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1.
Nazan Ulgen Tekerek Basak Nur Akyildiz Baris Derya Ercal Sabahattin Muhtaroglu 《Indian journal of pediatrics》2018,85(6):426-432
Objective
To detect the most effective biomarker to confirm ventilator associated pneumonia (VAP).Methods
Fifty patients with VAP suspicious diagnosis and 30 healthy patients were recruited. Suspicion of VAP was established if patients met the modified CPIS score?≥?6 points. The confirmation of VAP was defined by the quantitative culture of nonbronchoscopic bronchoalveolar lavage (BAL) >105 CFU/ml of pathogenic microorganism. Serum samples for determination of C-reactive protein (CRP), procalcitonin (PCT), pentraxin 3 (PTX3), surfactant protein D (SPD) were collected on suspected VAP.Results
Twenty seven of 50 patients were accepted as confirmed VAP group whose nonbronchoscopic BAL cultures were positive and rest of them were accepted as unconfirmed VAP group. PTX3, PCT and SPD levels were significantly higher in confirmed VAP group, (P?=?0.021, P?=?0.007, P?<?0.001 respectively). There were no significant differences in CRP levels between the two groups (P?=?0.062). The most sensitive marker for diagnosing VAP was SPD (P?<?0.001). Receiver operating characteristic (ROC) curve for modified clinical pulmonary infection score (CPIS) to confirm VAP was evaluated (AUC 0.741?±?0.07, P?<?0.001) and the optimal cutoff value was >7 with a sensitivity of 51.85% and a specificity of 91.3%. SPD levels were significantly higher in Acinetobacter baumannii and Pseudomonas aeruginosa infected patients than culture negative patients (P?<?0.001).Conclusions
The index findings suggest that serum SPD is the most sensitive biomarker in diagnosis of VAP and it can be used as an early and organism specific marker for Acinetobacter baumannii and Pseudomonas aeruginosa.2.
Background
Kawasaki disease (KD) is sometimes confused with urinary tract infection (UTI) because both can present with pyuria and C-reactive protein (CRP) elevation. The present study investigated the clinical and laboratory findings that can differentiate KD from UTI in febrile children with pyuria and CRP elevation.Methods
Medical records were retrospectively reviewed for children with KD and those with UTI. The clinical and laboratory findings between the KD with pyuria group (n?=?48) and the UTI group (n?=?118) were compared.Results
The KD with pyuria group had older age (P?<?0.001) and longer duration of fever (P?<?0.001) than the UTI group. In blood tests, both groups showed increased CRP level, but the value of CRP was higher in the KD with pyuria group than in the UTI group (P?<?0.001). The KD with pyuria group also showed higher values for liver enzymes than the UTI group (P?<?0.001); >?70.0% of children in the KD with pyuria group, but <?20.0% of children in the UTI group possessed elevated liver enzymes (P?<?0.001). On urinalysis, 40.7% of the UTI group had a positive nitrite test, but 0.0% of the KD with pyuria group had a positive nitrite test (P?<?0.001).Conclusions
Elevated liver enzymes are more specific to KD than to UTI, whereas a positive nitrite test is more specific to UTI than to KD. Our findings can be used as diagnostic clues to differentiate KD from UTI in febrile children with pyuria and CRP elevation.3.
Background
Gastroschisis is the most common congenital abdominal wall defect. Due to the exposure of midgut to amniotic fluid, the recovery of bowel function is often delayed. This study aimed to identify the factors associated with the successful early enteral feeding in gastroschisis and to develop further guidelines of treatment.Methods
A retrospective cohort study of gastroschisis babies from January 2006 to December 2015 was done. Exclusion criteria were incomplete data and death. Successful early enteral feeding was defined when full feeding was achieved within 21 days of life.Results
One hundred and five gastroschisis patients were divided into a successful early-feeding group (n?=?56, 53%) and a non-successful early-feeding group (n?=?49, 46%). In multivariable analysis, significant factors for successful feeding clustered by primary treatment were female (RR?=?1.38, P value <?0.001), gestational age >?36 weeks (RR?=?1.23, P value <?0.001), age at surgery less than 10 h (RR?=?1.15, P value <?0.001), postoperative extubation time <?4 days (RR?=?1.39, P value <?0.001), and age when feeding started less than 10 days (RR?=?35.69, P value?<?0.001).Conclusion
Several factors were found to be associated with successful early enteral feeding. The modifiable factors found in this study were surgery within 10 h, early postoperative extubation within 4 days, and feeding started before 10 days of life. These will guide the management of gastroschisis to achieve successful early enteral feeding.4.
Ismail Mohamed Elhawary Eman Abdel Ghany Abdel Ghany Walaa Alsharany Aboelhamed Shahinaz Gamal Eldin Ibrahim 《World journal of pediatrics : WJP》2018,14(4):350-356
Background
To determine the incidence and risk factors of post-phototherapy rebound hyperbilirubinemia because data about bilirubin rebound in neonates are lacking and few studies have concerned this condition.Methods
A prospective observational study was conducted on 500 neonates with indirect hyperbilirubinemia who were treated according to standard guidelines. Total serum bilirubin (TSB) was measured at 24–36 h after phototherapy; significant bilirubin rebound (SBR) is considered as increasing TSB that needs reinstitution of phototherapy.Results
A total of 124 (24.9%) neonates developed SBR with TSB increased by 3.4 (2.4–11.2) mg/dL after stopping phototherapy. Multiple logistic regression model revealed the following significant risk factors for rebound: low birth weight (B = 1.3, P < ?0.001, OR 3.5), suspected sepsis (B = 2.5, P < ?0.001, OR 12.6), exposure to intensive phototherapy (B = ?0.83, P = ?0.03, OR 2.3), hemolysis (B = ?1.2, P < ?0.001, OR 3.1), high discharge bilirubin level (B = ?0.3, P = ?0.001, OR 1.3), and short duration of conventional phototherapy (B = ?? 1.2, P < ?0.001, OR 0.3).Conclusions
SBR should be considered in neonates with hemolysis, low birth weight, suspected sepsis, short duration of conventional phototherapy, exposure to intensive phototherapy, and relatively high discharge TSB. These risk factors should be taken into account when planning post-phototherapy follow-up.5.
Background
Children with Kawasaki disease (KD) and pyuria have been misdiagnosed with urinary tract infection (UTI). We compared clinical and laboratory features at admission between two groups of infants under 6?months of age who showed initial pyuria, to identify the initial clues suggestive of KD.Methods
We retrospectively reviewed the medical records of children with fever who were under 6?months of age with pyuria, over a 10-year period (2007–2017). We included infants with sterile pyuria who were finally diagnosed with KD and those with UTI.Results
During the period investigated, 12 (9.9%) KD patients with sterile pyuria and 378 infants with UTI were included in this study. Older age (P?<?0.01), a longer duration of fever; total and before admission (P?<?0.01), more negative nitrite test (P?<?0.01), higher platelet count (P?=?0.04), increased C-reactive protein (CRP) (P?<?0.01) and erythrocyte sedimentation rate (ESR) (P?<?0.01), were identified as initial features of infants finally diagnosed with KD. In the receiver operating characteristic analysis, optimal cut-off values of 509?k/μL for platelet count, 60?mg/L for CRP, and 68?mm/H for ESR were selected. Patients with ESR?>?68?mm/hr had a ninefold higher odds of KD compared to those with lower ESR levels (odds ratio: 8.963, 95% confidence intervals: 1.936–41.493, P?=?0.005), whereas CRP and platelet count could not significantly increase in the odds of KD at a cut-off point.Conclusion
Persistent fever, elevated ESR, and negative urine nitrite test can serve as early clues to suspect KD in febrile infants with pyuria.6.
Aim of study
The diagnosis of biliary atresia (BA) remains challenging and delay can lead to significant morbidity with time to surgery a key factor in determining outcome. Prematurity may impact on outcome potentially delaying diagnosis. We sought to assess whether the premature BA infants (PBA) have a delayed time to surgery and as such, worse outcomes?Methods
Review of a single-centre prospectively maintained database. Prematurity was defined as delivery?<?37/40 gestation. PBA was compared with date-matched term biliary atresia controls on a 2:1 basis. Primary outcomes were clearance of jaundice (<?20 μmol/L) and native liver survival. A retrospective assessment of liver fibrosis was made on biopsies at diagnosis and at Kasai portoenterostomy (KPE) in both premature and term cohorts. Data are quoted as median (range) unless indicated. A P value of ≤?0.05 was considered statistically significant.Results
21 (female n?=?14, 67%) premature infants with BA were treated in the period Jan. 1988–Dec. 2016 and compared with 41 contemporaneous term BA controls. Median gestation was 33 (29–36) weeks and birth weight 1930 (948–4230)g. Twin pregnancy (n?=?10) was the leading cause for prematurity and significantly higher than the controls (48 vs. 0%; P?<?0.0001). Maternal co-morbidity was high (n?=?10, 48%) including pre-eclampsia (19%) and diabetes (14%). Liver biopsy was performed in 19 (90%) patients (all diagnostic) at a median of 57 (4–266) days. Delayed diagnosis (>?50 days) was seen in n?=?13 but not associated with parenteral nutrition use (46 vs. 33%, P?=?0.59) or phototherapy (50 vs. 83%, P?=?0.19). Both BASM (33 vs. 7.5%; P?=?0.01) and duodenal atresia (19 vs. 0%; P?=?0.01) were seen more frequently in the PBA cohort. Mean fibrosis scores (Ishak) from diagnostic biopsies were lower in the premature group than the control group (2.71 vs. 3.53, P?=?0.043) indicating less fibrosis but this equalized by time of subsequent KPE (P?=?0.17). Primary surgery was Kasai portoenterostomy (n?=?20) at an older median age than controls (65 vs. 56 days; P?=?0.06). Liver transplantation was the primary procedure in one late-presenting child. There was an increased but non-significant clearance of jaundice in the PBA group [n?=?12/20 (60%) vs 20/41 (48%); P?=?0.23] post-KPE. Native liver survival and true survival were not different (P?=?0.58 and 0.23).Conclusions
PBA infants have similar outcomes to term infants, despite delayed diagnosis and higher frequency of the syndromic form. The high incidence of discordant twins supports the theory that epigenetic modifications could contribute to the pathogenesis of BA.Level of evidence
IIIc Retrospective Matched Cohort Study.7.
Juma?Obayashi Shigeyuki?Furuta Takuya?Kawaguchi Kohei?Kawaguchi Kei?Ohyama Hideki?Nagae Munechika?Wakisaka Hiroaki?Kitagawa
Background
We investigated the efficacy of broad-spectrum antibiotics for prevention of postoperative intra-abdominal abscess in pediatric acute appendicitis with our 3 risk factors:—WBC?>?16.5 (×?103/µl), CRP?>?3.1 (mg/dl) and appendix maximum short diameter on diagnostic imaging?>?11.4 mm.Methods
Four hundred twenty-two patients were reviewed. Patients with 0–1 risk factors were assessed as low-risk and those with 2–3 were high-risk. In the low-risk group, Group A (n?=?66) patients received broad-spectrum antibiotics and Group B patients (n?=?265) received narrow-spectrum monotherapy. In the high-risk group, Group C patients (n?=?63) received broad-spectrum antibiotics and Group D patients (n?=?28), narrow-spectrum antibiotics. The outcomes were the incidence of postoperative abscess and the total duration of intravenous (IV) antibiotics.Results
The incidence of intra-abdominal abscess was 6.06% in Group A versus 1.89% in Group B (p?=?0.08), and 19.05% in Group C versus 3.57% in Group D (p?=?0.06). Total IV antibiotic duration (days) were 6.12?±?2.87 in Group A versus 3.83?±?0.69 in Group B (p?<?0.01), and 7.84?±?4.57 in Group C versus 4.00?±?0.82 in Group D (p?<?0.01).Conclusion
Broad-spectrum antibiotics did not prevent postoperative intra-abdominal abscess in either low or high-risk groups.8.
Aim of the study
To evaluate if gestational age (GA), mode of delivery and abdominal wall closure method influence outcomes in uncomplicated gastroschisis (GTC).Methods
Retrospective review of NICU admissions for gastroschisis, August 2008–July 2016. Primary outcomes were: time to start enteral feeds (on-EF), time to discontinue parenteral nutrition (off-PN), and length of stay (LOS).Main results
A total of 200 patients with GTC were admitted to our NICU. Patients initially operated elsewhere (n?=?13) were excluded. Patients with medical/surgical complications (n?=?62) were analyzed separately. The study included 125 cases of uncomplicated GTC. There were no statistically significant differences in the outcomes of patients born late preterm (34 0/7–36 6/7; n?=?70) and term (n?=?40): on-EF 19 (5–54) versus 17 (7–34) days (p?=?0.29), off-PN 32 (12–101) versus 30 (16–52) days (p?=?0.46) and LOS 40 (18–137) versus 37 (21–67) days (p?=?0.29), respectively. Patients born before 34 weeks GA (n?=?15) had significantly longer on-EF, off-PN and LOS times compared to late preterm patients: 26 (12–50) days (p?=?0.01), 41 (20–105) days (p?=?0.04) and 62 (34–150) days (p?<?0.01), respectively. There were no significant differences in outcomes between patients delivered by C-section (n?=?62) and patients delivered vaginally (n?=?63): on-EF 20 (5–50) versus 19 (7–54) days (p?=?0.72), off-PN 32 (12–78) versus 33 (15–105) days (p?=?0.83), LOS 42 (18–150) versus 41 (18–139) days (p?=?0.68), respectively. There were significant differences in outcomes between patients who underwent primary reduction (n?=?37) and patients who had a silo (88): on-EF 15 (5–37) versus 22 (6–54) days (p?<?0.01), off-PN 28 (12–52) versus 34 (15–105) days (p?=?0.04), LOS 36 (18–72) versus 44 (21–150) days (p?=?0.04), respectively.Conclusion
In our experience, late preterm delivery did not affect outcomes compared to term delivery in uncomplicated GTC. Outcomes were also not influenced by the mode of delivery. Patients who underwent primary reduction had better outcomes than patients who underwent silo placement.9.
Background
Little published research has shown the relationship between noninvasive US shear wave speed (SWS) measurements and degree of liver fibrosis as established by percutaneous biopsy in children.Objective
To assess the relationship between liver US shear wave speed (SWS) measurements and parenchymal fibrosis in children.Materials and methods
Sixty-two children (0–18 years old) with known or suspected liver disease underwent same-day US shear wave elastography (SWE) and clinically ordered percutaneous core needle biopsy. SWE was performed just before the liver biopsy in the area targeted for sampling, using an Acuson S3000 US system with a 9L4 transducer; six SWS measurements were acquired using Virtual Touch Quantification (VTQ) and Virtual Touch IQ (VTIQ) modes. Biopsy specimens were scored for histological fibrosis and inflammation. Bivariate relationships were assessed using Pearson correlation, while multiple linear regression analysis was used to establish the relationship between SWS and predictor variables. Receiver operating characteristic (ROC) curves were created to assess the abilities of VTQ and VTIQ to discern low vs. high liver fibrosis (histological fibrosis scores 0–2 vs. 3–6).Results
There were significant positive correlations between liver histological fibrosis score and VTQ (n?=?49) and VTIQ (n?=?48) mean shear wave speed measurements (r?=?0.68 and r?=?0.73; P-values <0.0001). There also were significant positive correlations between liver histological inflammation score and VTQ and VTIQ mean shear wave speed measurements (r?=?0.47 and r?=?0.44, and P?=?0.0006 and P?=?0.0016, respectively). For VTQ, both histological fibrosis (P?<?0.0001) and inflammation (P?=?0.04) scores were significant predictors of shear wave speed (model adjusted R 2?=?0.49). For VTIQ, only histological fibrosis score (P?<?0.0001) was a significant predictor of shear wave speed (model adjusted R 2?=?0.56). ROC areas under the curve were 0.84 and 0.86 for VTQ and VTIQ, respectively.Conclusion
Liver US shear wave speed measurements increase with increasing parenchymal fibrosis in children.10.
Objective
Exclusively breast-fed infants born to vitamin B12 (cobalamin, cbl)-deficient mothers can develop symptoms within a few months following delivery. The authors aimed to assess the relationship between maternal and infantile markers of cbl status.Methods
In 240 full-term infants (age, 2–30 d) admitted to Samsun Maternity and Child Health Hospital and their mothers, complete blood count testing and serum cbl, folate and plasma total homocysteine (tHcy) measurements were performed. In the mothers, serum ferritin and holotranscobalamin (holoTC) levels were measured additionally.Results
Among the infants, 146 (60.8%) had cbl deficiency (serum cbl <259 pg/mL), whereas 184 (76.7%) mothers had a low cbl level (serum cbl <300 pg/mL). When cbl deficiency was defined as a serum holoTC level?<?40 pmol/L, 152 (63.3%) mothers were found as deficient. In addition, 147 (61.3%) infants had an elevated tHcy level (>10 μmol/L), in 35 (23.8%) of these 147 infants tHcy level being markedly elevated (>20 μmol/L). None of the infants had folate deficiency. In the correlational analysis between maternal and infantile markers associated with cbl status, the strongest correlation was observed between maternal holoTC and infantile tHcy (r?=??0.49, p?<?0.001), followed by the correlation between maternal tHcy and infantile tHcy (r?=?0.47, p?<?0.001). The weakest correlations were found between maternal cbl and infantile cbl (r?=?0.28, p?<?0.001), and between maternal cbl and infantile tHcy (r?=??0.25, p?<?0.001).Conclusions
Maternal cbl status is an important determinant of infantile cbl status. Both maternal holoTC and tHcy may assist in predicting infantile cbl status. The finding of high prevalence of maternal and infantile cbl deficiency in this study points towards the need for effective strategies to prevent cbl deficiency in women prior to getting pregnant.11.
Purpose
The advent of laparoscopy has revolutionized surgical practice within the last 30 years. Conversion to open surgery, however, remains necessary at times, even for the most experienced laparoscopic surgeon.Methods
The kids’ inpatient database was analyzed for 2006, 2009, and 2012 for patients who underwent laparoscopic appendectomy and conversion to open (CPT 470.1 and V64.41, respectively). Variables included in multivariable analysis were determined based on those variables found to have significance on univariate analysis.Results
A total of 104,865 patients, ages 0–17 years, underwent laparoscopic appendectomy during the three study periods. Of these, 2370 (2.2%) laparoscopic surgeries were converted to open appendectomy. Multivariable logistic regression showed significantly higher rates of conversion amongst patients with peritonitis (OR 6.7, p?<?0.001) or abscess (OR 14.3, p?<?0.001), obesity (OR 2.02, p?<?0.001), age >?13 years (OR 1.53 for ages 13–15, OR 1.77 for ages 16–17, p?<?0.001 for both), or cared for at rural hospitals (OR 1.55, p?=?0.002). Rates of conversion decreased over time for children at adult hospitals and at urban hospitals, regardless of teaching status (p?<?0.001 for both).Conclusion
Risk factors for conversion from laparoscopic to open appendectomy included abscess, peritonitis, increased age, obesity, male gender, socioeconomic status and treatment at a non-pediatric-specific hospital, and the overall rate is decreasing over time.12.
Kam Lun Hon Yan Min Bao Kate C. Chan Kin Wai Chau Rong-Shan Chen Kun Tat Gary Cheok Wa Keung Chiu Li Deng Chun-Hui He Kin Mui Ieong Jeng Sum C. Kung Ping Lam Shu Yan David Lam Qun Ui Lee So Lun Lee Ting Fan Leung Theresa N. H. Leung Lei Shi Ka Ka Siu Wei-Ping Tan Maggie Haitian Wang Tak Wai Wong Bao-Jing Wu Ada Y. F. Yip Yue-Jie Zheng Daniel K. Ng 《World journal of pediatrics : WJP》2018,14(5):482-491
Background
Asthma is a significant chronic health problem worldwide. Management aims at disease control by reducing functional impairment and exacerbations and improving quality of life (QoL). We report a multi-center study to survey asthma control and QoL in four cities in the Pearl River Delta.Methods
The conjoint survey involved ten Hong Kong pediatric hospitals/units, two Shenzhen hospitals, two Macau hospitals, and two Guangzhou hospitals on asthma control (using Asthma Control Test) and QoL (Pediatric Allergic Disease Quality of Life Questionnaire, PADQLQ). Acceptability of a treatment is graded as very good/good/fair/poor.Results
Good asthma control was only reported in 80% subjects in Hong Kong, but higher in sister cities (85–94%, P <?0.001). Allergic rhinitis, “incense burning”, and “smoker in family” were prevalent among the four cities. Logistic regression showed better control of asthma was associated with better PADQLQ (B?=???0.029, P < 0.001), better acceptability of bronchodilator (B?=???1.488, P = 0.025), negatively with “smoker in family” (B?=???0.83, P = 0.015) and various PADQLQ domains. Conversely, worse PADQLQ was associated with allergic rhinitis severity (B?=?4.77, P <?0.001), poor control of asthma (B?=?7.56, P <?0.001), increased frequency of traditional Chinese medicine use (B?=?1.7, P < 0.05), increased frequency of bronchodilator usage (B?=?1.05, P < 0.05), “smoker in family” (B?=?4.05, P < 0.05), and incense burning at home (B?=?3.9, P < 0.05).Conclusions
There are some clinical and cultural differences among the four southern Chinese cities within the Guangdong province. This study identifies potentially modifiable environmental and treatment factors associated with poor asthma control and QoL for health-care interventions. Having a smoker in the family is independently associated with poor asthma control and QoL.13.
Purpose
Inguinal hernias have been reported in as many as 10–30% premature neonates, making inguinal herniorrhaphy (IHR) one of the most commonly performed surgical procedures. The timing of surgery remains controversial. The purpose of this report is to compare outcomes of IHR while in the NICU (inpatient) versus repair following discharge (outpatient) to determine optimal timing.Methods
Premature neonates having undergone IHR over a 5-year period were identified and a retrospective case cohort analysis was performed.Results
263 patients underwent IHR during the 5-year study period with 115 (43.7%) having surgical repair inpatient (IP; prior to discharge) and 148 having outpatient herniorrhaphy (OP). Patients with IHR performed IP had significantly lower birth weight (p?<?0.001), gestational age (p?<?0.001), longer duration of surgery (p?=?0.01) and were more likely to have post-operative ventilator dependence following repair; however, there were no differences in the rate of recurrence (p?=?0.44) and incarceration (p?=?0.45).Conclusion
Our study demonstrated no significant differences in the rates of incarceration or recurrence, following in- or out-patient IHR. These findings suggest that IHR can potentially be offered as an outpatient procedure following hospital discharge in appropriate patients. The optimal timing of IHR in premature infants remains elusive and will likely require additional multicenter investigation.14.
Xin-Ting Yu Avi Sadeh Hugh Simon Lam Jodi A. Mindell Albert Martin Li 《World journal of pediatrics : WJP》2017,13(5):496-502
Background
To describe the sleep patterns of children below 36 months in Hong Kong, and evaluate the associations between parental behaviors and childhood sleep/wake patterns.Methods
Parents of 1049 infants and toddlers completed an internet-based expanded version of the Brief Infant Sleep Questionnaire.Results
Total sleep duration (P<0.001), frequency (P<0.001) and duration (P<0.001) of nocturnal awakenings decreased with age, whereas the longest sleep duration (P<0.001) and nocturnal sleep duration (P<0.001) increased with age. Children who room- or bed-shared with parents had later bedtimes (P<0.001), but similar sleep duration compared with those who had a separate sleep location. Falling asleep independently was associated with longer nocturnal sleep duration (P<0.001) and less sleep awakenings (P<0.001). Full-time employment of parents was associated with shorter total sleep duration of children (P<0.001). Although breastfeeding was associated with more nocturnal awakenings (P<0.001), no association was detected between breastfeeding and shorter sleep duration in children.Conclusions
As infants and toddlers develop, their sleep consolidates. Falling asleep independently was associated with longer nocturnal sleep duration and fewer sleep awakenings, whereas sleep location was not. This is an important finding, especially for families with limited living space where parent/child room- or bed-sharing cannot be avoided.15.
Mathieu Nacher Véronique Lambert Anne Favre Gabriel Carles Narcisse Elenga 《BMC pediatrics》2018,18(1):393
Background
In French Guiana, pregnant women may be exposed to infectious, environmental, and social risks leading to congenital malformation. The objective of the study was to study mortality rates from congenital malformations among infants <?1?year and to compare them with those in mainland France.Methods
We used the CEPI DC (INSERM) database, which compiles annual data from death certificates in all French territories using the International Classification of Diseases. Annual deaths for French Guiana and mainland France between 2005 and 2015 were compiled. The age category studied was children less than 1?year and deaths from congenital malformations, deformations and chromosomal abnormalities were compiled. Crude risk ratios and 95% confidence intervals were calculated to quantify the excess risk of disease in French Guiana.Results
In French Guiana between 2005 and 2015 there were 666 deaths of children aged <?1?year, among which, 132 (19.8%) were due to congenital malformations and chromosomal anomalies. Overall the risk ratio of death from congenital malformations and chromosomal anomalies between French Guiana and mainland France was 2.7 (1.5–4.7), P?<?0.001 for neurological congenital malformations it was 4.8 (1.2–19.7), P?=?0.01 and for congenital malformations of the circulatory system it was 3.3 (1.5–6.9), P?=?0.001.Conclusions
The incidence of death from congenital malformations or chromosomal anomalies in French Guiana was significantly higher than in mainland France. Explanations for this may be infections, genetic causes, nutritional causes, and toxic causes that are prevalent. There is a need to identify factors that predispose children born in French Guiana to having a higher risk of congenital malformations and chromosomal anomalies.16.
Objective
To assess and compare the educational effectiveness of SNAPPS model with traditional method in developing reasoning skills of Pediatric residents in Out-patient department.Methods
40 case presentations with 4 residents (20 each with traditional and SNAPPS methods) were audiotaped and compared with respect to making differentials, reasoning for analyzing differentials, raising uncertainties by probing preceptor, and selecting case-related issues for self study. Residents feedback was collected using a self-designed proforma.Results
Residents made more differentials (median 3.0 vs 1.5; P<0.001), exhibited more clinical reasoning for analyzing differentials (P<0.001), raised uncertainties more often by probing preceptors (15/20 vs 1/20; P<0.001) and selected case related issues for self-study (12/20 vs 0/20; P<0.001) with SNAPPS compared to traditional case presentations. Residents found SNAPPS relevant to ambulatory teaching.Conclusion
SNAPPS promotes clinical reasoning and selfdirected learning.17.
Purpose
The purpose was to compare the resource utilization and outcomes between patients with suspected (SUSP) and confirmed (CONF) non-accidental trauma (NAT).Methods
The institutional trauma registry was reviewed for patients aged 0–18 years presenting from 2007 to 2012 with a diagnosis of suspicion for NAT. Patients with suspected and confirmed NAT were compared.Results
There were 281 patients included. CONF presented with a higher heart rate (142?±?27 vs 128?±?23 bpm, p?<?0.01), lower systolic blood pressure (100?±?18 vs 105?±?16 mm Hg, p?=?0.03), and higher Injury Severity Score (15?±?11 vs 9?±?5, p?<?0.01). SUSP received fewer consultations (1.6?±?0.7 vs 2.4?±?1.1, 95% CI ? 0.58 to ? 0.09, p?<?0.01) and had a shorter length of stay (1.6?±?1.3 vs 7.8?±?9.8 days, 95% CI ? 4.58 to ? 0.72, p?<?0.01). SUSP were more often discharged home (OR 94.22, 95% CI: 21.26–417.476, p?<?0.01). CONF had a higher mortality rate (8.2 vs 0%, p?<?0.01).Conclusions
Patients with confirmed NAT present with more severe injuries and require more hospital resources compared to patients in whom NAT is suspected and ruled out.18.
Objective
To measure the size of the anterior fontanelle (AF) in healthy late-preterm and term newborns and correlate it with birth weight, gestational age, gender, occipito-frontal circumference, small for gestational age status and birth weight z-score.Methods
This was an observational study carried out from October 2013 through April 2015 at a tertiary care hospital. Newborns?≥?34 wk gestation were enrolled. Fontanelle edge was palpated with index finger and size calculated by adding anterior-posterior and transverse diameters and dividing by two.Results
A total of 1010 neonates were enrolled. The mean AF size was 2.23?±?0.52 cm (mean?±?SD). There was a significant decrease in the size of the AF with advancing gestational maturity on one-way ANOVA (F?=?31.30) (P?<?0.001) and also by increasing birth weight (F?=?20.34) (P?<?0.001). There was no significant difference in the mean AF size between males; 2.21?±?0.54 cm and females; 2.25?±?0.55 cm (mean?±?SD) (P?=?0.575). There was a strong correlation between AF size with increasing birth weight; correlation (r)?=?0.985. In small for gestational age neonates the AF was larger, 2.27?±?0.55 (mean?±?SD) and a strong correlation between birth weight z-score and AF size was noted (r?=?1.012).Conclusions
The mean AF size in late-preterm and term Indian newborns in a mixed community hospital was 2.23?±?0.52. A strong correlation was found between AF size with increasing birth weight and with birth weight z-score in small for gestational age babies.19.
T. Chandrasekhar M. M. Suchitra M. Pallavi P. V. L. N. Srinivasa Rao Alok Sachan 《Indian pediatrics》2017,54(9):752-755
Objective
To study the prevalence of cardiovascular risk factors in pediatric obesity.OMethods
50 obese children (age 5–17y) and 50 apparently healthy non-obese children (body mass index of over 95th percentile and between 5th to 95th percentiles, respectively) using Centre for Disease Control growth charts were included. Fasting blood sugar, lipid profile, insulin, homeostasis model assessment of insulin resistance, uric acid, fibrinogen, lipoprotein (a), homocysteine, malondialdehyde, ferric reducing ability of plasma and nitric oxide were measured.Results
Insulin, insulin resistance, triglycerides, uric acid, fibrinogen, malondialdehyde, ferric reducing ability of plasma and nitric oxide were significantly higher (P <0.001) in obese children. Body mass index showed significant positive correlation with insulin r=0.519, P<0.001; insulin resistance r =0.479, P<0.001; uric acid r=0.289, P=0.005; fibrinogen r=0.461, P<0.001; and nitric oxide r=0.235, P=0.012.Conclusion
Pediatric obesity is associated with dyslipidemia, oxidative stress, insulin resistance and endothelial dysfunction, which are cardiovascular risk factors and components of metabolic syndrome. These children must be targeted for lifestyle and dietary modification.20.