Prevalence and multicenter observational study on falls of hospitalized children and Italian, linguistic-cultural validation of the Humpty Dumpty Fall Scale.

INTRODUCTION: Falls in hospitals are a major problem also in pediatric settings. No Pediatric Fall Risk Assessment Scales (PFRAS) are validated in Italian. GOALS: to perform the Italian validation of the Humpty-Dumpty Falls Scale (HDFS); to assess its predictive performance; to estimate the frequency of falls in hospitalized children and to analyze possible associations between children's clinical variables and falls. METHODS: The study's first step was the cultural-linguistic validation of HDFS in Italian. Second, evaluation of the Italian HDFS's performance on 1500 hospitalized children. Third, modifications of the Italian HDFS to improve its performance. Fourth, analysis of falls frequency and associations between falls and patients' clinical variables. RESULTS: The Italian HDFS (HDFS-ita) showed good Validity (SCVI=0.92) and inter-rater Reliability (Cohen's kappa=0.965), but poor Sensitivity (77.8%) and Specificity (36.6%). A new 3-item version of the HDFS-ita (HDFS-ita-M) was set, with a cut-off of 7, only for subjects 1 to 15 year-old. Although better, the HDFS-ita-M's performance remains poor (Sensitivity=77.8%, Specificity=53.3%, ROC curve's AOC=0.670). The frequency of pediatric falls was 6.38 per thousand children (CI95% 3.36-12.08) with a maximum frequency in children aged 3 to 6 years (11.28 per thousand children, CI95% 3.84-32.63). Motor/walking disorders (p=0.005), enuresis (p=0.0002), being in single room (p=0.04), admittance to pediatric neuropsychiatry/neurology wards (p=0.001), and neurological disorders (p=0.02) were associated to falls. DISCUSSION: HDFS-ita-M has a better but still poor performance than HDFS-ita. This study provides useful data about pediatric falls and their possible risk factors which will help pediatric hospitals in determining patient safety policies. Further studies are needed to determine an adequate panel of variables to estimate pediatric falls risk.

Short-term outcomes and their related risk factors of extremely preterm and extremely low birth weight infants in Guangdong province / 中华儿科杂志

To study the short-term outcomes and their related risk factors of extremely preterm infants (EPI) and extremely low birth weight infants (ELBWI) in Guangdong province. The neonatal and corresponding maternal medical records of 2 392 cases of EPI and ELBWI discharged from 26 tertiary hospitals in Guangdong province during 2013-2017 were collected. -square test or linear-by-linear association -square was used to analyze the following data on an annual basis: (1) the proportion of EPI and ELBWI in all discharged infants and preterm infants; (2) the difference in survival rate of EPI and ELBWI in different regions and types of hospital; and (3) the difference in incidence of complications. A binary Logistic regression model was established to analyze the death-related risk factors. From 2013 to 2017, the enrolled infants each year were 331, 418, 458, 574 and 611, respectively. Totally, there were 1 352 (56.5%) male infants. The gestational age was (27.7±1.9) weeks, and the birth weight was (919±158) g. The proportion of EPI and ELBWI in all discharged infants increased from 2013 to 2017 (χ(2)=68.636, 0.01), and so did the proportion in all discharged preterm infants (χ(2)=73.463, 0.01). The overall survival rate was 60.4% (1 445/2 392), which increased from 2013 to 2017 (χ(2)=11.424, 0.01). Besides, the survival rate was higher in the Pearl River Delta region than that in the non-Pearl River Delta region (61.7% (1 325/2 146) 48.8% (120/246), χ(2)=15.505, 0.01), and also higher in women and children specialist hospitals than that in general hospitals (66.5% (702/1 056) . 55.6% (743/1 336), χ(2)=29.104, 0.01). The overall incidence of complications was 89.0% (2 130/2 392) for neonatal respiratory distress syndrome (NRDS), 72.2% (1 041/1 442) for bronchopulmonary dysplasia (BPD), 40.5% (625/1 544) for retinopathy of prematurity (ROP), 12.3% (237/1 922) for necrotizing enterocolitis (NEC), 31.0% (578/1 865) for periventricular-intraventricular hemorrhage (PV-IVH), 34.1% (656/1 922) for nosocomial infection, 26.9% (625/2 327) for patent ductus arteriosus (PDA), and 4.4% (82/1 865) for periventricular leukomalacia (PVL). From 2013 to 2017, the incidence of PVL decreased (χ(2)=6.093, 0.014), but the incidence of BPD and PDA increased (χ(2)=24.476 and 11.741, respectively, both 0.01). Multivariate Logistic regression analysis showed that Apgar score ≤7 at 5-minute (1.830, 95 1.373-2.437, 0.01), NRDS (1.407, 95 1.222-1.621, 0.01), invasive assisted ventilation (1.825, 95 1.241-2.683, 0.01), maternal cervical insufficiency (2.044, 95 1.002-4.169, 0.049), and medical care withdrawal (25.532, 95 18.867-34.553, 0.01) increased the risk of early neonatal death, while the increase in gestational age (0.869, 95 0.802-0.941, 0.01), discharged from Guangzhou and Shenzhen (0.606, 95 0.451-0.813, 0.01), antenatal use of steroids (0.624, 95 0.471-0.828, 0.01), premature rupture of membranes (0.667, 95 0.466-0.955, 0.027), and pulmonary surfactant treatment (0.532, 95 0.419-0.676, 0.01) could decrease the risk. For the mortality in the late or post-neonatal period, placenta previa (2.355, 95 1.006-5.516, 0.048), cervical insufficiency (3.306, 95 1.259-8.679, 0.015), PV-IVH (1.486, 95 1.135-1.946, 0.01), invasive assisted ventilation (2.143, 95 1.208-3.801, 0.01), and medical care withdrawal (286.532, 95 87.840-934.661, 0.01) increased the risk, while the increase of birthweight (0.997, 95 0.996-0.999, 0.01) decreased the risk. The survival rate of EPI and ELBWI increases annually, but the incidence of complications is still high. Invasive assisted ventilation, medical care withdrawal and maternal cervical insufficiency are associated with mortality in both early and late neonatal or post-neonatal period.

A multicenter epidemiological study of neonatal bacterial meningitis in parts of South China / 中华儿科杂志

To analyze the epidemiological characteristics (pathogenic bacteria distribution, clinical menifestations and outcomes) of neonatal bacterial meningitis in parts of Guangdong Province and Guangxi Zhuang Autonomous Region. A retrospective epidemiological study was carried out in the infants with bacterial meningitis admitted to 12 hospitals in Guangdong Province and Guangxi Zhuang Autonomous Region from January 2011 to December 2016. The distribution of pathogenic bacteria and epidemiological characteristics were analyzed during different periods (2011-2012, 2013-2014, 2015-2016), between early-onset and late-onset cases, preterm infants and term infants. Numeric variables between groups were compared with Student's test. Non-numeric variables were analyzed with χ(2) test. A total of 838 cases which met the criteria of neonatal bacterial meningitis were admitted during the study period, within which males were 545 and females were 293, with an average onset age of 8 (2, 16) days and diagnosed at the age of 14 (8, 20) days. Blood or CSF cultures were positive in 249 infants (29.7%), with (GBS), (), (CoNS) as the most common bacteria. The culture positive rate were 29.6% (47/159), 33.6% (85/253) and 27.5% (117/426) respectively in the periods of 2011-2012, 2013-2014, and 2015-2016, without significant differences among groups (χ(2)=2.860, 0.239). In the culture positive cases, there were no significant differences between the Gram-negative bacilli and Gram-positive cocci proportion in the three different periods (χ(2)=2.081, 0.353). The positive rates of cerebrospinal fluid (CSF) culture and blood culture were 33.0% (64/194) and 28.7% (185/644) in early-onset and late-onset bacterium meningitis infants (χ(2)=1.297, =0.255). The differences of Gram-negative bacilli and Gram-positive cocci proportion in the two groups were statistically significant (15/49 83/103, χ(2)=8.967, 0.003), while the most common bacteria was GBS in both groups. The positive rates of CSF culture and blood culture were 26.9% (57/212) and 30.7% (192/626) in preterm infants and term infants, without significant difference between the two groups (χ(2)=0.830, 0.362). While the differences of Gram-negative bacilli and Gram-positive cocci proportion in the two groups were significant (40/18 58/134, χ(2)=28.074, 0.000), with E. coli in preterm infants while GBS in term infants. There were 45 cases (5.4%) of which cerebrospinal fluid (CSF) WBC counts were less than 20×10(6)/L when bacterial meningitis was diagnosed, among them 5 cases had positive CSF culture; there were 728 cases (90.9%, 728/801) of CSF WBC≤20×10(6)/L at discharge. The positive rate of blood culture and CSF culture were both Lower in cases treated with antibiotics > 24 hours and≤24 hours before diagnosis, with significant difference (χ(2)=19.668, 0.000). Fever was the most common clinical manifestation (633 cases, 75.5%), and hydrocephalus was the most common complication (167 cases, 19.9%), which was seen more commonly in Gram-negative bacillus cases(χ(2)=4.190, =0.041). There were 801 infants (95.6%) who were cured or improved at discharge but 13 deaths (1.6%). The median course of antibiotic before and after diagnosis were 3 days and 20 days, respectively. Single antibiotics was used in 255 (30.4%), mainly meropenem (146 cases, 57.3%) or third generation cephalosporin (67 cases, 26.3%), while combination treatment was used in 583 cases(69.6%), mainly meropenem and third generation cephalosporin (302 cases, 51.8%), or Penicillin (or vancomycin) and third generation cephalosporin (115 cases, 19.7%). There was no significant difference in efficacy between single and combined antibiotics treatment groups ( all>0.05). The most common bacteria of neonatal bacterial meningitis were GBS, and CoNS in parts of South China. GBS was the most common pathogen in both early-onset and late-onset bacterial meningitis, also most common in term infants. While the most common bacteria in preterm infants was Fever was the most common clinical manifestation and hydrocephalus was the main complication. Neonatal bacterial meningitis should not be excluded if the CSF WBC is within normal range. The positive rate of CSF or blood culture decreased significantly if antibiotic is used more than 24 hours before diagnosis. Single antibiotics for sensitive bacteria is as effective as combined antibiotics treatment.

Exposições ambientais e leucemias na infância no Brasil: uma análise exploratória de sua associação / Exposiciones ambientales y leucemias en la infancia en Brasil: un análisis exploratorio de su asociación / /Environmental exposure and childhood leukemia in Brazil: an exploratory analysis of their association

O presente estudo objetiva explorar as relações inaparentes que diversos fatores relativos às exposições ambientais e características individuais existentes em nosso meio possam ter no processo de desenvolvimento da leucemia na infância. A partir de um banco de dados clínicos e epidemiológicos obtido com estudo caso-controle de base hospitalar sobre fatores de risco para leucemias na infância, foi realizada análise multivariada exploratória por meio do emprego de análise de componentes principais e análise fatorial. Os resultados encontrados são sugestivos quanto à contribuição conjunta das exposições ambientais, e não apenas individualizadas, no desenvolvimento das leucemias na infância, sendo apoiados pelas evidências na literatura de que o processo de carcinogênese, em geral, e o da leucemogênese, em particular, resultem de efeitos de múltiplas mutações relacionadas a exposições ambientais conjuntas.

El presente estudio tiene como objetivo explorar las relaciones no aparentes que diversos factores relacionados con exposiciones ambientales, y características individuales existentes en nuestro medio, pueden llegar a tener en el proceso de desarrollo de la leucemia en la infancia. A partir de un banco de datos clínicos y epidemiológicos, obtenido con un estudio de control de casos de base hospitalaria sobre factores de riesgo para leucemias en la infancia, se realizó un análisis multivariado exploratorio, mediante el empleo de un análisis de componentes principales y análisis factorial. Los resultados encontrados son sugestivos en lo que se refiere a la contribución conjunta de las exposiciones ambientales, y no sólo individualizadas, en el desarrollo de las leucemias en la infancia. Siendo apoyados por evidencias en la literatura especializada de que el proceso de carcinogénesis, en general, y/o de la leucemogénesis en particular, resultan de efectos de múltiples mutaciones relacionadas a exposiciones ambientales conjuntas.

This study aims to explore the unapparent relations that several factors related to environmental exposure and individual characteristics existing in our environment may have with the process of developing childhood leukemia. From a database obtained from a clinical and epidemiological hospital-based, case-control study on risk factors for childhood leukemia, an exploratory multivariate analysis was performed using principal component analysis and factor analysis. The results indicate the joint contribution of not just individual but environmental exposure in the development of leukemia in childhood, and are supported by evidence in the literature that the process of carcinogenesis in general and of leukemogenesis in particular, result from effects of multiple mutations related to joint environmental exposure.