Prevalence and outcomes of neonates with severe COVID-19:An observational study at Children’s Hospital 1 in Ho Chi Minh City,Vietnam

Objective:To evaluate the impact of the severe COVID-19 pandemic on neonates and develop strategies to improve their outcomes.Methods:We conducted an observational cross-sectional study at Children's Hospital 1(CH1)from July 25,2021,to May 31,2022.All neonates who had fever or respiratory symptoms or were born from mothers with COVID-19 and had a positive RT-PCR SARS-CoV-2 result would be included.We classified neonates with COVID-19 into 2 groups:mild/moderate and severe for analysis.Differences between groups were analyzed using Fisher's exact test/Chi-square test for categorical variables and Student's t-test/Wilcoxon Rank Sum test for continuous variables.Results:This study included 88 newborns who had positive RT-PCR SARS-CoV-2 results.The severity COVID-19 rate among neonatal cases was found to be 13.6%(12/88),with a corresponding mortality rate of 1.1%(1/88).All severe cases showed lung abnormalities as evident on chest X-ray images.In addition to respiratory symptoms,a higher incidence of gastrointestinal manifestations,such as vomiting and diarrhea,was observed in the severe group,indicating a compelling association.The administration of anticoagulant and anti-inflammatory drugs in the study group resulted in a satisfactory outcome with no significant complications.Conclusions:The COVID-19 pandemic has had a substantial impact on the well-being of neonates.The management of COVID-19 in this population presents significant challenges.

Testing the value of simple arterial blood pressure measurements in a Greek children’s hospital

Arterial hypertension begins in childhood and may continue, without intervention, throughout adulthood with severe health sequelae.The base of timely diagnosis is the systematic blood pressure (BP) measurement. Background: The study aims at revealing the level of parental and community awareness and testing the value of a simple measurement in uncovering children who need further assessment when performing an in-hospital BP screening. Methods: BP was measured in 600 children (0 - 17 yr, mean age 5.1 ± 4.3 yr) at a Children’s hospital. Parents were asked to fill in a specially structured questionnaire. Results: In 47.2% of the subjects (40.1% of them were Greeks and 60.6% foreigners), BP had never been checked before (p arterial BP had never been checked before. Surprisingly, a health certificate was issued for school purposes for 81.2% of the schoolchildren of this study, and 75.3% of the enrolled children were allowed to participate in sports clubs without first checking BP. Moreover, parents demonstrated a low level of alertness with respect to paediatric hypertension. Conclusions: Simple arterial BP measurements can ensure early detection and thus early referral to specialists.

Correlation between an Independent Electronic Health Record &External Ranking of Children’s Hospitals

Introduction: To evaluate the correlation between the presence of an independent EHR (compared to a shared EHR system within an adult hospital system) and an externally-derived third party ranking of children’s hospitals. Methods: Children’s hospitals that ranked in the top fifty of the 2019-2020 US News and World Report (USNWR) were included in the analysis. The mean and median ranking of children’s hospitals with independent versus a shared EHR was evaluated. The 2019-2020 USNWR rankings of the top twenty adult hospitals in the United States were then evaluated. For each children’s hospital with an associated adult hospital that was both ranked, it was noted as to whether the EHR for the children’s hospital was independent or shared and statistical differences in rankings compared. Results: Among the top 50 children’s hospitals included, the median USNWR ranking for hospitals was statistically different with an independent EHR than with a shared EHR (13 vs. 30.0) (p = 0.002). The 21 top ranked adult hospitals were associated with 17 children’s hospitals ranked in the top 50. The median ranking for those with an independent EHR was statistically different for those with independent EHR versus shared EHR (7 vs. 28) (p = 0.002). Conclusion: Children’s hospitals with an independent EHR are associated with higher scores on an independent external ranking of hospital quality compared to those which share an EHR with a partner adult hospital.

Acute Thoracic Syndrome in Children: Epidemiological, Diagnostic and Evolutionary Aspects at the Albert Royer National Children’s Hospital in Dakar Senegal

Acute chest syndrome (ACS) is a serious pulmonary complication of sickle cell disease. It is estimated to be responsible for a quarter of deaths in the pediatric sickle cell population. In Senegal, there are not enough pediatric studies in this area. The objective of our study was to determine the epidemiological, diagnostic and evolutionary characteristics of ATS at the Albert Royer National Children’s Hospital (CHNEAR) in Dakar. This was a retrospective study in patients hospitalized at CHNEAR for ATS from January 1, 2021 to March 31, 2022. We included patients hospitalized and diagnosed with ATS. We had collected 102 patients, i.e. a hospital incidence of 2.96%. The average age of the children was 9 years old;the sex ratio was 1.04. The main symptoms on admission were hypoxemia (97.06%), chest pain (77.45%), dyspnea (77.45%) and fever (65.69%). 52.94% of patients had an associated vaso-occlusive crisis (VOC). The chest x-ray was abnormal in 92 patients, a rate of 90.20% and showed images of pneumonia (71%);bronchitis (17.65%) and pleurisy (0.98%). None of the children benefited from a pulmonary ultrasound. The treatment associated with analgesics (100%), broad-spectrum antibiotics (100%), oxygen therapy (100%), hydration (95.09%), transfusion (73.53%), non-ventilation invasive (6.86%), intubation (2.94%) and beta 2 mimetics (12.75%). No patient benefited from incentive spirometry. Almost all of the patients 95.10% (n = 97) had a favorable clinical evolution. However, five children (4.90%) had an unfavorable outcome including one case of complication such as stroke (0.98%) and four (4) cases of death. The average hospital stay was 8 days. ATS is common in children with sickle cell disease in Senegal and its etiologies seem to be dominated by infectious causes in our context.

Pneumothorax in Children: Epidemiological Diagnostic and Evolutionary Aspects at the Albert Royer National Children’s Hospital in Dakar

Pneumothorax is defined by the presence of air between the parietal pleura and the visceral pleura. Most of the child’s pneumothorax is traumatic. The spontaneous pneumothorax (PS) of the child is rare, and often associated with a favoring factor. When it is large, it can affect the life expectancy. The objective of our study was to determine the epidemiological, diagnostic and evolutionary aspects of pneumothorax in children aged 0 to 15 years, hospitalized at the Albert Royer National Children’s Hospital in Dakar. This is a retrospective descriptive study of patient records followed at the Albert Royer National Children’s Hospital (CHNEAR) for the management of a pneumothorax during the period from 2020 to 2022. During our study, 15 patients were hospitalized for pneumothorax, with an average annual incidence of 7.5 cases per year. The sex ratio (H/F) was 2.03. The average age was 3.7 years. Chest pain was present in 27% of patients, dyspnea was found in 93%, and cough in 87% of patients. All patients underwent chest radiography and the location of the pneumothorax was predominant on the right in 60% of cases. Thoracic drainage was performed in 93.3% of patients associated with etiological treatment. The average length of hospitalization was 27.8 days with a cure rate of 86.7% and a recurrence rate of 13.3%.

Conflict management styles of nurse managers and influencing factors in children’s hospital, Vietnam

Objective:This study aimed to describe the conflict management styles and identify factors affecting the conflict management styles of nurse managers.Materials and Methods:A cross-sectional study was conducted by interviewing nurse managers with a questionnaire,including the Rahim Organizational Conflict Inventory-II Form B,used to assess an individual’s approach to conflict management across five styles:cooperating,competing,compromising,obliging,and avoiding.Results:A total of 30 nurse managers participated in this study.The mean scores of the cooperating style were the highest at 4.3±0.4,followed by a compromising style at 3.4±0.5,an avoiding style at 3.1±0.6,an accommodating style at 2.9±0.7,and a competing style at 2.8±0.8(χ^(2)=66.624,P<0.001).The mean scores for avoiding style among bachelor’s degree nurse managers(3.2±0.6)were higher than those of master’s degree nurse managers(2.7±0.6)(P=0.036).Nurse managers over 40 years old,holding a managerial position for≥10 years,and frequent conflict handling rated higher mean scores for the cooperating style than their counterparts(P<0.05).Conclusion:The cooperating style was the most commonly used conflict management style among nurse managers.Factors affecting the conflict management style were age,education level,and experience in management and conflict handling.These findings are useful for developing interventions that enhance the competencies of nurse managers in conflict management.

Pulmonary Arterial Hypertension in Congenital Heart Disease with Left-to-Right Shunt: According to a Retrospective Study at Albert Royer’s National Children’s Hospital Center

Pulmonary arterial hypertension PAH is a progressive disease characterized by an increase in pulmonary arterial pressure and resistance. It often complicates congenital heart disease with a left-to-right shunt. The objective of this study is to evaluate the evolutionary profile of the pulmonary pressures of children with congenital heart disease with left-to-right shunt and to identify the factors favoring an evolution towards PAH. This is a retrospective, descriptive and analytical study over a period of four years and six months (from January 1, 2016 to June 30, 2020) at the Center National d’Enfant Albert Royer in Dakar on a series of 87 cases. The hospital frequency was 3.98 per thousand, and the incidence of PAH was 9.44%. The sex ratio of 0.74. The average age was 44.76 months. The average time between the onset of symptoms and the diagnosis of heart disease is 78.81 days. Dyspnea was found in 70.11% of cases, the burst of pulmonary B2 was found in 55%. Global heart failure was noted in 39.08% of cases. Cardiomegaly was found in 89.66% and pulmonary hypervascularization was found in 57.72% of cases. CIV was present in 54.02% of cases, followed by PCA in 21.14% and CAVc in 18.39% of cases. furosemide was used in 97.70% of cases and Captopril in 74.71% of cases. Sildenafil was used in 10.34% of patients, and 12.64% of patients benefited from surgical management. Eisenmenger syndrome was found in 12.64% of patients. PAH in these heart diseases is a formidable and frequent complication, due to an increase in precapillary flow. The major improvement in mortality and morbidity is early surgical management, in the first months of life, to prevent pulmonary vascular disease.

Sepsis during short bowel syndrome hospitalizations:Identifying trends,disparities,and clinical outcomes in the United States

BACKGROUND Short bowel syndrome(SBS)hospitalizations are often complicated with sepsis.There is a significant paucity of data on adult SBS hospitalizations in the United States and across the globe.AIM To assess trends and outcomes of SBS hospitalizations complicated by sepsis in the United States.METHODS The National Inpatient Sample was utilized to identify all adult SBS hospitalizations between 2005-2014.The study cohort was further divided based on the presence or absence of sepsis.Trends were identified,and hospitalization characteristics and clinical outcomes were compared.Predictors of mortality for SBS hospitalizations complicated with sepsis were assessed.RESULTS Of 247097 SBS hospitalizations,21.7%were complicated by sepsis.Septic SBS hospitalizations had a rising trend of hospitalizations from 20.8%in 2005 to 23.5%in 2014(P trend<0.0001).Compared to non-septic SBS hospitalizations,septic SBS hospitalizations had a higher proportion of males(32.8%vs 29.3%,P<0.0001),patients in the 35-49(45.9%vs 42.5%,P<0.0001)and 50-64(32.1%vs 31.1%,P<0.0001)age groups,and ethnic minorities,i.e.,Blacks(12.4%vs 11.3%,P<0.0001)and Hispanics(6.7%vs 5.5%,P<0.0001).Furthermore,septic SBS hospitalizations had a higher proportion of patients with intestinal transplantation(0.33%vs 0.22%,P<0.0001),inpatient mortality(8.5%vs 1.4%,P<0.0001),and mean length of stay(16.1 d vs 7.7 d,P<0.0001)compared to the non-sepsis cohort.A younger age,female gender,White race,and presence of comorbidities such as anemia and depression were identified to be independent predictors of inpatient mortality for septic SBS hospitalizations.CONCLUSION Septic SBS hospitalizations had a rising trend between 2005-2014 and were associated with higher inpatient mortality compared to non-septic SBS hospitalizations.

Pathogenic changes of community-acquired pneumonia in a children’s hospital in Beijing,China before and after COVID-19 onset:a retrospective study

Background This study aimed to analyze the pathogenic characteristics of community-acquired pneumonia(CAP)in a children’s hospital before and after the coronavirus disease 2019(COVID-19)pandemic and to provide testimony for preventing CAP in the future.Methods A retrospective analysis was performed.The information was collected from the electronic medical record system of the hospital.A total of 2739 children were included from February 1,2019,to January 31,2021.Results Among these 2739 patients were 1507(55.02%)males and 1232(44.98%)females;the median age was 3.84 years.There were 2364 cases during the pre-COVID-19 period and 375 cases during the post-COVID-19 period.The number of hospitalized children after the pandemic was 84.14%lower.The median age after the onset was 1.5 years younger than that before the onset(4.08 years old)(Z=−7.885,P<0.001).After the pandemic,the proportion of CAP in school-age children and Mycoplasma pneumoniae pneumonia(MPP)and influenza virus pneumonia(IVP)decreased significantly.During the pre-COVID-19 period,the proportions of detected pathogens were as follows:MP(59.56%)>bacteria(50.42%)>viruses(29.57%)>fungi(3.43%).During the post-COVID-19 period,the pathogen proportions were bacteria(56.53%)>viruses(53.60%)>MP(23.47%)>fungi(3.73%).Conclusions There was a significant decrease in the number of children with CAP hospitalized after the pandemic,especially among school-age children,and the pathogen proportions of CAP with MP and IV were significantly decreased.We inferred that CAP was effectively prevented in school-age children because of the strong mitigation measures.

Astrovirus infection in young children with diarrhea hospitalized at Beijing Children’s Hospital

Background This study was to assess certain epidemiol ogical and clinical characteristics of astrovirus infection in children with diarrhea below 5 years old hospitalized at the Beijing Children’s Hospital.Methods From September 1999 to August 2001, a total of 288 children with diarrhea below 5 years old hospitalized at Beijing Children’s Hospital were studied. Fecal specimens collected from each patient were tested for astrovirus by using enzyme immunoassay (EIA) and further serotyped by reverse-transcription polymerase chain reaction (RT-PCR) using serotype-specific primers.Results Astrovirus antigen was positive in 9.0% of the patients, and the rate of coinfection with rotavirus was 19.2% among the a strovirus positive patients. The patients with astrovirus infection were at the age of 7 days to 17 months, most (92.3%) of them were less than 12 months. Astrovirus infection occurred mainly between October and March of the following year. Main symptoms included watery stool, vomiting, fever, and dehydration. Increased activity of myocardial enzyme was seen in 4 patients. Of the 22 astrovirus positive specimens, 14 were successfully serotyped by RT-PCR and they were all serotype 1.Conclusions The overall incidence of astrovirus infection in yo ung children with diarrhea hospitalized at the Beijing Children’s Hospital was 9.0%. The predominant serotype was type 1. Astrovirus may play an important role in viral diarrhea in young children in Beijing, China.

Analysis of alternation with ibuprofen and acetaminophen in outpatient and emergency departments of a children’s hospital

In the present study,we retrospectively analyzed 105382 prescriptions of antipyretic drugs for children(0–14 years of age)in the outpatient and emergency departments of Ningbo Women and Children’s Hospital from January to December 2019.Ibuprofen and acetaminophen are relatively safe and the most commonly used drugs in daily life.Due to different dosage forms,there are acetaminophen suspension drops,acetaminophen oral solution,ibuprofen suspension,and ibuprofen suppositories for children.Through investigation,we found that the age of antipyretic drugs used by children in our hospital ranged from 3 months to 14 years old,which could be divided into two groups:single drug use and alternating use of ibuprofen and acetaminophen,with an alternating use rate of 3.19%.There were differences between the two groups in terms of age,gender,the proportion of emergency departments use,and the amount of single prescription(P<0.05).The age of the alternating use group was younger,and the male proportion,the proportion of emergency departments use,single prescription amount of the alternating use group were higher.In the alternating use group,ibuprofen and acetaminophen of different dosage forms were used alternatively.After pair comparison analysis,they only had an age difference(P<0.008),which was in line with the principle that different dosage forms are suitable for different ages.The method of alternation with ibuprofen and acetaminophen is mainly used in the emergency departments and children of younger age because most of the children have a refractory fever,which is complicated and changes relatively fast.There was no record of adverse reactions about alternation of ibuprofen and acetaminophen in the software system of adverse reactions.However,this study was a retrospective analysis,and there were risks of missing records.Therefore,alternating use of ibuprofen and acetaminophen still couldn’t ignore the risk of adverse reactions.

Clinical experiences in the management of critically ill patients with COVID‑19 in a designated children’s hospital in China

Omicron variant has been the dominant epidemic variant of novel coronavirus in the world since 2021.Studies have shown that the incidence of severe or critical cases with coronavirus disease 2019(COVID-19)is much lower than that of the previous novel coronavirus variants[1,2];however,it is still a major challenge to treat critical pediatric patients with COVID-19,especially for those with underlying diseases.

PK-tailored tertiary prophylaxis in patients with severe hemophilia A at beijing Children’s Hospital

Importance:Tertiary prophylaxis using a low-dose regimen is usually insufficient to prevent recurrent joint bleeding and deterioration in joint diseases in children with severe hemophilia A.Pharmacokinetic(PK)dosing is a useful approach to increase the precision and efficiency of prophylaxis.Objective:To explore the efficacy of PK-tailored tertiary prophylaxis in children with severe hemophilia A.Methods:We implemented a PK-tailored tertiary prophylaxis program for 15 boys with severe hemophilia A aged 5-16 years at Beijing Children’s Hospital.Following PK testing and a 6-month evaluation period(phase I),15 patients were divided in two groups according to individual PK data and actual bleeding:(1)a PK-tailored group[modified prophylaxis regimen according to PK data for the next 6 months(phase II);n=8]and(2)a maintenance group(continued the original regimen for the next 6 months;n=7).We compared the bleeding rate,infusion frequency,and factor VIII(FVIII)consumption between the two groups.results:In the PK-tailored group,the median annual joint bleeding rate was reduced from 7.8 in phase I to 1.4 in phase II,mean annual total factor consumption increased from 1619.0 IU/kg in phase I to 2401.9 IU/kg in phase II,and median infusion frequency for prophylaxis increased from 104 times/year in phase I to 156 times/year in phase II(P<0.05).Although the FVIII consumption increased,it remained at approximately half of the standard method.Interpretation:PK-tailored prophylaxis may represent a more efficient approach to individual prophylaxis in China,but further studies are required to verify this.

Bacteriological Profile of Acute Respiratory Infections in Children: About a Prospective Study at the Albert Royer Hospital in Dakar

Introduction: Acute Respiratory Infections (ARI) is a global public health priority. It is the leading cause of childhood morbidity and mortality, especially in developing countries. The main objective of this work was to look mainly at the bacteriological aspects of ARI in children in Senegalese hospitals. Methodology: We have been conducted a prospective descriptive mono-centric study over a period of one year (from July 1, 2017 to June 30, 2018) at the Albert Royer National child hospital in Dakar. A multiplex PCR (protein chain reaction) has been performed on nasopharyngeal swabs taken from all patients. This technique (viral RNA transcribed into DNA, then the DNA of the different pathogens is simultaneously amplified in the same tube by PCR Fast-tract®, multiplex). Results: During the study period, 109 patients were included. The hospital prevalence of acute respiratory infections was 3.7%. The mean age was 23.7 months with extremes between 1 month and 144 months. Peaks of consultations were found in the months of August, March and April with 22%, 15.6% and 12.8% respectively. Fever, respiratory distress and pulmonary condensation syndrome were the main signs found in our patients. Bacteriology was positive in 82.6% of samples and the most frequently found bacteria were Streptococcus pneumoniae in 38.5%, Haemophilus influenza b in 32.1% and Moraxella catarrhalis in 25.7%. Pneumonia was the main diagnosis, found in 61 cases, a prevalence of 59.9%. The average length of hospitalization was 10 days. Lethality was 1.8% or 2 cases. Conclusion: Acute Respiratory Infections in children still remains a public health problem in developing countries;children under 5 years of age are the most affected hence the need to strengthen ARI control programs. The identification of germs is indispensable in treatment and epidemiological surveillance in our regions.

Adherence to medication: A nation-wide study from the Children's Cancer Hospital, Egypt

AIM: To investigate adherence to medical regimen and predictors for non-adherence among children with cancer in Egypt. METHODS: We administered two study specific questionnaires to 304 parents of children diagnosed with cancer at the Children's Cancer Hospital in Cairo, Egypt, one before the first chemotherapy treatment and the other before the third. The questionnaires were translated to colloquial Egyptian Arabic, and due, to the high illiteracy level in Egypt an interviewer read thequestions in Arabic to each parent and registered the answers. Both questionnaires consisted of almost 90 questions each. In addition, a Case Report Form was filled in from the child's medical journal. The study period consisted of 7 mo(February until September 2008) and we had a participation rate of 97%. Descriptive statistics are presented and Fisher's exact test was used to check for possible differences between the adherent and non-adherent groups. A P-value below 0.05 was considered significant. Software used was SAS version 9.3 for Windows(SAS Institute Inc., Cary, NC, United States).RESULTS: Two hundred and eighty-one(90%) parents answered the second questionnaire, regarding their child's adherence behaviour. Approximately two thirds of the children admitted to their third chemotherapy treatment had received medical recommendations upon discharge from the first or second chemotherapy treatment(181/281, 64%). Sixty-eight percent(123/181) of the parents who were given medical recommendations reported that their child did not follow the recommendations. Two main predictors were found for non-adherence: child resistance(111/123, 90%) and inadequate information(100/123, 81%). In the adherent group, 20% of the parents(n = 12/58) reported trust in their child's doctor while 14 percent 8/58 reported trust in the other health-care professionals. Corresponding numbers for the non-adherent group are 8/123(7%) for both their child's doctor and other health-care professionals. Almost all of the parents expressed a lack of optimism towards the treatment(116/121, 96%), yet they reported an intention to continue with the treatment for two main reasons, for the sake of their child's life(70%)(P = 0.005) and worry that their child would die if they discontinued the treatment(81%)(P < 0.0001).CONCLUSION: Non-adherence to medical regimen is common among children diagnosed with cancer inEgypt, the main reasons being child resistance and inadequate information.

Combined Treatment Strategy and Outcome of High Risk Neuroblastoma: Experience of the Children’s Cancer Hospital-Egypt

Background: Neuroblastoma (NB) is remarkable for its wide spectrum of clinical behavior and biological characteristics in relation to outcome. The use of aggressive therapy, including autologous hematopoietic stem cell transplantation (HSCT) and the addition of isoretionin (cis-Retinoic Acid/cis-RA), has increased survival rates of patients with advanced disease. Methods: Pediatric 271 newly diagnosed high risk NB patients were prospectively enrolled into the study. Patients received neoadjuvant chemotherapy of alternating cycles: [cyclophosphamide, doxorubicin, vincristine (CAdO)] and [etoposide, carboplatin]. Intensification courses of “ICE” (ifosfamide, carboplatin, and etoposide) regimen were administered to patients with bone marrow (BM) residual infiltration. Whenever safely feasible, complete surgical resection or debulking of the primary tumor was attempted for patients achieving partial response. Eligible patients underwent HSCT, while radiation therapy to the primary and metastatic sites, as well as maintenance with cis-RA was given for 6 months. Results: The median age of our patients was 2.8 years with male to female ratio of 1.65:1. At 4 years, the overall and event free survivals were 33.7% and 23.3% for the entire group under study, with significantly higher rates (42.7% and 35.6%, respectively) for HSCT patients (n = 94;p 0.001). The outcome was also significantly correlated with response to induction therapy, pathological subtype, as well as other variables. Conclusion: Myeloablative therapy followed by stem cell rescue is regarded as the most important goal of high risk NB treatment to improve survival till present. Each of consolidation HSCT, post induction disease status, as well as international neuroblastoma pathology classification (INPC) subtype was an independent predictive variable of survival. A collaborative effort with an emphasis on biologic characteristics of aggressive disease and tailored therapy needs to be strengthened to further our understanding of this disease.

Cat scratch disease in childhood: a 10-year experience of an Italian tertiary care children’s hospital

Cat scratch disease(CSD),an infection caused by Bartonella henselae,is uncommon in Europe,whereas 24,000 cases per year have been reported in the United States[1,2].The typical manifestation of CSD consists of fever and subacute,solitary or regional,painful and self-limited lymphadenopathy in a patient with a history of previous scratching,biting,or contact with a kitten or cat[3].In 85%of patients,only one regional lymph node is involved,which is located in the axillary and epitrochlear regions in approximately half of the cases[4,5].One or more round,red-brown nontender papules can develop at the inoculation site or near the scratch after a few days and may persist until two to three weeks[6].

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.

Health and Nutritional Status of Young Foster Children Attending a Diarrhea Treatment Hospital in Bangladesh

There is scarcity of evidence-based information about socio-demographic as well as ailment factors associated with foster children in Bangladesh. Thus the aim of the present study was to determine the socio-economic, health and nutritional status of young foster children in urban Dhaka. A total of 208 (1%;n = 208/28,948) under-5 foster children were enrolled in the Diarrheal Disease Surveillance System of icddr,b between 1993-2012. Randomly selected under-5 children (n = 624) with a ratio of 1:3 were extracted and constituted as comparison group. Forty-three percent (n = 90) foster children were male. Lack of formal schooling of mother was higher among foster children compared to non-foster children (52% vs. 35%;p < 0.001). Higher proportion of foster children suffered from some or severe dehy-dration (60% vs. 47%;p = 0.001) and often received intravenous saline (12% vs. 5%;p = 0.002) in comparison to non-foster children. Significantly lower proportion of foster children had rotavirus diarrhea (26% vs. 43%;p < 0.001). In multivariate analysis, foster children were 2 times (95% CI: 1.31-4.32) more likely to be stunted and 194 times (95% CI: 82.25-457.76) more likely to be non-breastfed. Infants aged 6-11 months were 8 times (95% CI: 3.70-15.50) more likely to be foster compared to older children and probability of fostering was 7 times (95% CI: 3.96-13.33) higher among mothers with a median age of 25 years. The findings of our study clearly demonstrate the existing health and nutritional problems of foster children. Therefore, appropriate health and nutrition interventions are critical for foster children in Bangladesh.

Outcome after Discharge from Hospital of Children with Complicated Severe Acute Malnutrition and Predictors Factors of Non-Response during Outpatient Treatment, in Senegal

Introduction: Malnutrition is a public health problem. It is responsible for high morbidity and mortality in children aged 6 - 59 months. The aim of this study was to determine the outcome of children with complicated severe acute malnutrition after hospital discharge. Methods: This is a descriptive and analytical cross-sectional study conducted from March 1 to November 31, 2021 at the Albert Royer Children’s Hospital. Children discharged from hospital for complicated severe acute malnutrition were included. Results: A total of 103 children were included. The mean age of children at hospitalization was 16.41 ± 10.11 months and mean duration of follow-up after hospital discharge was 29.63 ± 8.59 months. Three children (2.91%) died after hospital discharge. The mean z-score of the weight-for-current height was -1.34 ± 1.08. Almost a quarter (24.27%) of the children remain acute malnourished with 3.88% of severe acute malnutrition (SAM). The predictors’ factors associated with non-response were weaning before 2 years of age (ORaj: 12.21;95% CI [6.82 - 18.44];p = 0.04) and tuberculosis (ORaj: 21.06;95% CI [12.54 - 41.09];p = 0.03). Conclusion: The rate of recovery of nutritional status in children with complicated severe acute malnutrition is satisfactory. Ablactation before the age of two and the existence of tuberculosis are significantly associated with non-recovery of nutritional status.