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Updated Saturday, 23 October 2021

Children ◽  
2021 ◽  
Vol 8 (11) ◽  
pp. 951
Author(s):  
Sara Rubenstein ◽  
Emily Grew ◽  
Katharine Clouser ◽  
Alexander Kwok ◽  
Aravindhan Veerapandiyan ◽  
...  

Most cases of COVID-19 in children and adolescents are mild or asymptomatic, but a small number of individuals may develop severe disease, requiring PICU admission and/or mechanical ventilation. We assessed the factors associated with negative short-term outcomes of COVID-19 in 82 pediatric patients at three hospitals within the United States during the spring and summer of 2020 using medical records, laboratory data, and imaging studies of all patients admitted with a positive RT-PCR test for SARS-CoV-2. We found that older patients were more likely to have an extended hospital stay, and those with high BMIs (over 25) were more likely to be admitted to the PICU during the early pandemic. In addition, older patients, those with high BMIs, and those with underlying medical conditions, were more likely to receive respiratory support. Given the association of age, BMI, and underlying medical conditions with more severe COVID-19, clinicians should keep these factors in mind when treating patients.


Children ◽  
2021 ◽  
Vol 8 (11) ◽  
pp. 950
Author(s):  
Xiaolu Han ◽  
Xiaoxuan Hong ◽  
Xianfu Li ◽  
Yuxi Wang ◽  
Zengming Wang ◽  
...  

For children, a special population who are continuously developing, a reasonable dosing strategy is the key to clinical therapy. Accurate dose predictions can help maximize efficacy and minimize pain in pediatrics. Methods: This study collected amlodipine pharmacokinetics (PK) data from 236 Chinese male adults and established a physiological pharmacokinetic (PBPK) model for adults using GastroPlus™. A PBPK model of pediatrics is constructed based on hepatic-to-body size and enzyme metabolism, used similar to the AUC0-∞ to deduce the optimal dosage of amlodipine for children aged 1–16 years. A curve of continuous administration for 2-, 6-, 12-, 16-, and 25-year-olds and a personalized administration program for 6-year-olds were developed. Results: The results show that children could not establish uniform allometric amplification rules. The optimal doses were 0.10 mg·kg−1 for ages 2–6 years and −0.0028 × Age + 0.1148 (mg/kg) for ages 7–16 years, r = 0.9941. The trend for continuous administration was consistent among different groups. In a 6-year-old child, a maintenance dose of 2.30 mg was used to increase the initial dose by 2.00 mg and the treatment dose by 1.00 mg to maintain stable plasma concentrations. Conclusions: A PBPK model based on enzyme metabolism can accurately predict the changes in the pharmacokinetic parameters of amlodipine in pediatrics. It can be used to support the optimization of clinical treatment plans in pediatrics.


Children ◽  
2021 ◽  
Vol 8 (11) ◽  
pp. 942
Author(s):  
Brenda Hiu Yan Law ◽  
Elizabeth Asztalos ◽  
Neil N. Finer ◽  
Maryna Yaskina ◽  
Maximo Vento ◽  
...  

Background: Optimal starting oxygen concentration for delivery room resuscitation of extremely preterm infants (<29 weeks) remains unknown, with recommendations of 21–30% based on uncertain evidence. Individual patient randomized trials designed to answer this question have been hampered by poor enrolment. Hypothesis: It is feasible to compare 30% vs. 60% starting oxygen for delivery room resuscitation of extremely preterm infants using a change in local hospital policy and deferred consent approach. Study design: Prospective, single-center, feasibility study, with each starting oxygen concentration used for two months for all eligible infants. Population: Infants born at 23 + 0–28 + 6 weeks’ gestation who received delivery room resuscitation. Study interventions: Initial oxygen at 30% or 60%, increasing by 10–20% every minute for heart rate < 100 bpm, or increase to 100% for chest compressions. Primary outcome: Feasibility, defined by (i) achieving difference in cumulative supplied oxygen concentration between groups, and (ii) post-intervention rate consent >50%. Results: Thirty-four infants were born during a 4-month period; consent was obtained in 63%. Thirty (n = 12, 30% group; n = 18, 60% group) were analyzed, including limited data from eight who died or were transferred before parents could be approached. Median cumulative oxygen concentrations were significantly different between the two groups in the first 5 min. Conclusion: Randomized control trial of 30% or 60% oxygen at the initiation of resuscitation of extremely preterm neonates with deferred consent is feasible. Trial registration: Clinicaltrials.gov NCT03706586


Children ◽  
2021 ◽  
Vol 8 (11) ◽  
pp. 943
Author(s):  
Barthélémy Tosello ◽  
Sahra Méziane ◽  
Noémie Resseguier ◽  
Stéphane Marret ◽  
Gilles Cambonie ◽  
...  

School-aged extremely preterm (EPT) children have multiple specific neurocognitive/behavioral disorders that are often associated with other disorders; this manifests a true neurobehavioral “phenotype” of prematurity. To determine a profile of cognitive/behavioral impairments in a population of school-aged EPT children (7–10 years-old) without major disabilities, a cross-sectional study was conducted in five medical centers. An algorithm distributed the study population according to four WISC-IV subtests, five NEPSY-2 subtests, and two variables of figure of Rey. The behavior (SDQ), anxiety (Spielberg STAI-C), and generic QoL (Kidscreen 10 and VSP-A) were also evaluated. The study included 231 school-aged EPT children. Three neurobehavioral “phenotypes” were defined according to their severity: 1 = moderately, 2 = minor, and 3 = unimpaired. In all the profiles, the working memory, perceptual reasoning, as well as mental flexibility, were close to or below average, and their emotional behavior was always troubled. Self-esteem and school-work were the most impacted QoL areas. The unimpaired neurobehavior exhibited emotional behavioral impairment and executive dysfunction. The profile analysis defined distinct outcome groups and provided an informative means of identifying factors related to developmental outcomes. The QoL deterioration is determined by the severity of the three neurobehavioral “phenotypes”, which is defined as well as by dysexecutive and/or behavioral disorders. 


Children ◽  
2021 ◽  
Vol 8 (11) ◽  
pp. 945
Author(s):  
Mark S. Scher

Hypertensive disorders of pregnancy (HDP) contribute to adverse gene-environment interactions prior to conception and continue throughout pregnancy. Embryonic/fetal brain disorders occur from interactions between genetic susceptibilities interacting with acquired diseases or conditions affecting the maternal/placental fetal (MPF) triad. Trimester-specific pathophysiological mechanisms, such as maternal immune activation and ischemic placental syndrome, contribute to adverse peripartum, neonatal and childhood outcomes. Two diagnostic approaches provide timelier diagnoses over the first 1000 days from conception until two years of age. Horizontal analyses assess the maturation of the triad, neonate and child. Vertical analyses consider systems-biology from genetic, molecular, cellular, tissue through organ networks during each developmental niche. Disease expressions associated with HDP have cumulative adverse effects across the lifespan when subjected to subsequent adverse events. Critical/sensitive periods of developmental neuroplasticity over the first 1000 days are more likely to result in permanent sequelae. Novel diagnostic approaches, beginning during pre-conception, will facilitate the development of effective preventive, rescue and reparative neurotherapeutic strategies in response to HDP-related trimester-specific disease pathways. Public health policies require the inclusion of women’s health advocacy during and beyond their reproductive years to reduce sequelae experienced by mothers and their offspring. A lower global burden of neurologic disease from HDP will benefit future generations.


Children ◽  
2021 ◽  
Vol 8 (11) ◽  
pp. 944
Author(s):  
T. C. Uwiera

Obstructive sleep apnea (OSA) is an increasingly recognized disorder with a reported incidence of 5.7% in children. Tonsillectomy (with or without adenoidectomy) in pediatric OSA in otherwise healthy non-obese children has a success rate of approximately 75%. However, the cure rate reported for all children undergoing tonsillectomy varies from 51% to 83%. This article reviews the history of tonsillectomy, its indications, techniques, various methods, risks, and successes. The article also explores other surgical options in children with residual OSA post-tonsillectomy.


Children ◽  
2021 ◽  
Vol 8 (10) ◽  
pp. 940
Author(s):  
Joanna Haynes ◽  
Peder Bjorland ◽  
Øystein Gomo ◽  
Anastasia Ushakova ◽  
Siren Rettedal ◽  
...  

Face mask ventilation of apnoeic neonates is an essential skill. However, many non-paediatric healthcare personnel (HCP) in high-resource childbirth facilities receive little hands-on real-life practice. Simulation training aims to bridge this gap by enabling skill acquisition and maintenance. Success may rely on how closely a simulator mimics the clinical conditions faced by HCPs during neonatal resuscitation. Using a novel, low-cost, high-fidelity simulator designed to train newborn ventilation skills, we compared objective measures of ventilation derived from the new manikin and from real newborns, both ventilated by the same group of experienced paediatricians. Simulated and clinical ventilation sequences were paired according to similar duration of ventilation required to achieve success. We found consistencies between manikin and neonatal positive pressure ventilation (PPV) in generated peak inflating pressure (PIP), mask leak and comparable expired tidal volume (eVT), but positive end-expiratory pressure (PEEP) was lower in manikin ventilation. Correlations between PIP, eVT and leak followed a consistent pattern for manikin and neonatal PPV, with a negative relationship between eVT and leak being the only significant correlation. Airway obstruction occurred with the same frequency in the manikin and newborns. These findings support the fidelity of the manikin in simulating clinical conditions encountered during real newborn ventilation. Two limitations of the simulator provide focus for further improvements.


Children ◽  
2021 ◽  
Vol 8 (10) ◽  
pp. 941
Author(s):  
Claudia Calvano ◽  
Elena Murray ◽  
Lea Bentz ◽  
Sascha Bos ◽  
Kathrin Reiter ◽  
...  

Only the minority of youth exposed to traumatic events receive mental health care, as trauma-informed clinical services are lacking or are poorly accessible. In order to bridge this gap, the Outpatient Trauma Clinic (OTC) was founded, an easily accessible early, short-time intervention, with onward referral to follow-up treatment. This report presents the OTC’s interventional approach and first outcome data. Using a retrospective naturalistic design, we analyzed trauma- and intervention-related data of the sample (n = 377, 55.4% female, mean age 10.95, SD = 4.69). Following drop-out analyses, predictors for treatment outcome were identified by logistic regression. The majority (81.9%) was suffering from posttraumatic stress disorder (PTSD) or adjustment disorders. Around one forth dropped out of treatment; these cases showed higher avoidance symptoms at presentation. In 91%, psychological symptoms improved. Experience of multiple traumatic events was the strongest predictor for poor treatment outcome (B = −0.823, SE = 0.313, OR = 0.439, 95% CI 0.238–0.811). Around two thirds were connected to follow-up treatment. The OTC realized a high retention rate, initial improvement of symptoms and referral to subsequent longer-term psychotherapeutic treatment in the majority. Further dissemination of comparable early intervention models is needed, in order to improve mental health care for this vulnerable group.


Children ◽  
2021 ◽  
Vol 8 (10) ◽  
pp. 938
Author(s):  
Honoria Ocagli ◽  
Danila Azzolina ◽  
Silvia Bressan ◽  
Daniele Bottigliengo ◽  
Elisabetta Settin ◽  
...  

This paper presents the epidemiology of foreign body injuries in the Pediatric Emergency Department (PED) of Padova (Italy) along with its trends over an eleven-year period based on administrative data. Annual incidence rates (IRs) of PED presentations for foreign body (FB) injuries per 1000 person-years were calculated. Univariable and multivariable generalized linear (GLM) Poisson models were estimated to evaluate the relationship between FB injury incidence and year, triage priority, nationality, injury site, and FB type. During the study period, there were 217,900 presentations of pediatric residents in the province of Padova; of these, 3084 (1.5%) reported FB injuries involving the ears, nose, throat, gastrointestinal tract or eyes. The annual IR of FB injury episodes increased from 10.45 for 1000 residents in 2007 (95% CI, 9.24, 11.77) to 12.66 for 1000 residents in 2018 (95% CI, 11.35, 14.08). Nonfood items were the FBs that were most frequently reported. The intermediate urgent triage code was the most represented for FB injuries, with IRs ranging from 5.44 (95% CI: 4.59, 6.40) in 2008 to 8.56 in 2018 (95% CI: 7.50, 9.74). A total of 170 patients who presented for FB injuries were hospitalized (5.5%). The annual FB-related injury IR has increased over time, although most episodes are not life threatening. Educational and prevention programs on FB-related injuries should be promoted and dedicated to childcare providers.


Children ◽  
2021 ◽  
Vol 8 (10) ◽  
pp. 939
Author(s):  
Charles Oberg

Pediatrics has witnessed an evolution from primary care, family-centered care, community pediatrics, social pediatrics and global pediatrics, which has shifted our attention beyond the clinic setting to an appreciation of children in their lived environment. We are witnessing the emergence of planetary pediatrics that further broadens the focus of children’s health to include the continued importance of clinical care, but also the impacts of climate change, environmental degradation, child migration, unrelenting war and conflict, social injustice, pandemics and violence against children. If we do not acknowledge the present and ever-increasing adverse planetary changes of what children are experiencing now and in the future, we will have failed to adequately protect them from impending catastrophes. The hope of pediatrics for the future is to improve the health and well-being of all children. This hope remains as relevant today as it was for our predecessors and serves as a beacon for the voyage through the remainder of the twenty-first century.


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