To improve clinicians' understanding, and to explore the diagnosis and treatment of pregnancy complicated with patent urachus. The clinical symptoms, ultrasound images, and delivery outcome of the pregnancy complicated with patent urachus were reported, and the literature was reviewed. The patient had umbilical leakage as a young child occasionally, the symptom of leakage was not obvious after she was 10 years old, and there was no asymptomatic before pregnancy and in the first and second trimesters. Umbilical leakage was present at gestational 33 weeks, and ultrasound showned a tubular structure (0.7 cm in width) was connected between the top of the bladder and the umbilicus, and there was anechoic areas inside. The pregnancy complicated with patent urachus was diagnosed. The patient was checked regularly, and kept the umbilicus clean and dry. Premature rupture of membranes occured at gestational 39 weeks 4 days. The patient was admitted to the obstetrics department, and she deliveried finally. After delivery, the symptoms of umbilical leakage urine relieved, and an elective resection of abnormal urachus was planned. The patent urachus creates a tube connection between the umbilicus and the anterosuperior wall of the bladder, it was termed an median umbilical ligament at birth as usual, which still communicated with the bladder after birth. The main clinical manifestations were umbilical leak and infection, which were the main diagnostic basis. Ultrasound, CT and MRI were important auxi-liary examination methods.The patients with symptoms in the neonatal and early childhood period were managed actively and had the potential for self resolution, especially for the children younger than 1 year. Therefore, patients under 1 year of age were offered surgery only if they had recurrent infections or failed to selfresolve. It is recommended to remove abnormal urachus before pregnancy for the women complica-ted with patent urachus. If the patent urachus was found during pregnancy, the umbilicus should be kept clean and dry to avoid infection. The pregnancy complicated with patient urachus is not contraindicated to vaginal delivery.
Humans ; Female ; Pregnancy ; Urachus/surgery* ; Pregnancy Complications/surgery* ; Adult ; Infant, Newborn

OBJECTIVES: Injuries are the leading cause of death among children and adolescents. Although numerous risk assessment tools for unintentional injuries in children have been developed and published both domestically and internationally, there is currently no global consensus on standardized use. This study aims to systematically characterize existing unintentional injury risk assessment tools for children aged 0-6 years, with the goal of informing scientific tool selection and optimization. METHODS: Relevant literature published up to January 2025 was retrieved from CNKI, Wanfang, PubMed, and Web of Science. An information extraction form was developed to gather data on the basic features of each assessment tool, assessment format, scoring methods and criteria, dimensions assessed, reliability and validity, and types of unintentional injuries covered. RESULTS: A total of 50 risk assessment tools for unintentional injuries among children aged 0-6 years were included. Among them, 35 tools assessed two or more types of unintentional injuries. Regarding assessment format, 38 tools relied on caregiver self-report, 2 on investigator interviews, 3 on direct observation by investigators, and 7 used multiple methods. The tools covered four major dimensions: knowledge, attitude, behavior, and environment. Eleven tools covered 3 dimensions, while only one tool addressed all 4. Nineteen tools provided clear scoring methods, 14 included criteria for risk determination, and only 11 had both scoring methods and risk criteria. Twenty-eight tools lacked both. Twenty-two tools had been evaluated for reliability and/or validity. Among the 25 English-language tools, only 3 had been translated into Chinese. CONCLUSIONS Currently, no existing tool comprehensively assesses all major types of unintentional injuries for children under six years of age. It is recommended that practitioners select appropriate tools based on specific needs. In addition, improvements should be pursued, such as translating and validating English-language tools, developing quantitative scoring methods and criteria for tools tailored to Chinese children for important but underrepresented injury types (e.g., road traffic injuries, drowning).
Humans ; Infant ; Child, Preschool ; Child ; Risk Assessment/methods* ; Accidental Injuries/prevention & control* ; Infant, Newborn ; Wounds and Injuries/epidemiology* ; Reproducibility of Results

OBJECTIVES: The diagnostic value of ultrasonographic quantitative indicators of umbilical cord coiling, such as the umbilical coiling index (UCI) and pitch value, in identifying hypercoiling and predicting adverse pregnancy outcomes remains controversial. This study aims to evaluate the predictive value of UCI, pitch value, and the cerebroplacental ratio in pregnancies complicated by umbilical cord hypercoiling. METHODS: Pregnant women with densely coiled umbilical cords identified by routine obstetric ultrasound at Changsha Maternal and Child Health Hospital between November 2022 and November 2024 were enrolled. Complete clinical data, including UCI, pitch value, and cerebroplacental ratio (CPR), were collected. Pregnancy outcome scores were calculated, and newborns were categorized into the normal outcome group (n=177) and adverse outcome group (n=85), with the latter further subdivided into mild (n=51), moderate (n=19), and severe (n=15) subgroups. Differences in baseline data, UCI, pitch value, and incidence of CRP<1 were compared between groups and among subgroups. Correlations between UCI, pitch value, and adverse pregnancy outcomes were analyzed. Receiver operating characteristic (ROC) curve were used to assess the predictive performance of UCI, pitch value, CPR<1, and their combinations. RESULTS: Compared with the normal outcome group, the adverse outcome group had higher age, parity, parity, incidence of CPR<1, and UCI, while gestational age at delivery and pitch values were lower (all P<0.05). The incidence of obesity, gestational diabetes mellitus, and hypertensive disorders of pregnancy did not differ significantly between the 2 groups (all P>0.05). The normal outcome group showed lower UCI and higher pitch values than all 3 adverse outcome subgroups (all P<0.05), while differences among the 3 adverse subgroups were not significant (all P>0.05). UCI was positively correlated with adverse pregnancy outcomes (r_s=0.350, P<0.05), whereas pitch value was negatively correlated (r_s=-0.286, P<0.05). ROC curve analysis showed that the area under the curve (AUC) values for predicting adverse outcomes were 0.837 for UCI, 0.886 for pitch value, and 0.610 for CPR<1, with sensitivities of 77.6%, 82.4%, and 27.1% and specificities of 78.5%, 83.6%, and 94.9%, respectively. The combined UCI+CPR<1 and pitch value+CPR<1 models yielded AUCs of 0.841 and 0.886, with sensitivities of 78.8% and 81.2% and specificities of 78.5% and 84.2%, respectively. No significant differences were found between the AUCs of UCI and pitch value (P>0.05), but both outperformed CPR<1 alone (both P<0.001). The combined models showed no significant improvement over UCI or pitch value alone (both P>0.05), though both were superior to CPR<1 alone (both P<0.001). CONCLUSIONS Most umbilical cord hypercoiling cases had favorable outcomes, with UCI, pitch value, CPR<1 and their combinations demonstrating significant predictive value for adverse pregnancy outcomes.
Humans ; Female ; Pregnancy ; Pregnancy Outcome ; Adult ; Ultrasonography, Prenatal/methods* ; Umbilical Cord/diagnostic imaging* ; Hemodynamics ; Predictive Value of Tests ; Infant, Newborn ; ROC Curve

OBJECTIVES: Prolonged invasive mechanical ventilation is associated with increased risks of severe complications such as retinopathy of prematurity and bronchopulmonary dysplasia. Although neonatal intensive care unit (NICU) follow the principle of early extubation, extubation failure rates remain high, and reintubation may further increase the risk of adverse outcomes. This study aims to identify risk factors and short-term prognosis associated with first extubation failure in neonates, to provide evidence for effective clinical intervention strategies. METHODS: Clinical data of neonates who received invasive ventilation in the NICU of Children's Hospital of Nanjing Medical University from January 1, 2019, to December 31, 2021, were retrospectively collected. Neonates were divided into a successful extubation group and a failed extubation group based on whether reintubation occurred within 72 hours after the first extubation. Risk factors and short-term outcomes related to extubation failure were analyzed. RESULTS: A total of 337 infants were included, with 218 males (64.69%). Initial extubation failed in 34 (10.09%) infants. Compared with the successful extubation group, the failed extubation group had significantly lower gestational age [(31.37±5.14) weeks vs (34.44±4.07) weeks], age [2.5 (1.00, 8.25) h vs 5 (1.00, 22.00) h], birth weight [(1 818.97±1128.80) g vs (2 432.18±928.94) g], 1-minute Apgar score (6.91±1.90 vs 7.68±2.03), and the proportion of using mask oxygenation after extubation (21% vs 46%) (all P<0.05). Conversely, compared with the successful extubation group, the failed extubation group had significantly higher rates of vaginal delivery (59% vs 32%), caffeine use during mechanical ventilation (71% vs 38%), dexamethasone use at extubation (44% vs 17%), the highest positive end-expiratory pressure level within 72 hours post-extubation [6(5.00, 6.00) cmH₂O vs 5 (0.00, 6.00) cmH₂O] (1 cmH₂O=0.098 kPa), the highest FiO₂ within 72 hours post-extubation [(34.35±5.95)% vs (30.22±3.58)%], and duration of noninvasive intermittent positive pressure ventilation after extubation [0.5 (0.00, 42.00) hours vs 0 (0, 0) hours] (all P<0.05). Multivariate analysis identified gestational age <28 weeks (OR=5.570, 95% CI 1.866 to 16.430), age at NICU admission (OR=0.959, 95% CI 0.918 to 0.989), and a maximum FiO₂≥35% within 72 hours post-extubation (OR=4.541, 95% CI 1.849 to 10.980) as independent risk factors for extubation failure (all P<0.05). Additionally, the failed extubation group exhibited significantly higher incidences of necrotizing enterocolitis grade II or above, moderate-to-severe bronchopulmonary dysplasia, severe bronchopulmonary dysplasia, retinopathy of prematurity, treatment abandonment due to poor prognosis, and discharge on home oxygen therapy (all P<0.05). Total hospital length of stay and total hospitalization costs were also significantly increased in the failed extubation group (all P<0.05). CONCLUSIONS Gestational age <28 weeks, younger age at NICU admission, and FiO₂≥35% after extubation are high-risk factors for first extubation failure in neonates. Extubation failure markedly increases the risk of adverse clinical outcomes.
Humans ; Infant, Newborn ; Male ; Female ; Airway Extubation/adverse effects* ; Risk Factors ; Retrospective Studies ; Respiration, Artificial/methods* ; Intensive Care Units, Neonatal ; Prognosis ; Gestational Age ; Bronchopulmonary Dysplasia ; Infant, Premature ; Treatment Failure ; Intubation, Intratracheal

BACKGROUND

Bronchial asthma is one of the most common chronic childhood diseases encountered in the primary care setting. Adherence to recommendations from clinical practice guidelines on asthma can be utilized as an indicator of quality of care when evaluating the implementation of the universal health care in the Philippines.

To determine the clinical profile of pediatric patients with bronchial asthma; and to evaluate the prescription patterns for asthma treatment in a primary care setting.

This was a retrospective cohort study that involved review of the electronic medical records in a rural site of the Philippine Primary Care Studies (PPCS). All patients less than 19 years old who were diagnosed with asthma from April 2019 to March 2021 were included. Quality indicators for asthma care were based on adherence to recommendations from the 2019 Global Initiative for Asthma (GINA) Guidelines.

This study included 240 asthmatic children with mean age of 6 years (SD ± 4.9) and a slight male preponderance (55.4%). Majority (138 children or 57.5%) were less than 6 years old. Out of the 240 children, 224 (93.3%) were prescribed inhaled short-acting beta-agonists (SABA) and 66 (27.5%) were prescribed oral SABA. Only 14 children (5.8%) were prescribed inhaled corticosteroids (ICS), with 13 children (5.4%) given ICS with longacting beta-agonists (LABA) preparations, and one child (0.4%) given ICS alone. Quality indicators used in this study revealed underutilization of ICS treatment across all age groups, and an overuse of SABA-only treatment in children 6 years old and above. Moreover, 71.3% of the total patients were prescribed antibiotics despite the current GINA recommendation of prescribing antibiotics only for patients with strong evidence of lung infection, such as fever or radiographic evidence of pneumonia.

There were 240 children diagnosed with asthma over a 2-year period in a rural community, with a mean age of 6 years old and a slight male predominance. This quality-of-care study noted suboptimal adherence of rural health physicians to the treatment recommendations of the GINA guidelines, with overuse of SABA and underuse of ICS for asthma control.

BACKGROUND AND OBJECTIVES

The etiology of pneumonia in the pediatric population varies by age group. Among patients one month to 59 months old, viral pathogens are the most common cause of lower respiratory infections. The study aims to determine the frequency distribution of antibiotic prescription among patients one month to 59 months old and to determine the adherence of primary care facilities to local guidelines with recommended antibiotics.

A descriptive retrospective study using electronic medical records was conducted at two primary care sites. Patients aged 1 month to 59 months old seeking consult via telemedicine or face-to-face diagnosed with community acquired pneumonia from April 2019-March 2020 in the rural facility and May 2019-April 2020 in the remote facility were included in the study. The primary outcome was to determine the patterns of antibiotic use in pneumonia in remote and rural areas and adherence to the recommended antibiotics by the 2016 Philippine Academy of Pediatric Pulmonologists pediatric community-acquired pneumonia clinical practice guidelines (CPG).

There were 30 pediatric patients diagnosed with pneumonia in the rural facility and 213 in the remote facility. Of these patients with pneumonia, 96.7% and 94.8% were prescribed antibiotics in the rural and remote sites, respectively. The most commonly prescribed antibiotic in the rural facility was co-amoxiclav (26.7%), while amoxicillin (51.6%) was the most common in the remote facility. Adherence to the CPG in the rural site was lower at 23.3% (n=8/30) compared to the remote site which was 55.9% (n=119/213).

Primary care physicians prescribed antibiotics in over 90% of the time upon the diagnosis of pneumonia in children aged one month to 59 months old, despite viral pneumonia being the more common in primary care setting. Adherence to recommended antibiotics was higher in the remote setting than in the rural setting. Use of EMR to monitor quality of care can improve patient outcomes and safety, pointing out the importance of improving the quality of documentation in the study sites.

OBJECTIVE

To determine the prevalence of rectal colonization with carbapenem-resistant organisms (CRO) among PGH neonatal intensive care unit (NICU) patients.

A prospective single-center observational study conducted over a 1-month period included all NICU 3 and cohort area patients admitted on April 24, 2024. Rectal swabs were collected for multidrug-resistant organism (MDRO) screening and repeated weekly for 1 month while admitted. Swabs were inoculated on chromogenic media, and isolates were identified and tested for antimicrobial sensitivity by disk diffusion. Clinical characteristics and outcomes were collected for 30 days from initial MDRO screening. Descriptive statistics were used to summarize the data.

The point prevalence of CRO colonization was 37% (14 of 38) at initial screening. There were 14 incident colonizations, hence the 4-week period prevalence of CRO colonization was 72.5% (29 of 40). The patients were mostly very preterm, very low birth weight neonates, majority were tested within the first 2 weeks of life, and half were exposed to meropenem at initial screening. Nosocomial infection developed in 29% and 64%, and 30-day mortality rate was 8% and 21% among initially non-CRO-colonized and CRO-colonized patients respectively. Despite high CRO colonization, no culture-proven CRO infection was observed. Surveillance screening documented persistent CRO colonization in 37%, but no decolonization. Escherichia coli, Klebsiella spp. and Serratia spp. were the most common colonizers.

The high prevalence of rectal CRO colonization in the NICU emphasizes the burden of antimicrobial resistance, but despite the high CRO colonization, no CRO infection was documented from the limited sample and study period.

BACKGROUND

The use of ceftazidime-avibactam (CAZ-AVI) has been recently introduced to combat multidrug-resistant organisms (MDROs) in the pediatric population. Case reports have documented the successful off-label use of CAZ-AVI in the treatment of MDRO sepsis in neonates; however, data remains to be limited, especially in the Philippines.

This study aims to explore the effects of CAZ-AVI on clinical outcomes including mortality rate, length of hospital stay since treatment initiation, and bacteriological eradication among patients admitted at the NICU with MDR Klebsiella hospital-acquired sepsis. Other objectives include comparing these outcomes betwee those who received CAZ-AVI (in combination with aztreonam, ATM) and those who received other 2nd line MDR-antibiotic regimens used for carbapenem-resistant Klebsiella growths, as well as exploring the association of factors such as gestational age and age at sepsis diagnosis of patients with their outcomes post-treatment with CAZ-AVI± ATM.

This is a retrospective cohort study of admitted patients in a neonatal intensive care unit of a tertiary hospital with MDR Klebsiella hospital-acquired sepsis across a two-year period. A review of medical records was done, and data were collected and analyzed.

There were a total 11 patients treated with CAZ-AVI ± ATM compared with 11 patients given other 2nd line antibiotic treatment regimens. The use of CAZ-AVI ± ATM exhibited a trend towards a decreased mortality rate (54.5%, p = 0.17), shorter length of hospital stays from treatment initiation (30.7 days, p = 0.50), and increased bacteriological eradication rates (63.6%, p < 0.05), compared with other 2nd line antibiotic treatment regimens, regardless of gestational age and age at sepsis diagnosis.

The use of CAZ-AVI ± ATM showed a more favorable trend compared with other 2nd line antimicrobials for with MDR Klebsiella hospital-acquired sepsis. These observations, however, require further confirmation with a prospective study, a longer study period, and an increase in sample size.

Human ; Infant, Newborn ; Mass Screening ; Neonatal Screening ; Censuses

Infant, Newborn ; Mass Screening ; Neonatal Screening