International Journal of Pediatrics https://www.hindawi.com The latest articles from Hindawi © 2017 , Hindawi Limited . All rights reserved. Evaluation of a Pilot Project to Introduce Simulation-Based Team Training to Pediatric Surgery Trauma Room Care Tue, 14 Feb 2017 00:00:00 +0000 http://www.hindawi.com/journals/ijpedi/2017/9732316/ Introduction. Several studies in pediatric trauma care have demonstrated substantial deficits in both prehospital and emergency department management. Methods. In February 2015 the PAEDSIM collaborative conducted a one and a half day interdisciplinary, simulation based team-training course in a simulated pediatric emergency department. 14 physicians from the medical fields of pediatric surgery, pediatric intensive care and emergency medicine, and anesthesia participated, as well as four pediatric nurses. After a theoretical introduction and familiarization with the simulator, course attendees alternately participated in six simulation scenarios and debriefings. Each scenario incorporated elements of pediatric trauma management as well as Crew Resource Management (CRM) educational objectives. Participants completed anonymous pre- and postcourse questionnaires and rated the course itself as well as their own medical qualification and knowledge of CRM. Results. Participants found the course very realistic and selected scenarios highly relevant to their daily work. They reported a feeling of improved medical and nontechnical skills as well as no uncomfortable feeling during scenarios or debriefings. Conclusion. To our knowledge this pilot-project represents the first successful implementation of a simulation-based team-training course focused on pediatric trauma care in German-speaking countries with good acceptance. Markus Lehner, Ellen Heimberg, Florian Hoffmann, Oliver Heinzel, Hans-Joachim Kirschner, and Martina Heinrich Copyright © 2017 Markus Lehner et al. All rights reserved. Interactive Palliative and End-of-Life Care Modules for Pediatric Residents Sun, 12 Feb 2017 00:00:00 +0000 http://www.hindawi.com/journals/ijpedi/2017/7568091/ Background. There is a need for increased palliative care training during pediatric residency. Objective. In this pilot study, we created a comprehensive experiential model to teach palliative care skills to pediatric residents. Our Comfort Care Modules (CCMs) address pediatric palliative care (PPC) topics of breaking bad news, dyspnea, anxiety, pain management, and the dying child. We also evaluated a scoring system and gathered qualitative data. Methods. The CCMs are part of the University of California San Diego pediatric residency’s second-year curriculum. Comparisons were made for statistical trends between residents exposed to the modules and those not exposed . Results. Nineteen of 36 residents (52%) completed surveys to self-rate their preparedness, knowledge, and confidence about PPC before and after the intervention. Resident scores increased in all areas. All improvements reached statistical significance except confidence when breaking bad news. Overall, the resident feedback about the CCMs was positive. Conclusions. This study demonstrates that the CCMs can be performed effectively in an academic setting and can benefit residents’ self-perception of preparedness, confidence, and knowledge about pediatric palliative care. In the future, we plan to implement the modules on a larger scale. We encourage their use in interprofessional settings and across institutions. Mindy K. Ross, Ami Doshi, London Carrasca, Patricia Pian, JoAnne Auger, Amira Baker, James A. Proudfoot, and Mark S. Pian Copyright © 2017 Mindy K. Ross et al. All rights reserved. Spectrum of Congenital Anomalies among Surgical Patients at a Tertiary Care Centre over 4 Years Thu, 09 Feb 2017 00:00:00 +0000 http://www.hindawi.com/journals/ijpedi/2017/4174573/ Introduction. Congenital anomalies are important causes of childhood death, chronic illness, and disability in many countries. Congenital malformations are rapidly emerging as one of the major worldwide problems. Aim. To study the percentage of various congenital anomalies among the patients admitted in Department of Pediatric Surgery at a tertiary care centre over a period of four years from 2011 to 2015 in our centre. Results. Neural tube defects were found to be the most common anomalies in 24.3% of the children admitted. Other common anomalies were anorectal malformation (20.7%), tracheoesophageal fistula (20%), and intestinal obstruction (14.84%). Majority (60.5%) of the patients were males. Conclusion. Congenital malformations are rapidly emerging as one of the major worldwide problems as they can result in long-term disability, which may have significant impacts on individuals, families, health-care systems, and societies. Regular antenatal visits and prenatal diagnosis are recommended for prevention, early intervention, and even planned termination, when needed. Arushi Agarwal, K. N. Rattan, Ankur Dhiman, and Ananta Rattan Copyright © 2017 Arushi Agarwal et al. All rights reserved. Associated Factors and Standard Percentiles of Blood Pressure among the Adolescents of Jahrom City of Iran, 2014 Mon, 16 Jan 2017 00:00:00 +0000 http://www.hindawi.com/journals/ijpedi/2017/3804353/ Background. High blood pressure in adults is directly correlated with increased risk of cardiovascular diseases. Hypertension in childhood and adolescence could be considered among the major causes of this problem in adults. This study aimed to investigate the factors associated with hypertension among the adolescents of Jahrom city in Iran and also standard percentiles of blood pressure were estimated for this group. Methods. In this community-based cross-sectional study 983 high school students from different areas of the city were included using a multistage random cluster sampling method in 2014. Blood pressure, weight, and height of each student measured using standard methods. Data were analyzed by statistical software SPSS 16. Results. In total, 498 male and 454 female students were included in this study. Average systolic blood pressure of students was 110.27 mmHg with a variation range of 80.6–151.3. Average diastolic blood pressure was 71.76 mmHg with the variation range of 49.3–105. Results of this study indicated that there was a significant relationship between gender, body mass index, and parental education level with systolic and diastolic blood pressure of the students (). Conclusions. Body mass index was one of the most important changeable factors associated with blood pressure in adolescents. Paying attention to this factor in adolescence could be effective in prevention of cardiovascular diseases in adulthood. Yaser Sarikhani, Seyed Taghi Heydari, Fatemeh Emamghorashi, Fatemeh Jafari, Reza Tabrizi, Saeed Karimpour, Ahmad Kalateh sadati, and Maryam Akbari Copyright © 2017 Yaser Sarikhani et al. All rights reserved. Prevalence, Response to Cysticidal Therapy, and Risk Factors for Persistent Seizure in Indian Children with Neurocysticercosis Tue, 10 Jan 2017 00:00:00 +0000 http://www.hindawi.com/journals/ijpedi/2017/8983958/ Background. Neurocysticercosis (NCC) is the commonest cause of childhood acquired epilepsy in developing countries. The use of cysticidal therapy in NCC, except “single lesion NCC,” is still debated in view of its doubtful usefulness and potential adverse effects. Methods. Children presenting with first episode of seizure or acute focal neurological deficit without fever were screened for NCC and received appropriate therapy (followup done for 1 year to look for the response and side effects). Results. The prevalence of NCC was 4.5%. Most common presenting feature was generalized seizure and commonest imaging finding was single small enhancing lesion in the parietal lobe. Abnormal EEG and CSF abnormalities were found in almost half of the children. The response to therapy was very good with infrequent recurrence of seizure and adverse effects of therapy were encountered rarely. No risk factors for persistent seizure could be identified. Conclusion. Present study shows that the response to cysticidal therapy is very good in NCC as seizure recurrence was observed in only 5%, 4.2%, and 4.2% of cases at 3-month, 6-month, and 1-year followup. Adverse effects of therapy were observed in 20% of cases during therapy but they were mild and self-limiting. Animesh Kumar, Anirban Mandal, Sheela Sinha, Amitabh Singh, and Rashmi Ranjan Das Copyright © 2017 Animesh Kumar et al. All rights reserved. Can a Risk Factor Based Approach Safely Reduce Screening for Retinopathy of Prematurity? Mon, 09 Jan 2017 09:22:43 +0000 http://www.hindawi.com/journals/ijpedi/2017/9372539/ Objective. Current American retinopathy of prematurity (ROP) screening guidelines is imprecise for infants ≥ 30 weeks with birth weights between 1500 and 2000 g. Our objective was to evaluate a risk factor based approach for screening premature infants at low risk for severe ROP. Study Design. We performed a 13-year review from Intermountain Health Care (IHC) data. All neonates born at ≤32 weeks were reviewed to determine ROP screening and/or development of severe ROP. Severe ROP was defined by stage ≥ 3 or need for laser therapy. Regression analysis was used to identify significant risk factors for severe ROP. Results. We identified 4607 neonates ≤ 32 weeks gestation. Following exclusion for death, with no retinal exam or incomplete data, 2791 (61%) were included in the study. Overall, severe ROP occurred in 260 (9.3%), but only 11/1601 ≥ 29 weeks (0.7%). All infants with severe ROP ≥ 29 weeks had at least 2 identified ROP risk factors. Implementation of this risk based screening strategy to the IHC population over the timeline of this study would have eliminated screening in 21% (343/1601) of the screened population. Conclusions. Limiting ROP screening for infants ≥ 29 and ≤ 32 weeks to only those with clinical risk factors could significantly reduce screening exams while identifying all infants with severe ROP. K. M. Friddle, B. A. Yoder, M. E. Hartnett, E. Henry, and R. J. DiGeronimo Copyright © 2017 K. M. Friddle et al. All rights reserved. Text Message Reminders Increase Appointment Adherence in a Pediatric Clinic: A Randomized Controlled Trial Thu, 29 Dec 2016 08:24:06 +0000 http://www.hindawi.com/journals/ijpedi/2016/8487378/ Background. High no-show rates can burden clinic productivity and affect patient care. Although multiple studies have shown that text messages improve appointment adherence, very little research has focused on low-income and predominantly African American populations in resident clinic settings. Objectives. To determine whether incorporating a text message reminder reduces the no-show rate at an urban, pediatric resident clinic. Methods. A randomized controlled trial was conducted at a tertiary level ambulatory pediatric practice between August 2014 and February 2015. Following a demographic survey, 170 patients were enrolled. Patients were randomized into control or intervention groups. All patients received the standard voice message appointment reminder, but the intervention group additionally received a text message reminder. The primary outcome was no-show rate. Results. 95.3% of the participants were African American, and the overall no-show rate was 30.8%. No-show rate was significantly lower in the intervention group (23.5%) than the control group (38.1%) representing a difference of 14.6% (). No demographic factors were found to alter the association between no-show rate and text message intervention. Conclusions. Text message reminders effectively improve show rates at a resident pediatric practice with high no-show rates, representing a promising approach to improving appointment adherence. Chia-Lei Lin, Nila Mistry, Jordana Boneh, Hong Li, and Rina Lazebnik Copyright © 2016 Chia-Lei Lin et al. All rights reserved. Rubella and Congenital Rubella Syndrome in the Philippines: A Systematic Review Wed, 28 Dec 2016 10:07:38 +0000 http://www.hindawi.com/journals/ijpedi/2016/8158712/ Background. As part of regional elimination efforts, rubella-containing vaccines (RCV) have recently been introduced in the Philippines, yet the true burden of rubella and congenital rubella syndrome (CRS) in the country is largely unknown. Objective. To provide baseline information on rubella and CRS prior to routine vaccine introduction in the Philippines. Methods. We conducted a systematic literature review on rubella and CRS in the Philippines, including a cross-sectional study conducted in 2002 among 383 pregnant women attending the obstetric outpatient clinic of the Philippine General Hospital to assess rubella susceptibility of women of childbearing age. Results. 15 locally published and unpublished studies were reviewed. Susceptibility to rubella among women of childbearing age was higher in rural communities. Retrospective reviews revealed congenital heart diseases, cataracts, and hearing impairments to be most common presentations in children of CRS. In the cross-sectional study, 59 (15.4%) of the 383 pregnant women enrolled were seronegative for rubella IgG. Conclusion. Similar to other countries introducing RCV, it was only recently that surveillance for rubella has been established. Previous studies show substantial disabilities due to CRS and a substantial proportion of susceptible women who are at risk for having babies affected with CRS. Establishment of CRS surveillance and enhanced awareness on rubella case detection should be prioritized. Anna Lena Lopez, Peter Francis N. Raguindin, Maria Asuncion Silvestre, Xenia Cathrine J. Fabay, Ariel B. Vinarao, and Ricardo Manalastas Copyright © 2016 Anna Lena Lopez et al. All rights reserved. Perceived Body Image, Eating Behavior, and Sedentary Activities and Body Mass Index Categories in Kuwaiti Female Adolescents Wed, 30 Nov 2016 07:36:10 +0000 http://www.hindawi.com/journals/ijpedi/2016/1092819/ Background. The State of Kuwait has a growing obesity epidemic in both genders and all age groups; however, obesity rates in the young seem to be rising. Methods. We conducted a cross-sectional survey in 169 Kuwaiti female adolescents attending both private and public schools spanning the six governorates in the State of Kuwait in order to explore female adolescents’ self-image, body dissatisfaction, type of school (private versus public), TV viewing, and computer games and their relationship to body mass index. Results. Approximately half the students classified as obese perceived their body image to lie in the normal range. Females in the obese category were the most dissatisfied with their body image, followed by those in the overweight category. Eating behavior, level of physical activity, school type, television viewing, computer/video usage, and desired BMI were not significantly associated with level of obesity. Conclusion. This study was one of the few studies to assess adolescent females’ body image dissatisfaction in relation to obesity in the State of Kuwait. The results suggest that including body image dissatisfaction awareness into obesity prevention programs would be of value. Lemia H. Shaban, Joan A. Vaccaro, Shiryn D. Sukhram, and Fatma G. Huffman Copyright © 2016 Lemia H. Shaban et al. All rights reserved. Viral Agents Causing Acute Respiratory Infections in Children under Five: A Study from Eastern India Sun, 27 Nov 2016 12:20:22 +0000 http://www.hindawi.com/journals/ijpedi/2016/7235482/ Background. Acute respiratory infections (ARIs) are important cause of mortality and morbidity in children under five in developing country. Methods. This observational study was conducted over two-year period in a tertiary care teaching hospital of Eastern India. Nasal and throat swabs were collected, transported to the laboratory at 2–8°C in viral transport media, and then processed for detection of viruses using mono/multiplex real-time polymerase chain reaction. Results. A total of 300 children aged 2–60 months with ARIs were included. The most common age group affected with LRI was 2–12 mo and with URI was >12–60 mo. Viruses were detected in 248 cases. In URI, 77 were positive for single virus and 19 were positive for more than one virus; in LRI, 113 were positive for single virus and 12 were positive for more than one virus. The most common viruses isolated from URI cases were rhinovirus and adenovirus. The most common viruses isolated from LRI cases were respiratory syncytial virus and influenza virus. Most cases occurred in the months of January, December, and August. Conclusion. Viruses constitute a significant cause of ARI in children under five. RSV, ADV, RV, and IFV were the most prevalent viruses isolated. Pravakar Mishra, Lipika Nayak, Rashmi Ranjan Das, Bhagirathi Dwibedi, and Amitabh Singh Copyright © 2016 Pravakar Mishra et al. All rights reserved. Discharge against Medical Advice at Neonatal Intensive Care Unit in Gujarat, India Thu, 24 Nov 2016 13:59:02 +0000 http://www.hindawi.com/journals/ijpedi/2016/1897039/ Objective. We explored reasons for discharged against medical advice (DAMA) of neonates from a neonatal intensive care unit (NICU) through in-depth interviews of the parents/guardians. Methods. Of 456 babies admitted to NICU during April 2014 to March 2015, 116 babies were DAMA. Parents of randomly selected 50 babies of these 116, residing within 50 kilometers, were approached for in-depth interviews at their homes. Audio recordings were done and manually transcribed, analyzed in detail to explore common threads leading to DAMA. Basic demographic information of the newborns was retrieved from hospital records. Results. The prevalence of DAMA was 25.4%. Of 50 parents approached, 41 in-depth interviews were completed. Nonaffordability (38.6%), no improvement (14.6%), poor prognosis (12%), and inappropriate behavior of the patient relation office personnel (10.6%) were major factors contributing to DAMA. Parents of 6.6% neonates wanted guarantee of survival and 5.3% parents reported poor behavior of nurses. No gender bias was observed related to DAMA. One-third of neonates (34.1%) were DAMA on first day of admission. Conclusions. The issue of DAMA needs attention. Besides nonaffordability and clinical characteristics of the baby, communication (breaking bad news, counseling, etc.) and lack of adequate infrastructure for relatives emerged as modifiable factors leading to DAMA. Bhanu Devpura, Pranav Bhadesia, Somashekhar Nimbalkar, Sandeep Desai, and Ajay Phatak Copyright © 2016 Bhanu Devpura et al. All rights reserved. Reservoir Cannulas for Pediatric Oxygen Therapy: A Proof-of-Concept Study Wed, 23 Nov 2016 07:46:48 +0000 http://www.hindawi.com/journals/ijpedi/2016/9214389/ Hypoxemia is a complication of pneumonia—the leading infectious cause of death in children worldwide. Treatment generally requires oxygen-enriched air, but access in low-resource settings is expensive and unreliable. We explored use of reservoir cannulas (RCs), which yield oxygen savings in adults but have not been examined in children. Toddler, small child, and adolescent breathing profiles were simulated with artificial lung and airway models. An oxygen concentrator provided flow rates of 0 to 5 L/min via a standard nasal cannula (NC) or RC, and delivered oxygen fraction (FdO2) was measured. The oxygen savings ratio (SR) and absolute flow savings (AFS) were calculated, comparing NC and RC. We demonstrated proof-of-concept that pendant RCs could conserve oxygen during pediatric therapy. SR mean and standard deviation were to , to , and to for toddler, small child, and adolescent models, respectively. Maximum AFS observed were , , and  L/min for the same models. RCs have the potential to reduce oxygen consumption during treatment of hypoxemia in children; however, further evaluation of products is needed, followed by clinical analysis in patients. Grace Wu, Alec Wollen, Robert M. DiBlasi, Stephen Himley, Eugene Saxon, Glenn Austin, Jaclyn Delarosa, Rasa Izadnegahdar, Amy Sarah Ginsburg, and Darin Zehrung Copyright © 2016 Grace Wu et al. All rights reserved. Congenital Lumbar Hernia: A 15-Year Experience at a Single Tertiary Centre Tue, 22 Nov 2016 13:59:36 +0000 http://www.hindawi.com/journals/ijpedi/2016/7162475/ Aim. Congenital lumbar hernia is an uncommon anomaly with only few cases reported in the English literature. This study was done to study the incidence, age at presentation, sex, associated anomalies, surgical management, and postoperative morbidity and mortality of congenital lumbar hernia in pediatric patients. Methods. Retrospective analysis of all patients of CLH over a period of 15 years (January 2000 to December 2015) was analyzed. Results. A total of 14 patients were encountered in this series. All presented within first 2 years of age. 12 were males and 2 were females. All of them presented with swelling in lumbar region. 13 were unilateral and 1 was bilateral. Left sided hernia was observed in 2 cases only. Lumbocostovertebral syndrome was found in all the patients in addition to other rare anomalies. All cases were managed with open surgical repair. Wound infection was seen in 2 cases. There was no mortality in our series. Conclusion. CLH is very rare among hernias. Surgery should be carried out within 1 year of age. For a defect of <5 cm, primary repair is done. For a defect of >5 cm, meshplasty should be considered. Prognosis is excellent. K. N. Rattan, Arushi Agarwal, Ankur Dhiman, and Ananta Rattan Copyright © 2016 K. N. Rattan et al. All rights reserved. Morbidity and Mortality in Preterm Infants following Antacid Use: A Retrospective Audit Mon, 21 Nov 2016 11:15:27 +0000 http://www.hindawi.com/journals/ijpedi/2016/9649162/ Background and Objectives. Antacids are often prescribed to preterm infants due to misdiagnosis of gastro-oesophageal reflux. This suppresses gastric acidity, a major defence mechanism against infection. This study aims to determine if ranitidine and omeprazole use in very low birth weight (VLBW) neonates, <1500 grams, is associated with increased risk of late onset sepsis, necrotising enterocolitis (NEC), and mortality. Methods. Retrospective analysis was conducted on neonates, <1500 grams, born and admitted into the Neonatal Intensive Care Unit at The Canberra Hospital during the period from January 2008 to December 2012. Information regarding late onset sepsis, NEC, mortality, ranitidine/omeprazole use, and other neonatal/hospital factors was collected for each neonate. Results. 360 neonates were evaluated, 64 received ranitidine and/or omeprazole, and 296 had not. There were no statistically significant differences in incidence of late onset sepsis (OR = 0.52, CI = 0.24–1.1, and p = 0.117), NEC Stage 2 and above (OR = 0.4, CI = 0.05–3.2, and = 0.7), or mortality (OR = 0.35, CI = 0.08–1.5, and = 0.19) between the two groups. After adjusting significant differences in neonatal and hospital factors, risk of late onset sepsis was significantly lower in those that received ranitidine/omeprazole (OR = 0.28, CI = 0.13–0.65, and = 0.003). Conclusions. Ranitidine and omeprazole use in VLBW preterm infants may not be associated with an increased risk of infection, NEC, and mortality. Natasha Singh, Aparna Dhayade, Abdel-Latif Mohamed, and Tejasvi Vasant Chaudhari Copyright © 2016 Natasha Singh et al. All rights reserved. Factors Associated with Successful Mentoring of Parents Addressing Childhood Obesity: A Mixed Methods Approach Sun, 20 Nov 2016 14:20:50 +0000 http://www.hindawi.com/journals/ijpedi/2016/5769621/ Objective. Parents mentoring other parents as a behavioral intervention for child obesity is novel with limited data describing the experience and dynamics of this approach. This study aimed to describe the experiences of parent mentors and the self-efficacy and attitudes of their mentees in the context of a clinical trial for childhood obesity. Methods. The context for this study was a randomized clinical trial using either parent mentors or a community health worker engaging parents of obese children in behavioral change over six months. Parent mentors were interviewed at the mid-point of the intervention using a semistructured questionnaire to elicit their perceptions and experiences during the process of mentoring. Parent mentees completed a survey assessing their self-efficacy, perception of the parent mentor, and attitudes and beliefs related to their child’s weight. Results. The qualitative analysis of parent mentor interviews indicated high commitment despite their nonprofessional status, facing challenges of engagement with fellow parents and attitudes of persistence and being nonjudgmental. The parent mentee ratings of parent mentors were overall very high and similar to the ratings of a community health worker (paraprofessional). Conclusion. The data suggest that a parent mentor model of intervention for child obesity is an acceptable mode of approaching behavior change in the Hispanic population around childhood obesity with potential for scalability if proven effective. Gabriela Abigail Villanueva and Byron Alexander Foster Copyright © 2016 Gabriela Abigail Villanueva and Byron Alexander Foster. All rights reserved. Process Mapping in a Pediatric Emergency Department to Minimize Missed Urinary Tract Infections Wed, 16 Nov 2016 14:04:43 +0000 http://www.hindawi.com/journals/ijpedi/2016/2625870/ Urinary tract infections (UTIs) are common in young children and are seen in emergency departments (EDs) frequently. Left untreated, UTIs can lead to more severe conditions. Our goal was to undertake a quality improvement (QI) initiative to help minimize the number of children with missed UTIs in a newly established tertiary care pediatric emergency department (PED). A retrospective chart review was undertaken to identify missed UTIs in children < 3 years old who presented to a children’s hospital’s ED with positive urine cultures. It was found that there was no treatment or follow-up in 12% of positive urine cultures, indicating a missed or possible missed UTI in a significant number of children. Key stakeholders were then gathered and process mapping (PM) was completed, where gaps and barriers were identified and interventions were subsequently implemented. A follow-up chart review was completed to assess the impact of PM in reducing the number of missed UTIs. Following PM and its implementation within the ED, there was no treatment or follow-up in only 1% of cases. Based on our results, the number of potentially missed UTIs in the ED decreased dramatically, indicating that PM can be a successful QI tool in an acute care pediatric setting. Morgan Black, Valene Singh, Vladimir Belostotsky, Madan Roy, Deborah Yamamura, Kathryn Gambarotto, Keith Lau, and April J. Kam Copyright © 2016 Morgan Black et al. All rights reserved. Echocardiography as a Screening Test for Myocardial Scarring in Children with Hypertrophic Cardiomyopathy Tue, 15 Nov 2016 06:16:12 +0000 http://www.hindawi.com/journals/ijpedi/2016/1980636/ Introduction. Hypertrophic cardiomyopathy (HCM) is burdened with morbidity and mortality including tachyarrhythmias and sudden cardiac death. These complications are attributed in part to the formation of proarrhythmic scars in the myocardium. The presence of extensive LGE is a risk factor for adverse outcomes in HCM. Late gadolinium enhancement (LGE) cardiac magnetic resonance imaging (cMRI) is the standard for the noninvasive evaluation of myocardial scars. However, echocardiography represents an attractive screening tool for myocardial scarring. The aim of this study was to compare the suitability of echocardiography to detect myocardial scars to the standard of cMRI-LGE. Methods. The cMRI studies and echocardiograms from 56 consecutive children with HCM were independently evaluated for the presence of cMRI-LGE and echocardiographic evidence of scarring by expert readers. Results. Echocardiography had a high sensitivity (93%) and negative predictive value (94%) in comparison to LGE. The false positive rate was high, leading to a low specificity (37%) and a low positive predictive value (35%). Conclusions. Given the poor specificity and positive predictive value, echocardiography is not a suitable screening test for the presence of myocardial scarring in children with HCM. However, children without echocardiographic evidence of myocardial scarring may not need to undergo cardiac magnetic resonance imaging to “rule in” LGE. Gregory Compton, Lynne Nield, Andreea Dragulescu, Lee Benson, and Lars Grosse-Wortmann Copyright © 2016 Gregory Compton et al. All rights reserved. Biodemographic Analysis of Factors Related to Perinatal Mortality in Portugal (1988–2011) Thu, 27 Oct 2016 14:18:25 +0000 http://www.hindawi.com/journals/ijpedi/2016/6123065/ Background. The purpose of this paper is to determine the relative mortality risks at delivery and during the first week of life with regard to maternal and foetal characteristics. Methods. Yearly individual digital records on live births and early neonatal mortality were used to infer the possible factors involved in perinatal deaths. Results. The results show that the number of births per year declined with time throughout the period studied. At the same time, rates decreased in 66.4% for stillbirths and in 70.2% for early neonatal mortality. Logistic regressions modelled the interaction of the two mortality indicators and covariables such as birth weight and the duration of gestation. Conclusions. This research provides a first biodemographic approach to the knowledge of factors influencing perinatal mortality in Portugal based on a set of foetal and maternal variables. Although the magnitude of the different perinatal mortality rates may be affected by the criteria used for selecting cases (multiple-singletons; minimum birth weight or minimum duration of gestation), one of the conclusions of the present analysis is that the relationship among the maternal and foetal variables that determine the relative risk remains unaltered. Certain resemblance with the factors determining negative birth outcomes in Spain is appreciated. Vicente Fuster Copyright © 2016 Vicente Fuster. All rights reserved. Is the Presence of the Father of the Baby during First Prenatal Ultrasound Study Visit Associated with Improved Pregnancy Outcomes in Adolescents and Young Adults? Tue, 04 Oct 2016 09:34:18 +0000 http://www.hindawi.com/journals/ijpedi/2016/4632628/ This study examined whether the presence of the father of the baby (FOB) at the first prenatal ultrasound study (US) visit of pregnant adolescents and young adults (AYA) is a marker for improved pregnancy outcomes. Charts of 400 pregnant AYA aged 14–22 years seen at an academic maternity hospital were assessed retrospectively for support persons brought to prenatal US visits. Logistic regression analysis was used to examine the association between FOB presence and gestational age and birth weight. Of 400 charts with support person recorded, 298 charts with first US visit data, singleton birth, and complete gestational data available were analyzed. FOB was present at 30.2% of visits, while the parent of the mother was present at 34.2% of visits. With FOB present, 3.3% of infants were born preterm (gestational age < 37 weeks) compared with 10.5% of infants with FOB absent (). Patients with FOB present also had significantly earlier gestational age at the first US visit (15 weeks) than those who did not (19 weeks; ). For AYA, the presence of FOB at initial prenatal US visits is a predictor of improved pregnancy outcome and likely represents increased support during the pregnancy. Sara H. Lee, Rina Lazebnik, Margaret Kuper-Sassé, and Noam Lazebnik Copyright © 2016 Sara H. Lee et al. All rights reserved. Spirulina Supplements Improved the Nutritional Status of Undernourished Children Quickly and Significantly: Experience from Kisantu, the Democratic Republic of the Congo Thu, 29 Sep 2016 11:37:10 +0000 http://www.hindawi.com/journals/ijpedi/2016/1296414/ Aim. Despite high levels of malnutrition, there is still very little information on the nutritional benefits of Spirulina, a natural alga that provides essential amino acids, rare essential lipids, and numerous minerals and vitamins, to undernourished children in the world. Methods. We carried out a prospective study of 50 children aged between six and 60 months. The intervention group consisted of 16 children who received 10 g of Spirulina daily, as well as the local diet administered by the nutritional centre, and the control group of 34 children who just received the local diet. Both groups of children were assessed on day zero, day 15, and day 30. Results. After treatment, the weight-for-age scores and weight-for-height scores increased significantly in the intervention group. At day 15, there was a statistically significant difference between the mean corpuscular volume, total proteins, and albumin () in both groups, in favour of the intervention group, and at day 30, this difference extended to all of the studied parameters (). Conclusion. This study found that the nutritional status of undernourished children who received Spirulina supplements as well as the local diet administered by the nutritional centre improved quickly and significantly. Féfé Khuabi Matondo, Kikuni Takaisi, Adolphine Bedi Nkuadiolandu, Aimé Kazadi Lukusa, and Michel Ntetani Aloni Copyright © 2016 Féfé Khuabi Matondo et al. All rights reserved. Suboptimal Clinical Documentation in Young Children with Severe Obesity at Tertiary Care Centers Tue, 06 Sep 2016 13:57:25 +0000 http://www.hindawi.com/journals/ijpedi/2016/4068582/ Background and Objectives. The prevalence of severe obesity in children has doubled in the past decade. The objective of this study is to identify the clinical documentation of obesity in young children with a BMI ≥ 99th percentile at two large tertiary care pediatric hospitals. Methods. We used a standardized algorithm utilizing data from electronic health records to identify children with severe early onset obesity (BMI ≥ 99th percentile at age <6 years). We extracted descriptive terms and ICD-9 codes to evaluate documentation of obesity at Boston Children’s Hospital and Cincinnati Children’s Hospital and Medical Center between 2007 and 2014. Results. A total of 9887 visit records of 2588 children with severe early onset obesity were identified. Based on predefined criteria for documentation of obesity, 21.5% of children (13.5% of visits) had positive documentation, which varied by institution. Documentation in children first seen under 2 years of age was lower than in older children (15% versus 26%). Documentation was significantly higher in girls (29% versus 17%, ), African American children (27% versus 19% in whites, ), and the obesity focused specialty clinics (70% versus 15% in primary care and 9% in other subspecialty clinics, ). Conclusions. There is significant opportunity for improvement in documentation of obesity in young children, even years after the 2007 AAP guidelines for management of obesity. Cassandra C. Brady, Vidhu V. Thaker, Todd Lingren, Jessica G. Woo, Stephanie S. Kennebeck, Bahram Namjou-Khales, Ashton Roach, Jonathan P. Bickel, Nandan Patibandla, Guergana K. Savova, Imre Solti, Ingrid A. Holm, John B. Harley, Isaac S. Kohane, and Nancy A. Crimmins Copyright © 2016 Cassandra C. Brady et al. All rights reserved. Nutritional Status and Intestinal Parasite in School Age Children: A Comparative Cross-Sectional Study Tue, 30 Aug 2016 10:20:03 +0000 http://www.hindawi.com/journals/ijpedi/2016/1962128/ Background. The objectives of this study were to determine the burden of underweight and intestinal parasitic infection in the urban and rural elementary school children. Methods. A comparative cross-sectional study design was conducted. Binary logistic regression was used to identify the determinants of malnutrition or intestinal parasites. Two independent samples’ -test was used to identify the effect of malnutrition on school performance or hemoglobin level. Results. A total of 2372 students were included. Quarters (24.8%) of school children were underweight. Underweight was associated with sex [adjusted odds ratio (AOR) 0.61; 95% CI = 0.47–0.78], age [AOR = 0.21; 95% CI = 0.16–0.28], intestinal parasitic infection [AOR 2.67; 95% CI = 2–3.55], and family size [AOR 23; 95% CI = 17.67–30.02]. The prevalence of intestinal parasite among school children was 61.7% [95% CI = 60%–64%]. Shoe wearing practice [AOR 0.71; 95% CI = 0.58–0.87], personal hygiene [AOR 0.8; 95% CI = 0.65–0.99], availability of latrine [AOR 0.34; 95% CI = 0.27–0.44], age [AOR 0.58; 95% CI = 0.48–0.7], habit of eating raw vegetables [AOR 3.71; 95% CI = 3.01–4.46], and family size [AOR 1.96; 95% CI = 1.57–2.45] were the predictors of intestinal parasitic infection. Berhanu Elfu Feleke Copyright © 2016 Berhanu Elfu Feleke. All rights reserved. Factors Associated with Klebsiella Bacteremia and Its Outcome in Under-Five Children Admitted with Diarrhea Mon, 29 Aug 2016 16:25:31 +0000 http://www.hindawi.com/journals/ijpedi/2016/4760610/ Although Klebsiella bacteremia in children is perceived to be associated with fatal consequences, data are scarce on those children presenting with diarrhea. We evaluated the factors associated with Klebsiella bacteremia in such children. In this retrospective chart analysis, data of all diarrheal children was retrieved from electronic medical record system (named as SHEBA) of Dhaka Hospital of International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), from January 1, 2010, to December 31, 2012, who had their blood culture done. This was a study having a case-control design where comparison of clinical and laboratory characteristics was done among children with Klebsiella bacteremia (cases = 30) and those without any bacteraemia (controls = 90). Controls were selected randomly. The cases more often had fatal outcome (). In logistic regression analysis, after adjusting for potential confounders such as young age, severe dehydration, severe wasting, abnormal mentation, hypotension, and fast breathing, the cases were independently associated with hospital-acquired infection and positive stool growth (for all, ). The study highlights the importance of obtaining blood cultures in hospitalized children under five years old with diarrheal illness in the presence of either hospital-acquired infection or positive stool culture to have better outcome. Shamima Akhter, Tahmeed Ahmed, Shafiqul Alam Sarker, Monira Sarmin, Abu S. M. S. B. Shahid, K. M. Shahunja, Shoeb Bin Islam, Lubaba Shahrin, Tahmina Alam, Nur Haque Alam, and Mohammod Jobayer Chisti Copyright © 2016 Shamima Akhter et al. All rights reserved. Evaluating Bone Health in Egyptian Children with Forearm Fractures: A Case Control Study Mon, 29 Aug 2016 08:58:10 +0000 http://www.hindawi.com/journals/ijpedi/2016/7297092/ Objective. To determine the likelihood of vitamin D deficiency and low bone mineral density in Egyptian children with forearm fractures. Methods. A case control study of 46 children aged 3 to 10 years with or without forearm fractures. Validated questionnaires were used to assess calcium and vitamin D intake as well as sun exposure. Serum calcium, phosphorus, alkaline phosphatase, and 25-hydroxy-vitamin D were collected. Bone mineral density was evaluated using dual-energy X-ray absorptiometry. Results. Compared to the Control group, calcium and vitamin D intake was lower in the Cases group (). Cases had higher Body Mass Index than Controls, . Children in the Cases group had lower mean serum calcium values compared to in Controls (). Alkaline phosphatase was higher in Cases than Controls (). Vitamin D and bone mineral density scores were significantly lower in the Cases group (). Conclusion. Our data shows an increased rate of vitamin D deficiency and decreased bone mineral density in Egyptian children with forearm fractures. Abeer El-Sakka, Cristina Penon, Adham Hegazy, Salwa Elbatrawy, Amr Gobashy, and Alvaro Moreira Copyright © 2016 Abeer El-Sakka et al. All rights reserved. Comparison of Axillary and Tympanic Temperature Measurements in Children Diagnosed with Acute Otitis Media Sun, 28 Aug 2016 09:13:18 +0000 http://www.hindawi.com/journals/ijpedi/2016/1729218/ Background. Acute otitis media [AOM] may affect the accuracy of tympanic temperature measurements. We aimed to compare tympanic temperature measurements in patients with AOM against control groups, as well as compare the tympanic temperatures with axillary thermometry. Methods. This is a prospective, observational study. Patients from pediatric outpatient and emergency clinics who were diagnosed as single-sided AOM were included consecutively in the study. Normal ears of patients and children having the same age and gender who were not diagnosed as AOM were also studied as controls. Results. In patients with AOM, infected ears had higher temperatures than normal ears with a mean of °C. There was no significant difference between the right and left tympanic temperatures in control group. Compared with axillary temperature, the sensitivity of tympanic temperature in the infected ear was 91.7% and the specificity was 74.8%. Conclusion. Comparisons of axillary and tympanic temperatures in children with AOM during the active infection concluded higher tympanic temperatures in infected ears. We suggest that the higher tympanic temperatures, approximately 0.5°C in our study, in infected ears may aid in diagnosis of patients with fever without a source in pediatric clinics. Hatice Hilal Doğan, Rabia Gönül Sezer, Tarık Kırkgöz, and Abdulkadir Bozaykut Copyright © 2016 Hatice Hilal Doğan et al. All rights reserved. Septic Arthritis of the Pediatric Shoulder: From Infancy to Adolescence Sun, 21 Aug 2016 12:16:37 +0000 http://www.hindawi.com/journals/ijpedi/2016/3086019/ Background. Septic arthritis of the glenohumeral joint in the pediatric population (<18 yo) is not commonly described in the literature. There is a corresponding paucity of information regarding its presentation and treatment. Methods. An IRB approved review of patients treated with irrigation and debridement by the Orthopaedic Department was completed. This retrospective study includes four patients, presenting from 2005 to 2015, with septic arthritis of the shoulder. Results. The mean age () at presentation was 5 years, with a range of 1 month to 15 years. Patients presented on average after 7 days with pain and a mean temperature of 39°C, erythrocyte sedimentation rate of 66 mm/hr, a C-reactive protein level of 11.17 g/dL, and a white blood cell count of 20.2 × 103/mcL. Staphylococcus aureus, Candida albicans, and Pseudomonas aeruginosa were cultured from the wounds. All cases were treated operatively with irrigation and debridement and with antimicrobial therapy. Patients received antibiotics for an average of 6 weeks. Conclusion. Septic arthritis of the shoulder occurs in all pediatric ages. Successful treatment of septic arthritis of the shoulder was accomplished in four cases without division of the biceps sheath, with an average follow-up of 8 months. Justin W. Walker and William L. Hennrikus Copyright © 2016 Justin W. Walker and William L. Hennrikus. All rights reserved. Fecal Microbiota and Diet of Children with Chronic Constipation Thu, 23 Jun 2016 11:05:35 +0000 http://www.hindawi.com/journals/ijpedi/2016/6787269/ Many factors explain dysbiosis in chronic constipation (CC), such as a low-fiber diet. The objective of this study was to compare the fecal microbiota of constipated and nonconstipated children and their intake frequencies of food. Methods. This observational study included 79 children (M/F 43/36) aged six to 36 months divided into two groups: cases (39 constipated children) and controls (40 nonconstipated children). We used a structured form to collect demographic variables, conducted anthropometric assessment, and collected food intake frequency data. The fecal microbiota of the stool samples was analyzed by real-time polymerase chain reaction (PCR) using the fluorophore SYBR® Green. Results. Constipated children had a smaller concentration of Lactobacillus per milligram of stool () than nonconstipated children, but the concentration of Bifidobacterium per milligram of stool () and the intake of fruits, vegetables (), and junk food () of the two groups did not differ. Constipated children consumed more dairy products (; ), were more frequently delivered via caesarean section (69.2%), were weaned earlier (median: 120; ), and had a family history of constipation (71.8%). Conclusions. Children with CC have a smaller concentration of Lactobacillus in their stools and consume more dairy products. Joyce Gomes de Moraes, Maria Eugênia Farias de Almeida Motta, Monique Ferraz de Sá Beltrão, Taciana Lima Salviano, and Giselia Alves Pontes da Silva Copyright © 2016 Joyce Gomes de Moraes et al. All rights reserved. Knowledge about Epilepsy and Attitudes toward Students with Epilepsy among Middle and High School Teachers in Kuwait Wed, 15 Jun 2016 12:18:21 +0000 http://www.hindawi.com/journals/ijpedi/2016/5138952/ Background and Objectives. Attitudes toward students with epilepsy and epilepsy-related knowledge of teachers are crucial for child’s safety in the school. The aim of this study was to evaluate teachers’ knowledge and attitudes toward epilepsy. Methods. This cross-sectional study included 824 teachers from 24 randomly selected middle and high schools. Scale of Attitudes Toward Persons with Epilepsy (ATPE) was modified to assess teachers’ knowledge about epilepsy and attitudes toward students with epilepsy. Results. Median knowledge score about epilepsy was 5 (out of 13), while median attitude score was 10 (out of 15). Both knowledge and attitude median scores were significantly higher in senior teachers with longer teaching experience and in respondents who dealt with a person with epilepsy. There was significant association between knowledge score and attitude score (). Logistic regression showed that significant variables, independently associated with poor knowledge after adjusting for possible confounders, were not having a family member with epilepsy (), unawareness of life circumstances of persons with epilepsy (), and a poor attitude score (). Conclusion. School teachers in Kuwait have relatively poor knowledge about epilepsy but have positive attitudes toward students with epilepsy. A number of historical and stigmatizing ideas about epilepsy still exist. It is recommended to provide teachers with information about handling seizures in the educational setting through development and implementation of epilepsy education programs. Eman Al-Hashemi, Abdullatif Ashkanani, Haneen Al-Qattan, Asmaa Mahmoud, Majd Al-Kabbani, Abdulaziz Al-Juhaidli, Ahmad Jaafar, and Zahraa Al-Hashemi Copyright © 2016 Eman Al-Hashemi et al. All rights reserved. Timing of Caffeine Therapy and Neonatal Outcomes in Preterm Infants: A Retrospective Study Sun, 08 May 2016 14:18:42 +0000 http://www.hindawi.com/journals/ijpedi/2016/9478204/ 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 http://www.hindawi.com/journals/ijpedi/2016/8356582/ 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 (Clinicaltrials.gov). 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.