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1.
Objective
To investigate the correlation between the initial prophylactic antibiotic use and the subsequent NEC in high-risk premature infants.Methods
We performed a literature search of PubMed, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), and the Web of Science, and nine studies with a total of 5207 infants were selected for inclusion in this study.Results
The pooled estimate for the seven studies combined indicating that prophylactic antibiotic usage was associated with a non-significant trend toward increased incidence of NEC [odds ratio (OR) 0.75; 95% confidence interval (CI) 0.26–2.17], and prolonged exposure to prophylactic antibiotics, compared with limited prophylactic antibiotic use, was associated with a significant trend toward the risk of increasing incidence of NEC (OR 1.31; 95% CI 1.08–1.59).Conclusion
Current evidence does not support the use of prophylactic antibiotics to reduce the incidence of NEC for high-risk premature infants.2.
Purpose
Infants with Alagille syndrome (AGS) frequently develop neonatal cholestasis, and some AGS infants who suspected of biliary atresia subsequently undergo the Kasai operation with the diagnosis of biliary atresia. The aim of this study was to investigate the effect of the Kasai operation on liver and patient outcomes among AGS patients, using a meta-analysis.Methods
A systematic review and meta-analysis of studies describing the outcomes of AGS patients with/without the Kasai operation were conducted. The analyzed outcomes were liver transplantation, not living with the native liver, and mortality for any reason.Results
We identified 6 studies (394 AGS patients). All studies were retrospective cohort or case-control studies. The incidences of liver transplantation, not living with the native liver, and mortality were significantly higher in AGS patients who underwent the Kasai operation than in those who did not undergo the Kasai operation (odds ratio: 6.46, 95% CI 3.23–12.89, p?<?0.00001; odds ratio: 25.88, 95% CI 2.83–236.84, p?<?0.004; odds ratio: 15.05, 95% CI 2.70–83.93, p?=?0.002, respectively).Conclusion
The Kasai operation was associated with poor outcomes in AGS patients. It remains unclear if the Kasai operation directly deteriorates liver and patient outcomes in AGS patients.3.
Yi-Fei Li Kai-Yu Zhou Jie Fang Chuan Wang Yi-Min Hua De-Zhi Mu 《World journal of pediatrics : WJP》2016,12(3):298-307
Background
There is no consensus on the effectiveness of prenatal diagnosis except for hospitalized outcomes. Hence, a meta-analysis of published literature was conducted to assess the effect of prenatal diagnosis.Methods
Literature review has identified relevant studies up to December 2013. A meta-analysis was performed according to the guidelines from the Cochrane review group and the PRISMA statement. Studies were identified by searching PubMed, Embase, the Cochrane Central Register of Controlled Trials and World Health Orgnization clinical trials registry center. Meta-analysis was performed in a fixed/random-effect model using Revman 5.1.1 according to the guidelines from the Cochrane review group and the PRISMA guidelines.Results
The results from 13 cohort studies in 12 articles were analyzed to determine the optimal treatment with the lower rate of perioperative mortality in prenatal diagnosis. The superiority of a prenatal diagnosis has been proven because the surgical procedure could be done in the early neonatal period (95% CI, -0.76, -0.40). The prenatal diagnosis has also remarkably reduced the preoperative and postoperative mortality rates in cases of transposition of the great arteries (95% CI=0.06, 0.80; 95% CI=0.01, 0.82, respectively), as well as the overall results with all subtypes (95% CI=0.18, 0.94; 95% CI=0.46, 0.94, respectively).Conclusions
Prenatal diagnosis is effective in perinatal management with an earlier intervention for major congenital heart disease, but only results in a reduced perioperative mortality in cases of transposition of the great arteries. Further investigations are required to evaluate the effect of prenatal diagnosis on life quality during a long-term follow-up.4.
Background
Minimizing the ionizing radiation dose to children is fundamental to pediatric radiology. The most widely accepted imaging examination for evaluating craniosynostosis is computed tomography (CT) of the head, an examination that involves ionizing radiation.Objective
To determine if sonography of the cranial sutures is an adequate screening examination for the diagnosis of craniosynostosis in patients with abnormal skull shape.Materials and methods
A retrospective review of all cranial suture ultrasound (US) examinations performed during the course of a 3-year period (July 2012 – September 2015) was undertaken. Results were compared with clinical follow-up and/or head CT to evaluate the accuracy of this modality as a screening tool to determine the presence or absence of craniosynostosis. Fifty-two sonographic exams were adequate for inclusion.Results
Forty-five of the examinations did not reveal synostosis. In each of these instances, follow-up physical exam findings and/or CT imaging confirmed that no abnormal premature suture closure was present. US findings demonstrated synostosis in seven cases. CT exam or operative reports of these cases confirmed all seven findings of premature suture closure. Statistical analysis demonstrated a sensitivity of 100% (95% confidence interval [CI]: 56.1–100.0%), a specificity of 100% (95% CI: 90.2–100.0%), and a negative predictive value of 100% (95% CI: 90.2–100.0%).Conclusion
Cranial US is a reliable screening tool to rule out craniosynostosis in patients with abnormal head shape.5.
Objectives
To evaluate the clinical, behavioral and health-care associated risk factors of intrapartum perinatal mortality (IPPM).Design
Prospective cohort study.Setting
Labor room and postnatal wards of a teaching hospital in North India.Participants
Pregnant women were eligible for enrolment in the study if period of gestation at delivery was 35 weeks or more or baby weighed at least 2000 g at birth, index pregnancy was not booked in antenatal clinic of the study hospital and fetus was delivered within 24 h of admission in the hospital.Methods
Information about antenatal care and events surrounding labor and delivery were retrieved from antenatal care records, referral notes, hospital clinical records and interview of mothers. Multivariate analysis was conducted using forward stepwise logistic regression analysis.Main Outcome Measure
IPPM was defined as asphyxiaspecific stillbirth or asphyxia-specific early neonatal death.Results
Among 248 emergency obstetric referrals during the study period, rate of IPPM was 8% (20/248, 18 fresh stillbirths and 2 asphyxia-specific neonatal deaths). District hospitals and community health-centers/first referral units contributed threefourths of all referrals. On logistic regression analysis significant risk factors for IPPM were presence of obstructed labor (OR: 23, 95% CI: 1.9–275.8), father engaged in unskilled labor (OR: 10, 95% CI: 1.3–77.7) and absence of urine examination during antenatal period (OR: 5.5, 95% CI: 1.8–16.3).Conclusions
Low socioeconomic status, inadequate antenatal care and poor intrapartum care due to unskilled birth attendance are risk factors of IPPM.6.
Background
Methylenetetrahydrofolate reductase (MTHFR) plays a crucial role in the hyperhomocysteinemia, which is a risk factor related to the occurrence of congenital heart defect (CHD). However, the association between MTHFR polymorphism and CHD has been inconclusive.Methods
We conducted an updated meta-analysis to provide comprehensive evidence on the role of MTHFR A1298C polymorphism in CHD. Databases were searched and a total of 16 studies containing 2207 cases and 2364 controls were included.Results
We detected that a significant association was found in the recessive model (CC vs. AA?+?AC: OR?=?1.38, 95% CI: 1.10–1.73) for the overall population. Subgroup analysis showed that associations were found in patients without Down Syndrome in genetic models for CC vs. AA (OR?=?1.47, 95% CI: 1.01–2.14), CC vs. AC (OR?=?1.29, 95% CI: 1.00–1.66) and recessive model (OR?=?1.44, 95% CI: 1.14–1.82). We conducted a meta-regression analysis, Galbraith plots and a sensitivity analysis to assess the sources of heterogeneity.Conclusions
In summary, our present meta-analysis supports the MTHFR 1298C allele as a risk factor for CHD. However, further studies should be conducted to investigate the correlation of plasma homocysteine levels, enzyme activity, and periconceptional folic acid supplementation with the risk of CHD.7.
Aklilu Endalamaw Eshetu Haileselassie Engeda Daniale Tekelia Ekubagewargies Getaneh Mulualem Belay Mekuriaw Alemayehu Tefera 《Italian journal of pediatrics》2018,44(1):141
Background
Different primary studies in Ethiopia showed the burden of low birth weight. However, variation among those studies was seen. This study was aimed to estimate the national prevalence and associated factors of low birth weight in Ethiopia.Methods
PubMed, Web of Science, Cochrane library, and Google Scholar were searched. A funnel plot and Egger’s regression test were used to see publication bias. I-squared statistic was applied to check heterogeneity of studies. A weighted inverse variance random-effects model was applied to estimate the national prevalence and the effect size of associated factors. The subgroup analysis was conducted by region, study design, and year of publication.Result
A total of 30 studies with 55,085 participants were used for prevalence estimation. The pooled prevalence of LBW was 17.3% (95% CI: 14.1–20.4). Maternal age?<?20?years (AOR?=?1.7; 95% CI:1.5–2.0), pregnancy interval?<?24?months (AOR?=?2.8; 95%CI: 1.4–4.2), BMI?<?18.5?kg/m2 (AOR?=?5.6; 95% CI: 1.7–9.4), and gestational age?<?37?weeks at birth (AOR?=?6.4; 95% CI: 2.5–10.3) were identified factors of LBW.Conclusions
The prevalence of low birth weight in Ethiopia remains high. This review may help policy-makers and program officers to design low birth weight preventive interventions.8.
Purpose
To examine the effects of obesity on specialty-specific surgical outcomes in children.Materials and methods
Retrospective cohort study using the National Surgical Quality Improvement Program, Pediatric, 2012–2014. Patients included those aged 2–17 years who underwent a surgical procedure in one of six specialties. Obesity was the primary patient variable of interest. Outcomes of interest were postoperative complications and operative times. Odds ratios for development of postoperative complications were calculated using stepwise multivariate regression analysis.Results
Obesity was associated with a significantly greater risk of wound complications (OR 1.24, 95% CI 1.13–1.36), but decreased risk of non-wound complications (OR 0.68, 95% CI 0.63–0.73) and morbidity (OR 0.79, 95% CI 0.75–0.84). Obesity was not a significant factor in predicting postoperative complications in patients undergoing otolaryngology or plastic surgery procedures. Anesthesia times and operative times were significantly longer for obese patients undergoing most types of pediatric surgical procedures.Conclusion
Obesity confers an increased risk of wound complications in some pediatric surgical specialties and is associated with overall decreased non-wound complications and morbidity. These findings suggest that the relationship between obesity and postoperative complications is complex and may be more dependent on underlying procedure- or specialty-related factors than previously suspected.9.
Objective
To quantitatively summarize the evidence from observational studies on the relation between pediatric asthma and food allergy.Methods
A literature search was conducted in Medline and EMBASE (August 2016). Two independent reviewers appraised the studies and extracted the estimates of interest. Methodological quality of the included studies was assessed using National Heart Lung and Blood Institute (NHLBI) Quality Assessment Tools. Data were pooled using random-effects meta-analysis.Results
A total of 32 relevant studies were identified but only 8 studies met the inclusion criteria. Using random-effect model, food allergy showed strong association with asthma in children (OR = 2.87 [95% CI: 2.05–4.00]; P < 0.0001).Conclusions
This study suggested that food allergy is associated with an increased risk of asthma in children.10.
Shrishail Gidaganti M. M. A. Faridi Manish Narang Prerna Batra 《Indian pediatrics》2018,55(3):206-210
Objective
To compare the incidence of meconium aspiration syndrome and feed intolerance in infants born through meconium stained amniotic fluid with or without gastric lavage performed at birth.Setting
Neonatal unit of a teaching hospital in New Delhi, India.Design
Parallel group unmasked randomized controlled trial.Participants
700 vigorous infants of gestational age ≥34 weeks from through meconium stained amniotic fluid.Intervention
Gastric lavage in the labor room with normal saline at 10 mL per kg body weight (n=350) or no gastric lavage (n=350). Meconiumcrit was measured and expressed as ≤30% and >30%.Outcome Measures
Meconium aspiration syndrome, feed intolerance and procedure-related complications during 72 h of observation.Results
5 (1.4%) infants in lavage group and 8 (2.2%) in no lavage group developed meconium aspiration syndrome (RR 0.63, 95% CI 0.21, 1.89). Feed intolerance was observed in 37 (10.5%) and 53 infants (15.1%) in lavage and no lavage groups, respectively (RR 0.70, 95% CI 0.47, 1.03). None of the infants in either group developed apnea, bradycardia or cyanosis during the procedure.Conclusion
Gastric lavage performed in the labor room does not seem to reduce either meconium aspiration syndrome or feed intolerance in vigorous infants born through meconium stained amniotic fluid.11.
Objective
To compare the diagnostic accuracy of INCLEN Diagnostic Tool for Autism Spectrum Disorder (INDT-ASD) against Diagnostic and Statistical Manual of Mental Disorders–5 (DSM-5) for the diagnosis of Autism Spectrum Disorder (ASD).Methods
118 children aged 2–9 years with symptoms suggestive of ASD were assessed by INDT-ASD and DSM-V by trained personnel. ASD diagnosis by INDT-ASD was compared against the expert’s DSM-5 diagnosis.Results
INDT-ASD had a sensitivity and specificity of 100% and 75%, respectively against DSM-5 for the diagnosis of ASD; specificity for Autistic Disorder was 87%.Conclusion
The INDT-ASD has a good sensitivity and specificity against DSM-5, and can continue to be used for the diagnosis of ASD even after the adoption of DSM-5 criteria.12.
Objectives
To determine the association between early childhood caries and nutritional status in preschool children.Methods
Cross-sectional study among preschool children (N=550, age 8–60 mo) were selected in tribal, rural and urban health care units of Kerala. An oral examination for early childhood caries status was done using Deft index. The anthropometric measurements were recorded. Multiple logistic regression with other covariates was used to determine the association between the early childhood caries and nutritional status.Results
The mean (SD) Deft scores were 0.93 (1.73), 2.22 (2.92) and 3.40 (3.23) for children with normal nutritional status, borderline undernutrition and undernutrition, respectively. Children with borderline undernutrition (adjusted OR 2.05, 95% CI 1.20, 3.49) or undernutrition (adjusted OR 3.46, 95% CI 1.93, 6.29) had higher odds of dental caries in comparison to those with normal nutritional status.Conclusion
Undernutrition is associated with early childhood caries among preschool children.13.
Background
The transanastomotic feeding tube (TAFT) is widely used around the world in patients with esophageal atresia (EA). However, the safety of the use of TAFT is still unknown and remains to be clarified.Methods
The following electronic databases were searched: PubMed, EMBASE and Cochrane. Studies comparing outcomes in patients with the use of TAFT (TAFT+) and patients without the use of TAFT (TAFT-) were scrutinized. The quality of included studies was evaluated with the Newcastle–Ottawa scale score. Statistical heterogeneity was assessed using the I2 value. A fixed or random-effect model was applied.Results
Four retrospective controlled studies involving 455 patients were included. The pooled estimates showed that the use of TAFT significantly increased the risk of stricture, with a risk ratio (RR) of 1.83 (95% CI 1.30–2.58; P?=?0.0005). The meta-analyses of other postoperative complications did not show significant differences between TAFT+ and TAFT- group, with a RR of 1.65 (95% CI 0.93–2.93; P?=?0.09) for anastomotic leakage, 0.91 (95% CI 0.34–2.44; P?=?0.85) for sepsis, 1.89 (95% CI 0.22–16.20; P?=?0.56) for tracheomalacia, 0.50 (95% CI 0.13–1.93; P?=?0.31) for gastroesophageal reflux, 1.29 (95% CI 0.28–5.92; P?=?0.74) for wound infection, and 0.97 (95% CI 0.03–36.75; p?=?0.99) for pneumonia.Conclusions
This study demonstrates that the use of TAFT in patients with EA significantly increases the risk of stricture. However, TAFT is not associated with other complications, including anastomotic leakage, sepsis, tracheomalacia, gastroesophageal reflux, wound infection and pneumonia.14.
Eileen M. Duggan Andre P. Marshall Katrina L. Weaver Shawn D. St. Peter Jamie Tice Li Wang Leena Choi Martin L. Blakely 《Pediatric surgery international》2016,32(7):649-655
Purpose
Our objective was to perform a meta-analysis on RCTs that compared outcomes in children with perforated appendicitis (PA) who underwent either early appendectomy (EA) or interval appendectomy (IA). We also sought to determine if the presence of an intra-abdominal abscess (IAA) at admission impacted treatment strategy and outcomes.Methods
We identified two RCTs comparing EA versus IA in children with PA. A meta-analysis was performed using regression models and the overall adverse event rate was analyzed. The treatment effect variation depending on the presence of IAA at admission was also evaluated.Results
EA significantly reduced the odds of an adverse event (OR 0.28, 95 % CI 0.1–0.77) and an unplanned readmission (OR 0.08, 95 % CI 0.01–0.67), as well as the total charges (79 % of the IA, 95 % CI 63–100) for those who did not have an IAA at admission. In children with an IAA, there was no difference between EA and IA. However, heterogeneity of treatment effect was present regarding IAA at presentation.Conclusions
While EA appears to improve outcomes in patients without an abscess, the published data support no significant difference in outcomes between EA and IA in patients with an abscess.15.
Objective
To compare left lateral, right lateral, and prone nursing positions of neonate for reducing pre-feed gastric residuals among ≤34 weeks neonates.Design
Randomized crossover trial.Setting
Level-III NICU.Participants
Neonates ≤34 weeks, receiving 50–150 mL/kg/day feeds through oro-gastric route.Intervention
Neonates were randomized to left lateral, right lateral and prone positions. Intervention position was given for eight hours (4 feeds, 9AM to 5PM) followed by a wash-off period of 16 hours. After 24 hours, each neonate crossed over to next position as per randomization card to complete three positions in three consecutive days. Gastric residuals were collected just before next feed.Main outcome
Pre-feed gastric residuals.Results
Sixty three neonates were randomized. Fewer neonates in right lateral position had gastric residuals compared to left lateral position [OR 0.09 (95% CI 0.04, 0.21), P<0.001]. Neonates in right lateral and prone positions had comparable gastric residuals [OR 0.90 (95% CI 0.36, 2.22), P=0.82]. Gastric residuals, as a proportion of last feed, were highest in left lateral [6% (2, 10), maximum 28%] position. Significantly higher proportion of neonates in right lateral position had episodes of regurgitation compared to other positions. Oxygen saturation, heart rate, time to full feeds and duration of hospital stay were comparable in the three groups.Conclusions
Left lateral position was associated with higher but clinically non-significant pre-feed gastric residuals as compared to right lateral position. Right lateral position was associated with significantly increased regurgitation episodes.16.
Ritchie Sharon Solomon Tanuja Sasi Abish Sudhakar Raman Krishna Kumar Balu Vaidyanathan 《Indian pediatrics》2018,55(5):400-404
Objective
To assess neurodevelopmental status in Indian infants undergoing corrective surgery for congenital heart disease (CHD) and to analyze factors associated with neurodevelopmental delay.Design
Cross-sectional study.Setting
Tertiary-care pediatric cardiology facility.Participants
Consecutive infants undergoing corrective surgery for CHD (January 2013–December 2014). Palliative procedures, and patients with known genetic syndromes were excluded.Main outcome measures
Neurodevelopmental evaluation 3 months, and one year after surgery using Developmental Assessment Scales for Indian Infants (DASII); scores were categorized as delayed if ≤70.Results
Of the 162 children enrolled, delayed PDI and MDI scores were observed in 33.5% and 19.6% of patients at 3 months, respectively; this reduced to 14.5 % on 1-year follow-up. On multivariate analysis, delayed PDI outcome at one year was predicted by early term birth and one-year postoperative head circumference Z-score <–2. Delayed MDI was associated with higher mean perfusion pressure on cardiopulmonary bypass. Cardiac diagnosis and peri-operative factors did not impact neurodevelopmental outcomes.Conclusions
Neurodevelopmental status is delayed in 14.5% of infants one year after corrective infant heart surgery.17.
Priya Tomar Amit Garg Rashee Gupta Abhishek Singh Navratan Kumar Gupta Amit Upadhyay 《Indian pediatrics》2017,54(3):199-203
Objective
To evaluate efficacy of two blood cultures taken simultaneously from two different sites as compared to standard practice of single blood culture in diagnosis of neonatal sepsis.Study Design
Prospective cohort study.Setting
A tertiary-care center at a public hospital.Participants
475 neonates admitted to intensive care unit with suspected sepsis, from August 2014-July 2015.Intervention
Two blood cultures drawn from two different peripheral veins in patients with suspected neonatal sepsis.Main outcome measures
Increase in culture-positivity rate with use of two blood cultures.Results
475 babies with suspected sepsis were enrolled. 185 patients had only first culture positive (38.9%). When we added second culture positivity, yield increased to 221 (46.5%). Adding on second culture increased the culture yield by 36 (7.6%; 95% CI 2.41 to 12.79; P=0.018). The most common organisms isolated were E. coli, S. aureus and Candida spp. Major morbidities and mortality were more common in blood culture positive patients Contamination was ruled out in 25 babies who grew Coagulase negative Staphylococcus (CONS) (n=10) and Candida spp. (n=15) in either of the two cultures.Conclusion
Two blood cultures taken simultaneously from two different sites improve rate of pathogen detection as compared to routine practice of single blood culture.18.
Context
Fever is the most common complaint in the pediatric and emergency departments. Caregivers prefer to detect fever in their children by tactile assessment.Objective
To summarize the evidence on the accuracy of caregivers’ tactile assessment for detecting fever in children.Evidence-acquisition
We performed a literature search of Cochrane Library, PubMed, Web of Knowledge, EMBASE (ovid), EBSCO and Google Scholar, without restriction of publication date, to identify English articles assessing caregivers’ ability of detecting fever in children by tactile assessment. Quality assessment was based on the 2011 Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) criteria. Pooled estimates of sensitivity and specificity were calculated with use of bivariate model and summary receiver operation characteristics plots for meta-analysis.Results
11 articles were included in our analysis. The summary estimates for tactile assessment as a diagnostic tool revealed a sensitivity of 87.5% (95% CI 79.3% to 92.8%) and specificity of 54.6% (95% CI 38.5% to 69.9%). The pooled positive likelihood ratio was 1.93 (95% CI 1.39 to 2.67) and negative likelihood ratio was 0.23 (95% CI 0.15 to 0.36). Area under curve was 0.82 (95% CI 0.7 to 0.85). The pooled diagnostic odds ratio was 8.46 (95% CI 4.54 to 15.76).Conclusion
Tactile assessment of fever in children by palpation has moderate diagnostic value. Caregivers’ assessment as “no fever” by touch is quite accurate in ruling out fever, while assessment as “fever” can be considered but needs confirmation19.
Parth?Bhatt Anusha?Lekshminarayanan Keyur?Donda Fredrick?Dapaah-Siakwan Badal?Thakkar Sumesh?Parat Shilpi?Chabra Zeenia?Billimoria
Purpose
Gastroschisis is a severe congenital anomaly associated with a significant morbidity and mortality. There are limited temporal trend data on incidence, mortality, length of stay, and hospital cost of gastroschisis. Our aim was to study these temporal trends using the National Inpatient Sample (NIS).Methods
We identified all neonatal admissions with a diagnosis of gastroschisis within the NIS from 2010 through 2014. We limited admission age to ≤?28 days and excluded all those transferred to other hospitals. We estimated gastroschisis incidence, mortality, length of hospital stay, and cost of hospitalization. For continuous variables, trends were analyzed using survey regression. Cochrane–Armitage trend test was used to analyze trends for categorical variables. P?<?0.05 was considered as significant.Results
The incidence of gastroschisis increased from 4.5 to 4.9/10,000 live births from 2010 through 2014 (P?=?0.01). Overall mortality was 3.5%, median length of stay was 35 days (95% CI 26–55 days), and median cost of hospitalization was $75,859 (95% CI $50,231–$122,000). After adjusting for covariates, there was no statistically significant change in mortality (OR?=?1.13; 95% CI 0.87–1.48), LOS (β?=???2.1?±?3.5; 95% CI ??9.0 to 4.8) and hospital cost (β?=???2.137?±?10.813; 95% CI ??23,331 to 19,056) with each calendar year increase on multivariate logistic regression analysis.Conclusion
The incidence of neonates with gastroschisis increased between 2010 and 2014. Incidence was highest in the West. No difference in mortality and resource utilization was observed.20.