Frontiers in Pediatrics最新文献

Objective: This systematic review and meta-analysis aimed to comprehensively evaluate the impact of physical exercise interventions on anxiety, depression, and emotional regulation in children diagnosed with attention deficit hyperactivity disorder (ADHD).

Methods: A comprehensive search was conducted across multiple databases, including Embase, Web of Science (WOS), PubMed, The Cochrane Library, Wanfang Data, VIP Information, and China National Knowledge Infrastructure (CNKI), from their inception up to July 2024. The search aimed to identify randomized controlled trials (RCTs) investigating the impact of physical exercise on anxiety, depression, and emotional regulation in children diagnosed with ADHD. The Physiotherapy Evidence Database (PEDro) scale was employed to assess the quality of the literature, while the revised Cochrane risk-of-bias tool (ROB-2) was used to evaluate the overall risk of bias. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) profiler method was utilized to further assess the quality of evidence. Meta-analysis, sensitivity analysis, and publication bias testing were performed using Stata 18.0 software. Effect sizes were calculated using the standardized mean difference (SMD) and 95% confidence intervals (CI).

Results: The analysis included 18 RCTs, encompassing 830 participants. Physical exercise exhibited a significant positive effect on anxiety (SMD = -0.58, p < 0.05), depression (SMD = -0.57, p < 0.05), and emotional regulation (SMD = 1.03, p < 0.05) in children diagnosed with ADHD. Subgroup analysis revealed that exercise programs with monotypic and mixed modalities, short duration, high frequencies, medium duration, and moderate intensities were the most efficacious in ameliorating anxiety symptoms. The mixed exercise program, when conducted for short duration, with low frequencies, medium duration, and moderate intensity was the most effective in alleviating depression symptoms. Exercise programs featuring mixed modalities, longer duration, moderate to high frequencies, shorter duration, and low intensity yielded the most significant improvements in emotional regulation.

Conclusions: Research demonstrates that physical exercise mitigates anxiety and depression and improves emotional regulation in children with ADHD. A dose-response relationship is evident, correlating with the type, duration, intensity, frequency, and overall exercise duration.

Systematic review registration: https://www.crd.york.ac.uk/prospero/, PROSPERO identifier (CRD42024571577).

Narcolepsy is a sleep-wake disorder with an onset commonly seen in individuals aged 10-30 years. Due to various reasons, the diagnosis of narcolepsy often experiences a delay of at least ten years. Diagnosing narcolepsy in children is particularly challenging due to atypical symptoms, leading to frequent misdiagnosis or missed diagnoses. We report a case of narcolepsy in a four-year-old girl to provide insights into the early diagnosis and treatment of narcolepsy in children. As a chronic condition, narcolepsy can lead to decreased quality of life, including psychological issues such as depression and anxiety. Furthermore, there are few randomized controlled trials involving pediatric narcolepsy patients. To provide a comprehensive treatment approach for pediatric narcolepsy, we review the current progress in the treatment of narcolepsy in children.

Object: This study aims to analyze the clinical characteristics of children with tracheobronchial foreign body and to investigate the factors influencing the surgical duration of rigid bronchoscopic foreign body removal under general anesthesia.

Methods: We retrospectively identified 421 children diagnosed with tracheobronchial foreign body undergoing rigid bronchoscopy between January 2020 and December 2021. A comprehensive analysis was conducted on patient demographics, including age, weight, gender, American Society of Anesthesiologists (ASA) physical status classification, foreign body type and location, duration of foreign body retention, preoperative symptoms, signs, imaging findings, tracheobronchial manifestations observed during bronchoscopy, and surgical durations. Statistical analysis utilized both univariate and multivariate linear regression models to assess factors influencing the surgical duration of tracheobronchial foreign body removal in children.

Results: The mean age of children with tracheobronchial foreign body was 1.59 years (1.32, 2.04). The male-to-female ratio was 1.8:1, and the ASA physical status classification was predominantly ASA II (96.7%). Organic foreign body accounted for 94.8% of cases, with 91.7% located unilaterally. Univariate and multivariate linear regression analyses revealed that ASA III, pulmonary rales, and the presence of one, two, or three specific tracheobronchial manifestations observed during bronchoscopy-including mucosal hyperemia and edema, purulent exudate, and granulation tissue-were independent risk factors associated with prolonged surgical duration for foreign body removal (P < 0.05).

Conclusion: ASA III, pulmonary rales, and various tracheobronchial manifestations observed during bronchoscopy are significant risk factors associated with prolonged surgical duration for foreign body removal in children.

Suppressors of cytokine signaling (SOCS) proteins play a critical role in regulating immune signaling pathways. Deficiency of SOCS1 leads to various autoimmune pathologies. We present two unrelated patients with distinct clinical manifestations. Patient 1, a 16-year-old male from Guinea, presented with Evans Syndrome, musculoskeletal pain and elevated liver enzymes. Patient 2, a 6-year-old German boy, developed recurrent oral aphthous ulcers, mild inflammatory bowel disease and chronic recurrent multifocal osteomyelitis. Both patients were diagnosed with SOCS1 deficiency by genetic testing. Treatment strategies included steroids, JAK inhibition and colchicine. These cases emphasize the importance of considering SOCS1 deficiency in patients with autoimmune or autoinflammatory diseases but also in patients with unexplained elevated IgE levels. They highlight the need for further research in ongoing multicenter registries to better understand this condition.

Introduction: Sleep-disordered breathing (SDB) is considered the second most common chronic health condition in children. Untreated SDB is associated with long-term health consequences. Our objective was to translate the Pediatric Sleep Questionnaire (PSQ) into Lithuanian and culturally adapt and validate the translated version in order to improve the diagnosis of SDB in Lithuanian children.

Methods: Translations and cultural adaptations were performed to generate a Lithuanian version of the PSQ. Psychometric analysis was conducted on 112 Lithuanian children aged 2-17 years. All patients underwent overnight polysomnography.

Results: The Lithuanian PSQ showed good internal consistency (Cronbach's alpha = 0.816). Lithuanian PSQ responses administered 14-30 days apart were strongly correlated (r = 0.924, p < 0.001, 95% CI 0.830-0.967). EFA of the Lithuanian PSQ confirmed four factors ("snoring", "behavior", "sleepiness", and "other"). We found a sensitivity of 72.7% and specificity of 64.6% for a Lithuanian PSQ cutoff score of 8 to predict moderate-to-severe apnea, and a sensitivity of 85.0% and specificity of 62.0% to predict severe apnea. Using a Lithuanian PSQ cutoff ratio of 0.4, a sensitivity of 72.7% and specificity of 63.3% were found to predict moderate-to-severe apnea, and a sensitivity of 85.0% and specificity of 60.9% were found to predict severe apnea.

Conclusions: The Lithuanian version of the PSQ is a reliable, validated, and culturally adapted screening tool for the prediction of moderate-to-severe sleep apnea in children aged 2-17 years. However, polysomnography should be performed to confirm the diagnosis of sleep apnea and other SDB, and to determine the degree of the disorder and the need for treatment.

Objective: Our study aimed to collect fetuses with recurrent 1q21.1 deletion or duplication syndrome for systematic clinical phenotype analysis to further delineate the intrauterine phenotype features of the two reciprocal syndromes.

Methods: Prenatal samples, including amniotic fluid and chorionic villus samples, were obtained by amniocentesis and chorionic villus sampling at our center, respectively. In total, 43 fetuses were diagnosed with recurrent 1q21.1 deletion or duplication syndrome via array comparative genomic hybridization (array CGH) or copy number variation sequencing (CNV-seq). Prenatal clinical data, pregnancy outcomes, and individual conditions after birth were collected.

Results: In total, 20 fetuses were diagnosed with 1q21.1 deletion syndrome, and 11 had abnormal ultrasound findings. The most common ultrasound features were renal anomalies, musculoskeletal abnormalities, and increased NT. Other less common ultrasound findings encompassed neurologic abnormalities, cardiovascular defects, absence of the gallbladder, intrauterine growth retardation, and cervical cystic hygroma. On the other hand, 23 fetuses had reciprocal 1q21.1 duplication syndrome, 11 of which had abnormal ultrasound findings, mainly nasal bone abnormalities, cardiovascular defects, increased NT, and neurologic abnormalities.

Conclusions: Our case study suggested that the prenatal clinical phenotypes of the recurrent 1q21.1 deletion syndrome and reciprocal duplication syndrome fetuses were highly diverse with incomplete penetrance. Additionally, our findings should expand the intrauterine phenotype associated with the recurrent 1q21.1 region by a series of prenatal ultrasonic anomalies in this work that were described for the first time, which might broaden knowledge of the genotype and phenotype correlation.

Objective: The study aimed to describe the characteristics and risk factors associated with disease severity across six waves of COVID-19 in the pediatric population in Mexico.

Methods: A cohort study was conducted using data from the Mexican Ministry of Health, covering the period from March 2020 to March 2023. The dataset included patients under 18 years of age with confirmed SARS-CoV-2 infection. Univariate, bivariate, and logistic regression analyses were performed to determine demographic and clinical characteristics, mortality across waves, and age group distributions.

Results: Of the total cohort, 9.5% were children, with 497,428 confirmed cases. Among these, 50% were male, 4.4% required hospitalization, and there were 1,447 (0.03%) deaths. The highest prevalence was observed in the 12-17-year age group (52%), followed by the 5-11-year age group (32%), with incidence rates peaking towards the end of 2021 and the early 2022. Although the 0-2-year age group represented 9.6% of cases, it had higher hospitalization (40%), ICU admission (58%), and case fatality rate (CFR) (44%). Cardiovascular disease, hypertension, diabetes and immunosuppression were identified as risk factors for severe outcomes. The initial wave displayed the highest CFR (OR 5.28) especially in children aged 0-2 years.

Conclusions: Children were less affected during the pandemic compared to adults; however, children under two years-old experienced more severe outcomes. Currently, with 95% of the population estimated to be immune due to vaccination and/or prior infection, children under 2 years of age are now at higher risk of severe disease and should be evaluated for vaccination as a public health policy.

In recent years, advancements in modern laboratory diagnostics have identified Kingella kingae (K. kingae) as the major cause of osteoarticular infections in early childhood. The introduction of novel diagnostic methods has ushered in a new era, transitioning from underrated infections to recognizing K. kingae as the primary etiology of skeletal system infections in children. This article provides a new perspective on K. kingae, exploring innovative diagnostic methods that have improved and will continue to transform the management of these infections.

Introduction: Cryptorchidism can damage cells in the cryptorchid testes due to elevated local temperatures, potentially impacting the fertility of the child in adulthood. Research indicates that vitamin D enhances sperm quality in adult males. This study aimed to explore whether vitamin D inhibits NLRP3 activation, thus helping to mitigate heat stress damage to testicular spermatogenic and Sertoli cells.

Materials and methods: Five cases of normal testicular tissue adjacent to a tumor (testis removed due to tumorous growth) and five cases of atrophied cryptorchid testicular tissue (testis removed) were analyzed for immunohistochemistry to determine NLRP3 expression in cryptorchid tissue. In Phase I, spermatogonia (GC-1) and Sertoli cells (TM4) were separated into blank and heat stress groups. Apoptosis, inflammatory factor levels, and the expression of Bcl-2 and NLRP3 genes and proteins were measured at 2, 6, and 10 h after heat stress treatment. In Phase II, the cells were re-cultured and divided into three groups: heat stress, siRNA + heat stress, and VD + heat stress. After 10 h, the apoptosis, inflammatory factor levels, and gene and protein expressions of Bcl-2 and NLRP3 were reassessed in each group.

Results: Immunohistochemistry indicated NLRP3 expression in cryptorchid tissue. Phase I, extending heat stress duration led to increased apoptosis in spermatogonia (GC-1) and testicular Sertoli cells (TM4), heightened levels of inflammatory factors, reduced BCL-2 expression, and elevated NLRP3 expression compared to the control group. Phase II, both the siRNA + heat stress and VD + heat stress groups showed decreased apoptosis in spermatogonia and Sertoli cells, lower inflammatory factor levels, increased BCL-2 expression, and decreased NLRP3 expression compared to the heat stress-only group, with statistically significant differences (P < 0.05).

Conclusions: This is the first time we found the expression of NLRP3 in cryptorchidism. Vitamin D can inhibit the expression of NLRP3 and reduce the damage of heat stress on testicular spermatogenic cells and Sertoli cells, and play a protective role for testicular spermatogenic cells and Sertoli cells. This provides a theoretical basis for preserving testicular function during the "treatment gap" in boys with cryptorchidism who have not received surgical treatment.

Objective: To explore the risk factors for the reactivate of retinopathy of prematurity (ROP) after intravitreal injection of anti-vascular endothelial growth factor (VEGF) and to construct a nomogram model to predict the risk of ROP reactivate.

Methods: A retrospective analysis was conducted on 185 ROP children who underwent anti-VEGF treatment at the First Affiliated Hospital of Zhengzhou University from January 2017 to October 2023. They were randomly divided into a training set (129 cases) and a validation set (56 cases) at a ratio of 7:3. The training set was further divided into a reactivate group (n = 18) and a non-reactivate group (n = 111) based on whether ROP recurred after treatment. Multivariable logistic regression analysis was used to screen for risk factors for ROP reactivate. A nomogram model was constructed using R software and validated using the validation set. The discrimination, calibration, and clinical net benefit of the model were evaluated using the receiver operating characteristic curve (ROC curve), calibration curve, and decision curve analysis, respectively.

Results: Multivariable logistic regression analysis showed that the number of red blood cell transfusions, use of pulmonary surfactant (PS) 2 times or more, and preoperative fundus hemorrhage were independent risk factors for ROP reactivate (P < 0.05). The area under the ROC curve (AUC) of the training set was 0.810 (95% CI: 0.706-0.914), and that of the validation set was 0.756 (95% CI: 0.639-0.873). The Hosmer-Leme show goodness-of-fit test indicated a good fit of the model (P = 0.31). Calibration curve analysis and decision curve analysis suggested high predictive efficacy and clinical application value of the model.

Conclusions: The number of red blood cell transfusions, use of PS 2 times or more, and preoperative fundus hemorrhage are independent risk factors for ROP reactivate. The nomogram model constructed based on these factors has high predictive efficacy and clinical application value.