Assessment of Ventricular Repolarization in Deaf–Mute Children

The long QT syndrome is a congenital disease with frequent familial transmission, characterized primarily by prolongation of the QT interval and by the occurrence of life-threatening arrhythmias. The syndrome may be familial, with or without congenital deafness, or it may be idiopathic. We attempted to assess ventricular repolarization and to identify patients with the Jervell and Lange–Nielsen syndrome among 132 deaf–mute school children. Five deaf–mute subjects had Jervell and Lange–Nielsen syndrome. The deaf–mute subjects were divided into two subgroups according to the length of their QT intervals: group 1 included 5 cases with the long QT interval (>440 msec), and group 2 included 127 subjects with the normal QT interval (≤440 msec). Group 3 was composed of 96 control subjects. The mean QT, QTc, JT, and JTc intervals (418 ± 70, 500 ± 38, 302 ± 65, and 389 ± 36 msec, respectively) in group 1 were significantly longer than those of group 2 (344 ± 23, 408 ± 22, 249 ± 34, and 291 ± 28 msec, respectively) and group 3 (325 ± 11, 383 ± 26, 228 ± 36, and 269 ± 46 msec, respectively). The dispersion (d) values (QT-d, QTc-d, JT-d, and JTc-d; 63 ± 10, 73 ± 8, 60 ± 8, and 62 ± 11 msec, respectively) of group 1 were significantly longer than those of group 2 (49 ± 16, 43 ± 11, 48 ± 21, and 45 ± 18 msec, respectively) and group 3 (33 ± 13, 33 ± 14, 28 ± 16, and 27 ± 14 msec, respectively) at similar mean RR intervals. Also, the mean QT, QTc, JT, and JTc intervals and the dispersion values (QT-d, QTc-d, JT-d, and JTc-d) in group 2 were significantly longer than those of group 3 at similar mean RR intervals. Consequently, in this study, we determined that the deaf–mute children who did not meet the criteria for Jervell and Lange–Nielsen syndrome still had evidence of subtle derepolarization abnormalities evidenced by intermediate prolongation of QTc, JTc, and the corresponding measures of dispersion, and we believe an electrocardiogram examination of deaf–mute subjects will reveal this potentially life-threatening syndrome.     

Parent–Child Agreement of Child Health-Related Quality-of-Life in Maltreated Children

This article examines the differences between self-reports and parent-proxy reports of pediatric health-related quality of life among families receiving child welfare services for child physical abuse and neglect. This study assesses child well-being using a pediatric health-related quality of life measure (Pediatric Quality of Life Inventory; PedsQL 4.0) with parent-child dyads (N?=?129). Child and parent reports are compared for total and domain score on the PedsQL. Child-reported scores are lower than parent-proxy reports on total and all domain scores. For the total score, 57 % of child reports are below the clinical cutoff for poor well-being compared with 19 % of parent proxy reports. Analyses indicate poor agreement between parent and child reports, with this disagreement associated with high parent anger and parental self-report of poor mental health. Fully assessing child health and well-being requires multiple perspectives of child well-being. Gaining information from both the child and the parent provides different but equally useful information.     

Baby Gate–Related Injuries Among Children in the United States, 1990–2010

ObjectiveBaby gates are one of the most widely used home safety products to protect children from home hazards. The objective was to describe the epidemiology of baby gate and barrier-associated injuries among children. It was hypothesized that injuries experienced by children ages ≤2 years and those >2 years were significantly different as a result of differences in gate interactions.MethodsA retrospective analysis was conducted by using nationally representative data from the National Electronic Injury Surveillance System. A total of 1188 actual cases were reviewed and national estimates generated.ResultsAn estimated 37,673 children were treated in emergency departments for injuries associated with gates, yielding an average of 1794 cases annually. The incidence of gate-related injuries increased significantly from 3.9 per 100,000 children in 1990 to 12.5 per 100,000 children in 2010 (P < .001). Patients were primarily boys (61.0%) and were <2 years of age (60.4%). Patients <2 years of age were most often injured by falls down stairs (odds ratio 6.72; 95% confidence interval 6.32–7.16) after the collapse of the gate. Patients aged 2 to 6 were most often injured by contact with the gate (odds ratio 2.03; 95% confidence interval 1.95–2.12), resulting in open wounds (55.4%) and soft-tissue injuries (24.2%).ConclusionsGiven the clear dichotomy between injury characteristics of patients aged <2 years and patients aged 2 to 6 years of age, as well as the prevalence of preventable injuries, greater efforts are needed to promote proper usage, ensure safety in product design, and increase awareness of age-related recommendations for use of gates.     

Is Waiting for Rehabilitation Services Associated with Changes in Function and Quality of Life in Children with Physical Disabilities?

Objectives. To determine whether longer waiting times for rehabilitation were associated with deterioration in child functional status and/or quality of life. Methods. Parents of 124 children (mean age 45 months) with physical disabilities (e.g., cerebral palsy, global developmental delay, spina bifida) who were referred to pediatric rehabilitation centers were interviewed every three months, from referral until admission into the rehabilitation program. Information from parental interviews included socio-demographics, parental empowerment (Family Empowerment Scale), function (WeeFIM: Functional Independence Measure for Children), and quality of life (PedsQL). Data on date of referral, age, gender, and diagnosis were obtained from hospital databases. Results. Half of the sample waited more than 9.1 months (95% confidence interval: 6.5–16.1) for admission to a public rehabilitation program. A total of 42% paid for some private services while waiting. Over the waiting period, there was statistically significant improvement in WeeFIM cognition and total scores but not in mobility scores. PedsQL psychosocial summary score declined over the waiting period (p < .05). Conclusion. Longer wait times for rehabilitation were associated with declining psychosocial quality of life. Reducing waiting times for rehabilitation services may allow rehabilitation specialists to address psychosocial problems for these children.     

Pulmonary Functions in Normal School Children in the Age Group of 6–15 Years in North India

Objective

Lung function tests have become an integral part of assessment of pulmonary disease. As few studies on pulmonary function tests have been carried out in young children in India, the study was carried out in normal urban and rural school children in Ludhiana district of North India to determine pulmonary functions in the age group 6–15 years and to find its correlation with regards to age, sex, height and weight.

Methods

The study group included 600 normal children between 6–15 years age from different urban and rural schools in the region. A preformed questionnaire was interviewed and detailed general physical and systemic examination was done. Pulmonary function tests were measured by using Micromedical Gold standard fully computerized portable auto spirometer (Superspiro Cat No. SU 6000).

Findings

The present study shows, all the three independent variables (age, weight and height) have linear positive correlation with lung function parameters, both for boys and girls. Lung function values in boys were significantly higher as compared to that of girls. Urban children had higher lung function parameters than rural children except IRV, FEF_25%. Among all anthropometric parameters, height was the most independent variable with maximum coefficient of correlation.

Conclusion

Equations derived from the present study for estimation of the expected values of lung function will help to interpret the observed lung function values in children of North India.     

Low Vitamin D Levels: Are Associated with Both Iron Deficiency and Anemia in Children and Adolescents?

We have read, with great interest, the recent article by Lee. In this excellent study, the authors investigated the association between vitamin D deficiency and anemia in a nationally representative sample of Korean children and adolescents. They concluded that vitamin D deficiency is associated with increased risk of anemia, especially iron deficiency anemia, in healthy female children and adolescents. We appreciate and congratulate the authors for having addressed such an important issue. However, we have some concerns regarding this report, which we would like to share with you. As a result, further studies are needed for the association between vitamin D deficiency and anemia. Factors affecting Vitamin D status and anemia such as measurement method, nutrition, medications, and infections should be considered to conclude an association between vitamin D and anemia. Therefore, we think that considering these confounders would add value to this well-written article.     

Children’s Bonding with Parents and Grandparents and Its Associated Factors

Previous literature has focused on the importance of both parental and grandparental bonding. However, few studies have been conducted to measure children’s bonding with parents and grandparents simultaneously, especially tested by the same instrument that offers more comparable results. Therefore, we studied the relationships between parental and grandparental bonding using the Parental Bonding Instrument (PBI), and possible associations between these bonds and sociodemographic variables in 905 Chinese children aged 10–14 years. Children’s bonding with mother, father, and grandparents were positively correlated, and the final mixed-effect model showed that several sociodemographic factors (e.g., gender, only children, parents’ marital status, and mother’s occupation) were associated with parental and grandparental bonding.     

Exercise Testing in Children With Wolff–Parkinson–White Syndrome: What Is Its Value?

This study was conducted to evaluate the accuracy of exercise testing for predicting accessory pathway characteristics in children with Wolff–Parkinson–White (WPW) syndrome. The study enrolled 37 children with WPW syndrome and candidates for invasive electrophysiologic study (EPS). Exercise testing was performed for all the study participants before the invasive study. Data from the invasive EPS were compared with findings from the exercise testing. The sudden disappearance of the delta (Δ) wave was seen in 10 cases (27 %). No significant correlation was found between the Δ wave disappearance and the antegrade effective refractory period of the accessory pathway (AERP-AP) or the shortest pre-excited RR interval (SPERRI). The sensitivity, specificity, and positive and negative predictive values of Δ wave disappearance, based on AERP-AP as gold standard, were respectively 29.4, 80, 71.4, and 40 %. The corresponding values with SPERRI as the gold standard were respectively 23.8, 71.4, 71.4 and 23.8 %. Exercise testing has a medium to low rate of accuracy in detecting low-risk WPW syndrome patients in the pediatric age group.     

Ceftriaxone use in the emergency department: are we doing it right?

OBJECTIVE: To evaluate the patterns of ceftriaxone use in an urban pediatric emergency department (PED) and to determine if overuse exists based on published guidelines for management of febrile infants. METHODS: We conducted a retrospective study of 229 young febrile patients who received ceftriaxone between January 1 and March 31, 1995, in a large urban PED in a teaching hospital in Atlanta. Patients younger than 3 months, patients with chronic illnesses (eg, sickle cell anemia, HIV), and those who received ceftriaxone for sexually transmitted diseases were excluded. RESULTS: During the study period, ceftriaxone was administered 289 times to 229 patients (53% male) aged 3 months to 18 years. Sixty patients (26%) received ceftriaxone two or more times for the same illness. Data were stratified based on age, source of fever, temperature, leukocyte count, diagnosis of pneumonia, and visit order (initial or follow-up). At the time of their initial visit, 180 of 229 patients had an identifiable focus of infection (76 had pneumonia), but no source could be identified in the remaining 49. Based on temperature, leukocyte count, and the presence or absence of a focus, ceftriaxone use, as compared with practice guidelines, was justified in 40 of 229 (17.5%) patients, questionable in 43 of 229 (18.8%), and not justified in 146 of 229 (63.7%). For the 60 patients who received ceftriaxone more than once, its use was justified in only 13%. Results of blood cultures were positive in 3 of 229 (1.3%) patients. Ceftriaxone was justified according to published guidelines in two of these three patients, whereas one patient with pneumonia and pneumococcal bacteremia could have been treated with oral antibiotics. Overall, for the entire study population (289 encounters at initial and subsequent visit combined), ceftriaxone use was justified in 48 patients (16.6%), questionable in 49 patients (17%), and not justified in 192 patients (66.4%). CONCLUSIONS: Based on published guidelines, ceftriaxone use in the PED was not justified in the majority of cases.     

Children’s rights in pediatrics

The United Nations Convention of Children’s Rights (UNCRC) introduced in 1989 has generated a global movement for the protection of children’s rights and has brought about a paradigm change in how children are perceived. Pediatric healthcare professionals are interacting with children and therefore with children’s rights on a daily basis. However, although at least 18 of the 54 articles are relevant for pediatric practice, there is limited systematic training on how pediatricians can support children’s rights in the clinical setting. This article discusses the principles and aims of the UNCRC and proposes a comprehensive checklist of rights vis-à-vis issues that arise in clinical practice.     

Hodgkin's Disease in Children in the West Midlands, 1957–1986: A Large Population-Based Study

One hundred forty-one children were diagnosed with Hodgkin's disease between 1957 and 1986 in the West Midlands Health Authority Region (1991 population, 1.I million children). Eighty-seven were boys and 54 were girls, representing a significant male:female ratio of 1.5:1 (P < 0.01). The average age-standardized incidence rate was 3.6 per million per year with a significant increase in the older age group (≥ 10 years) in the second half of the period (P= 0.02). The mixed cellularity subtype was more common in those younger than 10 years, with nodular sclerosing disease being seen more in those ≤ 10 years. Overall survival at 5 years was 76% (65% at 10 years) with a significant difference (P < 0.001) in survival between the first and last decades. There were six second malignancies, five of which could have been treatment related. A positive history of cancer in close relatives was found in 11 patients, and higher social class war found in more older than younger children. These findings support the hypothesis that Hodgkin's disease may have a viral etiology and may be linked with socioeco-nomic conditions.     

Characteristics Associated With Parent–Teacher Concordance on Child Behavior Problem Ratings in Low-Income Preschoolers

Objective

Assessment of pediatric behavior problems often requires rating scales from multiple reporters in different settings (eg, home and school); however, concordance between reporters may be low. Pediatricians must reconcile differences to inform treatment. We sought to examine characteristics predicting parent–teacher concordance on ratings of preschoolers' behavior problems.

Etiology and Risk Factors Determining Poor Outcome of Severe Pneumonia in Under–Five Children

Objectives

To determine the etiology of severe pneumonia (pneumonia with chest indrawing) in under-five children, and to study the risk factors for poor outcomes viz., ‘treatment failure’, ‘need for change in antibiotics’, ‘prolonged hospital stay’, ‘need for mechanical ventilation’ and ‘mortality.’

Methods

Children (age 2 mo to 5 y) with pneumonia and chest drawing were enrolled prospectively from October 2012 through September 2013. Clinical history was recorded, and examination, anthropometry and investigations (including chest X-ray, blood culture and nasopharyngeal swab culture) were performed. Children were managed as per standard guidelines, and recovery outcomes were recorded in form of ‘treatment failure’ (defined as persistence of features of severe pneumonia after 72 h or worsening of clinical condition before 72 h), need for change of antibiotics and prolonged (>5 d) hospital stay. The associations between the clinical, anthropometric and diagnostic risk factors and the recovery outcomes were evaluated by univariate and multivariate logistic regression analysis.

Results

Out of 120 children enrolled in the study, 36 (42%) were culture positive (nasopharyngeal/blood); most common bacteria isolated were Streptococcal pneumoniae and Staphylococcal aureus, respectively. Treatment failure was seen in 15 (12.5%), 34 (28.3%) needed change of antibiotics, and 50 (41.6%) children required prolonged hospitalization. Low birth weight, overcrowding, general danger signs (lethargy/unable to drink), clinical rickets, crepitation, leukocytosis and positive blood culture were significant risk factors for treatment failure, prolonged hospital stay and antibiotics change. On multivariate logistic regression analysis, respiratory rate of >70/min (OR 19.94, 95%CI 1.42–280.29), lethargy/unconsciousness (OR 114.2, 95%CI 3.14–4147.92), and positive blood culture (OR 15.24, 95%CI 2.53–91.67) had more chances of treatment failure. Duration of hospital stay was prolonged in those who had inability to drink (OR 3.89, CI 1.37–10.99) or abnormal chest X-ray (OR 8.45, CI 3.56–20.04). Children with rickets (OR 3.69, CI 1.14–11.96), and those with abnormal chest X-ray (OR 9.66, CI 2.62–35.53) had a higher odds of change in antibiotics. Presence of wheeze was a protective factor for treatment failure (OR 0.03, CI 0.00–0.37) and change of antibiotics (OR 0.24, CI 0.07–0.74).

Conclusions

Staphylococcus aureus and Streptococcus pneumoniae are the predominant organisms causing severe pneumonia in our setting. Children with risk factors such as respiratory rate >70/min, rickets, lethargy/unconsciousness, not able to drink, abnormal chest X-ray or positive blood culture are likely to have a delayed recovery or need of change of antibiotics, whereas those with wheeze are likely to recover faster with less chances of treatment failure.

     

Sleep Timing Moderates the Concurrent Sleep Duration–Body Mass Index Association in Low-Income Preschool-Age Children

ObjectiveTo test the independent main and moderating effects of sleep timing on body mass index (BMI) in low-income preschool-age children (M = 4.11 years, SD = 0.54).MethodsParents reported demographics and children's sleep concurrently, and a subset of children was followed longitudinally. Child height and weight were measured and BMI z score (BMIz) calculated. Regression analysis evaluated main effects of sleep timing (bedtime, weekday-to-weekend schedule shifting, napping) on concurrent BMIz and future rate of change, and their moderating effects on the sleep duration–BMIz association.ResultsOf 366 children (longitudinal subsample = 273), 50% were boys, 57% white, and 37% overweight or obese. Nocturnal sleep duration predicted concurrent BMIz, but not rate of change in BMIz over time. Bedtime was a moderator; the sleep duration–BMIz association was present only among children with bedtimes after 9 pm (β = −0.44; 95% confidence interval −0.69, −0.18). Schedule shifting was a moderator; the association between greater nocturnal sleep duration and lesser rate of future BMIz increase was present only among children with the most consistent sleep schedules (<45-minute delay in weekend bedtime: β = −0.12; 95% confidence interval −0.23, −0.01). Daytime napping did not moderate the nocturnal sleep duration–BMIz association. Covariates (sleep-disordered breathing, soda consumption, home chaos) did not explain these associations.ConclusionsAmong low-income preschoolers, sleep timing moderated the nocturnal sleep duration–BMIz association. Understanding how sleep timing and sleep duration relate to childhood obesity is important for prevention efforts.