Frontiers in Pediatrics最新文献

Objective: The objective of this study was to evaluate the feasibility of use and integration of a novel bubble CPAP (bCPAP) system into the PICU of the Mysore Medical College and Research Institute, India.

Study design: We conducted an explanatory sequential prospective mixed-methods study using questionnaire-based surveys, focus group discussions (FGDs), and patient records. Survey and FGD participants included nurses, pediatric postgraduates, and pediatricians who worked in the PICU and used the bCPAP system. The FGDs were transcribed, coded, and systematically analyzed for emergent themes using the COM-B framework.

Results: From July 31, 2023, to July 24, 2024, 81 children were treated with the bCPAP system. The median age was 6.5 months (IQR: 3-11), the median weight was 6.5 kg (IQR: 4.9-7.8), and the median treatment duration was 24 h (IQR: 18-38). Most (n = 72, 89%) patients treated with the bCPAP system were discharged home. Forty-eight healthcare workers completed the survey, and 29 participated in the FGDs. Survey respondents rated the bCPAP system as more effective (67%) or much more effective (17%) than previous treatments for respiratory distress. They found the integration of the bCPAP system into the PICU feasible (63%) or very feasible (35%). FGD participants reported that the bCPAP system was easy to use, portable, and required minimal training. They also noted rapid patient improvement and a reduction in the number of patients requiring mechanical ventilation.

Conclusion: The bCPAP system was integrated and adopted into the PICU of this public referral facility in Mysuru, India. Further research is needed in additional settings.

Purpose: This study aimed to assess cognitive processing in children with autism spectrum disorder (ASD) without co-occurring attention-deficit/hyperactivity disorder (ADHD) (ASD-alone), children with ADHD without co-occurring ASD (ADHD-alone), and children with ASD with co-occurring ADHD (ASD + ADHD).

Methods: Children were divided into four groups: ASD-alone (n = 57), ADHD-alone (n = 89), ASD + ADHD (n = 56), and typical development (TD) (n = 58). The Das-Naglieri Cognitive Assessment System (D-N CAS) was applied to evaluate planning, attention, simultaneous, and successive cognitive processes.

Results: Children with ASD-alone scored less on planning processing. Children with ADHD-alone scored lower on planning and attention processing. Children with ASD + ADHD scored lower on all four processes. Planning and attention exhibited satisfactory stratification precision in identifying ASD + ADHD among children with ASD, with area under the curve (AUC) values of 0.7426 and 0.8061, respectively. Successive processing had medium diagnostic value in diagnosing ASD + ADHD among children with ADHD, with an AUC of 0.618. Inattention symptoms were associated with planning and attention processing. Social affects and inattention symptoms were associated with the total D-N CAS score.

Conclusion: Children with ASD-alone, ADHD-alone, and ASD + ADHD exhibited distinct cognitive profiles. The D-N CAS, particularly its planning and attention scales, provided an approach for differential diagnosis in clinical settings.

Background: IgA nephropathy (IgAN) is a common primary glomerular disease in children. The efficacy and safety of glucocorticoid (GC) and immunosuppressive therapies remain debated. This study aimed to evaluate their clinical effectiveness and safety in pediatric IgAN.

Methods: A systematic search was conducted in six databases (PubMed, Web of Science, Cochrane, Embase, CNKI, Wanfang, and VIP), yielding 404 studies, of which eight met inclusion criteria. Eligible studies included RCTs or retrospective studies involving pediatric patients (≤18 years) treated with immunosuppressants plus GC. Outcomes assessed included proteinuria, hematuria, serum creatinine, and adverse events. Two researchers independently extracted and analyzed data. Network meta-analysis (NMA) was performed using R software, incorporating network plots, forest plots, and SUCRA rankings.

Results: Network topology showed strong links between GC monotherapy and regimens such as "tacrolimus + GC" and "mycophenolate mofetil (MMF) + GC." SUCRA rankings indicated superior efficacy of combination therapies in reducing proteinuria and hematuria. Forest plots revealed that all combination regimens significantly reduced proteinuria compared to GC alone (P < 0.05), with only MMF + GC significantly improving hematuria (P < 0.05). No significant differences in adverse event rates were found among treatment groups (P > 0.05). Funnel plots suggested minimal publication bias.

Conclusion: Combination therapies, especially tacrolimus + GC and MMF + GC, offer greater efficacy than GC monotherapy in pediatric IgAN, without increasing adverse events. These findings support their clinical application, though larger studies are needed to validate results and optimize treatment strategies.

Background: Lower urinary tract symptoms (LUTS) are common functional urinary disorders in children and can markedly impair quality of life. Attention-deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental condition, and emerging evidence suggests that affected children are at increased risk of LUTS. Nevertheless, systematic investigations into the relationship between ADHD and urodynamic characteristics in pediatric LUTS remain limited. This study aimed to evaluate the association between ADHD and urodynamic features in children with LUTS using a case-control design.

Methods: We conducted a retrospective case-control study including 144 children with LUTS, of whom 36 were diagnosed with ADHD. All participants underwent standardized urodynamic testing, with assessments of bladder capacity, detrusor pressure at maximum filling, and detrusor overactivity (DO). Children were categorized into ADHD and non-ADHD groups, and intergroup comparisons of urodynamic parameters were performed. Multivariable regression analysis was used to assess the independent association between ADHD and urodynamic abnormalities.

Results: Compared with the non-ADHD group (n = 108), children with ADHD (n = 36) exhibited significantly reduced volumes at first urge, strong urge, and maximum cystometric capacity (all p < 0.05). Conversely, detrusor pressure at maximum filling and the prevalence of DO were significantly higher in the ADHD group (both p < 0.05). Multivariable regression analysis identified DO as an independent predictor of urodynamic abnormalities in children with ADHD (OR = 3.43, 95% CI: 1.32-8.91, p = 0.012).

Conclusions: Children with ADHD display significant functional bladder abnormalities on urodynamic testing, particularly reduced bladder capacity, increased detrusor pressure during filling, and heightened detrusor activity. ADHD may influence bladder function, at least in part, through neurobehavioral mechanisms. These findings provide valuable clinical insights for the management of LUTS in children with ADHD and underscore the importance of early screening and intervention. Further research is needed to elucidate the underlying mechanisms and to develop effective therapeutic strategies.

Objective: This study aimed to summarize the clinical experience of Endoscopic Retrograde Cholangiopancreatography (ERCP) in a pediatric population, analyzing the disease spectrum, procedural characteristics, and clinical outcomes to contribute to the understanding of its application in children.

Methods: This study reviewed the clinical data of children who presented to our hospital and underwent ERCP and related procedures between January 2021 and December 2024. Collected data encompassed patient demographics, specific disease indications, detailed endoscopic techniques employed, procedural success rates, and the incidence and management of related complications.

Results: The study cohort had a mean age of 8.31 ± 3.63 years. The primary indication for ERCP was pancreatic disease, accounting for 72% (134/186) of procedures. These included chronic pancreatitis (n = 75), pancreatic trauma (n = 17), and acute pancreatitis with pseudocysts (n = 17). Biliary diseases constituted 28% (52/186), mainly choledocholithiasis (n = 33) and pancreatobiliary maljunction (n = 9). Commonly performed endoscopic interventions were pancreatic duct stent placement (n = 95), biliary stent placement (n = 50), and stone extraction from both ducts (n = 70 and 33, respectively). The overall procedural success rate was 90.5% (171/186). A significant difference was noted when stratified by operation time: procedures completed within 60 min had a 96.7% (115/119) success rate, compared to 80.0% (56/70) for those lasting 60 min or longer (P < 0.001). Post-procedure complications were recorded in 11 cases (5.9%), including post-pancreatitis (n = 6), infection (n = 4), and gastrointestinal bleeding (n = 1).All complications were all resolved with conservative medical management.

Conclusion: This study confirms that pancreatic diseases (accounting for 72%) are the main indication. Endoscopic Retrograde Cholangiopancreatography (ERCP) has a high success rate (90.5%) in the diagnosis and treatment of biliary and pancreatic diseases in children. However, prolonged procedure time (>60 min) significantly reduces the success rate.

Aim: We seek to elucidate the prevalence, types of respiratory symptoms experienced, and potential early-life risk factors of asthma in adolescence.

Methods: We performed a prospective cohort study including 294 adolescents [130 moderately-late preterm (MLP), 81 early preterm (EP), and 83 full-term (FT)]. Asthma, asthma-like symptoms, and smoking in early childhood and adolescence were self-reported. We collected prenatal and postnatal characteristics, including maternal smoking, bronchopulmonary dysplasia, and respiratory syncytial virus (RSV) infections.

Results: In 11% of EP, 4% of MLP, and 4% of FT adolescents, a formal asthma diagnosis was made. Asthma-like symptoms were reported in 14%, 14%, and 7% of the cases, respectively. Being hospitalized for an RSV infection was associated with a four times higher risk of asthma in adolescence (odds ratio 3.68 and 95% confidence interval 1.04-13.0), while other predictors did not contribute.

Conclusion: MLP adolescents have similar rates of asthma and asthma-like symptoms as their FT peers, while EP adolescents might have a higher risk of asthma but have similar rates of asthma-like symptoms. RSV infections that require hospitalization are associated with an asthma diagnosis in adolescence.

Clinical trial registration: https://www.controlled-trials.com, identifier ISRCTN 80622320.

Objectives: To describe the clinical characteristics, management, and outcomes of children with Mycoplasma pneumoniae pneumonia (MPP) complicated by pulmonary embolism (PE).

Methods: We conducted a retrospective review of eight children diagnosed with Mycoplasma pneumoniae pneumonia complicated by pulmonary embolism between January 2023 and December 2024 at our hospital. The diagnosis of pulmonary embolism was confirmed by computed tomography pulmonary angiography (CTPA). Demographic characteristics, clinical manifestations, laboratory findings, imaging features, treatment strategies, and outcomes were systematically collected.

Results: The cohort included six males and two females, with a mean age of 7.81 ± 3.64 years. The median interval from pneumonia onset to PE diagnosis was 14 days. All patients had severe or refractory MPP. Common symptoms included chest pain (n = 6), hemoptysis (n = 4), and dyspnea (n = 2). CTPA demonstrated pulmonary arterial filling defects in all cases. All patients received anticoagulation therapy with low-molecular-weight heparin followed by rivaroxaban, resulting in favorable clinical outcomes. During 3-6 months of follow-up, complete resolution of emboli was observed, thrombophilia-related laboratory abnormalities normalized, and no recurrence occurred.

Conclusions: Early diagnosis and timely anticoagulation are crucial for favorable outcomes in children with MPP-related PE. Although the small sample size limits generalizability, this case series provides a structured clinical dataset that captures demographic, laboratory, immunological, and imaging features. These data may serve as a reference for future studies aiming to better understand host susceptibility and immunothrombotic mechanisms in pediatric PE.

Introduction: Art and humanities-based approaches have been incorporated in Diversity, Equity and Inclusion (DEI) training and anti-bias curriculum to address structural racism and personal biases via reflection. Research has shown that the use of visual art or texts via narrative medicine workshops results in improved communication with patients and colleagues and increased commitment to interrupting bias.

Methods: Using members of a hospital-based Child Abuse Bias Mitigating Task Force, this study tests the hypothesis that narrative medicine workshops provide a space where conversations of race and bias in the context of child abuse evaluations can take place.

Results: Workshops participants noted the unique group experience that, through sharing and communal support, helped build compassion, function more effectively as a team, and even find confidence in their own voice. Intertwined with the ability to connect with and support each other as a team was the common thread of understanding differences in perspectives and personal histories. Most participants agree that the workshops increased their ease in having conversations about privilege and bias in clinical assessment.

Conclusion: We conclude that the use of art and creativity allows for personal and structural insights on racism and social advocacy with significant promise for reducing bias in child abuse evaluations.

Neuroblastoma is the most prevalent extracranial solid tumor in infancy and early childhood, accounting for 8%-10% of all pediatric malignancies and contributing significantly to cancer-related mortality. Its clinical spectrum ranges from spontaneous regression to aggressive metastatic disease, often influenced by underlying genetic aberrations such as MYCN amplification and chromosomal deletions (1p, 11q, and 17q). We present a rare case of a full-term male neonate diagnosed with stage 4 neuroblastoma originating from the left adrenal gland, exhibiting both MYCN amplification and 1p deletion. The patient had extensive liver metastases and supradiaphragmatic lymphadenopathy at diagnosis. Multimodal treatment, including intensive chemotherapy per the NB2004 protocol, surgical resection, high-dose consolidation chemotherapy, and autologous hematopoietic stem cell transplantation (AHSCT), led to complete remission by 11 months of age. Despite severe post-transplant complications such as sepsis and enteropathy, the patient remained disease-free with normal developmental milestones at follow-up. To the best of our knowledge, this is the first reported case of neonatal neuroblastoma with concurrent MYCN amplification and 1p deletion achieving favorable outcome through comprehensive multimodal therapy. This case underscores the importance of early diagnosis, genetic profiling, and aggressive treatment in managing high-risk neuroblastoma in neonates.

Background: Pulmonary artery sling (PAS) is a rare congenital vascular anomaly in which the left pulmonary artery (LPA) originates from the right pulmonary artery (RPA), forming a ring around the tracheobronchial tree. Due to non-specific respiratory symptoms, it is frequently misdiagnosed, leading to significant delays in diagnosis. This report emphasizes the crucial role of quantitative multimodal imaging in establishing a definitive diagnosis, stratifying risk, and guiding optimal surgical planning.

Case presentation: A 4-year-and-7-month-old boy presented with a 4-year history of recurrent cough and wheezing that was refractory to standard medical therapy. Echocardiography revealed a dilated main pulmonary artery (MPA) measuring 1.9 cm (Z-score +3.2) and an anomalous origin of the LPA from the RPA, with an elevated peak flow velocity of 1.75 m/s. Contrast-enhanced computed tomography angiography (CTA) subsequently confirmed a Type I PAS, enabling precise quantification of a severe focal stenosis of the LPA (minimal diameter 2.8 mm) and demonstrating the absence of significant intrinsic tracheobronchial stenosis. Based on these findings, the patient underwent successful reimplantation of the LPA onto the MPA with an autologous pericardial patch. The postoperative course was uneventful, with complete resolution of respiratory symptoms, and follow-up imaging confirmed a patent anastomosis with successful hemodynamic outcomes.

Conclusions: This case of isolated PAS underscores the indispensable role of a multimodal imaging strategy. While echocardiography can provide initial clues, quantitative CTA is paramount for definitive anatomical classification, precise stenosis quantification, and comprehensive preoperative planning. Early consideration of PAS in children presenting with refractory respiratory symptoms, coupled with advanced imaging, can prevent misdiagnosis and optimize outcomes.