Human milk fat globule delivers entrapped probiotics to the infant's gut and acts synergistically to ameliorate oxidative and pathogenic stress.

The human milk fat globule membrane (hMFGM) and Lactobacillus modulate the infant's gut and benefit health. Hence, the current study assesses the probiotic potential of Lactiplantibacillus plantarum (MRK3), Limosilactobacillus ferementum (MK1) isolated from infant feces, and its interaction with hMFGM during conditions mimicking infant digestive tract. Both strains showed high tolerance to gastrointestinal conditions, cell surface hydrophobicity, and strong anti-pathogen activity against Staphylococcus aureus. During digestion, hMFGM significantly exhibited xanthine oxidase activity, membrane roughness, and surface topography. In the presence of hMFGM, survival of MRK3 was higher than MK1, and electron microscopic observation revealed successful entrapment of MRK3 in the membrane matrix throughout digestion. Interestingly, probiotic-membrane matrix interaction showed significant synergy to alleviate oxidative stress and damage induced by cell-free supernatant of Escherichia coli in Caco-2 cells. Our results show that a probiotic-encapsulated membrane matrix potentially opens the functional infant formula development pathway.

Comparative proteomic analysis of donor human milk treated by high-pressure processing or Holder pasteurization on undigested proteins across dynamic simulated preterm infant digestion.

High-pressure processing (HPP) of donor human milk (DM) minimally impacts the concentration and bioactivity of some important bioactive proteins including lactoferrin, and bile salt-stimulated lipase (BSSL) compared to Holder pasteurization (HoP), yet the impact of HPP and subsequent digestion on the full array of proteins detectable by proteomics remains unclear. We investigated how HPP impacts undigested proteins in DM post-processing and across digestion by proteomic analysis. Each pool of milk (n = 3) remained raw, or was treated by HPP (500 MPa, 10 min) or HoP (62.5 °C, 30 min), and underwent dynamic in vitro digestion simulating the preterm infant. In the meal, major proteins were minimally changed post-processing. HPP-treated milk proteins better resisted proximal digestion (except for immunoglobulins, jejunum 180 min) and the extent of undigested proteins after gastric digestion of major proteins in HPP-treated milk was more similar to raw (e.g., BSSL, lactoferrin, macrophage-receptor-1, CD14, complement-c3/c4, xanthine dehydrogenase) than HoP.

Pediatric reference values of NT-proBNP and Galectin-3 based on a French cohort.

BACKGROUND: In pediatric cardiology, the fact that some new biomarkers have assay-specific normal values has to be considered for correct clinical decisions. The current study aimed to provide age-adjusted normative values for NT-proBNP and Galectin-3 using the Abbott immunoassay system from a prospective French pediatric cohort sera collection and to validate our data for NT-proBNP on a second retrospective cohort. METHODS: We analyzed 283 consecutive samples for NT-proBNP and 140 samples for Galectin-3 collected from apparently healthy children (0-18 years) with outpatient treatment at our institution (Hôpital Necker-Enfants malades, Paris, France) during 24 months. RESULTS: For NT-proBNP and Galectin-3, we establish four age partitions, respectively two (<2 years / >2 years) and establish upper reference values and their 90 % CI for each biomarker (Galectin-3 (ng/mL): 56 [44-70] / 26 [23-29]). We evaluated the diagnostic performance of our upper reference values of NT-proBNP on a retrospective cohort (n = 428) with positive predictive value of 0.92. CONCLUSIONS: Using Abbott immunoassay system, we report age-specific reference values for NT-proBNP and for the first time for Galectin-3 in a healthy French pediatric cohort. These data call for larger cohort studies to define more robustly percentiles and diagnostic performance for NT-proBNP.

Development of an equation to predict delta bilirubin levels using machine learning.

OBJECTIVE: Delta bilirubin (albumin-covalently bound bilirubin) may provide important clinical utility in identifying impaired hepatic excretion of conjugated bilirubin, but it cannot be measured in real-time for diagnostic purposes in clinical laboratories. METHODS: A total of 210 samples were collected, and their delta bilirubin levels were measured four times using high-performance liquid chromatography. Data collected included age, sex, diagnosis code, delta bilirubin, total bilirubin, direct bilirubin, total protein, albumin, globulin, aspartate aminotransferase, alanine transaminase, alkaline phosphatase, gamma-glutamyl transferase, lactate dehydrogenase, hemoglobin, serum hemolysis value, hemolysis index, icterus value (Iv), icterus index (Ii), lipemia value (Lv), and lipemia index. To conduct feature selection and identify the optimal combination of variables, linear regression machine learning was performed 1,000 times. RESULTS: The selected variables were total bilirubin, direct bilirubin, total protein, albumin, hemoglobin, Iv, Ii, and Lv. The best predictive performance for high delta bilirubin concentrations was achieved with the combination of albumin-direct bilirubin-hemoglobin-Iv-Lv. The final equation composed of these variables was as follows: delta bilirubin = 0.35 × Iv + 0.05 × Lv - 0.23 × direct bilirubin - 0.05 × hemoglobin - 0.04 × albumin + 0.10. CONCLUSION: The equation established in this study is practical and can be easily applied in real-time in clinical laboratories.

Perspectivas dos pais acerca da interação socialde crianças com cicatrizes de queimaduras / Parents' perspectives on the social interactionof children with burn scars

As queimaduras provocam efeitos físicos e psicológicos devastadores nos indivíduos, sobretudo em crianças e adolescentes, e podem modificar a qualidade de vida da pessoa. O objetivo foi analisar o impacto das cicatrizes por queimaduras em crianças menores de oito anos na interação com amigos, família e escola, na perspectiva dos pais. Estudo quantitativo de corte transversal realizado com os pais de crianças <8 anos de idade, vítimas de queimaduras e internadas em um Centro de Tratamento de Queimados no norte do Paraná e acompanhadas ambulatorialmente, de 2017 a 2020. A coleta de dados ocorreu por meio de dois instrumentos: caracterização sociodemográfica e clínica; e Brisbane Burn Scar Impact Profile. Realizou-se análise descritiva e teste Qui-quadrado utilizando-se o SPSS®. Participaram 34 pais cujas crianças sofreram queimaduras, sendo 52,9% de 1 a 3 anos de idade, 58,8% sexo masculino, 82,2% por agente etiológico térmico e a internação foi de 73,5% devido à Superfície Corpórea Queimada ≤20%. Após a alta os pais identificaram que as cicatrizes de queimaduras tinham "um pouco" e "pouco" impacto nas cicatrizes nas relações de amizade e na interação social. Para os pais, prevaleceu a resposta "nada" de impacto, seguido por "um pouco" e "muito" na escola, nas brincadeiras, nos jogos e nas atividades diárias. Quanto às reações emocionais e ao humor, a maior parte dos pais considerou "nada". Nesse sentido, os pais responderam às questões quanto à própria percepção sobre as atividades diárias do seu filho e, em geral, a cicatriz de queimadura não impactou na qualidade de vida da criança.

Burns cause devastating physical and psychological effects on individuals, especially children and adolescents, and can change a person's quality of life. The objective was to analyze the impact of burn scars in children under eight years of age in the interaction with friends, family and school, from the parents' perspective. Quantitative cross-sectional study carried out with the parents of children <8 years old who were victims of burns and admitted to a Burn Treatment Center in northern Paraná and monitored on an outpatient basis, from 2017 to 2020. Data collection occurred using two instruments: sociodemographic and clinical characterization; Brisbane Burn Scar Impact Profile. Descriptive analysis and Chi-square test were performed using SPSS®. 34 parents participated whose children suffered burns, 52.9% aged 1 to 3 years old, 58.8% male, 82.2% due to thermal etiological agent and 73.5% hospitalization was due to Burned Body Surface ≤ 20%. After discharge, the parents identified that the burn scars had "a little" and "little" impact on the scars in friendship relationships and social interaction. For parents, the answer "nothing" of impact prevailed, followed by "a little" and "a lot" in school, play, games and daily activities. As for emotional reactions and mood, most parents considered "nothing" that impacted the child with burn scars. In this sense, parents answered questions regarding their own perception of their child's daily activities and, in general, the burn scar did not impact the child's quality of life.

Ingestão de açúcar por crianças com dificuldades alimentares menores de 2 anos - estudo em um centro de referência brasileiro / Sugar intake by children with eating difficulties under2 years of age - study in a Brazilian reference center

Introdução: os primeiros anos de vida são essenciais para o crescimento e o desenvolvimento. A criança já nasce com a preferência pelo sabor doce, e ao consumir preparações açucaradas, propicia--se uma alimentação de baixa qualidade nutricional. O objetivo do estudo é descrever a ingestão de alimentos que contenham açúcar por crianças com dificuldades alimentares menores de 2 anos atendidas em um centro especializado. Material e métodos: trata-se de um estudo observacional retrospectivo, com dados obtidos do prontuário de crianças de ambos os sexos, atendidas no Centro de Excelência em Nutrição e Dificuldades Alimentares (CENDA), localizado no município de São Paulo. Dentre os alimentos consumidos foram selecionados aqueles que continham açúcar de adição em sua composição. Para categorizar os alimentos foi usada a classificação da What We Eat in America (WWEIA). Resultados: participaram do estudo 31 crianças com dificuldades alimentares, 77,4% apresentaram consumo de pelo menos um alimento contendo açúcar. Os alimentos mais consumidos foram biscoitos e brownies, bolos e tortas, milk-shakes e outras bebidas lácteas. Discussões e Conclusão: a fase de alimentação complementar pode se tornar um grande desafio para os pais e cuidadores, a mesma foi o ponto de partida para a maioria das crianças com dificuldade alimentares. O aprendizado do comer é um processo complexo que exige aquisição de habilidades na oferta de alimentos adequados e variados, contudo, o contexto se torna favorável com as práticas inadequadas, sendo uma delas a permissão do consumo de alimentos e produtos adoçados pelas mesmas.

Introduction: the first years of life are essential for growth and development. Children are born with a preference for sweet tastes, and through sugary consumption, they are provided with a diet of low nutritional quality. The objective of the study is to describe the intake of foods containing sugar by children with eating difficulties under 2 years of age treated in a specialized center. Material and methods: this is a retrospective observational study, with data obtained from the medical records of children of both sexes, attended at the Center for Excellence in Nutrition and Eating Difficulties (CENDA), located in the city of São Paulo. Among the foods consumed, those that contained added sugar in their composition were selected. To categorize foods, the What We Eat in America (WWEIA) classification was used. Results: 31 children with eating difficulties participated in the study, 77.4% consumed at least one food containing sugar. The most consumed foods were cookies and brownies, cakes and pies, milkshakes and other dairy drinks. Discussions and Conclusion: the complementary feeding phase can become a great challenge for parents and caregivers, as it was the starting point for the majority of children with eating difficulties. Learning to eat is a complex process that requires the acquisition of skills in offering adequate and varied foods. However, the context becomes favorable to inappropriate practices, one of which is allowing the consumption of sweetened foods and products, for the same reasons.

The effects of standardized intravenous treprostinil in pulmonary arterial hypertension patients after total cavo-pulmonary connection procedure.

OBJECTIVE: Total cavo-pulmonary connection (TCPC) is a palliative treatment for single ventricular malformations. For high-risk patients (preoperative mean pulmonary arterial pressure, mPAP > 15 mmHg), between the inhaled and oral targeted medications, the application of intravenous treprostinil as a bridge therapy to achieve "seamless" management is core postoperative treatment. This study intends to explore the effect of different administration regimens on early postoperative recovery. METHODS: This was a retrospective cohort study. High-risk pediatric patients (age ≤ 14 years) who underwent TCPC procedure in Fu Wai Hospital from 2015 to 2022 were included. Since the regimen of treprostinil was standardized in our center in 2021, the patients in 2020 and before were included in group 1, patients in 2021 and 2022 were included in group 2. The hemodynamic parameters were compared before and after the maintenance dose of treprostinil. The differences of demographic characteristics, surgical data and postoperative recovery were compared between the two groups. RESULTS: A total of 51 pediatric patients were included. Group 1 included 35 patients who received treprostinil at 1-3 postoperative days and an average dose of 12 ± 4 ng/(kg·min). Group 2 included 16 patients who received treprostinil within postoperative 1 day and an average dose of 22 ± 7 ng/(kg·min). There were no significant differences between the two groups in terms of age, weight, preoperative percutaneous oxygen saturation and mPAP,  heterotaxy syndrome, TCPC procedure type, other concurrent procedure, cardiopulmonary bypass time and aortic cross-clamp proportion (p > 0.05). After 24 h of treprostinil treatment, the mPAP in group 1 reduced from 17 ± 3 mmHg to 15 ± 2 mmHg (p < 0.001), and in group 2 from 17 ± 2 mmHg to 14 ± 2 mmHg (p < 0.001), with no difference between groups. In the postoperative recovery, patients in Group 2 exhibited a reduced duration of mechanical ventilation, 19 (11, 25) hours vs 69 (23, 189) hours, p = 0.001; a shorter stay in the ICU, 8 (6, 12) days vs 16 (9,26) days, p = 0.006; and a shorter postoperative length of stay, 27 (17,55) days vs 39 (29,58) days, p = 0.032. Patients in Group 2 also exhibited a lower incidence of thromboembolic events, 0 (0/26) vs 26% (9/35), p = 0.043; and the need for renal replacement therapy, 0 (0/26) vs 31% (11/35), p = 0.011. CONCLUSION: Treprostinil reduces pulmonary artery pressure after TCPC procedure. The standardized application of treprostinil may improve the postoperative recovery which should be proven by randomized controlled trials or matched cohort studies in the future.

Accelerating rare disease detection: an experience of multidisciplinary team model in undiagnosed diseases program in a children's hospital.

Background: A definite diagnosis goes undiscovered for a percentage of children with undiagnosed disorders, with significant medical, psychological, and social effects. Other than specialized clinical centers, exceptional molecular studies, common procedures, and devoted activities at the national and international levels, children with complex undiagnosed disorders require innovative approaches. Methods: In March 2016, Children's hospital of Fudan university represented the Children's Undiagnosed Diseases Program (UDP). The purpose of this study is to describe the project findings and underline the critical significance of multidisciplinary teamwork in China's undiagnosed rare illnesses program. We investigated the 758 cases in our UDP system retrospectively. Demographic information, laboratory test results, and genetic information were gathered. Results: Between January 2017 and December 2021, 758 cases were examined. Males made up 436 (57.5%) of the total. Over half of the patients were children under the age of five. The average patient course time preceding admission to UDP was 6.0 months (95% CI 10.512.6). These patients visited an average of 1.8 clinics during their diagnostic journey. Except for 69 individuals (90.9%), all had more than one presenting symptom in various organs: 460 (60.7%) had neurology difficulties, 151 (19.9%) had endocrine problems, and 141 (18.6%) had immunology problems. UDP has a diagnosis rate of 61.3%. Genetic testing was performed on 469 of the 758 patients, for a genetic diagnosis rate of 15.8%. The UDP method has a sensitivity of 94.5%, a specificity of 86.4%, a positive predictive value of 92.8%, and an negative predictive value of 89.5%. Conclusion: Our UDP targets an unmet need, namely the diagnosis of patients with complicated, multisystem illnesses. Using a multidisciplinary team model approach, this UDP pilot study achieved a reasonable diagnosis success rate, increasing the possibility of more diagnoses and new scientific discoveries of difficult and rare diseases.

A clinical protocol for a German birth cohort study of the Maturation of Immunity Against respiratory viral Infections (MIAI).

Introduction: Respiratory viral infections (RVIs) are a major global contributor to morbidity and mortality. The susceptibility and outcome of RVIs are strongly age-dependent and show considerable inter-population differences, pointing to genetically and/or environmentally driven developmental variability. The factors determining the age-dependency and shaping the age-related changes of human anti-RVI immunity after birth are still elusive. Methods: We are conducting a prospective birth cohort study aiming at identifying endogenous and environmental factors associated with the susceptibility to RVIs and their impact on cellular and humoral immune responses against the influenza A virus (IAV), respiratory syncytial virus (RSV) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The MIAI birth cohort enrolls healthy, full-term neonates born at the University Hospital Würzburg, Germany, with follow-up at four defined time-points during the first year of life. At each study visit, clinical metadata including diet, lifestyle, sociodemographic information, and physical examinations, are collected along with extensive biomaterial sampling. Biomaterials are used to generate comprehensive, integrated multi-omics datasets including transcriptomic, epigenomic, proteomic, metabolomic and microbiomic methods. Discussion: The results are expected to capture a holistic picture of the variability of immune trajectories with a focus on cellular and humoral key players involved in the defense of RVIs and the impact of host and environmental factors thereon. Thereby, MIAI aims at providing insights that allow unraveling molecular mechanisms that can be targeted to promote the development of competent anti-RVI immunity in early life and prevent severe RVIs. Clinical trial registration: https://drks.de/search/de/trial/, identifier DRKS00034278.

Our experience in repairs using the native esophagus such as the Foker and Gazi methods in the management of patients with long-gap esophageal atresia.

This study aimed to share our experience with infants with repaired long-gap esophageal atresia (LGEA) using the native esophagus and Foker and Gazi methods. We retrospectively analyzed the medical records of 10 patients with LGEA (six with pure esophageal atresia [EA], and four with distal trachea-esophageal fistula [TEF] + EA). The mean length between the esophageal pouches was 5.9 cm (4-9 cm). Five Foker methods, three Gazi methods, and two delayed primary repairs after a daily bougie were performed an average of 19.3 days after the first surgery and 26.4 days after the final esophageal anastomosis. For the Foker technique, it was 36.1 days. Their first oral intake was 10.2 days, and their transition to full enteral food was 26.2 days. An esophageal leak was detected in six patients. Fundoplication and dilatations were performed for three and four patients, respectively. For good results, LGEA patients should be operated on at least under the supervision of an experienced surgeon in specialized centers, and the team should be familiar with the techniques for using the native esophagus.

Utilizing artificial neural network system to predict the residual valve after endoscopic posterior urethral valve ablation.

PURPOSE: To build, train, and assess the artificial neural network (ANN) system in estimating the residual valve rate after endoscopic valve ablation and compare the data obtained with conventional analysis. METHODS: In a retrospective cross-sectional study between June 2010 and December 2020, 144 children with a history of posterior urethral valve (PUV) who underwent endoscopic valve ablation were enrolled in the study. MATLAB software was used to design and train the network in a feed-forward backpropagation error adjustment scheme. Preoperative and postoperative data from 101 patients (70%) (training set) were utilized to assess the impact and relative significance of the necessity for repeated ablation. The validated suitably trained ANN was used to predict repeated ablation in the next 33 patients (22.9%) (test set) whose preoperative data were serially input into the system. To assess system accuracy in forecasting the requirement for repeat ablation, projected values were compared to actual outcomes. The likelihood of predicting the residual valve was calculated using a three-layered backpropagating deep ANN using preoperative and postoperative information. RESULTS: Of 144 operated cases, 33 (22.9%) had residual valves and needs to repeated ablation. The ANN accuracy, sensitivity, and specificity for predicting the residual valve were 90.75%, 92.73%, and 73.19%, respectively. Younger age at surgery, hyperechogenicity of the renal parenchyma, presence of vesicoureteral reflux (VUR), and grade of reflux before surgery were among the most significant characteristics that affected postoperative outcome variables, the need for repeated ablation, and were given the highest relative weight by the ANN system.  Conclusions: The ANN is an integrated data-gathering tool for analyzing and finding relationships among variables as a complex non-linear statistical model. The results indicate that ANN is a valuable tool for outcome prediction of the residual valve after endoscopic valve ablation in patients with PUV.

A 7-Month Review of Clinical and Demographic Predictors of Childhood Mortality in a Tertiary Children Hospital in Freetown, Sierra Leone.

BACKGROUND: Sierra Leone ranks among nations with unacceptably high infant and under-5 mortality rates. Understanding the clinical and demographic dynamics that underpin paediatric mortalities is not only essential but fundamental to the formulation and implementation of effective healthcare interventions that would enhance child survival. SUBJECTS AND MATERIAL: This was a 7-month review of all mortalities from May 24th 2021 to December 31st 2021 at Ola During Children's Hospital in Freetown, Sierra Leone. Information on biodata, presenting complaints, illness duration, diagnoses, treatment given inclusive of point-of-care investigations, and duration of hospital stay retrieved from all mortalities were entered into Excel spreadsheets and were analyzed using SPSS version 25.0 for IBM. Multivariable regression analysis was done to determine factors independently associated with mortalities within 24 hours of admission. All associations were considered significant if p < 0.05. RESULTS: There were 840 deaths out of 5920 children admitted during the period giving a mortality of 14.2% with a male-to-female ratio of 1:1. Three hundred and four (36.2%) of these deaths occurred in the neonatal age group while 63.8% occurred in the post neonatal age group. Perinatal asphyxia was the leading cause of neonatal deaths while acute respiratory infections and severe malaria were the leading causes of post neonatal deaths. The majority (64.8%) of the mortalities occurred within the first 24 hours of admission. In a multivariable regression, only transfusion status and use of respiratory support were independently associated with mortality within 24 hours of admission (P<0.05). CONCLUSION: Paediatric mortality in Sierra Leone is high and is caused mainly by preventable morbidities such as perinatal asphyxia and infections. Most of the deaths occurred within 24 hours of admission. It is recommended that patients should be brought to the hospital early and preventive measures be instituted to address these causes.

CONTEXTE: La Sierra Leone se classe parmi les nations ayant des taux de mortalité infantile et des moins de cinq ans inacceptables. Comprendre la dynamique clinique et démographique qui sous-tend les mortalités pédiatriques est non seulement essentiel mais fondamental pour la formulation et la mise en œuvre d'interventions efficaces en matière de santé qui amélioreraient la survie des enfants. SUJETS ET MATÉRIEL: Il s'agissait d'une revue de sept mois de toutes les mortalités du 24 mai 2021 au 31 décembre 2021 à l'Hôpital Ola During Children's à Freetown, Sierra Leone. Les informations sur les données biométriques, les plaintes de présentation, la durée de la maladie, les diagnostics, les traitements administrés, y compris les investigations sur le lieu de soins, et la durée du séjour à l'hôpital ont été saisies dans des feuilles de calcul Excel et analysées à l'aide de SPSS version 25.0 pour IBM. Une analyse de régression multivariée a été effectuée pour déterminer les facteurs indépendamment associés aux mortalités dans les 24 heures suivant l'admission. Toutes les associations étaient considérées comme significatives si p < 0,05. RÉSULTATS: Il y a eu 840 décès sur 5920 enfants admis pendant la période, ce qui donne une mortalité de 14,2 % avec un rapport hommefemme de 1:1. Trois cent quatre (36,2 %) de ces décès sont survenus dans le groupe d'âge néonatal, tandis que 63,8 % sont survenus dans le groupe d'âge post-néonatal. L'asphyxie périnatale était la principale cause de décès néonatal, tandis que les infections respiratoires aiguës et le paludisme grave étaient les principales causes de décès post-néonatal. La majorité (64,8 %) des mortalités sont survenues dans les premières 24 heures suivant l'admission. Dans une régression multivariée, seul le statut transfusionnel et l'utilisation d'un support respiratoire étaient indépendamment associés à la mortalité dans les 24 heures suivant l'admission (P<0,05). CONCLUSION: La mortalité pédiatrique en Sierra Leone est élevée et est principalement causée par des morbidités évitables telles que l'asphyxie périnatale et les infections. La plupart des décès surviennent dans les 24 heures suivant l'admission. Il est recommandé que les patients soient amenés à l'hôpital tôt et que des mesures préventives soient mises en place pour traiter ces causes. MOTS CLÉS: Mortalité pédiatrique, Profil clinique, Déterminants, Freetown.

Caregivers' and nurses' perceptions of the Smart Discharges Program for children with sepsis in Uganda: A qualitative study.

Sepsis arises when the body's response to an infection injures its own tissues and organs. Among children hospitalized with suspected sepsis in low-income country settings, mortality rates following discharge are high, similar to mortality rates in hospital. The Smart Discharges Program uses a mobile health (mHealth) platform to identify children at high risk of post-discharge mortality to receive enhanced post-discharge care. This study sought to explore the perceptions and experiences of the caregivers and nurses of children enrolled into the Smart Discharges Program and the program's effect on post-discharge care. We conducted an exploratory qualitative study, which included in-person focus group discussions (FGDs) with 30 caregivers of pediatric patients enrolled in the Smart Discharges Program and individual, semi-structured interviews with eight Smart Discharges Program nurses. The study was carried out at four hospitals in Uganda in 2019. Following thematic analysis, three key themes pertaining to the Smart Discharges program were identified: (1) Facilitators and barriers to follow-up care after discharge; (2) Changed caregiver behavior following discharge; and (3) Increased involvement of male caregivers. Facilitators included telephone/text message reminders, positive nurse-patient relationship, and the complementary aspects of the program. Barriers included resource constraints and negative experiences during post-discharge care seeking. With regards to behavior, when provided with relevant and well-timed information, caregivers reported increased knowledge about post-discharge care and improvements in their ability to care for their child. Enrolment in the Smart Discharges Program also increased male caregiver involvement, increased provision of resources and improved communication within the family and with the healthcare system. The Smart Discharges approach is an impactful strategy to improve pediatric post-discharge care, and similar approaches should be considered to improve the hospital to home transition in similar low-income country settings.

Younger and rural children are more likely to be hospitalized for SARS-CoV-2 infections.

PURPOSE: To identify characteristics of SARS-CoV-2 infection that are associated with hospitalization in children initially evaluated in a Pediatric Emergency Department (ED). METHODS: We identified cases of SARS-CoV-2 positive patients seen in the Arkansas Children's Hospital (ACH) ED or hospitalized between May 27, 2020, and April 28, 2022, using ICD-10 codes within the Pediatric Hospital Information System (PHIS) Database. We compared infection waves for differences in patient characteristics and used logistic regressions to examine which features led to a higher chance of hospitalization. FINDINGS: We included 681 pre-Delta cases, 673 Delta cases, and 970 Omicron cases. Almost 17% of patients were admitted to the hospital. Compared to Omicron-infected children, pre-Delta and Delta-infected children were twice as likely hospitalized (OR = 2.2 and 2.0, respectively; p<0.0001). Infants under one year were >3 times as likely to be hospitalized than children ages 5-14 years regardless of wave (OR = 3.42; 95%CI = 2.36-4.94). Rural children were almost three times as likely than urban children to be hospitalized across all waves (OR = 2.73; 95%CI = 1.97-3.78). Finally, those with a complex condition had nearly a 15-fold increase in odds of admission (OR = 14.6; 95%CI = 10.6-20.0). CONCLUSIONS: Children diagnosed during the pre-Delta or Delta waves were more likely to be hospitalized than those diagnosed during the Omicron wave. Younger and rural patients were more likely to be hospitalized regardless of the wave. We suspect lower vaccination rates and larger distances from medical care influenced higher hospitalization rates.

A microbiome-directed therapeutic food for children recovering from severe acute malnutrition.

Globally, severe acute malnutrition (SAM), defined as a weight-for-length z-score more than three SDs below a reference mean (WLZ < -3), affects 14 million children under 5 years of age. Complete anthropometric recovery after standard, short-term interventions is rare, with children often left with moderate acute malnutrition (MAM; WLZ -2 to -3). We conducted a randomized controlled trial (RCT) involving 12- to 18-month-old Bangladeshi children from urban and rural sites, who, after initial hospital-based treatment for SAM, received a 3-month intervention with a microbiome-directed complementary food (MDCF-2) or a calorically more dense, standard ready-to-use supplementary food (RUSF). The rate of WLZ improvement was significantly greater in MDCF-2-treated children (P = 8.73 × 10-3), similar to our previous RCT of Bangladeshi children with MAM without antecedent SAM (P = 0.032). A correlated meta-analysis of plasma levels of 4520 proteins in both RCTs revealed 215 positively associated with WLZ (largely representing musculoskeletal and central nervous system development) and 44 negatively associated (primarily related to immune activation). Moreover, the positively associated proteins were significantly enriched by MDCF-2 (q = 1.1 × 10-6). Characterizing the abundances of 754 bacterial metagenome-assembled genomes in serially collected fecal samples disclosed the effects of acute rehabilitation for SAM on the microbiome and how, during treatment for MAM, specific strains of Prevotella copri function at the intersection between MDCF-2 glycan metabolism and anthropometric recovery. These results provide a rationale for further testing the generalizability of MDCF efficacy and for identifying biomarkers to define treatment responses.

Infantile Subglottic Hemangioma: A Case ReportInfantile Subglottic Hemangioma: A Case Report.

ABSTRACT: Subglottic hemangiomas are rare benign vascular tumors of infancy which involve the airway. It is a subtype of infantile hemangiomas and is a potentially life-threatening condition with a mortality rate of 50% if left untreated. Hence, early intervention in this condition is essential. Here we present a case of a 4-month-old infant, a male infant with a history of cough and noisy breathing requiring multiple hospital visits before eventually being diagnosed with subglottic hemangioma. Due to its similar presentation with other more common respiratory illnesses, the diagnosis can be missed. Oral propranolol is the first-line therapy, which was used successfully in our case.

Early Behavioural Signs among Nepalese Children with Autism Spectrum Disorder: A Descriptive Cross-sectional Study.

INTRODUCTION: Autism Spectrum Disorder is a complex neurodevelopmental condition. Early identification of symptoms is crucial for timely intervention, yet diagnosing very young children can be challenging due to the variability in symptom presentation and the influence of other developmental factors. This study aimed to find the prevalence of the emergence of early behavioural signs in Nepalese children with Autism Spectrum Disorder. METHODS: A descriptive cross-sectional study was conducted at the Centre for Autism in Kathmandu, Nepal, from January 2023 to June 2023. Ethical approval was obtained, and a sample of 120 children diagnosed with Autism Spectrum Disorder was included in the study. Convenience sampling method was used. Point estimate at 95% Confidence Interval was calculated. RESULTS: Among 120 children with Autism Spectrum Disorder, the prevalence of emergence of early behavioural signs was seen in 112 (93.33%) (88.83-97.77, 95% Confidence Interval) children. CONCLUSIONS: This study provides insights into the emergence of early behavioural signs in Nepalese children with Autism Spectrum Disorder which align with global patterns in prevalence and severity.

Acute Poisoning among Children Admitted in a Tertiary Care Hospital: A Descriptive Cross-sectional Study.

INTRODUCTION: Acute poisoning is one of the critical causes of hospital admission in children worldwide. Understanding the clinico-demographic profile of childhood poisoning will help in developing targeted prevention strategies. This study aimed to find the prevalence of acute poisoning cases among children admitted to a tertiary care hospital. METHODS: A descriptive cross-sectional study was done among 4972 children admitted in the pediatric ward, High Dependency Care Unit, and Pediatric Intensive Care Unit of a tertiary care hospital in Nepal. The data were collected from the hospital records from over three years between 1 January 2020 and 31 December 2022 after receiving ethical approval from the Institutional Review Committee. A convenience sampling method was used. Data related to the clinical and demographic data were collected from the patients with acute poisoning and analyzed. Point estimate at 95% Confidence Interval was calculated. RESULTS: Out of 4972 paediatric cases admitted to the hospital, acute poisoning was seen in 57 (1.14%) (0.81-1.39, 95% Confidence Interval) patients. Out of these acute poisoning cases, 31 (54.39%) were accidental. The mean age was 10.10±5.40 years with 35 (61.40%) patients from the adolescent age group. CONCLUSIONS: This study conducted in a Nepalese tertiary care hospital identifies acute poisoning as a notable concern among pediatric admissions.

Congenital Heart Disease among Children Undergoing Echocardiography in the Department of Paediatrics of Tertiary Care Centre: A Descriptive Cross-sectional Study.

INTRODUCTION: Congenital heart disease in children are a major cause of infant mortality and morbidity. It is important to detect and manage these disorders timely as they are preventable. The objective of this study was to find out proportion of congenital heart disease in children in paediatric department in a tertiary hospital. METHODS: This is a descriptive cross-sectional study carried out in the Department of Paediatric at Nepal Medical College and Teaching Hospital where all children (0-18 years) suspected to have congenital heart disease who underwent echocardiography were studied over a period of 1 year (2020-2021). The presence or absence of congenital heart disease were confirmed by echocardiography performed by paediatric cardiologist. The socioeconomic variables,clinical features and echocardiography findings were noted. RESULTS: Out of total 249 patients,the proportion of patients diagnosed to have cardiac disorders was 73 with male predominance of 165 (66.26%). The most common age group was found to be neonates 111 (44%).The notable clinical features were murmur 47 (18.87%), tachypnoea 27 (10.84%) ,tachycardia 27 (10.84%) and cyanosis 9 (3.61%), clubbing 2 (0.80%), oedema 1 (0.40%), hypertension 9 (3.65%), murmur 47 (18.87%).Out of the total, there were 49 (19.67%) cases of acyanotic congenital heart disease, and 27 (10.84%) cases of cyanotic congenital heart disease. CONCLUSIONS: Our study focuses on early recognition of cardiac diseases which is crucial for preventing morbidity and mortality.

Acute Post-infectious Glomerulonephritis in Children Admitted to a Tertiary Care Hospital: A Descriptive Cross-sectional Study.

INTRODUCTION: Post infectious glomerulonephritis remains the most common cause leading to the majority of hospital admissions in children of developing countries like ours. The aim of our study was to find the prevalence of post infectious glomerulonephritis, study the clinical profile, biochemical changes and its complication in children admitted in a tertiary care hospital of Nepal. METHODS: This descriptive cross-sectional study of children admitted at a tertiary care hospital was done from May 2020 till May 2023. A census sampling method was used and sample of 1554 children was taken. Detailed socio demographic data, clinical findings and laboratory investigations were done. Data analysis was done using SPSS software and the results obtained are shown in the form of frequencies along with percentages. RESULTS: Among 1554 patients, the prevalence of acute post-infectious glomerulonephritis was found to be 63 (4.05%) (3.07-5.03 at 95% Confidence Interval). The mean age of the patients was 9.06±3.48 years. Antistreptolysin O titer was raised in 34 (54%) patients, while low serum C3 was observed in 39 (61.90%) patients with acute post-infectious glomerulonephritis. CONCLUSIONS: Acute post-infectious glomerulonephritis (APIGN) remains a notable health concern in children, particularly in developing countries like Nepal. This highlights the need for ongoing surveillance, prevention strategies, and effective management protocols to address this burden effectively.