Clinical Pediatrics最新文献

The impact of the COVID-19 pandemic on pediatric obesity and comorbidities was investigated via a retrospective analysis of new patient visits at a pediatric weight management clinic. Prepandemic (N = 1590, January 1, 2017, to March 20, 2020) and postpandemic (N = 1040, April 1, 2020, to June 8, 2023), patients ages 2-21 years with overweight or obesity were studied. Results revealed significant increase in obesity severity during the postpandemic period (OR = 1.70 [1.45, 1.99]), with more comorbidities (OR = 1.28 [1.22, 1.34]). Prediabetes (OR = 1.62 [1.07, 2.47]), eating disorder/hyperphagia (OR = 1.77 [1.26, 2.50]), and attention deficit hyperactivity disorder (OR = 1.36 [1.09, 1.69]) diagnoses were more prevalent postpandemic. Patients aged 10 to <14 years (OR = 2.39 [1.51, 3.79]) and non-Hispanic patients (OR = 1.44 [1.07, 1.94]) had higher odds of mood/mental health disorder diagnoses postpandemic. In conclusion, the COVID-19 pandemic is associated with worsening pediatric obesity severity and higher prevalence of obesity-related comorbidities in new patients presenting for treatment.

Objective: To establish whether infants with macrocephaly and non-acute subdural hematomas (SDHs) had missed opportunities for measuring fronto-occipital circumference (FOC) and obtaining neuroimaging prior to diagnosis. Macrocephaly due to SDH in infancy is initially detected by FOC measurements and/or neuroimaging, as neurologic symptoms may be subtle or missed.

Methods: Retrospective chart review of infants with macrocephaly and non-acute SDHs referred to child abuse pediatricians for suspected abusive head trauma (AHT) over an 8-year period. A study sample of 35 infants met inclusion criteria and had complete prior medical records which were reviewed for missed opportunities for earlier SDH diagnosis. Four types of missed opportunities were identified: not initiating a workup for nonaccidental trauma (NAT) with a history or exam finding of a sentinel injury, not obtaining FOC when presenting with nonspecific neurologic symptoms, no neuroimaging for macrocephalic infants, and incomplete or delayed workup for macrocephaly.

Results: Most (91%) infants had missed opportunities for earlier diagnosis of macrocephaly and/or SDH. The most common missed opportunity was no neuroimaging when macrocephalic (N = 28; 54%). Other missed opportunities included not obtaining FOC on a symptomatic infant (N = 10), macrocephaly with incomplete or delayed workup (N = 9), and no NAT workup with a sentinel injury (N = 5). Most of these 35 infants (77%) were diagnosed with concerns for abuse and 43% required surgery upon diagnosis with SDH.

Conclusion: Measuring and reviewing FOC, especially in infants with nonspecific neurologic symptoms or infants with sentinel injuries, may facilitate earlier assessment for AHT. An earlier diagnosis of AHT will assist in developing appropriate safety and treatment interventions.

This study explored a mother's experience of caring for her child with Jeune syndrome through a phenomenological qualitative approach using letter writing. Data were analyzed inductively, and four major themes emerged: challenges and successes in medical treatment, emotional resilience and family dynamics, overcoming developmental and educational barriers, and hopes and aspirations for the future. The mother described interactions with health care providers, her child's surgeries, treatments, and postoperative care. She emphasized the importance of family support, emotional struggles, and concerns about her child's future health. Developmental delays, social difficulties, and limited access to formal education were noted. Future plans involved tracheostomy closure, dietary improvements, and genetic testing. Despite these challenges, the mother remained hopeful, emphasizing her child's postoperative recovery and potential for greater independence. This analysis highlights the struggles, victories, and aspirations of a mother facing a rare disease and offers inspiration to others in similar circumstances.

Food insecurity is a significant barrier to children's health. Clinic-based food safety net programs have the potential to improve health for patients experiencing food insecurity but have not been well studied in pediatric settings. This study aimed to evaluate the impact of a pediatric primary care clinic-based food pantry on food recipients' attitudes and behaviors and to explore recipients' recommendations for program improvements to better meet their needs. Telephone interviews were conducted with 20 English or Spanish-speaking adult caregivers who received food from a pediatric clinic-based food pantry. Five major themes emerged from interviews: financial impact, emotional impact, access to the pantry, perspectives on pantry food, and areas for improvement. We found that a pediatric clinic-based food pantry is a convenient, trusted, and positively regarded resource that can alleviate psychosocial consequences of food insecurity. Based on participant recommendations, we propose ways to optimize patient engagement in a clinic-based food pantry program.

The experience of a vaccination is more painful for children than adults. This randomized experimental study aimed to evaluate the impact of ShotBlocker and manual pressure on pain reduction during administering pneumococcal conjugate vaccines (PCV) in infants. The study was performed with 102 4-month-old infants who received the PCV at 3 health centers. The participants were randomly assigned to 1 of the 3 groups: ShotBlocker, manual pressure, and control. Each group included 34 infants, with an equal distribution of genders. Data collection tools included a demographic questionnaire, the Neonatal Infant Pain Scale, and video recordings. The results indicated that neither manual pressure nor ShotBlocker effectively reduced pain during PCV administration in 4-month-old infants. No statistically significant difference was found in Neonatal Infant Pain Scale (NIPS) scores among the groups after vaccination (F = 0.789, P > .05). These results highlight the need specific approaches to nonpharmacological pain management during vaccination for 4-month-old infants.Registration: Clinical trials number is NCT06813729 (ClinicalTrials.gov).

Kawasaki disease (KD) is an acute febrile illness that was recognized as the most common acquired cardiovascular disease among children. Recent years have witnessed a progressive increase in the proportion of cases diagnosed with incomplete KD owing to atypical clinical presentation. The typical reported gastrointestinal symptoms in these patients include diarrhea, vomiting, abdominal pain, hepatitis, gallbladder hydrops, and pancreatitis. This study reviewed 4 patients with KD at our hospital, who presented with acute abdomen. The presence of atypical symptoms such as gastrointestinal symptoms tends to obviate the other manifestations of KD, which may lead to misdiagnosis of acute abdomen and inappropriate surgical treatment. As illustrated in this case series, these children have clinical symptoms or signs suggestive of KD (especially lymphadenopathy or rash) early in the disease course that are liable to be missed or overlooked.

Chronic idiopathic constipation carries a significant burden on children and their families. Despite existing treatment guidelines, adherence and outcomes remain poor, with gaps in parental understanding contributing to these outcomes. This study aimed to develop a "curriculum of information needs" for parents of children with chronic constipation. This is a qualitative study which employed 15 semi-structured interviews with parents and health care professionals, in the United Kingdom. Thematic analysis of data produced 4 themes, with the primary study objective described in the first theme of a "curriculum of information needs." This curriculum encompasses key topics, such as; understanding constipation, behavioral strategies for management, and medication use, providing a framework to enhance parental knowledge and understanding of chronic constipation. Future efforts could integrate findings into designing accessible resources, including digital platforms and Artificial Intelligence-driven treatment tools, to improve adherence and outcomes.

Children with Trisomy 21 (Down syndrome, T21) frequently require intensive care due to multiple comorbidities. This retrospective study evaluated the reasons for pediatric intensive care unit (PICU) admission, clinical features, and mortality factors in genetically confirmed T21 patients admitted between January 2023 and December 2024. Thirty-seven patients were included (64.9% male; median age = 2.65 years). Respiratory failure was the leading cause of admission (81%), followed by sepsis (5.4%). The overall mortality rate was 13.5% (n = 5). All nonsurvivors required invasive mechanical ventilation and inotropic support. They more frequently exhibited tachycardia, arrhythmia, hypotension, pleural effusion, cytopenias, renal dysfunction, and electrolyte disturbances. Procalcitonin and lactate dehydrogenase (LDH) levels were also higher among nonsurvivors. In this single-center retrospective series, the primary reason for PICU admission among children with T21 was respiratory failure, while mortality was associated with mechanical ventilation, inotropic support, and renal/electrolyte disturbances. Larger, multicenter, and prospective studies are needed to ensure generalizability.