurements. Recent hemoglobin results that are avaliable in the medical charts of children were used to diagnose anemia. The data were analyzed using SPSS version 25. Results. From randomly included 373 children with CHD, 298 (79.9%) had acyanotic congenital heart disease (ACHD) and 75 (20.1%) had cyanotic congenital heart disease (CCHD). Twenty-five (33.3%) CCHD and 192 (64.4%) ACHD cases of children were malnourished. The most common type of CCHD and ACHD defects were ventricular septal defects and tetralogy of fallout, respectively. Overall, the prevalence of anemia in ACHD and CCHD was 24.5% and 72%, respectively. In children with ACHD, the frequency of anemia was reported to be significantly higher in the malnourished group than in the well-nourished. Conclusions. A high prevalence of anemia is observed in children with CHD. This study highly suggests further evaluation to determine the frequency and complications of blood indices and other hematological impairments in ACHD, CCHD, and children with both problems. Moreover, the findings of this study on illness profiles in children with CHD prompt further research into the cellular and molecular mechanisms underlying immune system dysfunction.

Henok Kumsa

Rediet Woldesenbet

Feven Mulugeta

Rajalakshmi Murugan

Tamirat Moges

Anemia in Children with Congenital Heart Disease: A Finding from Low-Resource Setting Hospitals

Iron deficiency anaemia is still a global public health concern with the highest burden among children 6 to 23 months due to their rapid growth spurt exceeding breastmilk supply. Therefore, nutritional supply is a key source of iron to attain the required nutrients for better growth and development. This was a cross-sectional descriptive study done at Ishaka Adventist Hospital (IAH) and Kampala International University Teaching Hospital (KIUTH) from April to July 2022. Participants were consecutively enrolled in the study. Structured questionnaires, 24-hour dietary recall, and clinical assessment were used to obtain data. Data analysis was done using the statistical package for social scientists (SPSS) V22.0. Bivariable and multivariable analyses were done using logistic regression for associations with significance set at <svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-0.0498209pt" id="M1" height="8.68572pt" version="1.1" viewBox="-0.0498162 -8.6359 8.15071 8.68572" width="8.15071pt"><g transform="matrix(.013,0,0,-0.013,0,0)"><path id="g113-81" d="M600 480C600 590 528 650 384 650H143L137 622C222 614 225 607 210 531L130 127C113 41 106 36 23 28L17 0H294L300 28C204 36 195 42 212 127L243 284L314 263C327 263 339 263 352 264C465 271 600 337 600 480ZM508 481C508 351 402 304 329 304C289 304 265 311 250 317L295 559C302 594 310 606 323 611C335 616 350 619 367 619C455 619 508 573 508 481Z"/></g></svg> value < 0.05. A total of 364 participants were enrolled, with the majority being males (198, 54.4%) and born at term (333, 91.5%). The modal age was 12-17 months [163(44.8%)] with a mean age of 14.1 months (SD 5.32). The overall prevalence of IDA was 151/364 (41.5%). The factors associated with IDA included male sex (aOR 1.61), current episode of diarrhoea (aOR 1.71), poor meal frequency (aOR 1.78), no vegetable consumption (aOR 2.47), and consuming fruits once (aOR 1.97) in 7 days preceding the study. The study finds a high prevalence of IDA among infants 6-23 months with at least four in 10 being affected. Screening for IDA should be recommended in male children with current diarrhoea, poor intake of fruits and vegetables, and poor meal frequency. The Mentzer index is an equally good alternative screening test for IDA.

Dickson Kajoba

Walufu Ivan Egesa

Solomon Muyombya

Yamile Arias Ortiz

Martin Nduwimana

Grace Ndeezi

Prevalence and Factors Associated with Iron Deficiency Anaemia among Children Aged 6-23 Months in Southwestern Uganda

The primary purpose of newborn screening for sickle cell disease is to diagnose the disease before the appearance of symptoms and to initiate early treatment. To answer the question “What genetic information needs to be communicated to parents when newborn screening reveals the presence of a sickle cell trait,” we conducted a survey using a self-administered online questionnaire. We received responses from 122 healthcare workers and members of sickle cell disease associations, in France and French overseas departments. Our results showed similar positions on this issue. The information conveyed is not consistent and is the result of grassroots initiatives. The negative consequences generated by this information could be reduced when this information is delivered by a multidisciplinary team, within the framework of a dedicated consultation. This information on sickle cell trait status should be given in at least three key periods: the neonatal period, early adolescence, and later adolescence, when reproductive implications become important. Neonatal screening programs should develop systems that allow referring physicians to easily access the results of neonatal screening electronically. Harmonization of practices should allow a better analysis of the consequences of this counselling on family projects.

Narcisse Elenga

Genetic Information to Share with Parents when Newborn Screening Reveals the Presence of Sickle Cell Trait

Background. Peer learning has been recognized for its effectiveness in health professional education. However, its effects on clinical research education are not clear and were explored qualitatively in this study. Methods. The peer-learning method was implemented in a clinical research education seminar for early-career physicians at a children’s and mothers’ hospital in 2019. We conducted semistructured interviews with participants about peer-learning experience and qualitatively analyzed verbatim transcripts using Engeström’s “activity theory” framework. Results. From framework analysis, learning processes were extracted mainly in four domains, namely, (a) instrument and its usage: research design and its match with research question, (b) outcome: research result, (c) community: seminar, and (d) division of labor: roles of participants and staff. Conclusions. In this report of a peer-learning trial in postgraduate clinical research education, the following two pathways of peer-learning effects were abstracted. The indirect pathway was the presentations by experienced participants providing concrete examples of research processes. The direct pathway was the questions from experienced participants to beginners about specific and concrete questions. There were also two points to consider in peer learning in clinical research education: gaps in premise knowledge and beginners’ frustration about expected outcomes. We believe that these extracted pathways and points imply the significance and considerations for continuing the peer-learning trial in clinical research education. Future tasks are to promote clinical research education with a view to the learning effects, not only on individuals, but also on groups.

Hiro Nakao

Osamu Nomura

Chie Nagata

Akira Ishiguro

Peer Learning Has Double Effects in Clinical Research Education: A Qualitative Study

Background. Respiratory difficulties are a common concern in preterm infants, and they can lead to long-term health problems. Few studies have investigated the use of spectral analysis as a biomarker to quantify respiration patterns in preterm infants. Objective. To evaluate the feasibility of using spectral analysis of heart rate variability as a biomarker for the quantification of respiratory patterns in very-low-birth-weight preterm infants compared to direct observation. Methods. In a comparative, small-scale feasibility study, 18 preterm infants born during their 27th to 28th gestational week (weighing <1500 grams) participated by convenience. Respiratory patterns (regular or irregular; shallow or deep) were directly observed on the 28th week during playback of speech recording. Heart rate variability was simultaneously measured using spectral analysis of heart periods, from which the mean values influenced by respiratory sinus arrhythmia (frequencies of 0.30–1.0 Hz) were compared to each observed respiratory pattern. The magnitudes of respiratory sinus arrhythmia and the area under the curve were determined. Results. The magnitude of respiratory sinus arrhythmia (frequencies of 0.30–1.0 Hz) in infants observed to be displaying irregular shallow respiration was greater than that in infants with regular deep respiration. Further, there was a shift from lower frequencies (<svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="90.373pt" style="vertical-align:-3.403299pt" id="M1" height="12.7112pt" version="1.1" viewBox="-0.0498162 -9.3079 90.373 12.7112"><g transform="matrix(.013,0,0,-0.013,0,0)"><path id="g190-103" d="M54 437L27 408L31 397H101V103C101 37 94 32 30 26V0H266V25C187 33 180 36 180 110V397H288C299 404 304 428 298 437H180V477C179 562 190 610 203 630C214 647 230 659 256 659C289 659 318 641 337 622C346 612 355 612 364 619C374 627 380 635 383 643C388 655 387 667 378 678C362 697 333 710 299 712C260 707 225 689 189 659C135 613 119 563 112 541S101 490 101 458V437H54Z"/></g><g transform="matrix(.013,0,0,-0.013,3.978,0)"><path id="g190-115" d="M181 342V451C133 431 89 419 40 411V388C98 381 102 377 102 311V104C102 38 95 32 33 26V0H263V26C186 32 181 38 181 104V287C203 343 235 372 261 372C277 372 289 366 304 352C310 346 318 345 330 350C349 359 362 379 362 399C362 422 338 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682 21 677V653C82 648 87 642 87 576V104C87 40 81 32 14 26V0H237V26C173 32 165 38 165 104V215C171 217 176 218 181 218C189 218 198 212 212 196C267 129 330 49 376 -2L513 0Z"/></g><g transform="matrix(.013,0,0,-0.013,82.742,0)"><path id="g117-34" d="M535 323V373H52V323H535ZM535 138V188H52V138H535Z"/></g></svg><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="39.414pt" style="vertical-align:-3.403299pt" height="12.7112pt" version="1.1" viewBox="93.9551838 -9.3079 39.414 12.7112"><g transform="matrix(.013,0,0,-0.013,94.005,0)"><path id="g113-49" d="M241 635C89 635 35 457 35 312C35 153 89 -12 240 -12C390 -12 443 166 443 312C443 466 390 635 241 635ZM238 602C329 602 354 454 354 312C354 172 330 22 240 22C152 22 124 173 124 313S148 602 238 602Z"/></g><g transform="matrix(.013,0,0,-0.013,100.245,0)"><path id="g113-47" d="M113 -12C146 -12 170 11 170 46C170 78 146 103 114 103S58 78 58 46C58 11 82 -12 113 -12Z"/></g><g 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Conclusion. In contrast with direct observation, spectral analysis allowed for the quantification of respiratory patterns in a vulnerable population of preterm infants of interest to the nursing scientific and practice community. Future directions include applying this biomarker to evaluate both developmental and pathological trends in the respiratory patterns of preterm infants.

Khlood Bubshait

Olivia Dizon

Charlene Krueger

Feasibility of Spectral Analysis as a Tool in Nursing Research to Quantify Patterns of Respiration in Premature Infants

Background. Congenital heart disease (CHD) remains the number one birth defect worldwide. Pulse oximetry screening (POS) is a widely used CHD screening modality effective in detecting critical lesions. This study is aimed at assessing the accuracy and cost-effectiveness of POS in a cohort of term well-babies admitted to a regular nursery in a tertiary care center. Methods. We reviewed the charts of term babies admitted to our regular nursery over a period of one year. The results of POS and the findings of echocardiography were collected. Similarly, we explored the records of our fetal echocardiography program to identify the fetuses screened for CHD during the same period. Results. 900 term babies were born and admitted to newborn nursery at our center, and 69 fetuses were evaluated by our fetal cardiology team during the study period. None of our term babies had a positive POS at birth or 24 hours of age. However, 56 babies had a cardiac echo before hospital discharge due to suspicious findings on physical examination or a family history of CHD. A simple noncritical CHD was noted in 10 of them. Additionally, 53 babies underwent echocardiography within the first five years of life; a simple CHD was noted in 6 of them. In parallel, 21 of our fetuses were found to have CHD: 16 simple CHD and 5 critical CHD (CCHD). Conclusion. Despite its cost-effectiveness and efficacy in screening for CCHD, POS is suboptimal for detecting simple CHD. In the absence of a proper prenatal screening and fetal echocardiography program, POS remains a cost-effective modality for detecting CCHD.

Ziad R. Bulbul

Nour K. Younis

Farah Malaeb

Haytham Bou Hussein

Mariam Arabi

Fadi Bitar

Newborn Pulse Oximetry Screening for Detecting Congenital Heart Disease: Experience at a Tertiary Care Center

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International Journal of Pediatrics provides a forum for pediatricians who diagnose and treat disorders in infants, children, and adolescents. Studies relate to pediatric subspecialities including adolescent medicine, cardiology, critical care etc.

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International Journal of Pediatrics provides a forum for pediatricians who diagnose and treat disorders in infants, children, and adolescents. Studies relate to pediatric subspecialities including adolescent medicine, cardiology, critical care etc.

International Journal of Pediatrics