Frontiers in Pediatrics最新文献

Objective: The current diagnostic and prognostic assessment of congenital diaphragmatic hernia (CDH) in neonates remains challenging. This study aimed to evaluate the utility of neonatal ultrasonography in the diagnosis and prognostic prediction of CDH in infants.

Materials and methods: A retrospective analysis was conducted on clinical data from 152 infants diagnosed with CDH and admitted to the Department of Neonatal Surgery at Children's Hospital between 2017 and 2023. The cohort included 86 (56.6%) males and 66 (43.4%) females. Multivariate logistic regression was employed to identify factors associated with CDH prognosis. Receiver operating characteristic (ROC) curve analysis was performed to assess the predictive value of significant ultrasonographic indicators.

Results: Multivariate logistic regression identified four factors as significant predictors of mortality: diaphragmatic defect length >4 cm [odds ratio [OR] = 2.41, 95% confidence interval [CI]: 1.08-10.58], the presence of hepatic herniation (OR = 2.61, 95% CI: 1.16-5.87), absence of a hernial sac (OR = 4.86, 95% CI: 2.00-11.76), and concomitant lung ultrasound abnormalities (OR = 10.86, 95% CI: 1.28-21.85). The combination of these four parameters demonstrated strong predictive performance for mortality, with an area under the ROC curve of 0.860 (95% CI: 0.786-0.935).

Conclusion: Diaphragmatic defect length, hepatic herniation, hernial sac status, and lung ultrasound findings serve as valuable prognostic indicators in infants with CDH. Integrating these four parameters enhances prognostic accuracy and may support clinical decision-making.

Background: The incidence of obstructive sleep apnea (OSA) in children has increased in recent years. Many primary hospitals have not polysomnography which can diagnose OSA. To investigate the lowest blood oxygen saturation at night (LSaO₂) combine with obstructive sleep apnea 18 items survey (OSA-18) scale to initially screen the sleep status of children with OSA.

Methods: A retrospective study of 189 children aged 4-12 years with sleep-disordered breathing was conducted. All children were monitored using polysomnography and divided into the simple snoring and OSA groups (mild, moderate, and severe). Their parents completed the OSA-18 scale. Correlation among three indices [LSaO2, OSA-18 scale, and obstructive apnea hypoventilation index (OAHI)] was assessed. Subsequently, series and parallel tests were used to understand the sensitivity and specificity of diagnosis.

Results: There was no statistical differences in sex (P = 0.909) and age (P = 0.894), and a significant difference in OSA-18 scores between the simple snoring and OSA groups (P = 0.014) but not in the LSaO2 (P = 0.409). OSA-18 and LSaO2 scores of the mild, moderate, and severe groups were significantly different (P < 0.05), and LSaO2 was correlated with the OAHI. Use of the OSA-18 scale combined with LSaO2 to assess the boundary value of mild and moderate-to-severe OSA was better than that of each index independently. The sensitivity and specificity the parallel test were 85.7% and 62.7%, respectively, can better predict OSA than series test.

Conclusion: The OSA-18 scale combined with LSaO2 has diagnostic value for the diagnosis of OSA, and can be used as a prediction tool for OSA.

Background: Breastfeeding promotion is a cornerstone of neonatal nursing, as it plays a pivotal role in safeguarding the health and fostering the development of newborns. This study aimed to assess neonatal nurses' Knowledge, Attitudes, and Practices (KAP) regarding breastfeeding for hospitalized neonates and identify factors influencing these domains.

Methods: A cross-sectional survey was conducted among neonatal nurses between July 1 and August 30, 2025. Eligible nurses were recruited via a rigorous screening process, and data were collected using a validated KAP scale. Benjamini-Hochberg false discovery rate (FDR) adjustment addressed multiple comparison biases, and comprehensive regression assumption checks (multicollinearity, residual normality, homoscedasticity) were performed to ensure result validity.

Results: A total of 122 neonatal nurses were included. Based on predefined scoring benchmarks (Low: ≤90; Moderate: 91-140; High: ≥141), participants demonstrated a moderate level of overall breastfeeding-related KAP (mean ± SD: 134.28 ± 14.02). Hierarchical regression analysis revealed: (1) Knowledge was significantly predicted by age (β = 0.304, p = 0.017), years of clinical experience (β = 0.433, p = 0.040), educational level (β = 0.385, p = 0.015), and specialized breastfeeding training (β = 0.402, p = 0.007); (2) Attitudes were significantly influenced by number of children (β = 0.224, p = 0.018), professional title (β = 0.196, p = 0.002), and specialized training (β = 0.264, p = 0.001); (3) Practices were significantly associated with years of clinical experience (β = 0.380, p = 0.028), professional title (β = 0.504, p = 0.011), educational level (β = 0.436, p = 0.020), and specialized training (β = 0.329, p = 0.001). Specialized breastfeeding training emerged as a consistent positive predictor across all KAP dimensions (medium effect sizes), explaining 56.0%-63.6% of the variance in the models (adjusted R ²).

Conclusion: Neonatal nurses exhibited positive attitudes but moderate knowledge and practice levels regarding breastfeeding, with targeted gaps in evidence-based care and parental education. These findings highlight the need for tailored training programs-prioritizing younger nurses, those with less experience, lower educational/professional titles, and untrained individuals-to enhance breastfeeding-related competence.

Background: Spinal muscular atrophy (SMA) is an autosomal recessive neuromuscular disorder caused by biallelic loss-of-function variants of the survival motor neuron 1 (SMN1) gene on chromosome 5q13. It has been reported that SMA may affect the function of the kidneys. Here, we report a patient with co-occurrence of SMA and IgA nephropathy (IgAN).

Case presentation: A 14-year-old girl presented with six months of limb weakness, progressive exacerbation of symptoms of left lower limb muscle weakness; her left lower limb muscle strength decreased, and bilateral knee tendon reflexes and Achilles tendon reflexes were not elicited. The patient was diagnosed with SMA type 3 in conjunction with the results of genetic testing. The patient had proteinuria and hematuria, and a renal biopsy was performed. Considering the patient's clinical and pathological characteristics, the final diagnosis was spinal muscular atrophy combined with IgA nephropathy. To the best of our knowledge, this is the first reported case that demonstrates the coexistence of SMA and IgAN.

Discussion and conclusions: The exact mechanism of renal impairment due to SMA is not fully understood, and the combination of SMA with IgAN is extremely rare. Our report suggests that there may be a potential association between them.

[This corrects the article DOI: 10.3389/fped.2025.1663214.].

Intravascular papillary endothelial hyperplasia (IPEH), or Masson's tumor, is a rare, benign vascular lesion that can closely resemble malignant vascular tumors. While primarily diagnosed in adulthood, pediatric cases are uncommon, and no prenatal diagnoses have been reported to date. Here, we present the first documented prenatal presentation of fetal intracranial IPEH detected in utero at 34 weeks of gestation. This case highlights the importance of considering IPEH in the differential diagnosis of fetal intracranial masses and underscores the role of early prenatal detection in optimizing perinatal and surgical management.

Objective: To explore the clinical characteristics of neonatal late-onset sepsis (LOS) and analyze the independent risk factors for secondary neonatal purulent meningitis (NPM).

Methods: This retrospective case-control study included infants diagnosed with LOS at the Children's Hospital of Soochow University between January 2018 and December 2023. The study divided the patients into two groups: the NPM group and the non-NPM group, based on the presence of secondary purulent meningitis. Clinical characteristics, laboratory markers, pathogen distribution, and treatment regimens were compared between the two groups. Independent risk factors were identified through multivariable logistic regression analysis, and a receiver operating characteristic (ROC) curve was used to evaluate the predictive performance.

Results: A total of 453 LOS patients were included, with 98 (21.6%) cases in the NPM group. Compared to the non-NPM group, the NPM group exhibited a higher frequency of prolonged fever (>3 days), fever peak >39 °C, tachypnea, seizures, irritability, poor feeding, and bulging anterior fontanel (all P < 0.05). Laboratory tests showed elevated procalcitonin (PCT) in the NPM group, while albumin, cholinesterase, glycocholic acid, and creatine kinase (CK) levels were decreased (all P < 0.05). Blood culture results revealed that the NPM group had a significantly higher proportion of non-Group B Streptococcus and Enterobacter cloacae, but a lower proportion of Staphylococcus aureus (P < 0.05). Multivariable analysis identified prolonged fever (>3 days), fever peak >39 °C, tachypnea, PCT >10.50 ng/mL, and CK <200 U/L as independent risk factors for LOS complicated by NPM. ROC analysis showed that the combined prediction model had an AUC of 0.804 (95% CI: 0.751-0.856), with a sensitivity of 75.24% and specificity of 72.83%, which outperformed the individual predictors for predicting NPM.

Conclusion: Prolonged high fever, abnormal respiration, elevated PCT, and decreased CK levels are important independent predictors of LOS complicated by NPM. The combined prediction model demonstrates high diagnostic efficacy, providing a useful reference for early identification of high-risk infants and the development of personalized intervention strategies.

Background: Calcineurin inhibitors are widely used in organ transplantation and nephrotic syndrome, with chronic toxicities well documented, but acute toxicity is rarely reported.

Case presentation: We report a 3.9-year-old boy with steroid-dependent nephrotic syndrome who accidentally ingested a single dose of cyclosporine A (CsA) at 75 mg/kg (1,500 mg)- over 20 times the intended dose of 3.5 mg/kg (70 mg)-due to medication error. He developed transient abdominal pain, diarrhea, and vomiting, which resolved without treatment. Error was discovered 12 h post-ingestion, and he was hospitalized with a CsA trough level of 1003 ng/mL (measured 13 h after ingestion), yet remained clinically stable. Management included CsA discontinuation, intravenous hydration, rifampin- and phenobarbital-induced cytochrome P450 activation, resulting in normalization of CsA levels within 48 h. A literature review identified 28 pediatric cases of acute CsA overdose, with presentations ranging from asymptomatic to severe neurotoxicity and acute kidney injury. The varied, including supportive care, gastrointestinal decontamination, and enzyme induction, with generally favorable outcomes.

Conclusions: Although rare, acute CsA overdose in children can pose serious risks. This case and review underscore the symptoms of overdose and prompt intervention to prevent complications.

Prompt and accurate detection of elevated intracranial pressure (ICP) is vital in the management of pediatric traumatic brain injury (TBI). While invasive ICP monitoring remains the gold standard, its application is often limited by contraindications or local logistical constraints. Consequently, a substantial number of moderate TBI cases are managed without direct ICP monitoring, despite the risk of secondary intracranial hypertension. This underscores the need for reliable, non-invasive diagnostic alternatives. One such technique-optic nerve sheath diameter (ONSD) measurement via point-of-care ultrasound (POCUS)-leverages cerebrospinal fluid (CSF) accumulation around the retrobulbar optic nerve as a surrogate marker for raised ICP. Although ONSD is recognised for its simplicity, speed, and repeatability, its clinical adoption in pediatric settings remains limited due to the absence of standardised guidelines and normative data. This manuscript synthesises the current evidence on ONSD measurement in children, highlighting its diagnostic potential, methodological considerations, and limitations. By consolidating recent research, we aim to support pediatric intensivists in the practical application of ONSD as a non-invasive tool for ICP assessment, ultimately improving clinical decision-making and prognostic evaluation in pediatric TBI.