Background: Epilepsy remains one of the major causes of neurological disorders affecting children worldwide, with a disproportionately high burden reported in low- and middle- income countries. Electroencephalography (EEG) remains a fundamental tool for diagnosis and classification of epilepsy, yet region-specific data on pediatric electroencephalographic findings are limited in South-South Nigeria. Aim of the work: to characterize the clinical indications and EEG findings among children evaluated for epilepsy in a tertiary healthcare institution located in Benin City, South-South Nigeria. Subjects and Methods: A retrospective descriptive cross-sectional audit of 260 EEG records of children aged between 0–11 years; was carried out at the Pediatric Neurology Clinic, University of Benin Teaching Hospital (UBTH) during April 2025 - December 2025 of 283 children who presented to the center in the same duration. The EEG recordings were obtained using a standard 19-channel digital system following the international 10-20 electrode placement and interpreted by consultant neurologists using the International League Against Epilepsy (ILAE) terminology. Results: The mean age of participants was 2.8 ± 2.0 years, (median age was 2.6 years; IQR:1-4 years). Males comprised 159 (61%) of the cohort. Recurrent seizures 220 (84.6%) were the leading indications for EEG referral. Overall, 230 (88.5%) of EEG findings were abnormal. Epileptiform abnormalities were observed in 194(74.6%) participants and comprised focal epileptiform discharges in 100 (38.5%), followed by generalized epileptiform discharges in 66 (25.4%), and multifocal abnormalities in 28 (10.8%) participants. On the other hand, non- epileptiform abnormalities (background slowing) were identified in 36 (13.8%) participants. While sex was not significantly associated with EEG results (p = 0.277), younger age was associated with EEG abnormalities (p < 0.001). Conclusion: A high burden of abnormal EEG findings was observed in this study underscoring the critical role of EEG in pediatric epilepsy evaluation. The findings highlight the need for improved access to EEG services and advanced neurodiagnostic modalities in resource-limited settings.
ackground: Neonatal pneumothorax (PTX) is a detrimental condition associated with high mortality and morbidity rates. Aim of the work: to study the frequency of pneumothorax in Neonatal Intensive Care Unit (NICU) at Cairo University Hospital, its risk factors, and outcome. Subjects and Methods: All neonates diagnosed with PTX admitted to NICU, Cairo University Hospital were included in this prospective study during January 2022 to 31st December 2022 (12 months). PTX was confirmed by the presence of air in the plural cavity by chest roentgenogram. Results: Among the 480 admitted neonates, 36 (7.5%) developed PTX during the study period. The gestational age (GA) ranged from 26 –39 weeks with a mean (± SD) of 34 ± 3.4 weeks. Of them 15 (41.67%) males and 21 (58.33%) females. All needed respiratory support; nasal cannula in 1 (2.78%) case, nasal continuous positive airway pressure (NCPAP) in 1 (2.78%) case, mechanical ventilation (MV) in 32 (88.89%) cases and high frequency oscillation ventilation (HFOV) in 2 (5.56%). Only 2 (5.56%) had spontaneous PTX, while underlying disease was respiratory distress syndrome (RDS) in 17 (47.22%), neonatal pneumonia in 9 (25%), meconium aspiration in 4 (11.11%), transient tachypnea of newborn in 3 (8.33%) and congenital cystic adenomatoid malformation in 1 (2.78%). Associated complications were intracranial hemorrhage in 17 (47.22%), sepsis in 16 (44.44%), necrotizing enterocolitis (NEC) in 7(19.44%), retinopathy of prematurity (ROP) in 5(13.89%), pulmonary hemorrhage in 4(11.4%), and bronchopulmonary dysplasia (BPD) in 3(8.33%). PTX was bilateral in 6(66.7%). Of those with PTX 15 (41.6%) died. Mortality rate was associated with prematurity (p=0.049), bilateral pneumothorax (p=0.002), and IVH (p= 0.032). Conclusion: PTX was encountered among 7.5% of the studied cohort of neonates admitted to Neonatal Intensive Care Unit. Mortality rate in those with PTX was higher if there were associated with prematurity, bilateral pneumothorax, and IVH.
Background: Nutrition is crucial for growth, development and overall functioning of a child. Nutrition education is a critical component of health promotion and disease prevention programs. Mothers with higher education are more likely to integrate in nutrition counselling programs and get most benefits of it. Aim of the work: to study the knowledge attainment after using the card of the Integrated Management of Childhood Illness (IMCI) program of WHO for nutritional counseling of mothers of infants. Subjects and Methods: A descriptive cross-sectional study that included 107 mothers of infants aged from 6 months- 2 years. They underwent breastfeeding and weaning practice counseling using a visual tool (mother illustrated card of IMCI program) and verbal counseling. Assessment of knowledge using pre- and post- educational questionnaires about proper nutrition practice recommended by WHO/UNICEF for infant’s feeding (2001) in Arabic language were employed. Results: The mean ± SD age of mothers who attended the counselling sessions was 28 ± 5.28 years (range 18 to 41 years). Of them 52 (48.6%) were highly educated (mean age± SD: 28.17±4.11 years) while the remaining 55 (51.4%) were school educated or illiterate (mean age ±SD 27.98±6.14 years) (p=0.852). A statistical short-term improvement of the maternal knowledge was noted after medical counseling and during the follow up visits (5 days later). Mean maternal knowledge scores before, immediately after and 5 days after nutritional education was 8.14±3.44, 21.64±2.04, 19.28±3.64 respectively (p = <0.001). Mean maternal knowledge scores of the highly educated before, immediately after and 5 days after nutritional education was 8.711±3.577, 21.269±2.285, 19.25±3.667, and for the less educated group was 7.618±3.286, 22±1.785, 19.309±3.676, (p=0.102, p=0.067 and p=0.934) respectively. Conclusion: Nutritional counseling using the card derived from the IMCI program was effective in delivering information for proper infant nutrition (breastfeeding and weaning practice) irrespective of maternal illiteracy or level of education.
Olive oil has been reported to reduce morbidity through its possible nutrigenomic role and improve the age-related disease through its nutraceutical role. We report a toddler with bile acid synthesis defect (BASD) type 2 associated with homozygous missense mutation in exon-2 of the AKR1D1 gene NM_005989.4:c236G>c, NP_005980.1:p.(Arg79Thr) who presented at the age of 5 months with liver cell failure and intracranial hemorrhage. Her condition worsened on ursodeoxycholic acid (UDCA). Cold compressed extra virgin olive oil was introduced 5ml every 3 hours and UDCA acid was withdrawn over 4 weeks. Within 2 months the jaundice disappeared. Now, at the age of 20 months she is still on the olive oil, she has no jaundice, no seizures, she has minimal divergent squint of left eye -corrected by eye glasses-, no liver cell failure, no splenomegaly, and she achieved the expected mental and motor milestones for age. Olive oil controlled the BASD gene expression in our reported case and allowed liver and functional recovery with normal global mental and developmental development.
Background: Klippel-Feil syndrome (KFS) is a rare congenital disorder characterized by fusion of two or more cervical and/or thoracic vertebrae. Although classically associated with a short neck, low posterior hairline, and limited cervical mobility, KFS has a wide spectrum of clinical presentations. Aim of the work: to provide a comprehensive overview of pediatric presentations and associated anomalies in KFS. Subjects and Methods: A PubMed search identified case reports of patients under 21 years of age with KFS published within the past 10 years. Patients were categorized by age using FDA and American Academy of Pediatrics guidelines. Associated conditions were grouped by ICD-10 classification. Chi-square analysis was used to assess differences across age groups. Results: A total of 73 pediatric patients with Klippel-Feil syndrome (KFS) were identified across 61 published articles (31 males, 41 females, 1 unknown). Children aged 2-11 made up the highest proportion of case reports 28/73 (38.4%). Additional congenital anomalies were present in 70 (95.9%) patients, with only 3 (4.1%) cases representing isolated KFS. Among those with associated anomalies, scoliosis 33/73 (45%) and Sprengel deformity 9/73 (12%) were most common. The musculoskeletal system (MSK) was most frequently affected 55/73 (75.3%), followed by neurologic 16/73 (21.9%) and cardiovascular (15.1%) involvement. Overall, MSK and congenital anomalies predominated, with variable distribution across age groups and limited statistical significance in observed trends. Conclusion: Pediatric KFS is frequently associated with multisystem congenital anomalies, particularly involving the MSK, neurologic, and cardiovascular systems, with a substantial proportion requiring intervention. These findings underscore the importance of routine, multidisciplinary evaluation and screening in cases identified in infancy, childhood, and adolescence to identify associated conditions and improve long-term outcomes.
Background: The chromosomal trisomy 21 known as Down syndrome (DS), is frequently associated with congenital structural heart disease, and functional abnormalities. Aim of the work: to evaluate systolic and diastolic cardiac function in children with DS and structurally normal hearts. Subjects and Methods: This cross-sectional case- control study included 80 children with Down syndrome confirmed by karyotyping, with structurally normal hearts, and were regularly monitored at Cairo University Specialized Children's Hospital's Pediatric Genetics Clinic and 80 healthy age and sex matched children as a control group. They all underwent tissue Doppler imaging (TDI), two-dimensional, and M-mode echocardiography. Results: The mean age of the studied DS patients was 2.5±1.54, 47(58.8%) were males, and 74(92.5%) had non-disjunction genetic types. Compared to controls, DS patients exhibited significantly lower systolic and diastolic blood pressures and higher heart and respiratory rates (p˂0.001). Conventional indices (EF% and FS%) were paradoxically elevated in DS (p˂0.001), whereas longitudinal function markers were markedly reduced: tricuspid annular plane systolic excursion (TAPSE) (16.0±2.59 vs 18.52±3.30, p˂0.001), mitral annular plane systolic excursion (MAPSE) (12.4±2.15 vs 15.04±2.94, p˂0.001), and TDI-derived LV and RV S′ velocities (p˂0.05). Decreased LV E′/A′ ratios and myocardial performance index (MPI) confirmed global dysfunction(p˂0.001). In absence of associated comorbidities, heart rate (cut off above 94 beats/minute) and systolic blood pressure (SBP) percentiles (cutoff ≤ 55th percentile) each predicted reliably LV systolic dysfunction, showing sensitivities of 84% and 81%, and specificity of 71% each. No significant effect of age, sex, BMI z-score, or genetic subtype on ventricular function was observed (p=0.78, p=0.34, p=0.33, and p= 0.99 respectively). Conclusion: Children with DS exhibit subclinical impairment of both left and right ventricular function despite structurally normal hearts. HR above 94/minute and lower SBP percentile less than 55th percentile for age predict LV systolic dysfunction and may serve as a simple practical bedside screening tool.
Background: Hemodynamics and cardiac function monitoring are crucial for management of the critically ill neonates. Conventional transthoracic echocardiography (TTE) remains the gold standard for assessing cardiovascular hemodynamics, but is limited by being intermittent and operator-dependent. Aim of the work: to identify the ability of electric cardiometry-derived contractility indices to detect left ventricle (LV) systolic dysfunction in clinically unstable newborns. Subjects and Methods: This cross-sectional study included 120 neonates, divided into two groups; 75(62.5%) hemodynamically stable, and 45 (37.5%) unstable. Demographic and clinical data were recorded. Both groups were assessed by electrical cardiometry (EC) and conventional m-mode and pulsed Doppler TTE simultaneously. Results: The study included 120 newborns, comprising 63 (52.5%) males and 57 (47.5%) females, with a mean postnatal age of 9.89 ± 8.24 days; of these, 83 (70%) were preterm and 37 (30%) were full-term. Using EC, hemodynamically unstable neonates demonstrated significantly lower stroke volume (SV) (3.26 ± 1.13 ml), stroke index (SI) (21.35 ± 5.87 ml/m²), cardiac output (CO) (0.49 ± 0.16 L/min), cardiac index (CI) (3.24 ± 0.85 L/min/m²), index of contractility (ICON) (73.02 ± 24.96), and left ventricular ejection time (LVET) (149.2 ± 49.36 ms) compared with the stable group values of SV (4.27 ± 1.18 ml), SI (27.73 ± 5.98 ml/m²), CO(0.62 ± 0.18 L/min), CI (3.92 ± 0.89 L/min/m²), ICON (103.22 ± 35.61), and LVET (172.04 ± 27.97 ms) (p < 0.001, p < 0.001, p < 0.001, p < 0.001, p < 0.001, and p = 0.006, respectively). The SV, CO, CI, and SI measurements between TTE and EC showed a strong significant correlation (r 0.993, p <0.001; r 0.990, p<0.001; r 0.969, p<0.001; r 0.973, p<0.001, respectively). Additionally, EC-derived ICON showed a strong positive correlation with echocardiographic fractional shortening (FS%) (r = 0.770, p < 0.001) and ejection fraction (EF%) (r 0.721 and p < 0.001). An ICON value below 65.9 predicted reduced contractility (FS <28% and ejection fraction <50%) with high sensitivity (96%) and good specificity (83%). None of the demographic or clinical variables had a significant effect on ICON values. Conclusion: EC provides a reliable, non-invasive, operator-independent tool for continuous cardiac monitoring in sick neonates. EC-derived ICON value below 65.9 is diagnostic for LV systolic dysfunction in critically sick newborns.
Negative pressure pulmonary edema (NPPE) is a known non-cardiogenic complication of upper-airway obstruction, yet it remains underrecognized in children. Although laryngospasm is well reported, the role of post-extubation tongue fallback as a trigger for NPPE has not been described in the literature. Delayed emergence from anesthesia, due to synergistic effects of anesthetic agents, can reduce airway tone and predispose to transient backward and downward displacement of the tongue (glossptosis) which may trigger NPPE. While post-extubation tongue fallback is usually benign and easily corrected, even a brief obstruction in a struggling child can generate sufficient negative intrathoracic pressure to cause NPPE. A brief tongue fallback can rapidly evolve into life-threatening NPPE within minutes. We report a child who developed acute NPPE after extubation from transient tongue fallback despite standard extubation practices, with full recovery after rapid recognition and supportive care. The child was tachypneic and started having recurrent cough and on auscultation there were de-novo coarse crackles heard on both lung fields more extensively on the left side of the chest. Immediate chin lift and jaw thrust maneuvers were performed, mouth opening for laryngoscopy showed a posteriorly displaced flaccid tongue obstructing the supraglottic area causing airway occlusion with no laryngospasm. Chest X-ray revealed bilateral diffuse pulmonary infiltrates suggestive of pulmonary edema. The child responded to furosemide and hydrocortisone. The child recovered uneventfully. NPPE diagnosis was based on high index of clinical suspicion and close monitoring in our reported child. Clinicians and medical staff should maintain high index of suspicion for NPPE in any child with post-extubation airway obstruction, as early identification and prompt management are critical to preventing NPPE.
Background: Diabetic Ketoacidosis (DKA) is a life-threatening complication and a leading cause of hospitalization in patients with type 1 Diabetes (T1D). Aim of the work: to assess the effect of parental illiteracy and other demographic characteristics on severity of DKA in children and adolescents with T1D. Subjects and Methods: This cross-sectional study included 78 children and adolescents with established T1D recruited over 6 months, presenting with DKA at the Intensive Care Unit (ICU), Cairo University Children's Hospital, Cairo, Egypt. Results: The mean age ± SD of the study group was 9.90±2.01 years. The group comprised 40 (51.3%) males and 38 (48.7%) females with mean diabetes duration of 3.2±1.0 years. Mean duration of hospital stay was 7±2.01 days. None of the participants experienced complications, as cerebral edema or renal or hepatic impairment. DKA was precipitated by poor nutritional control in 32 (41.1%), intercurrent infections in 24 (30.8%) and 17 (21.8%) were non-compliant and skipped insulin doses (p=0.025, 0.032 and 0.01 respectively). Multinomial logistic regression revealed that the most significant predictors of the severity of DKA were the female sex, the lesser educational level of the father, low family income, diabetes duration, infection, poor diet control, non-compliance to insulin therapy (p= 0.028, p=0.007, p<0.001, p=0.046, p<0.001, p<0.001 and p<0.001) respectively. There was a positive correlation between the severity of DKA and the mean HbA1c (p= 0.03). There was no statistically significant association between DKA severity and participants’ age, disease duration, body mass index (BMI), or maternal educational level (p=0.742, p=0.443, p=0.412, p=0.453 respectively). Conclusion: In our study, female sex, low educational level of father, low family income, diabetes duration, infection, poor diet control, non-compliance to insulin therapy predicted severe DKA. Both clinical and social determinants contribute to increased severity of DKA. Recognition of these predictors allows for the stratification of high-risk groups and developing targeted interventions.
Background: Etiology of most congenital heart diseases (CHDs) is multifactorial, they include genetic and environmental factors. Interleukin-6 (IL-6) gene variant rs1800795 was reported to be associated with CHD among Chinese children. Aim of the work: to study the relationship of IL-6 rs1800795 gene variant and circulating serum IL-6 level in children with CHD. Subjects and Methods: This cross-sectional case control study included 100 Egyptian children (6 months to 16 years), of both sexes. Of them 50 patients with confirmed CHD (cyanotic and acyanotic) -free of other associated disease-, and 50 age and sex matched apparently healthy children. The rs1800795 variant of IL-6 gene was genotyped using TaqMan real-time polymerase chain reaction (PCR). The level of serum IL-6 was measured by ELISA for all participants. Results: The CHD comprised 25(50%) males and 25(50%) females with transposition of great arteries in 2(4%), ventricular septal defect in 10(20%), pulmonary stenosis in 6(12%), atrial septal defect in 10 (20%) and patent ductus arteriosus in 10 (20%), double outlet right ventricle in 1 (2%), Fallot tetralogy in 3 (6%), pulmonary atresia in 2 (4%), coarctation of aorta in 3 (6%) and partial anomalous pulmonary venous return in 1 (2%). Their mean age of 2.77 ± 1.81years, was comparable to the control group of 24 males and 26 females (p=0.841) and a mean age of 2.55 ± 1.43 years (p=0.511). Children with CHD exhibited significantly elevated serum IL-6 levels compared to healthy controls (338.68 ± 53.03 vs 136.9 ± 31.53 p < 0.001). An inverse correlation was identified between serum IL-6 titres and oxygen saturation (r= -0.300, p= 0.034). There was no correlation between IL-6 level and pulmonary hypertension (p=0.272), or heart failure (p=0.842). Il-6 gene variant rs 1800795 (cc, cg) was observed in 16(32%), 18(36%) with CHD respectively versus 8(16%) and 12(24%) of healthy control children (p=0.017). An increased trend of rs1800795 CC genotype and C allele was detected in the CHD patient group (p=0.017, p=0.001). IL-6 gene variant, and alleles were comparable between cyanotic and acyanotic heart diseases (p=0.925, p=0.317) respectively. Conclusion: Our studied Egyptian cohort of children with CHD had associated high serum IL-6 level and preponderance of IL-6 gene variant rs1800795 compared to the healthy matched control group. The IL-6 level negatively correlated with oxygen saturation. Longer prospective studies are needed to verify IL-6 role in disease susceptibility and progression.
Background: Fibroblast growth factor 21 (FGF21) is an endocrine hormone expressed by the liver. It boosts glucose and lipid metabolism, and insulin sensitivity. Aim of the work: study the accuracy of FGF21 in diagnosis of metabolic associated fatty liver disease (MAFLD) in obese children. Subjects and Methods: Children recruited from the Obesity Clinic, Children's Hospital, Ain- Shams University were enrolled in the study. Anthropometric data, biochemical test results; including liver function tests, fasting lipid profile, serum glucose, serum insulin, insulin resistance -assessed by calculating HOMA-IR-, liver ultrasound score for MAFLD, and FGF21 levels were analyzed by ELISA. Patients were subdivided by ultrasound into group A obese children with normal liver and group B obese children with fatty liver. Results: This study included 39 (60%) males and 26 (40%) females, with mean ± SD age of 10.17 ± 2.54 years. Their body mass index (BMI) standard deviation score (SDS) was 3.36 ± 0.61, the mean waist/hip ratio (W/H ratio) was 0.93 ± 0.12, mean± SD systolic blood pressure was 1.36 ± 1.47 and diastolic blood pressure was 1.76 ± 0.84. 32 (49%) cases had insulin resistance (mean HOMA-IR = 3.81 ± 3.01), 21(32%) fulfilled the criteria of metabolic syndrome and 27 (41.5%) had MAFLD. Group A included 38 (58.8%) cases, and group B included 27 (41.5%) cases. Patients in group B had statistically higher SDS of BMI, SDS of waist circumference, SDS of hip circumference (p-value= < 0.001, p < 0.001, and p < 0.001 respectively). In group A 12 (31.5%) had dyslipidemia, 1(2.6%) had elevated TG and low HDL, 2 (5.3%) had elevated cholesterol and elevated LDL, 7 (18.4%) had elevated LDL and 2 (5.3%) had low HDL, while in group B, 22 (81.4%) had dyslipidemia, 10 (37%) had elevated TG, 16 had low HDL, 20 (74%) had increased LDL and 7(25%) had increased cholesterol (p=0.001). Mean FGF21 was 169.08 ± 153.68 pg/dl after 12 hours fasting (normal value= up to 115 pg/dl in children. Mean ± SD FGF21 in group A was 96.05 pg/dl ± 39.70 with median 90 pg/dl, while mean FGF21 in group B was 271.85 pg/dl ± 192.69 SD with median 180 pg/dl (p=0.001). FGF21 cutoff value of 115 pg/dl was diagnostic of fatty liver with sensitivity of 88.9%, specificity of 73.7% (p=0.001). FGF-21 correlated positively with US finding (p=0.001). Conclusion: Obese children with MAFLD had higher levels of FGF21. FGF21 value of 115 pg/dl may be added as a non-invasive biomarker for the diagnosis of MAFLD in obese children.
Background: Inflammatory bowel disease (IBD) and celiac disease are characterized by chronic intestinal inflammation, and extra-intestinal manifestations. Aim of the work: To assess if hypothyroidism is a contributing factor in short stature in children with IBD and celiac disease. Subjects and Methods: This cross-sectional study included 150 children divided into three groups (50 in each group). Group A included those with confirmed IBD and group B with confirmed celiac disease. Group C included healthy children as a control group. All children underwent detailed anthropometric measurements, and ELISA test for TSH, free T4, and free T3 levels. Results: The IBD group mean ± SD (median, range) age was 7.68 ± 3.27 (7.34, 1.69 – 14.46) years, 19 (38%) were females and 31(62%) were males. The celiac disease group mean ± SD (median, range) age was 9.42 ± 3.79 (7.55, 1.52 – 15.36) years, 25 (50%) were females and 25 (50%) were males, compared to the control group mean ± SD (median, range) age of 9.88 ± 3.25 (9.58, 3.49 – 16.53) years, 29 (58%) were females and 21 (42%) were males (p= 0.04, p= 0.095 respectively). The mean ± SD (median, range) of disease duration of IBD was 4.06 ± 2.1 (2.85, 1.6-9.2) years, while the mean ± SD (median, range) of disease duration of celiac disease was 4.39 ± 2.4 (4-, 1.55-12.5) years (p=0.5). The mean ± SD (median, range) weight Z score of IBD group was -0.42 ± 1.53 (-0.65, -4.24 – 2.42), and height Z score was -1.08 ± 1.6 (0.98, -3.64 –1.47), while the mean ± SD (median, range) weight Z score of celiac disease group was -0.72 ± 1.44 (-0.85, -3.68 – 2.24), and height Z score was -1.57± 1.29 (-1.4, -4.58 – -0.76) compared to the mean ± SD (median, range) weight Z score of the control group of -0.28 ± 0.89 (-0.29 , -1.6 – 1.87) , and height Z score was -0.53 ± 1.02 (-0.54-, -1.77–1.32) (p =0.008, p=0.000 respectively). Short stature (height Z score< -2 SD), was present in 17 (34%) of patients in celiac group, 13 (26%) of patients in IBD group and none of the control group (p=0.001). All had normal T3, T4 and TSH levels. Conclusion: Short stature is common among children with IBD and celiac disease. Hypothyroidism is not a main cause of short stature in IBD and celiac disease, other contributing factors to short stature in IBD and celiac disease should be searched for.
Background: Congenital heart diseases (CHDs) remain a significant global health burden and a leading cause of child mortality. However, limited evidence exists regarding the factors associated with CHDs, particularly in Indonesia. This study aims to identify factors associated with congenital heart defects (CHDs) in children. Methods: A case-control study was conducted using secondary data from pediatric cardiology patients at Ngoerah Hospital between 2021 and 2023, extracted from pedcardiobali.com. Patients aged 0–18 years who were diagnosed with CHD via echocardiography were included in the case group. Those with normal echocardiographic findings comprised the control group. Patients with incomplete medical records were excluded from the study. A total of 300 eligible subjects were selected, with 150 assigned to each group using a combination of purposive and random sampling methods. Multivariate logistic regression analysis was performed using SPSS version 29.0. Results: Among the 300 subjects, low birth weight (<2,500 grams) was significantly associated with CHDs (OR 3.365; 95% CI: 1.48–7.65; P = 0.004). Prematurity, maternal alcohol consumption, and congenital anomalies were identified as potential confounding factors (OR 1.19; 95% CI: 0.61–2.35; P = 0.61; OR 1.65; 95% CI: 0.45–6.06; P = 0.45; OR 1.98; 95% CI: 0.56–6.94; P = 0.29, respectively). No significant associations were found with maternal or paternal age, multiparity, multiple gestation, smoking, family history of CHDs, or maternal infection. Conclusion: Low birth weight is a dominant factor associated with CHDs. Early prenatal care and targeted interventions are crucial in reducing this risk. Further research is warranted to investigate the underlying mechanisms and genetic contributions to coronary heart disease (CHD).
Introduction: Children with Congenital Heart Disease are at high risk of feeding and growth problems. Nutrition practices for children with CHD still vary widely across institutions, including breastfeeding. This study aims to conduct a critical review to compare the effects of breastfeeding versus formula on the growth of infants with congenital heart disease. Methods: The article search was conducted online using the PubMed, EBSCO, and ProQuest databases with the keywords “Congenital Heart Disease,” “Human Milk,” “Formula,” and “Growth.” Result: Two articles were obtained in the form of systematic review studies. Results of the study stated that in infants with CHD with breastfeeding compared to formula milk Weight for age score is better with breastfeeding because breast milk is easier to digest Conclusion. Breast milk has been shown to have significant benefits on the growth of infants with CHD compared to formula, especially in terms of weight-for-age z-score.
Introduction: Refraction is the ability of the eye to refract light, which is divided into 3 categories of refractive status (RS), namely emmetropia, myopia, and hypermetropia. Increasing age in school-age children is also accompanied by the development of intraocular pressure (IOP) and accommodation amplitude (AA) values, which are assumed to affect retinal sensitivity (RS). Therefore, this study aims to investigate the effects of partial and simultaneous interactions between age, intraocular pressure (IOP), and age-related macular degeneration (AA) on retinal sensitivity (RS) in school-age children. Methods: This cross-sectional study utilized 236 eyeballs from children aged ≤18 years who consented to participate and completed all eye examinations at the Al-Ikhlas Singosari Orphanage in Malang. Variables included age, IOP, AA, and RS converted into spherical equivalent (SE). Data analysis employed partial and simultaneous regression tests. Result: Partially, increased age, IOP, and decreased AA influenced myopia (6.6%, 33.3%, and 19.1%, respectively), while reduced age, increased IOP, and increased AA influenced hypermetropia (14.3%, 47.2%, and 12.2%). Simultaneously, these variables affected myopia RS by 0.6% and hypermetropia RS by 2.6%, though not significantly. Conclusion: Age, IOP, and AA show effects on myopia and hypermetropia RS both partially and simultaneously, but the influence is small and insignificant.
Background: Tuberculosis (TB) remains a major global health challenge, particularly among children. Diagnosing pediatric TB is complicated due to nonspecific symptoms and the difficulty of obtaining sputum samples for microbiological confirmation. Immunological tests, such as the tuberculin skin test (TST) and interferon-gamma release assays (IGRAs), are commonly used to support diagnosis. However, TST has several limitations, including the need for multiple patient visits and potential cross-reactivity with Bacillus Calmette-Guérin (BCG) vaccination. This study aimed to compare the efficiency of IGRA and TST in terms of turnaround time and patient compliance. Methods: A diagnostic time comparison study was conducted in pediatric patients with suspected pulmonary or extrapulmonary TB at Saiful Anwar Hospital, Malang. Patients underwent both TST and IGRA testing. The time required to obtain results and patient compliance was recorded and analyzed. o Results: A total of 94 pediatric patients were included, with 17 diagnosed with extrapulmonary TB and 77 with pulmonary TB. IGRA demonstrated a significantly shorter turnaround time (25.43 ± 6.31 hours for pulmonary TB, and 25.58 ± 6.37 hours for extrapulmonary TB) compared to TST (50.16 ± 6,93 hours for extrapulmonary TB and 50.34 ± 7.16 hours for pulmonary TB). Additionally, IGRA provided higher positivity rates in both pulmonary and extrapulmonary TB cases. Conclusion: IGRA offers a faster and more convenient alternative to TST for diagnosing pediatric TB. Despite its higher cost, the efficiency and single-visit requirement of IGRA makes it a preferable diagnostic tool in clinical settings, especially for children suspected of having TB.
Introduction: Congenital Rubella Syndrome (CRS) is characterized by congenital cataracts, congenital heart disease (CHD), hearing loss, and developmental delay. It is caused by maternal rubella infection during pregnancy, transmitted transplacentally or via respiratory droplets. CRS carries a high risk of morbidity and mortality, with approximately 10–20% of affected infants dying within the first year of life. This case report describes a 15-year-old boy with CRS who developed pulmonary hypertension (PH) due to a persistent patent ductus arteriosus (PDA). Case Description: A 15-year-old boy presented with progressive abdominal distension over one week. Initially suspected of having nephritic syndrome, further evaluation revealed bilateral congenital cataracts, non-cyanotic CHD in the form of PDA, sensorineural hearing loss, and developmental delay, fulfilling criteria for CRS. The patient also exhibited delayed motor milestones (walking at age seven) and limb rigidity suggestive of cerebral palsy (CP). Echocardiography confirmed PDA (0.4 cm) with severe tricuspid and aortic regurgitation, and chest X-ray demonstrated cardiomegaly with PH. The PDA was successfully closed using an Amplatzer Duct Occluder (ADO) via catheterization. Conclusion: This case underscores the importance of early diagnosis and intervention in CRS patients with PDA to prevent irreversible pulmonary vascular disease. Despite a very late PDA closure at age 15, the patient achieved hemodynamic improvement and maintained functional capacity, highlighting that catheter-based closure remains feasible and beneficial even in adolescence. Multidisciplinary care, including timely cardiac intervention and neurodevelopmental support, can improve quality of life in CRS survivors.
Peanut allergy in children is a growing public health concern that significantly affects patients' quality of life. Although oral immunotherapy (OIT) has shown effectiveness in desensitizing allergic reactions, it is associated with a threefold increased risk of anaphylaxis compared to strict avoidance. As an alternative, epicutaneous immunotherapy (EPIT) has emerged as a promising therapy due to its favorable safety profile, ease of administration, and non-invasive nature. However, despite increasing interest in EPIT, there is still limited evidence assessing its efficacy and safety in pediatric populations. This literature review aims to summarize current findings on the mechanism of desensitization, clinical efficacy, safety, and impact on quality of life associated with EPIT in managing peanut allergy in children. Relevant articles were identified through database searches in PubMed, Cochrane, Science Direct, Scopus, and Google Scholar using Medical Subject Headings (MeSH) and keyword combinations such as "Epicutaneous Immunotherapy", "Peanut Allergy", and "Pediatric Allergy". EPIT works by delivering peanut allergens through a patch applied to intact skin. The allergen is taken up by Langerhans cells and presented to the immune system, triggering regulatory T-cell (Treg) responses that reduce allergic sensitivity. Viaskin© is the most clinically advanced EPIT delivery system currently available. Findings from clinical studies indicate that EPIT is effective in inducing desensitization, with a lower risk of systemic reactions compared to OIT. Furthermore, EPIT contributes to improved quality of life in children with peanut allergy. These results support EPIT as a promising therapeutic option for pediatric peanut allergy management.
