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Children, Volume 5, Issue 3 (March 2018)

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Cover Story (view full-size image) The reliability of wearable photoplethysmography (PPG) sensors to measure heart rate (HR) in [...] Read more.
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Open AccessOpinion Pediatric Melanoma and Drug Development
Received: 19 February 2018 / Revised: 14 March 2018 / Accepted: 14 March 2018 / Published: 20 March 2018
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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
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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. Full article
(This article belongs to the Section Oncology and Hematology)
Open AccessArticle Serum Zinc Level in Asthmatic and Non-Asthmatic School Children
Received: 20 January 2018 / Revised: 8 March 2018 / Accepted: 9 March 2018 / Published: 16 March 2018
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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
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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. Full article
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Open AccessArticle Assessment of the Baby Friendly Hospital Initiative Implementation in the Eastern Mediterranean Region
Received: 30 December 2017 / Revised: 5 March 2018 / Accepted: 6 March 2018 / Published: 11 March 2018
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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
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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. Full article
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Open AccessReview Communicating Effectively in Pediatric Cancer Care: Translating Evidence into Practice
Received: 19 December 2017 / Revised: 5 March 2018 / Accepted: 6 March 2018 / Published: 11 March 2018
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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
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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. Full article
(This article belongs to the Special Issue Pediatric Palliative Care)
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Open AccessArticle Some Socioeconomic Factors and Lifestyle Habits Influencing the Prevalence of Obesity among Adolescent Male Students in the Hail Region of Saudi Arabia
Received: 31 December 2017 / Revised: 26 February 2018 / Accepted: 5 March 2018 / Published: 9 March 2018
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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
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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. Full article
Open AccessArticle Accuracy of a Wrist-Worn Heart Rate Sensing Device during Elective Pediatric Surgical Procedures
Received: 2 November 2017 / Revised: 23 February 2018 / Accepted: 2 March 2018 / Published: 8 March 2018
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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
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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. Full article
(This article belongs to the Section Pediatric Surgery)
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Open AccessCase Report Interdisciplinary Pediatric Palliative Care Team Involvement in Compassionate Extubation at Home: From Shared Decision-Making to Bereavement
Received: 19 January 2018 / Revised: 2 March 2018 / Accepted: 5 March 2018 / Published: 7 March 2018
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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
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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. Full article
(This article belongs to the Special Issue Pediatric Palliative Care)
Open AccessArticle Trends in Pediatric Complicated Pneumonia in an Ontario Local Health Integration Network
Received: 2 December 2017 / Revised: 8 February 2018 / Accepted: 26 February 2018 / Published: 3 March 2018
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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
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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. Full article
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Open AccessArticle An Integrated Theatre Production for School Nutrition Promotion Program
Received: 21 December 2017 / Revised: 8 February 2018 / Accepted: 26 February 2018 / Published: 2 March 2018
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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
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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. Full article
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Open AccessArticle Impact of Supplemental Oxygen on Obstructive Sleep Apnea of Infants
Received: 28 December 2017 / Revised: 9 February 2018 / Accepted: 21 February 2018 / Published: 2 March 2018
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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
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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). Full article
Open AccessArticle The Relationship Between Sleep and Cognition in Children Referred for Neuropsychological Evaluation: A Latent Modeling Approach
Received: 5 December 2017 / Revised: 22 February 2018 / Accepted: 23 February 2018 / Published: 28 February 2018
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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
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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. Full article
(This article belongs to the Section Child Neurology)
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Open AccessReview Emerging Methodologies in Pediatric Palliative Care Research: Six Case Studies
Received: 9 January 2018 / Revised: 13 February 2018 / Accepted: 16 February 2018 / Published: 26 February 2018
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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
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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. Full article
(This article belongs to the Special Issue Pediatric Palliative Care)
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