Pediatrics and Child Health

Au regard des dégâts majeurs engendrés par la malnutrition aiguë, le Ministère de la santé
publique n’aménage aucun effort pour identifier des approches les mieux adaptées pour lutter de manière efficace et efficiente devant cette pathologie. Le nouveau protocole PCIMA
édition 2016 s’inscrit dans cette démarche afin de doter le pays d’un document technique de
référence pour permettre aux prestataires de terrain à mieux conduire la lutte contre la malnutrition.
La révision de l’ancien protocole intervenu cinq ans après sa mise en œuvre a permis au pays
d’acquérir un nouveau document qui suit la dynamique de l’évolution des progrès scientifiques, fruit des récentes découvertes dans le domaine de nutrition. Le nouveau protocole a le mérite d’approfondir les aspects cliniques des cas des complications médicales majeurs qui augmentaient sensiblement le risque de décès dans les formations hospitalières avec UNTI. Le souci du Ministère de la santé publique est celui de disposer des documents des directives techniques qui répondent au mieux à l’offre de service PCIMA de haute qualité. Le nouveau protocole PCIMA 2016 est beaucoup plus explicite, il fournit des éclaircissements, des commentaires, des informations scientifiques pour renforcer la compréhension des actes que l’on est appelé à poser devant certaines situations
spécifiques. Ceci renforce la confiance des utilisateurs et dissipe par conséquent des doutes ou des tergiversations.

Ce document technique de référence s’adresse à toutes les catégories de prestataires et leur
fournit les directives techniques actualisées pour améliorer leurs prestations. Il met toujours
en contribution la conjugaison des efforts des parties prenantes dans l’offre des soins à savoir
les structures des soins, la famille et la communauté. La PCIMA s’aligne dans le PNDS en respectant
les principes directeurs de mise en œuvre des activités basées sur l’intégration, la continuité, la globalité des soins centrés sur l’homme, la progressivité dans le développement des structures de prise en charge et l’amélioration de la couverture.

Je suis persuadé que ce document trouvera un écho favorable auprès des utilisateurs, puisqu’il vient
combler le vide tant décrié et surtout renforcer la qualité de la prestation des activités PCIMA sur toute l’étendue du territoire national. Par conséquent, les utilisateurs feront montre de haut niveau
de responsabilité pour garder jalousement cet outil de travail et en faire régulièrement référence
dans tous les instants pour garantir issue heureux dans le processus de prise en charge de la malnutrition aiguë.

De peur de ne pas être exhaustif dans la citation des tous ceux qui ont contribué à l’élaboration de
ce document, le PRONANUT présente toute sa gratitude à la consultation internationale de l’équipe de professeur Mac Golden pour l’encadrement dans l’élaboration de ce protocole, à l’UNICEF, au
PAM, à l’OMS et aux ONG Internationales et nationales ainsi qu’à tous ceux qui, de près ou de loin,
ont apporté un appui matériel, financier ou technique à l’élaboration de ce précieux outil de travail.

It is sometimes argued that the non-therapeutic, non-consensual alteration of children’s genitals should be discussed in two separate ethical discourses: one for girls (in which such alterations should be termed ‘female genital mutilation’ or FGM), and one for boys (in which such alterations should be termed ‘male circumcision’). In this article, I call into question the moral and empirical basis for such a distinction, and argue that all children—whether female, male, or intersex—should be free from having parts of their genitals removed unless there is a pressing medical indication.

Background: Neonatal sepsis is a common problem in most of the neonatal intensive care units. It contributes to significant mortality and morbidity among the neonates. Sepsis if properly treated can result in significant reduction in the neonatal mortality. Methodology: This study was a prospective observational study conducted at Government Kilpauk Medical college Hospital between October 2010 and October 2012.The aim of the study was to determine the clinical and etiological pattern of sepsis in our unit. Results: A total of 207 neonates were included in the study of which 88 neonates had culture positivity.34 neonates were early onset sepsis and 54 were late onset sepsis. The clinical presentation was nonspecific in most of the neonates while others had respiratory, gastrointestinal and Central nervous system symptoms. Klebsiella was the most common organism in our study followed by E. coli and Pseudomonas. Among the Gram-positive organisms Staphylococcus aureus. Conclusion: Early identification and interventions like careful selection of antibiotics based on the clinical and etiological pattern of organisms in neonatal sepsis is essential to prevent mortality and morbidity.

The current report reviews the developmental, psychological, and environmental factors that influence the conduct and behaviors of children and youth (generally, ages 6-25) seeking refuge in the United States. During immigration proceedings, interpretations and assumptions regarding child and youth behavioral histories commonly influence legal and judicial decisions. These include decisions, acts, and behaviors relating to child and youth histories in their country of origin, as well as histories during their time in the United States. This consensus report reviews general considerations relevant for interpreting child and youth behavior, as well as specific factors and experiences that are particularly relevant for immigrant child and youth populations.

The life cycle of sucking, swallowing and breathing has causes and consequences, the purpose of this document is to provide and disseminate it. It is written to respond to step mothers and some health professionals. El ciclo vital de succión, deglución y respiración tiene causas y consecuencias, el proposito de éste documento es el de dar a conocerlo y difundirlo. Esta escrito para dar respuestas a las madres y de paso a algunos profesionales de la salud.

Male circumcision, is practised for religious, social, cultural and medical reasons, it is one of the oldest and most common surgical procedure performed globally. It is estimated that one-third of males worldwide are circumcised, 2/3rd of whom are Muslim. The procedure is most commonly practiced in the Muslim world, Israel (where it is near-universal for religious reasons), the United States, and parts of Southeast Asia and Africa. It is relatively rare in Europe, Latin America, parts of Southern Africa, and most of Asia. Circumcision is performed approximately 1.2 million times each year in the United States.
The most important argument against circumcision is the permanent change of anatomy, histology and function of the penis, with potential complications, with a rates reported to be low in developed countries, whereas it may be up to 85% when circumcision is carried out by traditional circumcisers, rather than by medically trained professionals in developing countries. In some studies reporting the complications of circumcision, primary haemorrhage was the most common (52%), whereas infection, meatal stenosis, incomplete circumcision, penile oedema, glanular injury, penile adhesions, iatrogenic hypospadias and urethral injuries were also detected at different rates.

With more and more families presenting with two or more children with autism, this revolutionary treatment method in autism is transforming the lives of these autistic children and their families. Not only that, this approach is healing the lives of the entire family, thus being the FIRST, scientifically proven healing approach in autism that is truly (W) Holistic in every sense of the term. This is a win-win situation for all, as one can see the RESULTS of this path-breaking treatment in autism, right from Day ONE. The Problem While it is known that there is a " risk " of another child with autism being born in a family where the parents already have one child with autism, the actual statistics for the same is lacking. This article is inspired by my experience in healing children with autism in families with more than one child with autism. Autism Treatment Approach The healing method that was applied was Intent Healing™ that is based on Applied Energy Medicine and Applied Intentional Epigenetics. One can know more details about the same by perusing these articles on the scientific basis of the same and the case reports of successfully healed cases here: http://www.intenthealing.com/blog/ and in this online course on 'The Energy Basis of Autism and the Solution' , where the Testimonials and the Evidence of successfully healed cases of Autism, in line with EBM (Evidence Based Medicine) applying Intent Healing™ is available here: http://authenticautismsolutions.usefedora.com The treatment method applied was as follows: 1. Energy assessments of both parents and the autistic children: The energy patterns of the parents and the children were assessed over two days and two nights and the reports shared with the parents. This helps in understanding the underlying specific causes for the symptoms of autism seen in each child with autism, which was unique to each child. 2. Individual healing sessions with each parent: These sessions were done over skype and as Remote Healing sessions timed according to the time zones where the parents lived. Intent Healing™ energies were channeled in the sessions and the individual parents' energies were realigned first. 3. Individual sessions for each child: These sessions were done as Remote Healing sessions while each child was sleeping in bed at different times of the night. In some cases the sessions were done for one child and once the symptoms disappeared in that child the ISSN 2379-7150 sessions were done for the other child who had autism and then the third child after that. In some cases with two children with autism the sessions were done on the same day at different timings and improvements in the symptoms in both the children with each session were noted and documented till complete disappearance of all the symptoms was achieved. Results 1. In all the cases improvements of the symptoms in the children were seen right from the very FIRST session. 2. With consecutive sessions, PROGRESSIVE improvements in the symptoms were seen and documented in both the children with autism in the cases where the families had two children with autism and those families with more than two children with autism, the improvements were seen in ALL the autistic children. 3. In ALL the cases of families with two or more than two children with autism, 70-80% of the limiting symptoms of autism in each child disappeared over a span of 20-30 days were the sessions were done on consecutive days with no break in between. In families where the sessions were done for each child one after the other (doing the sessions for one child only first till the symptoms disappeared and then moving on to the next child and so on), the time period for recovery was correspondingly longer due to the logistics involved. 4. The ENTIRE FAMILY including the parents got healed in the process. By this I mean the physical well-being of the parents improved and they had more energy to devote to their individual creative pursuits and careers and were able to see progress in ALL aspects of their lives individually, as well as collectively, as a family.

Congenital Anomalies (CA) in Latin America are responsible for more than 20% of deaths that occur in the period of 0- 4 years of life, and may result in long-term disability, which may lead to negative emotional, individual, familiar, social and economic impact. In particular Cleft Lip and Palate are among the most
common CA and individuals with this condition may encounter problems in areas, such as feeding, speech, hearing and social integration, which can be treated with a multi-disciplinary team. The aim of this report was to present the case study proposal of a cognitive-behavioral intervention with support of positive psychology strategies for an 11 years old boy, with a cleft lip and palate. The boy was evaluated with ahealth behavioral interview, self-report, and functional behavioral analysis for the case formulation (Clinical Pathogenesis Map, Clinical Strengths Map and Goal Attainment Map). He participated in 20 sessions based in the “Optimistic Game”. The results had shown clinical changes in the emotional regulation, attributional style (pessimistic vs optimistic) and behavioral goals (social skills, health behaviors). These improvements allowed the expression of Positive emotions, Engagement, positive Relationships, Meaning and Accomplishment that are the components of the PERMA model in Positive Psychology.
Key words: orofacial clefts, attributional style, well-being, PERMA model.

OBJECTIVE:
This study aimed at evaluating the effects obtained by administering 30 mg of micronised dispersible ferric pyrophosphate plus 300 mg of alpha-lactalbumin (MDFP-AL) compared to 80 mg of ferrous gluconate (FG) in pregnant women affected by iron-deficiency anemia (IDA).

PATIENTS AND METHODS:
We considered eligible all second-trimester singleton pregnancies in women affected by IDA. We excluded any other disease, twin pregnancies, any other pharmacologic/nutraceutical treatments (besides folic acid) before/during pregnancy. We randomized patients in two groups: one underwent treatment with 1 tablet of MDFP-AL/day, the other one with 1 tablet of FG/day, for 30 days. We evaluated hemoglobin (Hb), ferritin, red blood cells (RBCs), serum iron, hematocrit (Hct), and side effects at baseline (T0), after 15 days (T1) and 30 days (T2).

RESULTS:
50 women met the inclusion/exclusion criteria. We did not observe significant differences between the two groups for mean age, gestational age at the enrollment and parity. In MDFP-AL group, after 15 days (T1) Hb, ferritin, serum iron and Hct and were significantly improved respect to baseline (T0); after 30 days (T2), all the parameters, including RBCs, were significantly improved respect to baseline (T0). Similarly, in FG group the investigated parameters were improved both after 15 (T1) and 30 days (T2) respect to baseline (T0), although less in percentage terms respect to MDFP-AL group. The side effects rate was 24% in FG group, whereas MDFP-AL group did not show any significant side effect.

CONCLUSIONS:
Overall, MDFP-AL is more effective and safe than FG for the treatment of IDA in pregnant women.

We invite you all to the International conference on Pediatrics & Neonatology to be held in London, UK on March 14-16, 2019
Will you be interested to participate as a speaker/delegate?
You can learn more about the scientific sessions at http://pediatrichealthcare.alliedacademies.com/
Email: pediatrics@pediatricscongress.com

Circumcision remains as one of the most controversial topics in current medical practice. The most important argument against circumcision is the permanent change of anatomy, histology and function of the penis, with potential complications, which were reported to be low in developed countries, whereas the rate of complication may be up to 45% when circumcision is carried out by traditional circumcisers rather than by medically trained professionals in developing countries. In some studies reporting the complications of circumcision, primary haemorrhage was the most common (52%) complica- tion, whereas infection, meatal stenosis, incomplete circumcision, penile oedema, glanular injury, penile adhesions, iatrogenic hypospadias and urethral injuries were also detected at different rates.
There are minor complications after circumcision that cannot be avoided even when the procedure is undertaken by specialized paediatric surgeons or urologists in properly equipped centres, especially if the child or his penis is congenitally abnormal, for example, circumcising a child with excessive suprapubic fat or a child with webbed penis or microphallus.

The prevalence of Autism is on the rise worldwide with studies presenting the worldwide prevalence rates as 1 in 68 children. This is rising alarmingly every year and the combined presentation of Autism with ADHD in the same child is also increasing. In this scenario it is shocking to note that many medical professionals in general and paediatricians in particular are unaware of the availability of an Autism Cure that is already being accessed by parents with children with autism from all over the world and these children are thriving completely free from their limiting symptoms. This article seeks to enlighten medical professionals about this Autism Cure and emphasizes the urgent necessity for them to update themselves about the same so that more children with Autism and ADHD (and their parents) need not suffer unnecessarily due to this " autism cure awareness gap " that is currently prevailing among medical professionals and paediatricians worldwide. Read More ... #Autism #AutismCure #AutismTreatment

Objective: Accurate assessment of pain is central to diagnosis and treatment in healthcare, especially in pediatrics. However, few studies have examined potential biases in adult observer ratings of children’s pain. Cohen et al. (2014) reported that adult participants rated a child undergoing a medical procedure as feeling more pain when the child was described as a boy as compared to a girl, suggesting a possible gender bias. To confirm, clarify, and extend this finding, we conducted a replication experiment and follow-up study examining the role of explicit gender stereotypes in shaping such asymmetric judgments.

Method: In an independent, pre-registered, direct replication and extension study with open data and materials (https://osf.io/t73c4/), we showed participants the same video from Cohen et al. (2014), with the child described as a boy or a girl depending on condition. We then asked adults to rate how much pain the child experienced and displayed, how typical the child was in these respects, and how much they agreed with explicit gender stereotypes concerning pain response in boys versus girls.

Results: Similar to Cohen et al. (2014), but with a larger and more demographically diverse sample, we found that the ‘boy’ was rated as experiencing more pain than the ‘girl’ despite identical clinical circumstances and identical pain behavior cross conditions. Controlling for explicit gender stereotypes eliminated the effect.

Conclusions: Explicit gender stereotypes—e.g., that boys are more stoic or girls are more emotive—may bias adult assessment of children’s pain.

Dengue-like diseases were known to be present all over the world during the 18th and 19th century except in Antarctica. Till the mid 20’s Dengue was assumed to be an innocuous non fatal disease but views on this changed in the 1950’s as the disease went under some strange evolution. People started dying from Dengue in the South East Asian countries and two major serious symptoms were found in these patients: (1) bleeding diathesis and (2) shock. Dengue was now named as ‘Dengue hemorrhagic fever-dengue shock syndrome’ and by 1975 because of this newly evolved disease many children were hospitalised and lost their lives.
In 1980’s disease expanded and many Asian countries like India, Sri Lanka, Maldives, Bangladesh and Pakistan were hit by Dengue. With invasion of every nook and corner India is one of the worst hit countries. Hyperendemicity that is circulation of multiple serotypes has become frequent. The recent epidemics in Sri Lanka and India were associated with multiple dengue virus serotypes, although DEN-3 is clearly more prominent. By end of the last century, this disease moved on from Asia to the Pacific regions and the United States of America (Fig-1). Currently 50 million Dengue viruses occur annually with the outcome of 500,000 hospitalization cases and deaths over 20,000.

Cleft lip and palate constitutes one of the most common congenital anomalies. It causes a range of functional as well as aesthetic problems. A cleft child's life becomes challenging with a lot of socio psychological problems and requires tremendous support, motivation and a definite treatment protocol by a craniofacial team. The team should function as an organization with a general policy for the treatment, and each member of the team should have insight into the different aspects of treatment. The dentist plays an important role in this team beginning from the cleft child's birth. All the care should be provided by the dentist with respect to the dentofacial growth from the cradle till adulthood so that the cleft patients successfully survives as a normal individual in the society. In a complete cleft lip and palate patient, the maxillary structure will be divided in two or three segments by the cleft of the palate and alveolus and may be associated with collapsed nostrils. Presurgical infant orthopaedic treatment aims at securing a good maxillary arch form in acceptable relationship with the mandible and to restore normal oral function. It was recognized that the cartilage in the new born is soft and lacks elasticity. The high maternal level of oestrogen at the time of birth correlates with an increase in hyaluronic acid, which inhibits the linking of the cartilage intercellular matrix. This process may be necessary to relax ligaments, cartilage, and connective tissue, enabling the foetus to pass through the birth canal. The level of oestrogen begins to decline immediately after birth [1]. So, it was considered to be advantageous to utilise this molding capability of the alveolus and the nasal cartilage at the earliest using presurgical infant orthopaedics, thus reducing the deformity. The attainment of an end-to-end position of the alveolar processes before lip operation was the ultimate goal for infant orthopaedics performed by all dental practitioners in the past so that to achieve an anatomical correct po

Poverty is a global issue that dramatically affects the lives of children, who are the generation of our future. The effects of poverty influences the future of the child traumatically. Permanently altering the structure of the brain, this will cause hardships in striving in education and the daily needs for problem solving. Thus, the cycle of poverty continues to trap these children. The exploration of the direct effects of poverty on the anatomy of the brain is crucial to mitigate these affects impoverished children will suffer in adulthood.

Use of elastic therapeutic taping (ETT) on sternocleidomastoid muscle in infants with congenital muscular torticollis.                                                                On which side of the child’s neck should tape be applied in the case of congenital muscular torticollis (CMT)? Is it the weak lengthened (unaffected) side, or the short (affected) side? This question was posed by a colleague and answering it resulted in this Clinical Note. The contents reflect the newest insights on this subject.

Agenesis of one or more teeth is not an uncommon finding in both primary and permanent dentition. The most commonly missing tooth in the permanent dentition is the third molars followed by the maxillary lateral incisors or the mandibular premolar. Congenitally missing maxillary central incisor is not a frequent finding. Presence of only one maxillary central incisor is a rare clinical finding termed as solitary median maxillary central incisor. This is a case report of a 7 year old female patient who reported with only one central incisor at the midline. Early diagnosis of the condition is very essential to rule out other associated problems.

El Ministerio de Salud de la Nación propone el control integral y oportuno de salud infantil. En ese marco, considera indispensable que durante el mismo se realice la observación del desarrollo infantil y se acompañe a la familia en ese proceso.
El IODI es un instrumento ordenador de la observación durante la consulta. Su objetivo es realizar el seguimiento del desarrollo en las niñas y niños menores de 4 años, así como contribuir a la detección oportuna de situaciones de riesgo y signos de alarma. Se espera que los equipos de salud consideren al niño inserto en su contexto y como integrante de un grupo conviviente en particular.

ÖZ Teknolojinin yaygınlaşması ile beraber artık birçok evin internete ulaşımı sağlanmıştır. Kullanımın yaygınlaşması beraberinde bağımlılıkları da getirmiştir. Televizyon bağımlılığı, internet bağımlılığı, mobil oyun bağımlılığı, sosyal medya bağımlılığı gibi birçok tanım literatüre girmiş ve üzerinde çalışmalar yapılmıştır. Tüm bu bağımlılık modelleri teknoloji bağımlılığı çatısında değerlendirilmektedir. Teknoloji bağımlısı çocuklarda ekran başında geçen sürenin artması, fiziksel inaktivite, psikososyal sorunlar, uyku bozuklukları, beslenme düzeninin bozulması, reklama maruz kalma, sağlıksız besin tüketimlerinde artış gibi birçok problem gözlenmektedir. Tüm bu sorunların obezite açısından risk oluşturduğu yapılan birçok çalışma ile de desteklemektedir. Obezite ile mücadele açısından fiziksel aktivite artırıcı uygulamaların arttırılması da önerilmektedir. Genel olarak bakıldığında teknolojinin doğru kullanımı ve bilgi düzeyinin artmasıyla risklerin en aza indirilebileceği düşünülmektedir. Bu çalışmanın amacı teknoloji bağımlısı çocuklarda oluşan ve obezite açısından risk faktörü olan etmenleri incelemektir. ABSTRACT With the widespread use of technology, many houses now have access to internets. The widespread use has also caused many kinds of dependencies. Many definitions such as television addiction, internet addiction, mobile game addiction, social media addiction have entered into the literature and have been studied. All these dependency models are evaluated in the context of technology dependency. In technology dependent children, many problems such as increased on-screen time, physical inactivity, psychosocial problems, sleep disturbances, deterioration of diet, exposure to advertising, increase in unhealthy food consumption are observed. All of these problems are also supported by many studies that pose a risk to obesity.It has also been proposed to increase physical activity-enhancing practices in terms of combating obesity. Nevertheless it is thought that the right use of technology and the increase in the level of knowledge can minimize the risks. The aim of this study is to investigate the factors that are risk factors for obesity in technology dependent children.

Resumo Introdução: O boletim de saúde infantil e juvenil é um instrumento imprescindível, que se destina ao registo dos factos mais importantes relacionados com a saúde da criança / adolescente. Apesar da sua reconhecida relevância, continua a ser subu-tilizado. O objetivo deste trabalho foi conhecer as práticas de registo dos pediatras e médicos de família no boletim de saúde infantil e juvenil, avaliando o grau de preenchimento das várias secções, nomeadamente nas consultas por idade-chave. Métodos: Estudo observacional, transversal e analítico. Amostra de conveniência constituída por crianças e adolescentes com idade inferior a 18 anos, portadoras do boletim de saúde infantil e juvenil, observadas na urgência pediátrica, consulta externa ou enfermaria de um serviço de pediatria, entre maio e junho de 2013. Foi utilizada uma grelha de avaliação elaborada pelos autores para anotação da presença / ausência de registos em cada secção do boletim. Resultados: Foram analisados os boletins de saúde infantil e juvenil de 200 crianças / adolescentes, com uma média de idade de 4 anos e 5 meses e mediana de 3 anos e 4 meses. Da avaliação do preenchimento das secções verificou-se que em 28% dos boletins não estava indicado o nome da criança; apresentavam registos em todas as consultas idade-chave 23,0% dos bole-tins; dos boletins com registos em todas as consultas, 91% pertenciam a crianças com idade inferior a seis anos (p = 0,004). As secções com taxas de preenchimento mais reduzidas foram a curva de índice de massa corporal, o desenvolvimento e a fotografia. A secção relativa a hospitalizações não continha registos em 95,4% da amostra. A observação dentária foi registada num único boletim. Discussão: O boletim de saúde infantil e juvenil possui secções com registos deficitários. Numa fase de transição, com a criação do boletim eletrónico, é urgente alertar e sensibilizar os profissionais de saúde para esta lacuna. Abstract Introduction: The personal child health record is a standard health and development record in the form of a booklet, given to parents/caregivers at a child's birth. It is an invaluable tool for health professionals to record the most important facts related to a child's health. Despite its known importance, it remains under used. The aim of this study was to analyse pae-diatricians' and family physicians' use of the personal child health record by assessing the thoroughness with which items are completed, especially key development stage examinations. Methods: This observational and cross-sectional study analysed a convenience sample of children under the age of 18, carrying the booklet and observed in the paediatric emergency room or outpatient clinic or ward of a district hospital between May and June 2013. A grid designed by the authors was used for recording the presence or absence of data in each field of the personal child health record.

We sought to quantify early deaths following neonatal circumcision (same hospital admission) and to identify factors associated with such mortality. We performed a retrospective analysis of all patients who underwent circumcision while hospitalized during the first 30 days of life from 2001-2010 using the National Inpatient Sample (NIS). Over 10 years, 200 early deaths were recorded among 9,833,110 subjects (1 death per 49,166 circumcisions). Note: this figure should not be interpreted as causal but correlational: it may include both under-counting and over-counting of deaths attributable to circumcision. Compared to survivors, subjects who died following newborn circumcision were more likely to have associated co-morbid conditions, such as cardiac disease (OR: 697.8 [378.5-1286.6] p<0.001), coagulopathy (OR: 159.6 [95.6-266.2] p<0.001), fluid and electrolyte disorders (OR: 68.2 [49.1-94.6] p<0.001), or pulmonary circulatory disorders (OR: 169.5 [69.7-412.5] p<0.001). Recognizing these factors could inform clinical and parental decisions, potentially reducing associated risks.

Pemeriksaan tekanan darah merupakan salah satu pemeriksaan sangat penting pada pasien. Di sisi lain, pada pasien anak merupakan pemeriksaan ini tidak selalu mudah dilakukan. Artikel membahas beberapa hal yang mungkin perlu kita ingat kembali dalam mengukur tekanan darah anak.

LATAR BELAKANG
Sphingomonas paucimobilis adalah bakteri aerobik, basil gram negatif dengan patogenitas rendah. Organisme ini umumnya terdapat pada bekas kateter infus yang dipakai berulang dan lingkungan terkontaminasi. Infeksi bakteri ini sangat jarang menyebabkan kematian. Pada bayi, terdapat satu laporan kasus namun tidak menimbulkan kematian. Kasus ini kemungkinan kasus letal S. paucimobilis pada bayi yang pertama kali dilaporkan.

PRESENTASI KASUS
Bayi perempuan usia 1 bulan 15 hari datang dengan keluhan demam sejak 2 hari, disertai bercak kemerahan di tubuh dan badan kaku. Pasien tidak minum ASI melainkan susu formula. Pemeriksaan 􏰉􏰑􏰔􏰊fisik menemukan keadaan sakit berat, apatis, merintih, tekanan darah 99/58mmHg, takykardi (212x/menit), demam (39,9C), saturasi oksigen normal (99%), akral hangat, namun didapatkan kaku kuduk. Laboratorium darah menunjukkan hemoglobin 8,6 g/dL, leukopenia (4.002/uL), Trombosit normal (220.000/uL). CT Scan dengan kontras menunjukkan adanya meningoencephalitis. Analisa cairan serebro spinal menunjukkan peningkatan leukosit 1.661 sel/uL, Pandy (+), Nonne (+) dan adanya bakteri S. paucimobilis multiresisten. Pada hari ke-4, terjadi perburukan dan pasien meninggal disebabkan syok sepsis dan meningitis walaupun telah mendapatkan antibiotik meropenem.

DISKUSI
Sebagian besar infeksi S.paucimobilis didapat dari lingkungan, terutama dari sumber air dan tanah. Hal yang paling mungkin menjadi sumber infeksi pada pasien ini berasal dari sumber air yang terkontaminasi. Ini diduga karena pasien mengonsumsi susu formula yang dibuat dengan air minum isi ulang. Antibiotik cephalosporin generasi ketiga dan carbapenem menjadi pilihan antibiotik yang umumnya paling efektif, namun ternyata tidak bermanfaat pada kasus ini.

KESIMPULAN
Bakteri S. paucimobilis umumnya dianggap tidak berbahaya dan selama ini tidak ditemukan laporan kematian bayi yang diakibatkannya. Laporan kasus ini dapat menjadi laporan kasus pertama infeksi letal akibat S. paucimobilis yang terjadi di komunitas pada bayi yang sebelumnya sehat. Kultur LCS dan pemberian antibiotik yang agresif harus segera dilakukan karena cepatnya perburukan kondisi pada pasien akibat infeksi ini.

Keywords : Sphingomonas paucimobilis, meningitis

Presented in Simposium Nasional Ikatan Dokter Anak Indonesia (SINAS IDAI) 24 April 2021, by Rizki Rudwi Pradesta.

Aims - Highlight the impact that diagnosis communication to an ill child and his siblings can have on the understanding and the experience of the disease, on the child’s compliance and on the communication within the family about the experience of illness. Methods - Through a qualitative approach, a study case has been conducted by observing doctor-child diagnosis communication and by interviewing parents. The materials have been studied by content analysis.
Results - Diagnosis communication to children helps their participation and understanding of the illness and supports parents to communicate with ill children and with their siblings. The latter often look isolated, suffering, sometimes forgotten and with many problematic behaviors.
Conclusions - Diagnosis communication is really  precious to promote children participation; however, it needs to be continuously renewed at home and in the hospital, and requires the constant promotion of an educational alliance with parents.

El crecimiento y desarrollo de un niño constituyen dos conjuntos de signos de gran utilidad para determinar el estado de salud de los pacientes en edad pediátrica. (Torres, A. 2002) Un estado de salud óptimo proporciona mejor respuesta al tratamiento médico y una disminución de infecciones que catalogan una mejor calidad de vida.

PEG 3350 là các chuỗi polyethylene glycol trơ về mặt sinh học, chúng còn có tên gọi khác là macrogol 3350.

Hiệp hội Nhi khoa - Tiêu hóa - Gan và Dinh dưỡng Châu Âu, Bắc Mỹ, và Viện Chăm sóc sức khỏe NICE – UK đã khuyến cáo sử dụng PEG 3350 là lựa chọn đầu tay trong các trường hợp táo bón chức năng ở trẻ nhỏ.

In 2012 the American Academy of Pediatrics (AAP) released a policy statement and technical report stating that the health benefits of newborn male circumcision outweigh the risks. In response, a group of mostly European doctors suggested that this conclusion may have been due to cultural bias among the AAP Task Force on Circumcision, since their conclusion differed from that of international peer organizations despite relying on a similar evidence base. In this article, we evaluate the charge of cultural bias as well as the response to it by the AAP Task Force. Along the way, we discuss ongoing disagreements about the ethical status of nontherapeutic infant male circumcision, and draw some more general lessons about the problem of cultural bias in medicine.