Frontiers in Pediatrics最新文献

Introduction: Increased intracranial pressure (ICP) is common with viral encephalitis in children which is associated with complications and prognosis. The optic nerve sheath diameter (ONSD) is a new indicator for the assessment of intracranial pressure using ultrasound, CT scan and MRI imaging. Given the influence of physical development on ONSD size in children, we expect more accurate assessment of intracranial pressure with ONSD/ETD (eyeball transverse diameter) ratio by ultrasound. The aim of the study is to determine the performance of the ONSD/ETD ratio measurement to predict ICP occurring in children with viral encephalitis and evaluate the therapeutic effect.

Methods: Children with viral encephalitis from May 2022 to June 2024 were recruited in this study. The initial ONSD/ETD ratio measurement by ultrasound were completed before lumbar puncture. Children were divided into the increased ICP group and the normal ICP group based on whether the ICP was over 200 mmH₂O measured by lumbar puncture. The ultrasound was repeated on the 3rd and 7th day of treatment.

Results: The ONSD/ETD ratios measured in the two groups before treatment were 0.231 ± 0.019 and 0.182 ± 0.012, respectively (p < 0.01). The ONSD/ETD ratio on the 3rd day of treatment in the increased ICP group was significantly lower than the data before treatment (p < 0.01). The data on the 7th day of treatment in increased ICP group was significantly lower than the data before treatment (p < 0.01), but not statistically significant compared to the data on the 3rd day of treatment (p = 0.650). The ROC curve demonstrated an AUC for ONSD/ETD ratio in predicting the occurrence of increased ICP in children with viral encephalitis was 0.974 [95% confidence interval (CI): 0.939-1.000, p < 0.01], with a sensitivity of 95.1% and specificity of 93.3% at a cut-off value of 0.198.

Conclusion: Our study shows that ONSD/ETD can be used as an easy reference tool for evaluating ICP in children with viral encephalitis which can reflect the therapeutic effect.

Objective: This study aimed to systematically evaluate the safety of cyclosporine (CsA) and tacrolimus (TAC) in pediatric nephrotic syndrome (NS) patients using real-world data from the FDA Adverse Event Reporting System (FAERS).

Methods: We analyzed adverse event (AE) reports from the FAERS database between Q4 2003 and Q2 2024, focusing on AEs associated with CsA and TAC in NS patients aged 18 years and younger. We employed three signal detection methods-Proportional Reporting Ratio (PRR), Relative Reporting Ratio (RRR), and Reporting Odds Ratio (ROR)-to assess the risk of drug-related AEs. Sensitivity analyses were conducted to explore the influence of gender on AE occurrence.

Results: A total of 207 CsA-related and 145 TAC-related AE reports were included. CsA was significantly associated with nephropathy toxic (ROR = 8.26, 95% CI: 4.21-16.20), urine output decreased (ROR = 29.93, 95% CI: 3.66-244.61), and posterior reversible encephalopathy syndrome (ROR = 6.70, 95% CI: 3.17-14.14). TAC was associated with an increased risk of dystonia (ROR = 67.93, 95% CI: 8.63-534.86), kidney fibrosis (ROR = 22.65, 95% CI: 8.16-62.87), and diabetic ketoacidosis (ROR = 46.51, 95% CI: 5.68-380.97). Sensitivity analysis indicated that gender influenced the occurrence of AEs, with CsA showing higher nephrotoxicity in male patients, while TAC was more strongly associated with metabolic disorders and neurological AEs in female patients.

Conclusion: In pediatric NS patients, CsA primarily induces nephrotoxicity and neurological complications, whereas TAC is more likely to cause kidney fibrosis and metabolic disorders. Enhanced monitoring of these AEs and individualized drug adjustments based on patient characteristics are recommended to optimize treatment outcomes and reduce AE incidence.

Objective: This study analyzed the changes in blood glucose and lipid metabolism levels in children with central precocious puberty (CPP) and the correlation between CPP and obesity.

Methods: In total, 88 children with CPP aged 6-10 years who were admitted to our hospital between January 2023 and June 2024 (the CPP group), and 88 children without CPP in the same age group who received health check-ups (the non-CPP group) were retrospectively enrolled in this study. General data [gender, age, bone age, and body mass index (BMI)] were collected. Levels of blood glucose metabolism indicators [fasting plasma glucose (FPG), 2-h postprandial blood glucose (2hPG), and hemoglobin A1c (HbA1c)] and blood lipid metabolism indicators [triglyceride (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C)] were compared. The incidence of obesity was calculated, and the Tanner stages of the obese group and the non-obese group were compared. The correlation between CPP degree (measured by Tanner staging) and obesity degree (measured by BMI) was analyzed using Spearman's correlation analysis.

Results: The differences in gender and age between the CPP and non-CPP groups were insignificant (P > 0.05). Bone age and BMI in the CPP group were higher than in the non-CPP group (P < 0.05). The CPP group had higher serum FPG, 2hPG, HbA1c, TG, TC, and LDL-C levels and lower serum HDL-C levels than the non-CPP group. The incidence of obesity was higher in the CPP group (21.59%, 19/88) than in the non-CPP group (6.82%, 6/88). The Tanner staging scores in the obese group for the boys (testes and pubic hair), girls (breasts and pubic hair), and as a whole (testes/breasts and pubic hair) were elevated compared to those in the non-obese group (P < 0.05). Spearman's correlation showed that the CPP degree (measured by Tanner staging) was positively correlated with the obesity degree (measured by BMI) in boys, girls, and the study sample as a whole (P < 0.001).

Conclusion: Children with CPP had abnormal levels of blood glucose and lipid metabolism, and the CPP degree in these children was positively correlated with the degree of obesity.

Background and aims: Childhood obesity leads to significant health risks, emphasizing the critical need for effective preventive measures during the preschool years. However, there is a lack of comprehensive studies on overweight and obesity among preschool children in Hainan Island, China's largest free-trade zone. Our study assessed the prevalence of overweight and obesity among preschool children across Hainan Island using Chinese, World Health Organization (WHO), and International Obesity Task Force (IOTF) criteria. Additionally, the potential factors influencing overweight and obesity among preschool children in Hainan Island were further explored.

Methods: We conducted a cross-sectional survey of children aged 3-6 years covering 18 cities and counties in China's largest free trade zone. The survey primarily involved anthropometric data collection and questionnaires on children's information and the sociodemographic characteristics of their parents or guardians. We recorded the height and weight of each child and calculated their body mass index (BMI). The z-score for BMI-for-age was calculated using the WHO-recommended Anthro and AnthroPlus software, and diagnoses of overweight and obesity were determined separately according to the Chinese, WHO, and IOTF criteria. The chi-squared test, t-test, or rank-sum test was applied to describe and statistically analyze the baseline characteristics of the participating children. Additionally, potential factors affecting overweight and obesity were analyzed using a multifactor binary logistic regression model.

Results: The prevalence of overweight and obesity among preschool children in Hainan Island was 11.30% based on the Chinese criteria, significantly higher than the rates of 5.80% and 5.40% observed according to the WHO and IOTF criteria, respectively (χ ² = 12,870.368, P < 0.001). After multifactorial adjusted analyses, we found that according to the three growth criteria, having overweight fathers or mothers, family incomes of more than 100,000 Yuan, fully active eating, and higher birth weights increased the risk of overweight and obesity among preschool children in Hainan Island.

Conclusion: The prevalence of overweight and obesity among preschool children in Hainan Island was lower compared to rates reported in other regions. Considering that the growth and development indicators for children under 7 years old in Hainan Island are generally lower than international standards, the use of Chinese standards may be more suitable for detecting overweight and obesity among preschool children in this area. Based on the risk factors identified in this study, preventive measures can be targeted in the future to reduce the risk of overweight and obesity in preschool children in Hainan Island.

Objective: To discover the potential association between diminished intraoperative average SctO₂ levels and postoperative neurodevelopmental delays among patients after pediatric living-donor liver transplantation.

Study design: Patients undergoing living-donor liver transplantation were recruited for this trial. The neurodevelopment status of patients was assessed using the Ages Stages Questionnaires. The primary outcome was the occurrence of neurodevelopmental delay among patients at different intervals following pediatric liver transplantation. Secondary outcomes included the duration of mechanical ventilation, rates of re-intubation, length of ICU stay, postoperative hospitalization, and intraoperative comparisons of mean arterial pressure (MAP), arterial partial pressure of oxygen (PaO₂), arterial partial pressure of carbon dioxide (PaCO₂), and hemoglobin (Hb) concentration.

Results: A total of 119 patients were included in the statistical analysis and assigned to high saturation group (HS) and low saturation group (LS) according to the average intraoperative cerebral tissue oxygen saturation values. Following adjustment for PELD scores, significant differences between the two groups were observed for the incidence of neurodevelopmental delay in communication at 1 and 3 months follow-up (P = 0.019 and P = 0.020, respectively), fine motor at six months follow-up (P = 0.014), and problem-solving abilities at one year follow-up (P = 0.047). Moverover, the length of ICU stay (P = 0.009) and postoperative hospitalization (P = 0.029) in LS group were also significant prolonged.

Conclusion: This prospective observational study revealed that the patients with low average SctO₂ values were more predisposed to experiencing postoperative neurodevelopment delays, suggesting a potential association between decreased average SctO₂ and neurodevelopmental delay.

Background: It has been widely demonstrated that siblings of children with autism spectrum disorder (ASD) have an increased risk of abnormal developmental trajectories. In response to this, early recognition protocols have been developed worldwide, aiming to promote early interventions that can positively impact the neurodevelopment of this population. This paper presents the protocol of a controlled trial: ERI-SIBS (Early Recognition and Intervention in SIBlingS at High Risk for Neurodevelopment Disorders) is an innovative and ecological early recognition and intervention program designed specifically for siblings of children with ASD.

Methods: We aim to recruit siblings at low risk and high risk of neurodevelopmental disorders. Based on clinical evaluation at T0, we will allocate the infants into three groups: Group 1, infants at low risk without any signs of neurodevelopmental disorders; Group 2, infants at high risk without any signs of neurodevelopmental disorders; Group 3: infants at low or high risk with signs suggestive of neurodevelopmental disorders. Children of Group 2 will undergo Active Monitoring (one 90 min session once a month for 6 months), while children of Group 3 will undergo Early Intervention (one 90 min session once a week for 6 months). In both cases, the ERI-SIBS contents are based on a multidimensional and naturalistic approach and always involve caregivers. All recruited children will be evaluated at three different time points (T0 within the 8 months of life of the child, T1 after 6 months and T2 after 12 months) using behavioural, technological, and biological techniques to assess infants' neurodevelopmental functions, parent-infant interaction, and early ASD markers.

Discussion: The ERI-SIBS study will expand knowledge regarding the impact of early intervention on families of infants at risk of neurodevelopmental disorders for the presence of a child with a diagnosis of ASD. The study will have the potential to significantly contribute to future research and the scientific and clinical debate on the best way to implement early intervention in at-risk populations.

Clinical trial registration: Clinicaltrials.gov identifier (NCT06512649).

Background: Mycoplasma pneumoniae infection accounts for a high proportion of community-acquired pneumonia and the incidence rate of severe M. pneumoniae pneumonia (MPP) has increased year by year. This study investigated the changes in lung diffusion function after M. pneumoniae infection, compared the lung diffusion and ventilation function of children with mild (MMPP) or severe M. pneumoniae pneumonia (SMPP) infections, and explored their clinical significance.

Objective: To study the changes in pulmonary ventilation and pulmonary diffusion function in children with MPP, and explore their clinical significance.

Methods: Data from 97 children with M. pneumoniae pneumonia hospitalized in Chengdu Women and Children's Central Hospital from June 2023 to December 2023 were collected and the participants were divided into an MMPP group (n = 44) and an SMPP group (n = 53). The changes in pulmonary ventilation function and diffusion function were compared between the two groups.

Results: The Z-scores of forced vital capacity and forced expiratory volume in the first second in the SMPP and MMPP groups were -1.684 ± 0.902 and -1.986 ± 0.818, and 0.164 ± 1.795 and -0.6104 ± 1.276, respectively. In the SMPP group, the two aforementioned indicators were lower than the normal value and significantly lower than those in the MMPP group (P < 0.001). The carbon monoxide diffusion capacity in the SMPP group (-5.931 ± 0.827) was significantly lower than that in the MMPP group (-5.0775 ± 1.1134) (P < 0.001). The forced expiratory flow at 75% vital capacity and the maximum mid expiratory flow in the SMPP group were -2.006 ± 1.2582 and -1.878 ± 1.008, respectively, which were lower than the normal value.

Conclusion: SMPP results in more severe ventilation dysfunction and diffuse dysfunction than MMPP.

Background: Congenital biliary dilatation (CBD) is a congenital malformation of the main biliary tract usually associated with the pancreatobiliary maljunction (PBM), determining stone formation, cholangitis, pancreatitis, and cholangiocarcinoma. The role of endoscopic retrograde cholangiopancreatography (ERCP) in treatment and diagnosis has not been established yet. Therefore, the aim of our study is to define the actual role of ERCP in children with CBD.

Methods: A retrospective review of consecutive patients with congenital biliary dilatation undergoing preoperative ERCP and subsequent surgical treatment at our pediatric tertiary referral center (Endoscopy and Digestive Surgery, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy) was performed between 2012 and 2023.

Results: A total of 31 patients were included in the present study. Preoperative ERCP detected a PBM in 28 patients (90%). According to Todani's classification, 2 patients (6.5%) had choledochal cyst (CC) type IV, and 29 patients (93.5%) were diagnosed with CC type I. In 18 (58%) patients, ERCP was performed for treating acute pancreatitis. Sphincterotomy could be performed in 23 of 31 (74%) patients. Patients who did not undergo sphincterotomy had a higher number of acute episodes while awaiting surgery.

Conclusions: The present study is supportive of an essential role of ERCP in the diagnostic and preoperative management of children with CBD with acute presentation or inconclusive magnetic resonance cholangiopancreatography findings.

Objective: This study evaluates the efficacy and safety of robot-assisted laparoscopic ipsilateral ureteroureterostomy (RAL-IUU) in treating children with duplex kidney ureteral malformations by detailing our early single-center experience.

Materials and methods: We conducted a retrospective analysis of clinical data from 14 children with complete duplex kidney ureteral malformations treated with RAL-IUU at our institution from December 2021 to January 2024. Clinical data included patient demographics, surgical details, and postoperative outcomes.

Results: The operation time averaged 128.71 ± 22.35 min in 14 cases, intraoperative blood loss was 7.57 ± 2.77 ml, drainage tube placement lasted for 3.14 ± 0.66 days, and hospital stay averaged 4.79 ± 0.70 days. Stent placement lasted 43.58 ± 6.33 days. Notable changes were observed in the upper moiety anterior-posterior diameter (APD) before and after surgery (23.84 ± 8.05 mm vs. 6.71 ± 2.20 mm, P < 0.001), diameter at the widest part of the upper moiety ureter (15.58 ± 6.07 mm vs. 4.61 ± 0.78 mm, P < 0.001), and split renal function of the upper moiety (12.28 ± 3.04% vs. 16.50 ± 2.75%, P < 0.001). Postoperative follow-up ranged from 6 to 18 months; during the period with a D-J stent, one case developed a urinary tract infection, one case had recurrent gross hematuria, and another child exhibited significant urinary irritative symptoms (frequency), with an abdominal plain film revealing that the D-J tube had descended completely into the bladder, and symptoms disappeared after the removal of the D-J tube. During the follow-up period post-D-J tube removal, none of the 14 children experienced a urinary tract infection again during the follow up period, urinary incontinence ceased.

Conclusion: RAL-IUU provides an excellent surgical field and operating space, precise suturing, and minimal surgical trauma. Postoperatively, there is a reduction in renal pelvis and ureteral hydronephrosis, recovery of split renal function, and minimal complications all with rapid recovery. RAL-IUU is a safe and feasible treatment option for children with complete duplex kidneys.

Aim: Healthcare services are in need of tools that can help to ensure a sufficient capacity in periods with high prevalence of respiratory tract infections (RTIs). During the COVID-19 pandemic, we forecasted the number of hospital admissions for RTIs among children aged 0-5 years. Now, in 2024, we aim to examine the accuracy and usefulness of our forecast models.

Methods: We conducted a retrospective analysis using data from 753,070 children aged 0-5 years, plotting the observed monthly number of RTI admissions, including influenza coded RTI, respiratory syncytial virus (RSV) coded RTI, COVID-19 coded RTI, and other upper and lower RTI, from January 1st, 2017, until May 31st, 2023. We determined the accuracy of four different forecast models, all based on monthly hospital admissions and different assumptions regarding the pattern of virus transmission, computed with ordinary least squares regression adjusting for seasonal trends. We compared the observed vs. forecasted numbers of RTIs between October 31st, 2021, and May 31st, 2023, using metrics such as mean absolute error (MAE), mean absolute percentage error (MAPE) and dynamic time warping (DTW).

Results: In our most accurate prediction, we assumed that the proportion of children who remained uninfected and non-hospitalized during the lockdown would be prone to hospitalization in the subsequent season, resulting in increased numbers when lockdown measures were eased. In this prediction, the difference between observed and forecasted numbers at the peak of hospitalizations requiring vs. not requiring respiratory support in November 2021 to January 2022 was 26 (394 vs. 420) vs. 48 (1810 vs. 1762).

Conclusion: In scenarios similar to the COVID-19 pandemic, when the transmission of respiratory viruses is suppressed for an extended period, a simple regression model, assuming that non-hospitalized children would be hospitalized the following season, most accurately forecasted hospital admission numbers. These simple forecasts may be useful for capacity planning activities in hospitals.