Frontiers in Pediatrics最新文献

Introduction: The 2024-2025 winter season was the first in which Nirsevimab was adopted as universal prophylaxis for bronchiolitis in Friuli Venezia Giulia, a region in the northeastern Italy. This report describes the impact of Nirsevimab universal prophylaxis on bronchiolitis from the perspective of a tertiary-level, children's hospital, the Institute IRCCS Burlo Garofolo in Trieste, Italy.

Methods: We conducted a retrospective observational study reviewing the medical records of all children diagnosed with bronchiolitis during the 2024-2025 winter season, and the winter seasons of the seven preceding years. For each infant admitted, we collected data on age, gender, viral testing result, the need for ventilatory support, and the length of hospital stay. The primary outcome was the number of infant admissions for bronchiolitis during the 2024-2025 winter season, compared with previous years.

Results: During the study period, from 2016 to 2025, 695 infants were diagnosed with bronchiolitis, and 195 were hospitalized. In the 2024-2025 winter season, 597 neonates, 94% of the children born at the Institute, received Nirsevimab prophylaxis. Following the introduction of Nirsevimab, we observed a drastic decrease in the number of infants requiring hospitalization, a marked reduction in infants needing ventilatory support, and a considerable decrease in the cumulative length of hospital stay for bronchiolitis, compared to previous years. These results were clearly related to a substantial decrease in the number of RSV-positive infants arrived at the Institute.

Discussion: In our population, Nirsevimab prophylaxis was very effective and led to a considerable reduction in the number of infants infected with RSV and requiring hospitalization. The hospital burden of bronchiolitis was significantly reduced.

Objective: Automated analysis of Electronic Fetal Monitoring (EFM) is essential for the precise assessment of fetal health. However, the subjective interpretation and expertise-dependent nature of conventional cardiotocogram (CTG) analysis hinder diagnostic consistency. This study aims to develop an objective interpretation approach comprising a systematic preprocessing pipeline for signal reconstruction and an attention-guided convolutional neural network for pattern classification to mitigate the risk of missed diagnoses.

Methods: A computer vision-based deep learning approach was developed. The workflow begins with a systematic preprocessing pipeline, where raw CTG images undergo grid removal, resampling, and curve reconstruction to generate standardized signal inputs. These signals are analyzed by a classifier based on the EfficientNet-B0 architecture, enhanced with a Convolutional Block Attention Module (CBAM). This attention mechanism enables the model to focus on clinically significant morphological features. The model was trained on a private clinical dataset using clinician-labeled FIGO classifications (Normal vs. Suspicious/Abnormal) as the primary outcome. To evaluate its clinical utility and robustness, the model was externally validated on the public CTU-UHB dataset, using objective umbilical artery pH levels (pH $\ge 7.05$ vs. pH $<7.05$ ) as the benchmark.

Results: On the internal clinical dataset, the model achieved an accuracy of 92.66% and a macro-average F1-score of 92.14%. When tested on the external CTU-UHB dataset, the model maintained an accuracy of 95.65%. These results indicate that the proposed algorithm aligns with expert visual classification and remains consistent when validated against objective physiological outcomes (pH levels). This consistency across benchmarks supports the potential robustness and clinical relevance of the learned morphological features.

Conclusion: This study presents an objective method for intrapartum CTG analysis. By integrating signal standardization with automated feature learning, the proposed approach addresses the inherent subjectivity of manual interpretation. It serves as a potential clinical decision support tool to assist in the consistency of fetal status assessment.

Introduction: Sepsis in children with acute lymphoblastic leukemia (ALL) is associated with high mortality and a frequent need for advanced organ support; therefore, reliable scoring systems are required to stratify risk in the pediatric intensive care unit (PICU).

Objective: To compare the performance of the Phoenix-8 and PELOD-2 scales, measured at 24 and 72 h after admission, for predicting 28-day mortality in children with ALL and sepsis or septic shock.

Methods: A retrospective cohort study including 61 patients aged 1 month to 18 years with ALL admitted to the PICU of a quaternary-level hospital in Bogotá, Colombia, between 2022 and 2024. Phoenix-8 and PELOD-2 scores were calculated at 24 and 72 h after admission. Receiver operating characteristic (ROC) curves, optimal cutoff points, sensitivity, and specificity were analyzed.

Results: Twenty-eight-day mortality was 23.0%; 27.9% of patients required invasive mechanical ventilation and 63.9% required vasoactive support. At 72 h, a PELOD-2 score ≥7 showed an area under the ROC curve (AUC) of 0.945, with a sensitivity of 92.9% and specificity of 91.1%. A Phoenix-8 score ≥8 achieved an AUC of 0.976, with a sensitivity of 92.9% and specificity of 91.3%, and was significantly associated with the use of mechanical ventilation, vasoactive agents, and renal replacement therapy.

Discussion: Phoenix-8 and PELOD-2 demonstrated moderate discriminative ability at admission but excellent performance at 72 h, making them clinically useful and comparable tools for prognostic stratification in children with ALL and sepsis.

Background: Congenital heart defects (CHD) are the most common congenital malformations, and, although survival rates now exceed 90%, children remain at risk for long-term psychomotor, cognitive, and psychosocial difficulties. Routine integration of patient-reported outcome measures (PROMs) into pediatric cardiology offers the potential to detect vulnerabilities early, guide preventive interventions, and facilitate patient- and family-centered care. However, practical implementation in routine settings remains challenging.

Objectives: This pilot study describes the early feasibility and implementation experience, and process adaptations for embedding the Pediatric Quality of Life Inventory™ Cardiac Module (PedsQL CM) into routine pediatric cardiology care, with a focus on the development of a pragmatic implementation model, aiming to enable longitudinal health-related quality of life (HRQoL) monitoring in children with CHD following surgical or catheter-based interventions.

Methods: We are conducting a prospective, single-center, non-interventional study at the University Medical Center Freiburg, enrolling children aged 2-17 years undergoing cardiac surgery or catheterization. The PedsQL CM, available in eight languages in age-appropriate self- and parent-proxy versions, is administered at baseline (hospital admission) and at 3, 6, 9, and 12 months post-intervention. Surveys are implemented in REDCap and distributed via QR codes and automated invitations. Clinical data (diagnosis, intervention details, perioperative parameters) are extracted from the institutional research database for linkage with HRQoL trajectories. Implementation process data are collected systematically, capturing feasibility, acceptability, barriers, and facilitators.

Preliminary results: By mid-study, 77 families have been enrolled. Key facilitators include the visible study team presence, iterative adaptations (e.g., a user-friendly guidance document, filter questions), automation, and interdisciplinary psychosocial team involvement. Barriers comprise limited staff resources, partial IT integration, and variable clinician engagement. Early HRQoL data reflect evidence-based patterns, with generally high scores in younger children and a downward trend during adolescence.

Conclusion: Embedding systematic, longitudinal HRQoL assessment in pediatric cardiology is feasible but requires sustained institutional commitment, robust workflows, and interdisciplinary collaboration. Disease-specific PROMs such as the PedsQL CM provide clinically meaningful insights that support proactive, individualized care. Multicenter collaboration and the extension of PROM pathways across pediatric subspecialties will be key to addressing coverage gaps, optimizing lifelong outcomes, and establishing best practice frameworks to integrate PROMs.

Background: Vocal cord dysfunction (VCD) is an underrecognized differential diagnosis for asthma and is often influenced by psychological factors. The COVID-19 pandemic introduced new stressors and disrupted access to pediatric care, potentially affecting VCD incidence and recognition.

Objectives: This study aimed to determine whether the incidence of pediatric VCD at Nemours Children's Hospital in Orlando changed during the COVID-19 pandemic and to identify psychological diagnoses most associated with VCD.

Methods: A retrospective chart review was conducted for patients diagnosed with VCD between January 2017 and July 2022, including 2.5 years before and 2.5 years during the pandemic. Demographics, diagnostic methods, triggers, comorbidities, and psychological conditions were extracted from the electronic medical record.

Results: Among 74,022 patients (45,199 pre-pandemic; 28,823 pandemic), VCD incidence significantly decreased during the pandemic (0.7% vs. 0.3%, p < 0.001). Psychological diagnoses also declined modestly: anxiety (2.6% vs. 2.0%), depression (0.3% vs. 0.2%), and ADHD (4.4% vs. 3.5%). Compared with non-VCD patients, those with VCD were older (median 14 vs. 9 years), predominantly female (71% vs. 47%), and more often White/non-Hispanic. They had higher rates of asthma (41% vs. 16%), allergic rhinitis (20% vs. 11%), gastroesophageal reflux (31% vs. 4%), and psychological conditions, including anxiety (8.5% vs. 2.3%), depression (1.5% vs. 0.2%), and panic attacks (0.8% vs. 0.1%).

Conclusions: In contrast to prior reports, VCD incidence declined during the pandemic, likely reflecting reduced healthcare access or underdiagnosis. Persistent associations with psychological conditions highlight the biopsychosocial nature of VCD and the importance of multidisciplinary evaluation in pediatric populations.

Background: This study examined caregiver assessment of executive functioning (EF) in perinatally HIV-infected (PHIV) and perinatally HIV-exposed but uninfected (PHEU) Kenyan children, and explored the extent to which various biopsychosocial factors influence EF outcomes.

Methods: Children aged 3-5 years that were PHIV (n = 43), PHEU (n = 52), or HIV-unexposed uninfected (HUU, n = 58) and their caregivers were enrolled in this study. EF was measured using the Childhood Executive Functioning Inventory. Caregivers' common mental disorders (CMDs) and parenting behaviour were evaluated using the Shona Symptoms Questionnaire (SSQ) and a parenting behaviour scale, respectively. We used analyses of variance to assess group differences in EF scores and a hierarchal linear regression model to explore covariates associated with EF outcomes.

Results: Overall, we observed significant negative effects of HIV exposure on EF scores, F (2, 149) = 8.591, p < 0.001. Compared to HUU children, PHIV children performed worse in working memory [mean difference (MD), 2.89 [95% CI: 0.65-5.14] p = 0.008], inhibitory control [MD, 2.47 (95% CI: 0.55-4.40), p = 0.008], and composite EF [MD, 5.37 (95% CI: 1.97-8.76), p = 0.001]. PHEU children showed poorer performance in working memory [MD, 3.24 (95% CI: 1.11-5.37), p = 0.001] and composite EF [MD, 4.97 (95% CI: 1.75-8.19), p = 0.001]. The observed EF impairment was strongly associated with caregivers' CMDs and advanced HIV disease in children.

Conclusion: Our study suggests that caregivers can observe overt executive dysfunction in children perinatally exposed to HIV. These findings underscore the importance of antiretroviral therapy adherence in PHIV children and the provision of psychosocial support to caregivers of HIV-exposed children to improve EF outcomes.

Kawasaki disease (KD) and multisystem inflammatory syndrome in children (MIS-C), associated with SARS-CoV-2 infection share overlapping clinical and laboratory features, making differential diagnosis particularly challenging during the COVID-19 pandemic. Accurate distinction is essential due to differences in pathophysiology, management strategies, and cardiovascular outcomes. We report the case of a 7-year-old boy presenting with prolonged fever, mucocutaneous manifestations, arthritis, and elevated inflammatory markers following SARS-CoV-2 exposure. The clinical course demonstrated features compatible with both incomplete Kawasaki disease and MIS-C. Laboratory findings and cardiac biomarkers showed a mixed profile, while echocardiography and coronary imaging revealed the development of coronary artery aneurysms. Notably, a complex congenital coronary artery anomaly was incidentally identified during coronary evaluation. Although such anomalies are not considered independent risk factors for coronary aneurysm formation, their presence may complicate the interpretation of coronary findings in the setting of systemic inflammation. The patient showed a rapid and sustained clinical response to systemic glucocorticoid therapy without intravenous immunoglobulin administration; however, coronary artery aneurysms subsequently developed. This case highlights the diagnostic and therapeutic challenges at the interface of KD and MIS-C and underscores the importance of an integrated, individualized approach that incorporates clinical evolution, laboratory data, and detailed coronary assessment.

Background: Ingestion of a metallic foreign body is common among young children. Although most objects pass spontaneously, some require endoscopic removal. Brass and similar metals can undergo acid-induced dezincification, leading to internal weakening even if the surface appears unchanged. This report describes a rare case of brass pendant ingestion affected by such corrosion.

Case presentation: A 4-year-old boy ingested a brass pendant that remained in his stomach for 72 h, prompting endoscopic retrieval. Although there was no visible corrosion, the pendant fractured at a narrow segment when traction was applied at a physiological esophageal narrowing site. The remaining portion was safely removed after re-grasping the thickest, structurally strongest region.

Conclusion: Despite having a normal appearance, metallic foreign bodies may weaken internally after 48-72 h (2-3 days) of gastric exposure. Hence, endoscopists should anticipate hidden corrosion and grasp the thickest, most reinforced area during removal while considering mechanical stress at esophageal narrowing sites to ensure safe retrieval.

Objective: The aim of this study was to evaluate the adjunctive therapeutic efficacy and safety of a concentrated compound phytodietary supplement in the management of prolonged diarrhea in infants, using data derived from real-world clinical settings.

Methods: This retrospective, observational study analyzed real-world clinical data from three tertiary hospitals. Medical records of infants aged 6-12 months diagnosed with prolonged diarrhea (duration >14 days) between January 2020 and August 2021 were reviewed. Infants who received standard therapy alone were assigned to the control group, while those who received standard therapy in combination with the phytodietary supplement comprised the intervention group. Therapeutic response was assessed after 7 days of treatment and categorized as cure, improvement, or ineffective.

Results: A total of 505 infants met the inclusion criteria, with 242 infants in the intervention group and 263 in the control group. Baseline characteristics, including sex distribution, median age, and nutritional status, did not differ significantly between groups. At day 7, the intervention group demonstrated cure, improvement, and ineffective rates of 52.9%, 40.9%, and 6.2%, respectively, yielding an overall efficacy rate of 93.8%. In contrast, the control group exhibited rates of 10.3%, 63.9%, and 25.8%, respectively, with a total efficacy rate of 74.2% (χ ² = 33.621, p < 0.01). The median diarrhea duration was 4 days in the intervention group vs. 6 days in the control group. Among 133 infants in the intervention group who underwent extended follow-up, the baseline prevalence of malnutrition was 40.6%. After 28 days, the number of complementary food categories increased by more than four, the prevalence of malnutrition declined to 31.6%, and the median Z-score for anthropometric indicators increased by 0.2 relative to baseline (p < 0.001, Cohen's d = 0.66).

Conclusion: This real-world analysis suggests that the adjunctive use of a concentrated phytodietary supplement in infants with prolonged diarrhea may enhance therapeutic outcomes, including a significant reduction in diarrhea duration and improved nutritional status. Continued use following resolution of diarrhea may support the introduction of complementary foods and contribute to improved growth trajectories. These findings support the potential clinical utility of phytodietary supplementation as an adjunct to standard care in the pediatric population.

Background: While numerous copy number variations (CNVs) associated with global developmental delay (GDD) have been extensively studied, CNVs on chromosome 2p remain underreported and poorly understood, particularly those involving the EIF2AK2 gene at 2p22.2. This study presents a novel case of pure partial tetrasomy and trisomy of 2p, advancing the understanding of genotype-phenotype correlations in this chromosomal region.

Case presentation: We present a 7-year-old male who presented with GDD, primarily affecting motor and language skills. Initial symptoms included poor balance and exercise tolerance at 15 months, followed by mild dysarthria and an abnormal gait at 3 years. Physical examination revealed high-set ears, ear leakage, and flat feet. Cranial MRI indicated ventriculomegaly, hypomyelination, and white matter volume loss. Genetic analysis identified two adjacent de novo copy-number gains at chromosome band 2p22.2, one showing tetrasomy and the other trisomy, resulting in a complex genomic amplification involving the EIF2AK2 gene. Whole Exome Sequencing (WES) and Chromosome Analysis by Medium Coverage Whole Genome Sequencing (CMA-seq) confirmed the presence of triplication and duplication, which were not present in the proband's parents. This case highlights a rare instance of pure partial tetrasomy and trisomy 2p22.2.

Conclusion: We report a complex de novo gain involving adjacent tetrasomy and trisomy segments at the 2p22.2 locus. Although formally classified as a Variant of Uncertain Significance (VUS) due to the lack of established dosage-sensitive genes, the involvement of EIF2AK2 suggests a potential pathogenic mechanism. We propose that the increased genomic dosage may trigger dysregulation of the integrated stress response (ISR) via a concentration-dependent gain-of-function effect, mirroring the phenotype of pathogenic point variations.