BackgroundDelayed abdominal closure (DAC) after congenital diaphragmatic hernia (CDH) repair is often guided by subjective assessment. This is particularly critical in neonates receiving extracorporeal membrane oxygenation (ECMO), where inappropriate closure can precipitate abdominal compartment syndrome (ACS), yet objective guidance is lacking. Here, we describe a case where intraoperative bladder pressure (BP) monitoring provided an objective guide for DAC.Case introductionA term male neonate with severe left-sided CDH and pulmonary hypertension required veno-arterial ECMO. On ECMO day 4, he underwent repair of the diaphragmatic defect. Following visceral reduction, abdominal wall tension increased, and BP was measured at 20mmHg. Based on this objective evidence of intra-abdominal hypertension, DAC was performed with placement of a temporary silastic silo. Following decompression, the BP decreased to 8 mmHg. The patient was successfully weaned from ECMO on postoperative day 1. Definitive abdominal wall closure was performed on day 7. The infant recovered and was discharged on day 38 of life.ConclusionIntraoperative BP monitoring is a simple, reproducible, and objective tool that can effectively guide the decision for DAC in neonates undergoing ECMO-assisted CDH repair, potentially preventing ACS and improving outcomes.
Mikiyas G. Teferi, Bethel A. Awoke, Iyassu S. Melkie
et al.
Background: Mortality prediction scoring systems are essential tools for quality assessment and clinical decision-making in pediatric intensive care units (PICUs). The Pediatric Index of Mortality 2 (PIM2) is widely used in high-income countries, but its validity in resource-limited settings remains uncertain. Objective: To evaluate the validity of PIM2 in predicting mortality among children admitted to a PICU in Ethiopia. Methods: A prospective observational study was conducted at Hawassa University Comprehensive Specialized Hospital PICU, Ethiopia, from February 1 to July 31, 2025. All children aged 1 month to 14 years admitted during the study period were enrolled. PIM2 scores were calculated within one hour of PICU admission using physiological and clinical variables. The primary outcome was mortality at PICU discharge. Discrimination was assessed using the area under the receiver operating characteristic curve (AUROC), and calibration was evaluated using the Hosmer-Lemeshow goodness-of-fit test. Results: Of 76 enrolled patients, 31 (40.8 %) died and 45 (59.2 %) survived. Median age was 24 months (IQR 12–48 months), and 47 (61.8 %) were male. The median PIM2 score was 8.5 % (IQR 3.2–25.6 %). PIM2 demonstrated poor discrimination with an AUROC of 0.651 (95 % CI 0.525–0.777, p = 0.029). Calibration was also poor (Hosmer-Lemeshow χ²=15.8, p = 0.045). The standardized mortality ratio was 1.32, indicating observed mortality exceeded predicted mortality by 32 %. Conclusions: PIM2 showed poor performance in predicting mortality in an Ethiopian PICU setting. This finding highlights the need for local recalibration or development of context-specific mortality prediction tools for resource-limited settings with different case-mix, disease patterns, and treatment protocols.
Çağla Karavaizoğlu, Kazım Okan Dolu, Ayşe Süleyman
et al.
Skin prick tests (SPT) are widely used in the diagnosis of allergic diseases because of their reliability, simplicity, cost-effectiveness, and rapid results. Herein, we report a 4-year-old boy who developed anaphylaxis with aeroallergen SPT in an asthmatic child. SPTs were positive for both house dust and Plantago allergens.Although the frequency of systemic reactions to SPTs is low, these tests should only be performed in medical facilities with appropriate equipment and well-trained medical personnel for anaphylaxis.
Acute disseminated encephalomyelitis (ADEM) is a severe acute inflammatory process of the Central Nervous System (CNS) consisting of multiple foci of perivascular demyelination. It is a relatively frequent complication of infections and immunization among children. Systemic lupus Erythematosus (SLE), is a chronic autoimmune disease, of unknown etiology, that touches multiple organs simultaneously or additionally, with serious morbidity and mortality. More frequent in females, it can be associated with other auto-immune diseases. ADEM is rarely reported as the initial presentation of SLE, even rarer in the pediatric population. We present one case of a 13 years old girl with a history of ADEM, who was diagnosed with SLE eight months later.
Kaila Lessner, Lauren McKinney, Ilana Anderson
et al.
Acute overdose of metformin can show potentially fatal lactic acidosis. Management should be directed towards close monitoring of renal function and hemodynamics. Patients may require dialysis or extracorporeal membrane oxygenation in cases of hemodynamic instability. This case presents an adolescent with massive metformin ingestion estimated at 100 g leading to metformin-associated lactic acidosis and subsequent respiratory failure, cardiovascular collapse, and acute kidney injury. The complications were successfully managed with venoarterial extracorporeal membrane oxygenation, continuous renal replacement therapy, and mechanical ventilation.
Summary: Background: Tissues such as the liver lobule, kidney nephron, and intestinal gland exhibit intricate patterns of zonated gene expression corresponding to distinct cell types and functions. To quantitatively understand zonation, it is important to measure cellular or genetic features as a function of position along a zonal axis. While it is possible to manually count, characterize, and locate features in relation to the zonal axis, it is labor-intensive and difficult to do manually while maintaining precision and accuracy. Methods: We addressed this challenge by developing a deep-learning-based quantification method called the “Tissue Positioning System” (TPS), which can automatically analyze zonation in the liver lobule as a model system. Findings: By using algorithms that identified vessels, classified vessels, and segmented zones based on the relative position along the portal vein to central vein axis, TPS was able to spatially quantify gene expression in mice with zone specific reporters. Interpretation: TPS could discern expression differences between zonal reporter strains, ages, and disease states. TPS could also reveal the zonal distribution of cells previously thought to be positioned randomly. The design principles of TPS could be generalized to other tissues to explore the biology of zonation. Funding: CPRIT (RP190208, RP220614, RP230330) and NIH (P30CA142543, R01AA028791, R01CA251928, R01DK1253961, R01GM140012, 1R01GM141519, 1R01DE030656, 1U01CA249245). The Pollack Foundation, Simmons Comprehensive Cancer Center Cancer & Obesity Translational Pilot Award, and the Emerging Leader Award from the Mark Foundation For Cancer Research (#21-003-ELA).
Pastor Escárcega-Fujigaki, Guillermo Hernandez-Peredo-Rezk, Hayde Velez-Blanco
et al.
Introduction: Choledochal cyst is a congenital anomaly of the bile duct without associated pathology as compared to esophageal atresia, whose pathology is usually part of the VACTERL association list (vertebral defects, anal atresia, cardiac defects, tracheoesophageal fistula, renal anomalies, and limb abnormalities). In addition to these core component features, patients may also have other congenital anomalies. Case presentation: A single case of the association of type 1 choledochal cyst (Todani), type III esophageal atresia (Ladd-Gross), evanescent testicle, and clinodactyly of both little fingers, is reported for the first time. A cytogenetic study reports an apparently normal male with a 46 XY karyotype, GTG bands, 400–550 band resolution, and extended exome sequencing without alterations. Esophageal plasty, hepatic-duodenal bypass in early childhood, and resection of the evanescent testicle with fixation of the contralateral testicle were performed at one year of age. We observed a satisfactory evolution after four years and four months of follow-up. Conclusion: In this report, we present this novel case of the association of type 1 choledochal cyst (Todani), type III esophageal atresia (Ladd-Gross), evanescent testicle, and clinodactyly of both little fingers, which has not been previously reported in the literature.
Catherine A. Brownstein, Elise Douard, Robin L. Haynes
et al.
Abstract In sudden unexplained death in pediatrics (SUDP) the cause of death is unknown despite an autopsy and investigation. The role of copy number variations (CNVs) in SUDP has not been well‐studied. Chromosomal microarray (CMA) data are generated for 116 SUDP cases with age at death between 1 and 28 months. CNVs are classified using the American College of Medical Genetics and Genomics guidelines and CNVs in our cohort are compared to an autism spectrum disorder (ASD) cohort, and to a control cohort. Pathogenic CNVs are identified in 5 of 116 cases (4.3%). Variants of uncertain significance (VUS) favoring pathogenic CNVs are identified in 9 cases (7.8%). Several CNVs are associated with neurodevelopmental phenotypes including seizures, ASD, developmental delay, and schizophrenia. The structural variant 47,XXY is identified in two cases (2/69 boys, 2.9%) not previously diagnosed with Klinefelter syndrome. Pathogenicity scores for deletions are significantly elevated in the SUDP cohort versus controls (p = 0.007) and are not significantly different from the ASD cohort. The finding of pathogenic or VUS favoring pathogenic CNVs, or structural variants, in 12.1% of cases, combined with the observation of higher pathogenicity scores for deletions in SUDP versus controls, suggests that CMA should be included in the genetic evaluation of SUDP.
Temitayo Victor Lawal, Kehinde Adebola Atoloye, Ayo Stephen Adebowale
et al.
Abstract Background Globally, child mortality and morbidity remain a serious health challenge and infectious diseases are the leading causes. The use of count models together with spatial analysis of the number of doses of childhood vaccines taken is limited in the literature. We used a Bayesian zero-inflated Poisson regression model with spatio-temporal components to assess the number of doses of childhood vaccines taken among children aged 12–23 months and their associated factors. Methods Data of 19,564 children from 2003, 2008, 2013 and 2018 population-based cross-sectional Nigeria Demographic and Health Survey were used. The childhood vaccines include one dose of Bacillus-Calmette-Guérin; three doses of Diphtheria-Pertussis-Tetanus; three doses of Polio and one dose of Measles. Uptake of all nine vaccines was regarded as full vaccination. We examined the multilevel factors associated with the number of doses of childhood vaccines taken using descriptive, bivariable and multivariable Bayesian models. Analysis was conducted in Stata version 16 and R statistical packages, and visualization in ArcGIS. Results The prevalence of full vaccination was 6.5% in 2003, 14.8% in 2008, 21.8% in 2013 and 23.3% in 2018. Full vaccination coverage ranged from 1.7% in Sokoto to 51.9% in Anambra. Factors associated with the number of doses of childhood vaccines taken include maternal age (adjusted Incidence “risk” Ratio (aIRR) = 1.05; 95% Credible Interval (CrI) = 1.03–1.07) for 25–34 years and (aIRR = 1.07; 95% CrI = 1.05–1.10) for 35–49 years and education: (aIRR = 1.11, 95% CrI = 1.09–1.14) for primary and (aIRR = 1.16; 95% CrI = 1.13–1.19) for secondary/tertiary education. Other significant factors are wealth status, antenatal care attendance, working status, use of skilled birth attendants, religion, mother’s desire for the child, community poverty rate, community illiteracy, and community unemployment. Conclusion Although full vaccination has remained low, there have been improvements over the years with wide disparities across the states. Improving the uptake of vaccines by educating women on the benefits of hospital delivery and vaccines through radio jingles and posters should be embraced, and state-specific efforts should be made to address inequality in access to routine vaccination in Nigeria.
This clinical report reviews the currently known health benefits of probiotic and prebiotic products, including those added to commercially available infant formula and other food products for use in children. Probiotics are supplements or foods that contain viable microorganisms that cause alterations of the microflora of the host. Use of probiotics has been shown to be modestly effective in randomized clinical trials (RCTs) in (1) treating acute viral gastroenteritis in healthy children; and (2) preventing antibiotic-associated diarrhea in healthy children. There is some evidence that probiotics prevent necrotizing enterocolitis in very low birth weight infants (birth weight between 1000 and 1500 g), but more studies are needed. The results of RCTs in which probiotics were used to treat childhood Helicobacter pylori gastritis, irritable bowel syndrome, chronic ulcerative colitis, and infantile colic, as well as in preventing childhood atopy, although encouraging, are preliminary and require further confirmation. Probiotics have not been proven to be beneficial in treating or preventing human cancers or in treating children with Crohn disease. There are also safety concerns with the use of probiotics in infants and children who are immunocompromised, chronically debilitated, or seriously ill with indwelling medical devices. Prebiotics are supplements or foods that contain a nondigestible food ingredient that selectively stimulates the favorable growth and/or activity of indigenous probiotic bacteria. Human milk contains substantial quantities of prebiotics. There is a paucity of RCTs examining prebiotics in children, although there may be some long-term benefit of prebiotics for the prevention of atopic eczema and common infections in healthy infants. Confirmatory well-designed clinical research studies are necessary.
Maya S. Iyer, David P. Way, Daniel J. Schumacher
et al.
The Accreditation Council for Graduate Medical Education (ACGME) requires General Pediatricians (GPeds) to learn thirteen procedures during training. However, GPeds infrequently perform these procedures in practice. We sought to determine:1) how GPeds learned procedures, 2) if GPeds self-reported achieving competence in the required ACGME procedures during training, and 3) if GPeds maintained these skills into practice. We conducted this mixed methods study from 2019–2020. 51 GPeds from central Ohio and the American Board of Pediatrics General Examination Committee were recruited via email or snowball sampling and participated in semi-structured recorded phone interviews probing procedural performance during training and current practice. Participants represented varied geographic regions and clinical settings. We employed Sawyer’s ‘Learn, See, Practice, Prove, Do, Maintain’ mastery learning pedagogical framework as a lens for thematic analysis. Participants did not demonstrate competence in all ACGME required procedures during training, nor sustain procedural skills in practice. Most participants learned procedures through a ‘see one, do one’ apprenticeship model. GPeds reported never being formally assessed on procedural competence during residency. All GPeds referred out at least one procedure. GPeds also believed that skill maintenance was unwarranted for procedures irrelevant to their current practice. GPeds did not sufficiently demonstrate competence in all ACGME required procedures during training, partially suggesting why they infrequently perform some procedures. Alternatively, these required procedures may not be relevant to their practice. Pediatric residency procedures education might consider using mastery learning for practice-specific procedures and surface-level methods (learning without mastery) for other skills.
Münevver Yılmaz, Ayse Berna Anil, Murat Anil
et al.
Objective: The aim of this study is to determine the clinical signs of traumatic brain injury and its long-term effects on prognosis by evaluating the clinical and radiological findings of the patients admitted to the pediatric emergency department due to blunt head trauma.
Method: The cases who applied to the pediatric emergency department due to head trauma were examined prospectively. Glaskow Coma (GCS) and Pediatric Trauma Scores (PTS) were calculated. The patients were evaluated neurologically 6 months after they were discharged.
Results: A total of 707 pediatric patients [mean age: 59.8 +- 42.6 months; range: 1 month to 13 years; 263 (37.2%) girls] were evaluated prospectively. Pathology was detected in 101 cases (45.9%) [(epidural hematoma, 14; subdural hematoma, 11; brain edema, 36; intracerebral hematoma, 6; subarachnoid hemorrhage, 8; cerebral contusion, 22. Seventy-two (10.1%) patients had skull fractures.] Seventeen cases (2.4%) were operated, and 7 (1.4%) cases were lost. In children aged < 2 years vomiting, tachypnea, focal neurological findings, multitrauma, GCS <15 and low PTS were more common with traumatic brain injury (p <0.05). Vomiting, GCS <15 and low PTS were more common in children >2 years old and with traumatic brain injury (p <0.05). Neurological sequelae were not detected in patients aged <2 years with mild trauma. Loss of consciousness, pulse rate, respiratory and blood pressure abnormalities, focal neurological findings, low GCS and PTS were more common in children aged >2 years and with neurological sequelae (p <0.05).
Conclusion: Physical examination findings, GCS, and PTS levels are useful tools in predicting the short- and long-term consequences of the injury.