Renal histologic changes in congenital ureteropelvic junction obstruction (UPJO), although well documented, are sparsely studied in children. This study aims to establish a histological grading depending on the glomerular and tubulo-interstitial changes in hydronephrotic kidneys and determine correlation with age at surgery and impact on function post-pyeloplasty. A renal cortical wedge biopsy was obtained after pyeloplasty and histological changes were graded from 1 to 4. A total of 47 viable biopsies from 57 children showed grade 1 changes in 10, grade 2 in 7, grade 3 in 27, and grade 4 in 3. Age at surgery, histological grade, and changes in differential renal function (DRF) were statistically analyzed. Younger age, near normal histology, and those with changes in 1 domain had preserved DRF pre-operatively. Renal histology and overall grade showed positive correlation with pre-operative DRF. However, no statistically significant association was noted with age at surgery or change in post-operative DRF.

Immune thrombocytopenic purpura (ITP) is an acquired immune-mediated bleeding disorder characterized by isolated low platelet (PLT) counts. Immune thrombocytopenic purpura pathogenesis involves multiple immune mechanisms causing PLT destruction and inadequate production. Owing to impaired immune homeostasis, ITP patients can develop other than anti-PLT autoantibodies even in the absence of clinical signs of autoimmune disease, such as anti-thyroglobulin (TG) and anti-thyroperoxidase (TPO) antibodies. Our objective is to determine the prevalence of antithyroid antibodies (ATAs) in the population of pediatric ITP patients, and the differences in ATA positivity prevalence in newly diagnosed/persistent ITP, and chronic ITP patient subgroups, as well as to establish the impact of ATA positivity on the treatment outcomes. A cross-sectional observational study was conducted involving 75 pediatric patients diagnosed with ITP and 60 healthy controls, carried out over a period of 11 years. The prevalence of ATA was significantly higher in ITP patients compared with controls (28% vs 5%, < .05). Initial PLT count was significantly lower in ATA-positive patients, but the treatment response did not differ between ATA-positive and ATA-negative patients. To conclude, our study confirmed that ITP patients have a higher prevalence of ATA compared with the healthy pediatric population; however, no association was found between ATA positivity and disease duration or treatment outcomes. Our findings suggest that ATA screening may not be prognostic for ITP in pediatric population, but further research with larger cohorts may be beneficial to elucidate the role of ATA in ITP pathogenesis and management.

Extravasation injuries are prevalent in pediatric hospitals and often result in tissue damage and extended hospital stays. However, limited data exist regarding risk factors for extravasation in children. This study aimed to identify these risk factors in pediatric patients receiving intravenous (IV) therapy. This prospective cohort study included 500 children aged 1 month to 18 years who had undergone either central or peripheral catheterization and were admitted to the pediatric intensive care unit (PICU) at Imam Hossein Children's Hospital in Isfahan, Iran, between July 2020 and July 2021. Data were collected on age, gender, length of hospitalization, catheter type, instances of extravasation, drugs administered, and treatment protocols. The median age was 36 months, and approximately 56% of participants were male. Among the cohort, the prevalence of extravasation was 9.8% (49 patients). Female gender ( = .002), central venous catheterization ( = .002), prolonged hospitalization (P < .001), reduced consciousness ( = .012), and the use of taping for vein fixation ( = .004) were all significantly associated with a higher risk of extravasation. This study underscores the need for health care providers to carefully assess risk factors for extravasation to mitigate injury risk, particularly in vulnerable pediatric populations.

We aimed to investigate the diagnostic value of leukocyte cell population data (CPD) parameters obtained from an automated hematology analyzer to be able to use it in the diagnosis of neonatal sepsis. Our study was a retrospective and cross-sectional analysis. The neonates were classified into 3 groups: culture-positive sepsis (n = 20), clinical sepsis (n = 87), and control (n = 269). CPD parameters were determined during complete blood count (CBC) by volume-conductivity-scatter (VCS) technology with DxH 900 Coulter Cell Analyzer. Mean neutrophil volume (MNVNE), standard deviations of volumes of neutrophils (SDVNE), standard deviations of volumes of monocytes (SDVMO), and monocyte distribution width (MDW) were significantly increased in the culture-positive sepsis group compared with the clinical sepsis and control groups ( < .05). We have demonstrated the diagnostic utility of leukocyte CPD parameters, especially MNVNE, MDW, and their combination, for neonatal sepsis. These parameters are advantageous because they are obtained during routine CBC analysis without the need for additional blood collection and extra costs.

Compassion fatigue is a state of emotional and physical exhaustion that arises from frequent contact with people who have experienced trauma or stress, which may affect particularly those working in health care. This study aimed to elucidate the prevalence and determinants of compassion fatigue among pediatric nurses.

Evidence shows that parents of children with chronic illnesses are mentally stressed. Thus far, developmental dysplasia of the hip (DDH) is unexplored in relation to its impact on mothers' well-being. The study aimed at contributing to fill this gap by exploring mothers' mental health facing infants' DDH, at the diagnosis time and by the end of the treatment; possible moderators of changes over time were mothers' hip worries, compliance to treatment, and severity of babies' DDH. The sample included 60 mother-infant dyads, 33 of which followed longitudinally. Multiple mother- and clinician-reported measures were administered. Multilevel models showed that the mothers' psychological condition remained stable over time. The mothers' hip worries, compliance to treatment, and severity of babies' DDH did not moderate mothers' mental health over time but were significant independent predictors of it. Our findings might have relevant clinical implications, for medical staff who deals with mothers and infants' DDH.

Tracheostomy-related emergencies (TREs) contribute significantly to preventable mortality. The retention of caregiver knowledge and skills acquired through simulation-based training (SBT) is unknown. This study aimed to assess the management of TREs by caregivers who did and did not receive SBT. A questionnaire containing 3 TRE scenarios and frequency of outpatient TREs was administered to 52 caregivers of children with tracheostomies; 34 caregivers had completed SBT. Most caregivers (80%) reported ≥1 TRE since discharge. Only 46% of caregivers answered all 3 TRE questions correctly. No differences were observed in correct responses for accidental decannulation ( = .16), oxygen desaturation ( = .84), and mucus plugging ( = .16) based on the completion of SBT. There were no differences between duration since SBT completion and correct responses for all 3 TRE questions. Caregivers showed knowledge deficiencies in TRE management regardless of SBT completion or duration since SBT. Periodic reassessment of knowledge may create targeted re-education opportunities for TRE management.

Complementary therapies are used to treat many pediatric symptoms and health conditions, and chiropractic care is one of the most commonly used forms of complementary therapies by children and adolescents. Research studies have investigated the evidence behind and safety of chiropractic care in pediatrics with various musculoskeletal and non-musculoskeletal conditions. There are limited data with a range of findings and often no definite conclusion. Despite the paucity of evidence of benefits of chiropractic care in children, the considerations around safety, and the differing opinions regarding pediatric chiropractic practice inside and outside the field, many pediatric patients visit chiropractors, and chiropractors often care for pediatric patients. Pediatric health care providers should discuss the use of all complementary therapies with patients, so guidance can be optimal with a focus on promoting health and safety.

To determine the ocular structural changes in obsessive-compulsive disorder (OCD) children with eye-rubbing compulsion.

This study aimed to describe the home-built environment of children with medical complexity (CMC) using novel photovoice methodology. Parents/guardians of CMC uploaded and discussed photographs of their home environment through semi-structured interviews. Conventional content analysis was applied to interview transcripts embedded with corresponding photographs. All participants modified their home environment to optimize the health, function, and well-being of the child and family; extent of modifications varied. Two main themes and subthemes characterized the home-built environment: (1) replicating hospital function and structure: ensuring accessibility, promoting safety, optimizing organization of supplies, and equipment and (2) maintaining a sense of home: self-expression, entertaining, family participation, and comfort. Elements of hospital structure and function and traditional home aesthetics and utility were equally important to families, the interplay between both facets informed modifications. By understanding the home-built environment, pediatric providers can more holistically support the health and well-being of CMC and their caregivers.

The study aimed to investigate the correlation between children's attendance at the emergency department and the cyberchondria of parents. The population for this cross-sectional study comprised parents of children aged 0 to 18 attending the emergency department. Research data were collected using an Information Form, the Cyberchondria Severity Scale (CSS). The participants had mean CSS scores of 41.45 ± 19.22. There were significant differences observed between the reason for choosing the emergency department with mean scores for the total CSS ( = 2.289, = .021), distress ( = 2.466, = .013), and compulsion ( = 2.822, = .005) subscales. A weak positive correlation was identified between the number of attendances at the emergency department in the last year and the excessiveness ( = .204) subscale. Participants had moderate levels of CSS. According to the research findings, most parents attended the emergency department for non-urgent reasons. In addition, as the cyberchondria severity level of parents increased, their attendance at health institutions and emergency departments was determined to increase.

We conducted a quality improvement (QI) study to increase rates of firearm screening/safety counseling by 25% over 10 months for children (4-18 years) at preventive visits in an academic continuity clinic. Plan-Do-Study-Act (PDSA) cycles consisted of 1) (January 2023) educating providers about best practices for screening, safe storage counseling, and use of cable firearm locks; 2) (May 2023) revising the preventive visit note template to prompt providers on best practices; and 3) (September 2023) providing caregiver educational resources to support safe storage practices. The baseline firearm screening rate was 38%. After PDSA 1, screening rates were 34%; following PDSA 2, screening rates increased to 82.5%; after PDSA 3, rates were 95%. This QI intervention increased provider screening for firearms, confidence in safety counseling, and confidence in the use of cable firearm locks during preventive visits. Revising the note template had the largest effect on increasing screening rates.

Clinicians continue to seek out ways to decrease antibiotic usage and its sequelae for infants with risk factors for Early Onset Sepsis (EOS). We carried out a large system intervention (LSI) to decrease antibiotic usage, decrease the proportion of infants exposed to any antibiotics and evaluate the financial impact of this intervention. Antibiotic use was monitored from January 2018 through June 2020 for infants born at York Hospital ≥ 35 weeks gestation and discharged from Newborn Nursery. LSIs, including the Kaiser Sepsis Calculator, were implemented January-June 2019. Quality metrics were compared 12-months before and after the intervention. Overall, 5021 infants were discharged from the nursery. Antibiotic usage decreased 68% and infant exposure to antibiotics decreased 64%. There was a savings of $697 per at risk newborn and there were no readmissions for EOS. A Systemic LSI can safely reduce newborn antibiotic exposure and create significant cost saving.

This retrospective, multicenter observational study analyzed data from 257 children under 2 years old admitted with viral bronchiolitis to pediatric intensive care units (PICU) at Wolfson Children's Hospital and UFHealth Shands Children's Hospital from January 2020 to March 2022. The study explores viral etiologies and their associations with hospital length of stay (H-LOS), PICU length of stay (P-LOS), and severity markers and scores. Younger age was associated with longer H-LOS and P-LOS ( < .001). Respiratory syncytial virus (RSV) was associated with younger age but not with H-LOS when controlled for age. RSV's impact on H-LOS varied by age ( = .018). Markers of severity did not differ between patients infected with RSV versus those without RSV, or in patients with co-infection versus single infection. In our population, pSOFA performed better than PELOD-2 in disease severity assessment.

This study aims to assess the parameters of arterial stiffness in active children and adolescents according to the type of sport they practice and compare them with those who do not participate in sport. There were 238 subjects, 80 practiced predominantly dynamic sports, 58 predominantly static sports, and 100 children and adolescents were not regularly included in sports. The control group was volunteers of similar age recruited from elementary schools. The control group had statistically significantly higher values of aortic pulse wave velocity (PWVao) in rest compared with the group of children and adolescent athletes ( < .001, median PWVao 6.28 [5.70-7.00] vs 5.74 [5.10-6.23] m/s). This group had a significantly higher body mass index than children and adolescent athletes ( = .046). Children and adolescents who practiced sports with a high level of dynamic load after 2 years showed significantly lower values of PWVao compared with those who practiced sports with a high level of static load ( = .040, PWVao median 5.64 (5.10-6.10) vs 5,95 (5.50-6.50) m/s). Based on our findings, continuous and regular physical activity, especially dynamic, benefits arterial stiffness and arterial blood pressure, the major predictors of cardiovascular risk.

Parental strategies for home management of pain crisis in children with sickle cell anemia are not well studied. Non-steroidal anti-inflammatory medications (NSAIDs) are thought of as the mainstay of home and in-patient pain management for pediatric patients with sickle cell disease. Parents and providers often fear the use of opioids due to the risk of addiction. Medical marijuana is a potential adjunct therapy, but parental concerns regarding its use are not known. We aimed to assess parental strategies for home pain control, as well as attitudes toward the use of medical marijuana in children with sickle cell disease. Although medical marijuana may be a safer alternative to opioids, parents had similar concerns regarding marijuana. There were significant concerns regarding the societal implications of marijuana use. Further study of the utility of marijuana is warranted, but clinicians must look beyond the medical and consider the social consequences that may impact treatment acceptability.