International Journal of Pediatrics The latest articles from Hindawi © 2017 , Hindawi Limited . All rights reserved. Implementing an Oxygen Supplementation and Monitoring Protocol on Inpatient Pediatric Bronchiolitis: An Exercise in Deimplementation Wed, 18 Oct 2017 00:00:00 +0000 Aim. Our goal in this study is to evaluate the effectiveness of our oxygen () protocol to reduce length of stay (LOS) for children hospitalized with bronchiolitis. Methods. In this retrospective cohort study, the outcomes of children ≤ 24 months old that were admitted with bronchiolitis and placed on the protocol were compared to historical controls. The primary outcome was hospital length of stay. Secondary outcomes were duration of supplementation, rates of pediatric intensive care unit transfer, and readmission. Results. Groups were not significantly different in age, gender, and rates of respiratory distress score assessment. Significantly more severely ill patients were in the protocol group. There were no significant differences between control and protocol groups with regard to mean LOS, rates of pediatric intensive care unit transfer, or seven-day readmission rates. By multiple regression analysis, the use of the protocol was associated with a nearly 20% significant decrease in the length of hospitalization (). Conclusion. Use of supplementation protocol increased LOS in the more ill patients with bronchiolitis but decreased overall LOS by having a profound effect on patients with mild bronchiolitis. Brian LeCleir, Leslie Jurecko, Alan T. Davis, Nicholas J. Andersen, Dominic Sanfilippo, Surender Rajasekaran, and Anthony Olivero Copyright © 2017 Brian LeCleir et al. All rights reserved. Adherence to Integrated Management of Childhood Illnesses Guideline in Treating South Sudanese Children with Cough or Difficulty in Breathing Mon, 18 Sep 2017 06:57:30 +0000 Background. Pneumonia substantially kills children aged 2–59 months in South Sudan. However, information on health workers adherence to Integrated Management of Childhood Illnesses (IMCI) guideline in treating children with cough/difficulty in breathing remains scarce. This study assessed factors associated with adherence to IMCI guideline in Aweil East County, South Sudan. Methods. This cross-sectional study involved 232 health workers from 36 health facilities. Data collected using structured questionnaire and checklist was double-entered in EpiData and analyzed with STATA at 5% significance level using logistic regression. Results. Respondents mean age was years, 154 (66.4%) were males, 104 (44.8%) reached secondary education, and 190 (81.9%) had certificate. 23 (9.9%, 95% CI: 6.4–14.5) adhered to IMCI guideline. Holding diploma (adjusted odds ratio (AOR) = 6.97; 95% Confidence Interval (CI): 1.82–26.67; ), shorter time to follow guideline steps (AOR = 12.0; 95% CI: 2.73–61.66; ), and nondifficult use (AOR = 27.7; 95% CI: 5.40–142.25; ) were associated with adherence. Conclusion. Adherence was low. Academic qualifications, guideline complexity, and availability of IMCI drugs were associated factors. Jonathan Izudi, Stanley Anyigu, and David Ndungutse Copyright © 2017 Jonathan Izudi et al. All rights reserved. The Fatty Acid Profile in Patients with Newly Diagnosed Diabetes: Why It Could Be Unsuspected Mon, 11 Sep 2017 08:34:46 +0000 Context. Several studies have shown a link between proinflammatory activity and the presence or deficit of some fatty acids. Inflammation is associated with several diseases including diabetes. Objective. To characterize and compare the fatty acids profiles in children with inaugural type 1 diabetes, diabetic children (at least 1 year after diagnosis), and healthy children. Design. Plasma fatty acids profiles in children with inaugural diabetes, children with noninaugural diabetes, and controls, all of whom were prepubescent with a BMI < 85th percentile, were evaluated. Results. Omega-3 fatty acid levels were higher in recently diagnosed subjects with diabetes than in controls. The ratio of omega-6/omega-3 fatty acids was higher in the control population. Omega-6 fatty acid levels were higher in the nonrecent diabetic subjects than in the children with recently diagnosed diabetes, and the levels were higher in the nonrecent diabetes group compared to the control group. Conclusion. Our findings showed higher levels of alpha-linolenic acid, EPA, and DHA, as well as mono- and polyunsaturated fatty acids, in diabetic children. These findings reinforce the importance of precocious nutritional attention and intervention in the treatment of diabetic children. C. Castro-Correia, S. Sousa, S. Norberto, C. Matos, V. F. Domingues, M. Fontoura, and C. Calhau Copyright © 2017 C. Castro-Correia et al. All rights reserved. Case-Control Pilot Study on Acute Diarrheal Disease in a Geographically Defined Pediatric Population in a Middle Income Country Thu, 10 Aug 2017 06:55:09 +0000 Introduction. Acute diarrheal disease (ADD) is a common cause of morbidity and mortality in children under 5 years of age. Understanding of the etiology of ADD is lacking in most low and middle income countries because reference laboratories detect limited number of pathogens. The objective of this study was to determine the feasibility to conduct a comprehensive case-control study to survey diarrheal pathogens among children with and without moderate-to-severe ADD. Materials and Methods. Microbiology and molecular-based techniques were used to detect viral, bacterial, and parasitic enteropathogens. The study was conducted in Bucaramanga, Colombia, after Institutional Review Board approval was obtained. Results. Ninety children less than 5 years of age were recruited after a written informed consent was obtained from parents or guardians. Forty-five subjects served as cases with ADD and 45 as controls. Thirty-six subjects out of 90 (40.0%) were positive for at least one enteropathogen, that is, 20 (44.4%) cases and 16 (35.5%) controls. Conclusions. The three most common enteric pathogens were enteroaggregative E. coli (10.0%), Norovirus (6.7%), and Salmonella spp. (5.6%). The E. coli pathogens were 18.8% of all infections making them the most frequent pathogens. Half of ADD cases were negative for any pathogens. Ana E. Farfán-García, Chengxian Zhang, Aamer Imdad, Monica Y. Arias-Guerrero, Nayibe T. Sánchez-Alvarez, Rikhil Shah, Junaid Iqbal, Maria E. Tamborski, and Oscar G. Gómez-Duarte Copyright © 2017 Ana E. Farfán-García et al. All rights reserved. Risk Factors for Acute Unintentional Poisoning among Children Aged 1–5 Years in the Rural Community of Sri Lanka Tue, 08 Aug 2017 08:23:01 +0000 Background. Acute poisoning in children is a major preventable cause of morbidity and mortality in both developed and developing countries. However, there is a wide variation in patterns of poisoning and related risk factors across different geographic regions globally. This hospital based case-control study identifies the risk factors of acute unintentional poisoning among children aged 1−5 years of the rural community in a developing Asian country. Methods. This hospital based case-control study included 600 children. Each group comprised three hundred children and all children were recruited at Anuradhapura Teaching Hospital, Sri Lanka, over two years (from February 2012 to January 2014). The two groups were compared to identify the effect of 23 proposed risk factors for unintentional poisoning using multivariate analysis in a binary logistic regression model. Results. Multivariate analysis identified eight risk factors which were significantly associated with unintentional poisoning. The strongest risk factors were inadequate supervision (95% CI: 15.4–52.6), employed mother (95% CI: 2.9–17.5), parental concern of lack of family support (95% CI: 3.65–83.3), and unsafe storage of household poisons (95% CI: 1.5–4.9). Conclusions. Since inadequate supervision, unsafe storage, and unsafe environment are the strongest risk factors for childhood unintentional poisoning, the effect of community education to enhance vigilance, safe storage, and assurance of safe environment should be evaluated. M. B. Kavinda Chandimal Dayasiri, Shaluka F. Jayamanne, and Chamilka Y. Jayasinghe Copyright © 2017 M. B. Kavinda Chandimal Dayasiri et al. All rights reserved. Corrigendum to “Perceived Body Image, Eating Behavior, and Sedentary Activities and Body Mass Index Categories in Kuwaiti Female Adolescents” Thu, 13 Jul 2017 00:00:00 +0000 Lemia H. Shaban, Joan A. Vaccaro, Shiryn D. Sukhram, and Fatma G. Huffman Copyright © 2017 Lemia H. Shaban et al. All rights reserved. Implementation and Evaluation of an Intervention for Children in Afghanistan at Risk for Substance Use or Actively Using Psychoactive Substances Wed, 05 Jul 2017 00:00:00 +0000 The present study examined the impact of a novel intervention for children at risk for substance use or actively using substances that was provided to 783 children between 4 and 18 years of age in Afghanistan. They received the Child Intervention for Living Drug-free (CHILD) protocol while in outpatient or residential treatment. CHILD included age-appropriate literacy and numeracy, drug education, basic living safety, and communication and trauma coping skills. A battery of measures examined multiple child health domains at treatment’s start and end and 12 weeks later. For younger children, there were no significant Gender or Gender X Time effects (all p’s > .16 and .35, resp.). The time main effect was significant for all outcomes (all p’s < .00192, the prespecified per-comparison error rate). Post hoc testing showed significant improvements from residential treatment entry to completion for all scales. For older children, a time main effect was significant for (all p’s < .00192, the prespecified per-comparison error rate) all but one outcome. Community follow-up means were significantly lower than residential treatment entry means. CHILD had a positive impact on children, and treatment impact endured from posttreatment to follow-up assessment. Abdul Subor Momand, Elizabeth Mattfeld, Brian Morales, Manzoor Ul Haq, Thom Browne, Kevin E. O’Grady, and Hendrée E. Jones Copyright © 2017 Abdul Subor Momand et al. All rights reserved. Common Clinical Characteristics and Rare Medical Problems of Fragile X Syndrome in Thai Patients and Review of the Literature Thu, 29 Jun 2017 00:00:00 +0000 Background. Clinical characteristics of fragile X syndrome (FXS) have been well documented in Caucasians, whereas in Asians they have rarely been described. Those that have been conducted used small cohorts that utilized DNA for diagnosis and larger cohorts that utilized cytogenetics for diagnosis. This study is to describe clinical characteristics of FXS in a large cohort of Thai patients diagnosed by standard molecular methods. Methods. Seventy-seven index cases and 46 affected relatives diagnosed with FXS were recruited into the study. To determine frequencies of common characteristics of FXS in prepubertal boys, we reviewed 56 unrelated cases aged between 18 and 146 months. To list rare medical problems, we reviewed 75 cases aged between 8 months to 71 years old, including 53 index cases and 22 affected relatives. In addition, we selected 16 clinical studies from various ethnicities for comparison with our findings. Results. In prepubertal boys with FXS, attention deficit and/or hyperactivity, prominent ears, macroorchidism, and elongated face were observed in 96%, 80%, 53%, and 48% of patients, respectively, whereas recognizable X-linked inheritance presented in 11% of patients. IQ scores ranged between 30 and 64 (mean ± SD = , ). We observed clinical findings that rarely or have never been reported, for example, medulloblastoma and tetralogy of Fallot. Conclusion. Attention deficit and/or hyperactivity and prominent ear are the most common behavioral and physical features in prepubertal boys with FXS, respectively. There are differences in frequencies of clinical characteristics observed between ethnicities; however, it is difficult to draw a solid conclusion due to different recruitment criteria and sample sizes within each study. Chariyawan Charalsawadi, Juthamas Wirojanan, Somchit Jaruratanasirikul, Nichara Ruangdaraganon, Alan Geater, and Pornprot Limprasert Copyright © 2017 Chariyawan Charalsawadi et al. All rights reserved. Choking Hazards: Are Current Product Testing Methods for Small Parts Adequate? Sun, 28 May 2017 00:00:00 +0000 Choking on small parts remains one of the leading causes of death and injury in infants and toddlers. The current method of testing for small parts, created by the Consumer Product Safety Commission (CPSC), has become outdated and has yet to be changed despite the many deaths and injuries of children. The method uses a device called the small parts test fixture (SPTF) that is supposed to mimic the size of a fully expanded throat of a toddler. If a product does not fit inside the cavity of the SPTF, then it is deemed safe to play with because it “will not fit” in the esophagus of a child. The present study obtains a dataset of products recalled by the CPSC within the last twelve years due to choking hazards/incidents and discovers that a noteworthy amount of the children’s products have parts that are larger than the fixture size and are still capable of causing choking. This study indicates that a larger SPTF size must be implemented by the CPSC in order to prevent future choking incidents on small parts. Athena Neofotistos, Nancy Cowles, and Ragini Sharma Copyright © 2017 Athena Neofotistos et al. All rights reserved. Therapeutic Hypothermia in Asphyxiated Neonates: Experience from Neonatal Intensive Care Unit of University Hospital of Marrakech Mon, 08 May 2017 07:02:28 +0000 Introduction. Therapeutic hypothermia (TH) is now recommended for the treatment neonates with hypoxic-ischemic encephalopathy (HIE). This treatment protocol is applied in our department since June 2012. The aim of this study is to report the first experience with head cooling in asphyxiated neonates in Morocco. Patients and Methods. Prospective study of newborns admitted for HIE from July 18, 2012, to May 15, 2014, in Neonatal Intensive Care Unit (NICU) of Mohamed VI University Hospital. The results were studied by comparing a newborn group who received hypothermia to a control group. Results. Seventy-two cases of neonates with perinatal asphyxia were admitted in the unit. According to inclusion criteria thirty-eight cases were eligible for the study. Only 19 cases have received the hypothermia protocol for different reason; the arrival beyond six hours of life was the main cause accounting for 41%. Complications of asphyxia were comparable in both groups with greater pulmonary hypertension recorded in the control group. The long-term follow-up of protocol group was normal in almost half of cases. Conclusion. Our first experience with the controlled TH supports its beneficial effect in newborns with HIE. This treatment must be available in all the centers involved in the neonatal care in Morocco. F. M. R. Maoulainine, M. Elbaz, S. Elfaiq, G. Boufrioua, F. Z. Elalouani, M. Barkane, and Nadia El Idrissi Slitine Copyright © 2017 F. M. R. Maoulainine et al. All rights reserved. Chronic Pain in Children: A Look at the Referral Process to a Pediatric Pain Clinic Wed, 22 Mar 2017 07:31:48 +0000 We reviewed the referral pattern of children with chronic pain to a specialized pediatric pain clinic. Data were obtained from referring physicians and medical records and during an interview with patients and their parents by physicians and a psychologist. We analyzed the following: referral diagnosis, demographics, duration of symptoms, number of physicians previously consulted, school attendance, sports activities, presence of psychological disorders, final team diagnosis, and outcomes. Children had been experiencing pain for months. Patients had consulted on average 3 physicians in addition to their pediatrician. 32% of the patients had missed at least 10 days of school in a calendar year, and 47% had stopped playing sports. 15% had an operation because of pain that had been unsuccessful. The most common missed diagnosis was anxiety (25%) and depression (13%). 69% of the patients were back to school and/or playing sports within 4 months from our initial consultation. 32% of the patients did not make any progress during the follow-up period. The most common reasons for failure to improve were no compliance with the recommended treatments and poorly controlled major mood disorder. The time to refer children with chronic pain for specialized care could be extremely long causing significant social and psychological consequence. Giovanni Cucchiaro, Jennifer Schwartz, Alec Hutchason, and Beatriz Ornelas Copyright © 2017 Giovanni Cucchiaro et al. All rights reserved. Plant Poisoning among Children in Rural Sri Lanka Thu, 09 Mar 2017 08:10:55 +0000 Plant poisoning is a common presentation in paediatric practice and an important cause of preventable mortality and morbidity in Sri Lanka. The burden of plant poisoning is largely underexplored. The current multicenter study based in rural Sri Lanka assessed clinical profiles, poison related factors, clinical management, complications, outcomes, and risk factors associated with plant poisoning in the paediatric age group. Among 325 children, 57% were male with 64% being below five years of age. 99.4% had ingested the poison. Transfer rate was 66.4%. Most had unintentional poisoning. Commonest poison plant was Jatropha circus and poisoning event happened mostly in home garden. 29% of parents practiced harmful first-aid practices. 32% of children had delayed presentations to which the commonest reason was lack of parental concern regarding urgency of seeking medical care. Presence of poisonous plants in home garden was the strongest risk factor for plant poisoning. Mortality rate was 1.2% and all cases had Oleander poisoning. The study revealed the value of community awareness regarding risk factors and awareness among healthcare workers regarding the mostly benign nature of plant poisoning in children in view of limiting incidence of plant poisoning and reducing expenditure on patient management. M. B. Kavinda Chandimal Dayasiri, Shaluka F. Jayamanne, and Chamilka Y. Jayasinghe Copyright © 2017 M. B. Kavinda Chandimal Dayasiri et al. All rights reserved. Role of Parental Smoking in Severe Bronchiolitis: A Hospital Based Case-Control Study Sun, 05 Mar 2017 00:00:00 +0000 Objective. Bronchiolitis is one of the commonest causes of hospitalization of infants and young children in Bangladesh. About 21% of under 5 children attending different hospitals of Bangladesh have bronchiolitis. Fifty percent (50%) men and three percent (3%) women of Bangladesh are smokers. Parental smoking is an important risk factor for both susceptibility and severity of bronchiolitis. The aim of this study was to find out the role of parental smoking in severe bronchiolitis. Design. Case-control study. Place and Duration of Study. The study was conducted in the Department of Paediatrics, Sylhet MAG Osmani Medical College Hospital, Bangladesh, from July 2013 to December 2015. Patients and Methods. Sixty-four patients admitted into the ward with severe bronchiolitis were enrolled as cases and sixty-four suitably matched apparently healthy children attending EPI centre and outpatient department presenting with nonrespiratory illness were enrolled as controls. Sample size was calculated using Guilford and Frucher formula. The technique was systematic random sampling. Every second case satisfying the inclusion and exclusion criteria was enrolled in the study. Results. The mean age of the patients was 7.53 (SD ± 4.75) months. Forty (62.5%) patients were male and twenty four (37.5%) patients were female. Male-to-female ratio was 1.7 : 1. Most of the cases (60.95%) came from low socioeconomic background. More than half of the cases (53.13%) were not exclusively breastfed babies. Mean length of hospital stay was 6.41 (SD ± 2.82) days. Thirty eight (59%) cases and twenty six (34%) controls were exposed to parental smoking. Result was highly significant (). Odds ratio was 2.8 (95% CI from 1.36 to 5.72). Conclusion. Exposure to parental smoking causes a statistically significant (, odds ratio = 2.8) increase in the risk of developing severe bronchiolitis in the first year of life. Rubina Farzana, Mujibul Hoque, Mohammad Shah Kamal, and Md. Moseh Uddin Choudhury Copyright © 2017 Rubina Farzana et al. All rights reserved. Urinary Lactate Dehydrogenase Activity and Its Isozyme Patterns in Kawasaki Disease Tue, 28 Feb 2017 09:19:22 +0000 Abnormal urinary findings, such as sterile pyuria, proteinuria, and microscopic hematuria, are often seen in the acute phase of Kawasaki disease (KD). We investigated the potential significance of urinary lactate dehydrogenase (U-LDH) activity and its isozyme patterns in KD. Total U-LDH activity and its isozymes (U-LDH1-5) levels were compared among 120 patients with KD, 18 patients with viral infection (VI), and 43 patients with upper urinary tract infection (UTI) and additionally compared between intravenous immunoglobulin (IVIG) responders () and nonresponders () with KD. Total U-LDH activity was higher in KD ( IU/L, ) and UTI patients ( IU/L, ) than in VI patients ( IU/L). In the isozyme pattern analysis, KD patients had high levels of U-LDH1 and U-LDH2, while UTI patients had high levels of U-LDH3, U-LDH4, and U-LDH5. Furthermore, IVIG nonresponders of KD had significantly higher levels of total U-LDH activity ( IU/L, ), especially U-LDH1 and U-LDH2 (), than IVIG responders ( IU/L). KD patients have increased levels of total U-LDH activity, especially U-LDH-1 and U-LDH2, indicating a unique pattern of U-LDH isozymes different from that in UTI patients. Yoichi Kawamura, Seiichiro Takeshita, Takashi Kanai, Mari Takizawa, Yusuke Yoshida, Yuki Tsujita, and Shigeaki Nonoyama Copyright © 2017 Yoichi Kawamura et al. All rights reserved. Associations between Parental and Friend Social Support and Children’s Physical Activity and Time Spent outside Playing Tue, 28 Feb 2017 07:25:38 +0000 The purpose of this study was to examine the structural validity of a parent and a child questionnaire that assessed parental and friends’ influences on children’s physical activity and investigate the associations between the derived factors, physical activity, and time spent outside. Children (, mean age = 11.7) and 144 of their parents completed questionnaires assessing parental and friends’ influences on children’s physical activity. Children wore a pedometer for six days. Exploratory factor analyses revealed four factors for the parental and five for the child’s questionnaire that explained 66.71% and 63.85% of the variance, respectively. Five factors were significantly associated with physical activity and five significantly associated with time spent outside. Higher correlations were revealed between “general friend support,” “friends’ activity norms,” and physical activity ( and 0.333 resp., ) and between “general friend support” and time spent outside (, ). Obtaining information relating to parental and friends’ influences on physical activity from both parents and children may provide a more complete picture of influences. Parents and friends seem to influence children’s physical activity behavior and time spent outside, but friends’ influences may have a stronger impact on children’s behaviors. Constantinos A. Loucaides and Niki Tsangaridou Copyright © 2017 Constantinos A. Loucaides and Niki Tsangaridou. All rights reserved. Prevalence and Associated Factors of Peer Victimization (Bullying) among Grades 7 and 8 Middle School Students in Kuwait Tue, 28 Feb 2017 00:00:00 +0000 Background. Peer victimization (bullying) is a universal phenomenon with detrimental effects. The aim of this study is to determine the prevalence and factors of bullying among grades 7 and 8 middle school students in Kuwait. Methods. The study is a cross-sectional study that includes a sample of 989 7th and 8th grade middle school students randomly selected from schools. The Revised Olweus Bully/Victim Questionnaire was used to measure different forms of bullying. After adjusting for confounding, logistic regression identified the significant associated factors related to bullying. Results. Prevalence of bullying was 30.2 with 95% CI 27.4 to 33.2% (3.5% bullies, 18.9% victims, 7.8% bully victims). Children with physical disabilities and one or both non-Kuwaiti parents or children with divorced/widowed parents were more prone to be victims. Most victims and bullies were found to be current smokers. Bullies were mostly in the fail/fair final school grade category, whereas victims performed better. The logistic regression showed that male gender (adjusted odds ration = 1.671, ), grade 8 student (adjusted odds ratio = 1.650, ), and student with physical disabilities (adjusted odds ratio = 1.675, ), were independently associated with bullying behavior. Conclusions. There is a need for a school-wide professional intervention program and improvement in the students’ adjustment to school environment to control bullying behavior. Ahmad J. Abdulsalam, Abdullah E. Al Daihani, and Konstantinos Francis Copyright © 2017 Ahmad J. Abdulsalam et al. 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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. 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