We evaluated the carbon footprint of a pediatric endoscopy unit through a two-week audit. Pediatric procedures generated 3.48 kg waste per case with an annuallized carbon footprint of 108.32 metric tons. Combining procedures and reducing hazardous waste offer opportunities to reduce environmental impact. Gastrointestinal endoscopy is essential for modern medical practice. The endoscopic procedures performed are lifesaving diagnostic and therapeutic interventions. The environmental impact of these endoscopic procedures has become an increasingly important topic of study and discussion. (1, 2) The carbon footprint associated with endoscopy is relatively high and largely attributable to the converging factors of high procedure volumes, energy-intensive disinfection processes, and the increasing use of single-use devices to prevent endoscope-transmitted infections. A study evaluating the carbon footprint of adult endoscopy revealed that each adult endoscopic procedure generates approximately 2.1 kg of disposable waste (2). This significant environmental burden raises concerns about sustainability in healthcare practices. Adult and pediatric endoscopy involve similar procedures, however the practice of endoscopy differs substantially. Pediatric endoscopy procedures are more often performed in an operating room setting and are performed in many-fold lower volumes than adult endoscopy procedures. The pediatric endoscopy carbon footprint has not been rigorously studied. Given the unique challenges and practice environment of pediatric endoscopy, it is crucial to evaluate the environmental impact of these procedures. Understanding how the environmental impact of pediatric and adult endoscopy procedures differ has the potential to advance our understanding of how specific differences in practice environment can impact the carbon footprint of procedures. Toward this goal, the present study aims to assess the environmental impact of pediatric endoscopy for the first time, focusing on the volume of disposable waste generated and the energy consumed during procedures.
The Expanded Programme on Immunization (EPI) is a public health intervention aimed at reducing child morbidity and mortality caused by vaccine-preventable infectious diseases, particularly in low-income countries. The Democratic Republic of Congo (DRC) is a country that introduced the national EPI program in 1978. Different ways exist to implement the EPI. The DRC opted for an initiative taken by the family. The coverage is however low, because the country did not conduct a research that identifies factors that constrain optimal vaccine implementation when the decision is at the household level. To get support for a project that investigates that knowledge, a survey was conducted among immunization experts to assess whether exploring the determinants of vaccination coverage in the city of Lubumbashi is worthwhile. Experts were purposively selected through a multidisciplinary approach, targeting individuals with substantial national and international experience in vaccine program implementation, both globally, locally in Africa, and in the DRC. An open-ended questionnaire was developed to explore expert perspectives on optimal vaccine delivery strategies that was conceived in the locally developed SCAVA / VACCIN+CONNECT- OS project (Adaptive Strategy for the Control of Vaccination Activities). Responses were analyzed using mixed quantitative and qualitative methods to identify expert consensus on the need for a local determinants study to enhance vaccine delivery. A total of 167 experts were contacted, and 111 responded (66%). Respondents represented a diverse sample in terms of gender (64% male), age (>50 y: 43%), experience (<10 y: 43%), and professional scope (local/global: 75%). Eighty percent (90/111) supported the initiation of the SCAVA / VACCIN+CONNECT- OS study, followed by the development of an actionable plan to address the identified barriers. They specified multiple reasons and causes of vaccine hesitancy at the household level. Twenty percent (21/111) held a different opinion, citing the immediate need for financial, logistical, and material resources to strengthen vaccination services. The survey demonstrates strong expert support for launching a determinant-focused study like SCAVA / VACCIN+CONNECT- OS as a prerequisite to successful and sustainable vaccination implementation in the DRC. The majority advocated for socio-anthropological and communication-centered public health models, addressing local economic, cultural, and behavioral factors, as an essential foundation for improving childhood immunization coverage.
This study explores the risk of delayed psychomotor development (PMD) in children treated for severe acute malnutrition (SAM) in the Democratic Republic of Congo. The present research is a sub-study of the EfRAMAS clinical trial conducted in health zones in the province of Kasaï Oriental. Children aged 6-59 months with SAM according to WHO criteria and no congenital malformations affecting child development were enrolled in the study. The risk of delayed psychomotor development was assessed among repeated cross-sectional samples of children at admission, discharge and 6 months after recovery, using the Ages and Stages Questionnaires (ASQ3). Mixed-effects linear regression with health center as random intercept was performed to identify potential predictors of the risk of psychomotor delay in children. A total of 413 children were included at admission, 143 at discharge and 581 at 6 months post-discharge. At admission, the risk of delayed psychomotor development was greatest in the domains of fine motor skills (21.3%), gross motor skills (23.7%) and problem solving (21.5%). At discharge, the risk of delay was considerably reduced, with 0% risk of delay in communication, while the three most affected domains hovered around 2%. At 6 months post-discharge, the risk of delay in gross motor skills and problem-solving was still present in over 10% of children. Age, sex, MUAC < 115 mm or WHZ < -3 as admission criteria, breastfeeding, episodes of illness during treatment, measles vaccination, mother's education level, and living in a female-headed household were predictors of the risk of psychomotor development delay. Globally, gross and fine motor skills and problem solving were the domains most affected for children with SAM. Regarding our findings, we recommend investing in the integration of children's psychosocial stimulation within the undernutrition management care pathway by trained health care workers, as well as in caregivers' parental skills. TRIAL REGISTRATION: International Standard Randomized Controlled Trial Network (ISRCTN15258669). Registered 25/01/2022.
To evaluate the efficacy of 2 different doses of aerosolized surfactant delivered by a drug/device combination system (APC-0101) in reducing the use of instilled liquid surfactant in preterm infants with respiratory distress syndrome (RDS). 261 preterm infants at 26-31 weeks' gestation with early RDS who were managed with nasal continuous positive airway pressure (NCPAP) or non-invasive ventilation (NIV) and had not received instilled liquid surfactant were randomized on the first day of life to 1 of 3 groups: control, low dose APC-0101, and high dose APC-0101. Infants in the two APC-0101 groups received up to 4 aerosolized surfactant treatments while on NCPAP/NIV. The primary outcome was the percentage of subjects who were treated with instilled liquid surfactant. Respiratory severity score (RSS) thresholds were pre-specified for subject selection and treatment algorithms. In the intent-to-treat (ITT) sample, the frequency of liquid surfactant instillation in the control group was 50.0% compared with 44.2% in the high dose APC-0101 group (P = 0.648). In exploratory analysis, the incidence of surfactant administration in the low dose APC-0101 group was 34.9% (P = 0.045 vs control). There were no differences between groups in other respiratory outcomes. The pre-specified high dose of aerosolized surfactant, delivered with the APC-0101 system, did not reduce the use of instilled liquid surfactant in infants with early RDS. An exploratory analysis of the low dose APC-0101 showed a reduction in instilled liquid surfactant, an observation that may merit evaluation in a subsequent study.
To determine whether blood-based biomarkers in the first days of life could specifically predict cerebral palsy (CP) and/or cognitive/language delay in infants with moderate-severe hypoxic-ischemic encephalopathy (HIE). A secondary analysis of the High-dose Erythropoietin for Asphyxia and Encephalopathy trial, which examined erythropoietin as an adjunct to therapeutic hypothermia for moderate-severe HIE. Recruitment took place in the United States from 2017-2019. Analysis focused on 180 infants with biomarker measurements performed at baseline, day 2, and day 4 of life. Outcomes assessed were: a diagnosis of CP at 2 years and Bayley III cognitive/language scores <85 and, separately, <70 at 2 years. Magnetic resonance imaging (MRI) of the brain was performed on day 4-6 of life. Mean gestational age was 39.0 weeks and 68 (44%) were female. After adjusting for multiple comparisons, 5 biomarkers: total tubulin-associated protein (Tau), glial fibrillary acidic protein, vascular endothelial growth factor, macrophage inflammatory protein 1b, and interleukin-13 were significantly altered in the CP group. On day 2 of life, Tau resulted in a receiver operating characteristic area under the curve (AUC) of 0.902 (95% CI: 0.812-0.992), specificity 91%, and sensitivity 88%, performing as well as detailed MRI scoring (AUC: 0.90 [95% CI: 0.80-1.0]). A different set of biomarkers showed altered expression in those with cognitive/language delay; Tau, ubiquitin carboxy-terminal hydrolase L1, S100 calcium-binding protein B, and neuron-specific enolase, with the best prediction seen with Tau on day 2 of life (AUC: 0.669 [95% CI: 0.564-0.774], sensitivity 40%, specificity 92%). Tau on day 2 of life demonstrated excellent prognostic value for CP in this cohort with moderate-severe HIE and gave similar prediction to detailed MRI score on day of life 4-6. Patterns of neurospecific biomarker perturbations were different for the prediction of cognitive/language delay, but Tau on day 2 remained the best performing biomarker. ClinicalTrials.gov NCT02811263.
Primary health care (PHC) is recognized as pivotal for achieving universal health coverage and reducing mortality rates among children younger than 5 years. To estimate the association of effective PHC coverage with child mortality in 3 diverse sub-Saharan countries over the past 2 decades and to estimate the number of child deaths that could occur by 2035 if PHC services are dismantled due to the current decrease in development assistance for health funding. This cohort study assessed children younger than 5 years from January 1, 2007, to December 31, 2022, in Mozambique, Gabon, and Ethiopia. The study drew on 5 national and subregional representative US Agency for International Development Demographic and Health surveys with longitudinal information from the 3 countries. Statistical analysis was performed from October 2024 to May 2026. An effective PHC coverage index (PHC index) was developed for this study, integrating core dimensions of child PHC service provision and access and structured into progressively ordered coverage categories. The outcome was child mortality, assessed with 2-way fixed-effects multivariable Poisson regression models with child-clustered standard errors, adjusted for relevant confounding factors at the individual, regional, and national levels. This evaluation was also integrated into validated microsimulation forecasting analysis. Of the 118 911 child-year observations of 37 583 children (mean [SD] age, 1.4 [1.3] years; 60 252 boys [50.7%]), Gabon had the greatest coverage of service provision, followed by Mozambique and Ethiopia, though Mozambique showed a marginally higher proportion in the highest category (Gabon, 796 of 33 269 [2.4%]); Mozambique, 554 of 20 728 [2.7%]; and Ethiopia, 317 of 64 914 [0.5%]); the inverse pattern was observed for the lowest coverage categories (Gabon, 2143 of 33 269 [6.4%]; Mozambique, 1976 of 20 728 [9.5%]; and Ethiopia, 32 189 of 64 914 [49.6%]). Across all child-year observations, there were 2166 deaths (1.8%). Ethiopia accounted for 2.1% of deaths (1338 of 64 914 child-years), Mozambique for 1.8% (364 of 20 728), and Gabon for 1.4% (464 of 33 269). Increasing PHC coverage was associated with decreases in child mortality in a dose-response manner, reaching a 58% reduction (rate ratio, 0.42 [95% CI, 0.19-0.91]) for consolidated high coverage. The dismantling of PHC coverage, triggered by the defunding of development assistance for health , may lead to an increase in preventable child deaths, amounting to an estimated 373 108 deaths (95% uncertainty interval, 313 152-444 244 deaths) across the 2025 to 2035 period. This cohort study found evidence indicating that PHC was associated with substantially reduced mortality rates among children younger than 5 years in sub-Saharan Africa over the past 2 decades. These findings suggest that PHC should be expanded rather than dismantled, particularly amid the ongoing defunding of development assistance for health.
To evaluate the impact of juvenile idiopathic arthritis (JIA) on the lives of children and young adults in Australia, including health care interactions, treatment, physical and mental health, social/familial impact, costs and quality of life, and to determine priorities for research. Cross-sectional online survey conducted from February through June 2023 across Australia of individuals 0-25 years diagnosed with JIA or their parents/caregivers. Analyses included descriptive statistics: percentages and counts for discrete variables and mean and SD for quantitative variables. Full text responses were coded into themes to quantify responses. Of 184 participants, mean age was 12 years; 67% were female. Participants averaged 25 visits annually to 5.6 health professionals. Blood tests and eye examinations averaged 4 and 3 per year, respectively. Over half (56%) had a hospitalization in the past year, of which 80% were day-stays. Medication use was high (97%), mostly conventional synthetic disease-modifying anti-rheumatic drugs (73.4%), non-steroidal anti-inflammatory drugs (73.4%), and biological disease-modifying anti-rheumatic drugs (53.3%) with adverse effects affecting 72%. The greatest health impact was on mental health (53%); half experienced moderate-severe pain and 30% required aids for daily living. Children missed 1 month of school/year. The greatest social impact on participants was sport (77%) and on families emotional health (59%). Mean annual government costs were 19 795 USD/participant. Quality of life measures were low with mean Pediatric Quality of Life Inventory score 54.5 and mean Child Health Utility instrument score 0.53. Priority research areas included long-term health impact, medication use, and physical impact. The broad burden of JIA highlights the need for models of holistic management that extend beyond clinical considerations to encompass and address the lived experience and needs of individuals and families affected by JIA.
To assess the safety of 20-valent pneumococcal conjugate vaccine (PCV20) in children in the US using data from the Vaccine Adverse Event Reporting System (VAERS), a national spontaneous surveillance system. We searched VAERS for reports of adverse events (AEs) after administration of PCV20 in children aged 0-17 years who received PCV20 from June 22, 2023, through January 24, 2025. We reviewed reports and available medical records for all serious reports and for AEs of special interest (seizures, anaphylaxis, hypotonic hyporesponsive episode, Kawasaki disease). We used empirical Bayesian data mining to identify AEs that were disproportionally reported. VAERS received 1040 reports after receipt of PCV20 in children aged 0-17 years; 107 (10.3%) were serious, which included 26 (2.5%) death reports. In 970 (93.3%) reports, PCV20 was concomitantly administered with another vaccine. The most reported AEs were fever (109, 10.4%), rash (75, 7.2%), urticaria (68, 6.5%), and injection-site erythema (54, 5.2%). The most commonly reported AE of special interest was seizure (42; 4.0%). Empirical Bayesian data mining revealed disproportionate reporting for "wrong product administered," but no adverse health events were associated with this vaccination error. Most reports after PCV20 administration in children were nonserious. The most common AEs were local and systemic reactions, consistent with prelicensure clinical trials. Although the VAERS system is not designed to assess causation of vaccination and AEs, no signals of new or unexpected AEs were identified, reinforcing the safety of PCV20 in US children.
To evaluate the diagnostic performance of fecal elastase (FE) in exocrine pancreatic insufficiency (EPI) and examine the risk factors for EPI in children with acute recurrent pancreatitis (ARP) or chronic pancreatitis (CP). We analyzed prospectively collected demographic, clinical, and EPI data of children with ARP or CP (n = 1007) enrolled in the INSPPIRE-2 (INternational Study group of Pediatric Pancreatitis: In search for a cuRE) consortium. FE performance was assessed against individual markers of fat malabsorption and a composite reference standard in which the presence of any 1 of the following was considered consistent with fat malabsorption in lieu of a gold-standard pancreas function test: (1) clinical diagnosis of EPI, (2) vitamin A or E deficiency, or (3) body mass index z-score ≤-2. Cox regression models were used to identify predictors of EPI. EPI was diagnosed in 195/1007 (19.4%) children with ARP/CP, with FE being the most commonly used diagnostic tool. FE demonstrated low sensitivity (55.8% and 65.1%), moderate specificity (82.8% and 75.5%), and a high negative predictive value (92% and 93%), at cut-offs of 100 μg/g and 200 μg/g stool, respectively, in detecting at least 1 marker of fat malabsorption. The 7-year cumulative incidence of EPI after the first pancreatitis episode was 24%. Genetic risk factors were associated with earlier progression to EPI (hazard ratio 1.56; 95% confidence interval 1.02-2.39). EPI affects nearly 20% of children with ARP/CP. FE is a valuable diagnostic tool in ruling out EPI. Children with genetic risk factors need closer surveillance due to an increased risk for developing EPI.
To identify distinct subgroups of children with medical complexity (CMC) based on patterns of complex chronic conditions (CCC) using latent class analysis and to examine differences in health care utilization across these subgroups. Retrospective cohort study from January 2022 to October 2025 for hospitalized encounters for CMC, identified by at least one CCC, from 49 pediatric tertiary hospitals. Latent class analysis was used to identify distinct patterns of CCCs among hospitalized children. The resulting 6 latent classes were treated as the categorical exposure. Outcomes included intensive care unit admission (ICU), invasive mechanical ventilation (IMV), medical/surgical complication, length of stay (LOS), and in-hospital mortality. Of 1,317,606 hospitalized encounters, latent class proportions were as follows: class 1: 127,069 (9.6%), class 2: 152,680 (11.6%), class 3: 347,525 (26.4%), class 4: 97,602 (7.4%), class 5: 68,644 (5.2%), and class 6: 524,086 (39.8%). Classes varied across type and number of CCCs. For adjusted outcomes, class 1 had the highest probability (34.90% [32.66, 37.21%]) of ICU admissions. Class 3 had the highest probability of a medical or surgical complication (34.48% [32.32, 36.72]). Class 6 had the highest probability of IMV (16.31% [15.28, 17.39]) and in-hospital mortality (2.87% [2.63, 3.13]), as well as the longest LOS (13.60 days [13.08, 14.14]). Meaningful subgroups of CMC exist among hospitalized encounters, with differential adverse healthcare utilization. The latent classes identified in this study offer a framework for characterizing heterogeneity among CMC and advancing health services research towards more specificity. Such frameworks are essential for evaluating efficacy of tailored interventions.
To assess accuracy of prediction of oxygenation index (OI=mean airway pressure*FiO2*100÷PaO2) with a non-invasive alternative, oxygen saturation index (OSI= FiO2*100÷SpO2) in a prospectively collected multicenter cohort of children with congenital diaphragmatic hernia (CDH) with substantial degree of hypoxemia (OI≥10 or OSI≥5). This secondary analysis of the Milrinone in CDH Trial studied 61 subjects with OI≥10 or OSI≥5 at randomization. Prospectively collected arterial blood gas (ABG) data with PaO2 and preductal and postductal SpO2 were used to compare all OI and preductal OSI, all OI and postductal OSI, preductal OI/OSI only and postductal OI/OSI, by simple linear and quadratic regression modelling. Indwelling arterial lines were present in 61 of 66 randomized subjects (51 as umbilical arterial lines). There were 572 matched pairs of PaO2-SpO2 data. Repeated measures correlation (95% CI) between all OI and preductal OSI by linear regression was 0.82 (0.79,0.85; n=61 patients, 572 samples), and between OI and OSI with SpO2 matched from the same preductal or postductal sites as the ABG were 0.97 (9.91,0.89) and 0.86 (0.84,0.89) respectively. The relationship between preductal OI and OSI was described best by the quadratic equation, OI=0.3*OSI+0.1*OSI2+2.4 (4 patients, 22 samples) and postductal OI and OSI by OI=0.6*OSI +0.08*OSI2+2.6 (54 patients, 477 samples). There was no difference in quasi-likelihood under the independence model information criterion (QlCu) between linear and quadratic models (461 vs 462 respectively). Use of site-specific (preductal vs postductal) quadratic equations captured the non-linear relationship but did not improve QlCu. Non-invasive OSI values correlate well with OI. The use of OSI based on preductal SpO2 may be a suitable alternate strategy for clinical trials even if post-ductal arterial access is available.
To review rates of nirsevimab immunization for respiratory syncytial virus (RSV) among mother-newborn dyads admitted to a single tertiary medical center system. A retrospective study examined RSV immunization rates across admitted mother-infant dyads between November 2024 and February 2025. Other collected data included gestational age, sex, delivery type, newborn medication receipt/declination, and maternal demographics. We analyzed specifically the relationship between RSV immunization and race and ethnicity, language, and other patient characteristics. Of 1156 mothers, 854 (74%) received the RSV vaccine during pregnancy. There were statistically significant differences in race and RSV vaccine receipt, with rates highest among Asian mothers (85%) and lowest among non-Hispanic Black mothers (59%). Among 302 newborns, 135 (55%) received nirsevimab during hospitalization. Differences in race and nirsevimab receipt were statistically significant, with uptake highest among Asian newborns (83%) and lowest among non-Hispanic White infants (47%). Secondary analyses showed significant associations between maternal and newborn RSV immunization and newborn medication acceptance, and between maternal RSV vaccination and maternal age, insurance type, and religion. Our study found substantial disparities in RSV immunization by race for mothers and infants. Some disparities were mitigated during the birth hospitalization, suggesting that the inpatient setting can effectively reduce health disparities. Given the effectiveness of RSV immunization addressing these disparities should be prioritized.
To determine the association between salivary substance P (SP) concentration and aspiration on videofluoroscopic swallow study (VFSS) in children with oropharyngeal dysphagia. We recruited children younger than 2 years of age who underwent VFSS within 3 months of study enrollment. Saliva samples were collected using absorbent collection devices and SP levels were measured by enzyme-linked immunosorbent immunoassays. We used the Student t test to compare levels between subjects with and without aspiration. Exploratory receiver operating characteristic analyses were used to determine optimal cut-off values and calculate sensitivity and specificity compared with gold-standard VFSS results. A subgroup analysis included only subjects with saliva collected within 1 month of VFSS. The cohort included 50 subjects with age 8.16 ± 0.83 months at sample collection. SP concentrations were 344.7 ± 42.9 pg/mL for patients with aspiration compared with 105.7 ± 40.5 pg/mL for those without aspiration (P < .001). On receiver operating characteristic analysis, the area under the curve was 0.868 (95% CI 0.721-1.0, P < .001). A cutoff of 65 pg/mL provided 97% sensitivity (95% CI 86%-99%) and 75% specificity (95% CI 43%-95%) for predicting aspiration on VFSS. In a subgroup analysis with 29 subjects who had VFSS within 1 month of sample collection, the area under the curve was 0.964 (95% CI 0.98-1.0, P < .001). A cutoff of 63.2 pg/mL provided 100% sensitivity (95% CI 85%-100%) and 83.3% specificity (95% CI 36%-100%) for predicting aspiration on VFSS. Salivary SP concentrations were found to be significantly greater in children with aspiration. Salivary SP may represent an early candidate biomarker that could be used to predict risk of aspiration in infants and toddlers.
To evaluate if extended infusion based enteral feeding was non-inferior to intermittent bolus feeding for hospital weight gain in infants born at extremely low birth weight (ELBW). Infants with ELBW and born at <29 weeks of gestation on minimal enteral nutrition were randomized to feeding advancements as extended milk infusion feeding (5-hour continuous milk infusion followed by 1-hour feeding break) or every 2 hour intermittent bolus feeding. The infusion feeding continued until a postmenstrual age of 30 weeks or postnatal weight of 1.2 kg. The primary outcome was in-hospital weight gain (g/kg/day) assessed using 2-point average model with a non-inferiority margin of -2. We randomized 132 infants (infusion, n=68; bolus, n=64). The median gestational age and birth weight were 26.4 ± 1.2 weeks and 752 ± 140 grams. The infusion group received infusion feedings for an average of 47 days (IQR: 44-53). The median time to full enteral feedings was similar (infusion: 10 days [IQR: 7-12]; bolus: 9 days [IQR: 7-12], P =.82]. The mean (SD) rate of weight gain at discharge was 15.3 ± 2.6 g/kg/day versus 15.7 ± 2.8 g/kg/day (mean difference, -0.4 g/kg/day, lower limit of the one sided 97.5% confidence interval: -1.15g/kg/day, per protocol analysis). The infusion group had significantly fewer days of feedings interruptions (6.7 days [5.6-8.1] vs 8.7 [7.4-10.1] per 100 patient days, P =.03) in the first 28 days. Duration of hospitalization and morbidities were similar in study groups. Among infants with ELBW that achieve early enteral feedings, extended infusion feeding was non-inferior to bolus feedings for hospital weight gain.
Urinary screening is a useful and non-invasive tool for identifying occult kidney disease in asymptomatic children and may be an important initial step in preventing progressive kidney disease. However, this screening is not commonly performed in children living in low-resource countries, including the Democratic Republic of the Congo (DRC). This study aimed to determine the prevalence of albuminuria and its associated factors among healthy school children living in DRC. In addition, the study examined the prevalence of urinary abnormalities detected by dipstick in this population. This cross-sectional study was conducted in 17 schools in Kinshasa. A multistage sampling procedure was applied, and 497 healthy school children aged 6 to 16 were randomly recruited. Anthropometric and clinical data were collected. Using a single-sample measurement, urinary albumin-to-creatinine ratio (ACR) was determined by an immunoturbidimetric method, and dipstick tests were performed to detect other urinary abnormalities (leukocyturia, nitrituria, proteinuria, hematuria). Albuminuria was defined as ACR ≥ 30 mg/g. Logistic regression was used to identify clinical factors associated with albuminuria. Among the 497 school children (208 boys and 289 girls), 58 had single-sample albuminuria, corresponding to a prevalence of 11.7%. There was no significant association between albuminuria and clinical variables based on univariate logistic regression analysis. Dipstick urinary abnormalities were present in 113 children (22.7%). Specifically, leukocyturia, nitrituria, proteinuria, and hematuria were detected in 14.3%, 1.6%, 8.2%, and 1.6% of participants, respectively. Leukocyturia and nitrituria were significantly more common among girls (p < 0.001). Urinary abnormalities are common among asymptomatic school children in the DRC. Although a single measurement was performed, these results raise the relevant question of the usefulness of urinary screening in children living in resource-limited settings. However, the feasibility, cost, and potential benefits of such a program warrant further evaluation in these settings.
To examine the association between birth weight and first-attempt intubation success in the delivery room after adjusting for key practice characteristics. This retrospective cohort study used data from the National Emergency Airway Registry for Neonates, including intubation encounters in the delivery room, from October 2014 to June 2022. The primary outcome was first-attempt success rate by birth weight. A logistic regression was created with birth weight as a continuous variable included in the model via restricted cubic splines to incorporate nonlinear effects. Additional outcomes included first-attempt success rate grouped by birth weight in 500 g intervals, number of attempts, and adverse events. Covariates included intubation method, device, provider experience, and discipline. A total of 3294 delivery room intubation encounters were collected. After exclusion of encounters with inconsistent reporting of intubation attempts, 3227 tracheal intubation encounters from 16 centers were included with a median gestational age of 30 weeks (IQR, 25-37). Fifty-one percent of all intubations were successful on first attempt. Birth weight had a significant, nonlinear effect on intubation success (P < .001). Furthermore, birth weight had a significant, linear effect on the odds of adverse tracheal intubation-associated events (P < .001). Lower birth weight was associated with lower first-attempt intubation success and higher odds of adverse events during delivery room intubation. Awareness that smaller infants are at a higher risk for difficult intubation may help optimize provider selection, equipment preparation, and procedural planning in the delivery room.
To investigate the association between parental incarceration and housing insecurity among a recent, nationally representative sample of children in the US. Data from the 2024 National Survey of Children's Health (NSCH), a nationally representative survey of noninstitutionalized US children aged 0-17 years, were examined. Weighted multinomial and logistic regression models were estimated to examine associations between parental incarceration and several indicators of housing insecurity (eg, frequent moves, homelessness, caregiver eviction stress, missed housing payments),adjusting for various child, caregiver, household, and neighborhood characteristics. Findings revealed substantial disparities in housing insecurity among children exposed to parental incarceration. Children with incarcerated parents disproportionately resided in households experiencing housing insecurity relative to peers, including higher rates of missed housing payments (31.66% vs 13.68%), caregiver eviction stress (22.30% vs 8.85%), lifetime childhood homelessness (17.44% vs1.95%), and lifetime moves (41.81% vs 10.77% reporting four or more moves). These associations were robust to multiple confounders. Addressing housing insecurity among children with incarcerated parents represents an important opportunity to reduce pediatric health inequities. Future research should prioritize efforts to characterize further this relationship, implement and test screenings in clinical settings, foster community partnerships, and support policies that reduce inequities in housing insecurity and parental incarceration for these children.
To assess the accuracy of transcutaneous carbon dioxide (tcPCO2) monitoring compared with intermittently sampled blood gas PCO2 in neonates undergoing therapeutic hypothermia (TH). Neonates ≥34 weeks of gestation undergoing TH were enrolled and subsequently monitored with continuous tcPCO2. Agreement between tcPCO2 and both temperature-corrected and measured (uncorrected) blood gas PCO2 from arterial, venous, and capillary sources was assessed using Bland-Altman (BA) analyses that accounted for paired repeated measures. 130 paired tcPCO2-PCO2 measurements were analyzed for 53 neonates. The mean difference (bias) between tcPCO2 and temperature-corrected PCO2 from all sources was 6.6 mm Hg with 95% limits of agreement (LOA) from -7.4 to +20.6 mm Hg. Relative to measured PCO2, the geometric mean ratio indicated a 4% overestimation of tcPCO2, with proportional 95% LOA from -25% to +35%. Capillary samples showed significant (P<0.05) non-constant variance in agreement with increasing variability at extreme PCO2 values, whereas arterial and venous samples demonstrated stable bias and variance across PCO2 ranges. Using transcutaneous CO2 monitoring in infants with neonatal encephalopathy receiving TH, there is moderate agreement with wide 95% LOA between tcPCO2 and PCO2 from all sources. Despite potential bias, tcPCO2 may assist in identifying trends and avoiding extreme PCO2 values during TH. https://clinicaltrials.gov/study/NCT04603547.
To determine if feedback with education and digital otoscopy could each potentially address lack of knowledge of acute otitis media (AOM) diagnostic criteria and difficulty visualizing the tympanic membrane and then result in more judicious use of antibiotics for AOM. Randomized controlled trial of 40 primary care pediatricians who each had an AOM treatment rate, defined as the proportion of encounters with an AOM diagnosis and antibiotic treatment divided by all encounters with a respiratory condition, above the network mean. Subjects were randomized into 1 of 4 arms: feedback with education, digital otoscopy, both, or control. A difference-in-differences analysis was used to assess for change in the intervention arms relative to the control arm. Both the feedback/education and combined arms of the study demonstrated a significant change in the AOM treatment rate relative to baseline compared with the control arm (-12.8% [95% CI: -20.9, -4.7] and -9.7% [-16.5, -2.9], respectively), yet digital otoscopy alone did not yield a significant change in the outcome (-7.3% [-16.8, 2.3]). Clinicians using digital otoscopy reported improved visualization of tympanic membranes and 70% would prefer a digital otoscope to a traditional otoscope. Antibiotic use for AOM can be modified with performance feedback and education. Although there appears to be no added effect of digital otoscopy alone in this trial, clinicians using digital otoscopy preferred it to traditional otoscopy and this technology holds promise for further development in AOM-related antibiotic stewardship.
To evaluate parental experiences following diagnosis of a cancer predisposition syndrome (CPS) in childhood and to assess parental perspectives on population-based genomic newborn screening (gNBS) for CPS. Participants were guardians of children diagnosed with a CPS by age 8, for whom cancer surveillance was recommended, and who had no history of cancer before the CPS diagnosis. Participants completed a demographic survey, genetic knowledge assessment, and a semistructured qualitative interview. Thematic analysis was performed on interview transcripts. Clinical data were abstracted from medical records. We enrolled 25 parents of children with 7 different CPS, including Li-Fraumeni syndrome (43%), familial adenomatous polyposis (14%), nevoid basal cell carcinoma syndrome (11%), and Beckwith-Wiedemann syndrome (11%). Parents characterized receiving a CPS diagnosis as emotionally challenging but also felt empowered by engagement in proactive cancer surveillance. They identified logistical, emotional, physical, and financial burdens of surveillance; however, most perceived that these burdens were outweighed by the medical and emotional advantages. The majority endorsed implementation of gNBS for pediatric cancer risk. Parents of presymptomatic children with a CPS experience both psychological distress and benefits following a genetic diagnosis. Despite the burdens of surveillance, parents express support for early genomic identification of cancer risk. These findings have implications for the care of children with CPS and inform implementation of population-based gNBS for CPS.