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Vol 18, No 11
Vol 18, No 11 November 2022 ISSN 1708-8569
Review article
Original articles
Research letters
Review article:
Pediatric dysphagia overview: best practice recommendation study by multidisciplinary experts
  Ebru Umay, Sibel Eyigor, Esra Giray, Evrim Karadag Saygi, Bulent Karadag, Nihal Durmus Kocaaslan, Deniz Yuksel, Arzu Meltem Demir, Engin Tutar, Canan Tikiz, Eda Gurcay, Zeliha Unlu, Pelin Celik, Ece Unlu Akyuz, Guven Mengu, Serkan Bengisu, Sibel Alicura, Necati Unver, Nida Yekteusaklari, Cuma Uz, Merve Cikili Uytun, Fatih Bagcier, Elif Tarihci, Mazlum Serdar Akaltun, Iclal Ayranci Sucakli, Damla Cankurtaran, Zeynep Aykın, Resa Aydın, Fatma Nazli
Background: Currently, there is no comprehensive and multidisciplinary recommendation study covering all aspects of pediatric dysphagia (PD). This study aimed to generate PD management recommendations with methods that can be used in clinical practice to fill this gap in our country and in the world, from the perspective of experienced multidisciplinary experts.
Methods: This recommendation paper was generated by a multidisciplinary team, using the seven-step process and a three-round modified Delphi survey via e-mail. First, ten open-ended questions were created, and then detailed recommendations including management, diagnosis, treatment, and follow-up were created with the answers from these questions. Each recommendation item was voted on by the experts as overall consensus (strong recommendation), approaching consensus (weak recommendation) and divergent consensus (not recommended).
Results: In the 1st Delphi round, a questionnaire of 414 items was prepared based on the experts* responses to ten open-ended questions. In the 2nd Delphi round, 59.2% of these items were accepted as pre-recommendation. In the 3rd Delphi round, 62.6% of 246 items were accepted for inclusion in the proposals. The final version recommendations consisted of 154 items.
Conclusions: This study includes comprehensive and detailed answers for every problem that could be posed in clinical practice for the management of PD, and recommendations are for all pediatric patients with both oropharyngeal and esophageal dysphagia.
  [Abstract] [Full Text] [PDF]  
Determinants of neonatal jaundice in Ethiopia: a systematic review and meta-analysis
  Habtamu Gebrehana Belay, Getachew Arage Debebe, Alemu Degu Ayele, Bekalu Getnet Kassa, Gedefaye Nibret Mihretie, Mulugeta Dile Worke
Background: Neonatal jaundice is a common condition characterized by a yellowish discoloration of the skin, conjunctiva, and sclera caused by elevated serum or plasma bilirubin levels during the newborn period. The condition is usually not dangerous, but it can progress to severe hyperbilirubinemia, which can lead to acute bilirubin encephalopathy and kernicterus, a bilirubin-induced neurological damage. Therefore, this study aimed to assess the pooled prevalence of neonatal jaundice and its determinants in Ethiopia.
Methods: Scopus, PubMed, Google Scholar, Embase, and CINAHL databases were searched for studies published between January 1, 2010 and July 30, 2021. A weighted DerSimonian Laird random-effects model was used to estimate the pooled prevalence of neonatal jaundice and its associated factors. The I2 was used to calculate the degree of heterogeneity. The funnel plot and Egger's regression test were used to assess publication bias.
Results: Totally 697 articles were generated from various databases, and the review included a total of eight articles. The pooled prevalence of neonatal jaundice was 30.96% [95% confidence interval (CI) 16.61%每45.31%] in Ethiopia. This review showed that prolonged labor [adjusted odd ratio (AOR) = 3.39; 95% CI 2.41每4.77), low birth weight (AOR = 5.12; 95% CI 3.11每8.72), birth asphyxia (AOR = 3.75; 95% CI 2.11每6.66), cephalohematoma (AOR = 7.07; 95% CI 2.72每18.38), ABO incompatibility (AOR = 6.05; 95% CI 2.95每12.42), Rhesus (RH) incompatibility (AOR = 3.77; 95% CI 2.04每6.96), male sex (AOR = 4.53; 95% CI 3.39每6.07), and neonatal sepsis (AOR = 2.47; 95% CI 1.49每4.08) were identified as a determining factor for neonatal jaundice in Ethiopia.
Conclusions: In low- and middle-income countries, neonatal jaundice is a significant healthcare burden, accounting for a significant portion of global childhood mortality and morbidity. However, some low-cost, effective, practical, and dependable solutions have been implemented. Prolonged labor, ABO incompatibility, RH incompatibility, birth asphyxia, neonatal sepsis, low birth weight, cephalohematoma, and male sex were identified as risk factors for neonatal jaundice in Ethiopia.
  [Abstract] [Full Text] [PDF]  
Original articles:
Comparison between hospital- and community-acquired septic shock in children: a single-center retrospective cohort study
  Guo-Yun Su, Chao-Nan Fan, Bo-Liang Fang, Zheng-De Xie, Su-Yun Qian
Background: We explored the differences in baseline characteristics, pathogens, complications, outcomes, and risk factors between children with hospital-acquired septic shock (HASS) and community-acquired septic shock (CASS) in the pediatric intensive care unit (PICU).
Methods: This retrospective study enrolled children with septic shock at the PICU of Beijing Children*s Hospital from January 1, 2016, to December 31, 2019. The patients were followed up until 28 days after shock or death and were divided into the HASS and CASS group. Logistic regression analysis was used to identify risk factors for mortality.
Results: A total of 298 children were enrolled. Among them, 65.9% ( n = 91) of HASS patients had hematologic/oncologic diseases, mainly with Gram-negative bacterial bloodstream infections (47.3%). Additionally, 67.7% (n = 207) of CASS patients had no obvious underlying disease, and most experienced Gram-positive bacterial infections (30.9%) of the respiratory or central nervous system. The 28-day mortality was 62.6% and 32.7% in the HASS and CASS groups, respectively (P < 0.001). Platelet [odds ratio (OR) = 0.996, 95% confidence interval (CI) = 0.992每1.000, P = 0.028], positive pathogen detection (OR = 3.557, 95% CI = 1.307每9.684, P = 0.013), and multiple organ dysfunction syndrome (OR = 10.953, 95% CI = 1.974每60.775, P = 0.006) were risk factors for 28-day mortality in HASS patients. Lactate (OR = 1.104, 95% CI = 1.022每1.192, P = 0.012) and mechanical ventilation (OR = 8.114, 95% CI = 1.806每36.465, P = 0.006) were risk factors for 28-day mortality in patients with CASS.
Conclusions: The underlying diseases, pathogens, complications, prognosis, and mortality rates varied widely between the HASS and CASS groups. The predictors of 28-day mortality were different between HASS and CASS pediatric patients with septic shock.
  [Abstract] [Full Text] [PDF]  
Pathogenic changes of community-acquired pneumonia in a children*s hospital in Beijing, China before and after COVID-19 onset: a retrospective study
  Li-Na Zhang, Ling Cao, Ling-Hui Meng
Background: This study aimed to analyze the pathogenic characteristics of community-acquired pneumonia (CAP) in a children*s hospital before and after the coronavirus disease 2019 (COVID-19) pandemic and to provide testimony for preventing CAP in the future.
Methods: A retrospective analysis was performed. The information was collected from the electronic medical record system of the hospital. A total of 2739 children were included from February 1, 2019, to January 31, 2021.
Results: Among these 2739 patients were 1507 (55.02%) males and 1232 (44.98%) females; the median age was 3.84 years. There were 2364 cases during the pre-COVID-19 period and 375 cases during the post-COVID-19 period. The number of hospitalized children after the pandemic was 84.14% lower. The median age after the onset was 1.5 years younger than that before the onset (4.08 years old) (Z = − 7.885, P < 0.001). After the pandemic, the proportion of CAP in school-age children and Mycoplasma pneumoniae pneumonia (MPP) and influenza virus pneumonia (IVP) decreased significantly. During the pre-COVID-19 period, the proportions of detected pathogens were as follows: MP (59.56%) > bacteria (50.42%) > viruses (29.57%) > fungi (3.43%). During the post-COVID-19 period, the pathogen proportions were bacteria (56.53%) > viruses (53.60%) > MP (23.47%) > fungi (3.73%).
Conclusions: There was a significant decrease in the number of children with CAP hospitalized after the pandemic, especially among school-age children, and the pathogen proportions of CAP with MP and IV were significantly decreased. We inferred that CAP was effectively prevented in school-age children because of the strong mitigation measures.
  [Abstract] [Full Text] [PDF]  
Effect of early atopic sensitization in children aged 0每2 years on the development of asthma symptoms at 9每11 years of age
  Himmet Haluk Akar, Ebru Nadir, Burçin Beken, Yakup Yeşil
Background: Personal genetic predisposition and early life environmental factors are important for the development of childhood asthma. We aimed to search whether egg, milk and mite sensitizations at 0每2 years old are risk factors for asthma symptoms at 9每11 years old.
Methods: A total of 210 wheezer children who had specific immunoglobulin (Ig) E in 2010每2012 were included in the study (followed by pediatric allergy). Patients were divided into non-atopic (group 1, n = 157) and atopic patients [groups 2每7, n = 53 (5 patients were in both group 4 and group 5)] based on sensitizations. Using the International Study of Asthma and Allergy in Childhood questionnaire, current wheeze (CW, 2nd question), exercise wheezing (EW, 7th question), and dry cough (DC, 8th question) were surveyed. Also, parental allergies, eczema at 0每2 years, current eosinophil percentage and total IgE were recorded.
Results: Eczema was observed as an important risk factor [CW: odds ratio (OR) = 2.83, 95% confidence interval (CI) = 1.54每5.23, P ≒ 0.001; EW: OR = 2.71, 95% CI = 1.33每5.54, P = 0.006; DC: OR = 3.03, 95% CI = 1.47每6.25, P = 0.003], whereas having no atopic sensitization at 0每2-year-old (group 1) was found as a significant protective factor for asthma at 9每11 years old (CW: OR = 0.32, 95% CI = 0.15每0.70, P = 0.004; EW: OR = 0.21, 95% CI 0.10每0.44, P ≒ 0.001; DC: OR = 0.25, 95% CI = 0.10每0.59, P = 0.002).
Conclusion: Early personal eczema is a significant risk factor for the development of asthma symptoms at 9每11 years old, whereas not having an allergic sensitization at 0每2 years old (group 1) is an important protective factor.
  [Abstract] [Full Text] [PDF]  
Integration of multiscale entropy and BASED scale of electroencephalography after adrenocorticotropic hormone therapy predict relapse of infantile spasms
  Lin Wan, Chu-Ting Zhang, Gang Zhu, Jian Chen, Xiu-Yu Shi, Jing Wang, Li-Ping Zou, Bo Zhang, Wen-Bin Shi, Chien-Hung Yeh, Guang Yang
Background: Even though adrenocorticotropic hormone (ACTH) demonstrated powerful efficacy in the initially successful treatment of infantile spasms (IS), nearly half of patients have experienced a relapse. We sought to investigate whether features of electroencephalogram (EEG) predict relapse in those IS patients without structural brain abnormalities.
Methods: We retrospectively reviewed data from children with IS who achieved initial response after ACTH treatment, along with EEG recorded within the last two days of treatment. The recurrence of epileptic spasms following treatment was tracked for 12 months. Subjects were categorized as either non-relapse or relapse groups. General clinical and EEG recordings were collected, burden of amplitudes and epileptiform discharges (BASED) score and multiscale entropy (MSE) were carefully explored for cross-group comparisons.
Results: Forty-one patients were enrolled in the study, of which 26 (63.4%) experienced a relapse. The BASED score was significantly higher in the relapse group. MSE in the non-relapse group was significantly lower than the relapse group in the band but higher in the lower frequency range (, , ). Sensitivity and specificity were 85.71% and 92.31%, respectively, when combining MSE in the /frequency of the occipital region, plus BASED score were used to distinguish relapse from non-relapse groups.
Conclusions: BASED score and MSE of EEG after ACTH treatment could be used to predict relapse for IS patients without brain structural abnormalities. Patients with BASED score ≡ 3, MSE increased in higher frequency, and decreased in lower frequency had a high risk of relapse.
  [Abstract] [Full Text] [PDF]  
Neutropenia: diagnosis and management
  Jing Zhang, Xiao-Yan Wu, Run-Ming Jin
  [Abstract] [Full Text] [PDF]  
Research letters:
A novel HNF4A mutation identified in a child with maturity onset diabetes of the young
  Ming-Qiang Zhu, Yang-Li Dai, Xue-Feng Chen, Hu Lin, Jin-Na Yuan, Ke Huang, Wei Wu, Jun-Fen Fu, Guan-Ping Dong
  [Abstract] [Full Text] [PDF]  
Third-line therapies in patients with Kawasaki disease refractory to first- and second-line intravenous immunoglobulin therapy
  Takashi Furuta, Hiroki Yasudo, Seigo Okada, Yuji Ohnishi, Akiko Kawakami-Miyake, Yasuo Suzuki, Shouichi Ohga, Shunji Hasegawa
  [Abstract] [Full Text] [PDF]  
Incident respiratory disease among youths using combustible tobacco, electronic nicotine products, or both: a longitudinal analysis
  Dharma N. Bhatta, Ruchi Adhikari
  [Abstract] [Full Text] [PDF]  
World Journal of Pediatric Surgery
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