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.