Therapeutic Effect and Safety of Early Treatment of Patent Ductus Arteriosus with Oral Ibuprofen in Preterm Infants

Background: Patent ductus arteriosus (PDA) is a common problem encountered in premature infants, especially those with respiratory distress syndrome. PDA can lead to life-threatening complications. Intravenous ibuprofen was shown to be as effective and to cause fewer side effects. If ibuprofen is effective intravenously, it will probably be effective orally too. Aim: This study was designed to determine the effectiveness and safety of oral ibuprofen compared to IV ibuprofen or no intervention for closing a PDA in preterm infants with RDS. Material and methods: A prospective study, randomized, a blindfold was conducted in NICU, at UOGH "Koço Gliozheni", Tirana, from February 2010-August 2013. The study included a total of 128 preterm infants, 28-35 weeks, ≤2500gr birth weight, in the first 48-96 hours of life, with SDR and confirm the presence of DBA's (Ǿ≥1.5mm) by echocardiographic examination. Infants were treated with Ibuprofen oral, intravenous Ibuprofen, no medical interventions, in randomized order. The cycle of treatment: 10 + 5 + 5/mg/kg, every 24 hours. Were highlighted the basic characteristics of infants included in the study, the effectiveness of treatment (closure of DBA's), side effects, complications, and the effectiveness of treatment. For continuous variables were calculated the average and standard deviation. The p≤0.05 value was accepted as statistically significant. All tests are two-sided. RR and OR were presented with 95% CI. Results: 38 infants were treated with Ibuprofen oral, 35 infants with intravenous Ibuprofen and 37 infants underwent no medical intervention. The effectiveness of early treatment: DBA remained open, after early treatment, in 7foshnja (18.4%) in group oral Ibuprofen vs 20 infants (54%) in the group that did not undergo any medical intervention [RR = 0.34; 95% CI = 0.16-0.7; p = 0.04], vs 6 infants (17.1%) in the group of intravenous Ibuprofen [RR = 1.07; 95% CI = 0.4-2.8; p≥0.05]. There was observed no statistically significant change of direction of side effects and complications, p≥0.05. Conclusions: Oral Ibuprofen is an effective and safe alternative when used for the treatment of DBAs to babies born prematurely and with low birth weight.Keywords: DBA, preterm births, Ibuprofen, treatment of early/late, side effects, complication

Trends in Mortality in Children Hospitalized with Meningococcal Infections in Albania from 2006 to 2014

Background: Lack of vaccination and modern health care facilities in many countries including Albania let meningococcemia to remain as a serious challenging disorder especially among children and in spite of improved diagnosis and earlier treatment its prognosis is still dismal. Patients expected to develop life-threatening complications in acute meningococcal infections require early recognition and appropriate monitoring. Different prognostic scoring systems have been developed. Aim: The aim of this study was to evaluate mortality in children hospitalized with meningococcal infections in Albania, including scoring systems in prognosticating mortality rate. Materials and Methods: This was a retrospective descriptive study, performed on 40 patients with definite diagnosis of meningococcal infection admitted to PICU in UHC “Mother Teresa”, Tirana, Albania, between 2006 and 2014. There were 40 patients, 22(55%) males, and 18(45%) females, from 2 months to 10 years old. We evaluated all the patients based on Stiehm and Damrosch and Glasgow meningococcal septicemia prognostic score. Data were collected by filling checklists. SSPS software was applied to analyze the data using chi-square test. Results: Overall mortality was 42%. According to the GMSPS(3) prognostic score of meningococcemia: 28 (70%) patients had a score <8 points and were recorded four deaths representing a mortality rate of 14.2%; the mortality rate of 12(45%) patients with a score ≥8 points resulted in 100% mortality. The sensitivity was 100%, specificity was 100%, the positive predictive value was 100% and the negative predictive value was 100% for a GMSPS score ≥8. According to the Stiehm and Damrosch criteria (2): 22(55%) patients had two or fewer factors present and was recorded three deaths representing a mortality rate of 13.6%; the mortality rate of 18(45%) patients with three or more factors present the mortality rate was 72.2%. The sensitivity was 90%, specificity was 80%, the positive predictive value was 75% and negative predictive value was 92.3% for the criterion ≥3 of the Stiehm and Damrosch criteria. Conclusions: Meningococci are still killers, they affect men more than women. The Stiehm and Damrosch and Glasgow meningococcal septicemia prognostic score can rapidly identify children with the fulminant meningococcal disease and poor prognosis and help us starting prompt administration of suitable antibiotics, critical care, and special therapeutic measures.Keywords: Meningococcal disease, meningococcemia, meningitis, children, scoring system

Diagnosis and Treatment of Chronic Neuropathic and Mixed Pain in Children and Adolescents: Results of a Survey Study amongst Practitioners

Validated diagnostic tools to diagnose chronic neuropathic and mixed pain in children are missing. Therapeutic options are often derived from therapeutics for adults. To investigate the international practice amongst practitioners for the diagnosis and treatment of chronic, neuropathic pain in children and adolescents, we performed a survey study among members of learned societies or groups whose members are known to treat pediatric pain. The survey included questions concerning practitioners and practice characteristics, assessment and diagnosis, treatment and medication. We analyzed 117 returned questionnaires, of which 41 (35%) were fully completed and 76 (65%) were partially completed. Most respondents based the diagnosis of neuropathic pain on physical examination (68 (58.1%)), patient history (67 (57.3%)), and underlying disease (59 (50.4%)) combined. Gabapentin, amitriptyline, and pregabalin were the first-choice treatments for moderate neuropathic pain. Tramadol, ibuprofen, amitriptyline, and paracetamol were the first-choice treatments for moderate mixed pain. Consensus on the diagnostic process of neuropathic pain in children and adolescents is lacking. Drug treatment varies widely for moderate, severe neuropathic, and mixed pain. Hence, diagnostic tools and therapy need to be harmonized and validated for use in children

Maternal and Perinatal Outcomes of Pregnant Patients with Coronavirus Disease 2019: Data from a University Hospital Setting in Tirana, Albania, May 2020 to November 2021

Scientific evidence suggests an increased risk of maternal and obstetric complications in pregnant patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This study is aimed at evaluating perinatal and maternal outcomes among patients with coronavirus disease 2019 (COVID-19) in a university hospital setting. This was a prospective cohort study of 177 pregnant women with confirmed SARS-CoV-2 infection at a tertiary hospital between May 2020 and November 2021. Both symptomatic and asymptomatic women with a positive reverse transcription-polymerase chain reaction test result at any time during pregnancy were included in this study. For the purpose of this study, we classified COVID-19 cases into two groups: mild and severe cases. The two groups were then compared to predict how the clinical presentation of COVID-19 affected adverse maternal and perinatal outcomes. Gestational age≥20 weeks at the time of infection was significantly associated with the occurrence of severe forms of the disease (relative risk (RR) 3.98, p=0.01). Cesarean section was the preferred mode of delivery, with 95 women (62.1%) undergoing surgery. A total of 149 neonates were delivered to women who had confirmed SARS-CoV-2 infection at any time during the course of pregnancy of which thirty-five (23.5%) were admitted to the neonatal intensive care unit (NICU). Severe forms of COVID-19 increased the risk of premature delivery (RR 6.69, p<0.001), emergency cesarean delivery (RR 9.4, p<0.001), intensive care hospitalization (RR 51, p<0.001), and maternal death (RR 12.3, p=0.02). However, severe forms of SARS-CoV-2 infection are not directly responsible for low birth weight or the need for neonatal resuscitation. Our findings suggest that pregnant women presenting with severe COVID-19 disease are at an increased risk of adverse maternal and perinatal outcomes, such as premature delivery, cesarean section, admission to the ICU, and maternal death. Infection after the 20th week of gestation increases the risk of developing severe forms of the disease

The research gap in chronic paediatric pain : A systematic review of randomised controlled trials

Background and Objective: Chronic pain is associated with significant functional and social impairment. The objective of this review was to assess the characteristics and quality of randomized controlled trials (RCTs) evaluating pain management interventions in children and adolescents with chronic pain. Methods: We performed a systematic search of PubMed, Embase and the Cochrane Library up to July 2017. We included RCTs that involved children and adolescents (3 months-18 years) and evaluated the use of pharmacological or non-pharmacological intervention(s) in the context of pain persisting or re-occurring for more than 3 months. Methodological quality was evaluated using the Cochrane Risk of Bias (ROB) Tool. Results: A total of 58 RCTs were identified and numbers steadily increased over time. The majority were conducted in single hospital institutions, with no information on study funding. Median sample size was 47.5 participants (Q1,Q3: 32, 70). Forty-five percent of RCTs included both adults and children and the median of the mean ages at inclusion was 12.9 years (Q1,Q3: 11, 15). Testing of non-pharmacological interventions was predominant and only 5 RCTs evaluated analgesics or co-analgesics. Abdominal pain, headache/migraine and musculoskeletal pain were the most common types of chronic pain among participants. Methodological quality was poor with 90% of RCTs presenting a high or unclear ROB. Conclusions: Evaluation of analgesics targeting chronic pain relief in children and adolescents through RCTs is marginal. Infants and children with long-lasting painful conditions are insufficiently represented in RCTs. We discuss possible research constraints and challenges as well as methodologies to circumvent them. Significance: There is a substantial research gap regarding analgesic interventions for children and adolescents with chronic pain. Most clinical trials in the field focus on the evaluation of non-pharmacological interventions and are of low methodological quality. There is also a specific lack of trials involving infants and children and adolescents with long-lasting diseases

The research gap in chronic paediatric pain: A systematic review of randomised controlled trials

Background and Objective: Chronic pain is associated with significant functional and social impairment. The objective of this review was to assess the characteristics and quality of randomized controlled trials (RCTs) evaluating pain management interventions in children and adolescents with chronic pain. Methods: We performed a systematic search of PubMed, Embase and the Cochrane Library up to July 2017. We included RCTs that involved children and adolescents (3Â&nbsp;months-18Â&nbsp;years) and evaluated the use of pharmacological or non-pharmacological intervention(s) in the context of pain persisting or re-occurring for more than 3Â&nbsp;months. Methodological quality was evaluated using the Cochrane Risk of Bias (ROB) Tool. Results: A total of 58 RCTs were identified and numbers steadily increased over time. The majority were conducted in single hospital institutions, with no information on study funding. Median sample size was 47.5 participants (Q1,Q3: 32, 70). Forty-five percent of RCTs included both adults and children and the median of the mean ages at inclusion was 12.9Â&nbsp;years (Q1,Q3: 11, 15). Testing of non-pharmacological interventions was predominant and only 5 RCTs evaluated analgesics or co-analgesics. Abdominal pain, headache/migraine and musculoskeletal pain were the most common types of chronic pain among participants. Methodological quality was poor with 90% of RCTs presenting a high or unclear ROB. Conclusions: Evaluation of analgesics targeting chronic pain relief in children and adolescents through RCTs is marginal. Infants and children with long-lasting painful conditions are insufficiently represented in RCTs. We discuss possible research constraints and challenges as well as methodologies to circumvent them. Significance: There is a substantial research gap regarding analgesic interventions for children and adolescents with chronic pain. Most clinical trials in the field focus on the evaluation of non-pharmacological interventions and are of low methodological quality. There is also a specific lack of trials involving infants and children and adolescents with long-lasting diseases