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Background: Integrated primary care (IPC) can address prevalent behavioral health concerns identified in pediatric office visits, but research on IPC consultation patterns is limited. Objective: This study investigated variation in consultation rates across presenting problems, patient sociodemographic factors, and IPC treatment duration. Method: Retrospective electronic health record data were extracted for 970 patients seen in 12 pediatric primary care sites and for whom behavioral health consultation was requested between June 2018 and December 2019. Logistic regressions were used to examine associations between sociodemographic variables, consultation reasons, and IPC visit type. We used multiple linear regression to assess the association between consultation reason and treatment duration. Results: Anxiety (36.2%) and disruptive behavior (29.7%) were the most common consultation reasons. Consultation requests for internalizing (anxiety, mood) problems were more prevalent in school-aged children and adolescents, whereas consultations for disruptive behavior (tantrums) and health-related issues (toileting, sleep concerns) were common in early childhood. Girls were less likely to receive consultation requests for attention deficit/hyperactivity disorder (ADHD) and autism/developmental concerns compared to boys, but more likely to receive consultation for internalizing problems. Consultation requests varied by patient race, ethnicity, visit type, and insurance type. Treatment duration after consultation was longer among patients with consultation requests for ADHD and for depression/mood concerns. Conclusions: Age-related behavioral health consultation patterns in IPC conform with expected developmental trends; however, sociodemographic findings suggest opportunities for enhancing care. Additional research is needed on IPC consultation given its promise for early identification, prevention, and treatment of pediatric mental health concerns.

Listening to, and acting on, the voices of children and families during clinical research and innovation is fundamental to ensuring enhanced pediatric health care, medicines development, and technological advances. While this is often discussed as an important step in ensuring patient-centered care, involving children and families across the life cycle of clinical research is not currently routine. The pediatric research community needs to address how to meaningfully involve children and families if they are to succeed in designing clinical research that suits the needs of pediatric patients and their families. This paper describes how an international community working under the umbrella International Children's Advisory Network (iCAN) and European Young Person's Advisory Group Network (eYPAGnet) has involved children and families in the design and delivery of pediatric clinical research. It offers practical solutions through various case studies assessed against seven patient engagement quality criteria within the Patient Engagement Quality Guidance (PEQG) tool, highlighting some of the lessons learnt from involving and engaging with children and families across different stages of clinical research, including pediatric trials for drug development programs., (© 2022. The Author(s).)

Objectives: This study examines the impacts of health-related quality of life (QoL) on children who suffer from cerebral palsy, in addition to sociodemographic characteristics and other aspects. Methods: Children who suffer from cerebral palsy (CP) who were referred to a Rehabilitation and Rheumatology Clinic in Bagdad, Iraq, were the subjects of a cross-sectional research. The primary data were gathered from parents and kids via a questionnaire. The CP module for The pediatric QoL inventory 3.0 in Arabic was used. The period of August 2022 to February 2023 was used for gathering the data. Researchers evaluated participants using the body mass index (BMI) and the gross motor function classification system. Data analysis was done using SPSS software, version 26 and involved calculating Mean±SD, reporting descriptive statistics, and testing random distribution assumptions. Reliability was assessed via the Cronbach α coefficient and interference analysis, with a considerable level set at P≤0.05. Results: This research enrolled 139 children of which 55.7% were male and the mean age was 5.7 years. The greatest age group was 5 years (51.1%), 59.7% of children were categorized in levels (III, IV and V) and the majority had a low QoL. The domain of daily activity received the highest score out of the six existing domains (57.05%). Discussion: CP affects the QoL of children aged 5 to 7 years. The intensity of the gross motor function classification system, physiological and topographical classification, and healthrelated QoL were associated significantly. [ABSTRACT FROM AUTHOR]

Introduction: Physical literacy (the physical, psychological, social and cognitive capacities needed for movement and physical activity) is arguably important to occupational therapy yet is not explicit within current practice. This study aimed to understand how occupational therapists can engage with the physical literacy concept. Method: Eight paediatric occupational therapists were recruited by purposive sampling. Participants completed up to three semi-structured interviews to understand perspectives on physical literacy, introduce a novel pictorial assessment and to seek feedback on the assessment after trialling. Interviews were transcribed verbatim and analysed using reflexive thematic analysis. Results: Sixteen interviews were conducted. Four themes were identified: 'Foreign tongue' (occupational therapists have an understanding of physical literacy but used different terminology); 'Sounds very OT oriented' (illustrating the connection between physical literacy and occupational therapy); 'We need the child's voice' (measure highlights the child's perspective); and 'Contemporary, useful BUT not for all' (measure had utility for some children but was dependant on child's condition). Conclusion: Occupational therapists can apply the physical literacy construct to traditional models and core concepts. The assessment can be used in paediatric occupational therapy practice supported by clinical reasoning, although future tool iterations may need to accommodate some children with disability. [ABSTRACT FROM AUTHOR]

Background Children with acute lymphoblastic leukemia (ALL), especially those with febrile neutropenia, are susceptible to sepsis. Several factors have been associated with the occurrence of sepsis in children with leukemia. Objective To identify potential risk factors associated with sepsis in children with ALL and febrile neutropenia. Methods This cross-sectional study was done in children with ALL who sought treatment at Dr. Hasan Sadikin General Hospital, Bandung, Indonesia from January 2019 to March 2022. We recorded patients’ gender, age, nutritional status, absolute neutrophil count (ANC), co-infection, prophylactic antibiotic use, and phase of chemotherapy. Results Of 131 subjects, 57.3% were male and 42.8% were wasted. Subjects had a median age of six years old and median ANC of 230 cells/mm3. Furthermore, 48.9% of subjects had co-infections, 87.8% had not received prophylactic antibiotics, and 48.9% were in the induction phase of chemotherapy. Multiple logistic regression analysis revealed that older age [OR 1.16 (95%CI 1.04 to 1.29); ?=0.149; P=0.008] and co-infection [OR 12.9 (95%CI 5.01 to 33.21); ?=2.551; P

Abstract Background Childhood and adolescence are critical periods for physical and mental development. For that, sounding the alarm for the warning signs and red flags of children’s mental health disorders is important to promote good health and mental wellness throughout the lifespan. The aim of the study was to assess children’s and adolescents’ mental health in relation to parenting styles. Methods This study used a descriptive cross-sectional design. From early May 2022 until late October 2022, Zagazig University in Egypt hosted this investigation. Subjects: For this study, 400 parents of Zagazig University staff, employees, and workers who agreed to engage in the current study were gathered as a convenience sample. Tools: In order to get the required data, three tools were utilized. Tool I: A questionnaire for interviews to gather demographic information about the participating parents and their children. Tool II: Adapted Ontario Child Health Study Emotional Behavioural Scale: Parent Version (for children 4–17 years). Tool III: Parenting style scale. Results It was found that criteria for conduct disorder constituted the highest followed by criteria for attention deficit hyperactivity disorder and major depression disorder with a mean and standard deviation of 15.10 ± 3.7, 12.83 ± 3.4, and 11.9 ± 2.8. Also, 66% of the participating parents practiced a permissive parenting style while 18% of them practiced the authoritative style and 16% for the authoritarian style. Conclusion It was determined that criteria of conduct disorder were the most prevalent, followed by criteria of attention deficit hyperactivity disorder and major depressive disorder. Additionally, there was high statistical significance between mental health disorders, parenting styles, and parental educational level. In order to protect children’s and adolescents’ mental health, this study recommended alerting parents and teachers about red flags and warning signs of mental health disorders for early detection and management. Additionally, educate parents about effective parenting methods and how to behave correctly with their children. Psychological counseling centers for seeking help should be available everywhere and announced.

Abstract Introduction Hypoxemia is a common complication of childhood respiratory tract infections and non-respiratory infections. Hypoxemic children have a five-fold increased risk of death compared to children without hypoxemia. In addition, there is limited evidence about hypoxemia and clinical predictors in Ethiopia. Therefore, this study was conducted to assess the prevalence and clinical predictors of hypoxemia among children with respiratory distress admitted to the University of Gondar Comprehensive Specialized Hospital. Methods An institutional-based cross-sectional study was conducted from December 2020 to May 2021 in northwest Ethiopia. A total of 399 study participants were selected using systematic random sampling. The oxygen saturation of the child was measured using Masimo rad-5 pulse oximetry. SPSS version 21 software was used for statistical analysis. Result In this study, the prevalence of hypoxemia among children with respiratory distress was 63.5%. The clinical signs and symptoms significantly associated with hypoxemia were: head-nodding (AOR: 4.1, 95% CI: 1.81–9.28) and chest indrawing (AOR: 3.08, 95% CI: 1.32–7.16) which were considered statistically the risk factors for hypoxemia while inability to feed (AOR: 0.13, 95% CI: 0.02–0.77) was the protective factor for hypoxemia. The most sensitive predictors of hypoxemia were fast breathing with sensitivity (98.4%), nasal flaring (100.0%), chest indrawing (83.6%), and intercostal retraction (93.1%). The best specific predictors of hypoxemia were breathing difficulty with specificity (79.4%), inability to feed (100.0%), wheezing (83.0%), cyanosis (98.6%), impaired consciousness (94.2%), head-nodding (88.7%), and supra-sternal retraction (96.5%). Conclusion and recommendation The prevalence of hypoxemia among children was high. The predictors of hypoxemia were the inability to feed, head nodding, and chest indrawing. It is recommended that the health care settings provide immediate care for the children with an inability to feed, head nodding, and chest indrawing. The policymakers better to focus on preventive strategies, particularly those with the most specific clinical predictors.

Abstract Background The main cause of growth and development delays remains unknown, but it can occur as an interaction between genetic, environmental, and socio-economic factors. Objective The aim of the study was to investigate the prevalence and social determinants of growth and developmental delays among children aged under five years in Qazvin, Iran. Methods A cross-sectional study was conducted between January 2019 to December 2020 with participation of 1800 mothers with children aged 4–60 months who were referred to comprehensive health centers in Qazvin city, Iran. Structural and intermediate social determinants of health were assessed including: parents and children socio-demographic characteristics, families’ living and economic status, parents’ behavioral factors, household food security, mother’s general health, and perceived social support. Children’s growth was assessed based on their anthropometric assessment and their development was assessed using their age-specific Ages and Stages Questionnaire. Data were analyzed using univariable and multivariable logistic regression models using SPSS software version 24 and Stata version 14. Results The prevalence of developmental problems in each domain were 4.28% for personal and social delay, 5.72% for gross motor delay, 6.5% for communication delay, 6.72% for fine motor delay, and 8% for problem-solving delay. The prevalence of weight growth delays was 13.56% and height growth delays was 4.66%. Communication, gross motor, and problem-solving delays were higher among children whose fathers’ smoked cigarettes. Fine motor delays were lower among mothers with education status of high school diploma and university degree vs. the under diploma group. Personal and social delay was significantly higher among families with fair economic status and lower among children when their fathers were employed (vs. unemployed). Weight and height growth delays were higher among mothers who had experienced pregnancy complications and household food insecure families, respectively. Conclusion There are different predictors of growth and developmental delay problems among Iranian children aged under five years including fathers’ smoking, families’ economic status, and household food insecurity as well as history of mothers’ pregnancy complications. The present study’s findings can be used to screen for at-risk of growth and developmental delays among children and could help in designing and implementation of timely interventions.

ABSTRACT Importance The 3‐min step test is a simple option to monitor submaximal exercise capacity, although its use via remote video monitoring has not been investigated in children with cystic fibrosis (CF). Objective This study aimed to assess the feasibility and reproducibility of performing the 3‐min step test with remote supervision. Methods A cross‐sectional study including CF patients (6–18 years) from two CF services were performed. Demographic, anthropometric, clinical, and lung function data were collected and two 3‐min step tests were performed: (i) in‐person supervision, and (ii) remotely supervised by video monitoring. Before and after the tests, heart rate (HR), oxygen saturation (SpO2), and the Borg score for dyspnea and lower limb fatigue were monitored. Results Twenty‐three patients (10.7 ± 3.7 years) with a mean FEV1 of 89.5% ± 23.2% were included. There were no significant differences between tests, with mean differences (95% confidence intervals) in final HR of –3.3 (–8.9, 2.4), change in HR of –1.9 (–6.1, 2.1), final SpO2 of 0.3 (–0.4, 1.0), and final dyspnea of 0.1 (–0.8, 0.9). The intraclass correlation coefficient was 0.852 (final HR), 0.762 (final SpO2), and 0.775 (final lower limb fatigue). Significant and moderate correlations were found between tests for final HR (r = 0.75), change in HR (r = 0.61), and final SpO2 (r = 0.61). The Bland–Altman analysis showed a mean difference in final SpO2 between tests of 0.3% (limit of agreement –3.0%, 3.5%). Interpretation Physiological responses between tests were similar, indicating it was feasible to perform the 3‐min step test with remote supervision in CF children.

Abstract Background Child and adolescent mental health is a major public health concern worldwide. The development of children’s social and emotional skills helps to improve mental health and wellbeing, and prevent anxiety and depression. The school-based social emotional learning (SEL) programmes have proved effective in a number of countries. But in Mainland China, there has been no empirical research of the effectiveness on children’s mental health. The study conducted a SEL programme in China during the COVID-19 pandemic and aimed to determine whether: (1) a SEL programme can reduce anxiety and depression, (2) the intervention effect is influenced by sociodemographic characteristics, (3) the programme effects change children’s emotion management and communication. Methods Participants were 230 children aged 8–12 years in the intervention school and 325 in the control school in two poor villages in central China. The study was a quasi-experimental trial, comprising 16 weekly 90-minute sessions. It used a mixed-methods design, with a quantitative survey administered at baseline, post-intervention, and 5-month follow-up, and qualitative interviews. Linear mixed effects regression modeling was used to analyse the intervention effectiveness, linear models were conducted to examine the moderation effect of sociodemographic variables, and the inductive thematic analysis approach was used for interview data. Results The intervention had no significant effect on anxiety or depression, except that intervention school children who lived with neither parent (left behind children) reported lower depression scores than control school at post-intervention and 5-month follow-up. Qualitative interviews showed after intervention children were more able to control tempers and better communicated their thoughts and feelings, improving their relationships with family and friends. Conclusions The programme was cheap, easy to implement, and warmly welcomed by children, schools and caregivers, suggesting it was feasible and potentially sustainable. More research is needed on the adaptation of the SEL programme in the Chinese context.

Abstract Background Migration exposes children and youth to vulnerabilities, including uprooting, lack of protection, limited access to services, and violence. Previous studies have shown that victimization experiences impact the mental health of migrant children, including depression, anxiety, and post-traumatic stress disorder. This study aims to examine the co-occurrence of multiple forms of maltreatment (polyvictimization) among migrant and Chilean children and youth and its association with depressive symptoms, addressing a research gap in Latin America. Methods Secondary data from the National Polyvictimization Survey (NPS) conducted by the Chilean Ministry of the Interior were analyzed. Measures assessing polyvictimization and depressive symptoms were administered to a sample of 1362 participants, with equal group sizes for migrants and Chilean-born individuals. Data analysis included descriptive statistics, group comparisons, correlation analyses, and multiple regression analyses. Results The study revealed marked differences in experiences of conventional crime victimization and polyvictimization between migrant and Chilean-born participants, with migrants facing slightly higher incidences. Correlational analysis indicated variable strengths of association between victimization types and depressive symptoms across groups, with Chilean-born individuals showing stronger correlations for certain victimization forms. Multiple regression analysis highlighted gender, polyvictimization, child maltreatment, internet victimization, sexual victimization, and peer/sibling victimization as significant predictors of depressive symptoms across the sample. Notably, an interaction was observed between child maltreatment and migrant status, indicating a mitigated impact of maltreatment on depressive symptoms among migrant adolescents. This suggests the potential for unique resilience or coping mechanisms in this group. Conclusions This study elucidates the varied victimization experiences of migrant children and youth in Chile, with a notable emphasis on the mitigating effect of migrant status on the relationship between child maltreatment and depressive symptoms. It highlights the resilience and potential adaptive strategies of migrant minors facing adversity. The findings underscore the necessity of developing support and intervention strategies that recognize the specific needs and strengths of migrant children and youth, advocating for policies that protect and empower this vulnerable demographic amidst new environmental challenges.

Abstract Background Global antipsychotic usage, including off-label prescriptions, has increased in recent decades. However, trends in China, particularly for children and adolescents, remain unclear. This study explored these trends from 2016 to 2021 and identified factors associated with off-label prescriptions. Methods In this retrospective study, we analyzed on-label and off-label prescriptions based on drug information approved by the China National Medical Products Administration. To identify factors associated with off-label prescriptions, we conducted multivariate logistic regression analysis. Results Our study included 48,258 antipsychotic prescriptions, 52.4% (25,295) of which were prescriptions for males. Of these, 61.7% (29,813) were off-label. Over time, the number of antipsychotics and the percentage of off-label prescriptions for children and adolescents overall increased from 2016 to 2021. The use of atypical antipsychotics increased, whereas that of typical antipsychotics decreased. For off-label usage, all of the factors in our study were associated with off-label usage, including age, sex, year, region, department, reimbursement, antipsychotic type, drug expense, number of polypharmacy and diagnoses. Additionally, tiapride (15.8%) and aripiprazole (18.6%) were the most common typical and atypical antipsychotics, respectively. For pediatric diseases, common diagnoses included mood or affective disorders (31.7%) and behavioral and emotional disorders, with onset usually occurring in childhood and adolescence (29.1%). Furthermore, a depressive state was the most common diagnosis for which antipsychotic polypharmacy was used for treatment. Conclusion In this retrospective study, off-label antipsychotic prescriptions were common, with trends generally increasing among children and adolescents from 2016 to 2021. However, there is a lack of evidence supporting off-label usage, thus emphasizing the need for studies on the efficacy and safety of these treatments.

Abstract Background Influenza is a main cause of illnesses during seasonal outbreaks. Identifying children with influenza who may need hospitalization may lead to better influenza outcomes. Objective To identify factors associated with the severity of influenza infection, specifically among children who were admitted to the hospital after being diagnosed with influenza at the emergency department. Methods A retrospective cohort study was conducted among pediatric patients (age

Abstract Background Anemia is a common complication of tuberculosis (TB), and there is evidence that its prevalence is higher in patients with TB. Although TB is very important in epidemiology, careful investigation of TB-related anemia in children has not been carried out systematically. This study aimed to describe the details of anemia in children with TB and its association with clinical characteristics and the severity of inflammation. Methods In this retrospective study, we explored Hb levels in 103 children with pulmonary TB (PTB) and they were divided into anemic or non-anemic groups. Logistics regression analysis was used to study the associations between anemia and demographic characteristics. Spearman correlations analysis was performed to analyse the associations between the biochemical parameters and hemoglobin levels in blood. Results The prevalence of anemia in children with TB was 37.9% (48.7% showed microcytic hypochromic anemia, and 5.1% showed normal cell anemia). Compared with the anemia (n = 39) group, the non-anemic group (n = 64) had longer fever duration and increased respiratory rate (P

Abstract Objectives To characterize the clinical features and to identify the predictors of recurrence of histiocytic necrotizing lymphadenitis (HNL) in Chinese children. Study design This study retrospectively analyzed the clinical characteristics, laboratory and pathological findings, and recurrence status of children diagnosed with HNL at a single center in China from January 2018 to May 2023. Logistic regression analysis was employed to identify predictors of HNL recurrence. Results 181 Chinese children with histopathologically confirmed HNL were enrolled (121 males and 60 females). The mean age was 9.3 ± 2.9 years. The most prominent clinical features were fever (98.9%) and cervical lymphadenopathy (98.3%). Aseptic meningitis was the most frequent complication (38.5%), while hemophagocytic lymphohistiocytosis and autoimmune disease were rare (1.7% and 1.2%, respectively). Recurrence occurred in 12.7% of patients. Erythrocyte sedimentation rate (> 30 mm/h) was the significant predictors of HNL recurrence, with odds ratios of 6.107, respectively. Conclusion Our study demonstrates that fever and cervical lymphadenopathy are the most frequent clinical manifestations of HNL in Chinese children, which often coexist with aseptic meningitis. HNL patients with risk factors require follow-up for recurrence.

Abstract Background Speech and language delay among children can result in social interaction problems, attention difficulties, decreased writing and reading abilities, and poor cognitive and behavioral development. Despite the mounting prevalence of speech and language delays in Ethiopia, there is a lack of literature addressing the factors contributing to this delay. Consequently, this study aims to identify determinants of speech and language delay among children aged 12 months to 12 years at Yekatit 12 Hospital in Addis Ababa, Ethiopia. Methods We conducted an institutional-based at Yekatit 12 Hospital, unmatched case–control study with 50 cases and 100 controls aged 12 months to 12 years. Interviewer-administered questionnaires were used to collect data from the parents or caregivers of the participating children. Epi Info v7 was used for sample calculation, and SPSS v26 was used for analysis. The chi-square test was performed to determine the relationship between speech and language delay and determining factors, which was then followed by logistic regression. The significant determining factors were identified based on the adjusted odds ratio (AOR), with a 95% CI and p-value (

Abstract Background There are limited data available, particularly in low- and middle-income countries (LMICs), on the long-term quality of life (QoL) and family functioning of primary caregivers of children and young people (CYPs) affected by primary brain tumors (PBTs). This study aimed to assess the factors associated with the mean change in QoL and family functioning scores of primary caregivers of CYP patients with PBTs 12 months posttreatment. Methods This prospective cohort study enrolled CYPs aged 5–21 years with newly diagnosed PBTs and their primary caregivers. The study was carried out between November 2020 and July 2023. The primary caregivers of CYPs were recruited from two major tertiary care centers in Karachi, Pakistan. The primary caregivers QoL were assessed by the Pediatric Quality of Life Inventory (PedsQL) Family Impact Module. The assessment was undertaken by a psychologist at the time of diagnosis and 12 months posttreatment. The data were analyzed with STATA version 12. Results Forty-eight CYPs with newly diagnosed PBTs and their primary caregivers (46 mothers and 2 fathers) were enrolled. At 12 months posttreatment, 25 (52%) CYPs and their primary caregivers (mothers) were reassessed, and 23 (48%) were lost to follow-up. On multivariable analysis, a significant decrease in mothers’ mean 12-month posttreatment QoL and family functioning scores was associated with CYP having posttreatment seizures (beta= -10.2; 95% CI: -18.4 to -2.0) and with the financial burden associated with the CYP’s illness (beta= -0.3; 95% CI: -0.4 to -0.1). However, in those cases where CYP had higher posttreatment quality of life scores (beta = 0.4; 95% CI = 0.1, 0.6) and posttreatment higher verbal intelligence scores (beta = 0.1; 95% CI = 0.01, 0.3), the mothers’ QoL and family functioning scores were significantly greater. Conclusion We found a significant decrease in QoL of mothers who had a high financial burden and whose CYP had posttreatment seizures. However, those whose CYPs had higher posttreatment verbal intelligence scores and quality of life scores had significantly greater QoL scores. Identification of the factors that influence primary caregivers QoL has the potential to aid in the development of targeted strategies to alleviate stressors and improve the overall quality of life for primary caregivers and their children who are at high risk.

Abstract Objective To analyze the clinical characteristics of esophageal button battery impactions in children and explore safe and effective treatment methods. Methods This retrospective cohort study was conducted at a single tertiary care center, Shenzhen Children’s Hospital, encompassing 89 children diagnosed with esophageal button battery impactions between January 2013 and January 2023. To minimize esophageal mucosal corrosion, prompt removal of the button battery with a first-aid fast track rigid esophagoscopy under general anesthesia was performed within thirty minutes of diagnosis. The clinical features and complications were recorded and analyzed. Results Button battery as esophageal foreign body was prevalent among children under 3 years old (79.8%), with boys exhibiting a higher incidence rate (56.2%) compared to girls (43.8%), and an average age of 25.8 months. The median duration from ingestion to hospital admission was 3 h (range: 0.5 h to 3 months). Common symptoms included vomiting and dysphagia, with early stage vomiting of brown foamy secretions being a characteristic presentation of esophageal button battery impactions. The majority (77.5%) of batteries were lodged in the upper esophagus. The larger batteries were verified to be more prone to complications. All 89 cases exhibited varying degrees of esophageal mucosal erosion, with 31 cases (34.8%) experiencing severe complications, including esophageal stenosis in 11 cases (35.5%), esophageal perforation in 9 cases (29%) with 4 cases of tracheoesophageal fistula, vocal cord paralysis in 6 cases (19.4%), hemorrhage in 2 cases (6.5%), mediastinitis in 2 cases (6.5%), and periesophageal abscess in 1 case (3.2%). Despite the severity of these complications, none of the patients died after emergency surgery. Conclusion Esophageal button battery impactions can lead to significant damage to the esophageal mucosa due to its strong corrosiveness. Prompt action is crucial to mitigate the risk of complications. For the first time, we implement a first-aid fast track surgical intervention following diagnosis is imperative to minimize the incidence of adverse outcomes.

Abstract Background Resistance to multiple antibiotics by several pathogens has been widely described in children and has become a global health emergency. This is due to increased use by parents, caregivers, and healthcare providers. This study aims to describe the prevalence rates of antibiotic prescribing, ascertain the impact of antimicrobial stewardship programs, and target improving the quality of antibiotic prescribing in the paediatric population over time in a hospital. Method A point prevalence survey of antibiotic use was performed yearly for 4 years to monitor trends in antibiotic prescribing. Data from all patients admitted before 8 a.m. on the day of the PPS were included. A web-based application designed by the University of Antwerp was used for data entry, validation, and analysis ( http://www.global-pps.com ). Results A total of 260 children, including 90 (34.6%) neonates and 170 (65.4%) older children, were admitted during the four surveys. Overall, 179 (68.8%) patients received at least one antibiotic. In neonates, the prevalence of antibiotic use increased from 78.9 to 89.5% but decreased from 100 to 58.8% in older children. There was a reduction in the use of antibiotics for prophylaxis from 45.7 to 24.6%. The most frequently prescribed antibiotic groups were third generation cephalosporins and aminoglycosides. The most common indications for antibiotic prescription were sepsis in neonates and central nervous system infection in older children. The documentation of reason in notes increased from 33 to 100%, while the stop-review date also increased from 19.4 to 70%. Conclusion The indicators for appropriate antibiotic prescription improved over time with the introduction of antibiotic stewardship program in the department.

INTRODUCTION: Maturity-onset diabetes of the young (MODY) is the most common type of monogenic diabetes. To date, mutations have been identified in 14 different genes of patients with a clinical diagnosis of MODY. This study screened mutations in 14 MODY-related genes and the regulator factor X6 (RFX6) gene in children. METHODS: The presence of clinical features of MODY and negative results for three autoantibody markers of type 1 diabetes mellitus (T1DM) in children and adolescents were used as inclusion criteria for genetic testing. The screening panel for next-generation sequencing included 14 MODY-related genes (GCK, HNF4A, HNF1A, HNF1B, PDX1, NEUROD1, KLF11, CEL, PAX4, INS, BLK, ABCC8, KCNJ11, and APPL1) and the RFX6 gene. RESULTS: Twenty-four different variants in MODY-related genes were identified in 49 children diagnosed with autoantibody-negative T1DM. Twelve variants were classified as pathogenic/likely pathogenic (P/LP) while 12 were interpreted as variant of unknown significance. Nine of the P/LP variants were found in GCK, two in HNF1B, and one in ABCC8. Three variants were novel, and one was a de novo variant. All but one of the variants exhibited heterozygotic inheritance. DISCUSSION AND CONCLUSION: The frequencies of the MODY subtypes differed from previous reports. Although GCK-MODY was the most frequent mutation in Turkish children, similar to previous studies, the second most prevalent MODY subtype was HNF1B-MODY. This study also established three additional novel mutations in different MODY genes.

Background Autism spectrum disorder (ASD) is one of the most common neurodevelopmental disorders. In children with ASD, the neurodevelopmental and behavioral disorders are characterized by impaired quality of interaction, communication, and social imagination, with limited interest and repetitive behavior. Various studies have found that the mean zinc level is lower in children with ASD than in children without ASD, especially in the low functioning autism. Objective To compare hair zinc level in children with and without ASD. Methods This case-control study included children with ASD and controls without ASD. Subjects were children under 5 years old who came to Prof I.G.N.G. Ngoerah Hospital and Masadini Clinic in Denpasar. Hair zinc cut-off level was determined by the area under curve (AUC) based on the receiver operating characteristic (ROC) curve. Results A total of 128 subjects consisted of 64 cases and 64 controls, with a mean age of 4 (SD 0.8) years. Most subjects were male (76%); 82.3% were well-nourished. The mean maternal age at delivery was 28.82 (SD 3.2) years. Subjects’ mean hair zinc level was 87.9 (SD 231.1) ?g/g. Bivariate analysis with Chi-square test revealed that children with hair zinc concentration of

Background Over the past two decades, heart failure in children has increased in terms of symptom recognition and prevalence. The initial clinical manifestations of heart failure in children are non-specific. Therefore, diagnosis requires the support of echocardiography. The symptomatic severity of heart failure in children can be classified through a simple scoring system such as Ross score. The duration of heart disease, duration of therapy, and cardiac remodeling status may have clinical and anatomical effects on the disease. Objective To analyze for a possible correlation between modified Ross score and echocardiographic score by subgroup analysis consisting of duration of heart disease, duration of therapy, and cardiac remodeling. Methods This cross-sectional study included children aged 1 month - 18 years with heart failure who sought treatment at Prof.Dr. I.G.N.G Ngoerah Hospital, Denpasar from June 2019 to February 2020. Cardiac remodeling was defined as >20% increase in left ventricle internal end diastolic dimension (LVIDd) compared to normal values, ??based on body surface area. Spearman’s correlation test was used for statistical analysis. Results A total of 30 subjects were analyzed in this study. The median modified Ross score and echocardiography score were 3 points (range 2-11) and 4 (range 2-6), respectively. The median durations of heart disease and preventive heart failure therapy were 2 years (range 7 days-15 years) and 1 year (range 7 days-15 years), respectively. The mean LVIDd was 4.3 (SD 1.4) cm. Twenty-one out of 30 subjects experienced a ? 20% increase of LVIDd from baseline. The modified Ross score and echocardiographic score had no significant correlation (r=0.18; P=0.33). However, the modified Ross score had significant correlations with duration of heart disease (r=-0.632; P0.05). Echocardiography score and remodelling process was significantly correlated (r=0.64; P

Background Preschool children generally have inadequate fruit and vegetable intake, but a high intake of calories. Nutrition education taught from an early age might instill good eating habits and behavior, especially regarding fruit and vegetable consumption. Objectives To compare preschoolers’ fruit and vegetable preferences, fiber intake, and consumption of high-calorie food before and after a gardening-cooking intervention. Methods This study had a quasi-experimental, pre- and post-test design, as well as intervention and control groups. Subjects were preschool children aged 4-6, selected by purposive sampling, with 33 subjects in each group. The intervention group engaged in nutrition education, gardening, and cooking programs. While the control group was not given the programs, only given nutrition education at the end of data collection. Data were analyzed using independent T-test, paired T-Test, Wilcoxon, and Mann-Whitney tests. Results There were significant increases in attitude score, fruit and vegetable preference, and fiber intake, as well as decreased intake of high calorie foods (P

Background Acute diarrhea is the most common gastrointestinal disease in children under five years of age with high morbidity and mortality risk. The use of lactose-free formula in the management of children with acute diarrhea was said to accelerate the diarrheal resolution time. Objective To determine the efficacy of lactose-free formula in managing acute diarrhea in pediatric patients by systematic review and meta-analysis. Methods A comprehensive literature search was conducted on PubMed, Proquest, Web of Science, and CINAHL Plus Database from November 1971 to July 11th, 2021. The study selection process was carried out under PRISMA 2020 guidelines based on several eligibility criteria. The quality of the included studies were further assessed using Modified Jadad Scores. Results Fifteen randomized controlled trials (RCTs) were included, involving a total of 1,390 children with acute diarrhea. Shorter recovery time (MD -0.21; 95%CI -0.50 to 0.08; P=0.16) was observed in patients receiving lactose-free formula than the control group. However, this finding was not statistically significant. The subgroup analysis showed that lactose-free formula significantly shortened the recovery time compared to oral rehydration solution (ORS) group (MD -0.70; 95%CI -0.98 to -0.41; P=0.00001). Furthermore, lactose-free formula also significantly reduced the amount of stool output (MD -0.61; 95%CI -0.86 to -0.36; P=0.00001) and the incidence of persistent diarrhea more than seven days (OR 0.22; 95%CI 0.10 to 0.51; P=0.0004) compared to the control group. Conclusion Lactose-free formula as dietary management for acute diarrhea in children can reduce stool output and the incidence of persistent diarrhea for more than seven days. It also may shorten the recovery time compared to the administration of ORS alone.

Abstract Background Neurospecific Enolase (NSE), a multifunctional protein, is present in various tissues of the body and plays an important role in many disease processes, such as infection, inflammation, tumours, injury, and immunity. In recent years, the application of NSE in respiratory diseases has become increasingly widespread and a research hotspot. Objective This study aims to explore the relationship between NSE and childhood pneumonia, providing assistance for the diagnosis and assessment of pneumonia. Methods Using prospective research and case-control methods, We selected 129 children with pneumonia hospitalised in Weifang People’s Hospital from September 2020 to April 2022 as the case group. Among them were 67 cases of Mycoplasma pneumoniae pneumonia (MP+), 62 cases of non-Mycoplasma pneumoniae pneumonia (MP -), and 21 cases of severe pneumonia. At the same time, 136 children who underwent outpatient health examinations were selected as the control group. The levels of NSE, ESR, CRP in cases group and NSE in control group were measured separately. Result The NSE levels in the MP + group were 17.86 (14.29–22.54) ng/mL, while those in the MP- group were 17.89 (14.10–21.66) ng/mL, both of which were higher than the control group’s NSE levels of 13.26(12.18,14.44) ng/mL (H = 46.92, P = 0.000). There was no statistically significant difference in NSE levels between the MP + and MP - groups (P > 0.05). The NSE level in the severe pneumonia group was 27.38 (13.95–34.06) ng/mL, higher than that in the mild pneumonia group, which was 17.68 (14.27–21.04) ng/mL, (P = 0.024). The AUC values for diagnosing pneumonia are NSE0.714, CRP0.539, and ESR0.535, with NSE having the highest diagnostic value. Conclusion Serum NSE can serve as an inflammatory indicator for paediatric pneumonia, which has important clinical guidance significance for the diagnosis, condition evaluation, and prognosis of paediatric pneumonia.

Abstract Background Agitation/delirium is commonly seen in children after anesthesia, and a proper dose of dexmedetomidine can prevent this complication. This study aimed to investigate the effects of different doses of Dexmedetomidine (DEX) on agitation/delirium and other complications in anesthetized children, providing clinical evidence for dose recommendations of DEX. Methods This study was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A systematic search was conducted in the Cochrane Library, PubMed, Web of Science, and EMBASE. Two independent researchers performed literature screening, data extraction, and assessed the methodological quality. Data analysis was conducted using R and STATA 16.0. Results In the final analysis, 20 randomized controlled trials (RCTs) involving 2521 children were included. The results showed that in comparison to normal saline, 1 µg/kg, 1.5 µg/kg, and 2 µg/kg intranasal DEX significantly reduced the incidence of post-anesthetic emergence agitation in children with the most effective dose being 2 µg/kg (SUCRA = 0.91). Compared with normal saline, 1 µg/kg, 1.5 µg/kg, and 2 µg/kg intranasal DEX reduced patient’s need for postoperative analgesia, with the most effective dose being 1.5 µg/kg (SUCRA = 0.78). However, 1 µg/kg DEX performed the best in reducing Pediatric Anaesthesia Emergence Delirium (PAED) Scale score (SUCRA = 0.88). Conclusion Compared with normal saline, intranasal administration of 2 µg/kg DEX and 1.5 µg/kg DEX are the optimal doses to reduce the incidence of agitation and the need for postoperative pain relief in children under general anesthesia. Given effectiveness and safety, intranasal use of 1 µg/kg DEX appears to be the most effective dosage for anesthetized children.

Abstract Background Deteriorating global physical activity (PA) levels among children warrants new and sustainable approaches to increase PA levels. This study aimed to determine the immediate and sustainable influences of a 9-week movement program on the PA levels in 7 to 8-year-old school children in the Raymond Mhlaba Municipality in the Eastern Cape Province of South Africa. Methods A randomized control trial including two groups (control group (CG) and intervention group (IG)), pre–post–retest (after six months of no intervention) design was used. Seventy school children, mean age 7.12 years (± 0.71) (n = 35 IG; n = 35 CG) participated in the study. A 9-week movement program was followed twice a week for 30 min during school hours. PA was measured for 7 consecutive days using a hip-mounted wGT3X-BT Actigraph accelerometer. The Test of Gross Motor Development-Third Edition (TGMD-3) was used to assess motor skills. Hierarchical Linear Modelling (HLM) was applied to analyze the data with time, sex, and group as predictors. Effect sizes were computed using Cohen’s d-cut points to assess the practical significance of changes over time. Estimated regression coefficients were also computed to determine the strength of the relationship between moderate-to-vigorous physical activity (MVPA) and fundamental movement skills (FMS). Results Before the intervention, 60% of the IG met the 60 min of daily MVPA guideline, while light physical activity (LPA) per day was also higher than sedentary behavior (SB) in both groups. No immediate (p

Abstract Background There exists a gap in our understanding of the age-dependent epidemiological dynamics of SARS-CoV-2 among school-age children in comparison to adults within the State of Qatar. Additionally, there has been limited assessment of the timely implementation of physical distancing interventions, notably national school closures, and their impact on infection trends. Methods We used the national database to capture all records of polymerase-chain-reaction (PCR) testing, and rapid antigen tests (RAT) conducted at all health care venues in Qatar and administered between August 26, 2020, and August 21, 2022, across all age groups (≥ 5 years old). Study participants under 18 years old were categorized into two age brackets: (5–11) and (12–17), aligning with the Primary and Preparatory/Secondary grade levels in Qatar, respectively. We assessed age group testing rates, incidence rates, and positivity rates in relation to adults. These epidemiological metrics were compared with the CDC’s thresholds for COVID-19 community transmission. Results Throughout the school years of 2020–2021 and 2021–2022, a total of 5,063,405 and 6,130,531 tests were respectively conducted. In the 2020–2021 school year, 89.6% of the tests were administered to adults, while 13.7% were conducted on children in the following year. The overall test positivity rates for the 2020–2021 and 2021–2022 school years were 5.8% and 8.1%, respectively. Adolescents underwent the fewest tests during the full study period compared to both adults and young children. Using the CDC indicators, we found that children and adolescents can significantly contribute to elevated infection rates, potentially driving community transmission upon relaxation of social restrictions. Conclusion It is crucial to acknowledge the potential for higher transmission among youth and adolescents when formulating transmission control strategies and making decisions regarding school closures. Employing data-driven indicators and thresholds to monitor COVID-19 community levels is important for informing decision-making. These approaches also enable the prompt implementation of infection control transmission mitigation measures in future pandemics.

Abstract Background Mental health issues (depression and suicidal ideation) are increasingly common in children and emerge as escalating public health concerns. The syndemics that underline the importance of risk factor clustering provides a framework for intervention, but there is a lack of research on syndemics involving the adverse interactions of children’s mental health problems. This study therefore examined the cumulative and synergistic effects of vulnerable conditions on depression and suicidal ideation among children in China. Methods A mental health screening census of students in grades 5–12 was conducted from November 2022 to January 2023 in Nanling County, Anhui Province, China. The prevalence and co-occurrence of vulnerable conditions (unfavorable parental marital status, left-behind experience, bullying victimization, and self-harm behavior), depression, and suicidal ideation and the cumulative and synergistic effects of vulnerable conditions on depression and suicidal ideation were explored. Results Nearly a quarter of students (24.8%) reported at least two syndemic conditions. Overall, the prevalence of depression and suicidal ideation were 20.2% and 24.2% respectively. The odds of depression and suicidal ideation were higher for children with one or more vulnerable conditions and were ten times higher for children with three or more vulnerable conditions compared with those without any vulnerable condition. These four vulnerable conditions can increase the odds of depression and suicidal ideation by interacting synergistically with each other. Conclusion Our findings signal the importance of addressing mental health syndemics among children in China by simultaneously considering concurrent vulnerable conditions.

Abstract Background Tuberculosis is one the leading causes of death from a single infectious disease, caused by the bacillus mycobacterium tuberculosis. In Ethiopia, even though several primary studies have been conducted on the incidence of tuberculosis among HIV-infected children, the pooled incidence rate of tuberculosis among HIV-infected children (aged 0–14 years) is unknown. Therefore, the main objectives of this systematic review and meta-analysis are to estimate the pooled incidence rate of tuberculosis among HIV-infected children and its predictors in Ethiopia. Method International electronic databases such as PubMed, HINARI, Science Direct, Google Scholar, and African Journals Online were searched using different search engines. Quality of primary studies was checked using the Joanna Briggs Institute checklist. The heterogeneity of studies was tested using I-square statistics. Publication bias was tested using a funnel plot and Egger’s test. Forest plots and tables were used to present the results. The random effect model was used to estimate the pooled incidence of tuberculosis among children living with HIV. Result A total of 13 studies were included in this systematic review and meta-analysis. The pooled incidence of tuberculosis among HIV-infected children was 3.77 (95% CI: 2.83, 5.02) per 100-person-year observations. Advanced HIV disease (HR: 2.72, 95% CI: 1.9; 3.88), didn’t receive complete vaccination (HR: 4.40, 95% CI: 2.16; 8.82), stunting (HR: 2.34, 95% CI: 1.64, 3.33), underweight (HR: 2.30, 95% CI: 1.61; 3.22), didn’t receive Isoniazid preventive therapy (HR: 3.64, 95% CI: 2.22, 5.96), anemia (HR: 3.04, 95% CI: 2.34; 3.98), fair or poor antiretroviral therapy adherence (HR: 2.50, 95% CI: 1.84; 3.40) and didn’t receive cotrimoxazole preventive therapy (HR: 3.20, 95% CI: 2.26; 4.40) were predictors of tuberculosis coinfection among HIV infected children. Conclusion This systematic review and meta-analysis concluded that the overall pooled incidence rate of tuberculosis among HIV-infected children was high in Ethiopia as compared to the END TB strategy targets. Therefore, emphasis has to be given to drug adherence (ART and Isoniazid) and nutritional counseling. Moreover, early diagnosis and treatment of malnutrition and anemia are critical to reduce the risk of TB coinfection. Registration Registered in PROSPERO with ID: CRD42023474956.

Abstract Background The risk factors for hemorrhagic cystitis (HC) in children undergoing hematopoietic stem cell transplantation (HSCT) are unclear. Therefore, we conducted this systematic review and meta-analysis to investigate the risk factors for HC in children undergoing HSCT. Methods We performed this meta-analysis by retrieving studies from PubMed, EMBASE, and the Cochrane Library up to October 10, 2023, and analyzing those that met the inclusion criteria. I2 statistics were used to evaluate heterogeneity. Results Twelve studies, including 2,764 patients, were analyzed. Male sex (odds ratio [OR] = 1.52; 95% confidence interval [CI], 1.16–2.00; p = 0.003, I2 = 0%), allogeneic donor (OR = 5.28; 95% CI, 2.60–10.74; p

Abstract Background The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), influenza A, and respiratory syncytial virus (RSV) infections have similar modes of transmission and clinical symptoms. There is a need to identify simple diagnostic indicators to distinguish these three infections, particularly for community hospitals and low- and middle-income countries that lack nucleic acid detection kits. This study used clinical data to assess the diagnostic value of routine blood tests in differentiating between SARS-CoV-2, influenza A, and RSV infections in children. Methods A total of 1420 children treated at the Hangzhou Children’s Hospital between December 2022 and June 2023 were enrolled in this study, of whom 351 had SARS-CoV-2, 671 had influenza, and 398 had RSV. In addition, 243 healthy children were also collected. The blood test results of SARS-CoV-2 patients were compared to those of patients with influenza A and RSV and the healthy controls. The area under the receiver operating characteristic curve (AUC-ROC) was employed to evaluate each blood parameter’s diagnostic value. Results Children with SARS-CoV-2 exhibited notably elevated levels of white blood cell (WBC) count, platelet (PLT) count, neutrophil count, and neutrophil-to-lymphocyte ratio (NLR) compared to influenza A patients (P

Abstract Background Prenatal exposure to the Zika virus can lead to microcephaly and adverse developmental outcomes, even in children without evident birth defects. The social environment plays a crucial role in infant health and developmental trajectories, especially during periods of heightened brain plasticity. The study aimed to assess socioenvironmental factors as predictors of developmental outcomes of 36-month-old children exposed to Zika virus prenatally. Study design This cross-sectional study included 53 mothers and 55 children enrolled in the Pediatric Outcomes of Prenatal Zika Exposure cohort study in Puerto Rico. The study performs follow-up developmental assessments of children born to mothers with confirmed and probable Zika virus infection during pregnancy. Mothers completed socioenvironmental questionnaires (e.g., Perceived Neighborhood Scale and US Household Food Insecurity Survey). Children’s developmental outcomes were assessed with the Bayley Scales of Infant and Toddler Development: Third Edition, the Ages and Stages Questionnaires: Third Edition, the Ages and Stages Questionnaire-Socioemotional: Second Edition, and the Child Adjustment and Parent Efficacy Scale. Results Linear regression models, adjusting for a child’s sex and age and maternal education, revealed that early life exposure to food insecurity and maternal pregnancy stressors were significantly associated with poorer developmental outcomes in Zika virus-exposed children at 36 months of age. Maternal resilience representation of adaptive ability was associated with the preservation of adequate developmental outcomes in children. Conclusions Pregnancy and early childhood are critical life periods for ensuring optimal brain development in children. While the mechanisms in the interaction of children with their environment are complex, the risk and protective factors identified in the study are modifiable through public policy and preventive initiatives. Implementation of comprehensive strategies that improve access to social support programs, educational and nutritional interventions, and mental health services during pregnancy and early childhood can enhance the developmental potential of vulnerable children.

Abstract Background Children with obesity have low 25 hydroxy-vitamin D (25-OH-D3) levels compared to lean children. Recommendations on when to start vitamin D supplementation differ largely between countries. Longitudinal data on 25-OH-D3 levels to guide treatment decisions are scarce since they are largely influenced by solar radiation and are difficult to compare. Methods We carried out a retrospective analysis of multiple 25-OH-D3 and parathyroid hormone (PTH) measurements in a cohort of 543 patients without vitamin D supplementation. All measurements were taken at the local paediatric obesity clinic as documented in the German-Austrian-Swiss APV (Prospective Documentation of Overweight Children and Adolescents) registry from 2009 to 2019. Serial 25-OH-D3 and PTH levels were adjusted for sunshine duration over the last 30 days to account for seasonal variation, as well as for sex and body mass index (BMI). We further performed an exploratory analysis of the association of sunshine duration, sex, BMI SDS (standard deviation score), abnormal lipid levels or dysglycemia with the 25-OH-D3 trend. Results 229 obese patients (mean BMI SDS: 2,58 (± 0,56), 53% females, mean age: 12 (± 3) years, range: 2–21 years) with two, 115 with three and 96 with four repeated 25-OH-D3 measurements were identified. Mean adjusted 25-OH-D3 (48.2 nmol/l) and PTH (34.9 ng/l) levels remained stable over 120 weeks. 5% of the patients had an elevated PTH > 65 ng/l. High total cholesterol ≥ 200 mg/dl and high triglycerides ≥ 130 mg/dl were associated with higher 25-OH-D3 levels. Conclusion We propose a simple method to include sunshine duration in the analysis of 25-OH-D3 levels to minimise the bias of seasonal variation. Based on our data we established the pragmatic strategy of limiting vitamin D supplementation to patients with biochemical signs of mineralisation disorders such as elevated PTH and alkaline phosphatase (AP). In children with normal PTH and AP we recommend adjustment of calcium intake and increase of outdoor activity instead.

Abstract Background Febrile seizures (FS) are the most common seizure disorder in children and a common neurologic complication in children with coronavirus disease 2019 (COVID-19). This study aimed to identify differences in clinical characteristics and disease burden between FS with and without COVID-19. Materials and methods We conducted a retrospective analysis of medical data at our hospital from December 2019 to July 2023, focusing on hospitalized patients under the age of 14 diagnosed with FS who underwent COVID-19 polymerase chain reaction (PCR) testing. Descriptive statistics and analysis of variance were employed to compare the COVID-19 and non-COVID-19 groups in terms of clinical characteristics and disease burden. Results A total of 514 patients were included, with 106 testing positive for COVID-19 and 408 testing negative. Patients with COVID-19 were older (34.87 ± 6.16 vs. 28.61 ± 11.35 months, P

Mitiku Desalegn,1 Tewoderos Shitemaw,2 Mesfin Tesfaye,3 Genanew Kassie Getahun3 1Department of Anesthesia, College of Medicine and Health Science, Wachemo University, Hossana, Ethiopia; 2Menelik II Medical and Health Science College, Addis Ababa, Ethiopia; 3Department of Public Health, Menelik II Medical and Health Science College, Addis Ababa, EthiopiaCorrespondence: Mitiku Desalegn, Email mitikudesalegn44@gmail.comBackground: The causes of virological failure are poorly recognized and investigated. This study aimed to identify determinant factors of viral failure in children taking first-line ART at a randomly selected federal hospital in Addis Ababa, Ethiopia.Methods: A facility-based unmatched case–control study was carried out from May 10, 2022, to July 20, 2022, G.C. among HIV-infected children on first-line antiretroviral therapy. There were 209 HIV-positive youngsters in the study’s overall sample size, comprising 53 cases and 156 controls. Data was gathered by chart review using an organized checklist in English. The data were entered using Epi-data 4.2 and exported into SPSS version 24 for analysis. The relationship between each explanatory variable and the result variable was described using both bivariate and multivariate analysis. An adjusted odds ratio with 95% confidence intervals was conducted, and a p-value < 0.05 was considered statistically significant.Results: Being male (AOR= 4.504; 95% CI: 1.498, 13.539), duration on ART exceeding 47 months (AOR=40.6; 95% CI:9.571,172.222), fair and poor drug adherence (AOR=16.348; 95% CI:4.690,56.990), missed clinical appointments (AOR = 3.177; 95% CI: 1.100– 9.174), and baseline WHO clinical stage 4 disease (AOR = 6.852; 95% CI: 1.540– 30.49) were associated with an increased risk of virological failure. Conversely, a history of drug change and a CD4 count ranging from 250 to 500 cells/mm3 were significantly protective factors (AOR = 0.071; 95% CI: 0.024– 0.214 and AOR=0.118; 95% CI: 0.030, 0.464, respectively).Conclusion: Being male, duration on ART > 47 months, fair and poor adherence, missed clinical appointments, and baseline WHO Stage 4 are factors that increase the odds of virological failure. History of ART Drug change and a CD4 count between 250 and 500 cells/mm3 are factors that decrease the odds of virological failure.Keywords: retrospective, virological failure, antiretroviral therapy, children, Ethiopia

Abstract Purpose Human adenoviruses (HAdVs) have always been suggested as one of the main causes of gastroenteritis in children. However, no comprehensive report on the global epidemiology of these viruses in pediatric gastroenteritis is available. Methods A systematic search was conducted to obtain published papers from 2003 to 2023 in three main databases PubMed, Scopus, and Web of Science. Results The estimated global pooled prevalence of HAdV infection in children with gastroenteritis was 10% (95% CI: 9-11%), with a growing trend after 2010. The highest prevalence was observed in Africa (20%, 95% CI: 14–26%). The prevalence was higher in inpatients (11%; 95% CI: 8-13%) and patients aged 5 years old and younger (9%; 95% CI: 7-10%). However, no significant difference was observed between male and female patients (P = 0.63). The most prevalent species was found to be the species F (57%; 95% CI: 41-72%). The most common HAdVs observed in children with gastroenteritis were types 40/41, 38, and 2. Analysis of case-control studies showed an association between HAdV and gastroenteritis in children (OR: 2.28, 95% CI; 1.51–3.44). Conclusion This study provided valuable insights into the importance of HAdVs in children with gastroenteritis, especially in hospitalized and younger children. The results can be used in future preventive measurements and the development of effective vaccines.

Abstract Background Ultrasound (US) is often the first method used to look for brain or cerebrospinal fluid (CSF) space pathologies. Knowledge of normal CSF width values is essential. Most of the available US normative values were established over 20 years ago, were obtained with older equipment, and cover only part of the age spectrum that can be examined by cranial US. This prospective study aimed to determine the normative values of the widths of the subarachnoid and internal CSF spaces (craniocortical, minimal and maximal interhemispheric, interventricular, and frontal horn) for high-resolution linear US probes in neurologically healthy infants and children aged 0–19 months and assess whether subdural fluid collections can be delineated. Methods Two radiologists measured the width of the CSF spaces with a conventional linear probe and an ultralight hockey-stick probe in neurologically healthy children not referred for cranial or spinal US. Results This study included 359 neurologically healthy children (nboys = 178, 49.6%; ngirls = 181, 50.4%) with a median age of 46.0 days and a range of 1–599 days. We constructed prediction plots, including the 5th, 50th, and 95th percentiles, and an interactive spreadsheet to calculate normative values for individual patients. The measurements of the two probes and the left and right sides did not differ, eliminating the need for separate normative values. No subdural fluid collection was detected. Conclusion Normative values for the widths of the subarachnoid space and the internal CSF spaces are useful for evaluating intracranial pathology, especially when determining whether an increase in the subarachnoid space width is abnormal.

Abstract Background Alcohol consumption by children and adolescents is receiving increasing attention. It may cause dyslipidemia, a risk factor for cardiovascular disease. However, the association between alcohol consumption and blood lipids in children and adolescents is unclear, and so we aimed to characterize this association. Methods Data from the China Health and Nutrition Survey were extracted from children and adolescents aged 7–18 years for whom information was available on alcohol consumption. The population was divided into drinking and nondrinking groups. The χ2, Student’s t, or Mann–Whitney U test was used to compare groups. Univariate and multivariate linear regression and propensity score matching (PSM) analysis were used to identify the association between alcohol consumption and blood lipids. Results This study included 408 children and adolescents with 35 drinkers and 373 nondrinkers. The drinkers had significantly lower values of total cholesterol (TC) (3.8 mmol/L for nondrinkers versus 3.5 mmol/L for drinkers, p = 0.002) and high-density lipoprotein cholesterol (HDL-C) (1.3 mmol/L for nondrinkers versus 1.2 mmol/L for drinkers, p = 0.007), but not for low-density lipoprotein cholesterol (LDL-C) (2.1 mmol/L for nondrinkers versus 2.0 mmol/L for drinkers, p = 0.092) or triglyceride (TG) (0.9 mmol/L for nondrinkers versus 0.8 mmol/L for drinkers, p = 0.21). The univariate and multivariate analyses led to the same conclusions. After PSM there was still a significant negative association between alcohol consumption and TC or HDL-C. Conclusion Alcohol consumption in children and adolescents exhibited significant negative associated with TC and HDL-C, but not with LDL-C or TG. These findings need to be confirmed in future prospective research, and the health effects of blood lipid changes caused by drinking in children and adolescents need to be clarified.

Abstract Background Diarrhea caused by Salmonella and Shigella species are the leading cause of illness especially in developing countries. These infections are considered as the main public health problems in children, including Ethiopia. This study aimed to assess the prevalence, associated factors, and antimicrobial susceptibility patterns of Salmonella and Shigella species in Sheik Hassan Yabere Referral Hospital Jigjiga, Eastern Ethiopia from August 05 to November 15, 2022. Method A cross-sectional study was conducted among 239 under-five children with diarrhea selected through a convenient sampling technique. A structured questionnaire was used to collect associated factors. A stool sample was collected and processed for the identification of Salmonella and Shigella species using MacConkey adar, Xylose Lysine Deoxycholate agar (Oxoid Ltd) and Biochemical tests. The antimicrobial susceptibility pattern of isolates was performed using the Kirby-Bauer disc diffusion technique. The data was entered into Epi-data version 4.6 and exported to the statistical package of social science version 22 for analysis. The association between outcome and independent variables was assessed using bivariate, multivariable, and chi-square and P-value

Abstract Background The impact of inadequate empirical antibiotic treatment on patient outcomes and hospitalization duration for non-life-threatening infections in children remains poorly understood. We aimed to assess the effects of inadequate empirical antibiotic treatment on these factors in pediatric patients. Methods The medical records of children admitted for infectious diseases with bacteria isolated from sterile sites between 2018 and 2020 were retrospectively reviewed. Patients who received adequate empirical treatment were compared with those who received inadequate treatment in terms of demographic, clinical, and laboratory variables. Results Forty-eight patients who received inadequate empirical antimicrobial treatment were compared to 143 patients who received adequate empirical treatment. Inadequate empirical antimicrobial treatment did not significantly affect the length of hospital stay or the incidence of complications in non-critically ill children with bacterial infections. Younger age and underlying renal abnormalities were identified as risk factors for inadequate antimicrobial treatment, while associated bacteremia was more common in the adequate antimicrobial treatment group. Conclusions inadequate antibiotic treatment did not affect the outcomes of non-critically ill children with bacterial infectious diseases. Therefore, routine empirical broad-spectrum treatment may not be necessary for these cases, as it can lead to additional costs and contribute to antibiotic resistance. Larger prospective studies are needed to confirm these findings.

Abstract Introduction Diarrhea is a common public health problem and the third leading cause of death in the world among children under the age of five years. An estimated 2 billion cases and 1.9 million deaths are recorded among children under the age of five years every year. It causes body fluid loss and electrolyte imbalance. Even though, early initiation of recommended homemade fluid is a simple and effective approach to prevent diarrhea-related complications and mortality of children, recommended homemade fluid utilization for the treatment of diarrhea is still low in sub-Saharan African countries. Therefore, this study aimed to assess the magnitude of recommended homemade fluid utilization for the treatment of diarrhea and associated factors among children under five in sub-Saharan African countries. Method The most recent Demographic and Health Survey dataset of 21 sub-Saharan African countries from 2015 to 2022 was used for data analysis. A total of 33,341 participants were included in this study as a weighted sample. Associated factors were determined using a multilevel mixed-effects logistic regression model. Significant factors in the multilevel mixed-effect logistic regression model were declared significant at p-values

Abstract Background Elimination disorder occurs in children over the age of normal toileting who continue to have an inability to control urination or feces, either during the day, at night, or both. Paediatric elimination disorders are not well understood by parents, teachers, medical professionals, mental health practitioners, and researchers. Hence, this study aimed to assess the magnitude of elimination disorder and associated factors among children and Adolescents aged 5–14 years old at Wolaita Sodo University Comprehensive Specialized Hospital, South Ethiopia, in 2022. Method A hospital-based cross-sectional study was conducted from September 22 to November 22, 2022, at Wolaita Sodo University Comprehensive Specialized Hospital. A systematic random sampling technique was employed to select 423 study subjects. The data were gathered using a structured, face-to-face interviewer-administered questionnaire. The development of the symptom score for dysfunctional elimination syndrome of Vancouver questionnaires was used to screen for elimination disorders. Logistic regression model was used to determine the association between the outcome and independent variables. A 95% CI and Odds ratio with corresponding p-value

Abstract Background Multisystem inflammatory syndrome in children (MIS-C) shows a significant overlap of symptoms with other hyper-inflammatory diseases such as Kawasaki disease (KD), but the real difference of the two conditions is still matter of debate. Coronary artery lesions (CAL) are the most relevant complication in KD. Nonetheless, CAL, myocarditis, pericarditis, arrhythmia are the main cardiovascular complications in MIS-C. A close clinical assessment is mandatory, both at the diagnosis and during the follow-up, by ECG and echocardiography. Cardiac magnetic resonance (MRI) adds important data to ultrasound findings. However, cardiac MRI studies in MIS-C are limited to a small number of cohorts. Methods We enrolled 20 children (age:1–16 years; 11 F; 9 M) with cardiac involvement secondary to MIS-C, all evaluated by cardiac MRI. Results 8 children showed pathological cardiac MRI: 2 showed pericardial effusion; 2 showed myocardial oedema; 1 showed aortic insufficiency; 3 showed delayed enhancement (one for acute myocarditis with oedema; 2 for myocardial fibrosis). Delayed enhancement was reduced significantly 5.6-9 months after the first MRI evaluation. 25% of patients with pathological MRI had CAL associated with valvular insufficiency of 2 valves. 17% of patients with normal MRI had CAL, associated with valvular insufficiency of 1 valve in 1 patient. The correlations between haematological, clinical, cardiologic parameters, treatment, did not reach the statistical significance. 4 patients were treated with anakinra. Among those, 2 patients showed a normal cardiac MRI. Cardiac lesions resolved in all the patients during the follow-up. Some patients with pathological cardiac MRI could not underwent a control with MRI, for the low compliance. However, echocardiography and ECG, documented the resolution of the pathological data in these cases. Conclusions A higher risk of CAL was documented in patients with an association of other cardiac lesions. Cardiac MRI is difficult to perform routinely; however, it is useful for evaluating the acute myocardial damage and the outcome of patients with MIS-C.

Abstract Background Cough variant asthma (CVA) is one of the most common causes of chronic cough in children worldwide. The diagnosis of CVA in children remains challenging. This study aimed to assess the diagnostic utility of impulse oscillometry (IOS) pulmonary function in children with CVA. Methods This study included children aged 4 to 12 years diagnosed with CVA who underwent IOS pulmonary function and bronchodilation (BD) tests. A control group of healthy children was matched. Pre- and post-BD IOS parameters were recorded and presented as mean ± standard deviation or median. Receiver operating characteristic (ROC) curves were plotted, and the area under the curve (AUC) was calculated to evaluate the discriminatory potential of the IOS parameters for diagnosing CVA. Results A total of 180 patients with CVA and 65 control subjects were included. The baseline IOS parameters in the CVA group, except X5%pred, were significantly greater compared to the control group. After inhalation of salbutamol sulfate, all IOS parameters improved significantly in the CVA group. However, Z5%pred, R5%pred, and R20%pred remained greater in the CVA group compared to the control group. The improvement rates of IOS parameters in the CVA group significantly surpassed those in the control group. The ROC curve results for pre-BD IOS parameters and the improvement rate during the BD test showed that the combinations of pre-Z5%pred+△Z5% and pre-R5%pred+△R5% achieved the highest AUC value of 0.920 and 0.898, respectively. The AUC values of these combined parameters surpassed those of individual ones. Conclusions This study highlights that children with CVA exhibit greater IOS parameters compared to healthy children. The changes in IOS parameters during the BD test provided valuable diagnostic information for CVA, and the combination of various parameters can help pediatricians accurately identify CVA in children.

Abstract Background Parents/caregivers of children with developmental disabilities (CDD) have a wide range of support needs and there are various interventions available. Support, challenges, and needs among parents/caregivers of CDD likely vary in different geographical settings. This study aimed to analyze the perceptions of support, challenges, and needs among parents/caregivers of CDD in Croatia, North Macedonia, and Serbia. Methods We conducted a cross-sectional study in March-April 2023 within the Erasmus + SynergyEd project. The eligible participants were parents and caregivers of CDD in Croatia, North Macedonia, and Serbia, who filled out a modified Caregiver Needs Survey online. Results Among 953 participants, 542 (57%) were from Croatia, 205 (21%) were from North Macedonia and 206 (22%) were from Serbia. The most common diagnosis of participants’ children was autism spectrum disorder (26%). The child most often received the first diagnosis at the median of 2 years, diagnosed by a team of professionals. More than half (58%) of children attended preschool and public school, while 22% did not attend any schooling. Additional support from the state/city/county was received by 66% of CDD. Most participants declared not participating in association/organization for family support. Participants mostly (68%) used experts who work with the child as a source of information about their child’s condition, followed by the Internet (53%). In the last 12 months, 60% of participants had difficulties with the availability of services in their area or problems getting appointments. The biggest problem in getting support was ensuring the child’s basic rights were protected. Participants stated that ensuring greater rights for CDD was the greatest need for their families. Conclusion Parents/caregivers of CDD in Croatia, North Macedonia, and Serbia faced multiple challenges, but most of them were satisfied with the services provided to their children. Future efforts to develop policies and services related to CDD should consider the opinions of their parents/caregivers and disparities in access to services.