Oniūnaitė, Urtė

Apatinių kvėpavimo takų infekcijos (AKTI) - vienos iš dažniausiai vaikams pasireiškiančių infekcijų [1, 2]. Šių ligų simptomai panašūs, tai apsunkina ligos diagnostiką [3, 4]. Turint omenyje, kad vaikai - jautri ir pažeidžiama populiacija, pirminės sveikatos priežiūros grandies gydytojai linkę imtis perteklinio ištyrimo bei gydymo [5]. Tiksli bei greita AKTI diagnostika yra reikšminga, kad ligonis laiku gautų tinkamą gydymą: tuomet gerėja paciento prognozė, mažėja komplikacijų dažnumas, ligoninės išlaidos, infekcijų plitimas, neracionalus antibiotikų skyrimas ir vartojimas, dėl kurio infekcijos tampa vis sunkiau valdomos ir reikalauja agresyvesnio gydymo [5, 6]. Europos pediatrų asociacija patvirtino, kad vaikų, sergančių savaime praeinančiomis kvėpavimo takų infekcijomis (įskaitant lengvos eigos ambulatoriškai gydomą visuomenėje įgytą pneumoniją (VĮP)), perteklinis antibiotikų vartojimas yra viena iš svarbių sveikatos priežiūros problemų Europoje [5, 7]. Siekiant sumažinti atsparių bakterijų atsiradimą ir stiprinti racionalų turimų antibiotikų naudojimą, būtina mažinti bendrą antibiotikų vartojimą ir tikslingai tirti ir gydyti pacientus pirminėje sveikatos priežiūros grandyje [1, 7].

Background, Objectives: Studies have demonstrated that neo-nates exhibit cortical responses to noxious stimuli, express clear physiological stress reactions. Major challenge – effective pain assessment. There is lack of studies investigating maternal fac-tors influencing neonatal stress and pain responses. This study aimed to identify these factors. Methods: We conducted a prospective quantitative study at the Lithuanian University of Health Sciences Kaunas Clinics (Dec2020–Nov 2021). Term and preterm neonates admitted to the Neonatology Department/NICU were included. Exclusion criteria: neonate endocrine, CNS disorders, treatment with glucocorticoids or analgesics, and dehydration. Data collected: neonate's vitals, demographics, PIPP score, mothers’ medical history. Newborn salivary cortisol and melatonin were measured via ELISA before and 30 minutes after venipuncture or heel prick. Statistical analysis performed with SPSS 29.0. p value < 0.05 considered significant. Results: 98 newborns included in the study, 63.3% born on term. 68.4% of birth – natural. Half of women < 30 y.o. (median29 years, IQR26-33). 73.5% had pathology during pregnancy, 62.2% had medical anesthesia/pain management during labor. Higher melatonin in newborns born via CPO post NICU procedure(p = 0.028). Newborns from mothers who had any pathology during pregnancy were 12.6x more likely to have higher cortisol before heel-lance procedure (p = 0.021). The method of delivery negatively correlated with pre-procedure cortisol concentration(p = 0.035, p = 0.068). Maternal harmful habits increase melatonin concentration 6.319x after the heel-lance prick. Pain relief during labor and harmful maternal habits were associated with difference in melatonin concentration before and after the heel-lance procedure (p = 0.005, p = 0.002). Neonates born via CPO had higher melatonin after NICU procedure (p = 0.028). Conclusion: We observed that neonatal stress and pain responses are significantly influenced by maternal factors, including maternal health, delivery method, and maternal behaviors.

Background, Objectives: Neonates, especially preterm infants in the NICU, undergo numerous procedures that may cause discomfort or pain. There is limited research on factors influencing neonatal stress and pain responses. This study aimed to identify factors in newborns associated with increased neonatal pain. Methods: We conducted a prospective quantitative study at the Lithuanian University of Health Sciences Kaunas Clinics (Dec2020–Nov 2021). Term and preterm neonates admitted to the Neonatology Department/NICU were included. Exclusion criteria: endocrine, and CNS disorders, treatment with glucocorticoids or analgesics, and dehydration. Data collected: neonates’ vitals, demographics, PIPP score, physiological parameters. Salivary cortisol and melatonin were measured via ELISA be-fore and 30 minutes after venipuncture or heel prick. Statistical analysis performed with SPSS 29.0. p value < 0.05 considered significant. Results: In total 98 newborns were included in the study,63.3% were term, 30 – treated in NICU. 68.4% of birth – natural, 9.2% had congenital malformations. Preterm neonates had greater increases in heart and respiratory rates during procedures (p < 0.001, p = 0.005), higher pre-procedural PIPP scores (p < 0.001), it remained similar after procedure. Females tended to have lower SpO2 before and after the procedure(p = 0.059, p = 0.057). Higher RR before, after the procedure associated with congenital abnormalities (p = 0.016, p = 0.050).Cortisol was higher in premature newborns after venipuncture(p = 0.039), also they had higher cortisol difference after NICU procedure (p = 0.039). Females had higher cortisol before procedure in NICU (p = 0.009). Congenital abnormalities associated with greater cortisol difference during heel-lance (B = 29.583,p = 0.039), lower gestational age – with higher cortisol difference in NICU procedures(p = 0.041). Neonatal sepsis was negatively correlated with melatonin concentration (p = 0.025).Conclusion: We observed that prematurity, congenital conditions, and neonatal sepsis are associated with heightened physiological and hormonal stress and pain responses.

Aim: Acute abdominal pain is a frequent pediatric emergency department (PED) complaint, with appendicitis as the top surgical cause. Diagnosis is challenging, especially in young children with vague symptoms. In this study we aimed to examine the alignment of Alvarado, PAS scores, and ultrasound with final appendicitis diagnoses. Materials and Methods: We conducted a retrospective single-center study of children aged 1–17 presenting with abdominal pain to our PED in September 2018. Alvarado, PAS, and HAS scores were calculated, and their diagnostic accuracy was assessed using AUC analysis. Results: Of 254 children (52.8% female, mean age 9.26 ± 4.64 years), 53 were diagnosed with appendicitis. Blood tests were performed in ~50%, and 95% had an abdominal US. Appendicitis was more common in older children and significantly associated with leukocytosis, neutrophilia, and CRP >60 mg/L. The Alvarado score showed a significant association (p < 0.001) and highest AUC (0.612), while PAS and HAS had slightly lower AUCs and were not statistically significant. Conclusions: Among clinical scoring systems, the Alvarado Score demonstrated the strongest, though moderate, predictive value for diagnosing appendicitis in this population.

Pediatric emergency medicine (PEM) presents unique challenges due to the diverse developmental stages and medical conditions of young patients. The increasing patient load and nonurgent referrals to pediatric emergency departments (PEDs) emphasize the need for personalized decision-making approaches. These approaches must accommodate the complexities of pediatric care while fostering collaboration between healthcare providers and families. Integrating artificial intelligence (AI) into healthcare settings can transform PEM by enhancing diagnostic accuracy, customizing treatments, and optimizing resource allocation. AI technologies leverage vast datasets, including electronic health records and genetic profiles, to generate personalized diagnostic and treatment plans. Machine learning algorithms can identify patterns in complex data, facilitating early disease detection and precise interventions. This literature review analyzes the role of AI in supporting pediatric emergency care through diagnostic assistance, predictive modeling for febrile disease progression, and outcome optimization. It also highlights the challenges of applying AI in PEM, including data limitations and the need for algorithmic transparency. By addressing these challenges, AI has the potential to revolutionize personalized care in pediatric emergency settings, ultimately improving patient outcomes and care delivery.

Background and Aims: off-label medication are prevalent in pediatrics and represents patient safety concern associated with elevated risk of adverse drug effects. We aimed to identify fac-tors linked to off-label drug use in our pediatric emergency department (PED). Methods: Retrospective data analysis was performed. All patients diagnosed with otitis or respiratory tract infections (RTIs)aged 0-18yrs who attended our PED September 1 st - October1st ;2022 were included. Data collected: gender, age, triage cathegory, chronic diseases, vital signs, PED-prescribed treatment(medications, dosages, administration methods). Statistical analysis was performed using SPSS 28.0, p < 0.05 was considered significant. Results: We analysed 473 patient records; median age- 3.595yrs(IQR1.97-5.77); 42.7%-female. Majority were triaged as 4 (not urgent)–85.6%. 17.1% had chronic diseases. 387 medications were prescribed, 47.5% were off-label. Mostly, off-label treatment was administered for unspecified external otitis (tobramycin & dexamethasone eye drops, n = 16 (100%)), acute laryngitis (adrenalin inhalations, dexamethasone orally), unspecified acute bronchitis (dexamethasone orally, salbutamol) (p < 0.001). 34.8% of salbutamol inhalations were misused by age (n = 16). Children received some medication orally vs injections (on dansetronn = 5, 62.5%; dexamethasone n = 82, 98.7%), intranasally vs IV(midazolam n = 7, 87.5%). IV adrenalin was always prescribed for inhalations (n = 46). There was no correlation between off-label prescription and gender, triage group, chronic diseases. We noted that younger children (3.4yrs (IQR1.9- 4.9) were more likely to receive off-label treatment (ORE - 0.17, CI95% (- 0.257-- 0.084);p < 0.001).Conclusions: We observed that leading cause of off-label use was inappropriate medication administration forms. External otitis, laryngitis, acute bronchitis were with highest prevalence of drug misuse. Younger children were more likely to receive off-label treatment in PED. Conclusions We observed that leading cause of off-label use was inappropriate medication administration forms. External otitis, laryngitis, acute bronchitis were with highest prevalence of drug misuse. Younger children were more likely to receive off-label treatment in PED.

Background: After the COVID-19 pandemic, Mycoplasma pneumoniae, a common respiratory pathogen, has resurged globally, with increased cases of rare complications like reactive infectious mucocutaneous eruption (RIME). RIME is characterized by a mucositis involving ≥2 surfaces and limited skin lesions following a respiratory infection. Here we present first two cases of RIME diagnosed in our hospital in children. Case Presentation Summary: Two previously healthy boys, aged 13 (Patient A) and 17 (Patient B) were hospitalized in 2024 due to a history of fever and mucosal lesions. Physical examination of both patients revealed signs of respiratory infection, including cough, cervical lymphadenopathy, crackles on auscultation, and oral mucosal eruptions with ulcers leading to serosanguinous slough and hemorrhagic crusts on the lips. While Patient A also had purulent bilateral conjunctivitis, few vesicular lesions on his right palm and left foot and elevated inflammatory markers (CRP 72.5 mg/L; PCT 1.3 μg/L), Patient B presented with widespread targetoid lesions, balanoposthitis, and left lung consolidation with low CRP. Patient B was immediately treated with clarithromycin due to high M. pneumoniae prevalence and atypical pneumonia, whereas Patient A was initially suspected to have severe stomatitis and first treated with penicillins, metronidazole, and acyclovir, which resulted in worsening of the condition: spreading oral erosions and facial swelling. Three days later M. pneumoniae IgM antibodies tested positive, leading to a diagnosis of RIME and subsequent treatment with clarithromycin. The diagnosis of Patient B was serologically confirmed on the 2nd day of hospitalization. Both patients showed significant improvement within 48 hours of treatment. Learning Points/Discussion: Cases of RIME, previously known as Mycoplasma induced rash and mucositis, have increased after COVID-19 pandemic due to a resurge of M. pneumoniae prevalence. RIME may be mistaken for other infections like herpes, coxsackievirus infection or Steven-Johnson syndrome, leading to diagnostic delays.

Apatinių kvėpavimo takų infekcijos (AKTI) - vienos dažniausių vaikų ligų, kartu - ir viena iš dažniausių apsilankymo vaikų skubios pagalbos skyriuje (VSPS) priežasčių [1, 2]. Šios ligos gali pasireikšti panašiais simptomais, diferencinė riba tarp jų yra labai nedidelė, todėl jas diagnozuoti gali būti sunkiau [3, 4]. Turint omenyje, jog vaikai - jautri, pažeidžiama populiacija, dažnai pirminės sveikatos priežiūros grandies gydytojai linkę imtis perteklinio ištyrimo bei gydymo [5]. Dauguma naujausių tyrimų teigia, jog tiek pacientų ištyrimas, tiek gydymas turėtų apsiriboti tik terapinės naudos turinčiais, kliniškai pagrįstais veiksmais [6]. Tiksli bei greita AKTI diagnostika yra reikšminga, kad ligonis laiku gautų tinkamą gydymą: tuomet gerėja paciento prognozė, mažėja komplikacijų dažnis, ligoninės kaštai, infekcijų plitimas, neracionalus antibiotikų vartojimas, dėl kurio infekcijos tampa vis sunkiau valdomos ir reikalauja agresyvesnio gydymo [5, 7]. Vienas iš pagrindinių iššūkių - atpažinti, kuriems pacientams antibakterinis ar kitas gydymas bus naudingas, todėl svarbu žinoti veiksnius, kurie susiję su atitinkamos infekcijos diagnostika, gydymu [1].

Off-label treatment is often seen in pediatrics, especially in pediatric intensive care and neonatal departments. It is linked to a broad range of factors, including restriction of pharmacological studies for ethical reasons, different pharmacokinetic and pharmacodynamic properties of medicines due to age and physiological differences in children, and the difficulty of manufacturing and do­sage determination. These gaps increase the likelihood of adverse reactions. Various measures are being taken to avoid unnecessary risks to children without depriving them of potentially effective pharmacotherapy. This study aimed to analyse the studies reported in literature on the relationship between off-label prescribing, the latest recommendations, and the impact of this treatment on the pediatric population. The literature shows that off-label are often prescribed due to children’s younger age, respiratory or rare dise­ases. Relevant groups of commonly misused medicines are as follows anti-infectives, respiratory medicines or treatment for neurological conditions. It has been ob­served that the most common off-label prescriptions are related to inappropriate dosage, patient age or indications for use. To deal with the problem, researchers are en­couraging the research community to find new, scienti­fically supported and effective treatments by increasing the sharing of high-quality research and data. This is to achieve trustworthy, evidence-based medical care and to protect children from ineffective or even harmful treat­ments. For off-label treatment, the European Academy of Paediatrics and the European Society of Perinatal and Paediatric Pharmacology have issued new guidelines to ensure the safest possible care for children.