Showing papers in "Pediatrics International in 2021"

Mental health in Japanese children during school closures due to the COVID-19.

Abstract: BACKGROUND: Changes in relationships, sleep rhythms, and physical activity caused by school closures instituted to curb the spread of COVID-19 influenced children's mental health. We explored changes in children's daily life and effects on their mental health during school closures. METHODS: Participants included elementary and junior high school students 9 years of age and older seen in the outpatient clinic during school closures and were required to complete the Japanese version of WHO Five Well-Being Index (WHO-5-J). The results were compared with those of students seen after schools reopened. RESULTS: Participants included 78 students in the school closure group and 113 in the school reopening group. Although those in the closure group devoted more time to family and sleep, their sleep rhythms, eating habits, and physical activities were disrupted. Although there were no significant differences between the two groups in total WHO-5-J scores, single WHO-5-J items such as activity and vigor and interest were significantly worse and rest was significantly better in the school closure group. CONCLUSION: Although school closures resulted in elementary and junior high school students spending more time with family and sleeping, their sleep rhythms, eating habits, and physical activities were disrupted. As the children's living environment changed, they felt less active and vigorous and had difficulty finding things that interested them. However, their sleep improved and overall, the number of children with potential mental health problems did not change.

Lung ultrasound compared to chest X-ray for the diagnosis of CAP in children

Abstract: BACKGROUND Community-acquired pneumonia (CAP) represents one of the most common infectious diseases among children. Diagnosis of CAP is mainly clinical. Chest X-ray (CXR) remains the gold standard for the diagnosis in severe or controversial conditions. Recently, some authors have focused on the application of ultrasound in lung diseases but the role of lung ultrasound (LUS) in the diagnosis of CAP is still debated. We aimed to study the concordance between LUS and CXR in evaluating specific signs of CAP. As a secondary aim, we sought to determine the sensitivity and specificity of LUS in CAP diagnosis compared with CXR. Finally, we evaluated the role of LUS during the follow up. METHODS We enrolled 68 children (<16 years old) hospitalized from October 2018 to September 2019 with a clinical and radiological diagnosis of CAP (cases: N = 41), or with no respiratory diseases (controls: N = 27), in whom a CXR was performed for clinical indications. All the children underwent LUS during hospitalization. The average time needed to perform LUS was 5-10 min for each child, and 19/41 cases were re-evaluated by LUS and CXR 30 days after discharge. RESULTS Lung ultrasound confirmed CAP diagnosis in 40/41 patients. Concordance between the two techniques was K = 0.88 for the right lung and K = 0.70 for the left lung. Lung ultrasound showed a sensitivity of 97% and a specificity of 96% compared with CXR. At the follow up, sensitivity increased to 100% while specificity was 94%. CONCLUSIONS Our study showed a potential benefit of LUS compared with CXR in the diagnosis and the follow up of CAP.

Regeneration using endogenous neural stem cells following neonatal brain injury.

Abstract: Despite recent advancements in perinatal care, the incidence of neonatal brain injury has not decreased. No therapies are currently available to repair injured brain tissues. In the postnatal brain, neural stem cells reside in the ventricular-subventricular zone (V-SVZ) and continuously generate new immature neurons (neuroblasts). After brain injury in rodents, V-SVZ-derived neuroblasts migrate toward the injured area using blood vessels as a scaffold. Notably, the neonatal V-SVZ has a remarkable neurogenic capacity. Furthermore, compared with the adult brain, after neonatal brain injury, larger numbers of neuroblasts migrate toward the lesion, raising the possibility that the V-SVZ could be a source for endogenous neuronal regeneration after neonatal brain injury. We recently demonstrated that efficient migration of V-SVZ-derived neuroblasts toward a lesion is supported by neonatal radial glia via neural cadherin (N-cadherin)-mediated neuron-fiber contact, which promotes RhoA activity. Moreover, providing blood vessel- and radial glia-mimetic scaffolds for migrating neuroblasts promotes neuronal migration and improves functional gait behaviors after neonatal brain injury. In the V-SVZ, oligodendrocyte progenitor cells (OPCs) are also generated and migrate toward the surrounding white matter, where they differentiate and form myelin. After white matter injury in rodents, the production and subsequent migration of V-SVZ-derived OPCs are enhanced. In the neonatal period, administration of growth factors at a specific time promotes oligodendrocyte regeneration and functional recovery after brain injury. These findings suggest that activating the high regenerative capacity that is specific to the neonatal period could lead to the development of new therapeutic strategies for neonatal brain injury.

Clinical guidelines for the treatment of congenital diaphragmatic hernia

Abstract: Congenital diaphragmatic hernia (CDH) is a birth defect of the diaphragm in which abdominal organs herniate through the defect into the thoracic cavity. The main pathophysiology is respiratory distress and persistent pulmonary hypertension because of pulmonary hypoplasia caused by compression of the elevated organs. Recent progress in prenatal diagnosis and postnatal care has led to an increase in the survival rate of patients with CDH. However, some survivors experience mid- and long-term disabilities and complications requiring treatment and follow-up. In recent years, the establishment of clinical practice guidelines has been promoted in various medical fields to offer optimal medical care, with the goal of improvement of the disease' outcomes, thereby reducing medical costs, etc. Thus, to provide adequate medical care through standardization of treatment and elimination of disparities in clinical management, and to improve the survival rate and mid- and long-term prognosis of patients with CDH, we present here the clinical practice guidelines for postnatal management of CDH. These are based on the principles of evidence-based medicine using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. The recommendations are based on evidence and were determined after considering the balance among benefits and harm, patient and society preferences, and medical resources available for postnatal CDH treatment.

Association between scanning frequency of flash glucose monitoring and continuous glucose monitoring‐derived glycemic makers in children and adolescents with type 1 diabetes

Abstract: BACKGROUND We assessed the association between scanning frequency of flash glucose monitoring (FGM) and continuous glucose monitoring (CGM)-derived glycemic markers in children and adolescents with type 1 diabetes. METHODS Subjects consisted of 85 children and adolescents with type 1 diabetes using FGM. We assessed the association between scanning frequencies of FGM- and CGM-derived metrics: Time in range (TIR) (70-180 mg/dL), time below range (TBR) ( 180 mg/dL), and other glycemic markers - laboratory-measured HbA1c and CGM-estimated glucose and HbA1c (eA1c) levels in the subjects. RESULTS The mean number of scans was 11.5 ± 3.5 (5-20) times per day, and scanning was most frequently conducted during a period of 18-24 h. Scanning frequency showed significant positive correlation with TIR (r = 0.719, P < 0.0001) and inverse correlation with time above range (r = -0.743, P < 0.0001), but did not correlate with TBR. There were also significant inverse correlations between scanning frequency and glucose, HbA1c, and eA1c levels (r = -0.765, -0.815, and -0.793, respectively, P < 0.0001). CONCLUSIONS Frequent glucose testing with FGM decreased hyperglycemia with increased TIR, but did not reduce TBR. Coping with a rapid fall of glucose and unexpected hypoglycemia with more advanced technology might contribute to a reduction in TBR.

Kawasaki disease mimickers.

Abstract: Background Kawasaki disease (KD) is an acute systemic vasculitis that predominantly affects patients younger than 5 years. In the absence of an available, affordable diagnostic test, detailed clinical history and physical examination are still fundamental to make a diagnosis. Methods We present five representative cases with KD-like presentations: systemic onset juvenile idiopathic arthritis, mycoplasma-induced rash and mucositis, staphylococcal scalded skin syndrome, BCGosis, and the recently described multisystemic inflammatory syndrome in children (MIS-C) associated with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) virus. Results Rash, fever, and laboratory markers of inflammation can be present in several childhood diseases that may mimic KD. Conclusion The term 'Kawasaki syndrome' instead of 'Kawasaki disease' may be more appropriate. Physicians should consider an alternative diagnosis that may mimic KD, particularly considering MIS-C during the present pandemic, as an aggressive diagnostic and therapeutic approach is needed.

Clinical Characteristics of Pediatric COVID-19 and Predictors of PCR Positivity.

Abstract: Background To identify the clinical findings and outcomes of children with COVID-19 and factors predicting RT-PCR positivity. Methods The data retrospectively analyzed for suspected and confirmed pediatric COVID-19 patients between March 20 and May 31, 2020. Results There were 404 children, of them, 176 (43.6%) patients were confirmed to have COVID-19 which were less symptomatic on admission (67.6% to 95.6%). Cough (44.9%), fever (38.1%), sore throat (18.5%), and smell-taste loss (12.7%) were the most common symptoms. Confirmed cases had 92.6% identified history of contact with COVID-19. Close contact with COVID-19 positive family members and coughs increased the RT-PCR positivity 23.8 and 5.0 times, respectively; while positivity decreased by 0.4 times if fever was over 38°C. Asymptomatic and mild cases were categorized as 'group 1' (n=153), moderate, severe and critical cases as 'group 2' (n=23) in terms of disease severity. Group 2 cases had higher C-reactive protein (40.9% to 15.9%) and procalcitonin (22.7% to 4.9%) levels and had more frequent lymphopenia (45.5% to 13.1%). Out of 23 cases, 19 had abnormal chest x-ray findings; of them, 15 patients underwent chest CTs, and all had abnormal findings. However, 26.0% of them needed respiratory support, and no patient required invasive ventilation. Conclusion Children with COVID-19 have milder clinical course and SARS-CoV-2 rarely causes severe disease in children. Contact history with COVID-19 and sore throat are the most important predictors for RT-PCR positivity. Consequently, the role of asymptomatic children in the contamination chain must be fully established and considered for the control of pandemic.

Sleep problems in children with autism spectrum disorder and typical development.

Abstract: BACKGROUND Although higher sleep problems have been mostly reported in children with autism spectrum disorder (ASD) compared with typically developing (TD) children, particularly in Western countries, such evidence is relatively scarce in developing countries. We therefore investigated sleep difficulties in Thai children aged 3-16 years with ASD compared with age- and gender-matched TD children by using the Children's Sleep Habits Questionnaire (CSHQ)-Thai version. METHODS Sixty-five children with ASD (mean age 97.7, SD 44.5 months; boys 70.8%) and 65 TD individuals (mean age 98.5, SD 43.5 months) were enrolled at a university-based hospital in Bangkok. Background characteristics, sleep duration variables, and the CSHQ were completed by the participants' parents. The CSHQ subscales and total score between children with ASD and TD controls were then compared. RESULTS Children with ASD were more likely to have longer sleep latency than TD individuals for both weekdays and the weekend. Those with ASD had higher CSHQ subscales including bedtime resistance, sleep onset delay, sleep anxiety, and night waking in addition to the CSHQ total scores than TD controls. In the ASD group, those who took psychostimulants for treatment of ADHD had lower scores on the sleep duration subscale compared with unmedicated individuals. CONCLUSIONS Sleep difficulties were more prevalent in children with ASD compared with TD individuals. Parents should be advised to be aware of sleep problems in individuals with ASD. As such, sleep disturbances will be identified early, resulting in appropriate management and improved quality of life, not only for those with ASD but also their families.

Transitional care for inflammatory bowel disease: A survey of Japanese pediatric gastroenterologists.

Abstract: BACKGROUND In 2019 we reported the results of a Japanese national survey designed to explore the views of adult gastroenterologists regarding transitional care for patients with childhood-onset inflammatory bowel disease (IBD). For the present study, we conducted a similar survey of pediatric gastroenterologists to compare the views of the two sets of specialists. METHODS The survey conducted in 2019 involved 48 representative members of the Japanese Society for Pediatric Gastroenterology, Hepatology and Nutrition. They were contacted by conventional mail and their answers were not anonymized. Respondents who had already referred patients with IBD to adult gastroenterologists were asked in a questionnaire to rank the importance of specific statements on a Likert scale. RESULTS The response rate was 79% and 29 (60%) of the respondents had experienced transitional care for patients with IBD. Transfer to adult care was considered by 90% of the respondents to be the ideal form of medical care for adolescents/young adults with IBD. However, 59% of the respondents had experienced some degree of difficulty when making referrals for such care. The majority of pediatric gastroenterologists considered that the ideal age for transfer was 18-22 years. Among the respondents, physicians at municipal hospitals considered that the presence of diseases other than IBD and a shortage of manpower were significantly more important issues than other practice settings. CONCLUSIONS The present survey revealed that the general views regarding transitional care for IBD between pediatric and adult gastroenterologists were similar, except for the appropriate time for transfer. The results underline the importance of preparing a transition program appropriate to practice settings.

Early term delivery is associated with increased neonatal respiratory morbidity.

Abstract: Background The recent increase in early term birth rates represents a growing challenge to public health given the association between early term birth and neonatal morbidities. We compared the risk of respiratory morbidity between early term and full-term infants. Methods This retrospective cohort population study included infants born at 37-41 weeks' gestation in a single tertiary care university hospital between 2014 and 2016. Newborns were categorized as early term (37-38 weeks) and full term (39-41 weeks). The primary outcome was respiratory morbidity. Results Of the 4,894 babies born at 37-41 weeks gestational age, 31% (n = 1,521) were early term births. The rate of cesarean deliveries, which were often elective, was higher for early term than for full-term newborns (P = 0.001). Compared with full-term newborns, early term newborns, had significantly higher risks of respiratory morbidity (13.2 % vs 6.3 %; odds ratio [OR], 2.28, P = 0.001), respiratory distress syndrome (0.5 % vs 0 %, P = 0.001), transient tachypnea of the newborn (11.2 % vs 4.6 %; OR, 2.72, P = 0.001), continuous positive airway pressure use (9.7 % vs 3.7 %; OR, 2.82, P = 0.001), and ventilation support (1.4% vs 0.4%; OR, 4.11, P = 0.001). Conclusions The elevated frequency of respiratory morbidity in early term infants emphasizes the importance of early term birth interventions. More than half of the early term births were elective cesarean sections; interventions should therefore focus on reducing elective cesarean procedures at the time of first birth.

Acute Recurrent and Chronic Pancreatitis in Children.

Abstract: Acute recurrent pancreatitis (ARP) is defined as two distinct episodes of acute pancreatitis (AP), whereas chronic pancreatitis (CP) is caused by persistent inflammation of the pancreas. In children they are caused by genetic mutations, autoimmune pancreatitis, congenital pancreatic abnormalities, and other conditions. Acute recurrent pancreatitis is frequently a precursor to CP, and both are thought to be on the same disease continuum. In particular, genetic factors are associated with early progression of ARP to CP. The diagnosis of CP, as in AP, is based on clinical findings, biochemical tests, and imaging studies. Findings of exocrine pancreatic dysfunction are also important in the diagnosis of CP. A step-up strategy has become increasingly standard for the treatment of patients with CP. This strategy starts with endoscopic treatment, such as pancreatic sphincterotomy and stenting, and progresses to surgery should endoscopic therapy fail or prove technically impossible. Non-opioid (e.g. ibuprofen / naproxen) and opioid (e.g. oxycodone) forms of analgesia are widely used in pediatric patients with AP or CP, whereas pancreatic enzyme replacement therapy may be beneficial for patients with abdominal pain, steatorrhea, and malnutrition. Despite the disparity in the age of onset, pediatric CP patients display some similarities to adults in terms of disease progress. To reduce the risk of developing pancreatic exocrine inefficiency, diabetes and pancreatic cancer in the future, clinicians need to be aware of the current diagnostic approach and treatment methods for ARP and CP and refer them to a pediatric gastroenterologist in a timely manner.

Clinical characteristics of hypertrophic cardiomyopathy in children: An 8-year single center experience.

Abstract: Background Hypertrophic cardiomyopathy (HCM) is the second most common pediatric cardiomyopathy. Although there is a large body of literature about HCM in adults, there is limited information on HCM in childhood. We evaluated various aspects of pediatric HCM patients treated at our center. Methods We identified 152 pediatric patients with HCM between October 2011 and October 2019. Clinical history, invasive (ICD, pacemaker, electrophysiologic study, catheter ablation therapy) and non-invasive (ECG, holter moniterization, echocardiography, cardiac MR, genetic study, medicam treatment) data were collected and evaluated. Results The mean ± standard deviation age of patients was 8.9 ± 5.7 years (1 month-18 years) and 67.8% were male. The most frequent clinical symptoms were murmur and palpitations. Three cases (2%) had aborted sudden death as the first manifestation of HCM. Of these patients, 120 (78.9%) had non-syndromic HCM and 32 (27.2%) had syndromic HCM. Asymmetric septal hypertrophy was common (48.3%) in the non-syndromic group, whereas concentric hypertrophy was common (56.2%) in syndromic group. Left ventricular outflow tract obstruction (LVOTO) occurred in 39 (25.6%) patients. Nine (5.9%) patients underwent electrophysiologic study and/or ablation and 16 patients underwent surgical intervention. Implantable cardioverter defibrillator (ICD) insertion was performed in 38 patients (26 transvenous, 12 epicardial). ICDs were inserted in three (7.9%) patients for secondary prevention; in the remaining patients (92.1%) the devices were placed for primary prevention. Mean SD follow-up time was 27.1 ± 22 months. Five (3.3%) patients died during the follow-up. No patient had heart transplantation or a long-term assistive device. Conclusion The etiology of HCM is heterogeneous and present at any age. It is important to determine the timing of surgery and potential risks for sudden cardiac arrest. As most cases of HCM are familial, evaluation of family members at risk should be a routine component of clinical management.

Mechanical stimulation is a risk factor for phlebitis associated with peripherally inserted central venous catheter in neonates.

Abstract: Background Our peripherally inserted central venous catheter (PICC) management plan for neonates previously included routine inspection for swelling and induration of the insertion site of a PICC using palpation. However, we discontinued routine palpation from July 13, 2018, owing to a peculiarly high incidence of PICC-related phlebitis. The aim of this study was to prove that routine palpation was the cause of PICC-related phlebitis. Methods We retrospectively reviewed medical records of infants who were admitted to the neonatal intensive care unit and underwent PICC placement from January 2018 to January 2019. The infants were classified into palpating (before July 13, 2018) and non-palpating (after or on July 13, 2018) groups. We analyzed and compared the incidence of PICC-related phlebitis in the two groups. Results Phlebitis related to PICC was more frequently observed in the palpating group (10/29 infants, 34.5%) than in the non-palpating group (1/31, 3.2%) (P = 0.002). After discontinuation of routine palpating in PICC management, the frequency of non-scheduled removal of the PICC due to phlebitis decreased. The indwelling period was significantly longer in the non-palpating group than in the palpating group. Conclusions Our results suggest that mechanical stimulation using palpation of the insertion site was the cause of PICC-related phlebitis, resulting in early non-scheduled removal.

Kawasaki disease following coronavirus disease 2019 with prolonged fecal viral shedding.

Abstract: Coronavirus disease 2019 (COVID-19) has grown into a pandemic. Recently, cases of Kawasaki-like syndrome associated with coronavirus disease 2019 (COVID-19) have been reported in the USA and Europe. The Centers for Disease Control and Prevention (CDC) and the European Centre for Disease Prevention and Control (ECDC) issued alerts concerning Kawasaki-like syndrome associated with COVID-19, also known as multisystem inflammatory syndrome in children (MIS-C) and pediatric inflammatory multisystem syndrome (PIMS). To date, there have been no reports of this syndrome from East Asia despite the high prevalence of Kawasaki disease (KD) in the area. Here we described a pediatric case of KD following COVID-19. A previously healthy, 21-month-old, male, Japanese patient presented with a fever and cough. The index patient was his mother, who previously received the diagnosis of COVID-19. Eight days after the onset of his mother’s symptoms, he had a fever, which lasted 2 days and was accompanied by a mild cough without respiratory distress. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was detected in nasopharyngeal and stool samples by real-time reverse transcriptase polymerase chain reaction (PCR). The patient was admitted for quarantine in accordance with the isolation protocol of the Japanese government at the time. He did not require specific medical treatment and recovered spontaneously. Figure 1a shows the trend in the viral load in the nasopharyngeal and stool samples. Although the patient met the national criteria for discharge, consisting of two consecutive negative nasopharyngeal PCR results for SARS-CoV-2, he remained hospitalized because his mother was still in quarantine. He was discharged on day 38 of illness following his mother’s recovery. Three weeks after discharge, he presented with a fever of 4 days’ duration and poor oral intake. He was readmitted on day 60 from COVID-19 onset. After the initial discharge, he had stayed home and had no contact with any sick individuals. On the second day of hospitalization, physical examination revealed left-dominant cervical lymphadenopathy, multiple oral aphthae, erythema of the lips, hands, and feet, and an erythematous rash on the back (Fig. 1b–e). He also had mild diarrhea but denied conjunctivitis, erythema at the Bacillus Calmette-Gu erin inoculation site, meningeal signs, vomiting, abdominal pain, respiratory distress, and peripheral hypoperfusion. Laboratory data showed elevated inflammatory and cytokine markers (Table S1). He met the criteria of KD on day 5 of the fever, and received intravenous immunoglobulin (2 g/ kg/dose), aspirin (30 mg/kg/day), and prednisolone (2 mg/kg/ day) in accordance with the high-risk treatment protocol. An echocardiogram and electrocardiogram was performed on days 5 and 11 of KD, respectively. His cardiac function and coronary arteries were normal. The treatments were clinically effective, and he recovered without any cardiovascular complications. His SARS-CoV-2 infection status as assessed by PCR at the second admission was positive only for the stool sample and negative for the nasopharyngeal, urine, and blood samples. A serological test for SARS-CoV-2 was positive. To the best of our knowledge, this is the first case of KD in Japan following COVID-19, with a detailed timeline showing evidence of prolonged fecal viral shedding. Most cases of Correspondence: Kazuhiro Uda, MD, Division of Infectious Diseases, Department of Pediatrics, Tokyo Metropolitan Children’s Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo 183-8561, Japan. Email: uddy0308@yahoo.co.jp Received 29 July 2020; revised 14 August 2020; accepted 20 August 2020. doi: 10.1111/ped.14452

The clinical characteristics of pediatric coronavirus disease 2019 in 2020 in Japan.

Abstract: BACKGROUND: Coronavirus disease 2019 (COVID-19) pandemic has affected the lives of young and old people. Most reports on pediatric cases suggest that children experience fewer and milder symptoms than adults do. This is the first nationwide study that focused on pediatric cases reported by pediatricians, including those with no or mild symptoms, in Japan. METHODS: We analyzed the epidemiological and clinical characteristics, and transmission patterns of 840 pediatric (<16 years old) COVID-19 cases reported between February and December 2020 in Japan, using a dedicated database that was voluntarily registered by the members of the Japan Pediatric Society. RESULTS: Almost half of patients (47.7%) were asymptomatic, while most of the others presented mild symptoms. At the time of admission or first outpatient clinic visit, 84.0% of the cases were afebrile (<37.5°C). In total, 609 cases (72.5%) were exposed to COVID-19-positive household members. We analyzed the influence of nationwide school closures that were introduced in March 2020 on COVID-19 transmission routes among children in Japan. Transmission within households occurred most frequently, with no significant difference between the periods before and after declaring nationwide school closures (70.9% and 74.5%, respectively). CONCLUSIONS: COVID-19 symptoms in pediatric cases are less severe than those in adult cases. School closure appeared to be limitedly effective, and controlling household transmission from adult family members is the most important measure for COVID-19 prevention among children.

Dog bite injuries in a tertiary care children's hospital: A seven-year review.

Abstract: BACKGROUND Dog bites are a major cause of traumatic injury in children. The aim of this study was to determine the experience, management, and outcome of dog bite injuries in our department. METHODS We retrospectively reviewed the clinical records for 127 patients (mean age 7.15 ± 4.24 years, range 1 to 17 years; 68 males) affected by dog-related injuries, from 2012 to 2018. Characteristics of patients and dogs, type and severity of injuries, circumstances of the accidents, treatment and outcome were analyzed. RESULTS Of 141 wounds, 73 (51.8%) affected the head and neck, 62 (44%) the limbs, and six (4.2%) affected the trunk. According to the Mcheik classification, 107 lesions (75.9%) were stage 1, 26 (18.4%) stage 2, and eight (5.7%) stage 3. Seventy-eight percent of the cases involved known dogs. The breed of the dog was recorded in 62/127 cases (48.8%) and the most common were mongrels (23/62, 37.1%). Seventy-five percent of the attacks occurred during spring and summer. All patients underwent antibiotic prophylaxis and immediate surgical repair. Wound infection was observed in two patients. Three unsightly scars required rectification, with good cosmetic results in all cases. CONCLUSIONS Our results are consistent with previous data showing that the typical dog-related injury occurs from a known dog, during spring and summer, and in younger boys, who are frequently exposed to head and neck wounds. Our experience showed the feasibility and safety of primary repair and antibiotic prophylaxis in all patients, with very low incidence of infection and good cosmetic results.

Long term Respiratory Outcomes of Post‐op Congenital Lung Malformations

Abstract: BACKGROUND Congenital lung malformations (CLM) are rare disorders and surgical intervention is the definitive treatment. Our aim is to evaluate the long-term lung function of patients with CLM after surgery compared to healthy children. METHODS Sixteen children with CLM (M/F: 9/7) and 30 age-matched, healthy controls (M/F: 13/17) were included in the study. Demographic data were recorded and both groups were compared by spirometry and the nitrogen-based Lung Clearance Index (LCI). RESULTS Mean ± SD age of the patients was 12.0 ± 5.4 years. The mean forced expiratory volume in 1 s (FEV1 ), forced vital capacity (FVC), FEV1 /FVC, and forced expiratory flow between 25% and 75% of force expiration (FEF25-75 ) predicted was, 86.68 ± 16.65, 88.00 ± 14.58, 97.44 ± 9.89, and 79.00 ± 26.41, respectively in the patient group. Patients with CLM had significantly lower values in FEV1 , FVC, FEF25-75 than healthy controls (P = 0.002, P 0.007, P 0.045). While the mean LCI2,5% value in patients' group was 8.33 ± 1.52, it was 7.28 ± 0.80 in healthy controls (P = 0.023). Strong inverse correlation between LCI and FEV1 , FEV1 /FVC was detected in the patient group (P = 0.023; r: -0.581, P 0.017; r: -0.606 respectively). CONCLUSION This study revealed that, in long-term follow-up, patients who had surgery because of CLM have impairment in the pulmonary function compared to healthy children and LCI may be more accurate in detecting airway diseases early than spirometry.

Delta brushes are not just a hallmark of EEG in human preterm infants

Abstract: The delta brush, a well-known characteristic waveform of the human preterm electroencephalogram, represents spontaneous electrical activity. Recent experimental animal model evidence suggests that delta brushes are not only spontaneous intrinsic activity but are also evoked by external sensory stimulation or spontaneous movement. They are also likely to reflect the activity of subplate neurons, which play an important role in early brain development and network organization. Here, evidence about delta brushes in human preterm electroencephalogram is provided along with future perspectives.

Regional Oxygen Saturation and Acute Kidney Injury in Premature Infants.

Abstract: Background Decreased renal blood flow plays a vital role in the etiology of acute kidney injury (AKI). In this study, we aim to investigate the role of renal regional oxygen saturation (rSO2 ) reductions in predicting AKI in the first 24 hours of life. Methods One-hundred premature babies with a gestational age of ≤32 weeks were included. Renal and cerebral rSO2 s were monitored for 24 hours by near-infrared spectroscopy (NIRS). Infants were followed up for the first 7 days for the diagnosis of AKI. Results Infants' median gestational age was 29 (23-32) weeks, and their birth weight was 1192 ± 355 g. It was found that the renal rSO2 values were lower in the first 24 hours of life in patients who developed AKI, and this decrease was statistically significant in the first 6 hours of life. Conclusion The low renal rSO2 values in the early hours of life in premature babies may have a role in predicting AKI.

Skin Manifestations During the COVID-19 Pandemic in the Pediatric Emergency Department.

Abstract: BACKGROUND The role of SARS-CoV-2 as the cause of chilblains in children remains a matter of debate but it is important to elucidate it for patient isolation and contact tracing. We sought to define the etiology, clinical presentation, time course, and outcomes of children presenting to the emergency department (ED) with cutaneous manifestations shortly after the first pandemic peak of COVID-19 in Spain. METHODS A prospective, observational study in children <15 years of age evaluated for skin lesions in the EDs of three pediatric hospitals. Children underwent a comprehensive work-up including tests for SARS-CoV-2 antibodies and polymerase chain reaction (PCR), and serology and PCR tests for other viruses and bacteria. A 1 month follow-up visit was conducted. RESULTS From April 14 through May 8, 2020, we enrolled 62 children. Of those, 34 had acro-ischemic skin lesions and 28 had a variety of skin rashes. Overall, 40% of children had mild systemic symptoms. Children with chilblains were older, had pain more frequently and a more prolonged duration of skin lesions, while those with non-specific rashes had fever more frequently. Lesions were resolved in 75% of children at follow up. Five patients demonstrated SARS-CoV-2 antibodies, and none tested positive with PCR. Three additional patients tested positive with PCR for rhinovirus, Mycoplasma pneumoniae and Chlamydia pneumoniae. CONCLUSIONS The number of ED visits for chilblains, which are rare in pediatrics, was high soon after the first peak of COVID-19 in Spain. The disease course was self-limited, outcomes were favorable, and the possibility of viral transmission was negligible as all patients tested negative for SARS-CoV-2 by PCR.

Issues of infant feeding for postnatal prevention of human T-cell leukemia/lymphoma virus type-1 mother-to-child transmission.

Abstract: BACKGROUND Nationwide antenatal human T-cell leukemia/lymphoma virus type-1 (HTLV-1) antibody screening has been conducted in Japan The purpose of our study was to clarify the issues related to feeding options to prevent postnatal mother-to-child transmission METHODS Of the pregnant carriers at 92 facilities in Japan between 2012 and 2015, 735 were followed prospectively Among the children born to them, 313 (426%) children were followed up to the age of 3 and tested for HTLV-1 antibodies The mother-to-child transmission rate was calculated for each feeding option selected before birth RESULTS Among the 313 pregnant carriers, 550, 351, 61, and 38% selected short-term breast-feeding (≤3 months), exclusive formula feeding, frozen-thawed breast-milk feeding, and longer-term breast-feeding, respectively Despite short-term breast-feeding, 8-18% of the mothers continued breast-feeding for 4-6 months The mother-to-child transmission rate with short-term breast-feeding was 23% (4/172), and its risk ratio compared with that of exclusive formula feeding was not significantly different (0365; 95% CI: 0116-1145) Because of the small number of children who were fed by frozen-thawed breast-milk, their mother-to-child transmission rate was not statistically reliable CONCLUSIONS Pregnant HTLV-1 carriers tended to select short-term breast-feeding in Japan While short-term breast-feeding was not always easy to wean within 3 months, it may be a viable option for preventing postnatal mother-to-child transmission because the vertical transmission rate with short-term breast-feeding was not significantly higher than that with exclusive formula feeding Increasing the follow-up rates for children born to pregnant carriers may provide clearer evidence of preventative effects by short-term breast-feeding and frozen-thawed breast-milk feeding

A microchip flow‐chamber assay screens congenital primary hemostasis disorders

Abstract: Background Von Willebrand disease (VWD) and platelet function disorders (PFDs) are congenital bleeding disorders caused by primary hemostasis defects. Platelet function tests are time-consuming and require considerable amounts of blood sample, and there have been no easy-to-use assays for assessing platelet function quickly and sensitively. We report the usefulness of a microchip flow-chamber system (T-TAS® ) for detecting and/or predicting clinical severity in patients with VWD type 1 and type 2N and platelet storage pool disease. Here, we developed an application of a screening assay for primary hemostasis disorders. Methods Microchips coated with collagen (PL-chip) and collagen/thromboplastin (AR-chip) were utilized to evaluate platelet thrombus formation (PTF) at high shear and fibrin-rich PTF at low shear, respectively, in whole blood samples from 22 patients with VWD (16 type 2A, four type 2B, two type 3) and four patients with PFDs (two BSS, two Glanzmann thrombasthenia). The time-to-increase by 10 kPa (T10 ) was calculated from flow pressure curves. Also, whole blood-induced platelet aggregation was assessed using Multiplate® analysis. Results PL-chip T10 values ≥10 min successfully distinguished patients with all types of VWD and PFDs from healthy controls, irrespective of age, bleeding scores, and von Willebrand factor levels. However, AR-chip assay incompletely distinguished between type 2A patients and healthy ones. Multiplate analysis permitted screening of PFDs and type 3 VWD, but values in type 2A partially overlapped with those in controls. PL-chip assay did not reflect the clinical severity in these patients. Conclusions T-TAS with PL-chip could be a quick screening tool for congenital primary hemostasis disorder, VWD, and PFDs.

The impact of COVID-19 pandemic on pediatric hospitalization in Kitami, Japan.

Abstract: BACKGROUND: Coronavirus disease 2019 (COVID-19) has drastically changed the recommended activities and environment of patients worldwide. Our aim was to assess the impact of COVID-19 on pediatric hospitalizations in Kitami, Japan. METHODS: A retrospective, single-center study was conducted on hospitalized patients aged 0-14 years at the Japanese Red Cross Kitami Hospital. We compared the incidence of pediatric patients hospitalized in 2020 with those in 2017-2019. RESULTS: The number of pediatric hospitalized patients dropped significantly in 2020 compared to that in 2017-2019 (median 43.0 vs. 78.5 per month, p < 0.001). The age was significantly older in 2020 (4.3 vs. 3.4 years, p < 0.001). Hospitalization from respiratory (8.5 vs. 30.5, p < 0.001) and gastrointestinal infections (3.0 vs. 6.0, p = 0.004) significantly decreased. Admission due to respiratory syncytial virus (0.0 vs. 4.0, p < 0.001), human metapneumovirus (0.0 vs. 1.0, p = 0.005), influenza (0.0 vs. 0.0, p = 0.009), adenovirus (0.0 vs. 1.0, p = 0.003), and rotavirus infection (0.0 vs. 0.0, p = 0.025) also decreased significantly. The <1-5 age groups significantly decreased (< 1 year old, 6.5 vs. 12.5, p < 0.001; 1-3 years old, 13.0 vs. 29.5, p < 0.001; 4-5 years old, 5.5 vs. 11.5, p < 0.001). Hospitalization due to foreign body ingestions increased significantly in 2020 (1.0 vs. 0.0, p = 0.010). CONCLUSIONS: The COVID-19 control measures inadvertently reduced the number of hospitalized pediatric patients, especially in younger children with respiratory and gastrointestinal infections.

Anti-nuclear Antibody Testing in Children: How Much Is It Really Necessary?

Abstract: Background In the pediatric age, anti-nuclear antibody (ANA) testing is most commonly ordered by general pediatricians to evaluate children with musculoskeletal system complaints. Given the limited utility of the test, we aimed to estimate the effectivity of ordering ANA testing in childhood. Methods Children referred to our department to be examined due to ANA positivity between 2008 and 2020 were included in the study. Those with less than one-year follow-up period, those with previously known rheumatic or autoimmune disease, and those diagnosed as an autoimmune and/or rheumatic disease at the first visit were excluded. Data were obtained from their medical records, retrospectively. The parents of all of the patients were called via phone, data were verified, and missing information was collected. Results Three hundred and fifty-eight patients (230 females) were eligible for the study. The median age at ANA positivity was found is 9.31 (1.3-17.86) years old and the median follow-up duration was 4.85 (1-11.91) years. Most of the patients had no underlying disease (n=337, 94.1%). The most common reason for ordering ANA testing was to evaluate musculoskeletal system symptoms (n=225, 62.8%). None of our patients referred to us due to ANA positivity developed any autoimmune conditions or ANA associated rheumatic disease. Hypermobility syndrome is the most common final diagnosis among our ANA-positive patients CONCLUSION: We suggest that instead of using it as a screening tool, ANA testing should be performed if only there is a strong suspicion of autoimmune diseases or certain rheumatic conditions such as systemic lupus erythematosus.

Prevalence of Wilson disease based on genome databases in Japan.

Abstract: BACKGROUND Wilson disease (WD) is an autosomal recessive disorder caused by mutations in the ATP7B gene. In 1984, Scheinberg and Sternlieb estimated the prevalence of WD to be 1:30 000. However, recent epidemiological studies have reported increasing prevalence rates in different populations. The carrier frequency of ATP7B variants and the prevalence of WD in the Japanese population have not been reported using multiple databases. METHODS Multiple public databases were used. First, we included mutations in the ATP7B gene that were registered in the Human Gene Mutation Database (HGMD) Professional, where 885 ATP7B variants were identified as pathogenic. Next, we investigated the allele frequencies of these 885 variants in Japanese individuals using the Human Genetic Variation Database (HGVD) and the Japanese Multi Omics Reference Panel (jMorp). RESULTS Of the 885 variants of ATP7B, 7 and 12 missense and nonsense variants, zero and three splicing variants, and zero and two small deletions were found in the HGVD and in jMorp, respectively. The total allele frequencies of the ATP7B mutations were 0.011 in the HGVD and 0.014 in the jMorp. According to these data, the carrier frequencies were 0.022 (2.2%) and 0.028 (2.8%), respectively, and patient frequencies were 0.000121 (1.21/10 000 individuals) and 0.000196 (1.96/10 000 individuals), respectively. CONCLUSIONS This is the first study to report the carrier frequency of ATP7B variants and the prevalence of WD in Japan using multiple databases. The calculated prevalence of WD was comparatively higher than that of previous reports, indicating previous underdiagnosis or the existence of less severe phenotypes.

COVID-19 IN Turkey: A tertiary center experience.

Abstract: Background The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has been causing a serious epidemic in our country and all over the world since December 2019 and has become a global health problem. The disease caused by the SARS-CoV-2 virus has been named as coronavirus disease 19 (COVID-19). Methods We report on the epidemiological and clinical features of 37 children diagnosed with COVID-19. Results The median age was 10 years, and 57.1% of the children were male. In addition, 78.3% of the children had histories of contact with adult patients who had been diagnosed with COVID-19, and 27.0% of our patients had coexisting medical conditions. We found that 40.5% of our patients had mild infection, while 32.4% had moderate infection, and 27.1% had developed severe or critical illness. The most common abnormal laboratory findings in our patients were decreased lymphocytes (45.9%) and increased D-dimer values (43.2%), while abnormal radiological findings were detected in 56.7% of the children. In addition, 64.8% of the patients had received azithromycin, 59.4% of the patients had received oseltamivir, and hydroxychloroquine was used in combination with azithromycin in 35.1% of the children. Non-invasive mechanical ventilation was required in 27.0% of the children. Conclusions Although COVID- 19 infection is usually mild in childhood, severe clinic can be seen in children with comorbidities or even in children who were previously healthy.

Expression of IFN‐induced Transmembrane Protein 1 in Glomerular Endothelial Cells

Abstract: BACKGROUND Glomerular endothelial cells (GECs) are directly exposed to circulating viral particles in the glomerulus. Although viral infections may trigger the development of acute kidney injury or the worsening of pre-existing chronic kidney disease, the specific molecular mechanisms underlying antiviral reactions via the activation of endothelial Toll-like receptor 3 signaling in the kidney remain to be determined. Interferon (IFN)-induced transmembrane protein 1 (IFITM1), a member of interferon-stimulated gene protein family, is involved in the prevention of viral entry into cerebral vascular endothelial cells, respiratory epithelial cells, and endometrium. However, as far as we are aware, the implication of IFITM1 associated with viral infections in GECs has not been investigated to date. METHODS Cultured, normal human GECs were treated with polyinosinic-polycytidylic acid (poly IC), a synthesized viral double-stranded RNA, then the expression of IFITM1 was examined by quantitative real-time reverse transcription-polymerase chain reaction and western blotting. To further elucidate the poly IC-induced signaling pathway, the cells were applied to RNA interference against IFN-β, nuclear factor-κB p65, and IFN regulatory factor 3. We also conducted an immunofluorescence study to examine endothelial IFITM1 expression in biopsy specimens from patients with chronic kidney disease. RESULTS We found that the activation of Toll-like receptor 3 induced endothelial expression of IFITM1, and that this involved IFN regulatory factor 3 and IFN-β, but not nuclear factor-κB. Intense endothelial IFITM1 immunoreactivity was observed in biopsy specimens from patients with lupus nephritis. CONCLUSIONS Antiviral reaction-related endothelial expression of IFITM1 may be involved, at least in part, in the development of particularly in lupus nephritis. Further detailed studies of the implication of interferon stimulated genes, including IFITM1 in GECs are needed.