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  Subjects -> HEALTH AND SAFETY (Total: 1353 journals)
    - CIVIL DEFENSE (23 journals)
    - DRUG ABUSE AND ALCOHOLISM (87 journals)
    - HEALTH AND SAFETY (564 journals)
    - HEALTH FACILITIES AND ADMINISTRATION (384 journals)
    - OCCUPATIONAL HEALTH AND SAFETY (106 journals)
    - PHYSICAL FITNESS AND HYGIENE (107 journals)
    - WOMEN'S HEALTH (82 journals)

HEALTH AND SAFETY (564 journals)                  1 2 3 | Last

Showing 1 - 200 of 203 Journals sorted alphabetically
16 de Abril     Open Access  
A Life in the Day     Hybrid Journal   (Followers: 12)
Acta Informatica Medica     Open Access   (Followers: 1)
Acta Scientiarum. Health Sciences     Open Access   (Followers: 1)
Adultspan Journal     Hybrid Journal   (Followers: 1)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 10)
Advances in Public Health     Open Access   (Followers: 23)
African Health Sciences     Open Access   (Followers: 2)
African Journal for Physical, Health Education, Recreation and Dance     Full-text available via subscription   (Followers: 7)
African Journal of Health Professions Education     Open Access   (Followers: 6)
Afrimedic Journal     Open Access   (Followers: 2)
Ageing & Society     Hybrid Journal   (Followers: 40)
Air Quality, Atmosphere & Health     Hybrid Journal   (Followers: 4)
AJOB Primary Research     Partially Free   (Followers: 3)
American Journal of Family Therapy     Hybrid Journal   (Followers: 11)
American Journal of Health Economics     Full-text available via subscription   (Followers: 13)
American Journal of Health Education     Hybrid Journal   (Followers: 31)
American Journal of Health Promotion     Hybrid Journal   (Followers: 27)
American Journal of Health Sciences     Open Access   (Followers: 7)
American Journal of Health Studies     Full-text available via subscription   (Followers: 11)
American Journal of Preventive Medicine     Hybrid Journal   (Followers: 28)
American Journal of Public Health     Full-text available via subscription   (Followers: 206)
American Journal of Public Health Research     Open Access   (Followers: 28)
American Medical Writers Association Journal     Full-text available via subscription   (Followers: 5)
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 5)
Annals of Health Law     Open Access   (Followers: 3)
Annals of Tropical Medicine and Public Health     Open Access   (Followers: 13)
Applied Biosafety     Hybrid Journal  
Applied Research In Health And Social Sciences: Interface And Interaction     Open Access   (Followers: 3)
Archive of Community Health     Open Access   (Followers: 1)
Archives of Medicine and Health Sciences     Open Access   (Followers: 3)
Arquivos de Ciências da Saúde     Open Access  
Asia Pacific Journal of Counselling and Psychotherapy     Hybrid Journal   (Followers: 9)
Asia Pacific Journal of Health Management     Full-text available via subscription   (Followers: 4)
Asia-Pacific Journal of Public Health     Hybrid Journal   (Followers: 9)
Asian Journal of Gambling Issues and Public Health     Open Access   (Followers: 4)
Atención Primaria     Open Access   (Followers: 1)
Australasian Journal of Paramedicine     Open Access   (Followers: 3)
Australian Advanced Aesthetics     Full-text available via subscription   (Followers: 4)
Australian Family Physician     Full-text available via subscription   (Followers: 3)
Australian Indigenous HealthBulletin     Free   (Followers: 6)
Autism & Developmental Language Impairments     Open Access   (Followers: 8)
Behavioral Healthcare     Full-text available via subscription   (Followers: 6)
Bijzijn     Hybrid Journal   (Followers: 2)
Bijzijn XL     Hybrid Journal   (Followers: 1)
Biomedical Safety & Standards     Full-text available via subscription   (Followers: 8)
BLDE University Journal of Health Sciences     Open Access  
BMC Oral Health     Open Access   (Followers: 6)
BMC Pregnancy and Childbirth     Open Access   (Followers: 21)
BMJ Simulation & Technology Enhanced Learning     Hybrid Journal   (Followers: 10)
Brazilian Journal of Medicine and Human Health     Open Access  
Buletin Penelitian Kesehatan     Open Access   (Followers: 2)
Buletin Penelitian Sistem Kesehatan     Open Access  
Cadernos de Educação, Saúde e Fisioterapia     Open Access   (Followers: 1)
Cadernos Saúde Coletiva     Open Access   (Followers: 1)
Cambridge Quarterly of Healthcare Ethics     Hybrid Journal   (Followers: 11)
Canadian Family Physician     Partially Free   (Followers: 11)
Canadian Journal of Community Mental Health     Full-text available via subscription   (Followers: 9)
Canadian Journal of Human Sexuality     Hybrid Journal   (Followers: 2)
Canadian Journal of Public Health     Hybrid Journal   (Followers: 20)
Case Reports in Women's Health     Open Access   (Followers: 3)
Case Studies in Fire Safety     Open Access   (Followers: 15)
Central Asian Journal of Global Health     Open Access   (Followers: 2)
CES Medicina     Open Access  
Child Abuse Research in South Africa     Full-text available via subscription   (Followers: 1)
Child's Nervous System     Hybrid Journal  
Childhood Obesity and Nutrition     Open Access   (Followers: 10)
Children     Open Access   (Followers: 2)
CHRISMED Journal of Health and Research     Open Access  
Christian Journal for Global Health     Open Access  
Ciência & Saúde Coletiva     Open Access   (Followers: 2)
Ciencia e Innovación en Salud     Open Access  
Ciencia y Cuidado     Open Access   (Followers: 1)
Ciencia, Tecnología y Salud     Open Access   (Followers: 1)
ClinicoEconomics and Outcomes Research     Open Access   (Followers: 2)
CME     Hybrid Journal   (Followers: 1)
CoDAS     Open Access  
Community Health     Open Access   (Followers: 3)
Conflict and Health     Open Access   (Followers: 7)
Contraception and Reproductive Medicine     Open Access  
Curare     Open Access  
Current Opinion in Behavioral Sciences     Hybrid Journal   (Followers: 4)
Day Surgery Australia     Full-text available via subscription   (Followers: 2)
Digital Health     Open Access   (Followers: 3)
Disaster Medicine and Public Health Preparedness     Hybrid Journal   (Followers: 13)
Dramatherapy     Hybrid Journal   (Followers: 2)
Drogues, santé et société     Full-text available via subscription   (Followers: 1)
Duazary     Open Access   (Followers: 1)
Düzce Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi / Journal of Duzce University Health Sciences Institute     Open Access  
Early Childhood Research Quarterly     Hybrid Journal   (Followers: 19)
East African Journal of Public Health     Full-text available via subscription   (Followers: 4)
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity     Hybrid Journal   (Followers: 20)
EcoHealth     Hybrid Journal   (Followers: 4)
Education for Health     Open Access   (Followers: 6)
electronic Journal of Health Informatics     Open Access   (Followers: 6)
ElectronicHealthcare     Full-text available via subscription   (Followers: 3)
Elsevier Ergonomics Book Series     Full-text available via subscription   (Followers: 4)
Emergency Services SA     Full-text available via subscription   (Followers: 2)
Ensaios e Ciência: Ciências Biológicas, Agrárias e da Saúde     Open Access  
Environmental Disease     Open Access   (Followers: 2)
Environmental Sciences Europe     Open Access   (Followers: 1)
Epidemics     Open Access   (Followers: 4)
Epidemiologic Perspectives & Innovations     Open Access   (Followers: 5)
Epidemiology, Biostatistics and Public Health     Open Access   (Followers: 18)
Ethics, Medicine and Public Health     Full-text available via subscription   (Followers: 5)
Ethiopian Journal of Health Development     Open Access   (Followers: 7)
Ethiopian Journal of Health Sciences     Open Access   (Followers: 6)
Ethnicity & Health     Hybrid Journal   (Followers: 13)
Eurasian Journal of Health Technology Assessment     Open Access  
European Journal of Investigation in Health, Psychology and Education     Open Access   (Followers: 2)
European Medical, Health and Pharmaceutical Journal     Open Access   (Followers: 1)
Evaluation & the Health Professions     Hybrid Journal   (Followers: 10)
Evidence-based Medicine & Public Health     Open Access   (Followers: 7)
Evidência - Ciência e Biotecnologia - Interdisciplinar     Open Access  
Expressa Extensão     Open Access  
Face à face     Open Access   (Followers: 1)
Families, Systems, & Health     Full-text available via subscription   (Followers: 9)
Family & Community Health     Partially Free   (Followers: 12)
Family Medicine and Community Health     Open Access   (Followers: 7)
Family Relations     Partially Free   (Followers: 11)
Fatigue : Biomedicine, Health & Behavior     Hybrid Journal   (Followers: 2)
Finnish Journal of eHealth and eWelfare : Finjehew     Open Access  
Food and Public Health     Open Access   (Followers: 13)
Food Quality and Safety     Open Access   (Followers: 1)
Frontiers in Public Health     Open Access   (Followers: 7)
Gaceta Sanitaria     Open Access   (Followers: 3)
Galen Medical Journal     Open Access  
Gazi Sağlık Bilimleri Dergisi     Open Access  
Geospatial Health     Open Access  
Gesundheitsökonomie & Qualitätsmanagement     Hybrid Journal   (Followers: 9)
Giornale Italiano di Health Technology Assessment     Full-text available via subscription  
Global Challenges     Open Access  
Global Health : Science and Practice     Open Access   (Followers: 6)
Global Health Promotion     Hybrid Journal   (Followers: 15)
Global Journal of Health Science     Open Access   (Followers: 10)
Global Journal of Public Health     Open Access   (Followers: 13)
Global Medical & Health Communication     Open Access   (Followers: 2)
Global Mental Health     Open Access   (Followers: 7)
Global Security : Health, Science and Policy     Open Access   (Followers: 1)
Globalization and Health     Open Access   (Followers: 5)
Hacia la Promoción de la Salud     Open Access  
Hastane Öncesi Dergisi     Open Access  
Hastings Center Report     Hybrid Journal   (Followers: 3)
HEADline     Hybrid Journal  
Health & Place     Hybrid Journal   (Followers: 15)
Health & Justice     Open Access   (Followers: 5)
Health : An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine     Hybrid Journal   (Followers: 7)
Health and Human Rights     Free   (Followers: 10)
Health and Social Care Chaplaincy     Hybrid Journal   (Followers: 9)
Health and Social Work     Hybrid Journal   (Followers: 56)
Health Behavior and Policy Review     Full-text available via subscription   (Followers: 3)
Health Care Analysis     Hybrid Journal   (Followers: 15)
Health Inform     Full-text available via subscription  
Health Information Management Journal     Hybrid Journal   (Followers: 19)
Health Issues     Full-text available via subscription   (Followers: 2)
Health Notions     Open Access  
Health Policy     Hybrid Journal   (Followers: 41)
Health Policy and Technology     Hybrid Journal   (Followers: 4)
Health Professional Student Journal     Open Access   (Followers: 2)
Health Promotion International     Hybrid Journal   (Followers: 22)
Health Promotion Journal of Australia : Official Journal of Australian Association of Health Promotion Professionals     Full-text available via subscription   (Followers: 8)
Health Promotion Practice     Hybrid Journal   (Followers: 16)
Health Prospect     Open Access   (Followers: 1)
Health Psychology     Full-text available via subscription   (Followers: 51)
Health Psychology Research     Open Access   (Followers: 19)
Health Psychology Review     Hybrid Journal   (Followers: 40)
Health Renaissance     Open Access  
Health Research Policy and Systems     Open Access   (Followers: 13)
Health SA Gesondheid     Open Access   (Followers: 2)
Health Science Reports     Open Access  
Health Sciences and Disease     Open Access   (Followers: 2)
Health Services Insights     Open Access   (Followers: 1)
Health Systems     Hybrid Journal   (Followers: 4)
Health Voices     Full-text available via subscription  
Health, Culture and Society     Open Access   (Followers: 12)
Health, Risk & Society     Hybrid Journal   (Followers: 13)
Healthcare     Open Access   (Followers: 3)
Healthcare in Low-resource Settings     Open Access   (Followers: 1)
Healthcare Quarterly     Full-text available via subscription   (Followers: 8)
Healthcare Technology Letters     Open Access  
HERD : Health Environments Research & Design Journal     Full-text available via subscription  
Highland Medical Research Journal     Full-text available via subscription  
Hispanic Health Care International     Full-text available via subscription  
HIV & AIDS Review     Full-text available via subscription   (Followers: 12)
Home Health Care Services Quarterly     Hybrid Journal   (Followers: 6)
Hong Kong Journal of Social Work, The     Hybrid Journal   (Followers: 2)
Hospitals & Health Networks     Free   (Followers: 4)
IEEE Journal of Translational Engineering in Health and Medicine     Open Access   (Followers: 3)
IMTU Medical Journal     Full-text available via subscription  
Indian Journal of Health Sciences     Open Access   (Followers: 2)
Indonesian Journal for Health Sciences     Open Access   (Followers: 1)
Indonesian Journal of Public Health     Open Access  
Infodir : Revista de Información científica para la Dirección en Salud     Open Access  
Inmanencia. Revista del Hospital Interzonal General de Agudos (HIGA) Eva Perón     Open Access  
Innovative Journal of Medical and Health Sciences     Open Access  
Institute for Security Studies Papers     Full-text available via subscription   (Followers: 2)
interactive Journal of Medical Research     Open Access  
International Archives of Health Sciences     Open Access  
International Health     Hybrid Journal   (Followers: 5)
International Journal for Equity in Health     Open Access   (Followers: 6)

        1 2 3 | Last

Journal Cover
Children
Number of Followers: 2  

  This is an Open Access Journal Open Access journal
ISSN (Online) 2227-9067
Published by MDPI Homepage  [203 journals]
  • Children, Vol. 5, Pages 44: Diagnosis, Evaluation and Treatment of
           Pulmonary Arterial Hypertension in Children

    • Authors: Benjamin Frank, D. Ivy
      First page: 44
      Abstract: Pulmonary Hypertension (PH), the syndrome of elevated pressure in the pulmonary arteries, is associated with significant morbidity and mortality for affected children. PH is associated with a wide variety of potential underlying causes, including cardiac, pulmonary, hematologic and rheumatologic abnormalities. Regardless of the cause, for many patients the natural history of PH involves progressive elevation in pulmonary arterial resistance and pressure, right ventricular dysfunction, and eventually heart failure. In recent years, a number of pulmonary arterial hypertension (PAH)-targeted therapies have become available to reduce pulmonary artery pressure and improve outcome. A growing body of evidence in both the adult and pediatric literature demonstrates enhanced quality of life, functional status, and survival among treated patients. This review provides a description of select etiologies of PH seen in pediatrics and an update on the most recent data pertaining to evaluation and management of children with PH/PAH. The available evidence for specific classes of PAH-targeted therapies in pediatrics is additionally discussed.
      Citation: Children
      PubDate: 2018-03-23
      DOI: 10.3390/children5040044
      Issue No: Vol. 5, No. 4 (2018)
       
  • Children, Vol. 5, Pages 45: From the Child’s Word to Clinical
           Intervention: Novel, New, and Innovative Approaches to Symptoms in
           Pediatric Palliative Care

    • Authors: Katharine Brock, Joanne Wolfe, Christina Ullrich
      First page: 45
      Abstract: Despite vast improvements in disease-based treatments, many children live with life-threatening disorders that cause distressing symptoms. These symptoms can be difficult to comprehensively assess and manage. Yet, frequent and accurate symptom reporting and expert treatment is critical to preserving a patient’s physical, psychological, emotional, social, and existential heath. We describe emerging methods of symptom and health-related quality-of-life (HRQOL) assessment through patient-reported outcomes (PROs) tools now used in clinical practice and novel research studies. Computer-based and mobile apps can facilitate assessment of symptoms and HRQOL. These technologies can be used alone or combined with therapeutic strategies to improve symptoms and coping skills. We review technological advancements, including mobile apps and toys, that allow improved symptom reporting and management. Lastly, we explore the value of a pediatric palliative care interdisciplinary team and their role in assessing and managing distressing symptoms and minimizing suffering in both the child and family. These methods and tools highlight the way that novel, new, and innovative approaches to symptom assessment and management are changing the way that pediatrics and pediatric palliative care will be practiced in the future.
      Citation: Children
      PubDate: 2018-03-28
      DOI: 10.3390/children5040045
      Issue No: Vol. 5, No. 4 (2018)
       
  • Children, Vol. 5, Pages 46: Risk Factors for Brachial Plexus Birth Injury

    • Authors: Emily Louden, Michael Marcotte, Charles Mehlman, William Lippert, Bin Huang, Andrea Paulson
      First page: 46
      Abstract: Over the course of decades, the incidence of brachial plexus birth injury (BPBI) has increased despite advances in healthcare which would seem to assist in decreasing the rate. The aim of this study is to identify previously unknown risk factors for BPBI and the risk factors with potential to guide preventative measures. A case control study of 52 mothers who had delivered a child with a BPBI injury and 132 mothers who had delivered without BPBI injury was conducted. Univariate, multivariable and logistic regressions identified risk factors and their combinations. The odds of BPBI were 2.5 times higher when oxytocin was used and 3.7 times higher when tachysystole occurred. The odds of BPBI injury are increased when tachysystole and oxytocin occur during the mother’s labor. Logistic regression identified a higher risk for BPBI when more than three of the following variables (>30 lbs gained during the pregnancy, stage 2 labor >61.5 min, mother’s age >26.4 years, tachysystole, or fetal malpresentation) were present in any combination.
      Citation: Children
      PubDate: 2018-03-29
      DOI: 10.3390/children5040046
      Issue No: Vol. 5, No. 4 (2018)
       
  • Children, Vol. 5, Pages 47: The Nuts and Bolts of Food Immunotherapy: The
           Future of Food Allergy

    • Authors: Sara Anvari, Katherine Anagnostou
      First page: 47
      Abstract: Food allergies are on the rise and have a major impact on the quality of life of the food allergic child and their family. Currently, the mainstream treatment for food allergies is strict avoidance and elimination of the allergenic food(s) from the patient’s diet in order to prevent an allergic reaction. However, recent advances in research have presented new therapeutic options for food allergic patients that are potentially becoming promising alternatives to traditional treatment. Food immunotherapy is the most popular of these new emerging interventions and has been studied intensively over the last decade for various foods. In this review, we discuss this exciting new development that is aspiring to become part of the mainstream therapy for food allergy.
      Citation: Children
      PubDate: 2018-04-04
      DOI: 10.3390/children5040047
      Issue No: Vol. 5, No. 4 (2018)
       
  • Children, Vol. 5, Pages 48: Reliability and Validity of the European Child
           Environment Questionnaire (ECEQ) in Children and Adolescents with Cerebral
           Palsy: Persian Version

    • Authors: Mahyar Salavati, Roshanak Vameghi, Seyed Hosseini, Ahmad Saeedi, Masoud Gharib
      First page: 48
      Abstract: The aim of this study was to assess the reliability and validity of the Persian version of the European Child Environment Questionnaire (ECEQ) in the Iranian context. In total, 332 parents (20.2% fathers and 79.8% mothers) of children and adolescents with cerebral palsy (CP) with an average age of 12.33 years (min 7.08 to max 18.08) from three provinces in Iran participated in the study. The original version of the questionnaire was translated and back-translated. Confirmatory construct validity was assessed by factor analysis and reliability was evaluated by Cronbach’s alpha (N = 332) and after two weeks’ test–retest reliability (n = 51) using an intraclass correlation coefficient (ICC). Eleven questions were dropped as they did not fit well into domains in the Persian version (p > 0.05). Cronbach’s alpha and intraclass correlation coefficient in all domains and overall were acceptable (higher than 0.70) and significant (p > 0.05). The Persian version of the ECEQ is suitable for assessing the needs and availability of environmental factors and is reliable and valid for children with CP, as reported by their parents.
      Citation: Children
      PubDate: 2018-04-09
      DOI: 10.3390/children5040048
      Issue No: Vol. 5, No. 4 (2018)
       
  • Children, Vol. 5, Pages 49: Ponseti Technique for the Management of
           Congenital Talipes Equinovarus in a Rural Set-Up in India: Experience of
           356 Patients

    • Authors: Rohit Malhotra, Ashutosh Mohapatra, Geetika Arora, Priyam Choudhury, Hitesh Joshi, Pranav Patel
      First page: 49
      Abstract: Congenital talipes equinovarus (CTEV), also known as clubfoot, is a complex congenital deformity of the foot that, left untreated, can limit a person’s mobility by making it difficult and painful to walk. Worldwide, 80% of children born with clubfoot are in low- and middle-income countries. The management of clubfoot has a long history. Non-operative management did not become popular, as an increasing number of orthopaedists started leaning towards surgical treatment. The late Dr. Ignacio Ponseti developed a method of clubfoot correction that successfully realigns clubfoot in infants without extensive and major surgery. The aim of the study was to assess the functional outcome of CTEV management by the Ponseti technique, to study the severity of CTEV deformity using the Pirani score, and to evaluate the cost-effectiveness of the technique. A total of 356 cases with 402 feet with CTEV were treated by the Ponseti method. The average age of the children and the number of casts applied before full correction were 4.03 months and 6.91, respectively. There was a good functional outcome in 95.45% of cases (score > 30) at the last follow up. The management of CTEV by the Ponseti technique provides a good functional and cosmetic outcome. In a developing country like India, this technique is a safe, easy, economical method of clubfoot management.
      Citation: Children
      PubDate: 2018-04-10
      DOI: 10.3390/children5040049
      Issue No: Vol. 5, No. 4 (2018)
       
  • Children, Vol. 5, Pages 50: Comparison of the Effect of Toothbrushing
           Education Via Video, Lecture and Pamphlet on the Dental Plaque Index of
           12-Year-Old Children

    • Authors: Javad Ramezaninia, Mohammad Mehdi Naghibi Sistani, Zohreh Ahangari, Hemmat Gholinia, Iman Jahanian, Samaneh Gharekhani
      First page: 50
      Abstract: The aim of this study was to compare the effect of different modes of toothbrushing education (lecture, video and pamphlet) on the dental plaque index (PI) of adolescents. The cluster randomized intervention was performed on 128 participants aged 12 years, who were allocated into four groups based on the type of intervention. Group 1: no intervention; and groups 2, 3, 4: education via lecture, video, and pamphlet, respectively (n = 32). Their plaque index was measured at the baseline, 24 h and two months later. Data were analyzed by repeated measures analysis of variance (ANOVA), one-way ANOVA, independent and paired t-test. The plaque indices of groups 2, 3, 4 at 24 h (p values < 0.001) and two months (p values < 0.001) showed a significant reduction when compared to the baseline. The lowest PI score was observed in the pamphlet, video and lecture groups at 24 h, respectively. After 2 months, the lowest score of PI was measured in lecture, video and pamphlet groups, respectively; however, these differences were non-significant. Therefore, toothbrushing education via lecture, video and pamphlet reduced the dental plaque index with the same effectiveness.
      Citation: Children
      PubDate: 2018-04-14
      DOI: 10.3390/children5040050
      Issue No: Vol. 5, No. 4 (2018)
       
  • Children, Vol. 5, Pages 32: Emerging Methodologies in Pediatric Palliative
           Care Research: Six Case Studies

    • Authors: Katherine Nelson, James Feinstein, Cynthia Gerhardt, Abby Rosenberg, Kimberley Widger, Jennifer Faerber, Chris Feudtner
      First page: 32
      Abstract: Given the broad focus of pediatric palliative care (PPC) on the physical, emotional, and spiritual needs of children with potentially life-limiting illnesses and their families, PPC research requires creative methodological approaches. This manuscript, written by experienced PPC researchers, describes issues encountered in our own areas of research and the novel methods we have identified to target them. Specifically, we discuss potential approaches to: assessing symptoms among nonverbal children, evaluating medical interventions, identifying and treating problems related to polypharmacy, addressing missing data in longitudinal studies, evaluating longer-term efficacy of PPC interventions, and monitoring for inequities in PPC service delivery.
      Citation: Children
      PubDate: 2018-02-26
      DOI: 10.3390/children5030032
      Issue No: Vol. 5, No. 3 (2018)
       
  • Children, Vol. 5, Pages 33: The Relationship Between Sleep and Cognition
           in Children Referred for Neuropsychological Evaluation: A Latent Modeling
           Approach

    • Authors: Adrian Svingos, Sarah Greif, Brittany Bailey, Shelley Heaton
      First page: 33
      Abstract: Children with conditions affecting cognitive processes experience high levels of sleep disturbance, which may further compound the cognitive ramifications of their disorders. Despite this, existing studies in this area have been primarily confined to only particular diagnostic groups and/or a limited scope of sleep and cognitive parameters. The current study characterized the nature of sleep problems and examined the relationship between a wide range of sleep-related problems and cognitive functioning in a large (N = 103) diagnostically heterogeneous sample of youth (aged 6–16) referred for neuropsychological assessment. Structural equation modeling was used to examine the relationship between sleep-related problems (i.e., daytime sleepiness, sleep onset latency, sleep fragmentation, sleep time variability, sleep debt) and cognitive performance (i.e., executive functioning, sustained attention, memory, processing speed). Sleep fragmentation emerged as the most prominent sleep-related problem in the present sample. Structural equation modeling demonstrated a negative association between sleep-related problems and cognition that did not reach statistical significance (β = −0.084, p = 0.629). The current statistical approach may be used as a conceptual framework for future work examining these multi-dimensional constructs in a parsimonious fashion.
      Citation: Children
      PubDate: 2018-02-28
      DOI: 10.3390/children5030033
      Issue No: Vol. 5, No. 3 (2018)
       
  • Children, Vol. 5, Pages 34: Impact of Supplemental Oxygen on Obstructive
           Sleep Apnea of Infants

    • Authors: Piyush Das, Rahul Kashyap, Suresh Kotagal
      First page: 34
      Abstract: Treatment options may be limited for infants with obstructive sleep apnea when there is no surgically correctable upper airway lesion. We therefore evaluated, retrospectively, the efficacy of low-flow oxygen as a therapeutic option for infant obstructive sleep apnea. We reviewed the medical charts of 23 infants who had undergone a therapeutic trial of low-flow oxygen during polysomnography. Split-night polysomnography was used in 21/23 subjects while 2/23 had undergone two separate, full-night polysomnography sleep architecture and respiratory findings on the baseline polysomnogram segment that was obtained in room air were compared with the segment on low-flow oxygen (0.25–1 L/min). Wilcoxon signed rank or McNemar’s test were used as indicated for comparing apnea hypopnea index and measures of sleep architecture at baseline and with oxygen therapy. The mean (±SD) age of subjects was 4.8 (±2.7) months, with 52% being males. The median apnea hypopnea index fell from a baseline of 18 (range 7–43) to 3 (range 1–19; p = 0.001) on oxygen. The baseline median obstructive/mixed apnea index decreased from 2 (range 1–16) to 1 during oxygen therapy (range 0–1; p = 0.003). Additionally, a significant decrease in central apnea index (median interquartile range (IQR) 1 (0–2) vs. 0 (0–1), p = 0.002) was noted. Sleep efficiency remained unaffected, while O2 saturation (SaO2) average and SaO2 nadir improved on oxygen. We were able to confirm the utility of low-flow oxygen in reducing central, obstructive, and mixed apneas and improving average oxygen saturation in infants with obstructive sleep apnea (OSA).
      Citation: Children
      PubDate: 2018-03-02
      DOI: 10.3390/children5030034
      Issue No: Vol. 5, No. 3 (2018)
       
  • Children, Vol. 5, Pages 35: An Integrated Theatre Production for School
           Nutrition Promotion Program

    • Authors: Robert Bush, Sandra Capra, Selina Box, David McCallum, Stephanie Khalil, Remo Ostini
      First page: 35
      Abstract: In the context of stubbornly high childhood obesity rates, health promotion activities in schools provide a potential avenue to improve children’s nutritional behaviours. Theatre production has a rich history as a health behaviour promotion strategy but lacks sound, outcome-based evaluation. This study evaluated the effect of an integrated, two-part, place-based theatre performance program with 212 students in five schools in a regional urban and semi-rural area. The program included a theatre performance and a healthy eating competition. A brief survey assessed student healthy eating knowledge and attitudes at three time points. Nutrition behaviour was measured by scoring the contents of children’s lunch boxes before, during and up to six weeks after the intervention. Statistical analysis tested change over time on five variables (Knowledge, Attitude, Sometimes foods, Everyday foods, Overall lunch box score). Results showed that both components of the integrated program improved nutrition knowledge and that the theatre performance improved children’s healthy eating attitudes. All three lunch box scores peaked after the integrated program and remained significantly higher than baseline at 4–6 weeks follow-up. Interaction effects were identified for school catchment area on four of the five dependent variables. Evaluation of this integrated theatre production program indicates the potential benefit of taking a “super-setting” approach. It demonstrates an effect from students taking home information they had learned and incorporating it into lunch box preparation. It also showed consistent effects for school geographical catchment. This study suggests that, with careful, theory-based design, theatre productions in schools can improve student nutritional activities.
      Citation: Children
      PubDate: 2018-03-02
      DOI: 10.3390/children5030035
      Issue No: Vol. 5, No. 3 (2018)
       
  • Children, Vol. 5, Pages 36: Trends in Pediatric Complicated Pneumonia in
           an Ontario Local Health Integration Network

    • Authors: Tahereh Haji, Adam Byrne, Tom Kovesi
      First page: 36
      Abstract: Following the introduction of 7-valent pneumococcal vaccine (PCV7), while overall rates of invasive pneumococcal disease and pneumococcal pneumonia in children declined, rates of empyema increased. We examined changes in the incidence of hospitalization for pediatric complicated pneumonia (PCOMP) in Eastern Ontario, Canada, particularly since the introduction of the 13-valent vaccine (PCV13). A retrospective chart review was carried out evaluating previously healthy children admitted with PCOMP, which included empyema, parapneumonic effusion, necrotizing pneumonia, and lung abscess between 2002 and 2015. Three-hundred seventy-one children were included. Subjects had a median age of four years, and 188/370 (50.8%) required a chest tube. Admission rates changed markedly during this time period. The number of admissions per year rose most sharply between 2009 and 2012, corresponding to the period following introduction of PCV7 and then the occurrence of pandemic influenza A (H1N1). In children who likely received PCV13, the incidence of PCOMP returned to approximately pre-PCV7 levels. In contrast, rates of PCOMP in older children (who would not have received PCV13) remained elevated during the post-PCV13 time period. While rates of PCOMP, particularly in older children, remain elevated following the introduction of PCV13, this might be expected to resolve with more widespread vaccine coverage with PCV13 and herd immunity.
      Citation: Children
      PubDate: 2018-03-03
      DOI: 10.3390/children5030036
      Issue No: Vol. 5, No. 3 (2018)
       
  • Children, Vol. 5, Pages 37: Interdisciplinary Pediatric Palliative Care
           Team Involvement in Compassionate Extubation at Home: From Shared
           Decision-Making to Bereavement

    • Authors: Andrea Postier, Kris Catrine, Stacy Remke
      First page: 37
      Abstract: Little is known about the role of pediatric palliative care (PPC) programs in providing support for home compassionate extubation (HCE) when families choose to spend their child’s end of life at home. Two cases are presented that highlight the ways in which the involvement of PPC teams can help to make the option available, help ensure continuity of family-centered care between hospital and home, and promote the availability of psychosocial support for the child and their entire family, health care team members, and community. Though several challenges to realizing the option of HCE exist, early consultation with a PPC team in the hospital, the development of strategic community partnerships, early referral to home based care resources, and timely discussion of family preferences may help to make this option a realistic one for more families. The cases presented here demonstrate how families’ wishes with respect to how and where their child dies can be offered, even in the face of challenges. By joining together when sustaining life support may not be in the child’s best interest, PPC teams can pull together hospital and community resources to empower families to make decisions about when and where their child dies.
      Citation: Children
      PubDate: 2018-03-07
      DOI: 10.3390/children5030037
      Issue No: Vol. 5, No. 3 (2018)
       
  • Children, Vol. 5, Pages 38: Accuracy of a Wrist-Worn Heart Rate Sensing
           Device during Elective Pediatric Surgical Procedures

    • Authors: Gloria Pelizzo, Anna Guddo, Aurora Puglisi, Annalisa De Silvestri, Calogero Comparato, Mario Valenza, Emanuele Bordonaro, Valeria Calcaterra
      First page: 38
      Abstract: The reliability of wearable photoplethysmography (PPG) sensors to measure heart rate (HR) in hospitalized patients has only been demonstrated in adults. We evaluated the accuracy of HR monitoring with a personal fitness tracker (PFT) in children undergoing surgery. HR monitoring was performed using a wrist-worn PFT (Fitbit Charge HR) in 30 children (8.21 ± 3.09 years) undergoing laparoscopy (n = 8) or open surgery (n = 22). HR values were analyzed preoperatively and during surgery. The accuracy of HR recordings was compared with measurements recorded during continuous electrocardiographic (cECG) monitoring; HRs derived from continuous monitoring with pulse oximetry (SpO2R) were used as a positive control. PFT-derived HR values were in agreement with those recorded during cECG (r = 0.99) and SpO2R (r = 0.99) monitoring. PFT performance remained high in children < 8 years (r = 0.99), with a weight < 30 kg (r = 0.99) and when the HR was < 70 beats per minute (bpm) (r = 0.91) or > 140 bpm (r = 0.99). PFT accuracy was similar during laparoscopy and open surgery, as well as preoperatively and during the intervention (r > 0.9). PFT–derived HR showed excellent accuracy compared with HRs measured by cECG and SpO2R during pediatric surgical procedures. Further clinical evaluation is needed to define whether PFTs can be used in different health care settings.
      Citation: Children
      PubDate: 2018-03-08
      DOI: 10.3390/children5030038
      Issue No: Vol. 5, No. 3 (2018)
       
  • Children, Vol. 5, Pages 39: Some Socioeconomic Factors and Lifestyle
           Habits Influencing the Prevalence of Obesity among Adolescent Male
           Students in the Hail Region of Saudi Arabia

    • Authors: Awfa Alazzeh, Eyad AlShammari, Majdi Smadi, Firas Azzeh, Bandar AlShammari, Suneetha Epuru, Shahidah Banu, Rafia Bano, Shadi Sulaiman, Jerold Alcantara, Syed Ashraf, Samir Qiblawi
      First page: 39
      Abstract: A cross-sectional study was conducted to investigate the effect of some socioeconomic factors and lifestyle habits on the prevalence of obesity among adolescent male students in the Hail region, Saudi Arabia. A questionnaire was filled by 1495 male adolescents distributed among 12 schools in the Hail region. Body weight and height were taken, and the Z-score of students was measured using Anthroplus software with a cutoff 1–2 and +2 standard deviations to determine overweight and obesity, respectively. The study revealed that 21.3% of students were overweight and 27% were obese, respectively. There was a negative association between family size of >8 and obesity (OR: 0.68, CI: 0.48–0.92, p = 0.05). Family income of <5000 SR was negatively associated with obesity (OR: 0.59, CI: 0.36–0.97, p = 0.03). Whether a subject’s mother worked (odds ratio (OR): 1.43, confidence interval CI: 1.03–1.99, p = 0.03) as well as the subject’s mother’s education—whether she can read and write, has a middle school degree, or has done postsecondary studies—were positively associated with obesity. Exercise, regardless of the duration, was negatively associated with obesity. In addition, sleeping <6 h/day had a positive association with obesity. Conclusion: a >8 family size and a low family income were negatively associated with obesity, while having an educated and working mother was positively associated with obesity.
      Citation: Children
      PubDate: 2018-03-09
      DOI: 10.3390/children5030039
      Issue No: Vol. 5, No. 3 (2018)
       
  • Children, Vol. 5, Pages 40: Communicating Effectively in Pediatric Cancer
           Care: Translating Evidence into Practice

    • Authors: Lindsay Blazin, Cherilyn Cecchini, Catherine Habashy, Erica Kaye, Justin Baker
      First page: 40
      Abstract: Effective communication is essential to the practice of pediatric oncology. Clear and empathic delivery of diagnostic and prognostic information positively impacts the ways in which patients and families cope. Honest, compassionate discussions regarding goals of care and hopes for patients approaching end of life can provide healing when other therapies have failed. Effective communication and the positive relationships it fosters also can provide comfort to families grieving the loss of a child. A robust body of evidence demonstrates the benefits of optimal communication for patients, families, and healthcare providers. This review aims to identify key communication skills that healthcare providers can employ throughout the illness journey to provide information, encourage shared decision-making, promote therapeutic alliance, and empathically address end-of-life concerns. By reviewing the relevant evidence and providing practical tips for skill development, we strive to help healthcare providers understand the value of effective communication and master these critical skills.
      Citation: Children
      PubDate: 2018-03-11
      DOI: 10.3390/children5030040
      Issue No: Vol. 5, No. 3 (2018)
       
  • Children, Vol. 5, Pages 41: Assessment of the Baby Friendly Hospital
           Initiative Implementation in the Eastern Mediterranean Region

    • Authors: Ayoub Al-Jawaldeh, Azza Abul-Fadl
      First page: 41
      Abstract: The Baby-Friendly Hospital Initiative (BFHI) is a global program for promoting support and protection for breastfeeding. However, its impact on malnutrition, especially in countries of the Eastern Mediterranean region (EMR) that are facing the turmoil of conflict and emergencies, deserves further investigation. Having said that, this paper aims to discuss the status and challenges to BFHI implementation in the EMR countries. Data on BFHI implementation, breastfeeding practices, and nutritional status were collected from countries through structured questionnaires, personal interviews, and databases. The 22 countries of the EMR were categorized as follows: 8 countries in advanced nutrition transition stage (group I), 5 countries in early nutrition transition stage (group II), 4 countries with significant undernutrition (group III), and 5 countries in complex emergency (group IV). The challenges to BFHI implementation were discussed in relation to malnutrition. BFHI was not implemented in 22.7% of EMR countries. Designated Baby-Friendly hospitals totaled 829 (group I: 78.4%, group II: 9.05%; group III: 7.36%; group: IV5.19%). Countries with advanced nutrition transition had the highest implementation of BFHI but the lowest breastfeeding continuity rates. On the other hand, poor nutritional status and emergency states were linked with low BFHI implementation and low exclusive breastfeeding rates but high continuity rates. Early initiation and longer duration of breastfeeding correlated negatively with overweight and obesity (p < 0.001). In countries with emergency states, breastfeeding continues to be the main source of nourishment. However, suboptimal breastfeeding practices prevail because of poor BFHI implementation which consequently leads to malnutrition. Political willpower and community-based initiatives are needed to promote breastfeeding and strengthen BFHI in the region.
      Citation: Children
      PubDate: 2018-03-11
      DOI: 10.3390/children5030041
      Issue No: Vol. 5, No. 3 (2018)
       
  • Children, Vol. 5, Pages 42: Serum Zinc Level in Asthmatic and
           Non-Asthmatic School Children

    • Authors: Atqah AbdulWahab, Aseel Zeidan, Tony Avades, Prem Chandra, Ashraf Soliman
      First page: 42
      Abstract: Asthma is one of the most common chronic disorders among children. Zinc (Zn) is an essential dietary antioxidant and may have a special role in assisting the airways of asthmatic subjects. The primary objective of this study was to measure serum Zn levels among asthmatic school children and to compare this to the serum Zn level in non-asthmatic children. The secondary objective was to investigate the relationship between Zn levels and the degree of asthma control. A cross-sectional study following forty asthmatic children and forty matched non-asthmatic children of both genders was conducted. Weight, height, body mass index (BMI), BMI Z-scores, serum Zn, hemoglobin, total protein, and albumin concentrations were measured in both groups. Serum immunoglobulin E (IgE) levels, the forced expiratory volume in 1 second (FEV1), and dosage of inhaled steroids were measured in asthmatic school children. The results show the mean Zn level among asthmatic children was 12.78 ± 1.8 μmol/L. Hypozincemia was detected in four asthmatic children. Asthma and control groups were matched in age, gender, and BMI Z score (p > 0.05). No significant difference was observed in Zn levels, hemoglobin, albumin, and total protein between both groups (p > 0.05). Among asthmatics, Zn levels were not significantly associated with the degree of asthma control (well controlled, mean Zn = 12.9 ± 1.5, partially controlled, mean Zn = 11.9 ± 1.6, and uncontrolled, mean Zn = 3.62 ± 2.2) (p = 0.053). The Zn level was not correlated with the FEV1 Z score. There was no significant association between Zn level and the dosage of inhaled steroids or IgE concentrations (p > 0.05). The findings show that Zn may not play a major role in the degree of asthma control. Larger studies are needed to confirm these results.
      Citation: Children
      PubDate: 2018-03-16
      DOI: 10.3390/children5030042
      Issue No: Vol. 5, No. 3 (2018)
       
  • Children, Vol. 5, Pages 43: Pediatric Melanoma and Drug Development

    • Authors: Klaus Rose, Jane Grant-Kels
      First page: 43
      Abstract: Importance—Pediatric melanoma occurs, albeit rarely. Should patients be treated by today’s medical standards, or be subjected to medically unnecessary clinical studies' Observations—We identified international, industry-sponsored pediatric melanoma studies triggered by regulatory demands in www.clinicaltrials.gov and further pediatric melanoma studies demanded by European Union pediatric investigation plans. We retrieved related regulatory documents from the internet. We analyzed these studies for rationale and medical beneficence on the basis of physiology, pediatric clinical pharmacology and rationale. Regulatory authorities define children by chronological age, not physiologically. Newborns’ organs are immature but they develop and mature rapidly. Separate proof of efficacy in underage patients is justified formally/regulatorily but lacks medical sense. Children—especially post-puberty—and adults vis-a-vis medications are physiologically very similar. Two adolescent melanoma studies were terminated in 2016 because of waning recruitment, while five studies in pediatric melanoma and other solid tumors, triggered by European Union pediatric investigation plans, continue recruiting worldwide. Conclusions and Relevance—Regulatory-demanded pediatric melanoma studies are medically superfluous. Melanoma patients of all ages should be treated with effective combination treatment. Babies need special attention. Children need dose-finding and pharmacokinetic studies but adolescents metabolize and respond to drugs similarly to adults. Institutional Review Boards/ethics committees should suspend ongoing questionable pediatric melanoma studies and reject newly submitted questionable studies.
      Citation: Children
      PubDate: 2018-03-20
      DOI: 10.3390/children5030043
      Issue No: Vol. 5, No. 3 (2018)
       
  • Children, Vol. 5, Pages 14: The Value of Food Allergy Prevention in
           Clinical Practice in Pediatrics: Targeting Early Life

    • Authors: Katherine Anagnostou, Jordan Orange
      First page: 14
      Abstract: Food allergies are common and increasing in prevalence, representing a major health concern in many countries around the world. In an effort to diminish the burden of food allergy, many research studies have focused on prevention, and recent findings have revolutionized the way we introduce allergenic foods in early life. We discuss the role of early allergenic food introduction and the value of food allergy prevention in this manuscript.
      Citation: Children
      PubDate: 2018-01-23
      DOI: 10.3390/children5020014
      Issue No: Vol. 5, No. 2 (2018)
       
  • Children, Vol. 5, Pages 15: Acknowledgement to Reviewers of Children in
           2017

    • Authors: Children Editorial Office
      First page: 15
      Abstract: Peer review is an essential part in the publication process, ensuring that Children maintains high quality standards for its published papers [...]
      Citation: Children
      PubDate: 2018-01-23
      DOI: 10.3390/children5020015
      Issue No: Vol. 5, No. 2 (2018)
       
  • Children, Vol. 5, Pages 16: A Review of Apps for Calming, Relaxation, and
           Mindfulness Interventions for Pediatric Palliative Care Patients

    • Authors: Taelyr Weekly, Nicole Walker, Jill Beck, Sean Akers, Meaghann Weaver
      First page: 16
      Abstract: Patients and families increasingly use mobile apps as a relaxation and distraction intervention for children with complex, chronic medical conditions in the waiting room setting or during inpatient hospitalizations; and yet, there is limited data on app quality assessment or review of these apps for level of engagement, functionality, aesthetics, or applicability for palliative pediatric patients. The pediatric palliative care study team searched smartphone application platforms for apps relevant to calming, relaxation, and mindfulness for pediatric and adolescent patients. Apps were reviewed using a systematic data extraction tool. Validated Mobile Application Rating Scale (MARS) scores were determined by two blinded reviewers. Apps were then characterized by infant, child, adolescent, and adult caregiver group categories. Reviewer discussion resulted in consensus. Sixteen of the 22 apps identified were included in the final analysis. The apps operated on either iOS or Android platforms. All were available in English with four available in Spanish. Apps featured a relaxation approach (12/16), soothing images (8/16), and breathing techniques (8/16). Mood and sleep patterns were the main symptoms targeted by apps. Provision of mobile apps resource summary has the potential to foster pediatric palliative care providers’ knowledge of app functionality and applicability as part of ongoing patient care.
      Citation: Children
      PubDate: 2018-01-26
      DOI: 10.3390/children5020016
      Issue No: Vol. 5, No. 2 (2018)
       
  • Children, Vol. 5, Pages 17: Utility of Non-Invasive Monitoring of Cardiac
           Output and Cerebral Oximetry during Pain Management of Children with
           Sickle Cell Disease in the Pediatric Emergency Department

    • Authors: Pradeep Padmanabhan, Chikelue Oragwu, Bibhuti Das, John Myers, Ashok Raj
      First page: 17
      Abstract: Pain crisis in children with sickle cell disease (SCD) is typically managed with intravenous fluids and parenteral opioids in the pediatric emergency department. Electrical cardiometry (EC) can be utilized to measure cardiac output (CO) and cardiac index (CI) non-invasively. Near-infrared spectroscopy (NIRS) measuring cerebral (rCO2) and splanchnic regional (rSO2) mixed venous oxygenation non-invasively has been utilized for monitoring children with SCD. We studied the value and correlation of NIRS and EC in monitoring hemodynamic status in children with SCD during pain crisis. We monitored EC and NIRS continuously for 2 h after presentation and during management. Forty-five children participated in the study. CO (D = 1.72), CI (D = 1.31), rSO2 (D = 11.6), and rCO2 (D = 9.3), all increased over time. CO max and CI max were achieved 1 h after starting resuscitation. rCO2 max attainment was quicker than rSO2, as monitored by NIRS. CI max correlated with rCO2 max (r = −0.350) and rSO2 max (r = −0.359). In adjustment models, initial CI significantly impacted initial rCO2 (p = 0.045) and rCO2 max (p = 0.043), while initial CO impacted rCO2 max (p = 0.030). Cardiac output monitoring and NIRS monitoring for cerebral and splanchnic oxygenation were feasible and improved the monitoring of therapeutic interventions for children with SCD during pain crisis.
      Citation: Children
      PubDate: 2018-01-29
      DOI: 10.3390/children5020017
      Issue No: Vol. 5, No. 2 (2018)
       
  • Children, Vol. 5, Pages 18: Current Government Actions and Potential
           Policy Options for Reducing Obesity in Queensland Schools

    • Authors: Naser Alsharairi
      First page: 18
      Abstract: School nutrition policies provide promising avenues towards the improvement of children’s eating habits and the prevention of obesity. Childhood obesity rates and related chronic diseases are increasing in Queensland, in part as a result of unhealthy eating habits and lack of physical activity. There is a very high investment by the Queensland government in maintaining healthy weight and promoting nutrition and physical activity among schoolchildren through delivering a range of initiatives across the state. However, there is a lack of evidence concerning the effectiveness of nutrition/physical education and parental involvement programs addressing obesity delivered in Queensland schools. This paper can be used to guide government and policy-makers regarding the most effective policy options that will promote healthy eating and physical activity among Queensland schoolchildren. The aim of this paper is to: (i) summarize current evidence on Queensland government responses to obesity; and (ii) discuss potential policy options that could support healthy eating and regular physical activity, and examine the evidence base for each option and suggest new areas for future research.
      Citation: Children
      PubDate: 2018-01-29
      DOI: 10.3390/children5020018
      Issue No: Vol. 5, No. 2 (2018)
       
  • Children, Vol. 5, Pages 19: Effects of Combining Medication and Pivotal
           Response Treatment on Aberrant Behavior in Children with Autism Spectrum
           Disorder

    • Authors: Mohammad Rezaei, AliReza Moradi, Mehdi Tehrani-Doost, HamidReza Hassanabadi, Reza Khosroabadi
      First page: 19
      Abstract: : The purpose of this study was to investigate the effects of combined risperidone (RIS) and pivotal response treatment (PRT) on children with autism spectrum disorder (ASD). A total of 34 children diagnosed with ASD according to the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-V) (mean age of 12.36 years) were randomly assigned to either of two groups; the first group (n = 17) received combined PRT–RIS while the second group (n = 17) received RIS only. Behavioral problems were evaluated with the Aberrant Behavior Checklist (ABC), whereas global improvement (GI) was measured with the Clinical Global Impressions (CGI). Assessment of ABC was performed before intervention, after intervention (12 weeks), and following 3 months of the intervention (follow-up). Total ABC scores were seen to decrease in both groups after 3 months, as compared with the scores prior to the interventions. Also, in both groups, mean scores of behavioral problems after the intervention were not significantly different from those prior to the intervention, in all subscales but the inappropriate speech (p < 0.001). However, both groups showed significant differences in mean scores of ABC subscales in both of the post-intervention evaluation stages. It was concluded that the combination of behavioral and drug interventions can further improve behavioral problems, ultimately improving patient’s communication and social skills.
      Citation: Children
      PubDate: 2018-01-30
      DOI: 10.3390/children5020019
      Issue No: Vol. 5, No. 2 (2018)
       
  • Children, Vol. 5, Pages 20: A Sleep Questionnaire for Children with Severe
           Psychomotor Impairment (SNAKE)—Concordance with a Global Rating of Sleep
           Quality

    • Authors: Larissa Dreier, Boris Zernikow, Markus Blankenburg, Julia Wager
      First page: 20
      Abstract: Sleep problems are a common and serious issue in children with life-limiting conditions (LLCs) and severe psychomotor impairment (SPMI). The “Sleep Questionnaire for Children with Severe Psychomotor Impairment” (Schlaffragebogen für Kinder mit Neurologischen und Anderen Komplexen Erkrankungen, SNAKE) was developed for this unique patient group. In a proxy rating, the SNAKE assesses five different dimensions of sleep(-associated) problems (disturbances going to sleep, disturbances remaining asleep, arousal and breathing disorders, daytime sleepiness, and daytime behavior disorders). It has been tested with respect to construct validity and some aspects of criterion validity. The present study examined whether the five SNAKE scales are consistent with parents’ or other caregivers’ global ratings of a child’s sleep quality. Data from a comprehensive dataset of children and adolescents with LLCs and SPMI were analyzed through correlation coefficients and Mann–Whitney U testing. The results confirmed the consistency of both sources of information. The highest levels of agreements with the global rating were achieved for disturbances in terms of going to sleep and disturbances with respect to remaining asleep. The results demonstrate that the scales and therefore the SNAKE itself is well-suited for gathering information on different sleep(-associated) problems in this vulnerable population.
      Citation: Children
      PubDate: 2018-02-01
      DOI: 10.3390/children5020020
      Issue No: Vol. 5, No. 2 (2018)
       
  • Children, Vol. 5, Pages 21: Pediatric Palliative Care in Infants and
           Neonates

    • Authors: Brian Carter
      First page: 21
      Abstract: The application of palliative and hospice care to newborns in the neonatal intensive care unit (NICU) has been evident for over 30 years. This article addresses the history, current considerations, and anticipated future needs for palliative and hospice care in the NICU, and is based on recent literature review. Neonatologists have long managed the entirety of many newborns’ short lives, given the relatively high mortality rates associated with prematurity and birth defects, but their ability or willingness to comprehensively address of the continuum of interdisciplinary palliative, end of life, and bereavement care has varied widely. While neonatology service capacity has grown worldwide during this time, so has attention to pediatric palliative care generally, and neonatal-perinatal palliative care specifically. Improvements have occurred in family-centered care, communication, pain assessment and management, and bereavement. There remains a need to integrate palliative care with intensive care rather than await its application solely at the terminal phase of a young infant’s life—when s/he is imminently dying. Future considerations for applying neonatal palliative care include its integration into fetal diagnostic management, the developing era of genomic medicine, and expanding research into palliative care models and practices in the NICU.
      Citation: Children
      PubDate: 2018-02-07
      DOI: 10.3390/children5020021
      Issue No: Vol. 5, No. 2 (2018)
       
  • Children, Vol. 5, Pages 22: A Case of Spontaneous Pneumomediastinum with
           Subcutaneous Emphysema in Children

    • Authors: Said Benlamkaddem, Mohamed Berdai, Smael Labib, Mustapha Harandou
      First page: 22
      Abstract: Spontaneous pneumomediastinum is defined as free air or gas contained within the mediastinum, which almost invariably originates from the alveolar space or the conducting airways. It is rare in pediatric patients; however, occasional cases are reported to result from forced Valsalva’s maneuver due to cough, emesis, a first attack of wheeze, or asthma exacerbations. We report the case of a 7-year-old previously healthy girl, with a history of persistent dry cough one day before, who was brought to our unit with face, neck and chest swelling. The chest X-ray and computed tomography (CT) scan showed subcutaneous emphysema with pneumomediastinum and pneumopericardium without evidence of the origin of this air leak. Laboratory tests and the bronchoscopy were normal. The patient was admitted in the pediatric critical care and received noninvasive monitoring, analgesia, oxygen, and omeprazole as a prophylaxis for a gastric ulcer. The patient improved, subcutaneous emphysema resolved, and she was discharged on the third day.
      Citation: Children
      PubDate: 2018-02-07
      DOI: 10.3390/children5020022
      Issue No: Vol. 5, No. 2 (2018)
       
  • Children, Vol. 5, Pages 23: Unintentional Childhood Injuries in Urban and
           Rural Ujjain, India: A Community-Based Survey

    • Authors: Aditya Mathur, Love Mehra, Vishal Diwan, Ashish Pathak
      First page: 23
      Abstract: Injuries are a major global public health problem. There are very few community-based studies on childhood injury from India. The objective of this cross-sectional, community-based survey was to identify the incidence, type, and risk factors of unintentional childhood injuries. The study was done in seven villages and ten contiguous urban slums in Ujjain, India. World Health Organization (WHO) tested tools and definitions were used for the survey, which included 2518 households having 6308 children up to 18 years of age, with 2907 children from urban households and 3401 from rural households. The annual incidence of all injuries was 16.6%, 95% Confidence Interval 15.7–17.5%, (n = 1049). The incidence was significantly higher among boys compared to girls (20.2% versus 12.7%, respectively), was highest in age group 6–10 years of age (18.9%), and in urban locations (17.5%). The most commonly identified injury types were: physical injuries (71%), burns (16%), poisonings (10%), agriculture-related injuries (2%), near drowning (2%), and suffocations (2%). The most common place of injury was streets followed by home. The study identified incidence of different types of unintentional childhood injuries and factors associated with increased risk of unintentional injuries. The results can help in designing injury prevention strategies and awareness programs in similar settings.
      Citation: Children
      PubDate: 2018-02-08
      DOI: 10.3390/children5020023
      Issue No: Vol. 5, No. 2 (2018)
       
  • Children, Vol. 5, Pages 24: Social Determinants of Perceived
           Discrimination among Black Youth: Intersection of Ethnicity and Gender

    • Authors: Shervin Assari, Cleopatra Howard Caldwell
      First page: 24
      Abstract: Most of the existing sociological and epidemiological literature has focused on the protective effects of high socioeconomic status (SES) on population health through reducing exposure to risk factors and increasing human and material resources that can mitigate adversities. Recent studies, however, have documented poor mental health of high SES Blacks, particularly African American males and Caribbean Black females. The literature also shows a link between perceived discrimination and poor mental health. To better understand the extra costs of upward social mobility for minority populations, this study explored ethnic by gender variations in the associations between SES indicators and perceived discrimination in an ethnically diverse national sample of Black youth. This study included 810 African American and 360 Caribbean Black youth who were sampled in the National Survey of American Life—Adolescent supplement (NSAL-A). Three SES indicators (financial hardship, family income, and income to needs ratio) were the independent variables. The dependent variable was perceived (daily) discrimination. Age was the covariate. Ethnicity and gender were the focal moderators. Linear regressions were used for data analysis in the pooled sample and also based on the intersection of ethnicity and gender. Considerable gender by ethnicity variations were found in the patterns of the associations between SES indicators and perceived discrimination. Financial hardship was a risk factor for perceived discrimination in African American males only. High family income and income to needs ratio were associated with high (but not low) perceived discrimination in African American males and Caribbean Black females. SES indicators were not associated with perceived discrimination for African American females or Caribbean Black males. When it comes to Black youth, high SES is not always protective. Whether SES reduces or increases perceived discrimination among Black youth depends on the intersection of ethnicity by gender. Additional research is needed to understand why and how high SES increases exposure and vulnerability to discrimination for some groups of Black youth.
      Citation: Children
      PubDate: 2018-02-15
      DOI: 10.3390/children5020024
      Issue No: Vol. 5, No. 2 (2018)
       
  • Children, Vol. 5, Pages 25: Autism Treatment Evaluation Checklist (ATEC)
           Norms: A “Growth Chart” for ATEC Score Changes as a Function of Age

    • Authors: Shreyas Mahapatra, David Vyshedsky, Samantha Martinez, Benjamin Kannel, Julia Braverman, Stephen Edelson, Andrey Vyshedskiy
      First page: 25
      Abstract: Most early-intervention Autism Spectrum Disorder (ASD) clinical trials are limited by the availability of psychometric technicians who assess each child’s abilities before and after therapeutic intervention. If parents could administer regular psychometric evaluations of their children, then the cost of clinical trials will be reduced, enabling longer clinical trials with the larger number of participants. The Autism Treatment Evaluation Checklist (ATEC) was designed nearly two decades ago to provide such a tool, but the norms on the longitudinal changes in ATEC in the “treatment as usual” population were lacking. Here we report the norms of the observational cohort who voluntarily completed ATEC evaluations over the period of four years from 2013 to 2017.
      Citation: Children
      PubDate: 2018-02-16
      DOI: 10.3390/children5020025
      Issue No: Vol. 5, No. 2 (2018)
       
  • Children, Vol. 5, Pages 26: Palliative Care for Children in Hospital:
           Essential Roles

    • Authors: Ross Drake
      First page: 26
      Abstract: Palliative care for children in pediatric hospitals is a vital part of the network of services supporting children with severe illness. This has been recognized, with a trend over the past decade for an increased number of pediatric palliative care (PPC) services established in pediatric hospitals. The inpatient team is in the unique position of influencing the early identification of children and their families, across the age and diagnostic spectrum, which could benefit from palliative care. These services have an opportunity to influence the integration of the palliative approach throughout the hospital, and in so doing, have the capacity to improve many aspects of care, including altering an increasingly futile and burdensome treatment trajectory, and ensuring improved symptom (physical and psychological) management.
      Citation: Children
      PubDate: 2018-02-19
      DOI: 10.3390/children5020026
      Issue No: Vol. 5, No. 2 (2018)
       
  • Children, Vol. 5, Pages 27: Paediatric Palliative Care in Resource-Poor
           Countries

    • Authors: Julia Downing, Sue Boucher, Alex Daniels, Busi Nkosi
      First page: 27
      Abstract: There is a great need for paediatric palliative care (PPC) services globally, but access to services is lacking in many parts of the world, particularly in resource-poor settings. Globally it is estimated that 21.6 million children need access to palliative care, with 8.2 needing specialist services. PC has been identified as important within the global health agenda e.g., within universal health coverage, and a recent Lancet commission report recognised the need for PPC. However, a variety of challenges have been identified to PPC development globally such as: access to treatment, access to medications such as oral morphine, opiophobia, a lack of trained health and social care professionals, a lack of PPC policies and a lack of awareness about PPC. These challenges can be overcome utilising a variety of strategies including advocacy and public awareness, education, access to medications, implementation and research. Examples will be discussed impacting on the provision of PPC in resource-poor settings. High-quality PPC service provision can be provided with resource-poor settings, and there is an urgent need to scale up affordable, accessible, and quality PPC services globally to ensure that all children needing palliative care can access it.
      Citation: Children
      PubDate: 2018-02-19
      DOI: 10.3390/children5020027
      Issue No: Vol. 5, No. 2 (2018)
       
  • Children, Vol. 5, Pages 28: Pediatric Palliative Care for Children with
           Progressive Non-Malignant Diseases

    • Authors: Harold Siden
      First page: 28
      Abstract: A substantial number of children cared for by pediatric palliative care physicians have progressive non-malignant conditions. Some elements of their care overlap with care for children with cancer while other elements, especially prognosis and trajectory, have nuanced differences. This article reviews the population, physical-emotional and social concerns, and trajectory.
      Citation: Children
      PubDate: 2018-02-20
      DOI: 10.3390/children5020028
      Issue No: Vol. 5, No. 2 (2018)
       
  • Children, Vol. 5, Pages 29: Distress Responses in a Routine Vaccination
           Context: Relationships to Early Childhood Mental Health

    • Authors: Nicole M. Racine, Hannah G. Gennis, Rebecca Pillai Riddell, Saul Greenberg, Hartley Garfield
      First page: 29
      Abstract: Social and emotional competencies, such as distress regulation, are established in early childhood and are critical for the development of children’s mental health and wellbeing. Routine vaccinations in primary care provide a unique opportunity to relate responses to a universal, relatively standardized, distress regulation paradigm (i.e., pain-related distress) to key developmental outcomes. The current study sought to examine distress regulation during routine vaccination in infancy and preschool as predictors of outcomes related to socioemotional competence in preschool. It was hypothesized that children with poorer distress regulation abilities post-vaccination would have lower socioemotional development. Furthermore, it was hypothesized that insensitive parenting would exacerbate this relationship for children with poor distress regulation abilities. As part of an ongoing longitudinal cohort, 172 parent–child dyads were videotaped during vaccinations in infancy and preschool, and subsequently participated in a full-day psychological assessment in a university lab. Videotapes were coded for child pre-needle distress (baseline distress), immediate post-needle pain-related distress reactivity (immediate distress reactivity), and pain-related distress regulation (distress regulation). Parent sensitivity during the preschool vaccination was also coded. Baseline distress prior to vaccination predicted greater externalizing problems and behavioral symptoms. Parent sensitivity did not moderate the association between any child distress behaviors and socioemotional development indicators. Child distress behaviors prior to injection, regardless of parent behavior, during the vaccination context may provide valuable information to health care professionals about child socioemotional functioning in the behavioral and emotional domains.
      Citation: Children
      PubDate: 2018-02-21
      DOI: 10.3390/children5020029
      Issue No: Vol. 5, No. 2 (2018)
       
  • Children, Vol. 5, Pages 30: The Sitting-Height Index of Build, (Body
           Mass)/(Sitting Height)3, as an Improvement on the Body Mass Index for
           Children, Adolescents and Young Adults

    • Authors: Richard Burton
      First page: 30
      Abstract: The body mass index (BMI) is unsatisfactory in being affected by both relative leg length and height, and, for use with children and adolescents, therefore needs to be interpreted in relation to age. The sitting-height index of build (body mass)/(sitting height)3, is largely free of these disadvantages. Furthermore, because that index is independent of relative leg length, the latter can be treated as a separate indicator of nutritional history and health risks. Past studies on white children and adults have shown body mass to be approximately proportional to (sitting height)3. Moreover, multiple regression of (body mass)1/3 on sitting height and leg length, using year-by-year averages, has indicated that leg length is an insignificant predictor of body mass. The present study used data for individuals, namely 2–20 years old males and females, black as well as white. Regression analysis as above again showed leg length to be an insignificant predictor of body mass, but only above the age of about nine years. However, sitting height is still a stronger predictor of body mass than leg length at all ages. The advantages of the sitting-height index of build for use with young people are confirmed.
      Citation: Children
      PubDate: 2018-02-22
      DOI: 10.3390/children5020030
      Issue No: Vol. 5, No. 2 (2018)
       
  • Children, Vol. 5, Pages 31: Children’s Environmental Health in the
           Digital Era: Understanding Early Screen Exposure as a Preventable Risk
           Factor for Obesity and Sleep Disorders

    • Authors: Candice Wolf, Seth Wolf, Miriam Weiss, Gustavo Nino
      First page: 31
      Abstract: The quantity, accessibility and focus on child-targeted programming has exponentially increased since it entered American households in the early 1900s. It may have started with the television (TV), but technology has evolved and now fits in our pockets; as of 2017, 95% of American families own a smartphone. Availability and child-tailored content has subsequently led to a decrease in the age at initial screen exposure. The negative effects that accompany the current culture of early screen exposure are extensive and need to be considered as technology continues to enter the home and inundate social interactions. Increased levels of early screen exposure have been associated with decreased cognitive abilities, decreased growth, addictive behavior, poor school performance, poor sleep patterns, and increased levels of obesity. Research on the adverse effects of early screen exposure is mounting, but further epidemiological studies are still needed to inform prevention and regulation policies.
      Citation: Children
      PubDate: 2018-02-23
      DOI: 10.3390/children5020031
      Issue No: Vol. 5, No. 2 (2018)
       
  • Children, Vol. 5, Pages 6: The Effect of Detectable HIV Viral Load among
           HIV-Infected Children during Antiretroviral Treatment: A Cross-Sectional
           Study

    • Authors: Visal Moolasart, Suthat Chottanapund, Jarurnsook Ausavapipit, Sirirat Likanonsakul, Sumonmal Uttayamakul, Don Changsom, Hatairat Lerdsamran, Pilaipan Puthavathana
      First page: 6
      Abstract: The RNA viral load of human immunodeficiency virus (HIV) is initially used to determine the status of the HIV infection. The goal of therapy following treatment failure is to achieve and maintain virologic suppression. A detectable viral load may relate to the progression of HIV infection. A cross-sectional survey was conducted from January 2013 to December 2014 at the Bamrasnaradura Infectious Diseases Institute, Thailand. The aim was to determine the prevalence of detectable HIV viral load (dVL) and analyze the factors associated with post-dVL conditions that occur independently of a switch to a new antiretroviral agent. The prevalence of dVL was 27% (27 of 101). The mean ages of dVL and non-dVL children were 12.0 and 12.3 years, respectively. Age, sex, body mass index for age z-scores, previous tuberculosis disease history and parental tuberculosis history of both groups were not significantly different (p > 0.05). The prevalence of poor adherence (<95%), influenza-like illness (ILI) and opportunistic infections were higher in dVL than non-dVL children (p < 0.05). The mean nadir CD4 cell count during the study was lower in dVL than non-dVL children (646 compared to 867, respectively; p < 0.05). Other factors were not significant (all p > 0.05). In multivariable analysis, dVL was significantly associated with ILI (odds ratio (OR) = 9.6, 95% confidence interval (CI) = 1.3–69.4), adherence (OR = 0.195, 95% CI = 0.047–0.811) and nadir CD4 during the study (OR = 1.102, 95% CI = 1.100–1.305). The prevalence of dVL was 27% with this dVL among HIV-infected children found to be associated with ILI, poor adherence and lower nadir CD4 during the study.
      Citation: Children
      PubDate: 2018-01-01
      DOI: 10.3390/children5010006
      Issue No: Vol. 5, No. 1 (2018)
       
  • Children, Vol. 5, Pages 7: Use of Pleuroperitoneal Shunt in Chylothorax
           Related to Central Line Associated Thrombosis in Sickle Cell Disease

    • Authors: Elizabeth Spiwak, Chad Wiesenauer, Arun Panigrahi, Ashok Raj
      First page: 7
      Abstract: Central vein thrombosis as a cause of chylothorax is uncommon, and in a few cases in the literature was related to thrombotic complications of central venous access devices (CVAD). Superior vena cava (SVC) occlusion-induced chylothorax has been described in adult sickle cell disease (SCD) in a setting of chronic indwelling CVAD. There are limited reports on chylothorax induced by central venous thrombosis secondary to chronic CVAD in children with SCD. We describe an 8-year-old male patient, with a history of SCD, maintained on long term erythrocytapheresis for primary prevention of stroke, and whose clinical course was complicated by chylothorax which was successfully treated with a pleuroperitoneal shunt.
      Citation: Children
      PubDate: 2018-01-02
      DOI: 10.3390/children5010007
      Issue No: Vol. 5, No. 1 (2018)
       
  • Children, Vol. 5, Pages 8: Factors Associated with Not Breastfeeding and
           Delaying the Early Initiation of Breastfeeding in Mecca Region, Saudi
           Arabia

    • Authors: Firas Azzeh, Awfa Alazzeh, Haifa Hijazi, Haneen Wazzan, Monya Jawharji, Abdelelah Jazar, Amira Filimban, Ali Alshamrani, Mai Labani, Taghreed Hasanain, Ahmad Obeidat
      First page: 8
      Abstract: The objective of the study was to find the determinants related to not breastfeeding (BF) and others related to the delay in the early initiation of BF in the Mecca region, Saudi Arabia. A cross-sectional study in the Maternity and Children Hospital and primary healthcare centers was performed. A questionnaire was filled by dietitians to 814 asymptomatic Saudi mothers. Determinants related to not BF and the delay in the early initiation of BF were determined by binary logistic regression, and the odds ratio (OR) and 95% confidence interval (CI) were determined. Significant factors associated with not BF were not rooming-in infants in the mother’s room (OR: 2.37; 95% CI: 1.66–3.41) and using a pacifier (OR: 1.62; 95% CI: 1.13–2.33). The most significant determinant of the early initiation of BF was the initiation of bottle feeding (OR: 18.16; 95% CI: 10.51–31.4), followed by not rooming-in infants in the mother’s room (OR: 2.2; 95% CI: 1.52–3.18), initiation of partial feeding (OR: 1.89; 95% CI: 1.3–2.74), uninformed mothers regarding the importance of BF (OR: 1.56; 95% CI: 1.04–2.35), and cesarean sections (OR:1.42; 95% CI: 1.02–1.98). Risk factors affecting BF and the early initiation of BF in Mecca City should be highlighted in national campaigns to increase mothers’ awareness and promote BF practice.
      Citation: Children
      PubDate: 2018-01-03
      DOI: 10.3390/children5010008
      Issue No: Vol. 5, No. 1 (2018)
       
  • Children, Vol. 5, Pages 9: A Retrospective Review of Resuscitation
           Planning at a Children’s Hospital

    • Authors: Jean Kelly, Jo Ritchie, Leigh Donovan, Carol Graham, Anthony Herbert
      First page: 9
      Abstract: Resuscitation plans (RP) are an important clinical indicator relating to care at the end of life in paediatrics. A retrospective review of the medical records of children who had been referred to the Royal Children’s Hospital, Brisbane, Australia who died in the calendar year 2011 was performed. Of 62 records available, 40 patients (65%) had a life limiting condition and 43 medical records (69%) contained a documented RP. This study demonstrated that both the underlying condition (life-limiting or life-threatening) and the setting of care (Pediatric Intensive Care Unit or home) influenced the development of resuscitation plans. Patients referred to the paediatric palliative care (PPC) service had a significantly longer time interval from documentation of a resuscitation plan to death and were more likely to die at home. All of the patients who died in the paediatric intensive care unit (PICU) had a RP that was documented within the last 48 h of life. Most RPs were not easy to locate. Documentation of discussions related to resuscitation planning should accommodate patient and family centered care based on individual needs. With varied diagnoses and settings of care, it is important that there is inter-professional collaboration, particularly involving PICU and PPC services, in developing protocols of how to manage this difficult but inevitable clinical scenario.
      Citation: Children
      PubDate: 2018-01-04
      DOI: 10.3390/children5010009
      Issue No: Vol. 5, No. 1 (2018)
       
  • Children, Vol. 5, Pages 10: Esophageal Web in a Down Syndrome
           Infant—A Rare Case Report

    • Authors: Nirmala Thomas, Roy Mukkada, Muhammed Abdul Jalal, Nisha Narayanankutty
      First page: 10
      Abstract: We describe the rare case of an infant with trisomy 21 who presented with recurrent vomiting and aspiration pneumonia and a failure to thrive. Infants with Down’s syndrome have been known to have various problems in the gastrointestinal tract. In the esophagus, what have been described are dysmotility, gastroesophageal reflux and strictures. This infant on evaluation was found to have an esophageal web and simple endoscopic dilatation relieved the infant of her symptoms. No similar case has been reported in literature.
      Citation: Children
      PubDate: 2018-01-11
      DOI: 10.3390/children5010010
      Issue No: Vol. 5, No. 1 (2018)
       
  • Children, Vol. 5, Pages 11: Current Evidence on Vitamin D Deficiency and
           Metabolic Syndrome in Obese Children: What Does the Evidence from Saudi
           Arabia Tell Us'

    • Authors: Asma Alaklabi, Naser Alsharairi
      First page: 11
      Abstract: Obesity and vitamin D deficiency represent major health problems among Saudi children, and have been linked to chronic diseases. Obese children are at risk of developing vitamin D deficiency, which appears to have negative influences on energy homeostasis, impeded bone mineralisation, insulin resistance and inflammation. Evidence supporting the association between vitamin D deficiency of obese children and metabolic syndrome has not specifically been studied in early childhood. The mechanisms through which vitamin D deficiency is associated with metabolic syndrome in obese children needs further elucidation. This commentary aims to (i) summarise current knowledge of the association between vitamin D deficiency and metabolic syndrome in obese children; and (ii) discuss current evidence for the association among Saudi Arabian children.
      Citation: Children
      PubDate: 2018-01-15
      DOI: 10.3390/children5010011
      Issue No: Vol. 5, No. 1 (2018)
       
  • Children, Vol. 5, Pages 12: A Child’s Concept of Pain: An International
           Survey of Pediatric Pain Experts

    • Authors: Joshua Pate, Julia Hush, Mark Hancock, G. Moseley, David Butler, Laura Simons, Verity Pacey
      First page: 12
      Abstract: A child’s ‘concept of pain’ refers to how they understand what pain actually is, what function pain serves, and what biological processes are thought to underpin it. We aimed to determine pediatric pain experts’ opinions of: (1) the importance and usefulness of assessing a child’s concept of pain in clinical and/or research settings; (2) the usefulness of the content of items within currently published adult-targeted resources for assessing a child’s concept of pain; and (3) important domains of a child’s concept of pain to assess. Forty-nine pediatric pain experts (response rate = 75.4%) completed an online survey. Descriptive statistics and frequency of responses were analyzed. Experts from all included disciplines reported that assessing a child’s concept of pain is important and useful both clinically and in a research setting (>80% reported very or extremely useful for each item). Experts considered that the content of 13 items from currently published adult-targeted resources was useful, but the wording was too complex for children aged 8–12 years. Experts considered that all seven of the proposed domains of a child’s concept of pain was important to assess. The findings can be used to inform the development of an assessment tool for a child’s concept of pain.
      Citation: Children
      PubDate: 2018-01-15
      DOI: 10.3390/children5010012
      Issue No: Vol. 5, No. 1 (2018)
       
  • Children, Vol. 5, Pages 13: ‘Total Pain’ in Children with
           Severe Neurological Impairment

    • Authors: Timothy Warlow, Richard Hain
      First page: 13
      Abstract: Many children with palliative care needs experience difficulty in managing pain. Perhaps none more so than those with severe neurological impairment. For many years; behaviours in these children were misunderstood. As a result; pain was poorly recognised and inadequately managed. Significant advances have been made in the assessment and management of pain in this challenging group of patients. We summarise these advances; drawing on our own experience working with infants; children and young adults with palliative care needs within a UK tertiary paediatric palliative care service. We expand on the recent understanding of ‘Total Pain’; applying a holistic approach to pain assessment and management in children with severe neurological impairment.
      Citation: Children
      PubDate: 2018-01-18
      DOI: 10.3390/children5010013
      Issue No: Vol. 5, No. 1 (2018)
       
  • Children, Vol. 5, Pages 1: Feeding Intolerance in Children with Severe
           Impairment of the Central Nervous System: Strategies for Treatment and
           Prevention

    • Authors: Julie Hauer
      First page: 1
      Abstract: Children with severe impairment of the central nervous system (CNS) experience gastrointestinal (GI) symptoms at a high rate and severity, including retching, vomiting, GI tract pain, and feeding intolerance. Commonly recognized sources of symptoms include constipation and gastroesophageal reflux disease. There is growing awareness of sources due to the impaired nervous system, including visceral hyperalgesia due to sensitization of sensory neurons in the enteric nervous system and central neuropathic pain due to alterations in the thalamus. Challenging the management of these symptoms is the lack of tests to confirm alterations in the nervous system as a cause of symptom generation, requiring empirical trials directed at such sources. It is also common to have multiple reasons for the observed symptoms, further challenging management. Recurrent emesis and GI tract pain can often be improved, though in some not completely eliminated. In some, this can progress to intractable feeding intolerance. This comprehensive review provides an evidence-based approach to care, a framework for recurrent symptoms, and language strategies when symptoms remain intractable to available interventions. This summary is intended to balance optimal management with a sensitive palliative care approach to persistent GI symptoms in children with severe impairment of the CNS.
      Citation: Children
      PubDate: 2017-12-22
      DOI: 10.3390/children5010001
      Issue No: Vol. 5, No. 1 (2017)
       
  • Children, Vol. 5, Pages 2: Enhancing Pediatric Palliative Care for Latino
           Children and Their Families: A Review of the Literature and
           Recommendations for Research and Practice in the United States

    • Authors: Sara Muñoz-Blanco, Jessica Raisanen, Pamela Donohue, Renee Boss
      First page: 2
      Abstract: As the demand for pediatric palliative care (PC) increases, data suggest that Latino children are less likely to receive services than non-Latino children. Evidence on how to best provide PC to Latino children is sparse. We conducted a narrative review of literature related to PC for Latino children and their families in the United States. In the United States, Latinos face multiple barriers that affect their receipt of PC, including poverty, lack of access to health insurance, language barriers, discrimination, and cultural differences. Pediatric PC research and clinical initiatives that target the needs of Latino families are sparse, underfunded, but essential. Education of providers on Latino cultural values is necessary. Additionally, advocacy efforts with a focus on equitable care and policy reform are essential to improving the health of this vulnerable population.
      Citation: Children
      PubDate: 2017-12-22
      DOI: 10.3390/children5010002
      Issue No: Vol. 5, No. 1 (2017)
       
  • Children, Vol. 5, Pages 3: Devices for Ambulatory Monitoring of
           Sleep-Associated Disorders in Children with Neurological Diseases

    • Authors: Adriana Ulate-Campos, Melissa Tsuboyama, Tobias Loddenkemper
      First page: 3
      Abstract: Good sleep quality is essential for a child’s wellbeing. Early sleep problems have been linked to the later development of emotional and behavioral disorders and can negatively impact the quality of life of the child and his or her family. Sleep-associated conditions are frequent in the pediatric population, and even more so in children with neurological problems. Monitoring devices can help to better characterize sleep efficiency and sleep quality. They can also be helpful to better characterize paroxysmal nocturnal events and differentiate between nocturnal seizures, parasomnias, and obstructive sleep apnea, each of which has a different management. Overnight ambulatory detection devices allow for a tolerable, low cost, objective assessment of sleep quality in the patient’s natural environment. They can also be used as a notification system to allow for rapid recognition and prompt intervention of events like seizures. Optimal monitoring devices will be patient- and diagnosis-specific, but may include a combination of modalities such as ambulatory electroencephalograms, actigraphy, and pulse oximetry. We will summarize the current literature on ambulatory sleep devices for detecting sleep disorders in children with neurological diseases.
      Citation: Children
      PubDate: 2017-12-25
      DOI: 10.3390/children5010003
      Issue No: Vol. 5, No. 1 (2017)
       
  • Children, Vol. 5, Pages 4: Pediatric Hypothermic Submersion Injury and
           Protective Factors Associated with Optimal Outcome: A Case Report and
           Literature Review

    • Authors: Daniel Kriz, Juan Piantino, Devin Fields, Cydni Williams
      First page: 4
      Abstract: Drowning is the 3rd leading cause of unintentional injury death worldwide, with the highest rates of fatality among young children. Submersion injuries with cardiac arrest can lead to long-term neurologic morbidity. Severe hypothermic submersion injuries have complex treatment courses and survivors have variable neurocognitive outcomes. We describe the course of a hypothermic submersion injury in a 6-year-old previously healthy boy. The description includes premorbid and post-injury neurocognitive functioning. A review of the literature of pediatric cold-water submersion injury was performed. Despite prolonged cardiopulmonary resuscitation (>100 min) and water temperature well above freezing, our patient had an optimal neurocognitive outcome following hypothermic submersion injury. Available literature is limited but suggests that increased submersion time, increased duration of resuscitation, and higher water temperatures are associated with worse outcomes. Care guidelines have been created, but outcomes related to these guidelines have not been studied. Our case highlights potential important determinants of outcome after drowning. Incident specific characteristics and therapeutic interventions should be considered when evaluating this population. Treatment guidelines based on currently available literature may fail to incorporate all potential variables, and consideration should be given to prolonged resuscitative efforts based on individual case characteristics until further data is available.
      Citation: Children
      PubDate: 2017-12-27
      DOI: 10.3390/children5010004
      Issue No: Vol. 5, No. 1 (2017)
       
  • Children, Vol. 5, Pages 5: Role of RDW in Prediction of Burn after Caustic
           Substance Ingestion

    • Authors: Emrah Aydin, Omer Beser, Soner Sazak, Ensar Duras
      First page: 5
      Abstract: A quantifiable, quick, inexpensive and reproducible predictor is needed to decide if caustic substance ingestion results in burn regardless of the symptoms. A multicenter cohort study was conducted to investigate the predictive value of red cell distribution width (RDW) in detecting the esophageal burns. The data of 174 patients were retrospectively analyzed. Eleven patients were excluded due to inability to define the substance ingested. Complete blood count (CBC) was taken at admission, and an esophagogastroduodenoscopy was performed within the first 12–24 h in all patients, regardless of their symptoms. The age and gender of the patients, the types of substances ingested, the parameters in the CBC and the severity of the esophageal injury were correlated. Esophageal burns were diagnosed in 38 of 163 patients (23.3%). The risk of esophageal burn with RDW values below 12.20 was significantly lower. Multivariate analysis showed that RDW was the most significant predictor of esophageal burn (p = 0.000, odds ratio (OR) 7.74 (95% confidence interval (CI), 3.02–19.9)). Receiver operating characteristic (ROC) curve analysis demonstrated 84.2% sensitivity at a cut-off value of 12.20 for RDW. The results showed that CBC parameters could avoid unnecessary esophagogastroduodenoscopy. The RDW values regardless of the symptomatology is a good predictor of esophageal burns, and an RDW value over 12.20 shows the increased risk of esophageal burn.
      Citation: Children
      PubDate: 2017-12-29
      DOI: 10.3390/children5010005
      Issue No: Vol. 5, No. 1 (2017)
       
  • Children, Vol. 4, Pages 75: Diagnostic Approach to Pulmonary Hypertension
           in Premature Neonates

    • Authors: Vasantha Kumar
      First page: 75
      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, 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.
      Citation: Children
      PubDate: 2017-08-24
      DOI: 10.3390/children4090075
      Issue No: Vol. 4, No. 9 (2017)
       
  • Children, Vol. 4, Pages 76: Mind-Body Medicine in Pediatrics

    • Authors: Hilary McClafferty
      First page: 76
      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 clinical guidance, with the dual goals of piquing curiosity and providing resources for clinicians interested in pursuing further training
      Citation: Children
      PubDate: 2017-08-25
      DOI: 10.3390/children4090076
      Issue No: Vol. 4, No. 9 (2017)
       
  • Children, Vol. 4, Pages 77: Sleep Disorders in a Sample of Adopted
           Children: A Pilot Study

    • Authors: Meghna Rajaprakash, Elizabeth Kerr, Benita Friedlander, Shelly Weiss
      First page: 77
      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 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.
      Citation: Children
      PubDate: 2017-08-29
      DOI: 10.3390/children4090077
      Issue No: Vol. 4, No. 9 (2017)
       
  • Children, Vol. 4, Pages 78: Experiences of Parent Peer Nutrition Educators
           Sharing Child Feeding and Nutrition Information

    • Authors: Richard Ball, Kerith Duncanson, Tracy Burrows, Clare Collins
      First page: 78
      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 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.
      Citation: Children
      PubDate: 2017-08-29
      DOI: 10.3390/children4090078
      Issue No: Vol. 4, No. 9 (2017)
       
  • Children, Vol. 4, Pages 79: Assessment of Initial Vancomycin Dosing in
           Pediatric Oncology Patients

    • Authors: Hillary Orr, Deni Trone, Joshua Elder, Ashok Raj
      First page: 79
      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 mcg/mL despite the addition of nephrotoxic agents.
      Citation: Children
      PubDate: 2017-08-28
      DOI: 10.3390/children4090079
      Issue No: Vol. 4, No. 9 (2017)
       
  • Children, Vol. 4, Pages 80: Vitamin D Deficiency: A Potential Modifiable
           Risk Factor for Cardiovascular Disease in Children with Severe Obesity

    • Authors: Anoop Iqbal, Amanda Dahl, Aida Lteif, Seema Kumar
      First page: 80
      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 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.
      Citation: Children
      PubDate: 2017-08-28
      DOI: 10.3390/children4090080
      Issue No: Vol. 4, No. 9 (2017)
       
  • Children, Vol. 4, Pages 81: Fever in Children: Pearls and Pitfalls

    • Authors: Egidio Barbi, Pierluigi Marzuillo, Elena Neri, Samuele Naviglio, Baruch Krauss
      First page: 81
      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 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.
      Citation: Children
      PubDate: 2017-09-01
      DOI: 10.3390/children4090081
      Issue No: Vol. 4, No. 9 (2017)
       
  • Children, Vol. 4, Pages 82: Sleep Disorders in Childhood Neurogenetic
           Disorders

    • Authors: Laura Dosier, Bradley Vaughn, Zheng Fan
      First page: 82
      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 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.
      Citation: Children
      PubDate: 2017-09-12
      DOI: 10.3390/children4090082
      Issue No: Vol. 4, No. 9 (2017)
       
  • Children, Vol. 4, Pages 83: If You Build It, They Will Come: Initial
           Experience with a Multi-Disciplinary Pediatric Neurocritical Care
           Follow-Up Clinic

    • Authors: Cydni Williams, Aileen Kirby, Juan Piantino
      First page: 83
      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 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.
      Citation: Children
      PubDate: 2017-09-19
      DOI: 10.3390/children4090083
      Issue No: Vol. 4, No. 9 (2017)
       
  • Children, Vol. 4, Pages 64: Middle Cerebral Artery Stroke as Amusement
           Park Injury: Case Report and Review of the Literature

    • Authors: Abby Baumgartle, Laura Wolfe, Vinay Puri, Karen Moeller, Salvatore Bertolone, Ashok Raj
      First page: 64
      Abstract: Strokes as amusement park injuries are rare, but have been reported in the literature. Only about 20 cases of cerebrovascular accidents after amusement park visits have been described. We report a healthy 12-year-old boy who presented with facial droop, slurred speech, and inability to use his right arm after riding roller coasters at a local amusement park. He was evaluated and found to have a left middle cerebral artery (MCA) infarction. The patient was treated with anticoagulants and has recovered with no major residual symptoms. It is likely that his neurological symptoms occurred due to the high head accelerations experienced on the roller coasters, which are more detrimental to children due to immature cervical spine development and muscle strength. Early diagnosis of dissection and stroke results in a favorable prognosis. Providers and parents should be aware of the potential risk of roller coasters and act quickly on neurologic changes in children that have recently been to an amusement park.
      Citation: Children
      PubDate: 2017-07-31
      DOI: 10.3390/children4080064
      Issue No: Vol. 4, No. 8 (2017)
       
  • Children, Vol. 4, Pages 65: Trending Longitudinal Agreement between Parent
           and Child Perceptions of Quality of Life for Pediatric Palliative Care
           Patients

    • Authors: Meaghann Weaver, Cheryl Darnall, Sue Bace, Catherine Vail, Andrew MacFadyen, Christopher Wichman
      First page: 65
      Abstract: Pediatric palliative care studies often rely on proxy-reported instead of direct child-reported quality of life metrics. The purpose of this study was to longitudinally evaluate quality of life for pediatric patients receiving palliative care consultations and to compare patient-reported quality of life with parent perception of the child’s quality of life across wellness domains. The 23-item PedsQL™ V4.0 Measurement Model was utilized for ten child and parent dyads at time of initial palliative care consultation, Month 6, and Month 12 to assess for physical, emotional, social, and cognitive dimensions of quality of life as reported independently by the child and by the parent for the child. Findings were analyzed using Bland–Altman plots to compare observed differences to limits of agreement. This study revealed overall consistency between parent- and child-reported quality of life across domains. Physical health was noted to be in closest agreement. At the time of initial palliative care consult, children collectively scored their social quality of life higher than parental perception of the child’s social quality of life; whereas, emotional and cognitive quality of life domains were scored lower by children than by the parental report. At the one year survey time point, the physical, emotional, and social domains trended toward more positive patient perception than proxy perception with congruence between quality of life scores for the cognitive domain. Findings reveal the importance of eliciting a child report in addition to a parent report when measuring and longitudinally trending perceptions on quality of life.
      Citation: Children
      PubDate: 2017-08-01
      DOI: 10.3390/children4080065
      Issue No: Vol. 4, No. 8 (2017)
       
  • Children, Vol. 4, Pages 66: Gut–Liver Axis Derangement in
           Non-Alcoholic Fatty Liver Disease

    • Authors: Marco Poeta, Luca Pierri, Pietro Vajro
      First page: 66
      Abstract: Non-alcoholic fatty liver disease (NAFLD) is the most frequent type of chronic liver disease in the pediatric age group, paralleling an obesity pandemic. A “multiple-hit” hypothesis has been invoked to explain its pathogenesis. The “first hit” is liver lipid accumulation in obese children with insulin resistance. In the absence of significant lifestyle modifications leading to weight loss and increased physical activity, other factors may act as “second hits” implicated in liver damage progression leading to more severe forms of inflammation and hepatic fibrosis. In this regard, the gut–liver axis (GLA) seems to play a central role. Principal players are the gut microbiota, its bacterial products, and the intestinal barrier. A derangement of GLA (namely, dysbiosis and altered intestinal permeability) may promote bacteria/bacterial product translocation into portal circulation, activation of inflammation via toll-like receptors signaling in hepatocytes, and progression from simple steatosis to non-alcoholic steato-hepatitis (NASH). Among other factors a relevant role has been attributed to the farnesoid X receptor, a nuclear transcriptional factor activated from bile acids chemically modified by gut microbiota (GM) enzymes. The individuation and elucidation of GLA derangement in NAFLD pathomechanisms is of interest at all ages and especially in pediatrics to identify new therapeutic approaches in patients recalcitrant to lifestyle changes. Specific targeting of gut microbiota via pre-/probiotic supplementation, feces transplantation, and farnesoid X receptor modulation appear promising.
      Citation: Children
      PubDate: 2017-08-02
      DOI: 10.3390/children4080066
      Issue No: Vol. 4, No. 8 (2017)
       
  • Children, Vol. 4, Pages 67: The Fetus Can Teach Us: Oxygen and the
           Pulmonary Vasculature

    • Authors: Payam Vali, Satyan Lakshminrusimha
      First page: 67
      Abstract: Neonates suffering from pulmonary hypertension of the newborn (PPHN) continue to represent an important proportion of patients requiring intensive neonatal care, and have an increased risk of morbidity and mortality. The human fetus has evolved to maintain a high pulmonary vascular resistance (PVR) in utero to allow the majority of the fetal circulation to bypass the lungs, which do not participate in gas exchange, towards the low resistance placenta. At birth, oxygen plays a major role in decreasing PVR to enhance pulmonary blood flow and establish the lungs as the organ of gas exchange. The failure of PVR to fall following birth results in PPHN, and oxygen remains the mainstay therapeutic intervention in the management of PPHN. Knowledge gaps on what constitutes the optimal oxygenation target leads to a wide variation in practices, and often leads to excessive oxygen use. Owing to the risk of oxygen toxicity, avoiding hyperoxemia is as important as avoiding hypoxemia in the management of PPHN. Current evidence supports maintaining arterial oxygen tension in the range of 50–80 mm Hg, and oxygen saturation between 90–97% in term infants with hypoxemic respiratory failure. Clinical studies evaluating the optimal oxygenation in the treatment of PPHN will be enthusiastically awaited.
      Citation: Children
      PubDate: 2017-08-03
      DOI: 10.3390/children4080067
      Issue No: Vol. 4, No. 8 (2017)
       
  • Children, Vol. 4, Pages 68: Key Challenges in the Search for Innovative
           Drug Treatments for Special Populations. Converging Needs in Neonatology,
           Pediatrics, and Medical Genetics

    • Authors: Stuart MacLeod
      First page: 68
      Abstract: The explosion of knowledge concerning the interplay of genetic and environmental factors determining pathophysiology and guiding therapeutic choice has altered the landscape in pediatric clinical pharmacology and pharmacy. The need for innovative research methods and design expertise for small clinical trials to be undertaken in sparse populations has been accentuated. At the same time, shortfalls in critical human resources represent a key challenge, especially in low- and middle-income countries where the need for new research and education directions is greatest. Unless a specific action plan is urgently developed, there will be a continuing gap in availability of the essential expertise needed to address treatment challenges in special patient populations such as neonates, patients suffering from rare or neglected diseases, and children of all ages.
      Citation: Children
      PubDate: 2017-08-04
      DOI: 10.3390/children4080068
      Issue No: Vol. 4, No. 8 (2017)
       
  • Children, Vol. 4, Pages 69: Trends in Food and Beverage Portion Sizes in
           Australian Children; a Time-Series Analysis Comparing 2007 and 2011–2012
           National Data

    • Authors: Daphne van der Bend, Tamara Bucher, Tracy Schumacher, Kate Collins, Nienke De Vlieger, Megan Rollo, Tracy Burrows, Jane Watson, Clare Collins
      First page: 69
      Abstract: In 2011–2012 approximately 26% of Australian children aged between 5–17 years were reported to be overweight or obese. Furthermore, the increase in prevalence of overweight and obesity among US children parallels reported increases in energy intake and portion sizes of common foods, leading to the recognition that availability of larger portion sizes contributes to the rise in overweight and obesity prevalence. Thus, the aim of this time-series analysis was to investigate whether selected food portion sizes in Australian children aged 2–16 years changed between 2007 and 2011–2012. Portion size data from 24-h recalls collected in Australian nutrition surveys were compared between 2007 and 2011–2012. Portion sizes changed significantly in 23% of items with increases in 15% and decreases in 8%. Changes in portion sizes varied by age, sex, and food group. Changes occurred for many meat-based items, energy-dense, nutrient-poor food items, breads, cereals, and some fruits and vegetables. Vegetable and fruit portion sizes were below the respective serving sizes of 75 g and 150 g in the Australian Guide to Healthy Eating, while portion sizes of some energy-dense, nutrient-poor foods have increased. These findings suggest approaches to increasing consumption of nutrient-dense core foods and reducing energy-dense, nutrient-poor food items in children are warranted.
      Citation: Children
      PubDate: 2017-08-04
      DOI: 10.3390/children4080069
      Issue No: Vol. 4, No. 8 (2017)
       
  • Children, Vol. 4, Pages 70: Health and Self-Regulation among School-Age
           Children Experiencing Family Homelessness

    • Authors: Andrew Barnes, Theresa Lafavor, J. Cutuli, Lei Zhang, Charles Oberg, Ann Masten
      First page: 70
      Abstract: Children in homeless families have high levels of adversity and are at risk for behavior problems and chronic health conditions, however little is known about the relationship between cognitive-emotional self-regulation and health among school-aged homeless children. Children (n = 86; mean age 10.5) living in shelters were assessed for health, family stress/adversity, emotional-behavioral regulation, nonverbal intellectual abilities, and executive function. Vision problems were the most prevalent health condition, followed by chronic respiratory conditions. Cumulative risk, child executive function, and self-regulation problems in children were uniquely related to child physical health. Homeless children experience problems with cognitive, emotional, and behavioral regulation as well as physical health, occurring in a context of high psychosocial risk. Several aspects of children’s self-regulation predict physical health in 9- to 11-year-old homeless children. Health promotion efforts in homeless families should address individual differences in children’s self-regulation as a resilience factor.
      Citation: Children
      PubDate: 2017-08-04
      DOI: 10.3390/children4080070
      Issue No: Vol. 4, No. 8 (2017)
       
  • Children, Vol. 4, Pages 71: The Pulmonary Circulation in the Single
           Ventricle Patient

    • Authors: Amanda Hauck, Nicolas Porta, Steven Lestrud, Stuart Berger
      First page: 71
      Abstract: In recent decades, survival of children with complex congenital heart disease has improved considerably. Specifically, children with a variety of congenital heart defects resulting in ‘single ventricle’ physiology can now undergo palliative surgery that allows survival beyond the neonatal period, and in many cases into adulthood, despite having a single functional ventricular pumping chamber supplying both the pulmonary and systemic circulation. Our growing understanding of the functionally univentricular heart has resulted in freedom from Fontan failure of >50% at 25 years post-Fontan. Yet there is still a fair amount of knowledge to be gained, specifically as it relates to the pulmonary circulation in this group of patients. Knowledge gaps relate not only to the pulmonary circulation after Fontan operation, but also at each stage of the single ventricle surgical palliation, including the native physiology prior to any intervention. The pulmonary circulation is affected by multiple issues related to the single ventricle, including specific details of the anatomy unique to each patient, any intervention(s) undertaken, and potential complications such as aortopulmonary collaterals, protein losing enteropathy, plastic bronchitis, venovenous collaterals, pulmonary arteriovenous fistulae, ventricular dysfunction, pulmonary venous stenosis, and more. This chapter will review the current knowledge with regard to the pulmonary circulation in the single ventricle patient, primarily after the Fontan operation. Additionally, it is our hope to help the practitioner assess the pulmonary circulation in the single ventricle patient; we will also discuss the evidence behind and approach to treatment strategies in order to optimize the pulmonary circulation in this complex group of patients.
      Citation: Children
      PubDate: 2017-08-07
      DOI: 10.3390/children4080071
      Issue No: Vol. 4, No. 8 (2017)
       
  • Children, Vol. 4, Pages 72: Assessment of Sleep in Children with Autism
           Spectrum Disorder

    • Authors: Makeda Moore, Victoria Evans, Grace Hanvey, Cynthia Johnson
      First page: 72
      Abstract: Sleep disturbances in children with autism spectrum disorder (ASD) are significantly more prevalent than found in typically developing (TD) children. Given the detrimental impact of poor sleep on cognitive, emotional, and behavioral functioning, it is imperative to screen and assess for sleep disturbances in this population. In this paper, we describe the screening and assessment process, as well as specific measures commonly used for assessing sleep in children with ASD. Advantages and limitations for use in children with ASD are discussed. While subjective measures, such as parent-report questionnaires and sleep diaries, are the most widely used, more objective measures such as actigraphy, polysomnography, and videosomnography provide additional valuable information for both diagnostic purposes and treatment planning. These objective measures, nonetheless, are limited by cost, availability, and feasibility of use with children with ASD. The current review provides an argument for the complementary uses of both subjective and objective measures of sleep specifically for use in children with ASD.
      Citation: Children
      PubDate: 2017-08-08
      DOI: 10.3390/children4080072
      Issue No: Vol. 4, No. 8 (2017)
       
  • Children, Vol. 4, Pages 73: Imaging Features of Non-Alcoholic Fatty Liver
           Disease in Children and Adolescents

    • Authors: Michele Di Martino, Kameliya Koryukova, Mario Bezzi, Carlo Catalano
      First page: 73
      Abstract: Non-invasive diagnosis and quantification of liver steatosis is important to overcome limits of liver biopsy, in order to follow up patients during their therapy and to establish a reference standard that can be used in clinical trials and longitudinal studies. Imaging offers several methods in this setting: ultrasound, which is the cheapest technique and easy to perform; magnetic resonance spectroscopy (MRS), which reflects the real content of triglycerides in a specific volume; and proton density fat fraction (PDFF) magnetic resonance, which is a simple method that reflects the distribution of the fat in the whole liver. Other techniques include ultrasound elastography (EUS) and magnetic resonance elastrography (MRE), which can evaluate the progression of non-alcoholic fatty liver disease (NAFLD) into non-alcoholic steato-hepatitis (NASH) and cirrhosis, by quantifying liver fibrosis.
      Citation: Children
      PubDate: 2017-08-11
      DOI: 10.3390/children4080073
      Issue No: Vol. 4, No. 8 (2017)
       
  • Children, Vol. 4, Pages 74: Insulin Resistance and NAFLD: A Dangerous
           Liaison beyond the Genetics

    • Authors: Melania Manco
      First page: 74
      Abstract: Over the last decade, the understanding of the association between insulin resistance (IR) and non-alcoholic fatty liver disease (NAFLD) has dramatically evolved. There is clear understanding that carriers of some common genetic variants, i.e., the patatin-like phospholipase domain-containing 3 (PNPLA3) or the transmembrane 6 superfamily member 2 (TM6SF2) are at risk of developing severe forms of NAFLD even in the presence of reduced or absent IR. In contrast, there are obese patients with “metabolic” (non-genetically driven) NAFLD who present severe IR. Owing to the epidemic obesity and the high prevalence of these genetic variants in the general population, the number of pediatric cases with combination of genetic and metabolic NAFLD is expected to be very high. Gut dysbiosis, excessive dietary intake of saturated fats/fructose-enriched foods and exposure to some chemicals contribute all to both IR and NAFLD, adding further complexity to the understanding of their relationship. Once NAFLD is established, IR can accelerate the progression to the more severe form of liver derangement that is the non-alcoholic steatohepatitis.
      Citation: Children
      PubDate: 2017-08-14
      DOI: 10.3390/children4080074
      Issue No: Vol. 4, No. 8 (2017)
       
  • Children, Vol. 4, Pages 103: Bronchitis and Its Associated Risk Factors in
           First Nations Children

    • Authors: Chandima Karunanayake, Donna Rennie, Vivian Ramsden, Mark Fenton, Shelley Kirychuk, Joshua Lawson, Raina Henderson, Laurie Jimmy, Jeremy Seeseequasis, Sylvia Abonyi, James Dosman, Punam Pahwa, The First Nations Lung Health Project Research Team
      First page: 103
      Abstract: Respiratory diseases, such as bronchitis and pneumonia, are common in First Nations children in Canada. The objectives are to determine prevalence and associated risk factors of bronchitis in children 6–17 years old residing in two reserve communities. The cross-sectional study was conducted in 2013 and children from two First Nations reserve communities participated. The outcome was ever presence/absence of bronchitis. Logistic regression analysis was conducted to examine the relationship between bronchitis and the individual and environmental factors. A total of 351 First Nations children participated in the study. The prevalence of bronchitis was 17.9%. While 86.6% had at least one parent who smoked, smoking inside home was 43.9%. Signs of mold and mildew in homes were high. Prevalence of houses with any damage caused by dampness was 42.2%, with 44.2% of homes showing signs of mold or mildew. Significant predictors of increased risk of bronchitis were: being obese; having respiratory allergies; exposed to parental cigarette smoking; and signs of mold and mildew in the home. There are several modifiable risk factors that should be considered when examining preventive interventions for bronchitis including obesity, smoking exposure, and home mold or dampness.
      Citation: Children
      PubDate: 2017-11-24
      DOI: 10.3390/children4120103
      Issue No: Vol. 4, No. 12 (2017)
       
  • Children, Vol. 4, Pages 104: Contribution of Discretionary Foods and
           Drinks to Australian Children’s Intake of Energy, Saturated Fat, Added
           Sugars and Salt

    • Authors: Brittany Johnson, Lucinda Bell, Dorota Zarnowiecki, Anna Rangan, Rebecca Golley
      First page: 104
      Abstract: Interventions are required to reduce children’s consumption of discretionary foods and drinks. To intervene we need to identify appropriate discretionary choice targets. This study aimed to determine the main discretionary choice contributors to energy and key nutrient intakes in children aged 2–18 years. Secondary analyses were performed with population weighted, single 24 h dietary recall data from the 2011–2012 National Nutrition and Physical Activity Survey. Cakes, muffins, and slices; sweet biscuits; potato crisps and similar snacks; and, processed meats and sugar-sweetened drinks were relatively commonly consumed and were within the top three to five contributors to per capita energy, saturated fat, sodium, and/or added sugars. Per consumer intake identified cereal-based takeaway foods; cakes, muffins and slices; meat pies and other savoury pastries; and, processed meats as top contributors to energy, saturated fat, and sodium across most age groups. Subgroups of sugar-sweetened drinks and cakes, muffins and slices were consistently key contributors to added sugars intake. This study identified optimal targets for interventions to reduce discretionary choices intake, likely to have the biggest impact on moderating energy intake while also reducing intakes of saturated fat, sodium and/or added sugars.
      Citation: Children
      PubDate: 2017-12-01
      DOI: 10.3390/children4120104
      Issue No: Vol. 4, No. 12 (2017)
       
  • Children, Vol. 4, Pages 105: Text Messaging Based Obesity Prevention
           Program for Parents of Pre-Adolescent African American Girls

    • Authors: Chishinga Callender, Deborah Thompson
      First page: 105
      Abstract: African American girls are at a greater risk of obesity than their nonminority peers. Parents have the primary control over the home environment and play an important role in the child obesity prevention. Obesity prevention programs to help parents develop an obesity-preventive home environment are needed. The purpose of this study was to collect formative research from parents of 8–10-year old African American girls about perceptions, expectations, and content for a text messaging based program. Mothers (n = 30) participated in surveys and interviews to inform message development and content. A professional expert panel (n = 10) reviewed draft text messages via a survey. All the mothers reported owning a cellphone with an unlimited texting plan, and they used their cellphones for texting (90.0%) and accessing the Internet (100.0%). The majority were interested in receiving text messages about healthy eating and physical activity (86.7%). Interviews confirmed survey findings. One hundred and seven text messages promoting an obesity-preventive home environment were developed. The expert panel and parents reported positive reactions to draft text messages. This research provides evidence that mobile health (mHealth) interventions appeal to parents of African American girls and they have ready access to the technology with which to support this approach.
      Citation: Children
      PubDate: 2017-12-04
      DOI: 10.3390/children4120105
      Issue No: Vol. 4, No. 12 (2017)
       
  • Children, Vol. 4, Pages 106: Multi-Family Pediatric Pain Group Therapy:
           Capturing Acceptance and Cultivating Change

    • Authors: Samantha Huestis, Grace Kao, Ashley Dunn, Austin Hilliard, Isabel Yoon, Brenda Golianu, Rashmi Bhandari
      First page: 106
      Abstract: Behavioral health interventions for pediatric chronic pain include cognitive-behavioral (CBT), acceptance and commitment (ACT), and family-based therapies, though literature regarding multi-family therapy (MFT) is sparse. This investigation examined the utility and outcomes of the Courage to Act with Pain: Teens Identifying Values, Acceptance, and Treatment Effects (CAPTIVATE) program, which included all three modalities (CBT, ACT, MFT) for youth with chronic pain and their parents. Program utility, engagement, and satisfaction were evaluated via quantitative and qualitative feedback. Pain-specific psychological, behavioral, and interpersonal processes were examined along with outcomes related to disability, quality of life, pain interference, fatigue, anxiety, and depressive symptoms. Participants indicated that CAPTIVATE was constructive, engaging, and helpful for social and family systems. Clinical and statistical improvements with large effect sizes were captured for pain catastrophizing, acceptance, and protective parenting but not family functioning. Similar effects were found for functional disability, pain interference, fatigue, anxiety, and depression. Given the importance of targeting multiple systems in the management of pediatric chronic pain, preliminary findings suggest a potential new group-based treatment option for youth and families. Next steps involve evaluating the differential effect of the program over treatment as usual, as well as specific CBT, ACT, and MFT components and processes that may affect outcomes.
      Citation: Children
      PubDate: 2017-12-07
      DOI: 10.3390/children4120106
      Issue No: Vol. 4, No. 12 (2017)
       
  • Children, Vol. 4, Pages 107: Darker Skin Tone Increases Perceived
           Discrimination among Male but Not Female Caribbean Black Youth

    • Authors: Shervin Assari, Cleopatra Caldwell
      First page: 107
      Abstract: Background: Among most minority groups, males seem to report higher levels of exposure and vulnerability to racial discrimination. Although darker skin tone may increase exposure to racial discrimination, it is yet unknown whether skin tone similarly influences perceived discrimination among male and female Caribbean Black youth. Objective: The current cross-sectional study tests the role of gender on the effects of skin tone on perceived discrimination among Caribbean Black youth. Methods: Data came from the National Survey of American Life-Adolescent Supplement (NSAL-A), 2003–2004, which included 360 Caribbean Black youth (ages 13 to 17). Demographic factors (age and gender), socioeconomic status (SES; family income, income to needs ratio, and subjective SES), skin tone, and perceived everyday discrimination were measured. Linear regressions were used for data analysis. Results: In the pooled sample, darker skin tone was associated with higher levels of perceived discrimination among Caribbean Black youth (b = 0.48; 95% Confidence Interval (CI) = 0.07–0.89). A significant interaction was found between gender and skin tone (b = 1.17; 95% CI = 0.49–1.86), suggesting a larger effect of skin tone on perceived discrimination for males than females. In stratified models, darker skin tone was associated with more perceived discrimination for males (b = 1.20; 95% CI = 0.69–0.72) but not females (b = 0.06; 95% CI = −0.42–0.55). Conclusion: Similar to the literature documenting male gender as a vulnerability factor to the effects of racial discrimination, we found that male but not female Caribbean Black youth with darker skin tones perceive more discrimination.
      Citation: Children
      PubDate: 2017-12-12
      DOI: 10.3390/children4120107
      Issue No: Vol. 4, No. 12 (2017)
       
  • Children, Vol. 4, Pages 108: Risk Factors Associated with Preterm Neonatal
           Mortality: A Case Study Using Data from Mt. Hope Women’s Hospital in
           Trinidad and Tobago

    • Authors: Karen Cupen, Annabel Barran, Virendra Singh, Isaac Dialsingh
      First page: 108
      Abstract: Preterm neonatal mortality contributes significantly to the high incidence of death among children under five years of age. Neonatal mortality also serves as an indicator of maternal health in society. The aim of the study is to examine the risk factors for preterm neonatal mortality at the neonatal intensive care unit (NICU) at Mount Hope Women’s Hospital in Trinidad and Tobago (MHWH). In this retrospective study, we included infants (N = 129), born < 37 weeks gestational age, between 1 January and 31 December 2015. Two binary logistic regression models (infant and maternal variables) were constructed to identify predictors of preterm neonatal mortality. Roughly 12% of the infants died after being admitted to the NICU. The binary logistic regression (infant model) had an excellent fit (area under the curve (AUC): 0.904, misclassification rate: 11.7%) whilst the maternal binary logistic model had a fair fit (AUC: 0.698). Birth weight, length of time on the ventilator and obstetric complications proved to significantly influence the odds of preterm neonatal death. The estimated models show that improvement in neonatal as well as maternal variables has direct impact on preterm neonatal mortality.
      Citation: Children
      PubDate: 2017-12-14
      DOI: 10.3390/children4120108
      Issue No: Vol. 4, No. 12 (2017)
       
  • Children, Vol. 4, Pages 109: Mercury Hair Concentration among Primary
           School Children in Malaysia

    • Authors: Nurul Abdul Samad, Zaleha Md Isa, Rozita Hod
      First page: 109
      Abstract: The main concern regarding mercury exposure is the adverse health effect on the developing nervous system. The objective of this cross-sectional study was to determine hair mercury levels and their association with socio-demographic characteristics, complaints about mercury poisoning symptoms and the fish consumption pattern among children in Malaysia. A cross-sectional study was conducted among 215 school children aged 11 years old. Hair was collected from the children and the total mercury was analyzed using oxygen combustion–gold amalgamation atomic absorption spectrophotometry. Anthropometric data, a fish consumption questionnaire and mercury poisoning symptoms were collected during a personal interview. The mean hair mercury level among primary school children was 0.63 ± 0.59 µg/g with the geometric mean of 0.47 µg/g. A total of 14% of respondents had hair mercury levels above 1 µg/g. A multiple binary logistic regression analysis outlined that fish consumption of at least one meal per week increased the likelihood of having a high mercury level (odds ratio (OR) 3.7, 95% confidence interval (CI) 1.3–10.4). This study confirms the existence of a mercury burden among Malaysian children and the level is high compared to other regional studies. This study provides important baseline data regarding the mercury level among children in Malaysia.
      Citation: Children
      PubDate: 2017-12-14
      DOI: 10.3390/children4120109
      Issue No: Vol. 4, No. 12 (2017)
       
  • Children, Vol. 4, Pages 110: “I Learned to Let Go of My Pain”. The
           Effects of Mindfulness Meditation on Adolescents with Chronic Pain: An
           Analysis of Participants’ Treatment Experience

    • Authors: Danielle Ruskin, Lauren Harris, Jennifer Stinson, Sara Kohut, Katie Walker, Erinn McCarthy
      First page: 110
      Abstract: Chronic pain can lead to significant negative outcomes across many areas of life. Recently, mindfulness-based interventions (MBIs) have been identified as potentially effective tools for improved pain management among adolescents living with pain. This study aimed to explore the experience of adolescents who participated in an eight-week mindfulness group adapted for adolescents with chronic pain (MBI-A), and obtain their feedback and suggestions on group structure and content. A mixed method design was used employing qualitative data from focus groups and data from a satisfaction questionnaire. Focus group data were transcribed and analyzed using inductive simple descriptive content analysis. Of the total participants (n = 21), 90% (n = 19) provided feedback by completing satisfaction questionnaires and seventeen (n = 17) of those also participated across two focus groups. Analysis of the focus group transcripts uncovered six themes: mindfulness skills, supportive environment, group exercises (likes and dislikes), empowerment, program expectations, and logistics. Participants reported positive experiences in the MBI-A program, including support received from peers and mindfulness skills, including present moment awareness, pain acceptance, and emotion regulation. Group members suggested increasing the number of sessions and being clearer at outset regarding a focus on reduction of emotional suffering rather than physical pain.
      Citation: Children
      PubDate: 2017-12-15
      DOI: 10.3390/children4120110
      Issue No: Vol. 4, No. 12 (2017)
       
  • Children, Vol. 4, Pages 111: Performance Comparison of Systemic
           Inflammatory Response Syndrome with Logistic Regression Models to Predict
           Sepsis in Neonates

    • Authors: Jyoti Thakur, Sharvan Pahuja, Roop Pahuja
      First page: 111
      Abstract: In 2005, an international pediatric sepsis consensus conference defined systemic inflammatory response syndrome (SIRS) for children <18 years of age, but excluded premature infants. In 2012, Hofer et al. investigated the predictive power of SIRS for term neonates. In this paper, we examined the accuracy of SIRS in predicting sepsis in neonates, irrespective of their gestational age (i.e., pre-term, term, and post-term). We also created two prediction models, named Model A and Model B, using binary logistic regression. Both models performed better than SIRS. We also developed an android application so that physicians can easily use Model A and Model B in real-world scenarios. The sensitivity, specificity, positive likelihood ratio (PLR) and negative likelihood ratio (NLR) in cases of SIRS were 16.15%, 95.53%, 3.61, and 0.88, respectively, whereas they were 29.17%, 97.82%, 13.36, and 0.72, respectively, in the case of Model A, and 31.25%, 97.30%, 11.56, and 0.71, respectively, in the case of Model B. All models were significant with p < 0.001.
      Citation: Children
      PubDate: 2017-12-19
      DOI: 10.3390/children4120111
      Issue No: Vol. 4, No. 12 (2017)
       
  • Children, Vol. 4, Pages 112: Smoothed Body Composition Percentiles Curves
           for Mexican Children Aged 6 to 12 Years

    • Authors: Melchor Alpizar, Vanessa-Giselle Peschard, Fabiola Escalante-Araiza, Nelly Altamirano-Bustamante, Chiharu Murata, Ramón Arenas-Pérez, Ernesto Rodriguez-Ayala
      First page: 112
      Abstract: Overweight children and childhood obesity are a public health problem in Mexico. Obesity is traditionally assessed using body mass index (BMI), but an excess of adiposity does not necessarily reflect a high BMI. Thus, body composition indexes are a better alternative. Our objective was to generate body composition percentile curves in children from Mexico City. A total of 2026 boys and 1488 girls aged 6 to 12 years old were studied in Mexico City. Body weight, height, and BMI calculation were measured. Total body fat percentage (TBFP) was derived from the skinfold thicknesses, and fat mass (FMI) and free fat mass indexes (FFMI) were calculated. Finally, age- and gender-specifıc smoothed percentile curves were generated with Cole’s Lambda, Mu, and Sigma (LMS) method. In general, height, weight, waist circumference (WC), and TBFP were higher in boys, but FFM was higher in girls. TBFP appeared to increase significantly between ages 8 and 9 in boys (+2.9%) and between ages 10 and 11 in girls (+1.2%). In contrast, FFM% decreased noticeably between ages 8 and 9 until 12 years old in boys and girls. FMI values peaked in boys at age 12 (P97 = 14.1 kg/m2) and in girls at age 11 (P97 = 8.8 kg/m2). FFMI percentiles increase at a steady state reaching a peak at age 12 in boys and girls. Smoothed body composition percentiles showed a different pattern in boys and girls. The use of TBFP, FMI, and FFMI along with BMI provides valuable information in epidemiological, nutritional, and clinical research.
      Citation: Children
      PubDate: 2017-12-20
      DOI: 10.3390/children4120112
      Issue No: Vol. 4, No. 12 (2017)
       
  • Children, Vol. 4, Pages 113: A Rare Case of Pure Erythroid Sarcoma in a
           Pediatric Patient: Case Report and Literature Review

    • Authors: Pablo Manresa, Fabián Tarín, María Niveiro, María Tasso, Olga Alda, Francisco López, Héctor Sarmiento, José Verdú, Francisco De Paz, Silvia López, María Del Cañizo, Esperanza Such, Eva Barragán, Fernanda Martirena
      First page: 113
      Abstract: We describe an exceptional case of erythroid sarcoma in a pediatric patient as a growing orbital mass with no evidence of morphologic bone marrow involvement, who was finally diagnosed of pure erythroid sarcoma based on histopathology and flow cytometry criteria. We discuss the contribution of standardized eight-color flow cytometry as a rapid and reliable diagnostic method. The use of normal bone marrow databases allowed us to identify small aberrant populations in bone marrow and later confirm the diagnosis in the neoplastic tissue.
      Citation: Children
      PubDate: 2017-12-20
      DOI: 10.3390/children4120113
      Issue No: Vol. 4, No. 12 (2017)
       
  • Children, Vol. 4, Pages 93: The Need for Early Referral: Characteristics
           of Children and Adolescents Who Are Overweight and Obese Attending a
           Multidisciplinary Weight Management Service

    • Authors: Jacqueline Walker, Rebecca Malley, Robyn Littlewood, Sandra Capra
      First page: 93
      Abstract: There is a need to examine the issue of childhood obesity from a systems perspective. This study aimed to describe the baseline characteristics of children attending pediatric multidisciplinary weight management services and understand how this information will inform future service delivery. A total of 51 children and adolescents who were overweight and obese (27 male) and aged between two and 16 years participated. Body size measures such as body mass index (BMI) and body fat percentage were collected. Participants and their parents/guardians also completed questionnaires on dietary intake, behaviors and habits, physical activity and health-related quality of life. A total of 72% of participants were classified as morbidly obese. Adolescents had significantly lower scores for overall diet, physical activity and particular health-related quality of life scores. No significant correlations were found between BMI z-scores and diet, physical activity and health-related quality of life. In adolescents, correlations were detected between dietary scores and health-related quality of life. Results confirm the need to critically examine the current context to adapt and tailor interventions to individual circumstances, and when combined with focused referral, triaging and screening processes, should assist in delivering the right care at the right time.
      Citation: Children
      PubDate: 2017-10-31
      DOI: 10.3390/children4110093
      Issue No: Vol. 4, No. 11 (2017)
       
  • Children, Vol. 4, Pages 94: Infantile Cytomegalovirus-Associated Severe
           Warm Autoimmune Hemolytic Anemia: A Case Report

    • Authors: Hassan Khalifeh, Youmna Mourad, Cynthia Chamoun
      First page: 94
      Abstract: Autoimmune hemolytic anemia is a rare hematologic entity in children. Etiologies are mainly viruses or bacteria. We describe here a case of severe warm autoimmune hemolytic anemia (IgG- and C3d-positive direct antiglobulin test) in an immunocompetent 6-month-old infant with acute Cytomegalovirus infection that responded well to corticotherapy and intraveneous immunoglobulins without using blood component transfusion. This case demonstrates the importance of recognizing CMV in infantile Autoimmune Hemolytic Anemia, especially because hemolysis can be severe and lethal.
      Citation: Children
      PubDate: 2017-11-03
      DOI: 10.3390/children4110094
      Issue No: Vol. 4, No. 11 (2017)
       
  • Children, Vol. 4, Pages 95: Upper Gastrointestinal Bleeding in Children: A
           Tertiary United Kingdom Children’s Hospital Experience

    • Authors: Omar Nasher, David Devadason, Richard Stewart
      First page: 95
      Abstract: The aim of this study was to review the aetiology, presentation and management of these patients with upper gastrointestinal bleeding (UGIB) at a tertiary children’s unit in the United Kingdom. This was a retrospective single-institution study on children (<16 years) who presented with acute UGIB over a period of 5 years using known International Classification of Diseases (ICD) codes. A total of 32 children (17 males, 15 females) were identified with a total median age at presentation of 5.5 years. The majority (24/32) of patients presented as an emergency. A total of 19/32 presented with isolated haematemesis, 8/32 with isolated melaena and 5/32 with a combination of melaena and haematemesis. On admission, the mean haemoglobin of patients who presented with isolated haematemesis was 11 g/dL, those with isolated melaena 9.3 g/dL and those with a combination 7.8 g/dL. Blood transfusion was required in 3/19 with haematemesis and 3/5 with haematemesis and melaena. A total of 19/32 underwent upper gastrointestinal endoscopy. Endoscopic findings were oesophageal varices (5/19) of which 4 required banding; bleeding gastric ulcer (1/19) requiring clips, haemospray and adrenaline; gastric vascular malformation (1/19) treated with Argon plasma coagulation therapy; duodenal ulcer (3/19) which required surgery in two cases; oesophagitis (5/19); and gastritis +/− duodenitis (3/19). A total of 13/32 patients did not undergo endoscopy and the presumed aetiology was a Mallory–Weiss tear (4/13); ingestion of foreign body (2/13); gastritis (3/13); viral illness (1/13); unknown (2/13). While UGIB is uncommon in children, the morbidity associated with it is very significant. Melaena, dropping haemoglobin, and requirement for a blood transfusion appear to be significant markers of an underlying cause of UGIB that requires therapeutic intervention. A multi-disciplinary team comprising gastroenterologists and surgeons is essential.
      Citation: Children
      PubDate: 2017-11-03
      DOI: 10.3390/children4110095
      Issue No: Vol. 4, No. 11 (2017)
       
  • Children, Vol. 4, Pages 96: Risk and Resilience Factors Related to
           Parental Bereavement Following the Death of a Child with a Life-Limiting
           Condition

    • Authors: Tiina Jaaniste, Sandra Coombs, Theresa Donnelly, Norm Kelk, Danielle Beston
      First page: 96
      Abstract: This paper reviews the theoretical and empirical literature on risk and resilience factors impacting on parental bereavement outcomes following the death of a child with a life-limiting condition. Over the past few decades, bereavement research has focussed primarily on a risk-based approach. In light of advances in the literature on resilience, the authors propose a Risk and Resilience Model of Parental Bereavement, thus endeavouring to give more holistic consideration to a range of potential influences on parental bereavement outcomes. The literature will be reviewed with regard to the role of: (i) loss-oriented stressors (e.g., circumstances surrounding the death and multiple losses); (ii) inter-personal factors (e.g., marital factors, social support, and religious practices); (iii) intra-personal factors (e.g., neuroticism, trait optimism, psychological flexibility, attachment style, and gender); and (iv) coping and appraisal, on parental bereavement outcomes. Challenges facing this area of research are discussed, and research and clinical implications considered.
      Citation: Children
      PubDate: 2017-11-09
      DOI: 10.3390/children4110096
      Issue No: Vol. 4, No. 11 (2017)
       
  • Children, Vol. 4, Pages 97: Sleep-Disordered Breathing in Children with
           Recurrent Wheeze/Asthma: A Single Centre Study

    • Authors: Marco Zaffanello, Emma Gasperi, Laura Tenero, Michele Piazza, Angelo Pietrobelli, Luca Sacchetto, Franco Antoniazzi, Giorgio Piacentini
      First page: 97
      Abstract: The relationship between asthma and sleep-disordered breathing is bidirectional due to common risk factors that promote airway inflammation. Obstructive sleep-disordered breathing and recurrent wheeze/asthma are conditions that involve the upper and the lower respiratory system, respectively. The aim of the present study was to investigate the sleep disordered breathing in children with recurrent wheeze/asthma. This was a retrospective study concerning children older than 2 years who underwent—between January 2014 and November 2016—an in-laboratory overnight polygraphic study. We match the children between those who do or do not have recurrent wheeze/asthma disease. We examined the clinical records of 137 children. We excluded eight patients because of neurological and genetic conditions. Children with recurrent wheeze/asthma (N = 28) were younger (p = 0.002) and leaner (p = 0.013) compared to non-affected children (N = 98). Children with wheeze/asthma and unaffected ones had a similar obstructive apnea-hypopnea index (p = 0.733) and oxygen desaturation index (p = 0.535). The logistic regression analysis, in which the condition of wheeze/asthma (yes/no) was a dependent variable, while demographic (age, sex, body mass index (BMI) Z-score) and polygraphic results during sleep (obstructive apnea-hypopnea index, central apnea index, peripheral oxygen saturation (SpO2), and snoring) were covariates, showed that children with wheeze/asthma had higher central apnea index (Exp(B) = 2.212; Wald 6.845; p = 0.009). In conclusion, children with recurrent wheeze/asthma showed an increased number of central sleep apneas than unaffected children. This finding may suggest a dysfunction of the breathing control in the central nervous system during sleep. Systemic or central inflammation could be the cause.
      Citation: Children
      PubDate: 2017-11-14
      DOI: 10.3390/children4110097
      Issue No: Vol. 4, No. 11 (2017)
       
  • Children, Vol. 4, Pages 98: Clinical Profile Associated with Adverse
           Childhood Experiences: The Advent of Nervous System Dysregulation

    • Authors: Jorina Elbers, Cynthia Rovnaghi, Brenda Golianu, Kanwaljeet Anand
      First page: 98
      Abstract: Background: We report the prevalence of children with multiple medical symptoms in a pediatric neurology clinic, describe their symptom profiles, and explore their association with adverse childhood experiences (ACEs). Methods: We retrospectively reviewed 100 consecutive patients from an outpatient pediatric neurology clinic. Patients were included if they were ≥5 years old and reported ≥4 symptoms that were unexplained for ≥3-months. Symptom profiles across six functional domains were recorded: (1) executive dysfunction, (2) sleep disturbances, (3) autonomic dysregulation, (4) somatization, (5) digestive symptoms, and (6) emotional dysregulation. ACEs were scored for all patients. Results: Seventeen patients reported ≥4 medical symptoms. Somatization, sleep disturbances, and emotional dysregulation occurred in 100% patients, with executive dysfunction (94%), autonomic dysregulation (76%), and digestive problems (71%) in the majority. Forty-two children reported ≥1 ACE, but children with ≥4 symptoms were more likely to report ACEs compared to other children (88% vs. 33%; p < 0.0001) and had a higher median total ACE score (3 vs. 1; p < 0.001). Conclusions: Children with multiple medical symptoms should be screened for potential exposure to ACEs. A clinical profile of symptoms across multiple functional domains suggests putative neurobiological mechanisms involving stress and nervous system dysregulation that require further study.
      Citation: Children
      PubDate: 2017-11-15
      DOI: 10.3390/children4110098
      Issue No: Vol. 4, No. 11 (2017)
       
  • Children, Vol. 4, Pages 99: Optimal Line and Tube Placement in Very
           Preterm Neonates: An Audit of Practice

    • Authors: Daragh Finn, Hannah Kinoshita, Vicki Livingstone, Eugene Dempsey
      First page: 99
      Abstract: Background: Placement of endotracheal tubes (ETTs) and umbilical catheters (UCs) is essential in very preterm infant care. The aim of this study was to assess the effect of an educational initiative to optimize correct placement of ETTs and UCs in very preterm infants. Methods: A pre–post study design, evaluating optimal radiological position of ETTs and UCs in the first 72 h of life in infants <32 weeks gestational age (GA) was performed. Baseline data was obtained from a preceding 34-month period. The study intervention consisted of information from the pre-intervention audit, surface anatomy images of the newborn for optimal UC positioning, and weight-based calculations to estimate insertion depths for endotracheal intubation. A prospective evaluation of radiological placement of ETTs and UCs was then conducted over a 12-month period. Results: During the study period, 211 infants had at least one of the three procedures performed. One hundred and fifty-seven infants were included in the pre-education group, and 54 in the post-education group. All three procedures were performed in 50.3% (79/157) in the pre-education group, and 55.6% (30/54) in the post-education group. There was no significant difference in accurate placement following the introduction of the educational sessions; depth of ETTs (50% vs. 47%), umbilical arterial catheter (UAC) (40% vs. 43%,), and umbilical venous catheter (UVC)(14% vs. 23%). Conclusion: Despite education of staff on methods for appropriate ETT, UVC and UAC insertion length, the rate of accurate initial insertion depth remained suboptimal. Newer methods of determining optimal position need to be evaluated.
      Citation: Children
      PubDate: 2017-11-17
      DOI: 10.3390/children4110099
      Issue No: Vol. 4, No. 11 (2017)
       
  • Children, Vol. 4, Pages 100: Parent Cardiac Response in the Context of
           Their Child’s Completion of the Cold Pressor Task: A Pilot Study

    • Authors: Kaytlin Constantin, Rachel Moline, C. McMurtry, Heidi Bailey
      First page: 100
      Abstract: Parents’ ability to regulate their emotions is essential to providing supportive caregiving behaviours when their child is in pain. Extant research focuses on parent self-reported experience or observable behavioural responses. Physiological responding, such as heart rate (HR) and heart rate variability (HRV), is critical to the experience and regulation of emotions and provides a complementary perspective on parent experience; yet, it is scarcely assessed. This pilot study examined parent (n = 25) cardiac response (HR, HRV) at rest (neutral film clip), immediately before the cold pressor task (pre-CPT), and following the CPT (post-CPT). Further, variables that may influence changes in HR and HRV in the context of pediatric pain were investigated, including (1) initial HRV, and (2) parent perception of their child’s typical response to needle procedures. Time-domain (root mean square of successive differences; RMSSD) and frequency-domain (high-frequency heart rate variability; HF-HRV) parameters of HRV were computed. HR and HF-HRV varied as a function of time block. Typical negative responses to needle pain related to higher parental HR and lower HRV at rest. Parents with higher HRV at baseline experienced the greatest decreases in HRV after the CPT. Consequently, considering previous experience with pain and resting HRV levels are relevant to understanding parent physiological responses before and after child pain.
      Citation: Children
      PubDate: 2017-11-21
      DOI: 10.3390/children4110100
      Issue No: Vol. 4, No. 11 (2017)
       
  • Children, Vol. 4, Pages 101: Factors Associated with the Need for, and the
           Impact of, Extracorporeal Membrane Oxygenation in Children with Congenital
           Heart Disease during Admissions for Cardiac Surgery

    • Authors: Salvatore Aiello, Rohit Loomba
      First page: 101
      Abstract: Introduction: This study aimed to determine factors associated with the need for extracorporeal membrane oxygenation (ECMO) in children with congenital heart disease (CHD) during admission for cardiac surgery (CS). A secondary aim was to determine how ECMO impacted length, cost, and mortality of the admission. Methods: Data from the Kids’ Inpatient Database (KIDS) were utilized. Admissions with CHD under 18 years of age with cardiac surgery were included. Need for ECMO in these admissions was then identified. Univariate analysis was conducted to compare characteristics between admissions with and without ECMO. Regression analyses were conducted to determine what factors were independently associated with ECMO and whether ECMO independently impacted admission characteristics. Results: A total of 46,176 admissions with CHD and CS were included in the final analysis. Of these, 798 (1.7%) required ECMO. Median age of ECMO admissions was 0.5 years. The following were associated with ECMO: decreased age, heart failure, acute kidney injury, arrhythmia, double outlet right ventricle, atrioventricular septal defect, transposition, Ebstein anomaly, hypoplastic left heart syndrome, common arterial trunk, tetralogy of Fallot, coronary anomaly, valvuloplasty, repair of total anomalous pulmonary venous connection, arterial switch, RV to PA conduit placement, and heart transplant (p < 0.01). ECMO independently increased length of stay by 17.8 days, cost of stay by approximately $415,917, and inpatient mortality 22-fold. Conclusion: Only a small proportion of CHD patients undergoing CS require ECMO, although these patients require increased resource utilization and have high mortality. Specific cardiac lesions, cardiac surgeries, and comorbidities are associated with increased need for ECMO.
      Citation: Children
      PubDate: 2017-11-22
      DOI: 10.3390/children4110101
      Issue No: Vol. 4, No. 11 (2017)
       
  • Children, Vol. 4, Pages 102: South Asian Children Have Increased Body Fat
           in Comparison to White Children at the Same Body Mass Index

    • Authors: Emma Eyre, Michael Duncan, Alan Nevill
      First page: 102
      Abstract: The ability of body mass index (BMI) to predict excess fat in South Asian children is unknown. This cross-sectional study examines the influence of ethnicity on body fatness in children. Weight status and body fat were determined using BMI, waist circumference (WC), two skinfold sites (SF; triceps and subscapula) and leg-to-leg bioelectrical impedance analysis (BIA; Tanita BF350, Tanita, Tokyo, Japan) in 194 children aged 8.47 ± 0.50 years from Coventry, United Kingdom. Biological maturity was also determined. Analysis of covariance (ANCOVA) identified significant differences between ethnic (p < 0.001) and gender groups’ BMI (p = 0.026), with a significant covariate for skinfold (p < 0.001) and bioelectrical impedance (p < 0.001). For a given body fat value, South Asian children and females had a lower BMI value (−1.12 kg/m2, p < 0.001 and −0.50 kg/m2, p = 0.026, respectively, when adjusted for SF; −1.56 kg/m2, p < 0.001 and −0.31 kg/m2, p = 0.16, respectively, when adjusted for BIA) compared with white children and boys. The prediction model including ethnicity, gender and BIA explained 80.4% of the variance in BMI. Maturation was not found to be a significant covariate (p > 0.05). To conclude, the findings suggest that BMI cut-points may need to be lowered in South Asian children, and thus age-by-sex-by-ethnicity specific BMI cut-points are needed in children. Further research examining body composition with health parameters in this population is needed.
      Citation: Children
      PubDate: 2017-11-22
      DOI: 10.3390/children4110102
      Issue No: Vol. 4, No. 11 (2017)
       
  • Children, Vol. 4, Pages 84: Sleep Disorders in Childhood Neurological
           Diseases

    • Authors: Abdullah Tolaymat, Zhao Liu
      First page: 84
      Abstract: Sleep problems are frequently addressed as a primary or secondary concern during the visit to the pediatric neurology clinic. Sleep disorders can mimic other neurologic diseases (e.g., epilepsy and movement disorders), and this adds challenges to the diagnostic process. Sleep disorders can significantly affect the quality of life and functionality of children in general and those with comorbid neurological diseases in particular. Understanding the pathophysiology of sleep disorders, recognizing the implications of sleep disorder in children with neurologic diseases and behavioral difficulties, and early intervention continue to evolve resulting in better neurocognitive outcomes.
      Citation: Children
      PubDate: 2017-09-22
      DOI: 10.3390/children4100084
      Issue No: Vol. 4, No. 10 (2017)
       
  • Children, Vol. 4, Pages 85: Coconut Allergy Revisited

    • Authors: Katherine Anagnostou
      First page: 85
      Abstract: Despite concerns voiced often by food-allergic patients, allergy to coconut is rare, not directly associated with nut allergy and few cases are reported so far in the literature. We present an interesting case of coconut allergy in a child that was previously tolerant to coconut and regularly exposed via both the skin and gastrointestinal route.
      Citation: Children
      PubDate: 2017-09-29
      DOI: 10.3390/children4100085
      Issue No: Vol. 4, No. 10 (2017)
       
  • Children, Vol. 4, Pages 86: A Potential Novel Mechanism for Vagus Nerve
           Stimulator-Related Central Sleep Apnea

    • Authors: Inga Forde, Meghna Mansukhani, Bhanu Kolla, Suresh Kotagal
      First page: 86
      Abstract: The treatment of epilepsy with vagus nerve stimulation can inadvertently cause obstructive and central sleep apnea (CSA). The mechanism for CSA seen in patients with a vagus nerve stimulator (VNS) is not fully known. We describe the case of a 13-year-old girl in whom VNS activation induced tachypnea and post-hyperventilation central apnea. Following adjustment of VNS settings, the post-hyperventilation CSA resolved. Polysomnography may assist with management when patients with epilepsy develop sleep disruption after VNS placement.
      Citation: Children
      PubDate: 2017-09-29
      DOI: 10.3390/children4100086
      Issue No: Vol. 4, No. 10 (2017)
       
  • Children, Vol. 4, Pages 87: Oligoarticular Hemarthroses and Osteomyelitis
           Complicating Pasteurella Meningitis in an Infant

    • Authors: Charles Nessle, Allison Black, Justin Farge, Victoria Statler
      First page: 87
      Abstract: A 5-month-old previously healthy female presented with a one-week history of fever and increased fussiness. Her presentation revealed an ill-appearing infant with an exam and cerebrospinal fluid (CSF) studies concerning bacterial meningitis; CSF cultures grew Pasteurella multocida. Additionally, brain magnetic resonance imaging (MRI) demonstrated cervical osteomyelitis. Despite multiple days of antibiotic therapy, she remained febrile with continued pain; MRI showed oligoarticular effusions, and aspiration of these joints yielded bloody aspirates. Evaluations for coagulopathy and immune complex-mediated arthropathy were negative. The patient improved following appropriate antibiotic therapy and spontaneous resolution of hemarthroses, and was discharged to a short-term rehabilitation hospital. P. multocida is a small, encapsulated coccobacillus that is part of the commensal oral flora of animals. It most commonly causes skin infections in humans, yet is a rare cause of meningitis in the pediatric population, especially in children <1 year of age. Transmission due to P. multocida is most commonly due to direct contact with animals. To our knowledge, this is the first case of oligoarticular hemarthroses and cervical osteomyelitis complicating P multocida meningitis. This case highlights the physician’s potential for cognitive bias and premature anchoring, and the resulting implications in delivering excellent patient care.
      Citation: Children
      PubDate: 2017-10-16
      DOI: 10.3390/children4100087
      Issue No: Vol. 4, No. 10 (2017)
       
  • Children, Vol. 4, Pages 88: Factors Associated with Malnutrition among
           Under-Five Children: Illustration using Bangladesh Demographic and Health
           Survey, 2014 Data

    • Authors: Ashis Talukder
      First page: 88
      Abstract: Child malnutrition remains one of the major public health problems in many parts of the world, especially in a developing country like Bangladesh. Several socioeconomic and demographic factors are responsible for this condition. The present study was conducted to uncover the risk factors associated with malnutrition among under-five children in Bangladesh by analyzing the data from a nationally representative Bangladesh Demographic and Health Survey (BDHS) in 2014. The ordinal dependent variable—child nutrition status (severely malnourished, moderately malnourished, and nourished)—was developed by calculating weight-for-age Z score (WAZ). Bivariate analysis was conducted by performing gamma measure and chi-square test of independence to explore the association between child nutrition status and selected independent variables. To know the adjusted effects of covariates, a popular ordinal model—namely, the proportional odds (PO) model—was considered. All the selected covariates were found highly significant (p < 0.01) in the bivariate setup. However, in the multivariate setup, father’s and mother’s education, wealth index, mother’s body mass index (BMI), and antenatal care service during pregnancy were found highly significant (p < 0.01) factors for child malnutrition. Among the divisions, only Dhaka had more control on child malnutrition, compared to the Sylhet division. Birth interval of children was also reported as a significant factor at a 5% level of significance. Finally, the results of this paper strongly highlighted the necessity of increasing parent’s education level, improving the mother’s nutritional status, and increasing facilities providing antenatal care service in order to achieve better nutrition status among under-five children in Bangladesh.
      Citation: Children
      PubDate: 2017-10-19
      DOI: 10.3390/children4100088
      Issue No: Vol. 4, No. 10 (2017)
       
  • Children, Vol. 4, Pages 89: Is There a Causal Relationship between
           Intussusception and Food Allergy'

    • Authors: Emrah Aydin, Omer Beşer, Esra Ozek, Soner Sazak, Ensar Duras
      First page: 89
      Abstract: Although intussusception and food allergy are common health problems in childhood, the relation between these two diseases remain obscure. The aim of this study is to investigate the relationship between food allergy and intussusception, and the factors associated with both. Patients diagnosed with intussusception by the Brighton Collaboration Intussusception Working Group criteria were prospectively investigated for food allergy per the European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) Guideline. They were analyzed per demographic features, clinical, physical and laboratory findings. There were eight (38.1%) patients diagnosed with food allergy, while 13 (61.9%) patients were non-allergic. The mean number of days of presenting symptoms was 1.13 days in the allergy group and 7.85 days in the non-allergy group. The mean number of intussusception attacks was 1.63 in the allergy group while 1 in the non-allergy group (p < 0.05, relative risk (RR) = 2.6). In the allergy group, one (13%) patient was followed up, six (75%) patients were reduced with pneumatic and one (13%) patient reduced manually. In the non-allergy group, four (31%) patients were followed up, six (46%) patients were reduced with pneumotic, one (7%) patient was reduced manually, and resection anastomosis was performed in two (15%) patients. Food allergy is an unrecognized associated factor for intussusception patients, which increases the risk for recurrence. Due to the small patient population, these results should be interpreted with caution.
      Citation: Children
      PubDate: 2017-10-19
      DOI: 10.3390/children4100089
      Issue No: Vol. 4, No. 10 (2017)
       
  • Children, Vol. 4, Pages 90: Sleep Disturbances in Newborns

    • Authors: Daphna Yasova Barbeau, Michael D. Weiss
      First page: 90
      Abstract: The purpose of this review is to serve as an introduction to understanding sleep in the fetus, the preterm neonate and the term neonate. Sleep appears to have numerous important roles, particularly in the consolidation of new information. The sleep cycle changes over time, neonates spend the most time in active sleep and have a progressive shortening of active sleep and lengthening of quiet sleep. Additionally, the sleep cycle is disrupted by many things including disease state and environment, and the amplitude integrated EEG can be a useful tool in evaluating sleep, and sleep disturbances, in neonates. Finally, there are protective factors for infant sleep that are still being studied.
      Citation: Children
      PubDate: 2017-10-20
      DOI: 10.3390/children4100090
      Issue No: Vol. 4, No. 10 (2017)
       
  • Children, Vol. 4, Pages 91: Solitary Intra-Osseous Myofibroma of the Jaw:
           A Case Report and Review of Literature

    • Authors: Anita Dhupar, Karla Carvalho, Poonam Sawant, Anita Spadigam, Shaheen Syed
      First page: 91
      Abstract: Myofibroma is a rare benign spindle cell neoplasm in children that usually affects both soft tissue and bone in the head and neck region. Approximately one third of these cases are seen within jaw bones as solitary lesions. Solitary intra-osseous myofibroma of the jaw bone shares its clinical, radiographic and histological features with other spindle cell tumors. The rarity of this lesion can make diagnosis difficult for clinicians and pathologists. We report a case of a solitary intra-osseous myofibroma in the mandible of a nine-year-old child.
      Citation: Children
      PubDate: 2017-10-24
      DOI: 10.3390/children4100091
      Issue No: Vol. 4, No. 10 (2017)
       
  • Children, Vol. 4, Pages 92: Pediatric Perioperative Pulmonary Arterial
           Hypertension: A Case-Based Primer

    • Authors: Shilpa Shah, Jacqueline Szmuszkovicz
      First page: 92
      Abstract: The perioperative period is an extremely tenuous time for the pediatric patient with pulmonary arterial hypertension. This article will discuss a multidisciplinary approach to preoperative planning, the importance of early identification of pulmonary hypertensive crises, and practical strategies for postoperative management for this unique group of children.
      Citation: Children
      PubDate: 2017-10-24
      DOI: 10.3390/children4100092
      Issue No: Vol. 4, No. 10 (2017)
       
 
 
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