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ABSTRACT Aims Design Methods Results Conclusions Implications for the Profession and/or Patient Care Impact Reporting Method Patient or Public Contribution To explore the impact of medical complexity, defined by the number of chronic conditions, on the complexity of care, as described by the frequency of nursing diagnoses (NDs) and nursing actions (NAs), in paediatric patients.Retrospective observational study.This study was conducted in an Italian university hospital and involved the analysis of electronic health records for neonatal and paediatric patients who were consecutively admitted from January to December 2022. The sample was classified into three categories—non‐chronic, single chronic and multimorbid patients—according to their clinical profiles. NDs recorded within the first 24 h from patient hospital admission and NAs performed throughout the hospital stay were counted for each group.Distinct variations in the prevalence and patterns of NDs and NAs were observed across different levels of medical complexity. A significant moderate positive correlation between the number of NDs and NAs was found. However, the frequency of NDs did not directly correlate with the number of chronic conditions. Conversely, a weak but significant negative correlation was identified between the quantity of NAs and the number of chronic conditions. While the frequency of NDs showed a stable but decreasing trend as the number of chronic conditions increased, a higher number of chronic conditions were associated with a lower quantity of NAs.We discovered a notable variation in the complexity of care across varying levels of medical complexity in paediatric patients. Our findings suggest that the complexity of care does not necessarily correspond to the degree of medical complexity. The observed negative relationship between the number of chronic conditions and the quantity of NAs underscores the need for further research to explore this unexpected finding and its implications for clinical practice.Without the adoption of standardised nursing terminologies, such as nursing diagnoses (NDs) and nursing actions (NAs), assessing the complexity of care in paediatric settings can be challenging. Integrating clinical nursing information systems that incorporate standardised NDs and NAs into electronic health records is crucial for accurately documenting and analysing the complexity of care and its relationship with medical complexity. In paediatric patients, the frequency of nursing diagnoses (NDs) at hospital admission is significantly associated with the quantity of nursing actions (NAs) delivered during hospitalisation. However, there is no correlation between the frequency of NDs and medical complexity, as defined by the number of chronic disorders. Specifically, the frequency of NDs decreases with increasing medical complexity, while the quantity of NAs is negatively associated with the number of chronic disorders. This indicates that the complexity of care cannot be inferred solely from medical complexity, and additional factors need to be explored. These findings enhance understanding of how complexity of care relates to medical complexity in paediatric patients. Insights into the prevalence and patterns of NDs and NAs can benefit nurses, managers, researchers and policymakers by informing clinical and organisational decision‐making to ensure high‐quality care. The study adhered to the RECORD Statement.Patients, service users, caregivers or public members were not directly involved in the design, conduct, analysis and interpretation of data or in writing this paper. Patients contributed only to data collection. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study is to develop a clinical decision‐making tool to guide utilisation of vein visualisation technologies and enhance chances of successful peripheral intravenous catheter (PIVC) insertion, using data collected from a vascular access team in a large paediatric medical centre in the United States. Design: Quantitative two‐phase, cluster analysis design. Methods: The study consisted of the following two phases: (1) a quantitative retrospective chart review to evaluate clinician utilisation and preference for vein visualisation technologies and (2) a quantitative prospective design, including a post‐discharge retrospective chart review, to confirm utilisation of vein visualisation technologies and factors influencing clinician decision‐making. Results: A total of 16 groups were created based on the cluster analysis and expert clinician input. The results of first‐attempt success analyses identified optimal device recommendations for each of the 16 patient groups. For patients older than 2 years old, the NIR device was more likely to result in first‐attempt success regardless of BMI or access site and the NIR device was most optimal for almost all categories of paediatric patients regardless of BMI or access site. The transilluminator was found to be the most optimal device to use with younger patients (< 2 years old) who are underweight. Conclusion: Vein visualisation technology is recommended by professional nursing organisations to improve PIV access. Yet, adoption of this useful technology to aid selection of an optimal vein for insertion and visualisation during insertion is limited. This is the first study to develop a clinical decision‐making tool for vein visualisation technology in PIVC insertion. Implications for the Profession and Patient Care: Vein visualisation technology allows for a rapid, thorough assessment of patients' vasculature to determine an optimal site for PIVC placement beyond what is visible to the naked eye or achievable using traditional methods. The tool was designed to guide healthcare professionals towards successful first attempt PIVC insertions, thereby improving patient outcomes and efficiency of care. Patient or Public Contribution: None. [ABSTRACT FROM AUTHOR]

Background. Due to the rarity of the combination of emergence diabetes mellitus type 1 (DM1), COVID-19, and multisystem inflammatory syndrome, each reported case represents valuable experience and increases the awareness of medical professionals. Clinical case description. A 7-year-old boy was admitted to the intensive care unit with a diagnosis of diabetes mellitus type 1, first identified. On day 2, ketoacidotic coma with a hyperosmolar component developed, a positive polymerase chain reaction (PCR) test for SARS-CoV-2 was obtained, and a picture of subarachnoid hemorrhage was described according to CT scans of the brain. On day 3, macrohematuria, peripheral edema, pasty complexion were noted; the clinical picture and laboratory examination data corresponded to a “cytokine storm” with the development of multiple organ failure. On day 5, tonic-clonic seizures and bloody discharge from the nasopharynx were noted. On day 6, a negative PCR test for SARS-CoV-2 was obtained, on chest X-rays there was a heterogeneous decrease in pneumatization in the basal sections on both sides, and bilateral hydrothorax. On day 9, meningeal symptoms were noted. On day 14, a repeated episode of a convulsive attack was registered, and changes in the brain according to MRI results were regarded as an inflammatory demyelinating lesion against the background of the course of multisystem inflammatory syndrome and DM or as posterior reversible encephalopathy (PRES syndrome). Against the background of the appointment of immunomodulatory, anticoagulant, antibacterial, antiviral therapy, positive dynamics was noted in the child's condition. On day 18, the patient in a stable condition of moderate severity was transferred to the Department of Pediatric Endocrinology for further treatment. After 14 days, the child was discharged from the hospital in a satisfactory condition. Conclusion. This case report may confirm the risk of developing multisystem inflammatory syndrome in children with DM1 and COVID-19, which requires an interdisciplinary approach and the appointment of therapy included in the standards of management of children with multisystem inflammatory syndrome.

ABSTRACT: Objectives: Ceftolozane-tazobactam (C/T) is a combination of a cephalosporin and a β-lactamase inhibitor with activity against Gram-negative bacilli (GNB). The study aims were to evaluate the activity of C/T in vitro vs. comparators against clinical GNB isolated from Chinese paediatric patients. Methods: From 2017–2021, 660 GNB isolates were collected from 20 hospitals across China. The minimum inhibitory concentrations were tested using a Trek Diagnostic System (Thermo Fisher Scientific). Susceptibility was determined by CLSI broth microdilution and the results were interpreted according to CLSI M100 (2021) breakpoints. Results: GNB isolates were obtained from paediatric patients < 18 years old, mainly from the bloodstream (n = 146), intraperitoneal cavity (n = 138), lower respiratory (n = 278) and urinary tract (n = 96). Overall, C/T was active against 76.6% of 436 Enterobacterales, with a descending susceptibility rate of 100.0% to S. marcescens, 92.2% to E. coli, 83.3% to K. oxytoca, 66.7% to K. aerogenes, 66.7% to P. mirabilis, 58.6% to K. pneumoniae and 57.1% to E. cloacae. The susceptibility of P. aeruginosa to C/T was 89.4%, which was the highest among the β-lactam antibiotics and was second only to amikacin (92.9%). Isolates of respiratory tract infection (RTI) derived P. aeruginosa were highly susceptible (93.8%) to C/T, while

Dysphonia is a frequent symptom in paediatric patients and it has a prevalence between 6 - 24%. In young patients, dysphonia has a direct importance because it impairs their communicative behaviour, their psychological status and also their social life. The most diagnosed voice pathologies in children are vocal nodules followed by vocal cord cysts, infectious and inflammatory causes, sulcus vocalis, laryngeal membranes, iatrogenic vocal cord paralysis, neurological causes, psychogenic factors, traumatic or irritative factors or, less commonly, laryngeal neoplasms. A correct diagnosis of dysphonia in paediatric patients is important for learning, voice training and their psychological development. Children with dysphonia have to be assessed with adequate equipment. It is recommended to use tools that are appropriate to the tolerance and cooperation of the patients and allow to have a good visualization of the vocal folds. Suitable preventive methods, early diagnosis, appropriate treatment of voice disorders should be taken into consideration in these cases. In this article, some of the most frequent causes of dysphonia in paediatric patients and their treatment options in order to achieve a proper voice are reviewed. [ABSTRACT FROM AUTHOR]

In recent decades, the prevalence of demyelinating diseases in paediatric patients has increased rapidly. In this context, there is an increasing need for the study of this pathology in children to enable timely diagnosis and early prescription of highly effective pathogenetic treatment. Neuromyelitis optica spectrum disorders (NMOSD) are a group of severe demyelinating disorders that are united by a single pathogenetic mechanism and primarily affection of the optic nerves and spinal cord. The review presents the main clinical and epidemiological features of NMOSD in the paediatric population. The issues of pathogenesis, which is based on the formation of antibodies against aquaporin-4, and possible therapeutic targets are discussed in detail. The diagnostic criteria and the underlying clinical manifestations as well as their characteristics in childhood are analysed. We present a differential diagnostic framework of the most common diseases, which have to be distinguished from NMOSD in children. Particular attention is paid to the pathogenetic treatment of exacerbations and targeted therapy to prevent exacerbations, which has relatively recently proven its efficacy and been approved for use in paediatric patients.

Viral infections caused by exposure to viruses such as Epstein–Barr, cytomegalovirus, or Parvovirus B19 have always been considered predisposing environmental factors for the onset of autoimmune diseases. More recently, autoimmune mechanisms such as molecular mimicry, T-cell activation, transient immunosuppression and inflammation have also been observed in cases of SARS-CoV-2 infection. Several newly diagnosed autoimmune disorders have been reported post-COVID-19, such as COVID-19-associated multisystemic inflammatory syndrome in children (MIS-C), type 1 diabetes mellitus, systemic lupus erythematosus, or rheumatoid arthritis. In this article, we present a new case of paediatric systemic lupus erythematosus (SLE) with haematological (macrophage activation syndrome), renal (stage 2), cutaneous (urticarial vasculitis) and digestive involvement, onset three and a half months post-COVID-19. In the dynamics, de novo infection generated by Epstein–Barr exposure was associated. The diagnosis was confirmed based on EULAR/ACR 2019 criteria. The aim of the article is to present a possible correlation between SARS-CoV-2 and Epstein–Barr as extrinsic factors in triggering or activating paediatric systemic lupus erythematosus. Keywords: paediatric systemic lupus erythematosus; post-COVID-19; Epstein–Barr; SARS- CoV-2; case report; paediatric patient.

Abstract Background Concurrent infections or co-infections caused by intestinal parasites and Helicobacter pylori are quite rampant in paediatrics living in endemic areas of sub-Saharan Africa, including Ethiopia, and if left untreated, can result in severe complications and hence must be addressed to ensure their health and well-being. Objectives To determine the prevalence of intestinal parasitic and H. pylori co-infections and associated factors among paediatric patients with gastrointestinal symptoms who attended the Arba Minch General Hospital (AMGH), Arba Minch, southern Ethiopia, from September to November 2020. Methods A cross-sectional study was conducted among a study population of 299 paediatric patients with gastrointestinal symptoms who visited AMGH. Stool samples were collected and analysed to detect H. pylori and intestinal parasites. A rapid lateral flow chromatographic immunoassay was employed to identify the H. pylori copra antigen, whereas the latter was detected using wet mount saline preparation and formol-ether concentration method. Socio-demographic, clinical, behavioural and other factors were obtained by means of a pre-tested structured questionnaire. Descriptive statistics and logistic regression analysis were done by Statistical Package for Social Service (SPSS) version 25; P values

Background: The Paediatric Cardiology unit of the University of Port Harcourt Teaching Hospital (UPTH) was set up in March 2005 and a consultant paediatrician interested in Cardiology was mandated by the Paediatric Department to attend to the increasing number of patients with cardiac diseases. Objective: To report our experience in the clinical diagnosis of heart diseases without modern diagnostic tools, in the first two years of a new Paediatric Cardiology unit. Methods: This was a prospective study carried out between March 2005 and February 2007 using detailed history, physical examination and a Flow Table. Results: Forty-nine children (29 males, 20 females), M: F= 1.5:1, with age range of eight days to 13 (mean 3.50+4.52) years, were seen. Ventricular septal defect was the commonest cardiac defect in 36.7 percent followed by Tetralogy of Fallot in 20.4 percent. The diagnosis was 68 percent accurate when compared with echocardiography (ECHO) diagnosis in 19 patients. Six patients had surgery, 12 were lost to follow-up, and seven (14 percent) have died. The remaining 24 are either receiving medications and/or are awaiting surgery. Conclusion: History and clinical examnination remain the mainstay of cardiac diagnosis in the absence of specialized tools such as an echocardiogram. Training of Fellows in Paediatric Cardiology and equipping of Federal and State government hospitals are of utmost necessity.

Purpose: The study aimed to evaluate effect of parental absence or presence on anxiety level of children in dental clinic.. Materials and Methods: 130 children who 6-9 years old were randomly divided into two groups as absence of parents (PA) (n=65) and presence of parents (PP) (n=65). Children in both groups were examined by the pediatric dentist as only clinical and radiographical without any dental treatment on first visit. The primary molars of children in both groups were restored with compomer resin with using the rubber dam on second visit. Before and after the dental procedures The Abeer Children Dental Anxiety Scale (ACDAS) was applied to all participants in both groups. All data were analysed with two sample t test and p value set at <0.05 for significance level. Results: The mean age of participants was 6.9±1,18 years. The ACDAS score of PP on first visit was significantly lower than ACDAS score of PP on second visit (p<0.001). When comparing the mean ACDAS score of PA group, score of second visit with 26.23±1.82 significantly lower than first visit with 28.52±1.96 (p<0.001). There were no significant differences between mean ACDAS score of females and males in both groups and visits (p>0.05). Conclusions: According to results of current study, parental absence is efficient method for developing to behaviours of children during the dental procedures such as composite restorations under local anaesthesia in children who 6-9 years old. [ABSTRACT FROM AUTHOR]

Coenzyme Q10 (CoQ) is a ubiquitous lipid with different biological functions. In blood, there is a close relationship between CoQ status and cholesterol, which strongly supports the study of both molecules simultaneously. The objective of this study was to evaluate plasma CoQ, lipoprotein concentrations and CoQ/Chol ratio in a cohort of paediatric patients with different types of dyslipidaemias. A total of 60 paediatric patients were recruited (age range: 7 months–18 years), including 52 with different types of hypercholesterolemia, 2 with isolated hypertriglyceridemia and 6 with hypobetalipoproteinemia. Plasma CoQ was analysed by HPLC with electrochemical detection, and lipoprotein and cholesterol concentrations by standard automated methods. The lowest CoQ values were detected in patients with hypobetalipoproteinemia and in two cases of liver cirrhosis. Mean CoQ values were significantly higher in hypercholesterolemic patients compared to controls (average values 1.07 µmol/L and 0.63 µmol/L) while the CoQ/cholesterol ratio did not show differences (170 vs. 163, respectively). Mean CoQ values were significantly lower in the group of patients with hypobetalipoproteinemia compared to controls (mean CoQ values of 0.22 µmol/L vs. 0.63 µmol/L, respectively), while those of CoQ/cholesterol did not show differences. Pearson's correlation test showed a positive correlation between the CoQ and cholesterol values (r = 0.565, p < 0.001) and between the CoQ and the LDL cholesterol values (r = 0.610, p < 0.001). Our results suggest that it is advisable to analyse plasma CoQ and cholesterol concentrations in patients with hypobetalipoproteinemia and hypercholesterolemia associated with liver damage. [ABSTRACT FROM AUTHOR]

Background: Invasive pulmonary aspergillosis (IPA) is a serious condition with high morbidity and mortality in paediatric patients with cancer, haematological diseases or immunodeficiencies with or without allogeneic haematopoietic stem cell transplantation (HSCT). The role of surgical intervention for the management of IPA has scarcely been investigated. Objectives: The aim of this study was to present a single center experience of management of IPA in paediatric patients of an oncological ward, to determine the short and long‐term outcomes after thoracic surgical interventions, and to outline the indications of surgical interventions in selected patients. Patients/Methods: We conducted a retrospective study of 44 paediatric patients with proven and probable IPA treated in our institution between January 2003 and December 2021. The primary endpoint was the overall survival after surgical interventions. Secondary endpoints included post‐operative morbidity and mortality. Results: The median age at diagnosis of IPA in our cohort was 11.79 years (range 0.11–19.6). The underlying conditions were malignancies in 34 (77%) patients and haematological or immunological disorders with allogeneic HSCT in 9 (23%) patients. We performed thoracic surgical interventions in 10 (22.7%) patients. Most patients received a video assisted thoracic surgery. Only one patient died within 90 days after surgery with a median follow‐up time of 50 months. No other major post‐operative complications occurred. The calculated 5‐year survival rate from IPA for patients after surgical intervention with curative intention was 57% and 56% for patients without (p =.8216). Conclusions: IPA resulted in relevant morbidity and mortality in our paediatric patient cohort. Thoracic surgical interventions are feasible and may be associated with prolonged survival as a part of multidisciplinary approach in selected paediatric patients with IPA. Larger scale studies are necessary to investigate the variables associated with the necessity of surgery. [ABSTRACT FROM AUTHOR]

Aim: To determine the incidence of pressure injuries from medical devices in children. Background: Medical devices can cause pressure injuries on skin and soft tissues. Design: A prospective, descriptive study adhering to STROBE guidelines. Methods: This study was conducted in the third‐level Paediatric Intensive Care Unit of Ege University Hospital in İzmir, Türkiye between April 2019 and October 2019 in Türkiye. Patients aged between 1 month and 18 years with medical devices were observed for pressure injuries using Braden scales and a specific monitoring form. Results: In this study, we followed 522 medical devices applied to 96 patients. The three most commonly used medical devices were the ECG probe (21%), the blood pressure cuff (16%) and the saturation probe. Out of the 522 medical devices followed, 36 caused pressure injuries (6.8%). Conclusion: The incidence of medical device‐related pressure injuries was found to be high. Effective training and implementation strategies need to be devised for paediatric nurses to prevent pressure injuries associated with medical devices. Relevance to Clinical Practice: The results of this study reveal that pressure injuries related to medical devices are an important health problem in paediatric hospitals. Therefore, awareness‐raising and educational activities among health professionals and nurses should be accelerated. Patient or Public Contribution: No patient or public contribution in the study. [ABSTRACT FROM AUTHOR]

Introduction: Burn injuries among children have emerged as a significant global public health concern, accounting for substantial morbidity and mortality worldwide. Low and Middle-Income Countries bear a significant burden of paediatric burn injuries. In Ghana, limited data exists on the prevalence, characteristics and outcomes of paediatric burns. This study provides vital data on the local burden and epidemiology of paediatric burns at Ghana’s main burns treatment center. The findings have significant value in informing prevention strategies, allocating resources, and improving quality of paediatric burn care. Study objective: To establish the prevalence and characteristics of paediatric burns injuries in Ghana’s leading burn center. Methodology: A retrospective cohort study analyzed data from 662 adult and paediatric patients who presented with burns from all over Ghana between 2020 and 2022. The study encompassed medical records of paediatric burn cases (aged 0–14 years) admitted to the center from January 2020 to December 2022. A purposive sampling technique was used to select cases based on the inclusion criteria and elimination of cases with 20 % missing data. A total of 335 paediatric records were reviewed. Data analytical methods: Descriptive statistics, such as frequencies, mean, percentages were used to establish period prevalence and demographic characteristics of paediatric burns. Chi-square analysis and univariate logistic regression was utilized to explore associations between categorical variables, and predictors of burn outcome. Results: The period prevalence of paediatric burns was found to be 50.6 %. Paediatric burn cases predominantly affected males (57.6 %). Majority of cases fell within the age range of 1 to 5 years (70.1 %). Hot water emerged as the leading cause (58.4 %), whiles superficial partial thickness burns (51.9 %) was the predominant type of burn. Most cases involved burns affecting less than 20 % Total Body Surface Area (59.0 %). Multi-part body injuries were common (87.2 %), with the lower limb being the most affected (25.36 %). The mortality rate was calculated to be 21.0 %. Higher TBSA was a significant predictor of mortality (p

ABSTRACT Aim The aim of this study is to develop a clinical decision‐making tool to guide utilisation of vein visualisation technologies and enhance chances of successful peripheral intravenous catheter (PIVC) insertion, using data collected from a vascular access team in a large paediatric medical centre in the United States. Design Quantitative two‐phase, cluster analysis design. Methods The study consisted of the following two phases: (1) a quantitative retrospective chart review to evaluate clinician utilisation and preference for vein visualisation technologies and (2) a quantitative prospective design, including a post‐discharge retrospective chart review, to confirm utilisation of vein visualisation technologies and factors influencing clinician decision‐making. Results A total of 16 groups were created based on the cluster analysis and expert clinician input. The results of first‐attempt success analyses identified optimal device recommendations for each of the 16 patient groups. For patients older than 2 years old, the NIR device was more likely to result in first‐attempt success regardless of BMI or access site and the NIR device was most optimal for almost all categories of paediatric patients regardless of BMI or access site. The transilluminator was found to be the most optimal device to use with younger patients (

IntroductionIt is widely acknowledged that good hand hygiene (HH) is an important non-pharmaceutical method for reducing the transmission of infectious diseases. Children are at high risk of infection due to their immature immune systems. Hospital transmitted infections are a cause for concern worldwide, with poor HH suggested to be responsible for up to 20% of cases. Patients, in particular paediatric patients, are often overlooked when it comes to the promotion of hand hygiene compliance (HHC) in hospitals. This report describes the clinical evaluation of the ‘Soaper Stars’; a collection of child-friendly HH products with linked educational resource, developed using the COM-B approach to behaviour change, and designed to encourage correct HH in paediatric patients and in schools.MethodThe Soaper Star products were distributed on paediatric wards in five UK hospitals, and the use of the products around mealtimes was evaluated. Workshops teaching the ‘why when and how’ of handwashing were run in four UK primary schools with pre and post evaluations conducted to establish impact on knowledge. Over 300 children were involved.ResultsThe Soaper Stars products stimulated a 38% increase in HHC compared to when only hospital-issued products were available, and verbal feedback from families indicated that having the Soaper Star products encouraged improved HHC by all visitors, not just the patient. Workshops in four schools (283 pupils) showed an increase in knowledge around the transmission of infection and the need for good HH that was sustained for at least 4 weeks.ConclusionThe results of this study demonstrate that providing children with the age-appropriate knowledge about why HH is necessary, and the child-friendly means to maintain their HH, will lead to greater HHC, not just by individual children, but also their families.

Fang et al. report a retrospective analysis of paediatric patients with haemophagocytic lymphohistiocytosis (HLH) associated with autoimmune/autoinflammatory disorders treated with ruxolitinib. Responses were impressive and rapid, and ruxolitinib was well tolerated. This study demonstrates that a subset of patients with HLH can be treated with JAK inhibition without the need for cytotoxic chemotherapy. Further work will be needed to better define patient selection for therapy, as some patient groups and HLH triggers, such as malignancy‐associated HLH, may be better suited for etoposide‐based therapy.Commentary on: Fang et al. Ruxolitinib‐based regimen in children with autoimmune disease or autoinflammatory disease related hemophagocytic lymphohistiocytosis. Br J Haematol 2024 (Online ahead of print). doi: 10.1111/bjh.19803. [ABSTRACT FROM AUTHOR]

Nutritional support measures for paediatric patients who have undergone organ, bone marrow, or hematopoietic stem cell transplantation need to be implemented to prevent infection during immunosuppressive therapy and to speed up recovery after the procedure. Children undergoing immunosuppressive therapy are at high risk of infection. Typical examples of foods with a high risk of infection are raw and uncooked foods. Special care should be taken to maintain an adequate nutritional status and provide all the nutrients and energy necessary for the child‘s growth and development, which will also improve recovery. It is essential to educate healthcare workers, kitchen staff and parents on proper hygiene, safe handling of high-risk foods and appropriate food preparation based on existing microbiological food safety guidelines.

Objective We aimed to investigate the clinical findings of hospitalized paediatric COVID-19 patients by the end of 2022.Method All confirmed children with COVID-19 infection admitted into Chaozhou Central Hospital during the COVID-19 outbreak from 19 December 2022 to 1 February 2023 were included. Detailed clinical data of those children were evaluated retrospectively.Results A total of 286 children, ranging in age from 1 month to 13 years old, were diagnosed with SARS-CoV-2 infection. Among these cases, 138 (48.3%) were categorized as mild, 126 (44.0%) as moderate and 22 (7.7%) as severe/critical. Symptoms varied among the children and included fever, upper respiratory tract symptoms, convulsions, sore throat, poor appetite, dyspnoea and gastrointestinal symptoms. Notably, febrile convulsions were observed in 96 (33.6%) patients, while acute laryngitis was documented in 50 (17.5%) cases. Among the severe/critical patients, eight developed multisystem inflammatory syndrome in children (MIS-C), and tragically, one patient’s condition worsened and resulted in death. Furthermore, MRI scans revealed abnormal brain signals in six severe/critical patients. The severe/critical group also exhibited more pronounced laboratory abnormalities, including decreased haemoglobin and elevated ALT, AST, LDH and CK levels.Conclusions Febrile convulsions and acute laryngitis are frequently observed in children diagnosed with SARS-CoV-2 Omicron infection. Moreover, MIS-C and abnormal neuroimaging appear to be relatively common phenomena in severe/critical cases.

Objective Adamantinomatous craniopharyngioma mainly affects children. Excessive weight gain is a major long-term complication. The primary objective of this study was to assess long-term weight changes in children treated for craniopharyngioma. The secondary objectives were to identify risk factors for excessive weight gain and to look for associations with hypothalamic damage by the tumour or treatment. Design Single-centre retrospective cohort study. Method Children managed for craniopharyngioma at our centre between 1990 and 2019 were included. The body mass index (BMI) standard deviation scores (SDS) at baseline and at last follow-up were compared. Univariate and multivariate analyses were performed in order to identify variables associated with the long-term BMI-SDS variation. Results The 108 patients had a mean follow-up of 10.4 years. The mean BMI-SDS increase over time was 2.11 (P <.001) overall, 1.21 (P <.001) in the group without hypothalamic involvement by the tumour, and 1.95 (P <.001) in the group managed using intended hypothalamus-sparing surgery. The absence of hypothalamic involvement by the tumour or treatment was significantly associated with less weight gain (P =.046 and P <.01, respectively). After adjustment, factors associated with a BMI-SDS change greater than 2 were female sex (P =.023), tumour involving the hypothalamus (P =.04), and higher baseline BMI (P <.001). Conclusion Clinically significant weight gain occurred in nearly all children treated for craniopharyngioma, including those whose hypothalamus was spared by the tumour and intentionally by treatment. However, hypothalamus integrity was associated with less weight gain. Despite hypothalamus-sparing strategies, hypothalamic obesity remains a major concern, indicating a need for novel treatment approaches. [ABSTRACT FROM AUTHOR]

Introduction: Measles is a highly contagious viral disease. In recent years, there has been an alarming increase in measles cases in Europe. Most patients were not vaccinated. The aim of this study was to analyse the clinical manifestation of measles in paediatric patients, considering the differences between infants and older children. Material and methods: This was a retrospective observational study, for which data were collected from the medical records of paediatric patients hospitalised due to measles January 2017 - December 2019. Stratification was based on age. In the younger group (infants), children under 13 months of age were included. Results: In total 84 children were enrolled in the study, including 26 infants (30.95%) and 58 older children (69.5%). In 67/84 (79.76%) participants no history of measles vaccination was reported. Among those not vaccinated, there were 28/67 (41.79%) children too young for vaccination. Fever and erythema occurred in all patients. The disease was complicated by pneumonia in 39/84 (46.43%) and acute otitis media in 19/84 (22.62%) children. Antibiotics were administered in 45/84 (69.05%) cases, of which 10/58 (17.24%) had 2 or more. The infants had significantly less frequent photophobia (p = 0.041693), lymphadenopathy (p = 0.005229), hepatomegaly (p = 0.030619), and splenomegaly (p = 0.019469), Instead, they were significantly more likely to have acute otitis media (p = 0.020141). Conclusions: Measles is a serious disease that most commonly affects unvaccinated children. The most common symptoms include fever and rash. Otitis media and pneumonia were the most common measles complications. The variations in symptoms and complications of measles differ significantly between infants and older children. [ABSTRACT FROM AUTHOR]

Aim of the study The aim of the study is to showcase the importance of the CT an MRI examination in the correct diagnosis of nasopharyngeal tumors in paediatric patients. Although nasopharyngeal cancer is rarely suspected in paediatric patients, representing only 1% of all malign tumors for this group age, its early detection is crucial for the prognosis of the patient. Material and methods We present a study lot of 83 patients assessed retrospectively that were diagnosed with nasopharyngeal lesions (benign adenoidian hypertrophy, juvenile angiofibroma, nasopharyngeal cancer and inverted papilloma) evaluated between April 2021- April 2022 in the Emergency Clinical Hospital “Prof. Dr. N. Oblu” Iasi, Romania. Although the majority of the diagnoses were incidentals during brain scan or MRI, we aim to showcase the principals of a CT and MRI neck examination in order to assess it correctly. Results and conclusions The CT and MRI imaging shown to be unmistakably an asset in diagnosis of nasopharyngeal lesions and also an ally in facilitating patient-based care.

Use of medicinal products in paediatric patients is identified as a risk factor for the occurrence of medication errors. To describe and identify root causes of medication errors in children and adolescents spontaneously reported to Agency for Medicinal Products and Medical Devices of Croatia (Agency). Agency's adverse drug reaction database was searched by using the Standardised MedDRA Query: medication errors (Broad) with data lock point set at 30th June 2022. Cases in which medication errors occurred in patients up to 18 years of age were analysed according to the patients' age group and gender, reporter's qualification, seriousness, reported preferred terms and active substances. For the first 30 most frequently reported active substances, an in-depth analysis was performed to identify the root cause of medication errors. Altogether, 6254 reports were spontaneously reported to the Agency, out of which 1947 (31 %) contained at least one preferred term belonging to Standardised MedDRA Query medication errors. More than half of patients experiencing medication errors belonged to the age group 2–11 years (66 %) and male gender (53 %). The most frequently reported ME PTs included accidental exposure to product by a child (64 %) and accidental overdose (17 %). Medication error root causes for the first 30 most frequently involved active substances included misinterpretation of prescribed dosage due to a very small volume resulting in salbutamol overdose; replacing millilitre and milligram units resulting in paracetamol solution overdose; interchange between medicinal products due to primary package similarities resulting in cholecalciferol overdose and interchange between oral solution and syrup resulting in valproate overdose. Healthcare professionals should counsel caregivers about the importance of keeping medicinal products out of children's reach and provide detailed instructions on how to appropriately use medicinal products. [ABSTRACT FROM AUTHOR]

Background: Advances in treatment could mitigate the expected adverse changes in the body composition of children and adolescents with type 1 diabetes (T1D). Objectives: To examine the evolution of weight status and body composition and their association with glycaemic control and partial clinical remission in youth with T1D. Methods: Ninety‐nine participants with T1D (median age 9.5 years [interquartile range 7.3, 12.9], 59.6% boys) were longitudinally followed for 3 years since diagnosis. Data at seven pre‐determined time points were extracted from medical files. Outcome measures included body mass index (BMI) z‐scores, muscle‐to‐fat ratio (MFR) z‐scores, haemoglobin A1c (HbA1c) levels, continuous glucose monitoring metrics, and insulin dose‐adjusted HbA1c (IDAA1c) levels. Results: The BMI z‐scores increased significantly (p < 0.001) for both sexes, with no significant change in MFR z‐scores over time. The girls had higher BMI z‐scores (p < 0.001) and lower MFR z‐scores than the boys (p = 0.016). The mean HbA1c levels decreased during the first month and at 3 months since diagnosis (p < 0.001), then plateaued and achieved a median overall HbA1c of 7.1% for the entire cohort. At 12 months, 37 participants (37.6%) were in partial clinical remission, as evidenced by IDAA1c ≤ 9. The odds of partial clinical remission at 2 years increased by 2.1‐fold for each standard deviation increase in the MFR z‐score (p < 0.001). Higher MFR z‐scores were associated with better metabolic control. Conclusions: Integration of body composition assessments could mitigate adverse body changes in paediatric patients with T1D. [ABSTRACT FROM AUTHOR]

Background: The recent guidelines suggest the use of genome‐wide analyses, such as whole exome sequencing (WES), at the beginning of the diagnostic approach for cases with suspected genetic conditions. However, in many realities it still provides for the execution of a multi‐step pathway, thus requiring several genetic tests to end the so‐called 'diagnostic odyssey'. Methods: We reported the results of GENE Project (Genomic analysis Evaluation NEtwork): a multicentre prospective cohort study on 125 paediatric outpatients with a suspected genetic disease in which we performed first‐tier trio‐WES, including exome‐based copy number variation analysis, in parallel to a 'traditional approach' of two/three sequential genetic tests. Results: First‐tier trio‐WES detected a conclusive diagnosis in 41.6% of patients, way above what was found with routine genetic testing (25%), with a time‐to‐result of about 50 days. Notably, the study showed that 44% of WES‐reached diagnoses would be missed with the traditional approach. The diagnostic rate (DR) of the two approaches varied in relation to the phenotypic class of referral and to the proportion of cases with a defined diagnostic suspect, proving the major difference for neurodevelopmental disorders. Moreover, trio‐WES analysis detected variants in candidate genes of unknown significance (EPHA4, DTNA, SYNCRIP, NCOR1, TFDP1, SPRED3, EDA2R, PHF12, PPP1R12A, WDR91, CDC42BPG, CSNK1D, EIF3H, TMEM63B, RIPPLY3) in 19.4% of undiagnosed cases. Conclusion: Our findings represent real‐practice evidence of how first‐tier genome‐wide sequencing tests significantly improve the DR for paediatric outpatients with a suspected underlying genetic aetiology, thereby allowing a time‐saving setting of the correct management, follow‐up and family planning. [ABSTRACT FROM AUTHOR]

Aim: Children have largely been unaffected by severe COVID‐19 compared to adults, but data suggest that they may have experienced new conditions after developing the disease. We compared outcomes in children who had experienced COVID‐19 and healthy controls. Methods: A retrospective nested cohort study assessed the incidence rate of new‐onset conditions after COVID‐19 in children aged 0–14 years. Data were retrieved from an Italian paediatric primary care database linked to Veneto Region registries. Exposed children with a positive nasopharyngeal swab were matched 1:1 with unexposed children who had tested negative. Conditional Cox regression was fitted to estimate the adjusted hazard ratios (aHR) and 95% confidence intervals (CI) for the exposure and outcome associations after adjusting for covariates. Results: We compared 1656 exposed and 1656 unexposed children from 1 February 2020 to 30 November 2021. The overall excess risk for new‐onset conditions after COVID‐19 was 78% higher in the exposed than unexposed children. We found significantly higher risks for some new conditions in exposed children, including mental health issues (aHR 1.8, 95% CI 1.1–3.0) and neurological problems (aHR 2.4, 95% CI 1.4–4.1). Conclusion: Exposed children had a 78% higher risk of developing new conditions of interest after COVID‐19 than unexposed children. [ABSTRACT FROM AUTHOR]

This paper provides recommendations for the nutritional management of children with chronic illnesses. Chronic diseases last for a long time and often substantially decrease the quality of life. They can increase the risk of stunting and affect the physical, mental and social life of children and adolescents and the whole family. Multidisciplinary team should treat this group of children in which the clinical dietitian plays an important role. Early identification of paediatric patients at risk, appropriate nutritional care and regular follow-up can have a significant impact on their health and the quality of life. This article presents some of the most common chronic diseases in the paediatric population for which nutritional management is of utmost importance. These include inflammatory bowel disease, food allergies, inborn errors of metabolism, autism spectrum disorders, cystic fibrosis, cancer and cerebral palsy.

Aim of the study To review the characteristics of aesthetic perception in pediatric patients regarding different dental medicine fields. Material and methods A literature search on PubMed and ScienceDirect has been performed using the following key terms:”pediatric”, “aesthetics”, “dental,” and “perception”. The inclusion criteria were represented by: recent studies between 2015 and 2023, published in the English language, studies regarding pediatric aesthetic aspects, and 6 to 18 years the subjects’ age (childhood through adolescence). Studies that did not meet inclusion criteria were excluded from this review. As a result, a number of 51 articles were selected. Results The selected articles (N=51) were grouped into five categories, as follows: the perception of aesthetic aspects regarding dental issues: colour, number, shape, size, and structure in pediatric dentistry (N=17); dentofacial aesthetics (N=7); the impact of dentofacial aesthetics on health-related quality of life in children (N=13); aesthetics of dental prosthetics and restorations in pediatric dentistry (N=5); and aesthetic aspects of orthodontic treatment and malocclusion (N=9). Conclusions Pediatric patients are aware of many aspects of dentofacial aesthetics; behavioral and psychosocial changes were demonstrated among children and adolescents dissatisfied with the shape of the face, the appearance of the smile, facial symmetry, and the aspects of the lips, chin, nose, or cheeks. Further research is still necessary regarding the perception and self-perception of the aesthetic expectations of dental treatments for children of 3-6 years old age group.

Nazir Ahmed,1 Fehmida Umar,2 Fahad Saleem,1 Qaiser Iqbal,1 Sajjad Haider,1 Mohammad Bashaar3 1Faculty of Pharmacy & Health Sciences, University of Balochistan, Quetta, Baluchistan, Pakistan; 2Gynecology & Obstetrics Unit 1, Sandeman Provincial Hospital Quetta, Quetta, Baluchistan, Pakistan; 3Research Services Division, SMART Afghan International Trainings & Consultancy, Kabul, AfghanistanCorrespondence: Mohammad Bashaar, SMART Afghan International Trainings & Consultancy, Kabul, Afghanistan, Tel +93 788233865, Email dr.mbashaar@gmail.comPurpose: Severe acute malnutrition (SAM) is the most prevalent reason for admission to a paediatric unit, and it is a leading cause of mortality in many countries, including Pakistan. This study aimed to assess treatment outcomes and associated factors among children aged 6– 59 months with severe acute malnutrition.Patients and Methods: A retrospective cohort study was conducted at the Outpatient Therapeutic Feeding Program Centre established at the Sheikh Khalifa bin Zayed Al Nahyan Medical Complex Quetta. Out of 225 patients’ records, data from 182 (80.8%) records were analysed based on the inclusion criteria. The SAM logbook was used as a source of data. Predictors of treatment outcomes were identified by applying a regression model with p< 0.05 taken as significant.Results: One hundred and twenty (65.9%) of the children were diagnosed with SAM, while the remaining 34.1% had Moderate Acute Malnutrition. Ninety-five (52.2%) children were included in the marasmus, while 47.8% were included in the Kwashiorkor cohort. The recovery rate was 68.6%; 22.5% were non-responsive, 11% defaulted on the program, and 3.5% died during management. The multivariate logistic regression identified the presence of diarrhea and the use of amoxicillin as significant prognosticators of treatment outcomes. Consequently, the odds of recovery on SAM among children with diarrhea [AOR = 0.60, 95% CI: (0.35– 0.75)] were lower than those without diarrhea. Likewise, children on PO amoxicillin had higher chances of recovery [AOR = 2.45, 95% CI: (2.21– 4.68)].Conclusion: This study found that the recovery rate among children treated for SAM was poor based on the established Sphere Standard recommendation. In addition to community-based educational campaigns, capacity enhancement of OTP and frequent monitoring of services as well as program evaluation based on the management protocol is recommended to reduce the frequency of SAM among children.Keywords: treatment outcomes, severe acute malnutrition, determinants, paediatric patients

Abstract Background The coronavirus disease 2019 outbreak has hit Beijing since mid-Nov, 2022, with soaring growth of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) among children. Therefore, it is vital to determine the clinical manifestations of epidemic SARS-CoV-2 strains in paediatric patients. Methods In this study, nucleic acid tests (NATs) for SARS-CoV-2 were performed in paediatric outpatients with symptoms of acute respiratory tract infection during 18 Nov–6 Dec, 2022. Half of the outpatients positive for SARS-CoV-2 were randomly selected to screen for other respiratory pathogens, whereas those with low cycle threshold values in SARS-CoV-2 NATs were amplified and sequenced to determine the SARS-CoV-2 variants. Finally, children positive for SARS-CoV-2 with clinical information in detail were enrolled in a follow-up study to identify potential factors significantly associated with long recovery. Results Among 9625 paediatric outpatients tested for nucleic acid of SARS-CoV-2, 733 (7.62%, 733/9625) were identified as SARS-CoV-2 NAT positive, with only three (0.82%, 3/366) co-infected with other pathogens among 366 randomly selected patients, and 71 (62.83%) determined as Omicron subvariant BF.7 and 42 (37.22%) as BA.5.2 among 113 successfully sequenced. Among the 681 patients with complete clinical information, fever was the most common symptom (96.8%). In a follow-up study of 592 patients, 46.96% became asymptomatic on the third day and 65.71% on the fifth day. Only 1.7% of infected children experienced febrile seizures. Combined with abnormal C-reactive protein, a higher percentage of antibiotics administration was observed. More co-living members and longer duration of first symptoms served as independent risk factors for long-term recovery, especially in children vaccinated for SARS-CoV-2. Conclusions BF.7 and BA.5.2 were the dominate Omicron subvariants and caused milder infections during the SARS-CoV-2 outbreak in Beijing. The number of co-living members and duration of first symptoms were independent risk factors for long-term recovery.

Coenzyme Q10 (CoQ) is a ubiquitous lipid with different biological functions. In blood, there is a close relationship between CoQ status and cholesterol, which strongly supports the study of both molecules simultaneously. The objective of this study was to evaluate plasma CoQ, lipoprotein concentrations and CoQ/Chol ratio in a cohort of paediatric patients with different types of dyslipidaemias. A total of 60 paediatric patients were recruited (age range: 7 months–18 years), including 52 with different types of hypercholesterolemia, 2 with isolated hypertriglyceridemia and 6 with hypobetalipoproteinemia. Plasma CoQ was analysed by HPLC with electrochemical detection, and lipoprotein and cholesterol concentrations by standard automated methods. The lowest CoQ values were detected in patients with hypobetalipoproteinemia and in two cases of liver cirrhosis. Mean CoQ values were significantly higher in hypercholesterolemic patients compared to controls (average values 1.07 µmol/L and 0.63 µmol/L) while the CoQ/cholesterol ratio did not show differences (170 vs. 163, respectively). Mean CoQ values were significantly lower in the group of patients with hypobetalipoproteinemia compared to controls (mean CoQ values of 0.22 µmol/L vs. 0.63 µmol/L, respectively), while those of CoQ/cholesterol did not show differences. Pearson’s correlation test showed a positive correlation between the CoQ and cholesterol values (r = 0.565, p < 0.001) and between the CoQ and the LDL cholesterol values (r = 0.610, p < 0.001). Our results suggest that it is advisable to analyse plasma CoQ and cholesterol concentrations in patients with hypobetalipoproteinemia and hypercholesterolemia associated with liver damage.

Caries is a multifactorial disease that involves a majority of the pediatric population. If not diagnosed and treated, it can lead to severe consequences affecting the permanent dentition. The objective of this study is to assess the prevalence of oral foci of infection in a multispeciality hospital during pandemic in Chennai, South India. Majority of the patients examined had caries.

Background: Perioperative cardiac arrest continues to occur. This study aims to identify risk factors for perioperative cardiac arrest in children presenting for noncardiac surgery and characterise its outcomes. Methods: Using the National Surgical Quality Improvement Program (NSQIP) Pediatric Database 2019 and 2020, 261 276 patients were included. Patients ≥18 yr and cardiac surgical procedures were excluded. Exploratory multivariable analysis was performed to identify independent predictors of perioperative cardiac arrest and associated outcomes. Results: The overall rate of cardiac arrest was 0.1%, with an intraoperative rate of 0.05% and 48-h postoperative rate of 0.06%. Significant risk factors for perioperative cardiac arrest included age

The use of ultrasound in regional anaesthesia is being increasingly used in adult and paediatric patients recently. Chances of bony ossification in children are less as compared to adults. Ultrasound imaging helps to delineate sacral and caudal anatomy. It also helps in guiding of caudal needle insertion and to visualize the caudal injectate. Hence ultrasound serves as an important tool in caudal epidural blocks specially in children. After obtaining the approval of ethical committee and parental written informed consent, a total of 70 children undergoing elective lower abdominal surgeries under caudal epidural anaesthesia were included in the study. After having met inclusion and exclusion criteria, patients were randomized based on computer generated randomization table into one of the two groups. Group ACaudal block by traditional method and whoosh test. Group B-Caudal block using ultrasound. In our study, percentage of successful blocks were comparable in group A (31 of 35) and group B (35 of 35) and the difference was statistically nonsignificant (p= 0.12). In the present study motor response after block was seen in only 4 patients in group A while none in group B and hence the difference was statistically nonsignificant (p<0.122). In the present study, the first puncture success rate was higher in Group B (33 of 35 patients) as compared to Group A (10 of 35 patients) and the difference was statistically significant (p value <0.0001). Second attempt was required in 20 of 35 patients in Group A as compared to 2 of 35 patients in Group B. In group A, 5 patients required third attempt while none in Group B required more than two attempts. [ABSTRACT FROM AUTHOR]

Introduction: Slit ventricle syndrome (SVS) remains a challenging problem in the early-shunted paediatric population. Various surgical and non-surgical treatments have been devised for this condition. However, there is currently no gold standard for its optimal management. Among various treatment modalities, subtemporal decompression (STD) is often performed as a last resort. We present our experience of STD in paediatric patients with SVS in whom initial treatment with programmable valves and anti-syphon device were not successful. Methods: This is a single-centre retrospective observational study and survival analysis. Patients who underwent STD for SVS were included. Pre- and post-operative imaging data and clinical outcomes were collected. Results: There were 20 patients (12 M, 8 F) with a mean age of 9 years (SD: 4) at first STD. 90% (n = 18) of patients had multiple shunt revisions pre-STD. At first STD, 70% (n = 14) and 30% (n = 6) of patients had unilateral or bilateral STD, respectively. STD led to a reduction in the frequency of shunt revisions in 60% (n = 12) of patients. The median time required before further STD, shunt surgery, or cranial vault surgery was 14 months. The median time before a further STD was required (either revision or contralateral side) was 89 months. At a median follow-up of 66.5 months (range: 1–159), 65% (n = 13) of patients had improvement in symptoms. Conclusions: A large proportion of patients with persistent SVS symptoms, refractory to multiple shunt revisions, benefitted from STD in combination with shunt optimization. It was also safe and well-tolerated. Therefore, in patients who have multiple failed shunts, STD may reduce the morbidity associated with further shunt revisions and can significantly improve symptomatology. [ABSTRACT FROM AUTHOR]

Aims: Aripiprazole is one of the most commonly prescribed antipsychotic drugs to children and adolescents worldwide, but it is associated with serious side‐effects, including weight gain. This study assessed the population pharmacokinetics of aripiprazole and its active metabolite and investigated the relationship between pharmacokinetic parameters and body mass index (BMI) in children and adolescents with autism spectrum disorder (ASD) and behavioural problems. Secondary outcomes were metabolic, endocrine, extrapyramidal and cardiac side‐effects and drug effectiveness. Methods: Twenty‐four children and adolescents (15 males, 9 females) aged 6–18 years were included in a 24‐week prospective observational trial. Drug plasma concentrations, side‐effects and drug effectiveness were measured at several time points during follow‐up. Relevant pharmacokinetic covariates, including CYP2D6, CYP3A4, CYP3A5 and P‐glycoprotein (ABCB1) genotypes, were determined. Nonlinear mixed‐effects modelling (NONMEM®) was used for a population pharmacokinetic analysis with 92 aripiprazole and 91 dehydro‐aripiprazole concentrations. Subsequently, model‐based trough concentrations, maximum concentrations and 24‐h area under the curves (AUCs) were analysed to predict outcomes using generalized and linear mixed‐effects models. Results: For both aripiprazole and dehydro‐aripiprazole, one‐compartment models best described the measured concentrations, with albumin and BMI as significant covariates. Of all the pharmacokinetic parameters, higher sum (aripiprazole plus dehydro‐aripiprazole) trough concentrations best predicted higher BMI z‐scores (P <.001) and higher Hb1Ac levels (P =.03) during follow‐up. No significant association was found between sum concentrations and effectiveness. Conclusions: Our results indicate a threshold with regard to safety, which suggests that therapeutic drug monitoring of aripiprazole could potentially increase safety in children and adolescents with ASD and behavioural problems. [ABSTRACT FROM AUTHOR]

Intraocular pressure (IOP) can increase with postural changes, which can cause ocular complications. Neck extension is commonly used during palatoplasty to improve surgical angulation. This study evaluates whether neck extension affects IOP during palatoplasty. In this prospective observational study, IOP was measured using a rebound tonometer at four specific time points: T1, 10 min after anaesthesia while in the supine position; T2, 5 min after neck extension; T3, at completion of palatoplasty with neck extended; and T4, 5 min after returning to the supine position. The primary outcome was the IOP at T2, and the secondary outcomes were the IOPs at T3 and T4. Haemodynamic and respiratory variables were also measured at each time point. Thirty-seven patients were included. IOP at T2 was significantly higher than at T1 (15.8 ± 3.4 mmHg vs 10.5 ± 2.8 mmHg, P < 0.001), and IOPs at T3 and T4 were also significantly higher than at T1 (T3 vs T1: 18.9 ± 3.6 mmHg vs 10.5 ± 2.8 mmHg, P < 0.001; T4 vs T1: 13.3 ± 3.7 mmHg vs 10.5 ± 2.8 mmHg, P < 0.001). However, no significant differences were observed for the haemodynamic and respiratory variables at any time point. Our findings indicate that the intraoperative neck extension position during palatoplasty significantly increases IOP in paediatric cleft palate patients undergoing a palatoplasty. [ABSTRACT FROM AUTHOR]

Introduction and Objective. COVID-19 caused by SARS-CoV 2 is a still serious danger. The disease which triggered off the COVID-19 pandemic and one of the biggest health crises in many years, began in the city of Wuhan, China, in 2019. The aim of this review is to distinguish most of the specific and non-specific manifestations of the disease among children. Review Methods. The literature review was based on different types of articles including reviews, meta-analyses, systemic reviews, and randomized controlled trials on PubMed, Web of Science, and Scopus databases. Key words featured COVID-19, MIS-C, SARS-CoV-2 manifestations, and specific, and non-specific manifestations of COVID-19. The literature search was performed until September 2023, and concerned only paediatric patients. Brief description of the state of knowledge. Research based on already published studies prevents the forming of firm conclusions. There are different symptoms of COVID-19 infection, some of them are typical, mild, and do not concern medical care units. There are also some non-specific manifestations, often related to multisystem inflammatory syndrome in children (MIS-C), which are more severe and sometimes demand involving intensive care units. Conclusions. A large group of infected children with asymptomatic or present mild symptoms of COVID-19. Nonspecific manifestations, such as cardiovascular, gastrointestinal, psychiatric, neurological, ophthalmic, dermatological, or rheumatological symptoms, can potentially be misleading and require more attention. [ABSTRACT FROM AUTHOR]

Background: The coronavirus disease 2019 outbreak has hit Beijing since mid-Nov, 2022, with soaring growth of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) among children. Therefore, it is vital to determine the clinical manifestations of epidemic SARS-CoV-2 strains in paediatric patients. Methods: In this study, nucleic acid tests (NATs) for SARS-CoV-2 were performed in paediatric outpatients with symptoms of acute respiratory tract infection during 18 Nov–6 Dec, 2022. Half of the outpatients positive for SARS-CoV-2 were randomly selected to screen for other respiratory pathogens, whereas those with low cycle threshold values in SARS-CoV-2 NATs were amplified and sequenced to determine the SARS-CoV-2 variants. Finally, children positive for SARS-CoV-2 with clinical information in detail were enrolled in a follow-up study to identify potential factors significantly associated with long recovery. Results: Among 9625 paediatric outpatients tested for nucleic acid of SARS-CoV-2, 733 (7.62%, 733/9625) were identified as SARS-CoV-2 NAT positive, with only three (0.82%, 3/366) co-infected with other pathogens among 366 randomly selected patients, and 71 (62.83%) determined as Omicron subvariant BF.7 and 42 (37.22%) as BA.5.2 among 113 successfully sequenced. Among the 681 patients with complete clinical information, fever was the most common symptom (96.8%). In a follow-up study of 592 patients, 46.96% became asymptomatic on the third day and 65.71% on the fifth day. Only 1.7% of infected children experienced febrile seizures. Combined with abnormal C-reactive protein, a higher percentage of antibiotics administration was observed. More co-living members and longer duration of first symptoms served as independent risk factors for long-term recovery, especially in children vaccinated for SARS-CoV-2. Conclusions: BF.7 and BA.5.2 were the dominate Omicron subvariants and caused milder infections during the SARS-CoV-2 outbreak in Beijing. The number of co-living members and duration of first symptoms were independent risk factors for long-term recovery. [ABSTRACT FROM AUTHOR]

Purpose: The objective of this study was to evaluate factors influencing voriconazole (VRC) plasma trough concentrations and provide research data for optimizing VRC dosing in Chinese paediatric patients. Methods: Medical records of inpatients were reviewed retrospectively. Multivariate linear regression analysis was used to identify the factors contributing to the variability of VRC plasma trough concentrations. Results: A total of 250 VRC plasma trough concentrations from 131 paediatric patients were included in the analysis. The median VRC plasma trough concentration was 1.28 mg·L−1 (range, 0.02 to 9.69 mg·L−1). The target range was achieved in 51.6% of patients, while subtherapeutic and supratherapeutic concentrations were obtained in 40.4% and 8.0% of paediatric patients, respectively. The most commonly identified cytochrome P450 2C19 (CYP2C19) phenotype was intermediate metabolizers (IMs) (48.9%), followed by normal metabolizers (NMs) (40.5%) and poor metabolizers (PMs) (10.7%), but no ultrarapid metabolizers (UMs) were observed in our study. VRC plasma trough concentrations adjusted for dose (Cmin/D) were significantly lower in both NMs and IMs compared to PMs (PN-P < 0.001 and PI-P = 0.010, respectively). The dosage of VRC required to achieve the therapeutic range was related to age, with children aged < 6 years needing a significantly higher oral dose of VRC. The oral and intravenous maintenance doses needed to reach the therapeutic range were significantly lower than the recommended maintenance dose (P < 0.001, P < 0.001). Factors such as CYP2C19 polymorphisms, the combination of omeprazole, levels of albumin and alanine aminotransferase, were found to affect VRC exposure and explained some of the variability. Conclusions: The VRC plasma trough concentration is significantly influenced by the CYP2C19 phenotype. The recommended maintenance dose for pediatric patients may not be appropriate for Chinese patients. To increase the probability of achieving the therapeutic range for VRC plasma trough concentration, the administration of VRC should consider the age of paediatric patients and the presence of CYP2C19 polymorphisms. [ABSTRACT FROM AUTHOR]

Summary: Background: Paediatric patients are often exposed to subtherapeutic levels or treatment failure of β-lactams, and prolonged infusion may be beneficial. We aimed to investigate the efficacy and safety of extended infusion (EI; defined as ≥3 h) or continuous infusion vs. short, intermittent infusion (SI; defined as ≤60 min) of β-lactams in patients 21 years were excluded. Odds ratios (OR) and median differences with 95% confidence intervals (CI) were calculated using a random-effects model. Risk of bias (ROB) was assessed using ROB2 and ROBINS-I tools. The protocol was registered with PROSPERO, CRD42022375397. Findings: In total, 19,980 articles were screened, out of which 19 studies (4195 patients) were included in the meta-analysis. EI administration was associated with a significantly lower all-cause mortality in both RCTs and non-RCTs [OR 0.74; CI 0.55–0.99; I2 = 0%; CI 0–58%]. Early microbiological eradication was higher with EI [OR 3.18; CI 2.24–4.51; I2 = 0%; CI 0–90%], but the clinical cure did not differ significantly between the two groups [OR 1.20; CI 0.17–8.71; I2 = 79%; CI 32–93%]. Achieving the optimal plasma level (50–100% fT > MIC) appeared favourable in the EI group compared to the SI. No significant differences were observed in the adverse events. The overall ROB was high because of the small sample sizes and clinically heterogeneous populations. Interpretation: Our findings suggest that extended infusion of β-lactams was associated with lower mortality and increased microbiological eradication and was considered safe compared to short-term infusion. Funding: None.

Background: Pneumonia is an infection of the lungs, caused by among other etiologies, bacteria, or viruses. It is an infection of the lung parenchyma and is caused by a wide variety of organisms in pediatric patients. The study focussed on assessing the socio-demographic, environmental, and health-related factors associated with pneumonia among children under five years. Methodology: A descriptive cross-sectional study design was used using a structured questionnaire amongst 85 respondents who were selected using a systematic sampling method to participate in the study. Results: From the study, the majority 50% were married, most 45 had attained primary level, the majority 62% of the respondents were from rural areas, the majority 43% were peasants, and 57% had more than 3 children, Results showed that 475% agreed that there was a window on respondents’ house and more on their house, majority 78% of the respondents were leaving their windows open daily, majority 28(70%) of the respondents were having their household near the street, majority 68% of the respondents were using wood for cooking, Conclusion: According to the study results and discussions, it was revealed that factors such as mothers’ age, parents’ level of education, and Household monthly income levels were associated with pneumonia among children aged five years and below Furthermore kind of fuel respondents use for cooking such as wood, respondents were not leaving their windows open daily, the house has less than two windows, not having a window on their house were associated with pneumonia among children aged five years and below. Recommendation: The researcher recommends that there should be an organized effort to mobilize communities on health benefits and use kitchens with enough smoke escape roots like windows and/or chimneys and control programs should focus on treatment and prevention of severe pneumonia among children.

Aims: Nusinersen is administered intrathecally for treating spinal muscular atrophy (SMA). Procedural sedation is common with intrathecal treatment in children. The purpose of this study is to emphasize that intrathecal treatment of paediatric patients with SMA I, II and III can be tolerated with procedural sedation instead of general anaesthesia. Methods: Data were collected the from the anaesthesia charts and electronic medical records of 14 paediatric patients with SMA types I, II and III who underwent procedural sedation for repeated intrathecal treatments for SMA. Intravenous induction was performed, and patients were oxygenated with a face mask or nasal cannula while spontaneous breathing continued. Results: Fourteen patients were included in the study: one SMA I, eight SMA II and five SMA III. They underwent 88 intrathecal nusinersen injections in total. In the one SMA I patient, of 8 months, the procedure was performed under local anaesthesia. In all other patients, the treatments were performed under procedural sedation. Different combinations of midazolam, ketamine, propofol, fentanyl and remifentanil were used. The mean doses of the agents used were 0.03 mg kg−1, 0.97 mg kg−1, 2.71 mg kg−1, 0.84 μg kg−1 and 0.5 μg kg−1, respectively. There were no intraoperative or postoperative complications. Conclusion: We found the procedural sedation to be sufficient, safe and effective in SMA II and III paediatric patients who underwent nusinersen treatment intrathecally, provided anaesthetic agents are titrated and administered carefully. [ABSTRACT FROM AUTHOR]

Background: Deferasirox has proved good efficacy and acceptable safety for the management of thalassaemia patients. However, some patients are unresponsive or intolerant to once-daily administration of deferasirox even at a high dose. The current study evaluated the effectiveness and tolerability of twice-daily dosing of deferasirox among transfusion-dependent paediatric beta-thalassaemia patients. Methods: This prospective randomized single-blinded parallel study included all transfusion-dependent paediatric beta-thalassaemia patients prescribed with deferasirox, who visit the study site for their regular blood transfusions and follow-up. The enrolled patients were randomized into intervention and control groups by using a simple block randomization method. In the intervention group, the once-daily dosing of deferasirox was changed to twice-daily dosing with the same total daily dose. Whereas, in the control group, the patients continued with the once-daily deferasirox dosing. The serum ferritin levels of both groups were determined on the enrolment day and after 6 months of follow-up. Results: Forty-one patients were included for analysis. A statistically significant mean decrease in serum ferritin levels was detected in the intervention group, while the serum ferritin levels of the control group significantly increased from baseline. The twice-daily dosing of deferasirox was better tolerated by the thalassaemia patients when compared to once-daily dosing. Conclusion: This study concludes that twice-daily dosing of deferasirox with the same total daily dose significantly enhances the iron chelation efficacy and tolerability among transfusion-dependent paediatric beta-thalassaemia patients when compared to once-daily regimen. [ABSTRACT FROM AUTHOR]

Background and Objectives: Gastrointestinal tract infections caused by Clostridioides difficile bacteria are diagnosed in pediatric patients with increasing frequency. Children treated at pediatric units are a group of patients at high risk of this infection; therefore, appropriate differential diagnostics and an individual approach to every case are of particular importance. The goal of the study was to assess the clinical parameters of patients with a confirmed CD infection and colonization. Materials and Methods: Every positive case was subjected to a retrospective analysis based on medical history and an infection notification note. Results: Positive results were obtained for 30 patients, among whom the results of 18 patients were considered to justify the diagnosis of an infection. In the remaining patients, treatment was not initiated in only three cases. Cases were detected where treatment was initiated despite the lack of sufficient clinical evidence. Conclusions: This study demonstrates that there are many factors that result in a high risk of the occurrence of CDI in oncology patients, such as antibiotic therapy, multiple hospitalizations, and myelosuppression. [ABSTRACT FROM AUTHOR]

Salbutamol sulphate oral soft jelly in asthma has been formulated and evaluated as the goal of the current investigation. A person with asthma has inflamed, narrowed, swollen, and excess mucusproducing airways, which makes breathing difficult. Salbutamol is used to treat asthma and chronic obstructive pulmonary disease (COPD.It works by relaxing the muscle of the airways into the lungs, which makes it easier to breathe . It functions by loosening the muscles in the lungs' airways, which facilitates breathing. Salbutamol is available as an inhaler, tablets, and certain liquid oral dose forms, but due to patient noncompliance issues, oral jellies containing salbutamol sulphate were developed. This study's aim is to create oral jelly, which by avoiding first pass effect, promotes patient compliance and bioavailability while avoiding many negative effects of conventional dosage forms Salbutamol sulphate oral jelly is simple to swallow and improves patient compliance in paediatric patients. Many paediatric patients find it difficult to swallow tablets and capsules, as well as to use the salbutamol inhalation in cases of asthma. The best In vitro medication release was demonstrated by the salbutamol sulphate oral jelly (F2) batch at 85% in 60 minutes. The drug concentration was discovered to be between 98.23% and 99.25%, which was within the pharmacopoeial range of 98% to 101%. Salbutamol sulphate's UV spectra were examined, and it was discovered that its greatest absorption occurs at 217.50 nm. The cost-effective salbutamol sulphate oral soft jelly also demonstrated improved compliance and an increase in bioavailability. [ABSTRACT FROM AUTHOR]