Effect of a care-coordinated responsive parenting intervention on obesogenic risk behaviours among mother-infant dyads enrolled in WIC

BACKGROUND

Integrating health care and social care presents opportunities to deliver responsive parenting (RP) interventions for childhood obesity prevention.

OBJECTIVES

This analysis examined the effect of an integrated RP intervention on infant obesogenic risk behaviours.

METHODS

This secondary analysis included 228 mother-infant dyads in the Women, Infants, and Children Enhancements to Early Healthy Lifestyles for Baby (WEE Baby) Care study, a pragmatic randomized clinical trial that integrated care between paediatric clinicians and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) nutritionists to encourage RP. Mothers were randomized to a 6-month RP intervention or standard care. The Early Healthy Lifestyle risk assessment tool was completed at infant ages 2 and 6 months. Logistic regression examined study group effects on obesogenic risk behaviours, while t-tests assessed study group effects on a total obesogenic risk behaviour score. Models adjusted for milk type and parity.

RESULTS

RP mothers were less likely to report nighttime feedings at 2 (adjusted odds ratio [aOR] 0.21, 95% confidence interval [CI] 0.07-0.62) and 6 months (aOR 0.36, 95% CI 0.16-0.81); pressure to finish the bottle (aOR 0.53, 95% CI 0.30-0.93) and using screens when feeding/playing at 2 months (aOR 0.34, 95% CI 0.17-0.67); and putting their infant to bed after 8:00 PM at 6 months (aOR 0.46, 95% CI 0.21-0.97). RP mothers had significantly lower obesogenic risk behaviour scores at 2 months (p = 0.009) but not at 6 months (p = 0.06) compared to standard care.

CONCLUSIONS

The WEE Baby Care intervention decreased some obesogenic risk behaviours among WIC mother-infant dyads. Integrated care in health and social settings can be used to provide patient-centred RP guidance to improve early obesogenic risk behaviours in high-risk populations.

Invasive procedures and atraumatic care in pediatric nursing practice: nurses' perceptions

Introduction

Invasive procedures in pediatric nursing practice require a child-centered approach to minimize pain levels associated with manifestations of stress, anxiety, and long-term traumatic reactions.

Method

This cross-sectional study aimed at identifying nurses' perception of stress, anxiety, and pain levels in children and adolescents (0-18 years) undergoing invasive procedures, and strategies used to minimize the associated distress. Based on a literature review, an online questionnaire was developed that evaluates the distress associated with frequent invasive procedures and strategies used to reduce discomfort.

Results

Participants were 157 nurses who provided nursing care to children in all types of healthcare settings, such as hospitals and community health centers. Nurses evaluated lumbar puncture and catheter insertion as the procedures that caused more stress, anxiety, and pain in all age groups. ANOVA and post-hoc analyses indicate that nurses perceived adolescents as experiencing less stress than children in all the invasive procedures. Pediatric specialist nurses perceived a significantly higher total level of distress (an index that indicates stress, anxiety or pain in the whole group of procedures) compared to nurses with other specialties or generalist nurses, in all age groups. Non-pharmacological strategies were the most frequently used strategies used by nurses for minimizing distress in children, including distraction (51.2%), preparation (30.7%), and sensory techniques (14.6%). Pharmacological strategies, such as topical anesthetics and light sedation, were less frequently used.

Conclusion

This study highlights the importance of specialized training and knowledge concerning strategies to reduce distress in pediatric invasive procedures, suggesting the need for more significant investment in education and support for nursing professionals to improve patient experience.

Therapeutic effect of bismuth subsalicylate in a propionic acid-induced autism model

Inflammation-induced oxidative stress in macrophages and microglia is associated with excessive production of reactive oxygen species, initiating a damaging cycle of neuroinflammation and cellular injury. These processes are significant contributors to the pathophysiology of autism spectrum disorders, which involve neuronal dysfunction, cell loss, and behavioral impairments. Under conditions of oxidative stress, activated microglia release pro-inflammatory mediators, further intensifying neuronal damage. Bismuth subsalicylate (BSS), a compound with well-documented anti-inflammatory and antioxidant properties, has shown potential in mitigating such neurodegenerative processes. This study aimed to evaluate the effects of BSS in reducing neuroinflammation and oxidative stress in a propionic acid (PPA)-induced autism model, alongside its impact on behavioral outcomes. The study utilized 30 male Wistar albino rats, with PPA administered intraperitoneally at 250 mg/kg/day for 5 days to induce an autism-like phenotype. Rats were divided into three groups: Group 1 (Normal control, n = 10); Group 2 (PPA + saline, PPAS, n = 10); and Group 3 (PPA + BSS, PPAB, n = 10). Treatments were administered for 15 days. Behavioral performance was assessed through three-chamber sociability, open field, and passive avoidance learning tests, followed by biochemical and histological evaluations of brain tissues. Biochemical analysis revealed a significant increase in malondialdehyde, tumor necrosis factor-alpha, and interleukin-17 levels in the PPAS group, indicating heightened oxidative stress and inflammation. Treatment notably reduced these markers, suggesting its efficacy in mitigating oxidative damage and inflammatory responses. Immunohistochemical results demonstrated reduced glial activation and enhanced neuronal preservation in the hippocampal and cerebellar regions of treated rats. Additionally, behavioral impairments in social interaction, exploration, and memory were significantly improved with BSS therapy. These results suggest that BSS may confer neuroprotective effects through attenuation of oxidative stress and neuroinflammation, potentially contributing to improved neuronal function and behavioral performance in a PPA-induced autism model.

Life-Threatening Anemia and Thrombocytopenia in a Toddler with Influenza B: Case Report and Literature Review

Background: Seasonal influenza viruses are primarily known for causing respiratory illness, but rare hematologic complications can occur, especially in young children. While influenza A is more commonly linked to severe manifestations, influenza B can similarly precipitate life-threatening cytopenias, particularly in toddlers. Case Presentation: We report the case of a previously healthy 1-year-and-8-months-old girl who presented with a high fever, cough, and marked pallor during peak influenza season. Laboratory tests revealed significant microcytic, hypochromic anemia and severe thrombocytopenia. Rapid antigen testing was positive for influenza B. An extensive workup for other causes of bicytopenia, including leukemia, hemolysis, aplastic anemia, and other viral infections, yielded negative results. The child was managed with urgent red blood cell and platelet transfusions, oseltamivir antiviral therapy, broad-spectrum antibiotics, corticosteroids, and supportive care. Bone marrow aspiration was deferred in light of the rapid hematologic recovery. Her hemoglobin greatly improved, and her platelet count reached normal values at discharge. Conclusions: Our case underscores the need to consider influenza in the differential diagnosis of unexplained cytopenias during flu season. This case illustrates that influenza B can mimic hematologic malignancies. Rapid diagnosis and supportive treatment are essential to avoid fatal outcomes. Influenza vaccination plays a significant role in preventing severe complications, such as those we encountered.

Thoracoscopic Repair of Recurrent CDH is Associated with a Significantly Lower Complication Rate and Shorter ICU and Hospital Stay: A Prospective, Propensity Score-Matched Analysis

Congenital diaphragmatic hernia (CDH) is a malformation that significantly impacts neonatal morbidity and mortality. Recurrence after surgical repair remains a potentially life-threatening long-term complication. Conventionally, recurrent CDH has been managed through open surgery. However, thoracoscopic repair (TR) represents a novel alternative for recurrent CDH as it has reduced the length of hospital stay and mortality rate in the primary CDH repair.A prospective, propensity score-matched analysis was conducted on pediatric patients who underwent recurrent CDH repair at the University Hospital Mannheim between 2013 and 2023, to compare the outcomes of laparotomy versus TR. Patients were categorized based on the surgical technique employed. Comparative analysis, including propensity scoring, encompassed outcome measures such as duration of ICU and hospital stays, rate of complications, and operative duration.In total, 703 patients were treated for CDH, of whom 69 children underwent laparotomy (56) or TR (16) for CDH recurrence. After propensity score matching, TR group demonstrated a significantly shorter duration of surgery (178 [93-311] versus 225 [113-450] min, p = 0.042), reduced ICU stay (0 [0-10] versus 1 (0-69) days, p = 0.011), and decreased overall hospital stay (6 [3-34] versus 12 [7-40] days, p = 0.001). Moreover, the postoperative complications were significantly lower in the TR group (21.43% versus 73.68%, p = 0.003).TR for recurrent CDH repair is associated with shorter operation times, reduced ICU and overall hospital stays, and fewer complications compared with laparotomy. These findings suggest that TR may be preferable for the management of recurrent CDH, warranting larger randomized controlled studies to confirm the long-term safety and efficacy of this approach.

The evolving genetic landscape of neuromuscular fetal akinesias

Fetal akinesia is a broad term used to describe absent (or reduced, fetal hypokinesia) fetal movements, and it can be detected as early as the first trimester. Depending on the developmental age of onset, anything that interferes or limits the normal in utero movement results in a range of deformations affecting multiple organs and organ systems. Arthrogryposis, also termed arthrogryposis multiplex congenita (AMC), is a definitive terminology for multiple congenital contractures, with two major subgroups; amyoplasia and distal arthrogryposis (DA). The spectrum includes fetal akinesia deformation sequence (FADS), lethal congenital contracture syndrome (LCCS), and multiple pterygium syndrome (MPS). Variants in more than >400 genes are known to cause AMC, and it is increasingly recognized that variants in genes encoding critical components (including ventral horn cell, peripheral nerve, neuromuscular junction, skeletal muscle) of the extended motor unit underlie ∼40% of presentations. With unbiased screening approaches, including sequencing of comprehensive disease gene panels, exomes and genomes, novel genes and phenotypic expansions associated with known human disease genes have been uncovered in the setting of fetal akinesia. Autosomal-recessive titinopathy is the most frequent genetic cause of AMC. Accurate genetic diagnosis is critical to genetic counseling and informing family planning. Around 50% remain undiagnosed following comprehensive prenatal, diagnostic or research screening. Comprehensive phenotyping and periodic reanalysis with appropriate genomic tools are valuable strategies when faced with initial inconclusive results. There are likely many novel causative genes still to identify, which will inform our understanding of the molecular pathways underlying early human development and in utero movement.

A Systematic Review of Guided, Parent-Led Digital Interventions for Preadolescent Children with Emotional and Behavioural Problems

Emotional and behavioural problems (EBP) are prevalent amongst children, and guided, parent-led digital interventions offer one method of improving access to effective treatments. This systematic review (PROSPERO: CRD42023484098) aimed to examine the evidence base for, and characteristics of, these types of interventions through a narrative synthesis. Systematic searches were conducted using Medline, EMBASE, PsycINFO, Scopus and Web of Science in January 2024 and February 2025, supplemented with hand searching in March/April 2024 and February 2025. Studies were eligible if they reported outcomes related to preadolescent EBP from a guided, fully parent-led, fully digital intervention. Thirteen studies were eligible, including 2643 children and covering eight interventions (addressing anxiety problems, comorbid anxiety and depression, attention deficit hyperactivity disorder, conduct disorder and disruptive behaviour). Studies included randomised controlled trials and pre-post studies. The QualSyst checklist was used to assess study quality; all studies were rated as good quality. All studies showed statistically significant improvements in the child's symptoms or interference levels, with small to very large effect sizes immediately post-treatment, and at least medium effect sizes by follow-up, suggesting a promising evidence base. A wide range of intervention characteristics were identified, forming a basis for future intervention development for childhood EBP. However, there was a lack of consistency in how information was reported across studies (such as completion rates) and studies lacked information on parent demographics and key intervention details. Further high quality randomised controlled trials for a wider range of EBP are needed to continue building the evidence base.

Gender-stratified analyses of symptoms associated with life-threatening events in patients calling out-of-hours primary care for shortness of breath

BACKGROUND

Women and men seem to perceive shortness of breath (SOB) differently. However, it is unknown whether symptom presentation varies between genders during a life-threatening event (LTE).

AIM

To assess whether symptoms associated with an LTE vary between women and men with SOB calling out-of-hours primary care (OHS-PC).

METHODS

Cross-sectional study including data from patients contacting two large Dutch OHS-PC centres for SOB between 1 September 2020 and 31 August 2021. We compared symptoms mentioned during triage conversations between patients with and without LTEs (amongst others, acute coronary syndrome, pulmonary embolism, acute heart failure and severe pneumonia), stratified by gender.

RESULTS

We included 1,861 adults contacting OHS-PC for SOB (mean age 53.3 years, 55.3% women). The risk of an LTE was lower in women than in men (15.0% vs. 18.7%, RR 0.80; 95% CI 0.65-0.98). Patients with LTEs were older, more often had someone else calling for them, a history of cardiovascular disease, cardiovascular medication use and inability to speak full sentences compared to those without LTEs. Differences between women and men were only apparent for calling at night (women: 24.0% vs. 15.2%, p = 0.006, versus men: 18.7% vs. 22.5%, p = 0.300; p-value interaction term: 0.009) and participation of general practitioners during telephone triage (women: 49.4% vs. 49.5%, p = 0.975, versus men: 56.1% vs. 43.0%, p = 0.003; p-value interaction term: 0.033).

CONCLUSIONS

Among patients contacting OHS-PC with SOB, about 1 in 6 had an LTE, more often men than women. We found no strong evidence of symptom differences between gender groups predictive of LTEs.

TRIAL REGISTRATION

The Netherlands Trial Register, number: NL9682, registration date: 20-08-2021.

Early postnatal inhibition of neurosteroid synthesis changes the later-life adverse outcome of neonatal asphyxia in rats

Birth asphyxia (BA) is a common cause of hypoxic-ischemic encephalopathy (HIE), neonatal seizures, and detrimental neurodevelopment. Brain levels of neurosteroids such as allopregnanolone rise in response to acute hypoxic stress, which is thought to represent an endogenous protective mechanism that reduces excitotoxicity in the developing brain. In the present study, we investigated how inhibition of neurosteroid synthesis by the steroid 5α-reductase inhibitor finasteride affects the adverse outcomes of BA/HIE. Intermittent asphyxia was induced in neonatal rats at postnatal day 11. Finasteride (50 mg/kg) was administered immediately before asphyxia. Behavioral and cognitive tests were performed over the subsequent 14 months, which corresponds to ∼50 % of the lifespan of the outbred rat strain used. In contrast to our expectation, finasteride decreased the severity and duration of the neonatal seizures and did not increase mortality. Subsequent behavioral experiments showed no adverse development of motor function, but finasteride-treated rats exhibited increased anxiety-like behavior in the open field, elevated plus-maze, and light-dark box tests. The increased anxiety-like behavior was correlated with enhanced mossy fiber sprouting in the hippocampal CA3a region. While vehicle-treated post-asphyxial rats showed a serious decline in cognitive functions, this was not observed in the finasteride-treated group. One possible explanation of the latter finding is that a significant loss of CA3c neurons in the dorsal hippocampus was only determined in vehicle-treated but not finasteride-treated post-asphyxial rats. Overall, the present study indicates that the role of neurosteroids in BA and its adverse outcome is much more complex than previously thought.

Your baby has down syndrome: a reflexive thematic analysis of breaking the news to parents

The communication of a Down syndrome diagnosis to mothers is a pivotal moment that can impact their emotional well-being and the subsequent care for their child. This study aimed to explore maternal experiences with receiving a Down syndrome diagnosis. A total of 40 mothers participated, 42.5% received a prenatal diagnosis, 17.5% received the diagnosis during labor and delivery, and 40% received the information at the early postnatal period. Through reflexive thematic analysis, four key themes emerged: (1) About Who and How the News Was Delivered (2), About When the News Was Delivered (3), On Where the News Should Be Delivered (4), parents' positive experiences emerging from this, predominantly, negative episode. Our findings emphasize the need for improved training for healthcare professionals in delivering sensitive diagnoses, with an emphasis on empathy, accurate information, and support resources for families.

Clinical, Immunologic, and Genetic Characteristics in Patients With Syndrome of Undifferentiated Recurrent Fevers

OBJECTIVE

Syndrome of undifferentiated recurrent fevers (SURF) is characterized by recurrent fevers and autoinflammation without a confirmed molecular diagnosis of a hereditary recurrent fever syndrome, and not fulfilling criteria for periodic fever, adenitis, pharyngitis, aphthous stomatitis syndrome (PFAPA). The goal of this study was to characterize clinical features of patients with SURF compared to patients with PFAPA and to analyze their cytokine signature, genetic variations, and responses to treatment.

METHODS

We enrolled 46 patients observed at Cincinnati Children's Hospital Medical Center. Baseline data and inflammatory cytokines were collected at enrollment, and their clinical course was followed. Cytokine analysis was performed using a cytokine multiplex assay. Many patients had specific or whole exome genetic testing.

RESULTS

The prevalence of rash and arthralgias were higher in patients with SURF compared to patients with PFAPA. Pharyngitis and adenopathy were less frequent. A subset of patients with SURF clustered together with elevated proinflammatory cytokines and more frequently required biologic therapy. Focused analysis of whole exome sequencing  data revealed that variants of unknown clinical significance (VUCS) were frequently identified in genes implicated in B cell development, immunodeficiencies, and inflammatory bowel disease risk. Treatments for patients with SURF commonly included on-demand steroids, colchicine, and anti-interleukin-1 therapy.

CONCLUSION

Our findings suggest SURF is a heterogeneous group but has distinct clinical and immunologic features from disorders such as PFAPA. Patients have frequent VUCS, which may have relevance to disease pathogenesis. A subset of patients showed more inflammation and an increased need for biologic therapy. Further research is necessary to define whether there exist distinct SURF endotypes and to better predict treatment outcomes.

The nurse's role in assisting with a lumbar puncture in an infant or child

A lumbar puncture may be performed for various reasons, but is commonly used to facilitate the diagnosis of central nervous system infections in infants and children. It involves inserting a needle into the lower spine to obtain cerebrospinal fluid, which is then sent for testing in a laboratory. The results of the tests, together with a clinical assessment of a patient, can guide the effective treatment of infections and reduce the risk of neurological conditions. This article outlines some of the reasons why lumbar punctures are performed, discusses the practical aspects of the procedure and explains how nurses can effectively support the child and their family, while also assisting the practitioner undertaking the procedure.

The Obesity-Epigenetics-Microbiome Axis: Strategies for Therapeutic Intervention

Obesity (OB) has become a serious health issue owing to its ever-increasing prevalence over the past few decades due to its contribution to severe metabolic and inflammatory disorders such as cardiovascular disease, type 2 diabetes, and cancer. The unbalanced energy metabolism in OB is associated with substantial epigenetic changes mediated by the gut microbiome (GM) structure and composition alterations. Remarkably, experimental evidence also indicates that OB-induced epigenetic modifications in adipocytes can lead to cellular "memory" alterations, predisposing individuals to weight regain after caloric restriction and subsequently inducing inflammatory pathways in the liver. Various environmental factors, especially diet, play key roles in the progression or prevention of OB and OB-related disorders by modulating the GM structure and composition and affecting epigenetic mechanisms. Here, we will first focus on the key role of epigenetic aberrations in the development of OB. Then, we discuss the association between abnormal alterations in the composition of the microbiome and OB and the interplays between the microbiome and the epigenome in the development of OB. Finally, we review promising strategies, including prebiotics, probiotics, a methyl-rich diet, polyphenols, and herbal foods for the prevention and/or treatment of OB via modulating the GM and their metabolites influencing the epigenome.

Nutritional management of pediatric nephrotic syndrome regarding oxidative stress and antioxidant balance

Pediatric nephrotic syndrome remains a complex clinical entity, with incompletely elucidated pathogenetic mechanisms, in which oxidative stress appears to have a substantial etiopathogenic role. Recent evidence supports the involvement of redox imbalance in podocyte damage, impaired glomerular function, and systemic decline. All this suggests that antioxidant interventions can favorably modulate the course of the disease. This narrative review aims to synthesize the most relevant data from the current literature on the interaction between oxidative stress and nephrotic syndrome in children, with a focus on the therapeutic potential of antioxidants. The analysis focuses on the molecular mechanisms by which oxidative stress contributes to the progression of renal dysfunction, the role of oxidative biomarkers in disease monitoring, and the ability of antioxidants to reduce the need for immunosuppressants and corticosteroids, thus contributing to the decrease in associated morbidity. The translational perspectives of antioxidant therapy are also discussed, in the context of the urgent need for effective adjuvant strategies with a safety profile superior to conventional therapies. By integrating these data, the paper supports the valorization of antioxidant interventions as an emerging direction in the management of pediatric nephrotic syndrome and substantiates the need for controlled clinical trials, with rigorous design, in this field.

Consensus Approach for Standardization of the Timing of Brain Magnetic Resonance Imaging and Classification of Brain Injury in Neonates With Neonatal Encephalopathy/Hypoxic-Ischemic Encephalopathy: A Canadian Perspective

BACKGROUND

Neonatal encephalopathy (NE) and hypoxic-ischemic encephalopathy (HIE) are linked to significant neurodevelopmental impairments. Magnetic resonance imaging (MRI) is the preferred modality for classifying brain injury severity in HIE, yet considerable variability exists among institutions in terms of MRI timing, protocols, injury classification, and scoring systems for predicting long-term outcomes.

METHODS

A Canadian taskforce comprising radiologists and neonatologists was established to develop a consensus on the optimal timing of brain MRI, appropriate MRI protocols, and a unified approach to the classification and scoring of brain injury in infants with NE secondary to hypoxic-ischemic insult. The taskforce proposed a radiological classification and scoring system that is both simplified and modified from previously validated systems.

RESULTS

The consensus resulted in a standardized MRI protocol and a streamlined classification system designed to reduce interinstitutional variability. This proposed system offers a uniform framework for assessing the severity of brain injury and serves as a potential tool for predicting long-term neurodevelopmental outcomes.

CONCLUSION

Once validated, the proposed radiological classification and scoring system can be applied across centers to facilitate consistent outcome comparisons, improve prognostication for neonates with NE/HIE, and enhance the quality of family counseling regarding long-term neurodevelopmental prospects.

Evaluation of fecal neutrophil gelatinase-associated lipocalin levels in childhood inflammatory bowel disease

OBJECTIVES

Inflammatory bowel disease (IBD) is an immune-mediated, chronic, remitting, and relapsing disease. Calprotectin, used in monitoring the disease activity, is expressed from neutrophilic granulocytes during inflammation. Neutrophil gelatinase-associated lipocalin (NGAL) is strongly expressed in both granulocytes and the intestinal epithelial cell layer. The aim of the study was to compare fecal NGAL (FNGAL) with fecal calprotectin (FCAL) in children with IBD.

METHODS

Forty-four children with IBD and 22 healthy children were included in the study. The patients were divided into two groups, patients with active disease and remission group. Clinical and demographic characteristics, disease activity scores, and serum and fecal markers of the patients were recorded.

RESULTS

The mean age of the patients was 13.2 ± 3.4 years (range 6-17 years) and male/female: 0.62. FNGAL levels of patients with active disease were higher than those in the remission group (p < 0.001). A statistically significant positive correlation was observed between Pediatric Ulcerative Colitis Activity Index scores and white blood cell count, platelets, neutrophil-to-albumin ratio (NAR), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and FNGAL. There was a positive correlation between Pediatric Crohn's Disease Activity Index scores and platelets, NAR, ESR, CRP, and FNGAL, whereas there was a statistically significantly negative correlation with activity scores and albumin. While FNGAL had 95.5% sensitivity and 81.8% specificity, FCAL had 86.7% sensitivity and 85.7% specificity.

CONCLUSIONS

FNGAL levels were found to be high and sensitive in determining disease activity in our patients with IBD, suggesting that it may be a valuable biomarker.

Gut microbiota in cancer initiation, development and therapy

Cancer has long been associated with genetic and environmental factors, but recent studies reveal the important role of gut microbiota in its initiation and progression. Around 13% of cancers are linked to infectious agents, highlighting the need to identify the specific microorganisms involved. Gut microbiota can either promote or inhibit cancer growth by influencing oncogenic signaling pathways and altering immune responses. Dysbiosis can lead to cancer, while certain probiotics and their metabolites may help reestablish micro-ecological balance and improve anti-tumor immune responses. Research into targeted approaches that enhance therapy with probiotics is promising. However, the effects of probiotics in humans are complex and not yet fully understood. Additionally, methods to counteract harmful bacteria are still in development. Early clinical trials also indicate that modifying gut microbiota may help manage side effects of cancer treatments. Ongoing research is crucial to understand better how gut microbiota can be used to improve cancer prevention and treatment outcomes.

Early onset sepsis: clinical observation or risk factors approach?

OBJECTIVES

To compare the perinatal risk factors approach for early-onset sepsis (EOS), which is based on categorical risk stratification, with the clinical observation-based approach, evaluating their impact on laboratory testing frequency, the use of antibiotic therapy, and EOS incidence.

METHODS

Retrospective observational study, conducted from November 2021 to March 2022. Newborns (NB) at 34 wk of age were included and clinical data from prenatal care, birth, hospitalization, and laboratory tests were evaluated.

RESULTS

Sample of 1,086 newborns. Ninety-seven NB (8.9 %) underwent infectious screening in the clinical observation approach versus 279 (26.5 %) in the perinatal risk factors approach, which represents a 65.2 % decrease in the clinical observation approach (p < 0.01). Under the perinatal risk factors approach, 35 (3.2 %) of NBs received empirical antibiotic therapy for EOS, versus only 22 (2.0 %) in the clinical observation approach, which would be a 37.1 % decrease in the clinical observation strategy (p < 0.01). We found no difference in the incidence of culture-confirmed EOS.

CONCLUSION

The clinical observation approach, when compared to the perinatal risk factors approach, reduces laboratory testing and the use of antibiotic therapy, with no impact on the incidence of EOS. Further research is required to determine the best way to systematize serial examinations of NB's and which symptoms would be the best predictors of EOS.

Clinical Reflections and the Lived Experience of Child Life Therapy at an Australian Centre

A cancer diagnosis in childhood is life changing for children and their families. Children may experience medical and physical side-effects, and both children and carers may suffer from distress and other psychological challenges. Supportive care interventions are vitally important in helping children and their families cope adaptively to ensure positive long-term adjustment. Child Life Therapy (CLT) is an allied health profession that involves evidence-based interventions that focus on supporting, educating, and empowering young people through their healthcare journey.

Is the state anxiety level of inpatient children associated with nursing care quality? A cross-sectional study

AIM

The aim of the research was to investigate the predictive effect of nursing care quality perceived by inpatient children aged 9 to 12 on state anxiety levels.

METHODS

The research was conducted with 201 inpatient children. Data were gathered using "The Scale for Evaluating the Quality of Care from Children's Point of View (psychosocial care, physical care, and information)" and "The State Anxiety Inventory for Children."

RESULTS

In the study, statistically significant, negative, and weak correlations were found between the sub-dimension mean scores of psychosocial care, physical care, information, and the mean scores of state anxiety levels. "Information" was found to have a statistically significant and negative predictive effect on state anxiety levels. It was found that the satisfaction of inpatient children with nursing care quality was related to their state anxiety levels, and particularly, the information provided by nurses significantly influenced their state anxiety levels.

CONCLUSION

Therefore, it was concluded that to minimize anxiety during children's hospitalization, nursing care quality should be improved in terms of psychosocial care, physical care, and information provision. Pediatric nurses providing care in the clinic should pay attention to meeting the care needs of children, as satisfying nursing care can reduce their state anxiety levels.

PRACTICE IMPLICATIONS

The study's findings underscore the critical role of nursing care quality in managing anxiety levels among pediatric inpatients. The negative correlations found between psychosocial care, physical care, and information provision with state anxiety levels underscore the significance of a holistic approach and family-centered care in nursing.

Long-term laboratory follow-up is essential in pediatric patients with celiac

OBJECTIVES

Celiac disease (CeD) requires long-term follow. The role of laboratory testing other than celiac serology during follow up is unclear. We aimed to determine which laboratory tests are required during follow up based on the prevalence of abnormal tests and timing of abnormalities appearance.

METHODS

Retrospective chart-review of children diagnosed with CeD between 1999 and 2018 was conducted. Demographic, clinical and laboratory data were recorded from diagnosis and during follow-up.

RESULTS

The cohort included 500 children with CeD [59.8% females, median(IQR) age at diagnosis 5.7(3.7-8.9) years]. Mean follow-up time was 5.5 years (range 1.5-16.2). The most frequently abnormal laboratory tests at time of diagnosis were low ferritin (64.3%), vitamin D (33.6%), zinc (29.9%), hemoglobin (29.2%), and folate (14.7%). In 74 (14.8%) patients, anemia developed only during follow up, while in another 46 patients, anemia resolved after diagnosis and reappeared later (after a mean ± SD 2.8 ± 2.1 years from CeD diagnosis, for the entire group). Abnormal values that developed during follow up were low folate in 40 patients (3.9 ± 2.6 years), and abnormal liver enzymes in 18 patients (3.1 ± 2.7 years). Elevated TSH during follow-up was observed in 14/280 (5%) patients, after a mean ± SD of 2.2 ± 1.6 years from diagnosis. Patients diagnosed as teenagers (12-18 years) had shorter intervals to reappearance of anemia and folate deficiency.

CONCLUSIONS

Multiple laboratory abnormalities may occur in pediatric patients with CeD, both at diagnosis and during long-term follow-up. We suggest continued monitoring of hemoglobin, ferritin, folate, liver, and thyroid function in addition to celiac serology during follow-up of CeD.

Effectiveness of social robots in improving psychological well-being of hospitalised children: A systematic review and meta-analysis

AIM

To evaluate the effectiveness of social robots in reducing pain, stress, and anxiety among hospitalised children.

BACKGROUND

Children are often subjected to painful medical procedures during hospitalisation, resulting in pain, stress and anxiety. This can have significant implications for a child's psychological and overall well-being. Therefore, it is essential to alleviate these emotions among hospitalised children.

METHODS

The review included studies involving hospitalised children ages 1-12 who underwent any medical procedure and received interventions involving social robots. Six databases were searched for articles published on the review topic. The search timeline was from January 2013 to January 2024. The included studies need to assess the effectiveness of the robots in improving primary outcomes such as pain, stress, distress, or anxiety levels. A meta-analysis of these variables was conducted.

RESULTS

The meta-analysis of 313 participants found that social robots had a standardised mean difference (SMD) of -0.10 (95 % CI: -0.41 to 0.22, P = 0.54) in reducing pain, indicating no significant effect. For stress and distress, with a total of 309 participants, the SMD was -0.33 (95 % CI: -0.62 to -0.03, P = 0.003), and for anxiety, including 335 participants, the SMD was -0.42 (95 % CI: -0.73 to -0.10, P = 0.09). These findings suggest that while social robots are not effective in reducing pain, however, they are effective in lowering stress and anxiety levels in hospitalised children undergoing painful medical procedures.

CONCLUSION

This review highlights the efficacy of social robots when introduced to hospitalised children who are undergoing painful medical procedures. Nurses could consider integrating social robots into patient care protocols, which would yield advantages for anxious young children and their parents, as social robots help improving the child's psychological and overall well-being during medical procedures.

Retrospective Analysis of Burn Injuries in Children with Autism Spectrum Disorder

Children with neurodevelopmental disorders are at risk for burn injury, but the clinical outcomes, particularly mortality, are unknown in this patient population in the United States (U.S.). The main objectives of this study are to evaluate (1) subject characteristics; (2) burn injury type; (3) clinical care provided; and (4) mortality in children with autism spectrum disorder (ASD), hypothesizing that this patient population has similar mortality and critical care management requirements when compared to children without ASD. This is a retrospective observational cohort study utilizing the TriNetX ® electronic health record database of subjects aged 0 to 18 years with burn injury associated diagnostic codes. Data were analyzed for demographics, diagnostic, medication, procedural codes, and mortality. We analyzed 99,323 subjects (n, %) coded for a burn injury [3083 (3.1%) with ASD and 96,240 (96.9%) without ASD]. Children with ASD had a higher odds of 1-year all-cause mortality [1.9 (1.06, 3.40), p = 0.004], need for critical care services [1.88 (1.40, 2.52), p < 0.001], and mechanical ventilation [2.69 (1.74, 4.17), p < 0.001] compared to those without. Our study found that U.S. children with ASD who had a burn injury had a higher odds of mortality and critical care needs when compared to children without ASD. Future studies are needed to understand the impact of burn injuries and factors associated with mortality in this patient population.

The psychosocial impact of childhood constipation on the children and family: A scoping review

BACKGROUND

Constipation is a common and complex health issue among children that negatively affects multiple domains of children's and families' lives. Emotional, psychological, and behavioural problems in children, as well as anxiety, distress and frustration in parents, are some of the reported effects.

AIM

This manuscript presents a systematic scoping review synthesising current evidence on the psychosocial impact of childhood constipation on children and their families.

METHODS

This review was guided by Arksey and O'Malley's five-stage framework, updated by Levac, Colquhoun and O'Brien and the Joanna Briggs Institute. Five databases were systematically searched: PUBMED, CINAHL, ASSIA, PsycINFO and Google Scholar, which yielded 2836 records. Following a systematic screening process, 32 articles met the inclusion criteria. Results were analysed, discussed and presented using the PAGER framework.

RESULTS

The four key patterns that emerged were the psychosocial impact of childhood constipation on children, their parents, and school and academic life, and parental factors associated with childhood constipation.

CONCLUSION

Childhood constipation significantly impacts the quality of life for both children and their parents, as well as the school life and academic performance. Various parental factors are linked to a higher prevalence of constipation in children.

IMPLICATIONS

Neglecting to assess and address psychosocial issues in children with constipation can prolong the condition and significantly reduce their overall quality of life, contributing to multimorbidity. Adopting a holistic approach to managing constipation in children and their families is essential for promoting overall well-being.

Pediatric endogenous endophthalmitis: Clinical features and treatment outcomes

CONTEXT

Forty-eight pediatric patients treated for endogenous endophthalmitis were analyzed. Redness and vitritis were the common symptom and sign, respectively; infection with Gram-negative bacilli was frequent. Children under 5 and with systemic illness had poorer visual prognosis.

PURPOSE

To Analyze the demographics, clinical-microbiological profiles, and treatment outcomes of pediatric patients with endogenous endophthalmitis.

METHODS

We conducted a retrospective analysis of electronic medical records covering 8 years from 2016 to 2023 at a tertiary eye care center in India, focusing on patients of age <18 years diagnosed with endogenous endophthalmitis. Data extraction included demographic variables, clinical presentations, microbiological analyses, therapeutic interventions, and visual outcomes.

RESULTS

The analysis included 48 patients with an average age of 5.4 ± 4.98 years and an equal gender ratio. During the study period, 48 children with endogenous endophthalmitis were treated; it was 5% (48 of 961) of all endophthalmitis patients and 20.8% (48 of 231) of pediatric endophthalmitis patients. Common symptoms included redness (62.5%), reduced vision (20.8%), leucocoria (27.08%), pain (22.91%), and watering/discharge (29.16%). Clinical signs included vitritis (89.58%) and anterior chamber exudates/hypopyon (47.91%). Vitreous culture positivity was 54.05%; common isolates were Gram-negative bacilli (35%), Gram-positive cocci (25%), and Gram-positive bacilli and fungi (20% each). Systemic infection was present in 72.9% (35 of 48) of patients, with respiratory tract infection being the most common (39.5%). All eyes received intravitreal antibiotic injections, and 28 (75.7%) received vitrectomy. Children under 5 with systemic illness had a worse visual prognosis. Unfavorable outcomes were associated with Gram-positive bacilli and fungal infection. Approximately 45% of eyes worsened to phthisis.

CONCLUSIONS

Any redness in a child with systemic infection warrants prompt ophthalmic evaluation. Children under 5 with systemic illness are associated with a worse visual prognosis. Unfavorable outcomes are linked to Gram-positive bacilli and fungal infection.

Global Perspectives on Allergen Labeling: Harmonization of Regulations and Practices

The prevention of allergic reactions relies on avoiding allergenic foods making it crucial to accurately label products and provide clear information to customers. The "Big Eight" allergenic foods (milk, eggs, peanuts, tree nuts, shellfish, fish, soybeans, and wheat) recommended by the Codex Alimentarius form the basis of the global allergy labeling system. Nevertheless, countries worldwide have developed their own labeling systems tailored to their unique dietary habits and allergy prevalence. With the increase in global food trade and allergy rates, inconsistent international food allergy labeling can jeopardize consumer safety and confuse manufacturers. This review provides a comprehensive overview of the Big Eight allergenic foods and a comparative analysis of allergen labeling regulations across various global regions. It highlights the need for internationally consistent labeling standards, and harmonized approaches for precautionary allergen labeling as well as emphasizes global efforts to enhance the identification of allergenic foods. Furthermore, this review aims to enhance global food safety management, promote international cooperation, and help consumers make informed food choices.

Hirschsprung Disease with Prenatal Signs: Case Report and Review of the Literature

Introduction: Hirschsprung's disease (HD) is diagnosed postnatally, mainly by means of a rectal biopsy. During pregnancy a few signs have been scattered reported that, in retrospect, where suggestive for HD. The aim of the study was to provide a review of the literature on prenatal signs, with a new case. Methods: A systematic and manual search of the literature using the keywords "prenatal diagnosis, meconium peritonitis, Hirschsprung disease" was conducted on PUBMED, Scopus, and SCIE (Web of Science). Results: Following the PRISMA guidelines, 8 articles were retrieved that describe a total of 11 cases of prenatal signs suggestive of HD. The case of a fetus with meconium peritonitis and hereditary trigonocephaly is reported. Conclusion: The literature is very scanty on prenatal signs or symptoms suggestive for HD. The association of HD and craniostenosis has been previously reported, but the present case is unique due to the concurrent presence of meconium peritonitis and hereditary trigonocephaly.

Navigating ADHD in Belgian Elementary Schools: Teacher Insights and Intervention Gaps

BACKGROUND

The presence of pupils with ADHD in the classroom can influence the learning climate, impacting both the individual pupil and the broader class group. However, limited research has examined teachers' perspectives on this impact and on effective classroom approaches to support pupils with ADHD.

METHOD

We conducted five semistructured focus group discussions with 22 elementary school teachers from different school networks in Flanders, the Dutch-speaking part of Belgium. Data analysis was independently conducted by two researchers.

RESULTS

According to teachers in this study, ADHD behaviour shapes the learning climate both for the pupil and their peers, as well as the broader class relations. Interventions in the approach to a pupil with ADHD can be categorized based on the level of application: individual pupil level or class context level, each encompassing multiple interventions. A key finding is that Flemish primary teachers often feel inadequately trained to address behavioural or attention disorders. Despite available resources in Belgium, such as an ADHD toolkit, their limited awareness and under-implementation in practice pose challenges.

CONCLUSIONS

The positive characteristics of a pupil with ADHD were more apparent in our research than in previously conducted studies. We also shed light on interventions within the classroom environment to support learning, such as teachers' mixed feelings about medication administration and the importance of providing information to peers. Most teachers unanimously expressed a significant lack of knowledge regarding classroom interventions due to minimal coverage in their teacher training, highlighting a need for accessible and relevant tools to address ADHD in pupils.

The Difficulties Experienced by Children with Celiac Disease in the Kahramanmaras Centered Earthquake in Turkey: A Qualitative Research

INTRODUCTION

In natural disasters, children encounter serious health problems.

METHOD

This qualitative phenomenological study investigated the problems encountered by children with a diagnosis of celiac disease who lived in the earthquake region of Kahramahmaras in Turkey. Colaizzi method, a phenomenological research method, was used in the study. Data collection involved in-depth interviews conducted with the 'Introductory Information Form' and 'Semi-structured Interview Form,' both developed by the researchers.

RESULTS

This study was conducted with 17 children diagnosed with celiac disease living in the Kahramanmaras earthquake region of Turkey. Four main themes emerged from the data: (1) nutrition security and access problems, (2) dietary noncompliance, (3) psychological effects, and (4) difficulties in accessing health services.

CONCLUSIONS

The earthquake not only disrupted the physical and emotional well-being of children with celiac disease but also highlighted systemic vulnerabilities in disaster preparedness and response for individuals with special dietary needs.

Associations between air pollution and surrounding greenness with internalizing and externalizing behaviors among schoolchildren

BACKGROUND

Air pollution and greenness are emerging as modifiable risk and protective factors, respectively, in child psychopathology. However, research shows inconsistencies. Here, we examined associations between air pollution and surrounding greenness with internalizing and externalizing behaviors. In addition, the potential modifying role of the genetic susceptibility for these traits and socioeconomic status (SES) was explored.

METHODS

This population-based study included 4485 schoolchildren aged 5-18 years from Spain. Internalizing and externalizing behaviors were assessed using the Child Behavior Checklist (CBCL). Average air pollution (NO2, PM2.5, PM10, PMcoarse, and PM2.5 absorbance) and surrounding greenness (NDVI within 100-m, 300-m, and 500-m buffers) school exposure were estimated for 12 months before outcome assessment. Genetic liability was assessed by computing polygenic risk scores (PRS) and SES was calculated using the Hollingshead Four-Factor Index. Associations were analyzed using negative binomial mixed-effects models.

RESULTS

Although no associations survived multiple testing, we found that increases of 5.48 μg/m3 in PM10 and 2.93 μg/m3 in PMcoarse were associated with a 6% (Mean Ratio (MR) = 1.06; 95% CI: 1.01-1.12) and a 4% (MR = 1.04; 95% CI: 1.00-1.09) increase in internalizing behavior scores. A 0.1 increase in NDVI within a 100-m buffer was associated with a 6% decrease in externalizing behavior (MR = 0.94; 95% CI: 0.89-0.99). Neither differences by sex or age, or moderation effects by PRS or SES, were observed.

CONCLUSIONS

We found preliminary evidence of detrimental effects of air pollution on internalizing behavior and protective effects of greenness on externalizing behavior, which were not modified by sex, age, SES, or genetic liability. If confirmed, these results reinforce the need for improving air quality, especially around schools, as part of preventive strategies focused on childhood psychopathology.

Evaluating the Need for Pre-CoMiSS™, a Parent-Specific Cow's Milk-Related Symptom Score: A Qualitative Study

Background/Objectives: Cow's milk allergy (CMA) presents a significant clinical burden. The Cow's Milk-related Symptom Score (CoMiSS™) is a widely used clinical screening tool designed to raise awareness of CMA among healthcare professionals. This qualitative study aimed to assess the need for a parent-reported CoMiSS™ tool (Pre-CoMiSS™) and explore its potential usefulness for parents and primary care physicians (PCPs). Methods: Participants were parents of infants aged 2-12 months and PCPs from Germany, Sweden, Spain, and the United Kingdom (UK) selected from a local panel of potential respondents. Interviews, conducted by experienced qualitative research moderators, consisted of pre-decided standardised questions. Thematic analysis was undertaken, and themes were derived from the data. Results: A total of 26 parent interviews and 18 primary care physician interviews were conducted. Parents from all countries found the Pre-CoMiSS™ tool helpful for understanding their baby's signs, easy to use, and useful for facilitating consultation with the physician. Physicians in the UK, Spain, and Sweden found that the Pre-CoMiSS™ tool was helpful for improving symptom reporting and for medical consultations; however, in Germany, physicians had mixed opinions, expressing concerns that the tool might increase parental anxiety, lead to overdiagnosis of CMA, and add to their workload. Conclusions: A parent-specific tool for recording cow's milk-related symptoms was generally well received by parents and most physicians, though concerns about parental anxiety and workload were noted, particularly in Germany. With further validation and refinement, Pre-CoMiSS™ may be a useful tool for parents to record their infant's symptoms related to feeding and support PCPs in considering CMA in these infants.

Impact of tailored dietary interventions on suspected carbohydrate intolerance patients based on genetic testing

BACKGROUND

carbohydrate intolerance presents a complex scenario where symptoms arise following the consumption of specific substrate and alleviate upon their elimination from the diet. Lactose Intolerance is one of the most prevalent types of food intolerance. Primary lactose intolerance is linked to genetic factors, Lactase Non-Persistence phenotype, while secondary lactose intolerance might be a temporary condition resulting from intestinal damage and loss of disaccharidase activity. Fructose absorption is an energy-independent process, leading to limited and variable absorption. Fructose undergoes quick absorption into the bloodstream through active transporters, specifically GLUT-5 and GLUT-2, found in the initial segment of the small intestine. The management of carbohydrate intolerance requires precise testing methods, accurate diagnostics, and customized dietary interventions. Genetic testing plays a crucial role in determining an individual's genetic profile, helping decide whether permanent restrictions on specific nutrients, such as lactose, are necessary.

OBJECTIVE

this research aims to understand the origin of suspected carbohydrate intolerance, combining genetic testing with breath tests to enhance the efficacy of treatment plans, as customized dietary interventions will be based on the patient's genetic profile and carbohydrate absorption capacity.

MATERIAL AND METHODS

a combination of genetic testing (lactase non-persistence and celiac disease risk) and breath test for lactose and fructose were performed. Recommendations such as low lactose, low fructose or gluten-free diets; or a combination of them were provided based on each patient's testing profile results.

RESULTS

after the nutritional intervention, a significant improvement was noted in all gastrointestinal symptoms, except for reflux and nausea, and in all of the extraintestinal symptoms.

CONCLUSIONS

designing dietary interventions based on primary and secondary causes for carbohydrate intolerance can avoid unnecessary food restrictions; improving patients' quality of life and treatment effectiveness through tailored dietary interventions.

Advancing multidisciplinary management of pediatric hyperinflammatory disorders

Pediatric hyperinflammatory diseases, including Still's disease, Kawasaki disease (KD), multisystem inflammatory syndrome in children (MIS-C), and recurrent pericarditis (RP), represent a spectrum of conditions characterized by immune dysregulation and systemic inflammation. Each disorder exhibits distinct pathophysiological mechanisms and clinical features, yet their overlapping presentations often pose diagnostic challenges. Early and accurate differentiation is critical to mitigate complications such as macrophage activation syndrome (MAS), coronary artery aneurysms, and myocardial dysfunction. This narrative review explores the pathophysiology, diagnostic criteria, and management of these conditions, emphasizing the utility of advanced biomarkers, imaging modalities, and genetic testing. For Still's disease, the review highlights the transformative role of biologic therapies targeting IL-1 and IL-6 in reducing systemic inflammation and improving outcomes. In KD, timely administration of intravenous immunoglobulin (IVIG) and combination with high-dose steroids in high-risk patients is pivotal for preventing coronary complications. MIS-C, associated with SARS-CoV-2 infection, requires tailored immunomodulatory approaches, including corticosteroids and biologics, to address severe hyperinflammation and multiorgan involvement. RP management prioritizes NSAIDs, colchicine, and IL-1 inhibitors to reduce recurrence and corticosteroid dependence. The review advocates for a multidisciplinary approach, integrating standardized diagnostic algorithms and disease-specific expertise to optimize patient care. Future research directions include the identification of predictive biomarkers, exploration of novel therapeutic targets, and development of evidence-based treatment protocols to enhance long-term outcomes in pediatric inflammatory diseases.

Life skills among school-going adolescents in South India: A gender comparison

BACKGROUND

The stress faced by adolescents in the current situation is enormous. Research studies show that various psychosocial factors and life skills deficits are the mediating factors resulting in behavioral, psychological, and health-related problems among adolescents. The present study aims to study and compare the life skills among 8th- and 9th-grade male and female students attending the schools of Udupi, Karnataka, India.

MATERIAL AND METHODS

A descriptive research design was considered for the present study. The study was conducted in two settings, that is, rural and urban areas of Udupi District, of Karnataka. In the study, 8th- and 9th-grade students attending two urban schools and eight rural schools of Udupi District were considered as the study population for the current study. A total sample of 594 students equally representing two schools in urban and eight schools in rural based on male and female ratio and medium of instruction were drawn from the study population. The schools were selected based on the willingness of the school administration. The schools were selected based on the medium of instruction with equal representation of gender. A stratified random sampling technique was adopted to draw the sample, giving equal representation to domicile, gender, and medium of instruction. A semi structured data sheet and Life Skills Scale were administered. Written informed consent was taken from all participants and parents. Participants were assured of confidentiality and anonymity. Participants were informed that they had the option of withdrawing from the study at any point in time.

RESULTS

The present results reveal that 48% of the adolescents had a moderate level of life skills; 29% of them had a high level of life skills, and the remaining 23% of them had a low level of life skills. Female students had better overall life skills, social skills, and emotional skills compared to male students, whereas male students had better thinking skills than females had. Female students tend to cope with stress better than males [p=<.001]. Male students had better interpersonal relationships and critical thinking life skills compared to female students (P = .001).

CONCLUSION

Female students tend to cope with stress better than male students. Strengthening life skills among school students can be a popular approach for prevention and health promotion in schools. Identification of life skills at an early stage can be effective in providing life skills training for the promotion of mental health among school children. Schools should incorporate life skills in their course and curriculum to support and promote mental health.

Practice of pediatric palliative extubation in Brazil: a case series

OBJECTIVE

To describe the clinical profile, procedures applied and outcomes of patients undergoing palliative extubation in the pediatric intensive care unit at a high-complexity teaching hospital in the northeastern region of Brazil.

METHODS

This is a descriptive analysis of a case series that included patients aged under 14 years who underwent palliative extubation in the pediatric intensive care unit between 2016 and 2023 (seven years). Data on admission diagnoses, palliative extubation indications, applied therapies, and outcomes following palliative extubation were retrieved from medical records.

RESULTS

In total, 35 patients were included in the service database. In eight patients, reports could not be found, and these patients were excluded. Twenty-seven patients aged between five days and ten years, mostly females (51.8%) and those with chronic diseases (77.8%), were included in the study. All patients were classified on the basis of World Health Organization pediatric palliative care indication categories. Palliative extubation was considered after the identification of severe neurological impairment, inadequate response or absence of curative therapies, and failure of mechanical ventilation weaning. Palliative care approaches were discussed with the family in 74% of the cases before palliative extubation. Following palliative extubation, 48.1% of patients presented symptoms, and dyspnea (84.6%) and agitation (53.8%) were the most common symptoms. Death occurred in 88.8% of the children from 20 minutes to 38 days after palliative extubation at the hospital. Three children (11.2%) were discharged from the hospital.

CONCLUSION

Palliative extubation was mostly performed in infants diagnosed with complex chronic conditions and severe and irreversible diseases, all of whom were referred to other palliative care. Death in the hospital while controlling for some symptoms was the main outcome.

Influence of dietary Saccharomyces cerevisiae fermentation product on markers of inflammation and cartilage metabolism in young exercising horses challenged with intra-articular lipopolysaccharide

The objective was to evaluate dietary Saccharomyces cerevisiae fermentation product (SCFP) on joint inflammation and cartilage metabolism in exercising yearlings challenged with intra-articular lipopolysaccharide (LPS), hypothesizing dietary SCFP (TruEquine®C, Diamond V Mills, Inc.) would ameliorate joint inflammation and increase cartilage metabolism. Thirty Quarter Horse yearlings were stratified by bodyweight (BW), age, sex, and randomly assigned to dietary treatments (n = 10/treatment): control (0), 46, or 92 mg/kg BW/d SCFP. Treatments were top-dressed to 1% BW/d concentrate void of added microbials. Horses were stalled (3.6 m × 7.3 m), offered ad libitum Coastal bermudagrass hay, and exercised 30 min/d, 5 d/wk. On days 0, 21, 42, and 56, wither height, hip height, heart girth, body length, body condition scores (BCS), and BW were recorded. On day 46, one radial carpal joint received 0.8 mL of a 0.5 ng LPS solution or sterile lactated Ringer's solution (LRS) in the contralateral joint. Synovial fluid was collected pre- (0) and 6, 12, 24, and 336 hours post-injection and analyzed for prostaglandin E2 (PGE2), carboxypropeptide of type II collagen (CPII), and collagenase cleavage neopeptide (C2C) via commercial ELISA, and chemokines (CCL2, and CCL11) and cytokines (TNF α and IL-10) via multiplex platform. Rectal temperature (RT), heart rate (HR), respiration rate (RR), and carpal circumference (CC) were recorded prior to arthrocentesis. Data were analyzed using PROC MIXED of SAS. By day 56, growth parameters increased (P < 0.01), BCS did not change (P = 0.39), and BW had a treatment × d interaction (P = 0.02) where control tended to be heavier than 92 mg/kg BW on day 56 (P = 0.07). Clinical parameters (RT, HR, RR, CC) were uninfluenced by diet (P ≥ 0.29) but varied over time (P ≤ 0.03). Treatments did not influence cartilage metabolism (CPII, C2C, and CPII:C2C) (P ≥ 0.46) or logPGE2, logCCL2, CCL11, or logIL-10 (P ≥ 0.23). There was a treatment × h interaction for CCL11 (P = 0.04) where control was greater than SCFP groups at h 6. LogIL-10 had a treatment × h interaction where 46 mg/kg BW was lower than control and 92 mg/kg BW at h 12 (P = 0.05). There was a main effect of treatment for TNF α (P = 0.04) where 92 mg/kg BW was lower than 46 mg/kg BW and tended to be lower than control. Results indicate that SCFP didn't influence cartilage metabolism or PGE2, though SCFP may ameliorate inflammatory cytokines and chemokines following an acute, intra-articular insult.

Improving Postoperative Pediatric Recovery by Efficient Recovery Room Care-A Comprehensive Review

Background/Objectives: Efficient postoperative recovery room care in pediatric patients is crucial for optimizing perioperative safety, patient outcome, and effective pain management. However, this area is frequently underemphasized, leading to higher complication rates compared to the operating room, which in turn increases healthcare costs. Improving pediatric recovery room care offers a significant opportunity to enhance the quality and safety of perioperative pediatric care. From an economic perspective, this is prudent; however, more importantly, every child has the right to the highest attainable standard of health, as outlined by the United Nations. Key aspects of recovery room care include ensuring adequate staffing and equipment, while also prioritizing the child's privacy and parental presence, both of which are crucial for enhancing patient well-being. A +multimodal approach to postoperative pain management is essential for minimizing fear and stress, alongside strict adherence to established guidelines for the management of postoperative nausea, vomiting, and emergence delirium. Furthermore, addressing risk factors such as hypothermia and airway complications, as well as promoting early intake of clear fluids, plays a crucial role in optimizing pediatric recovery. Organizational strategies such as quality improvement initiatives, structured handovers, standardized care protocols with checklists, continuous staff training, and well-defined discharge criteria are further essential components to reduce translational gaps and to enhance postoperative pediatric safety. Conclusions: Improving pediatric postoperative anesthetic care is a multifaceted challenge for all healthcare providers that can significantly enhance care quality and safety while also reducing costs. Success in this area requires addressing both structural and medical factors.

Development of an atraumatic care education model based on family-centered care to improve maternal behavior in reducing children's stress during hospitalization

PURPOSE

this study aimed to develop an atraumatic care education model based on family centered care to improve maternal behavior in minimizing hospitalization stress.

DESIGN AND METHODS

This study utilized a quantitative research design with a cross-sectional approach. A total of 120 mothers of hospitalized children were selected through purposive sampling. A self-designed questionnaire was administered, which included sections on nurse competency, maternal factors, service factors, and learning facilities. Data analysis was conducted using inferential statistics, specifically employing Smart PLS for structural equation modeling (SEM).

RESULTS

The results indicated that the atraumatic care education model, based on family-centered care, was directly influenced by nurse competency (t = 2.829, p = 0.005), maternal factors (t = 3.237, p = 0.001), service factors (t = 4761, p = 0.000), and learning facilities (t = 2.005, p = 0.046). However, none of these factors had a significant impact on maternal behavior in reducing child hospitalization stress (t = 0.970, 0.794, 0.039, 1.290; p = 0.333, 0.429, 0.969, 0.198). On the other hand, the atraumatic care education model based on family-centered care was found to directly influence maternal behavior in minimizing child hospitalization stress (t = 34.065, p = 0.000).

CONCLUSIONS

The atraumatic care education model based on family-centered care, includes four key variables: nurse competency, maternal factors, service factors, and learning facilities. This model can be used as a framework to enhance maternal behavior in reducing stress associated with child hospitalization.

PRACTICAL IMPLICATIONS

The findings suggest that the atraumatic care education model based on family-centered care, can be a valuable tool in improving maternal behavior and reducing stress during child hospitalization. Healthcare providers, especially pediatric nurses, should focus on enhancing their competency in delivering atraumatic care education, as well as addressing factors related to the mother, the quality of services, and the availability of learning resources.

Analysis of the Efficacy and Safety of Weekly Calcifediol 100 µg in Vitamin D Deficient Patients

Background/Objectives: Adequate vitamin D levels are critical for overall health, yet vitamin D deficiency remains prevalent. This study aims to evaluate the efficacy and safety of a standardized weekly supplementation regimen of 100 μg calcifediol for patients with varying degrees of vitamin D deficiency. Methods: A post hoc pool analysis was conducted from a randomized, double-blind, placebo-controlled, multicenter, two-cohort trial. Cohort 1 included vitamin D mild deficiency patients (25(OH)D levels > 10 < 20 ng/mL) and Cohort 2 severe deficiency patients (25(OH)D levels ≤ 10 ng/mL). As both had placebo and weekly calcifediol 100 μg arms (ratio 1:2), a pooled analysis of safety and efficacy was conducted. The primary outcome was the percentage of subjects achieving 25(OH)D levels ≥ 20 ng/mL and/or ≥30 ng/mL at various time points. Results: A total of 401 participants across both cohorts were included in the analysis, 130 who received a placebo and 271 calcifediol 100 µg weekly. By week 52, 94.5% of individuals in the calcifediol group achieved 25(OH)D levels ≥ 20 ng/mL, compared to 25.3% in the placebo group (p < 0.0001). At this same week, 80.5% of subjects in the calcifediol group, but none in the placebo group (p < 0.0001), had 25(OH)D levels ≥ 30 ng/mL. The mean 25(OH)D level plateaued around 40.7 ng/mL from weeks 16 to 52. The frequency of treatment-emergent adverse events was similar in both groups, placebo and calcifediol. Conclusions: Weekly supplementation of 100 μg calcifediol effectively restores vitamin D levels in individuals with both mild and severe deficiencies, demonstrating a favourable safety profile.

Association of postural orthostatic tachycardia syndrome, hypermobility spectrum disorders, and mast cell activation syndrome in young patients; prevalence, overlap and response to therapy depends on the definition

Background

The close association of syndromes of orthostatic intolerance with and without postural orthostatic tachycardia syndrome (POTS) with Joint Hypermobility Disorders (JHD) including Hypermobility Spectrum Disorder (HSD) and hypermobile Ehlers Danlos Syndrome (hEDS) and with Mast Cell Activation Syndrome (MCAS) is now firmly established. However, the prevalence of each entity relative to the other is not well established and is affected greatly by the various definitions used for each syndrome. Use of restricting definitions for each syndrome can be problematic in the clinical setting as it under-estimates the presence of disease, thereby preventing clinicians from considering potentially helpful therapeutic options.

Methods

A retrospective review of the clinical records of 100 young patients meeting POTS criteria was undertaken to determine the frequency of HSD, near-hEDS, and hEDS as well as the frequency of MCAS using consensus-1, conservative consensus-2, and clinical criteria regardless of lab support. Effectiveness of MCAS therapies was assessed in relation to the method of MCAS diagnosis.

Results

From records of 392 patients with orthostatic intolerance syndromes, 100 patients met POTS criteria. The frequency of JHD ranged from 13% using strict criteria of hEDS to 34% using HSD Criteria. The frequency of MCAS ranged from 2% using consensus-1 criteria, to 37% using conservative consensus-2 criteria, to 87% using clinical criteria. Patients diagnosed by clinical criteria with or without the aid of labs responded to therapy similarly to those diagnosed with stricter criteria.

Conclusion

Using overly strict criteria to diagnose conditions which have a high prevalence of co-occurrence misses opportunities for potential therapeutic strategies.

Meta-analysis of budesonide and surfactant combination for the prevention of bronchopulmonary dysplasia in preterm neonates based on gestational age

Background

Budesonide, an inhaled corticosteroid, and surfactant, a substance that lowers surface tension in the lungs, are both used to prevent Bronchopulmonary Dysplasia (BPD). This meta-analysis evaluates the effectiveness of combining budesonide and surfactant in preventing BPD in preterm neonates compared to surfactant alone.

Method

A comprehensive search of electronic databases, including PubMed, Scopus, Google Scholar, CNKI, and Embase, was conducted from their inception up to August 30, 2024. The focus was on evaluating the combination of Budesonide and surfactant for the prevention of BPD in preterm neonates. This assessment involved calculating ORs and their 95% CIs to determine the treatment's effectiveness. The primary outcomes measured were the incidence of BPD and mortality rates, while secondary outcomes included the rates of intraventricular hemorrhage (IVH), retinopathy of prematurity (ROP), patent ductus arteriosus (PDA), sepsis, neonatal necrotizing enterocolitis (NEC), and pneumothorax.

Results

This research, combining a meta-analysis and observational data, indicates that Budesonide-Surfactant therapy significantly reduces BPD in preterm neonates with NRDS, regardless of gestational age. Additional benefits, including decreased mortality (in ≥27 gestational weeks), NEC, PDA, ROP, and Sepsis, were observed in the observational study, though pneumothorax increased in the ≥27 gestational weeks group. The meta-analysis corroborated reductions in BPD, PDA, and mortality (in ≥27 gestational weeks), supporting the potential of Budesonide-Surfactant to improve outcomes in preterm infants.

Conclusions

The intratracheal administration of pulmonary surfactants combined with budesonide was associated with a reduction in the incidence of BPD, mortality, and PDA. Although the prevalence of ROP, NEC, IVH, and sepsis was lower in the test group compared to the control group, these differences did not reach statistical significance. These findings suggest that the combined use of budesonide and surfactant is effective in preventing BPD and mortality, as well as in reducing certain secondary outcomes.

Genetics and epigenetics in gestational diabetes contributing to type 2 diabetes

Gestational diabetes mellitus (GDM) is a common pregnancy complication and a risk factor for the subsequent development of type 2 diabetes (T2D) in mothers and of several metabolic diseases in offspring. However, the molecular underpinnings of these risks are not well understood. Genome-wide association studies (GWAS) and epigenetic studies may provide complementary insights into the causal relationships between GDM exposure and maternal/offspring metabolic outcomes. In this review we discuss the potential pathophysiological roles of specific genetic variants and commonly reported differentially methylated loci in GDM development, and their link to the progression to T2D in both the mother and the offspring in later life, pointing to the potential for tailored interventional strategies based on these genetic and epigenetic mechanisms.

Deer velvet powder-induced antral stricture mimicking infantile hypertrophic pyloric stenosis in a 3-month-old infant: a case report

Antral stricture is a rare cause of gastric outlet obstruction in infants, typically linked to infantile hypertrophic pyloric stenosis (IHPS). We report a case of a 3-month-old male with a 1.5-month history of progressively worsening, nonbilious vomiting. Although initial imaging suggested IHPS, intraoperative findings revealed a sealed antral perforation with dense adhesions, leading to a distal gastrectomy with Billroth I reconstruction. A detailed retrospective history disclosed that the infant had been given deer velvet powder, suspected to have contributed to the perforation and subsequent stricture formation. This novel association highlights potential risks of unregulated supplement use in infants and underscores the need for further investigation.

Interleukin-15 gene polymorphism in children with celiac disease: a single-center experience

The purpose of this study is to evaluate the demographics, clinical presentation, laboratory findings, and gastrointestinal endoscopic findings in children with CD and assess their relationship with interleukin-15 (IL-15) single-nucleotide polymorphism (SNP) (rs2857261) and serum IL-15 levels. This case-control and prospective cohort study included 54 newly diagnosed pediatric CD patients attending the Gastroenterology Clinic at Alexandria University Children's Hospital and 44 age- and sex-matched healthy controls. Demographics, clinical data, laboratory tests, Marsh classification, and IL-15 SNP (rs2857261) genotypes were analyzed. Follow-up after 9 months on a gluten-free diet (GFD) was conducted. The mean age of patients and controls was 8.62 ± 4.4 and 8.07 ± 4.7 years, respectively, with no significant difference (p = 0.55). Male representation was 48.1% in patients and 47.7% in controls (p = 0.97). The most common presenting symptoms in CD patients were abdominal distension (61.11%) and failure to thrive (59.26%). Laboratory findings showed that mean anti-tissue transglutaminase immunoglobulin A was 103 ± 168 U/ml, and anti-endomysium immunoglobulin A was positive in 51.85% of patients. Histopathological assessment revealed Marsh 3C as the most common finding (37%), while 37% of patients were diagnosed without biopsy. IL-15 SNP (rs2857261) analysis showed a significantly higher prevalence of the A/A genotype in CD patients compared to controls (p < 0.0001). The A/G and G/G genotypes were protective against CD, with odds ratios of 0.088 and 0.079, respectively. No significant associations were observed between IL-15 genotypes and clinical, laboratory, or histological variables. After 6 to 9 months on a GFD, genotype did not significantly influence symptom resolution (p > 0.05).

CONCLUSIONS

Serum IL-15 levels are elevated in newly diagnosed pediatric CD patients. The IL-15 SNP (rs2857261) A/A genotype is associated with increased susceptibility to CD, while the A/G and G/G genotypes appear protective. These findings highlight IL-15 as a potential biomarker and therapeutic target in CD. Further large-scale studies are warranted to validate these findings and explore therapeutic applications.

WHAT IS KNOWN

• Celiac disease is an immune-mediated enteropathy linked to HLA-DQ2/DQ8 alleles, with IL-15 playing a key role in its pathogenesis. • Variability in IL-15 genetic polymorphisms has been suggested but remains underexplored in pediatric populations.

WHAT IS NEW

• This study identifies the IL-15 SNP (rs2857261) A/A genotype as a risk factor for CD, while A/G and G/G genotypes are protective. • Elevated serum IL-15 levels in newly diagnosed patients highlight its potential as a biomarker and therapeutic target.

Comparative evaluation of certain biomarkers emphasizing abnormal GABA inhibitory effect and glutamate excitotoxicity in autism spectrum disorders

Introduction

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by social communication deficits and repetitive behaviors. An imbalance between the excitatory neurotransmitter glutamate and the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) might play a crucial role in ASD. This study explores the biochemical markers associated with GABAergic and glutamatergic signaling in individuals with autism and healthy controls, aiming to identify potential diagnostic and therapeutic targets.

Methods

The study included 46 male individuals with autism and 26 age- and gender-matched healthy controls. The plasma levels of excitatory amino acid transporter 2 (EAAT2), potassium chloride co-transporter 2 (KCC2), Na-K-Cl co-transporter 1 (NKCC1), vitamin D3 (VD3), GABA, gamma aminobutyric acid type a receptor subunit alpha 5 (GABRA5), and glutamate were measured using ELISA. Statistical analyses, including correlation, multiple regression, and receiver operating characteristic (ROC) curve analysis, were performed to evaluate the diagnostic utility and interrelationships of these biomarkers.

Results

Significant biochemical differences were found between individuals with autism and healthy controls. Individuals with autism had notably lower levels of EAAT2, KCC2, NKCC1, VD3, GABA, and GABRA5, especially in the severe group. Altered KCC2/NKCC1 and GABA/glutamate ratios highlighted the imbalance in neurotransmission. The correlation and multiple regression analyses showed significant interconnections between biomarkers. The ROC analysis indicated that EAAT2, KCC2, GABA, and the ratios of KCC2/NKCC1 and GABA/glutamate have high diagnostic potential.

Conclusion

These findings support the hypothesis that GABA and glutamate imbalance is central to the pathophysiology of ASD. Significant disruptions in neurotransmitter signaling and chloride homeostasis, particularly in severe cases, provide insights into the neurobiological mechanisms of ASD. Restoring the GABA-glutamate balance could be an effective therapeutic strategy for ASD, warranting further research into these biochemical pathways for targeted treatments.

The Strategies of Picture Books as a Mode of Health Communication for Young Children with Coeliac Disease

Background/Objectives: Coeliac disease, a chronic and lifelong health condition, is one of the most common autoimmune diseases. However, it is also one of the most under-recognised conditions, and emotionally and cognitively appropriate materials are especially lacking for young children and their families who are coping with this disease. Effective health communication is essential for educating and supporting children living with coeliac disease as well as their families and communities. Picture books can serve as useful and accessible educational and health promotion tools, promoting adaptive coping strategies for dealing with a potentially traumatic condition. Methods: This study aimed to fill a critical gap in the literature by examining a range of picture books (n = 9) aimed at children three to eight years of age diagnosed with coeliac disease. Reflective thematic and structural narrative analyses were applied to explore strategies and themes used in these books and how they align with the current literature on developing coping through children's narratives. Results: Four themes were developed and measured against an existing model of coping narratives to find a more specific model that recognises the specific concerns of coeliac disease. The four themes found were Information Provision; Promotion of CD Management; Anxiety and Hypervigilance Reduction, with two subthemes of Validating Feelings and Reducing Concerns; and Community and Connection. Conclusions: The findings have likely implications for the following applications: incorporation into clinician training (as a therapeutic and health promotion intervention), support within schools, authors of similar books for children coping with chronic illness, and coping approaches for individuals/families to promote health literacy/support regarding living with coeliac disease.

EEG-Guided Titration of Sevoflurane and Pediatric Anesthesia Emergence Delirium: A Randomized Clinical Trial

Importance

Pediatric anesthesia emergence delirium (PAED) is a common complication of general anesthesia and has unknown etiology. Exposure to volatile anesthetics may contribute to PAED, and excessive exposure may occur frequently during routine pediatric anesthesia.

Objective

To examine whether use of electroencephalography (EEG) monitoring can reduce PAED by minimizing exposure to sevoflurane while maintaining a state of unconsciousness under anesthesia.

Design, Setting, and Participants

A single-center, parallel-group, 2-arm, superiority randomized clinical trial with a 1:1 allocation ratio was conducted from October 13, 2021, to March 18, 2023, at an academic tertiary pediatric hospital in Japan. The follow-up period was 24 ± 6 hours postoperatively or uneventful discharge to home, whichever came first. The observer for the primary outcome was blinded to patient assignment. The trial included a convenience sample of children aged 1 to younger than 6 years undergoing general anesthesia for procedures for which reliable antinociception can be provided. Data analysis was performed in March 2023.

Intervention

EEG-guided titration of anesthesia to minimize sevoflurane exposure (EEG-guided group) vs standard 1.0-minimum alveolar concentration (MAC) sevoflurane anesthesia (control group).

Main Outcomes and Measures

Proportion of patients who developed PAED, defined by a maximum PAED score of 10 or higher.

Results

Of the 177 participants who completed follow-up, 125 (71%) were male and 52 (29%) were female. The EEG-guided group included 91 participants (mean [SD] age, 2.9 [1.5] years), and the control group included 86 participants (mean [SD] age, 2.8 [1.6] years). In the EEG-guided group, sevoflurane exposure was reduced by 1.4 MAC-hours (96.65% CI, 1.1 to 1.6 MAC-hours). A total of 30 (35%) in the control group and 19 (21%) in the EEG-guided group developed PAED (difference, 14%; 96.65% CI, -0.0019% to 28%; 95% CI, 0.92% to 27%; P = .04). Children in the EEG-guided group emerged a mean of 21.4 minutes (96.65% CI, 15.4 to 27.4 minutes) earlier from general anesthesia and spent a mean of 16.5 minutes less (96.65% CI, 10.8 to 22.3 minutes less) in the postanesthesia care unit.

Conclusions and Relevance

EEG-guided management of general anesthesia reduced sevoflurane exposure and pediatric anesthesia emergence delirium in children, with faster emergence and shorter postanesthesia care unit stays. The findings suggest that high concentrations of sevoflurane for induction followed by routine use of 1.0-MAC sevoflurane for maintenance may be excessive.

Trial Registration

Japan Registry of Clinical Trials Identifier: jRCTs032210248.

The impact of COVID-19 pandemic on the incidence, presentation, and management of type 1 diabetes in children and adolescents: a narrative review

Type 1 diabetes (T1D) is an autoimmune condition affecting approximately 1.5 million children and adolescents worldwide, with an incidence of approximately 2-3% each year and rising. During the recent COVID-19 pandemic, a significant increase in incidence of T1D in children and adolescents was observed in numerous countries worldwide, with an increased number of newly-diagnosed cases presenting with diabetic ketoacidosis. The increased frequency of T1D presenting with diabetic ketoacidosis has been attributed not only to the SARS-CoV-2 virus itself but also to the restrictions imposed by the pandemic. The shift to telemedicine and unwillingness to seek medical care due to fear of infection contributed to delayed diagnosis and more severe disease presentation. Furthermore, the periods of lockdown that were implemented during the pandemic presented multiple challenges for children and adolescents living with T1D and disrupted the management of their condition. Changes in physical activity and diet as well as shortage of medical supplies during that period have been linked to worsening of glycemic control, which were at least partly offset by increased parental involvement and use of telemedicine.