Risk Factors for Abuse in Children with Congenital Heart Disease Presenting at a Pediatric Tertiary Care Hospital

Background:Congenital heart disease(CHD)is a chronic medical condition often diagnosed at birth and requires surgical intervention,multiple hospitalizations,and lifelong care.This can put significant stress on the family,leading to altered maternal mental health,bonding and attachment issues,and the potential for child abuse.The purpose of this study is to explore the characteristics of a sample of young children with CHD who experienced hospitalization with concurrent concern for child abuse in a free-standing pediatric tertiary care hos-pital.Methods:Electronic medical records were reviewed for children aged 0–5 years old who were hospitalized with concern for child abuse between 2016 and 2020.Variables were extracted related to the history of presenta-tion,and sociodemographics including SDOH,admission,and discharge condition/follow-up.Descriptive statis-tics were used to characterize the sample and correlations to identify an association with abuse type.Results:Out of 251 hospitalizations involving concern for child abuse,49(19.5%)had a diagnosis of CHD.The majority of cases were neglect(51%),<1 year of age(80%),male(57%),Hispanic ethnicity(45%),and publicly insured(90%).CHD severity was moderate to severe(71%)with multiple co-occurring medical conditions(genetic syn-drome,failure to thrive(FTT),prematurity,history of a feeding tube,developmental delay,and intrauterine drug exposure).Correlations associated with physical abuse were age,maternal mental health,head injury,and history of Child Protective Services(CPS)involvement.Neglect correlated with age,FTT,head injury,history of a feeding tube,previous CPS involvement,and substance use.Correlates specifically related to prenatal substance use included age,maternal mental health status,history of domestic violence,CPS involvement,feeding tube,FTT,lack of housing,employment status,and public insurance.Conclusions:Our study highlights the risk for abuse in children with CHD,regardless of defect severity.The most common abuse type was neglect(mostly prenatal substance use)which was associated with few child characteristics,but many parent/caregiver and neighborhood factors.This underscores the need for individual and/or family-based screening and approaches to provide psy-chological support and needed resources to assist parents of children with CHD to prevent abuse.Interventions should focus on families of low socioeconomic status with limited support and/or resources.

New mutation in EPCAM for congenital tufting enteropathy:A case report

BACKGROUND Congenital tufting enteropathy(CTE)is a rare cause of diarrhea in children.However,it can result in early-onset of chronic diarrhea and failure to thrive.Children with this disease have to depend on total parenteral nutrition(TPN),and eventually small intestine transplantation.The epithelial cell adhesion molecule(EPCAM)gene was identified to be associated with CTE.Here,we present a case of an infant with CTE due to a mutation not reported in the literature before.CASE SUMMARY A 1-year and 7-mo infant boy exhibited intractable watery diarrhea and mushy stool within 1 wk after birth,for which he had required medical treatment and hospitalization several times.His sister presented similar symptoms and died at the age of two.On admission,his body weight was 5700 g(-4.8 SDS)and measured 66 cm(-5.4 SDS)in height.Meanwhile,he cannot speak or climb.He exhibited mild anemia,hypocalcemia,hypomagnesemia,and an infection in the upper respiratory tract.Microvilli sparse and vacuolar degeneration of epithelial cells were reported by small intestine biopsy.Whole-exome sequencing showed a novel homozygous splice mutation(c.657+1[IVS6]G>A)in the EPCAM gene.He was treated with TPN and recombinant human growth hormone.After 2 mo,his body weight was up to 8500 g and he has been waiting for small bowel transplantation.CONCLUSION CTE is rare but fatal.Patients with CTE require rapid diagnosis and therapy to improve their survival.

Effect of long-term Helicobacter pylori infection on growth of children:a cohort study

Background:The effects of Helicobacter pylori(H.pylori)infection on growth are a controversial issue.We investigated the effects of long-term H.pylori infection on height and weight in children.Methods:A total of 200 children of 7-18 years old suffering from dyspeptic complaints were classified into two groups:H.pylori positive and negative groups,respectively.Whether the infection was impoved was followed up while performing urea breath test,and according to exposure time to the infection,the children were further divided into group 1(≤1.5 months),group 2(>1.5-≤6 months)and group 3(>6 months).Antropometric measurements were obtained and repeated every six months.Results:Mean growth velocity scores in the H.pylori positive and negative groups were 0.49±3.85[95%confidence interval(CI):-0.21-1.18]and 1.98±4.42(95%CI:1-2.96),respectively.The difference between both groups was statistically significant(P=0.012).Mean growth velocity scores in groups 1,2 and 3 were 0.96±3.84,0.16±4.51 and-0.85±3.09,respectively.Mean growth velocity scores of group 3 were significantly lower than those of groups 0 and 1(P=0.005 and P=0.041).The mean weight scores in group 3 were similar to those in group 2,but the scores in group 3 were signifi cantly lower than those in group 1(-1.75±1.05,-1.21±1.37 and-0.88±1.49,respectively).Conclusion:As the duration of exposure is prolonged in children with H.pylori infection,the negative effect of the infection on both height and weight is evident.