Childhood Lead Poisoning: Rhode Island Kids Count Issue Brief.

ERIC Educational Resources Information Center

Rhode Island KIDS COUNT, Providence.

Noting that childhood lead poisoning is one of the most common preventable pediatric health problems, this report examines lead poisoning as a health problem to which infants and young children are most susceptible and as a housing problem directly related to a shortage of safe, affordable housing. The report details screening rates in Rhode…

Intraosseous infusion in elective and emergency pediatric anesthesia: when should we use it?

PubMed

Neuhaus, Diego

2014-06-01

Difficulties to establish a venous access may also occur in routine pediatric anesthesia and lead to hazardous situations. Intraosseous infusion is a well tolerated and reliable but rarely used alternative technique in this setting. According to recent surveys, severe complications of intraosseous infusion stay a rare event. Minor complications and problems in getting an intraosseous infusion started on the other side seem to be more common than generally announced. The EZ-IO intraosseous infusion system has received expanded EU CE mark approval for an extended dwell time of up to 72 h and for insertion in pediatric patients in the distal femur. Key values of blood samples for laboratory analysis can be obtained with only 2 ml of blood/marrow waste and do also offer reliable values using an I-Stat point-of-care analyzer. Most problems in using an intraosseous infusion are provider-dependent. In pediatric anesthesia, the perioperative setting should further contribute to reduce these problems. Nevertheless, regular training, thorough anatomical knowledge and prompt availability especially in the pediatric age group are paramount to get a seldom used technique work properly under pressure. More longitudinal data on large cohorts were preferable to further support the safety of the intraosseous infusion technique in pediatric patients.

Approach to common bacterial infections: community-acquired pneumonia.

PubMed

Iroh Tam, Pui-Ying

2013-04-01

Community-acquired pneumonia (CAP) occurs more often in early childhood than at almost any other age. Many microorganisms are associated with pneumonia, but individual pathogens are difficult to identify, which poses problems in antibiotic management. This article reviews the common as well as new, emerging pathogens, as well as the guidelines for management of pediatric CAP. Current guidelines for pediatric CAP continue to recommend the use of high-dose amoxicillin for bacterial CAP and azithromycin for suspected atypical CAP (usually caused by Mycoplasma pneumoniae) in children. Copyright © 2013 Elsevier Inc. All rights reserved.

Electronic Medical Records (EMRs), Epidemiology, and Epistemology: Reflections on EMRs and Future Pediatric Clinical Research

PubMed Central

Wasserman, Richard C.

2011-01-01

Electronic medical records (EMRs) are increasingly common in pediatric patient care. EMR data represent a relatively novel and rich resource for clinical research. The fact, however, that pediatric EMR data are collected for the purposes of clinical documentation and billing rather than research creates obstacles to their use in scientific investigation. Particular issues include accuracy, completeness, comparability between settings, ease of extraction, and context of recording. Although these problems can be addressed through standard strategies for dealing with partially accurate and incomplete data, a longer term solution will involve work with pediatric clinicians to improve data quality. As research becomes one of the explicit purposes for which pediatricians collect EMR data, the pediatric clinician will play a central role in future pediatric clinical research. PMID:21622040

Rampant Caries

ERIC Educational Resources Information Center

Guzman-Armstrong, Sandra

2005-01-01

Although dental caries in the pediatric and adolescent population has consistently declined in the United States, it is still the most common childhood disease. Dental problems are the number one reason for missing school next to the common cold. Dental caries are an infectious, communicable disease resulting in destruction of tooth structure by…

Assessment in Multisite Randomized Clinical Trials of Patients with Autistic Disorder: The Autism RUPP Network.

ERIC Educational Resources Information Center

Arnold, L. Eugene; Aman, Michael G.; Martin, Andres; Collier-Crespin, Angie; Vitiello, Benedetto; Tierney, Elaine; Asarnow, Robert; Bell-Bradshaw, Felicia; Freeman, Betty Jo; Gates-Ulanet, Patricia; Klin, Ami; McCracken, James T.; McDougle, Christopher J.; McGough, James J.; Posey, David J.; Scahill, Lawrence; Swiezy, Naomi B.; Ritz, Louise; Volkmar, Fred

2000-01-01

This paper explains how the Autism Research Units on Pediatric Psychopharmacology (RUPP Autism Network) resolved common assessment problems including communication problems compromising use of the patient as informant, broad subject heterogeneity, difficulties in assessing low-end IQs, scarcity of autism-adapted cognitive and neuropsychological…

Nutritional status of pediatric patients with congenital heart disease: pre- and post cardiac surgery.

PubMed

Ratanachu-Ek, Suntaree; Pongdara, Aujjimavadee

2011-08-01

Malnutrition is common in infants and children with congenital heart disease (CHD). Cardiac surgery has improved patient survival and nutritional status. To evaluate the impact of cardiac surgery on nutritional status of pediatric patients with CHD. A prospective cohort study was conducted in pediatric patients with CHD, admitted for cardiac surgery at Queen Sirikit National Institute of Child Health (QSNICH), Bangkok, from August 1st, 2002 to 2003. Demographic data, cardiac and related problems were obtained before operation. Anthropometry was performed at the presentation and post cardiac surgery. Nutritional status was assessed by Z-score of weight for age (ZWA), weight for height (ZWH) and height for age (ZHA). Malnutrition was defined as Z-score <- 2 and compared pre- and post-operation using Chi-square. Paired t-test was used to compare mean Z-score and p-value < 0.05 was statistically significant. All of 161 pediatric patients with CHD undergoing cardiac surgery were 41% males and 59% females. Patients' age ranged from 1 month to 15 years. The related problems included low birth weight (28%) and feeding problem (58%). The most common CHD was ventricular septal defect (29%). The nutritional status of the patients before surgery was defined as normal 57%, malnutrition 40% and over-nutrition 3%. Malnutrition included underweight 28%, wasting 22% and stunting 16%. Post cardiac surgery, the means of ZWA, ZWH and ZHA were significantly increased and the prevalence of underweight and wasting were decreased to 17% and 6% respectively, with statistically significant from the baseline (p < 0.05). Malnutrition was found in 40% of pediatric patients with CHD and cardiac surgery has a significant positive effect on weight gain and nutritional status.

Exercise and Asthma

MedlinePlus

... Español Text Size Email Print Share Exercise and Asthma Page Content Article Body Almost every child (and ... of Pediatrics about asthma and exercise. What is asthma Asthma is the most common chronic medical problem ...

Global pediatric environmental health.

PubMed

Guidotti, Tee L; Gitterman, Benjamin A

2007-04-01

Children are uniquely vulnerable to environmental health problems. Developed countries report as the most common problems ambient (outdoor) air pollution and lead. Developing countries have a wider range of common problems, including childhood injuries, indoor air pollution, infectious disease, and poor sanitation with unsafe water. Globally, the agencies of the United Nations act to protect children and perform essential reporting and standards-setting functions. Conditions vary greatly among countries and are not always better in developing countries. Protecting the health of children requires strengthening the public health and medical systems in every country, rather than a single global agenda.

Pediatric surgeons on the Internet: a multi-institutional experience.

PubMed

Wulkan, M L; Smith, S D; Whalen, T V; Hardin, W D

1997-04-01

An estimated 24 million people, or 11% of the North American population over 16 years of age, use the Internet. An estimated 40% of households have computers, and 37 million people have Internet access. The experience of three pediatric surgery Internet sites are reviewed to evaluate current practices and future potential of the Internet to practicing pediatric surgeons. The sites reviewed are the Pediatric Surgery Bulletin Board System (BBS), the Pediatric Surgery List Server, and the Pediatric Surgery Website. Statistics were collected at each site to characterize the number of users, traffic load, topics of interest, and times of peak use. There are currently 79 subscribers to the Pediatric Surgery BBS and 100 subscribers to the Pediatric Surgery List Server. The average user of the BBS is a young man who has placed an average of 52 calls to the BBS since joining. There have been 1413 Internet electronic mail messages sent. Twenty-five percent of the traffic has been related to clinical problems and 5% to research, teaching, and career issues. Traffic at this site has been increasing exponentially with most of the dialogue concentrated on clinical issues and problem cases. In a 3-month period the Pediatric Surgery Website received 16,270 hits. The most commonly accessed areas include an electronic mail directory, case studies, the job board, information on the pediatric surgical residency, and information on upcoming meetings. Pediatric surgeons are exploring the Internet and using available pediatric surgery resources. The scope of professional information available to pediatric surgeons on the Internet is still limited but is increasing rapidly. The Internet will impact the way physicians practice medicine through education and communication.

Do On-Site Mental Health Professionals Change Pediatricians' Responses to Children's Mental Health Problems?

PubMed

McCue Horwitz, Sarah; Storfer-Isser, Amy; Kerker, Bonnie D; Szilagyi, Moira; Garner, Andrew S; O'Connor, Karen G; Hoagwood, Kimberly E; Green, Cori M; Foy, Jane M; Stein, Ruth E K

2016-01-01

To assess the availability of on-site mental health professionals (MHPs) in primary care; to examine practice/pediatrician characteristics associated with on-site MHPs; and to determine whether the presence of on-site MHPs is related to pediatricians' comanaging or more frequently identifying, treating/managing, or referring mental health (MH) problems. Analyses included American Academy of Pediatrics (AAP) members who participated in an AAP Periodic Survey in 2013 and who practiced general pediatrics (n = 321). Measures included sociodemographics, practice characteristics, questions about on-site MHPs, comanagement of MH problems, and pediatricians' behaviors in response to 5 prevalent MH problems. Weighted univariate, bivariate, and multivariable analyses were performed. Thirty-five percent reported on-site MHPs. Practice characteristics (medical schools, universities, health maintenance organizations, <100 visits per week, <80% of patients privately insured) and interactions of practice location (urban) with visits and patient insurance were associated with on-site MHPs. There was no overall association between colocation and comanagement, or whether pediatricians usually identified, treated/managed, or referred 5 common child MH problems. Among the subset of pediatricians who reported comanaging, there was an association with comanagement when the on-site MHP was a child psychiatrist, substance abuse counselor, or social worker. On-site MHPs are more frequent in settings where low-income children are served and where pediatricians train. Pediatricians who comanage MH problems are more likely to do so when the on-site MHP is a child psychiatrist, substance abuse counselor, or social worker. Overall, on-site MHPs were not associated with comanagement or increased likelihood of pediatricians identifying, treating/managing, or referring children with 5 common child MH problems. Copyright © 2016 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

Imaging pediatric magnet ingestion with surgical-pathological correlation.

PubMed

Otjen, Jeffrey P; Rohrmann, Charles A; Iyer, Ramesh S

2013-07-01

Foreign body ingestion is a common problem in the pediatric population and a frequent cause for emergency room visits. Magnets are common household objects that when ingested can bring about severe, possibly fatal gastrointestinal complications. Radiography is an integral component of the management of these children. Pediatric and emergency radiologists alike must be aware of imaging manifestations of magnet ingestion, as their identification drives decision-making for consulting surgeons and gastroenterologists. Radiology can thus substantially augment the clinical history and physical exam, facilitating appropriate management. This manuscript sequentially presents cases of magnet ingestion featuring imaging findings coupled with surgical and pathological correlation. Each case is presented to highlight ways in which the radiologist can make impactful contributions to diagnosis and management. Clinical overview with pitfalls of magnet ingestion imaging and an imaging decision tree will also be presented.

Prescription Drug Shortages: Implications for Ambulatory Pediatrics.

PubMed

Donnelly, Katie A; Zocchi, Mark S; Katy, Tamara A; Fox, Erin R; van den Anker, John N; Mazer-Amirshahi, Maryann E

2018-05-08

To describe contemporary drug shortages affecting general ambulatory pediatrics. Data from January 2001 to December 2015 were obtained from the University of Utah Drug Information Service. Two pediatricians reviewed drug shortages and identified agents used in ambulatory pediatrics. Shortage data were analyzed by the type of drug, formulation, reason for shortage, duration, marketing status, if a pediatric friendly-formulation was available, or if it was a single-source product. The availability of an alternative, and whether that alternative was affected by a shortage, also was noted. Of 1883 products in shortage during the study period, 314 were determined to be used in ambulatory pediatrics. The annual number of new pediatric shortages decreased initially but then increased to a high of 38 in 2011. Of the 314 pediatric shortages, 3.8% were unresolved at the end of the study. The median duration of resolved shortages was 7.6 months. The longest shortage was for ciprofloxacin 500-mg tablets. The most common class involved was infectious disease drugs. Pediatric-friendly dosage forms were affected in 19.1% of shortages. An alternative agent was available for 86% drugs; however, 29% of these also were affected. The most common reason for shortage was manufacturing problems. Drug shortages affected a substantial number of agents used in general ambulatory pediatrics. Shortages for single-source products are a concern if a suitable alternative is unavailable. Providers working in the ambulatory setting must be aware of current shortages and implement mitigation strategies to optimize patient care. Copyright © 2018 Elsevier Inc. All rights reserved.

School psychologists: strategic allies in the contemporary practice of primary care pediatrics.

PubMed

Wodrich, D L; Landau, S

1999-10-01

Immense changes in the developmental/behavioral aspects of primary care pediatrics have resulted from revisions in special education laws, introduction of managed care, widened dissemination of information about disabilities to parents, and the changing character of American society. Challenges associated with contemporary pediatric practice can be diminished by routine collaboration with school psychologists. An alliance with school-based psychologists permits pediatricians access to children in their natural environments and potential collaboration for preventing illness and emotional/behavior problems. Further, school psychologists can provide a partner for assessing and treating both common and low-incident disorders without the constraints imposed by managed care.

Polyethylene glycol 3350 without electrolytes for treatment of childhood constipation

PubMed Central

Chung, Seen; Cheng, Adam; Goldman, Ran D.

2009-01-01

ABSTRACT QUESTION I have come across many pediatric patients with functional constipation. Is polyethylene glycol 3350 without electrolytes a safe and effective long-term treatment option for these patients? ANSWER Functional constipation is a common and often difficult problem for parents and families to deal with. Polyethylene glycol 3350 is a safe and effective long-term laxative in pediatric populations, but there are limited studies for its use in children younger than 2 years of age. PMID:19439699

Esophageal foreign bodies and eosinophilic esophagitis--the need for esophageal mucosal biopsy: a 12-year survey across pediatric subspecialties.

PubMed

Williams, Paul; Jameson, Samuel; Bishop, Phyllis; Sawaya, David; Nowicki, Michael

2013-06-01

Esophageal foreign body impaction (EFBI) is a common problem requiring urgent endoscopy. EFBI may be the first sign of underlying esophageal pathology, yet mucosal biopsies are rarely performed. We report a retrospective analysis of 572 children requiring removal of an EFBI over a 12-year period by pediatric otolaryngologists (ENT), surgeons (PS), and gastroenterologists (PGI). The method of removal [direct laryngoscopy (DL), rigid endoscopy (RE), flexible endoscopy (FE)], type of foreign body (inanimate or food), whether mucosal biopsies were performed, and histologic findings of biopsy samples were recorded for each patient. Foreign body removal was most commonly performed by PGI (298 [52 %]); the remaining were equally distributed between ENT (136 [24 %]) and PS (138 [24 %]). The method of foreign body removal used by ENT was RE (89 %), DL (8 %), and FE (3 %). Pediatric surgery preferred FE (62 %), followed by RE (27 %) and DL (11 %). Pediatric gastroenterology used FE exclusively. Esophageal biopsies were never performed by ENT or PS; PGI performed esophageal biopsies more commonly in children with meat bolus impactions (50 %) than in children with inanimate foreign bodies (12 %). Mucosal pathology was more common in children with meat bolus impaction (100 %) than in children with inanimate foreign bodies (45 %). Esophageal mucosal biopsy should be considered for all children with EFBI not attributed to stricture, particularly those with meat bolus impaction.

[Complications in pediatric anesthesia].

PubMed

Becke, K

2014-07-01

As in adult anesthesia, morbidity and mortality could be significantly reduced in pediatric anesthesia in recent decades. This fact cannot conceal the fact that the incidence of anesthetic complications in children is still much more common than in adults and sometimes with a severe outcome. Newborns and infants in particular but also children with emergency interventions and severe comorbidities are at increased risk of potential complications. Typical complications in pediatric anesthesia are respiratory problems, medication errors, difficulties with the intravenous puncture and pulmonal aspiration. In the postoperative setting, nausea and vomiting, pain, and emergence delirium can be mentioned as typical complications. In addition to the systematic prevention of complications in pediatric anesthesia, it is important to quickly recognize disturbances of homeostasis and treat them promptly and appropriately. In addition to the expertise of the performing anesthesia team, the institutional structure in particular can improve quality and safety in pediatric anesthesia.

Advances in pediatrics in 2014: current practices and challenges in allergy, gastroenterology, infectious diseases, neonatology, nutrition, oncology and respiratory tract illnesses.

PubMed

Caffarelli, Carlo; Santamaria, Francesca; Cesari, Silvia; Sciorio, Elisa; Povesi-Dascola, Carlotta; Bernasconi, Sergio

2015-10-31

Major advances in the conduct of pediatric practice have been reported in the Italian Journal of Pediatrics in 2014. This review highlights developments in allergy, gastroenterology, infectious diseases, neonatology, nutrition, oncology and respiratory tract illnesses. Investigations endorse a need to better educate guardians and improve nutritional management in food allergy. Management of hyperbilirubinemia in neonates and of bronchiolitis have been improved by position statements of scientific societies. Novel treatments for infant colic and inflammatory bowel diseases have emerged. Studies suggest the diagnostic utility of ultrasonography in diagnosing community-acquired pneumonia. Progress in infectious diseases should include the universal varicella vaccination of children. Recommendations on asphyxia and respiratory distress syndrome have been highlighted in neonatology. Studies have evidenced that malnutrition remains a common underestimated problem in developing countries, while exposure to cancer risk factors in children is not negligible in Western countries. Advances in our understanding of less common diseases such as cystic fibrosis, plastic bronchitis, idiopathic pulmonary hemosiderosis facilitate diagnosis and management. Researches have led to new therapeutic approaches in patent ductus arteriosus and pediatric malignancies.

[Prevalence of sensitization to inhalant allergens in the immunology department from Hospital de Especialidades Pediátricas María, Honduras, 2016].

PubMed

Gonzales-González, Victoria Alejandra; Díaz-Flores, Adolfo Martín; Fernández-Zelaya, Karla Zobeyda; Rivera-Reyes, María Félix

2017-01-01

Allergic diseases are a public health problem; estimates indicate that between 30% and 40% of the world population is affected by some allergy. Knowing the prevalence of allergen sensitization allows for adequate diagnoses and treatments to be offered. In Honduras there are no studies available in pediatric patients. The purpose of this research was to identify the most common types of sensitization in children and their correlation with the most common allergic diseases in patients on immunotherapy at the Maria Hospital of Pediatric Specialties. Cross-sectional, descriptive, retrospective study in which medical records and databases of patients on allergic immunotherapy at the Maria Hospital of Pediatric Specialties were reviewed between January 2015 and June 2016. 215 children on immunotherapy were assessed; ages ranged from 3 to 18 years, with a mean of 10.8 years. Aeroallergen-positive epicutaneous tests were identified in 73.02%. The most common aeroallergens were Dermatophagoides farinae and Dermatophagoides pteronyssinus mix (96.74%), American cockroach 37.21%, and Aspergillus fumigatus and Homodenderum cladosporioides (16.28%). House dust mites and American cockroach were the most common causes of sensitization in patients on immunotherapy.

Conscious Sedation: Emerging Trends in Pediatric Dentistry

PubMed Central

Attri, Joginder Pal; Sharan, Radhe; Makkar, Vega; Gupta, Kewal Krishan; Khetarpal, Ranjana; Kataria, Amar Parkash

2017-01-01

Dental fear and anxiety is a common problem in pediatric patients. There is considerable variation in techniques used to manage them. Various sedation techniques using many different anesthetic agents have gained considerable popularity over the past few years. Children are not little adults; they differ physically, psychologically, and emotionally. The purpose of this review is to survey recent trends and concerning issues in the rapidly changing field of pediatric sedation. We will study the topic from the perspective of an anesthesiologist. It will also provide information to practitioners on the practice of conscious sedation in dentistry and will also outline the route of administration, pharmacokinetics, and pharmacodynamics of various drugs used. PMID:28663606

Cranberry use among pediatric nephrology patients.

PubMed

Super, Elizabeth A; Kemper, Kathi J; Woods, Charles; Nagaraj, Shashi

2005-01-01

Recurrent urinary tract infections are common in children, and the use of complementary therapies is common in other children with recurrent illnesses. However, little is known about the use of cranberry products by children with renal disease. We hypothesized that, because cranberry is often used to prevent urinary tract infections (UTI) in adult women, many parents would give it to their children, particularly to children prone to recurrent UTI (rUTI). Anonymous, cross-sectional, self-administered survey of parents of children seen in the pediatric nephrology clinic at Brenner Children's Hospital between June 1, 2004, and August 13, 2004. Of the 117 parents surveyed, the patients' average age was 10.3 years, and 15% reported rUTI as a problem. Overall, 29% of surveyed parents gave cranberry products therapeutically; as expected, use was higher among those with rUTI (65%) than among those with other renal conditions (23%); odds ratio = 6.1 (2.0, 18.4, P < .001); many parents gave cranberry to treat as well as prevent diverse renal problems. Most felt it was beneficial and only 1 parent reported a side effect (nausea). Only 23% of those who used it had discussed cranberry use with their physician. Cranberry is commonly used therapeutically among patients seen in a pediatric nephrology clinic and is perceived as useful by parents, though uncommonly discussed with physicians. Randomized controlled trials are needed to determine the effectiveness of cranberry juice therapy for rUTI in children.

[Recommendations for the prevention of organic foreign bodies aspiration].

PubMed

Rodríguez, Hugo; Cuestas, Giselle; Gregori, Darío; Lorenzoni, Giulia; Tortosa, Susana; Rodríguez D'Aquila, Máximo; Rodríguez D'Aquila, Juan A; Carrera, Sandra; Passali, Desiderio

2017-10-01

Foreign body aspiration remains a common and potentially serious pediatric problem. Most aspirated foreign bodies are food. The education of parents and caregivers about choking hazards and how to avoid them is critical to reduce the incidence of these events. The pediatricians play a key role in promoting injury prevention. We indicate the main characteristics of hazardous food and we present recommendations on age-appropriate meals, adequate forms of food preparation and behavioral rules at mealtimes in order to reduce food choking. Sociedad Argentina de Pediatría.

The integration of behavioral health interventions in children's health care: services, science, and suggestions.

PubMed

Kolko, David J; Perrin, Ellen

2014-01-01

Because the integration of mental or behavioral health services in pediatric primary care is a national priority, a description and evaluation of the interventions applied in the healthcare setting is warranted. This article examines several intervention research studies based on alternative models for delivering behavioral health care in conjunction with comprehensive pediatric care. This review describes the diverse methods applied to different clinical problems, such as brief mental health skills, clinical guidelines, and evidence-based practices, and the empirical outcomes of this research literature. Next, several key treatment considerations are discussed to maximize the efficiency and effectiveness of these interventions. Some practical suggestions for overcoming key service barriers are provided to enhance the capacity of the practice to deliver behavioral health care. There is moderate empirical support for the feasibility, acceptability, and clinical utility of these interventions for treating internalizing and externalizing behavior problems. Practical strategies to extend this work and address methodological limitations are provided that draw upon recent frameworks designed to simplify the treatment enterprise (e.g., common elements). Pediatric primary care has become an important venue for providing mental health services to children and adolescents due, in part, to its many desirable features (e.g., no stigma, local setting, familiar providers). Further adaptation of existing delivery models may promote the delivery of effective integrated interventions with primary care providers as partners designed to address mental health problems in pediatric healthcare.

Responding to Emotional Stress in Pediatric Hospitals: Results From a National Survey of Chief Nursing Officers.

PubMed

Huetsch, Michael; Green, Jeremy

2016-01-01

The aim of this study was to identify leadership awareness of emotional stress and employee support efforts in pediatric hospitals. The current pediatric environment has seen increases in treatment intensity, care duration, and acuity of patients resulting in increased likelihood of being exposed to emotional events. Mail survey was sent to chief nursing officers at 87 pediatric hospitals. A total of 49 responses (56%) were received. Hospitals with less than 250 beds were significantly more likely to rate emotional stress as a large to very large problem, whereas ANCC Magnet® hospitals felt better about support efforts after patient deaths. Most commonly used support offerings focused on staff recovery after a traumatic event as opposed to training for prevention of emotional stress. Emotional stress is a well-recognized issue in pediatric hospitals with comparatively large resource commitment. Further focus on caregiver prevention training and unit leadership recognition of stress may be needed.

Listening to the Patient Voice in Narcolepsy: Diagnostic Delay, Disease Burden, and Treatment Efficacy.

PubMed

Maski, Kiran; Steinhart, Erin; Williams, David; Scammell, Thomas; Flygare, Julie; McCleary, Kimberly; Gow, Monica

2017-03-15

Describe common symptoms, comorbidities, functional limitations, and treatment responsiveness among patients with narcolepsy. Investigate the effect of pediatric onset of narcolepsy symptoms on time to diagnosis of narcolepsy and presence of comorbid depression. Cross-sectional survey of 1,699 people in the United States with self-reported diagnosis of narcolepsy. We utilized mixed-methods data analyses to report study findings. Most participants reported receiving a diagnosis of narcolepsy more than 1 y after symptom onset. We found that the strongest predictor of this delayed diagnosis was pediatric onset of symptoms (odds ratio = 2.4, p < 0.0005). Depression was the most common comorbidity but we detected no association with pediatric onset of narcolepsy symptoms. Overall, participants reported that fatigue and cognitive difficulties were their most burdensome symptoms in addition to sleepiness and cataplexy. The majority of participants reported residual daytime fatigue and/or sleepiness despite treatment. Most participants reported they could not perform at work or school as well as they would like because of narcolepsy symptoms. This study provides unique insight into the narcolepsy disease experience. The study quantifies the problem of diagnostic delay for narcolepsy patients in the United States and highlights that symptoms are more likely to be missed if they develop before 18 y of age. These results suggest that narcolepsy awareness efforts should be aimed at parents, pediatric health care providers, school professionals, and children/adolescents themselves. Disease burden is high because of problems with fatigue, cognition, and persistence of residual symptoms despite treatment. © 2017 American Academy of Sleep Medicine

Sleep problems in children with attention-deficit/hyperactivity disorder: prevalence and the effect on the child and family.

PubMed

Sung, Valerie; Hiscock, Harriet; Sciberras, Emma; Efron, Daryl

2008-04-01

To determine the prevalence of sleep problems in children with attention-deficit/hyperactivity disorder (ADHD) and their associations with child quality of life (QOL), daily functioning, and school attendance; caregiver mental health and work attendance; and family functioning. Cross-sectional survey. Pediatric hospital outpatient clinic, private pediatricians' offices, and ADHD support groups in Victoria, Australia. Schoolchildren with ADHD. Main Exposure Attention-deficit/hyperactivity disorder. Primary measure was caregivers' reports of their children's sleep problems (none, mild, or moderate or severe). Secondary outcomes were (1) child QOL (Pediatric Quality of Life Inventory), daily functioning (Daily Parent Rating of Evening and Morning Behavior scale), and school attendance, (2) caregiver mental health (Depression Anxiety Stress Scale) and work attendance, and (3) family functioning (Child Health Questionnaire subscales). Caregivers also reported on how their pediatrician treated their children's sleep problems. Two hundred thirty-nine of 330 (74%) eligible families completed the survey. Child sleep problems were common (mild, 28.5%; moderate or severe, 44.8%). Moderate or severe sleep problems were associated with poorer child psychosocial QOL, child daily functioning, caregiver mental health, and family functioning. After adjusting for confounders, all associations held except for family impacts. Compared with children without sleep problems, those with sleep problems were more likely to miss or be late for school, and their caregivers were more likely to be late to work. Forty-five percent of caregivers reported that their pediatricians had asked about their children's sleep and, of these, 60% reported receiving treatment advice. Sleep problems in children with ADHD are common and associated with poorer child, caregiver, and family outcomes. Future research needs to determine whether management of sleep problems can reduce adverse outcomes.

Management of pediatric uveitis

PubMed Central

Wentworth, Bailey A.; Freitas-Neto, Clovis A.

2014-01-01

Pediatric uveitis is a topic of special interest not only because of the unique diagnostic and therapeutic challenges but also because of the lifetime burden of vision loss if the problem is not adequately treated, as well as the economic and psychological toll on the family. Often, uveitis in children is discovered as part of a routine eye exam; this silent, insidious inflammation can be difficult to treat and can lead to further complications if not handled skillfully. Corticosteroids have long been the mainstay of therapy; however, the significant associated side effects mandate a corticosteroid-sparing therapeutic regimen in pursuit of remission. In this review, we cover the therapeutic options for pediatric uveitis, specifically focusing on the most common non-infectious varieties, juvenile idiopathic arthritis-associated uveitis and pars planitis. PMID:24991418

Motor Deficits Following Pediatric Mild Traumatic Brain Injury: Implications for School Psychologists

ERIC Educational Resources Information Center

Davis, Andrew S.; Moore, Brittney; Rice, Valerie; Decker, Scott

2015-01-01

Mild traumatic brain injury (mTBI), sometimes referred to as concussion, is one of the most common acquired neurological problems of childhood. When children return to school following mTBI, school psychologists should be actively involved in the determination of neurocognitive and functional deficits for the purpose of designing strength-based…

Pediatric Sports Medicine Injuries: Common Problems and Solutions.

PubMed

Huleatt, Joel B; Nissen, Carl W; Milewski, Matthew D

2018-04-01

The treatment of sports injuries in the skeletally immature has a unique set of complications. Growth deformity may occur after anterior cruciate ligament reconstruction; therefore, skeletal age is used to help guide the choice between physeal sparing and transphyseal techniques. Arthrofibrosis after tibial spine fracture fixation can be reduced by initiating immediate range of motion, and should be treated early and cautiously to avoid iatrogenic fracture. Nonunions of medial epicondyle elbow fractures are more common with nonoperative treatment, but seldom lead to clinical problems outside of certain athletes. Risks of OCD fixation are specific to the material of screw used. Copyright © 2017 Elsevier Inc. All rights reserved.

Conceptualization and treatment of chronic abdominal pain in pediatric gastroenterology practice.

PubMed

Schurman, Jennifer V; Hunter, Heather L; Friesen, Craig A

2010-01-01

The aim of this study was to examine how children with abdominal pain presently are viewed, assessed, and treated by pediatric gastroenterologists across North America, as well as how perspectives have changed since initial release of the Rome criteria for functional gastrointestinal disorders approximately 15 years ago. One hundred seventy-four full members of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition completed a pediatric gastroenterology practice survey designed by the authors in 2006. The responses were examined for practice patterns and specific knowledge/use of the Rome criteria. The responses were also compared with historical data from 151 North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition members who completed a similar survey in 1992. There were few changes in the evaluation, treatment, or outcomes for children with abdominal pain for the past 15 years. Knowledge of the Rome criteria was common, but use in practice was not; several specific problems with the criteria were identified. A mismatch also appeared between belief in the importance of psychological factors in the creation/maintenance of pediatric abdominal pain and integration of these factors as part of standard evaluation and treatment. Finally, controversy emerged regarding both the term "functional" and the importance of histologic inflammation in the pathophysiology of pediatric abdominal pain. The evolution and dissemination of the Rome criteria for the past 15 years have not substantially changed evaluation or treatment practices for children with abdominal pain. Many areas of inconsistency and controversy remain. More focused research is needed to better understand this common pain condition and to establish an effective treatment program that can be disseminated across practitioners.

Use and reimbursement of off-label drugs in pediatric anesthesia: the Italian experience.

PubMed

Salvo, Ida; Landoni, Giovanni; Mucchetti, Marta; Cabrini, Luca; Pani, Luca

2014-06-01

Most of the drugs used in anesthesia are off-label in children even if they present solid clinical evidence in adults. This lack of authorization is caused by multiple factors including the difficulty in conducting research in this area (due to the ethical concerns and/or the low number of available participants, the high variability of the outcome measures) and the lack of economic interest of the pharmaceutical companies (due to the limited market). Define a list of medicinal products commonly used off-label in pediatrics anesthesia to be reimbursed by Italian National Health System. We hereby describe the methodological framework used to allow reimbursed use of a list of medicinal products, widely used off-label in pediatric patients, ensuring the best therapeutic results with the lowest possible risk for children. A task force of pediatric anesthesiologists from Italy petitioned the Italian Medicines Agency (AIFA) to allow a number of commonly utilized but off-label drugs for pediatric anesthesia to be reimbursed for specific indications. For each drug, both the supporting literature and expert opinion were used, and the resulting list of drugs allowed to be used/reimbursed officially by AIFA was significantly expanded. This paper documents one approach to the problem of off-label use of drugs for pediatric patients that can be a model for future efforts. Continuous efforts are needed from government institutions and sponsors on drug development and on drug approval process in pediatrics, as research on drug effectiveness and safety is mandatory in children as in adults. At the same time, clinicians must become more familiar with the drug-approval process, participate to sponsored trials, and perform ztrials themselves. © 2014 John Wiley & Sons Ltd.

Doctor-office collaborative care for pediatric behavioral problems: a preliminary clinical trial.

PubMed

Kolko, David J; Campo, John V; Kilbourne, Amy M; Kelleher, Kelly

2012-03-01

To evaluate the feasibility and clinical benefits of an integrated mental health intervention (doctor-office collaborative care [DOCC]) vs enhanced usual care (EUC) for children with behavioral problems. Cases were assigned to DOCC and EUC using a 2:1 randomization schedule that resulted in 55 DOCC and 23 EUC cases. Preassessment was conducted in 4 pediatric primary care practices. Postassessment was conducted in the pediatric or research office. Doctor-office collaborative care was provided in the practice; EUC was initiated in the office but involved a facilitated referral to a local mental health specialist. Of 125 referrals (age range, 5-12 years), 78 children participated. Children and their parents were assigned to receive DOCC or EUC. Preassessment diagnostic status was evaluated using the Schedule for Affective Disorders and Schizophrenia for School-aged Children. Preassessment and 6-month postassessment ratings of behavioral and emotional problems were collected from parents using the Vanderbilt Attention-Deficit/Hyperactivity Disorder Diagnostic Parent Rating Scale, as well as individualized goal achievement ratings forms. At discharge, care managers and a diagnostic evaluator completed the Clinical Global Impression Scale, and pediatricians and parents completed satisfaction and study feedback measures. Group comparisons found significant improvements for DOCC over EUC in service use and completion, behavioral and emotional problems, individualized behavioral goals, and overall clinical response. Pediatricians and parents were highly satisfied with DOCC. The feasibility and clinical benefits of DOCC for behavioral problems support the integration of collaborative mental health services for common mental disorders in primary care.

Listening to the Patient Voice in Narcolepsy: Diagnostic Delay, Disease Burden, and Treatment Efficacy

PubMed Central

Maski, Kiran; Steinhart, Erin; Williams, David; Scammell, Thomas; Flygare, Julie; McCleary, Kimberly; Gow, Monica

2017-01-01

Study Objectives: Describe common symptoms, comorbidities, functional limitations, and treatment responsiveness among patients with narcolepsy. Investigate the effect of pediatric onset of narcolepsy symptoms on time to diagnosis of narcolepsy and presence of comorbid depression. Methods: Cross-sectional survey of 1,699 people in the United States with self-reported diagnosis of narcolepsy. We utilized mixed-methods data analyses to report study findings. Results: Most participants reported receiving a diagnosis of narcolepsy more than 1 y after symptom onset. We found that the strongest predictor of this delayed diagnosis was pediatric onset of symptoms (odds ratio = 2.4, p < 0.0005). Depression was the most common comorbidity but we detected no association with pediatric onset of narcolepsy symptoms. Overall, participants reported that fatigue and cognitive difficulties were their most burdensome symptoms in addition to sleepiness and cataplexy. The majority of participants reported residual daytime fatigue and/or sleepiness despite treatment. Most participants reported they could not perform at work or school as well as they would like because of narcolepsy symptoms. Conclusions: This study provides unique insight into the narcolepsy disease experience. The study quantifies the problem of diagnostic delay for narcolepsy patients in the United States and highlights that symptoms are more likely to be missed if they develop before 18 y of age. These results suggest that narcolepsy awareness efforts should be aimed at parents, pediatric health care providers, school professionals, and children/adolescents themselves. Disease burden is high because of problems with fatigue, cognition, and persistence of residual symptoms despite treatment. Citation: Maski K, Steinhart E, Williams D, Scammell T, Flygare J, McCleary K, Gow M. Listening to the patient voice in narcolepsy: diagnostic delay, disease burden and treatment efficacy. J Clin Sleep Med. 2017;13(3):419–425. PMID:27923434

A pediatric digital storytelling system for third year medical students: The Virtual Pediatric Patients

PubMed Central

D'Alessandro, Donna M; Lewis, Tamra E; D'Alessandro, Michael P

2004-01-01

Background Computer-based patient simulations (CBPS) are common, effective, instructional methods for medical students, but have limitations. The goal of this project was to describe the development of a CBPS designed to overcome some of these limitations and to perform an online evaluation. Methods In 1996, patients and families experiencing a common pediatric problem were interviewed, photographed and a chart review completed. A digital storytelling template was developed: 1. patient's story, evaluation and clinical course, 2. problem-based approach to the evaluation, and 3. discussion of disease process. The media was digitized and placed onto the Internet. The digital stories and a 10-question online survey were pilot tested. Online survey responses were collected from 1999–2003. Overall use of the digital stories was measured by computer server logs and by the number of hyperlinks to the CBPS. Results Eight stories were created using this system. Over 4.5 years, 814,148 digital story pages were read by 362,351 users. Hyperlink citations from other websites to the CBPS were 108. Online survey respondents (N = 393) described the overall quality as excellent or very good (88.4%). The stores were clearly written (92%) at an appropriate level (91.4%). Respondents felt they could begin to evaluate a similar case presentation (95.4%), and would remember the case in the future (91%). Conclusions A new type of CBPS, the digital storytelling system, has been developed and evaluated which and appears to be successful in overcoming some of the limitations of earlier CBPS by featuring patient's stories in their own words, by focusing on problems rather than diseases, and by having stories that are quick for students to work through. PMID:15260883

A pediatric digital storytelling system for third year medical students: the virtual pediatric patients.

PubMed

D'Alessandro, Donna M; Lewis, Tamra E; D'Alessandro, Michael P

2004-07-19

Computer-based patient simulations (CBPS) are common, effective, instructional methods for medical students, but have limitations. The goal of this project was to describe the development of a CBPS designed to overcome some of these limitations and to perform an online evaluation. In 1996, patients and families experiencing a common pediatric problem were interviewed, photographed and a chart review completed. A digital storytelling template was developed: 1. patient's story, evaluation and clinical course, 2. problem-based approach to the evaluation, and 3. discussion of disease process. The media was digitized and placed onto the Internet. The digital stories and a 10-question online survey were pilot tested. Online survey responses were collected from 1999-2003. Overall use of the digital stories was measured by computer server logs and by the number of hyperlinks to the CBPS. Eight stories were created using this system. Over 4.5 years, 814,148 digital story pages were read by 362,351 users. Hyperlink citations from other websites to the CBPS were 108. Online survey respondents (N = 393) described the overall quality as excellent or very good (88.4%). The stores were clearly written (92%) at an appropriate level (91.4%). Respondents felt they could begin to evaluate a similar case presentation (95.4%), and would remember the case in the future (91%). A new type of CBPS, the digital storytelling system, has been developed and evaluated which and appears to be successful in overcoming some of the limitations of earlier CBPS by featuring patient's stories in their own words, by focusing on problems rather than diseases, and by having stories that are quick for students to work through.

Common management issues in pediatric patients with mild bleeding disorders.

PubMed

O'Brien, Sarah H

2012-10-01

Type 1 von Willebrand disease and mild platelet function defects are among the most common disorders seen by pediatric hematologists. The management and prevention of bleeding in these patients can be challenging, as there are limited published data to guide clinical practice, and a complete lack of randomized clinical trials. Desmopressin (DDAVP) and antifibrinolytics are the mainstays of treatment in these patients, yet the optimal dosing and timing of these agents to prevent or resolve bleeding, while minimizing adverse side effects, is sometimes unclear. DDAVP-induced hyponatremia is a particularly under-recognized complication in children with bleeding disorders who undergo surgery. Clinicians need to be aware of local measures that are equally important in treating problems such as epistaxis and surgical bleeding. This review will discuss the published literature and provide practical suggestions regarding four common management issues in the care of children and adolescents with mild bleeding disorders: epistaxis, heavy menstrual bleeding, dental extractions, and tonsillectomy. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Recognizing, Differentiating, and Referring Students with Absence Seizures: What Factors Affect Preservice Teachers' Decision Making?

ERIC Educational Resources Information Center

Nasewicz, Nicole

2009-01-01

Attention-Deficit/Hyperactivity Disorder (ADHD) and epilepsy are common pediatric disorders that often occur co-morbidly. Both disorders predispose children to a wide range of school-related problems, some of which are the same and others vastly different. Fortunately, with early diagnosis and comprehensive disease management, the long-term…

Pediatric Enteric Feeding Techniques: Insertion, Maintenance, and Management of Problems

DOE Office of Scientific and Technical Information (OSTI.GOV)

Nijs, Els L. F., E-mail: nijs@email.chop.ed; Cahill, Anne Marie, E-mail: cahill@email.chop.ed

Enteral feeding is considered a widespread, well-accepted means of delivering nutrition to adults and children who are unable to consume food by mouth or who need support in maintaining adequate nutrition for a variety of reasons, including acute and chronic disease states. Delivery of enteral feeding to nutritionally deprived patients may be achieved by several means. In this article, the indications and insertion of enteral access in children will be reviewed. In addition, common complications and management of problems will be discussed.

Ethical problems in pediatrics: what does the setting of care and education show us?

PubMed

Guedert, Jucélia Maria; Grosseman, Suely

2012-03-16

Pediatrics ethics education should enhance medical students' skills to deal with ethical problems that may arise in the different settings of care. This study aimed to analyze the ethical problems experienced by physicians who have medical education and pediatric care responsibilities, and if those problems are associated to their workplace, medical specialty and area of clinical practice. A self-applied semi-structured questionnaire was answered by 88 physicians with teaching and pediatric care responsibilities. Content analysis was performed to analyze the qualitative data. Poisson regression was used to explore the association of the categories of ethical problems reported with workplace and professional specialty and activity. 210 ethical problems were reported, grouped into five areas: physician-patient relationship, end-of-life care, health professional conducts, socioeconomic issues and health policies, and pediatric teaching. Doctors who worked in hospitals as well as general and subspecialist pediatricians reported fewer ethical problems related to socioeconomic issues and health policies than those who worked in Basic Health Units and who were family doctors. Some ethical problems are specific to certain settings: those related to end-of-life care are more frequent in the hospital settings and those associated with socioeconomic issues and public health policies are more frequent in Basic Health Units. Other problems are present in all the setting of pediatric care and learning and include ethical problems related to physician-patient relationship, health professional conducts and the pediatric education process. These findings should be taken into consideration when planning the teaching of ethics in pediatrics. This research article didn't reports the results of a controlled health care intervention. The study project was approved by the Institutional Ethical Review Committee (Report CEP-HIJG 032/2008).

Parenting Stress and Emotional/Behavioral Problems in Adolescents with Primary Headache.

PubMed

Operto, Francesca Felicia; Craig, Francesco; Peschechera, Antonia; Mazza, Roberta; Lecce, Paola Alessandra; Margari, Lucia

2017-01-01

Primary headache is a frequent and disabling disorder, common among children and adolescents, and it is a painful syndrome often accompanied by functional impairment and associated with emotional and behavior problems. The aim of this study was to investigate parenting stress and emotional/behavioral problems in adolescents affected by primary headache compared with healthy adolescents. The study population consisted of 35 adolescents and a control group of 23 healthy subjects. The assessment included the administration of clinical standardized scales such as Parent Stress Index-Short Form, Pediatric Migraine Disability Assessment Score Questionnaire, and Child Behavior Checklist (CBCL). Headache group and control group did not differ in terms of parenting stress ( p  = 0.29). On the contrary, headache group showed more internalizing problems ( p  = 0.023), affective problems ( p  = 0.01), anxious ( p  = 0.001), and somatic complaints ( p  < 0.001) compared with control group. In addition, we found a significant correlation between PSI domains and specific CBCL subscales in the headache group. The findings emphasize the need for expanded intervention in the clinical treatment of pediatric headache, a treatment that may also include the family members. Further research is needed.

Hematologic problems in pediatric patients.

PubMed

Cahill, M

1996-02-01

To provide a review of the common hematologic disorders of childhood: iron deficiency anemia, aplastic anemia, sickle cell disease, and hemophilia. Review articles and book chapters pertaining to the care and treatment of children with hematologic disorders. These common hematologic disorders of childhood have the potential to cause not only acute illness but chronic medical problems, particularly in the growing child. Anticipating and preventing the long-term effects of the illness and treatment are the primary goals of care. Nursing assessment, patient education, and long-term follow-up are major factors in the care of children with hematologic disorders. Nurse-managed comprehensive care clinics have provided successful programs directed at acute care and maintenance care for these children and their families.

The Pediatric Urinary Tract and Medical Imaging.

PubMed

Penny, Steven M

2016-01-01

The pediatric urinary tract often is assessed with medical imaging. Consequently, it is essential for medical imaging professionals to have a fundamental understanding of pediatric anatomy, physiology, and common pathology of the urinary tract to provide optimal patient care. This article provides an overview of fetal development, pediatric urinary anatomy and physiology, and common diseases and conditions of the pediatric urinary tract.

Pediatric lower extremity mower injuries.

PubMed

Hill, Sean M; Elwood, Eric T

2011-09-01

Lawn mower injuries in children represent an unfortunate common problem to the plastic reconstructive surgeon. There are approximately 68,000 per year reported in the United States. Compounding this problem is the fact that a standard treatment algorithm does not exist. This study follows a series of 7 pediatric patients treated for lower extremity mower injuries by a single plastic surgeon. The extent of soft tissue injury varied. All patients were treated with negative pressure wound therapy as a bridge to definitive closure. Of the 7 patients, 4 required skin grafts, 1 required primary closure, 1 underwent a lower extremity amputation secondary to wounds, and 1 was repaired using a cross-leg flap. Function limitations were minimal for all of our patients after reconstruction. Our basic treatment algorithm is presented with initial debridement followed by the simplest method possible for wound closure using negative pressure wound therapy, if necessary.

Pediatric foreign bodies and their management.

PubMed

Kay, Marsha; Wyllie, Robert

2005-06-01

Ingestion of foreign bodies is a common pediatric problem, with more than 100,000 cases occurring each year. The vast majority of pediatric ingestions are accidental; increasing incidence of intentional ingestions starts in the adolescent age group. In the United States, the most common pediatric foreign bodies ingested are coins, followed by a variety of other objects, including toys, toy parts, sharp objects, batteries, bones, and food. In adolescents and adults, meat or food impactions are the most common accidental foreign body ingestion. Esophageal pathology underlies most cases of food impaction. Management of foreign body ingestions varies based on the object ingested, its location, and the patient's age and size. Esophageal foreign bodies as a group require early intervention because of their potential to cause respiratory symptoms and complications, esophageal erosions, or even an aortoesophageal fistula. Ingested batteries that lodge in the esophagus require urgent endoscopic removal even in the asymptomatic patient due to the high risk of complications. Sharp foreign bodies increase the foreign body complication rate from less than 1% to 15% to 35%, except for straight pins, which usually follow a relatively benign course unless multiple pins are ingested. Magnets are increasingly ingested, due to their ubiquitous nature and the perception that they do not pose a risk. Ingestion of multiple magnets creates a significant risk of obstruction, perforation, and fistula development. Methods to deal with foreign bodies include the suture technique, the double snare technique, and the combined forceps/snare technique for long, large, and sharp foreign bodies, along with newer equipment, such as retrieval nets and a variety of specialized forceps.

Malignancy and mortality in pediatric patients with inflammatory bowel disease: a multinational study from the porto pediatric IBD group.

PubMed

de Ridder, Lissy; Turner, Dan; Wilson, David C; Koletzko, Sibylle; Martin-de-Carpi, Javier; Fagerberg, Ulrika L; Spray, Christine; Sladek, Malgorzata; Shaoul, Ron; Roma-Giannikou, Eleftheria; Bronsky, Jiri; Serban, Daniela E; Cucchiara, Salvatore; Veres, Gabor; Ruemmele, Frank M; Hojsak, Iva; Kolho, Kaija L; Davies, Ieuan H; Aloi, Marina; Lionetti, Paolo; Veereman-Wauters, Gigi; Braegger, Christian P; Trindade, Eunice; Wewer, Anne V; Hauer, Almuthe; Levine, Arie

2014-02-01

The combination of the severity of pediatric-onset inflammatory bowel disease (IBD) phenotypes and the need for intense medical treatment may increase the risk of malignancy and mortality, but evidence regarding the extent of the problem is scarce. Therefore, the Porto Pediatric IBD working group of ESPGHAN conducted a multinational-based survey of cancer and mortality in pediatric IBD. A survey among pediatric gastroenterologists of 20 European countries and Israel on cancer and/or mortality in the pediatric patient population with IBD was undertaken. One representative from each country repeatedly contacted all pediatric gastroenterologists from each country for reporting retrospectively cancer and/or mortality of pediatric patients with IBD after IBD onset, during 2006-2011. We identified 18 cases of cancers and/or 31 deaths in 44 children (26 males) who were diagnosed with IBD (ulcerative colitis, n = 21) at a median age of 10.0 years (inter quartile range, 3.0-14.0). Causes of mortality were infectious (n = 14), cancer (n = 5), uncontrolled disease activity of IBD (n = 4), procedure-related (n = 3), other non-IBD related diseases (n = 3), and unknown (n = 2). The most common malignancies were hematopoietic tumors (n = 11), of which 3 were hepatosplenic T-cell lymphoma and 3 Ebstein-Barr virus-associated lymphomas. Cancer and mortality in pediatric IBD are rare, but cumulative rates are not insignificant. Mortality is primarily related to infections, particularly in patients with 2 or more immunosuppressive agents, followed by cancer and uncontrolled disease. At least 6 lymphomas were likely treatment-associated by virtue of their phenotype.

Pediatric sleep apnea

MedlinePlus

Sleep apnea - pediatric; Apnea - pediatric sleep apnea syndrome; Sleep-disordered breathing - pediatric ... Untreated pediatric sleep apnea may lead to: High blood pressure Heart or lung problems Slow growth and development

Insomnia of childhood.

PubMed

Lipton, Jonathan; Becker, Ronald E; Kothare, Sanjeev V

2008-12-01

Insomnia is a major public health problem and is the most common sleep disturbance in both adults and children. The causes of sleeplessness are age-dependent and have potentially enormous effects on cognitive development, behavior, family dynamics, and the metabolic health of children. Here we review the epidemiology, cause, pathophysiology, and clinical approach to pediatric insomnia. Normal sleep is crucial for brain function, behavior, and normal metabolism. Consistently, sleep loss has been linked to behavioral and attention problems, impaired learning and memory, obesity, and psychiatric disorders. The neurological mechanisms that govern sleep initiation and maintenance are poorly understood. The types of insomnia are age-dependent and can occur as primary disorders, or in the context of another primary sleep disorder such as restless legs syndrome, or secondary to another underlying medical condition. Children with chronic diseases and especially children with neurodevelopmental disorders are at particular risk of insomnia. Pediatric insomnia is common and is a source of potential psychophysiological stress to both children and their caregivers. The causes of insomnia are various. Pediatricians should have a working knowledge of the causes of sleeplessness in order to promptly curtail the chronic effects of sleep loss and effectively screen for underlying, potentially treatable disorders.

Challenges of training and delivery of pediatric surgical services in Africa.

PubMed

Chirdan, Lohfa B; Ameh, Emmanuel A; Abantanga, Francis A; Sidler, Daniel; Elhalaby, Essam A

2010-03-01

The practice of pediatric surgery in Africa presents multiple challenges. This report presents an overview of problems encountered in the training of pediatric surgeons as well as the delivery of pediatric surgical services in Africa. A returned structured self-administered questionnaire sent to pediatric surgeons practicing in Africa was reviewed and analyzed using SPSS version 11.5 (SPSS, Chicago, IL). Forty-nine (57%) of 86 questionnaires were returned from 8 countries. Great variability in the requirements and training of pediatric surgeons, even within the same country, was found. Many surgical colleges are responsible for standardization and board certification of pediatric surgeons across Africa. There were 6 (12%) centers that train middle level manpower. Twenty-six (53%) participants have 1 to 2 trainees, whereas 22 (45%) have irregular or no trainee. A pediatric surgical trainee needs 2 to 4 (median, 2) years of training in general surgery to be accepted for training in pediatric surgery, and it takes a trainee between 2 to 4 (median, 3) years to complete training as a pediatric surgeon in the countries surveyed. The number of pediatric surgeons per million populations is lowest in Malawi (0.06) and highest in Egypt (1.5). Problems facing adequate delivery of pediatric surgical services enumerated by participants included poor facilities, lack of support laboratory facilities, shortage of manpower, late presentation, and poverty. The training of pediatric surgical manpower in some African countries revealed great variability in training with multiple challenges. Delivery of pediatric surgical services in Africa presents problems like severe manpower shortage, high pediatric surgeon workload, and poor facilities. Standardization of pediatric surgery training across the continent is advocated, and the problems of delivery of pediatric surgical services need to be addressed urgently, not only by health care planners in Africa but by the international community and donor agencies, if the African child is to have access to essential pediatric surgical services like his or her counterpart in other developed parts of the world.

Strategic assessment of the availability of pediatric trauma care equipment, technology and supplies in Ghana.

PubMed

Ankomah, James; Stewart, Barclay T; Oppong-Nketia, Victor; Koranteng, Adofo; Gyedu, Adam; Quansah, Robert; Donkor, Peter; Abantanga, Francis; Mock, Charles

2015-11-01

This study aimed to assess the availability of pediatric trauma care items (i.e. equipment, supplies, technology) and factors contributing to deficiencies in Ghana. Ten universal and 9 pediatric-sized items were selected from the World Health Organization's Guidelines for Essential Trauma Care. Direct inspection and structured interviews with administrative, clinical and biomedical engineering staff were used to assess item availability at 40 purposively sampled district, regional and tertiary hospitals in Ghana. Hospital assessments demonstrated marked deficiencies for a number of essential items (e.g. basic airway supplies, chest tubes, blood pressure cuffs, electrolyte determination, portable X-ray). Lack of pediatric-sized items resulting from equipment absence, lack of training, frequent stock-outs and technology breakage were common. Pediatric items were consistently less available than adult-sized items at each hospital level. This study identified several successes and problems with pediatric trauma care item availability in Ghana. Item availability could be improved, both affordably and reliably, by better organization and planning (e.g. regular assessment of demand and inventory, reliable financing for essential trauma care items). In addition, technology items were often broken. Developing local service and biomedical engineering capability was highlighted as a priority to avoid long periods of equipment breakage. Copyright © 2015 Elsevier Inc. All rights reserved.

Strategic assessment of the availability of pediatric trauma care equipment, technology and supplies in Ghana

PubMed Central

Ankomah, James; Stewart, Barclay T; Oppong-Nketia, Victor; Koranteng, Adofo; Gyedu, Adam; Quansah, Robert; Donkor, Peter; Abantanga, Francis; Mock, Charles

2015-01-01

Background This study aimed to assess the availability of pediatric trauma care items (i.e. equipment, supplies, technology) and factors contributing to deficiencies in Ghana. Methods Ten universal and 9 pediatric-sized items were selected from the World Health Organization’s Guidelines for Essential Trauma Care. Direct inspection and structured interviews with administrative, clinical and biomedical engineering staff were used to assess item availability at 40 purposively sampled district, regional and tertiary hospitals in Ghana. Results Hospital assessments demonstrated marked deficiencies for a number of essential items (e.g. basic airway supplies, chest tubes, blood pressure cuffs, electrolyte determination, portable Xray). Lack of pediatric-sized items resulting from equipment absence, lack of training, frequent stock-outs and technology breakage were common. Pediatric items were consistently less available than adult-sized items at each hospital level. Conclusion This study identified several successes and problems with pediatric trauma care item availability in Ghana. Item availability could be improved, both affordably and reliably, by better organization and planning (e.g. regular assessment of demand and inventory, reliable financing for essential trauma care items). In addition, technology items were often broken. Developing local service and biomedical engineering capability was highlighted as a priority to avoid long periods of equipment breakage. PMID:25841284

Interactive data collection: benefits of integrating new media into pediatric research.

PubMed

Kennedy, Christine; Charlesworth, Annemarie; Chen, Jyu-Lin

2003-01-01

Despite the prevalence of children's computerized games for recreational and educational purposes, the use of interactive technology to obtain pediatric research data remains underexplored. This article describes the development of laptop interactive data collection (IDC) software for a children's health intervention study. The IDC integrates computer technology, children's developmental needs, and quantitative research methods that are engaging for school-age children as well as reliable and efficient for the pediatric health researcher. Using this methodology, researchers can address common problems such as maintaining a child's attention throughout an assessment session while potentially increasing their response rate and reducing missing data rates. The IDC also promises to produce more reliable data by eliminating the need for manual double entry of data and reducing much of the time and costs associated with data cleaning and management. Development and design considerations and recommendations for further use are discussed.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Deng, J.

This imaging educational program will focus on solutions to common pediatric image quality optimization challenges. The speakers will present collective knowledge on best practices in pediatric imaging from their experience at dedicated children’s hospitals. One of the most commonly encountered pediatric imaging requirements for the non-specialist hospital is pediatric CT in the emergency room setting. Thus, this educational program will begin with optimization of pediatric CT in the emergency department. Though pediatric cardiovascular MRI may be less common in the non-specialist hospitals, low pediatric volumes and unique cardiovascular anatomy make optimization of these techniques difficult. Therefore, our second speaker willmore » review best practices in pediatric cardiovascular MRI based on experiences from a children’s hospital with a large volume of cardiac patients. Learning Objectives: To learn techniques for optimizing radiation dose and image quality for CT of children in the emergency room setting. To learn solutions for consistently high quality cardiovascular MRI of children.« less

Nutrition support of the pediatric patient with AIDS.

PubMed

Bentler, M; Stanish, M

1987-04-01

Maintaining optimal nutrition in the pediatric patient with Acquired Immune Deficiency Syndrome (AIDS) is challenging, but it may be one of the most effective therapies. Patients experience numerous complications that compromise nutritional status. Infection, fever, diarrhea, feeding problems, and decreased intake all contribute to malnutrition, which in turn predisposes the patient even more to infection and malabsorption. Nutrition assessment should be done routinely so that new problems may be identified and treated. High-calorie, high-protein feedings, vitamin supplementation, and, when necessary, gavage feedings or parenteral nutrition are recommended to improve nutritional status and prevent further deficits. Maintaining optimal nutrition in the pediatric patient with Acquired Immune Deficiency Syndrome (AIDS) poses a significant challenge to the health care team. Patients may experience numerous complications that compromise nutritional status. The patient is at high risk for opportunistic infections, especially of the lungs, central nervous system, gastrointestinal (GI) tract, and skin. Such infections are common causes of morbidity and mortality. Impaired nutritional status may further impair the patient's immunocompetence. A study by Kotler and Gaety demonstrated severe progressive malnutrition in adult AIDS patients, with the lowest measures of lean body mass occurring in those patients close to death at the time of the study. While no studies of children with AIDS have been done to date, we have subjectively observed feeding problems, weight loss, and malnutrition in most of the patients we have seen.

Outcomes research in pediatric settings: recent trends and future directions.

PubMed

Forrest, Christopher B; Shipman, Scott A; Dougherty, Denise; Miller, Marlene R

2003-01-01

Pediatric outcomes research examines the effects of health care delivered in everyday medical settings on the health of children and adolescents. It is an area of inquiry in its nascent stages of development. We conducted a systematic literature review that covered articles published during the 6-year interval 1994-1999 and in 39 peer-reviewed journals chosen for their likelihood of containing child health services research. This article summarizes the article abstraction, reviews the literature, describes recent trends, and makes recommendations for future work. In the sample of journals that we examined, the number of pediatric outcomes research articles doubled between 1994 and 1999. Hospitals and primary care practices were the most common service sectors, accounting for more than half of the articles. Common clinical categories included neonatal conditions, asthma, psychosocial problems, and injuries. Approximately 1 in 5 studies included multistate or national samples; 1 in 10 used a randomized controlled trial study design. Remarkably few studies examined the health effects of preventive, diagnostic, long-term management, or curative services delivered to children and adolescents. Outcomes research in pediatric settings is a rapidly growing area of inquiry that is acquiring breadth but has achieved little depth in any single content area. Much work needs to be done to inform decision making regarding the optimal ways to finance, organize, and deliver child health care services. To improve the evidence base of pediatric health care, more effectiveness research is needed to evaluate the overall and relative effects of services delivered to children and adolescents in everyday settings.

TH-B-207B-00: Pediatric Image Quality Optimization

DOE Office of Scientific and Technical Information (OSTI.GOV)

NONE

This imaging educational program will focus on solutions to common pediatric image quality optimization challenges. The speakers will present collective knowledge on best practices in pediatric imaging from their experience at dedicated children’s hospitals. One of the most commonly encountered pediatric imaging requirements for the non-specialist hospital is pediatric CT in the emergency room setting. Thus, this educational program will begin with optimization of pediatric CT in the emergency department. Though pediatric cardiovascular MRI may be less common in the non-specialist hospitals, low pediatric volumes and unique cardiovascular anatomy make optimization of these techniques difficult. Therefore, our second speaker willmore » review best practices in pediatric cardiovascular MRI based on experiences from a children’s hospital with a large volume of cardiac patients. Learning Objectives: To learn techniques for optimizing radiation dose and image quality for CT of children in the emergency room setting. To learn solutions for consistently high quality cardiovascular MRI of children.« less

TH-B-207B-01: Optimizing Pediatric CT in the Emergency Department

DOE Office of Scientific and Technical Information (OSTI.GOV)

Dodge, C.

This imaging educational program will focus on solutions to common pediatric image quality optimization challenges. The speakers will present collective knowledge on best practices in pediatric imaging from their experience at dedicated children’s hospitals. One of the most commonly encountered pediatric imaging requirements for the non-specialist hospital is pediatric CT in the emergency room setting. Thus, this educational program will begin with optimization of pediatric CT in the emergency department. Though pediatric cardiovascular MRI may be less common in the non-specialist hospitals, low pediatric volumes and unique cardiovascular anatomy make optimization of these techniques difficult. Therefore, our second speaker willmore » review best practices in pediatric cardiovascular MRI based on experiences from a children’s hospital with a large volume of cardiac patients. Learning Objectives: To learn techniques for optimizing radiation dose and image quality for CT of children in the emergency room setting. To learn solutions for consistently high quality cardiovascular MRI of children.« less

Practical use and pitfalls of hepatocyte-specific contrast agents (HSCAs) for pediatric hepatic and biliary magnetic resonance imaging.

PubMed

Ayyala, Rama S; Anupindi, Sudha A; Callahan, Michael J

2017-02-01

Magnetic resonance imaging is commonly used to evaluate for hepatic and biliary pathology in the pediatric population. Recently, there has been increased use of hepatocyte-specific contrast agents (HSCAs), such as Gadoxetate disodium in children. Traditionally, HSCAs have been used to characterize focal liver lesions. However, these agents can also be used to problem solve specific hepatic or biliary diagnostic dilemmas. The purpose of this manuscript is to review the practical uses of HSCA in children with both hepatic and biliary indications, and review the corresponding imaging findings. We will highlight the diagnostic uses of HSCA in children, as well as pitfalls encountered.

Pediatric emergence delirium: Canadian Pediatric Anesthesiologists' experience.

PubMed

Rosen, H David; Mervitz, Deborah; Cravero, Joseph P

2016-02-01

Pediatric emergence agitation/delirium (ED) is a cluster of behaviors seen in the early postanesthetic period with negative emotional consequences for families and increased utilization of healthcare resources. Many studies have looked at identifying risk factors for ED and at pharmacologic regimens to prevent ED. There are few published reports on treatment options and efficacy for established ED episodes, and essentially no data concerning current practice in the treatment of ED. We sought to elicit the experience and opinions of Canadian Pediatric Anesthesiologists on the incidence of ED in their practice, definitions and diagnostic criteria, preventative strategies, treatments, and their perceived efficacy. A web-based survey was sent to pediatric anesthesiologists working at academic health science centers across Canada. The participants were selected based on being members of the Canadian Pediatric Anesthesia Society (CPAS), which represents the subspecialty in Canada. All members of CPAS who had e-mail contact information available in the membership database were invited to participate. A total of 209 members out of the total of 211 fulfilled these criteria and were included in the study population. The response rate was 51% (106/209). Of respondents, 42% felt that ED was a significant problem at their institutions, with 45% giving medication before or during anesthesia to prevent the development of ED. Propofol was the most common medication given to prevent ED (68%) and to treat ED (42%). Total intravenous anesthesia (TIVA) was considered by 38% of respondents as a technique used to prevent ED. Medications used for treatment included propofol (42%), midazolam (31%), fentanyl (10%), morphine (7%), and dexmedetomidine (5%), with 87% of respondents rating effectiveness of treatment as 'usually works quickly with one dose'. We present information on current practice patterns with respect to prophylaxis and treatment of ED among a specialized group of pediatric anesthesiologists and highlight the importance of further research in improving the treatment of this common and challenging peri-anesthetic occurrence. © 2015 John Wiley & Sons Ltd.

Pediatric dental chair vs. traditional dental chair: a pediatric dentist's poll.

PubMed

Barjatya, Khushboo; Vatsal, Ankur; Kambalimath, Halaswamy V; Kulkarni, Vinay Kumar; Reddy, Naveen Banda

2015-01-01

Proper positioning of the child patient, can not only have positive ramifications for the operator's posture, comfort, and career longevity - it can also lead to better treatment and increased productivity. The aim of the survey questionnaire was to assess the utilization, need, and attitude concerning dental chairs among pediatric dentist while working on and managing the child patient. The questions were structured using adobe forms central online software, regarding the user-friendliness of pediatric dental chair vs. traditional adult dental chair available in the market. Our result shows that out of 337 respondents, 79% worked on pediatric dental chair, whereas 21% had no experience of it. Of these 79% pediatric dentist, 48% preferred pediatric dental chair. But pediatric dental problem still has certain disadvantages like higher cost, leg space problem, lower availability, etc. During the research it was found that ergonomics and usability issues were the main problems. Thus, pediatric dental chair is not so popular in the current scenario. This study allowed for general ideas for the improvement of dental chairs and thus improved dental chair would fill the gap in the current scenario.

Stopping sports injuries in kids: an overview of the last year in publications.

PubMed

Franklin, Corinna C; Weiss, Jennifer M

2012-02-01

Sports participation is common among children and adolescents throughout the United States; along with that participation comes risk of injury, sometimes serious. Over 4 million sports or recreational injuries are sustained by school-age children per year in the USA. This injury prevalence has led to significant interest in prevention strategies. In this review, we examine the last year of publications related to sports injury prevention in the pediatric population. Pediatric and adolescent athletes differ from adults in significant ways that often render them more susceptible to injury. Concussion is a particular problem, as are injuries to the thrower's elbow and injury to the female athlete's knee. Recognition, proper rest, and attention to mechanics may assist in decreasing the incidence and severity of these issues. Further inquiry into the nature, prevalence, causes, and, in particular, sequelae of pediatric sports injuries is required. In the interim, attention to proper technique, core and neuromuscular conditioning, and helmet use are important preventive measures; avoidance of overtraining and providing adequate rest for recovery are essential for pediatric and adolescent athletes.

Pediatric parenting stress and its relation to depressive symptoms and fear of hypoglycemia in parents of young children with type 1 diabetes mellitus.

PubMed

Patton, Susana R; Dolan, Lawrence M; Smith, Laura B; Thomas, Inas H; Powers, Scott W

2011-12-01

Parents of young children with type 1 diabetes (T1DM) maintain full responsibility for their child's daily diabetes self-care and thus may be vulnerable to experiencing parenting stress. This study examined several psychological correlates of pediatric parenting stress in parents of young children with T1DM. Parents of 39 young children with T1DM (ages 2-7 years) completed measures of pediatric parenting stress, mealtime behavior problems, depressive symptoms, and fear of hypoglycemia. For parents of young children, higher stress frequency and difficulty were associated with higher parental depressive symptoms and fear. Regression analyses identified that 58% of the variance in stress frequency was associated with parental depressive symptoms. For stress difficulty, 68% of the variance was associated with parental depressive symptoms and fear. Pediatric parenting stress is common in parents of young children with T1DM. Stress and the psychological correlates measured in this study are amenable to intervention and should be regularly assessed in parents of young children with T1DM.

Child maltreatment and pediatric asthma: a review of the literature.

PubMed

Schreier, Hannah M C; Chen, Edith; Miller, Gregory E

2016-01-01

Child maltreatment is a common problem with known adverse consequences, yet its contributions to the development and course of pediatric asthma are only poorly understood. This review first describes possible pathways connecting child maltreatment to pediatric asthma, including aspects of the physical home environment, health behaviors and disease management, and psychological consequences of child maltreatment. We subsequently review existing studies, which generally report an association between maltreatment experiences and asthma outcomes in childhood. However, this literature is in its early stages; there are only a handful studies, most of them rely on self-reports of both child maltreatment and asthma history, and none have investigated the physiological underpinnings of this association. Taken together, however, the studies are suggestive of child maltreatment playing a role in pediatric asthma incidence and expression that should be explored further. Existing data are sparse and do not allow for specific conclusions. However, the data are suggestive of child maltreatment influencing asthma risk and morbidity long before the adult years. Future research should focus on understanding how child maltreatment contributes to asthma disease risk and progression in this highly vulnerable population.

Diabetes Prevention and Treatment Programs for Western PA - Pediatrics/Platelet Gel

DTIC Science & Technology

2009-09-01

common behaviors contributing to obesity (e.g. sweetened beverage consumption). Advise: Physician advises patient about behaviors contributing to...drinks and other sweetened beverages are a leading cause of weight Cooperative Agreement W81XWH-06-2-0024 Final Report 44 problems. It is recommended...Family history of obesity-related illnesses Principal obesity-related habits (sweet beverage consumption, fast food, media time, family dining

Pediatric Dermatology

PubMed Central

McMahon, Patrick

2017-01-01

Skin changes are common in children. Common concerns are birthmarks (e.g., hemangiomas and port wine stains), atopic and contact dermatitis, acne, and alopecia areata. The authors review advances in common and not so common skin changes in pediatric patients. PMID:28360970

Eunice Kennedy Shriver National Institute of Child Health and Human Development Pediatrics Formulation Initiative: proceedings from the Second Workshop on Pediatric Formulations.

PubMed

Giacoia, George P; Taylor-Zapata, Perdita; Zajicek, Anne

2012-11-01

The Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health (NIH) organized a workshop held in November 2011 to address knowledge gaps that limit the availability of adequate pediatric formulations. This workshop was used as a means to identify the types of research innovations needed and to stimulate research efforts designed to improve the availability of pediatric formulations and the technologies required to make these formulations. Information for this article was gathered from the proceedings of the Second US PFI Workshop sponsored by the Eunice Kennedy Shriver National Institute of Child Health and Human Development in Bethesda, Maryland, on November 1 and 2, 2011, as well as from post-workshop discussions. The workshop preparation began with formation of 4 working groups: Biopharmaceutics, Biopharmaceutics Classification System (BCS), New Technology and Drug Delivery Systems, and Taste and Flavor. The recommendations of the 4 working groups will form the basis for the development of a blueprint to guide future research efforts. The pediatric-specific problems identified include the heterogeneity of the population, the small size of the pediatric drug market, the limited number of new formulations for the large number of off-patent and unlabeled drugs, and the lack of universal agreement on how to define appropriate formulations for different ages and stages of development. There was consensus on the need to develop a universal technology platform for flexible pediatric dosage forms, transforming an empirical process into a science-based platform. A number of problems affect the availability of drugs in the developing world. Age-appropriate solid oral pediatric medicines for common diseases can have a global impact. Success on a global scale depends on the commitment of policy makers, regulators, scientists, pharmaceutical companies, sponsors, government, and research foundations to address gaps in knowledge and solve public health issues related to the availability of formulations in the developing world. Solutions to the worldwide lack of appropriate pediatric formulations will require the development of a road map and the commitment of policy makers, regulators, scientists, pharmaceutical sponsors, academic institutions, governments, and research foundations. The development of a universal, cost-effective platform using existing or developing innovative technology that produces flexible pediatric dosage forms remains an important but elusive goal. Published by EM Inc USA.

Impact of attention on social functioning in pediatric medulloblastoma survivors.

PubMed

Holland, Alice Ann; Colaluca, Beth; Bailey, Laurie; Stavinoha, Peter L

2018-02-01

Parent-reported attention problems have been associated with social functioning in a broad sample of pediatric cancer survivors. The present study focused on a more homogeneous sample (pediatric medulloblastoma survivors), with the novel inclusion of self-reported attention ratings. Thirty-three pediatric medulloblastoma survivors, ages 7-18 years, completed a brief IQ measure and self-report of attentional and social functioning. Parents rated patients' attentional and social functioning. Mean attention ratings were average based on both parent- and self-report, though parent ratings were significantly discrepant from normative means. No significant demographic or treatment-related predictors of self-reported attention problems were identified, whereas female gender was associated with greater parent-reported attention problems. Canonical correlation analysis revealed a significant association between parent-reported attention difficulties and social functioning in pediatric medulloblastoma survivors, but there was no association between self-reported attention problems and measures of social functioning. Consistent with existing literature in broader samples of pediatric cancer survivors, the present study further affirms attention deficits as an underlying contributor to social deficits in pediatric medulloblastoma survivors while also finding little relationship between self-reports of attention and social performance. Notably, present findings provide additional support suggesting that attention functioning is a more significant contributor to social outcomes for pediatric medulloblastoma survivors than the level of cognitive ability.

Hair and Scalp Disorders in a Tuscan Pediatric Dermatological Outpatient Clinic: A Clinical and Epidemiological Evaluation.

PubMed

Conti, Rossana; Colucci, Roberta; Arunachalam, Meena; Berti, Samantha; Fabroni, Caterina; De Martino, Maurizio; Dragoni, Federica; Lazzeri, Linda; Pisaneschi, Lisa; Moretti, Silvia

2016-01-01

The aim of this study was to evaluate the clinical and epidemiological profile of hair and scalp disorders in children referred to the Pediatric Dermatology Outpatient Clinic. We performed a retrospective study of children with hair loss problems or scalp diseases who turned to the Pediatric Dermatology Service, Anna Meyer Pediatric Hospital, Florence, Italy, from January 1, 2009, to December 31, 2009. Demographics, personal and familial medical history, laboratory tests, clinical examination, final diagnosis and therapeutic interventions were obtained from the manual chart review. Of the 2,640 children who had access to the Pediatric Dermatology Service, 190 (7.19%) had a hair or scalp disorder. Among the 190 children, 60 (31.57%) presented with nonscarring alopecia, 56 (29.47%) had benign neoplasias, hamartomas or vascular malformations of the scalp, 51 (26.84%) had scalp inflammatory diseases, 14 (7.36%) had scarring alopecia, 5 (2.63%) had infections and 2 (1.05%) had infestation of the scalp. A case of constitutional hypertrichosis (0.52%) and also a case (0.52%) of lamellar ichthyosis were diagnosed. Our results underline that hair and scalp diseases represent an important percentage of admittances to a dermatological pediatric outpatient clinic. The variety and complexity of the diseases observed in this study included diseases commonly found also in adulthood. © 2015 S. Karger AG, Basel.

Prevalence of DSM-5 avoidant/restrictive food intake disorder in a pediatric gastroenterology healthcare network.

PubMed

Eddy, Kamryn T; Thomas, Jennifer J; Hastings, Elizabeth; Edkins, Katherine; Lamont, Evan; Nevins, Caitlin M; Patterson, Rebecca M; Murray, Helen B; Bryant-Waugh, Rachel; Becker, Anne E

2015-07-01

Few published studies have evaluated the clinical utility of new diagnostic criteria for avoidant/restrictive food intake disorder (ARFID), a DSM-5 reformulation of feeding and eating disorder of infancy or early childhood. We examined the prevalence of ARFID and inter-rater reliability of its diagnostic criteria in a pediatric gastrointestinal sample. We conducted a retrospective chart review of 2,231 consecutive new referrals (ages 8-18 years) to 19 Boston-area pediatric gastroenterology clinics for evidence of DSM-5 ARFID. We identified 33 (1.5%) ARFID cases; 22 of whom (67%) were male. Most were characterized by insufficient intake/little interest in feeding (n = 19) or limited diet due to sensory features of the food (n = 7). An additional 54 cases (2.4%) met one or more ARFID criteria but there was insufficient information in the medical record to confer or exclude the diagnosis. Diagnostic agreement between coders was adequate (κ = 0.72). Common challenges were (i) distinguishing between diagnoses of ARFID and anorexia nervosa or anxiety disorders; (ii) determination of whether the severity of the eating/feeding disturbance was sufficient to warrant diagnosis in the presence of another medical or psychiatric disorder; and (iii) assessment of psychosocial impairment related to eating/feeding problems. In a pediatric treatment-seeking sample where ARFID features were common, cases meeting full criteria were rare, suggesting that the diagnosis is not over-inclusive even in a population where eating/feeding difficulties are expected. © 2014 Wiley Periodicals, Inc.

Involving Pediatric Residents in the Care of Children with Behavior Problems.

ERIC Educational Resources Information Center

Collins, Edward W.; O'Shea, John S.

1979-01-01

Behaviorally disturbed children are treated through the Pediatric/Adolescent Primary Care Unit at Rhode Island Hospital in a program designed to combine the care of children with behavior problems and the training of pediatric residents. The coordination of each child's care becomes the responsibility of a resident or nurse practitioner. (JMD)

In pursuit of the perfect penis: Hypospadias repair outcomes.

PubMed

Winship, Brenton B; Rushton, H Gil; Pohl, Hans G

2017-06-01

Hypospadias is commonly assessed and repaired by pediatric urologists. Mild, distal hypospadias is generally more a cosmetic problem than a functional one and is more frequently encountered than severe, proximal hypospadias. Outcomes following repair, especially of mild phenotypes, are important to understand, but range widely in timing and measurability. Surgical complications, postoperative satisfaction of parents, patients, surgeons and even lay observers, urinary function, sexual function, and quality of life all may be considered as relevant outcomes of hypospadias repair. Existing studies examining these outcomes are diverse in their conclusions, but are important to understand when counseling parents and patients prior to any surgical intervention. Copyright © 2017 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

NCI, NHLBI/PBMTC First International Conference on Late Effects after Pediatric Hematopoietic Cell Transplantation: Endocrine Challenges--Thyroid Dysfunction, Growth Impairment, Bone Health, & Reproductive Risks

PubMed Central

Dvorak, Christopher C.; Gracia, Clarisa R.; Sanders, Jean E.; Cheng, Edward Y.; Baker, K. Scott; Pulsipher, Michael A.; Petryk, Anna

2011-01-01

The endocrine system is highly susceptible to damage by high-dose chemotherapy and/or irradiation prior to hematopoietic cell transplantation (HCT) during childhood. The specific endocrine organs most affected by HCT include the thyroid gland, the pituitary, and the gonads. In addition, hormones that support development and stability of the skeletal system are also affected. Insufficiency of thyroid hormone is one of the most common late sequelae of HCT, and occurs more often in young children. Deficiency in the pituitary’s production of growth hormone is a problem of unique concern to the pediatric population. The reproductive risks of HCT depend on the patient’s gender and pubertal status at the time of HCT. Pubertal or gonadal failure frequently occurs, especially in females. Infertility risks for both genders remain high, while methods of fertility preservation are limited in all but post-pubertal males. Bone health post-HCT can be compromised by low bone mineral density as well as avascular necrosis, but the data on both problems in the pediatric HCT population are limited. In this paper, the current state of knowledge, gaps in that knowledge, and recommendations for future research are addressed in detail for each of these systems. PMID:22005649

Adverse Drug Reactions in Children: The Double-Edged Sword of Therapeutics.

PubMed

Elzagallaai, A A; Greff, Mje; Rieder, M J

2017-06-01

Adverse drug reactions (ADRs) represent a major health problem worldwide, with high morbidity and mortality rates. ADRs are classified into Type A (augmented) and Type B (bizarre) ADRs, with the former group being more common and the latter less common but often severe and clinically more problematic due to their unpredictable nature and occurrence at any dose. Pediatric populations are especially vulnerable to ADRs due to the lack of data for this age group from the drug development process and because of the wide use of off-label and unlicensed use of drugs. Children are more prone to specific types of ADRs because of the level of maturity of body systems involved in absorption, metabolism, transportation, and elimination of drugs. This state-of-the-art review provides an overview of definitions, classifications, epidemiology, and pathophysiology of ADRs and discusses the available evidence for related risk factors and causes of ADRs in the pediatric population. © 2017 American Society for Clinical Pharmacology and Therapeutics.

Against risk-benefit review of prisoner research.

PubMed

Chwang, Eric

2010-01-01

The 2006 Institute of Medicine (IOM) report, 'Ethical Considerations for Research Involving Prisoners', recommended five main changes to current US Common Rule regulations on prisoner research. Their third recommendation was to shift from a category-based to a risk-benefit approach to research review, similar to current guidelines on pediatric research. However, prisoners are not children, so risk-benefit constraints on prisoner research must be justified in a different way from those on pediatric research. In this paper I argue that additional risk-benefit constraints on prisoner research are unnecessary: the current Common Rule regulations, omitting category-based restrictions but conjoined with the IOM report's other four main recommendations, ensure that prisoner research is as ethical as non-prisoner research is. I explain why four problems which which may be more prevalent in prisons and which risk-benefit constraints may seem to address - coercion, undue inducements, exploitation, and protection from harm - are in fact not solved by adding further risk-benefit constraints on prisoner research.

The role of ethics in pediatrics.

PubMed

Cooke, Robert E

1975-10-01

Medical ethics has increased in importance in medical education and practice as a consequence of advances in definitive treatment of patients. Most problems in ethics related to medicine have certain common denominators. Medical scientists and practitioners frequently disclaim any ethical absolutes or consider as important only nonmoral consequences rather than ethical principles such as justice, noninjury, truth-telling, etc. Failure to differentiate moral from nonmoral decisions as well as differences in level of moral reasoning also account for substantial differences in analyzing a given clinical problem. Finally, individual moral policy may be rendered ineffective because of institutional policies that result from purely pragmatic considerations.

Urinary Tract Infection in Children: Management in the Era of Antibiotic Resistance-A Pediatric Urologist's View.

PubMed

Kutasy, Balazs; Coyle, David; Fossum, Magdalena

2017-04-01

Antibiotic resistance to uropathogens has grown significantly worldwide. Today, pediatric urologist experience a situation that needs appropriate action because urinary tract infections are one of the most common bacterial infections in children. In this overview we aimed at presenting the clinical aspects of antibiotic usage in pediatric urology. Our intention was to take part of the important debate regarding future management of bacterial resistance against antibiotics. We searched PubMed for the terms: [UTI in children], [Recurrent UTI in children], and [Antibiotic resistance in UTI]. When using these terms, we found a numerous amount (3875) of published clinical articles related to the topic. By means of an overview, we chose not to focus on a specific condition but to an overall understanding of the problems related to pediatric urology in general. We found that usage of antibiotics has had an unquestionable benefit to reduce the morbidity and mortality related to urinary tract infections in childhood. However, recent studies suggest that early exposure to antibiotics in childhood might have negative systemic effects related to neurocognitive function, body metabolism, and fat distribution. In addition to increased resistance to common antimicrobial agents, it has resulted in increased costs and inadequate effect in severe infections. This calls for changes in the clinical management of urinary pathogens in pediatric urology. As the prevalence of antibiotic resistance grows, pediatric urologists have a key role in managing its consequences and its prevention. In this overview we looked at the consequences of antibiotic usage treating urinary tract infections in childhood. We found that the prevalence of antibiotic resistance has grown. We concluded that decision-makers must know about the short- and long-term effects of antibiotic usage in children. When we understand the development of antibiotic resistance better, we can build up prevention strategies. Copyright © 2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Bacterial bloodstream infections and antimicrobial susceptibility pattern in pediatric hematology/oncology patients after anticancer chemotherapy.

PubMed

Al-Mulla, Naima A; Taj-Aldeen, Saad J; El Shafie, Sittana; Janahi, Mohammed; Al-Nasser, Abdullah A; Chandra, Prem

2014-01-01

Bloodstream infections in pediatric hematology and oncology represent a major problem worldwide, but this has not been studied in Qatar. In this study, we investigated the burden of infection and the resistance pattern in the bacterial etiology, in the only tertiary pediatric hematology and oncology center in Qatar. All pediatric cancer patients (n=185) were evaluated retrospectively during the period 2004-2011; a total of 70 (38%) patients were diagnosed with bloodstream infections. Bacterial etiology was determined, along with their susceptibility patterns. Neutropenia, duration of neutropenia, fever, duration of fever, and C-reactive protein (CRP) were evaluated throughout the study. A total of 70 patients (38%) were diagnosed with acute leukemias, lymphomas, solid tumors, or brain tumors; those patients experienced 111 episodes of bacteremia. The most common Gram-positive (n=64 [55%]) isolates were Staphylococcus epidermidis (n=26), Staphylococcus hominis (n=9), and Staphylococcus haemolyticus (n=7), and the common Gram-negative (n=52 [45%]) isolates were Klebsiella pneumoniae (n=14), Pseudomonas aeruginosa (n=10), and Escherichia coli (n=7). There was a significant association observed between fever with positive blood culture and different types of cancer (P=0.035). The majority of bacteremia (n=68 [61.3%]) occurred in nonneutropenic episodes. Elevated values of CRP (≥5 mg/L) were detected in 82 (95.3%) episodes and were negatively correlated with absolute neutrophil count (ANC) (r=-0.18; P=0.248) among all cases. However, the infection-related fatality rate was 2.2% (n=4), with three caused by Gram-negative pathogens. Multidrug resistant organisms were implicated in 33 (28.4%) cases and caused three of the mortality cases. Multidrug resistant organisms cause mortality in pediatric cancer patients. Investigation of antimicrobial susceptibility of these organisms may guide successful antimicrobial therapy and improve the surveillance and quality of pediatric malignancy care.

Pediatric Obesity and Ear, Nose, and Throat Disorders

MedlinePlus

... Marketplace Find an ENT Doctor Near You Pediatric Obesity and Ear, Nose, and Throat Disorders Pediatric Obesity ... self-esteem, and isolation from their peers. Pediatric obesity and otolaryngic problems Otolaryngologists, or ear, nose, and ...

Nitrous oxide in pediatric anesthesia: friend or foe?

PubMed

Schmitt, Erica L; Baum, Victor C

2008-06-01

Nitrous oxide has been used in clinical practice for over 150 years, often for pediatric procedures. Not only are there problems when used in patients with a variety of inborn errors of metabolism, but effects of nitrous oxide on the developing human brain are unknown. A recent adult human trial found that the use of nitrous oxide was associated with increased adverse outcome. Animal studies in several species have shown that nitrous oxide can be associated with apoptosis in the developing brain. Nitrous oxide can also inhibit major enzymatic pathways and repeated exposure may lead to neurologic damage. Single nucleotide polymorphisms in at least one of these enzymes are common in the population. There is a growing body of evidence that supports avoidance of nitrous oxide in both pediatric and adult patients, but the thousands of patients who have been exposed to nitrous oxide without apparent complications would suggest that further studies on long-term side effects and possible neurologic consequences need to be done.

Congenital esophageal stenosis diagnosed in an infant at 9 month of age.

PubMed

Savino, F; Tarasco, V; Viola, S; Locatelli, E; Sorrenti, M; Barabino, A

2015-10-06

Esophageal stenosis is a relatively uncommon condition in pediatrics and requires an accurate diagnostic approach. Here we report the case of a 9-month old female infant who presented intermittent vomiting, dysphagia and refusal of solid foods starting after weaning. She was treated for gastroesophageal reflux. At first, radiological investigation suggested achalasia, while esophagoscopy revelaed a severe congenital esophageal stenosis at the distal third of the esophagus. She underwent four endoscopic balloon dilatations that then allowed her to swallow solid food with intermittent mild dysphagia. After 17 months of esomeprazole treatment off therapy impedance-pH monitoring was normal. At 29 months of follow-up the child is asymptomatic and eats without problems.Infants with dysphagia and refusal of solid foods may have undiagnosed medical conditions that need treatment. Many disorders can cause esophageal luminal stricture; in the pediatric age the most common are peptic or congenital. Careful assessment with endoscopy is needed to diagnose these conditions early and referral to a pediatric gastroenterologic unit may be necessary.

Common Pediatric Disabilities: Medical Aspects and Educational Implications.

ERIC Educational Resources Information Center

Tyler, Janet Siantz; Colson, Steven

1994-01-01

This paper presents definitions of common pediatric disabilities and information about incidence, causes, diagnosis, common characteristics, complications with educational implications, and multidisciplinary intervention approaches. It covers the following conditions: attention deficit hyperactivity disorder, cerebral palsy, Down syndrome, fragile…

iPhone app adherence to expert-recommended guidelines for pediatric obesity prevention.

PubMed

Wearing, Jessica R; Nollen, Nikki; Befort, Christie; Davis, Ann M; Agemy, Carolina K

2014-04-01

Pediatric obesity is a serious and prevalent problem. Smartphone technology, which is becoming increasingly available to children of diverse backgrounds, presents a unique opportunity to instill healthy behaviors before the onset of obesity. Past studies have examined the use of smartphone applications as tools of health behavior modification for adults. The present study examines the content of children's exercise and nutrition smartphone apps. Sixty-two iPhone apps were identified and coded by two independent raters for adherence to expert-recommended behaviors (e.g., five fruits/vegetables per day) and strategies (e.g., self-monitoring diet/physical activity) for the prevention of pediatric obesity. App behavioral and strategy index scores were uniformly low. Apps were more likely to address expert-recommended behaviors for the prevention of pediatric obesity (93.5%), whereas few apps addressed recommended strategies (20.9%). The most common behaviors addressed included physical activity (53.2%) and fruit/vegetable consumption (48.3%). Other important behaviors (e.g., screen time [1.6%] and family meals together [1.6%]) were rarely addressed. Current children's diet and exercise apps could be improved with increased adherence to expert-recommended guidelines, especially expert-recommended strategies.

iPhone App Adherence to Expert-Recommended Guidelines for Pediatric Obesity Prevention

PubMed Central

Wearing, Jessica R.; Befort, Christie; Davis, Ann M.; Agemy, Carolina K.

2014-01-01

Abstract Background: Pediatric obesity is a serious and prevalent problem. Smartphone technology, which is becoming increasingly available to children of diverse backgrounds, presents a unique opportunity to instill healthy behaviors before the onset of obesity. Past studies have examined the use of smartphone applications as tools of health behavior modification for adults. The present study examines the content of children's exercise and nutrition smartphone apps. Method: Sixty-two iPhone apps were identified and coded by two independent raters for adherence to expert-recommended behaviors (e.g., five fruits/vegetables per day) and strategies (e.g., self-monitoring diet/physical activity) for the prevention of pediatric obesity. Results: App behavioral and strategy index scores were uniformly low. Apps were more likely to address expert-recommended behaviors for the prevention of pediatric obesity (93.5%), whereas few apps addressed recommended strategies (20.9%). The most common behaviors addressed included physical activity (53.2%) and fruit/vegetable consumption (48.3%). Other important behaviors (e.g., screen time [1.6%] and family meals together [1.6%]) were rarely addressed. Conclusions: Current children's diet and exercise apps could be improved with increased adherence to expert-recommended guidelines, especially expert-recommended strategies. PMID:24655230

Pediatric and Adolescent Issues in Underserved Populations.

PubMed

Desai, Neerav; Romano, Mary Elizabeth

2017-03-01

Children and adolescents in underserved populations have health care risks that are different from those of the adult population. Providers need to be aware of these needs and the available resources. Providers should work with school and community organizations to provide timely and appropriate preventive health care and screen for medical and mental health problems that occur more commonly in these high-risk patient populations. Copyright © 2016 Elsevier Inc. All rights reserved.

What Is a Pediatric Gastroenterologist?

MedlinePlus

... Life Medical Home Health Insurance Pediatric Specialists Family ... Page Content Article Body If your child has a digestive system, liver, or nutritional problem, a pediatric gastroenterologist has ...

Annual Research Review: Functional Somatic Symptoms and Associated Anxiety and Depression--Developmental Psychopathology in Pediatric Practice

ERIC Educational Resources Information Center

Campo, John V.

2012-01-01

Background: Medically unexplained physical symptoms, commonly referred to as functional somatic symptoms (FSS), are common in pediatric medical settings and associated with suffering, impairment, and medical help seeking. The association of pediatric FSS with anxiety and depressive symptoms and disorders across the life span is reviewed.Method:…

CLINICAL CHARACTERISTICS AND ANTIBIOTIC RESISTANCE PATTERN OF PATHOGENS IN PEDIATRIC URINARY TRACT INFECTION.

PubMed

Amornchaicharoensuk, Yupaporn

2016-09-01

Medical records of children less than 15-years of age admitted to hospital for urinary tract infection (UTI) from January 2010 to December 2014 were reviewed. Among 100 children (59% males and 41% females) with upper UTI, the most common pathogen (88%) was Escherichia coli, of which 69% were nonextended spectrum beta-lactamase (ESBL) and 19 % ESBL producers. Resistance to ampicillin and trimethoprim/sulfamethoxazole was 90% and 60%, respectively. All ESBL-producing E. coli were resistant to ampicillin and third generation cephalosporins (cefotaxime and ceftriaxone), while 87% and 1.5% of non ESBL-producing E. coli were resistant to ampicillin and the two third generation cephalosporins, respectively. These data highlight the high prevalence of ESBL-producing E. coli in pediatric UTI and the potential problem in treating such infections.

Clinic-friendly screening for cognitive and mental health problems in school-aged youth with epilepsy.

PubMed

Asato, Miya R; Doss, Julia L; Plioplys, Sigita

2015-07-01

Cognitive, psychiatric, psychosocial, and behavioral difficulties are common in youth with epilepsy. Collectively, these comorbidities can be referred to as mental health problems as they reflect brain and behavioral function. Detection and treatment of mental health problems remain an unmet need in epilepsy care that can impact epilepsy, psychosocial, scholastic, and quality-of-life outcomes. Given limited resources in everyday pediatric epilepsy practice, this targeted review provides a stratified plan and suggested tools for screening school-aged youth with epilepsy for the presence of mental health problems. Comanagement of epilepsy and associated comorbidities is a newer concept that may help address the complex, long-term needs of patients by using a multidisciplinary team approach and by engaging primary care providers. Copyright © 2015 Elsevier Inc. All rights reserved.

The challenge of pediatric cardiac services in the developing world.

PubMed

Hewitson, John; Brink, Johan; Zilla, Peter

2002-10-01

Pediatric cardiac services are too expensive for most developing nations. Problems other than cardiac disease take priority when it comes to budget allocations. Poor health infrastructure and referral systems, malnutrition, and the HIV/AIDS pandemic aggravate the situation, and the increasing economic divide is threatening what services do exist. We highlight how the practice of pediatric cardiac surgery in South Africa compares with first-world standards and outline some of the problems faced by pediatric cardiac services in developing nations. Copyright 2002, Elsevier Science (USA). All rights reserved.

How many referrals to a pediatric orthopaedic hospital specialty clinic are primary care problems?

PubMed

Hsu, Eric Y; Schwend, Richard M; Julia, Leamon

2012-01-01

Many primary care physicians believe that there are too few pediatric orthopaedic specialists available to meet their patients' needs. However, a recent survey by the Practice Management Committee of the Pediatric Orthopaedic Society of North America found that new referrals were often for cases that could have been managed by primary care practitioners. We wished to determine how many new referral cases seen by pediatric orthopaedic surgeons are in fact conditions that can be readily managed by a primary care physician should he/she chose to do so. We prospectively studied all new referrals to our hospital-based orthopaedic clinic during August 2010. Each new referral was evaluated for whether it met the American Board of Pediatrics criteria for being a condition that could be managed by a primary care pediatrician. Each referral was also evaluated for whether it met the American Academy of Pediatrics Surgery Advisory Panel guidelines recommending referral to an orthopaedic specialist, regardless of whether it is for general orthopaedics or pediatric orthopaedics. On the basis of these criteria, we classified conditions as either a condition manageable by primary care physicians or a condition that should be referred to an orthopaedic surgeon or a pediatric orthopaedic surgeon. We used these guidelines not to identify diagnosis that primary care physicians should treat but, rather, to compare the guideline-delineated referrals with the actual referrals our specialty pediatric orthopaedic clinic received over a period of 1 month. A total of 529 new patient referrals were seen during August 2010. A total of 246 (47%) were considered primary care conditions and 283 (53%) orthopaedic specialty conditions. The most common primary care condition was a nondisplaced phalanx fracture (25/246, 10.1%) and the most common specialty condition was a displaced single-bone upper extremity fracture needing reduction (36/283, 13%). Only 77 (14.6%) of the total cases met the strict American Academy of Pediatrics Surgery Advisory Panel guidelines recommending referral to pediatric orthopaedics, with scoliosis being the most frequent condition. For 38 (7.2%) cases, surgical treatment was required or recommended. Patient age, referral source, or type of insurance did not influence whether the condition was a primary care or a specialty care case. A total of 134 (25%) cases were referred without having an initial diagnosis made by the referring clinician. These patients were more likely to have been referred from a primary care practitioner than from a tertiary care practitioner whether the diagnosis eventually made was considered to be a primary care condition (P=0.03; relative risk, 1.9; 95% confidence interval, 96-3.86). Almost half of all new referrals to a tertiary pediatric orthopaedic clinic were for conditions considered to be manageable by primary care physicians should they chose to do so. This has implications for pediatric orthopaedic workforce availability, reimbursement under the Affordable Care Act, and pediatric musculoskeletal training needs for providers of primary care.

What Is a Pediatric Allergist / Immunologist?

MedlinePlus

... Life Medical Home Health Insurance Pediatric Specialists ... Content Article Body If your child suffers from allergies or other problems with his immune system, a pediatric allergist/immunologist has special skills to ...

Multidrug resistance in pediatric urinary tract infections.

PubMed

Gaspari, Romolo J; Dickson, Eric; Karlowsky, James; Doern, Gary

2006-01-01

Urinary tract infections (UTIs) represent a common infection in the pediatric population. Escherichia coli is the most common uropathogen in children, and antimicrobial resistance in this species complicates the treatment of pediatric UTIs. Despite the impact of resistance on empiric antibiotic choice, there is little data on multidrug resistance in pediatric patients. In this paper, we describe characteristics of multidrug-resistant E. coli in pediatric patients using a large national database of uropathogens antimicrobial sensitivities. Antimicrobial susceptibility patterns to commonly prescribed antibiotics were performed on uropathogens isolated from children presenting to participating hospitals between 1999 and 2001. Data were analyzed separately for four pediatric age groups. Single and multidrug resistance to ampicillin, amoxicillin-clavulanate, cefazolin, ciprofloxacin, nitrofurantoin, and trimethoprim-sulfamethoxazole (TMP-SMX) were performed on all specimens. There were a total of 11,341 E. coli urine cultures from 343 infants (0-4 weeks), 1,801 toddlers (5 weeks-24 months), 6,742 preteens (2-12 years), and 2,455 teens (13-17 years). E. coli resistance to ampicillin peaked in toddlers (52.8%) but was high in preteens (52.1%), infants (50.4%), and teens (40.6%). Resistance to two or more antibiotics varied across age groups, with toddlers (27%) leading preteens (23.1%), infants (21%), and teens (15.9%). Resistance to three or more antibiotics was low in all age groups (range 3.1-5.2%). The most common co-resistance in all age groups was ampicillin/TMP-SMZ. In conclusion, less than half of all pediatric UTIs are susceptible to all commonly used antibiotics. In some age groups, there is a significant percentage of co-resistance between the two most commonly used antibiotics (ampicillin and TMP-SMZ).

Empirically supported treatments for feeding difficulties in young children.

PubMed

Davis, Ann McGrath; Bruce, Amanda; Cocjin, Jose; Mousa, Hayat; Hyman, Paul

2010-06-01

Pediatric feeding problems are common among children and present severe issues for families. Unfortunately, treatment outcome studies with this population are sparse. The current study reviews the literature regarding treatment studies of children with severe feeding issues, provides an overview of empirically supported treatments for children who do eat orally, and finally summarizes interventions that attempt to reintroduce oral feeding to children who have been fed by gastrostomy tube or other non-oral feeding route.

NCI, NHLBI/PBMTC first international conference on late effects after pediatric hematopoietic cell transplantation: endocrine challenges-thyroid dysfunction, growth impairment, bone health, & reproductive risks.

PubMed

Dvorak, Christopher C; Gracia, Clarisa R; Sanders, Jean E; Cheng, Edward Y; Baker, K Scott; Pulsipher, Michael A; Petryk, Anna

2011-12-01

The endocrine system is highly susceptible to damage by high-dose chemotherapy and/or irradiation before hematopoietic cell transplantation (HCT) during childhood. The specific endocrine organs most affected by HCT include the thyroid gland, the pituitary, and the gonads. In addition, hormones that support development and stability of the skeletal system are also affected. Insufficiency of thyroid hormone is 1 of the most common late sequelae of HCT, and occurs more often in young children. Deficiency in the pituitary's production of growth hormone is a problem of unique concern to the pediatric population. The reproductive risks of HCT depend on the patient's gender and pubertal status at the time of HCT. Pubertal or gonadal failure frequently occurs, especially in females. Infertility risks for both genders remain high, whereas methods of fertility preservation are limited in all but postpubertal males. Bone health post-HCT can be compromised by low bone mineral density as well as avascular necrosis, but the data on both problems in the pediatric HCT population are limited. In this paper, the current state of knowledge, gaps in that knowledge, and recommendations for future research are addressed in detail for each of these systems. Copyright © 2011 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.

[Demand for hospitalization due to psychosocial causes in a pediatric hospital].

PubMed

Bella, Mónica E; Borgiattino, Vanesa

2016-06-01

Health care services show epidemiological changes and an increase in the number of consultations due to mental causes and violence without having the necessary capacity to respond to this increasing demand. To analyze and compare the demand for hospitalization due to psychosocial causes in a pediatric hospital during three different periods. Descriptive, retrospective study. The cases were children/adolescents hospitalized for psychosocial causes at Hospital de Niños de la Santísima Trinidad, Córdoba. The data were processed using frequency analysis and chi-square test. 221 records were analyzed. The hospitalization rate was 0.73% in the year 2000, 1.44% in 2005 and 1.26% in 2010. The hospitalization rate for psychosocial causes increased from 0.06 in 2000 to 0.10 in the years 2005 and 2010. The most common reasons for admission were: suspected child abuse in 44.2% (p < 0.0001), suicidal behavior in 18.7%, suspected sexual abuse in 10.05% and substance abuse in 6.8%. The psychomotor agitation episode and psychotic episode showed a prevalence of 2.4% in 2000, while in 2010 it was of 9.5% for the psychomotor agitation episode and of 5.7% for the psychotic episode. Suicidal behavior and suspected sexual abuse were more common in women and the psychomotor agitation episode and substance abuse were more common in men. Hospitalizations for psychosocial causes and, particularly, mental causes in children/adolescents have increased and show a different behavior according to age and gender. Health problems related to violence were the most frequent ones. Sociedad Argentina de Pediatría.

MO-DE-207-04: Imaging educational program on solutions to common pediatric imaging challenges

DOE Office of Scientific and Technical Information (OSTI.GOV)

Krishnamurthy, R.

This imaging educational program will focus on solutions to common pediatric imaging challenges. The speakers will present collective knowledge on best practices in pediatric imaging from their experience at dedicated children’s hospitals. The educational program will begin with a detailed discussion of the optimal configuration of fluoroscopes for general pediatric procedures. Following this introduction will be a focused discussion on the utility of Dual Energy CT for imaging children. The third lecture will address the substantial challenge of obtaining consistent image post -processing in pediatric digital radiography. The fourth and final lecture will address best practices in pediatric MRI includingmore » a discussion of ancillary methods to reduce sedation and anesthesia rates. Learning Objectives: To learn techniques for optimizing radiation dose and image quality in pediatric fluoroscopy To become familiar with the unique challenges and applications of Dual Energy CT in pediatric imaging To learn solutions for consistent post-processing quality in pediatric digital radiography To understand the key components of an effective MRI safety and quality program for the pediatric practice.« less

Munchausen syndrome by proxy: ongoing clinical challenges.

PubMed

Squires, Janet E; Squires, Robert H

2010-09-01

In 1977, Roy Meadow, a pediatric nephrologist, first described a condition he subsequently coined Munchausen syndrome by proxy. The classic form involves a parent or other caregiver who inflicts injury or induces illness in a child, deceive the treating physician with fictitious or exaggerated information, and perpetrate the trick for months or years. A related form of pathology is more insidious and more common but also damaging. It involves parents who fabricate or exaggerate symptoms of illness in children, causing overly aggressive medical evaluations and interventions. The common thread is that the treating physician plays a role in inflicting the abuse upon the child. Failure to recognize the problem is common because the condition is often not included in the differential diagnosis of challenging or confusing clinical problems. We believe that a heightened "self-awareness" of the physician's role in Munchausen syndrome by proxy will prevent or reduce the morbidity and mortality associated with this diagnosis. In addition, we believe contemporary developments within the modern health care system likely facilitate this condition.

Refusal of medical treatment in the pediatric emergency service: analysis of reasons and aspects.

PubMed

Gündüz, Ramiz Coşkun; Halil, Halit; Gürsoy, Cüneyt; Çifci, Atilla; Özgün, Seher; Kodaman, Tuğba; Sönmez, Mehtap

2014-01-01

Refusal of treatment for acutely ill children is still an important problem in the emergency service. When families refuse medical treatment for their acutely ill children, healthcare professionals may attempt to provide information and negotiate with the family concerning treatment refusal and its possible adverse outcomes, and request consent for refusal of medical treatment. There is insufficient data about refusal of treatment in our country. The purpose of this study was to analyze the causes of treatment refusal in the pediatric emergency service. We collected data recorded on informed consent forms. During a 2-year-study period, 215 patients refused treatment recommended by acute health care professionals. The majorty of patients were in the 0-2 year age group. Hospitalization was the type of treatment most commonly refused; restrictions regarding family members staying with their children during hospitalization and admission to another hospital were the major reasons for refusal of treatment. Clarifying the reasons for treatment refusal may help us to overcome deficiencies, improve conditions, resolve problems and build confidence between healthcare providers and service users, increasing users' satisfaction in the future.

Overcoming Challenges to Care in the Juvenile Justice System: A Case Study and Commentary.

PubMed

Savage, Rebekah J; Reese, Jasmine M; Wallace, Stephenie; Wang, Timothy; Jester, Traci; Lowe, Robert; Hyndman, LaKeshia; Durant, Nefertiti

2017-01-01

Youth in the criminal justice system commonly suffer from multiple medical and psychological health problems. Because they likely live in lower socioeconomic environments, the medical care they receive through the justice system might be their only recent medical care and can result in the discovery of health problems or chronic illnesses that must be managed while in the system and beyond. We describe the case of an adolescent diagnosed with a serious chronic disease during his time in an urban detention center to illustrate how health workers and justice staff must use a team approach in caring for this vulnerable population of children. Barriers to appropriate care, including social and systems-level challenges, are discussed. The lessons learned in this case can be applied more broadly to other vulnerable youth populations, including those in foster care and impoverished communities where the primary care pediatrician (or other assigned pediatric specialist) is both the leader of the medical team and an advocate for quality care. © American Academy of Pediatrics, 2017. All rights reserved.

Malnutrition in Hospitalized Pediatric Patients: Assessment, Prevalence, and Association to Adverse Outcomes.

PubMed

Daskalou, Efstratia; Galli-Tsinopoulou, Assimina; Karagiozoglou-Lampoudi, Thomais; Augoustides-Savvopoulou, Persefone

2016-01-01

Malnutrition is a frequent finding in pediatric health care settings in the form of undernutrition or excess body weight. Its increasing prevalence and impact on overall health status, which is reflected in the adverse outcomes, renders imperative the application of commonly accepted and evidence-based practices and tools by health care providers. Nutrition risk screening on admission and nutrition status evaluation are key points during clinical management of hospitalized pediatric patients, in order to prevent health deterioration that can lead to serious complications and growth consequences. In addition, anthropometric data based on commonly accepted universal growth standards can give accurate results for nutrition status. Both nutrition risk screening and nutrition status assessment are techniques that should be routinely implemented, based on commonly accepted growth standards and methodology, and linked to clinical outcomes. The aim of the present review was to address the issue of hospital malnutrition in pediatric settings in terms of prevalence, outline nutrition status evaluation and nutrition screening process using different criteria and available tools, and present its relationship with outcome measures. Key teaching points • Malnutrition-underweight or excess body weight-is a frequent imbalance in pediatric settings that affects physical growth and results in undesirable clinical outcomes. • Anthropometry interpretation through growth charts and nutrition screening are cornerstones for the assessment of malnutrition.To date no commonly accepted anthropometric criteria or nutrition screening tools are used in hospitalized pediatric patients. • Commonly accepted nutrition status and screening processes based on the World Health Organization's growth standards can contribute to the overall hospital nutrition care of pediatric patients.

Automation and adaptation: Nurses' problem-solving behavior following the implementation of bar coded medication administration technology.

PubMed

Holden, Richard J; Rivera-Rodriguez, A Joy; Faye, Héléne; Scanlon, Matthew C; Karsh, Ben-Tzion

2013-08-01

The most common change facing nurses today is new technology, particularly bar coded medication administration technology (BCMA). However, there is a dearth of knowledge on how BCMA alters nursing work. This study investigated how BCMA technology affected nursing work, particularly nurses' operational problem-solving behavior. Cognitive systems engineering observations and interviews were conducted after the implementation of BCMA in three nursing units of a freestanding pediatric hospital. Problem-solving behavior, associated problems, and goals, were specifically defined and extracted from observed episodes of care. Three broad themes regarding BCMA's impact on problem solving were identified. First, BCMA allowed nurses to invent new problem-solving behavior to deal with pre-existing problems. Second, BCMA made it difficult or impossible to apply some problem-solving behaviors that were commonly used pre-BCMA, often requiring nurses to use potentially risky workarounds to achieve their goals. Third, BCMA created new problems that nurses were either able to solve using familiar or novel problem-solving behaviors, or unable to solve effectively. Results from this study shed light on hidden hazards and suggest three critical design needs: (1) ecologically valid design; (2) anticipatory control; and (3) basic usability. Principled studies of the actual nature of clinicians' work, including problem solving, are necessary to uncover hidden hazards and to inform health information technology design and redesign.

Automation and adaptation: Nurses’ problem-solving behavior following the implementation of bar coded medication administration technology

PubMed Central

Holden, Richard J.; Rivera-Rodriguez, A. Joy; Faye, Héléne; Scanlon, Matthew C.; Karsh, Ben-Tzion

2012-01-01

The most common change facing nurses today is new technology, particularly bar coded medication administration technology (BCMA). However, there is a dearth of knowledge on how BCMA alters nursing work. This study investigated how BCMA technology affected nursing work, particularly nurses’ operational problem-solving behavior. Cognitive systems engineering observations and interviews were conducted after the implementation of BCMA in three nursing units of a freestanding pediatric hospital. Problem-solving behavior, associated problems, and goals, were specifically defined and extracted from observed episodes of care. Three broad themes regarding BCMA’s impact on problem solving were identified. First, BCMA allowed nurses to invent new problem-solving behavior to deal with pre-existing problems. Second, BCMA made it difficult or impossible to apply some problem-solving behaviors that were commonly used pre-BCMA, often requiring nurses to use potentially risky workarounds to achieve their goals. Third, BCMA created new problems that nurses were either able to solve using familiar or novel problem-solving behaviors, or unable to solve effectively. Results from this study shed light on hidden hazards and suggest three critical design needs: (1) ecologically valid design; (2) anticipatory control; and (3) basic usability. Principled studies of the actual nature of clinicians’ work, including problem solving, are necessary to uncover hidden hazards and to inform health information technology design and redesign. PMID:24443642

Recommendations and Extraction of Clinical Variables of Pediatric Multiple Sclerosis Using Common Data Elements.

PubMed

Newland, Pamela; Newland, John M; Hendricks-Ferguson, Verna L; Smith, Judith M; Oliver, Brant J

2018-06-01

The purpose of this article was to demonstrate the feasibility of using common data elements (CDEs) to search for information on the pediatric patient with multiple sclerosis (MS) and provide recommendations for future quality improvement and research in the use of CDEs for pediatric MS symptom management strategies Methods: The St. Louis Children's Hospital (SLCH), Washington University (WU) pediatrics data network was evaluated for use of CDEs identified from a database to identify variables in pediatric MS, including the key clinical features from the disease course of MS. The algorithms used were based on International Classification of Diseases, Ninth/Tenth Revision, codes and text keywords to identify pediatric patients with MS from a de-identified database. Data from a coordinating center of SLCH/WU pediatrics data network, which houses inpatient and outpatient records consisting of patients (N = 498 000), were identified, and detailed information regarding the clinical course of MS were located from the text of the medical records, including medications, presence of oligoclonal bands, year of diagnosis, and diagnosis code. There were 466 pediatric patients with MS, with a few also having the comorbid diagnosis of anxiety and depression. St. Louis Children's Hospital/WU pediatrics data network is one of the largest databases in the United States of detailed data, with the ability to query and validate clinical data for research on MS. Nurses and other healthcare professionals working with pediatric MS patients will benefit from having common disease identifiers for quality improvement, research, and practice. The increased knowledge of big data from SLCH/WU pediatrics data network has the potential to provide information for intervention and decision-making that can be personalized to the pediatric MS patient.

[Pediatric organ transplantation].

PubMed

Carcassonne, M; Delarue, A; Monfort, G; Noirclerc, M; Guys, J M; Torres, C

1989-01-01

Since we started our pediatric kidney transplant program in 1970, we advocate children's transplantation to be performed in pediatric surgery units. Recent progress in immuno-suppression with ciclosporine and in operative procedures lead us to extend the program to liver transplantations in 1986, then to heart and lung transplantations in 1988. The Pediatric Transplant Unit was designed to assume the pre-operative evaluation of the recipients and the post-operative course of transplanted patients, closely connected to all specialists dealing with medical and surgical diseases of children. 29 patients were transplanted (kidney: 8, liver: 14, heart: 1, lungs: 6) with a 83% overall survival rate. The goal of this paper is not to discuss and compare indications or results with others series. Through our experience of pediatric organ transplantation, we shall try to point out the main advantages of a Pediatric Transplantation Unit: it optimizes the management of the rare pediatric donnors, and allows better skill and efficiency of the numerous specialities concerned by organ transplantation, such as intensive care, infectiology, immunology, radiology... The common medical and para-medical staff, common operative theater, and common use of equipment in the same department for transplantation of different organs is also an important matter to be considered now in term of cost-effectiveness.

Pediatric critical incidents reported over 15 years at a tertiary care teaching hospital of a developing country.

PubMed

Abbasi, Shemila; Khan, Fauzia Anis; Khan, Sobia

2018-01-01

The role of critical incident (CI) reporting is well established in improving patient safety but only a limited number of available reports relate to pediatric incidents. Our aim was to analyze the reported CIs specific to pediatric patients in our database and to reevaluate the value of this program in addressing issues in pediatric anesthesia practice. Incidents related to pediatric population from neonatal period till the age of 12 years were selected. A review of all CI records collected between January 1998 and December 2012, in the Department of Anaesthesiology of Aga Khan University hospital was done. This was retrospective form review. The Department has a structured CI form in use since 1998 which is intermittently evaluated and modified if needed. A total of 451 pediatric CIs were included. Thirty-four percent of the incidents were reported in infants. Ninety-six percent of the reported incidents took place during elective surgery and 4% during emergency surgery. Equipment-related events (n = 114), respiratory events (n = 112), and drug events (n = 110) were equally distributed (25.6%, 25.3%, and 24.7%). Human factors accounted for 74% of reports followed by, equipment failure (10%) and patient factors (8%). Only 5% of the incidents were system errors. Failure to check (equipment/drugs/doses) was the most common cause for human factors. Poor outcome was seen in 7% of cases. Medication and equipment are the clinical areas that need to be looked at more closely. We also recommend quality improvement projects in both these areas as well as training of residents and staff in managing airway-related problems in pediatric patients.

The impact of pediatric obesity on hospitalized children with lower respiratory tract infections in the United States.

PubMed

Okubo, Yusuke; Nochioka, Kotaro; Testa, Marcia A

2018-04-01

Obesity is the most common public health problem and is a clinically complicating risk factor among hospitalized children. The impact of pediatric obesity on the severity and morbidity of lower respiratory tract infections remains unclear. We conducted a retrospective cohort study of bronchitis and pneumonia among children aged 2-20 years using hospital discharge records. The data were obtained from the Kid's Inpatient Database in 2003, 2006, 2009, and 2012, and were weighted to estimate the number of hospitalizations in the United States. We used the International Classification of Diseases, Ninth Revision, Clinical Modification code (278.0×) to classify whether the patient was obese or not. We investigated the associations between pediatric obesity and use of mechanical ventilation using multivariable logistic regression model. In addition, we ascertained the relationships between pediatric obesity, comorbid blood stream infections, mean healthcare cost, and length of hospital stay. We estimated a total of 133 602 hospitalizations with pneumonia and bronchitis among children aged between 2 and 20 years. Obesity was significantly associated with use of mechanical ventilation (adjusted OR 2.90, 95% CI 2.15-3.90), comorbid bacteremia or septicemia (adjusted OR 1.58, 95% CI 1.03-2.44), elevated healthcare costs (adjusted difference $383, 95%CI $276-$476), and prolonged length of hospital stay (difference 0.32 days, 95%CI 0.23-0.40 days), after adjusting for patient and hospital characteristics using multivariable logistic regression models. Pediatric obesity is an independent risk factor for severity and morbidity among pediatric patients with lower respiratory tract infections. These findings suggest the importance of obesity prevention for pediatric populations. © 2017 John Wiley & Sons Ltd.

Safety-pin ingestion in children: a cultural fact.

PubMed

Gün, Feryal; Salman, Tansu; Abbasoglu, Latif; Celik, Rüya; Celik, Alaaddin

2003-08-01

Pediatric foreign-body (FB) ingestion is a common problem. Many of these FBs are sharp objects such as needles, toothpicks and safety pins (SP). This report reviews the management of SP ingestion in children. During a 16-year period, we recorded 49 pediatric cases of witnessed SP ingestion. In all children, SPs were used to attach the blue beads to the child's suits with the belief of averting the evil eye. The mean age was 8 months ranging from 4 months to 2 years, and 30 patients were males and 19 were females. SPs were most commonly sited in esophagus (37%) and stomach (37%). In the remainder, the SPs have already reached the duodenum and intestine. In this series, 20 (41%) children passed SPs spontaneously, 14 (28.5%) required endoscopic removal and 15 (30.5%) underwent surgery. The outcome of all patients was uneventful. All of the esophageal SPs require endoscopic intervention, however, after passing into stomach the patients can be observed with keeping the surgical intervention in mind if the SP displays a fixed position for more than three days.

Bacterial isolates and their antimicrobial susceptibility patterns among pediatric patients with urinary tract infections.

PubMed

Ayelign, Birhanu; Abebe, Betelehem; Shibeshi, Adugna; Meshesha, Sosina; Shibabaw, Tewodros; Addis, Zelalem; Gelaw, Aschalew; Dagnew, Mulat

2018-01-01

Urinary tract infection is a common pediatric problem with the potential to produce long-term morbidity. Therefore, appropriate diagnosis and prompt treatment is required. However, studies about magnitude of uropathogenicity and antimicrobial resistance pattern of pediatric urinary tract infection (UTI) are lacking in resource limited countries including Ethiopia. This study was aimed to determine bacterial isolates, antimicrobial susceptibility pattern among pediatric patients with UTI. A cross- sectional study was conducted. Pathogenic bacterial isolates were identified by culture and biochemical methods following standard procedures. Antimicrobial susceptibility testing of the isolates for commonly used antibiotics was done using the standard disc diffusion method on Muller Hinton agar. Associations between dependent and independent variables were measured using chi-square test and within 95% confidence interval. P values <0.05 were considered as statistically significant. A total of 310 pediatric patients were included in the study, and 82 (26.45%) bacterial isolates were detected. Gram- negative bacteria were predominant etiologic agents of UTI in this study. E. coli was the most frequently occurring pathogen (n=45; 54.88%) followed by S. aureus and P.aeruginosa (n=8; 9.75% for both), P. vulgaris , P.aeruginosa (n=4; 4.88%, for both) and Enterococcus species (n=3; 3.66%). All K. pneumoniae , P. mirabilis , and K. ozanae straines were 100% resistance to ampicillin, followed by P. aeruginosa (87.5%) and E. coli (69%). While all Gram- positive bacterial isolates were 100% sensitive to ciprofloxacin. Malnutrition, history of catherization and previous history of UTI were independently associated with UTI (p=0.000). There was a high prevalence of uropathogenic bacteria and drug resistance particularly to ampicillin (72%) and tetracycline (37.80%). This condition indicates that antibiotic selection should be based on knowledge of the local prevalence of bacterial organisms and antibiotic sensitivities rather than empirical treatment.

Posttraumatic stress following pediatric injury: update on diagnosis, risk factors, and intervention.

PubMed

Kassam-Adams, Nancy; Marsac, Meghan L; Hildenbrand, Aimee; Winston, Flaura

2013-12-01

After pediatric injury, transient traumatic stress reactions are common, and about 1 in 6 children and their parents develop persistent posttraumatic stress (PTS) symptoms that are linked to poorer physical and functional recovery. Meta-analytic studies identify risk factors for persistent PTS, including preinjury psychological problems, peritrauma fear and perceived life threat, and posttrauma factors such as low social support, maladaptive coping strategies, and parent PTS symptoms. There is growing prospective data indicating that children's subjective appraisals of the injury and its aftermath influence PTS development. Secondary prevention of injury-related PTS often involves parents and focuses on promoting adaptive child appraisals and coping strategies. Web-based psychoeducation and targeted brief early intervention for injured children and their parents have shown a modest effect, but additional research is needed to refine preventive approaches. There is a strong evidence base for effective psychological treatment of severe and persistent PTS via trauma-focused cognitive behavioral therapy; evidence is lacking for psychopharmacological treatment. Pediatric clinicians play a key role in preventing injury-related PTS by providing "trauma-informed" pediatric care (ie, recognizing preexisting trauma, addressing acute traumatic stress reactions associated with the injury event, minimizing potentially traumatic aspects of treatment, and identifying children who need additional monitoring or referral).

A Qualitative Study to Assess How Primary Care Versus Psychiatric Providers Evaluate and Treat Pediatric Patients With Irritability.

PubMed

Scandinaro, Anna L; Hameed, Usman; Dellasega, Cheryl A

2018-04-05

To determine how primary care versus specialist practitioners assess and treat school-aged children with irritability. Seventeen providers from family medicine, pediatrics, and psychiatry participated in in-depth interviews from June to August 2016 about the process they use to evaluate irritability. Data on demographic traits and measures of confidence were also collected. Primary care (family medicine and pediatrics) participants expressed frustration over the lack of time and specialized knowledge they had to accurately assess children with irritability, even though they were often the first clinician consulted when problems arose. There were clear and sometimes contradictory differences between how practitioners with a general versus specialized practice assessed mental health status in the clinic setting. Input on treatment approaches revealed that medication prescription was more common by primary care participants, and therapy was preferred by the psychiatry participants. Overall, family medicine and pediatric practitioners were significantly less confident in their ability to evaluate mental health status, while child and adolescent psychiatry participants were supportive of having more initial triage and possible treatment occur at the primary care level, suggesting a need for more training about childhood irritability in the primary care setting. © Copyright 2018 Physicians Postgraduate Press, Inc.

Teaching Ethics to Pediatric Residents: A Literature Analysis and Synthesis.

PubMed

Martakis, K; Czabanowska, K; Schröder-Bäck, P

2016-09-01

Ethics education rarely exists in pediatric resident curricula, although ethical conflicts are common in the clinical practice. Ethics education can prepare residents to successfully handle these conflicts. We searched for methods in teaching ethics to clinical and especially pediatric residents, and identified recurring barriers to ethics teaching and solutions to overcome them. Literature from 4 electronic databases with peer-reviewed articles was screened in 3 phases and analyzed. The literature included papers referring to applied methods or recommendations to teaching ethics to clinical residents, and on a second level focusing especially on pediatrics. An analysis and critical appraisal was conducted. 3 231 articles were identified. 96 papers were included. The applied learning theory, the reported teaching approaches, the barriers to teaching ethics and the provided solutions were studied and analyzed. We recommend case-based ethics education, including lectures, discussion, individual study; regular teaching sessions in groups, under supervision; affiliation to an ethics department, institutional and departmental support; ethics rounds and consultations not as core teaching activity; recurring problems to teaching ethics, primarily deriving from the complexity of residential duties to be addressed in advance; teaching ethics preferably in the first years of residency. We may be cautious generalizing the implementation of results on populations with different cultural backgrounds. © Georg Thieme Verlag KG Stuttgart · New York.

Assessment of sleep in pediatric cancer patients.

PubMed

İnce, Dilek; Demirağ, Bengü; Karapınar, Tuba Hilkay; Oymak, Yeşim; Ay, Yılmaz; Kaygusuz, Arife; Töret, Ersin; Vergin, Canan

2017-01-01

İnce D, Demirağ B, Karapınar TH, Oymak Y, Ay Y, Kaygusuz A, Töret E, Vergin C. Assessment of sleep in pediatric cancer patients. Turk J Pediatr 2017; 59: 379-386. The purpose of the study is to describe sleep habits, assess the prevalence of sleep disturbances in pediatric cancer patients and healthy controls, and to compare sleep patterns, sleep problems. One hundred-thirty-five patients and 190 healthy controls were evaluated. Healthy children matched for age, sex, economic status, parental education and family structure constituted the control group. Sleep was evaluated by using the Children`s Sleep Habits Questionnaire (CSHQ). Sleep problems were detected in half of patients. There were no significant differences in total sleep score and subscale scores between patients and controls. Solely the wake-time was found significantly different between patients and controls. Although our results indicated that neither childhood cancer survivors nor patients with cancer during treatment period had more sleep problems than their healthy peers, sleep problems were not uncommon in whole study group. This study underlines the need to screen, assess and manage sleep problems in children with diagnosis of cancer.

A rare cause of short stature: Leri Weill dyschondrosteosis.

PubMed

Cakir, M; Kalyoncu, M; Odemiş, E; Okten, A

2003-01-01

Short stature is a common pediatric problem. It may occur rarely as a result of genetic disorders. Leri-Weill dyschondrosteosis (LWD) is one of the rare genetic disorders of skeletal system resulting with short stature. It is characterized by shortness of stature and Madelung deformity of the wrist. Here we report a case of LWD with some skeletal stigmas of Turner syndrome. She has also depressed medial tibial condyles that to our knowledge, has not previously been reported in LWD.

Renal and urologic manifestations of pediatric condition falsification/Munchausen by proxy.

PubMed

Feldman, Kenneth W; Feldman, Marc D; Grady, Richard; Burns, Mark W; McDonald, Ruth

2007-06-01

Renal and urologic problems in pediatric condition falsification (PCF)/Munchausen by proxy (MBP) can pose frustrating diagnostic and management problems. Five previously unreported victims of PCF/MBP are described. Symptoms included artifactual hematuria, recalcitrant urinary infections, dysfunctional voiding, perineal irritation, glucosuria, and "nutcracker syndrome", in addition to alleged sexual abuse. Falsifications included false or exaggerated history, specimen contamination, and induced illness. Caretakers also intentionally withheld appropriately prescribed treatment. Children underwent invasive diagnostic and surgical procedures because of the falsifications. They developed iatrogenic complications as well as behavioral problems stemming from their abuse. A PCF/MBP database was started in 1995 and includes the characteristics of 135 PCF/MBP victims examined by the first author between 1974 and 2006. Analysis of the database revealed that 25% of the children had renal or urologic issues. They were the presenting/primary issue for five. Diagnosis of PCF/MBP was delayed an average of 4.5 years from symptom onset. Almost all patients were victimized by their mothers, and maternal health falsification and somatization were common. Thirty-one of 34 children had siblings who were also victimized, six of whom died. In conclusion, falsifications of childhood renal and urologic illness are relatively uncommon; however, the deceits are prolonged and tortuous. Early recognition and intervention might limit the harm.

Healthcare-associated infections among pediatric oncology patients in Pakistan: risk factors and outcome.

PubMed

Siddiqui, Naveed-ur-Rehman; Wali, Rabia; Haque, Anwar-ul; Fadoo, Zehra

2012-05-14

Pediatric oncology patients are at increased risk of contracting healthcare-associated infections (HAIs), which are responsible for increased morbidity and mortality rates as well as treatment costs.  This study aimed to identify the frequency of HAIs among pediatric oncology patients and their outcome. Pediatric oncology patients admitted between January 2009 and June 2010 in a pediatric ward at Aga Khan University Hospital, Karachi, Pakistan, who developed HAIs, were analyzed. A total of 90 HAIs were identified in 32 patients in 70 admissions. The HAI rate among pediatric oncology patients was 3.1/100 admission episodes. Bloodstream infections (63 episodes, 90.0%) were the most common, followed by urinary tract infection (two episodes, 2.9%). Gram-positive infections were seen in 54 (60%) patients, followed by Gram-negative infection in 34 (37.8%), and fungi in 2 (2.8%) cases. Coagulase negative staphylococci was the most common Gram-positive and Escherichia coli and Pseudomonas aeruginosa were most common Gram-negative infections. Mortality rate among pediatric oncology patients who developed HAIs was 12.5% (4/32). Total parental nutrition use and length of stay longer than 30 days were the identified risk factors associated with increased mortality among pediatric oncology patients who developed HAIs. We report an HAI rate among pediatric oncology patients of 3.1/100 admission episodes with a mortality rate of 12.5% in Pakistan. Further studies should be done, especially in the developing world, to identify the risk factors associated with increased mortality among pediatric oncology patients so that adequate measures can be taken to reduce the mortality among these patients.

Vulvovaginitis and other common vulvar disorders in children.

PubMed

Rome, Ellen S

2012-01-01

Vulvovaginitis, labial adhesions, and other vulvar disorders occur commonly in children and can provoke high anxiety in both the parent and child. Performed correctly, the pediatric gynecologic examination can diagnose and treat, educate and reassure both parent and child. This examination requires patience, sensitivity, direct communication with the child as well as with the parent, and an open manner that inspires trust in both parties to manage a potentially anxiety-provoking situation. This chapter will review common vulvar disorders, including vulvovaginitis, lichen sclerosis et atrophicus, bubble bath vaginitis, labial adhesions, urethral prolapse, and other common problems. A discussion of childhood sexual abuse is beyond the scope of this chapter, with appropriate references available elsewhere. Practical pearls will be offered to make this exam easy for the primary care clinician and/or subspecialist. Copyright © 2012 S. Karger AG, Basel.

Need for appropriate formulations for children: the national institute of child health and human development-pediatric formulations initiative, part 1.

PubMed

Giacoia, George P; Taylor-Zapata, Perdita; Mattison, Donald

2007-01-01

The development and compounding of pharmacotherapeutic formulations that are suitable for infants and young children can be a challenging problem. This problem results from the lack of knowledge on the acceptability of different dosage forms and formulations in children in relation to age and developmental status, as well as the lack of reliable documentation of formulations used in pediatric clinical trials. As part of its mandate under the Best Pharmaceuticals for Children Act to improve pediatric therapeutics, the National Institute of Child Health and Human Development has sponsored the Pediatric Formulation Initiative. The goal of this ongoing initiative is to address the issues and concnerns associated with pediatric therapeutics by convening groups of researchers and experts in pediatric formulations from academia, pharmaceutical companies, the National Institutes of Health, and the U.S. Food and Drug Administration.

[The topical problems of pediatric balneotherapy and the spa and health resort-based treatment of the children].

PubMed

Razumov, A N; Khan, M A

2016-01-01

This article is devoted to the topical problems of pediatric balneotherapy with special reference to the organization of the spa and health resort-based treatment of the children in the Russian Federation. The main issues discussed by the authors include the current state of health resort care for the children, the problem of statutory regulation of the activities of the children's spa and health resort facilities, the approaches to increasing the availability of the spa and health resort-based treatment for the children at the enhanced risk of the development of chronic diseases, disabilities, and tuberculosis. Also considered are the problems of the development of the regulatory framework for the medical rehabilitation of the children based at the spa and health resort facilities. The principal goals to be sought in climatotherapy, physiotherapy, balneotherapy, and pelotherapy in the pediatric context are outlined along with the further prospects for the development of the main areas of pediatric balneology.

Pediatric pre-hospital emergencies in Belgium: a 2-year national descriptive study.

PubMed

Demaret, Pierre; Lebrun, Frédéric; Devos, Philippe; Champagne, Caroline; Lemaire, Roland; Loeckx, Isabelle; Messens, Marie; Mulder, André

2016-07-01

This study aims to describe the pediatric physician-staffed EMS missions at a national level and to compare the pediatric and the adult EMS missions. Using a national database, we analyzed 254,812 interventions including 15,294 (6 %) pediatric emergencies. Less children than adults received an intravenous infusion (52.7 versus 77.1 %, p < 0.001), but the intra-osseous access was used more frequently in children (1.3 versus 0.8 %, p < 0.001). More children than adults benefited from a therapeutic immobilization (16.3 versus 13.2 %, p < 0.001). Endotracheal intubation was rare in children (2.1 %) as well as cardiopulmonary resuscitation (1.2 %). Children were more likely than adults to suffer from a neurological problem (32.4 versus 21.3 %, p < 0.001) or from a trauma (27.1 versus 16.8 %, p < 0.001). The prevalence of the pediatric diagnoses showed an age dependency: the respiratory problems were more prevalent in infants (40.3 % of the 0-12-months old), 52.1 % of the 1-4-year-old children suffered from a neurological problem, and the prevalence of trauma raised from 14.8 % of the infants to 47.1 % of the 11-15 year olds. Pre-hospital pediatric EMS missions are not frequent and differ from the adult interventions. The pediatric characteristics highlighted in this study should help EMS teams to be better prepared to deal with sick children in the pre-hospital setting. • Pediatric and adult emergencies differ. • Pediatric life-threatening emergencies are not frequent. What is New: • This study is the first to describe a European national cohort of pediatric physician-staffed EMS missions and to compare the pediatric and the adult missions at a national level. • This large cohort study confirms scarce regional data indicating that pediatric pre-hospital emergencies are not frequent and mostly non-life-threatening.

Improving the Quality of Home Health Care for Children With Medical Complexity.

PubMed

Nageswaran, Savithri; Golden, Shannon L

2017-08-01

The objectives of this study are to describe the quality of home health care services for children with medical complexity, identify barriers to delivering optimal home health care, and discuss potential solutions to improve home health care delivery. In this qualitative study, we conducted 20 semistructured in-depth interviews with primary caregivers of children with medical complexity, and 4 focus groups with 18 home health nurses. During an iterative analysis process, we identified themes related to quality of home health care. There is substantial variability between home health nurses in the delivery of home health care to children. Lack of skills in nurses is common and has serious negative health consequences for children with medical complexity, including hospitalizations, emergency room visits, and need for medical procedures. Inadequate home health care also contributes to caregiver burden. A major barrier to delivering optimal home health care is the lack of training of home health nurses in pediatric care and technology use. Potential solutions for improving care include home health agencies training nurses in the care of children with medical complexity, support for nurses in clinical problem solving, and reimbursement for training nurses in pediatric home care. Caregiver-level interventions includes preparation of caregivers about: providing medical care for their children at home and addressing problems with home health care services. There are problems in the quality of home health care delivered to children with medical complexity. Training nurses in the care of children with medical complexity and preparing caregivers about home care could improve home health care quality. Copyright © 2017 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

Handheld Metal Detector for Metallic Foreign Body Ingestion in Pediatric Emergency.

PubMed

Hamzah, Hazwani Binte; James, Vigil; Manickam, Suraj; Ganapathy, Sashikumar

2018-01-04

Foreign body ingestion is a common problem for which children present to the emergency department. The most common ingested foreign bodies among children are coins. Metal detector is an equipment, which measures a change in inductance of a coil when an electroconductive material is placed near it and produces an audio-visual signal. The present study was conducted to determine the effectiveness and feasibility of HMD in the local Pediatric population. This was a prospective study conducted in the pediatric emergency department among children presenting with history of foreign body ingestion. The outcome measured was presence or absence of metallic foreign body detected on handheld metal detector examination. During the study period, 36 patients with history of foreign body ingestion presented to the emergency department. Among these, 28 were metallic foreign body ingestions. Coins were the most common type of foreign body ingested. Among the metallic foreign bodies ingested, all the coins were accurately identified by the handheld metal detector. Non-coin metallic foreign bodies like metallic screw, needle and stapler pin were not identified by the handheld metal detector. The study demonstrates that handheld metal detector can be safely and reliably used as a screening tool in the process of detecting ingested coins. The plain radiograph still appears to be superior as it accurately localizes sharp metallic objects as well as cell batteries (button batteries) which need to be detected early and removed in order to prevent complications. Handheld metal detector is an effective tool that can be used in the follow up of patients to confirm whether the coin like metallic foreign body has been expelled. Handheld metal detector examination is more sensitive than traditional X-ray examination to detect radiolucent metallic foreign bodies like aluminium.

The Changing Role of Pediatric Well-Child Care

ERIC Educational Resources Information Center

Kuo, Alice A.; Inkelas, Moira

2007-01-01

Identifying potential developmental and behavioral problems during the first 3 years of life is an important factor in promoting a child's healthy development. The early identification of a potential developmental or behavioral problem leads to further evaluation and possible diagnosis or treatment if needed. Pediatric health care professionals…

Pediatric functional magnetic resonance neuroimaging: tactics for encouraging task compliance.

PubMed

Schlund, Michael W; Cataldo, Michael F; Siegle, Greg J; Ladouceur, Cecile D; Silk, Jennifer S; Forbes, Erika E; McFarland, Ashley; Iyengar, Satish; Dahl, Ronald E; Ryan, Neal D

2011-05-06

Neuroimaging technology has afforded advances in our understanding of normal and pathological brain function and development in children and adolescents. However, noncompliance involving the inability to remain in the magnetic resonance imaging (MRI) scanner to complete tasks is one common and significant problem. Task noncompliance is an especially significant problem in pediatric functional magnetic resonance imaging (fMRI) research because increases in noncompliance produces a greater risk that a study sample will not be representative of the study population. In this preliminary investigation, we describe the development and application of an approach for increasing the number of fMRI tasks children complete during neuroimaging. Twenty-eight healthy children ages 9-13 years participated. Generalization of the approach was examined in additional fMRI and event-related potential investigations with children at risk for depression, children with anxiety and children with depression (N=120). Essential features of the approach include a preference assessment for identifying multiple individualized rewards, increasing reinforcement rates during imaging by pairing tasks with chosen rewards and presenting a visual 'road map' listing tasks, rewards and current progress. Our results showing a higher percentage of fMRI task completion by healthy children provides proof of concept data for the recommended tactics. Additional support was provided by results showing our approach generalized to several additional fMRI and event-related potential investigations and clinical populations. We proposed that some forms of task noncompliance may emerge from less than optimal reward protocols. While our findings may not directly support the effectiveness of the multiple reward compliance protocol, increased attention to how rewards are selected and delivered may aid cooperation with completing fMRI tasks. The proposed approach contributes to the pediatric neuroimaging literature by providing a useful way to conceptualize and measure task noncompliance and by providing simple cost effective tactics for improving the effectiveness of common reward-based protocols.

Pediatric functional magnetic resonance neuroimaging: tactics for encouraging task compliance

PubMed Central

2011-01-01

Background Neuroimaging technology has afforded advances in our understanding of normal and pathological brain function and development in children and adolescents. However, noncompliance involving the inability to remain in the magnetic resonance imaging (MRI) scanner to complete tasks is one common and significant problem. Task noncompliance is an especially significant problem in pediatric functional magnetic resonance imaging (fMRI) research because increases in noncompliance produces a greater risk that a study sample will not be representative of the study population. Method In this preliminary investigation, we describe the development and application of an approach for increasing the number of fMRI tasks children complete during neuroimaging. Twenty-eight healthy children ages 9-13 years participated. Generalization of the approach was examined in additional fMRI and event-related potential investigations with children at risk for depression, children with anxiety and children with depression (N = 120). Essential features of the approach include a preference assessment for identifying multiple individualized rewards, increasing reinforcement rates during imaging by pairing tasks with chosen rewards and presenting a visual 'road map' listing tasks, rewards and current progress. Results Our results showing a higher percentage of fMRI task completion by healthy children provides proof of concept data for the recommended tactics. Additional support was provided by results showing our approach generalized to several additional fMRI and event-related potential investigations and clinical populations. Discussion We proposed that some forms of task noncompliance may emerge from less than optimal reward protocols. While our findings may not directly support the effectiveness of the multiple reward compliance protocol, increased attention to how rewards are selected and delivered may aid cooperation with completing fMRI tasks Conclusion The proposed approach contributes to the pediatric neuroimaging literature by providing a useful way to conceptualize and measure task noncompliance and by providing simple cost effective tactics for improving the effectiveness of common reward-based protocols. PMID:21548928

Theory of mind mediates the prospective relationship between abnormal social brain network morphology and chronic behavior problems after pediatric traumatic brain injury.

PubMed

Ryan, Nicholas P; Catroppa, Cathy; Beare, Richard; Silk, Timothy J; Crossley, Louise; Beauchamp, Miriam H; Yeates, Keith Owen; Anderson, Vicki A

2016-04-01

Childhood and adolescence coincide with rapid maturation and synaptic reorganization of distributed neural networks that underlie complex cognitive-affective behaviors. These regions, referred to collectively as the 'social brain network' (SBN) are commonly vulnerable to disruption from pediatric traumatic brain injury (TBI); however, the mechanisms that link morphological changes in the SBN to behavior problems in this population remain unclear. In 98 children and adolescents with mild to severe TBI, we acquired 3D T1-weighted MRIs at 2-8 weeks post-injury. For comparison, 33 typically developing controls of similar age, sex and education were scanned. All participants were assessed on measures of Theory of Mind (ToM) at 6 months post-injury and parents provided ratings of behavior problems at 24-months post-injury. Severe TBI was associated with volumetric reductions in the overall SBN package, as well as regional gray matter structural change in multiple component regions of the SBN. When compared with TD controls and children with milder injuries, the severe TBI group had significantly poorer ToM, which was associated with more frequent behavior problems and abnormal SBN morphology. Mediation analysis indicated that impaired theory of mind mediated the prospective relationship between abnormal SBN morphology and more frequent chronic behavior problems. Our findings suggest that sub-acute alterations in SBN morphology indirectly contribute to long-term behavior problems via their influence on ToM. Volumetric change in the SBN and its putative hub regions may represent useful imaging biomarkers for prediction of post-acute social cognitive impairment, which may in turn elevate risk for chronic behavior problems. © The Author (2016). Published by Oxford University Press. For Permissions, please email: journals.permissions@oup.com.

Theory of mind mediates the prospective relationship between abnormal social brain network morphology and chronic behavior problems after pediatric traumatic brain injury

PubMed Central

Ryan, Nicholas P.; Catroppa, Cathy; Beare, Richard; Silk, Timothy J.; Crossley, Louise; Beauchamp, Miriam H.; Yeates, Keith Owen; Anderson, Vicki A.

2016-01-01

Childhood and adolescence coincide with rapid maturation and synaptic reorganization of distributed neural networks that underlie complex cognitive-affective behaviors. These regions, referred to collectively as the ‘social brain network’ (SBN) are commonly vulnerable to disruption from pediatric traumatic brain injury (TBI); however, the mechanisms that link morphological changes in the SBN to behavior problems in this population remain unclear. In 98 children and adolescents with mild to severe TBI, we acquired 3D T1-weighted MRIs at 2–8 weeks post-injury. For comparison, 33 typically developing controls of similar age, sex and education were scanned. All participants were assessed on measures of Theory of Mind (ToM) at 6 months post-injury and parents provided ratings of behavior problems at 24-months post-injury. Severe TBI was associated with volumetric reductions in the overall SBN package, as well as regional gray matter structural change in multiple component regions of the SBN. When compared with TD controls and children with milder injuries, the severe TBI group had significantly poorer ToM, which was associated with more frequent behavior problems and abnormal SBN morphology. Mediation analysis indicated that impaired theory of mind mediated the prospective relationship between abnormal SBN morphology and more frequent chronic behavior problems. Our findings suggest that sub-acute alterations in SBN morphology indirectly contribute to long-term behavior problems via their influence on ToM. Volumetric change in the SBN and its putative hub regions may represent useful imaging biomarkers for prediction of post-acute social cognitive impairment, which may in turn elevate risk for chronic behavior problems. PMID:26796967

Common office procedures and analgesia considerations.

PubMed

Baxter, Amy

2013-10-01

This article reviews common office procedures and analgesia considerations for pediatric outpatients. Layer times of onset of analgesics to coincide with procedures. Pediatric procedural distress is multimodal. Always address parent and child fear and attention, along with pain. Copyright © 2013 Elsevier Inc. All rights reserved.

Validity of Level of Supervision Scales for Assessing Pediatric Fellows on the Common Pediatric Subspecialty Entrustable Professional Activities.

PubMed

Mink, Richard B; Schwartz, Alan; Herman, Bruce E; Turner, David A; Curran, Megan L; Myers, Angela; Hsu, Deborah C; Kesselheim, Jennifer C; Carraccio, Carol L

2018-02-01

Entrustable professional activities (EPAs) represent the routine and essential activities that physicians perform in practice. Although some level of supervision scales have been proposed, they have not been validated. In this study, the investigators created level of supervision scales for EPAs common to the pediatric subspecialties and then examined their validity in a study conducted by the Subspecialty Pediatrics Investigator Network (SPIN). SPIN Steering Committee members used a modified Delphi process to develop unique scales for six of the seven common EPAs. The investigators sought validity evidence in a multisubspecialty study in which pediatric fellowship program directors and Clinical Competency Committees used the scales to evaluate fellows in fall 2014 and spring 2015. Separate scales for the six EPAs, each with five levels of progressive entrustment, were created. In both fall and spring, more than 300 fellows in each year of training from over 200 programs were assessed. In both periods and for each EPA, there was a progressive increase in entrustment levels, with second-year fellows rated higher than first-year fellows (P < .001) and third-year fellows rated higher than second-year fellows (P < .001). For each EPA, spring ratings were higher (P < .001) than those in the fall. Interrater reliability was high (Janson and Olsson's iota = 0.73). The supervision scales developed for these six common pediatric subspecialty EPAs demonstrated strong validity evidence for use in EPA-based assessment of pediatric fellows. They may also inform the development of scales in other specialties.

Enhancing Pediatricians' Behavioral Health Competencies Through Child Psychiatry Consultation and Education.

PubMed

Walter, Heather J; Kackloudis, Gina; Trudell, Emily K; Vernacchio, Louis; Bromberg, Jonas; DeMaso, David R; Focht, Glenn

2018-07-01

The objective of this study was to assess feasibility, utilization, perceived value, and targeted behavioral health (BH) treatment self-efficacy associated with a collaborative child and adolescent psychiatry (CAP) consultation and BH education program for pediatric primary care practitioners (PCPs). Eighty-one PCPs from 41 member practices of a statewide pediatric practice association affiliated with an academic medical center participated in a program comprising on-demand telephonic CAP consultation supported by an extensive BH learning community. Findings after 2 years of implementation suggest that the program was feasible for large-scale implementation, was highly utilized and valued by PCPs, and was attributed by PCPs with enhancing their BH treatment self-efficacy and the quality of their BH care. After participation in the program, nearly all PCPs believed that mild to moderate presentations of common BH problems can be effectively managed in the primary care setting, and PCP consultation utilization was congruent with that belief.

Need for appropriate formulations for children: the national institute of child health and human development-pediatric formulations initiative, part 2.

PubMed

Giacoia, George P; Taylor-Zapata, Perdita; Mattison, Donald

2007-01-01

The development and compounding of pharmacotherapeutic formulations that are suitable for infants and young children can be a challenging problem. This problem results from the lack of knowledge on the acceptability of different dosage forms and formulations to children in relation to age and developmental status, as well as the lack of reliable documentation of formulations used in pediatric clinical trials. As part of its mandate under the Best Pharmaceuticals for Children Act to improve pediatric therapeutics, the National Institute of Child Health and Human Development has sponsored the Pediatric Formulations Initiative. The goal of this ongoing initiative is to address the issues and concerns associated with pediatric therapeutics by convening groups of researchers and experts in pediatric formulations from academia, pharmaceutical companies, the National Institutes of Health, and the U.S. Food and Drug Administration. In this second part of a two-part article, the activities of the various groups that constitute the Pediatric Formulations Initiative are discussed, in addition the Initiative's future activities and plans are outlined.

Down Syndrome: Eye Problems

MedlinePlus

American Association for Pediatric Ophthalmology and Strabismus Home About AAPOS Patient Info Resources Allied Health News & Events Meetings J AAPOS American Association for Pediatric Ophthalmology ...

Menstrual Characteristics and Related Problems in 9- to 18-Year-Old Turkish School Girls.

PubMed

Yücel, Gül; Kendirci, Mustafa; Gül, Ülkü

2018-03-14

To determine the cross-sectional characteristics of menstruating girls, dysmenorrhea, and the frequencies of related problems. Descriptive, cross-sectional study. Randomly selected primary, junior, and high schools in the city center of Kayseri. Two thousand female adolescents of ages between 9 and 18 years. We used a questionnaire addressing the epidemiological characteristics of menstruation, such as age at menarche, duration of menstrual intervals, average days of bleeding, and any menstrual problems and their frequencies. This study consists of a sufficient number of participants from all age groups. Of the participant (n = 2000) girls, 63.7% (n = 1274) had started menstruating. The mean age at menarche was 12.74 (±1.03) years. With a prevalence of 84.8% (n = 1080), dysmenorrhea was the most prevalent menstrual problem and the average pain score was 5.87 (±2.45). Of the menstruating girls, 34% (n = 439) used painkillers, the most commonly used was acetaminophen; during their period the prevalence of nonmedical methods to relieve pain was 35.2%; the rate of seeking medical help for dysmenorrhea was 9.3% (n = 119). In menstruating participants, 90.8% discussed their menstrual problems with their mothers. The rate of school absenteeism in menstruating girls was 15.9% in general and 18% in those with dysmenorrhea. Problems related to menstruation are common in adolescents and these problems affect their social life. In adolescent girls, the most common menstrual problem is dysmenorrhea and it affects school performance and attendance. Girls with menstrual problems showed a low rate of seeking medical help. Copyright © 2018 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

Barbiturate Induction for the Prevention of Emergence Agitation after Pediatric Sevoflurane Anesthesia

PubMed Central

Nakahara, Haruna; Kimoto, Ayako; Beppu, Yuki; Yoshimura, Maki; Kojima, Toshiyuki; Fukano, Taku

2015-01-01

OBJECTIVES: Emergence agitation (EA) is a common and troublesome problem in pediatric patients recovering from general anesthesia. The incidence of EA is reportedly higher after general anesthesia maintained with sevoflurane, a popular inhalational anesthetic agent for pediatric patients. We conducted this prospective, randomized, double-blind study to test the effect of an intravenous ultra-short–acting barbiturate, thiamylal, administered during induction of general anesthesia on the incidence and severity of EA in pediatric patients recovering from Sevoflurane anesthesia. METHODS: Fifty-four pediatric patients (1 to 6 years of age) undergoing subumbilical surgeries were randomized into 2 groups. Patients received either intravenous thiamylal 5mg/kg (Group T) or inhalational Sevoflurane 5% (Group S) as an anesthetic induction agent. Following induction, general anesthesia was maintained with Sevoflurane and nitrous oxide (N2O) in both groups. To control the intra- and post-operative pain, caudal block or ilioinguinal/iliohypogastric block was performed. The incidence and severity of EA were evaluated by using the Modified Objective Pain Scale (MOPS: 0 to 6) at 15 and 30 min after arrival in the post-anesthesia care unit (PACU). RESULTS: Fifteen minutes after arrival in the PACU, the incidence of EA in Group T (28%) was significantly lower than in Group S (64%; p = 0.023) and the MOPS in Group T (median 0, range 0 to 6) was significantly lower than in Group S (median 4, range 0 to 6; p = 0.005). The interval from discontinuation of Sevoflurane to emergence from anesthesia was not significantly different between the 2 groups. CONCLUSIONS: Thiamylal induction reduced the incidence and severity of EA in pediatric patients immediately after Sevoflurane anesthesia. PMID:26472953

Sleep problems in pediatric epilepsy and ADHD: The impact of comorbidity.

PubMed

Ekinci, Ozalp; Okuyaz, Çetin; Gunes, Serkan; Ekinci, Nuran; Kalınlı, Merve; Tan, Muhammet Emin; Teke, Halenur; Direk, Meltem Çobanoğulları; Erdoğan, Semra

2017-06-01

Attention-deficit hyperactivity disorder (ADHD) is a frequent comorbidity in pediatric epilepsy. Although sleep problems are commonly reported in both children with primary ADHD and epilepsy, those with epilepsy-ADHD comorbidity have not been well studied. This study aimed to compare sleep problems among three groups of children: 1) children with epilepsy, 2) children with epilepsy and ADHD (epilepsy-ADHD), and 3) children with primary ADHD. 53 children with epilepsy, 35 children with epilepsy-ADHD, and 52 children with primary ADHD completed the Children's Sleep Habits Questionnaire (CSHQ). Neurology clinic charts were reviewed for the epilepsy-related variables. ADHD subtypes were diagnosed according to the DSM-IV. Children with epilepsy-ADHD had the highest CSHQ total scores, while children with primary ADHD had higher scores than those with epilepsy. Besides the total score, epilepsy-ADHD group differed from the primary ADHD and epilepsy groups with higher CSHQ subscores on sleep onset delay and sleep anxiety. The frequency of moderate-severe sleep problems (CSHQ>56) was 62.9% in children with epilepsy-ADHD, while it was 40.4% and 26.4% in children with primary ADHD and epilepsy, respectively. CSHQ total scores were not different between ADHD subtypes in both children with epilepsy-ADHD and those with primary ADHD. None of the epilepsy-related variables were found to be associated with CSHQ scores. Epilepsy-ADHD is associated with a significantly poor sleep quality which is beyond that of primary ADHD and epilepsy. Copyright © 2017 Elsevier Inc. All rights reserved.

Perception of pediatric neurology among non-neurologists.

PubMed

Jan, Mohammed M S

2004-01-01

Pediatric neurology is considered a relatively new and evolving subspecialty. In Saudi Arabia, neurologic disorders in children are common, and the demand for trained pediatric neurologists is strong. The aim was to study the perception of the pediatric neurology specialty among practicing generalists and their referral practices. Attendees of a symposium on pediatric epilepsy comprehensive review for the generalist were included. A structured 25-item questionnaire was designed to examine their demographics, training, practice, and referral patterns. One hundred nineteen participants attended the symposium, and 90 (76%) questionnaires were returned. Attendees' ages were 22 to 70 years (mean 32 years), with 65.5% female physicians. There were 32% consultants, 51% trainees, and 17% students. Most physicians (67%) were practicing general pediatrics. Only 36% received a structured pediatric neurology rotation during training. Children with neurologic complaints constituted 28.5% of those seen in their practice, and they referred 32.5% of them to pediatric neurology. Only 32% were moderately or highly confident in making the diagnosis or providing the appropriate treatment. Those who received a structured pediatric neurology rotation felt more comfortable in their management (P = .03). Many physicians (38.5%) had no direct access to a pediatric neurologist for referrals. To conclude, pediatric neurologic disorders are common in daily practice. Most generalists did not receive a structured neurology rotation during their training and were not highly confident in diagnosing and treating these children. Given the limited number of pediatric neurologists, I highly recommend that generalists receive appropriate neurologic training.

Effects of Adenotonsillectomy on Neurocognitive Function in Pediatric Obstructive Sleep Apnea Syndrome

PubMed Central

Horiuchi, Fumie; Oka, Yasunori; Komori, Kenjiro; Tokui, Yasumasa; Matsumoto, Teruhisa; Ueno, Shu-ichi

2014-01-01

Obstructive sleep apnea syndrome (OSAS) in children does not only present with symptoms of sleep disturbances but also with associated symptoms such as growth failure, enuresis, academic learning difficulties, and behavioral problems, including attention deficit/hyperactivity disorder- (ADHD-) like symptoms. We evaluated neurocognitive functions before and after adenotonsillectomy in a patient with OSAS. An 11-year-old boy suspected of having ADHD with nocturnal enuresis was referred for evaluation. He was found to have adenotonsillar hypertrophy. Presence of snoring was evident only after detailed medical interview. Polysomnography confirmed the diagnosis of OSAS, which was subsequently treated by adenotonsillectomy. The apnea/hypopnea index decreased from 21.9 at baseline to 1.8 after surgery, and the frequency of enuresis fell from almost nightly to 2-3 times per month. Neurocognitive and behavioral assessment after the treatment of OSAS showed significant improvement in cognitive functions, especially attention capacity and considerable amelioration of behavioral problems including ADHD-like symptoms. As the most common cause of pediatric OSAS is adenotonsillar hypertrophy, medical interview and oropharyngeal examination should always be performed in children suspected of having ADHD. The necessity of sleep evaluation for children with ADHD-like symptoms was also emphasized. PMID:24971187

Pediatric glaucoma surgery: a report by the American Academy Of Ophthalmology.

PubMed

Chen, Teresa C; Chen, Philip P; Francis, Brian A; Junk, Anna K; Smith, Scott D; Singh, Kuldev; Lin, Shan C

2014-11-01

To review the current published literature to evaluate the success rates and long-term problems associated with surgery for pediatric glaucoma. Literature searches of the PubMed and Cochrane Library databases were last conducted in May 2012. The search yielded 838 potentially relevant citations, of which 273 were in non-English languages. The titles and abstracts of these articles were reviewed by the authors, and 364 were selected for possible further review. Members of the Ophthalmic Technology Assessment Committee Glaucoma Panel reviewed the full text of these articles and used the 36 that met inclusion and exclusion criteria for this Ophthalmic Technology Assessment. There were no studies on the topic that provided level I evidence. The assessment included only level II and level III studies. Surgeons treat pediatric glaucoma most commonly with goniotomy, trabeculotomy, trabeculectomy, combined trabeculotomy and trabeculectomy, tube shunt surgery, cyclodestruction, and deep sclerectomy. Certain surgical options seem better for specific diagnoses, such as primary congenital glaucoma, aphakic glaucoma, and glaucomas associated with other ocular or systemic anomalies. There are many surgical options for the treatment of the pediatric glaucomas. The relative efficacy of these various procedures for particular diagnoses and clinical situations should be weighed against the specific risks associated with the procedures for individual patients. Copyright © 2014 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Promoting mental health competency in residency training.

PubMed

Bauer, Nerissa S; Sullivan, Paula D; Hus, Anna M; Downs, Stephen M

2011-12-01

To evaluate the effect our developmental-behavioral pediatrics (DBP) curricular model had on residents' comfort with handling mental health issues. From August 2007 to January 2010, residents participating in the Indiana University DBP rotation completed a self-assessment questionnaire at baseline and at rotation end. Residents rated their comfort with the identification, treatment, and counseling of mental health problems using a 5-point scale. Ninety-four residents completed both self-assessments. At baseline, categorical pediatric residents possessed higher comfort levels toward identification (mean 2.8 vs. 2.3 for non-categorical pediatrics residents, p<0.05), treatment (2.6 vs. 2.2, p<0.05) and counseling of mental health issues (2.7 vs. 2.1, p<0.005). Residents who were parents were also more comfortable. At rotation end, all residents showed significant improvements in self-rated comfort (4.0 vs. 2.6 for identification, p≤0.05; 4.0 vs. 2.4 for treatment, p≤0.05; and 4.0 vs. 2.4 for counseling, p≤0.05). This remained true regardless of being a categorical pediatric resident, a parent, or primary care-oriented. Our curricular model promotes residents' comfort with handling common mental health issues in practice. Increasing residents' comfort may influence the frequency of active discussion of mental health issues during well-child visits and lead to earlier diagnosis and needed treatment. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Study of inhaler technique in asthma patients: differences between pediatric and adult patients

PubMed Central

Manríquez, Pablo; Acuña, Ana María; Muñoz, Luis; Reyes, Alvaro

2015-01-01

Objective: Inhaler technique comprises a set of procedures for drug delivery to the respiratory system. The oral inhalation of medications is the first-line treatment for lung diseases. Using the proper inhaler technique ensures sufficient drug deposition in the distal airways, optimizing therapeutic effects and reducing side effects. The purposes of this study were to assess inhaler technique in pediatric and adult patients with asthma; to determine the most common errors in each group of patients; and to compare the results between the two groups. Methods: This was a descriptive cross-sectional study. Using a ten-step protocol, we assessed inhaler technique in 135 pediatric asthma patients and 128 adult asthma patients. Results: The most common error among the pediatric patients was failing to execute a 10-s breath-hold after inhalation, whereas the most common error among the adult patients was failing to exhale fully before using the inhaler. Conclusions: Pediatric asthma patients appear to perform most of the inhaler technique steps correctly. However, the same does not seem to be true for adult patients. PMID:26578130

The safety of pharmacologic treatment for pediatric obesity.

PubMed

Chao, Ariana M; Wadden, Thomas A; Berkowitz, Robert I

2018-04-01

Pediatric obesity is a serious public health concern. Five medications have been approved by the Food and Drug Administration (FDA) for chronic weight management in adults with obesity, when used as an adjunct to lifestyle modification. Orlistat is the only FDA-approved medication for pediatric patients aged 12 years and above. Areas covered: This paper summarizes safety and efficacy data from clinical trials of weight loss medications conducted among pediatric samples. Relevant studies were identified through searches in PubMed. Expert opinion: Orlistat, as an adjunct to lifestyle modification, results in modest weight losses and may be beneficial for some pediatric patients with obesity. However, gastrointestinal side effects are common and may limit use. In adults taking orlistat, rare but severe adverse events, including liver and renal events, have been reported. Recent pediatric pharmacokinetic studies of liraglutide have demonstrated similar safety and tolerability profiles as found in adults, with gastrointestinal disorders being the most common adverse events. Clinical trials are needed of liraglutide, as well as other medications for obesity, that systematically evaluate their risks and benefits in pediatric patients.

The Malone antegrade continence enema for neurogenic and structural fecal incontinence and constipation.

PubMed

Koyle, M A; Kaji, D M; Duque, M; Wild, J; Galansky, S H

1995-08-01

Problems of fecal elimination are commonly encountered by the pediatric urologist and surgeon. The Malone antegrade continence enema has been described as a means to administer a large volume enema via a continent catheterizable appendicocecostomy, resulting in reliable fecal elimination. Of 22 patients undergoing this procedure 16 reported total continence 4 months or longer after surgery. Complications are relatively minor and tap water appears to be a safe solution for the antegrade continence enema. A nonrefluxing, imbricated appendicocecostomy is preferable to prevent cutaneous fecal or gas leaks.

[Guidelines for the follow up of patients with bronchopulmonary dysplasia].

PubMed

Pérez Tarazona, S; Rueda Esteban, S; Alfonso Diego, J; Barrio Gómez de Agüero, M I; Callejón Callejón, A; Cortell Aznar, I; de la Serna Blázquez, O; Domingo Miró, X; García García, M L; García Hernández, G; Luna Paredes, C; Mesa Medina, O; Moreno Galdó, A; Moreno Requena, L; Pérez Pérez, G; Salcedo Posadas, A; Sánchez Solís de Querol, M; Torrent Vernetta, A; Valdesoiro Navarrete, L; Vilella Sabaté, M

2016-01-01

Bronchopulmonary dysplasia (BPD) is the most common complication of preterm birth, and remains a major problem in pediatric pulmonology units. The decision of discharging from the Neonatal Unit should be based on a thorough assessment of the condition of the patient and compliance with certain requirements, including respiratory and nutritional stability, and caregiver education on disease management. For proper control of the disease, a schedule of visits and complementary tests should be established prior to discharge, and guidelines for prevention of exacerbations and appropriate treatment should be applied. In this paper, the Working Group in Perinatal Respiratory Diseases of the Spanish Society of Pediatric Pulmonology proposes a protocol to serve as a reference for the follow up of patients with BPD among different centers and health care settings. Key factors to consider when planning discharge from the Neonatal Unit and during follow up are reviewed. Recommendations on treatment and prevention of complications are then discussed. The final section of this guide aims to provide a specific schedule for follow-up and diagnostic interventions to be performed in patients with BPD. Copyright © 2015 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.

Special considerations in the pediatric use of radionuclides for kidney studies

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ash, J.M.; Antico, V.F.; Gilday, D.L.

1982-10-01

Radionuclide renal studies are particularly well suited to pediatrics as renal problems in children usually are part of a dynamic process which requires serial assessment. The absence of side-effects and the low radiation dose has added to their popularity in pediatrics. A number of different renal parameters can be evaluated using the appropriate radiopharmaceutical and method of analysis. The renal study is of value to assess patients with hydronephrosis both pre-operatively and for serial follow-up post-operatively, as well as to distinguish obstructive from non-obstructive uropathy. Perfusion to the kidney may be assessed and ischemic areas detected in children with hypertensionmore » or trauma. The renal scan commonly is used in patients with congenital anomalies such as ectopic and duplex kidneys, nonvisualized kidney on IVP and in children with oliguria or anuria secondary to diseases such as acute tubular necrosis, hemolytic uremic syndrome, and renal vein thrombosis. It frequently is done as an emergency procedure in neonates. In conjunction with the IVP and ultrasound, the renal study is useful in some cases of abdominal mass to distinguish between hydronephrosis, cystic kidneys and tumors.« less

Pediatric maxillofacial fractures.

PubMed

Spring, P M; Cote, D N

1996-05-01

Maxillofacial trauma in the pediatric population is a relatively infrequent occurrence. Studies have demonstrated consistently that 5% of all facial fractures occur in children. The low percentage of facial fractures in this age group has been attributed, in part, to the lack of full pneumatization of the sinuses until later in childhood. Review of the literature indicates that boys are more commonly affected than girls and that the majority of pediatric facial fractures occur in children between 6 and 12 years of age. Motor vehicle accidents, falls, and blunt trauma are responsible for the largest number of pediatric facial fractures. The most common site of facial fracture is the nose and dentoalveolan complex, followed by the mandible, orbit, and midface in most pediatric cohorts. Management of the mandible is often conservative owing to the high percentage of isolated condylar fractures in children. Open reduction and internal fixation of pediatric facial fractures is indicated in complex mandible, midface, and orbital fractures. The effect of rigid fixation on facial skeleton growth is not completely understood.

Peer-relationship-problems account for quality of life impairments in pediatric psoriasis.

PubMed

Matterne, Uwe; Apfelbacher, Christian

2016-05-01

Most research on HRQoL-impairments in psoriasis has been conducted in adult patients, small pediatric patient samples or samples not representative of the pediatric population at large. We thus aimed to comprehensively describe HRQoL in pediatric psoriasis compared to psoriasis-free children and adolescents, identify domains most commonly affected and analyze its impact on HRQoL while controlling for important other predictors of HRQoL in a representative pediatric sample. The impact of lifetime-prevalence of psoriasis on total and subscale HRQoL was analyzed by complex sample general linear models alone and adjusted for sociodemographic and clinical variables in a population-based sample (n=6518) of children and adolescents aged 11-17. Total HRQoL and the physical domain were significantly affected by lifetime-psoriasis in univariate analysis. In multivariate analyses, lifetime-psoriasis significantly impacted on total HRQoL and the subscale 'quality of relationships with friends/peers'. Although substantial amounts of variance in HRQoL were explained by mental health, independent effects of lifetime-psoriasis remained after adjustment for this covariate. Total explained variance in total HRQoL was 20%. Our findings suggest psoriasis to be a significant burden as it affects HRQoL even when controlling for mental health. Most of this effect appears to be driven by perceived impairments in the quality of relationship with friends/peers. How this exactly occurs needs to be explored in future research. Meanwhile clinicians need to be more attentive to this effect of psoriasis. Copyright © 2016 Elsevier Inc. All rights reserved.

Global surgery for pediatric hydrocephalus in the developing world: a review of the history, challenges, and future directions.

PubMed

Muir, Ryan T; Wang, Shelly; Warf, Benjamin C

2016-11-01

OBJECTIVE Pediatric hydrocephalus is one of the most common neurosurgical conditions and is a major contributor to the global burden of surgically treatable diseases. Significant health disparities exist for the treatment of hydrocephalus in developing nations due to a combination of medical, environmental, and socioeconomic factors. This review aims to provide the international neurosurgery community with an overview of the current challenges and future directions of neurosurgical care for children with hydrocephalus in low-income countries. METHODS The authors conducted a literature review around the topic of pediatric hydrocephalus in the context of global surgery, the unique challenges to creating access to care in low-income countries, and current international efforts to address the problem. RESULTS Developing countries face the greatest burden of pediatric hydrocephalus due to high birth rates and greater risk of neonatal infections. This burden is related to more general global health challenges, including malnutrition, infectious diseases, maternal and perinatal risk factors, and education gaps. Unique challenges pertaining to the treatment of hydrocephalus in the developing world include a preponderance of postinfectious hydrocephalus, limited resources, and restricted access to neurosurgical care. In the 21st century, several organizations have established programs that provide hydrocephalus treatment and neurosurgical training in Africa, Central and South America, Haiti, and Southeast Asia. These international efforts have employed various models to achieve the goals of providing safe, sustainable, and cost-effective treatment. CONCLUSIONS Broader commitment from the pediatric neurosurgery community, increased funding, public education, surgeon training, and ongoing surgical innovation will be needed to meaningfully address the global burden of untreated hydrocephalus.

A portrait of pediatric radiologists in the United States.

PubMed

Merewitz, Leonard; Sunshine, Jonathan H

2006-01-01

In recognition of the importance of pediatric radiology and the apparent shortage of radiologists in the field, the purpose of this study was to provide an extensive and detailed portrait of pediatric radiologists, their professional activities, and the practices in which they work. We tabulated data from the American College of Radiology's 2003 Survey of Radiologists, a stratified random sample survey that achieved a 63% response rate with a total of 1,924 responses. Responses were weighted to make them representative of all radiologists in the United States. We compare information about pediatric radiologists with that for other radiologists. Approximately 3% of radiologists, some 800-900 physicians, are pediatric radiologists. Depending on how pediatric radiologist is defined, two thirds to three quarters of them spend 70% or more of their clinical work time doing pediatric radiology. Unlike other radiologists, a greater percentage of pediatric radiologists desire a reduction in workload (with a corresponding reduction in income) than desire an increase in workload. Pediatric radiologists who spend 70% or more of their clinical work time in their field are older than radiologists in general (average age, 55 vs 51 years), and the fraction of pediatric radiologists younger than 45 years is lower than for other subspecialists ( approximately 20% vs 37%). Pediatric radiologists are disproportionately women (one third or more, depending on definition, are women, vs 19% for other subspecialists and 15% for nonsubspecialists), hospital-based, in academic practices (approximately half vs one fifth for other subspecialists), and in the main cities of large metropolitan areas. A shortage of pediatric radiologists exists and is likely to intensify. Access to pediatric radiologists is probably a problem except for children in large metropolitan areas who connect readily to academic hospitals. Means to overcome these problems need to be actively sought.

Differences in Antipsychotic-Related Adverse Events in Adult, Pediatric, and Geriatric Populations.

PubMed

Sagreiya, Hersh; Chen, Yi-Ren; Kumarasamy, Narmadan A; Ponnusamy, Karthik; Chen, Doris; Das, Amar K

2017-02-26

In recent years, antipsychotic medications have increasingly been used in pediatric and geriatric populations, despite the fact that many of these drugs were approved based on clinical trials in adult patients only. Preliminary studies have shown that the "off-label" use of these drugs in pediatric and geriatric populations may result in adverse events not found in adults. In this study, we utilized the large-scale U.S. Food and Drug Administration (FDA) Adverse Events Reporting System (AERS) database to look at differences in adverse events from antipsychotics among adult, pediatric, and geriatric populations. We performed a systematic analysis of the FDA AERS database using MySQL by standardizing the database using structured terminologies and ontologies. We compared adverse event profiles of atypical versus typical antipsychotic medications among adult (18-65), pediatric (age < 18), and geriatric (> 65) populations. We found statistically significant differences between the number of adverse events in the pediatric versus adult populations with aripiprazole, clozapine, fluphenazine, haloperidol, olanzapine, quetiapine, risperidone, and thiothixene, and between the geriatric versus adult populations with aripiprazole, chlorpromazine, clozapine, fluphenazine, haloperidol, paliperidone, promazine, risperidone, thiothixene, and ziprasidone (p < 0.05, with adjustment for multiple comparisons). Furthermore, the particular types of adverse events reported also varied significantly between each population for aripiprazole, clozapine, haloperidol, olanzapine, quetiapine, risperidone, and ziprasidone (Chi-square, p < 10 -6 ). Diabetes was the most commonly reported side effect in the adult population, compared to behavioral problems in the pediatric population and neurologic symptoms in the geriatric population. We also found discrepancies between the frequencies of reports in AERS and in the literature. Our analysis of the FDA AERS database shows that there are significant differences in both the numbers and types of adverse events among these age groups and between atypical and typical antipsychotics. It is important for clinicians to be mindful of these differences when prescribing antipsychotics, especially when prescribing medications off-label.

Use of gadolinium-based magnetic resonance imaging contrast agents and awareness of brain gadolinium deposition among pediatric providers in North America.

PubMed

Mithal, Leena B; Patel, Payal S; Mithal, Divakar; Palac, Hannah L; Rozenfeld, Michael N

2017-05-01

Numerous recent articles have reported brain gadolinium deposition when using linear but not macrocyclic gadolinium-based contrast agents (GBCAs). To determine the current landscape of gadolinium use among pediatric institutions and the knowledge base of radiologists and referring providers with regard to GBCAs and brain gadolinium deposition. We e-mailed voluntary closed surveys to 5,390 physicians in various pediatric professional societies between January 2016 and March 2016. We used chi-square and Fisher exact tests to compare response distributions among specialties. We found that 80% of surveyed pediatric hospitals use macrocyclic contrast agents. In the last year, 58% switched their agent, most commonly to gadoterate meglumine, with the most common reason being brain gadolinium deposition. Furthermore, surveys indicated that 23% of hospitals are considering switching, and, of these, 83% would switch to gadoterate meglumine; the most common reasons were brain gadolinium deposition and safety. Radiologists were more aware of brain gadolinium deposition than non-radiologist physicians (87% vs. 26%; P<0.0001). Radiologists and referring providers expressed similar levels of concern (95% and 89%). Twelve percent of radiologists and 2% of referring providers reported patients asking about brain gadolinium deposition. Radiologists were significantly more comfortable addressing patient inquiries than referring pediatric physicians (48% vs. 6%; P<0.0001). The number of MRIs requested by referring pediatric physicians correlated with their knowledge of brain gadolinium deposition, contrast agent used by their hospital, and comfort discussing brain gadolinium deposition with patients (P<0.0001). Since the discovery of brain gadolinium deposition, many pediatric hospitals have switched to or plan to switch to a more stable macrocyclic MR contrast agent, most commonly gadoterate meglumine. Despite this, there is need for substantial further education of radiologists and referring pediatric providers regarding GBCAs and brain gadolinium deposition.

Pediatric epilepsy: The Indian experience.

PubMed

Gadgil, Pradnya; Udani, Vrajesh

2011-10-01

Epilepsy is a common clinical entity in neurology clinics. The understanding of the genetics of epilepsy has undergone a sea change prompting re-classification by the International league against epilepsy recently. The prevalence rates of epilepsy in India are similar to those of developed nations. However, the large treatment gap is a major challenge to our public health system. Perinatal injuries are a major causative factor in pediatric group. We have discussed a few common etiologies such as neurocysticercosis and newer genetic epilepsy syndromes. We have also briefly touched upon the Indian experience in pediatric epilepsy surgery.

Extrapulmonary involvement in pediatric tuberculosis.

PubMed

Kritsaneepaiboon, Supika; Andres, Mariaem M; Tatco, Vincent R; Lim, Cielo Consuelo Q; Concepcion, Nathan David P

2017-09-01

Tuberculosis in childhood is clinically challenging, but it is a preventable and treatable disease. Risk factors depend on age and immunity status. The most common form of pediatric tuberculosis is pulmonary disease, which comprises more than half of the cases. Other forms make up the extrapulmonary tuberculosis that involves infection of the lymph nodes, central nervous system, gastrointestinal system, hepatobiliary tree, and renal and musculoskeletal systems. Knowledge of the imaging characteristics of pediatric tuberculosis provides clues to diagnosis. This article aims to review the imaging characteristics of common sites for extrapulmonary tuberculous involvement in children.

Pediatrics

NASA Technical Reports Server (NTRS)

Spackman, T. J.

1978-01-01

The utilization of the Lixiscope in pediatrics was investigated. The types of images that can presently be obtained are discussed along with the problems encountered. Speculative applications for the Lixiscope are also presented.

Practice variation on use of antibiotics: An international survey among pediatric urologists.

PubMed

Kim, Jin K; Chua, Michael E; Ming, Jessica M; Braga, Luis H; Smith, Grahame H H; Driver, Christopher; Koyle, Martin A

2018-05-19

Although there is abundance in literature focusing on the use of prophylactic antibiotics for adult urological procedures, the evidence for using antibiotics following common pediatric urological procedures is limited with no specific guidelines for use. Consequently, current practices on antibiotic usage for common interventions may be variable among practicing pediatric urologists, lacking evidence-based support. The aim was to evaluate the current practice pattern on antibiotic usage for common interventions amongst pediatric urologists (PU) practicing in four English-speaking sectors of the world. An anonymous survey of five scenarios with multiple choice options was disseminated to all active practicing members of the Pediatric Urologist of Canada (PUC) and Society of Pediatric Urology of Australia and New Zealand (SPUNZA), as well as all those attending the 2016 British Association of Pediatric Urology (BAPU) and 2017 American Association of Pediatric Urology (AAPU) meetings. The response for each scenario was summarized for overall practice pattern variation and the pattern for each sector was compared using the Fisher exact test. A total of 126 respondents completed the survey (68.5% response rate) with at least a 65% response rate for each of the four sectors. The majority of respondents do not use antibiotics for indwelling urethral (46.8%) and suprapubic catheters (53.4%); however, they do give antibiotics for J-J stent placement (65.1%) and hypospadias surgery (84.9%), and use antibiotics after hypospadias surgery where catheters or stents are left indwelling (80.9%, 84.2%, respectively). Among those surveyed, the PUC members and AAPU PU demonstrated similar practice patterns which often significantly differed from that of SPUNZA members and BAPU attendees. Specifically, a significantly larger proportion of the North American pediatric urologists do not use antibiotics for common procedures compared with Australia, New Zealand, and the UK (Table). In the absence of prospective studies in antibiotic use for pediatric patients to guide clinicians, there is a clear variability among sectors in the use of antibiotics for most clinical scenarios investigated. With increasing resistance patterns and possible adverse effects of antibiotics, it is important that the international pediatric urology community engage in discussions and collaborations to address this issue. Practice patterns in antibiotic usage amongst PU varies widely, some of which may be associated with their local "culture." There is a need to understand these differences and begin to standardize treatment in the hopes of increasing appropriate use of antibiotics internationally. Copyright © 2018 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Enhanced Cleaning and Education to Prevent Transmission of Clostridium difficile in Pediatrics

PubMed Central

Aslam, Anoshé; Melendez, Giselle; Wang, Min; Stell, Frederic; Kelly, Paulette; Killinger, James; Dannaoui, Aimee; Riedman, Scott; Lopez, Ruben; Ackerman, Jill; Chou, Alexander; Wexler, Leonard; Smith, David; Sanchez, Stacy; Robilotti, Elizabeth; Kamboj, Mini; Eagan, Janet

2017-01-01

Abstract Background Transmission of healthcare-associated Clostridium difficile infection (HA-CDI) has been shown to occur directly or indirectly through a contaminated environment. At a tertiary-care cancer center, HA-CDI rates were higher for pediatric units than for other general oncology units. To address the problem, a multidisciplinary team, including Infection Control, Nursing, and Environmental Services (EVS), was convened and identified refusals and room clutter as barriers to proper cleaning of rooms on the unit. Aim: The aim of this study seeks to reduce HA-CDI in the inpatient pediatrics setting through environmental and educational interventions. Methods In the first phase of the study from February to April 2016, a baseline assessment of prevalent environmental disinfection practices was made among Nursing, EVS, Physicians, and Patient Representatives. Based on this feedback, the following were implemented during Phase 2, from June through October 2016: 1) Unit-wide disinfection with bleach twice a day including common and high traffic areas; 2) Initiation of a “preferred time for cleaning” program to engage families; 3) Enhanced visitor and family education on PPE use; 4) Creation of a communication plan in case of refusal to clean rooms; and 5) Dedicated use of diaper scales. Results During the first phase of the study, the following barriers to cleaning were identified: 1) High refusal rate as cleaning was perceived as inconvenient by families due to timing; 2) Common perception among EVS staff that multiple requests for cleaning the room may appear intrusive to the families; 3) Excessive clutter in the room; 4) Lack of education regarding PPE use; and 5) Shared equipment for diapers. To overcome these barriers, several interventions as outlined in methods were implemented. In Phase 2, there were 0 cases of HA-CDI identified in pediatric patients starting in July through October, 2016. Conclusion Control of CDI on pediatric units poses unique challenges. Engagement of key stakeholders is essential to identify and meet these challenges and to devise effective strategies that will ultimately lead to reduced hospital-based transmission of CDI. Disclosures All authors: No reported disclosures.

Pediatric Psychosomatic Medicine: Creating a Template for Training

PubMed Central

Walker, Audrey; Pao, Maryland; Nguyen, Ngoc

2012-01-01

There is a critical public health problem in the United States today, the problem of childhood psychiatric disorders in youngsters with physical illnesses. Currently there is a pressing need for well-trained pediatric psychosomatic medicine practitioners as well as advanced training in the field. Yet, this training does not currently exist. This article will present the innovative Montefiore Medical Center/Albert Einstein College of Medicine (MMC/AECOM) program as a model for a training curriculum, clinical training experience, and clinical research training setting in this important and rapidly expanding area of need in pediatric mental health. PMID:22658325

Social work in a pediatric primary health care team in a group practice program.

PubMed

Coleman, J V; Lebowitz, M L; Anderson, F P

1976-01-01

The inclusion of a psychiatric social worker as a member of a pediatric team in a prepaid group practice extends the range of pediatric mental health services to children. This paper discusses the collaboration of the social worker with the pediatricians and allied health personnel on the team in dealing with the emotional problems of referred children and their parents. Case examples are included. All cases seen by the social worker during a 6-month period are reviewed. With available psychiatric backup a wide range of emotional problems are identified, and effective mental health care is provided.

Review for the generalist: evaluation of pediatric hip pain

PubMed Central

Houghton, Kristin M

2009-01-01

Hip pathology may cause groin pain, referred thigh or knee pain, refusal to bear weight or altered gait in the absence of pain. A young child with an irritable hip poses a diagnostic challenge. Transient synovitis, one of the most common causes of hip pain in children, must be differentiated from septic arthritis. Hip pain may be caused by conditions unique to the growing pediatric skeleton including Perthes disease, slipped capital femoral epiphysis and apophyseal avulsion fractures of the pelvis. Hip pain may also be referred from low back or pelvic pathology. Evaluation and management requires a thorough history and physical exam, and understanding of the pediatric skeleton. This article will review common causes of hip and pelvic musculoskeletal pain in the pediatric population. PMID:19450281

Pioneers in Pediatric Psychology: Integrating Nutrition and Child Development Interventions

PubMed Central

2015-01-01

As part of the Pioneers in Pediatric Psychology series, this article provides a brief personal account of Maureen Black's career as a pediatric psychologist. It traces the transition of the Society of Pediatric Psychology (SPP) from a section of the Division of Clinical Psychology of the American Psychological Association (APA) to an independent division of APA, which occurred during my presidency of SPP. The article addresses three aspects of pediatric psychology that have been central to my career: pediatric nutritional problems, global child development, and the advancement of children's health and development through policy-related strategies. The article concludes with Lessons Learned and Recommendations for the future of pediatric psychology. PMID:25619198

Oral and Dental Considerations in Pediatric Leukemic Patient

PubMed Central

Padmini, Chiyadu; Bai, K. Yellamma

2014-01-01

Throughout the world, there have been drastic decline in mortality rate in pediatric leukemic population due to early diagnosis and improvements in oncology treatment. The pediatric dentist plays an important role in the prevention, stabilization, and treatment of oral and dental problems that can compromise the child's health and quality of life during, and follow up of the cancer treatment. This manuscript discusses recommendations and promotes dental care of the pediatric leukemic patients. PMID:24724033

U.S. vaccine and immune globulin product shortages, 2001-15.

PubMed

Ziesenitz, Victoria C; Mazer-Amirshahi, Maryann; Zocchi, Mark S; Fox, Erin R; May, Larissa S

2017-11-15

Trends in shortages of vaccines and immune globulin products from 2001 through 2015 in the United States are described. Drug shortage data from January 2001 through December 2015 were obtained from the University of Utah Drug Information Service. Shortage data for vaccines and immune globulins were analyzed, focusing on the type of product, reason for shortage, shortage duration, shortages requiring vaccine deferral, and whether the drug was a single-source product. Inclusion of the product into the pediatric vaccination schedule was also noted. Of the 2,080 reported drug shortages, 59 (2.8%) were for vaccines and immune globulin products. Of those, 2 shortages (3%) remained active at the end of the study period. The median shortage duration was 16.8 months. The most common products on shortage were viral vaccines (58%), especially hepatitis A, hepatitis B, rabies, and varicella vaccines (4 shortages each). A vaccine deferral was required for 21 shortages (36%), and single-source products were on shortage 30 times (51%). The most common reason for shortage was manufacturing problems (51%), followed by supply-and-demand issues (7%). Thirty shortages (51%) were for products on the pediatric schedule, with a median duration of 21.7 months. Drug shortages of vaccines and immune globulin products accounted for only 2.8% of reported drug shortages within a 15-year period, but about half of these shortages involved products on the pediatric vaccination schedule, which may have significant public health implications. Copyright © 2017 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Pediatric Urologic Interventional Radiology

PubMed Central

Linscott, Luke

2011-01-01

Interventional radiologists are playing an increasingly important role in pediatric urologic intervention, working closely with the pediatric urologist. Interventional radiologists are frequently asked to establish percutaneous access to the renal collecting system prior to nephrolithotomy. Additionally, procedures such as percutaneous nephrostomy, ureteral stent placement and exchange, and renal parenchymal biopsy are frequently encountered requests. This article will review these common procedures and highlight techniques and pathology that are unique to the pediatric population. PMID:23204639

Recent advances in delivery mechanisms for aerosol therapy during pediatric respiratory diseases.

PubMed

Wu, Yue'E; Zhang, Chonglin; Zhen, Qing

2018-04-01

The treatment of pediatric surgery diseases via utilization of aerosol delivery mechanisms is in progress for the betterment of pediatric care. Over the years, aerosol therapy has come to play an integral role in the treatment of pediatric respiratory diseases. Inhaled aerosol agents such as bronchodilators, corticosteroids, antibiotics, and mucolytics are commonly delivered to spontaneously breathing pediatric patients with a tracheostomy. Administering therapeutic inhaled aerosols to pediatric patients is challenging. The pediatric population ranges in age, which means patients with different airway sizes, breathing patterns, and cooperation levels. These patient-related factors impact the deposition of aerosol drugs in the lungs. The present review article will discuss the recent advancements in the delivery mechanisms for aerosol therapy in pediatric patients with respiratory diseases.

Association between Search Behaviors and Disease Prevalence Rates at 18 U.S. Children's Hospitals.

PubMed

Daniel, Dennis; Wolbrink, Traci; Logvinenko, Tanya; Harper, Marvin; Burns, Jeffrey

2017-10-01

Background Usage of online resources by clinicians in training and practice can provide insight into knowledge gaps and inform development of decision support tools. Although online information seeking is often driven by encountered patient problems, the relationship between disease prevalence and search rate has not been previously characterized. Objective This article aimed to (1) identify topics frequently searched by pediatric clinicians using UpToDate (http://www.uptodate.com) and (2) explore the association between disease prevalence rate and search rate using data from the Pediatric Health Information System. Methods We identified the most common search queries and resources most frequently accessed on UpToDate for a cohort of 18 children's hospitals during calendar year 2012. We selected 64 of the most frequently searched diseases and matched ICD-9 data from the PHIS database during the same time period. Using linear regression, we explored the relationship between clinician query rate and disease prevalence rate. Results The hospital cohort submitted 1,228,138 search queries across 592,454 sessions. The majority of search sessions focused on a single search topic. We identified no consistent overall association between disease prevalence and search rates. Diseases where search rate was substantially higher than prevalence rate were often infectious or immune/rheumatologic conditions, involved potentially complex diagnosis or management, and carried risk of significant morbidity or mortality. None of the examined diseases showed a decrease in search rate associated with increased disease prevalence rates. Conclusion This is one of the first medical learning needs assessments to use large-scale, multisite data to identify topics of interest to pediatric clinicians, and to examine the relationship between disease prevalence and search rate for a set of pediatric diseases. Overall, disease search rate did not appear to be associated with hospital disease prevalence rates based on ICD-9 codes. However, some diseases were consistently searched at a higher rate than their prevalence rate; many of these diseases shared common features.

Recent developments in pediatric headache.

PubMed

Hershey, Andrew D

2010-06-01

This review will focus on some of the recent findings in pediatric headache including headache characteristics, epidemiology, comorbid associations and treatment updates. Pediatric headache remains a frequent health problem for children and their families, yet there remain many gaps in our knowledge. This review will broadly address some of the recent findings and highlight the gaps in our understanding and treatment of pediatric headache. There will be a focus on pediatric migraine as this has been the best characterized and studied. Our understanding of pediatric headache is improving with increased recognition of the characteristics and associated symptomology. This should further guide the individualized treatment approaches for improved outcome and reduction of progression into adulthood.

Drug interactions may be important risk factors for methotrexate neurotoxicity, particularly in pediatric leukemia patients.

PubMed

Forster, Victoria J; van Delft, Frederik W; Baird, Susan F; Mair, Shona; Skinner, Roderick; Halsey, Christina

2016-11-01

Methotrexate administration is associated with frequent adverse neurological events during treatment for childhood acute lymphoblastic leukemia. Here, we present evidence to support the role of common drug interactions and low vitamin B 12 levels in potentiating methotrexate neurotoxicity. We review the published evidence and highlight key potential drug interactions as well as present clinical evidence of severe methotrexate neurotoxicity in conjunction with nitrous oxide anesthesia and measurements of vitamin B 12 levels among pediatric leukemia patients during therapy. We describe a very plausible mechanism for methotrexate neurotoxicity in pediatric leukemia patients involving reduction in methionine and consequential disruption of myelin production. We provide evidence that a number of commonly prescribed drugs in pediatric leukemia management interact with the same folate biosynthetic pathways and/or reduce functional vitamin B 12 levels and hence are likely to increase the toxicity of methotrexate in these patients. We also present a brief case study supporting out hypothesis that nitrous oxide contributes to methotrexate neurotoxicity and a nutritional study, showing that vitamin B 12 deficiency is common in pediatric leukemia patients. Use of nitrous oxide in pediatric leukemia patients at the same time as methotrexate use should be avoided especially as many suitable alternative anesthetic agents exist. Clinicians should consider monitoring levels of vitamin B 12 in patients suspected of having methotrexate-induced neurotoxic effects.

Pediatric surgical capacity building - a pathway to improving access to pediatric surgical care in Haiti.

PubMed

Kaseje, Neema; Jenny, Hillary; Jeudy, Andre Patrick; MacLee, Jean Louis; Meara, John G; Ford, Henri R

2018-02-01

Lack of human resources is a major barrier to accessing pediatric surgical care globally. Our aim was to establish a model for pediatric surgical training of general surgery residents in a resource constrained region. A pediatric surgical program with a pediatric surgical rotation for general surgery residents in a tertiary hospital in Haiti in 2015 was established. We conducted twice daily patient rounds, ran an outpatient clinic, and provided emergent and elective pediatric surgical care, with tasks progressively given to residents until they could run clinic and perform the most common elective and emergent procedures. We conducted baseline and post-intervention knowledge exams and dedicated 1 day a week to teaching and research activities. We measured the following outcomes: number of residents that completed the rotation, mean pre and post intervention test scores, patient volume in clinic and operating room, postoperative outcomes, resident ability to perform most common elective and emergent procedures, and resident participation in research. Nine out of 9 residents completed the rotation; 987 patients were seen in outpatient clinic, and 564 procedures were performed in children <15years old. There was a 50% increase in volume of pediatric cases and a 100% increase in procedures performed in children <4years old. Postoperative outcomes were: 0% mortality for elective cases and 18% mortality for emergent cases, 3% complication rate for elective cases and 6% complication rate for emergent cases. Outcomes did not change with increased responsibility given to residents. All senior residents (n=4) could perform the most common elective and emergent procedures without changes in mortality and complication rates. Increases in mean pre and post intervention test scores were 12% (PGY1), 24% (PGY2), and 10% (PGY3). 75% of senior residents participated in research activities as first or second authors. Establishing a program in pediatric surgery with capacity building of general surgery residents for pediatric surgical care provision is feasible in a resource constrained setting without negative effects on patient outcomes. This model can be applied in other resource constrained settings to increase human resources for global pediatric surgical care provision. III. Copyright © 2017 Elsevier Inc. All rights reserved.

Vision and Vestibular System Dysfunction Predicts Prolonged Concussion Recovery in Children.

PubMed

Master, Christina L; Master, Stephen R; Wiebe, Douglas J; Storey, Eileen P; Lockyer, Julia E; Podolak, Olivia E; Grady, Matthew F

2018-03-01

Up to one-third of children with concussion have prolonged symptoms lasting beyond 4 weeks. Vision and vestibular dysfunction is common after concussion. It is unknown whether such dysfunction predicts prolonged recovery. We sought to determine which vision or vestibular problems predict prolonged recovery in children. A retrospective cohort of pediatric patients with concussion. A subspecialty pediatric concussion program. Four hundred thirty-two patient records were abstracted. Presence of vision or vestibular dysfunction upon presentation to the subspecialty concussion program. The main outcome of interest was time to clinical recovery, defined by discharge from clinical follow-up, including resolution of acute symptoms, resumption of normal physical and cognitive activity, and normalization of physical examination findings to functional levels. Study subjects were 5 to 18 years (median = 14). A total of 378 of 432 subjects (88%) presented with vision or vestibular problems. A history of motion sickness was associated with vestibular dysfunction. Younger age, public insurance, and presence of headache were associated with later presentation for subspecialty concussion care. Vision and vestibular problems were associated within distinct clusters. Provocable symptoms with vestibulo-ocular reflex (VOR) and smooth pursuits and abnormal balance and accommodative amplitude (AA) predicted prolonged recovery time. Vision and vestibular problems predict prolonged concussion recovery in children. A history of motion sickness may be an important premorbid factor. Public insurance status may represent problems with disparities in access to concussion care. Vision assessments in concussion must include smooth pursuits, saccades, near point of convergence (NPC), and accommodative amplitude (AA). A comprehensive, multidomain assessment is essential to predict prolonged recovery time and enable active intervention with specific school accommodations and targeted rehabilitation.

Pediatric Cystic Nephroma Is Morphologically, Immunohistochemically, and Genetically Distinct From Adult Cystic Nephroma.

PubMed

Li, Yunjie; Pawel, Bruce R; Hill, Dana A; Epstein, Jonathan I; Argani, Pedram

2017-04-01

The term cystic nephroma has traditionally been used to refer to 2 neoplasms, a lesion in adults that is now thought to be part of the spectrum of mixed epithelial stromal tumor (MEST) and a pediatric lesion that has been associated with mutations in the DICER1 gene. A direct detailed morphologic, immunohistochemical, and genetic comparison of these 2 lesions has not been performed. In this study, we compare the morphologic features, immunoreactivity for estrogen receptor and inhibin, and DICER1 genetic status of 12 adult cystic nephroma/MEST (median age 50.5 y, all females) and 7 pediatric cystic nephroma (median age 1.3 y, male:female=6:1). Both lesions (11 of 12 adult cases, 6 of 7 pediatric cases) frequently demonstrated subepithelial accentuation of stromal cellularity, though the increased cellularity frequently included inflammatory cells in the pediatric cases. All adult and pediatric cases labeled for estrogen receptor; however, whereas most (83%) of adult cases labeled for inhibin at least focally, no pediatric case labeled for inhibin. Most adult cases (58%) demonstrated wavy, ropy collagen in association with cellular stroma, whereas this was not found in pediatric cases. 86% of pediatric cases demonstrated DICER1 mutations, whereas only 1 of 10 adult cases demonstrated a DICER1 mutation. In summary, although cellular stroma and estrogen receptor immunoreactivity are commonly present in both adult and pediatric cystic nephroma, ropy collagen and inhibin immunoreactivity are far more common in adult cystic nephroma/MEST, whereas DICER1 mutations are far more prevalent in pediatric cystic nephroma. These results support the current World Health Organization Classification's separation of adult and pediatric cystic nephromas as distinct entities.

Pediatric epilepsy: The Indian experience

PubMed Central

Gadgil, Pradnya; Udani, Vrajesh

2011-01-01

Epilepsy is a common clinical entity in neurology clinics. The understanding of the genetics of epilepsy has undergone a sea change prompting re-classification by the International league against epilepsy recently. The prevalence rates of epilepsy in India are similar to those of developed nations. However, the large treatment gap is a major challenge to our public health system. Perinatal injuries are a major causative factor in pediatric group. We have discussed a few common etiologies such as neurocysticercosis and newer genetic epilepsy syndromes. We have also briefly touched upon the Indian experience in pediatric epilepsy surgery. PMID:22069423

Common pediatric head and neck congenital/developmental anomalies.

PubMed

LaPlante, Justin K; Pierson, Nicholas S; Hedlund, Gary L

2015-01-01

Pediatric head and neck neuroradiology is a broad and complex topic. This article focuses on several of the common and sometimes challenging pediatric head and neck congenital/developmental anomalies physicians may encounter in clinical practice. Although some diagnoses may be evident on physical examination, others may present a diagnostic dilemma. Patients may initially present with a variety of secondary findings. Imaging serves an important role in making a diagnosis, guiding referral, and in some cases even providing treatment options through interventional radiology. Key diagnostic criteria and critical points of interest for each diagnosis are presented. Copyright © 2015 Elsevier Inc. All rights reserved.

Pediatric Residency Education and the Behavioral and Mental Health Crisis: A Call to Action.

PubMed

McMillan, Julia A; Land, Marshall; Leslie, Laurel K

2017-01-01

For at least 4 decades, the need for improved pediatric residency training in behavioral and mental health has been recognized. The prevalence of behavioral and mental health conditions in children, adolescents, and young adults has increased during that period. However, as recently as 2013, 65% of pediatricians surveyed by the American Academy of Pediatrics indicated that they lacked training in recognizing and treating mental health problems. Current pediatric residency training requirements do not stipulate curricular elements or assessment requirements in behavioral and mental health, and fewer than half of pediatric residents surveyed felt that their competence in dealing with mental health problems was good to excellent. It is time that pediatric residency programs develop the capacity to prepare their residents to meet the behavioral and mental health needs of their patients. Meeting this challenge will require a robust curriculum and effective assessment tools. Ideal training environments will include primary care ambulatory sites that encourage residents to work longitudinally in partnership with general pediatricians and behavioral and mental health trainees and providers; behavioral and mental health training must be integrated into both ambulatory and inpatient experiences. Faculty development will be needed, and in most programs it will be necessary to include nonpediatrician mental health providers to enhance pediatrician faculty expertise. The American Board of Pediatrics intends to partner with other organizations to ensure that pediatric trainees develop the competence needed to meet the behavioral and mental health needs of their patients. Copyright © 2017 by the American Academy of Pediatrics.

Strengthening the Coordination of Pediatric Mental Health and Medical Care: Piloting a Collaborative Model for Freestanding Practices

ERIC Educational Resources Information Center

Greene, Carolyn A.; Ford, Julian D.; Ward-Zimmerman, Barbara; Honigfeld, Lisa; Pidano, Anne E.

2016-01-01

Background: Collaborative pediatric mental health and primary care is increasingly recognized as optimal for meeting the needs of children with mental health problems. This paper describes the challenges faced by freestanding specialty mental health clinics and pediatric health practices to provide such coordinated mind-and-body treatment. It…

Training Pediatric Residents and Pediatricians about Adolescent Mental Health Problems: A Proof-of-Concept Pilot for a Proposed National Curriculum

ERIC Educational Resources Information Center

Kutner, Lawrence; Olson, Cheryl K.; Schlozman, Steven; Goldstein, Mark; Warner, Dorothy; Beresin, Eugene V.

2008-01-01

Objective: This article presents a DVD-based educational program intended to help pediatric residents and practicing pediatricians recognize and respond to adolescent depression in busy primary care settings. Methods: Representatives from pediatrics and adolescent medicine, child and adolescent psychiatry and psychology, and experts in the…

National Training Course. Emergency Medical Technician. Paramedic. Instructor's Lesson Plans. Module XII. Pediatrics and Neonatal.

ERIC Educational Resources Information Center

National Highway Traffic Safety Administration (DOT), Washington, DC.

This instructor's lesson plan guide on pediatrics and neonatal transport is one of fifteen modules designed for use in the training of emergency medical technicians (paramedics). Five units of study are presented: (1) approach to the pediatric patient including patient assessment; (2) pathophysiology and management of problems unique to the…

Pediatric hospitalist comanagement of surgical patients: structural, quality, and financial considerations.

PubMed

Rappaport, David I; Rosenberg, Rebecca E; Shaughnessy, Erin E; Schaffzin, Joshua K; O'Connor, Katherine M; Melwani, Anjna; McLeod, Lisa M

2014-11-01

Comanagement of surgical patients is occurring more commonly among adult and pediatric patients. These systems of care can vary according to institution type, comanagement structure, and type of patient. Comanagement can impact quality, safety, and costs of care. We review these implications for pediatric surgical patients. © 2014 Society of Hospital Medicine.

Animal-assisted activities in pediatric oncology: results from a survey of top-ranked pediatric oncology hospitals

PubMed Central

Chubak, Jessica; Hawkes, Rene

2015-01-01

Animal-assisted activities (AAA) are increasingly common, yet little is known about practices in pediatric oncology. To address this gap, we surveyed the top twenty pediatric oncology hospitals in the United States in May and June of 2014. Questionnaires were sent via email and generally returned by email or postal mail. Among the nineteen responding hospitals, the 18 that offered AAA to pediatric patients formed the basis of our analysis. All sites had written AAA policies. Most programs were restricted to dogs. At 11 hospitals, children with cancer could participate in AAA activities. Outpatient waiting rooms and individual inpatient rooms were the most common locations for AAA with pediatric oncology patients. Safety precautions varied by hospital, but all required hand sanitation after visits and that animals receive an annual health examination, be on a leash or in a carrier, be ≥1 year old, and not be directly from a shelter. Our findings reveal consistencies and variations in practice that may help other hospitals develop their own programs and researchers identify areas of future study. PMID:26589356

Animal-Assisted Activities: Results From a Survey of Top-Ranked Pediatric Oncology Hospitals.

PubMed

Chubak, Jessica; Hawkes, Rene

2016-07-01

Animal-assisted activities (AAA) are increasingly common, yet little is known about practices in pediatric oncology. To address this gap, we surveyed the top 20 pediatric oncology hospitals in the United States in May and June of 2014. Questionnaires were sent via e-mail and generally returned by e-mail or postal mail. Among the 19 responding hospitals, the 18 that offered AAA to pediatric patients formed the basis of our analysis. All sites had written AAA policies. Most programs were restricted to dogs. At 11 hospitals, children with cancer could participate in AAA activities. Outpatient waiting rooms and individual inpatient rooms were the most common locations for AAA with pediatric oncology patients. Safety precautions varied by hospital, but all required hand sanitation after visits and that animals receive an annual health examination, be on a leash or in a carrier, be ≥1 year old, and not be directly from a shelter. Our findings reveal consistencies and variations in practice that may help other hospitals develop their own programs and researchers identify areas of future study. © 2015 by Association of Pediatric Hematology/Oncology Nurses.

Child protection and the development of child abuse pediatrics in New York City.

PubMed

Palusci, Vincent J

2017-11-01

The history of child abuse pediatrics reflects the development of medicine as a profession influenced by social movements reacting to poverty, economic exploitation, and child maltreatment. As physicians began to specialize in caring for children, egregious cases led them to recognize children were affected by special medical problems and diseases which were compounded by poor conditions and abuse and neglect. They developed the fields of pediatrics and child abuse pediatrics to advocate for their needs in courts and communities. Using a history of prominent physicians and cases, the objectives of this article are to: (1) rediscover the founding of pediatrics in NYC in the context of the environment which served as the setting for its development; (2) highlight our early understanding of the medical issues surrounding child maltreatment, with advocacy and forensic medicine becoming a growing part of medical care for children; and (3) explore the development of child abuse pediatrics in light of prominent physicians making major contributions to child protection. Timelines show the early interplay among social problems, publicized cases, private and governmental agencies, and the development of child abuse pediatrics. The article concludes with potential lessons to be learned and further questions about this interplay of child protection systems and the development of child abuse pediatrics. Copyright © 2017 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

Saudi Guidelines on the Diagnosis and Treatment of Pulmonary Hypertension: Pulmonary hypertension in children

PubMed Central

Al Dabbagh, Maha; Banjar, Hanna; Galal, Nasser; Kouatli, Amjad; Kandil, Hammam; Chehab, May

2014-01-01

Pulmonary hypertension (PH) is relatively uncommon in children. Pulmonary arterial hypertension (PAH) in pediatric comprises a wide spectrum of diseases, from a transient neonatal condition to a progressive disease associated with morbidity and mortality. Most common PAH in pediatric are idiopathic (IPAH) or PAH associated with congenital heart disease (PAH-CHD), while other associated conditions, such as connective tissue disease (CTD), are less common in pediatrics. Despite better understanding of PH and the availability of new medications during recent decades; the diagnosis, investigation and choice of therapy remain a challenge in children, as evidence-based recommendations depend mainly on adult studies. In this review, we provide a detailed discussion about the distinctive features of PAH in pediatric, mainly emphacysing on classification and diagnostic algorithm. PMID:25076989

Pharmacotherapy challenges of Fontan-associated plastic bronchitis: a rare pediatric disease.

PubMed

Brooks, Kristina; Caruthers, Regine L; Schumacher, Kurt R; Stringer, Kathleen A

2013-09-01

Pediatric pharmacotherapy is often challenging due to the paucity of available clinical data on the safety and efficacy of drugs that are commonly used in children. This quandary is even more prevalent in children with rare diseases. Although extrapolations for dosing and administration are often made from available adult data with similar disease states, this translation becomes even more problematic in rare pediatric diseases. Understanding of rare disease pathophysiology is typically poor, and few, if any, effective therapies have been studied and identified. One condition that illustrates these issues is plastic bronchitis, a rare, most often pediatric disease that is characterized by the production of obstructive bronchial airway casts. This illness primarily occurs in children with congenital heart disease, often after palliative surgery. Plastic bronchitis is a highly clinically relevant and therapeutically challenging problem with a high mortality rate, and, a generally accepted effective pharmacotherapy regimen has yet to be identified. Furthermore, the disease is ill defined, which makes timely identification and treatment of children with plastic bronchitis difficult. The pharmacotherapies currently used to manage this disease are largely anecdotal and vary between the use of macrolide antibiotics, mucolytics, bronchodilators, and inhaled fibrinolytics in a myriad of combinations. The purpose of this review is 2-fold: first, to highlight the dilemma of treating plastic bronchitis, and second, to bring attention to the continuing need for studies of drug therapies used in children so safe and effective drug regimens can be established, particularly for rare diseases. © 2013 Pharmacotherapy Publications, Inc.

Children's Hospital Association Consensus Statements for Comorbidities of Childhood Obesity

PubMed Central

Eneli, Ihuoma; Hampl, Sarah; Mietus-Snyder, Michele; Mirza, Nazrat; Rhodes, Erinn; Sweeney, Brooke; Tinajero-Deck, Lydia; Woolford, Susan J.; Pont, Stephen J.

2014-01-01

Abstract Background: Childhood obesity and overweight affect approximately 30% of US children. Many of these children have obesity-related comorbidities, such as hypertension, dyslipidemia, fatty liver disease, diabetes, polycystic ovary syndrome (PCOS), sleep apnea, psychosocial problems, and others. These children need routine screening and, in many cases, treatment for these conditions. However, because primary care pediatric providers (PCPs) often are underequipped to deal with these comorbidities, they frequently refer these patients to subspecialists. However, as a result of the US pediatric subspecialist shortage and considering that 12.5 million children are obese, access to care by subspecialists is limited. The aim of this article is to provide accessible, user-friendly clinical consensus statements to facilitate the screening, interpretation of results, and early treatment for some of the most common childhood obesity comorbidities. Methods: Members of the Children's Hospital Association (formerly NACHRI) FOCUS on a Fitter Future II (FFFII), a collaboration of 25 US pediatric obesity centers, used a combination of the best available evidence and collective clinical experience to develop consensus statements for pediatric obesity-related comorbidities. FFFII also surveyed the participating pediatric obesity centers regarding their current practices. Results: The work group developed consensus statements for use in the evaluation and treatment of lipids, liver enzymes, and blood pressure abnormalities and PCOS in the child with overweight and obesity. The results of the FFFII survey illustrated the variability in the approach for initial evaluation and treatment as well as pattern of referrals to subspecialists among programs. Conclusions: The consensus statements presented in this article can be a useful tool for PCPs in the management and overall care of children with overweight and obesity. PMID:25019404

Pediatric Glioma at the Optic Pathway and Thalamus

PubMed Central

Park, Eun Suk; Park, Jun Bum; Ra, Young-Shin

2018-01-01

Gliomas are the most common pediatric tumors of the central nervous system. In this review, we discuss the clinical features, treatment paradigms, and evolving concepts related to two types of pediatric gliomas affecting two main locations: the optic pathway and thalamus. In particular, we discuss recently revised pathologic classification, which adopting molecular parameter. We believe that our review contribute to the readers’ better understanding of pediatric glioma because pediatric glioma differs in many ways from adult glioma according to the newest advances in molecular characterization of this tumor. A better understanding of current and evolving issues in pediatric glioma is needed to ensure effective management decision. PMID:29742884

Qualitative Study of Foster Caregivers’ Views on Adherence to Pediatric Appointments

PubMed Central

Schneiderman, Janet U.; Kennedy, Andrea K.; Sayegh, Caitlin S.

2016-01-01

The current study is a qualitative investigation of how foster caregivers, primarily Latinos, view adherence to pediatric appointments with the purpose of identifying how the child welfare system, pediatric clinics, and pediatric health providers serving foster children might promote appointment attendance. Participants in the study had a return appointment at an outpatient pediatric clinic that only served children in the child welfare system. Twenty-eight caregivers (13 related and 15 unrelated) participated in telephone interviews after the date of their scheduled pediatric appointment (32% missed their return appointment). Semistructured interview guides included general questions about what promotes attending the pediatric appointment, what makes it difficult to attend the pediatric appointment, and how pediatric care affects the foster child. Analysis of qualitative data using content analysis identified three themes: (a) multiple methods to attend appointments, which included caregivers’ organizational and problem-solving skills; (b) positive health care experiences, which consisted of caregivers’ personal relationships with providers and staff members and clinic organization; and (c) necessity of pediatric care, which included recognition of the need for health care, especially timely immunizations. All caregivers also reported that appointments reminders would be helpful. Unrelated caregivers more often said that appointment attendance was facilitated by clinic organization compared to related caregivers. Nonadherent caregivers mentioned their need to solve problems to attend appointments or reschedule appointments more than attenders. In summary, caregivers said they valued regular pediatric health care to treat their child’s chronic conditions and prevent illnesses, but they acknowledged that their home lives were hectic and attending scheduled appointments was sometimes difficult. Foster caregivers in this study identified the ideal pediatric clinic environment that encourages adherence to health care appointments. This environment is an organized clinic with easy access including parking, engaged pediatric health providers, ability to reschedule appointments when necessary, and an individualized and consistent appointment reminder system. PMID:27291938

Vitamin D Prescribing Practices in Primary Care Pediatrics: Underpinnings From the Health Belief Model and Use of Web-Based Delphi Technique for Instrument Validity.

PubMed

DelGiudice, Nancy J; Street, Nancy; Torchia, Ronald J; Sawyer, Susan S; Bernard, Sylvia Allison; Holick, Michael F

2018-05-24

Vitamin D deficiency and insufficiency is a pandemic problem in children and adolescents in the United States. The problem may be aggravated by the inconsistent implementation of current clinical practice guidelines for vitamin D management by pediatric primary care providers. This study examines the relationship between primary care providers' prescribing vitamin D to children ages 1 through 18 years and their practice actions and knowledge. A descriptive correlation design was used. Participants were recruited from a purposive sample of pediatricians and pediatric nurse practitioners through an online invitation to participate in a survey. Reliability and validity was established for the survey developed by the principal investigator using a web-based Delphi technique. Results from this study indicate that although most providers are aware that vitamin D insufficiency and deficiency are problems, fewer than half currently recommend 600- to 1,000-IU supplementation to their patients ages 1 through 18 years. Copyright © 2018 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.

Characteristics of pediatric chemotherapy medication errors in a national error reporting database.

PubMed

Rinke, Michael L; Shore, Andrew D; Morlock, Laura; Hicks, Rodney W; Miller, Marlene R

2007-07-01

Little is known regarding chemotherapy medication errors in pediatrics despite studies suggesting high rates of overall pediatric medication errors. In this study, the authors examined patterns in pediatric chemotherapy errors. The authors queried the United States Pharmacopeia MEDMARX database, a national, voluntary, Internet-accessible error reporting system, for all error reports from 1999 through 2004 that involved chemotherapy medications and patients aged <18 years. Of the 310 pediatric chemotherapy error reports, 85% reached the patient, and 15.6% required additional patient monitoring or therapeutic intervention. Forty-eight percent of errors originated in the administering phase of medication delivery, and 30% originated in the drug-dispensing phase. Of the 387 medications cited, 39.5% were antimetabolites, 14.0% were alkylating agents, 9.3% were anthracyclines, and 9.3% were topoisomerase inhibitors. The most commonly involved chemotherapeutic agents were methotrexate (15.3%), cytarabine (12.1%), and etoposide (8.3%). The most common error types were improper dose/quantity (22.9% of 327 cited error types), wrong time (22.6%), omission error (14.1%), and wrong administration technique/wrong route (12.2%). The most common error causes were performance deficit (41.3% of 547 cited error causes), equipment and medication delivery devices (12.4%), communication (8.8%), knowledge deficit (6.8%), and written order errors (5.5%). Four of the 5 most serious errors occurred at community hospitals. Pediatric chemotherapy errors often reached the patient, potentially were harmful, and differed in quality between outpatient and inpatient areas. This study indicated which chemotherapeutic agents most often were involved in errors and that administering errors were common. Investigation is needed regarding targeted medication administration safeguards for these high-risk medications. Copyright (c) 2007 American Cancer Society.

Application of Pyridostigmine in Pediatric Gastrointestinal Motility Disorders: A Case Series.

PubMed

Manini, Mhd Louai; Camilleri, Michael; Grothe, Rayna; Di Lorenzo, Carlo

2018-04-01

Gastrointestinal (GI) motility disorders are common in children. Treatment is challenging with limited medical and surgical options. Pyridostigmine, an acetyl cholinesterase inhibitor, increases acetylcholine at the neuromuscular junction promoting intestinal contractions. Little is known about the role and dosing of pyridostigmine in pediatric GI motility disorders. We present a case series of children with GI dysmotility managed with oral pyridostigmine. Patients' diagnoses include chronic intestinal pseudo-obstruction, gastroparesis with delayed small bowel transit, chronic constipation with failure to thrive, and prolonged ileus after pelvic surgery with chronic opioid use. Pyridostigmine was effective and safe in all cases. Pyridostigmine decreased abdominal distention, increased bowel movement frequency, and improved enteral feeding tolerance. Effective dosing ranged between 0.25-2.0 mg/kg/day. One patient experienced cramping abdominal pain while on pyridostigmine, but pain resolved after medication was discontinued. We found oral pyridostigmine to be helpful in children with different GI motility problems. Pyridostigmine should be considered in such patients when other treatment interventions have not been beneficial.

Space Maintenance with an Innovative "Tube and Loop" Space Maintainer (Nikhil Appliance).

PubMed

Srivastava, Nikhil; Grover, Jyotika; Panthri, Prerna

2016-01-01

Despite the best efforts in prevention, premature loss of primary teeth continues to be a common problem in pediatric dentistry, resulting in disruption of arch integrity and adversely affecting the proper alignment of permanent successors. Space maintainers (SMs) are special appliances used for maintaining space created due to premature loss of primary teeth. Band and loop SM is mostly indicated for the premature loss of single primary molar, but this appliance has a number of limitations both for operators and for patients. Presented in this article is an innovative "Tube and Loop" SM (Nikhil appliance) which offers several advantages over the conventional band and loop SM. It is not only easy and quick to fabricate but can also be completed in a single sitting and cumbersome steps like impression making and laboratory procedures namely soldering are eliminated. How to cite this article: Srivastava N, Grover J, Panthri P. Space Maintenance with an Innovative "Tube and Loop" Space Maintainer (Nikhil Appliance). Int J Clin Pediatr Dent 2016;9(1):86-89.

Treatment of idiopathic clubfoot: an historical review.

PubMed

Dobbs, M B; Morcuende, J A; Gurnett, C A; Ponseti, I V

2000-01-01

Idiopathic clubfoot, one of the most common problems in pediatric orthopaedics, is characterized by a complex three-dimensional deformity of the foot. The treatment of clubfoot is controversial and continues to be one of the biggest challenges in pediatric orthopaedics. This controversy is due in part to the difficulty in measuring and evaluating the effectiveness of different treatment methods. We believe the heart of the debate is a lack of understanding of the functional anatomy of the deformity, the biological response of young connective tissue to injury and repair, and their combined effect on the long-term treatment outcomes. The aim of this review is not only to assess the different methods of clubfoot treatment used over the years in light of an evolving understanding of the pathoanatomy of the deformity, but to also clarify factors that allow a safe, logical approach to clubfoot management. Further research will be needed to fully understand the pathogenesis of clubfoot, as well as the long-term results and quality of life for the treated foot.

Verbal abuse of pediatric nurses by patients and families.

PubMed

Truman, Ann; Goldman, Myra; Lehna, Carlee; Berger, Jill; Topp, Robert

2013-01-01

The purpose of this study was to determine the extent to which nurses practicing in a pediatric hospital encounter verbal abuse by patients and families and their reactions to this abuse. Verbal abuse, the most common type of workplace violence against nurses results in declining morale and job satisfaction, and can negatively impact nurse turnover and quality of patient care. The study employed a concurrent triangulation strategy using mixed methods. The 162 nurses who volunteered completed a 3-part questionnaire, and a subgroup participated in one of three focus groups. Eighty-two percent of subjects reported verbal abuse an average of 4 times per month. The majority of these continued to think about the incident for a few hours (25%), a few days (36%), or a week or more (12%). Nearly half reported feeling angry or powerless and 14% said they thought of leaving their position. The findings of this study described the nature and scope of the problem, and prompted improvement in processes and education to support nurses.

Management of periodontal health in children: pediatric dentistry and periodontology interface.

PubMed

Drummond, Bernadette K; Brosnan, Michael G; Leichter, Jonathan W

2017-06-01

The oral health of children and adolescents mirrors their general health. Because oral health care is often delivered in isolation from general health care, oral signs and symptoms do not always alert practitioners to their significance beyond the mouth. An important example of this is the association of a higher risk of dental caries and periodontal disease in children and adolescents with overweight, obesity and prediabetic conditions. Oral-health practitioners need to consider the health conditions that their patients may have. This will aid in diagnosis and alert the practitioner to oral conditions that may not resolve without general health-care intervention also. This paper reviews the more common oral conditions involving periodontal health in children and adolescents, and discusses the diagnosis of these conditions, potential associated health problems and the roles of pediatric dentistry and periodontology in the management of these conditions with the goal of children entering adulthood with healthy dentitions. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Doctors and lawyers collaborating to HeLP children--outcomes from a successful partnership between professions.

PubMed

Klein, Melissa D; Beck, Andrew F; Henize, Adrienne W; Parrish, Donita S; Fink, Elaine E; Kahn, Robert S

2013-08-01

Clear associations exist between socioeconomic risks and health, and these risks are often amenable to legal interventions. This is a case study of an implementation of a medical-legal partnership (MLP) in three pediatric primary care centers that serve a predominantly high-risk population. Referral circumstances and outcomes over the first three years are described. During the three-year study period, 1,808 MLP referrals were made for 1,614 patients by all levels of provider. Those referred were more likely to have asthma (p<.0001) and developmental delay/behavioral disorder (p<.0001) than the general clinic population. Housing (37%) and income/health benefit (33%) problems were the most common reasons for referral. Referrals led to 1,742 (89%) positive legal outcomes affecting nearly 6,000 cohabitating children and adults and translating into nearly $200,000 in recovered back benefits. Successful MLP implementation enabled pediatric providers to address social determinants of health potentially improving health and reducing disparities.

[Pediatric anesthesia emergence delirium after elective ambulatory surgery: etiology, risk factors and prevalence].

PubMed

Gololobov, Alik; Todris, Liat; Berman, Yakov; Rosenberg-Gilad, Zipi; Schlaeffer, Pnina; Kenett, Ron; Ben-Jacob, Ron; Segal, Eran

2015-04-01

Emergence delirium (ED) is a common problem among children and adults recovering from general anesthesia after surgery. Its symptoms include psychomotor agitation, hallucinations, and aggressive behavior. The phenomenon, which is most probably an adverse effect of general anesthesia agents, harms the recovery process and endangers the physical safety of patients and their health. Ranging between 10% and 80%, the exact prevalence of ED is unknown, and the risk factors of the phenomenon are unclear. The aim of the current retrospective study was to determine the prevalence rate of ED in 3947 children recovering from general anesthesia after short elective ambulatory surgery, and to map the influence of various risk factors on this phenomenon. Data were collected using electronic medical records. ED severity was assessed using the Pediatric Anesthesia Emergence Delirium Scale. Results showed the prevalence of ED among children. ED was significantly correlated with patients' age, type of surgery and premedication. ED was not correlated with severity of pain, type of anesthesia or with patients' sex.

The Diagnosis and Management of Concussion in Children and Adolescents.

PubMed

Rose, Sean C; Weber, Kevin D; Collen, James B; Heyer, Geoffrey L

2015-08-01

Concussion is a complex brain injury that results in more than 100,000 emergency department visits for school-aged children each year in the United States. All 50 US states have passed concussion legislation designed to promote safety in youth sports. Most of these laws require medical clearance by a licensed health care provider before returning to sport, which may have contributed to an increase in pediatric subspecialty referrals, particularly referrals to the child neurologist. We reviewed the literature on pediatric concussion. This review summarizes the current knowledge and recommendations for concussion diagnosis and management in children and adolescents, athletes and nonathletes. It highlights concussion epidemiology, pathophysiology, advances in neuroimaging, and potential health risks including second impact syndrome and chronic traumatic encephalopathy. It also underscores clinical areas where evidence is lacking. The diagnosis and management of concussion requires specific considerations in children. Further concussion research must be done to minimize injury risk and to optimize medical care for this common problem. Copyright © 2015 Elsevier Inc. All rights reserved.

Feeding and Swallowing Disorders in Pediatric Neuromuscular Diseases: An Overview

PubMed Central

van den Engel-Hoek, Lenie; de Groot, Imelda J.M.; de Swart, Bert J.M.; Erasmus, Corrie E.

2015-01-01

Feeding and swallowing problems in infants and children have a great impact on health and wellbeing. The aim of this study was to provide an overview of recognized feeding and swallowing problems in different groups of children with neuromuscular diseases, based on relevant literature and expert opinion, and to propose recommendations for the assessment and treatment of these problems. Almost all pediatric neuromuscular diseases are accompanied by feeding and swallowing problems during the different phases of deglutition, problems that give rise to a wide variety of signs and symptoms, which emphasizes the importance of a comprehensive feeding and swallowing assessment by a speech and language therapist. PMID:27858755

Adolescent Sleepiness: Causes and Consequences.

PubMed

Hansen, Shana L; Capener, Dale; Daly, Christopher

2017-09-01

Insufficient sleep duration and poor sleep quality are common among adolescents. The multidimensional causes of insufficient sleep duration and poor sleep quality include biological, health-related, environmental, and lifestyle factors. The most common direct consequence of insufficient and/or poor sleep quality is excessive daytime sleepiness, which may contribute to poor academic performance, behavioral health problems, substance use, and drowsy driving. Evaluation of sleepiness includes a detailed sleep history and sleep diary, with polysomnography only required for the assessment of specific sleep disorders. Management involves encouraging healthy sleep practices such as having consistent bed and wake times, limiting caffeine and electronics at night before bed, and eliminating napping, in addition to treating any existing sleep or medical disorders. [Pediatr Ann. 2017;46(9):e340-e344.]. Copyright 2017, SLACK Incorporated.

Rett syndrome and menstruation.

PubMed

Hamilton, Amy; Marshal, Michael P; Sucato, Gina S; Murray, Pamela J

2012-04-01

Describe the experience that girls with Rett syndrome have with menstruation including menstrual hygiene, dysmenorrhea, premenstrual syndrome (PMS), and attempts at treatment. Anonymous web-based survey. Convenience sample recruited from Rett syndrome LISTSERV in July of 2009. Mothers of girls with Rett syndrome between the ages of 10-25 who have had at least one menses. Prevalence, frequency, and severity of dysmenorrhea and PMS; hygiene concerns; and treatments attempts and perceived effectiveness. Dysmenorrhea and PMS are common problems among young women with Rett syndrome. Despite their frequency and severity they do not routinely limit activities. Multiple treatment attempts are common. Hormonal contraception is used mostly for menstrual cycle control with oral contraceptive pills the most commonly used method. Young women with Rett syndrome have standard symptoms of dysmenorrhea and PMS as well as autism spectrum specific PMS symptoms. Hormonal contraception is commonly used for menstrual management. Copyright © 2012 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

Dental Health and Orthodontic Problems

MedlinePlus

... of yesteryear. Dr. Jim Steiner, director of pediatric dentistry at Children’s Hospital in Cincinnati, Ohio, attributes the ... ago,” says Dr. Jim Steiner, director of pediatric dentistry at Children's Hospital in cincinnati, Ohio, “the silver ...

Pioneers in pediatric psychology: integrating nutrition and child development interventions.

PubMed

Black, Maureen M

2015-05-01

As part of the Pioneers in Pediatric Psychology series, this article provides a brief personal account of Maureen Black's career as a pediatric psychologist. It traces the transition of the Society of Pediatric Psychology (SPP) from a section of the Division of Clinical Psychology of the American Psychological Association (APA) to an independent division of APA, which occurred during my presidency of SPP. The article addresses three aspects of pediatric psychology that have been central to my career: pediatric nutritional problems, global child development, and the advancement of children's health and development through policy-related strategies. The article concludes with Lessons Learned and Recommendations for the future of pediatric psychology. © The Author 2015. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Epidemiologic Analysis of Onychomycosis in the San Diego Pediatric Population.

PubMed

Totri, Christine R; Feldstein, Stephanie; Admani, Shehla; Friedlander, Sheila F; Eichenfield, Lawrence F

2017-01-01

Onychomycosis (OM) is thought to be a rare disease in children, although there are few epidemiologic studies. This 3-year retrospective case series of nearly 400 children seen at Rady Children's Hospital-San Diego (RCHSD) describes the characteristics of OM found in this pediatric population. From 2011 to 2013, the Pediatric and Adolescent Dermatology Clinic at RCHSD saw a total of 36,634 unique patients, of whom 433 were unique patients with OM. Thirty-four patients met exclusion criteria, leaving 399 (1.1%) with a diagnosis of OM by a pediatric dermatologist. Nail cultures were obtained in 242 cases (60.7%), 116 (48.0%) of which were positive. Trichophyton rubrum was the most commonly isolated pathogen, responsible for 106 cases (91.3%) of positive cultures in the cohort. Our study provides important regional information regarding epidemiologic data in pediatric onychomycosis, highlighting the diagnostic methods most commonly used and the pathogens most frequently encountered in our practice. © 2016 Wiley Periodicals, Inc.

Foreign bodies in the aerodigestive tract in pediatric patients.

PubMed

Higo, Ryuzaburo; Matsumoto, Yu; Ichimura, Keiichi; Kaga, Kimitaka

2003-12-01

To investigate pediatric foreign body cases in the aerodigestive tract, and to elucidate the characteristic problems in Japan. A total of 310 pediatric patients (age 15 or below), gathered from two medical university hospitals (University of Tokyo and Jichi Medical School), were included in this study. Data were collected by retrospective chart review and were statistically analyzed. Two-year-olds were the most common patients, and the range from age 1 to age 4 included 67.7% of all the patients. The most involved sites were the nose (39.4%) and the pharynx (38.4%), followed by the esophagus (12.9%) and the trachea-bronchi (6.5%). Fish bones and toys were the representative foreign bodies (30.7 and 13.6%, respectively). Other foreign bodies often encountered included coins, food, candy, peanuts and nuts, and batteries. The type of foreign body was closely related to the site in which foreign bodies were lodged: 77.3% of foreign bodies in the pharynx were fish bones, and toys were the most common impacted foreign body in the nose. In the esophagus, representative impacted foreign bodies were coins (35.7%), but disk-type battery ingestion has been increasing in recent years. Although most foreign bodies in the esophagus were safely removed, one case of a disk-type battery had a serious sequela. In the trachea-bronchi, peanuts, food, cotton, and coins were impacted. A rigid bronchoscope was basically used to remove foreign bodies, but in some cases, a fine flexible endoscope, with a channel for fiber forceps, was useful, because it could be inserted into narrow bronchi. Advance of a flexible endoscope will make it an excellent tool for diagnosis and management of the trachea-bronchial foreign body. Fish bones in the pharynx, which were closely related to Japanese eating habits, and toys in the nose, were the typical foreign bodies encountered in this study. In the esophagus, an increased incidence of disk-type battery ingestion has become a serious problem in recent years. Since prevention is the most essential way to manage foreign body cases, feedback from studies to public education should be encouraged.

Surgical Intervention for Medically Refractory Hyperthyroidism.

PubMed

Knollman, Philip D; Giese, Ann; Bhayani, Mihir K

2016-05-01

Pediatric hyperthyroidism can be multifactorial, with Graves' disease (GD) being the most common etiology. Treatment focuses on identification of the cause of the hyperthyroidism and achieving a biochemical cure with symptom resolution. This article highlights the clinical presentation, diagnosis, and treatment of a pediatric patient with GD. [Pediatr Ann. 2016;45(5):e171-e175.]. Copyright 2016, SLACK Incorporated.

[Develooment of the lower urinary tract and its functional disorders].

PubMed

Peco-Antić, Amira; Miloševski-Lomić, Gordana

2015-01-01

A normal development of lower urinary tract function control evolves from involuntary bladder empting (incontinence) during infancy to daytime urinary continence, and finally a successful day and night continence that is generally achieved by the 5th to 7th year of age.This gradual process primarily depends on the progressive maturation of the neural control of the lower urinary tract, but it is also influenced by behavioral training that evolves through social support. Functional voiding disorders (bladder dysfunction) are common problems during childhood. They are present in 5-15 % of general pediatric population, and in one-fifth of school-age children or in over one-third of patients of the pediatric urologist or nephrologist. More than half of children with bladder dysfunction have vesicoureteral reflux, and more than two-thirds have recurrent urinary tract infections. There is also a frequent association of bladder dysfunction with constipation and encopresis (dysfunctional elimination syndrome). Bladder dysfunction may cause a permanent damage to the upper urinary tract and kidneys. In addition, urinary incontinence, as the most common manifestation of bladder dysfunction can be the cause of major stress in school- age children and have a negative effect on the child's feeling of self-esteem. Thus, a timely detection and treatment of this group of disorders in children is highly significant.

ABCs of SLEEPING: A review of the evidence behind pediatric sleep practice recommendations.

PubMed

Allen, Stephanie L; Howlett, Melissa D; Coulombe, J Aimée; Corkum, Penny V

2016-10-01

The ABCs of SLEEPING mnemonic was developed to serve as an organizing framework for common pediatric sleep recommendations. The mnemonic stands for 1) age appropriate bedtimes and wake-times with consistency, 2) schedules and routines, 3) location, 4) exercise and diet, 5) no electronics in the bedroom or before bed, 6) positivity 7) independence when falling asleep and 8) needs of child met during the day, 9) equal great sleep. This review examines the empirical evidence behind the practices and recommendations captured by the ABCs of SLEEPING mnemonic for children aged 1 to 12. A search was conducted of key electronic databases (PubMed, PsycINFO, CINAHL, & EMBASE) to identify English articles that included the concepts of sleep, insomnia, and/or bedtime. 77 articles were eligible for inclusion and were coded to extract key details and findings regarding the relations between sleep practices identified in the ABCs of SLEEPING mnemonic and sleep outcomes. Findings provided preliminary support for many of the recommendations that are commonly made to families regarding healthy sleep practices. However, more robust investigations are needed to better understand the causal contributions of healthy sleep practices to the onset and maintenance of children's sleep problems. Copyright © 2015 Elsevier Ltd. All rights reserved.

Practice Variations in the Management of Inflammatory Bowel Disease Between Pediatric and Adult Gastroenterologists.

PubMed

Assa, Amit; Avni, Irit; Ben-Bassat, Ofer; Niv, Yaron; Shamir, Raanan

2016-03-01

Different practice guidelines and consensus statements for both pediatric- and adult-onset inflammatory bowel disease exist. Although variations in medical care among gastroenterologists are common, it is unknown whether there are fundamental differences between disciplines. The primary aim of the present study was to investigate differences in common practices across disciplines. This was a prospective, questionnaire-based survey of gastroenterologists attending gastroenterology meetings in Israel. The questionnaire covered attitudes to medical resources, diagnostic and follow-up measures as well as therapeutic approaches. Overall, 120 (60%) of the approached adult gastroenterologists (AGs) and 49 (75%) pediatric gastroenterologists (PGs) completed the questionnaire. The 2 groups differed significantly in various practice areas. Pediatric patients are seen more frequently and for longer appointments. PGs tend to assess thiopurine metabolites (96% vs 47%) more often during treatment. There is a significant variation in practice between groups concerning infectious serology status and vaccinations. Methotrexate in Crohn patients is used more commonly by PGs (55% vs 22%). Long-term combination therapy of thiopurines and anti-tumor necrosis factorα agents is used more often by AGs. In patients with ulcerative colitis AGs use oral 5-aminosalicylic acid once daily (51% vs 21%) and add rectal agents from the first day of treatment (72% vs 35%) more often as compared with PGs. This study demonstrates that common practices in inflammatory bowel disease patients differ significantly between adult and pediatric practitioners. These findings call for investigating the reasons for these differences and promoting strategies to diminish these gaps.

Progress in pediatrics in 2011. Choices in endocrinology, gastroenterology, hemato-oncology, infectious diseases, otolaryngology, pharmacotherapy and respiratory tract illnesses

PubMed Central

2012-01-01

Main progresses in endocrinology, gastroenterology, hemato-oncology, infectious diseases, otolaryngology, pharmacotherapy, and respiratory tract illnesses selected from articles published in The Italian Journal of Pediatrics in 2011 were reviewed. Risk factors for gastroenteritis and appendicitis in developing countries may be useful in improving our understanding of these diseases. Childhood hearing impairment is a world-wide problem which continues to have an high prevalence in newborns. Among the mechanisms of diseases, obese children often have asthma and high hepcidin levels that may reduce serum iron concentrations. In cystic fibrosis, 18q distal deletion has been described as a novel mutation. Hypothyroidism in children with central nervous system infections may increase mortality rates. Infrared tympanic thermometer (IRTT) in oral mode for the measurement of body temperature may be useful in fever screening in a busy setup. In newborns, the transmission of CMV infection through breast milk may be prevented through freezing or pasteurization. Recent advances in treatment of constipation, urinary tract infections, leukemia, pain in children with cancer, neonates with sepsis or difficult weaning from mechanical ventilation will likely contribute towards optimizing management of these common disorders. The work of the Family Pediatricians Medicines for Children Research Network aims to develop competence, infrastructure, networking and education for pediatric clinical trials. PMID:22682313

Progress in pediatrics in 2011. Choices in endocrinology, gastroenterology, hemato-oncology, infectious diseases, otolaryngology, pharmacotherapy and respiratory tract illnesses.

PubMed

Caffarelli, Carlo; Santamaria, Francesca; Cesari, Silvia; Di Giorgio, Angela; Bernasconi, Sergio

2012-06-08

Main progresses in endocrinology, gastroenterology, hemato-oncology, infectious diseases, otolaryngology, pharmacotherapy, and respiratory tract illnesses selected from articles published in The Italian Journal of Pediatrics in 2011 were reviewed. Risk factors for gastroenteritis and appendicitis in developing countries may be useful in improving our understanding of these diseases. Childhood hearing impairment is a world-wide problem which continues to have an high prevalence in newborns. Among the mechanisms of diseases, obese children often have asthma and high hepcidin levels that may reduce serum iron concentrations. In cystic fibrosis, 18q distal deletion has been described as a novel mutation. Hypothyroidism in children with central nervous system infections may increase mortality rates. Infrared tympanic thermometer (IRTT) in oral mode for the measurement of body temperature may be useful in fever screening in a busy setup. In newborns, the transmission of CMV infection through breast milk may be prevented through freezing or pasteurization. Recent advances in treatment of constipation, urinary tract infections, leukemia, pain in children with cancer, neonates with sepsis or difficult weaning from mechanical ventilation will likely contribute towards optimizing management of these common disorders. The work of the Family Pediatricians Medicines for Children Research Network aims to develop competence, infrastructure, networking and education for pediatric clinical trials.

Prescribing errors in adult congenital heart disease patients admitted to a pediatric cardiovascular intensive care unit.

PubMed

Echeta, Genevieve; Moffett, Brady S; Checchia, Paul; Benton, Mary Kay; Klouda, Leda; Rodriguez, Fred H; Franklin, Wayne

2014-01-01

Adults with congenital heart disease (CHD) are often cared for at pediatric hospitals. There are no data describing the incidence or type of medication prescribing errors in adult patients admitted to a pediatric cardiovascular intensive care unit (CVICU). A review of patients >18 years of age admitted to the pediatric CVICU at our institution from 2009 to 2011 occurred. A comparator group <18 years of age but >70 kg (a typical adult weight) was identified. Medication prescribing errors were determined according to a commonly used adult drug reference. An independent panel consisting of a physician specializing in the care of adult CHD patients, a nurse, and a pharmacist evaluated all errors. Medication prescribing orders were classified as appropriate, underdose, overdose, or nonstandard (dosing per weight instead of standard adult dosing), and severity of error was classified. Eighty-five adult (74 patients) and 33 pediatric admissions (32 patients) met study criteria (mean age 27.5 ± 9.4 years, 53% male vs. 14.9 ± 1.8 years, 63% male). A cardiothoracic surgical procedure occurred in 81.4% of admissions. Adult admissions weighed less than pediatric admissions (72.8 ± 22.4 kg vs. 85.6 ± 14.9 kg, P < .01) but hospital length of stay was similar. (Adult 6 days [range 1-216 days]; pediatric 5 days [Range 2-123 days], P = .52.) A total of 112 prescribing errors were identified and they occurred less often in adults (42.4% of admissions vs. 66.7% of admissions, P = .02). Adults had a lower mean number of errors (0.7 errors per adult admission vs. 1.7 errors per pediatric admission, P < .01). Prescribing errors occurred most commonly with antimicrobials (n = 27). Underdosing was the most common category of prescribing error. Most prescribing errors were determined to have not caused harm to the patient. Prescribing errors occur frequently in adult patients admitted to a pediatric CVICU but occur more often in pediatric patients of adult weight. © 2013 Wiley Periodicals, Inc.

Impact of hypothermia in the rural, pediatric trauma patient.

PubMed

Waibel, Brett H; Durham, Chris A; Newell, Mark A; Schlitzkus, Lisa L; Sagraves, Scott G; Rotondo, Michael F

2010-03-01

Hypothermia is an independent predictor of mortality in adult trauma studies. However, the impact of hypothermia on the pediatric trauma population has not been described. The purpose of this study is to evaluate hypothermia as a cofactor to mortality, complications, and among survivors, hospital length of stay parameters in the pediatric trauma population. Retrospective review of a prospectively collected database (National Trauma Registry of the American College of Surgeons) over a 5-yr period (July 2002 to June 2007). A rural, level I trauma center. One thousand six hundred twenty-nine pediatric patients admitted with a traumatic injury. None. Multivariate regression models were used to evaluate the association of hypothermia with mortality, infectious complications, organ dysfunction, and among survivors, hospital length of stay parameters. Of 1,629 pediatric trauma patients admitted, 182 (11.1%) patients were hypothermic (temperature below 36 degrees C) on admission. Hypothermia had an adjusted odds ratio (AOR) of 2.41 (95% confidence interval [CI], 1.12-5.22, p = .025) for mortality. After controlling for covariates, hypothermia had associations with developing pneumonia (AOR, 0.185, 95% CI, 0.040-0.853; p = .031) and a bleeding diathesis (AOR, 3.14, 95% CI, 1.04-9.44; p = .042). The median days in the hospital, intensive care unit (ICU), and ventilator were longer in the hypothermic cohort; however, after controlling for covariates, hypothermia was not associated with differences in hospital days, ICU days, or ventilator days. Hypothermia is a common problem at admission among pediatric trauma patients. Hypothermia is associated with an increase in the odds of death and the development of a bleeding diathesis, while having decreased odds for developing pneumonia. While the length of stay indicators were longer in the hypothermic cohort among survivors, no significant association was noted with hypothermia for hospital, ICU, or ventilator days after controlling for confounders.

Pediatric Abdominal Pain: An Emergency Medicine Perspective.

PubMed

Smith, Jeremiah; Fox, Sean M

2016-05-01

Abdominal pain is a common complaint that leads to pediatric patients seeking emergency care. The emergency care provider has the arduous task of determining which child likely has a benign cause and not missing the devastating condition that needs emergent attention. This article reviews common benign causes of abdominal pain as well as some of the cannot-miss emergent causes. Copyright © 2016 Elsevier Inc. All rights reserved.

Hard to Swallow: Developmental Biological Insights into Pediatric Dysphagia

PubMed Central

LaMantia, Anthony-Samuel; Moody, Sally A.; Maynard, Thomas M.; Karpinski, Beverly A.; Zohn, Irene E.; Mendelowitz, David; Lee, Norman H.; Popratiloff, Anastas

2015-01-01

Pediatric dysphagia—feeding and swallowing difficulties that begin at birth, last throughout childhood, and continue into maturity—is one of the most common, least understood complications in children with developmental disorders. We argue that a major cause of pediatric dysphagia is altered hindbrain patterning during pre-natal development. Such changes can compromise craniofacial structures including oropharyngeal muscles and skeletal elements as well as motor and sensory circuits necessary for normal feeding and swallowing. Animal models of developmental disorders that include pediatric dysphagia in their phenotypic spectrum can provide mechanistic insight into pathogenesis of feeding and swallowing difficulties. A fairly common human genetic developmental disorder, DiGeorge/22q11.2 Deletion Syndrome (22q11DS) includes a substantial incidence of pediatric dysphagia in its phenotypic spectrum. Infant mice carrying a parallel deletion to 22q11DS patients have feeding and swallowing difficulties. Altered hindbrain patterning, neural crest migration, craniofacial malformations, and changes in cranial nerve growth prefigure these difficulties. Thus, in addition to craniofacial and pharyngeal anomalies that arise independently of altered neural development, pediatric dysphagia may reflect disrupted hindbrain patterning and its impact on neural circuit development critical for feeding and swallowing. The mechanisms that disrupt hindbrain patterning and circuitry may provide a foundation to develop novel therapeutic approaches for improved clinical management of pediatric dysphagia. PMID:26554723

[Regional differences in acute poisoning in under 14 year-old children in Spain].

PubMed

Salazar, J; Zubiaur, O; Azkunaga, B; Molina, J C; Mintegi, S

2015-01-01

The identification of variations in different profiles of pediatric poisonings may improve the prevention of these episodes. To analyze the profile of pediatric acute poisonings in different regions of Spain. A study was conducted, based on a prospective registry of the acute pediatric poisonings registered in 53 Spanish pediatric emergency departments included in the Toxicology Surveillance System of the Spanish Society of Pediatric Emergencies between 2008 and 2013. The regions were defined taking into account geographic factors, and the structuring of regional pediatric societies. A total of 566 poisoning were recorded in children less than 14 years. Poisonings due to dosage errors were more common in Madrid (12.4% of the whole group of poisonings vs 5.0% in the other regions, P=.009); recreational poisonings were more common in the Basque-Navarre region and Zaragoza (14.4% vs 3.4% in the others, P=.0008); and CO poisoning in Catalonia, Madrid and others (7.1% vs 0.3%, P<.0001). The profiles of acute poisonings in children less than 14 years vary significantly between the different Spanish regions. An epidemiological Surveillance System is a good tool to collect information in order to design preventive actions. Copyright © 2014 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

Imaging of Sports-related Injuries of the Lower Extremity in Pediatric Patients.

PubMed

O'Dell, M Cody; Jaramillo, Diego; Bancroft, Laura; Varich, Laura; Logsdon, Gregory; Servaes, Sabah

2016-10-01

With increasing participation and intensity of training in youth sports in the United States, the incidence of sports-related injuries is increasing, and the types of injuries are shifting. In this article, the authors review sports injuries of the lower extremity, including both acute and overuse injuries, that are common in or specific to the pediatric population. Common traumatic injuries that occur in individuals of all ages (eg, tears of the acetabular labrum and anterior cruciate ligament) are not addressed, although these occur routinely in pediatric sports. However, some injuries that occur almost exclusively in high-level athletes (eg, athletic pubalgia) are reviewed to increase awareness and understanding of these entities among pediatric radiologists who may not be familiar with them and thus may not look for them. Injuries are described according to their location (ie, hip, knee, or foot and ankle) and pathologic process (eg, apophysitis, osteochondritis dissecans). Examples of abnormalities and normal variants of the anatomy that are often misdiagnosed are provided. The injuries reviewed represent a common and growing subset of pathologic processes about which all pediatric and musculoskeletal radiologists should be knowledgeable. Understanding physeal injury is especially important because missed diagnoses can lead to premature physeal closure and osteoarthritis. © RSNA, 2016.

Clinical Characteristics of Pediatric Trichotillomania: Comparisons with Obsessive-Compulsive and Tic Disorders.

PubMed

Rozenman, Michelle; Peris, Tara S; Gonzalez, Araceli; Piacentini, John

2016-02-01

This study compared youth ages 5-17 years with a primary diagnosis of trichotillomania (TTM, n = 30) to those with primary OCD (n = 30) and tic disorder (n = 29) on demographic characteristics, internalizing, and externalizing symptoms. Findings suggest that youth with primary TTM score more comparably to youth with tics than those with OCD on internalizing and externalizing symptom measures. Compared to the OCD group, youth in the TTM group reported lower levels of anxiety and depression. Parents of youth in the TTM group also reported fewer internalizing, externalizing, attention, and thought problems than those in the OCD group. Youth with TTM did not significantly differ from those with primary Tic disorders on any measure. Findings suggest that pediatric TTM may be more similar to pediatric tic disorders than pediatric OCD on anxiety, depression, and global internalizing and externalizing problems.

Health care Professionals' Experiences and Needs When Delivering End-of-Life Care to Children: A Qualitative Study.

PubMed

Bergsträsser, Eva; Cignacco, Eva; Luck, Patricia

2017-01-01

Pediatric end-of-life care (EOL care) entails challenging tasks for health care professionals (HCPs). Little is known about HCPs' experiences and needs when providing pediatric EOL care in Switzerland. This study aimed to describe the experiences and needs of HCPs in pediatric EOL care in Switzerland and to develop recommendations for the health ministry. The key aspect in EOL care provision was identified as the capacity to establish a relationship with the dying child and the family. Barriers to this interaction were ethical dilemmas, problems in collaboration with the interprofessional team, and structural problems on the level of organizations. A major need was the expansion of vocational training and support by specialized palliative care teams. We recommend the development of a national concept for the provision of EOL care in children, accompanied by training programs and supported by specialized pediatric palliative care teams located in tertiary children's hospitals.

Challenges of pediatric residency training in Taiwan.

PubMed

Tsai, Tsuen-Chiuan; Harasym, Peter H

2006-01-01

A crisis in pediatric residency training today has raised serious concerns about the healthcare quality for children in Taiwan. The purpose of this study was to document the problems and to propose possible solutions for improvement. The problems include: 1) manpower shortage due to the difficulty of recruiting pediatric residents; 2) heavy workload that hinders learning; 3) lack of assessment and poor program planning; and 4) inadequate institutional and financial support. As a result, physicians' competencies are not guaranteed at the end of residency training, even with the pediatric board certification. Possible solutions may include: 1) conducting research on physician manpower statistics, work hours and environment; 2) establishing a Residency Program Review Committee and provision of standards for accreditation; 3) defining the competencies mandated as a general pediatrician and developing a set of measurable qualitative standards; 4) encouraging new programs with flexibility (e.g., primary care); and 5) pursuing adequate institutional and financial supports.

Does Length of Developmental Behavioral Pediatrics Training Matter?

PubMed

Stein, Ruth E K; Storfer-Isser, Amy; Kerker, Bonnie D; Garner, Andrew; Szilagyi, Moira; Hoagwood, Kimberly E; O'Connor, Karen G; Green, Cori M; Horwitz, Sarah McCue

Since 1997 pediatric residencies have been required to provide a 4-week block rotation in developmental and behavioral pediatrics (DBP), but it is not known whether this has altered the care and management of children by practicing pediatricians. The objective of this study was to compare the self-reported practice patterns of pediatricians who were trained with 4 or more weeks of DBP with the practice patterns of those who were trained for <4 weeks. We used self-reported practices from the American Academy of Pediatrics Periodic Survey 85. Pediatricians were asked whether they never, sometimes, or usually inquired about and screened for, and whether they treated/managed/comanaged attention deficit hyperactivity disorder, depression, anxiety, behavior problems and learning problems. They were also asked about a series of barriers to care. Analyses were weighted to account for low response rates. Those with more DBP training were significantly more likely to treat/manage/co-manage depression, anxiety, behavior problems and learning problems, but were still doing so less than one third of the time. There were no differences in the care of patients with attention deficit hyperactivity disorder or in screening or inquiring about mental health conditions. Those with more training were more likely to perceive somewhat fewer barriers and to report more specific familiarity with some Diagnostic and Statistical Manual of Mental Disorders criteria and some treatment modalities. Longer length of training is associated with more treatment, but significant deficits in self-reported practice remain, leaving much room for additional improvement in the training of clinicians in DBP. Copyright © 2016 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

Pediatric lung transplantation

PubMed Central

2017-01-01

Pediatric lung transplantation has been undertaken since the 1980s, and it is today considered an accepted therapy option in carefully selected children with end-stage pulmonary diseases, providing carefully selected children a net survival benefit and improved health-related quality of life. Nowadays, >100 pediatric lung transplants are done worldwide every year. Here, specific pediatric aspects of lung transplantation are reviewed such as the surgical challenge, effects of immunosuppression on the developing pediatric immune system, and typical infections of childhood, as it is vital to comprehend that children undergoing lung transplants present a real challenge as children are not ‘just small adults’. Further, an update on the management of the pediatric lung transplant patient is provided in this review, and future challenges outlined. Indications for lung transplantation in children are different compared to adults, the most common being cystic fibrosis (CF). However, the primary diagnoses leading to pediatric lung transplantation vary considerably by age group. Furthermore, there are regional differences regarding the primary indication for lung transplantation in children. Overall, early referral, careful patient selection and appropriate timing of listing are crucial to achieve real survival benefit. Although allograft function is to be preserved, immunosuppressant-related side effects are common in children post-transplantation. Strategies need to be put into practice to reduce drug-related side effects through careful therapeutic drug monitoring and lowering of target levels of immunosuppression, to avoid acute-reversible and chronic-irreversible renal damage. Instead of a “one fits all approach”, tailored immunosuppression and a personalized therapy is to be advocated, particularly in children. Further, infectious complications are a common in children of all ages, accounting for almost 50% of death in the first year post-transplantation. However, chronic lung allograft dysfunction (CLAD) remains the major obstacle for improved long-term survival. PMID:28932575

Hospital discharges for fever and neutropenia in pediatric cancer patients: United States, 2009.

PubMed

Mueller, Emily L; Walkovich, Kelly J; Mody, Rajen; Gebremariam, Achamyeleh; Davis, Matthew M

2015-05-10

Fever and neutropenia (FN) is a common complication of pediatric cancer treatment, but hospital utilization patterns for this condition are not well described. Data were analyzed from the Kids' Inpatient Database (KID), an all-payer US hospital database, for 2009. Pediatric FN patients were identified using: age ≤19 years, urgent or emergent admit type, non-transferred, and a combination of ICD-9-CM codes for fever and neutropenia. Sampling weights were used to permit national inferences. Pediatric cancer patients accounted for 1.5 % of pediatric hospital discharges in 2009 (n = 110,967), with 10.1 % of cancer-related discharges meeting FN criteria (n = 11,261). Two-fifths of FN discharges had a "short length of stay" (SLOS) of ≤3 days, which accounted for approximately $65.5 million in hospital charges. Upper respiratory infection (6.0 %) and acute otitis media (AOM) (3.7 %) were the most common infections associated with SLOS. Factors significantly associated with SLOS included living in the Midwest region (OR = 1.65, 1.22-2.24) or West region (OR 1.54, 1.11-2.14) versus Northeast, having a diagnosis of AOM (OR = 1.39, 1.03-1.87) or viral infection (OR = 1.63, 1.18-2.25) versus those without those comorbidities, and having a soft tissue sarcoma (OR = 1.47, 1.05-2.04), Hodgkin lymphoma (OR = 2.33, 1.62-3.35), or an ovarian/testicular tumor (OR = 1.76, 1.05-2.95) compared with patients without these diagnoses. FN represents a common precipitant for hospitalizations among pediatric cancer patients. SLOS admissions are rarely associated with serious infections, but contribute substantially to the burden of hospitalization for pediatric FN.

Epidemiology of Pediatric Prehospital Basic Life Support Care in the United States.

PubMed

Diggs, Leigh Ann; Sheth-Chandra, Manasi; De Leo, Gianluca

2016-01-01

Children have unique medical needs compared to adults. Emergency medical services personnel need proper equipment and training to care for children. The purpose of this study is to characterize emergency medical services pediatric basic life support to help better understand the needs of children transported by ambulance. Pediatric basic life support patients were identified in this retrospective descriptive study. Descriptive statistics were used to examine incident location, possible injury, cardiac arrest, resuscitation attempted, chief complaint, primary symptom, provider's primary impression, cause of injury, and procedures performed during pediatric basic life support calls using the largest aggregate of emergency medical services data available, the 2013 National Emergency Medical Services Information System (NEMSIS) Public Release Research Data Set. Pediatric calls represented 7.4% of emergency medical services activations. Most pediatric patients were male (49.8%), White (40.0%), and of non-Hispanic origin (56.5%). Most incidents occurred in the home. Injury, cardiac arrest, and resuscitation attempts were highest in the 15 to 19 year old age group. Global complaints (37.1%) predominated by anatomic location and musculoskeletal complaints (26.9%) by organ system. The most common primary symptom was pain (30.3%) followed by mental/psychiatric (13.4%). Provider's top primary impression was traumatic injury (35.7%). The most common cause of injury was motor vehicle accident (32.3%). The most common procedure performed was patient assessment (27.4%). Median EMS system response time was 7 minutes (IQR: 5-12). Median EMS scene time was 12 minutes (IQR: 8-19). Median transport time was 14 minutes (IQR: 8-24). Median EMS total call time was 51 minutes (IQR: 33-77). The epidemiology of pediatric basic life support can help to guide efforts in both emergency medical services operations and training.

Sleep and sedation in the pediatric intensive care unit.

PubMed

Carno, Margaret-Ann; Connolly, Heidi V

2005-09-01

Sleep is an important and necessary function of the human body. Somatic growth and cellular repair occur during sleep. Critically ill children have disturbed sleep while in the pediatric intensive care unit related both to the illness itself and to light, noise, and caregiver activities disrupting an environment conducive to sleep. Medications administered in the pediatric intensive care unit can also disrupt sleep. This article reviews what is known about sleep in the pediatric intensive care unit and the effects of common sedation medications on sleep.

Approach to the Pediatric Prescription in a Community Pharmacy

PubMed Central

Benavides, Sandra; Huynh, Donna; Morgan, Jill; Briars, Leslie

2011-01-01

Pediatric patients are more susceptible to medication errors for a variety of reasons including physical and social differences and the necessity for patient-specific dosing. As such, community pharmacists may feel uncomfortable in verifying or dispensing a prescription for a pediatric patient. However, the use of a systematic approach to the pediatric prescription can provide confidence to pharmacists and minimize the possibility of a medication error. The objective of this article is to provide the community pharmacist with an overview of the potential areas of medication errors in a prescription for a pediatric patient. Additionally, the article guides the community pharmacist through a pediatric prescription, highlighting common areas of medication errors. PMID:22768015

Selecting appropriate gastroenteric contrast media for diagnostic fluoroscopic imaging in infants and children: a practical approach.

PubMed

Callahan, Michael J; Talmadge, Jennifer M; MacDougall, Robert D; Kleinman, Patricia L; Taylor, George A; Buonomo, Carlo

2017-04-01

In our experience, questions about the appropriate use of enteric contrast media for pediatric fluoroscopic studies are common. The purpose of this article is to provide a comprehensive review of enteric contrast media used for pediatric fluoroscopy, highlighting the routine use of these media at a large tertiary care pediatric teaching hospital.

Sex prevalence of pediatric kidney stone disease in the United States: an epidemiologic investigation.

PubMed

Novak, Thomas E; Lakshmanan, Yegappan; Trock, Bruce J; Gearhart, John P; Matlaga, Brian R

2009-07-01

To define the sex prevalence of inpatient hospital discharges for pediatric patients diagnosed with upper urinary tract stone disease. The study examined inpatient admissions for pediatric urolithiasis in 2003, using the Healthcare Cost and Utilization Project Kids' Inpatient Database. We used the International Classification of Disease, 9th edition, Clinical Modification codes, to identify patients with a principal diagnosis of renal (592.0) or ureteral (592.1) calculi. Sex prevalence was assessed, and the results were stratified by age group. In the 2003 Kids' Inpatient Database, the sex distribution among pediatric patients with stone formation varied significantly by age. In the first decade of age, a male predominance was found that had shifted to a female predominance in the second decade. Overall, however, girls in the pediatric population were more commonly affected by stones than were boys. In this nationally representative sample, the sex distribution of pediatric urolithiasis varied with age, with boys more commonly affected in the first decade of age and girls in the second decade. Although the reason for this unique epidemiologic finding is not readily apparent, additional studies can build on this hypothesis-generating work.

Clinical, demographic, and laboratory characteristics of children with nephrolithiasis.

PubMed

Sas, David J; Becton, Lauren J; Tutman, Jeffrey; Lindsay, Laura A; Wahlquist, Amy H

2016-06-01

While the incidence of pediatric kidney stones appears to be increasing, little is known about the demographic, clinical, laboratory, imaging, and management variables in this patient population. We sought to describe various characteristics of our stone-forming pediatric population. To that end, we retrospectively reviewed the charts of pediatric patients with nephrolithiasis confirmed by imaging. Data were collected on multiple variables from each patient and analyzed for trends. For body mass index (BMI) controls, data from the general pediatrics population similar to our nephrolithiasis population were used. Data on 155 pediatric nephrolithiasis patients were analyzed. Of the 54 calculi available for analysis, 98 % were calcium based. Low urine volume, elevated supersaturation of calcium phosphate, elevated supersaturation of calcium oxalate, and hypercalciuria were the most commonly identified abnormalities on analysis of 24-h urine collections. Our stone-forming population did not have a higher BMI than our general pediatrics population, making it unlikely that obesity is a risk factor for nephrolithiasis in children. More girls presented with their first stone during adolescence, suggesting a role for reproductive hormones contributing to stone risk, while boys tended to present more commonly at a younger age, though this did not reach statistical significance. These intriguing findings warrant further investigation.

Pediatric constipation therapy using guidelines and polyethylene glycol 3350.

PubMed

Bell, Edward A; Wall, Geoffrey C

2004-04-01

To review current guidelines on the treatment of functional constipation in pediatric patients, with an emphasis on the role of polyethylene glycol 3350 (PEG 3350). Primary medical literature published in English was identified by MEDLINE search (1980-May 2003). Recently published treatment guidelines relating to pediatric functional constipation and its pharmacotherapy are assessed and compared. Published trials evaluating PEG 3350 in pediatric subjects are discussed and their results applied to the clinical role and use of this new agent. Constipation is a common disorder among children. A number of factors may play a role. A variety of medications are commonly used for this disorder, although few treatments have undergone evaluation by controlled clinical trials. Consensus guidelines recommend either osmotic laxatives, mineral oil, or their combination for maintenance treatment in concert with patient and parental education and behavioral training. PEG 3350 solution (MiraLax) has been shown in recent clinical studies to be an effective maintenance treatment for pediatric constipation. PEG 3350 is an effective and well-tolerated treatment choice for pediatric constipation, especially as an adjunct to education and behavioral training. PEG 3350 is an option for children with constipation who have failed or are intolerant of other pharmacotherapies.

[Current situation of pediatric emergency in tertiary and teaching hospitals in 15 provinces, municipalities and autonomous regions in China Mainland].

PubMed

2014-12-01

Pre-hospital care, emergency department and critical care medicine are the key components of emergency medical service system. Two investigations about the pediatric critical care medicine in China mainland showed great progress. In recent years, most hospitals in China mainland have established emergency department, hardware configuration and staff status were gradually standardized. But most of the emergency departments mainly provide service to adult patients and pediatric emergency medicine lags behind. The purpose of this investigation was to understand the current situation and main problems of pediatric emergency in China mainland. A questionnaire developed by the Subspecialty Group of Pediatrics, Chinese Society of Emergency Medicine and the Subspecialty Group of Emergency Medicine, Chinese Society of Pediatrics was e-mailed to the members of the above-mentioned two subspecialty groups. The contents of the questionnaire included 46 items which were divided into 5 categories: the general situation of the hospital, the pediatric emergency setting and composition, key equipments and techniques, staff status, training program and running data from 2011 to 2012. Sixty-three questionnaires were delivered and 27 (42.9%) hospitals responded which located in 15 different provinces, municipalities and autonomous regions. Among the 27 hospitals, 10 (37.0%) had no pediatric resuscitation room; 25 (92.6%) had no equipments for cardiac output monitor and gastric lavage; 13 (48.1%) had no bedside fibrolaryngoscope or fiberbronchoscope; 5 (18.5%) had no blood gas analyzer; 4 (14.8%) without respirator, defibrillator, bedside radiography or ultrasonic equipment; 2 (7.4%) had no neonatal incubator; 9 (33.3%) could not do intraossous infusion. The average ratio of professional emergency pediatricians to all physicians was 43.5%. Twenty hospitals incompletely filled in the pediatric emergency running data. The main problems existing in pediatric emergency include: imperfect pediatric emergency settings; short of key equipment; key rescue techniques are not popularized, acute shortage of emergency pediatricians and inadequate monitoring and management of pediatric emergency. The major ways to solve the predicament in pediatric emergency should include: the policy and financial support from national and local government; training pediatricians, especially urgent training of emergency pediatricians; improving pediatric emergency development and management.

Errors detected in pediatric oral liquid medication doses prepared in an automated workflow management system.

PubMed

Bledsoe, Sarah; Van Buskirk, Alex; Falconer, R James; Hollon, Andrew; Hoebing, Wendy; Jokic, Sladan

2018-02-01

The effectiveness of barcode-assisted medication preparation (BCMP) technology on detecting oral liquid dose preparation errors. From June 1, 2013, through May 31, 2014, a total of 178,344 oral doses were processed at Children's Mercy, a 301-bed pediatric hospital, through an automated workflow management system. Doses containing errors detected by the system's barcode scanning system or classified as rejected by the pharmacist were further reviewed. Errors intercepted by the barcode-scanning system were classified as (1) expired product, (2) incorrect drug, (3) incorrect concentration, and (4) technological error. Pharmacist-rejected doses were categorized into 6 categories based on the root cause of the preparation error: (1) expired product, (2) incorrect concentration, (3) incorrect drug, (4) incorrect volume, (5) preparation error, and (6) other. Of the 178,344 doses examined, 3,812 (2.1%) errors were detected by either the barcode-assisted scanning system (1.8%, n = 3,291) or a pharmacist (0.3%, n = 521). The 3,291 errors prevented by the barcode-assisted system were classified most commonly as technological error and incorrect drug, followed by incorrect concentration and expired product. Errors detected by pharmacists were also analyzed. These 521 errors were most often classified as incorrect volume, preparation error, expired product, other, incorrect drug, and incorrect concentration. BCMP technology detected errors in 1.8% of pediatric oral liquid medication doses prepared in an automated workflow management system, with errors being most commonly attributed to technological problems or incorrect drugs. Pharmacists rejected an additional 0.3% of studied doses. Copyright © 2018 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

A systematic review on the prevalence of metabolic syndrome in Iranian children and adolescents.

PubMed

Kelishadi, Roya; Hovsepian, Silva; Djalalinia, Shirin; Jamshidi, Fahimeh; Qorbani, Mostafa

2016-01-01

Metabolic syndrome (MetS), a cluster of cardiovascular risk factors, is one of the most common metabolic disorders, which lead to many chronic diseases. The link between childhood MetS and occurrence of atherosclerosis and its sequels in adulthood is well documented. This study aims to systematically review the prevalence of MetS among Iranian children and adolescents. An electronic search was conducted on studies published from January 1990 to January 2015. The main international electronic data sources were PubMed and the NLM Gateway (for MEDLINE), Institute of Scientific Information (ISI), and SCOPUS. For Persian databases, we used domestic databases. We included all available population-based studies and national surveys conducted in the pediatric age group aged 3-21-year-old. In this review, 2138 articles were identified (PubMed: 265; SCOPUS: 368; ISI: 465; Scientific Information Database: 189; IranMedex: 851; Irandoc: 46). After quality assessment, 13 qualified articles were evaluated. The number of total population and points of data were 24,772 and 125, respectively. Regarding the geographical distribution, we found 2 national, 6 provincial, and 5 district level points of data. The prevalence range of MetS among children was 1-22% using different definitions. Reported range of pediatric MetS defined by different criteria was as follows: National Cholesterol Education Program-Adult Treatment Panel III; 3-16%, International Diabetes Federation; 0-8%, American Heart Association; 4-9.5%, The National Health and Nutrition Examination Survey III; 1-18%, de Ferranti; 0-22%. MetS is a common metabolic disorder among Iranian children and adolescents, with increasing trends during the last decades. This finding provides baseline useful information for health policy makers to implement evidence based-health promotion for appropriate controlling of this growing health problem for the pediatric population.

Validity of the international consultation on incontinence questionnaire-pediatric lower urinary tract symptoms: a screening questionnaire for children.

PubMed

De Gennaro, Mario; Niero, Mauro; Capitanucci, Maria Luisa; von Gontard, Alexander; Woodward, Mark; Tubaro, Andrea; Abrams, Paul

2010-10-01

Lower urinary tract symptoms are common in pediatric patients. To our knowledge no validated instruments properly designed to screen lower urinary tract symptoms in the pediatric population have been published to date. In the International Consultation on Incontinence Questionnaire Committee the psychometric properties of a screening questionnaire for pediatric lower urinary tract symptoms were assessed. The 12-item International Consultation on Incontinence Questionnaire-Pediatric Lower Urinary Tract Symptoms was developed in child and parent self-administered versions, and produced in English, Italian and German using a standard cross-cultural adaptation process. The questionnaire was self-administered to children 5 to 18 years old and their parents presenting for lower urinary tract symptoms (cases) or to pediatric/urological clinics for other reasons (controls). A case report form included history, urinalysis, bladder diary, flowmetry/post-void residual urine volume and clinician judgment on whether each child did or did not have lower urinary tract symptoms. Questionnaire psychometric properties were evaluated and data were stratified into 3 age groups, including 5 to 9, 10 to 13 and 14 to 18 years. A total of 345 questionnaires were completed, of which 147 were negative and 198 were positive for lower urinary tract symptoms. A mean of 1.67% and 2.10% of items were missing in the child and parent versions, respectively. Reliability (Cronbach's α) was unacceptable in only the 5 to 9-year-old group. The high ICC of 0.847 suggested fair child/parent equivalence. Sensitivity and specificity were 89% and 76% in the child version, and 91% and 73.5% in the parent version, respectively. The questionnaire is an acceptable, reliable tool with high sensitivity and specificity to screen for lower urinary tract symptoms in pediatric practice. Problems related to literacy suggest use of the child versions for patients older than 9 years. In research this questionnaire could be used to recalibrate the prevalence of lower urinary tract symptoms in children. Copyright © 2010 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Dental approach in the pediatric oncology patient: characteristics of the population treated at the dentistry unit in a pediatric oncology brazilian teaching hospital.

PubMed

Carrillo, Camila; Vizeu, Heloisa; Soares-Júnior, Luis Alberto; Fava, Marcelo; Filho, Vicente Odone

2010-06-01

The objective of this paper was to characterize the population seen at the dentistry unit of the hematology-oncology service of the Oncology-Hematology Service, Instituto da Criança at the Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo. Oral problems resulting from cancer therapy increase the risk of infection, length of hospital stay, treatment cost and negative impact on the course and prognosis of the disease. Of the 367 medical records of cancer patients seen from November 2007 until December 2008: 186 with a cancer diagnosis and complete clinical data were selected, while 20 with a cancer diagnosis and incomplete records were excluded; 161 medical records with only hematological diagnosis were also excluded. The following characteristics were assessed: ethnicity, gender, age, diagnosis and characteristics of the neoplasm, cancer therapy status and performed dental procedures. Review of 1,236 visits indicated that 54% (n=100) of the patients had blood cancers, 46% (n=86) had solid tumors and 63% were undergoing anticancer therapy. The proportion of males (52.7%) in the study population was slightly greater. The most common cancer was acute lymphocytic leukemia (32.2%). Cancer occurred more often among those patients aged 5 to 9 years. The most common dental procedures were restorative treatment, preventive treatment and removal of infectious foci. The characteristics of the studied population were similar to those of the general Brazilian and global populations, especially regarding gender and diagnosis distributions. The aim of implementation of the dentistry unit was to maintain good oral health and patients' quality of life, which is critical to provide oral care and prevent future oral problems.

Dental Approach in the Pediatric Oncology Patient: Characteristics of the Population Treated at the Dentistry Unit in a Pediatric Oncology Brazilian Teaching Hospital

PubMed Central

Carrillo, Camila; Vizeu, Heloisa; Soares-Júnior, Luis Alberto; Fava, Marcelo; Filho, Vicente Odone

2010-01-01

OBJECTIVES: The objective of this paper was to characterize the population seen at the dentistry unit of the hematology-oncology service of the Oncology-Hematology Service, Instituto da Criança at the Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo. Oral problems resulting from cancer therapy increase the risk of infection, length of hospital stay, treatment cost and negative impact on the course and prognosis of the disease. METHOD: Of the 367 medical records of cancer patients seen from November 2007 until December 2008: 186 with a cancer diagnosis and complete clinical data were selected, while 20 with a cancer diagnosis and incomplete records were excluded; 161 medical records with only hematological diagnosis were also excluded. The following characteristics were assessed: ethnicity, gender, age, diagnosis and characteristics of the neoplasm, cancer therapy status and performed dental procedures. RESULTS: Review of 1,236 visits indicated that 54% (n=100) of the patients had blood cancers, 46% (n=86) had solid tumors and 63% were undergoing anticancer therapy. The proportion of males (52.7%) in the study population was slightly greater. The most common cancer was acute lymphocytic leukemia (32.2%). Cancer occurred more often among those patients aged 5 to 9 years. The most common dental procedures were restorative treatment, preventive treatment and removal of infectious foci. CONCLUSION: The characteristics of the studied population were similar to those of the general Brazilian and global populations, especially regarding gender and diagnosis distributions. The aim of implementation of the dentistry unit was to maintain good oral health and patients’ quality of life, which is critical to provide oral care and prevent future oral problems. PMID:20613931

Pediatric Baseline Patch Test Series: Initial Findings of the Pediatric Contact Dermatitis Workgroup.

PubMed

Yu, JiaDe; Atwater, Amber Reck; Brod, Bruce; Chen, Jennifer K; Chisolm, Sarah S; Cohen, David E; de la Feld, Salma; Gaspari, Anthony A; Martin, Kari Lyn; Montanez-Wiscovich, Marjorie; Sheehan, Michael; Silverberg, Nanette; Lugo-Somolinos, Aida; Thakur, Binod K; Watsky, Kalman; Jacob, Sharon E

2018-06-21

Allergic contact dermatitis is a challenging diagnostic problem in children. Although epicutaneous patch testing is the diagnostic standard for confirmation of contact sensitization, it is less used in children by dermatologists treating children, pediatric dermatologists, and pediatricians, when compared with adult practitioners. The aim of the study was to create and evaluate standardization of a pediatric patch test series for children older than 6 years. We surveyed dermatologists and allergists conducting epicutaneous patch testing in children attending the 2017 American Contact Dermatitis Society meeting held in Washington, DC. This was followed by discussion of collected data and consensus review by a pediatric contact dermatitis working group at the conference. A baseline pediatric patch test panel was established through working group consensus.

Citation classics in pediatric orthopaedics.

PubMed

Varghese, Ranjit A; Dhawale, Arjun A; Zavaglia, Bogard C; Slobogean, Bronwyn L; Mulpuri, Kishore

2013-09-01

The purpose of this study was to identify the clinical pediatric orthopaedic articles with at least 100 citations published in all orthopaedic journals and to examine their characteristics. All journals dedicated to orthopaedics and its subspecialties were selected from the Journal Citation Report 2001 under the subject category "orthopedics." Articles cited 100 times or more were identified using the database of the Science Citation Index Expanded (SCI-EXPANDED, 1900 to present). The articles were ranked in a comprehensive list. Two authors independently reviewed the full text of each article and applied the inclusion and exclusion criteria to the list of articles. The 2 lists were then compared. All disagreements were resolved by consensus with input from the senior author. The final list of pediatric orthopaedic articles was then compiled. There were a total of 49 journals under the search category "orthopedics." Five journals were excluded as they were non-English journals. The remaining 44 journals were screened for articles with at least 100 citations. A total of 135 clinical pediatric orthopaedic articles cited at least 100 times were included. The most cited article was cited 692 times. The mean number of citations per article was 159 (95% confidence interval, 145-173). All the articles were published between 1949 and 2001, with 1980 and 1989 producing the most citation classics (34). The majority (90) originated from the United States, followed by the United Kingdom (12) and Canada (11). Scoliosis/kyphosis was the most common topic with 26 papers. The second most common subject was hip disorders (24). Therapeutic studies were the most common study type (71). Ninety-seven papers were assigned a 4 for level of evidence. The list of citation classics in pediatric orthopaedic articles is useful for several reasons. It identifies important contributions to the field of pediatric orthopaedics and their originators; it facilitates the understanding and discourse of modern pediatric orthopaedic history and reveals trends in pediatric orthopaedics.

Barriers to the Identification and Management of Psychosocial Problems: Changes from 2004 to 2013

PubMed Central

Horwitz, Sarah McCue; Storfer-Isser, Amy; Kerker, Bonnie D.; Szilagyi, Moira; Garner, Andrew; O’Connor, Karen G.; Hoagwood, Kimberly E.; Stein, Ruth E.K.

2015-01-01

Objective Pediatricians report many barriers to caring for children with mental health (MH) problems. The American Academy of Pediatrics (AAP) has focused attention on MH problems but the impact on perceived barriers is unknown. We examined whether perceived barriers and their correlates changed from 2004 to 2013. Methods In 2004, 832/1600 (52%) and in 2013, 594/1617 (36.7%) of randomly selected AAP members surveyed responded to Periodic Surveys, answering questions about socio-demographics, practice characteristics, and 7 barriers to identifying, treating/managing and referring child/adolescent MH problems. To reduce non-response bias, weighted descriptive and logistic regression analyses were conducted. Results Lack of training in treatment of child MH problems (~65%) and lack of confidence treating children with counseling (~60%) did not differ across surveys. Five barriers (lack of training in identifying MH problems, lack of confidence diagnosing, lack of confidence treating with medications, inadequate reimbursement and lack of time) were less frequently endorsed in 2013 (all p<.01), although lack of time was still endorsed by 70% in 2013. In 2004, 34% of pediatricians endorsed 6 or 7 barriers compared to 26% in 2013 (p<.005). Practicing general pediatrics exclusively was associated with endorsing 6 or 7 barriers in both years (p <.001). Conclusion Although fewer barriers were endorsed in 2013, most pediatricians believe that they have inadequate training in treating child MH problems, a lack of confidence to counsel children, and limited time for these problems. These findings suggest significant barriers still exist, highlighting the need for improved developmental and behavioral pediatrics training. What’s New This study compares reported barriers from the 2004 and 2013 Periodic Surveys. Although pediatricians report fewer barriers in 2013, 66% continue to report lack of training in counseling or medication of children with MH problems, suggesting deficits in developmental and behavioral pediatrics training. PMID:26409303

Personal experience in pediatric emergency medicine training in Canada and China.

PubMed

Lin, Gang-Xi; Luo, Yi-Ming; Cheng, Adam; Yang, Shu-Yu; Wang, Jian-She; Goldman, Ran-D

2012-10-01

Currently, pediatric emergency medicine (PEM) as practiced in many developed countries is different from ours in China. Chinese pediatric emergency medicine is just children's internal medicine and does not include general surgery, ear-nose-throat, etc. If children have an emergency condition that require specialized treatments they need to go to different departments. However in Canada, the pediatric emergency physicians will first treat the patients whatever the condition, then, if it is a complicated sub specialty problem, they will consult the specialist or let the patient see the specialist later. In addition, resuscitation is done in the pediatric intensive care unit (PICU) in China, but it is done in the emergency room in Canada. This article compares the differences in the pediatric emergency systems in Canada and China and also introduces the international standard system of pediatric triage.

Pediatric allergy and immunology in Israel.

PubMed

Geller-Bernstein, Carmi; Etzioni, Amos

2013-03-01

After the geographic and sociodemographic settings as well as the health care in Israel are briefly described, the scope of pediatric allergy and immunology in Israel is presented. This includes specific disorders commonly encountered, the environment that induces symptoms, the specialists who treat them, and the common challenges of patients, parents, doctors, and allied health personnel who collaborate to manage the maladies and patient care. Allergies usually affect some overall 15-20% of the pediatric population. The main allergens are inhaled, ingested, or injected (insects stings). Generally, the incidence of the various allergens affecting children in Israel, is similar to other parts of the Western world. Owing to the high consanguinity rate in the Israeli population, the prevalence of the various immunodeficiency conditions (in the adaptive as well as the innate system) is higher than that reported worldwide. Pediatric allergists/immunologists also treat autoimmune disorders affecting the pediatric group. Pediatric allergy and clinical immunology are not separate specialties. The 25 specialists who treat children with allergic/immunologic diseases have undergone a basic training in Pediatrics. They also received an additional 2-yr training in allergy and clinical immunology and then have to pass the board examinations. They work mainly in pediatric allergy units, in several hospitals that are affiliated to the five medical schools in the country. Aside from clinical work, most of the centers are also heavily involved in clinical and basic research in allergy and immunology. © 2013 John Wiley & Sons A/S. Published by Blackwell Publishing Ltd.

Health status, emotional/behavioral problems, health care use, and expenditures in overweight/obese US children/adolescents.

PubMed

Turer, Christy Boling; Lin, Hua; Flores, Glenn

2013-01-01

To examine the association of overweight/obesity with health, health care utilization, and expenditures in a national sample of 10- to 17-year-old children and adolescents. Secondary analysis of 2005 to 2009 Medical Expenditure Panel Survey data (n = 17,224). Outcome measures included suboptimal health, emotional/behavioral problems, health care utilization, and expenditures. Overweight and obese children and adolescents had greater risk of suboptimal health (adjusted risk ratio [ARR], 1.4 and 1.7; P < .01), use of prescriptions (ARR, both 1.1; P = .01), and emergency department visits (ARR, 1.2 and 1.1; P = .01); overweight children/adolescents had lower mean out-of-pocket expenditures (∼$100, P < .01); and obese children/adolescents had greater risk of emotional/behavioral problems (ARR, 1.2; P < .01) and specialist visits (ARR, 1.1; P = .01). The most common specialty referral among obese children/adolescents was psychiatry. Overweight and obesity were not associated with office visits or total expenditures. A greater proportions of children and adolescents with suboptimal health and emotional/behavioral problems had health care expenditures, and those with suboptimal health were more likely to have out-of-pocket expenditures. Pediatric overweight and obesity affect child and adolescent health status, emotional/behavioral problems, and specific domains of health care utilization, but do not appear to be associated with total health care expenditures. Out-of-pocket expenditures are lower among overweight children and adolescents. These findings highlight the need for early intervention in overweight children/adolescents, when health care expenditures may not be greater, and suggest that it may prove useful to pay special attention to the health status and emotional/behavioral problems of overweight and obese children/adolescents in weight-management interventions. Copyright © 2013 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

Comparison of Rating Scales in the Development of Patient-Reported Outcome Measures for Children with Eye Disorders.

PubMed

Hatt, Sarah R; Leske, David A; Wernimont, Suzanne M; Birch, Eileen E; Holmes, Jonathan M

2017-03-01

A rating scale is a critical component of patient-reported outcome instrument design, but the optimal rating scale format for pediatric use has not been investigated. We compared rating scale performance when administering potential questionnaire items to children with eye disorders and their parents. Three commonly used rating scales were evaluated: frequency (never, sometimes, often, always), severity (not at all, a little, some, a lot), and difficulty (not difficult, a little difficult, difficult, very difficult). Ten patient-derived items were formatted for each rating scale, and rating scale testing order was randomized. Both child and parent were asked to comment on any problems with, or a preference for, a particular scale. Any confusion about options or inability to answer was recorded. Twenty-one children, aged 5-17 years, with strabismus, amblyopia, or refractive error were recruited, each with one of their parents. Of the first 10 children, 4 (40%) had problems using the difficulty scale, compared with 1 (10%) using frequency, and none using severity. The difficulty scale was modified, replacing the word "difficult" with "hard." Eleven additional children (plus parents) then completed all 3 questionnaires. No children had problems using any scale. Four (36%) parents had problems using the difficulty ("hard") scale and 1 (9%) with frequency. Regarding preference, 6 (55%) of 11 children and 5 (50%) of 10 parents preferred using the frequency scale. Children and parents found the frequency scale and question format to be the most easily understood. Children and parents also expressed preference for the frequency scale, compared with the difficulty and severity scales. We recommend frequency rating scales for patient-reported outcome measures in pediatric populations.

Pediatric common variable immunodeficiency: immunologic and phenotypic associations with switched memory B cells.

PubMed

Yong, Pierre L; Orange, Jordan S; Sullivan, Kathleen E

2010-08-01

Recent studies suggest that patients with common variable immunodeficiency (CVID) and low numbers of switched memory B cells have lower IgG levels and higher rates of autoimmune disease, splenomegaly, and granulomatous disease; however, no prior literature has focused exclusively on pediatric cases. We examined the relationship between switched memory B cells and clinical and immunologic manifestations of CVID in a pediatric population. Forty-five patients were evaluated. Patients were categorized as Group I (<5 switched memory B cells/ml, n = 24) or Group II (> or =5 switched memory B cells/mL, n = 21). CD3(+) T-cell counts and CD19(+) B-cell levels were lower among Group I patients. Only those in Group I had meningitis, sepsis, bronchiectasis, granulomatous lung disease, autoimmune cytopenias, or hematologic malignancies. Segregation of pediatric patients into high risk (Group I) and average risk (Group II) may assist in targeting surveillance appropriately.

Predictors of Outcome of Convulsive Status Epilepticus Among an Egyptian Pediatric Tertiary Hospital.

PubMed

Halawa, Eman F; Draz, Iman; Ahmed, Dalia; Shaheen, Hala A

2015-11-01

Convulsive status epilepticus is a common neurologic emergency in pediatrics. We aimed to study the etiology, clinical features, and prognostic factors among pediatric patients with convulsive status epilepticus. Seventy patients were included in this cohort study from pediatric emergency department of the specialized Children Hospital of Cairo University. The outcome was evaluated using the Glasgow Outcome Score. Acute symptomatic etiology was the most common cause of convulsive status epilepticus. Refractory convulsive status epilepticus was observed more significantly in cases caused by acute symptomatic etiologies. The outcome was mortality in 26 (37.1%) patients, severe disability in 15 (21.4%), moderate disability in 17 (24.3%), and good recovery in 12 (17.1%) patients. The significant predictor of mortality was lower modified Glasgow Coma Scale score on admission, whereas lower modified Glasgow Coma Scale score on admission and refractory convulsive status epilepticus were the significant predictors for disability and mortality. © The Author(s) 2015.

Nosocomial infection in a pediatric intensive care unit in a developing country.

PubMed

Abramczyk, Marcelo L; Carvalho, Werther B; Carvalho, Eduardo S; Medeiros, Eduardo A S

2003-12-01

Determine the rate and outcome of nosocomial infection (NI) in pediatric intensive care unit patients in a developing country. Prospective cohort study using the Centers for Disease Control and Prevention definitions to diagnose nosocomial infection and NNISS (National Nosocomial Infection Surveillance System) methodology. São Paulo Hospital - Universidade Federal de São Paulo - Brazil, a 700-bed teaching hospital with an 8-bed pediatric intensive care unit. All 515 children consecutively admitted to the pediatric intensive care unit from April 1996 to October 1997. The NI incidence was 18.3% and the mean infection rate per 1,000 patient days was 46.1; the ventilator-associated pneumonia rate was 18.7 per 1,000 ventilator days; the central line-associated bloodstream infection rate was 10.2 per 1,000 central line days; and the urinary tract catheter-associated infection rate was 1.8 per 1,000 catheter days. Pneumonia was the most common NI (31.6%), followed by bloodstream infections (17.3%), and surgical site infection (17.3%). Gram-negative bacterias were the most common pathogens identified in the NIs (54.8%), followed by Gram-positive bacterias (23.8%), and yeasts. Pneumonia was the most common type of NI. A high incidence of ventilator-associated pneumonia and central line-associated bloodstream infections was found, whereas the urinary tract catheter-associated infection rate was low. Gram-negative bacterias were the most common etiologic agents identified in the unit, and yeasts were frequently found. Pediatric patients have characteristics of their own, with major differences when compared to the adult population.

[Enterobiasis in pediatric subjects in north-western Italy: a study of home remedies].

PubMed

Dutto, M; Montù, D; Raineri, G

2012-01-01

The present study examines the most common home remedies in the Piedmont region of northwest Italy currently used in the treatment of pediatric enterobiasis, commonly known as pinworm infection. The remedies in question, typically based on popular beliefs and as such are nearly useless, were noted through interviews with subjects who had come to the local Hygiene and Public Health Services offices for information about pinworm prevention and treatment. Analysis of replies by the subjects clearly indicates that local families are ill-prepared to recognize the symptoms this parasitic infection; often it is confused with pediatric ketosis, therefore leading to inappropriate treatment which at times may be potentially harmful to the patient.

A worldview of the professional experiences and training needs of pediatric psycho-oncologists

PubMed Central

Oppenheim, Daniel; Breyer, Joanna; Battles, Haven; Zadeh, Sima; Patenaude, Andrea Farkas

2012-01-01

BACKGROUND Thirty years after the origin of the field of psycho-oncology, limited data exist about the work practices of professionals providing psychosocial care to children with cancer and their families. METHOD A survey was designed to assess training, work environment, theoretical orientation, services provided, sub-specialty areas or areas of special interest, satisfactions, challenges and continuing education needs of pediatric psycho-oncologists. Members of national and international psycho-oncology organizations were invited to participate in the web-based survey. RESULTS 786 professionals from 63 countries responded. The sample consisted mostly of psychologists (41%), physicians (20%), and social workers (14%). Approximately half of the participants worked in a designated psycho-oncology unit. Psychologists and social workers provided the majority of psychosocial services. Individual sessions with parents were most common (42%), followed by sessions with children (41%), survivors (36%), families (31%) and siblings (25%). Therapies provided include CBT (50%), relaxation (43%), psychodynamic psychotherapy (27%), play therapy (26%), and imagery (23%). Two-thirds report having appropriate supervision; 37% conduct research; only half feel their salary is appropriate. Differences in therapeutic modalities were found by country. Clinicians desire training on clinical interventions, improving communication with medical staff, research and ethics. CONCLUSIONS An international cohort of clinicians providing pediatric psycho-oncology services perform a wide variety of tasks, use a range of therapeutic approaches and report considerable work satisfaction. Problem areas include professional inter-relations, inadequate supervision and needs for additional, specialized training. Opportunity exists for global collaboration in pediatric psycho-oncology research and practices to enhance clinical effectiveness and reduce professional isolation. PMID:22461180

Variation in Pediatric Organ Donor Management Practices Among US Organ Procurement Organizations.

PubMed

Ream, Robert S; Armbrecht, Eric S

2018-03-01

Reports of actual pediatric organ donor management practice among US organ procurement organizations are sparse, and the use of standardized management guidelines is unknown. A recent consensus statement from the Society of Critical Care Medicine, the American College of Chest Physicians, and the Association of Organ Procurement Organizations offers guidelines for the management of the pediatric organ donor. To describe the use of guidelines and routine practices in the management of the pediatric organ donor with respect to hemodynamics, lung and ventilator management, fluid and electrolytes, hormonal replacement therapy, the use of blood products, thermoregulation, and prophylactic antibiotics. Cross-sectional observational study using a survey and follow-up telephone interview with respondents from all 58 US organ procurement organizations. All 58 US Organ Procurement Organizations participated. A majority employed written guidelines for the management of pediatric donor hemodynamics, thermoregulation, fluids, and electrolytes. Management of blood products, the lung, and mechanical ventilation were less commonly committed to written guidelines, but common practices were described. All used various forms of hormonal replacement therapy and the majority administered empiric antibiotic therapy. Wide variation was observed in the management of the lung, mechanical ventilation, and glycemic control. Most OPOs used forms of standardized donor management for the pediatric organ donor although variation in the content of that management exists. Barriers to an evidence-based approach to the pediatric donor need to be determined and addressed.

Fundamentals in Biostatistics for Investigation in Pediatric Dentistry: Part II -Biostatistical Methods.

PubMed

Pozos-Guillén, Amaury; Ruiz-Rodríguez, Socorro; Garrocho-Rangel, Arturo

The main purpose of the second part of this series was to provide the reader with some basic aspects of the most common biostatistical methods employed in health sciences, in order to better understand the validity, significance and reliability of the results from any article on Pediatric Dentistry. Currently, as mentioned in the first paper, Pediatric Dentists need basic biostatistical knowledge to be able to apply it when critically appraise a dental article during the Evidence-based Dentistry (EBD) process, or when participating in the development of a clinical study with dental pediatric patients. The EBD process provides a systematic approach of collecting, review and analyze current and relevant published evidence about oral health care in order to answer a particular clinical question; then this evidence should be applied in everyday practice. This second report describes the most commonly used statistical methods for analyzing and interpret collected data, and the methodological criteria to be considered when choosing the most appropriate tests for a specific study. These are available to Pediatric Dentistry practicants interested in reading or designing original clinical or epidemiological studies.

Use of Actigraphy for Assessment in Pediatric Sleep Research

PubMed Central

Meltzer, Lisa J.; Montgomery-Downs, Hawley E.; Insana, Salvatore P.; Walsh, Colleen M.

2011-01-01

The use of actigraphs, or ambulatory devices that estimate sleep-wake patterns from activity levels, has become common in pediatric research. Actigraphy provides a more objective measure than parent-report, and has gained popularity due to its ability to measure sleep-wake patterns for extended periods of time in the child’s natural environment. The purpose of this review is: (1) to provide comprehensive information on the historic and current uses of actigraphy in pediatric sleep research; (2) to review how actigraphy has been validated among pediatric populations; and (3) offer recommendations for methodological areas that should be included in all studies that utilize actigraphy, including the definition and scoring of variables commonly reported. The poor specificity to detect wake after sleep onset was consistently noted across devices and age groups, thus raising concerns about what is an “acceptable” level of specificity for actigraphy. Other notable findings from this review include the lack of standard scoring rules or variable definitions. Suggestions for the use and reporting of actigraphy in pediatric research are provided. PMID:22424706

Risk factors for the development of Clostridium difficile infection in hospitalized children.

PubMed

Samady, Waheeda; Pong, Alice; Fisher, Erin

2014-10-01

This article defines the risk factors for Clostridium difficile infection (CDI) in hospitalized children in light of recent studies demonstrating a change in the epidemiology of these infections in both adults and children. Antibiotic exposure within the past 4-12 weeks was noted in a majority of published cases of pediatric CDI, and that remains a key risk factor for infection. Past and/or prolonged hospitalization increase a child's risk for CDI as they increase potential contact with C. difficile spores. Of all CDI, hospital-acquired infection remains more common. Many comorbid conditions have been linked with CDI, with the strongest association existing in children with cancer and inflammatory bowel disease. Severe infections occur infrequently in pediatric patients. Markers established in adults for severe CDI resulting in colectomy or transfer to ICU have not been shown to correlate in pediatric patients. Recent antibiotic exposure and hospitalization remain key risk factors for CDI in the hospitalized pediatric patient. Patients with comorbid conditions such as malignancy and inflammatory bowel disease are at higher risk for CDI. Resistant infections and severe outcomes are not common in the pediatric population.

Maxillofacial trauma of pediatric patients in Malaysia: a retrospective study from 1999 to 2001 in three hospitals.

PubMed

Rahman, Roslan Abdul; Ramli, Roszalina; Rahman, Normastura Abdul; Hussaini, Haizal Mohd; Idrus, Sharifah Munirah Ai; Hamid, Abdul Latif Abdul

2007-06-01

Maxillofacial trauma in children is not common worldwide. Domestic injuries are frequently seen in younger children while older children are mostly involved in motor vehicle accidents (MVA). The objective of this study was to analyze the pattern of maxillofacial injuries in pediatric patients referred to three government main hospitals in different areas of West Malaysia. Patients' records of three selected hospitals in Malaysia (National University of Malaysia Hospital, Kajang Hospital and Seremban Hospital) from January 1999 to December 2001 were reviewed. Data associated with demographics, etiology of injury in relation to age group, type of injuries whether soft tissues of hard tissue in relation to age group and treatment modalities were collected. A total of 521 pediatric patients' records were reviewed. Malays made up the majority of patients with maxillofacial injuries in the three hospitals. Males outnumbered females in all the three hospitals. Injuries commonly occur in the 11-16 years old. MVA was the most common etiology followed by fall and assault. Soft tissue injuries were the most common type of injuries in all the hospitals. In relation to fractures, mandible was the most common bone to fracture with condyle being the most common site. Orbital fracture was the most common fracture in the midfacial area. Most of the fractures were managed conservatively especially in the younger age groups. Open reduction with or without internal fixation was more frequently carried out in the 11-16 years old group. Children exhibit different pattern of clinical features depending on the etiology and stage of their bone maturation. A dedicated team, who is competent in trauma and aware of the unique anatomy, physical and psychological characteristics of children, should manage pediatric patient with trauma.

PDGFRA amplification is common in pediatric and adult high-grade astrocytomas and identifies a poor prognostic group in IDH1 mutant glioblastoma

PubMed Central

Phillips, Joanna J.; Aranda, Derick; Ellison, David W.; Judkins, Alexander R.; Croul, Sidney E.; Brat, Daniel J.; Ligon, Keith L.; Horbinski, Craig; Venneti, Sriram; Zadeh, Gelareh; Santi, Mariarita; Zhou, Shengmei; Appin, Christina L.; Sioletic, Stefano; Sullivan, Lisa M.; Martinez-Lage, Maria; Robinson, Aaron E.; Yong, William H.; Cloughesy, Timothy; Lai, Albert; Phillips, Heidi S.; Marshall, Roxanne; Mueller, Sabine; Haas-Kogan, Daphne A.; Molinaro, Annette M.; Perry, Arie

2013-01-01

High-grade astrocytomas (HGAs), corresponding to WHO grades III (AA) and IV (GBM), are biologically aggressive and their molecular classification is increasingly relevant to clinical management. PDGFRA amplification is common in HGAs, although its prognostic significance remains unclear. Using fluorescence in situ hybridization (FISH), the most sensitive technique for detecting PDGFRA copy number gains, we determined PDGFRA amplification status in 123 pediatric and 263 adult HGAs. A range of PDGFRA FISH patterns were identified and cases were scored as non-amplified (normal and polysomy) or amplified (low-level and high-level). PDGFRA amplification was frequent in pediatric (29.3%) and adult (20.9%) tumors. Amplification was not prognostic in pediatric HGAs. In adult tumors diagnosed initially as GBM, the presence of combined PDGFRA amplification and IDH1R132H mutation was a significant independent prognostic factor (p=0.01). In HGAs, PDGFRA amplification is common and can manifest as high-level and focal or low-level amplifications. Our data indicate that the latter is more prevalent than previously reported with copy number averaging techniques. To our knowledge, this is the largest survey of PDGFRA status in adult and pediatric HGAs and suggests PDGFRA amplification increases with grade and is associated with a less favorable prognosis in IDH1 mutant de novo GBMs. PMID:23438035

Foreign body ingestion in children

PubMed Central

Dereci, Selim; Koca, Tuğba; Serdaroğlu, Filiz; Akçam, Mustafa

2015-01-01

Aim: Foreign bodies ingested by the oral route enter into the gastrointestinal tract and are considered a significant health problem in the childhood. In this study, we evaluated the pediatric patients who presented to our hospital with the complaint of ingestion of foreign body. Material and Methods: The hospital records of all children who presented to our clinic because of ingestion of foreign body between January 2008 and January 2015 were examined retrospectively. The complaints at admission, the types of foreign bodies ingested, the localization of the foreign body in the gastrointestinal tract and the approaches and treatment methods used were examined. Results: Thirty-six (56%) of 64 patients included in the study were male and 28 (44%) were female and the mean age was 5.7±4.6 years (10 months–17 years). Thirty eight (59%) of 64 children who were included in the assessment were below the age of five years. The most common complaint at presentation was parental recognition of the ingested object and dysphagia. The most commonly ingested foreign bodies included coins, sewing pins, safety pins and hairclips. Nail clipper detected in the stomach, sewing pin which penetrated through the duodenal wall and stuck to hepatic parenchyma were the first pediatric cases in the literature. Upper esophagus was the most common location for foreign bodies. Endoscopic examinations were performed in 55 of 64 children. Conclusions: Early detection and treatment of ingested foreign bodies in the upper gastrointestinal system is important in terms of preventing possible complications. In our study, the most frequent foreign bodies detected in the upper digestive tract were coins and they were most frequently detected in the upper esophagus. Most of our patients were below the age of five years. Flexible endoscopic method was used commonly for treatment. PMID:26884693

Pediatric patients with common variable immunodeficiency: long-term follow-up.

PubMed

Mohammadinejad, P; Aghamohammadi, A; Abolhassani, H; Sadaghiani, M S; Abdollahzade, S; Sadeghi, B; Soheili, H; Tavassoli, M; Fathi, S M; Tavakol, M; Behniafard, N; Darabi, B; Pourhamdi, S; Rezaei, N

2012-01-01

Common variable immunodeficiency (CVID) is the most common form of symptomatic primary immunodeficiency disease. It is characterized by hypogammaglobulinemia, increased predisposition to infections, autoimmunity, and cancer. This study was performed to evaluate the clinical and immunological features of a group of pediatric patients with CVID. The study population comprised 69 individuals with CVID diagnosed during childhood. The patients were followed up for a mean (SD) period of 5.2 (4.3) years. The mean diagnostic delay was 4.4 (3.6) years, which was significantly lower in patients who were diagnosed recently. Children were classified according to 5 clinical phenotypes: infections only (n=39), polyclonal lymphocytic infiltration (n=17), autoimmunity (n=12), malignancy (n=7), and enteropathy (n=3). Postdiagnosis survival (10-year) was 71%. The high percentages of pediatric patients with CVID in Iran may be due to the considerable prevalence of parental consanguinity in the region and an underlying genetic background.

Pediatric functional gastrointestinal disorders

USDA-ARS?s Scientific Manuscript database

Functional gastrointestinal disorders continue to be a prevalent set of conditions faced by the healthcare team and have a significant emotional and economic impact. In this review, the authors highlight some of the common functional disorders seen in pediatric patients (functional dyspepsia, irrita...

Domestic minor sex trafficking: what the PNP needs to know.

PubMed

Hornor, Gail

2015-01-01

Human trafficking is a major global public health problem and represents a substantial human rights violation. Human trafficking has been receiving attention in both the lay media and professional literature. Human trafficking can include commercial sex, forced labor, child soldiers, and stealing of human organs. One form of human trafficking represents a significant American pediatric health problem: domestic minor sex trafficking (DMST). DMST is the commercial sexual abuse of children by selling, buying, or trading their sexual service. This continuing education article will define DMST and discuss it in terms of prevalence, risk factors, and practice implications for the pediatric nurse practitioner. Copyright © 2015 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.

Pediatric feeding and swallowing rehabilitation: An overview.

PubMed

van den Engel-Hoek, Lenie; Harding, Celia; van Gerven, Marjo; Cockerill, Helen

2017-05-16

Children with neurological disabilities frequently have problems with feeding and swallowing. Such problems have a significant impact on the health and well-being of these children and their families. The primary aims in the rehabilitation of pediatric feeding and swallowing disorders are focused on supporting growth, nutrition and hydration, the development of feeding activities, and ensuring safe swallowing with the aim of preventing choking and aspiration pneumonia. Pediatric feeding and swallowing disorders can be divided into four groups: transient, developmental, chronic or progressive.This article provides an overview of the available literature about the rehabilitation of feeding and swallowing disorders in infants and children. Principles of motor control, motor learning and neuroplasticity are discussed for the four groups of children with feeding and swallowing disorders.

The APA and the Rise of Pediatric Generalist Network Research

PubMed Central

Wasserman, Richard; Serwint, Janet R.; Kuppermann, Nathan; Srivastava, Rajendu; Dreyer, Benard

2010-01-01

The Academic Pediatric Association (APA – formerly the Ambulatory Pediatric Association) first encouraged multi-institutional collaborative research among its members over thirty years ago. Individual APA members went on subsequently to figure prominently in establishing formal research networks. These enduring collaborations have been established to conduct investigations in a variety of generalist contexts. At present, four generalist networks – Pediatric Research in Office Settings (PROS), the Pediatric Emergency Care Applied Network (PECARN), the COntinuity Research NETwork (CORNET), and Pediatric Research in Inpatient Settings (PRIS) – have a track record of extensive achievement in generating new knowledge aimed at improving the health and health care of children. This review details the history, accomplishments, and future directions of these networks and summarizes the common themes, strengths, challenges and opportunities inherent in pediatric generalist network research. PMID:21282083

Building a Common Pediatric Research Terminology for Accelerating Child Health Research

PubMed Central

Bailey, L. Charles; Forrest, Christopher B.; Padula, Michael A.; Hirschfeld, Steven

2014-01-01

Longitudinal observational clinical data on pediatric patients in electronic format is becoming widely available. A new era of multi-institutional data networks that study pediatric diseases and outcomes across disparate health delivery models and care settings are also enabling an innovative collaborative rapid improvement paradigm called the Learning Health System. However, the potential alignment of routine clinical care, observational clinical research, pragmatic clinical trials, and health systems improvement requires a data infrastructure capable of combining information from systems and workflows that historically have been isolated from each other. Removing barriers to integrating and reusing data collected in different settings will permit new opportunities to develop a more complete picture of a patient’s care and to leverage data from related research studies. One key barrier is the lack of a common terminology that provides uniform definitions and descriptions of clinical observations and data. A well-characterized terminology ensures a common meaning and supports data reuse and integration. A common terminology allows studies to build upon previous findings and to reuse data collection tools and data management processes. We present the current state of terminology harmonization and describe a governance structure and mechanism for coordinating the development of a common pediatric research terminology that links to clinical terminologies and can be used to align existing terminologies. By reducing the barriers between clinical care and clinical research, a Learning Health System can leverage and reuse not only its own data resources but also broader extant data resources. PMID:24534404

Pediatric epidermoid cysts masquerading as ranulas: A case series.

PubMed

Reddy, Abhita; Kreicher, Kathryn L; Patel, Neha A; Schantz, Stimson; Shinhar, Shai

2016-02-01

Pediatric neck masses represent a variety of differential diagnoses. A common pathology in pediatric cystic neck tumors include ranulas, mucus retention cysts due to salivary gland obstruction. Epidermoid cysts are lesions infrequently encountered in the pediatric population and may appear similarly to ranulas on computed tomography imaging. MRI more easily differentiates these masses, and should therefore be the preferred imaging modality. Due to their distinct intraoperative management, ranulas and epidermoid cysts should be distinguished preoperatively through proper workup. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Current Treatment Strategies in Pediatric Alopecia Areata

PubMed Central

Wang, Etienne; Lee, Joyce SS; Tang, Mark

2012-01-01

Alopecia areata (AA) is a non-scarring autoimmune disease of the hair follicle that can present at any age. Pediatric cases are commonly seen in a dermatology clinic, and management can potentially be challenging, with a small proportion of cases experiencing a chronic relapsing course marked by distressing hair loss that can bring about significant psychosocial morbidity. We review the established treatments for pediatric alopecia areata, alongside second and third line therapies that have shown to be efficacious. We also offer a treatment algorithm as a guide to the treatment of pediatric AA. PMID:23248364

Designing pediatric vaccine formularies and pricing pediatric combination vaccines using operations research models and algorithms.

PubMed

Jacobson, Sheldon H; Sewell, Edward C; Allwine, Daniel A; Medina, Enrique A; Weniger, Bruce G

2003-02-01

The National Immunization Program, housed within the Centers for Disease Control and Prevention in the USA, has identified several challenges that must be faced in childhood immunization programs to deliver and procure vaccines that immunize children from the plethora of childhood diseases. The biomedical issues cited include how drug manufacturers can combine and formulate vaccines, how such vaccines are scheduled and administered and how economically sound vaccine procurement can be achieved. This review discusses how operations research models can be used to address the economics of pediatric vaccine formulary design and pricing, as well as how such models can be used to address a new set of pediatric formulary problems that will surface with the introduction of pediatric combination vaccines into the US pediatric immunization market.

Caregiver reports of common symptoms in children following a traumatic brain injury.

PubMed

Hooper, Stephen R; Alexander, Joshua; Moore, Daniel; Sasser, Howell C; Laurent, Sherry; King, Jennifer; Bartel, Sheri; Callahan, Beth

2004-01-01

This study describes the common symptoms in children and adolescents following a traumatic brain injury (TBI) as reported by their primary caregivers. Utilizing data from a large-scale state demonstration project, 681 children who had sustained a TBI were ascertained from both Hospital Emergency Departments (n = 409) and Pediatric Inpatient settings (n = 272). The sample ranged in age from infancy to 18 years, was largely male (59.7%), and had equal numbers of Caucasian and minority patients. Most of the participants experienced a mild TBI (83%), with about 5.1% being moderate and 12% severe. Caregivers described the presence of current symptoms (neurological, neurocognitive, behavioral, school problems) using a series of dichotomous questions regarding their child via a structured telephone interview at 1, 4, and 10 months post-injury. Inpatient children were described as manifesting more symptoms at each of the follow-up time points than their ED counterparts. At 1 month inpatients were described as having more symptoms across all 4 domains. At 4 and 10 months, the inpatients were described as having more neurocognitive symptoms and as not returning to school on a full-time basis, with behavior problems approaching significance at the 10-month point. A large number of individuals from both groups also reported persistent symptoms 10 months post-injury including headaches, attention and memory problems, low frustration tolerance, sleep problems, personality changes, and new school problems. Practical implications of these findings for the ongoing management of these children are discussed.

Evaluation and Management of Dehydration in Children.

PubMed

Santillanes, Genevieve; Rose, Emily

2018-05-01

The article discusses the evaluation of dehydration in children and reviews the literature on physical findings of dehydration. Pediatric dehydration is a common problem in emergency departments and wide practice variation in treatment exists. Dehydration can be treated with oral, nasogastric, subcutaneous, or intravenous fluids. Although oral rehydration is underutilized in the United States, most children with dehydration can be successfully rehydrated via the oral route. Selection of oral rehydration solution and techniques for successful oral rehydration are presented. Appropriate selection and rate of administration of intravenous fluids are also discussed for isonatremic, hyponatremic, and hypernatremic dehydration. Copyright © 2017 Elsevier Inc. All rights reserved.

Obstructive sleep apnea (OSA): a complication of acute infectious mononucleosis infection in a child.

PubMed

Cheng, Jeffrey

2014-03-01

Independently, obstructive sleep apnea (OSA) and infectious mononucleosis are not uncommon in the pediatric population, but acute onset of OSA, as a respiratory complication in the setting of acute EBV infection is extremely uncommon. Previous reports of this clinical entity are sparse and from nearly two decades ago. Urgent adenotonsillectomy was commonly advocated. This complication may be managed medically with systemic corticosteroids and non-invasive continuous positive airway pressure (CPAP), and a case is presented to highlight an updated management approach to this rarely encountered clinical problem in children. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Nonsurgical Management of Pediatric Temporomandibular Joint Dysfunction.

PubMed

Scrivani, Steven John; Khawaja, Shehryar Nasir; Bavia, Paula Furlan

2018-02-01

Temporomandibular disorders (TMD) are a subgroup of craniofacial pain problems involving the temporomandibular joint (TMJ), masticatory muscles, and associated head and neck musculoskeletal structures. These disorders are subclassified into TMJ articular disorders and masticatory muscle disorders. Patients with TMD most commonly present with pain, restricted or asymmetric mandibular motion, and TMJ sounds during mandibular movements. The prevalence tends to increase with age. Management of TMJ articular disorders consists of a combination of patient education, home-care plan, biobehavioral therapy, physical therapy, orthotic jaw appliance therapy, pharmacotherapy, and/or surgery. The goal is to increase function, reduce pain, and improve quality of life. Copyright © 2017 Elsevier Inc. All rights reserved.

Practice patterns of doctors of chiropractic with a pediatric diplomate: a cross-sectional survey

PubMed Central

2010-01-01

Background Complementary and alternative medicine (CAM) is growing in popularity, especially within the pediatric population. Research on CAM practitioners and their specialties, such as pediatrics, is lacking. Within the chiropractic profession, pediatrics is one of the most recently established post-graduate specialty programs. This paper describes the demographic and practice characteristics of doctors of chiropractic with a pediatric diplomate. Methods 218 chiropractors with a pediatric diplomate were invited to complete our survey using either web-based or mailed paper survey methods. Practitioner demographics, practice characteristics, treatment procedures, referral patterns, and patient characteristics were queried with a survey created with the online survey tool, SurveyMonkey©®. Results A total of 135 chiropractors responded (62.2% response rate); they were predominantly female (74%) and white (93%). Techniques most commonly used were Diversified, Activator ®, and Thompson with the addition of cranial and extremity manipulation to their chiropractic treatments. Adjunctive therapies commonly provided to patients included recommendations for activities of daily living, corrective or therapeutic exercise, ice pack\\cryotherapy, and nutritional counseling. Thirty eight percent of respondents' patients were private pay and 23% had private insurance that was not managed care. Pediatrics represented 31% of the survey respondents' patients. Chiropractors also reported 63% of their work time devoted to direct patient care. Health conditions reportedly treated within the pediatric population included back or neck pain, asthma, birth trauma, colic, constipation, ear infection, head or chest cold, and upper respiratory infections. Referrals made to or from these chiropractors were uncommon. Conclusions This mixed mode survey identified similarities and differences between doctors of chiropractic with a pediatric diplomate to other surveys of doctors of chiropractic, CAM professionals, and pediatric healthcare providers. The pediatric diplomate certificate was established in 1993 and provides didactic education over a 2 to 3 year span. The results of this study can be used for historical information as this specialty continues to grow. PMID:20546582

Dental traumatology: an orphan in pediatric dentistry?

PubMed

Andreasen, Jens Ove; Lauridsen, Eva; Daugaard-Jensen, Jette

2009-01-01

Traumatic dental injuries are very frequent during childhood and adolescence. In fact, 2 out of 3 children have suffered a traumatic dental injury before adulthood. This fact links dental traumatology to pediatric dentistry. Unfortunately, this is not reflected by active participation by pediatric dentists in acute treatment, follow-up, and research. To examine the status of pediatric dentistry in relation to dental trauma, a publication analysis was undertaken in 1980, 1990, 2000, and 2007 about trauma articles published in 4 pediatric journals: journal of Dentistry for Children, Pediatric Dentistry, The journal of Pedodontics, and the International journal of Pediatric Dentistry. This study shows an average publication rate of trauma articles of approximately 3 percent of all articles published and with no improvement in later decennia. If only clinical studies are considered (leaving out case reports), the publication rate is less than 1 percent--completely out of proportion to the size of the problem dental trauma impose in children.

The Inadequacy of Pediatric Fracture Care Information in Emergency Medicine and Pediatric Literature and Online Resources.

PubMed

Tileston, Kali; Bishop, Julius A

2015-01-01

Emergency medicine and pediatric physicians often provide initial pediatric fracture care. Therefore, basic knowledge of the various treatment options is essential. The purpose of this study was to determine the accuracy of information commonly available to these physicians in textbooks and online regarding the management of pediatric supracondylar humerus and femoral shaft fractures. The American Academy of Orthopaedic Surgeons Clinical Practice Guidelines for pediatric supracondylar humerus and femoral shaft fractures were used to assess the content of top selling emergency medicine and pediatric textbooks as well as the top returned Web sites after a Google search. Only guidelines that addressed initial patient management were included. Information provided in the texts was graded as consistent, inconsistent, or omitted. Five emergency medicine textbooks, 4 pediatric textbooks, and 5 Web sites were assessed. Overall, these resources contained a mean 31.6% (SD=32.5) complete and correct information, whereas 3.6 % of the information was incorrect or inconsistent, and 64.8% was omitted. Emergency medicine textbooks had a mean of 34.3% (SD=28.3) correct and complete recommendations, 5.7% incorrect or incomplete recommendations, and 60% omissions. Pediatric textbooks were poor in addressing any of the American Academy of Orthopaedic Surgeons guidelines with an overall mean of 7.14% (SD=18.9) complete and correct recommendations, a single incorrect/incomplete recommendation, and 91.1% omissions. Online resources had a mean of 48.6% (SD=33.1) complete and correct recommendations, 5.72% incomplete or incorrect recommendations, and 45.7% omissions. This study highlights important deficiencies in resources available to pediatric and emergency medicine physicians seeking information on pediatric fracture management. Information in emergency medicine and pediatric textbooks as well as online is variable, with both inaccuracies and omissions being common. This lack of high-quality information could compromise patient care. Resources should be committed to ensuring accurate and complete information is readily available to all physicians providing pediatric fracture care. In addition, orthopaedic surgeons should take an active role to ensure that nonorthopaedic textbooks and online resources contain complete and accurate information.

Comparison of pediatric and adult antibiotic-associated diarrhea and Clostridium difficile infections

PubMed Central

McFarland, Lynne Vernice; Ozen, Metehan; Dinleyici, Ener Cagri; Goh, Shan

2016-01-01

Antibiotic-associated diarrhea (AAD) and Clostridum difficile infections (CDI) have been well studied for adult cases, but not as well in the pediatric population. Whether the disease process or response to treatments differs between pediatric and adult patients is an important clinical concern when following global guidelines based largely on adult patients. A systematic review of the literature using databases PubMed (June 3, 1978-2015) was conducted to compare AAD and CDI in pediatric and adult populations and determine significant differences and similarities that might impact clinical decisions. In general, pediatric AAD and CDI have a more rapid onset of symptoms, a shorter duration of disease and fewer CDI complications (required surgeries and extended hospitalizations) than in adults. Children experience more community-associated CDI and are associated with smaller outbreaks than adult cases of CDI. The ribotype NAP1/027/BI is more common in adults than children. Children and adults share some similar risk factors, but adults have more complex risk factor profiles associated with more co-morbidities, types of disruptive factors and a wider range of exposures to C. difficile in the healthcare environment. The treatment of pediatric and adult AAD is similar (discontinuing or switching the inciting antibiotic), but other treatment strategies for AAD have not been established. Pediatric CDI responds better to metronidazole, while adult CDI responds better to vancomycin. Recurrent CDI is not commonly reported for children. Prevention for both pediatric and adult AAD and CDI relies upon integrated infection control programs, antibiotic stewardship and may include the use of adjunctive probiotics. Clinical presentation of pediatric AAD and CDI are different than adult AAD and CDI symptoms. These differences should be taken into account when rating severity of disease and prescribing antibiotics. PMID:27003987

Unintentional Pediatric Cocaine Exposures Result in Worse Outcomes than Other Unintentional Pediatric Poisonings.

PubMed

Armenian, Patil; Fleurat, Michelle; Mittendorf, George; Olson, Kent R

2017-06-01

Unintentional pediatric cocaine exposures are rare but concerning due to potentially serious complications such as seizures, dysrhythmias, and death. The objectives were to assess the demographic and clinical characteristics of pediatric cocaine exposures reported to the California Poison Control System. This is a retrospective study of all confirmed pediatric (< 6 years of age) cocaine exposures reported to the California Poison Control System from January 1, 1997-September 30, 2010. Case narratives were reviewed for patient demographics, exposure details, clinical effects, therapy, hospitalization, and final outcome. Of the 86 reported pediatric cocaine exposures, 36 had positive urine drug testing and were included in the study cohort. The median age at presentation was 18 months (range: 0-48 months), and 56% were male (n = 20). The most common clinical manifestations were tachycardia and seizures. The most common disposition was admission to an intensive care unit (n = 14; 39%). Eleven cases (31%) were classified as having a major effect as per American Association of Poison Control Centers case coding guidelines. One child presented in asystole with return of spontaneous circulation after cardiopulmonary resuscitation and multiple vasoactive medications. The proportion of cocaine exposures with serious (moderate or major) outcomes (66.7%; 95% confidence interval 50.3-79.8%) was higher than other pediatric poisonings reported to the American Association of Poison Control Centers during the study period (0.88%; 95% confidence interval 0.87-0.88). Although pediatric cocaine exposures are rare, they result in more severe outcomes than most unintentional pediatric poisonings. Practitioners need to be aware of the risk of recurrent seizures and cardiovascular collapse associated with cocaine poisoning. Copyright © 2017 Elsevier Inc. All rights reserved.

The impact of fatal pediatric trauma on aboriginal children.

PubMed

Bratu, Ioana; Lowe, Danielle; Phillips, Leah

2013-05-01

Injuries are the leading cause of death in young people. Our aim is to examine the differences between aboriginal and non-aboriginal pediatric trauma mortality as a means to focus on prevention strategies. The records for all traumatic pediatric (0-18 years) deaths between 1996 and 2010 were reviewed from the regional Medical Examiner's office. The majority of the total 932 pediatric deaths were the result of non-intentional injuries (640) followed by suicide (195), homicide (65), child abuse (15), and undetermined (17). Despite being only 3.3% of the provincial population, Aboriginals represented 30.9% of pediatric trauma fatalities. Aboriginal fatalities occurred most commonly in the home, with males and females equally affected. Road related events were the main causes of injury overall. Up to three-quarters of Aboriginal children who died in a non-pedestrian road related event did not wear an indicated protective device. Pedestrian deaths were over-represented in Aboriginal children. The second most common cause of death was suicide for both non-Aboriginal and Aboriginal children. Almost half of all of the suicides were Aboriginal. Homicide and child abuse had similar proportions for both non-Aboriginal and Aboriginal children. Pediatric Aboriginal injury prevention should be a priority and tailored for Aboriginal communities. Copyright © 2013 Elsevier Inc. All rights reserved.

Guidelines for the Diagnosis and Treatment of Cutaneous Mastocytosis in Children

PubMed Central

Castells, Mariana; Metcalfe, Dean D.; Escribano, Luis

2012-01-01

Mastocytosis is a disease with many variants, all of which are characterized by a pathologic increase in mast cells in cutaneous tissue and extracutaneous organs such as the bone marrow, liver, spleen and lymph nodes. The disease presents in two primary age-related patterns: pediatric-onset mastocytosis and adult-onset mastocytosis, which may differ in their clinical manifestations and disease course. Pediatric-onset mastocytosis commonly is diagnosed prior to 2 years of age, and usually consists of cutaneous disease, with urticaria pigmentosa (UP) the most common pattern. The course of pediatric-onset mastocytosis is variable. This is in contrast to adult onset disease which generally presents with systemic findings and increases in extent and severity over time. Because pediatric forms of mastocytosis often differ in presentation and prognosis from adult variants, it is most important to understand pediatric mastocytosis and not rely on adult approaches as a guide on how to identify and manage disease. This is especially important in selecting therapy where antiproliferative agents have a very different set of concerns when used to treat adult mastocytosis compared to pediatric mastocytosis, especially in terms of long-term toxicity. This review is directed at providing age-specific information surrounding the care of the child with mastocytosis. PMID:21668033

[Idiopathic Nephrotic Syndrome: recommendations of the Nephrology Branch of the Chilean Society of Pediatrics. Part two].

PubMed

Hevia, Pilar; Nazal, Vilma; Rosati, María Pía; Quiroz, Lily; Alarcón, Claudia; Márquez, Sonia; Cuevas, Karen

2015-01-01

Idiopathic nephrotic syndrome is the most common glomerular disease in childhood, affecting 1 to 3 per 100,000 children under the age of 16. It most commonly occurs in ages between 2 and 10. Its cause is unknown, and its histology corresponds to minimal change disease in 90% of cases, or focal segmental glomerulosclerosis. Steroid-resistant nephrotic syndrome represents 10-20% of idiopathic nephrotic syndrome in pediatrics. It has a poor prognosis, and its management is a significant therapeutic challenge. Half of patients evolve to end-stage renal disease within 5 years, and are additionally exposed to complications secondary to persistent NS and to the adverse effects of immunosuppressive therapy. The primary goal of treatment is to achieve complete remission, but even a partial remission is associated with a better renal survival than the lack of response. This paper is the result of the collaborative effort of the Nephrology Branch of the Chilean Society of Pediatrics with aims at helping pediatricians and pediatric nephrologists to treat pediatric idiopathic nephrotic syndrome. In this second part, handling of steroid-resistant nephrotic syndrome as well as nonspecific therapies are discussed. Copyright © 2015 Sociedad Chilena de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

Enhancing the Capacity of School Nurses to Reduce Excessive Anxiety in Children: Development of the CALM Intervention.

PubMed

Drake, Kelly L; Stewart, Catherine E; Muggeo, Michela A; Ginsburg, Golda S

2015-08-01

Excessive anxiety is among the most common psychiatric problems facing youth. Because anxious youth tend to have somatic complaints, many seek help from the school nurse. Thus, school nurses are in an ideal position to provide early intervention. This study addresses this problem and describes the plans to develop and test a new intervention (Child Anxiety Learning Modules; CALM), delivered by school nurses, to reduce child anxiety and improve academic functioning. An iterative development process including consultation with an expert panel, two open trials, and a pilot randomized controlled study comparing CALM to usual care is proposed. Feedback will be solicited from all participants during each phase and data on outcome measures will be provided by children, parents, teachers, and independent evaluators. Data will be collected on intervention satisfaction and feasibility. Primary outcomes that include child anxiety symptoms, classroom behavior, and school performance (e.g., attendance, grades, standardized test scores) will be collected at pre- and post-interventions and at a 3-month follow-up evaluation. Pediatric anxiety is a common problem that school nurses frequently encounter. Consequently, they are well positioned to play a key role in enhancing access to behavioral health interventions to reduce anxiety and may therefore make a significant positive public health impact. © 2015 Wiley Periodicals, Inc.

Dengue fever

PubMed Central

Badreddine, Samar; Al-Dhaheri, Fahmi; Al-Dabbagh, Ammar; Al-Amoudi, Abdulrahman; Al-Ammari, Maged; Elatassi, Nader; Abbas, Haytham; Magliah, Rami; Malibari, Abdulbasit; Almoallim, Hani

2017-01-01

Objectives: To delineate the clinical features and outcomes of dengue infection and to guide clinician of early diagnosis and identification of risks factors for dengue hemorrhagic fever. Methods: This study is a retrospective cross-sectional. Clinical records of 567 patients with a confirmed diagnosis of dengue infection, admitted to a single hospital in Jeddah, Saudi Arabia, between January 2010 and June 2014 were reviewed. Results: Dengue infection was most common in adult males. Sixty-eight percent of infections were in Saudi nationals. In addition to the diagnostic clinical features, leucopenia and thrombocytopenia were typical of dengue infection. Approximately 4.1% of adult patients and 7.1% of pediatric patients developed dengue hemorrhagic fever (DHF). Abdominal pain and vomiting were more common in patients developing DHF. Mean platelet count was lower in adult, but not pediatric patients developing DHF. Peak alanine aminotransferase (ALT) was higher in adult and pediatric patients developing DHF. Three patients died, 2 of them developed DHF. Ninety-eight percent of adult patients and 92% of pediatric patients made a full recovery. Conclusions: Dengue infection is common in Jeddah. Abdominal pain and vomiting, thrombocytopenia, and elevated ALT are typical of severe infection, which is more likely to be associated with significant morbidity and mortality. PMID:28917067

Types and Treatment of Pediatric Sleep Disturbances

ERIC Educational Resources Information Center

Hamilton, Gloria J.

2009-01-01

This article provides an overview of pediatric sleep disturbances with emphases on types and treatments. Relationships between sleep disorders and comorbid conditions function to exacerbate and maintain both disorders. An estimated 20% of teenagers experience chronic partial sleep deprivation, resulting in problems with memory, attention, and…

Perioperative pulmonary aspiration is infrequent and low risk in pediatric anesthetic practice.

PubMed

Kelly, Christopher J; Walker, Robert W M

2015-01-01

Recent studies have reported perioperative pulmonary aspiration in pediatric practice to be an uncommon problem associated with low morbidity and mortality. This paper examines the recent publications in both the adult and pediatric literature and looks at some of the potential risk factors involved, both patient and anesthetic, in the development of aspiration of gastric contents. We also look at the risk of severe morbidity following pulmonary aspiration and speculate on possible reasons behind the assertion that pulmonary aspiration in pediatric anesthetic practice is rare and a low-risk event. © 2014 John Wiley & Sons Ltd.

Long-acting reversible contraception in the pediatric emergency department: clinical implications and common challenges.

PubMed

Koyama, Atsuko; Dorfman, David H; Forcier, Michelle M

2015-04-01

Long-acting reversible contraception (LARC) is recommended as first-line contraception for adolescents and young adults. As the use of LARC increases, pediatric emergency medicine clinicians should be able to recognize different types of LARC and address their common adverse effects, adverse reactions, and complications. This continuing medical education activity provides an overview of LARC and will assist clinicians in the evaluation and management of patients with LARC-associated complaints.

Scoping review of pediatric tonsillectomy quality of life assessment instruments.

PubMed

Kao, Stephen Shih-Teng; Peters, Micah D J; Dharmawardana, Nuwan; Stew, Benjamin; Ooi, Eng Hooi

2017-10-01

Sleep-disordered breathing or recurrent tonsillitis have detrimental effects on the child's physical health and quality of life. Tonsillectomy is commonly performed to treat these common conditions and improve the child's quality of life. This scoping review aims to present a comprehensive and descriptive analysis of quality of life questionnaires as a resource for clinicians and researchers when deciding which tool to use when assessing the quality of life effects after tonsillectomy. A comprehensive search strategy was undertaken across MEDLINE (PubMed), CINAHL, Embase, and Cochrane CENTRAL. Quality of life questionnaires utilized in studies investigating pediatric patients undergoing tonsillectomy for chronic tonsillitis or sleep-disordered breathing were included. Methodological quality and data extraction were conducted as per Joanna Briggs Institute methodology. Ten questionnaires were identified, consisting of six generic and four disease-specific instruments. The Pediatric Quality of Life Inventory was the most commonly utilized generic questionnaire. The Obstructive Sleep Apnea-18 was the most commonly utilized disease-specific questionnaire. This review identified a range of generic and disease-specific quality of life questionnaires utilized in pediatric patients who have undergone tonsillectomy with or without adenoidectomy for sleep-disordered breathing or chronic tonsillitis. Important aspects of each questionnaire have been summarized to aid researchers and clinicians in choosing the appropriate questionnaire when evaluating the quality of life effects of tonsillectomy. NA Laryngoscope, 127:2399-2406, 2017. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

The Met Needs for Pediatric Surgical Conditions in Sierra Leone: Estimating the Gap.

PubMed

Burgos, Carmen Mesas; Bolkan, Håkon Angell; Bash-Taqi, Donald; Hagander, Lars; Von Screeb, Johan

2018-03-01

In low- and middle-income countries, there is a gap between the need for surgery and its equitable provision, and a lack of proxy indicators to estimate this gap. Sierra Leone is a West African country with close to three million children. It is unknown to what extent the surgical needs of these children are met. To describe a nationwide provision of pediatric surgical procedures and to assess pediatric hernia repair as a proxy indicator for the shortage of surgical care in the pediatric population in Sierra Leone. We analyzed results from a nationwide facility survey in Sierra Leone that collected data on surgical procedures from operation and anesthesia logbooks in all facilities performing surgery. We included data on all patients under the age of 16 years undergoing surgery. Primary outcomes were rate and volume of surgical procedures. We calculated the expected number of inguinal hernia in children and estimated the unmet need for hernia repair. In 2012, a total of 2381 pediatric surgical procedures were performed in Sierra Leone. The rate of pediatric surgical procedures was 84 per 100,000 children 0-15 years of age. The most common pediatric surgical procedure was hernia repair (18%), corresponding to a rate of 16 per 100,000 children 0-15 years of age. The estimated unmet need for inguinal hernia repair was 88%. The rate of pediatric surgery in Sierra Leone was very low, and inguinal hernia was the single most common procedure noted among children in Sierra Leone.

Musculoskeletal anomalies in a large cohort of boys with 49, XXXXY.

PubMed

Sprouse, Courtney; Tosi, Laura; Stapleton, Emily; Gropman, Andrea L; Mitchell, Francie L; Peret, Rick; Sadeghin, Teresa; Haskell, Kathryn; Samango-Sprouse, Carole A

2013-02-15

49, XXXXY is a rare aneuploidy and variant of Klinefelter syndrome, occurring in 1 per 80,000-100,000 live births. We present a cohort of 40 affected males, focusing on musculoskeletal problems. Subjects were participants in an annual 49er family support group meeting. Children were examined in a multidisciplinary clinic by a pediatric neurologist and geneticist, a pediatric orthopedist, a neurodevelopmentalist, and two physical therapists. The patient data were collected from this clinic from 2004 to 2012. All patients were required to have karyotypes that confirmed the presence of XXXXY. There was a high prevalence of musculoskeletal disorders, particularly hypotonia (34 patients [85%]), radioulnar synostosis (30 [75%]), pes planus (26 [65%]), asymmetric hip rotation (27 [67.5%]), and clinodactyly (24 [60%]). Other, less common lower-extremity disorders, included, 5 patients (12.5%) with unilateral club foot, 5 boys (12.5%) with pes cavus, 10 patients (25%) genu valgum and 2 children with genu varus (5%). To our knowledge, this is the first large cohort of boys with 49, XXXXY that focuses on musculoskeletal disorders. There was an increased incidence of hypotonia, clubfoot, avascular necrosis of the femoral head, radioulnar synostosis, and pes planus compared to the normative population. Boys with 49, XXXXY would benefit from multidisciplinary evaluations, particularly from pediatric orthopedists, physical therapists, neurologists, and geneticists for appropriate medical care. Copyright © 2013 Wiley Periodicals, Inc.

Early detection of acute kidney injury after pediatric cardiac surgery

PubMed Central

Jefferies, John Lynn; Devarajan, Prasad

2016-01-01

Acute kidney injury (AKI) is increasingly recognized as a common problem in children undergoing cardiac surgery, with well documented increases in morbidity and mortality in both the short and the long term. Traditional approaches to the identification of AKI such as changes in serum creatinine have revealed a large incidence in this population with significant negative impact on clinical outcomes. However, the traditional diagnostic approaches to AKI diagnosis have inherent limitations that may lead to under-diagnosis of this pathologic process. There is a dearth of randomized controlled trials for the prevention and treatment of AKI associated with cardiac surgery, at least in part due to the paucity of early predictive biomarkers. Novel non-invasive biomarkers have ushered in a new era that allows for earlier detection of AKI. With these new diagnostic tools, a more consistent approach can be employed across centers that may facilitate a more accurate representation of the actual prevalence of AKI and more importantly, clinical investigation that may minimize the occurrence of AKI following pediatric cardiac surgery. A thoughtful management approach is necessary to mitigate the effects of AKI after cardiac surgery, which is best accomplished in close collaboration with pediatric nephrologists. Long-term surveillance for improvement in kidney function and potential development of chronic kidney disease should also be a part of the comprehensive management strategy. PMID:27429538

Review of family relational stress and pediatric asthma: the value of biopsychosocial systemic models.

PubMed

Wood, Beatrice L; Miller, Bruce D; Lehman, Heather K

2015-06-01

Asthma is the most common chronic disease in children. Despite dramatic advances in pharmacological treatments, asthma remains a leading public health problem, especially in socially disadvantaged minority populations. Some experts believe that this health gap is due to the failure to address the impact of stress on the disease. Asthma is a complex disease that is influenced by multilevel factors, but the nature of these factors and their interrelations are not well understood. This paper aims to integrate social, psychological, and biological literatures on relations between family/parental stress and pediatric asthma, and to illustrate the utility of multilevel systemic models for guiding treatment and stimulating future research. We used electronic database searches and conducted an integrated analysis of selected epidemiological, longitudinal, and empirical studies. Evidence is substantial for the effects of family/parental stress on asthma mediated by both disease management and psychobiological stress pathways. However, integrative models containing specific pathways are scarce. We present two multilevel models, with supporting data, as potential prototypes for other such models. We conclude that these multilevel systems models may be of substantial heuristic value in organizing investigations of, and clinical approaches to, the complex social-biological aspects of family stress in pediatric asthma. However, additional systemic models are needed, and the models presented herein could serve as prototypes for model development. © 2015 Family Process Institute.

Patch testing in Israeli children with suspected allergic contact dermatitis: A retrospective study and literature review.

PubMed

Zafrir, Yaron; Trattner, Akiva; Hodak, Emmillia; Eldar, Oren; Lapidoth, Moshe; Ben Amitai, Dan

2018-01-01

Childhood allergic contact dermatitis is recognized as a significant clinical problem. The objective was to evaluate the rate of positive patch tests in Israeli children with clinically suspected allergic contact dermatitis, identify possible sex and age differences, compare results with those in Israeli adults, and review pediatric studies in the literature. The study sample included 343 children and adolescents (197 female, 146 male; 1-18 years of age, mean age 11.8 years) with clinically suspected allergic contact dermatitis who underwent patch testing with a standard pediatric series of 23 allergens at a tertiary medical center from 1999 to 2012. Data on clinical characteristics and test results were collected retrospectively from the medical files. Ninety-eight subjects (28.6%) (75 girls [38.1%], 23 boys [15.8%]) had at least one positive reaction. The most frequent reactions were to nickel sulfate, followed by potassium dichromate and cobalt chloride. Nickel sulfate sensitivity was more common in girls, especially those younger than 3 years and older than 12 years. The prevalence of contact sensitization was similar in subjects with and without atopic dermatitis (50% and 51%, respectively). Nickel is the most common allergen in Israeli children, especially girls. Patch testing should be performed in children with clinically suspected allergic contact dermatitis regardless of atopic background. © 2017 Wiley Periodicals, Inc.

Pediatric glioblastoma multiforme: A single-institution experience.

PubMed

Ansari, Mansour; Nasrolahi, Hamid; Kani, Amir-Abbas; Mohammadianpanah, Mohammad; Ahmadloo, Niloofar; Omidvari, Shapour; Mosalaei, Ahmad

2012-07-01

Glioblastoma multiforme (GBM) is the most common astrocytoma in adults and has a poor prognosis, with a median survival of about 12 months. But, it is rare in children. We report our experience on the pediatric population (20 years or younger) with GBM. Twenty-three patients with GBM who were treated at our hospital during 1990-2008 were evaluated. The mean age was 15.2 years, and the majority of them (14/23) were male. All had received radiotherapy and some had also received chemotherapy. The mean survival was 16.0 months. Two cases survived more than 5 years. Age, radiation dose and performance status were significantly related to survival. GBM in pediatric patients were not very common in our center, and prognosis was unfavorable.

Gender Distribution of Pediatric Stone Formers

NASA Astrophysics Data System (ADS)

Novak, Thomas E.; Trock, Bruce J.; Lakshmanan, Yegappan; Gearhart, John P.; Matlaga, Brian R.

2008-09-01

Recent epidemiologic evidence suggests that the gender prevalence among adult stone-formers is changing, with an increasing incidence of stone disease among women. No similar data have ever been reported for the pediatric stone-forming population. We performed a study to define the gender distribution among pediatric stone-formers using a large-scale national pediatric database. Our findings suggest that gender distribution among stone formers varies by age with male predominance in the first decade of life shifting to female predominance in the second decade. In contrast to adults, females in the pediatric population are more commonly affected by stones than are males. The incidence of pediatric stone disease appears to be increasing at a great rate in both sexes. Further studies should build on this hypothesis-generating work and define the effects of metabolic and environmental risk factors that may influence stone risk in the pediatric patient population

NIH scientists map gene changes driving tumors in common pediatric soft-tissue cancer

Cancer.gov

Scientists have mapped the genetic changes that drive tumors in rhabdomyosarcoma, a pediatric soft-tissue cancer, and found that the disease is characterized by two distinct genotypes. The genetic alterations identified in this malignancy could be useful

Drug-induced seizures in children and adolescents presenting for emergency care: current and emerging trends.

PubMed

Finkelstein, Y; Hutson, J R; Freedman, S B; Wax, P; Brent, J

2013-01-01

Seizures may be the presenting manifestation of acute poisoning in children. Knowledge of the etiologic agent, or likely drug-class exposure, is crucial to minimize morbidity and optimize care. To describe the agents most commonly responsible for pediatric drug-induced seizures, whose evaluation included a medical toxicology consultation in the United States. Using the 37 participating sites of the Toxicology Investigators Consortium (ToxIC) Case Registry, a cross-country surveillance tool, we conducted an observational study of a prospectively collected cohort. We identified all pediatric (younger than 18 years) reports originating from an Emergency Department (ED) which included a chemical or drug-induced seizure, and required a medical toxicology consultation between April 1, 2010 and March 31, 2012. Results. We identified 142 pediatric drug-induced seizure cases (56% male), which represent nearly 5% of pediatric cases requiring bedside consultation by medical toxicologists. One-hundred and seven cases (75%) occurred in children aged 13-18 years, and 86 (61%) resulted from intentional ingestions. Antidepressants were the most commonly identified agents ingested (n = 61; 42%), of which bupropion was the leading drug (n = 30; 50% of antidepressants), followed by anticholinergics/antihistamines (n = 31; 22%). All antidepressant-induced seizures in teenagers were intentional and represented self-harm behavior. Sympathomimetic agents, including street drugs, represent the most common agents in children younger than 2 years (n = 4/19). Antidepressants, and specifically bupropion, are presently the most common medications responsible for pediatric drug-induced seizures requiring medical toxicology consultation in the United States. In teenagers presenting with new-onset seizures of unknown etiology, the possibility of deliberate self-poisoning should be explored, since most drug-induced seizures in this age group resulted from intentional ingestion.

Preterm piglets are a clinically relevant model of pediatric GI disease

USDA-ARS?s Scientific Manuscript database

The goal of our research is to establish how nutritional support, enteral versus parenteral, affects gut function and susceptibility to disease in early development. We and others have used the neonatal pig to establish unique models of clinically relevant problems in pediatric gastroenterology, esp...

Pediatric Art Therapy: Strategies and Applications.

ERIC Educational Resources Information Center

Prager, Anne

1995-01-01

Describes the strategies used in a practice of art therapy on the pediatric unit of a large, teaching hospital for children, illustrating points with case material. Strategies include assessment rounds to evaluate which children could benefit from art therapy, stressing staff communications, and circumventing problems resulting from illness which…

Implant and clinical characteristics for pediatric and congenital heart patients in the national cardiovascular data registry implantable cardioverter defibrillator registry.

PubMed

Jordan, Christopher P; Freedenberg, Vicki; Wang, Yongfei; Curtis, Jeptha P; Gleva, Marye J; Berul, Charles I

2014-12-01

In 2010, the National Cardiovascular Data Registry enhanced pediatric, nonatherosclerotic structural heart disease and congenital heart disease (CHD) data collection. This report characterizes CHD and pediatric patients undergoing implantable cardioverter defibrillator implantation. In this article, we report implantable cardioverter defibrillator procedures (April 2010 to December 2012) in the registry for 2 cohorts: (1) all patients with CHD (atrial septal defect, ventricular septal defect, tetralogy of Fallot, Ebstein anomaly, transposition of the great vessels, and common ventricle) and (2) patients <21 years. We evaluated indications and characteristics to include transvenous and nontransvenous lead implants, CHD type, and New York Heart Association class. There were 3139 CHD procedures, 1601 for patients <21 years and 126 for CHD <21 years. Implantable cardioverter defibrillator indications for patients with CHD were primary prevention in 1943 (61.9%) and secondary prevention in 1107 (35.2%). Pediatric patients had 935 (58.4%) primary prevention and 588 (36.7%) secondary prevention devices. Primary prevention had higher New York Heart Association class. Nontransvenous age (35.9 ± 23.2 versus 40.1 ± 24.6 years; P=0.05) and nontransvenous height (167.1 ± 18.9 cm; range, 53-193 cm versus 170.4 ± 13.1 cm; range, 61-203 cm; P<0.01) were lower than for transvenous patients. CHD and pediatrics had similar rates of transvenous (97%) and nontransvenous (3%) leads and did not differ from the overall registry. Transposition of the great vessels and common ventricle had higher rates of nontransvenous leads. Primary prevention exceeds secondary prevention for CHD and pediatrics. Nontransvenous lead patients were younger, with higher rates of transposition of the great vessels and common ventricle patients compared with transvenous lead patients. © 2014 American Heart Association, Inc.

The Triangle Technique: a new evidence-based educational tool for pediatric medication calculations.

PubMed

Sredl, Darlene

2006-01-01

Many nursing student verbalize an aversion to mathematical concepts and experience math anxiety whenever a mathematical problem is confronted. Since nurses confront mathematical problems on a daily basis, they must learn to feel comfortable with their ability to perform these calculations correctly. The Triangle Technique, a new educational tool available to nurse educators, incorporates evidence-based concepts within a graphic model using visual, auditory, and kinesthetic learning styles to demonstrate pediatric medication calculations of normal therapeutic ranges. The theoretical framework for the technique is presented, as is a pilot study examining the efficacy of the educational tool. Statistically significant results obtained by Pearson's product-moment correlation indicate that students are better able to calculate accurate pediatric therapeutic dosage ranges after participation in the educational intervention of learning the Triangle Technique.

Space Maintenance with an Innovative “Tube and Loop” Space Maintainer (Nikhil Appliance)

PubMed Central

Grover, Jyotika; Panthri, Prerna

2016-01-01

ABSTRACT Despite the best efforts in prevention, premature loss of primary teeth continues to be a common problem in pediatric dentistry, resulting in disruption of arch integrity and adversely affecting the proper alignment of permanent successors. Space maintainers (SMs) are special appliances used for maintaining space created due to premature loss of primary teeth. Band and loop SM is mostly indicated for the premature loss of single primary molar, but this appliance has a number of limitations both for operators and for patients. Presented in this article is an innovative “Tube and Loop” SM (Nikhil appliance) which offers several advantages over the conventional band and loop SM. It is not only easy and quick to fabricate but can also be completed in a single sitting and cumbersome steps like impression making and laboratory procedures namely soldering are eliminated. How to cite this article: Srivastava N, Grover J, Panthri P. Space Maintenance with an Innovative “Tube and Loop” Space Maintainer (Nikhil Appliance). Int J Clin Pediatr Dent 2016;9(1):86-89. PMID:27274163

Pediatric jaw fractures: indications for open reduction.

PubMed

Krausen, A S; Samuel, M

1979-01-01

Jaw fractures in children are generally managed without major surgical intervention. Closed reduction usually is sufficient to restore normal anatomy and function. The one inviolate principle is early treatment. During the past three years, four pediatric jaw fractures that required open reduction were treated. This mode of treatment was necessitated by the limitations imposed by pediatric dental anatomy and by the type of fractures encountered. In at least 24 months of follow-up, no dental problems have been seen.

Epidemiology of Global Pediatric Traumatic Brain Injury: Qualitative Review.

PubMed

Dewan, Michael C; Mummareddy, Nishit; Wellons, John C; Bonfield, Christopher M

2016-07-01

Traumatic brain injury (TBI) is a common condition affecting children all over the world, and it represents a global public health concern. It is unclear how geopolitical, societal, and ethnic differences may influence the nature of TBI among children. A comprehensive literature search was conducted incorporating studies with hospital-, regional-, or country-specific pediatric TBI epidemiology data published between 1995 and 2015. Incidence, age, severity, mechanism of injury, and other relevant injury characteristics were extracted and compared across diverse geographic regions. Thirty articles met inclusion criteria, incorporating TBI data from more than 165,000 children on 5 continents. The worldwide incidence of pediatric TBI ranges broadly and varies greatly by country, with most reporting a range between 47 and 280 per 100,000 children. After the age of 3, male children suffered higher rates of TBI than females. A bimodal age distribution is often described, with very young children (0-2 years) and adolescents (15-18) more commonly injured. Mild TBI (Glasgow Coma Scale ≥13) constitutes more than 80% of injuries, and up to 90% of all injuries are associated with negative imaging. Only a small fraction (<10%) requires surgical intervention. Independent of country or region of origin, the vast majority of children suffering TBI achieve a good clinical outcome. Hospital admission rates vary widely, with U.S. patients more commonly admitted than those from other countries. Falls and motor vehicle collisions (MVCs) represent the majority of injury mechanisms. In Africa and Asia, pedestrians were most commonly injured in MVCs, while vehicle occupants were more likely involved among Australian, European, and U.S. For children, nonaccidental trauma was prevalent in developing and developed nations alike. TBI is a relatively common entity stretching across traditional geographic and demographic boundaries and affecting pediatric populations worldwide. Continued civil infrastructure development and public health policy reforms may help to reduce the societal burden of pediatric TBI. Copyright © 2016 Elsevier Inc. All rights reserved.

Common pediatric cerebellar tumors: correlation between cell densities and apparent diffusion coefficient metrics.

PubMed

Koral, Korgün; Mathis, Derek; Gimi, Barjor; Gargan, Lynn; Weprin, Bradley; Bowers, Daniel C; Margraf, Linda

2013-08-01

To test whether there is correlation between cell densities and apparent diffusion coefficient (ADC) metrics of common pediatric cerebellar tumors. This study was reviewed for issues of patient safety and confidentiality and was approved by the Institutional Review Board of the University of Texas Southwestern Medical Center and was compliant with HIPAA. The need for informed consent was waived. Ninety-five patients who had preoperative magnetic resonance imaging and surgical pathologic findings available between January 2003 and June 2011 were included. There were 37 pilocytic astrocytomas, 34 medulloblastomas (23 classic, eight desmoplastic-nodular, two large cell, one anaplastic), 17 ependymomas (13 World Health Organization [WHO] grade II, four WHO grade III), and seven atypical teratoid rhabdoid tumors. ADCs of solid tumor components and normal cerebellum were measured. Tumor-to-normal brain ADC ratios (hereafter, ADC ratio) were calculated. The medulloblastomas and ependymomas were subcategorized according to the latest WHO classification, and tumor cellularity was calculated. Correlation was sought between cell densities and mean tumor ADCs, minimum tumor ADCs, and ADC ratio. When all tumors were considered together, negative correlation was found between cellularity and mean tumor ADCs (ρ = -0.737, P < .05) and minimum tumor ADCs (ρ = -0.736, P < .05) of common pediatric cerebellar tumors. There was no correlation between cellularity and ADC ratio. Negative correlation was found between cellularity and minimum tumor ADC in atypical teratoid rhabdoid tumors (ρ = -0.786, P < .05). In atypical teratoid rhabdoid tumors, no correlation was found between cellularity and mean tumor ADC and ADC ratio. There was no correlation between the ADC metrics and cellularity of the pilocytic astrocytomas, medulloblastomas, and ependymomas. Negative correlation was found between cellularity and ADC metrics of common pediatric cerebellar tumors. Although ADC metrics are useful in the preoperative diagnosis of common pediatric cerebellar tumors and this utility is generally attributed to differences in cellularity of tumors, tumor cellularity may not be the sole determinant of the differences in diffusivity.

DETECTION, RIBOTYPING AND ANTIMICROBIAL RESISTANCE PROPERTIES OF CLOSTRIDIUM DIFFICILE STRAINS ISOLATED FROM THE CASES OF DIARRHEA.

PubMed

Kouzegaran, Samaneh; Ganjifard, Mahmood; Tanha, Amir Saber

2016-10-01

Clostridium difficile is the most prevalent cause of antibiotic-associated infectious diarrhea al-around the world. Prevalence of virulent and resistant strains of Clostridium difficile is increasing now a day. The present investigation was carried out to study the prevalence, ribotyping and antibiotic resistance pattern of C. difficile isolated from diarrheic and non-diarrheic pediatrics. Four-hundred stool specimens were collected from the diarrheic and non-diarrheic pediatrics hospitalized due to the diseases other than diarrhea. Samples were cultured and their positive results were subjected to disk diffusion and PCR-based ribotyping. Thirty-five out of 400 (8.75%) samples were positive for C. difficile . Prevalence of C. difficile in diarrheic and non-diarrheic pediatrics were 11.25% and 4.16%, respectively. Male had the higher prevalence of bacteria than female ( P < 0.05). eight to twelve months old pediatrics were the most commonly infected group. R27 (14.28%), R1 (10.71%), R12 (7.14%), R13 (7.14%) and R18 (7.14%) were most commonly detected ribotypes. There were no positive results for studied ribotypes in non-diarrheic pediatrics. C. difficile strains had the highest levels of resistance against tetracycline (71.42%), erythromycin (57.14%), moxifloxacin (48.57%), metronidazole (28.57%) and clindamycin (22.85%) antibiotics. Prescription of antibiotics in diarrheic pediatrics, males and also 8-12 months old pediatrics should be done in a regular and cautious manner.

The management of menstrual suppression and uterine bleeding: a survey of current practices in the Pediatric Blood and Marrow Transplant Consortium.

PubMed

Adegite, Enitan A; Goyal, Rakesh K; Murray, Pamela J; Marshal, Mike; Sucato, Gina S

2012-09-01

Current guidelines recommend the use of combined hormonal contraceptive pills for menstrual suppression in pediatric blood and marrow transplant (BMT) recipients but recent research reveals that provider practice varies. This study was designed to describe the current practice for managing menstrual issues, that is, menstrual suppression and uterine bleeding, in pediatric BMT patients and to better understand health care providers' practices in the use of gonadotropin-releasing hormone agonists (GnRHa). A cross sectional survey consisting of 53 questions was distributed via email to principal investigators in the Pediatric Blood and Marrow Transplant Consortium (PBMTC). Responses were collected using www.surveymonkey.com. Menstrual suppression and uterine bleeding in pediatric BMT patients are primarily managed by pediatric oncologists (97%). The most frequently reported hormonal method used for induction of therapeutic amenorrhea was GnRHa (41%). The top three reasons for choosing a method were greater likelihood of amenorrhea, concerns about side effects, and possible gonadal protection. Continuous combined hormonal contraceptive pills were the most commonly used method for the management of clinically significant uterine bleeding regardless of primary method used for menstrual suppression. Despite the 2002 PBMTC guidelines, wide variation in menstrual suppression management practices still exists. Our data show that use of GnRHa is more common than previously reported. Additional research is needed to develop evidence-based practice guidelines in pediatric BMT patients. Copyright © 2012 Wiley Periodicals, Inc.

Primary and secondary management of pediatric soft tissue injuries.

PubMed

Hogg, Nicholas J V

2012-08-01

Injury is the most common cause of death in pediatric patients, with a large proportion related to head injury. The craniofacial region in children develops rapidly and at an early age, making the area more prominent compared with the remainder of the body, increasing the likelihood of injury. This article reviews the primary management of pediatric soft tissue injuries, including assessment, cleansing, surgical technique, anesthesia, and considerations for special wounds. The secondary management of pediatric facial injury is also discussed, including scar revision, management of scar hypertrophy/keloids, and staged surgical correction. Copyright © 2012 Elsevier Inc. All rights reserved.

Diagnostic Approach to Pediatric Spine Disorders.

PubMed

Rossi, Andrea; Martinetti, Carola; Morana, Giovanni; Severino, Mariasavina; Tortora, Domenico

2016-08-01

Understanding the developmental features of the pediatric spine and spinal cord, including embryologic steps and subsequent growth of the osteocartilaginous spine and contents is necessary for interpretation of the pathologic events that may affect the pediatric spine. MR imaging plays a crucial role in the diagnostic evaluation of patients suspected of harboring spinal abnormalities, whereas computed tomography and ultrasonography play a more limited, complementary role. This article discusses the embryologic and developmental anatomy features of the spine and spinal cord, together with some technical points and pitfalls, and the most common indications for pediatric spinal MR imaging. Copyright © 2016 Elsevier Inc. All rights reserved.

A 10-year retrospective review of pediatric lung abscesses from a single center

PubMed Central

Madhani, Kavi; McGrath, Eric; Guglani, Lokesh

2016-01-01

INTRODUCTION: Pediatric lung abscesses can be primary or secondary, and there is limited data regarding response to treatments and patient outcomes. OBJECTIVES: To assess the clinical and microbiologic profile of pediatric patients with lung abscess and assess the differences in outcomes for patients treated with medical therapy or medical plus surgical therapy. METHODS: A retrospective review of all pediatric patients ≤ 18 years of age that were treated as an inpatient for lung abscess between the dates of August 2004 and August 2014 was conducted. Patients were divided into two subgroups based on the need for surgical intervention. RESULTS: A total of 39 patients with lung abscess (30 treated with medical therapy alone, 9 also required surgical interventions) were included. Fever, cough, and emesis were the most common presenting symptoms, and most of the patients had underlying respiratory (31%) or neurologic disorders (15%). Staphylococcus aureus was the most common organism in those that had culture results available, and ceftriaxone with clindamycin was the most common combination of antibiotics used for treatment. Comparison of medical and surgical subgroups identified the duration of fever and abscess size as risk factors for surgical intervention. CONCLUSIONS: Pediatric lung abscesses can be managed with medical therapy alone in most cases. Presence of prolonged duration of fever and larger abscess size may be predictive of the need for surgical intervention. Good clinical response to prolonged therapy with ceftriaxone and clindamycin was noted. PMID:27512508

How do pediatric anesthesiologists define intraoperative hypotension?

PubMed

Nafiu, Olubukola O; Voepel-Lewis, Terri; Morris, Michelle; Chimbira, Wilson T; Malviya, Shobha; Reynolds, Paul I; Tremper, Kevin K

2009-11-01

Although blood pressure (BP) monitoring is a recommended standard of care by the ASA, and pediatric anesthesiologists routinely monitor the BP of their patients and when appropriate treat deviations from 'normal', there is no robust definition of hypotension in any of the pediatric anesthesia texts or journals. Consequently, what constitutes hypotension in pediatric anesthesia is currently unknown. We designed a questionnaire-based survey of pediatric anesthesiologists to determine the BP ranges and thresholds used to define intraoperative hypotension (IOH). Members of the Society of Pediatric Anesthesia (SPA) and the Association of Paediatric Anaesthetists (APA) of Great Britain and Ireland were contacted through e-mail to participate in this survey. We asked a few demographic questions and five questions about specific definitions of hypotension for different age groups of patients undergoing inguinal herniorraphy, a common pediatric surgical procedure. The overall response rate was 56% (483/860), of which 76% were SPA members. Majority of the respondents (72%) work in academic institutions, while 8.9% work in institutions with fewer than 1000 annual pediatric surgical caseload. About 76% of respondents indicated that a 20-30% reduction in baseline systolic blood pressure (SBP) indicates significant hypotension in children under anesthesia. Most responders (86.7%) indicated that they use mean arterial pressure or SBP (72%) to define IOH. The mean SBP values for hypotension quoted by SPA members was about 5-7% lower across all pediatric age groups compared to values quoted by APA members (P = 0.001 for all age groups). There is great variability in the BP parameters used and the threshold used for defining and treating IOH among pediatric anesthesiologists. The majority of respondents considered a 20-30% reduction from baseline in SBP as indicative of significant hypotension. Lack of a consensus definition for a common clinical condition like IOH could have implications for patient care as well as future clinical research.

Bridging Adult Experience to Pediatrics in Oncology Drug Development.

PubMed

Leong, Ruby; Zhao, Hong; Reaman, Gregory; Liu, Qi; Wang, Yaning; Stewart, Clinton F; Burckart, Gilbert

2017-10-01

Pediatric drug development in the United States has grown under the current regulations made permanent by the Food and Drug Administration Safety and Innovation Act of 2012. Over 1200 pediatric studies have now been submitted to the US FDA, but there is still a high rate of failure to obtain pediatric labeling for the indication pursued. Pediatric oncology represents special problems in that the disease is most often dissimilar to any cancer found in the adult population. Therefore, the development of drug dosing in pediatric oncology patients represents a special challenge. Potential approaches to pediatric dosing in oncology patients include extrapolation of efficacy from adult studies in those few cases where the disease is similar, inclusion of adolescent patients in adult trials when possible, and bridging the adult dose to the pediatric dose. An analysis of the recommended phase 2 dose for 40 molecularly targeted agents in pediatric patients provides some insight into current practices. Increased knowledge of tumor biology and efforts to identify and validate molecular targets and genetic abnormalities that drive childhood cancers can lead to increased opportunities for precision medicine in the treatment of pediatric cancers. © 2017, The American College of Clinical Pharmacology.

A Surgical Approach to Pediatric Glaucoma

PubMed Central

Khan, Arif O

2015-01-01

Glaucoma in children differs from adult-onset disease and typically requires surgical intervention. However, affected children exhibit a spectrum of disease severity and prospective data guiding the choice of operation are lacking. This article reviews common procedures and a surgical approach to pediatric glaucoma. PMID:26069523

Pediatric Pharmacokinetic Data: Implications for Environmental Risk Assessment for Children

EPA Science Inventory

Pharmacology and toxicology share a common interest in pharmacokinetic data, especially as it is available in pediatric populations. These data have been critical to the clinical pharmacologist for many years in designing age-specific dosing regimens. Now they are being used incr...

Complications of pediatric auditory brain stem implantation via retrosigmoid approach.

PubMed

Bayazit, Yildirim A; Abaday, Ayça; Dogulu, Fikret; Göksu, Nebil

2011-01-01

We aimed to present the complications of auditory brain stem implantations (ABI) in pediatric patients which were performed via retrosigmoid approach. Between March 2007 and February 2010, five prelingually deaf children underwent ABI (Medel device) operation via retrosigmoid approach. All children had severe cochlear malformations. The ages ranged from 20 months to 5 years. The perioperative complications encountered in 2 patients were evaluated retrospectively. No intraoperative complication was observed in the patients. Cerebrospinal fluid (CSF) leakage was the most common postoperative complication that was seen in 2 patients. The CSF leak triggered a cascade of comorbidities, and elongated the hospitalization. Pediatric ABI surgery can lead to morbidity. The CSF leak is the most common complication encountered in retrosigmoid approach. The other complications usually result from long-term hospital stay during treatment period of the CSF leak. Therefore, every attempt must be made to prevent occurrence of CSF leaks in pediatric ABI operations. Copyright © 2011 S. Karger AG, Basel.

[Surgical treatment of burns : Special aspects of pediatric burns].

PubMed

Bührer, G; Beier, J P; Horch, R E; Arkudas, A

2017-05-01

Treatment of pediatric burn patients is very important because of the sheer frequency of burn wounds and the possible long-term ramifications. Extensive burns need special care and are treated in specialized burn centers. The goal of this work is to present current standards in burn therapy and important innovations in the treatment of burns in children so that the common and small area burn wounds and scalds in pediatric patients in day-to-day dermatological practice can be adequately treated. Analysis of current literature, discussion of reviews, incorporation of current guidelines. Burns in pediatric patients are common. Improvement of survival can be achieved by treatment in burn centers. The assessment of burn depth and area is an important factor for proper treatment. We give an overview for outpatient treatment of partial thickness burns. New methods may result in better long-term outcome. Adequate treatment of burn injuries considering current literature and guidelines improves patient outcome. Rational implementation of new methods is recommended.

Epsilon aminocaproic acid reduces blood transfusion and improves the coagulation test after pediatric open-heart surgery: a meta-analysis of 5 clinical trials.

PubMed

Lu, Jun; Meng, Haoyu; Meng, Zhaoyi; Sun, Ying; Pribis, John P; Zhu, Chunyan; Li, Quan

2015-01-01

Excessive postoperative blood loss after cardiopulmonary bypass is a common problem, especially in patients suffering from congenital heart diseases. The efficacy of epsilon aminocaproic acid (EACA) as a prophylactic treatment for postoperative bleeding after pediatric open-heart surgery has not been determined. This meta-analysis investigates the efficacy of EACA in the minimization of bleeding and blood transfusion and the maintenance of coagulation tests after pediatric open-heart surgery. A comprehensive literature search was performed to identify all randomized clinical trials on the subject. PubMed, Embase, the Cochrane Library, and the Chinese Medical Journal Network were screened. The primary outcome used for the analysis was postoperative blood loss. Secondary outcomes included postoperative blood transfusion, re-exploration rate and postoperative coagulation tests. The mean difference (MD) and risk ratio (RR) with 95% confidence intervals (CI) were used as summary statistics. Five trials were included in this meta-analysis of 515 patients. Prophylactic EACA was associated with a reduction in postoperative blood loss, but this difference did not reach statistical significance (MD: -7.08; 95% CI: -16.11 to 1.95; P = 0.12). Patients treated with EACA received fewer postoperative blood transfusions, including packed red blood cells (MD: -8.36; 95% CI: -12.63 to -4.09; P = 0.0001), fresh frozen plasma (MD: -3.85; 95% CI: -5.63 to -2.08; P < 0.0001), and platelet concentrate (MD: -10.66; 95% CI: -18.45 to -2.87; P = 0.007), and had a lower re-exploration rate (RR: 0.46; 95% CI: 0.23 to 0.92; P = 0.03). Prophylactic EACA also improved coagulation tests 6 hours after open-heart surgery. Prophylactic EACA minimizes postoperative blood transfusion and helps maintain coagulation in pediatric patients undergoing open-heart surgery. Therefore, the results of this study indicate that adjunctive EACA is a good choice for the prevention of postoperative blood transfusion following pediatric cardiac surgery.

Pediatric Traumatic Brain Injury. Special Topic Report #3.

ERIC Educational Resources Information Center

Waaland, Pamela K.; Cockrell, Janice L.

This brief report summarizes what is known about pediatric traumatic brain injury, including the following: risk factors (e.g., males especially those ages 5 to 25, youth with preexisting problems including previous head injury victims, and children receiving inadequate supervision); life after injury; physical and neurological consequences (e.g.,…

Introducing Teamwork Challenges in Simulation Using Game Cards.

PubMed

Chang, Todd P; Kwan, Karen Y; Liberman, Danica; Song, Eric; Dao, Eugene H; Chung, Dayun; Morton, Inge; Festekjian, Ara

2015-08-01

Poor teamwork and communication during resuscitations are linked to patient safety problems and poorer outcomes. We present a novel simulation-based educational intervention using game cards to introduce challenges in teamwork. This intervention uses sets of game cards that designate roles, limitations, or communication challenges designed to introduce common communication or teamwork problems. Game cards are designed to be applicable for any simulation-based scenario and are independent from patient physiology. In our example, participants were pediatric emergency medicine fellows undergoing simulation training for orientation. We describe the use of card sets in different scenarios with increasing teamwork challenge and difficulty. Both postscenario and summative debriefings were facilitated to allow participants to reflect on their performance and discover ways to apply their strategies to real resuscitations. In this article, we present our experience with the novel use of game cards to modify simulation scenarios to improve communication and teamwork skills.

Developmental output failure: a study of low productivity in school-aged children.

PubMed

Levine, M D; Oberklaid, F; Meltzer, L

1981-01-01

Children with low academic productivity in late elementary and junior high school present a vexing problem to parents and schools. A subgroup of these youngsters may have underlying subtle handicaps that result in reduced productivity and chronic underachievement. Such children may be clinically characterized as exhibiting "developmental output failure." Using parent and teacher questionnaires, educational achievement tests, and pediatric neurodevelopmental assessments, a group of 26 children was selected according to predetermined criteria from among the clinic population seen in The School Function Program at The Children's Hospital Medical Center. Common findings among the group included problems with expressive language, fine motor tasks, finger agnosia, attention, and retrieval memory. It is suggested that clinicians be aware of the possibility that a child in this age group with low academic work output may have underlying developmental dysfunctions, whose manifestations may not have been evident earlier in life.

APPROACHES TO THE ASSESSMENT OF AROUSALS AND SLEEP DISTURBANCE IN CHILDREN

PubMed Central

Paruthi, Shalini; Chervin, Ronald D.

2010-01-01

Childhood arousals, awakenings, and sleep disturbances during the night are common problems for both patients and their families. Additionally, inadequate sleep may contribute to daytime sleepiness, behavioral problems, and other important consequences of pediatric sleep disorders. Arousals, awakenings, and sleep disturbances can be quantified by routine polysomnography, and arousal scoring is generally performed as part of the standard polysomnogram. Here we review current approaches to quantification of arousals and sleep disturbances and examine outcomes that have been associated with these measures. Initial data suggest that computer-assisted identification of nonvisible arousals, cyclic alternating patterns, or respiratory cycle-related EEG changes may complement what can be accomplished by human scorers. Focus on contiguous bouts of sleep or specific sleep stages may prove similarly useful. Incorporation of autonomic arousal measures—such as heart rate variability, pulse transit time, or peripheral arterial tone—into standard reports may additionally capture subtle sleep fragmentation. PMID:20620104

Do On-site Mental Health Professionals Change Pediatricians’ Responses to Children’s Mental Health Problems?

PubMed Central

Horwitz, Sarah McCue; Storfer-Isser, Amy; Kerker, Bonnie D.; Szilagyi, Moira; Garner, Andrew S.; O’Connor, Karen G.; Hoagwood, Kimberly E.; Green, Cori M.; Foy, Jane M.; Stein, Ruth E.K.

2016-01-01

Objective The objectives were to: assess the availability of on-site mental health professionals (MHP) in primary care; examine practice/pediatrician characteristics associated with on-site MHPs; and determine whether presence of on-site MHPs is related to pediatricians’ co-managing or more frequently identifying, treat/managing or referring MH problems. Methods Analyses included AAP members who participated in an AAP Periodic Survey in 2013 and who practiced general pediatrics (N=321). Measures included socio-demographics, practice characteristics, questions on about on-site MHPs, co-management of MH problems and pediatricians’ behaviors in response to 5 prevalent MH problems. Weighted univariate, bivariate and multivariable analyses were performed. Results Thirty-five percent reported on-site MHPs. Practice characteristics (medical schools/universities/HMOs, <100 visits/week, <80% of patients privately insured), and interactions of practice location (urban) with visits and patient insurance, were associated with on-site MHPs. There was no overall association between co-location and co-management or whether pediatricians usually identified, treat/managed or referred 5 common child MH problems. Among the subset of pediatricians who reported co-managing there was an association with co-management when the on-site MHP was a child psychiatrist, SA counselor, or social worker. Conclusions On-site MHPs are more frequent in settings where low-income children are served and where pediatricians train. Pediatricians who co-manage MH problems are more likely to do so when the on-site MHP is a child psychiatrist, SA counselor, or social worker. Overall, on-site MHPs were not associated with co-management or increased likelihood of pediatricians identifying, treating/managing, or referring children with 5 common child MH problems. PMID:27064141

Understanding the pediatric dermatology workforce shortage: mentoring matters.

PubMed

Admani, Shehla; Caufield, Maura; Kim, Silvia S; Siegfried, Elaine C; Friedlander, Sheila Fallon

2014-02-01

To target pediatric dermatologists directly in order to evaluate their current demographics and the most important motivating factors that influenced their career choice. Pediatric dermatology is one of the pediatric subspecialties with an inadequate supply to meet current patient needs. A survey was designed to evaluate the training pathway, employment status, participation in teaching, and clinical practice characteristics of pediatric dermatologists. The survey was administered to attendants of the 2010 Society for Pediatric Dermatology annual meeting. Any remaining board certified pediatric dermatologists who had not previously responded were queried via Survey Monkey. There was a 71% response rate. The majority chose a career in pediatric dermatology early, often prior to starting a dermatology residency. The vast majority of respondents noted mentorship as the most important influence on their decision to pursue a career in pediatric dermatology. The most common obstacles cited by respondents were financial hardship and resistance of some dermatology programs to accept applicants previously trained in pediatrics. Our survey provides evidence to support the importance of early exposure to the field and, most importantly, to committed pediatric dermatologists who can serve as mentors. This information may be helpful in approaching solutions to the workforce shortage in the field of pediatric dermatology. Copyright © 2014 Mosby, Inc. All rights reserved.

Factors associated with adolescent and caregiver reported problems in using asthma medications.

PubMed

Sleath, Betsy; Carpenter, Delesha M; Walsh, Kathleen E; Davis, Scott A; Watson, Claire Hayes; Lee, Charles; Loughlin, Ceila E; Garcia, Nacire; Reuland, Daniel S; Tudor, Gail

2018-04-18

The purpose of this study was to: (a) describe the types of medication problems/concerns youth with asthma and their caregivers reported and (b) examine the association between socio-demographic characteristics and youth and caregiver reported medication problems/concerns. English-and Spanish-speaking youth ages 11-17 with persistent asthma were recruited at four pediatric clinics. Youth were interviewed and caregivers completed questionnaires about reported asthma medication concerns/problems. Multiple logistic regression was used to analyze the data. Three hundred and fifty-nine youth were recruited. Eighty percent of youth and 70% of caregivers reported one or more problems in using asthma medications. The most commonly reported problems by youth were: (a) hard to remember when to take the asthma medication (54%) and (b) hard to use asthma medication at school (34%). Younger children were significantly more likely to report difficulty in understanding their asthma medication's directions and difficulty reading the print on the medication's package. Caregivers' top-reported problem was that it is hard for their child to remember to take their asthma medications (49%). Caregivers without Medicaid were significantly more likely to express difficulty paying for their child's asthma medications. Difficulty remembering to take asthma medication was a significant problem for youth and their caregivers. Providers should work with youth and their caregivers to identify asthma medication problems and discuss strategies to address those problems.

Forced-Air Warming During Pediatric Surgery: A Randomized Comparison of a Compressible with a Noncompressible Warming System.

PubMed

Triffterer, Lydia; Marhofer, Peter; Sulyok, Irene; Keplinger, Maya; Mair, Stefan; Steinberger, Markus; Klug, Wolfgang; Kimberger, Oliver

2016-01-01

Perioperative hypothermia is a common problem, challenging the anesthesiologist and influencing patient outcome. Efficient and safe perioperative active warming is therefore paramount; yet, it can be particularly challenging in pediatric patients. Forced-air warming technology is the most widespread patient-warming option, with most forced-air warming systems consisting of a forced-air blower connected to a compressible, double layer plastic and/or a paper blanket with air holes on the patient side. We compared an alternative, forced-air, noncompressible, under-body patient-warming mattress (Baby/Kleinkinddecke of MoeckWarmingSystems, Moeck und Moeck GmbH; group MM) with a standard, compressible warming mattress system (Pediatric Underbody, Bair Hugger, 3M; group BH). The study included 80 patients aged <2 years, scheduled for elective surgery. After a preoperative core temperature measurement, the patients were placed on the randomized mattress in the operation theater and 4 temperature probes were applied rectally and to the patients' skin. The warming devices were turned on as soon as possible to the level for pediatric patients as recommended by the manufacturer (MM = 40°C, BH = 43°C). There was a distinct difference of temperature slope between the 2 groups: core temperatures of patients in the group MM remained stable and mean of the core temperature of patients in the group BH increased significantly (difference: +1.48°C/h; 95% confidence interval, 0.82-2.15°C/h; P = 0.0001). The need for temperature downregulation occurred more often in the BH group, with 22 vs 7 incidences (RR, 3.14; 95% confidence interval, 1.52-6.52; P = 0.0006). Skin temperatures were all lower in the MM group. Perioperatively, no side effects related to a warming device were observed in any group. Both devices are feasible choices for active pediatric patient warming, with the compressible mattress system being better suited to increase core temperature. The use of lower pediatric forced-air temperature settings, as recommended by the manufacturer, in the noncompressible mattress group resulted in more stable core temperature conditions, with fewer forced-air temperature adjustments necessary to avoid hyperthermia.

Radiation doses for pediatric nuclear medicine studies: comparing the North American consensus guidelines and the pediatric dosage card of the European Association of Nuclear Medicine.

PubMed

Grant, Frederick D; Gelfand, Michael J; Drubach, Laura A; Treves, S Ted; Fahey, Frederic H

2015-04-01

Estimated radiation dose is important for assessing and communicating the risks and benefits of pediatric nuclear medicine studies. Radiation dose depends on the radiopharmaceutical, the administered activity, and patient factors such as age and size. Most radiation dose estimates for pediatric nuclear medicine have not been based on administered activities of radiopharmaceuticals recommended by established practice guidelines. The dosage card of the European Association of Nuclear Medicine (EANM) and the North American consensus guidelines each provide recommendations of administered activities of radiopharmaceuticals in children, but there are substantial differences between these two guidelines. For 12 commonly performed pediatric nuclear medicine studies, two established pediatric radiopharmaceutical administration guidelines were used to calculate updated radiation dose estimates and to compare the radiation exposure resulting from the recommendations of each of the guidelines. Estimated radiation doses were calculated for 12 common procedures in pediatric nuclear medicine using administered activities recommended by the dosage card of the EANM (version 1.5.2008) and the 2010 North American consensus guidelines for radiopharmaceutical administered activities in pediatrics. Based on standard models and nominal age-based weights, radiation dose was estimated for typical patients at ages 1, 5, 10 and 15 years and adult. The resulting effective doses were compared, with differences greater than 20% considered significant. Following either the EANM dosage card or the 2010 North American guidelines, the highest effective doses occur with radiopharmaceuticals labeled with fluorine-18 and iodine-123. In 24% of cases, following the North American consensus guidelines would result in a substantially higher radiation dose. The guidelines of the EANM dosage card would lead to a substantially higher radiation dose in 39% of all cases, and in 62% of cases in which patients were age 5 years or younger. For 12 commonly performed pediatric nuclear medicine studies, updated radiation dose estimates can guide efforts to reduce radiation exposure and provide current information for discussing radiation exposure and risk with referring physicians, patients and families. There can be substantial differences in radiation exposure for the same procedure, depending upon which of these two guidelines is followed. This discordance identifies opportunities for harmonization of the guidelines, which may lead to further reduction in nuclear medicine radiation doses in children.

Pediatric Spine Trauma in the United States--Analysis of the HCUP Kid'S Inpatient Database (KID) 1997-2009.

PubMed

Mendoza-Lattes, Sergio; Besomi, Javier; O'Sullivan, Cormac; Ries, Zachary; Gnanapradeep, Gnanapragasam; Nash, Rachel; Gao, Yubo; Weinstein, Stuart

2015-01-01

Few references are available describing the epidemiology of pediatric spine injuries. The purpose of this study is to examine the prevalence, risk factors and trends during the period from 1997 to 2009 of pediatric spine injuries in the United States using a large national database. Data was obtained from the Kid's Inpatient Database (KID) developed by the Healthcare Cost and Utilization Project (HCUP), for the years 1997-2009. This data includes >3 million discharges from 44 states and 4121 hospitals on children younger than 20 years. Weighted variables are provided which allow for the calculation of national prevalence rates. The Nationwide Emergency Department Sample (NEDS), HCUP. net, and National Highway Traffic Safety Administration (NHTSA) data were used for verification and comparison. A prevalence of 107.96 pmp (per million population) spine injuries in children and adolescents was found in 2009, which is increased from the 77.07 pmp observed in 1997. The group 15 to 19 years old had the highest prevalence of all age groups in (345.44 pmp). Neurological injury was present in 14.6% of the cases, for a prevalence of 15.82 pmp. The majority (86.7%) of these injuries occurred in children >15 years. Motor vehicle collisions accounted for 52.9% of all spine injuries, particularly in children >15 years. Between 1997 and 2009 the hospital length of stay decreased, but hospital charges demonstrated a significant increase. Pediatric Spine Injuries continue to be a relevant problem, with rates exceeding those of other industrialized nations. Teenagers >15 years of age were at greatest risk, and motor vehicle collisions accounted for the most common mechanism. An increase in prevalence was observed between 1997 and 2009, and this was matched by a similar increase in hospital charges. III.

Retrieval practice as an effective memory strategy in children and adolescents with traumatic brain injury.

PubMed

Coyne, Julia H; Borg, Jacquelyn M; DeLuca, John; Glass, Leslie; Sumowski, James F

2015-04-01

To investigate whether retrieval practice (RP) is a more effective memory strategy than restudy in children and adolescents with traumatic brain injury (TBI). Three × two within-subjects experiment: 3 (learning condition: massed restudy [MR], spaced restudy [SR], retrieval practice [RP]) × 2 (stimulus type: verbal paired associates [VPAs] and face-name pairs [FNPs]). The dependent measure was delayed recall of VPAs and FNPs. Subacute pediatric neurorehabilitation center. Pediatric survivors of TBI (N=15) aged 8 to 16 years with below-average memory. During RP, participants were quizzed on to-be-learned information (VPAs and FNPs) shortly after it was presented, such that they practiced retrieval during the learning phase. MR consisted of repeated restudy (tantamount to cramming). SR consisted of restudy trials separated in time (ie, distributed learning). Delayed recall of 24 VPAs and 24 FNPs after a 25-minute delay. VPAs and FNPs were equally divided across 3 learning conditions (16 per condition). There was a large main effect of learning condition on delayed recall (P<.001; ηp(2)=.84), with better mean recall of VPAs and FNPs studied through RP (6.23±1.39) relative to MR (3.60±1.53; P<.001) and SR (4.77±1.39; P<.001). Moreover, RP was the single best learning strategy for every participant. Memory problems and related academic learning difficulties are common after pediatric TBI. Herein, we identify RP as a promising and simple strategy to support learning and improve memory in children and adolescents with TBI. Our experimental findings were quite robust and set the stage for subsequent randomized controlled trials of RP in pediatric TBI. Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Efficacy of nitroglycerine ointment in the treatment of pediatric anal fissure.

PubMed

Joda, Ali E; Al-Mayoof, Ali F

2017-11-01

Anal fissure is the most common anal disease in children. In the past few decades, the understanding of its pathophysiology has led to a progressive reduction in invasive procedures in favor of conservative treatment based on stool softeners and the relaxation of the anal sphincter. This randomized controlled study assessed the safety and efficacy of nitroglycerine (NTG) ointment in the treatment of pediatric anal fissure, which had not yet been proved. An unequal randomized controlled study included 105 pediatric patients with anal fissure who had presented to the private and outpatient clinics of the Central Teaching Hospital of Pediatrics during the period from February 2015 to May 2016. The control group consisted of 70 patients. Both groups were treated with classical conservative therapy of sitz bath, stool softener, and local anesthetic. In the second group, chemical sphincterotomy with 0.2% NTG ointment was used in 35 patients, and was applied at the anal canal twice daily for 8weeks. The primary outcomes of symptomatic improvement and healed fissure, as well as side effects, were analyzed. The average age of patients was 2years (range, 4months to 5years). Patients in the NTG group had 77% symptomatic relief and 60% healed fissure compared to the control group, which had 54% and 32.8% respectively. All were statistically significant. No serious adverse effects were noticed during the treatment period. The use of 0.2% NTG ointment is an effective therapy for anal fissure in children in terms of good healing rate and rapid symptom relief, but it has the drawback of a long treatment period, making patient compliance more difficult, in addition to the problems of tolerance and recurrence. Prospective randomized controlled study (treatment study). Type 2. Copyright © 2017 Elsevier Inc. All rights reserved.

Quality of life and symptom prevalence as reported by children with cancer in Lebanon.

PubMed

Abu-Saad Huijer, Huda; Sagherian, Knar; Tamim, Hani

2013-12-01

To date, there are no studies on quality of life (QoL) and symptom prevalence reported by pediatric oncology patients in Lebanon. The purpose of this study was to evaluate the QoL, symptom prevalence and symptom management among a sample of pediatric oncology patients. The study design was cross-sectional. The Pediatric Quality of Life Inventory (PedsQL) cancer module and the Memorial Symptom Assessment Scale were administered in Arabic using face-to-face interviews to a convenience sample of 85 pediatric cancer patients (7-18 years) at a tertiary hospital in Lebanon. The mean age of the study group was 12.5 years with leukemia being the most common cancer (43.5%). The lowest scores on the PedsQL subscales were in nausea (score = 64.82; SD = 25.76) and worry (score = 68.14; SD = 30.07), thus indicating more problems in these areas. A comparison based on age showed significant differences in pain and hurt, nausea, and worry. In children (7-12 years), lack of appetite, pain, and nausea were mostly prevalent whereas adolescents (13-18 years) experienced lack of energy, irritability, and pain. In both age groups, pain and nausea were the most frequently treated symptoms. Overall, the participants had good health-related QoL as indicated by most of the PedsQL subscales. Symptom management was found to be inadequate and in some cases ineffective. More attention should be given to the management of symptoms in general using pharmacological and non-pharmacological techniques. Of particular importance is the importance of providing psychological support to alleviate symptom burden and improve QoL. Copyright © 2013 Elsevier Ltd. All rights reserved.

Pediatric ADHD Medication Exposures Reported to US Poison Control Centers.

PubMed

King, Samantha A; Casavant, Marcel J; Spiller, Henry A; Hodges, Nichole L; Chounthirath, Thitphalak; Smith, Gary A

2018-06-01

: media-1vid110.1542/5754332180001PEDS-VA_2017-3872 Video Abstract OBJECTIVES: To describe the characteristics and trends of exposures to attention-deficit/hyperactivity disorder (ADHD) medications among individuals 0 to 19 years old reported to US poison control centers. National Poison Data System data from 2000 through 2014 were retrospectively analyzed to examine pediatric ADHD medication exposures. From 2000 through 2014, there were 156 365 exposures reported to US poison control centers related to ADHD medications. The overall rate of reported exposures increased 71.2% from 2000 to 2011, followed by a 6.2% decrease from 2011 to 2014. Three-fourths (76.0%) of exposures involved children ≤12 years old. Methylphenidate and amphetamine medications accounted for 46.2% and 44.5% of exposures, respectively. The most common reason for exposure was therapeutic error (41.6%). Intentional medication exposures (including suspected suicide and medication abuse and/or misuse) were reported most often among adolescents (13-19 years old), accounting for 50.2% of exposures in this age group. Overall, the majority of exposed individuals (60.4%) did not receive health care facility treatment; however, 6.2% were admitted to a hospital for medical treatment, and there were 3 deaths. The increasing number and rate of reported ADHD medication exposures during the study period is consistent with increasing trends in ADHD diagnosis and medication prescribing. Exposures associated with suspected suicide or medication abuse and/or misuse among adolescents are of particular concern. Unintentional and intentional pediatric exposures to ADHD medications are an increasing problem in the United States, affecting children of all ages. Copyright © 2018 by the American Academy of Pediatrics.

Pediatric Dysphagia: Physiology, Assessment, and Management.

PubMed

Dodrill, Pamela; Gosa, Memorie M

2015-01-01

Infancy and childhood represent a time of unparalleled physical growth and cognitive development. In order for infants and children to reach their linear and neurological growth potential, they must be able to reliably and safely consume sufficient energy and nutrients. Swallowing difficulties (dysphagia) in pediatric populations can have a detrimental effect on dietary intake and, thus, growth and development. As a result, it is imperative to accurately identify and appropriately manage dysphagia in pediatric populations. This article provides an overview of dysphagia in children, as well as common causes of childhood swallowing difficulties, populations at risk for pediatric dysphagia, techniques used to assess swallowing in pediatric patients, and the current treatment options available for infants and children with dysphagia. © 2015 S. Karger AG, Basel.

Developmental Screening Using the Ages and Stages Questionnaire: Standardized versus Real-World Conditions

ERIC Educational Resources Information Center

San Antonio, Marianne C.; Fenick, Ada M.; Shabanova, Veronika; Leventhal, John M.; Weitzman, Carol C.

2014-01-01

Developmental screens are often used in nonstandardized conditions, such as pediatric waiting rooms, despite validation under standardized conditions. We examined the reproducibility of the Ages and Stages Questionnaire (ASQ), a developmental screening instrument commonly used in pediatric practices, under standardized versus nonstandardized…

Behavioral Assessment and Intervention in Pediatric Diabetes

ERIC Educational Resources Information Center

Wysocki, Tim

2006-01-01

This article reviews the empirical research literature on behavioral assessment and intervention methods in the context of diabetes mellitus in children and adolescents. The review summarizes the pathophysiology, medical management, and monitoring of pediatric type 1 and type 2 diabetes. Next, the article describes common behavioral barriers to…

Two Sides of the Same Coin: Pediatric-Onset and Adult-Onset Common Variable Immune Deficiency.

PubMed

Sanchez, Lauren A; Maggadottir, Solrun Melkorka; Pantell, Matthew S; Lugar, Patricia; Rundles, Charlotte Cunningham; Sullivan, Kathleen E

2017-08-01

Common variable immunodeficiency (CVID) is a complex, heterogeneous immunodeficiency characterized by hypogammaglobulinemia, recurrent infections, and poor antibody response to vaccination. While antibiotics and immunoglobulin prophylaxis have significantly reduced infectious complications, non-infectious complications of autoimmunity, inflammatory lung disease, enteropathy, and malignancy remain of great concern. Previous studies have suggested that CVID patients diagnosed in childhood are more severely affected by these complications than adults diagnosed later in life. We sought to discern whether the rates of various infectious and non-infectious conditions differed between pediatric-diagnosed (ages 17 or younger) versus adult-diagnosed CVID (ages 18 or older). Using the United States Immunodeficiency Network (USIDNET) database, we performed a retrospective analysis of 457 children and adults with CVID, stratified by age at diagnosis. Chi-squared testing was used to compare pediatric versus adult groups. After correcting for multiple comparisons, we identified few statistically significant differences (p ≤ 0.0004) between pediatric and adult groups. Pediatric-onset CVID patients had more frequent diagnoses of otitis media, developmental delay, and failure to thrive compared with adult-onset CVID patients. Adult CVID patients were more frequently diagnosed with bronchitis, arthritis, depression, and fatigue. Diagnoses of autoimmunity, lymphoma, and other malignancies were higher in adults but not to a significant degree. Serum immunoglobulins (IgG, IgA, and IgM) and lymphocyte subsets did not differ significantly between the two groups. When complications of infections and co-morbid conditions were viewed categorically, there were few differences between pediatric-onset and adult-onset CVID patients. These results suggest that pediatric CVID is not a distinct phenotype. Major features were comparable across the groups. This study underscores the need for continued longitudinal study of pediatric and early-onset CVID patients to further characterize accrual of features over time.

Comparative characteristics of primary hyperparathyroidism in pediatric and young adult patients.

PubMed

Nicholson, Kristina J; McCoy, Kelly L; Witchel, Selma F; Stang, Michael T; Carty, Sally E; Yip, Linwah

2016-10-01

Primary hyperparathyroidism is rare in pediatric patients. Our study aim was to compare primary hyperparathyroidism in pediatric (<19 years) and young adult (19-29 years) patients. A prospectively collected database from a single, high-volume institution was queried for all patients age <30 years who had initial parathyroidectomy for primary hyperparathyroidism yielding 126/4,546 (2.7%) primary hyperparathyroidism patients representing 39 pediatric and 87 young adult patients. Presenting symptoms, operative data, and postoperative course were compared for patients age 0-19 years and 20-29 years. Sporadic primary hyperparathyroidism was present in 81.7% and occurred less often in pediatric patients than young adult patients (74.4% vs 86.2%, P = .12). Among patients with hereditary primary hyperparathyroidism, multiple endocrine neoplasia type 1 was the most common type. Multiglandular disease was common in both pediatric (30.7%) and young adult (21.8%) patients. Following parathyroidectomy, 3 (2.3%) patients had permanent hypoparathyroidism and none had permanent recurrent laryngeal nerve paralysis. Biochemical cure at 6 months was equally likely in pediatric and young adult patients (97.1% vs 93.6%, P = .44) with comparable follow-up (78.4 months vs 69.1 months, P = .66) and rates of recurrent disease (5.9% vs 10.3%, P = .46). Recurrence was due to multiple endocrine neoplasia 1-related primary hyperparathyroidism in all cases. Although primary hyperparathyroidism is sporadic in most patients <19 years, they are more likely to have multiple endocrine neoplasia type 1-associated primary hyperparathyroidism (23%). Parathyroidectomy for primary hyperparathyroidism can be performed safely in pediatric patients with a high rate of cure. Follow-up for patients with hereditary disease is necessary. Copyright © 2016 Elsevier Inc. All rights reserved.

Pediatric Contact Dermatitis Registry Inaugural Case Data.

PubMed

Goldenberg, Alina; Mousdicas, Nico; Silverberg, Nanette; Powell, Douglas; Pelletier, Janice L; Silverberg, Jonathan I; Zippin, Jonathan; Fonacier, Luz; Tosti, Antonella; Lawley, Leslie; Wu Chang, Mary; Scheman, Andrew; Kleiner, Gary; Williams, Judith; Watsky, Kalman; Dunnick, Cory A; Frederickson, Rachel; Matiz, Catalina; Chaney, Keri; Estes, Tracy S; Botto, Nina; Draper, Michelle; Kircik, Leon; Lugo-Somolinos, Aida; Machler, Brian; Jacob, Sharon E

2016-01-01

Little is known about the epidemiology of allergic contact dermatitis (ACD) in US children. More widespread diagnostic confirmation through epicutaneous patch testing is needed. The aim was to quantify patch test results from providers evaluating US children. The study is a retrospective analysis of deidentified patch test results of children aged 18 years or younger, entered by participating providers in the Pediatric Contact Dermatitis Registry, during the first year of data collection (2015-2016). One thousand one hundred forty-two cases from 34 US states, entered by 84 providers, were analyzed. Sixty-five percent of cases had one or more positive patch test (PPT), with 48% of cases having 1 or more relevant positive patch test (RPPT). The most common PPT allergens were nickel (22%), fragrance mix I (11%), cobalt (9.1%), balsam of Peru (8.4%), neomycin (7.2%), propylene glycol (6.8%), cocamidopropyl betaine (6.4%), bacitracin (6.2%), formaldehyde (5.7%), and gold (5.7%). This US database provides multidisciplinary information on pediatric ACD, rates of PPT, and relevant RPPT reactions, validating the high rates of pediatric ACD previously reported in the literature. The registry database is the largest comprehensive collection of US-only pediatric patch test cases on which future research can be built. Continued collaboration between patients, health care providers, manufacturers, and policy makers is needed to decrease the most common allergens in pediatric consumer products.

Recommendations for the National Institute for Neurologic Disorders and Stroke spinal cord injury common data elements for children and youth with SCI.

PubMed

Mulcahey, M J; Vogel, L C; Sheikh, M; Arango-Lasprilla, J C; Augutis, M; Garner, E; Hagen, E M; Jakeman, L B; Kelly, E; Martin, R; Odenkirchen, J; Scheel-Sailer, A; Schottler, J; Taylor, H; Thielen, C C; Zebracki, K

2017-04-01

In 2014, the adult spinal cord injury (SCI) common data element (CDE) recommendations were made available. This project was a review of the adult SCI CDE for relevance to children and youth with SCI. The objective of this study was to review the National Institute of Neurologic Disorders and Stroke (NINDS) adult SCI CDEs for relevance to children and youth with SCI. International. The pediatric working group consisted of international members with varied fields of expertise related to pediatric SCI. The group convened biweekly meetings for 6 months in 2015. All of the adult SCI CDEs were reviewed, evaluated and modified/created for four age groups: 0-5 years, 6-12 years, 13-15 years and 16-18 years. Whenever possible, results of published research studies were used to guide recommendations. In the absence of empirical support, grey literature and international content expert consensus were garnered. Existing pediatric NINDS CDEs and new CDEs were developed in areas where adult recommendations were not appropriate. After internal working group review of domain recommendations, these pediatric CDEs were vetted during a public review from November through December 2015. Version 1.0 of the pediatric SCI CDEs was posted in February 2016. The pediatric SCI CDEs are incorporated directly into the NINDS SCI CDE sets and can be found at https://commondataelements.ninds.nih.gov.

Bilateral vocal cord paralysis in children.

PubMed

Chen, Eunice Y; Inglis, Andrew F

2008-10-01

Bilateral vocal cord paralysis in children with its many causes presents a challenging problem to the pediatric otolaryngologist. Traditionally, management of bilateral vocal cord paralysis includes securing the airway with a tracheotomy and waiting for spontaneous recovery. Surgeons have tried a variety of surgical procedures in lieu of or in addition to tracheotomy, but none are perfect solutions to the problem. This article reviews the current surgical procedures for bilateral vocal cord paralysis in the pediatric population with a particular focus on the senior author's experience with the endoscopic posterior costal cartilage grafting procedure.

Pediatric glioblastoma multiforme: A single-institution experience

PubMed Central

Ansari, Mansour; Nasrolahi, Hamid; Kani, Amir-Abbas; Mohammadianpanah, Mohammad; Ahmadloo, Niloofar; Omidvari, Shapour; Mosalaei, Ahmad

2012-01-01

Background: Glioblastoma multiforme (GBM) is the most common astrocytoma in adults and has a poor prognosis, with a median survival of about 12 months. But, it is rare in children. We report our experience on the pediatric population (20 years or younger) with GBM. Patients and Methods: Twenty-three patients with GBM who were treated at our hospital during 1990–2008 were evaluated. Results: The mean age was 15.2 years, and the majority of them (14/23) were male. All had received radiotherapy and some had also received chemotherapy. The mean survival was 16.0 months. Two cases survived more than 5 years. Age, radiation dose and performance status were significantly related to survival. Conclusion: GBM in pediatric patients were not very common in our center, and prognosis was unfavorable. PMID:23248421

Shared and unique common genetic determinants between pediatric and adult celiac disease.

PubMed

Senapati, Sabyasachi; Sood, Ajit; Midha, Vandana; Sood, Neena; Sharma, Suresh; Kumar, Lalit; Thelma, B K

2016-07-22

Based on age of presentation, celiac disease (CD) is categorised as pediatric CD and adult CD. It however remains unclear if these are genetically and/or phenotypically distinct disorders or just different spectrum of the same disease. We therefore explored the common genetic components underlying pediatric and adult CD in a well characterized north Indian cohort. A retrospective analysis of children (n = 531) and adult (n = 871) patients with CD between January 2001 and December 2010 was done. The database included basic demographic characteristics, clinical presentations, associated diseases and complications, if any. The genotype dataset was acquired for children (n = 217) and adult CD patients (n = 340) and controls (n = 736) using Immunochip. Association analysis was performed using logistic regression model to identify susceptibility genetic variants. The predominant form of CD was classical CD in both pediatric and adult CD groups. There was remarkable similarity between pediatric and adult CD except for quantitative differences between the two groups such as female preponderance, non-classical presentation, co-occurrence of other autoimmune diseases being more common amongst adult CD. Notably, same HLA-DQ2 and -DQ8 haplotypes were established as the major risk factors in both types of CD. In addition, a few suggestively associated (p < 5 × 10(-4)) non-HLA markers were identified of which only ANK3 (rs4948256-A; rs10994257-T) was found to be shared and explain risk for ~45 % of CD patients with HLA allele. Overall phenotypic similarity between pediatric and adult CD groups can be explained by contribution of same HLA risk alleles. Different non-HLA genes/loci with minor risk seem to play crucial role in disease onset and extra intestinal manifestation of CD. None of the non-HLA risk variants reached genome-wide significance, however most of them were shown to have functional implication to disease pathogenesis. Functional relevance of our findings needs to be investigated to address clinical heterogeneity of CD. This present study is the first comparative study based on common genetic markers to suggest that CD in pediatric age group and in adults are the spectrum of the same disease with novel and shared genetic risk determinants. Follow-up fine mapping studies with larger study cohorts are warranted for further genetic investigation.

Improving cognitive outcomes for pediatric stroke.

PubMed

Greenham, Mardee; Anderson, Vicki; Mackay, Mark T

2017-04-01

The past 20 years have seen a 35% increase in prevalence of pediatric stroke. Contrary to widely held views, children do not recover better than adults. This review explores the impact of pediatric stroke on cognitive domains, including intellectual and executive functions, memory and behavior, and the influence of age, lesion characteristics, and comorbidities on outcome. Cognitive problems occur in up to half of ischemic and hemorrhagic stroke survivors. Single-center studies have shown intelligence quotient scores skewed to the lower end of the average range, with greater impairment in performance than verbal domains. Executive function, such as attention and processing speed are particularly vulnerable to the effects of pediatric stroke. Age at stroke, larger infarct size, cortical/subcortical lesion location, epilepsy, and comorbid physical deficits are associated with poorer cognitive outcomes. Cognitive impairment occurs relatively frequently following pediatric stroke but the nature, severity, and predictors of specific deficits are not well defined. Improving understanding of outcomes following pediatric stroke is a key priority for families but a paucity of data limits the ability to develop targeted disease, and age-specific pediatric rehabilitation strategies to optimize cognitive outcomes following pediatric stroke.

The Effects of Attention Problems on Psychosocial Functioning in Childhood Brain Tumor Survivors: A 2-Year Postcraniospinal Irradiation Follow-up.

PubMed

Oh, Yunhye; Seo, Hyunjung; Sung, Ki Woong; Joung, Yoo Sook

2017-03-01

To examine the psychosocial outcomes and impact of attention problems in survivors of pediatric brain tumor. The survivors' cognitive functioning was measured using the Wechsler Intelligence Scale for Children. The Child Behavior Checklist-Attention Problems scale was used to screen for attention problems, and participants were classified as having attention problems (n=15) or normal attention (n=36). Psychosocial functioning was examined with the Korean Personality Rating scale for Children (K-PRC) at precraniospinal radiation and at 2-year follow-up. The attention problem group showed significantly higher depression and externalizing symptoms (delinquency, hyperactivity) and more significant impairment in family relationships than did the normal attention group at baseline. At follow-up, the attention problem group demonstrated significantly more delinquency and impaired family and social relationships. With the K-PRC scores, except for the somatization, social relationship subscale, there were significant differences between groups, but not in terms of treatment by time interaction or within time. At follow-up, multiple linear regressions showed that age at diagnosis significantly predicted K-PRC somatization (B=-1.7, P=0.004) and social relationships (B=-1.7, P=0.004), baseline full-scale intelligence quotient predicted K-PRC depression (B=-0.4, P=0.032) and somatization (B=-0.3, P=0.015), and attention problems at baseline predicted K-PRC depression (B=-15.2, P=0.036) and social relationships (B=-11.6, P=0.016). Pediatric brain tumor survivors, in particular, patients with attention problems, had worse psychosocial functioning at baseline and follow-up. Attention problems at baseline need to be carefully evaluated in assessing psychosocial functioning of pediatric brain tumor survivors.

Pediatric Thermal Burns and Treatment: A Review of Progress and Future Prospects

PubMed Central

Mathias, Elton

2017-01-01

Burn injuries are a devastating critical care problem. In children, burns continue to be a major epidemiologic problem around the globe resulting in significant morbidity and death. Apparently, treating these burn injuries in children and adults remains similar, but there are significant physiological and psychological differences. The dermal layer of the skin is generally thinner in neonates, infants, and children than in adults. Enhanced evaporative loss and need for isotonic fluids increases the risk of hypothermia in the pediatric population. The pain management of the children with major burns challenges the skills of the personnel of every unit. Managing these wounds requires intensive therapeutic treatment for multi-organ dysfunction, and surgical treatment to prevent sepsis and other complications that further delay wound closure. Alternatives to the practice of donor site harvest and autografting for the treatment of severe burns and other complex skin defects are urgently needed for both adult and pediatric populations. This review article focuses on thermal burn pathophysiology and pain management and provides an overview of currently approved products used for the treatment of pediatric burn wounds. A new promising approach has been presented as a first-line therapy in the treatment of burns to reduce surgical autografting in pediatric patients. PMID:29232903

[Focus of childhood obesity from pediatrics].

PubMed

Hurtado-López, Erika F; Macías-Rosales, Rocío

2014-01-01

The prevalences of overweight and obesity have increased dramatically in the last two decades in the adult and children population. The Organization for Cooperation and Economic Development reported in 2010 that Mexico ranks first worldwide in childhood obesity. The 2006 National Health and Nutrition Survey reported that one of every three teenagers are overweight and obese. In the last decades, pediatric hospitals in different parts of the world reported the prevalence of secondary malnutrition, since in those days overweight and obesity did not represent health problems. Currently, the prevalence of overweight and obesity has been scarcely studied in pediatric hospitals. In the Hospital de Pediatría (Children's Hospital) of the Instituto Mexicano del Seguro Social's Centro Médico Nacional de Occidente it is reported a prevalence of overweight of 15.4 % and obesity of 12.2 %, which reflects a nutritional transition.Due to the high prevalence of overweight and obesity in this pediatric hospital of reference, one could conclude that the pediatrician should be able to make a correct evaluation of the nutritional state, because, if he does not detect these problems, we will be condemning children to suffer from a chronic disease for the rest of their lives, and with all the implications in the short, medium and long term.

Pediatric inflammatory bowel disease in South India.

PubMed

Avinash, B; Dutta, A K; Chacko, A

2009-07-01

Among 34 children diagnosed to have inflammatory bowel disease (IBD) over past 8 years, 23 had Crohns disease and 11 had ulcerative colitis. Pediatric patients accounted for 7% of new cases of IBD seen annually. Median delay in diagnosis was 15 months. Nutritional impairment was significantly more common in Crohns disease.

The Pediatric Diabetes Consortium: Improving care of children with Type 1 diabetes through collaborative research

USDA-ARS?s Scientific Manuscript database

Although there are some interactions between the major pediatric diabetes programs in the United States, there has been no formal, independent structure for collaboration, the sharing of information, and the development of joint research projects that utilize common outcome measures. To fill this un...

Jaundice in the full-term newborn.

PubMed

Cohen, Shannon Munro

2006-01-01

Jaundice is a common problem affecting over half of all full-term and most preterm infants. Jaundice describes the yellow orange hue of the skin caused by excessive circulating levels of bilirubin that accumulate in the skin. In most healthy full-term newborns, jaundice is noticed during the first week of life. Shortened hospital stays and inconsistent follow up, especially for first-time breastfeeding mothers, prompted the American Academy of Pediatrics (AAP) to update management guidelines. Health care providers need to be familiar with the diagnosis and management of jaundice to prevent brain, vision, and hearing damage. Treatment of choice for jaundice remains close observation and frequent feeding followed by phototherapy, and finally exchange transfusion for severe or refractory cases.

Isolated ileal ganglioneuromatosis in an 11-year-old boy: Case report and review of literature.

PubMed

Mitra, Subhashis; Mukherjee, Sanghamitra; Chakraborty, Hema

2016-01-01

Ganglioneuromatous proliferation in the gastrointestinal tract is a rare occurrence and is usually associated with specific syndrome complexes such as multiple endocrine neoplasia Type 2B or von Recklinghausen's disease. We report here a case of diffuse intestinal ganglioneuromatosis, presenting as intestinal obstruction and chronic constipation in an 11-year-old boy. Sporadic cases of intestinal ganglioneuromatosis in the absence of any systemic manifestations are a very rare cause of enteric motility disorders in childhood, and we discuss the pathological and clinical significance of this finding. Histopathological identification of this uncommon cause of a common pediatric problem is important since the condition is amenable to surgical treatment.

Pearls of mandibular trauma management.

PubMed

Koshy, John C; Feldman, Evan M; Chike-Obi, Chuma J; Bullocks, Jamal M

2010-11-01

Mandibular trauma is a common problem seen by plastic surgeons. When fractures occur, they have the ability to affect the patient's occlusion significantly, cause infection, and lead to considerable pain. Interventions to prevent these sequelae require either closed or open forms of reduction and fixation. Physicians determining how to manage these injuries should take into consideration the nature of the injury, background information regarding the patient's health, and the patient's comorbidities. Whereas general principles guide the management of the majority of injuries, special consideration must be paid to the edentulous patient, complex and comminuted fractures, and pediatric patients. These topics are discussed in this article, with a special emphasis on pearls of mandibular trauma management.

Pearls of Mandibular Trauma Management

PubMed Central

Koshy, John C.; Feldman, Evan M.; Chike-Obi, Chuma J.; Bullocks, Jamal M.

2010-01-01

Mandibular trauma is a common problem seen by plastic surgeons. When fractures occur, they have the ability to affect the patient's occlusion significantly, cause infection, and lead to considerable pain. Interventions to prevent these sequelae require either closed or open forms of reduction and fixation. Physicians determining how to manage these injuries should take into consideration the nature of the injury, background information regarding the patient's health, and the patient's comorbidities. Whereas general principles guide the management of the majority of injuries, special consideration must be paid to the edentulous patient, complex and comminuted fractures, and pediatric patients. These topics are discussed in this article, with a special emphasis on pearls of mandibular trauma management. PMID:22550460

Pediatric Residents' Responses that Discourage Discussion of Psychosocial Problems in Primary Care

ERIC Educational Resources Information Center

Wissow, Lawrence S.; Larson, Susan; Anderson, Jada; Hadjiisky, Elizabeth

2005-01-01

Objective: Studies spanning nearly 4 decades demonstrate that doctors ignore or dismiss many patient bids for discussion of psychosocial topics. We sought to understand characteristics of doctors, patients, and visits in which this occurs. Methods: Reanalysis of 167 audiotapes from 2 studies of parent-doctor communication in a pediatric residents'…

Collaborative Consultation to Support Children with Pediatric Health Issues: A Review of the Biopsychoeducational Model

ERIC Educational Resources Information Center

Grier, Betsy Chesno; Bradley-Klug, Kathy L.

2011-01-01

Medical technology continues to improve, increasing life expectancies and capabilities of children with chronic illnesses and disabilities. Pediatric health issues have an impact on children's academic, emotional, behavioral, and social functioning. This article reviews a consultative Biopsychoeducational Model, based on a problem-solving process,…

Assessing Psychosocial Impairment in the Pediatric Emergency Department: Child/Caregiver Concordance

ERIC Educational Resources Information Center

Montano, Zorash; Mahrer, Nicole E.; Nager, Alan L.; Claudius, Ilene; Gold, Jeffrey I.

2011-01-01

The objective of this study was to examine the level of agreement between child- and caregiver-reports of the child's psychosocial problems presenting to a Pediatric Emergency Department (PED) using a validated screening tool. This was an anonymous, prospective, cross-sectional, multi-informant (child and caregiver) study assessing cognitive,…

Functional abdominal pain disorders in children.

PubMed

Rajindrajith, Shaman; Zeevenhooven, Judith; Devanarayana, Niranga Manjuri; Perera, Bonaventure Jayasiri Crispus; Benninga, Marc A

2018-04-01

Chronic abdominal pain is a common problem in pediatric practice. The majority of cases fulfill the Rome IV criteria for functional abdominal pain disorders (FAPDs). At times, these disorders may lead to rather serious repercussions. Area covered: We have attempted to cover current knowledge on epidemiology, pathophysiology, risk factors related to pathophysiology, clinical evaluation and management of children with FAPDs. Expert commentary: FAPDs are a worldwide problem with a pooled prevalence of 13.5%. There are a number of predisposing factors and pathophysiological mechanisms including stressful events, child maltreatment, visceral hypersensitivity, altered gastrointestinal motility and change in intestinal microbiota. It is possible that the environmental risk factors intricately interact with genes through epigenetic mechanisms to contribute to the pathophysiology. The diagnosis mainly depends on clinical evaluation. Commonly used pharmacological interventions do not play a major role in relieving symptoms. Centrally directed, nonpharmacological interventions such as hypnotherapy and cognitive behavioral therapy have shown both short and long term efficacy in relieving pain in children with FAPDs. However, these interventions are time consuming and need specially trained staff and therefore, not currently available at grass root level. Clinicians and researchers should join hands in searching for more pragmatic and effective therapeutic modalities to improve overall care of children with FAPDs.

Pediatric Cancer Patients' Important End-of-Life Issues, Including Quality of Life: A Survey of Pediatric Oncologists and Nurses in Japan.

PubMed

Nagoya, Yuko; Miyashita, Mitsunori; Shiwaku, Hitoshi

2017-05-01

Research into the key themes and concepts of quality of life (QOL) relevant to the end-of-life (EOL) care of pediatric cancer patients in the Japanese context is imperative. This study aimed at identifying the key items and constructive concepts of QOL at EOL of pediatric cancer patients. In 2015, pediatricians and nurses were recruited from 163 pediatric oncology treatment facilities in Japan. The questionnaire was developed on the basis of a previous qualitative study. Items that were rated as "very important" or "important" by at least 80% of the respondents were considered as "common and important" QOL items. Exploratory factor analysis was performed to conceptualize QOL of the pediatric cancer patients during EOL care. A total of 157 pediatricians and 270 nurses participated in this study. Fifty-five items were refined to 35 "common and important" QOL items. On factor analysis, 12 domains (containing 29 items) were identified: playing and learning; fulfilling wishes; spending time with family; receiving relief from physical and psychological suffering; making many wonderful memories; having a good relationship with the medical staff; having a peaceful death in the presence of family; spending time with a minimum of medical treatment; living one's life as usual; spending time in a calm hospital environment; being oneself; and having a close family. Although the respondents in this study were medical care providers rather than the patients or their family members, findings should help medical staff provide better palliative care to Japanese pediatric cancer patients.

Chapter 6 state of the science of pediatric traumatic brain injury: biomarkers and gene association studies.

PubMed

Reuter-Rice, Karin; Eads, Julia K; Berndt, Suzanna Boyce; Bennett, Ellen

2015-01-01

Our objective is to review the most widely used biomarkers and gene studies reported in pediatric traumatic brain injury (TBI) literature, to describe their findings, and to discuss the discoveries and gaps that advance the understanding of brain injury and its associated outcomes. Ultimately, we aim to inform the science for future research priorities. We searched PubMed, MEDLINE, CINAHL, and the Cochrane Database of Systematic Reviews for published English language studies conducted in the last 10 years to identify reviews and completed studies of biomarkers and gene associations in pediatric TBI. Of the 131 biomarker articles, only 16 were specific to pediatric TBI patients, whereas of the gene association studies in children with TBI, only four were included in this review. Biomarker and gene attributes are grossly understudied in pediatric TBI in comparison to adults. Although recent advances recognize the importance of biomarkers in the study of brain injury, the limited number of studies and genomic associations in the injured brain has shown the need for common data elements, larger sample sizes, heterogeneity, and common collection methods that allow for greater understanding of the injured pediatric brain. By building on to the consortium of interprofessional scientists, continued research priorities would lead to improved outcome prediction and treatment strategies for children who experience a TBI. Understanding recent advances in biomarker and genomic studies in pediatric TBI is important because these advances may guide future research, collaborations, and interventions. It is also important to ensure that nursing is a part of this evolving science to promote improved outcomes in children with TBIs.

Using Workflow Diagrams to Address Hand Hygiene in Pediatric Long-Term Care Facilities1

PubMed Central

Carter, Eileen J.; Cohen, Bevin; Murray, Meghan T.; Saiman, Lisa; Larson, Elaine L.

2015-01-01

Hand hygiene (HH) in pediatric long-term care settings has been found to be sub-optimal. Multidisciplinary teams at three pediatric long-term care facilities developed step-by-step workflow diagrams of commonly performed tasks highlighting HH opportunities. Diagrams were validated through observation of tasks and concurrent diagram assessment. Facility teams developed six workflow diagrams that underwent 22 validation observations. Four main themes emerged: 1) diagram specificity, 2) wording and layout, 3) timing of HH indications, and 4) environmental hygiene. The development of workflow diagrams is an opportunity to identify and address the complexity of HH in pediatric long-term care facilities. PMID:25773517

Sedation and Monitoring in the Pediatric Patient during Gastrointestinal Endoscopy.

PubMed

Chung, Hyun Kee; Lightdale, Jenifer R

2016-07-01

Sedation is a fundamental component of pediatric gastrointestinal procedures. The 2 main types of sedation for pediatric endoscopy remain general anesthesia and procedural sedation. Although anesthesiologist-administered sedation protocols are more common, there is no ideal regimen for endoscopy in children. This article discusses specific levels of sedation for endoscopy as well as various regimens that can be used to achieve each. Risks and considerations that may be specific to performing gastrointestinal procedures in children are reviewed. Finally, potential future directions for sedation and monitoring that may change the practice of pediatric gastroenterology and ultimately patient outcomes are examined. Copyright © 2016 Elsevier Inc. All rights reserved.

Magnetic resonance imaging of the pediatric neck: an overview.

PubMed

Shekdar, Karuna V; Mirsky, David M; Kazahaya, Ken; Bilaniuk, Larissa T

2012-08-01

Evaluation of neck lesions in the pediatric population can be a diagnostic challenge, for which magnetic resonance (MR) imaging is extremely valuable. This article provides an overview of the value and utility of MR imaging in the evaluation of pediatric neck lesions, addressing what the referring clinician requires from the radiologist. Concise descriptions and illustrations of MR imaging findings of commonly encountered pathologic entities in the pediatric neck, including abnormalities of the branchial apparatus, thyroglossal duct anomalies, and neoplastic processes, are given. An approach to establishing a differential diagnosis is provided, and critical points of information are summarized. Copyright © 2012 Elsevier Inc. All rights reserved.

Medical marijuana in pediatric oncology: A review of the evidence and implications for practice.

PubMed

Ananth, Prasanna; Reed-Weston, Anne; Wolfe, Joanne

2018-02-01

Medical marijuana (MM) has become increasingly legal at the state level and accessible to children with serious illness. Pediatric patients with cancer may be particularly receptive to MM, given purported benefits in managing cancer-related symptoms. In this review, we examine the evidence for MM as a supportive care agent in pediatric oncology. We describe the current legal status of MM, mechanism of action, common formulations, and potential benefits versus risks for pediatric oncology patients. We offer suggestions for how providers might approach MM requests. Throughout, we comment on avenues for future investigation on this growing trend in supportive care. © 2017 Wiley Periodicals, Inc.

Exposure Matching for Extrapolation of Efficacy in Pediatric Drug Development

PubMed Central

Mulugeta, Yeruk; Barrett, Jeffrey S.; Nelson, Robert; Eshete, Abel Tilahun; Mushtaq, Alvina; Yao, Lynne; Glasgow, Nicole; Mulberg, Andrew E.; Gonzalez, Daniel; Green, Dionna; Florian, Jeffry; Krudys, Kevin; Seo, Shirley; Kim, Insook; Chilukuri, Dakshina; Burckart, Gilbert J.

2017-01-01

During drug development, matching adult systemic exposures of drugs is a common approach for dose selection in pediatric patients when efficacy is partially or fully extrapolated. This is a systematic review of approaches used for matching adult systemic exposures as the basis for dose selection in pediatric trials submitted to the U.S. Food and Drug Administration (FDA) between 1998 and 2012. The trial design of pediatric pharmacokinetic (PK) studies and the pediatric and adult systemic exposure data were obtained from FDA publicly available databases containing reviews of pediatric trials. Exposure matching approaches that were used as the basis for pediatric dose selection were reviewed. The PK data from the adult and pediatric populations were used to quantify exposure agreement between the two patient populations. The main measures were the pediatric PK studies trial design elements and drug systemic exposures (adult and pediatric). There were 31 products (86 trials) with full or partial extrapolation of efficacy with an available PK assessment. Pediatric exposures had a range of mean Cmax and AUC ratios (pediatric/adult) of 0.63-4.19 and 0.36-3.60 respectively. Seven of the 86 trials (8.1%) had a pre-defined acceptance boundary used to match adult exposures. The key PK parameter was consistently predefined for antiviral and anti-infective products. Approaches to match exposure in children and adults varied across products. A consistent approach for systemic exposure matching and evaluating pediatric PK studies is needed to guide future pediatric trials. PMID:27040726

Assessment and Management of Treatment-Refractory Obsessive-Compulsive Disorder in Children

PubMed Central

Bloch, Michael H.; Storch, Eric A.

2015-01-01

OBJECTIVE To review the assessment and treatment of treatment-refractory pediatric obsessive-compulsive disorder (OCD). METHOD A PubMed search was conducted to identify controlled trials in pediatric OCD. Additionally, practice guidelines for the treatment of adults and children were further reviewed for references in treatment-refractory OCD across the lifespan. RESULTS Pharmacotherapy with selective serotonin reuptake inhibitors (SSRIs) and cognitive-behavioral therapy are effective treatments for pediatric OCD. Evidence suggests that CBT is additionally effective even in pediatric patients with refractory OCD symptoms. Antipsychotic augmentation, raising SSRI dosage, and several glutamate-modulating agents have some evidence of efficacy in adults with treatment-refractory OCD but have not been studied in pediatric populations. CONCLUSION Several pharmacological treatment options exist for children with refractory OCD symptoms. However, little evidence-based data exist to guide treatment for our most challenging pediatric OCD patients. Further research is needed to evaluate the efficacy/side-effect profile of commonly used interventions in treatment-refractory pediatric OCD. PMID:25791142

Nutraceuticals in the prophylaxis of pediatric migraine: Evidence-based review and recommendations.

PubMed

Orr, Serena L; Venkateswaran, Sunita

2014-07-01

The literature on complementary and alternative medicine (CAM) is expanding. One of the most common conditions for which CAM is studied in the pediatric population is migraine. Nutraceuticals are a form of CAM that is being used for pediatric migraine prophylaxis. A literature search was carried out in order to identify both observational studies and randomized controlled trials on the use of nutraceuticals for the prophylaxis of pediatric migraine. Adult studies on included nutraceuticals were also reviewed. Thirty studies were reviewed on six different nutraceuticals: butterbur, riboflavin, ginkgolide B, magnesium, coenzyme Q10 and polyunsaturated fatty acids. Overall, the quality of the evidence for the use of nutraceuticals in pediatric migraine prophylaxis is poor. Further research needs to be done in order to study the efficacy of nutraceuticals for the prophylaxis of pediatric migraine. © International Headache Society 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Management of natural health products in pediatrics: a provider-focused quality improvement project.

PubMed

Gutierrez, Emily; Silbert-Flagg, JoAnne; Vohra, Sunita

2015-01-01

The use of natural health products by pediatric patients is common, yet health care providers often do not provide management guidance. The purpose of this project was to improve management of natural health products by pediatric nurse practitioners. Pediatric nurse practitioners from large metropolitan city were recruited (n = 32). A paired pretest-posttest design was used. Study participants were engaged to improve knowledge of natural health products, and a management toolkit was created and tested. Mean knowledge scores increased from 59.19 to 76.3 (p < .01). Management practices improved with regard to patient guidance (p < .01) and resource utilization (p < .01). Assessments of product use (p = .51) and drug/herb interactions (p = .35) were not significant. This investigation is the first known study to improve knowledge and management of natural health products in pediatric clinical practice. Copyright © 2015 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.

International consensus on the diagnosis and management of pediatric patients with hereditary angioedema with C1 inhibitor deficiency.

PubMed

Farkas, H; Martinez-Saguer, I; Bork, K; Bowen, T; Craig, T; Frank, M; Germenis, A E; Grumach, A S; Luczay, A; Varga, L; Zanichelli, A

2017-02-01

The consensus documents published to date on hereditary angioedema with C1 inhibitor deficiency (C1-INH-HAE) have focused on adult patients. Many of the previous recommendations have not been adapted to pediatric patients. We intended to produce consensus recommendations for the diagnosis and management of pediatric patients with C1-INH-HAE. During an expert panel meeting that took place during the 9th C1 Inhibitor Deficiency Workshop in Budapest, 2015 (www.haenet.hu), pediatric data were presented and discussed and a consensus was developed by voting. The symptoms of C1-INH-HAE often present in childhood. Differential diagnosis can be difficult as abdominal pain is common in pediatric C1-INH-HAE, but also commonly occurs in the general pediatric population. The early onset of symptoms may predict a more severe subsequent course of the disease. Before the age of 1 year, C1-INH levels may be lower than in adults; therefore, it is advisable to confirm the diagnosis after the age of one year. All neonates/infants with an affected C1-INH-HAE family member should be screened for C1-INH deficiency. Pediatric patients should always carry a C1-INH-HAE information card and medicine for emergency use. The regulatory approval status of the drugs for prophylaxis and for acute treatment is different in each country. Plasma-derived C1-INH, recombinant C1-INH, and ecallantide are the only agents licensed for the acute treatment of pediatric patients. Clinical trials are underway with additional drugs. It is recommended to follow up patients in an HAE comprehensive care center. The pediatric-focused international consensus for the diagnosis and management of C1-INH-HAE patients was created. © 2016 The Authors. Allergy Published by John Wiley & Sons Ltd.

Attenuating the defibrillation dosage decreases postresuscitation myocardial dysfunction in a swine model of pediatric ventricular fibrillation

PubMed Central

Berg, Marc D.; Banville, Isabelle L.; Chapman, Fred W.; Walker, Robert G.; Gaballa, Mohammed A.; Hilwig, Ronald W.; Samson, Ricardo A.; Kern, Karl B.; Berg, Robert A.

2009-01-01

Objective The optimal biphasic defibrillation dose for children is unknown. Postresuscitation myocardial dysfunction is common and may be worsened by higher defibrillation doses. Adult-dose automated external defibrillators are commonly available; pediatric doses can be delivered by attenuating the adult defibrillation dose through a pediatric pads/cable system. The objective was to investigate whether unattenuated (adult) dose biphasic defibrillation results in greater postresuscitation myocardial dysfunction and damage than attenuated (pediatric) defibrillation. Design Laboratory animal experiment. Setting University animal laboratory. Subjects Domestic swine weighing 19 ± 3.6 kg. Interventions Fifty-two piglets were randomized to receive biphasic defibrillation using either adult-dose shocks of 200, 300, and 360 J or pediatric-dose shocks of ~50, 75, and 85 J after 7 mins of untreated ventricular fibrillation. Contrast left ventriculograms were obtained at baseline and then at 1, 2, 3, and 4 hrs postresuscitation. Postresuscitation left ventricular ejection fraction and cardiac troponins were evaluated. Measurements and Main Results By design, piglets in the adult-dose group received shocks with more energy (261 ± 65 J vs. 72 ± 12 J, p < .001) and higher peak current (37 ± 8 A vs. 13 ± 2 A, p < .001) at the largest defibrillation dose needed. In both groups, left ventricular ejection fraction was reduced significantly at 1, 2, and 4 hrs from baseline and improved during the 4 hrs postresuscitation. The decrease in left ventricular ejection fraction from baseline was greater after adult-dose defibrillation. Plasma cardiac troponin levels were elevated 4 hrs postresuscitation in 11 of 19 adult-dose piglets vs. four of 20 pediatric-dose piglets (p = .02). Conclusions Unattenuated adult-dose defibrillation results in a greater frequency of myocardial damage and worse postresuscitation myocardial function than pediatric doses in a swine model of prolonged out-of-hospital pediatric ventricular fibrillation cardiac arrest. These data support the use of pediatric attenuating electrodes with adult biphasic automated external defibrillators to defibrillate children. PMID:18496405

Recommendations for the clinical management of children with refractory epilepsy receiving the ketogenic diet.

PubMed

Alberti, María J; Agustinho, Ariela; Argumedo, Laura; Armeno, Marisa; Blanco, Virginia; Bouquet, Cecilia; Cabrera, Analía; Caraballo, Roberto; Caramuta, Luciana; Cresta, Araceli; de Grandis, Elizabeth S; De Martini, Martha G; Diez, Cecilia; Dlugoszewski, Corina; Escobal, Nidia; Ferrero, Hilario; Galicchio, Santiago; Gambarini, Victoria; Gamboni, Beatriz; Guisande, Silvina; Hassan, Amal; Matarrese, Pablo; Mestre, Graciela; Pesce, Laura; Ríos, Viviana; Sosa, Patricia; Vaccarezza, María; Viollaz, Rocío; Panico, Luis

2016-02-01

The ketogenic diet, a non-drug treatment with proven effectiveness, has been the most commonly used therapy in the past decade for the management of refractory epilepsy in the pediatric population. Compared to adding a new drug to a pre-existing treatment, the ketogenic diet is highly effective and reduces the number of seizures by 50-90% in approximately 45-60% of children after six months of treatment. For this reason, the Argentine Society of Pediatric Neurology established the Ketogenic Diet Working Group. It is integrated by pediatric dietitians, pediatricians, pediatric neurologists and B.S. in Nutrition, who developed recommendations for the optimal management of patients receiving the classical ketogenic diet based on expert consensus and scientific publications in this field. Sociedad Argentina de Pediatría.

Behavioral Pediatrics Feeding Assessment Scale in Young Children With Autism Spectrum Disorder: Psychometrics and Associations With Child and Parent Variables.

PubMed

Allen, Stephanie L; Smith, Isabel M; Duku, Eric; Vaillancourt, Tracy; Szatmari, Peter; Bryson, Susan; Fombonne, Eric; Volden, Joanne; Waddell, Charlotte; Zwaigenbaum, Lonnie; Roberts, Wendy; Mirenda, Pat; Bennett, Teresa; Elsabbagh, Mayada; Georgiades, Stelios

2015-07-01

The factor structure and validity of the Behavioral Pediatrics Feeding Assessment Scale (BPFAS; Crist & Napier-Phillips, 2001) were examined in preschoolers with autism spectrum disorder (ASD). Confirmatory factor analysis was used to examine the original BPFAS five-factor model, the fit of each latent variable, and a rival one-factor model. None of the models was adequate, thus a categorical exploratory factor analysis (CEFA) was conducted. Correlations were used to examine relations between the BPFAS and concurrent variables of interest. The CEFA identified an acceptable three-factor model. Correlational analyses indicated that feeding problems were positively related to parent-reported autism symptoms, behavior problems, sleep problems, and parenting stress, but largely unrelated to performance-based indices of autism symptom severity, language, and cognitive abilities, as well as child age. These results provide evidence supporting the use of the identified BPFAS three-factor model for samples of young children with ASD. © The Author 2015. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Children's Preferences for Pediatric Dentist Attire: A Multicenter Study.

PubMed

Ram, Diana; Hermida, Maria Laura; Jerozolimsky, Andrea Braun; Slav, Or-Yan; Wang, Hao-Yu; Abbate, Florencia Puig; Rodriguez, Ana Lorente; Cuadros-Fernández, Cristina; Leon, Roberto Vofovics; Davidovich, Esti

2018-01-01

Data are conflicting regarding the effect of professional staff attire on children at pediatric dental clinics. To compare the preferences of children and their parents in three countries, regarding the gender and attire of pediatric dentists. A multi-centered study was conducted in pediatric dental clinics in Israel (N=100), Uruguay (N=270) and Spain (N=200). Children, aged 4-12 years, and their parents were asked to choose the pediatric dentist they preferred from 5 pictures of the same male and 5 pictures of the same female, in different attire. In Israeli clinics, where half of the pediatric dentists were male, and they wore white coats or casual attire, these were preferred by children, with no preference regarding the dentist's gender. In Spain, where the majority of dentists were females, wearing surgical scrubs, children preferred female dentists with this attire. In Uruguay, where female dentists wore surgical or pediatric scrubs, these were preferred by children. Parents more often selected female than male dentists; they preferred pediatric scrubs for their children's dentists more often than their children preferred such attire. Children's preferences for the attire of pediatric dentists reflected the common wearing apparel for dentists at the clinics they attended.

Skill qualifications in pediatric minimally invasive surgery.

PubMed

Iwanaka, Tadashi; Morikawa, Yasuhide; Yamataka, Atsuyuki; Nio, Masaki; Segawa, Osamu; Kawashima, Hiroshi; Sato, Masahito; Terakura, Hirotsugu; Take, Hiroshi; Hirose, Ryuichiro; Yagi, Makoto

2011-07-01

In 2006, The Japanese Society of Pediatric Endoscopic Surgeons devised a plan to develop a pediatric endoscopic surgical skill qualification (ESSQ) system. This system is controlled by The Japan Society for Endoscopic Surgery. The standard requirement for skills qualification is the ability of each applicant to complete common types of laparoscopic surgery. The main goal of the system is to decrease complications of laparoscopic surgery by evaluating the surgical skills of each applicant and subsequently certify surgeons with adequate skills to perform laparoscopic operations safely. A committee of pediatric ESSQ created a checklist to assess the applicant's laparoscopic surgical skills. Skills are assessed in a double-blinded fashion by evaluating an unedited video recording of a fundoplication for pediatric gastroesophageal reflux disease. The initial pediatric ESSQ system was started in 2008. In 2008 and 2009, respectively, 9 out of 17 (53%) and 6 out of 12 (50%) applicants were certified as expert pediatric laparoscopic surgeons. Our ultimate goal is to provide safe and appropriate pediatric minimally invasive procedures and to avoid severe complications. To prove the predictive validity of this system, a survey of the outcomes of operations performed by certified pediatric surgeons is required.

Enhancing pediatric clinical trial feasibility through the use of Bayesian statistics.

PubMed

Huff, Robin A; Maca, Jeff D; Puri, Mala; Seltzer, Earl W

2017-11-01

BackgroundPediatric clinical trials commonly experience recruitment challenges including limited number of patients and investigators, inclusion/exclusion criteria that further reduce the patient pool, and a competitive research landscape created by pediatric regulatory commitments. To overcome these challenges, innovative approaches are needed.MethodsThis article explores the use of Bayesian statistics to improve pediatric trial feasibility, using pediatric Type-2 diabetes as an example. Data for six therapies approved for adults were used to perform simulations to determine the impact on pediatric trial size.ResultsWhen the number of adult patients contributing to the simulation was assumed to be the same as the number of patients to be enrolled in the pediatric trial, the pediatric trial size was reduced by 75-78% when compared with a frequentist statistical approach, but was associated with a 34-45% false-positive rate. In subsequent simulations, greater control was exerted over the false-positive rate by decreasing the contribution of the adult data. A 30-33% reduction in trial size was achieved when false-positives were held to less than 10%.ConclusionReducing the trial size through the use of Bayesian statistics would facilitate completion of pediatric trials, enabling drugs to be labeled appropriately for children.

A study of the mutational landscape of pediatric-type follicular lymphoma and pediatric nodal marginal zone lymphoma.

PubMed

Ozawa, Michael G; Bhaduri, Aparna; Chisholm, Karen M; Baker, Steven A; Ma, Lisa; Zehnder, James L; Luna-Fineman, Sandra; Link, Michael P; Merker, Jason D; Arber, Daniel A; Ohgami, Robert S

2016-10-01

Pediatric-type follicular lymphoma and pediatric marginal zone lymphoma are two of the rarest B-cell lymphomas. These lymphomas occur predominantly in the pediatric population and show features distinct from their more common counterparts in adults: adult-type follicular lymphoma and adult-type nodal marginal zone lymphoma. Here we report a detailed whole-exome deep sequencing analysis of a cohort of pediatric-type follicular lymphomas and pediatric marginal zone lymphomas. This analysis revealed a recurrent somatic variant encoding p.Lys66Arg in the transcription factor interferon regulatory factor 8 (IRF8) in 3 of 6 cases (50%) of pediatric-type follicular lymphoma. This specific point mutation was not detected in pediatric marginal zone lymphoma or in adult-type follicular lymphoma. Additional somatic point mutations in pediatric-type follicular lymphoma were observed in genes involved in transcription, intracellular signaling, and cell proliferation. In pediatric marginal zone lymphoma, no recurrent mutation was identified; however, somatic point mutations were observed in genes involved in cellular adhesion, cytokine regulatory elements, and cellular proliferation. A somatic variant in AMOTL1, a recurrently mutated gene in splenic marginal zone lymphoma, was also identified in a case of pediatric marginal zone lymphoma. The overall non-synonymous mutational burden was low in both pediatric-type follicular lymphoma and pediatric marginal zone lymphoma (4.6 mutations per exome). Altogether, these findings support a distinctive genetic basis for pediatric-type follicular lymphoma and pediatric marginal zone lymphoma when compared with adult subtypes and to one another. Moreover, identification of a recurrent point mutation in IRF8 provides insight into a potential driver mutation in the pathogenesis of pediatric-type follicular lymphoma with implications for novel diagnostic or therapeutic strategies.

A study of the mutational landscape of pediatric-type follicular lymphoma and pediatric nodal marginal zone lymphoma

PubMed Central

Ozawa, Michael G; Bhaduri, Aparna; Chisholm, Karen M; Baker, Steven A; Ma, Lisa; Zehnder, James L; Luna-Fineman, Sandra; Link, Michael P; Merker, Jason D; Arber, Daniel A; Ohgami, Robert S

2016-01-01

Pediatric-type follicular lymphoma and pediatric marginal zone lymphoma are two of the rarest B-cell lymphomas. These lymphomas occur predominantly in the pediatric population and show features distinct from their more common counterparts in adults: adult-type follicular lymphoma and adult-type nodal marginal zone lymphoma. Here we report a detailed whole-exome deep sequencing analysis of a cohort of pediatric-type follicular lymphomas and pediatric marginal zone lymphomas. This analysis revealed a recurrent somatic variant encoding p.Lys66Arg in the transcription factor interferon regulatory factor 8 (IRF8) in 3 of 6 cases (50%) of pediatric-type follicular lymphoma. This specific point mutation was not detected in pediatric marginal zone lymphoma or in adult-type follicular lymphoma. Additional somatic point mutations in pediatric-type follicular lymphoma were observed in genes involved in transcription, intracellular signaling, and cell proliferation. In pediatric marginal zone lymphoma, no recurrent mutation was identified; however, somatic point mutations were observed in genes involved in cellular adhesion, cytokine regulatory elements, and cellular proliferation. A somatic variant in AMOTL1, a recurrently mutated gene in splenic marginal zone lymphoma, was also identified in a case of pediatric marginal zone lymphoma. The overall non-synonymous mutational burden was low in both pediatric-type follicular lymphoma and pediatric marginal zone lymphoma (4.6 mutations per exome). Altogether, these findings support a distinctive genetic basis for pediatric-type follicular lymphoma and pediatric marginal zone lymphoma when compared with adult subtypes and to one another. Moreover, identification of a recurrent point mutation in IRF8 provides insight into a potential driver mutation in the pathogenesis of pediatric-type follicular lymphoma with implications for novel diagnostic or therapeutic strategies. PMID:27338637

[Eyberg inventory of child behavior. Standardization of the Spanish version and its usefulness in ambulatory pediatrics].

PubMed

García-Tornel Florensa, S; Calzada, E J; Eyberg, S M; Mas Alguacil, J C; Vilamala Serra, C; Baraza Mendoza, C; Villena Collado, H; González García, M; Calvo Hernández, M; Trinxant Doménech, A

1998-05-01

Taking into account the high prevalence of behavioral problems in the pediatric outpatient clinic, a need for a useful and easy to administer tool for the evaluation of this problem arises. The psychometric characteristics of the Spanish version of the Eyberg Behavioral Child Inventory (EBCI), [in Spanish Inventario de Eyberg para el Comportamiento de Niño (IECN)], a 36-item questionnaire were established. The ECBI inventory/questionnaire was translated into Spanish. The basis of the ECBI is the evaluation of the child's behavior through the parents' answers to the questionnaire. Healthy children between 2 and 12 years of age were included and were taken from pediatric outpatient clinics from urban and suburban areas of Barcelona and from our hospital's own ambulatory clinic. The final sample included 518 subjects. The mean score on the intensity scale was 96.8 and on the problem scale 3.9. Internal consistency (Cronbach's alpha) was 0.73 and the test-retest had an r of 0.89 (p < 0.001) for the intensity scale and r = 0.93 (p < 0.001) for the problem scale. Interrater reliability for the intensity scale was r = 0.58 (p < 0.001) and r = 0.32 (p < 0.001) for the problem scale. Concurrent validity between both scales was r = 0.343 (p < 0.001). The IECN is a useful and easy tool to apply in the pediatrician's office as a method for early detection of behavior problems.

Treating Mucocele in Pediatric Patients Using a Diode Laser: Three Case Reports.

PubMed

Bagher, Sara M; Sulimany, Ayman M; Kaplan, Martin; Loo, Cheen Y

2018-05-09

A mucocele is the most common minor salivary gland disease and among the most common biopsied oral lesions in pediatric patients. Clinically, a mucocele appears as a round well-circumscribed painless swelling ranging from deep blue to mucosa alike in color. Mucoceles rarely resolve on their own and surgical removal under local anesthesia is required in most cases. Different treatment options are described in the literature, including cryosurgery, intra-lesion injection of corticosteroid, micro-marsupialization and conventional surgical removal using a scalpel, and laser ablation. Therefore, the goal of this paper was to report three cases of mucocele removal in pediatric patients using a diode laser with a one-month follow-up. Mucoceles were removed by a pediatric dentist using a diode laser with a wavelength of 930 nm in continuous mode and a power setting of 1.8 Watts. In all cases, no bleeding occurred during or after the procedure and there was no need for suturing. On clinical examination during the one-month follow-up, in all three cases there was minimal or no scarring, minimal post-operative discomfort or pain, and no recurrence. Diode lasers provide an effective, rapid, simple, bloodless and well accepted procedure for treating mucocele in pediatric patients. Minimal post-operative discomfort and scarring was reported by all the three patients.

An occurrence of sepsis during inpatient fecal disimpaction.

PubMed

Darrow, Cory J; Devito, Justin F

2014-01-01

Functional constipation is a common pediatric problem that is often treated through well-established algorithms. Fecal disimpaction is the initial therapeutic step, and severe cases require hospitalization for intensive therapies. We describe a significant unexpected complication of this common clinical situation. An 8-year-old boy with suspected chronic functional constipation was hospitalized for disimpaction by continuous nasogastric administration of polyethylene glycol electrolyte (PEG-E) solution. On the sixth day of disimpaction, the patient abruptly developed fever, tachycardia, and tachypnea. Evaluation included blood culture, which grew Escherichia coli, and treatment with a course of appropriate antibiotics was provided. The safety of PEG-E solutions has been shown in studies of children with constipation, which made this patient's illness surprising. Several potential etiologies of his infection were considered, including bacterial translocation (BT). BT is defined as the passage of live microbes and microbial products from the gastrointestinal tract to extraintestinal sites, such as the bloodstream. It has been shown to occur in a variety of clinical conditions but is of unclear clinical significance. In this case, physical damage to the intestinal mucosa was thought to contribute to the potential occurrence of BT, and prolonged disimpaction was considered as a risk factor. E coli sepsis in a child undergoing inpatient nasogastric fecal disimpaction with PEG-E represents a clinical problem never before reported in the literature and should increase clinicians' indices of suspicion for uncommon complications of common procedures.

Transitioning patients with hypospadias and other penile abnormalities to adulthood: What to expect?

PubMed Central

Braga, Luis H.

2018-01-01

Hypospadias patients presenting to adult urologists do so with a wide range of symptoms and problems, including urethral stricture (45–72%), lower urinary tract symptoms (with or without stricture) (50–82%), urethrocutaneous fistula (16–30%), persisting hypospadias (14–43%), micturition spraying (24%), ventral curvature (14–24%), urinary tract infection (15–25%), or lichen sclerosus (13%; range 8–43). Many of these men have concurrent complications as the result of multiple operations and a variety of techniques. Patients with childhood repairs performed by a pediatric urologist are often lost to followup during adolescence and will reemerge in adulthood after what appeared to be a successful pediatric single-stage repair, stressing the need for long-term followup and transitional care. One of the major challenges in successful transitional care is that patients can feel traumatized with feelings of hopelessness surrounding their defects, leaving them hesitant to seek care. As well, these patients often have little knowledge regarding the type of repair or original location of the meatus. Urethral stricture is the most common presenting complication and could be related to various factors, with the clear etiology still under debate. These strictures can fall under four categories based on length, location, and previous surgeries. To lessen the difficulties in transitioning hypospadias patients from pediatric to adult practitioners, followup throughout childhood and adolescence for physical examination, as well as uroflowmetry, is mandatory. PMID:29681271

Pediatricians' beliefs and prescribing patterns of adolescent contraception: a provider survey.

PubMed

Swanson, K J; Gossett, D R; Fournier, M

2013-12-01

Teen pregnancy and sexually transmitted infection (STI) rates continue to be significant public health problems in the United States. While general pediatricians are in a unique position to improve these issues by addressing contraception with their adolescent patients, there are no data describing their current prescribing patterns. This study sought to elucidate the beliefs and prescribing patterns of general pediatricians and pediatrics residents and to distinguish whether these were affected by practice setting, level of training, or gender. General pediatricians and pediatrics residents affiliated with Lurie Children's Hospital in Chicago, IL, were asked to complete a survey regarding adolescent contraception. Questions were related to obtaining information about contraception, contraceptive counseling, knowledge of contraceptive methods, prescribing patterns of contraceptives, and concerns about individual contraceptive methods. 120 physicians of an eligible 411 physicians participated in this study (29%). 79% of participants had prescribed at least 1 contraceptive method. The most commonly prescribed method was oral contraceptive pills at 72%. We noted few differences in prescribing patterns based on above criteria. Numerous misconceptions existed among participants, including a high rate of concern about infertility with IUD use (29% among physicians who prescribed at least 1 method of contraception). General pediatricians can improve their rates of prescribing contraception to adolescents, and could utilize more of the approved methods. One way to do so may be to implement educational interventions among general pediatricians. Copyright © 2013 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

The delegation of tasks in the era of e-health to support community interventions in maternal and child health: lessons learned from the PACT-Denbaya project.

PubMed

Bagayoko, C-O; Niang, M; Anne, A; Traoré, D; Sangho, H; Traoré, A-K; Geissbuhler, A

2017-11-01

The PACT-Denbaya project (Program for community access to telemedicine for families) aimed to help improve the health of mothers and child in rural communities through the delegation of obstetric-gynecologic and pediatric tasks, supported by teleconsultations. This operational research took place in 6 community health centers in the Dioïla health district in Mali. Our method was based of the delegation of tasks, supported by teleconsultations. Experts in pediatrics and obstetrics/gynecology provided a week-long training program to general practitioners and midwives, in the management of the most common problems in the field and in the use of the "Bogou" teleconsultation and "Dudal" tele-education platforms to ensure exchanges and follow-up. Overall, 17 healthcare providers, that is, general practitioners, nurse-obstetricians, and midwives participated in sessions to strengthen gynecology-obstetric and pediatric capacity in the field. The evaluation of knowledge and of the indicators compared with the baseline of 8359 pregnancies and 1991 documented deliveries and of user satisfaction showed that this type of service resulted in decreased maternal and child mortality. In view of these results, we can deduce that the delegation of tasks, when it is supported by telehealth, encounters no resistance from the specialists and contributes to the significant improvement of maternal and infant health in remote areas. A long-term impact study is necessary to reinforce these results.

Vitamin D supplementation: we must not fail our children!

PubMed

Drury, Rosalyn; Rehm, Andreas; Johal, Simran; Nadler, Robert

2015-05-01

There is increasing concern that vitamin D deficiency poses a major health problem for children. Deficiency can cause hypocalcemic seizures, growth disturbances, and rickets and may influence diabetes, cardiovascular dysfunction, autoimmune diseases, and attention deficit hyperactivity disorders. Reduced vitamin D levels in children presenting to pediatric orthopedic services are common.In the United Kingdom, recommendations on vitamin D supplementation are set by the Department of Health (DoH) and the National Institute of Health and Clinical Excellence. These state that all children aged 6 months to 5 years ought to receive 7 to 8.5 μg of vitamin D daily.We carried out a survey of 203 parents attending our pediatric and pediatric orthopedic and fracture clinics to evaluate parental awareness of the DoH recommendations on vitamin D supplementation for children and to assess the extent to which children were receiving vitamin D supplements.About 85.71% of parents were not aware of the recommendations. Only 14.29% stated that they were aware of the benefits of vitamin D for their children and just 17.73% of children were receiving vitamin D supplementation; 17 via formula milk and 18 via multivitamin formulations.Parents are generally not aware about vitamin D supplementation because of a lack of information with the high rates of reported suboptimal vitamin D levels amongst children not being addressed resulting in increased health risks to our children. Major improvements are needed in the implementation of supplementation at all points of contact between parents and health-care professionals.

Using elements of hypnosis prior to or during pediatric dental treatment.

PubMed

Peretz, Benjamin; Bercovich, Roly; Blumer, Sigalit

2013-01-01

Most dental practitioners are familiar with pediatric patients expressing dental fear or anxiety. Occasionally, the dentist may encounter a situation where all behavioral techniques fail, while, for some reason, premedication or general anesthesia are contraindicated or rejected by the patient or his/her parents and a different approach is required. Hypnosis may solve the problem in some cases. The purpose of this study was to review the literature about techniques that use elements of hypnosis and hypnotic techniques prior to or during pediatric dental treatment. There is a limited amount of literature regarding the use of hypnosis and hypnotic elements in pediatric dentistry. Induction techniques, reframing, distraction, imagery suggestions, and hypnosis are identified, although mostly anecdotally, while there are very few structured controlled studies. Nevertheless, the advantages of using hypnotic elements and hypnosis in pediatric dentistry are evident.

When the going gets tough: pediatric constipation and encopresis.

PubMed

Philichi, Lisa

2008-01-01

Constipation and encopresis are two common conditions seen in the pediatric gastroenterology setting. Organic causes cannot be excluded although they are rarely diagnosed in infants and children with defecation disorders. To successfully treat these disorders, a combination of family education, disimpaction and maintenance medications, a well-balanced diet, and behavior management is essential.

Psychopathology in pediatric epilepsy: role of antiepileptic drugs.

PubMed

Caplan, Rochelle

2012-01-01

Children with epilepsy are usually treated with antiepileptic drugs (AEDS). Some AEDs adversely affect behavior in susceptible children. Since psychiatric comorbidity is prevalent in pediatric epilepsy, this paper attempts to disentangle these AED side effects from the psychopathology associated with this illness. It first outlines the clinical and methodological problems involved in determining if AEDs contribute to the behavior and emotional problems of children with epilepsy. It then presents research evidence for and against the role AEDs play in the psychopathology of children with epilepsy, and outlines how future studies might investigate this problem. A brief description of how to clinically separate out AED effects from the complex illness-related and psychosocial factors that contribute to the behavior difficulties of children with epilepsy concludes the paper.

Efforts by the American Academy of Pediatrics to prevent and reduce violence and its effects on children and adolescents.

PubMed

Comerci, G D

1996-01-01

The American Academy of Pediatrics (AAP) is an organization of 53,000 pediatricians committed to the attainment of optimal physical, mental, and social health for all infants, children, adolescents, and young adults. Recognizing the major impact that violence has on children and youth, the AAP has been working to prevent and reduce violence and its effects on the pediatric population. This article will describe AAP efforts intended to help pediatricians, other professionals, and the public to combat the problem.

Commentary: pediatric eHealth interventions: common challenges during development, implementation, and dissemination.

PubMed

Wu, Yelena P; Steele, Ric G; Connelly, Mark A; Palermo, Tonya M; Ritterband, Lee M

2014-07-01

To provide an overview of common challenges that pediatric eHealth researchers may encounter when planning, developing, testing, and disseminating eHealth interventions along with proposed solutions for addressing these challenges. The article draws on the existing eHealth literature and the authors' collective experience in pediatric eHealth research. The challenges associated with eHealth interventions and their proposed solutions are multifaceted and cut across a number of areas from eHealth program development through dissemination. Collaboration with a range of individuals (e.g., multidisciplinary colleagues, commercial entities, primary stakeholders) is the key to eHealth intervention success. To ensure adequate resources for design, development, and planning for sustainability, a number of public and private sources of funding are available. A study design that addresses ethical concerns and security issues is critical to ensure scientific integrity and intervention dissemination. Table I summarizes key issues to consider during eHealth intervention development, testing, and dissemination. © The Author 2014. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Mortality and Epidemiology in 256 Cases of Pediatric Traumatic Brain Injury: Korean Neuro-Trauma Data Bank System (KNTDBS) 2010-2014.

PubMed

Jeong, Hee-Won; Choi, Seung-Won; Youm, Jin-Young; Lim, Jeong-Wook; Kwon, Hyon-Jo; Song, Shi-Hun

2017-11-01

Among pediatric injury, brain injury is a leading cause of death and disability. To improve outcomes, many developed countries built neurotrauma databank (NTDB) system but there was not established nationwide coverage NTDB until 2009 and there have been few studies on pediatric traumatic head injury (THI) patients in Korea. Therefore, we analyzed epidemiology and outcome from the big data of pediatric THI. We collected data on pediatric patients from 23 university hospitals including 9 regional trauma centers from 2010 to 2014 and analyzed their clinical factors (sex, age, initial Glasgow coma scale, cause and mechanism of head injury, presence of surgery). Among all the 2617 THI patients, total number of pediatric patients was 256. The average age of the subjects was 9.07 (standard deviation±6.3) years old. The male-to female ratio was 1.87 to 1 and male dominance increases with age. The most common cause for trauma were falls and traffic accidents. Age ( p =0.007), surgery ( p <0.001), mechanism of trauma ( p =0.016), subdural hemorrhage (SDH) ( p <0.001), diffuse axonal injury (DAI) ( p <0.001) were statistically significant associated with severe brain injury. Falls were the most common cause of trauma, and age, surgery, mechanism of trauma, SDH, DAI increased with injury severity. There is a critical need for effective fall and traffic accidents prevention strategies for children, and we should give attention to these predicting factors for more effective care.

Facial palsy in children: emergency department management and outcome.

PubMed

Wang, Cheng-Hsien; Chang, Yu-Che; Shih, Hong-Mo; Chen, Chun-Yu; Chen, Jih-Chang

2010-02-01

To describe the characteristics of children who present to an emergency department (ED) with facial palsy and determine the association of outcome with etiology, degree of initial paralysis, and ED management. This was a retrospective cohort study of children who presented to an ED with facial nerve paralysis (FNP). There were 85 patients with a mean age of 8.0 (SD, 6.1) years; 60% (n = 51) of the patients were male, and 65.9% (n = 56) were admitted to the hospital. Bell palsy (50.6%) was the most common etiology followed by infectious (22.4%), traumatic (16.5%), congenital (7.1%), and neoplastic etiologies (3.5%). Patients with Bell palsy had shorter recovery times (P = 0.049), and traumatic cases required a longer time for recovery (P = 0.016). Acute otitis media (AOM)-related pediatric FNP had shorter recovery times than non-AOM-related cases (P = 0.005) in infectious group. Patients given steroid therapy did not have a shorter recovery time (P = 0.237) or a better recovery (P = 0.269). There was no difference in recovery rate of pediatric patients with Bell palsy between hospitalization or not (P = 0.952). Bell palsy, infection, and trauma were most common etiologies of pediatric FNP. Recovery times were shorter in pediatric patients with Bell palsy and AOM-related FNP, whereas recovery took longer in traumatic cases. Steroid therapy did not seem beneficial for pediatric FNP. Hospitalization is not indicated for pediatric patients with Bell palsy.

Morphine clearance in children: does race or genetics matter?

PubMed

Sadhasivam, Senthilkumar; Krekels, Elke H J; Chidambaran, Vidya; Esslinger, Hope R; Ngamprasertwong, Pornswan; Zhang, Kejian; Fukuda, Tsuyoshi; Vinks, Alexander A

2012-01-01

Interindividual variability in analgesic response and adverse effects of opioids because of narrow therapeutic indices are major clinical problems. Morphine is an opioid commonly used in children to manage perioperative pain. Al-though size and age often are considered primary covariates for morphine pharmacokinetic models, the impact of other factors important in personalizing care such as race and genetic variations on morphine disposition is not well documented. Genotype blinded clinical observational pharmacokinetic study. One hundred forty-six African American and Caucasian children scheduled for elective outpatient adenotonsillectomy were enrolled in our prospective genotype blinded observational study with standard perioperative clinical care. Tertiary care pediatric institution. Morphine bolus for intraoperative analgesia in children and pharmacokinetic analyses in different races. Pharmacokinetics and pharmacogenetics of intravenous morphine in a homogeneous pediatric outpatient surgical pain population were evaluated. The authors observed that African American children have higher morphine clearance than Caucasian children. The increased clearance is directed toward the formation of morphine-3-glucuronide formation, rather than the formation of morphine-6-glucuronide. Common uridine diphosphate glucuronosyl transferase (UGT) 2B7 genetic variations (2161C>T and 802C>T) were not associated with observed racial differences in morphine's clearance although the wild type of the UGT2B7 isozyme is more prevalent in the African Americans. Race of the child is an important factor in perioperative intravenous morphine's clearance and its potential role in personalizing analgesia with morphine needs further investigation.

Microbiology and mortality of pediatric febrile neutropenia in El Salvador.

PubMed

Gupta, Sumit; Bonilla, Miguel; Gamero, Mario; Fuentes, Soad L; Caniza, Miguela; Sung, Lillian

2011-05-01

Febrile neutropenia (FN) and infection-related mortality are major problems for children with cancer in low-income countries. Identifying predictors for adverse outcome of FN in low-income countries permits targeted interventions. We describe the nature and predictors of microbiologically documented infection (MDI) and mortality of FN in children with cancer in El Salvador. We examined Salvadoran pediatric oncology patients admitted with FN over a 1-year period. Data were collected prospectively. Demographic, treatment, and admission-related variables were examined as predictors of outcomes. Hundred six FN episodes among 85 patients were included. Twenty-three of 106 episodes (22%) were microbiologically documented; 13 of 106 episodes (12%) resulted in death. Gram-positive and gram-negative organisms were isolated in 14 of 23 and 11 of 23 specimens; polymicrobial infections were common (11 of 23 episodes of MDI). Older age decreased the MDI risk [odds ratio (OR) per year=0.87, 95% confidence interval (CI), 0.75-0.99; P=0.04] while increasing number of days since the last chemotherapy increased the risk (OR=1.03 per day, 95% CI, 1.01-1.04; P=0.002). Pneumonia diagnosed either clinically (OR=6.6, 95% CI, 1.8-30.0; P=0.005) or radiographically (OR=5.5, 95% CI, 1.7-18.1; P=0.005) was the only predictor of mortality. In El Salvador, polymicrobial infections were common. Pneumonia at admission identified children with FN at high risk of death; these children may benefit from targeted interventions.

Bourdieu at the bedside: briefing parents in a pediatric hospital.

PubMed

LeGrow, Karen; Hodnett, Ellen; Stremler, Robyn; McKeever, Patricia; Cohen, Eyal

2014-12-01

The philosophy of family-centered care (FCC) promotes partnerships between families and staff to plan, deliver, and evaluate services for children and has been officially adopted by a majority of pediatric hospitals throughout North America. However, studies indicated that many parents have continued to be dissatisfied with their decision-making roles in their child's care. This is particularly salient for parents of children with chronic ongoing complex health problems. These children are dependent upon medical technology and require frequent hospitalizations during which parents must contribute to difficult decisions regarding their child's care. Given this clinical issue, an alternative theoretical perspective was explored to redress this problem. Pierre Bourdieu's theoretical concepts of field, capital, and habitus were used to analyze the hierarchical relationships in pediatric acute care hospitals and to design a briefing intervention aimed at improving parents' satisfaction with decision making in that health care setting. © 2014 John Wiley & Sons Ltd.

An overview of pediatric dysphagia.

PubMed

Prasse, Jane E; Kikano, George E

2009-04-01

Difficulty swallowing or dysphagia can be present in children and adults alike. Pediatric dysphagias have long been recognized in the literature. Certain groups of infants with specific developmental and/or medical conditions have been identified as being at high risk for developing dysphagia. Still others may present with a swallowing or feeding problem as their primary symptom. Left untreated, these problems in infants and children can lead to failure to thrive, aspiration pneumonias, gastroesophageal reflux, and/or the inability to establish and maintain proper nutrition and hydration. Awareness of the prevalence of pediatric dysphagia in today's population and the signs and symptoms of this condition aids in its treatment. Early detection of dysphagia in infants and children is important to prevent or minimize complications. This article provides a review of symptoms, etiologies, and resources available regarding management of this condition to help the primary care physician and the families of young children and infants in its management.

Periscopic Spine Surgery.

DTIC Science & Technology

2000-02-01

radiation medicine, the neurosurgery intensive care unit (ICU), and the pediatrics ICU [Geary 1999a]. The major procedures impacted are spine tumor...radiation medicine, and the pediatric intensive care unit . Hardware and software problems addressed included modifications of patient positioning...planning. Attempts have been made to link mechanical tissue properties to cellular interaction through electrical impedance [7] and to Hounsfield units

What Teachers Need to Know about Pediatric Bipolar Disorder: A Delphi Study

ERIC Educational Resources Information Center

Lyons, Valerie E.

2013-01-01

The number of children diagnosed with pediatric bipolar disorder has increased 4,000% from 1994 to 2003. Researchers have identified the need for teachers' professional development in this area but have not specified what teachers need to know to effectively educate students. The problem addressed was this lack of clinical knowledge and…

Pediatric Thoracic Trauma in Iraq and Afghanistan.

PubMed

Keneally, Ryan J; Shields, Cynthia H; Hsu, Albert; Prior, Howard I; Creamer, Kevin M

2018-04-06

The objective of this study is to review available data on pediatric thoracic trauma seen at U.S. military treatment facilities in Iraq and Afghanistan and describe the scope of injuries, patterns seen, and associated mortality. The results were compared with adults injured in Iraq and Afghanistan and other reports of pediatric thoracic trauma in the literature. The investigators received approval from the Uniformed Services University of the Health Sciences' institutional review board before the study. The Joint Theatre Trauma Registry was queried for all patients with an ICD-9 code for thoracic trauma. Two-tailed Student's t-test, Mann-Whitney rank sum, χ2, ANOVA, or multiple logistic regression was used as indicated. There were 955 patients under the age of 18 yr, just over 12% of all thoracic trauma. Penetrating injuries were common (73.6%), including gunshot wounds. The most common pediatric diagnoses were contusions (45%), pneumothorax (40%), and rib and/or sternal fractures (18%). The overall mortality for children was 15.2% compared with 13.8% and 9% for civilian adults and Coalition members with thoracic trauma, respectively. Mortality was inversely related to age among pediatric patients. Children under 2 yr of age had the highest mortality (25.1%). Patients under 12 yr of age were more likely to die than those between 12 and 18 (OR 2.02, 95% CI 1.27-3.22) yr. Thoracic vascular injuries and cardiac injuries resulted in the highest mortality among pediatric patients. The presence of a hemothorax was independently associated with an increased risk for mortality (OR 1.78, 95% CI 1.06-2.99) as was a concomitant head injury (OR 2.17, 95% CI 1.33-3.54). There was a 2.7% incidence of burns among pediatric patients with a high associated mortality (46.2%). Nearly one-half of all the children identified required a transfusion (47%). Penetrating injuries predominated and these children commonly required a transfusion. Mortality was inversely related to age. Children with a hemothorax or a concomitant head injury had significant increases in mortality. Children with thoracic injury as the result of a burn suffered the highest mortality.

Critical assessment of pediatric neurosurgery patient/parent educational information obtained via the Internet.

PubMed

Garcia, Michael; Daugherty, Christopher; Ben Khallouq, Bertha; Maugans, Todd

2018-05-01

OBJECTIVE The Internet is used frequently by patients and family members to acquire information about pediatric neurosurgical conditions. The sources, nature, accuracy, and usefulness of this information have not been examined recently. The authors analyzed the results from searches of 10 common pediatric neurosurgical terms using a novel scoring test to assess the value of the educational information obtained. METHODS Google and Bing searches were performed for 10 common pediatric neurosurgical topics (concussion, craniosynostosis, hydrocephalus, pediatric brain tumor, pediatric Chiari malformation, pediatric epilepsy surgery, pediatric neurosurgery, plagiocephaly, spina bifida, and tethered spinal cord). The first 10 "hits" obtained with each search engine were analyzed using the Currency, Relevance, Authority, Accuracy, and Purpose (CRAAP) test, which assigns a numerical score in each of 5 domains. Agreement between results was assessed for 1) concurrent searches with Google and Bing; 2) Google searches over time (6 months apart); 3) Google searches using mobile and PC platforms concurrently; and 4) searches using privacy settings. Readability was assessed with an online analytical tool. RESULTS Google and Bing searches yielded information with similar CRAAP scores (mean 72% and 75%, respectively), but with frequently differing results (58% concordance/matching results). There was a high level of agreement (72% concordance) over time for Google searches and also between searches using general and privacy settings (92% concordance). Government sources scored the best in both CRAAP score and readability. Hospitals and universities were the most prevalent sources, but these sources had the lowest CRAAP scores, due in part to an abundance of self-marketing. The CRAAP scores for mobile and desktop platforms did not differ significantly (p = 0.49). CONCLUSIONS Google and Bing searches yielded useful educational information, using either mobile or PC platforms. Most information was relevant and accurate; however, the depth and breadth of information was variable. Search results over a 6-month period were moderately stable. Pediatric neurosurgery practices and neurosurgical professional organization websites were inferior (less current, less accurate, less authoritative, and less purposeful) to governmental and encyclopedia-type resources such as Wikipedia. This presents an opportunity for pediatric neurosurgeons to participate in the creation of better online patient/parent educational material.

[Clinical application evaluation of Guidelines for the Diagnosis and Treatment of Common Diseases of Pediatrics in Traditional Chinese Medicine].

PubMed

Liu, Meng-Yu; Yang, Wei; Wang, Li-Ying; Zhao, Xue-Yao; Wang, Yue-Xi; Liu, Yu-Qi; Han, Xue-Jie; Lv, Ai-Ping

2017-09-01

Clinical application evaluation research of Guidelines for the Diagnosis and Treatment of Common Diseases of Pediatrics in Traditional Chinese Medicine intends to evaluate the quality level and clinical application of the guideline. A questionnaire and prospective case survey methods were used to evaluate the applicability evaluation based on the clinician questionnaire and the application evaluation based on clinical case observation. The applicability evaluation, familiarity and utilization rate of doctors' guidelines were 85.06%, 62.76%; Sort by technical grade, intermediate grade doctors have a higher familiarity rate and utilization rate, while the junior grade doctor's is lower; Guide quality level of applicability evaluation, other items' rational percentage are better than 96% except the items of health preserving and prevention and other treatment is relatively low; Items' applicable percentage of applicability evaluation are more than 91% except the item of guide simplicity. Comprehensive applicability evaluation, The percentage of the guideline applicable to clinical practice accounted for 94.94%. The consistency rate of syndrome differentiation and clinical application is more than 96% in addition to prescription medication, other treatments and health preserving and prevention of the guidelines apply consistency of application evaluation. The percentage of good treatment effect accounted for 92.96% of application effect evaluation. The safety percentage is 99.89% and economy is 97.45%. The research shows that of Guidelines for the Diagnosis and Treatment of Common Diseases of Pediatrics in Traditional Chinese Medicine quality level is good and is basically applicable to pediatric clinical practice which can be used as a standardized recommendation of pediatric common diseases' treatment specification. A small part of the guidelines are not applicable and need to be further consummated. Health preserving and prevention and other treatment of the guideline need to be revised. Copyright© by the Chinese Pharmaceutical Association.

Child sex trafficking and commercial sexual exploitation: health care needs of victims.

PubMed

Greenbaum, Jordan; Crawford-Jakubiak, James E

2015-03-01

Child sex trafficking and commercial sexual exploitation of children (CSEC) are major public health problems in the United States and throughout the world. Despite large numbers of American and foreign youth affected and a plethora of serious physical and mental health problems associated with CSEC, there is limited information available to pediatricians regarding the nature and scope of human trafficking and how pediatricians and other health care providers may help protect children. Knowledge of risk factors, recruitment practices, possible indicators of CSEC, and common medical and behavioral health problems experienced by victims will help pediatricians recognize potential victims and respond appropriately. As health care providers, educators, and leaders in child advocacy, pediatricians play an essential role in addressing the public health issues faced by child victims of CSEC. Their roles can include working to increase recognition of CSEC, providing direct care and anticipatory guidance related to CSEC, engaging in collaborative efforts with medical and nonmedical colleagues to provide for the complex needs of youth, and educating child-serving professionals and the public. Copyright © 2015 by the American Academy of Pediatrics.

Chiari malformation Type I surgery in pediatric patients. Part 2: complications and the influence of comorbid disease in California, Florida, and New York.

PubMed

Greenberg, Jacob K; Olsen, Margaret A; Yarbrough, Chester K; Ladner, Travis R; Shannon, Chevis N; Piccirillo, Jay F; Anderson, Richard C E; Wellons, John C; Smyth, Matthew D; Park, Tae Sung; Limbrick, David D

2016-05-01

OBJECTIVE Chiari malformation Type I (CM-I) is a common and often debilitating pediatric neurological disease. However, efforts to guide preoperative counseling and improve outcomes research are impeded by reliance on small, single-center studies. Consequently, the objective of this study was to investigate CM-I surgical outcomes using population-level administrative billing data. METHODS The authors used Healthcare Cost and Utilization Project State Inpatient Databases (SID) to study pediatric patients undergoing surgical decompression for CM-I from 2004 to 2010 in California, Florida, and New York. They assessed the prevalence and influence of preoperative complex chronic conditions (CCC) among included patients. Outcomes included medical and surgical complications within 90 days of treatment. Multivariate logistic regression was used to identify risk factors for surgical complications. RESULTS A total of 936 pediatric CM-I surgeries were identified for the study period. Overall, 29.2% of patients were diagnosed with syringomyelia and 13.7% were diagnosed with scoliosis. Aside from syringomyelia and scoliosis, 30.3% of patients had at least 1 CCC, most commonly neuromuscular (15.2%) or congenital or genetic (8.4%) disease. Medical complications were uncommon, occurring in 2.6% of patients. By comparison, surgical complications were diagnosed in 12.7% of patients and typically included shunt-related complications (4.0%), meningitis (3.7%), and other neurosurgery-specific complications (7.4%). Major complications (e.g., stroke or myocardial infarction) occurred in 1.4% of patients. Among children with CCCs, only comorbid hydrocephalus was associated with a significantly increased risk of surgical complications (OR 4.5, 95% CI 2.5-8.1). CONCLUSIONS Approximately 1 in 8 pediatric CM-I patients experienced a surgical complication, whereas medical complications were rare. Although CCCs were common in pediatric CM-I patients, only hydrocephalus was independently associated with increased risk of surgical events. These results may inform patient counseling and guide future research efforts.

Psychosocial Profile and Quality of Life in Children With Type 1 Narcolepsy: A Case-Control Study

PubMed Central

Rocca, Francesca Letizia; Finotti, Elena; Pizza, Fabio; Ingravallo, Francesca; Gatta, Michela; Bruni, Oliviero; Plazzi, Giuseppe

2016-01-01

Study Objectives: To investigate behavioral aspects and quality of life in children and adolescents with type 1 narcolepsy (NT1). Methods: We performed a case-control study comparing 29 patients with NT1 versus sex- and age-matched patients with idiopathic epilepsy (n = 39) and healthy controls (n = 39). Behavior and quality of life were evaluated by self-administered questionnaires (Child Behavior Checklist, Pediatric Quality of Life Inventory). Patient groups were contrasted and scale results were correlated with clinical and polysomnographic parameters, and cerebrospinal fluid hypocretin-1 levels. Results: Young patients with NT1 showed increased internalizing problems associated with aggressive behavior. Emotional profile in patients with NT1 positively correlated with age at onset, diagnostic delay, and subjective sleepiness, whereas treatment and disease duration were associated with fewer behavioral problems (attention problems, aggressive behavior, and attention deficit/hyperactivity disorder). Psychosocial health domains of pediatric NT1 were worse than in healthy controls, whereas the physical health domains were comparable. Conclusions: Young NT1 patients show a discrete pattern of altered behavioral, thought, and mood profile in comparison with healthy controls and with idiopathic epilepsy patients thus suggesting a direct link with sleepiness. Further studies investigating behavior in patients with idiopathic hypersomnia or type 2 narcolepsy are needed to disentangle the role of REM sleep dysfunction and hypocretin deficiency in psychiatric disorders. Symptoms of withdrawal, depression, somatic complaints, thought problems, and aggressiveness were common, NT1 children perceived lower school competencies than healthy children, and their parents also reported worse psychosocial health. Our data suggest that early effective treatment and disease self-awareness should be promoted in NT1 children for their positive effect on behavior and psychosocial health. Citation: Rocca FL, Finotti E, Pizza F, Ingravallo F, Gatta M, Bruni O, Plazzi G. Psychosocial profile and quality of life in children with type 1 narcolepsy: a case-control study. SLEEP 2016;39(7):1389–1398. PMID:27166243

Pediatric hospital medicine core competencies: development and methodology.

PubMed

Stucky, Erin R; Ottolini, Mary C; Maniscalco, Jennifer

2010-01-01

Pediatric hospital medicine is the most rapidly growing site-based pediatric specialty. There are over 2500 unique members in the three core societies in which pediatric hospitalists are members: the American Academy of Pediatrics (AAP), the Academic Pediatric Association (APA) and the Society of Hospital Medicine (SHM). Pediatric hospitalists are fulfilling both clinical and system improvement roles within varied hospital systems. Defined expectations and competencies for pediatric hospitalists are needed. In 2005, SHM's Pediatric Core Curriculum Task Force initiated the project and formed the editorial board. Over the subsequent four years, multiple pediatric hospitalists belonging to the AAP, APA, or SHM contributed to the content of and guided the development of the project. Editors and collaborators created a framework for identifying appropriate competency content areas. Content experts from both within and outside of pediatric hospital medicine participated as contributors. A number of selected national organizations and societies provided valuable feedback on chapters. The final product was validated by formal review from the AAP, APA, and SHM. The Pediatric Hospital Medicine Core Competencies were created. They include 54 chapters divided into four sections: Common Clinical Diagnoses and Conditions, Core Skills, Specialized Clinical Services, and Healthcare Systems: Supporting and Advancing Child Health. Each chapter can be used independently of the others. Chapters follow the knowledge, skills, and attitudes educational curriculum format, and have an additional section on systems organization and improvement to reflect the pediatric hospitalist's responsibility to advance systems of care. These competencies provide a foundation for the creation of pediatric hospital medicine curricula and serve to standardize and improve inpatient training practices. (c) 2010 Society of Hospital Medicine.

Safety Profile of Cough and Cold Medication Use in Pediatrics.

PubMed

Green, Jody L; Wang, George Sam; Reynolds, Kate M; Banner, William; Bond, G Randall; Kauffman, Ralph E; Palmer, Robert B; Paul, Ian M; Dart, Richard C

2017-06-01

The safety of cough and cold medication (CCM) use in children has been questioned. We describe the safety profile of CCMs in children <12 years of age from a multisystem surveillance program. Cases with adverse events (AEs) after ingestion of at least 1 index CCM ingredient (brompheniramine, chlorpheniramine, dextromethorphan, diphenhydramine, doxylamine, guaifenesin, phenylephrine, and pseudoephedrine) in children <12 years of age were collected from 5 data sources. An expert panel determined relatedness, dose, intent, and risk factors. Case characteristics and AEs are described. Of the 4202 cases reviewed, 3251 (77.4%) were determined to be at least potentially related to a CCM, with accidental unsupervised ingestions (67.1%) and medication errors (13.0%) the most common exposure types. Liquid (67.3%), pediatric (75.5%), and single-ingredient (77.5%) formulations were most commonly involved. AEs occurring in >20% of all cases included tachycardia, somnolence, hallucinations, ataxia, mydriasis, and agitation. Twenty cases (0.6%) resulted in death; most were in children <2 years of age (70.0%) and none involved a therapeutic dose. The overall reported AE rate was 0.573 cases per 1 million units (ie, tablets, gelatin capsules, or liquid equivalent) sold (95% confidence interval, 0.553-0.593) or 1 case per 1.75 million units. The rate of AEs associated with CCMs in children was low. Fatalities occurred even less frequently. No fatality involved a therapeutic dose. Accidental unsupervised ingestions were the most common exposure types and single-ingredient, pediatric liquid formulations were the most commonly reported products. These characteristics present an opportunity for targeted prevention efforts. Copyright © 2017 by the American Academy of Pediatrics.

Providers' Experiences with Vaginal Dilator Training for Patients with Vaginal Agenesis.

PubMed

Patel, Vrunda; Hakim, Julie; Gomez-Lobo, Veronica; Amies Oelschlager, Anne-Marie

2018-02-01

To examine providers' experiences with vaginal dilator training for patients with vaginal agenesis. Anonymous electronic survey. Members of the North American Society for Pediatric and Adolescent Gynecology. How providers learn about vaginal dilator training, common techniques, and methods used for patient training, assessment of patient readiness, common patient complaints, issues leading to early discontinuation. There were a total of 55 completed survey responses of which 31 respondents (56%) had been in practice for more than 10 years. Forty-nine were gynecologists (89%), 20 had completed a fellowship in pediatric and adolescent gynecology (36%), and 6 were reproductive endocrinologists (11%). Thirty-one respondents had first learned about vaginal dilator training through lectures (56%) whereas only 9 through mentorship and fellowship (16%). According to respondents, the most common issue leading to early discontinuation was lack of patient motivation and readiness (n = 42; 76%). The most common complication was pain or discomfort (n = 45; 82%). More than half of respondents determined dilator therapy was successful when patients reported comfortable sexual intercourse (n = 30; 55%) and 65% (n = 35) did not delineate any restrictions to initiation of sexual intercourse. Most respondents (87%) requested further vaginal dilator training at either a clinical meeting (n = 26; 47%) or with a training video (n = 22; 40%). Our study in an experienced cohort of pediatric gynecology providers highlights the need for further research and training on vaginal dilation education. Copyright © 2017 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

Exercise interventions for patients with pediatric cancer during inpatient acute care: A systematic review of literature.

PubMed

Rustler, Vanessa; Hagerty, Meaghan; Daeggelmann, Julia; Marjerrison, Stacey; Bloch, Wilhelm; Baumann, Freerk T

2017-11-01

Physical inactivity has been shown to exacerbate negative side effects experienced by pediatric patients undergoing cancer therapy. Exercise interventions are being created in response. This review summarizes current exercise intervention data in the inpatient pediatric oncology setting. Two independent reviewers collected literature from three databases, and analyzed data following the PRISMA statement for systematic reviews and meta-analyses. Ten studies were included, representing 204 patients. Good adherence, positive trends in health status, and no adverse events were noted. Common strategies included individual, supervised, combination training with adaptability to meet fluctuating patient abilities. We recommend that general physical activity programming be offered to pediatric oncology inpatients. © 2017 Wiley Periodicals, Inc.

Benefits of Ultrasound Imaging for Placement of Caudal Epidural Blockade in 3 Pediatric Patients: A Case Report.

PubMed

Sinskey, Jina L; Vecchione, Tricia M; Ekstrom, Benjamin G; Boretsky, Karen

2018-06-01

Pediatric caudal epidural blockade, the most common pediatric regional anesthetic, is classically placed using surface landmark technique with infrequent use of ultrasound guidance. We present 3 cases where ultrasound guidance facilitated successful placement and helped prevent complications. One infant had an unanticipated S5 dural sac necessitating needle redirection to avoid subarachnoid injection. A 5-year old had proper needle position with inability to inject secondary to needle blockage confirmed with ultrasound. An expremature infant had initial needle placement anterior to the sacrum with subsequent proper placement using real-time ultrasound imaging. Ultrasound guidance for pediatric caudal placement confers advantages and increased routine use should be considered.

Time-to-Antibiotic Administration as a Quality of Care Measure in Children with Febrile Neutropenia: A Survey of Pediatric Oncology Centers

PubMed Central

McCavit, Timothy L.; Winick, Naomi

2011-01-01

Time-to-antibiotic administration (TTA) has been suggested as a quality-of-care (QOC) measure for pediatric oncology patients with febrile neutropenia (FN). Unknown, however, is to what extent pediatric oncology centers utilize TTA. Therefore, we designed and administered an electronic survey (68% response rate) of programs in the Children's Oncology Group to assess TTA utilization. Nearly half of respondents track TTA. Most reported using a benchmark of less than 60 minutes from arrival. TTA is a commonly used QOC measure for pediatric FN despite an absence of studies establishing its validity and a lack of data supporting its impact on outcomes of FN. PMID:21509930

Quantitative Assessment of Neovascularization after Indirect Bypass Surgery: Color-Coded Digital Subtraction Angiography in Pediatric Moyamoya Disease.

PubMed

Cho, H-H; Cheon, J-E; Kim, S-K; Choi, Y H; Kim, I-O; Kim, W S; Lee, S-M; You, S K; Shin, S-M

2016-05-01

For the postoperative follow-up in pediatric patients with Moyamoya disease, it is essential to evaluate the degree of neovascularization status. Our aim was to quantitatively assess the neovascularization status after bypass surgery in pediatric Moyamoya disease by using color-coded digital subtraction angiography. Time-attenuation intensity curves were generated at ROIs corresponding to surgical flap sites from color-coded DSA images of the common carotid artery, internal carotid artery, and external carotid artery angiograms obtained pre- and postoperatively in 32 children with Moyamoya disease. Time-to-peak and area under the curve values were obtained. Postoperative changes in adjusted time-to-peak (ΔTTP) and ratios of adjusted area under the curve changes (ΔAUC ratio) of common carotid artery, ICA, and external carotid artery angiograms were compared across clinical and angiographic outcome groups. To analyze diagnostic performance, we categorized clinical outcomes into favorable and unfavorable groups. The ΔTTP at the common carotid artery increased among clinical and angiographic outcomes, in that order, with significant differences (P = .003 and .005, respectively). The ΔAUC ratio at the common carotid artery and external carotid artery also increased, in that order, among clinical and angiographic outcomes with a significant difference (all, P = .000). The ΔAUC ratio of ICA showed no significant difference among clinical and angiographic outcomes (P = .418 and .424, respectively). The ΔTTP for the common carotid artery of >1.27 seconds and the ΔAUC ratio of >33.5% for the common carotid artery and 504% for the external carotid artery are revealed as optimal cutoff values between favorable and unfavorable groups. Postoperative changes in quantitative values obtained with color-coded DSA software showed a significant correlation with outcome scores and can be used as objective parameters for predicting the outcome in pediatric Moyamoya disease, with an additional cutoff value calculated through the receiver operating characteristic curve. © 2016 by American Journal of Neuroradiology.

International Consensus On (ICON) Pediatric Asthma

PubMed Central

Papadopoulos, N. G.; Arakawa, H.; Carlsen, K.-H.; Custovic, A.; Gern, J.; Lemanske, R.; Le Souef, P.; Makela, M.; Roberts, G.; Wong, G.; Zar, H.; Akdis, C. A.; Bacharier, L. B.; Baraldi, E.; van Bever, H. P.; de Blic, J.; Boner, A.; Burks, W.; Casale, T. B.; Castro-Rodriguez, J. A.; Chen, Y. Z.; El-Gamal, Y. M.; Everard, M. L.; Frischer, T.; Geller, M.; Gereda, J.; Goh, D. Y.; Guilbert, T. W.; Hedlin, G.; Heymann, P. W.; Hong, S. J.; Hossny, E. M.; Huang, J. L.; Jackson, D. J.; de Jongste, J. C.; Kalayci, O.; Khaled, N.; Kling, S.; Kuna, P.; Lau, S.; Ledford, D. K.; Lee, S. I.; Liu, A. H.; Lockey, R. F.; Lodrup-Carlsen, K.; Lotvall, J.; Morikawa, A.; Nieto, A.; Paramesh, H.; Pawankar, R.; Pohunek, P.; Pongracic, J.; Price, D.; Robertson, C.; Rosario, N.; Rossenwasser, L. J.; Sly, P. D.; Stein, R.; Stick, S.; Szefler, S.; Taussig, L. M.; Valovirta, E.; Vichyanond, P.; Wallace, D.; Weinberg, E.; Wennergren, G.; Wildhaber, J.; Zeiger, R. S.

2015-01-01

Asthma is the most common chronic lower respiratory disease in childhood throughout the world. Several guidelines and/or consensus documents are available to support medical decisions on pediatric asthma. Although there is no doubt that the use of common systematic approaches for management can considerably improve outcomes, dissemination and implementation of these are still major challenges. Consequently, the International Collaboration in Asthma, Allergy and Immunology (iCAALL), recently formed by the EAACI, AAAAI, ACAAI and WAO, has decided to propose an International Consensus on (ICON) Pediatric Asthma. The purpose of this document is to highlight the key messages that are common to many of the existing guidelines, while critically reviewing and commenting on any differences, thus providing a concise reference. The principles of pediatric asthma management are generally accepted. Overall, the treatment goal is disease control. In order to achieve this, patients and their parents should be educated to optimally manage the disease, in collaboration with health care professionals. Identification and avoidance of triggers is also of significant importance. Assessment and monitoring should be performed regularly to re-evaluate and fine-tune treatment. Pharmacotherapy is the cornerstone of treatment. The optimal use of medication can, in most cases, help patients control symptoms and reduce the risk for future morbidity. The management of exacerbations is a major consideration, independent from chronic treatment. There is a trend towards considering phenotype specific treatment choices; however this goal has not yet been achieved. PMID:22702533

Morbidity of pediatric dog bites: a case series at a level one pediatric trauma center.

PubMed

Garvey, Erin M; Twitchell, Denice K; Ragar, Rebecca; Egan, John C; Jamshidi, Ramin

2015-02-01

Pediatric dog bite injuries are common and vary in severity. We sought to characterize predisposing factors, required interventions, and morbidity. A prospective clinical database at a level one pediatric trauma center was reviewed for dog bite injuries over 74 consecutive months ending December 2013. This included all patients brought in by ambulance and/or seen by the trauma team. Of 650 dog bite incidents, 282 met the criteria for inclusion in the trauma database. Median age was 5 years (range, 2 months to 17 years) and 55% (154/282) of patients were male. Pit bulls were most frequently responsible, accounting for 39% (83/213) of incidents in which dog breed was documented. Fifty-three percent (150/282) of dogs belonged to the patient's immediate or extended family. Sixty-nine percent (194/282) of patients required operative intervention: 76% laceration repairs, 14% tissue transfers, and 2% neurosurgical interventions. The most severe injuries were depressed skull fractures, intracranial hemorrhage, laryngotracheal transection, and bilateral orchiectomy. Median length of stay was 1 day (range, 0 to 25 days). There were no mortalities. Pediatric dog bites span a wide range of ages, frequently require operative intervention, and can cause severe morbidity. Dog familiarity did not confer safety, and in this series, Pit bulls were most frequently responsible. These findings have great relevance for child safety. Pediatric dog bites are common and can vary in severity from superficial wounds to life-threatening injuries. Dog familiarity may confer a false sense of safety. A national dog bite prevention and education campaign should be developed with the goal of decreasing the incidence of pediatric dog bites. Copyright © 2015 Elsevier Inc. All rights reserved.

Discontinuation and Nonpublication of Randomized Clinical Trials Conducted in Children.

PubMed

Pica, Natalie; Bourgeois, Florence

2016-09-01

Trial discontinuation and nonpublication represent potential waste in research resources and lead to compromises in medical evidence. Pediatric trials may be particularly vulnerable to these outcomes given the challenges encountered in conducting trials in children. We aimed to determine the prevalence of discontinuation and nonpublication of randomized clinical trials (RCTs) conducted in pediatric populations. Retrospective, cross-sectional study of pediatric RCTs registered in ClinicalTrials.gov from 2008 to 2010. Data were collected from the registry and associated publications identified (final search on September 1, 2015). Of 559 trials, 104 (19%) were discontinued early, accounting for an estimated 8369 pediatric participants. Difficulty with patient accrual (37%) was the most commonly cited reason for discontinuation. Trials were less likely to be discontinued if they were funded by industry compared with academic institutions (odds ratio [OR] 0.46, 95% confidence interval [CI] 0.27-0.77). Of the 455 completed trials, 136 (30%) were not published, representing 69 165 pediatric participants. Forty-two unpublished trials posted results on ClinicalTrials.gov. Trials funded by industry were more than twice as likely to result in nonpublication at 24 and 36 months (OR 2.21, 95% CI 1.35-3.64; OR 3.12, 95% CI 1.6-6.08, respectively) and had a longer mean time to publication compared with trials sponsored by academia (33 vs 24 months, P < .001). In this sample of pediatric RCTs, discontinuation and nonpublication were common, with thousands of children exposed to interventions that did not lead to informative or published findings. Trial funding source was an important determinant of these outcomes, with both academic and industry sponsors contributing to inefficiencies. Copyright © 2016 by the American Academy of Pediatrics.

Strategic Planning for Research in Pediatric Critical Care.

PubMed

Tamburro, Robert F; Jenkins, Tammara L; Kochanek, Patrick M

2016-11-01

To summarize the scientific priorities and potential future research directions for pediatric critical care research discussed by a panel of experts at the inaugural Strategic Planning Conference of the Pediatric Trauma and Critical Illness Branch of the Eunice Kennedy Shriver National Institute of Child Health and Human Development. Expert opinion expressed during the Strategic Planning Conference. Not applicable. Chaired by an experienced expert from the field, issues relevant to the conduct of pediatric critical care research were discussed and debated by the invited participants. Common themes and suggested priorities were identified and coalesced. Of the many pathophysiologic conditions discussed, the multiple organ dysfunction syndrome emerged as a topic in need of more study that is most relevant to the field. Additionally, the experts offered that the interrelationship and impact of critical illness on child development and family functioning are important research priorities. Consequently, long-term outcomes research was encouraged. The expert group also suggested that multidisciplinary conferences are needed to help identify key knowledge gaps to advance and direct research in the field. The Pediatric Critical Care and Trauma Scientist Development National K12 Program and the Collaborative Pediatric Critical Care Research Network were recognized as successful and important programs supported by the branch. The development of core data resources including biorepositories with robust phenotypic data using common data elements was also suggested to foster data sharing among investigators and to enhance disease diagnosis and discovery. Multicenter clinical trials and innovative study designs to address understudied and poorly understood conditions were considered important for field advancement. Finally, the growth of the pediatric critical care research workforce was offered as a priority that could be spawned in many ways including by expanded transdisciplinary and multiprofessional collaboration and diversity representation.

Development and Evaluation of the American College of Surgeons NSQIP Pediatric Surgical Risk Calculator.

PubMed

Kraemer, Kari; Cohen, Mark E; Liu, Yaoming; Barnhart, Douglas C; Rangel, Shawn J; Saito, Jacqueline M; Bilimoria, Karl Y; Ko, Clifford Y; Hall, Bruce L

2016-11-01

There is an increased desire among patients and families to be involved in the surgical decision-making process. A surgeon's ability to provide patients and families with patient-specific estimates of postoperative complications is critical for shared decision making and informed consent. Surgeons can also use patient-specific risk estimates to decide whether or not to operate and what options to offer patients. Our objective was to develop and evaluate a publicly available risk estimation tool that would cover many common pediatric surgical procedures across all specialties. American College of Surgeons NSQIP Pediatric standardized data from 67 hospitals were used to develop a risk estimation tool. Surgeons enter 18 preoperative variables (demographics, comorbidities, procedure) that are used in a logistic regression model to predict 9 postoperative outcomes. A surgeon adjustment score is also incorporated to adjust for any additional risk not accounted for in the 18 risk factors. A pediatric surgical risk calculator was developed based on 181,353 cases covering 382 CPT codes across all specialties. It had excellent discrimination for mortality (c-statistic = 0.98), morbidity (c-statistic = 0.81), and 7 additional complications (c-statistic > 0.77). The Hosmer-Lemeshow statistic and graphic representations also showed excellent calibration. The ACS NSQIP Pediatric Surgical Risk Calculator was developed using standardized and audited multi-institutional data from the ACS NSQIP Pediatric, and it provides empirically derived, patient-specific postoperative risks. It can be used as a tool in the shared decision-making process by providing clinicians, families, and patients with useful information for many of the most common operations performed on pediatric patients in the US. Copyright © 2016 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Food and Drug Administration (FDA) postmarket reported side effects and adverse events associated with pulmonary hypertension therapy in pediatric patients.

PubMed

Maxey, Dawn M; Ivy, D Dunbar; Ogawa, Michelle T; Feinstein, Jeffrey A

2013-10-01

Because most medications for pediatric pulmonary hypertension (PH) are used off label and based on adult trials, little information is available on pediatric-specific adverse events (AEs). Although drug manufacturers are required to submit postmarket AE reports to the Food and Drug Administration (FDA), this information is rarely transmitted to practitioners. In the setting of a recent FDA warning for sildenafil, the authors sought to give a better description of the AEs associated with current therapies in pediatric PH. In January 2010, a written request was made to the Food and Drug Administration for AE records of commonly used PH medications. Reports were screened for pediatric patients, analyzed in terms of AEs, and compared with the medical literature. Arbitrarily, AEs that could be attributed to concomitant medications were not attributed to the PH medication in question. Adverse events occurring in more than 5 % of events for each drug were assumed to be associated with the targeted PH medication. Between November 1997 and December 2009, 588 pediatric AE reports (death in 257 cases) were reported for the three most commonly used therapies: bosentan, epoprostenol, and sildenafil. Many of the AEs were similar to those reported previously. However, 27 AEs not previously reported in the literature (e.g., pulmonary hemorrhage, hemoptysis, and pneumonia) were found. The FDA postmarket records for PH medications in pediatric patients show a significant number of AEs. The discovery of AEs not previously reported will better inform those caring for these complex and critically ill children, and the large number of deaths suggest they may be underreported in current literature.

Parent-Reported Penicillin Allergy Symptoms in the Pediatric Emergency Department.

PubMed

Vyles, David; Chiu, Asriani; Simpson, Pippa; Nimmer, Mark; Adams, Juan; Brousseau, David C

2017-04-01

Children often present to the pediatric emergency department (ED) with a reported penicillin allergy. The true incidence of pediatric penicillin allergy is low, and patients may be inappropriately denied first-line antibiotics. We hypothesized that more than 70% of reported penicillin allergies in the pediatric ED are low risk for true allergy. Parents of children presenting to the pediatric ED with parent-reported penicillin allergy completed an allergy questionnaire. The questionnaire included age at allergy diagnosis, symptoms of allergy, and time to allergic reaction from first dose. The allergy symptoms were dichotomized into high and low risk in consultation with a pediatric allergist before questionnaire implementation. A total of 605 parents were approached; 500 (82.6%) completed the survey. The median (interquartile range) age of the children at diagnosis was 1 year (7 months, 2 years); 75% were diagnosed before their third birthday. Overall, 380 (76%) (95% confidence interval 72.3, 79.7) children had exclusively low-risk symptoms. The most commonly reported symptoms were rash (466, 92.8%) and itching (203, 40.6%). Of the 120 children with one or more high-risk symptom, facial swelling (50, 10%) was the most common. Overall, 354 children (71%) were diagnosed after their first exposure to penicillin. Symptom onset within 24 hours of medication administration occurred in 274 children (54.8%). Seventy-six percent of patients with parent-reported penicillin allergy have symptoms unlikely to be consistent with true allergy. Determination of true penicillin allergy in patients with low-risk symptoms may permit the increased use of first-line penicillin antibiotics. Copyright © 2016 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

Strategic Planning for Research in Pediatric Critical Care

PubMed Central

Tamburro, Robert F.; Jenkins, Tammara L.; Kochanek, Patrick M.

2016-01-01

Objective To summarize the scientific priorities and potential future research directions for pediatric critical care research discussed by a panel of experts at the inaugural Strategic Planning Conference of the Pediatric Trauma and Critical Illness Branch of the Eunice Kennedy Shriver National Institute of Child Health and Human Development. Data Sources Expert opinion expressed during the Strategic Planning Conference. Study Selection Not applicable Data Extraction Chaired by an experienced expert from the field, issues relevant to the conduct of pediatric critical care research were discussed and debated by the invited participants. Data Synthesis Common themes and suggested priorities were identified and coalesced. Conclusions Of the many pathophysiological conditions discussed, the multiple organ dysfunction syndrome emerged as a topic in need of more study that is most relevant to the field. Additionally, the experts offered that the inter-relationship and impact of critical illness on child development and family functioning are important research priorities. Consequently, long-term outcomes research was encouraged. The expert group also suggested that multidisciplinary conferences are needed to help identify key knowledge gaps to advance and direct research in the field. The Pediatric Critical Care and Trauma Scientist Development National K12 Program and the Collaborative Pediatric Critical Care Research Network were recognized as successful and important programs supported by the branch. The development of core data resources including biorepositories with robust phenotypic data using common data elements was also suggested to foster data sharing among investigators and to enhance disease diagnosis and discovery. Multicenter clinical trials and innovative study designs to address understudied and poorly understood conditions were considered important for field advancement. Finally, the growth of the pediatric critical care research workforce was offered as a priority that could be spawned in many ways including by expanded transdisciplinary and multiprofessional collaboration and diversity representation. PMID:27679964

Surveillance of bloodstream infections in pediatric cancer centers – what have we learned and how do we move on?

PubMed Central

Simon, Arne; Furtwängler, Rhoikos; Graf, Norbert; Laws, Hans Jürgen; Voigt, Sebastian; Piening, Brar; Geffers, Christine; Agyeman, Philipp; Ammann, Roland A.

2016-01-01

Pediatric patients receiving conventional chemotherapy for malignant disease face an increased risk of bloodstream infection (BSI). Since BSI may represent an acute life-threatening event in patients with profound immunosuppression, and show further negative impact on quality of life and anticancer treatment, the prevention of BSI is of paramount importance to improve and guarantee patients’ safety during intensive treatment. The great majority of all pediatric cancer patients (about 85%) have a long-term central venous access catheter in use (type Broviac or Port; CVAD). Referring to the current surveillance definitions a significant proportion of all BSI in pediatric patients with febrile neutropenia is categorized as CVAD-associated BSI. This state of the art review summarizes the epidemiology and the distinct pathogen profile of BSI in pediatric cancer patients from the perspective of infection surveillance. Problems in executing the current surveillance definition in this patient population are discussed and a new concept for the surveillance of BSI in pediatric cancer patients is outlined. PMID:27274442

Surveillance of bloodstream infections in pediatric cancer centers - what have we learned and how do we move on?

PubMed

Simon, Arne; Furtwängler, Rhoikos; Graf, Norbert; Laws, Hans Jürgen; Voigt, Sebastian; Piening, Brar; Geffers, Christine; Agyeman, Philipp; Ammann, Roland A

2016-01-01

Pediatric patients receiving conventional chemotherapy for malignant disease face an increased risk of bloodstream infection (BSI). Since BSI may represent an acute life-threatening event in patients with profound immunosuppression, and show further negative impact on quality of life and anticancer treatment, the prevention of BSI is of paramount importance to improve and guarantee patients' safety during intensive treatment. The great majority of all pediatric cancer patients (about 85%) have a long-term central venous access catheter in use (type Broviac or Port; CVAD). Referring to the current surveillance definitions a significant proportion of all BSI in pediatric patients with febrile neutropenia is categorized as CVAD-associated BSI. This state of the art review summarizes the epidemiology and the distinct pathogen profile of BSI in pediatric cancer patients from the perspective of infection surveillance. Problems in executing the current surveillance definition in this patient population are discussed and a new concept for the surveillance of BSI in pediatric cancer patients is outlined.

Parental understanding and attitudes of pediatric obstructive sleep apnea and adenotonsillectomy.

PubMed

Strocker, Ali M; Shapiro, Nina L

2007-11-01

To explore parental perceptions and knowledge of pediatric obstructive sleep apnea (OSA) and adenotonsillectomy. Cross-sectional study. National polling organization. Population-based sample of 584 parents. Online surveys. Responses to questions regarding knowledge of pediatric OSA and treatment with adenotonsillectomy. Ninety-five percent of parents acknowledged that pediatric OSA is a "serious condition". Fifteen percent considered themselves to be "knowledgeable" about it. One fifth understood that untreated OSA could lead to cardiopulmonary disease, failure to thrive, or behavioral problems, such as attention deficit hyperactivity disorder. Less than 20% knew that pediatric OSA could be treated with adenotonsillectomy. Thirty-seven percent believed adenotonsillectomy to be an "outdated" procedure. Upon learning that adenotonsillectomy can treat OSA, 82% reported they would be eager to have a child with OSA undergo adenotonsillectomy. The majority of parents do not understand symptoms, consequences and treatment of pediatric OSA secondary to adenotonsillar hypertrophy. Otolaryngologists should be diligent in communicating issues of this disorder with parents and pediatricians.

Abdominal emergencies in pediatrics.

PubMed

Coca Robinot, D; Liébana de Rojas, C; Aguirre Pascual, E

2016-05-01

Abdominal symptoms are among the most common reasons for pediatric emergency department visits, and abdominal pain is the most frequently reported symptom. Thorough history taking and physical examination can often reach the correct diagnosis. Knowing the abdominal conditions that are most common in each age group can help radiologists narrow the differential diagnosis. When imaging tests are indicated, ultrasonography is usually the first-line technique, enabling the diagnosis or adding relevant information with the well-known advantages of this technique. Nowadays, plain-film X-ray studies are reserved for cases in which perforation, bowel obstruction, or foreign body ingestion is suspected. It is also important to remember that abdominal pain can also occur secondary to basal pneumonia. CT is reserved for specific indications and in individual cases, for example, in patients with high clinical suspicion of abdominal disease and inconclusive findings at ultrasonography. We review some of the most common conditions in pediatric emergencies, the different imaging tests indicated in each case, and the imaging signs in each condition. Copyright © 2016 SERAM. Published by Elsevier España, S.L.U. All rights reserved.

Pediatric radiology malpractice claims - characteristics and comparison to adult radiology claims.

PubMed

Breen, Micheál A; Dwyer, Kathy; Yu-Moe, Winnie; Taylor, George A

2017-06-01

Medical malpractice is the primary method by which people who believe they have suffered an injury in the course of medical care seek compensation in the United States and Canada. An increasing body of research demonstrates that failure to correctly diagnose is the most common allegation made in malpractice claims against radiologists. Since the 1994 survey by the Society of Chairmen of Radiology in Children's Hospitals (SCORCH), no other published studies have specifically examined the frequency or clinical context of malpractice claims against pediatric radiologists or arising from pediatric imaging interpretation. We hypothesize that the frequency, character and outcome of malpractice claims made against pediatric radiologists differ from those seen in general radiology practice. We searched the Controlled Risk Insurance Co. (CRICO) Strategies' Comparative Benchmarking System (CBS), a private repository of approximately 350,000 open and closed medical malpractice claims in the United States, for claims related to pediatric radiology. We further queried these cases for the major allegation, the clinical environment in which the claim arose, the clinical severity of the alleged injury, indemnity paid (if payment was made), primary imaging modality involved (if applicable) and primary International Classification of Diseases, 9th revision (ICD-9) diagnosis underlying the claim. There were a total of 27,056 fully coded claims of medical malpractice in the CBS database in the 5-year period between Jan. 1, 2010, and Dec. 31, 2014. Of these, 1,472 cases (5.4%) involved patients younger than 18 years. Radiology was the primary service responsible for 71/1,472 (4.8%) pediatric cases. There were statistically significant differences in average payout for pediatric radiology claims ($314,671) compared to adult radiology claims ($174,033). The allegations were primarily diagnosis-related in 70% of pediatric radiology claims. The most common imaging modality implicated in pediatric radiology claims was radiography. The highest payouts in pediatric radiology pertained to missed congenital and developmental anomalies (average $1,222,932) such as developmental dysplasia of the hip and congenital central nervous system anomalies. More than half of pediatric radiology claims arose in the ambulatory setting. Pediatric radiology is not immune from claims of medical malpractice and these claims result in high monetary payouts, particularly for missed diagnoses of congenital and developmental anomalies. Our data suggest that efforts to reduce diagnostic error in the outpatient radiology setting, in the interpretation of radiographs, and in the improved diagnosis of fractures and congenital and developmental anomalies would be of particular benefit to the pediatric radiology community.

Pediatric physical therapists' use of support walkers for children with disabilities: a nationwide survey.

PubMed

Low, Sheryl A; McCoy, Sarah Westcott; Beling, Janna; Adams, Janet

2011-01-01

This study investigated pediatric physical therapists' use of support walkers (SWs) for children with disabilities. An 8-page survey was mailed to 2500 randomly selected members of the Section on Pediatrics of the American Physical Therapy Association. Respondents to the survey included 513 pediatric physical therapists who were users of SWs. Descriptive statistics were calculated and themes were analyzed. Several SWs were reported as used most often to improve gait, mobility, participation at school, and interaction with peers. Use commonly included a month trial before purchase and 9 sessions of physical therapy to train a child for use in school. Reasons given for the use of SWs were improving impairments, functional limitations, and participation with peers. Pediatric physical therapists use SWs to increase postural control, mobility, and children's participation in school.

Childhood obesity for pediatric gastroenterologists.

PubMed

Huang, Jeannie S; Barlow, Sarah E; Quiros-Tejeira, Ruben E; Scheimann, Ann; Skelton, Joseph; Suskind, David; Tsai, Patrika; Uko, Victor; Warolin, Joshua P; Xanthakos, Stavra A

2013-01-01

Obesity in childhood is one of the major health issues in pediatric health care today. As expected, the prevalence of obesity-related comorbidities has risen in parallel with that of obesity. Consultation regarding these concomitant diseases and subsequent management by subspecialists, including pediatric gastroenterologists, is now common and has resulted in obesity being recognized as a chronic disease requiring coordination of care. Although medications and even surgery may provide effective, though often temporary, treatments for obesity and its comorbidities, behavioral interventions addressing healthy dietary and physical activity habits remain a mainstay in the obesity treatment paradigm. Therefore, the issue of weight management must be addressed by both general practitioner and subspecialist alike. In this report, we review select aspects of pediatric obesity and obesity-related management issues because it relates in particular to the field of pediatric gastroenterology and hepatology.

Childhood Obesity for Pediatric Gastroenterologists

PubMed Central

Huang, Jeannie S.; Barlow, Sarah E.; Quiros-Tejeira, Ruben E.; Scheimann, Ann; Skelton, Joseph; Suskind, David; Tsai, Patrika; Uko, Victor; Warolin, Joshua P.; Xanthakos, Stavra A.

2014-01-01

Obesity in childhood is one of the major health issues in pediatric health care today. As expected, the prevalence of obesity-related comorbidities has risen in parallel with that of obesity. Consultation regarding these concomitant diseases and subsequent management by subspecialists, including pediatric gastroenterologists, is now common and has resulted in obesity being recognized as a chronic disease requiring coordination of care. Although medications and even surgery may provide effective, though often temporary, treatments for obesity and its comorbidities, behavioral interventions addressing healthy dietary and physical activity habits remain a mainstay in the obesity treatment paradigm. Therefore, the issue of weight management must be addressed by both general practitioner and subspecialist alike. In this report, we review select aspects of pediatric obesity and obesity-related management issues because it relates in particular to the field of pediatric gastroenterology and hepatology. PMID:23282941

How Do US Pediatric Residency Programs Teach and Evaluate Community Pediatrics and Advocacy Training?

PubMed

Lichtenstein, Cara; Hoffman, Benjamin D; Moon, Rachel Y

2017-07-01

In 2013, the Accreditation Council for Graduate Medical Education updated requirements for training in community pediatrics and advocacy in pediatric residency programs. In light of this update, the aim of this study was to better understand how community pediatrics is being taught and evaluated in pediatric residency programs in the United States. Cross-sectional exploratory study using a Web-based survey of pediatric residency program directors in September 2014. Questions focused on teaching and evaluation of 10 community pediatrics competencies. Of 85 programs (43% response rate), 30% offered a separate training track and/or 6-block individualized curriculum in community pediatrics or advocacy. More than 75% required all residents to learn 7 of 10 competencies queried. Respondents in urban settings were more likely to teach care of special populations (P = .02) and public speaking (P < .01). Larger programs were more likely to teach (P = .04) and evaluate (P = .02) community-based research. Experiential learning and classroom-based didactics were the most frequent teaching methodologies. Many programs used multiple teaching methodologies for all competencies. Observation was the most frequent evaluation technique used; portfolio review and written reflection were also commonly reported. Our findings show a strong emphasis on community pediatrics and advocacy teaching among responding US pediatric residency programs. Although respondents reported a variety of teaching and evaluation methods, there were few statistically significant differences between programs. Copyright © 2017 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

Beyond ADHD: How Well Are We Doing?

PubMed Central

Stein, Ruth EK; Storfer-Isser, Amy; Kerker, Bonnie D.; Garner, Andrew; Szilagyi, Moira; Hoagwood, Kimberly E.; O’Connor, Karen G.; Horwitz, Sarah McCue

2017-01-01

Background and Objectives There has been increasing emphasis on the role of the pediatrician with respect to behavioral, learning and mental health (MH) issues, and developmental behavioral rotations are now required in pediatric residency programs. We sought to examine whether this newer emphasis on MH is reflected in pediatricians’ reports of their current practices. Methods Data from two Periodic Surveys (PS) conducted in 2004 and 2013 by the American Academy of Pediatrics (AAP) were examined to see whether there were differences in self-reported behaviors of usually inquiring/screening, treating/managing/co-managing, or referring patients for ADHD, anxiety, depression, behavioral problems or learning problems. We examined patterns for all practicing members and for those who practiced general pediatrics exclusively. Results There were few changes over the decade in the percentage who inquired or screened among all clinicians; among those exclusively practicing general pediatrics, the percentage who inquired or screened increased about 10% for ADHD and depression. ADHD remained the only condition for which the majority of respondents treated/managed/co-managed (57%). While there was some increase in the percentages who treated other conditions, the other conditions were usually treated by < 30% of respondents. A similar pattern of results was observed in analyses adjusted for physician, practice, and patient characteristics. Conclusions Despite the changing nature of pediatric practice and increased efforts to emphasize the importance of behavior, learning and MH, the pediatric community appears to be making little progress toward providing for the long-term behavioral, learning and MH needs of children and adolescents in its care. PMID:26514649

A study protocol testing the implementation, efficacy, and cost effectiveness of the ezParent program in pediatric primary care

PubMed Central

Schoeny, Michael; Risser, Heather; Johnson, Tricia

2016-01-01

Introduction Up to 20% of children demonstrate behavior problems that interfere with relationship development and academic achievement. Parent participation in behavioral parent training programs has been shown to decrease child problem behaviors and promote positive parent-child relationships. However, attendance and parent involvement in face-to-face parent training remain low. Testing the implementation, efficacy, and cost of alternative delivery models is needed to (a) increase the reach and sustainability of parent training interventions and (b) address the barriers to parent participation and implementation of such programs, specifically in primary health care settings. The purpose of this paper is to describe the study protocol evaluating the implementation, efficacy, and cost-effectiveness of delivering the tablet-based ezParent program in pediatric primary care sites. Methods The implementation of the ezParent in four pediatric primary care sites will be evaluated using a descriptive design and cost-effectiveness analysis. The efficacy of the ezParent will be tested using a randomized controlled trial design with 312 parents of 2 to 5 year old children from pediatric primary care settings. Data on parenting and child behavior outcomes will be obtained from all participants at baseline, and 3, 6, and 12 months post baseline. Discussion Integrating and evaluating the implementation of the ezParent in pediatric primary care is an innovative opportunity to promote positive parenting with potential for universal access to the preschool population and for low cost by building on existing infrastructure in pediatric primary care. PMID:27592122

[Drug administration to pediatric patients: Evaluation of the nurses' preparation habits in pediatric units].

PubMed

Ménétré, S; Weber, M; Socha, M; Le Tacon, S; May, I; Schweitzer, C; Demoré, B

2018-04-01

In hospitals, the nursing staff is often confronted with the problem of the preparation and administration of drugs for their pediatric patients because of the lack of indication, pediatric dosage, and appropriate galenic form. The goal of this study was to give an overview of the nurses' preparation habits in pediatric units and highlight their daily problems. This single-center prospective study was conducted through an observation of the nursing staff during the drug preparation process in medicine, surgery and intensive care units. We included 91 patients (55 boys and 36 girls), with an average age of 6.3 years (youngest child, 10 days old; oldest child, 18 years old). We observed a mean 2.16 drug preparations per patient [1-5]. We collected 197 observation reports regarding 66 injectable drugs and 131 oral drugs (71 liquid forms and 60 solid forms). The majority of these reports concerned central nervous system drugs (63/197), metabolism and digestive system drugs (50/197), and anti-infective drugs (46/197). The study highlights the nurses' difficulties: modification of the solid galenic forms, lack of knowledge on oral liquid form preservation or reconstitution methods, withdrawal of small volumes, and vague and noncompliant labeling. This study led to the creation of a specific working group for pediatrics. This multidisciplinary team meets on a regular basis to work toward improving the current habits to both simplify and secure drug administration to hospitalized children. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Irritability in Pediatric Patients: Normal or Not?

PubMed Central

Hameed, Usman; Dellasega, Cheryl A.

2016-01-01

The goal of this article is to describe the concept of irritability in children and youth, which has been revisited in the DSM-5. Traditionally, this behavior has been more commonly associated with mood disorders, which may account for the rising incidence of bipolar disorder diagnosis and overuse of mood-stabilizing medications in pediatric patients. While not predictive of mania, persistent nonepisodic irritability, if undetected, may escalate to violent behavior with potentially serious outcomes. It is therefore important to educate clinicians about how to accurately assess irritability in pediatric patients. PMID:27486529

Impact of Serum Vancomycin Trough Levels in the Treatment of Central Nervous System Shunt Infections Caused by Coagulase-Negative Staphylococci.

PubMed

Gibson, Ashley; Kaplan, Sheldon L; Vallejo, Jesus G

2018-04-26

Coagulase-negative staphylococci (CoNS) are a common cause of pediatric ventricular shunt infections. The Infectious Diseases Society of America recommends vancomycin serum troughs of 15-20 µg/mL when treating CoNS shunt infections in adult patients. We report a series of pediatric cases of CoNS shunt infections in which clinical cure was obtained with troughs < 15 µg/mL. These findings question the relevance of this recommendation in pediatric patients. © 2018 S. Karger AG, Basel.

Acquired pathology of the pediatric spine and spinal cord.

PubMed

Palasis, Susan; Hayes, Laura L

2015-09-01

Pediatric spine pathology poses a diagnostic challenge for radiologists. Acquired spine pathology often yields nonspecific signs and symptoms in children, especially in the younger age groups, and diagnostic delay can carry significant morbidity. This review is focused on some of the more common diagnostic dilemmas we face when attempting to evaluate and diagnose acquired pediatric spine anomalies in daily practice. An understanding of some of the key differentiating features of these disease processes in conjunction with pertinent history, physical exam, and advanced imaging techniques can indicate the correct diagnosis.

Risk in pediatric anesthesia.

PubMed

Paterson, Neil; Waterhouse, Peter

2011-08-01

Risk in pediatric anesthesia can be conveniently classified as minor or major. Major morbidity includes cardiac arrest, brain damage and death. Minor morbidity can be assessed by clinical audits with small patient samples. Major morbidity is rare. It is best assessed by very large clinical studies and by review of closed malpractice claims. Both minor and major morbidity occur most commonly in infants and children under three, especially those with severe co-morbidities. Knowledge of risk profiles in pediatric anesthesia is a starting point for the reduction of risk. © 2010 Blackwell Publishing Ltd.

Which is the best way of performing a Micturating Cystourethrogram in children?

PubMed

Al-Imam, Ola Ali; Al-Nsour, Nareeman Moh'd; Al-Khulaifat, Samih

2008-01-01

The Micturating Cystourethrogram (MCU) is a tough and stressful examination for patients and their parents as well as the radiologists and pediatric radiology nurses. Even though, it is one of the most commonly used fluoroscopic procedures in pediatric radiology practice, there is no definite agreement as to the best way to perform it, considering that this examination results in the children receiving a high dose of radiation to the gonadal region. This review was undertaken to determine the best way to perform the MCU in modern pediatric radiology practice.

Pediatric orthopedic trauma: principles of management.

PubMed

Gladden, Paul B; Wilson, Charles H; Suk, Michael

2004-05-01

Musculoskeletal injuries in the pediatric population are unique and require a thorough evaluation by a trained specialist. Unlike adults, many of the injuries may be treated closed due to the amazing growth and remodeling potential of children. Special consideration should be taken in treating certain fracture patterns to prevent the long-term consequences of growth deformities and protect children from child abuse. It is the goal of this article to outline common orthopedic injuries in the pediatric population to facilitate proper care in the multidisciplinary evaluation and treatment of children.

Teaching Child Health Problems of Developing Countries to European Medical Students

ERIC Educational Resources Information Center

Farquhar, J. W.; And Others

1976-01-01

A summary of a symposium presented at the Association of Pediatric Education in Europe. Included are a comparison of child health problems in the developed and undeveloped world, discussion of why Third World child health problems should concern European doctors, and suggested aims, objectives, and curriculum. (JT)

“The Biological Effects of Childhood Trauma”

PubMed Central

De Bellis, Michael D.; A.B., Abigail Zisk

2014-01-01

I. Synopsis Trauma in childhood is a grave psychosocial, medical, and public policy problem that has serious consequences for its victims and for society. Chronic interpersonal violence in children is common worldwide. Developmental traumatology, the systemic investigation of the psychiatric and psychobiological effects of chronic overwhelming stress on the developing child, provides a framework and principles when empirically examining the neurobiological effects of pediatric trauma. Despite the widespread prevalence of childhood trauma, less is known about trauma's biological effects in children as compared to adults with child trauma histories; and even less is known about how these pediatric mechanisms underlie trauma's short-term and long-term medical and mental health consequences. This article focuses primarily on the peer-reviewed literature on the neurobiological sequelae of childhood trauma in children and adults with histories of childhood trauma. We also review relevant studies of animal models of stress to help us better understand the psychobiological effects of trauma during development. Next, we review the neurobiology of trauma, its clinical applications and the biomarkers that may provide important tools for clinicians and researchers, both as predictors of posttraumatic stress symptoms and as useful tools to monitor treatment response. Finally, we offer suggestions for future researchers. PMID:24656576

The role of stents in the treatment of congenital heart disease: Current status and future perspectives

PubMed Central

Peters, Bjoern; Ewert, Peter; Berger, Felix

2009-01-01

Intravascular or intracardiac stenoses occur in many forms of congenital heart disease (CHD). Therefore, the implantation of stents has become an accepted interventional procedure for stenotic lesions in pediatric cardiology. Furthermore, stents are know to be used to exclude vessel aneurysm or to ensure patency of existing or newly created intracardiac communications. With the further refinement of the first generation of devices, a variety of “modern” stents with different design characteristics have evolved. Despite the tremendous technical improvement over the last 20 years, the “ideal stent” has not yet been developed. Therefore, the pediatric interventionalist has to decide which stent is suitable for each lesion. On this basis, currently available stents are discussed in regard to their advantages and disadvantages for common application in CHD. New concepts and designs developed to overcome some of the existing problems, like the failure of adaptation to somatic growth, are presented. Thus, in the future, biodegradable or growth stents might replace the currently used generation of stents. This might truly lead to widening indications for the use of stents in the treatment of CHD. PMID:20300265

Current role of perampanel in pediatric epilepsy.

PubMed

De Liso, Paola; Moavero, Romina; Coppola, Giangennaro; Curatolo, Paolo; Cusmai, Raffaella; De Sarro, Giovambattista; Franzoni, Emilio; Vigevano, Federico; Verrotti, Alberto

2017-06-02

Perampanel is among the latest AEDs approved, indicated for the treatment of partial-onset seizures with or without secondary generalization, and for primary generalized tonic-clonic seizures, in patients aged 12 years and older. This paper summarizes the clinical recommendations on the current role of perampanel in the treatment of pediatric epilepsies and future directions for research. The optimal dosage should be comprised between 4 and 12 mg/day, with 8 mg/day being the most common dosage used. The rate and severity of adverse events, including psychiatric symptoms, can be decreased by starting at low doses, and titrating slowly. Overall, perampanel presents an acceptable risk/benefit ratio, but special caution should be made to the risk of seizure aggravation and behavioral problems. The favorable cognitive profile, the ease of use of the titration scheme and the once-daily formulation offer advantage over other AEDs and make this drug particularly suitable for adolescent population. Perampanel is a welcome addition to the armamentarium of the existing AEDs, as it represents a new approach in the management of epilepsy, with a novel mechanism of action and a potential to have a considerable impact on the treatment of adolescents with epilepsy.

Somatic USP8 Gene Mutations Are a Common Cause of Pediatric Cushing Disease.

PubMed

Faucz, Fabio R; Tirosh, Amit; Tatsi, Christina; Berthon, Annabel; Hernández-Ramírez, Laura C; Settas, Nikolaos; Angelousi, Anna; Correa, Ricardo; Papadakis, Georgios Z; Chittiboina, Prashant; Quezado, Martha; Pankratz, Nathan; Lane, John; Dimopoulos, Aggeliki; Mills, James L; Lodish, Maya; Stratakis, Constantine A

2017-08-01

Somatic mutations in the ubiquitin-specific protease 8 (USP8) gene have been recently identified as the most common genetic alteration in patients with Cushing disease (CD). However, the frequency of these mutations in the pediatric population has not been extensively assessed. We investigated the status of the USP8 gene at the somatic level in a cohort of pediatric patients with corticotroph adenomas. The USP8 gene was fully sequenced in both germline and tumor DNA samples from 42 pediatric patients with CD. Clinical, biochemical, and imaging data were compared between patients with and without somatic USP8 mutations. Five different USP8 mutations (three missense, one frameshift, and one in-frame deletion) were identified in 13 patients (31%), all of them located in exon 14 at the previously described mutational hotspot, affecting the 14-3-3 binding motif of the protein. Patients with somatic mutations were older at disease presentation [mean 5.1 ± 2.1 standard deviation (SD) vs 13.1 ± 3.6 years, P = 0.03]. Levels of urinary free cortisol, midnight serum cortisol, and adrenocorticotropic hormone, as well as tumor size and frequency of invasion of the cavernous sinus, were not significantly different between the two groups. However, patients harboring somatic USP8 mutations had a higher likelihood of recurrence compared with patients without mutations (46.2% vs 10.3%, P = 0.009). Somatic USP8 gene mutations are a common cause of pediatric CD. Patients harboring a somatic mutation had a higher likelihood of tumor recurrence, highlighting the potential importance of this molecular defect for the disease prognosis and the development of targeted therapeutic options. Copyright © 2017 Endocrine Society

Replacement of Dislodged Gastrostomy Tubes After Stoma Dilation in the Pediatric Emergency Department.

PubMed

Bhambani, Shiloni; Phan, Tammy H; Brown, Lance; Thorp, Andrea W

2017-06-01

A dislodged gastrostomy tube (GT) is a common complaint that requires evaluation in the pediatric emergency department (ED) and, on occasion, will require stoma dilation to successfully replace the GT. The objective of this study was to describe the frequency that stoma dilation is required, the success rate of replacement, complications encountered, and the techniques used to confirm placement of the GT after dilation. We conducted a retrospective medical record review of children 0-18 years who presented to the pediatric ED from February 2013 through February 2015 with a dislodged GT that required stoma dilation by pediatric emergency physicians with serially increasing Foley catheter sizes prior to successful placement of the GT. We reviewed a total of 302 encounters in 215 patients, with 97 (32%) of the encounters requiring stoma dilation prior to replacing a GT. The median amount of dilation was 2 French between the initial Foley catheter size and the final GT size. There was a single complication of a mal-positioned balloon that was identified at the index visit. No delayed complications were encountered. We performed confirmation of placement in all patients. The two most common forms of confirmation were aspiration of gastric contents (56/97 [58%]) followed by contrast radiograph in 39 (40%). The practice of serial dilation of a gastrostomy stoma site to allow successful replacement of a gastrostomy tube in pediatric patients who present to the ED with a dislodged gastrostomy tube is generally successful and without increased complication. All patients received at least one form of confirmation for appropriate GT placement with the most common being aspiration of gastric contents.

Use of targeted transversus abdominus plane blocks in pediatric patients with anterior cutaneous nerve entrapment syndrome.

PubMed

Nizamuddin, Sarah L; Koury, Katharine M; Lau, Mary E; Watt, Lisa D; Gulur, Padma

2014-01-01

Anterior cutaneous nerve entrapment syndrome (ACNES) is a commonly overlooked source of chronic abdominal wall pain. A diagnosis of ACNES should be considered in cases of severe, localized abdominal pain that is accentuated by physical activity. Providers should consider diagnosing ACNES once a patient has both a positive result from a Carnett's test and precise localization of pain. We describe the use of transversus abdominus plane (TAP) blocks to treat ACNES in the pediatric patient population. TAP blocks are a treatment modality which have been described less frequently in the management of this syndrome, with rectus sheath blocks being used more commonly. TAP blocks can be used effectively for ACNES by targeting the site of maximal tenderness, which was identified using ultrasound guidance. Moreover, TAP blocks are an attractive procedure option for ACNES as they are less invasive than other commonly used techniques. We present 3 case series reports of pediatric patients evaluated at our institution for severe abdominal pain to describe the clinical manifestations, sequelae, and outcome of ACNES. Though the exact incidence of ACNES in the pediatric population is unknown, this condition has significant implications from chronic pain. Chronic pain can lead to significant emotional and social impacts on these pediatric patients, as well as their on their families. Further, the extensive utilization of health care resources is impacted when children with undiagnosed ACNES undergo invasive treatments when ACNES is not in the early differential. The purpose of this case series report is to prompt better recognition of the condition ACNES, and to highlight the efficacy of TAP blocks as a management strategy.

Newly Recognized Pediatric Cases of Typhus Group Rickettsiosis, Houston, Texas, USA

PubMed Central

Erickson, Timothy; da Silva, Juliana; Nolan, Melissa S.; Marquez, Lucila; Munoz, Flor M.

2017-01-01

An increase in typhus group rickettsiosis and an expanding geographic range occurred in Texas, USA, over a decade. Because this illness commonly affects children, we retrospectively examined medical records from 2008–2016 at a large Houston-area pediatric hospital and identified 36 cases. The earliest known cases were diagnosed in 2011. PMID:29148369

Update in pediatrics: focus on fat-soluble vitamins.

PubMed

Sathe, Meghana N; Patel, Ashish S

2010-08-01

This article provides an update on fat-soluble vitamins (A, D, E, and K) in the healthy pediatric population and in children with chronic disease states that commonly cause deficiencies, specifically cystic fibrosis and cholestatic liver disease. For each fat-soluble vitamin, the biological function, nutrition availability, absorption, deficiency, toxic states, and monitoring parameters are defined.

A Quantitative Ethnopharmacological Documentation of Natural Pharmacological Agents Used by Pediatric Patients in Mauritius

PubMed Central

Mahomoodally, M. Fawzi; Sreekeesoon, D. Priyamka

2014-01-01

The pediatric population constitutes the most vulnerable patients due to a dearth of approved drugs. Consequently, there is a pressing need to probe novel natural pharmacological agents in an endeavour to develop new drugs to address pediatric illnesses. To date, no studies have explored the use of natural therapies for pediatric health care in Mauritius. Parents (n = 325) from different regions of the island were interviewed. Quantitative indexes such as fidelity level (FL), informant consensus factor (F IC), and use-value (UV) were calculated. Thirty-two plants were reported to be used by pediatric patients. Gastrointestinal disorders (F IC = 0.97) encompassing regurgitation, infantile colic, and stomach aches were the most common ailments managed with herbs. Matricaria chamomilla used for infantile colic and its pharmacological properties has previously been documented for pediatric patients. Product from A. mellifera (UV = 0.75) was the most utilized zootherapy for managing cough. Most plants and animal products reported in this study have bioactive constituents supported by existing scientific literature but their use for the pediatric population is scant. The present ethnopharmacological study has opened new perspectives for further research into their pharmacology, which can subsequently support and facilitate timely pediatric medicinal product development. PMID:24949418

Behavior of pediatric medical residents during a clinical simulation of a violent mother in a pediatric emergency.

PubMed

Enríquez, Diego; Gómez Traverso, Raúl; Szyld, Edgardo

2016-06-01

Physicians are frequently victims of both physical and verbal violence. Specific training is required for staff so that they are able to deal with these situations. To assess the clinical management and behavior of pediatric medical residents towards a violent mother during a pediatric emergency simulation. To assess the clinical management and behavior of pediatric medical residents towards a violent mother during a pediatric emergency simulation. Sixty-eight pediatric medical residents divided into 15 groups were observed. Twelve handled the episode appropriately; only two groups asked the security staff to remove the mother from the scene (recommended behavior). Other two groups managed to remove the mother from the clinical scenario but in the midst of struggles. Out of all physicians, 54.4% (n = 37) came into physical contact with the mother, and 95.6% had not previously received guidelines on how to manage violent situations. Only a few groups managed to remove the violent mother from the scene. Unconsented physical contact with the mother was one of the most commonly observed behaviors. A lack of institutional guidelines on how to handle violent situations was detected. patient simulation, violence, workplace violence. Sociedad Argentina de Pediatría.

Overview of pediatric peripheral facial nerve paralysis: analysis of 40 patients.

PubMed

Özkale, Yasemin; Erol, İlknur; Saygı, Semra; Yılmaz, İsmail

2015-02-01

Peripheral facial nerve paralysis in children might be an alarming sign of serious disease such as malignancy, systemic disease, congenital anomalies, trauma, infection, middle ear surgery, and hypertension. The cases of 40 consecutive children and adolescents who were diagnosed with peripheral facial nerve paralysis at Baskent University Adana Hospital Pediatrics and Pediatric Neurology Unit between January 2010 and January 2013 were retrospectively evaluated. We determined that the most common cause was Bell palsy, followed by infection, tumor lesion, and suspected chemotherapy toxicity. We noted that younger patients had generally poorer outcome than older patients regardless of disease etiology. Peripheral facial nerve paralysis has been reported in many countries in America and Europe; however, knowledge about its clinical features, microbiology, neuroimaging, and treatment in Turkey is incomplete. The present study demonstrated that Bell palsy and infection were the most common etiologies of peripheral facial nerve paralysis. © The Author(s) 2014.

Optimizing pediatric interdental fixation by use of a paramedian palatal fixation site.

PubMed

McNichols, Colton H; Hatef, Daniel A; Cole, Patrick D; Hollier, Larry H

2012-03-01

Condylar fractures are the most common injury seen in pediatric mandibular trauma. These injuries often cannot be adequately stabilized by conservative techniques such as splinting. The pediatric condyle fracture often requires a period of intermaxillary fixation. Because of the characteristics of the developing dentition, circumdental wiring is often not possible. Surgeons commonly achieve interdental stabilization by the connection of a circum-mandibular wire and a second wire placed through a drill hole in the piriform aperture. This method can be problematic in the young patient whose palatal suture is still patent. In this brief technical note, the use of a paramedian drill hole through the palate posterior to the maxillary incisors is described. It is believed that this method is superior to other techniques because it avoids injury to the deciduous tooth buds and allows for the maxillary wire to be seated in more structurally sound tissues.

Extramedullary Relapse of Acute Lymphoblastic Leukemia Presenting as Abnormal Uterine Bleeding: A Case Report.

PubMed

Robillard, Diana T; Kutny, Matthew A; Chewning, Joseph H; Arbuckle, Janeen L

2017-06-01

Acute lymphoblastic leukemia (ALL) is the most common childhood malignancy. Relapse of ALL occurs in 15%-20% of patients, with 2%-6% occurring exclusively in extramedullary sites. Relapse of ALL in gynecologic organs is extremely rare. We present a case of a 12-year-old girl with a history of ALL who was referred to the pediatric gynecology clinic with abnormal uterine bleeding. She was determined to have an extramedullary uterine relapse of her ALL. Abnormal uterine bleeding in the setting of childhood malignancy is a frequent reason for consultation to pediatric and adolescent gynecology services. This bleeding is commonly attributed to thrombocytopenia due to bone marrow suppressive chemotherapeutic agents. However, as shown in this report, abnormal uterine bleeding might be a manifestation of an extramedullary relapse. Copyright © 2017 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

Seizures in Pediatric Patients With Liver Transplant and Efficacy of Levetiracetam.

PubMed

Kılıç, Betül; Güngör, Serdal; Arslan, Müjgan; Selimoğlu, Mukadder Ayşe; Yılmaz, Sezai

2017-07-01

The aim of this study was to evaluate the risk factors, clinical implications, and prognosis of new-onset seizures that occurred after pediatric liver transplantation, and to assess the efficacy of levetiracetam treatment. The clinical and laboratory data of liver transplanted 28 children who had seizures after liver transplantation and specifically of 18 children who received levetiracetam were analyzed retrospectively. Sixteen patients (88.9%) remained seizure-free and in 2 (11.1%), more than 50% reduction in seizures were detected with levetiracetam treatment. In conclusion, seizures are generally the most common complication by a spectrum of seizure types, and sometimes cause symptomatic epilepsy. The most common risk factors for seizures in transplant recipients is immunosuppressant toxicity. Currently, there isn't a specific treatment involving the transplant patient population. Levetiracetam may be preferable in pediatric patients as it's reliable for liver disease and has advantages in the treatment of postoperative seizures due to its intravenous usage.

Cerebrospinal Fluid Shunting Complications in Children

PubMed Central

Hanak, Brian W.; Bonow, Robert H.; Harris, Carolyn A.; Browd, Samuel R.

2018-01-01

Although cerebrospinal fluid (CSF) shunt placement is the most common procedure performed by pediatric neurosurgeons, shunts remain among the most failure-prone life-sustaining medical devices implanted in modern medical practice. This article provides an overview of the mechanisms of CSF shunt failure for the 3 most commonly employed definitive CSF shunts in the practice of pediatric neurosurgery: ventriculoperitoneal, ventriculopleural, and ventriculoatrial. The text has been partitioned into the broad modes of shunt failure: obstruction, infection, mechanical shunt failure, overdrainage, and distal catheter site-specific failures. Clinical management strategies for the various modes of shunt failure are discussed as are research efforts directed towards reducing shunt complication rates. As it is unlikely that CSF shunting will become an obsolete procedure in the foreseeable future, it is incumbent on the pediatric neurosurgery community to maintain focused efforts to improve our understanding of and management strategies for shunt failure and shunt-related morbidity. PMID:28249297

Self-Efficacy and Select Characteristics in Nurses Who Respond to a Pediatric Emergency

ERIC Educational Resources Information Center

McNeill, Nancy

2016-01-01

Nurses at a suburban northeastern U.S. community hospital reported that they felt unprepared to effectively respond to a pediatric emergency. Empirical data were not available to identify if this local problem was due to a lack of the nurses' self-confidence or if other factors were involved. The purpose of this study was to determine if there…

Pediatric Genital Injury: An Analysis of the National Electronic Injury Surveillance System

PubMed Central

Casey, Jessica T.; Bjurlin, Marc A.; Cheng, Earl Y.

2013-01-01

Objective To describe the characteristics of pediatric genital injuries presenting to United States emergency departments (EDs). Methods A retrospective cohort study utilizing the U.S. Consumer Product Safety Commission (CPSC) National Electronic Injury Surveillance System (NEISS) from 1991-2010 to evaluate pediatric genital injuries was performed. Results Pediatric genital injuries represented 0.6% of all pediatric injuries with the incidence of injuries rising through the period studied, 1991-2010. The mean age at injury was 7.1 years old and was distributed 56.6% girls and 43.4% boys. A total of 43.3% had lacerations and 42.2% had contusions/abrasions. The majority of injuries occurred at home (65.9%), and the majority of patients (94.7%) were treated and released from the hospital. The most common consumer products associated with pediatric genital trauma were: bicycles (14.7% of all pediatric genital injuries), bathtubs (5.8%), daywear (5.6%), monkey bars (5.4%), and toilets (4.0%). Conclusion Although pediatric genital injuries represent a small proportion of overall injuries presenting to the ED, genital injuries continue to rise despite public health measures targeted to decrease childhood injury. Our results can be used to guide further prevention strategies for pediatric genital injury. PMID:23953603

Childhood injury: a status report, part 2.

PubMed

Crawley-Coha, Teri

2002-04-01

The October issue of The Journal of Pediatric Nursing carried the first of two parts on childhood injury. That article reviewed the importance of prevention, the short- and long-term effects of injury on the child and the family, and how to incorporate prevention strategies at home and at work. Also reviewed were three of the most common mechanisms of injury, motor vehicle crashes, bicycle crashes, and pool drowning, and prevention measures. In this second part, the remaining primary areas of concern for common pediatric injuries are addressed: poisoning, fires and burns, and firearms. Copyright 2002, Elsevier Science (USA). All rights reserved.

Current practice and views of neurologists on the transition from pediatric to adult care.

PubMed

Oskoui, Maryam; Wolfson, Christina

2012-12-01

To describe the current practice and views of neurologists on transitioning patients from pediatric to adult care, a cross-sectional study of all pediatric and adult neurologists in the province of Quebec, Canada, was conducted. The response rate was 73% for pediatric and 49% for adult neurologists. Most pediatric neurologists do not have a patient transition program or policy in place. Although a transfer summary is commonly provided, critical information is often lacking. Nearly half of neurologists believed that patients experience a gap in care during the transition process, and most agreed that the transition process is often poorly coordinated, highlighting patient, family, and health care factors. Current practice does not follow existing consensus statements for transition of care with respect to timing, communication, and preparation, and many pediatric neurologists experience difficulty in finding an appropriate adult health care provider for their patients. Neurologists reported many challenges in the current transition of care process.

Management of Pediatric Migraine: Current Therapies.

PubMed

Khrizman, Marina; Pakalnis, Ann

2018-02-01

Migraine is one of the most common neurologic conditions in pediatrics. It can be a significant stressor, causing absences from school and interruption of parents' work and family schedules. The mainstay of treatment remains educating patients about healthy lifestyle practices and the influences of sleep, stressors, and hydration on triggering migraine attacks. Psychological therapies such as biofeedback or cognitive-behavioral therapy may be beneficial in some patients, especially those with prominent psychological comorbidities. New advances in the pathophysiology of migraine and additional pediatric approval of abortive therapy with triptans have led to significant advances in the management of migraine in children. Some challenges to preventive therapy were recently noted with the negative results obtained in the Childhood and Adolescent Migraine Prevention Study, which compared prescription drugs to placebo. Inherent differences between adult and pediatric headaches, with shorter duration of pediatric migraine and prominent placebo effect, present recurring challenges for clinicians. [Pediatr Ann. 2018;47(2):e55-e60.]. Copyright 2018, SLACK Incorporated.

Use of intravenous acetaminophen (paracetamol) in a pediatric patient at the end of life: case report.

PubMed

Marks, Adam D; Keefer, Patricia; Saul, D'Anna

2013-12-01

For the better part of 100 years, acetaminophen (or paracetamol as it is known outside of the United States) has been a common first-line analgesic in pediatrics and is typically well tolerated with minimal side effects. Its use as an anti-pyretic is also well-documented and thus it is used broadly for symptom control in the general pediatric population. In pediatric palliative care, acetaminophen is also used as an adjuvant to opioid therapy for pain as well as an anti-pyretic. For many pediatric patients near end-of-life, however, the ability to tolerate oral intake is diminished and rectal suppository administration can be distressing or contraindicated as in the setting of neutropenia, thus limiting use of acetaminophen by its usual routes. In Europe and Australia, an intravenous formulation of acetaminophen has been used for many years and has only recently become available in the United States. Here, we describe a case using intravenous acetaminophen in a pediatric patient at the end of life.

Melatonin Treatment in Children with Developmental Disabilities

PubMed Central

Schwichtenberg, A.J.; Malow, Beth A.

2015-01-01

Melatonin is commonly recommended to treat sleep problems in children with developmental disabilities. However, relatively few studies document the efficacy and safety of melatonin in pediatric populations with developmental diagnoses. This chapter reviews recent studies of melatonin efficacy across a wide breadth of developmental disabilities. Overall, short treatment trials (1 week to 3 months) of melatonin were associated with a significant decrease in sleep onset latency time for each of the disorders reviewed, with one notable exception, tuberous sclerosis. In general, reported side effects were uncommon and mild in nature. Across disorders, additional research is needed to draw disability-specific conclusions. However, studies to date provide positive support for future trials that include larger groups of children with specific disabilities/syndromes. PMID:26055866

Moral Dilemmas in Pediatric Orthopedics.

PubMed

Mercuri, John J; Vigdorchik, Jonathan M; Otsuka, Norman Y

2015-12-01

All orthopedic surgeons face moral dilemmas on a regular basis; however, little has been written about the moral dilemmas that are encountered when providing orthopedic care to pediatric patients and their families. This article aims to provide surgeons with a better understanding of how bioethics and professionalism apply to the care of their pediatric patients. First, several foundational concepts of both bioethics and professionalism are summarized, and definitions are offered for 16 important terms within the disciplines. Next, some of the unique aspects of pediatric orthopedics as a subspecialty are reviewed before engaging in a discussion of 5 common moral dilemmas within the field. Those dilemmas include the following: (1) obtaining informed consent and assent for either surgery or research from pediatric patients and their families; (2) performing cosmetic surgery on pediatric patients; (3) caring for pediatric patients with cognitive or physical impairments; (4) caring for injured pediatric athletes; and (5) meeting the demand for pediatric orthopedic care in the United States. Pertinent considerations are reviewed for each of these 5 moral dilemmas, thereby better preparing surgeons for principled moral decision making in their own practices. Each of these dilemmas is inherently complex with few straightforward answers; however, orthopedic surgeons have an obligation to take the lead and better define these kinds of difficult issues within their field. The lives of pediatric patients and their families will be immeasurably improved as a result. Copyright 2015, SLACK Incorporated.

Chronic Pain in Children and Adolescents: Diagnosis and Treatment of Primary Pain Disorders in Head, Abdomen, Muscles and Joints.

PubMed

Friedrichsdorf, Stefan J; Giordano, James; Desai Dakoji, Kavita; Warmuth, Andrew; Daughtry, Cyndee; Schulz, Craig A

2016-12-10

Primary pain disorders (formerly "functional pain syndromes") are common, under-diagnosed and under-treated in children and teenagers. This manuscript reviews key aspects which support understanding the development of pediatric chronic pain, points to the current pediatric chronic pain terminology, addresses effective treatment strategies, and discusses the evidence-based use of pharmacology. Common symptoms of an underlying pain vulnerability present in the three most common chronic pain disorders in pediatrics: primary headaches, centrally mediated abdominal pain syndromes, and/or chronic/recurrent musculoskeletal and joint pain. A significant number of children with repeated acute nociceptive pain episodes develop chronic pain in addition to or as a result of their underlying medical condition "chronic-on-acute pain." We provide description of the structure and process of our interdisciplinary, rehabilitative pain clinic in Minneapolis, Minnesota, USA with accompanying data in the treatment of chronic pain symptoms that persist beyond the expected time of healing. An interdisciplinary approach combining (1) rehabilitation; (2) integrative medicine/active mind-body techniques; (3) psychology; and (4) normalizing daily school attendance, sports, social life and sleep will be presented. As a result of restored function, pain improves and commonly resolves. Opioids are not indicated for primary pain disorders, and other medications, with few exceptions, are usually not first-line therapy.

Child sexual abuse: consequences and implications.

PubMed

Hornor, Gail

2010-01-01

Sexual abuse is a problem of epidemic proportions in the United States. Given the sheer numbers of sexually abused children, it is vital for pediatric nurse practitioners to understand both short-term and long-term consequences of sexual abuse. Understanding consequences of sexual abuse can assist the pediatric nurse practitioner in anticipating the physical and mental health needs of patients and also may assist in the identification of sexual abuse victims. Sexual abuse typically does not occur in isolation. Implications for practice will be discussed. Copyright © 2010 National Association of Pediatric Nurse Practitioners. Published by Mosby, Inc. All rights reserved.

Rare Solitary Fibrous Tumor in the Pediatric Neck: A Case Report and Review of the Literature

PubMed Central

Cox, Eric L; Schwartz, Erich J; Korkigian, Shant A

2017-01-01

Solitary fibrous tumors (SFT) are a rare type of mesenchymal-derived tumor not commonly found in the pediatric population, especially in the head and neck. Tumors of this nature are most commonly seen in the adult population and are identified with unique immunohistochemical markers, specifically signal transducer and activator of transcription 6 (STAT6) and hematopoietic progenitor cell antigen (CD34). Including SFTs in the differential diagnosis while working up a mass can be difficult considering their relatively non-descript appearance on imaging and the low yield immunohistochemical staining that must be ordered to confirm diagnosis. The current literature identifies only a handful of cases of SFTs occurring in the pediatric population, with a majority arising from the pleura. We present the case of a 13-year-old male who underwent radical excision of a left occipital triangle neck mass after radiological and pathological workup failed to conclusively make a diagnosis. Postoperative pathologic analysis revealed it to be an SFT. Due to the exceptionally rare presentation of SFTs in pediatric patients, the aim of this case report is to discuss diagnostic measures, solitary fibrous tumor etiology, as well as a recent risk stratification system used for the evaluation of postoperative disease progression. Our hope is that clinicians will include SFTs in their differential diagnosis when working up a neck mass in the pediatric population. PMID:28484679

Recommendations for the Use of Common Outcome Measures in Pediatric Traumatic Brain Injury Research

PubMed Central

Wilde, Elisabeth A.; Anderson, Vicki A.; Bedell, Gary; Beers, Sue R.; Campbell, Thomas F.; Chapman, Sandra B.; Ewing-Cobbs, Linda; Gerring, Joan P.; Gioia, Gerard A.; Levin, Harvey S.; Michaud, Linda J.; Prasad, Mary R.; Swaine, Bonnie R.; Turkstra, Lyn S.; Wade, Shari L.; Yeates, Keith O.

2012-01-01

Abstract This article addresses the need for age-relevant outcome measures for traumatic brain injury (TBI) research and summarizes the recommendations by the inter-agency Pediatric TBI Outcomes Workgroup. The Pediatric Workgroup's recommendations address primary clinical research objectives including characterizing course of recovery from TBI, prediction of later outcome, measurement of treatment effects, and comparison of outcomes across studies. Consistent with other Common Data Elements (CDE) Workgroups, the Pediatric TBI Outcomes Workgroup adopted the standard three-tier system in its selection of measures. In the first tier, core measures included valid, robust, and widely applicable outcome measures with proven utility in pediatric TBI from each identified domain including academics, adaptive and daily living skills, family and environment, global outcome, health-related quality of life, infant and toddler measures, language and communication, neuropsychological impairment, physical functioning, psychiatric and psychological functioning, recovery of consciousness, social role participation and social competence, social cognition, and TBI-related symptoms. In the second tier, supplemental measures were recommended for consideration in TBI research focusing on specific topics or populations. In the third tier, emerging measures included important instruments currently under development, in the process of validation, or nearing the point of published findings that have significant potential to be superior to measures in the core and supplemental lists and may eventually replace them as evidence for their utility emerges. PMID:21644810

[Idiopathic Nephrotic Syndrome: recommendations of the Nephrology Branch of the Chilean Society of Pediatrics. Part One].

PubMed

Hevia, Pilar; Nazal, Vilma; Rosati, María Pía; Quiroz, Lily; Alarcón, Claudia; Márquez, Sonia; Cuevas, Karen

2015-01-01

Idiopathic nephrotic syndrome is the most common glomerular disease in childhood, affecting 1 to 3 per 100,000 children under the age of 16. It most commonly occurs in ages between 2 and 10. Its cause is unknown and its histology corresponds to minimal change disease in 90% of cases, or focal segmental glomerulosclerosis. 80 to 90% of cases respond to steroids (steroid-sensitive nephrotic syndrome) with good prognosis and long-term preservation of renal function over time. 70% of patients with SSNS have one or more relapses in their evolution, and of these, 50% behave as frequent relapsing or steroid-dependent, a group that concentrate the risk of steroid toxicity. Patients with steroid-resistant nephrotic syndrome have a poor prognosis and 50% of them evolve to end-stage renal disease. The goal of therapy is to induce and maintain remission of the disease, reducing the risk secondary to proteinuria while minimizing the adverse effects of treatments, especially with prolonged use of corticosteroids. This paper is the result of the collaborative effort of the Nephrology Branch of the Chilean Society of Pediatrics with aims at helping pediatricians and pediatric nephrologists to treat pediatric SNI. In this first part, recommendations of steroid-sensitive nephrotic syndrome are discussed. Copyright © 2015 Sociedad Chilena de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

Association of problem behavior with sleep problems and gastroesophageal reflux symptoms.

PubMed

Sakaguchi, Katsuyoshi; Yagi, Takakazu; Maeda, Aya; Nagayama, Kunihiro; Uehara, Sawako; Saito-Sakoguchi, Yoko; Kanematsu, Kyoko; Miyawaki, Shouichi

2014-02-01

There are few large-scale epidemiologic studies examining the associations between sleep problems, gastroesophageal reflux disease (GERD) symptoms, lifestyle and food habits and problem behaviors (PB) in adolescents. The aim of this study was to evaluate the associations among these factors in Japanese adolescents. A cross-sectional survey of 1840 junior high school students was carried out using questionnaires. The subjects were classified into PB or normal behavior (NB) groups using the Pediatric Symptom Checklist (PSC). The scores of the sleep-related factors, sleep bruxism, lifestyle and food habits, and GERD symptoms were compared. Logistic regression analysis was used to determine the factors related to PB. Mean subject age was 13.3 ± 1.8 years. The PB group had significantly longer sleep latency and higher GERD symptom score (P < 0.001). Furthermore, the PB group was significantly more likely to experience absence of the mother at dinner time, skip breakfast, and have <30 min of conversation among family at dinner time. The PB group had significantly higher frequencies of sleep bruxism, difficulty falling asleep within 30 min, nightmares, feeling of low sleep quality, daytime somnolence, and daytime lack of motivation. Feelings of low sleep quality had the strongest association with PB, with an adjusted odds ratio of 12.88 (95% confidence interval: 8.99-18.46). PB in adolescents are associated with sleep problems, including sleep bruxism, as well as lifestyle and food habits and GERD symptoms. © 2013 The Authors. Pediatrics International © 2013 Japan Pediatric Society.

SCREENING FOR PSYCHOSOCIAL PROBLEMS IN CHILDREN ATTENDING THE PEDIATRIC CLINIC AT KING KHALID UNIVERSITY HOSPITAL (KKUH) IN RIYADH (KSA)

PubMed Central

Al-Ayed, Ibrahim H.; Al-Haider, Fatimah A.

2008-01-01

Introduction: Psychosocial problems are highly prevalent among children and adolescents. One approach to facilitating recognition and referral of these problems is to use parent-completed screening questionnaire as part of routine primary care. Aim and methods: The purpose of this study was to determine the prevalence and type of psychosocial problems in a random sample of children attending the pediatric clinic at KKUH at the time of the study. A 2-part questionnaire was designed for the study. The first part contained basic biographic data in addition to items which reflect the socioeconomic status of the family. The second part of the questionnaire comprised the inventory, which is a modified version of the Pediatric Symptoms Checklist (PSC).The inventory consisted of 38 items classified into five categories. The total score of the inventory ranged from 0-114. Results: Three-hundred-twelve questionnaires were completed. The average of the total score was only 22.3 out of 114. The lowest score was 0 and the highest 84. The average scores of behavioral symptoms (BS) were the highest (7.03 out of 27) while that of the learning problems (LP) was the lowest (1.5 out of 18). The average score for mood symptoms (MS) was 5.6 out of 24, that for personality characteristics (PC) was 4.5 out of 24 and that for somatic symptoms (SS) was 4.3 out of 24. Conclusion: This study revealed the feasibility of screening for behavioral problems of children in an outpatient setting. It is necessary to implement screening procedures for psycho-behavioral problems, and train pediatricians to screen children presenting at clinics. PMID:23012163

Screening for psychosocial problems in children attending the pediatric clinic at king khalid university hospital (kkuh) in riyadh (ksa).

PubMed

Al-Ayed, Ibrahim H; Al-Haider, Fatimah A

2008-01-01

Psychosocial problems are highly prevalent among children and adolescents. One approach to facilitating recognition and referral of these problems is to use parent-completed screening questionnaire as part of routine primary care. The purpose of this study was to determine the prevalence and type of psychosocial problems in a random sample of children attending the pediatric clinic at KKUH at the time of the study. A 2-part questionnaire was designed for the study. The first part contained basic biographic data in addition to items which reflect the socioeconomic status of the family. The second part of the questionnaire comprised the inventory, which is a modified version of the Pediatric Symptoms Checklist (PSC).The inventory consisted of 38 items classified into five categories. The total score of the inventory ranged from 0-114. Three-hundred-twelve questionnaires were completed. The average of the total score was only 22.3 out of 114. The lowest score was 0 and the highest 84. The average scores of behavioral symptoms (BS) were the highest (7.03 out of 27) while that of the learning problems (LP) was the lowest (1.5 out of 18). The average score for mood symptoms (MS) was 5.6 out of 24, that for personality characteristics (PC) was 4.5 out of 24 and that for somatic symptoms (SS) was 4.3 out of 24. This study revealed the feasibility of screening for behavioral problems of children in an outpatient setting. It is necessary to implement screening procedures for psycho-behavioral problems, and train pediatricians to screen children presenting at clinics.

Prophylactic antibiotics in pediatric shunt surgery.

PubMed

Biyani, N; Grisaru-Soen, G; Steinbok, P; Sgouros, S; Constantini, S

2006-11-01

The optimal antibiotic prophylaxis for pediatric shunt-related procedures is not clear. There is much inconsistency among different medical centers. This paper summarizes and analyzes the various prophylactic antibiotic regiments used for shunt-related surgeries at different pediatric neurosurgery centers in the world. A survey questionnaire was distributed through the Pediatric Neurosurgery list-server (an e-mail-based special interest group in pediatric neurosurgery). Forty-five completed questionnaires were received, one per medical center, primarily from pediatric neurosurgeons with the following geographic breakdown: 25 from North America, 13 from Europe, and 7 from Asia and other countries. All centers routinely administered prophylactic antibiotics for shunt-related procedures. The drugs of choice were first-generation cephalosporins (23), second-generation cephalosporins (10), naficillin/oxacillin (4), vancomycin (3), clindamycin (1), amoxicillin (1), and mixed protocols in three centers. The initial drug administration ("first dose") was: in the department before transfer to operating room (5), upon arrival to operating room (11), at induction of anesthesia (13), and at initial skin incision (16). The duration of antibiotic dosage also varied: single dose (13), 24-h administration (26), 48-h administration (2), and longer than 48 h in four centers. Two general tendencies were noted, common to the majority of participating centers. There was a general trend to modify antibiotic treatment protocol in "high-risk" populations. The second common theme noted in more than half of responding centers was the use of long-term antibiotic treatment for externalized devices (such as externalized shunts, external ventricular drains or lumbar drains), usually till the device was in place.

Are pediatric critical care medicine fellowships teaching and evaluating communication and professionalism?

PubMed

Turner, David A; Mink, Richard B; Lee, K Jane; Winkler, Margaret K; Ross, Sara L; Hornik, Christoph P; Schuette, Jennifer J; Mason, Katherine; Storgion, Stephanie A; Goodman, Denise M

2013-06-01

To describe the teaching and evaluation modalities used by pediatric critical care medicine training programs in the areas of professionalism and communication. Cross-sectional national survey. Pediatric critical care medicine fellowship programs. Pediatric critical care medicine program directors. None. Survey response rate was 67% of program directors in the United States, representing educators for 73% of current pediatric critical care medicine fellows. Respondents had a median of 4 years experience, with a median of seven fellows and 12 teaching faculty in their program. Faculty role modeling or direct observation with feedback were the most common modalities used to teach communication. However, six of the eight (75%) required elements of communication evaluated were not specifically taught by all programs. Faculty role modeling was the most commonly used technique to teach professionalism in 44% of the content areas evaluated, and didactics was the technique used in 44% of other professionalism content areas. Thirteen of the 16 required elements of professionalism (81%) were not taught by all programs. Evaluations by members of the healthcare team were used for assessment for both competencies. The use of a specific teaching technique was not related to program size, program director experience, or training in medical education. A wide range of techniques are currently used within pediatric critical care medicine to teach communication and professionalism, but there are a number of required elements that are not specifically taught by fellowship programs. These areas of deficiency represent opportunities for future investigation and improved education in the important competencies of communication and professionalism.

Patterns of Use of Peripheral Nerve Blocks and Trigger Point Injections for Pediatric Headache: Results of a survey of the American Headache Society Pediatric & Adolescent Section

PubMed Central

Szperka, Christina L.; Gelfand, Amy A.; Hershey, Andrew D.

2016-01-01

Objective To describe current patterns of use of nerve blocks and trigger point injections for treatment of pediatric headache. Background Peripheral nerve blocks are often used to treat headaches in adults and children, but the available studies and practice data from adult headache specialists have shown wide variability in diagnostic indications, sites injected, and medication(s) used. The purpose of this study was to describe current practice patterns in the use of nerve blocks and trigger point injections for pediatric headache disorders. Methods A survey was created in REDCap, and sent via email to the 82 members of the Pediatric & Adolescent Section of the American Headache Society in June 2015. The survey queried about current practice and use of nerve blocks, as well as respondents’ opinions regarding gaps in the evidence for use of nerve blocks in this patient population. Results Forty-one complete, 5 incomplete, and 3 duplicate responses were submitted (response rate complete 50%). Seventy-eight percent of the respondents identified their primary specialty as Child Neurology, and 51% were certified in headache medicine. Twenty-six (63%) respondents perform nerve blocks themselves, and 7 (17%) refer patients to another provider for nerve blocks. Chronic migraine with status migrainosus was the most common indication for nerve blocks (82%), though occipital neuralgia (79%), status migrainosus (73%), chronic migraine without flare (70%), post-traumatic headache (70%), and new daily persistent headache (67%) were also common indications. The most commonly selected clinically meaningful response for status migrainosus was ≥50% reduction in severity, while for chronic migraine this was a ≥50% decrease in frequency at 4 weeks. Respondents inject the following locations: 100% inject the greater occipital nerve, 69% lesser occipital nerve, 50% supraorbital, 46% trigger point injections, 42% auriculotemporal, and 34% supratrochlear. All respondents used local anesthetic, while 12 (46%) also use corticosteroid (8 bupivacaine only, 4 each lidocaine + bupivacaine, lidocaine + corticosteroid, bupivacaine + corticosteroid, lidocaine + bupivacaine + corticosteroid, and 2 lidocaine only). Conclusion Despite limited evidence, nerve blocks are commonly used by pediatric headache specialists. There is considerable variability among clinicians as to injection site(s) and medication selection, indicating a substantial gap in the literature to guide practice, and supporting the need for further research in this area. PMID:27731894

Pediatric Major Head Injury: Not a Minor Problem.

PubMed

Leetch, Aaron N; Wilson, Bryan

2018-05-01

Traumatic brain injury is a highly prevalent and devastating cause of morbidity and mortality in children. A rapid, stepwise approach to the traumatized child should proceed, addressing life-threatening problems first. Management focuses on preventing secondary injury from physiologic extremes such as hypoxemia, hypotension, prolonged hyperventilation, temperature extremes, and rapid changes in cerebral blood flow. Initial Glasgow Coma Score, hyperglycemia, and imaging are often prognostic of outcome. Surgically amenable lesions should be evacuated promptly. Reduction of intracranial pressure through hyperosmolar therapy, decompressive craniotomy, and seizure prophylaxis may be considered after stabilization. Nonaccidental trauma should be considered when evaluating pediatric trauma patients. Copyright © 2017 Elsevier Inc. All rights reserved.

The Prevalence of Malnutrition and Effectiveness of STRONGkids Tool in the Identification of Malnutrition Risks among Pediatric Surgical Patients

PubMed Central

Durakbaşa, Çiğdem Ulukaya; Fettahoğlu, Selma; Bayar, Ahu; Mutus, Murat; Okur, Hamit

2014-01-01

Background: High prevalence of malnutrition along with the risk for the development of malnutrition in hospitalised children has been reported. However, this problem remains largely unrecognised by healthcare workers. Aims: To determine the prevalence of malnutrition and effectiveness of STRONGkids nutritional risk screening (NRS) tool in the identification of malnutrition risk among pediatric surgical patients. Study Design: Cross-sectional study. Methods: A total of 494 pediatric surgical patients (median age 59 months, 75.8% males) were included in this prospective study conducted over 3 months. SD-scores <−2 for Body Mass Index (BMI) for age or weight-for-height (WFH) and height-for-age (HFA) were considered to indicate acute and chronic malnutrition, respectively. The STRONGkids NRS tool was used to determine risk for malnutrition. Results: Malnutrition was detected in 13.4% in this group of pediatric surgical patients. Acute malnutrition was identified in 10.1% of patients and more commonly in patients aged ≤60 months than aged >60 months (13.4 vs. 6.6%, p=0.012). Chronic malnutrition was identified in 23 (4.6%) of patients with no significant difference between age groups. There were 7 (1.4%) children with coexistent acute and chronic malnutrition. The STRONGkids tool revealed that 35.7% of patients were either in the moderate or high risk group for malnutrition. Malnutrition, as revealed by anthropometric measurements, was more likely in the presence of gastrointestinal (26.9%, p=0.004) and inguinoscrotal/penile surgery (4.0%, p=0.031), co-morbidities affecting nutritional status (p<0.001) and inpatient admissions (p=0.014). Among patients categorized as low risk for malnutrition, there were more outpatients than inpatients (89.3 vs. 10.7%, p<0.001) and more elective surgery cases than emergency surgery cases (93.4 vs. 6.6%, p<0.001). Conclusion: Providing data on the prevalence of malnutrition and risk of malnutrition in a prospectively recruited group of hospitalised pediatric surgical patients, the data acquired in the present study emphasise the need to raise clinician’s awareness about the importance of nutritional status assessment among hospitalised pediatric patients and the benefits of identifying patients at the risk of nutritional depletion before malnutrition occurs. Our findings support the use of the STRONGkids tool among pediatric surgical patients to identify patients at risk for malnutrition and to increase the physician’s awareness of nutritional assessment among hospitalised patients upon admission. PMID:25667785

Genome-wide network analysis of Wnt signaling in three pediatric cancers

NASA Astrophysics Data System (ADS)

Bao, Ju; Lee, Ho-Jin; Zheng, Jie J.

2013-10-01

Genomic structural alteration is common in pediatric cancers, and analysis of data generated by the Pediatric Cancer Genome Project reveals such tumor-related alterations in many Wnt signaling-associated genes. Most pediatric cancers are thought to arise within developing tissues that undergo substantial expansion during early organ formation, growth and maturation, and Wnt signaling plays an important role in this development. We examined three pediatric tumors--medullobastoma, early T-cell precursor acute lymphoblastic leukemia, and retinoblastoma--that show multiple genomic structural variations within Wnt signaling pathways. We mathematically modeled this pathway to investigate the effects of cancer-related structural variations on Wnt signaling. Surprisingly, we found that an outcome measure of canonical Wnt signaling was consistently similar in matched cancer cells and normal cells, even in the context of different cancers, different mutations, and different Wnt-related genes. Our results suggest that the cancer cells maintain a normal level of Wnt signaling by developing multiple mutations.

Recurrent parotitis as a presentation of primary pediatric Sjögren syndrome.

PubMed

Baszis, Kevin; Toib, Dana; Cooper, Megan; French, Anthony; White, Andrew

2012-01-01

Parotitis is a common condition seen in the pediatric population, usually as an isolated occurrence associated with viral or bacterial infection. The differential diagnosis expands when recurrent parotitis is encountered. One etiology is primary pediatric Sjögren syndrome (SS), an autoimmune condition typically associated with dryness of the eyes and mouth in adults. Pediatric patients often present with isolated recurrent bilateral parotitis, however, and we describe 4 such cases in children aged 9 to 17 years at presentation. Despite lack of ocular complaints, 3 of these patients had ocular findings on ophthalmologic exam. Our patients also exhibited classic laboratory abnormalities, including positive antinuclear antibody, SS A, and SS B antibodies; presence of rheumatoid factor; and hypergammaglobulinemia. Consideration of SS in the child with recurrent parotitis is important for timely and appropriate referral and treatment. We review the differential diagnosis of parotitis in children as well as the salient features of pediatric SS.

Epidemiology of pediatric skin diseases in the mid-western Anatolian region of Turkey.

PubMed

Kacar, Seval Dogruk; Ozuguz, Pinar; Polat, Serap; Manav, Vildan; Bukulmez, Aysegul; Karaca, Semsettin

2014-10-01

The field of pediatric dermatology has gained importance with the increment of pediatric patients and the discrepancy of their skin diseases with the adult versions. We aimed to describe frequency and distribution of pediatric skin diseases, and the diagnostic procedures and treatments prescribed. Cross-sectional epidemiological study. We collected data about diagnostic patterns, diagnostic methods and treatment modalities in pediatric dermatology outpatient clinic visits over 18 months. Infectious diseases (27.9%) and among them viral warts (17.5%) were the most prevalent diagnoses, followed by acne-acneiform diseases (19.9%) and allergic diseases (14.5%). Among the diagnostic tests histopathology was required in 5.2%, usually to diagnose inflammatory and tumoral lesions. Topical treatments (49.3%) were followed by systemic treatments (32.4%) in majority of cases. Viral warts were among the most common dermatoses, and preventive measures for HPV transmission should become important part of public health efforts in children.

Initial resuscitation and management of pediatric septic shock

PubMed Central

Martin, Kelly; Weiss, Scott L.

2015-01-01

The pediatric sepsis syndrome remains a common cause of morbidity, mortality, and health care utilization costs worldwide. The initial resuscitation and management of pediatric sepsis is focused on 1) rapid recognition of abnormal tissue perfusion and restoration of adequate cardiovascular function, 2) eradication of the inciting invasive infection, including prompt administration of empiric broad-spectrum antimicrobial medications, and 3) supportive care of organ system dysfunction. Efforts to improve early and aggressive initial resuscitation and ongoing management strategies have improved outcomes in pediatric severe sepsis and septic shock, though many questions still remain as to the optimal therapeutic strategies for many patients. In this article, we will briefly review the definitions, epidemiology, clinical manifestations, and pathophysiology of sepsis and provide an extensive overview of both current and novel therapeutic strategies used to resuscitate and manage pediatric patients with severe sepsis and septic shock. PMID:25604591

Epsilon aminocaproic acid reduces blood transfusion and improves the coagulation test after pediatric open-heart surgery: a meta-analysis of 5 clinical trials

PubMed Central

Lu, Jun; Meng, Haoyu; Meng, Zhaoyi; Sun, Ying; Pribis, John P; Zhu, Chunyan; Li, Quan

2015-01-01

Background: Excessive postoperative blood loss after cardiopulmonary bypass is a common problem, especially in patients suffering from congenital heart diseases. The efficacy of epsilon aminocaproic acid (EACA) as a prophylactic treatment for postoperative bleeding after pediatric open-heart surgery has not been determined. This meta-analysis investigates the efficacy of EACA in the minimization of bleeding and blood transfusion and the maintenance of coagulation tests after pediatric open-heart surgery. Methods: A comprehensive literature search was performed to identify all randomized clinical trials on the subject. PubMed, Embase, the Cochrane Library, and the Chinese Medical Journal Network were screened. The primary outcome used for the analysis was postoperative blood loss. Secondary outcomes included postoperative blood transfusion, re-exploration rate and postoperative coagulation tests. The mean difference (MD) and risk ratio (RR) with 95% confidence intervals (CI) were used as summary statistics. Results: Five trials were included in this meta-analysis of 515 patients. Prophylactic EACA was associated with a reduction in postoperative blood loss, but this difference did not reach statistical significance (MD: -7.08; 95% CI: -16.11 to 1.95; P = 0.12). Patients treated with EACA received fewer postoperative blood transfusions, including packed red blood cells (MD: -8.36; 95% CI: -12.63 to -4.09; P = 0.0001), fresh frozen plasma (MD: -3.85; 95% CI: -5.63 to -2.08; P < 0.0001), and platelet concentrate (MD: -10.66; 95% CI: -18.45 to -2.87; P = 0.007), and had a lower re-exploration rate (RR: 0.46; 95% CI: 0.23 to 0.92; P = 0.03). Prophylactic EACA also improved coagulation tests 6 hours after open-heart surgery. Conclusions: Prophylactic EACA minimizes postoperative blood transfusion and helps maintain coagulation in pediatric patients undergoing open-heart surgery. Therefore, the results of this study indicate that adjunctive EACA is a good choice for the prevention of postoperative blood transfusion following pediatric cardiac surgery. PMID:26339364

Trends in the epidemiology of pediatric severe sepsis*.

PubMed

Hartman, Mary E; Linde-Zwirble, Walter T; Angus, Derek C; Watson, R Scott

2013-09-01

In the past decade, guidelines have been developed for the early detection and management of severe sepsis in children and neonates. However, severe sepsis continues to be a significant U.S. healthcare problem, accounting for over 720,000 annual hospitalizations. Large-scale epidemiologic studies of severe sepsis continue to be limited, particularly in children. We present data from 1995, 2000, and 2005 in seven U.S. states, examining how case mix, outcome, and resource use for pediatric severe sepsis have changed over time. We constructed a database including all acute-care hospitalizations for children in the seven states. For each case, we extracted data on demographic characteristics; the principal diagnosis, up to six secondary diagnoses, and six procedures as classified by the International Classification of Diseases, 9th Revision, Clinical Modification codes; and in-hospital fatality. We identified patients with severe sepsis using International Classification of Diseases, 9th Revision, Clinical Modification codes for both infection and acute organ failure. Retrospective observational cohort dataset from seven U.S. states from 1995, 2000, and 2005. Children in the U.S. 0-19 years old. None. In 2005, 17,542 children were hospitalized with severe sepsis in the seven states; there was an 81% increase in pediatric severe sepsis cases since 1995 and a 45% increase since 2000. This corresponded to an increase in prevalence from 0.56 to 0.89 cases per 1,000 pediatric population. Between 1995 and 2005, the prevalence of severe sepsis in newborns more than doubled, from 4.5 to 9.7 cases per 1,000 births. The most common infecting organisms in all 3 years were Staphylococcus species. From 1995 to 2005, the case-fatality rate decreased from 10.3% to 8.9%. Case fatality associated with Staphylococcus aureus increased, whereas fatality associated with Streptococcus pneumoniae decreased by 75%. Nationally, there were 75,255 pediatric hospitalizations in 2005 involving severe sepsis, with an associated cost of $4.8 billion. Between 1995 and 2005, the prevalence of severe sepsis in U.S. children steadily rose, due to a significant increase in the prevalence of severe sepsis in newborns.

Dealing with sub-trochanteric fracture in a child with osteopetrosis : A case report.

PubMed

Behera, P; Khurana, A; Saibaba, B; Aggarwal, S

2016-12-01

Osteopetrosis is a rare hereditary condition which may have autosomal recessive or autosomal dominant inheritance. Patients tend to present most commonly with fractures but involvement of cranial nerves and hematopoetic system is not uncommon. Patients with infantile and intermediate type tend to present more often with problems other than orthopaedic problems. While diagnosis can be made on the basis of radiographs, management needs to be customized for every patient. Non operative and operative management both have their advantages and disadvantages. We are here reporting a case of sub-trochanteric fracture in an eight-year-old child which was managed successfully with a dynamic hip screw (DHS). Surgery could be performed successfully by taking precautions during reduction, drilling and screw placement. At the latest follow up, which was after one and half years of surgery, the fracture had united well and the child faced no limitations of activities. Thus, open reduction and fixation with DHS can be considered as an effective management modality for pediatric sub-trochanteric fractures in osteopetrosis.

Methylenetetrahydrofolate reductase polymorphisms and therapy response in pediatric acute lymphoblastic leukemia.

PubMed

Aplenc, Richard; Thompson, Jennifer; Han, Peggy; La, Mei; Zhao, Huaqing; Lange, Beverly; Rebbeck, Timothy

2005-03-15

A significant portion of patients treated for pediatric acute lymphoblastic leukemia (ALL) relapse. We hypothesized that common polymorphisms with moderate effect sizes and large attributive risks could explain an important fraction of ALL relapses. Methylenetetrahydrofolate reductase (MTHFR) is central to folate metabolism and has two common functional polymorphisms (C677T and A1298G). Methotrexate (MTX), which interrupts folate metabolism, is a mainstay of pediatric ALL therapy. MTX inhibits the synthesis of dTMP needed for DNA replication by blocking the conversion of 5,10-methylenetetrahydrofolate to 5-methyltetrahydrofolate by MTHFR. We hypothesized that a deactivating MTHFR allele would increase ALL relapse risk by potentially increasing 5,10-methylenetetrahydrofolate and dTMP, enhancing DNA synthesis and thus opposing MTX. To test this hypothesis, we genotyped 520 patients on the Children's Cancer Study Group ALL study, CCG-1891. The MTHFR C677T variant allele was statistically significantly associated with relapse (chi2 = 4.38, P = 0.036). This association remained significant (hazard ratio = 1.82, P = 0.008), controlling for important covariates, and was more predictive of relapse than other predictors, including day 7 bone marrow response. The MTHFR C677T variant allele was not associated with an increased risk of toxicity or infection. The MTHFR A1298G polymorphism was not associated with altered risks of relapse, toxicity, or infection. Haplotype analysis showed six common haplotypes that did not provide additional information predictive for relapse. These data provide evidence that the MTHFR C677T polymorphism is a common genetic variant conferring a moderate relative risk and a high attributable risk for relapse in pediatric ALL patients.

Antibiotic Resistance Patterns of Outpatient Pediatric Urinary Tract Infections

PubMed Central

Edlin, Rachel S.; Shapiro, Daniel J.; Hersh, Adam L.; Copp, Hillary L.

2014-01-01

Purpose We characterize the current national patterns of antibiotic resistance of outpatient pediatric urinary tract infection. Materials and Methods We examined outpatient urinary isolates from patients younger than 18 years in 2009 using The Surveillance Network®, a database with antibiotic susceptibility results and patient demographic data from 195 United States hospitals. We determined the prevalence and antibiotic resistance patterns for the 6 most common uropathogens, ie Escherichia coli, Proteus mirabilis, Klebsiella, Enterobacter, Pseudomonas aeruginosa and Enterococcus. We compared differences in uropathogen prevalence between males and females using chi-square analysis. Results We identified 25,418 outpatient urinary isolates. E. coli was the most common uropathogen overall but the prevalence of E. coli was higher among females (83%) than males (50%, p <0.001). Other common species among males were Enterococcus (17%), P. mirabilis (11%) and Klebsiella (10%). However, these uropathogens each accounted for 5% or less of female isolates (p <0.001). Resistance among E. coli was highest for trimethoprim-sulfamethoxazole (24%) but lower for nitrofurantoin (less than 1%) and cephalothin (15%). Compared to 2002 Surveillance Network data, E. coli resistance rates increased for trimethoprim-sulfamethoxazole (from 23% to 31% in males and from 20% to 23% in females) and ciprofloxacin (from 1% to 10% and from 0.6% to 4%, respectively). Conclusions E. coli remains the most common pediatric uropathogen. Although widely used, trimethoprim-sulfamethoxazole is a poor empirical choice for pediatric urinary tract infections in many areas due to high resistance rates. First-generation cephalosporins and nitrofurantoin are appropriate narrow-spectrum alternatives given their low resistance rates. Local antibiograms should be used to assist with empirical urinary tract infection treatment. PMID:23369720

Antibiotic resistance patterns of outpatient pediatric urinary tract infections.

PubMed

Edlin, Rachel S; Shapiro, Daniel J; Hersh, Adam L; Copp, Hillary L

2013-07-01

We characterize the current national patterns of antibiotic resistance of outpatient pediatric urinary tract infection. We examined outpatient urinary isolates from patients younger than 18 years in 2009 using The Surveillance Network®, a database with antibiotic susceptibility results and patient demographic data from 195 United States hospitals. We determined the prevalence and antibiotic resistance patterns for the 6 most common uropathogens, ie Escherichia coli, Proteus mirabilis, Klebsiella, Enterobacter, Pseudomonas aeruginosa and Enterococcus. We compared differences in uropathogen prevalence between males and females using chi-square analysis. We identified 25,418 outpatient urinary isolates. E. coli was the most common uropathogen overall but the prevalence of E. coli was higher among females (83%) than males (50%, p <0.001). Other common species among males were Enterococcus (17%), P. mirabilis (11%) and Klebsiella (10%). However, these uropathogens each accounted for 5% or less of female isolates (p <0.001). Resistance among E. coli was highest for trimethoprim-sulfamethoxazole (24%) but lower for nitrofurantoin (less than 1%) and cephalothin (15%). Compared to 2002 Surveillance Network data, E. coli resistance rates increased for trimethoprim-sulfamethoxazole (from 23% to 31% in males and from 20% to 23% in females) and ciprofloxacin (from 1% to 10% and from 0.6% to 4%, respectively). E. coli remains the most common pediatric uropathogen. Although widely used, trimethoprim-sulfamethoxazole is a poor empirical choice for pediatric urinary tract infections in many areas due to high resistance rates. First-generation cephalosporins and nitrofurantoin are appropriate narrow-spectrum alternatives given their low resistance rates. Local antibiograms should be used to assist with empirical urinary tract infection treatment. Copyright © 2013 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Pediatric trauma BIG score: Predicting mortality in polytraumatized pediatric patients.

PubMed

El-Gamasy, Mohamed Abd El-Aziz; Elezz, Ahmed Abd El Basset Abo; Basuni, Ahmed Sobhy Mohamed; Elrazek, Mohamed El Sayed Ali Abd

2016-11-01

Trauma is a worldwide health problem and the major cause of death and disability, particularly affecting the young population. It is important to remember that pediatric trauma care has made a significant improvement in the outcomes of these injured children. This study aimed at evaluation of pediatric trauma BIG score in comparison with New Injury Severity Score (NISS) and Pediatric Trauma Score (PTS) in Tanta University Emergency Hospital. The study was conducted in Tanta University Emergency Hospital to all multiple trauma pediatric patients attended to the Emergency Department for 1 year. Pediatric trauma BIG score, PTS, and NISS scores were calculated and results compared to each other and to observed mortality. BIG score ≥12.7 has sensitivity 86.7% and specificity 71.4%, whereas PTS at value ≤3.5 has sensitivity 63.3% and specificity 68.6% and NISS at value ≥39.5 has sensitivity 53.3% and specificity 54.3%. There was a significant positive correlation between BIG score value and mortality rate. The pediatric BIG score is a reliable mortality-prediction score for children with traumatic injuries; it uses international normalization ratio (INR), Base Excess (BE), and Glasgow Coma Scale (GCS) values that can be measured within a few minutes of sampling, so it can be readily applied in the Pediatric Emergency Department, but it cannot be applied on patients with chronic diseases that affect INR, BE, or GCS.

Determination of School-Related Problems in Children Treated for Cancer

ERIC Educational Resources Information Center

Yilmaz, Medine C.; Sari, Hatice Yildirim; Cetingul, Nazan; Kantar, Mehmet; Erermis, Serpil; Aksoylar, Serap

2014-01-01

This descriptive and case-control study was carried out in a pediatric oncology outpatient clinic to determine the school-related physical, social, and psychological problems and problems experienced in academic achievement of children treated for cancer. The sample of the study consisted of 56 Turkish patients with cancer, aged 7-18 years, who…

Affect and Mood Problems Related to School Aged Youth. An Introductory Packet.

ERIC Educational Resources Information Center

California Univ., Los Angeles. Center for Mental Health in Schools.

This introductory packet provides an introduction to affect and mood problems, framing the discussion within the classification scheme developed by the American Pediatric Association. Included is information on the symptoms and severity of a variety of affect and mood problems, as well as information on interventions ranging from environmental…

Anxiety, Fears, Phobias, and Related Problems: Intervention and Resources for School Aged Youth. An Introductory Packet.

ERIC Educational Resources Information Center

California Univ., Los Angeles. Center for Mental Health in Schools.

This introductory packet provides an introduction to anxiety problems, framing the discussion within the classification scheme developed by the American Pediatric Association. The variations in degree of problem are discussed with respect to interventions that range from environmental accommodations to behavioral strategies to medication. The…

Dissecting spontaneous cerebrospinal fluid collection.

PubMed

Champagne, Pierre-Olivier; Decarie, Jean-Claude; Crevier, Louis; Weil, Alexander G

2018-04-01

Hydrocephalus is a common condition in the pediatric population known to have many causes and presentation patterns. We report from the analysis of 2 cases the existence of a new complication of pediatric hydrocephalus. Naming this entity "dissecting intraparenchymal cerebrospinal fluid collection", we advance a hypothesis regarding its pathophysiology and discuss its clinical implications and management. Copyright © 2018 Elsevier Ltd. All rights reserved.

The lived experience of pediatric burn nurses following patient death.

PubMed

Kellogg, Marni B; Barker, Marianne; McCune, Nancy

2014-01-01

The purpose of this study is to describe the lived experience of pediatric burn unit nurses who have experienced the death of a patient. A qualitative phenomenological design was used for the interview and analysis. Methods were incorporated into the design to ensure reliability, consistency, and rigor. Using a semi-structured interview guide and phenomenological concepts, the investigators interviewed seven registered nurses who were employed in a pediatric burn unit. Data obtained were analyzed for common themes that emerged during examination of transcribed interviews. Four common themes of feelings were identified: 1) grief and sadness, 2) helplessness, 2) compartmentalization of feelings, and 4) lack of preparedness for dealing with situations involving the death of a pediatric patient. While nurses are emotionally supportive to patients and families, the emotional support available to nurses who are dealing with these situations is lacking. By developing individual coping strategies and seeking peer support, nurses attempt to deal with emotional situations faced in the workplace. Nurses, nurse educators, and administrators must understand the impact of nurses' grief following patient death. By understanding and validating their emotions, it is hoped that nurses will be supported in a way that will enhance a healthy professional environment and personal well-being.

Big and disparate data: considerations for pediatric consortia.

PubMed

Stingone, Jeanette A; Mervish, Nancy; Kovatch, Patricia; McGuinness, Deborah L; Gennings, Chris; Teitelbaum, Susan L

2017-04-01

Increasingly, there is a need for examining exposure disease associations in large, diverse datasets to understand the complex determinants of pediatric disease and disability. Recognizing that children's health research consortia will be important sources of big data, it is crucial for the pediatric research community to be knowledgeable about the challenges and opportunities that they will face. The present review will provide examples of existing children's health consortia, highlight recent pooled analyses conducted by children's health research consortia, address common challenges of pooled analyses, and provide recommendations to advance collective research efforts in pediatric research. Formal consortia and other collective-science initiatives are increasingly being created to share individual data from a set of relevant epidemiological studies to address a common research topic under the concept that the joint effort of many individual groups can accomplish far more than working alone. There are practical challenges to the participation of investigators within consortia that need to be addressed in order for them to work. Researchers who access consortia with data centers will be able to go far beyond their initial hypotheses and potentially accomplish research that was previously thought infeasible or too costly.

Initiation of a medical toxicology consult service at a tertiary care children's hospital.

PubMed

Wang, George Sam; Monte, Andrew; Hatten, Benjamin; Brent, Jeffrey; Buchanan, Jennie; Heard, Kennon J

2015-05-01

Currently, only 10% of board-certified medical toxicologists are pediatricians. Yet over half of poison center calls involve children < 6 years, poisoning continues to be a common pediatric diagnosis and bedside toxicology consultation is not common at children's hospitals. In collaboration with executive staff from Department of Pediatrics and Emergency Medicine, regional poison center, and our toxicology fellowship, we established a toxicology consulting service at our tertiary-care children's hospital. There were 139 consultations, and the service generated 13 consultations in the first month; median of 11 consultations per month thereafter (range 8-16). The service increased pediatric cases seen by the fellowship program from 30 to 94. The transition to a consult service required a culture change. Historically, call center advice was the mainstay of consulting practice and the medical staff was not accustomed to the availability of bedside medical toxicology consultations. However, after promotion of the service and full attending and fellowship coverage, consultations increased. In collaboration with toxicologists from different departments, a consultation service can be rapidly established. The service filled a clinical need that was disproportionately utilized for high acuity patients, immediately utilized by the medical staff and provided a robust pediatric population for the toxicology fellowship.

Pediatric and adolescent anterior shoulder instability: clinical management of first-time dislocators.

PubMed

Lin, Kenneth M; James, Evan W; Spitzer, Elad; Fabricant, Peter D

2018-02-01

The purpose of this review is to discuss the epidemiology, pathoanatomy, diagnosis, and clinical management of pediatric and adolescent patients following a first-time shoulder dislocation. Shoulder instability is becoming increasingly common as pediatric and adolescent patients engage in earlier organized sports competition. Recommended treatment following a first-time glenohumeral dislocation event in adolescents depends on several factors, but surgical stabilization is becoming more frequently performed. Surgical indications include bony Bankart lesion, ALPSA lesion, bipolar injury (e.g. Hill-Sachs humeral head depression fracture) or off-season injury in an overhead or throwing athlete. Complications following surgical treatment are rare but most commonly are associated with recurrent instability. Young children (eg. open proximal humerus growth plate), individuals averse to surgery, or in-season athletes who accept the risk of redislocation may complete an accelerated rehabilitation program for expedited return to play in the absence of the structural abnormalities listed above. Following a first-time dislocation event in pediatric and adolescent patients, a detailed discussion of the risks and benefits of nonoperative versus operative management is critical to match the recommended treatment with the patient's injury pattern, risk factors, and activity goals.

An evolving scientific basis for the prevention and treatment of pediatric obesity

PubMed Central

Katzmarzyk, PT; Barlow, S; Bouchard, C; Catalano, PM; Hsia, DS; Inge, TH; Lovelady, C; Raynor, H; Redman, LM; Staiano, AE; Spruijt-Metz, D; Symonds, ME; Vickers, M; Wilfley, D; Yanovski, JA

2014-01-01

The 2013 Pennington Biomedical Research Center’s Scientific Symposium focused on the treatment and management of pediatric obesity and was designed to (i) review recent scientific advances in the prevention, clinical treatment and management of pediatric obesity, (ii) integrate the latest published and unpublished findings and (iii) explore how these advances can be integrated into clinical and public health approaches. The symposium provided an overview of important new advances in the field, which led to several recommendations for incorporating the scientific evidence into practice. The science presented covered a range of topics related to pediatric obesity, including the role of genetic differences, epigenetic events influenced by in utero development, pre-pregnancy maternal obesity status, maternal nutrition and maternal weight gain on developmental programming of adiposity in offspring. Finally, the relative merits of a range of various behavioral approaches targeted at pediatric obesity were covered, together with the specific roles of pharmacotherapy and bariatric surgery in pediatric populations. In summary, pediatric obesity is a very challenging problem that is unprecedented in evolutionary terms; one which has the capacity to negate many of the health benefits that have contributed to the increased longevity observed in the developed world. PMID:24662696

An evolving scientific basis for the prevention and treatment of pediatric obesity.

PubMed

Katzmarzyk, P T; Barlow, S; Bouchard, C; Catalano, P M; Hsia, D S; Inge, T H; Lovelady, C; Raynor, H; Redman, L M; Staiano, A E; Spruijt-Metz, D; Symonds, M E; Vickers, M; Wilfley, D; Yanovski, J A

2014-07-01

The 2013 Pennington Biomedical Research Center's Scientific Symposium focused on the treatment and management of pediatric obesity and was designed to (i) review recent scientific advances in the prevention, clinical treatment and management of pediatric obesity, (ii) integrate the latest published and unpublished findings and (iii) explore how these advances can be integrated into clinical and public health approaches. The symposium provided an overview of important new advances in the field, which led to several recommendations for incorporating the scientific evidence into practice. The science presented covered a range of topics related to pediatric obesity, including the role of genetic differences, epigenetic events influenced by in utero development, pre-pregnancy maternal obesity status, maternal nutrition and maternal weight gain on developmental programming of adiposity in offspring. Finally, the relative merits of a range of various behavioral approaches targeted at pediatric obesity were covered, together with the specific roles of pharmacotherapy and bariatric surgery in pediatric populations. In summary, pediatric obesity is a very challenging problem that is unprecedented in evolutionary terms; one which has the capacity to negate many of the health benefits that have contributed to the increased longevity observed in the developed world.

Neuroinvasive Arboviral Disease in the United States: 2003 to 2012

PubMed Central

Gaensbauer, James T.; Lindsey, Nicole P.; Messacar, Kevin; Staples, J. Erin; Fischer, Marc

2017-01-01

OBJECTIVE To describe the epidemiologic and clinical syndromes associated with pediatric neuroinvasive arboviral infections among children in the United States from 2003 through 2012. METHODS We reviewed data reported by state health departments to ArboNET, the national arboviral surveillance system, for 2003 through 2012. Children (<18 years) with neuroinvasive arboviral infections (eg, meningitis, encephalitis, or acute flaccid paralysis) were included. Demographic, clinical syndrome, outcome, geographic, and temporal data were analyzed for all cases. RESULTS During the study period, 1217 cases and 22 deaths due to pediatric neuroinvasive arboviral infection were reported from the 48 contiguous states. La Crosse virus (665 cases; 55%) and West Nile virus (505 cases; 41%) were the most common etiologies identified. Although less common, Eastern equine encephalitis virus (30 cases; 2%) resulted in 10 pediatric deaths. La Crosse virus primarily affected younger children, whereas West Nile virus was more common in older children and adolescents. West Nile virus disease cases occurred throughout the country, whereas La Crosse and the other arboviruses were more focally distributed. CONCLUSIONS Neuroinvasive arboviral infections were an important cause of pediatric disease from 2003 through 2012. Differences in the epidemiology and clinical disease result from complex interactions among virus, vector, host, and the environment. Decreasing the morbidity and mortality from these agents depends on vector control, personal protection to reduce mosquito and tick bites, and blood donor screening. Effective surveillance is critical to inform clinicians and public health officials about the epidemiologic features of these diseases and to direct prevention efforts. PMID:25113294