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Vol 19, No 2
Vol 19, No 2 February 2023 ISSN 1708-8569
 
Review articles
Meta-analysis
Original articles
Research letters
   
Review articles:
Treatment of hepatitis C in children and adolescents: how far have we reached?
  Vybhav Venkatesh, Keerthivasan Seetharaman, Neha Anushree
 
Background: Hepatitis C virus (HCV) infection is a global public health problem and also generates a significant case load in children and adolescents. With the introduction of directly acting antivirals (DAA), the treatment and care of HCV-infected patients have progressed significantly. The available treatment options in children are limited, and this review aims to provide an overview of treatment of HCV infection in children and adolescents with the current available DAA regimens.
Data sources: This comprehensive review was undertaken after searching the PubMed/Medline and Embase databases for the available up-to-date literature on pediatric HCV infection and treatment using hepatitis C virus infection/HCV, directly acting antivirals/DAA, natural history, treatment, pediatrics, children, and adolescents as keywords.
Results: Combination therapies with highly effective DAA regimes, such as sofosbuvir/ledipasvir, sofosbuvir/velpatasvir, glecaprevir/pibrentasvir, sofosbuvir/daclatasvir, sofosbuvir/ribavirin and others, are available for use in children. Most of the DAA regimens have either received or are pending to receive regulatory approval by different medical/drug agencies for use in children and adolescents. Pan-genotypic regimens are also available in children and adolescents, and these regimens can be used while skipping genotype testing.
Conclusions: The literature on different DAA regimens for use in children shows that these regimens have higher cure rates with minimal side effects and shorter duration of therapy.
  [Abstract] [Full Text] [PDF]  
Fever without a source in children: international comparison
  Sanne Graaf, Maya Wietske Keuning, Dasja Pajkrt, Frans Berend Plötz
 
Background: Fever without a source (FWS) in children poses a diagnostic challenge. To distinguish a self-limiting infection from a serious infection, multiple guidelines have been developed to aid physicians in the management of FWS. Currently, there is no comparison of existing FWS guidelines.
Methods: This comparative review describes consistencies and differences in guideline definitions and diagnostic and therapeutic recommendations. A literature search was performed to include secondary care FWS guidelines of high-income countries, composed by national or regional pediatric or emergency care associations, available in English or Dutch.
Results: Ten guidelines of five high-income countries were included, with varying age ranges of children with FWS. In children younger than one month with FWS, the majority of the guidelines recommended laboratory testing, blood and urine culturing and antibiotic treatment irrespective of the clinical condition of the patient. Recommendations for blood culture and antibiotic treatment varied for children aged 1每3 months. In children aged above three months, urine culture recommendations were inconsistent, while all guidelines consistently recommended cerebral spinal fluid testing and antibiotic treatment exclusively for children with a high risk of serious infection.
Conclusions: We found these guidelines broadly consistent, especially for children with FWS younger than one month. Guideline variation was seen most in the targeted age ranges and in recommendations for children aged 1每3 months and above three months of age. The findings of the current study can assist in harmonizing guideline development and future research for the management of children with FWS.
  [Abstract] [Full Text] [PDF]  
Meta-analysis:
Safety and clinical efficacy of linezolid in children: a systematic review and meta-analysis
  Yi Shi, Hai-Lan Wu, Yu-Hang Wu, Shuang Li, Li-Ya Zhang, Shan-Shan Xu, He-Yu Huang, Chun-Hong Zhang, Xu-Ben Yu, Kang Cai, Jing Zhang, Li-Su Huang
 
Background: We aimed to evaluate the tolerability and efficacy of linezolid in children for treating suspected and diagnosed Gram-positive bacterial infections.
Methods: A systematic literature search was conducted up to April 23, 2021, using linezolid and its synonyms as search terms. Two reviewers independently identified and extracted relevant randomized controlled trials and prospective cohort studies. The extracted studies were included in a single-rate meta-analysis of adverse events and clinical outcomes using random-effects models.
Results: A total of 1082 articles were identified, and nine studies involving 758 children were included in the meta-analysis. The overall proportion of adverse events was 8.91% [95% confidence interval (CI) = 1.64%每36.52%], with diarrhea (2.24%), vomiting (2.05%), and rash (1.72%) being the most common. The incidences of thrombocytopenia and anemia were 0.68% and 0.16%, respectively. Some specific adverse events, including rash and gastrointestinal events, were more frequent in the oral administration subgroup. In terms of efficacy, the overall proportion of clinical improvement was 88.80% (95% CI = 81.31%每93.52%). Children with a history of specific bacteriological diagnosis or concomitant antibiotic therapy had a 1.13-fold higher clinical improvement than children without such histories. The proportion of microbial eradication was 92.68% (95% CI = 84.66%每96.68%). The proportion of all-cause mortality was 0.16% (95% CI = 0.00%每7.75%).
Conclusions: Linezolid was well-tolerated in pediatric patients and was associated with a low frequency of adverse events, such as anemia, thrombocytopenia, and neutropenia. Moreover, linezolid was effective in children with diagnosed and suspected Gram-positive infections.
  [Abstract] [Full Text] [PDF]  
Original articles:
Global variation in skin injures and skincare practices in extremely preterm infants
  Pranav Jani, Umesh Mishra, Julia Buchmayer, Rajesh Maheshwari, Daphne D*Çruz, Karen Walker, Duygu Gözen, Krista Lowe, Audrey Wright, James Marceau, Mihaela Culcer, Archana Priyadarshi, Adrienne Kirby, James E. Moore, Ju Lee Oei, Vibhuti Shah, Umesh Vaidya, Abdelmoneim Khashana, Sunit Godambe, Fook Choe Cheah, Wen-Hao Zhou, Xiao-Jing Hu, Muneerah Satardien
 
Background: Globally, are skincare practices and skin injuries in extremely preterm infants comparable? This study describes skin injuries, variation in skincare practices and investigates any association between them.
Methods: A web-based survey was conducted between February 2019 and August 2021. Quantifying skin injuries and describing skincare practices in extremely preterm infants were the main outcomes. The association between skin injuries and skincare practices was established using binary multivariable logistic regression adjusted for regions.
Results: Responses from 848 neonatal intensive care units, representing all geographic regions and income status groups were received. Diaper dermatitis (331/840, 39%) and medical adhesive-related skin injuries (319/838, 38%) were the most common injuries. Following a local skincare guideline reduced skin injuries [medical adhesive-related injuries: adjusted odds ratios (aOR) = 0.63, 95% confidence interval (CI) = 0.45每0.88; perineal injuries: aOR = 0.66, 95% CI = 0.45每0.96; local skin infections: OR = 0.41, 95% CI = 0.26每0.65; chemical burns: OR = 0.46, 95% CI = 0.26每0.83; thermal burns: OR = 0.51, 95% CI = 0.27每0.96]. Performing skin assessments at least every four hours reduced skin injuries (abrasion: aOR = 0.48, 95% CI = 0.33每0.67; pressure: aOR = 0.51, 95% CI = 0.34每0.78; diaper dermatitis: aOR = 0.71, 95% CI = 0.51每0.99; perineal: aOR = 0.52, 95% CI = 0.36每0.75). Regional and resource settings-based variations in skin injuries and skincare practices were observed.
Conclusions: Skin injuries were common in extremely preterm infants. Consistency in practice and improved surveillance appears to reduce the occurrence of these injuries. Better evidence regarding optimal practices is needed to reduce skin injuries and minimize practice variations.
  [Abstract] [Full Text] [PDF]  
Gestational age-specific neonatal mortality in Hong Kong: a population-based retrospective study
  Xue-Lian Wang, Eman Leung, Genevieve Po Gee Fung, Hugh Simon Lam
 
Background: The neonatal period is the most vulnerable period during childhood, with the risk of death being the highest even in developed countries/regions. Hong Kong*s neonatal mortality (1㏑) is among the world*s lowest and has remained similar for 15 years. This study aimed to explore neonatal deaths in Hong Kong in detail and determine whether neonatal mortality is reducible at such a low level.
Methods: Live births in public hospitals in Hong Kong during 01 Jan 2006每31 Dec 2017 were included. Relevant data were extracted from the electronic medical records. Gestational age-specific mortality was calculated, and the trends were analyzed using the Cochran每Armitage trend test. Causes of death were summarized, and risk factors were identified in multivariate logistic regression analysis.
Results: In 490,034 live births, 755 cases (1.54㏑) died during the neonatal period, and 293 (0.6㏑) died during the post-neonatal period. The neonatal mortality remained similar overall (P = 0.17) and among infants born at 24每29 weeks* gestation (P = 0.4), while it decreased in those born at 23 (P = 0.04), 30每36 (P < 0.001) and ≡ 37 (P < 0.001) weeks* gestation. Neonates born at < 27 weeks* gestation accounted for a significantly increased proportion among cases who died (27.6% to 51.9%), with hemorrhagic conditions (24%) being the leading cause of death. Congenital anomalies were the leading cause of death in neonates born ≡ 27 weeks* gestation (52%), but its cause-specific mortality decreased (P = 0.002, 0.6㏑ to 0.41㏑), with most of the decrease attributed to trisomy 13/18 and multiple anomalies.
Conclusion: Reduction of neonatal mortality in developed regions may heavily rely on improved quality of perinatal and neonatal care among extremely preterm infants.
  [Abstract] [Full Text] [PDF]  
Association of different central venous pressure levels with outcome of living-donor liver transplantation in children under 12 years
  Yi-Chen Fan, Xiao-Qiang Wang, Dan-Yan Zhu, Xiao-Rong Huai, Wei-Feng Yu, Dian-San Su, Zhi-Ying Pan
 
Background: Pediatric liver transplantation is an important modality for treating biliary atresia. The overall survival (OS) rate of pediatric liver transplantation has significantly improved compared with that of 20 years ago, but it is still unsatisfactory. The anesthesia strategy of maintaining low central venous pressure (CVP) has shown a positive effect on prognosis in adult liver transplantation. However, this relationship remains unclear in pediatric liver transplantation. Thus, this study was conducted to review the data of pediatric living-donor liver transplantation to analyze the associations of different CVP levels with the prognosis of recipients.
Methods: This was a retrospective study and the patients were divided into two groups according to CVP levels after abdominal closure: low CVP (LCVP) (≒ 10 cmH2O, n = 470) and high CVP (HCVP) (> 10 cmH2O, n = 242). The primary outcome measured in the study was the overall survival rate. The secondary outcomes included the duration of mechanical ventilation in the intensive care unit (ICU), length of stay in the ICU, and postoperative stay in the hospital. Patient demographic and perioperative data were collected and compared between the two groups. Kaplan-Meier curves were constructed to determine the associations of different CVP levels with the survival rate.
Results: In the study, 712 patients, including 470 in the LCVP group and 242 in the HCVP group, were enrolled. After propensity score matching, 212 pairs remained in the group. The LCVP group showed a higher overall survival rate than the HCVP group in the Kaplan-Meier curves and multivariate Cox regression analyses (P = 0.018), and the HCVP group had a hazard ratio of 2.445 (95% confidence interval, 1.163每5.140).
Conclusion: This study confirmed that a low-CVP level at the end of surgery is associated with improved overall survival and a shorter length of hospital stay.
  [Abstract] [Full Text] [PDF]  
Clinical characteristics and mortality risk prediction model in children with acute myocarditis
  Shi-Xin Zhuang, Peng Shi, Han Gao, Quan-Nan Zhuang, Guo-Ying Huang
 
Background: Acute myocarditis (AMC) can cause poor outcomes or even death in children. We aimed to identify AMC risk factors and create a mortality prediction model for AMC in children at hospital admission.
Methods: This was a single-center retrospective cohort study of AMC children hospitalized between January 2016 and January 2020. The demographics, clinical examinations, types of AMC, and laboratory results were collected at hospital admission. In-hospital survival or death was documented. Clinical characteristics associated with death were evaluated.
Results: Among 67 children, 51 survived, and 16 died. The most common symptom was digestive disorder (67.2%). Based on the Bayesian model averaging and HosmerLemeshow test, we created a final best mortality prediction model (acute myocarditis death risk score, AMCDRS) that included ten variables (male sex, fever, congestive heart failure, left-ventricular ejection fraction < 50%, pulmonary edema, ventricular tachycardia, lactic acid value > 4, fulminant myocarditis, abnormal creatine kinase-MB, and hypotension). Despite differences in the characteristics of the validation cohort, the model discrimination was only marginally lower, with an AUC of 0.781 (95% confidence interval = 0.675每0.852) compared with the derivation cohort. Model calibration likewise indicated acceptable fi t (Hosmer每Lemeshow goodness-of-fi t, P¼ = 0.10).
Conclusions: Multiple factors were associated with increased mortality in children with AMC. The prediction model AMCDRS might be used at hospital admission to accurately identify AMC in children who are at an increased risk of death.
  [Abstract] [Full Text] [PDF]  
Research letters:
Cat scratch disease in childhood: a 10-year experience of an Italian tertiary care children*s hospital
  Lara Fusani, Elisabetta Venturini, Elena Chiappini, Luisa Galli
 
  [Abstract] [Full Text] [PDF]  
Depression in children with nephrotic syndrome related to parents* stress, quality of life, and depression
  Hui-Mei Huang, Wei He, Xue-Yun Gao, Hong-Li Sun, Ying Bao
 
  [Abstract] [Full Text] [PDF]  
Prenatal diagnosis of congenital chloride diarrhea by whole exome sequencing in four Chinese families and prenatal genotype每phenotype association study
  Ying-Fei Shao, Hong Wang, Yi-Xiu Wang, Le-Ping Shao, Sai Wang
 
  [Abstract] [Full Text] [PDF]  
   
 
 
 
World Journal of Pediatric Surgery
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