Children

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Open AccessArticle

If You Build It, They Will Come: Initial Experience with a Multi-Disciplinary Pediatric Neurocritical Care Follow-Up Clinic

by Cydni N. Williams, Aileen Kirby and Juan Piantino

Children 2017, 4(9), 83; https://doi.org/10.3390/children4090083 - 19 Sep 2017

Cited by 41 | Viewed by 5080

Abstract

Pediatric Neurocritical Care diagnoses account for a large proportion of intensive care admissions. Critical care survivors suffer high rates of long-term morbidity, including physical disability, cognitive impairment, and psychosocial dysfunction. To address these morbidities in Pediatric Neurocritical Care survivors, collaboration between Pediatric Neurology [...] Read more.

Pediatric Neurocritical Care diagnoses account for a large proportion of intensive care admissions. Critical care survivors suffer high rates of long-term morbidity, including physical disability, cognitive impairment, and psychosocial dysfunction. To address these morbidities in Pediatric Neurocritical Care survivors, collaboration between Pediatric Neurology and Pediatric Critical Care created a multidisciplinary follow-up clinic providing specialized evaluations after discharge. Clinic referrals apply to all Pediatric Neurocritical Care patients regardless of admission severity of illness. Here, we report an initial case series, which revealed a population that is heterogenous in age, ranging from 1 month to 18 years, and in diagnoses. Traumatic brain injuries of varying severity as well as neuroinfectious and inflammatory diseases accounted for the majority of referrals. Most patients (87%) seen in the clinic had morbidities identified, requiring ongoing evaluation and expansion of the clinic. Cognitive and psychological disturbance were seen in over half of patients at the initial clinic follow-up. Sleep disturbances, daytime fatigue, headache or chronic pain, and vision or hearing concerns were also common at initial follow-up. Data from this initial population of clinic patients reiterates the need for specialized follow-up care, but also highlights the difficulties related to providing this comprehensive care and evaluating interventions to improve outcomes. Full article

(This article belongs to the Section Pediatric Neurology & Neurodevelopmental Disorders)

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Open AccessReview

Sleep Disorders in Childhood Neurogenetic Disorders

by Laura Beth Mann Dosier, Bradley V. Vaughn and Zheng Fan

Children 2017, 4(9), 82; https://doi.org/10.3390/children4090082 - 12 Sep 2017

Cited by 8 | Viewed by 7684

Abstract

Genetic advances in the past three decades have transformed our understanding and treatment of many human diseases including neurogenetic disorders. Most neurogenetic disorders can be classified as “rare disease,” but collectively neurogenetic disorders are not rare and are commonly encountered in general pediatric [...] Read more.

Genetic advances in the past three decades have transformed our understanding and treatment of many human diseases including neurogenetic disorders. Most neurogenetic disorders can be classified as “rare disease,” but collectively neurogenetic disorders are not rare and are commonly encountered in general pediatric practice. The authors decided to select eight relatively well-known neurogenetic disorders including Down syndrome, Angelman syndrome, Prader–Willi syndrome, Smith–Magenis syndrome, congenital central hypoventilation syndrome, achondroplasia, mucopolysaccharidoses, and Duchenne muscular dystrophy. Each disorder is presented in the following format: overview, clinical characteristics, developmental aspects, associated sleep disorders, management and research/future directions. Full article

(This article belongs to the Special Issue Sleep Medicine in Children and Adolescents)

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Open AccessReview

Fever in Children: Pearls and Pitfalls

by Egidio Barbi, Pierluigi Marzuillo, Elena Neri, Samuele Naviglio and Baruch S. Krauss

Children 2017, 4(9), 81; https://doi.org/10.3390/children4090081 - 1 Sep 2017

Cited by 72 | Viewed by 30096

Abstract

Fever in children is a common concern for parents and one of the most frequent presenting complaints in emergency department visits, often involving non-pediatric emergency physicians. Although the incidence of serious infections has decreased after the introduction of conjugate vaccines, fever remains a [...] Read more.

Fever in children is a common concern for parents and one of the most frequent presenting complaints in emergency department visits, often involving non-pediatric emergency physicians. Although the incidence of serious infections has decreased after the introduction of conjugate vaccines, fever remains a major cause of laboratory investigation and hospital admissions. Furthermore, antipyretics are the most common medications administered to children. We review the epidemiology and measurement of fever, the meaning of fever and associated clinical signs in children of different ages and under special conditions, including fever in children with cognitive impairment, recurrent fevers, and fever of unknown origin. While the majority of febrile children have mild, self-resolving viral illness, a minority may be at risk of life-threatening infections. Clinical assessment differs markedly from adult patients. Hands-off evaluation is paramount for a correct evaluation of breathing, circulation and level of interaction. Laboratory markers and clinical prediction rules provide limited help in identifying children at risk for serious infections; however, clinical examination, prudent utilization of laboratory tests, and post-discharge guidance (“safety netting”) remain the cornerstone of safe management of febrile children. Full article

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Open AccessArticle

Experiences of Parent Peer Nutrition Educators Sharing Child Feeding and Nutrition Information

by Richard Ball, Kerith Duncanson, Tracy Burrows and Clare Collins

Children 2017, 4(9), 78; https://doi.org/10.3390/children4090078 - 29 Aug 2017

Cited by 6 | Viewed by 6256

Abstract

The aim of this study was to describe the experiences of parents as peer educators disseminating nutrition and child feeding information. Parents of infants aged from birth to three years were trained as peer educators in a face-to-face workshop, and then shared evidence-based [...] Read more.

The aim of this study was to describe the experiences of parents as peer educators disseminating nutrition and child feeding information. Parents of infants aged from birth to three years were trained as peer educators in a face-to-face workshop, and then shared evidence-based child feeding and nutrition information via Facebook, email, and printed resources for six months to peers, family, and social media contacts. Semi-structured telephone or group interviews were conducted after a six-month online and face-to-face peer nutrition intervention period investigating peer educator experiences, barriers, enablers of information dissemination, and the acceptability of the peer educator model. Transcripts from interviews were independently coded by two researchers and thematically analysed. Twenty-eight participants completed the study and were assigned to either group or individual interviews. The cohort consenting to the study were predominantly female, aged between 25 and 34 years, non-indigenous, tertiary educated, and employed or on maternity leave. Dominant themes to emerge from the interviews included that the information was trustworthy, child feeding practice information was considered most helpful, newer parents were the most receptive and family members the least receptive to child feeding and nutrition information, and sharing and receiving information verbally and via social media were preferred over print and email. In conclusion, parents reported positive experiences as peer nutrition educators, and considered it acceptable for sharing evidence-based nutrition information. Further research may determine the impact on diet quality and the food-related behaviours of babies and young children on a population level. Full article

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Open AccessArticle

Sleep Disorders in a Sample of Adopted Children: A Pilot Study

by Meghna Rajaprakash, Elizabeth Kerr, Benita Friedlander and Shelly Weiss

Children 2017, 4(9), 77; https://doi.org/10.3390/children4090077 - 29 Aug 2017

Cited by 4 | Viewed by 5295

Abstract

Sleep disorders occur in up to 25% of children and are more prevalent in children who have attention problems and attachment issues. Research shows that foster children display sleep problems, but limited knowledge exists on sleep problems in adopted children. This pilot study [...] Read more.

Sleep disorders occur in up to 25% of children and are more prevalent in children who have attention problems and attachment issues. Research shows that foster children display sleep problems, but limited knowledge exists on sleep problems in adopted children. This pilot study aimed to identify the types of sleep disorders in adopted children and associated psychosocial factors. Parents of adopted children in Ontario, Canada, ages 2–10 years were asked to complete questionnaires evaluating demographic measures, sleep history, and the presence of behavioral problems. Insomnias and parasomnias were reported in adopted children and were associated with attention problems. This pilot study emphasizes the need for further research on the underlying factors governing the relationship between poor sleep and behavioral problems in adopted children. Full article

(This article belongs to the Special Issue Sleep Medicine in Children and Adolescents)

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Open AccessArticle

Vitamin D Deficiency: A Potential Modifiable Risk Factor for Cardiovascular Disease in Children with Severe Obesity

by Anoop Mohamed Iqbal, Amanda R. Dahl, Aida Lteif and Seema Kumar

Children 2017, 4(9), 80; https://doi.org/10.3390/children4090080 - 28 Aug 2017

Cited by 15 | Viewed by 6817

Abstract

Severe obesity is associated with abnormal lipids and increased risk for cardiovascular disease. Obesity is a risk factor for vitamin D deficiency. We examined relationship between 25-hydroxy vitamin D (25(OH)D) concentrations and lipids in children with severe obesity. Medical records of 376 children [...] Read more.

Severe obesity is associated with abnormal lipids and increased risk for cardiovascular disease. Obesity is a risk factor for vitamin D deficiency. We examined relationship between 25-hydroxy vitamin D (25(OH)D) concentrations and lipids in children with severe obesity. Medical records of 376 children were reviewed. Linear regression models and logistic regression were used to examine the relationship between 25(OH)D and lipids after adjustment for age, gender, season of blood draw, body mass index (BMI) z-score, and BMI % of 95th percentile. Two-hundred sixty-three out of 376 children (70%) had 25(OH)D concentrations < 30 ng/mL. Concentrations of 25(OH)D were positively correlated with those of high-density lipoprotein cholesterol (HDL-C) (r² = 0.08, r = 0.22, β = 0.16, 95% CI = 0.05–0.27, p = 0.004). HDL-C was lower in children with 25(OH)D < 30 ng/mL (n = 263) compared to those with 25(OH)D ≥ 30 ng/mL (n = 113) (41.3 ± 10.2 vs. 46.4 ± 12 mg/dL, p < 0.0001). Children with 25(OH)D concentrations < 30 ng/mL had greater adjusted odds of low HDL-C (<40 mg/dL) compared with those with 25(OH)D ≥ 30 ng/mL (47.9% vs. 29.2%, OR 2.15 (1.33–3.51), p = 0.0019). Total cholesterol and non-HDL-C were not correlated with 25(OH)D concentrations. Vitamin D deficiency is highly prevalent in children with severe obesity. Prospective clinical trials are warranted to determine if vitamin D supplementation can improve HDL-C and potentially decrease risk for cardiovascular disease in children with obesity. Full article

(This article belongs to the Special Issue Nutrition in the Prevention and Treatment of Children with Chronic Diseases)

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Open AccessBrief Report

Assessment of Initial Vancomycin Dosing in Pediatric Oncology Patients

by Hillary Orr, Deni Trone, Joshua Elder and Ashok Raj

Children 2017, 4(9), 79; https://doi.org/10.3390/children4090079 - 28 Aug 2017

Cited by 6 | Viewed by 4617

Abstract

This was a retrospective audit assessing vancomycin dosing of 60 mg/kg/day in the attainment of therapeutic concentrations between 10–20 mcg/mL among 56 pediatric oncology patients. Twelve patients (21%) achieved therapeutic concentrations of 10–20 mcg/mL, while 44 patients (79%) obtained trough levels below 10 [...] Read more.

This was a retrospective audit assessing vancomycin dosing of 60 mg/kg/day in the attainment of therapeutic concentrations between 10–20 mcg/mL among 56 pediatric oncology patients. Twelve patients (21%) achieved therapeutic concentrations of 10–20 mcg/mL, while 44 patients (79%) obtained trough levels below 10 mcg/mL despite the addition of nephrotoxic agents. Full article

(This article belongs to the Section Pediatric Hematology & Oncology)

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Open AccessEditorial

Mind-Body Medicine in Pediatrics

by Hilary McClafferty

Children 2017, 4(9), 76; https://doi.org/10.3390/children4090076 - 25 Aug 2017

Cited by 3 | Viewed by 4667

Abstract

The primary goals of this Special Issue are to encourage readers to become more familiar with the range of mind-body therapies and to explore their application in the pediatric clinical setting. The Special Issue includes a deliberate mix of case studies and practical [...] Read more.

The primary goals of this Special Issue are to encourage readers to become more familiar with the range of mind-body therapies and to explore their application in the pediatric clinical setting. The Special Issue includes a deliberate mix of case studies and practical clinical guidance, with the dual goals of piquing curiosity and providing resources for clinicians interested in pursuing further training Full article

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Open AccessReview

Diagnostic Approach to Pulmonary Hypertension in Premature Neonates

by Vasantha H.S. Kumar

Children 2017, 4(9), 75; https://doi.org/10.3390/children4090075 - 24 Aug 2017

Cited by 17 | Viewed by 12773

Abstract

Bronchopulmonary dysplasia (BPD) is a form of chronic lung disease in premature infants following respiratory distress at birth. With increasing survival of extremely low birth weight infants, alveolar simplification is the defining lung characteristic of infants with BPD, and along with pulmonary hypertension, [...] Read more.

Bronchopulmonary dysplasia (BPD) is a form of chronic lung disease in premature infants following respiratory distress at birth. With increasing survival of extremely low birth weight infants, alveolar simplification is the defining lung characteristic of infants with BPD, and along with pulmonary hypertension, increasingly contributes to both respiratory morbidity and mortality in these infants. Growth restricted infants, infants born to mothers with oligohydramnios or following prolonged preterm rupture of membranes are at particular risk for early onset pulmonary hypertension. Altered vascular and alveolar growth particularly in canalicular and early saccular stages of lung development following mechanical ventilation and oxygen therapy, results in developmental lung arrest leading to BPD with pulmonary hypertension (PH). Early recognition of PH in infants with risk factors is important for optimal management of these infants. Screening tools for early diagnosis of PH are evolving; however, echocardiography is the mainstay for non-invasive diagnosis of PH in infants. Cardiac computed tomography (CT) and magnetic resonance are being used as imaging modalities, however their role in improving outcomes in these patients is uncertain. Follow-up of infants at risk for PH will help not only in early diagnosis, but also in appropriate management of these infants. Aggressive management of lung disease, avoidance of hypoxemic episodes, and optimal nutrition determine the progression of PH, as epigenetic factors may have significant effects, particularly in growth-restricted infants. Infants with diagnosis of PH are managed with pulmonary vasodilators and those resistant to therapy need to be worked up for the presence of cardio-vascular anomalies. The management of infants and toddlers with PH, especially following premature birth is an emerging field. Nonetheless, combination therapies in a multi-disciplinary setting improves outcomes for these infants. Full article

(This article belongs to the Special Issue New Trend in Pediatric Cardiology: Pulmonary Hypertension)

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Children, Volume 4, Issue 9 (September 2017) – 9 articles

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