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Journal of Tissue Viability Aug 2022Diaper dermatitis (DD) is a significant problem in the care of newborns, infants, and young children and good recognition of signs and symptoms optimises timely...
RATIONALE
Diaper dermatitis (DD) is a significant problem in the care of newborns, infants, and young children and good recognition of signs and symptoms optimises timely treatment. There is also a need for a standardised set of related descriptors to enable communication between health care providers about diagnosis and treatment.
OBJECTIVE
The study aimed to review the literature for descriptive words to define the clinical signs, symptoms, and characteristics, including anatomical locations and assessment scales or tools, in the newborn, infants and young children population who have been diagnosed with DD.
METHODS
A systematic review process utilising PRISMA guidelines [1] was conducted using advanced search techniques to analyse the terms from the database thesauri and keywords. Data bases including Ovid MEDLINE® and Epub Ahead of Print, in-Process & Other Non-Indexed Citations, Daily and Versions® were searched from 1946 to March 18, 2021. Cochrane Handbook Searching for and selecting studies were used as a guide and as best practice to conduct the search.
RESULTS
Of the 551 publications originally identified, 55 full text publications were examined and 21 met the inclusion criteria. The wide range of descriptors used in the literature for DD supports the need for a clearer approach to report the signs and symptoms, and the severity, of DD.
CONCLUSIONS
These findings point to gaps in the literature, both in recording signs and symptoms of DD and features such as wetness, infection, anatomical location, severity and pain in newborns, infants, and young children. There is a need to develop a robust methodological tool to bridge the gap and link a common terminology on signs and symptoms to support diagnosis of the severity of DD.
Topics: Child; Child, Preschool; Diaper Rash; Humans; Infant; Infant, Newborn
PubMed: 35562302
DOI: 10.1016/j.jtv.2022.03.003 -
Acta Paediatrica (Oslo, Norway : 1992) May 2022In previously healthy subjects, primary varicella presents with a distinctive vesicular rash that is more intense on the trunk and head than on the extremities. However,... (Review)
Review
AIM
In previously healthy subjects, primary varicella presents with a distinctive vesicular rash that is more intense on the trunk and head than on the extremities. However, an atypical presentation may occasionally develop. We aimed at systematically assessing the characteristics of cases affected by atypical primary varicella rash.
METHODS
The United States National Library of Medicine, Excerpta Medica and Web of Science databases were reviewed, without date or language restrictions. Articles were eligible if reporting previously healthy and immunocompetent subjects with a primary varicella rash (i.e., a photo-localised primary varicella or skin inflammation-associated primary varicella).
RESULTS
Thirty-eight reports providing information on 59 cases of atypical primary varicella were identified. Twenty-four cases (median 8.5 years of age, 19 females) were photo-localised and 35 (median 4.8 years of age, 15 females) were associated with pre-existing skin inflammation (including cast occlusion, diaper irritation, operative sites, burns, insect bites, vaccinations or pre-existing skin disease). The skin rash was monomorphic and without a "starry sky" appearance.
CONCLUSION
Primary varicella may have a modified presentation in areas of irritation such as sun exposure or pre-existing inflammation. There is a need for a wider awareness of these modulators of varicella rash.
Topics: Adolescent; Adult; Chickenpox; Exanthema; Female; Herpesvirus 3, Human; Humans; Inflammation; Skin; Young Adult
PubMed: 35178772
DOI: 10.1111/apa.16300 -
Journal of Drugs in Dermatology : JDD Nov 2021The skin of neonates and infants undergoes a maturation process from birth and is susceptible to barrier disruption. The current algorithm follows a US-based consensus...
BACKGROUND
The skin of neonates and infants undergoes a maturation process from birth and is susceptible to barrier disruption. The current algorithm follows a US-based consensus paper on skincare approaches using gentle cleansers and moisturizers in neonatal and healthy infant skin. This summary provides clinical information for pediatric dermatologists, dermatologists, and pediatric healthcare providers treating neonates and infants.
METHODS
The project used a modified Delphi process comprising virtual discussions followed by an online follow-up replacing the use of a questionnaire. During the virtual meeting, the systematic literature review results and a draft algorithm addressing over-the-counter skincare for neonates and infants with healthy skin were discussed and adopted using evidence coupled with the expert opinion and experience of the panel.
RESULTS
The algorithm addresses three clinical signs: xerosis, erythema, and erosion/bulla. A growing body of evidence recognizes the benefits of ongoing daily use of non-alkaline cleansers and ceramides containing moisturizers to reduce inflammation and maintain a healthy skin barrier function. Diaper rash is common in infants presenting as erythema or, in more severe cases, skin erosion. Skin protection with a barrier cream and frequent diaper changes using disposable diapers resolves most cases; however, if the rash continuous despite appropriate care, rule out a candida infection.
CONCLUSION
The current algorithm focuses on neonatal and infant healthy skin that can benefit from skincare. When applied from birth onwards, gentle cleansers and moisturizers containing barrier lipids help maintain the protective skin barrier. J Drugs Dermatol. 2021;20(11):1195-1205. doi:10.36849/JDD.6219.
Topics: Algorithms; Child; Diaper Rash; Humans; Infant; Infant Care; Infant, Newborn; Skin; Skin Care
PubMed: 34784132
DOI: 10.36849/jdd.6219 -
Annals of Family Medicine 2021Accurate diagnosis of urinary tract infection in children is essential because children left untreated can experience permanent renal injury. We aimed to assess the... (Meta-Analysis)
Meta-Analysis
PURPOSE
Accurate diagnosis of urinary tract infection in children is essential because children left untreated can experience permanent renal injury. We aimed to assess the diagnostic value of clinical features of pediatric urinary tract infection.
METHODS
We performed a systematic review and meta-analysis of diagnostic test accuracy studies in ambulatory care. We searched the PubMed, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials, Health Technology Assessment, and Database of Abstracts of Reviews of Effects databases from inception to January 27, 2020 for studies reporting 2 × 2 diagnostic accuracy data for clinical features compared with urine culture in children aged <18 years. For each clinical feature, we calculated likelihood ratios and posttest probabilities of urinary tract infection. To estimate summary parameters, we conducted a bivariate random effects meta-analysis and hierarchical summary receiver operating characteristic analysis.
RESULTS
A total of 35 studies (N = 78,427 patients) of moderate to high quality were included, providing information on 58 clinical features and 6 prediction rules. Only circumcision (negative likelihood ratio [LR-] 0.24; 95% CI, 0.08-0.72; n = 8), stridor (LR- 0.20; 95% CI, 0.05-0.81; n = 1), and diaper rash (LR- 0.13; 95% CI, 0.02-0.92; n = 1) were useful for ruling out urinary tract infection. Body temperature or fever duration showed limited diagnostic value (area under the receiver operating characteristic curve 0.61; 95% CI, 0.47-0.73; n = 16). The Diagnosis of Urinary Tract Infection in Young Children score, Gorelick Scale score, and UTIcalc (https://uticalc.pitt.edu) might be useful to identify children eligible for urine sampling.
CONCLUSIONS
Few clinical signs and symptoms are useful for diagnosing or ruling out urinary tract infection in children. Clinical prediction rules might be more accurate; however, they should be validated externally. Physicians should not restrict urine sampling to children with unexplained fever or other features suggestive of urinary tract infection.
Topics: Child; Child, Preschool; Diagnostic Tests, Routine; Fever; Humans; Male; ROC Curve; Urinalysis; Urinary Tract Infections
PubMed: 34546950
DOI: 10.1370/afm.2684 -
Journal of Pediatric Surgery Nov 2020To establish the cogency of recommendations for the appropriate age for pull-through and ileostomy closure in Total Colonic Aganglionosis-Hirschsprung Disease's (TCA-HD). (Meta-Analysis)
Meta-Analysis
AIM
To establish the cogency of recommendations for the appropriate age for pull-through and ileostomy closure in Total Colonic Aganglionosis-Hirschsprung Disease's (TCA-HD).
METHOD
Medline, PubMed, Cochrane, and the ClinicalKey databases were searched without date restriction. The studies that reported TCA-HD cases were evaluated for the number of cases, age at the definitive procedure, age at the ileostomy closure, reported complications, and the type of procedure. Perianal excoriation and diaper rash rates were analyzed using SPSS software, with p < 0.05 considered significant.
RESULTS
Twenty-five studies mentioned TCA-HD findings between 1968 and 2019. The total number of patients who had definitive surgery was 218. Analysis showed no correlation between development of diaper rash and the age of the patient at the time of the definitive surgery or ileostomy closure. Studies scored between six and nine of nine possible stars on the NOS scoring system.
CONCLUSION
There is no correlation between age of surgery and postoperative diaper rash. Delaying the definitive procedure or ileostomy closure for TCA-HD has limited support on a review of current studies. The perianal excoriation/diaper rash is not reported in the literature at a high enough frequency to warrant keeping a diverting ileostomy until toilet trained of urine.
TYPE OF STUDY
Systematic review and meta-analysis. Levels of evidence IV.
Topics: Anastomosis, Surgical; Hirschsprung Disease; Humans; Ileostomy; Infant; Postoperative Complications; Treatment Outcome
PubMed: 32106964
DOI: 10.1016/j.jpedsurg.2020.02.007 -
The Journal of Pediatrics Dec 2019To characterize the incidence of adverse events (AEs) associated with antibiotics used to treat acute otitis media in children. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To characterize the incidence of adverse events (AEs) associated with antibiotics used to treat acute otitis media in children.
STUDY DESIGN
We searched MEDLINE for studies conducted between January 1, 1966, and August 25, 2018. Two authors independently assessed potential studies and extracted the data. We included published randomized controlled trials, cross-sectional studies, and cohort studies that evaluated the incidence of diarrhea, generalized rash, diaper rash, and candidal diaper dermatitis associated with the use of amoxicillin, amoxicillin/clavulanate, azithromycin, cefdinir, and placebo in children with acute otitis media.
RESULTS
We included 82 studies in the meta-analysis. The incidence of diarrhea, listed from lowest to highest, was azithromycin (2.2%), placebo (6.9%), low-dose amoxicillin (8.7%), cefdinir (13.0%), high-dose amoxicillin (13.8%), and high-dose amoxicillin/clavulanate (18.9%). The incidence of generalized rash, listed from lowest to highest, was azithromycin (1.4%), placebo (2.3%), low-dose amoxicillin (2.9%), high-dose amoxicillin/clavulanate (4.9%), and high-dose amoxicillin (6.5%). In studies of low-dose amoxicillin, we found a higher incidence of diarrhea in studies that used daily diaries to collect information about diarrhea and a lower incidence of generalized rash in studies that reported only rashes judged to be secondary to antibiotic use.
CONCLUSIONS
The incidence of AEs varies widely depending on which antibiotic is used and how the information on AEs was collected or reported. The AEs rates reported here may be helpful to clinicians when choosing an antibiotic to treat acute otitis media.
Topics: Acute Disease; Anti-Bacterial Agents; Child; Drug-Related Side Effects and Adverse Reactions; Global Health; Humans; Incidence; Otitis Media
PubMed: 31561959
DOI: 10.1016/j.jpeds.2019.08.043 -
Pflege 2017Background: The incontinence-associated dermatitis (IAD) is a common condition in newborns, infants and toddlers. For the therapy nurses and parents have the choice... (Comparative Study)
Comparative Study Review
Background: The incontinence-associated dermatitis (IAD) is a common condition in newborns, infants and toddlers. For the therapy nurses and parents have the choice between numerous barrier creams based on zinc oxide, Dexpanthenol or Vaseline in various combinations of active agents and with additional ingredients. Research question: Which combination of active ingredients in local barrier creams reduce pain, severity of or duration of healing in IAD in neonates, infants and young children? Method: MEDLINE and CINAHL was systematically search for randomized controlled trials on the effect of barrier creams in pediatric patients with IAD. These were evaluated on validity and applicability. Results: 15 RCTs were found, of which six were included in the systematic review. The methodological quality of these trials ranges from good to poor, partially high bias risk were recognizable. Barrier creams containing the active ingredients zinc oxide / lanolin, zinc oxide / cod liver oil, zinc oxide / Dexpanthenol, paraffin / beeswax / Dexpanthenol show effects. They reduce the IAD-associated symptoms. Conclusions: The investigated barrier creams can be used in the pediatric nursing for the treatment of IAD. Because of limitations it cannot be ruled out that further studies will change the results.
Topics: Child, Preschool; Dermatologic Agents; Diaper Rash; Emollients; Female; Humans; Infant; Infant, Newborn; Male; Neonatal Nursing; Randomized Controlled Trials as Topic; Skin Care; Urinary Incontinence
PubMed: 28071289
DOI: 10.1024/1012-5302/a000522