Frontiers in Pediatrics最新文献

Introduction: Northern Iran is one of the regions of the country most affected by COVID-19. The aim of the current study was to examine the demographics, clinical characteristics, and outcomes of suspected and laboratory-confirmed patients <18 years of age hospitalized over two years (during six waves of SARS-CoV-2).

Methods: This retrospective cohort study examined hospitalized patients with suspected SARS-CoV-2 infection in Babol, northern Iran. The study included patients <18 years of age admitted to a pediatric referral hospital from March 7, 2020 to March 20, 2022. Epidemiological and demographic characteristics, real-time PCR cycle threshold (Ct), clinical data and COVID-19 results were analyzed in the hospitalized patients.

Results: Totally, 2,731 patients with suspected COVID-19 were examined from March 2020 to 2022, with a mean age of 4.6 years, and were male (54.3%). Most suspected cases occurred during the fifth (Delta) and sixth (Omicron) relapse (30% and 20%, respectively). Among them, 461 patients had comorbidities, with brain and neurological diseases (BND), malignancies and hematopoietic and blood disorders (HBDs) being the most common (6.7%, 2.6% and 2.1%, respectively). Real-time RT- PCR showed that 391 patients were positive. The mean age of the positive patients was 5.2 years. Most positive cases were in the fifth wave (30.9%), male (53.7%) and 1-5 years old (49.1%). BND (9.5%) and cardiovascular diseases (CVD) (4.3%) were common underlying conditions. A higher viral load (Ct score = 9-20) was most common in the fifth wave. Moreover, 8.7% of ICU admissions and 2.4% of deaths were due to a Ct score of 9-20. Most deaths occurred in the 1-5 age group and were associated with BND. More deaths occurred in women (73.9% overall, 71.4% real-time RT- PCR -positive), and the highest mortality was in the fifth wave. The risk ratio of mortality was higher in children with kidney disease (KD) and BND.

Conclusion: There were 27 ICU admissions (6.9%) and seven deaths (1.8%). The current study also revealed that children of any age can be susceptible to SARS-CoV-2 infection, while children aged 1-5 years are more susceptible to COVID-19. The Delta variant is associated with higher rates of hospitalization and ICU admission, and the presence of BND is associated with higher mortality rates.

Cerebral Palsy (CP) is a leading cause of childhood motor disability, making independent walking a crucial therapeutic goal. Robotic assistive devices offer potential to enhance mobility, promoting community engagement and quality of life. This is an observational report of 22 cases of children with CP in which we evaluated the Moonwalker exoskeleton (a dynamic moving aid system) usability, functional changes, and caregivers' perspectives based on the International Classification of Functioning (ICF). All children (aged 2-8 years, with a severe gait impairment and inability to use a conventional walker) underwent Moonwalker training for 20 sessions, followed by home use for five months. Post-treatment, majority of children showed improved endurance assessed by the 10-m walk test with a notable involvement of the upper trunk and arm movements for gait assistance. Many of them achieved rather remarkable results reaching a velocity of ≥0.5 m/s given the constraints of the walking exoskeleton and the children's size, while at admission all children walked at a speed of less than 0.5 m/s. Several positive environmental factors and family adherence were noted, as assessed by ICF in a subgroup of children. This study on a sample of children demonstrated that the Moonwalker exoskeleton allows walking and training at home in children with severe CP, enhancing development, social interaction, and endurance, while being well-received by families.

Introduction: Prematurity is a factor that contributes to the increase in infant morbidity and mortality and is associated with factors determining child growth, such as nutritional deficits, mainly during the COVID-19 pandemic.

Objective: To evaluate the factors determining the growth of premature neonates treated at a secondary health service during the COVID-19 pandemic.

Method: Observational retrospective and prospective cohort study of premature patients followed at the follow-up clinic in the municipality of Carapicuíba from February 2020 to December 2023. Through a review of medical records, anthropometric data were collected from birth to corrected gestational age, approximately six months, and nutritional and non-nutritional data with direct or indirect influence on growth. Statistical analysis with tests for quantitative and qualitative variables was carried out with the SPSS Statistics software version 27.0 (SPSS et al., USA).

Result: The study analyzed a sample of 302 newborns, predominantly male (51.7%) and classified as moderately preterm (47.4%), with an average gestational age of 32.4 ± 2.8 weeks. Prenatal complications occurred in 59.3% of cases, while neonatal complications, such as extrauterine growth restriction (EUGR, 30.8%) and use of parenteral nutrition (36.1%), were common, with an average hospital stay of 30.2 ± 26.1 days. Most newborns were artificially fed (51%) Moreover, they received multivitamins (71.9%). At six months, the newborns showed healthy growth with an average weight of 6.718.2 ± 1.346.5 g. Multiple linear regression analysis revealed significant associations between EUGR and negative Z scores for weight, length, and head circumference at six months. Complications such as anemia and congenital abnormalities also negatively impacted these scores. Comparatively, the newborns in the group pre-vaccination against COVID-19 had more significant growth at six months and more prevalence of newborns born large for gestational age (LGA), while complications such as gastroesophageal reflux disease and viral bronchiolitis was more common in the post-vaccination group.

Conclusion: During the COVID-19 pandemic, non-nutritional factors, especially EUGR, significantly influenced the anthropometry of premature babies. This condition highlighted the need for more effective therapeutic strategies and public health measures to improve the growth and development of premature infants.

Introduction: Macrolide-unresponsive Mycoplasma pneumoniae pneumonia (MUMPP) cases have been rapidly increasing. The primary reason for this increased incidence is the pathogen's acquisition of resistance through mutations in 23S rRNA genes. Due to the unfeasibility of testing for macrolide susceptibility at the time of admission, this study aimed to assess the clinical features of pediatric MUMPP, using insights from laboratory tests and patterns of chest radiographic resolution.

Material and methods: We conducted a retrospective review of 161 patients with M. pneumoniae pneumonia (MPP) between January 2023 and December 2023. These patients were categorized into two groups based on their responsiveness to macrolides: 72 patients were in the MUMPP group, and 89 patients were in the macrolide-sensitive Mycoplasma pneumoniae pneumonia (MSMP) group.

Results: MUMPP patients experienced a longer duration of fever and hospital stay. A higher proportion of MUMPP patients had shortness of breath, transcutaneous blood oxygen saturation (SpO₂) lower than 94%, bilateral lobar infiltrates, lobar pneumonia and pleural effusion. The serum level of serum ferritin (SF), interleukin-6(IL-6), D-dimer, lactate dehydrogenase to albumin rate (LAR), and neutrophil to lymphocyte rate (NLR) were higher in MUMPP group.

Conclusions: Our findings revealed that patients with MUMPP exhibit more severe initial radiographic indicators and clinical course compared to those with MSMP. Therefore, it is crucial to promptly administer alternative therapeutic agents besides macrolides for the management of MUMPP.

Introduction: Osteogenesis imperfecta (OI) is a congenital skeletal disorder characterized by bone fragility. Bisphosphonates (BISs) have become the mainstream treatment in children with OI. However, an optimal treatment protocol has not yet been established, while BIS treatment tends to be administered to normalize bone mineral density (BMD). Bone quality is an important component of bone strength. The trabecular bone score (TBS) is a quantitative measure of the microstructure that affects bone quality. This study investigated the TBS during BIS treatment in children with OI.

Materials and methods: Twenty-nine children with OI were enrolled and classified into two groups: mild (type 1) and moderate to severe (types 3 and 4). Dual-energy x-ray absorptiometry images were retrospectively analyzed for TBS calculation. The relationship between the areal BMD (aBMD), its Z-score, height-adjusted BMD (BMD_HAZ) Z-score, TBS, and TBS Z-score with the treatment duration was assessed for each group.

Results: In the mild group, the aBMD, its Z-score, and BMDHAZ Z-score showed a significant positive correlation with treatment duration (r = 0.68, 0.68, 0.72, respectively, p < 0.01). The TBS Z-score tended to increase with treatment duration, albeit without reaching significance. In the moderate to severe group, the TBS Z-score showed a significant positive correlation with treatment duration (r = 0.48, p < 0.01), in contrast to the aBMD Z-score, which did not increase. Finally, the BMDHAZ Z-score only showed a weak positive correlation with treatment duration (r = 0.37, p < 0.01).

Conclusion: Because BIS affect the BMD and TBS differently based on the severity of OI, treatment goals may need to be stratified by disease severity.

Objectives: Previous studies on Enhanced Recovery After Surgery (ERAS) in pediatric Laparoscopic Pyeloplasty (LP) lacked clear control cases and discussed the obstacles in the implementation process. This article details the obstacles and lessons learned during the implementation of ERAS in patients with ureteropelvic junction obstruction (UPJO).

Methods: An ERAS protocol was implemented in the UPJO population undergoing LP, which included preoperative, intraoperative, and postoperative management. The clinical data of ERAS program Before Implementation (BI) and After Implementation (AI) were collected and analyzed retrospectively.

Results: A total of 107 patients (BI 46, AI 61) were enrolled. Compared with the BI group, the AI group had an earlier normal diet (19.83 h vs. 9.53 h, p < 0.001), ambulation (39.10 h vs. 12.70 h, p < 0.001), resumption of defecation (89.88 h vs. 27.90 h, p < 0.001), less need for additional analgesia (19.5% vs. 1.6%, p = 0.002) and shorter postoperative hospital stay (POS) (6.00 d vs. 1.91 d, p < 0.001) without increasing complications and readmission rates. Patients in the AI group had a median protocol score of 17 (IQR 16-18), and the compliance rate of the ERAS protocol was negatively correlated with the length of POS (R ² = 0.69, p < 0.001).

Conclusions: The application of ERAS in pediatric LP is feasible and sustainable, with the potential for even greater impact as compliance improves. Common barriers were uncertain start time of surgery, lack of knowledge of ERAS among pathway participants, and support from anesthesiologists. Pre-determining the start time of surgery, strengthening preoperative education and positive communication among team members can help to promote the full implementation of ERAS program.

Introduction: Patient education is crucial in managing chronic diseases like Juvenile Idiopathic Arthritis (JIA). Traditional methods such as videos and brochures often fail to maintain long-term knowledge retention. Therapeutic Patient Education (TPE) offers a more effective, patient-centered approach.

Objective: PAFLAR aimed to implement a TPE program with a "train the trainers" masterclass to ensure effective delivery and improve outcomes for children with JIA.

Methods: PAFLAR's TPE program was designed through a focus group, involving a literature review and strategic planning for the implementation step. The program includes specialized training for healthcare professionals enhancing their abilities to deliver TPE workshops. Participants were selected based on volunteerism and commitment to the project. Evaluations were conducted through feedback assessment of both patients and participants.

Results: PAFLAR launched a TPE program in 2023, aimed at training healthcare providers to implement TPE effectively. This initiative included both in-person and virtual masterclasses, resulting in five workshops conducted in Kenya, Tunisia, and Nigeria. These workshops covered various aspects of JIA management, such as patient and family education, self-esteem, physical activity, treatment adherence, and pain management. Early results showed significant improvements in patients' and parents' understanding and management of JIA, with positive feedback indicating a need for further sessions.

Conclusion: PAFLAR has taken the initial step in implementing a TPE program for JIA across three countries, representing different regions of Africa. The TPE program offers a promising alternative to traditional patient education methods, significantly improving patient care, empowering healthcare providers, and advancing healthcare systems.

Objective: To evaluate existing clinical evidence for the efficacy of alpha blockers in the management of pediatric stone disease.

Methods: We conducted a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Cohort and randomized control trials of patients less than 18 years old with kidney stones managed with alpha-adrenergic antagonists were included. Outcomes included stone expulsion time, stone passage rate, mean number of pain episodes, and mean need for analgesics. We performed data extraction of the selected articles, and results were assimilated and synthesized qualitatively. Data extraction and risk of bias assessment was conducted by two independent reviewers.

Results: Of 257 relevant studies, 9 studies with 1,039 patients were included. Six studies measured stone expulsion time, with 5 studies noting statistically significant decreases in stone expulsion time for the treatment group compared to the control. Seven studies measured the stone expulsion rate, and 5 reported a statistically significant increased expulsion rate in the treatment group. Four studies reported a decrease in the mean number of pain episodes in the treatment group and two studies showed a decreased analgesic requirement compared to control. Two studies found alpha blockers not superior to watchful waiting after shock wave lithotripsy. Risk of bias was high in some studies, primarily due to incomplete reporting on methodology and study design.

Conclusions: Alpha blockers are supported by a growing body of evidence to be effective against nephrolithiasis in children, however large-scale, well-designed studies are needed to confirm these findings.

Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=330068, PROSPERO (CRD42022330068).