European Journal of Pediatrics最新文献

Environmental light exposure plays a role in the entrainment of the infant circadian rhythm, which is crucial for growth and development. This scoping review aims to evaluate existing literature linking the role of light exposure in the development of the infant circadian rhythm. This scoping review is conducted in accordance with the PRISMA-ScR guidelines. The search strategy was conducted in a total of six databases (PubMed, Cochrane Database of Systematic Reviews, Science Direct, Google Scholar, Taylor and Francis, and Wiley) as of August 2024. Reviews, narrative studies, observational studies, and experimental studies published from 2012 to 2024 were extracted. These studies discussed the role of light exposure on the development of infant circadian rhythm. A total of 25 studies were retrieved (3 observational studies, 6 experimental studies, and 16 reviews). Evidence showed that cycled lighting is beneficial for the entrainment of the infant circadian rhythm according to the 24-h light-dark cycle. Cycled lighting improved nighttime sleep and daytime wakefulness, promoting optimum growth and development. Limited experimental studies were conducted due to the ethical considerations of infants as study participants. Conclusions: Given the benefits of cycled lighting in the development of the circadian rhythm development, it should be implemented in both healthcare and home settings to promote optimum growth and development of the infant.

Phthalic acid esters, or phthalates, are plasticizers commonly used in the plastics industry and they are known for their endocrine-disrupting effects. Numerous epidemiological studies have been conducted to evaluate the effects of phthalate exposure on thyroid function, both in adults and children. However, there is still considerable debate surrounding this issue. Therefore, a systematic review was conducted to clarify existing evidence and offer new insights into the magnitude of this disruption and its potential consequences for children and adolescents' health. A comprehensive literature search using MEDLINE, Scopus, and Web of Science databases was performed. The inclusion criteria for the studies were the determination of regression coefficients between phthalates concentrations and thyroid levels, in children and adolescents. The quality assessment of the included studies was performed using the Newcastle Ottawa Scale for longitudinal studies and the Critical Appraisal Checklist for Analytical Cross-Sectional Studies scale for cross-sectional studies. Seventeen studies were included in this review, involving a total of 5616 participants, with similar phthalate levels across the diverse studies. Significant positive correlations between T3 (total and free) levels and phthalate exposure were found, as well as persistent negative associations between total-T4 levels and phthalate exposure. On the contrary, associations found regarding TSH and free-T4 did not show a consistent pattern. Conclusion: This review gathered enough evidence to conclude that exposure to phthalates causes an increase in T3 (total and free) levels and a decrease in total-T4 levels, which is consistent with previous animal studies. These findings highlight the importance of minimizing contact with plasticizers and microplastics in the environment, guaranteeing the safety of food products for the health of children and adolescents.

Unlike any other medical field, fetal medicine addresses two patients: the fetus and the mother. Its primary goal is to improve neonatal outcomes, specifically by reducing mortality and morbidity, including long-term impacts, while minimizing risks to the mother. The aim of fetal interventions for life-threatening malformations is to decrease morbidity and mortality by mitigating the impact of the malformation on fetal growth and development. Although some randomized controlled trials have evaluated fetal medicine procedures, they have faced challenges such as the rarity of most conditions and ethical concerns related to clinical equipoise. Prematurity, an intrinsic risk of membrane puncture, remains a significant burden of fetal surgery, and maternal safety must always be prioritized when considering such procedures. Despite 50 years of research in fetal medicine, many questions remain, due to advancements in ultrasound technology and genetics, the inherent risks associated with fetal procedures, the lack of appropriate medical device for rare diseases and the cost associated with conditions that require complex multidisciplinary neonatal care. Justice and parental autonomy must be respected but the principle of non-maleficence should prevail.

This study examined the prevalence of different BMI categories among newly diagnosed pediatric celiac disease (CD) patients in Israel from 2002 to 2018. A retrospective cross-sectional study using the database of Clalit Health Services in Israel included 5520 newly diagnosed CD children aged 2-18 between 2002 and 2018. Data on BMI, gender, ethnicity, and socioeconomic status (SES) were collected and analyzed Of the 5520 CD patients, 57.5% were female, 39.7% had low SES, and 77.1% were Jewish. At diagnosis, 13.1% were underweight, 73% had normal BMI, 9.1% overweight, and 4.8% were obese. Underweight and obese patients tended to be older at diagnosis (9 years) compared with normal and overweight patients (8 years) (P < 0.001). A higher proportion of Arab patients were underweight, while more Jewish patients were obese. Lower SES was significantly associated with increased underweight risk (P < 0.001). Over time, diagnosed patients had improved SES and were less underweight (P < 0.001). Male gender increased obesity risk (OR 1.36 [95% CI 1.06-1.74], P = 0.017), while Arab ethnicity was protective for obesity (OR 0.67 [95% CI, (0.45-0.99)], P = 0.047)Conclusion: Underweight prevalence significantly decreased in the second decade, but no significant change in overweight and obesity was noted. Underweight was associated with older age at diagnosis, poverty, and Arab ethnicity. Obesity was associated with older age and was more frequent in Jewish and male patients. Physicians should have a low threshold for CD screening regardless of BMI status to enable timely diagnosis and treatment to prevent long-term health consequences. What Is Known: • Celiac disease is traditionally associated with underweight due to malabsorption, but recent reports suggest an increasing prevalence of overweight and obesity in pediatric patients at diagnosis What Is New: • This study found that underweight prevalence decreased significantly over time, while overweight and obesity prevalence remained unchanged. Underweight was associated with older age, poverty, and Arab ethnicity, while obesity was more common in Jewish and male patients.

Advancements in neonatal critical care continue, enhancing perinatal communication is essential to address the bioethical challenges faced. In perinatal care, various life-limiting or life-threatening conditions that address ethical issues can arise, both during the prenatal and postnatal phases. The diagnosis, prognosis, and potential treatment of these conditions significantly influence the lives of both the unborn child and the newborn, thereby directly impacting parental choices and experiences. This review arises from the necessity to highlight the importance of developing a structured framework concerning the critical components of perinatal care, with a specific focus on the pivotal role of communication. A standardized approach is recommended for counseling at the time of diagnosis of critical fetal conditions, to care for the couple and to support their decision making.

Conclusions: In perinatal critical clinical scenarios, it is imperative that healthcare providers communicate to parents using effective communication strategies, with standardized frameworks. Moreover, integrating perinatal palliative care into the treatment pathway for fetuses with limited life expectancy is essential, within referral centers.

What is known: • In perinatal care, different life-limiting or life-threatening conditions that address ethical issues can arise, both during the prenatal and postnatal phases. • The diagnosis, prognosis, and potential treatment of critical fetal and postnatal conditions significantly affect the lives of the child and parents.

What is new: • Communication has a pivotal role concerning the critical components of perinatal care. • A standardized approach is recommended for counseling at the time of diagnosis of critical fetal conditions, to care for the couple and to support their decision making.

Estimated glomerular filtration rate (eGFR) based on different formulas is commonly used as a bedside tool to assess kidney function in children and young adults. The purpose of this study was to perform a measurement of glomerular filtration rate (mGFR) in children with chronic kidney disease (CKD) with a standard 5-point protocol using iohexol clearance and compare it to a simplified protocol for mGFR determination and to some of the most commonly used eGFR formulas. A 5-point standard protocol using iohexol clearance was used for determination of mGFR in 50 children with mild stages of CKD. The result was compared to 2- and 3-point sampling protocol as well as with some standard children eGFR formulas. We calculated the prediction performance for eGFR formulas to distinguish CKD1 and CKD 2 stages, formulas' accuracy, and cutoff values. Data were prospectively collected. All eGFR formulas exhibited a statistically significant positive correlation with mGFR. The best correlation was found with CKID2012 eGFR formula and with cystatin C-based eGFR formulas. The correlation between standard and simplified protocols for mGFR determination was also strong, while creatinine clearance did not prove to be a reliable method for estimating GFR. The error distribution with simplified protocols was not dispersed. The prediction value was strong for CKID2012 and bedside Schwartz formula. Conclusion: Fewer sampling points can be safely used for measuring GFR in children. eGFR formulas that are not based solely on creatinine should be considered more often in GFR estimation. What is Known? • Iohexol clearance is an established method of measuring GFR in children and adolescents using different protocols. • Estimating GFR in children and adolescents is troublesome and is done using different formulas with anthropometric and biochemical markers in children and adolescents. What is New? • Iohexol measurement with two or three blood withdrawals can reliably distinguish between CKD1 and CKD2 patients. • eGFR formulas have moderate reliability to predict distinguish between CKD1 and CKD2 patients, of which CKID2012 and bedside Schwartz formula were the most accurate in our study.

Neuroblastoma, " a malignancy originating from neural crest cells, is most commonly diagnosed in children and adolescents. Polymorphisms within the long noncoding RNA (lncRNA) HOXA distal transcript antisense RNA (HOTTIP) are believed to have the capacity to alter an individual's susceptibility to various cancers. This study aimed to investigate the link between HOTTIP gene polymorphisms and neuroblastoma susceptibility. We identified the genotypes of two prevalent polymorphisms (rs3807598 and rs1859168) within the HOTTIP via the TaqMan assay in a cohort comprising 402 individuals diagnosed with neuroblastoma and 473 healthy controls. Logistic regression was used to evaluate the associations between the HOTTIP polymorphisms and the likelihood of neuroblastoma susceptibility. Additionally, the genotype-tissue expression (GTEx) database was used to investigate how these HOTTIP gene variations influence gene expression across different tissues. Our findings demonstrated a significant association between the rs1859168 C > A polymorphism and reduced neuroblastoma susceptibility (CA vs. CC: adjusted odds ratio (OR) = 0.55, 95% confidence interval (CI) = 0.40-0.74, P = 0.0001; CA/AA vs. CC: adjusted OR = 0.69, 95% CI = 0.53-0.91, P = 0.010). The additional stratified analysis revealed that the presence of rs1859168 CA/AA or two protective genotypes was associated with a lower susceptibility in specific subgroups, such as older children and girls. Expression quantitative trait locus (eQTL) analysis revealed that the rs1859168 CC genotype was related to high expression of the HOTTIP gene.

Conclusion: We found that HOTTIP gene polymorphisms were associated with a reduced likelihood of neuroblastoma in Chinese children. Further studies with large cohorts and diverse ethnicities are warranted to verify our results.

What is known: • Genetic variations can influence neuroblastoma susceptibility. HOTTIP gene polymorphisms may alter an individual's susceptibility to various cancers.

What is new: • HOTTIP gene polymorphisms were associated with a reduced risk of neuroblastoma in Chinese children.

The present study aims at providing reference values from the general pediatric population for the German version of the 21-item self-report post version of the Postconcussion Symptom Inventory for adolescents aged 13-17 years (PCSI-SR13) following pediatric traumatic brain injury (pTBI). A total of N = 950 adolescents completed an adapted version of the PCSI-SR13. Prior to establishing reference values using percentiles, psychometric properties (i.e., reliability and factorial validity) and regression analyses were examined to identify factors contributing to PCSI-SR13 scores. In addition, construct assessment in the general population sample was compared to that in the pTBI sample (N = 234) using measurement invariance analyses and direct comparisons at the score levels. The results indicate good reliability (Cronbach's α and McDonald's ω of 0.97 each). The four-factor structure covering physical, emotional, cognitive, and fatigue symptom groups could be replicated with χ²(183) = 995.96, p < 0.001, χ²/df = 5.44, CFI = 0.99, TLI = 0.98, RMSEA (90% CI) = 0.068 (0.064, 0.073), SRMR = 0.03. With minor restrictions, the assessment of symptoms was comparable between the general population and the pTBI samples. Participants in the pTBI sample reported a significantly higher symptom burden than those in the general population sample. Reference values were provided using the total sample without further stratification. Conclusion: For the German post version of the PCSI-SR13, reference values are now available for direct score comparisons and for drawing conclusions about the clinical relevance of the reported symptoms, while considering the prevalence in a comparable general population without a history of pTBI.Trial registration: The study is retrospectively registered in the German Clinical Trials Register and in the International Clinical Trials Registry Platform (ID DRKS00032854).