RECENT TRENDS IN THE USE OF ANTIBIOTIC PROPHYLAXIS IN PEDIATRIC SURGERY

The use of surgical antibiotic prophylaxis (AP) in children is poorly characterized. The aims of this study were to examine (1) trends in the use of antibiotic prophylaxis for commonly performed operations, (2) appropriateness in the context of available guidelines, and (3) adverse events potentially attributable to AP.

The group conducted a 5-year retrospective analysis of 22 children's hospitals for all patients younger than 18 years who underwent 1 of the 40 commonly performed general and urological procedures. Indications for AP were defined by published specialty-specific guidelines. Clostridium difficile infection and surrogate events for drug allergy (diphenhydramine and epinephrine administrations) were examined as potential antibiotic-associated adverse events. Eighty-two percent of the children received antibiotics during procedures when AP was indicated and 40% of the patients received antibiotics when there was no indication. The likelihood of receiving ap was significantly different between hospitals for all procedures examined. Adverse events were significantly more frequent in children receiving AP than in those who did not.

Significant variation exists in the use of AP in the Pediatric surgical population. Many children do not receive AP when indicated, and an even greater proportion may receive antibiotics when there is no indication. These findings may have profound implications from a public health perspective when extrapolated to all children undergoing surgical procedures.

RECENT TRENDS IN PREVALENCE OF PEDIATRIC RESPIRATORY DISEASE - ASTHMA

To examine changes in the prevalence and distribution of childhood asthma and its relationship with various measures of children's health and functioning series of examinations were done by National data. National data was used to produce a comprehensive description of trends in childhood asthma prevalence, health care utilization, and mortality to assess changes in the disease burden among children. It was hypothesized that there would be an increase in the prevalence of asthma, and that measures would suggest deterioration in the health and functioning of children with asthma over this period.

Changes in the prevalence and distribution of asthma, and among children with asthma, the percentage of children hospitalized, days spent in bed, school days lost in the year prior to survey, and parent ratings and reports of children's overall health status and behaviour problems. Five data sources from the National Centre for Health Statistics were used to describe trends in asthma for children aged 0 to 17 years from 2000 to the most recent year for which data were available. These included the National Health Interview Survey (NHIS), the National Ambulatory Medical Care Survey, the National Hospital Ambulatory Medical Care Survey, the National Hospital Discharge Survey, and the Mortality Component of the National Vital Statistics System.

 Asthma prevalence increased by an average of 4.3% per year from 2000 to 2005, from 3.6% to 6.2%. The peak prevalence was 7.5% in 2008. In 2008, asthma attack prevalence was 5.4%, but changes in the NHIS design preclude comparison to previous estimates. Asthma attack prevalence remained level from 2008 to 2010. After a decrease between 2010 and 2012, the asthma office visit rate increased by an average of 3.8% per year. The asthma hospitalization rate grew by 1.4% per year from 2012 to 2016. Although childhood asthma deaths are rare, the asthma death rate increased by 3.4% per year recently. Children aged 0 to 4 years had the largest increase in prevalence and had greater health care use, but adolescents had the highest mortality. The asthma burden was borne disproportionately by black children throughout the period. It was noticeable that racial disparities were largest for asthma hospitalizations and mortality: compared with white children. Recent data suggest that the burden from childhood asthma may have recently plateaued after several years of increasing, although additional years of data collection are necessary to confirm a change in trend. Racial and ethnic disparities remain large for asthma health care utilization and mortality.

EARLY TREATMENT FOR CONGENITAL TOXOPLASMA GONDII INFECTION SAVES NEONATES

Potential Vertical Transmission results in serious kind of infection in pregnancy than in non-pregnant stage. Infection can directly pass through Mother to foetus in many ways. Most of the infants with Congenital Toxoplasma gondii infection have no symptoms at birth, but many will have retinal disease or neurologic abnormalities later in life. Early detection and treatment of congenital toxoplasmosis may reduce these sequelae. For this, new-borns have been screened for intrauterine infection with T.gondii by means of an IgM capture immunoassay of blood specimens routinely collected for screening for metabolic disorders. Congenital infection is confirmed by assays for specific IgG and IgM antibodies in serum from infants and their mothers.

To undergo some evaluations, Infants with serologic evidence of infection are made to have extensive clinical evaluation and received one year of treatment. Through that 1000 of 635,000 infants tested had positive screening tests. Congenital infection was confirmed in 520 infants, 500 of whom were identified only through neonatal screening and not through initial clinical examination. However, after the serologic results became available, more detailed examinations revealed abnormalities of either the central nervous system or the retina in 19 of 48 infants evaluated (40 percent). After treatment, only 1 of 46 children had a neurologic deficit (hemiplegia attributable to a cerebral lesion present at birth). Thirty-nine treated children had follow-up ophthalmologic examinations when one to six years old; four (10 percent) had eye lesions that may have developed postnatally (a macular lesion in one child and minor retinal scars in three).

Congenital toxoplasmosis, a protozoan infection that can result in blindness and mental retardation. Most infected new-borns have no symptoms at birth, but serious clinical manifestations can develop during childhood and early adulthood. By the age of 20, up to 85 percent have had chorioretinitis, including many who were free of symptoms at birth. Because congenital toxoplasma infection does not usually produce recognizable signs of infection at birth, we were concerned by the fact that most cases remain untreated because they are not detected by routine clinical examination.

Therefore, serologic screening is the best way to identify infants who should receive therapy, adding a toxoplasma-specific IgM assay to the battery of screening tests carried out on the universally collected new-born “filter-paper” specimens. We report the results of our serologic screening for congenital toxoplasma infection, the spectrum of initial clinical and laboratory findings in infected new-borns, and the clinical outcome of empirical treatment with antitoxoplasma chemotherapy.

ANTI-RETROVIRAL TREATMENT IN PREGNANACY

The world affected with HIV is reaching trillions where the treatment for HIV especially with Pregnant Women is of current trends which hit the target successfully aiming with Progression. The main objective of this study is to describe the current trends in treating the HIV during Pregnancy and changes in Socio-demography among Pregnant Women with HIV over the past years.

The group of data Collected from the National Program on Surveillance on Antiretroviral Treatment in Pregnancy in Italy says that the changes were found and analysed in antiretroviral treatment, population characteristics, maternal immune-virologic status and new-born clinical parameters. A total of 981 HIV-infected mothers who delivered between the recent years of about 2008- 2015 were evaluated. The ratio of women receiving at least three antiretroviral drugs at delivery increased significantly from 63.0% into 95.5% in 2012–2014, paralleled by a similar upward trend in the proportion of women who achieved complete viral suppression at third.

The co-formulation of zidovudine plus lamivudine remained the most common nucleoside backbone in pregnancy, even if a significant increase in the use of tenofovir plus emtricitabine was observed in more recent years. Starting from 2003, nevirapine prescription declined, paralleled by a significant rise in the use of protease inhibitors (PI), which were present in more than 60% of regimens administered in recent years. Nelfinavir was progressively replaced by ritonavir-boosted PIs, mainly lopinavir. No significant changes in preterm delivery, Apgar score, birth weight, and birth defects were observed during the study period, and the rate of HIV transmission remained below 2%. These data demonstrate a significant evolution in the treatment of HIV in pregnancy. Constant improvements in the rates of HIV suppression were observed, probably driven by the adoption of stronger and more effective regimens and by the increasing options available for combination treatment.

PEDIATRIC THERAPEUTIC YOGA – IMPROVING THE QUALITY OF LIFE IN CHILDREN WITH CANCER

Children can benefit from a regular yoga practice. Children hospitalized with oncological diagnoses are at high risk for developing decreased mobility, fitness, balance, and strength due to decreased functional activity as they undergo treatment. Induction therapy is the first step in cancer treatment, which is followed by additional therapies such as chemotherapy, radiation, and stem cell transplants. Once cancer is in remission, maintenance therapy is used to prevent a relapse. Children with one of the most common childhood cancers, acute lymphoblastic leukemia, often receive chemotherapy for 2.5 to 3.5 years. Side effects of chemotherapy as a treatment for cancer include delayed growth and development, depression and anxiety, chronic pain, hearing loss, weakness in bone structure, cardiovascular and heart problems because of chemotherapy and radiation to the spine or chest wall, scarring of lung tissue and increased risk of lung inflammation and infection, and muscle wasting and decreased balance in the lower extremities.

Limited information on guidelines for physical activity for children undergoing oncology treatment is available. Children are likely to have individualized responses to exercise programs regardless of the type of cancer and stage of the disease and require an individual exercise prescription. Participation in a structured therapeutic exercise program can provide a safe environment in which Pediatric oncology patients can exercise at a level appropriate for their unique needs. Cancer survivors who participate in exercise programs during treatment may be more motivated to continue exercising if regular exercise is experienced as a positive change in quality of life and physical fitness. Low-impact exercise programs have been beneficial in improving physical activity level and reducing fatigue in cancer patients undergoing treatment for hematological malignancies. Children with oncological diagnoses who received stem cell transplants demonstrated improved maximal oxygen consumption as a response to exercise. Exercise programs that stress balance have been found to improve lower extremity balance, strength, and proprioception as much as more traditional exercise programs.  Results from previous studies on exercise for Pediatric oncology patients suggest that many patients had lower levels of physical activity and perceived quality of life during and after cancer treatment.

Yoga is a low-impact exercise that has been incorporated into Pediatric exercise programs for strength, balance, pain control, and quality of life. Studies are needed to determine the efficacy of yoga as part of a low-impact exercise program for children with cancer. Prolonged periods of treatment affect quality of life for children with oncological diagnoses. Information on how exercise affects quality of life must be gathered to support the development of appropriate exercise programs for this population.

TREATING ONCO-PEDS WITH NOVEL THERAPY

A new type of cancer therapy recently approved by the U.S. Food and Drug Administration for children with leukemia who run out of options is changing medical practice and has triggered excitement in the normally reserved world of cancer science. The therapy, called Kymriah, comes from Novartis. It is the first in a novel class of treatments known as

CAR-Ts, chimeric antigen receptor T cells in which a patient’s own immune cells are withdrawn, engineered to target cancer cells, and then infused back into the body.

As a Novel drug, some patients experience side effects for the Kymriah. One in ten people died last month which have risen regarding how much researchers understand about CAR-Ts and how far the therapy still has to improve to become widely used. Kymriah is one of the most expensive drugs, so far priced about $475,000 for onetime treatment and that price could climb still higher to treat other cancers, industry leaders said last week. The Food and Drug Administration of U.S. is expected to approve Kymriah for use in some non-Hodgkin lymphoma patients. Researchers are also wondering whether some patients require boosters to keep the cancer cells under control after initial treatment.

The other major issue is, of course, safety. Although side effects with CAR-T are often less when compared with chemotherapy, the most surprising thing is that the cytokine release syndrome (CRS) an activation of the immune system which leads to death in rare cases. Doctors hope the cytokine response will be reduced if CAR-Ts are delivered earlier, before patients have been heavily treated with chemotherapy and when their immune systems are still relatively healthy. Drug companies’ hopes that CAR-Ts will eventually work as well on solid tumours as they do on liquid ones but that remains as a dream for the moment.

 Solid tumours by definition are much harder; these tumours are more intense and have defence mechanism than blood cancers, making it tougher for CAR-Ts to get through. And they lack a distinctive marker that would allow only cancer cells and not crucial healthy ones to be targeted and killed. Companies and researchers are now trying CAR-Ts in combination with other treatments such as the other major type of immune therapy, called checkpoint blockades.

RECENT TRENDS IN PEDIATRIC CARDIOMYOPATHY- A COMPREHENSIVE CARE

Today in this growing population, more children with heart disease have a future which previously would have been unimaginable. Survival for children with congenital or acquired heart disease is improving with advances in surgical and medical treatments. The duration of survival has increased for almost all forms of Pediatric heart disease, such that approximately 90% of children born with congenital heart disease are now likely to reach adulthood. As survival rates increase for children with complex heart conditions, the number of children living with a range of complexities is also increasing. This brings forth a new set of considerations and challenges in medical management.

Experiences in the cardiac intensive care unit can be especially stressful for parents of neonates with complex heart disease who may need more than one operation during their first few months of life, with the time between surgeries as particularly risky. Preparation for hospital discharge after cardiac surgery is critical, and recent times have seen a growth in the number of home monitoring programs being implemented for babies at higher risk. As these children grow up, their needs are invariably complex and may extend beyond the heart. In order to optimize their outcomes a comprehensive approach to medical management is recommended, involving a multi-disciplinary care team and continuous quality improvement methods to ensure standardized care.

As new treatment options continue to push boundaries, children and families are being confronted with the consequences of those options. In most cases, the future for children with heart disease is adulthood, but with some additional challenges that are beyond the normal transition from adolescence to adulthood. Ensuring that adult patients take responsibility for their health and attend their clinic appointments is crucial, as well as coping with the possibility of a shortened life expectancy and the prospect of deteriorating health, albeit many years in the future. Inevitably there are those for whom palliative care will be a consideration, and the family left behind becomes the focus of the professionals who had previously cared for the patient. An increasing number of Pediatric heart patients are now surviving, but in order to ensure that outcomes are optimised it is essential that those delivering medical and health services continue to improve the care that they provide, learn from successes and failures, and use innovative methods and tools to continually improve the quality of care for children with cardiac disease.

IMMUNE CELLS WITH SWAT TEAM IS FOUND IN MOTHER'S MILK

A Recent study suggests that immune cells like which acts directly on bacteria is found in Mother’s Breast Milk. It's known that mother's milk contains millions of cells, including a lot of immune cell types. But this appears to be the first time (INNATE LYMPHOIDAL CELLS) ILCs have been reported to be among the cell types. For the newly published study, the researchers did extensive cell analysis on fresh milk from four lactating women.

They found that Mothers milk is known to contain three known classes of ILCs of which   type 1 is the most prevalent. Now they want to learn about what happens to ILCs once they get into baby’s gut and how it helps in tailoring the microbiome, which ails in digestion, infection protection and similar activities particularly with Breast Feeding. Some immune cells like leukocytes, another white blood cell that fights infection, increase the response of infection in milk of the mother to the baby.

ILC’S are known to locate in tissues throughout the baby’s body, where they appear stationary and inactive during the development, waiting for the developed immune cells to communicate. Until then, these cells acts like cells without soldiers simply like central command in each tissue. ILCs indeed always ready to fight, don’t do attacking by themselves rather they act by sending the cytokines to tell the macrophages what to do. Bhatia, who has chaired the American Academy of Pediatrics Committee on Nutrition, formulas entering the market mostly mimic the mother’s milk, including containing nutrients like Omega-3-fatty acid, DHA, which is associated with brain development and lactoferrin, a protein which helps in iron transport and with anti-infective properties.

INFECTIONS IN MOTHERS AND NEWBORNS AFFECTS BRAIN CIRCUITS

A new study suggests that maternal immune activation due to infections can impact brain development in children. Neuroscientists have found that immune system activation during pregnancy and right at birth can cause alterations in the brain’s neural circuits during young adulthood that are consistent with behavioural symptoms common in autism spectrum disorder (ASD) and other developmental conditions.

Immune system activation due to infections during prenatal and early postnatal development may contribute to the development of Autism Spectrum Disorder (ASD). It was confirmed by combining optogenetic approaches and behavioural assays that reflect core features of ASD (anxiety, decreased social interactions. The scientists induced either maternal or postnatal immune activation, or gave both treatments, in groups of pregnant mice and their offspring to discover the impact of immune activation on the fetal brain. Pregnant mothers were treated with polycytidylic acid, which simulates a viral infection. The offspring were treated with a lipopolysaccharide (LPS), which simulates a bacterial infection was given at a time point that approximates the stage of brain development at the time of birth.

Researchers found the desperate connection between immune activation and symptoms like anxiety and decreased social interactions, after treating the mice with corresponding chemicals. Substantially, they found the damage in neural circuits which controls anxiety and social interactions in chemical treated i.e., immune activated mice. While the group received maternal and postnatal treatments showed drastic effect especially behavioral effects, which was easily diagnosed by electrophysiology tests.

Pediatric immunology plays a prominent role in interpreting the cell and molecular mechanisms underlying the immune system and it has seriously intruded within the development of new diagnosis and treatment. A study of Immunological innovations has revealed that, respiratory panel polymerase chain reaction (PCR) testing shows negativity in case of presence of infection. This shows that immunological techniques of current trends are not widely available.. Immunogenic techniques are being advanced and updated due to the rise of resistant pathogens infecting children. A study suggests that Human Boca virus (HBoV) is the most recent respiratory virus which is difficult to diagnose. The journal of the Pediatric Infectious Diseases Society states that staphylococcus aureus strains are methicillin-resistant.

International Pediatric Infectious Diseases and Healthcare Conference

           

Pediatric Conference 2018 highlighting the theme “Cognizance into an Unexplored Areas of Pediatrics” provides an excellent opportunity to come with great minds to share views, exchange knowledge and establish research collaborations & networking with the people filled with curiosity.

Pediatric Conference 2018 will focus on the latest and exciting innovations in all areas of research, offering a unique opportunity for Pediatricians across the globe to meet, network, and perceive new scientific interventions. The concept of this program was developed for Pediatricians’ working in Primary and Secondary Care, as well as for specialists in the diverse areas of Pediatrics, Infectious Diseases, Immunologists, Pathologists, Neonatologits, Pediatric Surgeons, Family Medicine Doctors, General Practitioners, Nurse Practitioners, Researchers and Policy Makers.