Parenting style in a rapidly developing country: A report from the state of Qatar.

OBJECTIVE: To investigate the different styles of parenting in the State of Qatar, a country that is considered a cosmopolitan hub with rapid development. MATERIALS AND METHODS: A cross-sectional study was conducted at Sidra Medicine, the only tertiary pediatric hospital in Qatar. Parents of children 3-14 years old were offered a questionnaire. RESULTS: A total of 114 questionnaires were completed (response rate = 95%). Approximately 65% of parents were between 30 and 39 years of age. Almost 90% of parents state that they are confident of their parenting ability. More than 90% of the participating parents stated that they are responsive to their child's feeling and needs, give comfort and understanding when their child is upset, praise their child when well-behaved, give reasons why rules should be followed, help children understand the impact of their behavior, explain consequences of bad behavior, take into account their child's desire before asking him/her to do something, encourage their child to freely express him/herself when disagreeing with his/her parents, and show respect to their child's opinion. However, 60% of parents sometimes scold, yell, and criticize their child when he/she misbehaves but less than 50% of them use threats as a consequence with little or no justification. Furthermore, two-thirds of parents give consequences by putting their child off somewhere with little or no explanation. Moreover, one in four participants gives in to their child when he/she causes a commotion about something, threatens their child with consequences more often than actually giving them, and states consequences to their child and do not actually do them. CONCLUSION: Residents in Qatar have a mixed type of parental style (authoritative, authoritarian, and permissive). This study will guide us to raise the awareness about the types of parenting style in Qatar, in order to provide professional parenting counseling taking into consideration the cultural background.

Parents attitudes toward the human papilloma virus (HPV) vaccine: A new concept in the State of Qatar.

BACKGROUND: Human papillomavirus (HPV) is one of the leading causes of cervical and genital cancer in both genders. PURPOSE: To delineate parental attitude regarding HPV in Qatar. METHODS: A cross-sectional study using a questionnaire was conducted at Sidra Medicine, Qatar. RESULTS: A total of 334 questioners were completed. More than 60% of the parents were not aware that HPV can cause cervical and genital cancer. When asked about the level of comfort in giving their children a vaccine that would prevent them from getting genital cancer, 77% of the participants answered "very comfortable." Interestingly, less than 4% of the parents stated that their children's primary care physicians ever mentioned that such a vaccine exists. When asked about the most preferable mode of receiving information regarding the HPV vaccine, 54% preferred the clinician's office, followed by 34% of whom preferred social media. In terms of the preferred age to receive the vaccine, 45% of the participants preferred to administer the vaccine to their children before they were mature enough to understand sexual relations, while 22% recommended vaccination right before marriage and 15% preferred to wait till they were grown up and decide for themselves. Furthermore, only 42% of the caregivers agreed that it is important to explain to their children that the vaccine can protect against some of the sexually transmitted infections. Finally, approximately 20% of the participants were not convinced about the HPV vaccine. CONCLUSION: A large proportion of parents residing in Qatar have a positive perception regarding the HPV vaccine. TheParents' attitudes and perceptions are considered indispensable targets for community health intervention. We will share the result of our study with the ministry of public health in Qatar with a goal to incorporate the HPV vaccine in the National Immunization Schedule.

Parental perceptions of child's healthy diet: Evidence from a rapidly developing country.

BACKGROUND: There are no studies in Qatar or in the Middle East to investigate parental perception of healthy diet in childhood. PURPOSE: To investigate parental perception of childhood healthy diet in the State of Qatar. METHODS: Cross-sectional prospective study at Hamad Medical Corporation, State of Qatar. Parents of children <14 years old were invited to complete a questionnaire. RESULTS: A total of 398 parents agreed to participate, while 22 parents refused (response rate 94%). About 80% of parents were between 20 and 39 years of age, and 77% were females. Around 230 (58%) parents had ≥1 housemaid to help with housework, including food preparation. Whilst 151 children (37%) fell into the overweight and obese category, only 68 parents (17%) perceived that their child was in this category. Less than half the participants (n = 179, 45%) stated that childhood weight should be monitored prior to 5 years of age, while around 35% stated the same, but for children ages 5-14 years. Most participants (n = 324, 81%) agreed that parental eating habits could influence childhood weight. In terms of food preparation at home, mothers cooked almost 50% of the times, housemaids 30%, followed by grandmothers (16.6%), and fathers (3.4%). When asked about the frequency of school meals being prepared at home, 237 parents (60%) prepared their children's lunch box only 1-2 times per week. Moreover, 63% of parents chose the quality of food based on nutritional values, while 44% and 35% chose it based on safety and taste, respectively. When queried about whether the child's pediatrician or the primary care physician counsel families regarding childhood healthy diet, 187 families (47%) had not received counseling by their children's health care providers. Most families agreed that healthy diets lead to better school performance (n = 372, 94%) and better physical activity quality (n = 379, 96%). Compared to families living in the rural areas, parents living in the capital Doha had better insights that healthy diets result in better in school performance (p = 0.032). CONCLUSION: Parental perception is an important target for public health interventions. Within the current sample, families were aware of the positive impact of healthy diet on overall wellbeing. Qatar is a well-resourced country and it would be cost effective to train and professionally develop pediatricians and primary care physicians to be more proactive in tackling childhood obesity.

Parental Perception of a Dental Home for Children with Special Needs.

BACKGROUND AND OBJECTIVES: There is a major gap in the literature that addresses parental perception of acquiring a dental home for children with special healthcare needs (CSHCN). The objectives of this study are to assess parental perceptions and challenges in acquiring a dental home for their CSHCN. METHODS: Cross-sectional prospective study using a questionnaire. RESULTS: A total of 302 questionnaires were completed by caregivers. More than 70% of children had developmental delay, 20% had musculoskeletal disabilities, and the rest had respiratory compromise on non-invasive ventilation, learning disability, and visual and hearing disabilities; 75% of the caregivers do not believe pediatricians are qualified to contribute in oral hygiene. Moreover, 70% of children had not had a routine dentist visit in the 12 months preceding the interview. The reasons given for the lack of such visits included the long time of appointments (25%), difficulty in child's mobility (17%), the perception that dental care is expensive (9%), and a lack of dentist experience in dealing with children with special needs (5%). When asked what factors would encourage caregivers to choose a dental home for their children, 63% mentioned quick appointments, followed by dentists specialized in children with special needs (51%), child friendly atmosphere (21%), low cost (26.6%), close to home (20%), and others (6%). Interestingly, the majority of parents (75%) believed that the primary pediatrician of the child should initiate the dental home process. CONCLUSION: Despite proper resources, children with special healthcare needs lack proper oral healthcare. This could be attributed to the lack of a dental home. A pediatrician's role is crucial in initiating the process of acquiring a dental home for this special population.

Vasopressin in the Amelioration of Social Functioning in Autism Spectrum Disorder.

Autism spectrum disorder (ASD) is a developmental disability described by diagnostic criteria that comprise deficits in social communication and the existence of repetitive, restricted patterns of behavior, interests, or activities that can last throughout life. Many preclinical studies show the importance of arginine vasopressin (AVP) physiology in social functioning in several mammalian species. Currently, there is a trend to investigate more specific pharmacological agents to improve social functioning in patients with ASD. Neurobiological systems that are crucial for social functioning are the most encouraging conceivable signaling pathways for ASD therapeutic discovery. The AVP signaling pathway is one of the most promising. The purpose of this commentary is to detail the evidence on the use of AVP as an agent that can improve social functioning. The pharmacologic aspects of the drug as well as its potential to ameliorate social functioning characteristics in human and animal studies are described in this manuscript. AVP, especially in its inhaled form, seems to be safe and beneficial in improving social functioning including in children with autism. Larger randomized studies are required to implement a long awaited safe and feasible treatment in people with a deficiency in social functioning.

Parental perception of fluoridated tap water.

PURPOSE: The purpose of this study was to investigate parental knowledge and preference of tap water in a country where faucet water is fluoridated according to international standards and where the average percentage of dental caries in young children reaches up to approximately 73%. MATERIALS AND METHODS: A cross-sectional perspective study was conducted at Hamad Medical Corporation, the only tertiary care and academic hospital in the state of Qatar. Parents of children older than 1 year of age were offered an interview survey. RESULTS: A total of 200 questionnaires were completed (response rate = 100%). The mean age of participant children was 6 ± 4 years. One of the main finding in our study was that primary care physicians never discussed the topic of the best water choice for children in our community, as expressed by more than 86% of parents. More than two-third of parents used bottled water. The main concerns of why parents did not allow their children to drink tap water were taste (8.94%), smell (9.76%), concerns of toxins content (32.52%), and concerns that tap water might cause unspecified sickness (52.03%). Amid revealing participants that our tap water is safe and that fluorine can prevent dental caries, 33% of parents would you use tap water due to its fluoride content. The study also showed that 65% of parents would allow their children to drink tap water if it is free from any toxic ingredients. CONCLUSION: Actions to augment fluoridated water acceptability in the developing world, such as focusing on safety and benefits, could be important in the disseminated implementation of the use of faucet water. Ultimately, a slump in the prevalence of dental caries among children will depend on the ability of pediatricians and dental professionals to institute evidence-based and preventive approach that can benefit oral health in childhood. These data will also allow us to propose the use of tap water safely in young children in the state of Qatar while simultaneously advocating awareness of oral health.

Involving parents in road safety decision making: Keeping our children safe.

PURPOSE: The purpose of the study was to delineate parental concept of road safety in the state of Qatar, integrate parental thoughts and ideas into public safety, and share our data with authorities to assist in implementing campaigns against speeding in a country with a high rate of motor vehicle accidents. METHODS: A cross-sectional prospective study was conducted at Hamad Medical Corporation (HMC), the only tertiary care and academic hospital in the state of Qatar. Parents of children younger than 18 years of age and residents of the State of Qatar were offered an interview survey. RESULTS: A total of 200 questionnaires were completed (response rate = 98%). Approximately 80% of parents were in between 20 and 40 years of age, and 61% of them were females. Almost 40% of participating families reside outside of the city of Doha. Interestingly, only 1 in 2 parents thought their children were safe while riding with them in the car. Moreover, only 47% of parents always used car seats, seatbelts, and proper restraints. This is inspite that nearly 82% of parents felt that these restraints protect children in case of an accident. Parents were also asked of the best place to receive information regarding road safety. Almost 50% preferred to receive the information through social media, whereas 44.3% opted for local television. Role modeling was also assessed and it showed that 85% of parents believed that the most effective way in teaching children and young people to use roads in a safe way is to always provide a positive role model when using the roads. CONCLUSION: A large proportion of residents in the state of Qatar perceive that children are not safe while commuting in roads. Social media, a space where most of our community inhabit, seems to be the best setting to target our people.

Parental attitudes about acquiring a dental home for preschool children: a new concept in the Arab state of Qatar.

OBJECTIVE: The purpose of the study was to assess parental perceptions and acceptability of a dental home for their preschool children, a new concept in the state of Qatar. METHODS: A cross-sectional prospective study was conducted at Hamad Medical Corporation, in the state of Qatar. Parents of infants and children <5 years of age were offered an interview survey. RESULTS: A total of 309 questionnaires were completed (response rate =98%). More than 90% of the participants believed that oral health and dentition affected total-body well-being. Only 18% of parents stated that their children had excellent oral health. Interestingly, more than two-thirds of children had not had a routine dentist visit in the 12 months preceding the interview. Reasons for not having such visits included long appointment times (17.4%), the perception that dental care was expensive (15.5%), the notion that deciduous teeth did not need care (9%), the impression that insurance did not cover dental procedures (8%), unawareness of location of dental centers (4%), the child did not want to go (4%), the notion that children are difficult to handle during a dental procedure (3%), a combination of these factors (33.5%), and other factors (5%). When asked what factors would encourage them to enrol a dental home for their children, almost 20% mentioned speedy appointments followed by dentists specialized in pediatrics (14.3%), child-friendly atmosphere (12%), low cost (12%), close to home (5.7%), none (2.7%), others (2%), and all of the above (32.3%). CONCLUSION: Counseling by primary-care physicians can increase dental home acceptability in the state of Qatar, especially that access to health care is easy in our community.

Breastfeeding rates and barriers: a report from the state of Qatar.

OBJECTIVE: The aim of the study was to outline breastfeeding barriers faced by women residing in the State of Qatar. METHODS: A cross-sectional study through a telephone interview was conducted at Hamad Medical Corporation, the only tertiary care and accredited academic institution in the State of Qatar. Mothers of children born between the period of January 1, 2012 and December 31, 2012 in the State of Qatar were contacted. RESULTS: Of the total 840 mothers who were contacted for the telephone survey, 453 mothers agreed to be interviewed (response rate 53.9%), while 364 (43.3%) did not answer the phone, and 21 (2.5%) answered the phone but refused to participate in the study. The overall breastfeeding initiation rate among the mothers was 96.2%, with 3.8% mothers reporting that they had never breastfed their baby. The percentage of mothers who exclusively breastfed their children in the first 6 months was 24.3%. The most common barriers to breastfeeding as perceived by our participants were the following: perception of lack of sufficient breast milk after delivery (44%), formula is easy to use and more available soon after birth (17.8%), mom had to return to work (16.3%), lack of adequate knowledge about breastfeeding (6.5%), and the concept that the infant did not tolerate breast milk (4.9%). CONCLUSION: Exclusive breastfeeding barriers as perceived by women residing in the State of Qatar, a wealthy rapidly developing country, do not differ much from those in other nations. What varies are the tremendous medical resources and the easy and comfortable access to health care in our community. We plan to implement a nationwide campaign to establish a prenatal breastfeeding counseling visit for all expecting mothers.

Identifying agents triggering bronchiolitis in the State of Qatar.

BACKGROUND: Bronchiolitis is considered as the most frequent lower respiratory tract infection in infants and young children. This disorder is marked by acute inflammation, edema, damage of epithelial cells lining small airways, and augmentation of mucus production. OBJECTIVE: The goal of the study was to identify agents triggering bronchiolitis in the State of Qatar. MATERIALS AND METHODS: A cross-sectional retrospective study was performed at Hamad Medical Corporation, the only tertiary and academic medical center in the State of Qatar. The study included infants and young children aged 0-24 months who were admitted to our pediatric ward with diagnosis of acute bronchiolitis (2010-2012). RESULTS: Eight hundred thirty-five infants and young children met the study inclusion criteria with mean age at diagnosis of 3.61±3.56 months. Respiratory virus real-time polymerase chain reaction was performed on 769 (92.0%) of the participants. Respiratory syncytial virus (RSV) was positive in 352 (45.7%) children admitted with clinical bronchiolitis. In addition, no viruses were identified in 142 (18.4%) of those admitted, and respiratory viruses other RSV were found in 275 (35.7%) of the children. Our investigations and observations show that there has been a steady and periodic seasonal variation in the RSV rate over the study period. A seasonal trend for the RSV (detected by respiratory virus real-time polymerase chain reaction) rate was evident, showing annual peaks in the months of October, November, December, and January, with a significant test for seasonality (test statistics [T]=3.15, P=0.009). CONCLUSION: In countries with desert hot weather, bronchiolitis might affect children throughout the year. Our results suggest that the combination of date regarding uninterrupted RSV seasonality can provide guidance for health care planning and application of RSV prevention scheme, such as extending the palivizumab immunoglobulin series.

Parental preference and perspectives on continuous pulse oximetry in infants and children with bronchiolitis.

OBJECTIVE: The purpose of the study was to investigate parental preference of continuous pulse oximetry in infants and children with bronchiolitis. MATERIALS AND METHODS: A cross-sectional prospective study was conducted at Hamad Medical Corporation in Qatar. Parents of infants and children <24 months old and hospitalized with bronchiolitis were offered an interview survey. RESULTS: A total of 132 questionnaires were completed (response rate 100%). Approximately 90% of participants were 20-40 years of age, and 85% were females. The mean age of children was 7.2±5.8 months. Approximately eight in ten parents supported the idea of continuous pulse oximetry in children with bronchiolitis. Almost 43% of parents believed that continuous pulse-oximetry monitoring would delay their children's hospital discharge. Interestingly, approximately 85% of caregivers agreed that continuous pulse oximetry had a good impact on their children's health. In addition, around one in two of the participants stated that good bedside examinations can obviate the need for continuous pulse oximetry. Furthermore, 80% of parents believed that continuous pulse-oximetry monitoring would give the health-care provider a good sense of security regarding the child's health. Finally, being a male parent was associated with significantly increased risk of reporting unnecessary fatigue, attributed to the sound of continuous pulse oximetry (P=0.031). CONCLUSION: Continuous pulse-oximetry monitoring in children with bronchiolitis was perceived as reassuring for parents. Involving parents in decision-making is considered essential in the better management of children with bronchiolitis or any other disease. The first step to decrease continuous pulse oximetry will require provider education and change as well. Furthermore, we recommend proper counseling for parents, emphasizing that medical technology is not always essential, but is a complementary mode of managing a disease.

The importance of educating postgraduate pediatric physicians about food allergy.

BACKGROUND: Food allergy is an increasing public health burden, and is considered among the most common chronic noncommunicable diseases in children. Proper diagnosis and management of food allergy by a health care provider is crucial in keeping affected children safe while simultaneously averting unnecessary avoidance. OBJECTIVE: The rationale of the study was to estimate the knowledge of pediatric residents and academic general pediatric fellows with regard to food allergies in children. METHODS: A cross-sectional and prospective study was carried out at Hamad Medical Corporation, the only tertiary care, academic and teaching hospital in the State of Qatar. The study took place between January 1, 2015 and September 30, 2015. RESULTS: Out of the 68 questionnaires distributed, 68 (100%) were returned by the end of the study. Among the participants, 15 (22%) were in post-graduate year-1 (PGY-1), 16 (23.5%) in PGY-2, 17 (25%) in PGY-3, 12 (16%) in PGY-4, and 8 (12%) were academic general pediatric fellows. Our trainees answered 60.14% of knowledge based questions correctly. In the section of treatment and management of food allergy in childhood, 23 (34%) of respondents' main concern when taking care of a patient with food allergies was making sure the patient is not exposed to food allergen, while 22 (33%) reported no concerns. In the section of treatment and management of food allergy in childhood, 22 (33%) of participants reported no concerns in taking care of a child with food allergy, while 23 (34%) of respondents' main concern was making sure the patient is not exposed to food allergen. In the teaching and training section, 56% of participants stated that they have not received formal education on how to recognize and treat food allergies, while 59% claimed not being trained on how to administer injectable epinephrine. Furthermore, approximately 60% of all participants expressed the need of additional information about recognizing and treating food allergies and recommended certification and regulation of food allergy training for all residents. CONCLUSION: There is an appreciable lack of knowledge in identifying food allergy and managing anaphylaxis reaction in children, among pediatric residents. Robust efforts should be implemented by attending immunologists to improve the lack of knowledge and improve the trainee's confidence when facing such cases.

Melatonin in the management of perinatal hypoxic-ischemic encephalopathy: light at the end of the tunnel?

Perinatal hypoxic-ischemic encephalopathy (HIE) affects one to three per 1,000 live full-term births and can lead to severe and permanent neuropsychological sequelae, such as cerebral palsy, epilepsy, mental retardation, and visual motor or visual perceptive dysfunction. Melatonin has begun to be contemplated as a good choice in order to diminish the neurological sequelae from hypoxic-ischemic brain injury. Melatonin emerges as a very interesting medication, because of its capacity to cross all physiological barriers extending to subcellular compartments and its safety and effectiveness. The purpose of this commentary is to detail the evidence on the use of melatonin as a neuroprotection agent. The pharmacologic aspects of the drug as well as its potential neuroprotective characteristics in human and animal studies are described in this study. Melatonin seems to be safe and beneficial in protecting neonatal brains from perinatal HIE. Larger randomized controlled trials in humans are required, to implement a long-awaited feasible treatment in order to avoid the dreaded sequelae of HIE.

Parental preference for fluoride varnish: a new concept in a rapidly developing nation.

OBJECTIVE: The objective of this study was to investigate parental preference for fluoride varnish in a country where the average percentage of dental caries in young children is up to ~73%. Consequently, the aim of this study, despite being a pilot, was to create a nationwide project in the State of Qatar to promote oral health in children. METHODS: A cross-sectional perspective study was conducted at Hamad Medical Corporation in Qatar. Parents of children aged ≤5 years were offered an interview survey. A total of 200 questionnaires were completed (response rate =100%). The study was conducted between December 1, 2014 and March 30, 2015, and included all children aged >1 year and <5 years who came to the outpatient clinics for well-child and sick visits. We also included children who were admitted to the inpatient wards. RESULTS: The mean age of participant children was 2.8±1.1 years. When inquiring regarding parents' knowledge and awareness of dental health, we found that >90% of families were aware that dental health affects the health of the whole body. The study showed that ~70% of parents were not aware of the existence of fluoride varnish, but would allow a health provider to apply fluoride varnish. Furthermore, ~80% of parents would not stop brushing their child's teeth and would not skip dentist appointments if varnish was to be applied. Approximately 40% of parents conveyed some concerns regarding the safety of fluoride varnish, despite being considered as a new concept. The main concern was that the child might swallow some of the fluoride. Another important concern expressed by parents was the availability of the fluoride varnish in all clinics. CONCLUSION: The robust positive attitude of parents in this sample suggests that introducing fluoride varnish is feasible and acceptable in our community. Actions to augment fluoride varnish acceptability in the developing world, such as focusing on safety, could be important in the disseminated implementation of fluoride varnish.

Physician and medical student perceptions and expectations of the pediatric clerkship: a Qatar experience.

BACKGROUND: The average number of clerkship weeks required for the pediatric core rotation by the US medical schools is significantly lower than those required for internal medicine or general surgery. OBJECTIVE: The objective behind conducting this survey study was to explore the perceptions and expectations of medical students and pediatric physicians about the third-year pediatric clerkship. METHODS: An anonymous survey questionnaire was distributed to all general pediatric physicians at Hamad Medical Corporation and to students from Weill Cornell Medical College-Qatar. RESULTS: Feedback was obtained from seven attending pediatricians (100% response rate), eight academic pediatric fellow physicians (100% response rate), 36 pediatric resident physicians (60% response rate), and 36 medical students (60% response rate). Qualitative and quantitative data values were expressed as frequencies along with percentages and mean ± standard deviation and median and range. A P-value <0.05 from a 2-tailed t-test was considered to be statistically significant. Participants from both sides agreed that medical students receive <4 hours per week of teaching, clinical rounds is the best environment for teaching, adequate bedside is provided, and that there is no adequate time for both groups to get acquainted to each other. On the other hand, respondents disagreed on the following topics: almost two-thirds of medical students perceive postgraduate year 1 and 2 pediatric residents as the best teachers, compared to 29.4% of physicians; 3 weeks of inpatient pediatric clerkship is enough for learning; the inpatient pediatric environment is safe and friendly; adequate feedback is provided by physicians to students; medical students have accessibility to physicians; students are encouraged to practice evidence-based medicine; and students get adequate exposure to multi-professional teams. CONCLUSION: Assigning devoted physicians for education, providing proper job description or definition of the roles of medical student and physician in the pediatric team, providing more consistent feedback, and extending the duration of the pediatric clerkship can diminish the gap of perceptions and expectations between pediatric physicians and medical students.

Is ketamine a lifesaving agent in childhood acute severe asthma?

Children with acute severe asthma exacerbation are at risk of developing respiratory failure. Moreover, conventional aggressive management might be futile in acute severe asthma requiring intubation and invasive ventilation. The aim of this review is to detail evidence on the use of ketamine in childhood asthma exacerbations. A search of the MEDLINE, EMBASE, and Cochrane databases was performed, using different combinations of the following terms: ketamine, asthma, use, exacerbation, and childhood. In addition, we searched the references of the identified articles for additional articles. We then reviewed titles and included studies that were relevant to the topic of interest. Finally, the search was limited to studies published in English and Spanish from 1918 to June 2015. Due to the scarcity in the literature, we included all published articles. The literature reports conflicting results of ketamine use for acute severe asthma in children. Taking into consideration the relatively good safety profile of the drug, ketamine might be a reasonable option in the management of acute severe asthma in children who fail to respond to standard therapy. Furthermore, pediatricians and pediatric emergency clinicians administering ketamine should be knowledgeable about the unique actions of this drug and its potential side effects.

Pulse oximetry in bronchiolitis: is it needed?

Infants admitted to health-care centers with acute bronchiolitis are frequently monitored with a pulse oximeter, a noninvasive method commonly used for measuring oxygen saturation. The decision to hospitalize children with bronchiolitis has been largely influenced by pulse oximetry, despite its questionable diagnostic value in delineating the severity of the illness. Many health-care providers lack the appropriate clinical fundamentals and limitations of pulse oximetry. This deficiency in knowledge might have been linked to changes in the management of bronchiolitis. The aim of this paper is to provide the current evidence on the role of pulse oximetry in bronchiolitis. We discuss the history, fundamentals of operation, and limitations of the apparatus. A search of the Google Scholar, Embase, Medline, and PubMed databases was carried out for published articles covering the use of pulse oximetry in bronchiolitis.

Virus-induced secondary bacterial infection: a concise review.

Respiratory diseases are a very common source of morbidity and mortality among children. Health care providers often face a dilemma when encountering a febrile infant or child with respiratory tract infection. The reason expressed by many clinicians is the trouble to confirm whether the fever is caused by a virus or a bacterium. The aim of this review is to update the current evidence on the virus-induced bacterial infection. We present several clinical as well in vitro studies that support the correlation between virus and secondary bacterial infections. In addition, we discuss the pathophysiology and prevention modes of the virus-bacterium coexistence. A search of the PubMed and MEDLINE databases was carried out for published articles covering bacterial infections associated with respiratory viruses. This review should provide clinicians with a comprehensive idea of the range of bacterial and viral coinfections or secondary infections that could present with viral respiratory illness.

Risk of urinary tract infection in infants and children with acute bronchiolitis.

OBJECTIVES: To estimate the prevalence of urinary tract infection in infants and children with bronchiolitis. METHODS: A retrospective cross-sectional study involving patients zero to 24 months of age who were hospitalized with acute bronchiolitis was conducted. RESULTS: A total of 835 paediatric patients with acute bronchiolitis were admitted to the paediatric ward between January 2010 and December 2012. The mean (± SD) age at diagnosis was 3.47±2.99 months. There were 325 (39%) girls and 510 (61%) boys. For the purpose of data analysis, the patient population was divided into three groups: group 1 included children hospitalized with respiratory syncytial virus (RSV) bronchiolitis; group 2 included children hospitalized with clinical bronchiolitis with no virus detected; and group 3 included children hospitalized with clinical bronchiolitis due to a respiratory virus other than RSV. Results revealed that urinary tract infection was present in 10% of patients, and was most common in group 3 (13.4%) followed by group 2 (9.7%), and was least common in group 1 (6%) (P=0.030). CONCLUSIONS: The possibility of a urinary tract infection should be considered in a febrile child with a diagnosis of bronchiolitis, particularly if the trigger is a respiratory virus other than RSV.

OBJECTIF: Évaluer la prévalence d'infections urinaires chez les nourrissons atteints de bronchiolite. MÉTHODOLOGIE: Les chercheurs ont effectué une étude transversale rétrospective auprès de patients de zéro à 24 mois hospitalisés en raison d'une bronchiolite aiguë. RÉSULTATS: Au total, 835 patients d'âge pédiatrique atteints de bronchiolite aiguë ont été hospitalisés dans l'aile pédiatrique entre janvier 2010 et décembre 2012. D'un âge moyen (± ÉT) de 3,47±2,99 mois au diagnostic, ils étaient répartis entre 325 filles (39 %) et 510 garçons (61 %). Pour les besoins de l'analyse de données, la population de patients était divisée entre trois groupes : le groupe 1 se composait de nourrissons hospitalisés en raison d'une bronchiolite à virus syncytial respiratoire (VRS), le groupe 2, de nourrissons hospitalisés en raison d'une bronchiolite clinique sans qu'un virus soit décelé et le groupe 3, de nourrissons hospitalisés en raison d'une bronchiolite clinique causée par un autre virus respiratoire que le VRS. Les résultats ont révélé une infection urinaire chez 10 % des patients, plus courante dans le groupe 3 (13,4 %), puis le groupe 2 (9,7 %), et moins courante dans le groupe 1 (6 %) (P=0,030). CONCLUSIONS: Il faut envisager la possibilité d'infection urinaire chez un nourrisson fébrile atteint d'une bronchiolite diagnostiquée, particulièrement si elle est déclenchée par un autre virus respiratoire que le VRS.

Does cesarean section pose a risk of respiratory syncytial virus bronchiolitis in infants and children?

OBJECTIVE: To determine the risk of acquiring acute respiratory syncytial virus (RSV) bronchiolitis in infants and children delivered by the mode of cesarean section (C-section). METHODS: A retrospective and descriptive study was conducted at Hamad Medical Corporation. Patients with ages 0 to 36 months hospitalized with acute bronchiolitis were included in the study. RESULTS: The risk of RSV bronchiolitis was observed to be higher among C-section delivery compared to normal spontaneous vaginal delivery [odds ratio=1.10; 95% confidence interval (0.57, 1.80); P=0.965]; however, it was not statistically significant. Gestational age ≤35 weeks was significantly associated with increased risk of RSV bronchiolitis compared to gestational age >35 weeks [odds ratio=3.12; 95% confidence interval (1.53, 6.38); P=0.002]. CONCLUSIONS: Delivery by C-section does not appear to increase the risk of RSV bronchiolitis in infants compared with normal spontaneous vaginal delivery.