Clinical Pediatrics最新文献

Preoperative anxiety is common among pediatric patients and is associated with adverse perioperative outcomes. This prospective single-arm pilot study evaluated the feasibility of the WeGo Telepresence Robotics Program-a real-time, child-operated virtual tour-as a tool to reduce preoperative anxiety. Fifteen pediatric patients (ages 5-14) undergoing elective surgery participated in a WeGo tour before surgery. Anxiety was measured using the Modified Yale Preoperative Anxiety Scale (mYPAS) before and after the intervention. Mean mYPAS scores significantly decreased from 33.22 ± 12.11 to 24.00 ± 1.76 (P < .001), with no significant associations between anxiety reduction and age, sex, or prior surgery. All patients experienced a reduction or maintenance of low anxiety levels, including those with brief technical interruptions. These findings support the feasibility of implementing WeGo in the preoperative setting and suggest potential benefits as a non-pharmacological tool, with future applications as an adjunct to standard care. Further studies are warranted to validate efficacy and assess broader applications.

Pain has an important impact on children's life, leading frequently to health care seeking. Using data from the Generation XXI cohort at 10 years, we aimed to characterize pain experience, health care use, and medical diagnoses according to children and parent reports. Of the 3725 children reporting pain, 26.7% had a parent-reported impact on at least one of their daily activities. An impact on daily activities was more likely in children with more frequent, more intense, multisite, and longer-lasting pain and also medication use. Among children with pain, 17.0% sought health care and 12.5% obtained a medical diagnosis as a result, more frequently boys. The most frequent diagnosis categories were musculoskeletal, gastroenterological, and psychological. Health care use was associated with higher pain frequency, duration, and use of medications. Despite the higher prevalence of pain among girls, we highlight a similar impact in both sexes. Most pediatric pain is managed without resorting to health care.

This study investigates the diagnostic efficacy of combining ultrasonography, Pediatric Appendicitis Score (PAS), and C-reactive protein (CRP) for appendicitis in children. We retrospectively analyzed 268 children with acute abdominal pain from 2017 to 2020. Compared with those of any single diagnostic method, the sensitivity and negative predictive value of ultrasonography combined with the pediatric appendicitis score and C-reactive protein were higher in diagnosing acute appendicitis (P < .05). In addition, the sensitivity of ultrasonography combined with C-reactive protein was also greater for diagnosing acute complicated appendicitis (P < .05). Ultrasonography correlated closely with pathological examination findings for appendicitis types (Kappa = 0.888; P < .05). The combined use of ultrasonography, the Pediatric Appendicitis Score, and C-reactive protein enhances the diagnostic accuracy for acute appendicitis. Furthermore, the integration of ultrasonography with C-reactive protein levels may assist in determining the pathological subtype of appendicitis in pediatric patients.

Objective: To describe the clinical presentation at diagnosis and identify risk factors affecting outcomes in patients with juvenile spondyloarthropathy (JSpA).

Methods: This retrospective cohort study reviewed records of patients ≤18 years old diagnosed with JSpA (2008-2023) at a pediatric rheumatology clinic, with at least 2 follow-up visits. Remission was defined as (1) on medication (inactive disease ≥6 months) or (2) off medication (inactive disease ≥12 months).

Results: Eighty-eight patients were included; 90.9% were male. The mean age of onset was 12.6 years. Peripheral arthritis (77.3%) and enthesitis (39.8%) were common. Sacroiliitis was found in 56.8% at diagnosis. Risk factors associated with sacroiliitis included peripheral arthritis and enthesitis, polyarticular, and hip involvement. Golimumab and etanercept were anti-tumor necrosis factor (TNF) agents frequently used. Clinical remission on and off medication occurred in 33% and 10.2%, respectively.

Conclusion: The JSpA in this cohort demonstrated substantial disease burden, with frequent axial and peripheral involvement. Although 43.2% of patients achieved clinical remission, sustained remission off medication was observed in only 10.2%, reflecting the chronic disease course. Early diagnosis and optimized treatment strategies remain essential to improve outcomes.

Excess screen time is an emerging hazard to physical and mental well-being of children. This observational cross-sectional study aimed to assess and compare knowledge regarding screen exposure guidelines among 100 mothers and 150 primigravida antenatal women (AW) using a questionnaire framed based on the Indian Academy of Paediatrics parental guidelines. Only 16% of mothers and none among the AW exhibited good knowledge while 48% of mothers and 79.3% of AW demonstrated poor knowledge (p = .01). Mothers showed higher awareness regarding the minimum permissible age to introduce social media platforms, whereas AW exhibited a higher knowledge regarding ill effects of excess screen use on mental health and physical ill effects like obesity. Women from both groups were unaware of the minimal permissible age to introduce screens and the signs of mobile phone addiction. This emphasizes the need for targeted educational intervention for mothers and AW to promote healthy screen habits among children.

Lysosomal dysfunction in Gaucher disease (GD) leads to inflammation, impaired cellular homeostasis, and disrupted autophagy. The alteration in immune system and the pro-inflammatory state in GD involves in the pathogenesis of the disease with increased levels of cytokines and chemokines. In this study, we aimed to analyze immunological abnormalities and association with HLA alleles in GD patients. Whole blood count, lyso-Gb3 levels, and immunological status were evaluated. A total of 13 patients confirmed to have GD were enrolled in our study. The most common positive antibody was anti-CCP and ANA. Only one patient's HLA profile was predisposing to autoimmune disease but had no clinical findings. None of the patients had symptoms of any related diseases with detected immunological markers. In our study, clinical status of GD or HLA alleles were not associated with positive markers of autoimmune diseases. Further studies are needed to elucidate inflammatory mechanism in GD.

Commercial blenderized formula for children dependent on feeding tubes is becoming increasingly popular. We aimed to determine if these formula provide complete nutrition for children. We compared the nutrient composition of popular commercial blenderized tube feeds to the Dietary Reference Intake (DRI) for age. We analyzed 3 brands: Compleat Pediatric, Real Food Blends, and Nourish. For children consuming a standard volume, all blenderized tube feeds met macronutrient requirements. None met all the fiber and micronutrient requirements with important deficiencies in vitamin D, calcium, B vitamins, and iron. Deficiencies were common in nonfortified feeds like Real Food Blends. There were micronutrients above the tolerable upper limits, especially in young children, in fortified feeds like Compleat and Nourish. No currently available commercial blenderized tube feeds provide complete nutrition for children compared to DRI for age. Physicians should be aware of possible deficiencies and/or toxicities associated with their long-term use.

Growing pains (GPs) are non-inflammatory pain syndromes affecting children aged 4 to 14 years. This case-control study aims to investigate the role of vitamin D deficiency in GP development. The study was conducted for 6 months. Healthy children without a history of GP were recruited as control subjects. Serum concentrations of calcium, phosphate, and alkaline phosphatase were measured. Vitamin D3 supplementation was administered to those identified with deficient or insufficient 25-hydroxyvitamin D (25-OHD). A total of 95.6% of the GP group and 93.3% of the control group had insufficient or deficient 25-OHD levels. No significant correlations for serum calcium, serum phosphate, and alkaline phosphatase with 25-OHD level in either group. Children with sufficient 25-OHD also experienced similar reduction in pain as those who received supplementation. The study found no significant difference in vitamin D levels between children with GP and those without.