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Children, Volume 8, Issue 7 (July 2021) – 87 articles

Cover Story (view full-size image): Early childhood is recognized as a critical period for the development of foundational movement skills (FMS). Play is suggested to be an important context for child development and FMS. Many young children spend a significant amount of time in early childhood education settings (preschool). At preschool, children can access free play through several recess periods each day. This study sought to examine the association between play behaviors during preschool recess and FMS. The findings suggest that the type of play behaviors young children engage in during recess are associated with FMS, with more time spent in active games without equipment associated with higher total and locomotor FMS scores. View this paper
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Article
PlA2 Polymorphism of Platelet Glycoprotein IIb/IIIa and C677T Polymorphism of Methylenetetrahydrofolate Reductase (MTHFR), but Not Factor V Leiden and Prothrombin G20210A Polymorphisms, Are Associated with More Severe Forms of Legg–Calvé–Perthes Disease
Children 2021, 8(7), 614; https://0-doi-org.brum.beds.ac.uk/10.3390/children8070614 - 20 Jul 2021
Viewed by 176
Abstract
The possible association of common polymorphic variants related to thrombophilia (the rs6025(A) allele encoding the Leiden mutation, rs1799963(A), i.e., the G20210A mutation of the prothrombin F2 gene, the rs1801133(T) variant of the methylenetetrahydrofolate reductase (MTHFR) gene that encodes an enzyme involved in [...] Read more.
The possible association of common polymorphic variants related to thrombophilia (the rs6025(A) allele encoding the Leiden mutation, rs1799963(A), i.e., the G20210A mutation of the prothrombin F2 gene, the rs1801133(T) variant of the methylenetetrahydrofolate reductase (MTHFR) gene that encodes an enzyme involved in folate metabolism, and rs5918(C), i.e., the ‘A2’ allele of the platelet-specific alloantigen system that increases platelet aggregation induced by agonists), with the risk of Legg–Calvé–Perthes disease (LCPD) and the degree of hip involvement (Catterall stages I to IV) was analyzed in a cohort study, including 41 children of ages 2 to 10.9 (mean 5.4, SD 2.2), on the basis of clinical and radiological criteria of LCPD. In 10 of the cases, hip involvement was bilateral; thus, a total of 51 hips were followed-up for a mean of 75.5 months. The distribution of genotypes among patients and 118 controls showed no significant differences, with a slightly increased risk for LCPD in rs6025(A) carriers (OR: 2.9, CI: 0.2–47.8). Regarding the severity of LCPD based on Catterall classification, the rs1801133(T) variant of the MTHFR gene and the rs5918(C) variant of the platelet glycoprotein IIb/IIIa were associated with more severe forms of Perthes disease (Catterall III–IV) (p < 0.05). The four children homozygous for mutated MTHFR had a severe form of the disease (Stage IV of Catterall) and a higher risk of non-favorable outcome (Stulberg IV–V). Full article
(This article belongs to the Special Issue Lower Limb Diseases and Injuries in Children and Adolescents)
Article
Airway Malacia: Clinical Features and Surgical Related Issues, a Ten-Year Experience from a Tertiary Pediatric Hospital
Children 2021, 8(7), 613; https://0-doi-org.brum.beds.ac.uk/10.3390/children8070613 - 20 Jul 2021
Viewed by 167
Abstract
Background: Few studies have been carried out with the aim of describing the clinical course and follow-up of patients with tracheomalacia. We aim to describe the symptoms at diagnosis and the post-treatment clinical course of patients affected by airway malacia. Methods: We retrospectively [...] Read more.
Background: Few studies have been carried out with the aim of describing the clinical course and follow-up of patients with tracheomalacia. We aim to describe the symptoms at diagnosis and the post-treatment clinical course of patients affected by airway malacia. Methods: We retrospectively analyzed characteristics of pediatric patients with a diagnosis of airway malacia. Patients were classified into three groups: bronchomalacia (BM), tracheomalacia (TM) and tracheo-bronchomalacia (TBM). Demographic and clinical data, diagnostic work-up and surgical treatment were recorded. Results: 13/42 patients were affected by congenital syndromes (30.9%). Esophageal atresia with or without tracheal-esophageal fistula (EA/TEF) was detected in 7/42 patients (16.7%). Cardiovascular anomalies were found in 9/42 (21.4%) and idiopathic forms in 13/42 (30.9%). BM occurred in 7/42 (16.6%), TM in 23/42 (54.7%) and TBM in 12/42 (28.6%). At the diagnosis stage, a chronic cough was reported in 50% of cases with a higher prevalence in EA/TEF (p = 0.005). Surgery was performed in 16/42 (40%) of children. A chronic cough and acute respiratory failure were correlated to the need for surgery. During follow-up, there was no difference in persistence of symptoms between conservative vs surgical treatment (p = 0.47). Conclusion: the management of tracheomalacia remains a challenge for pediatricians. Clinical manifestations, such as a barking cough and acute respiratory failure may suggest the need for surgery. Follow-up is crucial, especially in those patients affected by comorbidities, so as to be able to manage effectively the possible persistence of symptoms, including those that may continue after surgical treatment. Full article
(This article belongs to the Special Issue Child Health and Surgery)
Article
Vitamin D Insufficiency Prior to Paediatric Liver Transplantation Is Associated with Early T-Cell Mediated Rejection
Children 2021, 8(7), 612; https://0-doi-org.brum.beds.ac.uk/10.3390/children8070612 - 20 Jul 2021
Viewed by 194
Abstract
Objectives: T-cell mediated rejection (TCMR) can compromise long-term liver allograft survival. The immunomodulatory properties of vitamin D are increasingly recognized. We investigated whether perturbations in vitamin D metabolism prior to LT may predispose to TCMR in a representative cohort of paediatric LT [...] Read more.
Objectives: T-cell mediated rejection (TCMR) can compromise long-term liver allograft survival. The immunomodulatory properties of vitamin D are increasingly recognized. We investigated whether perturbations in vitamin D metabolism prior to LT may predispose to TCMR in a representative cohort of paediatric LT recipients. Methods: In this retrospective single-center study of children who underwent liver transplantation between 2005 and 2017, we collected serum 25(OH) vitamin D levels and other parameters related to vitamin D metabolism. Post-transplant variables were collected from medical records during the first year following LT. Results: Eighty-two patients were included. Twenty-six (32%) developed TCMR, 52 (65%) presented at least one event of 25(OH) D insufficiency during the year before the transplant, while 23 (32%) had at least one documented elevated plasma parathyroid hormone level. Forty-six patients benefited from nutritional support (56%). The development of TCMR was associated with vitamin D insufficiency pre-LT (p = 0.01). No significant correlations were identified between PTH levels and incidence of TCMR. The association was stronger in patients transplanted for cholestatic diseases (p = 0.004). Conclusions: Vitamin D insufficiency before a liver transplant may be associated with TCMR during the first year post-LT. These findings warrant further investigation. Full article
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Article
Evaluation of the Erosive and Cariogenic Potential of Over-the-Counter Pediatric Liquid Analgesics and Antipyretics
Children 2021, 8(7), 611; https://0-doi-org.brum.beds.ac.uk/10.3390/children8070611 - 19 Jul 2021
Viewed by 173
Abstract
To evaluate the cariogenic and erosive potentials of over-the-counter pediatric oral liquid antipyretics and analgesics, we tested nine over-the-counter pediatric oral liquid medications classified as antipyretic or analgesic medicines available in Korea. For each substance, we measured the pH with a pH meter [...] Read more.
To evaluate the cariogenic and erosive potentials of over-the-counter pediatric oral liquid antipyretics and analgesics, we tested nine over-the-counter pediatric oral liquid medications classified as antipyretic or analgesic medicines available in Korea. For each substance, we measured the pH with a pH meter and the sugar content with a sugar content meter. We determined the titratable acidity (TA) levels based on the volumes of NaOH solution that had to be added to reach a pH of 7.0. We also evaluated the dental erosion potentials with an International Organization for Standardization method based on observing changes in the pH of a CaPO4 solution upon introducing a small volume of the solution to be tested. The oral liquid medications had pH values of 3.40–5.68. In the TA assessments, several oral liquid medications required greater volumes of NaOH solution to reach a pH of 7.0. The dental erosion potentials varied but correlated strongly with the NaOH volumes needed to reach a neutral pH (r = 0.84; p < 0.0001). Many oral liquid antipyretics and analgesics have features that can promote dental erosion. A correct understanding of pediatric antipyretics and analgesics is required in dentistry for children’s oral health. Full article
(This article belongs to the Special Issue Oral Health Promotion in Paediatric Population)
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Article
Effects on Recovery of Pediatric Patients Undergoing Total Intravenous Anesthesia with Propofol versus Ketofol for Short—Lasting Laparoscopic Procedures
Children 2021, 8(7), 610; https://0-doi-org.brum.beds.ac.uk/10.3390/children8070610 - 19 Jul 2021
Viewed by 288
Abstract
Background: Combining ketamine and propofol (ketofol) was suggested as a new concept for sedation and general anesthesia in pediatric populations for various conditions. The aim of the present study was to determine the effect of total intravenous anesthesia (TIVA) with propofol and ketofol [...] Read more.
Background: Combining ketamine and propofol (ketofol) was suggested as a new concept for sedation and general anesthesia in pediatric populations for various conditions. The aim of the present study was to determine the effect of total intravenous anesthesia (TIVA) with propofol and ketofol on recovery after laparoscopic surgery in pediatric patients. Methods: Two hundred children with median age of 5 years who underwent laparoscopic surgery were randomized into two groups. Propofol 1% was used for induction and maintenance of anesthesia in group I, while ketamine-propofol combination (ketofol) was used in group II. Ketamine-propofol combination (ketofol) was prepared in the same applicator for group II. Ketofol ratios of 1:4 and 1:7 were used for induction and maintenance of anesthesia, respectively. A reduced McFarlan infusion dose was used in group I (1.2, 1.0, and 0.8 mL/kg/h for 15, 15, and 30 min, respectively), while a McFarlan infusion dose was used in group II (1.5, 1.3, and 1.1 mL/kg/h for 15, 15, and 30 min, respectively). Extubating time, duration of anesthesia, and length of stay in post-anesthesia care unit (PACU) were recorded. Results: Extubating time was significantly lower in the ketofol group than in the propofol group (240 s vs. 530 s; p < 0.00001). Significantly shorter duration of anesthesia (47 min vs. 60 min; p < 0.00001) as well as length of stay in the PACU (35 min vs. 100 min; p < 0.00001) were recorded in ketofol compared to the propofol group. Total fentanyl (100 µg (interquartile range, IQR 80, 125) vs. 50 µg (IQR 40, 60); p < 0.00001) and propofol (260 mg (IQR 200, 350) vs. 160 mg (IQR 120, 210); p < 0.00001) consumption per body weight were significantly lower in the ketofol group. Conclusions: TIVA with ketamine-propofol combination (ketofol) using a reduced McFarlan dose regimen shortened extubating time, duration of anesthesia, as well as length of stay in the PACU in pediatric anesthesia after laparoscopic surgery. Full article
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Review
Neglecting Maternal Depression Compromises Child Health and Development Outcomes, and Violates Children’s Rights in South Africa
Children 2021, 8(7), 609; https://0-doi-org.brum.beds.ac.uk/10.3390/children8070609 - 19 Jul 2021
Viewed by 234
Abstract
The intention of the South African Children’s Act 38 of 2005 is to provide guarantees for the protection and promotion of optimum health and social outcomes for all children. These guarantees are the provision of basic nutrition, basic health care and social services, [...] Read more.
The intention of the South African Children’s Act 38 of 2005 is to provide guarantees for the protection and promotion of optimum health and social outcomes for all children. These guarantees are the provision of basic nutrition, basic health care and social services, optimal family or parental care, as well as protection from maltreatment, neglect and abuse services. However, despite these guarantees, child and maternal mortality remain high in South Africa. The literature identifies maternal depression as a common factor that contributes to negative health and social outcomes for both mothers and their children. Despite the availability of easy-to-use tools, routine screening for maternal depression is not carried out in public health services, which is the source of services for the majority of women in South Africa. The results are that the mothers miss out on being diagnosed and treated for maternal depression, which results in negative child outcomes, such as malnutrition, as well as impacts on mental, social and physical health, and even death. The long-term impacts of untreated maternal depression include compromised child cognitive development, language acquisition and deviant behaviors and economic disadvantage in later life. The author concludes that the neglect of screening for, and treatment of maternal depression therefore violates the constitutional rights of the affected children, and goes against the spirit of the Constitution. The author recommends that maternal and child health services integrate routine screening for maternal depression, which will not only satisfy the Constitutional mandate, but also improve the health and developmental outcomes of the children and reduce child mortality. Full article
(This article belongs to the Section Global and Public Health)
Editorial
The Epidemic of Obesity in a Pandemic Era: Urgency to Invest in Adolescent Health
Children 2021, 8(7), 608; https://0-doi-org.brum.beds.ac.uk/10.3390/children8070608 - 19 Jul 2021
Viewed by 227
Abstract
In September 2015, United Nations’ 193 member states signed up to the Sustainable Development Goals (SDGs) of the global development agenda 2030 [...] Full article
(This article belongs to the Special Issue Childhood and Adolescent Obesity and Weight Management)
Review
Myocarditis and Pericarditis Following mRNA COVID-19 Vaccination: What Do We Know So Far?
Children 2021, 8(7), 607; https://0-doi-org.brum.beds.ac.uk/10.3390/children8070607 - 18 Jul 2021
Viewed by 331
Abstract
This is a cross-sectional study of 29 published cases of acute myopericarditis following COVID-19 mRNA vaccination. The most common presentation was chest pain within 1–5 days after the second dose of mRNA COVID-19 vaccination. All patients had an elevated troponin. Cardiac magnetic resonance [...] Read more.
This is a cross-sectional study of 29 published cases of acute myopericarditis following COVID-19 mRNA vaccination. The most common presentation was chest pain within 1–5 days after the second dose of mRNA COVID-19 vaccination. All patients had an elevated troponin. Cardiac magnetic resonance imaging revealed late gadolinium enhancement consistent with myocarditis in 69% of cases. All patients recovered clinically rapidly within 1–3 weeks. Most patients were treated with non-steroidal anti-inflammatory drugs for symptomatic relief, and 4 received intravenous immune globulin and corticosteroids. We speculate a possible causal relationship between vaccine administration and myocarditis. The data from our analysis confirms that all myocarditis and pericarditis cases are mild and resolve within a few days to few weeks. The bottom line is that the risk of cardiac complications among children and adults due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection far exceeds the minimal and rare risks of vaccination-related transient myocardial or pericardial inflammation. Full article
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Article
Transnasal Sphenopalatine Ganglion Block for the Preventive Treatment of Chronic Daily Headache in Adolescents
Children 2021, 8(7), 606; https://doi.org/10.3390/children8070606 - 18 Jul 2021
Viewed by 188
Abstract
Chronic headaches are a major source of morbidity in the pediatric population, affecting physical function, school attendance, social capacity, mood, and sleep. In adults, repetitive sphenopalatine ganglion (SPG) blockade has been studied as a preventive treatment for chronic migraines. This case series aims [...] Read more.
Chronic headaches are a major source of morbidity in the pediatric population, affecting physical function, school attendance, social capacity, mood, and sleep. In adults, repetitive sphenopalatine ganglion (SPG) blockade has been studied as a preventive treatment for chronic migraines. This case series aims to evaluate the SPG block for the preventive treatment of chronic daily headache (CDH) in adolescents. We prospectively evaluated 17 adolescents (14 females, 14 ± 1 year) with CDH not responding to cognitive behavioral therapy (CBT), physiotherapy, and standard medications. Each patient received 10 SPG blocks (two blocks/week) using the Tx360® device. At the end of treatment, 10 patients (59%) reported a Patient’s Global Impression of Change (PGIC) score ≥ 67%, and 3 months after the end of treatment, nine patients (53%) sustained a PGIC ≥ 67%. There was also a statistically significant reduction in the depression subscale of the Revised Children’s Anxiety and Depression Scale (RCADS) at the end of treatment and 3 months post-treatment compared with baseline. The procedure was well tolerated with no adverse effects. In our study, the use of repeat SPG blockade was associated with sustained benefits on the PGIC and the depression subscale of the RCADS when used as preventive headache treatment in adolescents with refractory CDH. Full article
(This article belongs to the Section Child Neurology)
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Article
Parental Response to Only Children: Breaking the Stereotypes
Children 2021, 8(7), 605; https://0-doi-org.brum.beds.ac.uk/10.3390/children8070605 - 17 Jul 2021
Viewed by 313
Abstract
While much has been written about the relationship between only child status and parents’ behavior toward children, and consequent personality and intelligence, little is known about the relationship between only child status, parental response to illness, and subsequent child illness behavior. In this [...] Read more.
While much has been written about the relationship between only child status and parents’ behavior toward children, and consequent personality and intelligence, little is known about the relationship between only child status, parental response to illness, and subsequent child illness behavior. In this study, 227 mothers of 342 children completed measures designed to assess: (a) their children’s school attendance, (b) their own psychological status, and (c) their own responses to their children’s expressions of stomach pain. Parents of only children were more likely to minimize their children’s gastrointestinal symptoms than were parents of children with at least one sibling. In addition, only children were less likely to miss school. Parental protectiveness did not differ as a function of only child status. These findings are somewhat discrepant with commonly held beliefs about parents’ patterns of responding to only children. Full article
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Article
Quality of Life Outcomes According to Differential Nusinersen Exposure in Pediatric Spinal Muscular Atrophy
Children 2021, 8(7), 604; https://0-doi-org.brum.beds.ac.uk/10.3390/children8070604 - 17 Jul 2021
Viewed by 197
Abstract
The purpose of this study was to explore early changes in patient and family caregiver report of quality of life and family impact during the transitional period of nusinersen use. Communication; family relationships; physical, emotional, social, and cognitive functioning; and daily activities were [...] Read more.
The purpose of this study was to explore early changes in patient and family caregiver report of quality of life and family impact during the transitional period of nusinersen use. Communication; family relationships; physical, emotional, social, and cognitive functioning; and daily activities were measured using Pediatric Quality of Life modules (Family Impact Modules and both Patient and Proxy Neuromuscular-Specific Reports) pre- and post-nusinersen exposure. A total of 35 patients with SMA (15 Type 1, 14 Type 2, and 6 Type 3) were grouped according to nusinersen exposure. When analyzed as a whole cross-sectional clinical population, no significant differences were found between the initial and final surveys. Nusinersen therapy was associated with improved communication and emotional functioning in subsets of the population, particularly for patients on maintenance therapy for longer duration. Several unexpected potentially negative findings including increases in family resources and trends towards increases in worry warrant further consideration. Further research is warranted to explore the impact of novel pharmaceuticals on quality of life for children with SMA longitudinally to optimize clinical and psychosocial outcomes. Full article
(This article belongs to the Special Issue Neuromuscular Disorders in Children and Adolescents)
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Case Report
ArtiSential® Articulated Wrist-Like Instruments and Their First Application in Pediatric Minimally Invasive Surgery: Case Reports and Literature Review of the Most Commonly Available Robot-Inspired Devices
Children 2021, 8(7), 603; https://0-doi-org.brum.beds.ac.uk/10.3390/children8070603 - 17 Jul 2021
Viewed by 274
Abstract
Background: Robotic surgery is currently a reality in surgical practice, and many endeavors have been made to extend its application also in pediatric surgery. In the absence of easy access to a robotic surgical system, new devices have been developed to offer a [...] Read more.
Background: Robotic surgery is currently a reality in surgical practice, and many endeavors have been made to extend its application also in pediatric surgery. In the absence of easy access to a robotic surgical system, new devices have been developed to offer a valid alternative such as wristed instruments. These differ from conventional laparoscopic instruments owing to a wrist-like mechanism at the tip, which faithfully reproduces the movements of the surgeon’s hands, regaining more movement’s degrees; Methods: We present two case reports in which the patients were subjected to minimally invasive procedures with aid of wristed instruments, followed by a review of the literature regarding the devices commonly marketed; Results: Articulated or wristed instruments render the same features seen in robotic surgery, such as major dexterity in smaller spaces, restitution of more natural movements and the ability to get over obstacles in a direct visual line. Our center recently equipped with ArtiSential® articulated instruments and so far, they have proven to be of great value; Conclusions: wristed instruments could represent a standpoint for surgeons wanting to benefit from the advantages of robotic surgery with a cost-sensitive perspective. Full article
(This article belongs to the Special Issue Minimally Invasive and Robotic Pediatric Surgery)
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Article
Needs Assessment for the Development of an Electronic Cross-Facility Health Record (ECHR) for Pediatric Palliative Care: A Design Thinking Approach
Children 2021, 8(7), 602; https://0-doi-org.brum.beds.ac.uk/10.3390/children8070602 - 16 Jul 2021
Viewed by 220
Abstract
Background: Pediatric palliative care (PPC) is characterized by years of multisectoral and multi-professional care. Sharing information between PPC professionals is, therefore, essential for quality care. The evidence shows that electronic cross-facility health records (ECHRs) provide useful support in this context. To our knowledge, [...] Read more.
Background: Pediatric palliative care (PPC) is characterized by years of multisectoral and multi-professional care. Sharing information between PPC professionals is, therefore, essential for quality care. The evidence shows that electronic cross-facility health records (ECHRs) provide useful support in this context. To our knowledge, no ECHRs have been developed through a user-centered approach for this specific setting in Germany. Methods: Guided by design thinking, first, qualitative interviews were conducted to assess the needs of PPC professionals. Second, the elicited needs were specified in focus groups (FGs). Based on the needs stated in the interviews, prototypes of the ECHR were developed and discussed in the FGs. The indicated needs were supplemented and specified in an iterative process. The prototypes were further adapted according to these results. The unified theory of acceptance and use of technology was the basic model in the evaluation of needs. Results: Across seven main categories, past and current medication, emergency view, and messaging functions were identified as the participants’ desired core components of an ECHR. Utilizing design thinking facilitated the explicit articulation of user needs. Conclusions: Developing an ECHR with the content identified would allow for real-time data during emergencies, tracking what other PPC professionals have done, and making the applied treatments visible to others. This would offer a broader picture of the complex conditions common to PPC. Full article
(This article belongs to the Special Issue Pediatric Palliative Care Update)
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Article
Two Approaches for a Genetic Analysis of Pompe Disease: A Literature Review of Patients with Pompe Disease and Analysis Based on Genomic Data from the General Population
Children 2021, 8(7), 601; https://0-doi-org.brum.beds.ac.uk/10.3390/children8070601 - 16 Jul 2021
Viewed by 194
Abstract
In this study, two different approaches were applied in the analysis of the GAA gene. One was analyzed based on patients with Pompe disease, and the other was analyzed based on GAA genomic data from unaffected carriers in a general population genetic database. [...] Read more.
In this study, two different approaches were applied in the analysis of the GAA gene. One was analyzed based on patients with Pompe disease, and the other was analyzed based on GAA genomic data from unaffected carriers in a general population genetic database. For this, GAA variants in Korean and Japanese patients reported in previous studies and in patients reported in the Pompe disease GAA variant database were analyzed as a model. In addition, GAA variants in the Korean Reference Genome Database (KRGDB), the Japanese Multi Omics Reference Panel (jMorp), and the Genome Aggregation Database (gnomAD) were analyzed. Overall, approximately 50% of the pathogenic or likely pathogenic variants (PLPVs) found in unaffected carriers were also found in real patients with Pompe disease (Koreans, 57.1%; Japanese, 46.2%). In addition, there was a moderate positive correlation (Spearman’s correlation coefficient of 0.45–0.69) between the proportion of certain PLPVs in patients and the minor allele frequency of their variants in a general population database. Based on the analysis of general population databases, the total carrier frequency for Pompe disease in Koreans and Japanese was estimated to be 1.7% and 0.7%, respectively, and the predicted genetic prevalence was 1:13,657 and 1:78,013, respectively. Full article
(This article belongs to the Special Issue Neuromuscular Disorders in Children and Adolescents)
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Article
Is ABO-Incompatible Living Donor Liver Transplantation Really a Good Alternative for Pediatric Recipients?
Children 2021, 8(7), 600; https://0-doi-org.brum.beds.ac.uk/10.3390/children8070600 - 16 Jul 2021
Viewed by 256
Abstract
Background: ABO-incompatible (ABOi) living donor liver transplantation (LDLT) has been proposed to compensate for donor shortage. To date, few studies have reported detailed ABOi LDLT results in large series of pediatric patients. C4d complement deposition in graft capillaries has been reported to be [...] Read more.
Background: ABO-incompatible (ABOi) living donor liver transplantation (LDLT) has been proposed to compensate for donor shortage. To date, few studies have reported detailed ABOi LDLT results in large series of pediatric patients. C4d complement deposition in graft capillaries has been reported to be associated with antibody-mediated rejection in solid organ transplantation. Methods: A retrospective case–control study was conducted, comparing clinical outcomes of each of 34 consecutive pediatric ABOi LDLT recipients with those of 2 non-ABOi pairs (n = 68), matched according to pre-transplant diagnostic criteria, age, and date of transplantation. In addition, we studied the C4d immunostaining pattern in 22 ABOi and in 36 non-ABOi recipients whose liver biopsy was performed within the first 4 post-transplant weeks for suspected acute rejection. Results: The incidence of biliary complications was higher in ABOi recipients (p < 0.05), as were the incidence of acute humoral rejection (p < 0.01) and the incidence of retransplantation (p < 0.05). All children who required retransplantation were older than 1 year at the time of ABOi LDLT. Positive C4d immunostaining was observed in 13/22 (59%) ABOi recipients versus 3/36 (8.3%) non-ABOi recipients (p < 0.0001). Conclusions: ABOi LDLT is a feasible option for pediatric end-stage liver disease but carries increased risks for the recipient, especially for children older than 1 year, even with a specific preparation protocol. C4d immunostaining may be a hallmark of acute humoral rejection in ABOi liver transplantation. Full article
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Article
Positive Rate of Tests for Group a Streptococcus and Viral Features in Children with Acute Pharyngitis
Children 2021, 8(7), 599; https://0-doi-org.brum.beds.ac.uk/10.3390/children8070599 - 16 Jul 2021
Viewed by 206
Abstract
Group A streptococcus (GAS) is an important cause of acute pharyngitis. We investigated the positive rate of GAS tests and clinical viral features in children with acute pharyngitis. A retrospective review was conducted for patients <15 years old with both rapid antigen detection [...] Read more.
Group A streptococcus (GAS) is an important cause of acute pharyngitis. We investigated the positive rate of GAS tests and clinical viral features in children with acute pharyngitis. A retrospective review was conducted for patients <15 years old with both rapid antigen detection test (RADT) and throat culture results. Patients were excluded if they were diagnosed with influenza or had received antibiotics within two weeks before these tests. A total of 377 patients were eligible. The median age of patients was 3.5 years, and 45.4% of total patients were <3 years old. Among all patients, 68.7% had at least one viral feature, and 39% had more than two. The overall positiv rate for GAS was 11.4%. The GAS positive rate was significantly lower in patients <3 years old than in older patients (1.8% vs. 19.4%, p < 0.0001). The overall sensitivity and specificity of RADT were 75.0% (95% CI: 57.8–87.9) and 97.9% (95% CI: 95.8–99.2), respectively. The GAS positive rate was not significantly different between patients with and without viral features (12.4% vs. 9.3%, p = 0.4854). In patients aged 3–14 years, the GAS positive rate was not associated with the modified Centor score or the frequency of clinical viral features. Despite a low prevalence of GAS pharyngitis, testing for GAS was frequently performed in children <3 years old in this study. Appropriate use of laboratory testing for GAS pharyngitis and judicious prescription of antibiotics were imperative. Full article
(This article belongs to the Section Pediatric Infectious Diseases)
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Article
Ten Years (2011–2021) of the Italian Lombardy ADHD Register for the Diagnosis and Treatment of Children and Adolescents with ADHD
Children 2021, 8(7), 598; https://0-doi-org.brum.beds.ac.uk/10.3390/children8070598 - 15 Jul 2021
Viewed by 259
Abstract
Background: The purpose of this article is to update the diagnostic assessment, therapeutic approach, and 12–18 month follow-up of patients added to the Italian Lombardy Attention Deficit Hyperactivity Disorder (ADHD) Register. Methods: Medical records of patients added to the Registry from 2011 to [...] Read more.
Background: The purpose of this article is to update the diagnostic assessment, therapeutic approach, and 12–18 month follow-up of patients added to the Italian Lombardy Attention Deficit Hyperactivity Disorder (ADHD) Register. Methods: Medical records of patients added to the Registry from 2011 to 2021 were analysed. Results: 4091 of 5934 patients met the criteria for a diagnosis of ADHD, and 20.3% of them presented a familiarity with the disorder. A total of 2879 children (70.4%) had at least one comorbidity disorder, in prevalence a learning disorder (39%). Nearly all (95.9%) received at least one psychological prescription, 17.9% of them almost one pharmacological treatment, and 15.6% a combination of both. Values of ≥5 of the Clinical Global Impression—Severity scale (CGI-S) are more commonly presented by patients with a pharmacological prescription than with a psychological treatment (p < 0.0001). A significant improvement was reported in half of the patients followed after 1 year, with Clinical Global Impression—Improvement scale (CGI-I) ≤ 3. In all, 233 of 4091 are 18-year-old patients. Conclusions: A ten-year systematic monitoring of models of care was a fruitful shared and collaborative initiative in order to promote significant improvement in clinical practice, providing effective and continuous quality of care. The unique experience reported here should spread. Full article
(This article belongs to the Special Issue Recent Advances in Child and Adolescent Psychiatry)
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Article
Three-Year Trend in Escherichia coli Antimicrobial Resistance among Children’s Urine Cultures in an Italian Metropolitan Area
Children 2021, 8(7), 597; https://0-doi-org.brum.beds.ac.uk/10.3390/children8070597 - 14 Jul 2021
Viewed by 229
Abstract
Urinary tract infections (UTIs) are among the most common bacterial infections in children, and Escherichia coli is the main pathogen responsible. Several guidelines, including the recently updated Italian guidelines, recommend amoxicillin-clavulanic acid (AMC) as a first-line antibiotic therapy in children with febrile UTIs. [...] Read more.
Urinary tract infections (UTIs) are among the most common bacterial infections in children, and Escherichia coli is the main pathogen responsible. Several guidelines, including the recently updated Italian guidelines, recommend amoxicillin-clavulanic acid (AMC) as a first-line antibiotic therapy in children with febrile UTIs. Given the current increasing rates of antibiotic resistance worldwide, this study aimed to investigate the three-year trend in the resistance rate of E. coli isolated from pediatric urine cultures (UCs) in a metropolitan area of northern Italy. We conducted a retrospective review of E. coli-positive, non-repetitive UCs collected in children aged from 1 month to 14 years, regardless of a diagnosis of UTI, catheter colonization, urine contamination, or asymptomatic bacteriuria. During the study period, the rate of resistance to AMC significantly increased from 17.6% to 40.2% (p < 0.001). Ciprofloxacin doubled its resistance rate from 9.1% to 16.3% (p = 0.007). The prevalence of multidrug-resistant E. coli rose from 3.9% to 9.2% (p = 0.015). The rate of resistance to other considered antibiotics remained stable, as did the prevalence of extended spectrum beta-lactamases and extensively resistant E. coli among isolates. These findings call into question the use of AMC as a first-line therapy for pediatric UTIs in our population, despite the indications of recent Italian guidelines. Full article
(This article belongs to the Special Issue Childhood Innate Immunity and Infectious Diseases)
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Article
Treatment with Methylphenidate Improves Affective but Not Cognitive Empathy in Youths with Attention-Deficit/Hyperactivity Disorder
Children 2021, 8(7), 596; https://0-doi-org.brum.beds.ac.uk/10.3390/children8070596 - 14 Jul 2021
Viewed by 200
Abstract
Background: Beside the core symptoms, patients with attention-deficit/hyperactivity disorder (ADHD) frequently show relevant difficulty in developing relationships with peers. Although ADHD symptoms may account for social impairment, deficits in cognitive and/or affective empathy have also been involved. Our aim was to investigate the [...] Read more.
Background: Beside the core symptoms, patients with attention-deficit/hyperactivity disorder (ADHD) frequently show relevant difficulty in developing relationships with peers. Although ADHD symptoms may account for social impairment, deficits in cognitive and/or affective empathy have also been involved. Our aim was to investigate the effect of methylphenidate (MPH) treatment on affective and cognitive empathy. Methods: Sixty-one drug-naïve youths with ADHD (age range 6 to 17 years, mean 10.3 ± 2.8 years, 51 males) naturalistically treated with MPH monotherapy were followed up for 6 months for ADHD symptoms and empathy, measured with the Basic Empathy Scale. Results: After being treated with MPH, the patients showed a significant improvement in affective and cognitive empathy scores. Linear regression models showed that changes in inattention symptoms predicted changes in affective but not in cognitive empathy, while changes in the hyperactivity/impulsivity symptoms did not predict changes in affective or cognitive empathy. Conclusions: Our study provides a further contribution for a better understanding of the possible effects of the MPH on youth’s characteristics. Full article
(This article belongs to the Section Child and Adolescent Psychiatry)
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Article
Associations between Perceived Child-Parent Relationships and School Engagement among 9–11 Aged Children
Children 2021, 8(7), 595; https://0-doi-org.brum.beds.ac.uk/10.3390/children8070595 - 14 Jul 2021
Viewed by 231
Abstract
School engagement has been shown to protect students from dropping out of education, depression and school burnout. The aim of this Finnish study was to explore the association between child-parent relationships and how much 99,686 children aged 9–11 years liked school. The data [...] Read more.
School engagement has been shown to protect students from dropping out of education, depression and school burnout. The aim of this Finnish study was to explore the association between child-parent relationships and how much 99,686 children aged 9–11 years liked school. The data were based on the 2019 School Health Promotion Study, conducted by the Finnish Institute for Health and Welfare. This asked children whether they liked school or not and about their child-parent relationships. Univariate and multivariate analyses were used to examine the data separately for boys and girls and the results are presented as odds ratios (OR) and 95% confidence intervals (CI). According to the results, girls showed more school engagement than boys (81.9% versus 74.0%), and it was more common in children who felt that their parents communicated with them in a supportive way. This association was slightly stronger for girls than boys (OR 2.46 95% CI 2.33–2.59 versus OR 2.10 95% CI 2.02–2.20). It is important that child-parent relationships and communication are considered during school health examinations, so that children who have lower support at home can be identified. Full article
Article
Randomized Trial of Oxygen Saturation Targets during and after Resuscitation and Reversal of Ductal Flow in an Ovine Model of Meconium Aspiration and Pulmonary Hypertension
Children 2021, 8(7), 594; https://0-doi-org.brum.beds.ac.uk/10.3390/children8070594 - 14 Jul 2021
Viewed by 385
Abstract
Neonatal resuscitation (NRP) guidelines suggest targeting 85–95% preductal SpO2 by 10 min after birth. Optimal oxygen saturation (SpO2) targets during resuscitation and in the post-resuscitation management of neonatal meconium aspiration syndrome (MAS) with persistent pulmonary hypertension (PPHN) remains uncertain. Our [...] Read more.
Neonatal resuscitation (NRP) guidelines suggest targeting 85–95% preductal SpO2 by 10 min after birth. Optimal oxygen saturation (SpO2) targets during resuscitation and in the post-resuscitation management of neonatal meconium aspiration syndrome (MAS) with persistent pulmonary hypertension (PPHN) remains uncertain. Our objective was to compare the time to reversal of ductal flow from fetal pattern (right-to-left), to left-to-right, and to evaluate pulmonary (QPA), carotid (QCA)and ductal (QDA) blood flows between standard (85–94%) and high (95–99%) SpO2 targets during and after resuscitation. Twelve lambs asphyxiated by endotracheal meconium instillation and cord occlusion to induce MAS and PPHN were resuscitated per NRP guidelines and were randomized to either standard (85–94%) or high (95–99%) SpO2 targets. Out of twelve lambs with MAS and PPHN, six each were randomized to standard and high SpO2 targets. Median [interquartile range] time to change in direction of blood flow across the ductus arteriosus from right-to-left, to left-to-right was significantly shorter with high SpO2 target (7.4 (4.4–10.8) min) compared to standard SpO2 target (31.5 (21–66.2) min, p = 0.03). QPA was significantly higher during the first 10 min after birth with higher SpO2 target. At 60 min after birth, the QPA, QCA and QDA were not different between the groups. To conclude, targeting SpO2 of 95–99% during and after resuscitation may hasten reversal of ductal flow in lambs with MAS and PPHN and transiently increase QPA but no differences were observed at 60 min. Clinical studies comparing low and high SpO2 targets assessing hemodynamics and neurodevelopmental outcomes are warranted. Full article
(This article belongs to the Special Issue Stabilization and Resuscitation of Newborns)
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Opinion
Gestation-Based Viability–Difficult Decisions with Far-Reaching Consequences
Children 2021, 8(7), 593; https://0-doi-org.brum.beds.ac.uk/10.3390/children8070593 - 13 Jul 2021
Viewed by 256
Abstract
Most clinicians rely on outcome data based on completed weeks of gestational of fetal maturity for antenatal and postnatal counseling, especially for preterm infants born at the margins of viability. Contemporary estimation of gestational maturity, based on ultrasounds, relies on the use of [...] Read more.
Most clinicians rely on outcome data based on completed weeks of gestational of fetal maturity for antenatal and postnatal counseling, especially for preterm infants born at the margins of viability. Contemporary estimation of gestational maturity, based on ultrasounds, relies on the use of first-trimester scans, which offer an accuracy of ±3–7 days, and depend on the timing of the scans and the measurements used in the calculations. Most published literature on the outcomes of babies born prematurely have reported on short- and long-term outcomes based on completed gestational weeks of fetal maturity at birth. These outcome data change significantly from one week to the next, especially around the margin of gestational viability. With a change in approach solely from decisions based on survival, to disability-free survival and long-term functional outcomes, the complexity of the parental and care provider’s decision-making in the perinatal and postnatal period for babies born at less than 25 weeks gestation remains challenging. While sustaining life following birth at the margins of viability remains our priority—identifying and mitigating risks associated with extremely preterm birth begins in the perinatal period. The challenge of supporting the normal maturation of these babies postnatally has far-reaching consequences and depends on our ability to sustain life while optimizing growth, nutrition, and the repair of organs compromised by the consequences of preterm birth. This article aims to explore the ethical and medical complexities of contemporary decision-making in the perinatal and postnatal periods. We identify gaps in our current knowledge of this topic and suggest areas for future research, while offering a perspective for future collaborative decision-making and care for babies born at the margins of viability. Full article
(This article belongs to the Special Issue Health Care in Premature Infants)
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Article
Influence of a Child’s Cancer on the Functioning of Their Family
Children 2021, 8(7), 592; https://0-doi-org.brum.beds.ac.uk/10.3390/children8070592 - 13 Jul 2021
Viewed by 185
Abstract
Background—A child’s cancer affects their entire family and is a source of chronic stress for a sick child, as well as for their parents and siblings. It deprives them of the feeling of security; introduces uncertainty, fear and anxiety; and destabilises their life. [...] Read more.
Background—A child’s cancer affects their entire family and is a source of chronic stress for a sick child, as well as for their parents and siblings. It deprives them of the feeling of security; introduces uncertainty, fear and anxiety; and destabilises their life. It mobilises the family since they have to reconcile the treatment and frequent appointments at the hospital with the hardships of everyday life. The emotional burden they have to deal with is enormous. Recognition of the needs of such a family allows for the implementation of support, psychosocial care and psychoeducation, as well as the provision of reliable information. Patients and Methods—A population survey was conducted between 2015 and 2020. Caregivers of children diagnosed with cancer were invited to participate in the study to assess their problems and needs. Results—All respondents in their legal status were parents of children with cancer. The study included 800 people, where women accounted for 85% and men accounted for 15%. The mean age of the mother was 38.09, SD = 7.25, and the mean age of the father was 41.11, SD = 7.03. The occurrence of problems negatively correlated with both the age of the parents (p < 0.0001) and the level of education (p < 0.0001). Parents who admitted having financial problems more often reported problems of a different kind; moreover, financial problems were more often reported by parents of children who were ill for a longer time (p = 0.01). Conclusions—Parents of children suffering from cancer reported numerous psychological, social and somatic problems. The identification of problems through screening should translate into specific interventions, thus creating support for the families of children with cancer. Promoting coping with difficult emotions and the ability to solve problems when a child is ill has a positive effect on the functioning of the family. Full article
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Article
Achievement Goals, Fear of Failure and Self-Handicapping in Young Elite Athletes with and without Chronic Pain
Children 2021, 8(7), 591; https://0-doi-org.brum.beds.ac.uk/10.3390/children8070591 - 12 Jul 2021
Viewed by 300
Abstract
Background: Pain is a common problem in elite athletes. This exploratory study compares goal orientations towards sport, fear of failure, self-handicapping and pain catastrophizing between active young elite athletes with and without chronic pain (CP) complaints (longer than three months). It examines the [...] Read more.
Background: Pain is a common problem in elite athletes. This exploratory study compares goal orientations towards sport, fear of failure, self-handicapping and pain catastrophizing between active young elite athletes with and without chronic pain (CP) complaints (longer than three months). It examines the associations between chronic pain, fear of failure, goal orientations, self-handicapping and pain catastrophizing in young elite athletes. We explore how far goal orientation can be explained by these factors. Methods: Young elite athletes completed an online questionnaire. Data analysis: Independent samples t-test, correlational analyses and multivariate regression analyses. Results: Participants were 132 young elite athletes (mean 16 years); data for 126 were analyzed. A total of 47% reported current pain, of which 60% had CP. Adolescents with CP showed significantly more pain intensity, fear of failure, self-handicapping and mastery–avoidance goals than those without. Pain intensity was significantly related to fear of failure, self-handicapping, pain catastrophizing and mastery–avoidance. Self-handicapping and fear of failure contributed significantly to mastery–avoidance variance. Performance–avoidance and –approach goals were explained by fear of failure. Conclusion: CP was common, with sufferers showing more fear of failure and self-handicapping strategies, and being motivated to avoid performing worse (mastery–avoidance). Self-handicapping and fear of failure influenced mastery–avoidance orientation, and fear of failure explained part of performance–avoidance and –approach orientations. Longitudinal studies should explore the role of these factors in the trajectory of CP in these athletes. Full article
(This article belongs to the Special Issue Pediatric Pain Rehabilitation)
Article
Family Presence Restrictions and Telemedicine Use in Neonatal Intensive Care Units during the Coronavirus Disease Pandemic
Children 2021, 8(7), 590; https://0-doi-org.brum.beds.ac.uk/10.3390/children8070590 - 12 Jul 2021
Viewed by 338
Abstract
We aimed to describe parental presence policy and telemedicine use in Japanese neonatal intensive care units (NICUs) before and during the coronavirus disease (COVID-19) pandemic. This cross-sectional study was performed through an online survey in 110 level III units from 19 November 2020 [...] Read more.
We aimed to describe parental presence policy and telemedicine use in Japanese neonatal intensive care units (NICUs) before and during the coronavirus disease (COVID-19) pandemic. This cross-sectional study was performed through an online survey in 110 level III units from 19 November 2020 to 18 December 2020. Nurses’ evaluation of the current situation (during COVID-19) was compared with their retrospective pre-COVID-19 (December 2019) evaluation. Responses were received from 52 NICUs distributed across all regions in Japan. The median allowed parental presence time decreased from 12 h to 1 h, and 29 NICUs allowed entry of parents simultaneously during COVID-19. There was an increase in the number of units providing telemedicine through telephone and online visits during COVID-19 compared to that before COVID-19 (from 2% to 19%). The hybrid design NICUs, with 11–89% of beds in single-patient rooms, allowed a longer parental presence time in the NICUs than those with ≥90% of beds in multi-bed rooms. The number of units implementing kangaroo care decreased during COVID-19 compared to that before COVID-19. The need for telemedicine increased among Japanese NICUs to mitigate the adverse effect of parental restriction and limited physical contact due to the COVID-19 pandemic. Full article
(This article belongs to the Section Pediatric Nursing)
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Case Report
A Case of Tracheal Stenosis as an Isolated Form of Immunoproliferative Hyper-IgG4 Disease in a 17-Year-Old Girl
Children 2021, 8(7), 589; https://0-doi-org.brum.beds.ac.uk/10.3390/children8070589 - 12 Jul 2021
Viewed by 243
Abstract
Immunoglobulin G4-related disease (IgG4-RD) is a lymphoproliferative disease which is described almost exclusively in adults. There are only a few pediatric patients who have been observed with this disorder. Here, we describe a rare case of IgG4-RD in a 17-year-old girl with a [...] Read more.
Immunoglobulin G4-related disease (IgG4-RD) is a lymphoproliferative disease which is described almost exclusively in adults. There are only a few pediatric patients who have been observed with this disorder. Here, we describe a rare case of IgG4-RD in a 17-year-old girl with a single manifestation—tracheal stenosis without previous intubation or other inciting event. She had mixed dyspnea and noisy and weakened breathing. Immunoproliferative hyper-IgG4 disease was diagnosed, based on elevated serum IgG4 and histological findings. Until now we have chosen to treat the girl only with corticosteroids with a good response so far. The general condition as well as the respiratory function are regularly monitored. The tracheal involvement of IgG4-RD is uncommon. Nonetheless, it is a manifestation that should be included in the differential diagnosis of tracheal stenosis. Full article
(This article belongs to the Special Issue Childhood Innate Immunity and Infectious Diseases)
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Review
Impact of Sports Education Model in Physical Education on Students’ Motivation: A Systematic Review
Children 2021, 8(7), 588; https://0-doi-org.brum.beds.ac.uk/10.3390/children8070588 - 11 Jul 2021
Viewed by 277
Abstract
Background: Research has suggested that applying the Sport Education Model (SEM) in Physical Education (PE) increases students’ motivation. However, it is important to systematize this evidence to have a clearer idea. Therefore, this study aimed to analyze the impact of the SEM on [...] Read more.
Background: Research has suggested that applying the Sport Education Model (SEM) in Physical Education (PE) increases students’ motivation. However, it is important to systematize this evidence to have a clearer idea. Therefore, this study aimed to analyze the impact of the SEM on the students’ motivation. Methods: A systematic review with a narrative synthesis was performed. In March 2021, an articles search was conducted in PubMed, Scopus, and Web of Science. Eligibility criteria were: longitudinal or experimental study design; outcomes included PE settings; results reported the relationship between the SEM and students’ motivation. Results: Fourteen studies were included, totaling 2146 students. The majority of the studies indicated a significant association between the SEM and motivation, particularly in autonomy and more enjoyment toward PE. Conclusions: This review supports that the SEM has a positive impact on motivation. The SEM offers a wide range of opportunities for students to develop more self-determined motivated behavior in PE classes. Therefore, the SEM should be considered when developing or adapting existing PE programs to promote students’ intrinsic motivation to engage in physical activity. Full article
(This article belongs to the Section Global and Public Health)
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Article
Patient-Reported Outcome Measures and Clinical Outcomes in Children with Foregut Anomalies
Children 2021, 8(7), 587; https://0-doi-org.brum.beds.ac.uk/10.3390/children8070587 - 10 Jul 2021
Viewed by 393
Abstract
Increasing numbers of children and adults with chronic disease status highlight the need for a value-based healthcare system. Patient-reported outcome measures (PROMs) are essential to value-based healthcare, yet it remains unclear how they relate to clinical outcomes such as health and daily functioning. [...] Read more.
Increasing numbers of children and adults with chronic disease status highlight the need for a value-based healthcare system. Patient-reported outcome measures (PROMs) are essential to value-based healthcare, yet it remains unclear how they relate to clinical outcomes such as health and daily functioning. We aimed to assess the added value of self-reported PROMs for health status (HS) and quality of life (QoL) in the long-term follow-up of children with foregut anomalies. We evaluated data of PROMs for HS and/or QoL among eight-year-olds born with congenital diaphragmatic hernia (CDH), esophageal atresia (EA), or congenital lung malformations (CLM), collected within the infrastructure of a multidisciplinary, longitudinal follow-up program. Clinical outcomes were categorized into different outcome domains, and their relationships with self-reported HS and QoL were assessed through multivariable linear regression analyses. A total of 220 children completed HS and/or QoL self-reports. In children with CDH and EA, lower cognition was significantly associated with lower self-reported HS. Due to the low number of cases, multivariable linear regression analysis was not possible in children with CLM. HS, QoL, and clinical outcomes represent different aspects of a child’s wellbeing and should be measured simultaneously to facilitate a more holistic approach to clinical decision making. Full article
(This article belongs to the Special Issue Evaluation of Long-Term Outcomes of Congenital Diaphragmatic Hernia)
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Article
Impact of the Poor Oral Health Status of Children on Their Families: An Analytical Cross-Sectional Study
Children 2021, 8(7), 586; https://0-doi-org.brum.beds.ac.uk/10.3390/children8070586 - 09 Jul 2021
Viewed by 181
Abstract
The impact of poor oral health may not just be limited to the children themselves but can impact their families. The current study aims to perform psychometric analyses of the Arabic version of the Family Impact Scale and investigate the association of its [...] Read more.
The impact of poor oral health may not just be limited to the children themselves but can impact their families. The current study aims to perform psychometric analyses of the Arabic version of the Family Impact Scale and investigate the association of its domains with the oral health status of children. This cross-sectional study was carried out in a sample of 500 parent-child dyads from high schools of Jazan city of the Kingdom of Saudi Arabia. The Arabic version of the Family Impact Scale was subjected to reliability and validity tests. The explanatory variables in the current study are: the oral health status, parents combined income, parents’ education, age and sex of the child. The descriptive analysis was reported using proportions, this was followed by the bivariate and multivariable analyses. About 24.2% of children were reported to have fair, poor, and very poor oral health. A lower frequency of family impact corresponded with better oral health (OH) status of children (p < 0.001). The likelihood of parent’s taking time off from work and having financial difficulties was nearly two-times greater if their children had poor oral health. Similarly, interruption in sleep and other normal activities of parents is four times and five times greater, respectively, if the child has poor oral health status. Thus, the poor oral health of school children in the Jazan region of Saudi Arabia is a matter of grave concern as it is observed to be associated with family impacts; particularly affecting the parent’s work, sleep, and other normal family activities. Full article
(This article belongs to the Special Issue Oral Health Promotion in Paediatric Population)
Article
Antibiotic Resistance Patterns of Uropathogens Causing Urinary Tract Infections in Children with Congenital Anomalies of Kidney and Urinary Tract
Children 2021, 8(7), 585; https://0-doi-org.brum.beds.ac.uk/10.3390/children8070585 - 08 Jul 2021
Viewed by 577
Abstract
Background: Urinary tract infections (UTI) are common in children worldwide. Congenital anomalies of kidney and urinary tract (CAKUT) increase the risk of UTI and consequently antibiotic resistance. Antibiotic resistance represents an important public health issue worldwide. We aimed to evaluate the local trend [...] Read more.
Background: Urinary tract infections (UTI) are common in children worldwide. Congenital anomalies of kidney and urinary tract (CAKUT) increase the risk of UTI and consequently antibiotic resistance. Antibiotic resistance represents an important public health issue worldwide. We aimed to evaluate the local trend in terms of bacterial uropathogen resistance in the western part of Romania in children with CAKUT and UTI. Methods: 252 children with CAKUT were admitted to our hospital over a five-year period. Of them, 91 developed at least one UTI episode, with a total number of 260 positive urine cultures. We collected data about age at diagnosis of CAKUT, sex, origin environment, type and side of CAKUT, number of UTIs, type of uropathogen, and uropathogens antibiotic resistance. Results: Distribution of uropathogens was Escherichia coli (38.84%), Klebsiella spp. (21.15%), Enterococcus spp. (15.76%), Proteus spp. (8.07%), Pseudomonas spp. (8.07%), Enterobacter spp. (2.3%), other Gram-negative bacteria (2.3%), and other Gram-positive bacteria (3.45%). High antibiotic resistance was detected for ampicillin, amoxicillin, and second-generation cephalosporins. Escherichia coli presented high resistance for cefepime and ceftriaxone. Pseudomonas spp. remained susceptible to amikacin, quinolones, and colistin. Vancomycin, teicoplanin, linezolid, and piperacillin/tazobactam remained effective in treating Gram-positive UTI. Conclusions: High antibiotic resistance was identified for frequently used antibiotics. Lower antibiotic resistance was observed for some broad-spectrum antibiotics. Understanding uropathogens’ antibiotic resistance is important in creating treatment recommendations, based on international guidelines, local resistance patterns, and patient particularities. Full article
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