International Journal of Pediatrics The latest articles from Hindawi © 2017 , Hindawi Limited . 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. 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 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 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 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 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 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 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 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 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 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.