Results: A total of 2109 neonates were enrolled; the median age was 6 days and 55.7% were males. More than half the newborns (67.5%) visited the ED out of hours, and 99% were nonreferral. The frequency of multiparity and cesarean delivery were 48.9% and 57.4%, respectively. The most common complaints were jaundice (66.3%), irritability (9.3%), vomiting (3.4%), and fever (2.6%). While the hospitalization rate was 13%, 12.8% had a serious illness (sepsis, pneumonia, bronchiolitis, etc.). Serious diseases and hospitalization rates were higher among neonates with low birth weight and prematurity (P < .005, P < .001). Mothers who were primiparous and had their pregnancy at a younger age (<21 years) used EDs frequently for nonserious conditions (P < .05, P < .05, respectively). Early postpartum discharge, admission out of hours, age ≤ 7 days, residence in proximity to the hospital, and primiparity were significantly associated with readmission to the ED within 24 hours (P = .001, P < .001, P < .001, P = .014 and P < .001, respectively).
Italy is one of the few countries in the world where pediatric neuropsychiatry is still a united discipline not following the separation that has been underway for several years between adulthood neurology and psychiatry. However, in practice, many pediatric neuropsychiatrists here operate as if this separation was present, dealing with either neurologic or psychiatric pathologies of the developmental age. Indeed, due to the increasing hyperspecialization of skills, there are some pediatric neuropsychiatrists, in the field of neurology, who deal almost only with epilepsy or neuromuscular diseases, while there are others, in the field of psychiatry, who deal almost only with autism spectrum disorder (ASD). At least partially, this trend towards the hyperspecialization of skills is inevitable due to the recent great progress of neurosciences, but at the same time, this situation entails serious risks for adequate patient care. Each individual, particularly during development, should be considered as a single entity both in physiologic and pathologic situations. A clear distinction between normal neurologic and psychic development is very difficult and probably pointless, especially in the earliest stages of life. This distinction becomes almost impossible when, for some reason, the development of the individual shows domain-specific or global deficits. In this regard, there would be innumerable examples of pathologic conditions whose clinical picture at onset may appear misleading and requires a global neuropsychiatric approach; here we will mention only a few. The first example: a child aged around 2 years showing language delay, potentially the prelude to a specific language disorder, who unfortunately in the following months begins to present a series of signs such as epileptic seizures, ataxia, as well as cognitive, motor, and visual deterioration, leading then, based on the results of instrumental tests, to a diagnosis of neuronal ceroid lipofuscinosis type 2 disease. It is known that the first sign of this disease can be language delay (1). The second example: a boy aged 15 months presenting a mild motor developmental delay, but who after a few months starts to show the classic signs of ASD. A consistent series of data shows that, in ASD, motor type signs, including a delay in the gross motor and fine motor acquisitions, may occur even before the impairment of social communication skills (2, 3). The third example: a girl aged 18 months showing an apparently non-specific global developmental delay, whose clinical picture subsequently becomes more complicated following the loss of acquired skills and the appearance of symptoms including handwashing stereotypies, breathing abnormalities during wakefulness (hyperventilation alternating with apnea), and others, leading to a diagnosis of atypical Rett syndrome, whose onset is often difficult to identify (4, 5). These examples highlight that an overall picture of the developing individual, through a global approach combining both the neurologic and psychiatric perspective, facilitates an adequate diagnostic framework and therefore a correct management. The fact that pediatric neuropsychiatry remains a united discipline is not a legacy of the past, but reflects a modern way of dealing with the neuropsychiatric disorders of the developing individual.
Congenital factor VII (FVII) deficiency is a rare bleeding disorder inherited autosomal recessively (1, 2). It is the most common congenital rare factor deficiency in the world. The clinical picture is variable; it may be asymptomatic or may lead to critical bleeding (3). There is a weak correlation between FVII activity and clinical findings (1, 4). Mucocutaneous bleeding is observed predominantly. Bleeding such as hematoma and hemarthrosis occur rarely compared to patients with haemophilia (1, 3, 4). The clinical picture and follow-up of patients who present with hemarthrosis is similiar to patients with haemophilia. Development of a target joint and subsequent chronic synovitis and arthropathy may be observed. Use of radioisotope synovectomy (RS), which is known to have successful outcomes in patients with haemophilia with secondary prophylaxis and surgical interventions, is limited in patients with FVII deficiency. Here, we share our experience of radioisotope synovectomy in the ankle joint in a patient with congenital FVII deficiency who developed a target joint and chronic synovitis.
Coronavirus disease-2019 (COVID-19) has affected nearly 2 million people and caused up to 100,000 people death worldwide until today. This severe disease has seen less in children than adults. This may be due to the fact that cytokine storm in children is milder, viral load exposure is less than in adults, and angiotensin converting enzyme receptor levels are different from adults. It should be kept in mind that COVID-19 may cause severe illness in infants under 1 year old and in children with chronic diseases such as chronic kidney disease undergoing dialysis, sickle cell disease, chronic liver disease, endocrine disorders, chronic lung disease, cardiovascular disease, immune deficiency, and severe obesity. Fever and cough are the most common symptoms in COVID-19, and children can also be asymptomatic. Laboratory findings are variable in children. Ground-glass opacity, consolidation, patchy shadowing, halo sign, and interstitial anomalies can be detected in lung computed tomography, or it can be normal. In this review, the frequency of COVID-19 in children, differences between adults, the course of pregnancy and newborn, clinical and laboratory findings, and treatment options are reviewed.
The child healthcare system in Ukraine is coordinated and managed at a central level by the Ministry of Health and at a local level by the regional health authorities. The Ministry of Health has executive the power for the implementation of state health policies and controls and manages state-owned health facilities. The system of public funding for the pediatric healthcare system is divided into two sources: central and local. Primary healthcare is organized by the National Health Service of Ukraine. Secondary level healthcare is mostly organized by the Ministry of Health, which gives money for hospitals and medical centers. Since 2014, due to reform and decentralization in Ukraine, local, regional, and city administrations received money from the Ukrainian government for the formation of decentralized budgets.
From a clinical perspective, the possible scenarios of this association are very heterogeneous. The first and most frequent scenario is represented by an individual with ASD presenting epilepsy with very heterogeneous features (with two onset peaks, respectively in early childhood and towards adolescence): focal forms prevail, often benign, with good response to antiepileptic drugs and high chances of suspending the therapy without seizure relapse. Note that epilepsy diagnosis can be complex in individuals with ASD, particularly if an intellectual disability coexists, due to the difficulties in history taking. The main factor favoring the appearance of epilepsy in these individuals is the comorbidity with an intellectual disability. Other favoring factors include cerebral lesions, comorbid rare diseases, and pre-/peri-/neonatal personal antecedents. In this scenario, seizures impact negatively on the quality of life of affected individuals and their families, but do not substantially modify ASD evolution.
Violence in health is an important public health problem that threatens community peace. In our study, it was aimed to examine the state of exposure to violence among employees in our clinic in the last one year and our employees' opinions and attitudes about violence.The study was performed cross-sectionally. In this study the Violent Incident Form developed by Arnetz (1998) was used as a data collection tool.A total of 182 healthcare workers were included in the study. Of the participants, 14 (7.7%) were faculty members, 37 (20.3%) were physicians, 24 (13.2%) were interns, 70 (38.5%) were nurses, 10 (5.5%) were medical secretaries, and 27 (14.8%) were ancillary health personnel. The female/male ratio was 143/39. Seventy-nine (43.4%) of the employees had been exposed to violence at least once in the last year. Of those experiencing violence, 57 (72%) were female, 28 (35%) were nurses, 21 (27%) were residents, 16 (20%) were interns, five (6.5%) were faculty members, five (6.5%) were allied health personnel, and four (5%) were medical secretaries. Physicians were exposed to violence with a higher rate (p<0.05). Exposure to violence was observed most frequently in the pediatric emergency department. Of all the violent incidents, 58% occurred during night shifts and 46% occurred during examination/treatment/physical care. The perpetrator was a patient in only one incident, the other perpetrators were patients' relatives, and 63% of the perpetrators were men. All violent incidents involved verbal violence, seven (8.8%) incidents contained elements of physical violence, such as spitting, pushing, kicking, biting, restraining or using an object. Only 29 (36.7%) of the 79 staff reported violence, and 50 (63.3%) did not take any action after the violence.Violence in health is a common and serious problem even in tertiary hospitals. In our study, only one-third of the affected staff reported violence after exposure to violence. The risk of violence should be reduced in order to ensure a safe work environment, which will be possible by raising awareness of healthcare workers and effective implementation of violence prevention programs.Sağlıkta şiddet toplum huzurunu tehdit eden önemli halk sağlığı sorunudur. Çalışmamızda kliniğimizde çalışanların son bir yıl içerisinde şiddete maruz kalma durumları, şiddetle ilgili görüş ve tutumlarının incelenmesi amaçlandı.Çalışma kesitsel olarak yapıldı. Çocuk Sağlığı ve Hastalıkları Anabilim Dalı’ndaki sağlık çalışanlarının tümüne Arnetz (1998) tarafından geliştiren “Şiddet Olay Formu” anketi uygulandı.Çalışmaya toplam 182 sağlık çalışanı alındı. Katılımcıların 14’ü (%7,7) öğretim üyesi, 37’si (%20,3) asistan doktor, 24’ü (%13,2) intörn doktor, 70’i (%38,5) hemşire, 10’u (%5,5) tıbbı sekreter, 27’si (%14,8) sağlık çalışanıydı. Kadın/erkek oranı 143/39 idi. Çalışanların 79’u (%43,4) son bir yıl içinde en az bir kez şiddete maruz kalmıştı. Şiddete maruz kalanların %72’si kadın ve 28’i (%35) hemşire, 21’i (%27) asistan doktor, 16’sı (%20) intörn doktor, beşi (%6,5) öğretim üyesi, beşi (%6,5) yardımcı sağlık çalışanı, dördü (%5) tıbbi sekreterdi. Doktorların daha fazla şiddete maruz kaldığı görüldü (p<0,05). Şiddete en sık maruz kalınan birim çocuk acil servisti. Tüm şiddet olaylarının %58’i nöbet saatlerinde, %46’sı muayene/tedavi/fiziksel bakım sırasında meydana gelmişti. Saldırgan sadece bir olayda hasta iken, diğerlerinde hasta yakınıydı ve saldırganların %63’ü erkekti. Tüm şiddet olayları sözel şiddet içerirken; yedi şiddet olayında (%8,8) tükürme, itme, tekme atma, ısırma, sıkıştırma, eşya fırlatma gibi fiziksel şiddet unsurları bulunmaktaydı. Şiddete uğrayan 79 çalışanın 50’si (%63,3) şiddet sonrası hiçbir girişimde bulunmazken, sadece 29’u (%36,7) şiddeti bildirmişti.Sağlıkta şiddet, üçüncü basamak hastanelerde bile yaygın ve ciddi bir sorundur. Çalışmamızda şiddet maruziyeti sonrası bildirim oranı 1/3 olarak bulunmuştur. Güvenli çalışma ortamının sağlanması için şiddet riskinin azaltılması, sağlık çalışanlarının farkındalıklarının arttırılması, şiddeti önleme programlarının etkin uygulanmasıyla mümkün olacaktır.
This article describes the child healthcare system in Cyprus up to June 2019. Before that Cyprus used to be the only country in the European Union without a universal National Health System. Up to 2019 child healthcare in Cyprus consisted of two separate sectors: the public and the private system. The public healthcare system is financed by the government, while in the private sector the patients pay themselves or are covered by private insurance. There is easy access to acute medical care in the emergency departments of five public hospitals across the country. However, primary care is not available free-of-charge to all children. Primary healthcare is delivered in the paediatric outpatient departments of various public and private hospitals and clinics, as well as by numerous paediatricians within private practices. Secondary care is provided mainly in the public sector and to a lesser extent in private clinics. Tertiary care is available only centrally in the capital of Cyprus, at a dedicated university-affiliated maternity and children's public hospital with specialist paediatric services. Current major child health challenges in Cyprus include dealing with obesity, mental health, chronic illnesses, and vulnerable groups. However, the basic available health indicators for children show an improving trend over time. A national healthcare system was introduced at the end of 2017 and is expected to remove the inequalities and discrepancies that currently extend over the area of child health by tackling financial, quality, equity, efficiency, and effectiveness issues.
Abstract An early diagnosis of autism spectrum disorder, leading to a timely enabling intervention, is associated with a better long-term prognosis and allows the early detection of any medical comorbidities that are sometimes found in individuals with autism. It is, therefore, an important challenge to begin the diagnostic procedure of these children as soon as possible. Nowadays, much progress has been made in this respect compared with the past, but considerable work remains. A fundamental role in starting a correct and timely diagnostic procedure is obviously played by the pediatrician. Today, many tools are available for the early screening of autism in the general population, but unfortunately, their real effectiveness has yet to be established. In this narrative review, we address the topic of the early diagnosis of autism spectrum disorder, emphasizing, in particular, those that are now considered the first warning signs. We list a few of the most important signs to consider when a child aged around 18 months presents to a pediatrician, subdivided into three subgroups: social-communication skills; patterns of behavior, interests, or activities; and sensory behaviors and reactivity/temperament. We deal separately with the possible presence of slight motor signs, which can also go unnoticed, but probably they should be considered as very early signs appearing even before social-communication deficits.
Invasive fungal infections may cause morbidity and mortality in pediatric patients with hematologic and oncologic malignancies treated with intensive protocols. We present a case of mucormycosis in an 8-year-old boy with acute lymphoblastic leukemia. In our patient, the suspicion for an oculoorbital and paranasal infection only due to mild pain in the orbital area without any abnormal pathologic findings in the ophthalmologic and otolaryngologic examination, led us to an early diagnosis. Despite the use of antifungal therapy, the lesion persisted and fever subsided after surgical drainage of the periorbital abscess. Antifungal treatment continued during chemotherapy. He has been in remission for four years. Mucormycosis should be in the differential diagnosis in infections in children with cancer, especially leukemia, according to clinical and radiologic findings. A high degree of suspicion and prompt systemic empirical antifungal therapy, as well as surgical debridement, are crucial for the survival of patients. Beside antifungals, early surgery plays an important role in patients with mucormycosis.
The child healthcare system in Ukraine is coordinated and managed at a central level by the Ministry of Health and at a local level by the regional health authorities. The Ministry of Health has executive the power for the implementation of state health policies and controls and manages state-owned health facilities. The system of public funding for the pediatric healthcare system is divided into two sources: central and local. Primary healthcare is organized by the National Health Service of Ukraine. Secondary level healthcare is mostly organized by the Ministry of Health, which gives money for hospitals and medical centers. Since 2014, due to reform and decentralization in Ukraine, local, regional, and city administrations received money from the Ukrainian government for the formation of decentralized budgets.
Despite the constant tendency to decrease the number of births, children and adolescents account for one-fifth of the Polish population. Healthcare for children is free and it is organized similarly to the care for adult patients. In primary healthcare, children can be under the medical care of general practitioners, family physicians or pediatricians. In secondary and tertiary care, pediatricians or physicians with pediatric subspecialties provide medical services. The number of pediatricians and nurses is not sufficient and still differs from the European average. Nonetheless, population health indicators (e.g. infant mortality rate) are constantly improving, and despite the strong influence of the anti-vaccine movements, 90% of children are vaccinated according to the schedule.
We report a preterm newborn diagnosed as having congenital cytomegalovirus infection who developed lung cysts during her clinical follow-up. The lung cysts were shown in chest X-ray, and confirmed by thoracic computed tomography. A few weeks after starting ganciclovir therapy, we observed that the cystic lung changes of the patient were completely improved. No adverse effects of antiviral therapy were observed. Based on this presented patient, it should be kept in mind that congenital cytomegalovirus infection may cause lung cysts.
AIM:Malignant melanoma is the most frequent skin cancer in children and adolescents. It comprises 1-3% of all malignancies. In this study, we aimed to evaluate the clinical aspects, histopathologic features, and treatment outcomes of our patients with malignant melanoma.MATERIAL AND METHODS:Patients aged <15 years who were treated between 2003 and 2018 for malignant melanoma were retrospectively analyzed.RESULTS:Seventeen patients (10 females, 7 males), with a median age of 7 years (range, 7 months-13 years) were evaluated. Five patients had congenital melanocytic nevi. All had cutaneous melanoma except one with mucosal (conjunctival) melanoma. The most frequent primary tumor site was the lower extremities (35%). Sentinel lymphoscintigraphy, sentinel node biopsy, and PET/CT were performed as the staging procedures at initial diagnosis. Localized disease was present in eight patients; nine had regional lymph node metastasis. The only treatment was surgery in localized disease; surgery and adjuvant interferon treatment was given in patients with regional lymph node metastasis. Three developed distant metastasis (bone, lung, brain) at a median of 9 months. A three-year-old patient received a BRAF inhibitor (vemurafenib), and a 13-year-old patient received a check point inhibitor (ipilimumab); both died of progressive disease. The median follow-up for all patients was 25 months. The 5-year overall survival was 76.6%.CONCLUSION:Although malignant melanoma is rare in children, prognosis is good if diagnosed early. Physicians should be aware of skin lesions and full-layer biopsy should be obtained in suspicious skin lesions. Patients with congenital melanocytic nevi should also be followed up cautiously.
Childhood hypertension has become a significant public health problem due to increased prevalence in recent decades. High blood pressure causes increased mortality and morbidity in childhood, precedes adult hypertension, and causes increased cardiovascular events in adulthood. These concerns have led to an update of guidelines about childhood hypertension by the European Society of Hypertension in 2016 and the American Academy of Hypertension in 2017. This review highlights the important developments in these guidelines and recent literature about childhood hypertension in terms of diagnosis, prevalence, risk factors, diagnostic tools, prevention and management.
Hypertrophic cardiomyopathy has the highest incidence rate among genetically inherited cardiac diseases. It develops as a result of mutations in genes in related to the sarcomere protein in cardiac muscle. Generally, this results in asymmetrical hypertrophy. Patients who are symptomatic and have a significantly narrow left ventricular undergo should receive surgical treatment, whereas patients with a sudden cardiac death risk should receive treatment with an implantable cardiac defibrillator. This paper presents an infant with hypertrophic cardiomyopathy who was recently identified as having a mutation that resulted in a deletion-insertion type framework shift in the gene MYBPC3, who had family history of sudden death at a young age, and received myectomy and treatment with an implantable cardiac defibrillator in the same session due to a severely narrowed left ventricular outflow tract.
Until 1989, Romania was one of the countries of the communist bloc in Europe and its healthcare system was characterized by centralized planning and severe underfunding, with low performance and low quality healthcare. Since 1998, Romania replaced the Semashko model with a social health insurance system, highly centralized under the management of the Ministry of Health as the central administrative authority. After joining the European Union, quality of life increased in our country and there were efforts to improve the quality of healthcare, including pediatric and neonatal care. Still, Romania has the lowest share of health expenditure of gross domestic product among the European Union Member States and the lowest level of expenditure per inhabitant. The Romanian health system is organized on three levels of assistance: primary, secondary and tertiary assistance. This overview presents the organization and the characteristics of pediatric and neonatal healthcare in Romania at all levels, the infrastructure and the human resources, the educational system from medical school to pediatric residency, professional organizations, national health programs, and the child health status in Romania. Infant mortality, the most descriptive single indicator of the quality of a health system, decreased constantly for the last 30 years in Romania, but is still the highest in the European Union. Even though there were great improvements in the healthcare for children, more efforts should be made to assure a better quality of care for the future of our nation, both on the human resources (in great danger due to the brain-drain of medical professionals during the last 12 years), and on the infrastructure plan.
