Frontiers in Pediatrics最新文献

Purpose: The incidence of medial to lateral diagonal elbow injury (MELAINE) in children without dislocation is relatively low. This article explores the clinical characteristics and treatment outcomes of this fracture type.

Methods: A retrospective analysis of elbow fracture was performed in Dalian Women and Children's Medical Center (Group) and Shanxi Provincial Children's Hospital, between January 2019 and January 2025. The collected data encompassed patient age, gender, side, diagnose. Additional parameters included the injury mechanism, elbow joint range of motion, and radiological findings. We also recorded the carrying angle (CA), Elbow Performance Scale (EPS) score, treatment method, healing time, and complications.

Results: The study included 21 patients (2.21%, 21/949), mean age 9.4 ± 3.08 years (range 8-14 years); 14 males and 7 females, 13 left and 8 right, from injury to surgery was 3.1 days (range 1-11 days), and the mean follow-up duration was 11.46 ± 1.73 months (range 6-37 months). 8 extension-type and 13 flexion-type. All patients underwent open reduction and internal fixation, performed via a medial approach in 19 cases, a lateral approach in 10 cases, and a combined medial and lateral approach in 8 cases. At final follow-up, the mean elbow flexion-extension and forearm pronation-supination arcs on the fractured side were 139.2° ± 9.4°, 4.5° ± 3.4°, 75.8° ± 8.1°, and 79.6° ± 8.2°, respectively, showing no significant difference from the healthy side (p > 0.05). The carrying angle on the injured side measured 14.3° ± 2.8°, respectively, compared to 15.1° ± 1.7° on the healthy side (p = 1.78). According to the EPS rating, most patients achieved an "excellent" (n = 18, 85.7%) or "good" (n = 3, 14.3%) outcome.

Conclusion: In older children and adolescents, medial-to-lateral diagonal elbow fractures without dislocation may be missed. The fractures frequently involve significant displacement of the medial epicondyle, yet surgical intervention can often achieve favorable clinical outcomes.

Objective: Investigate the current status of family management styles among families of children aged 1-7 years with bronchial asthma and analyze influencing factors to provide a basis for developing intervention strategies.

Methods: A cross-sectional questionnaire survey was administered between February and December 2024 to 257 pediatric patients with physician-diagnosed asthma and their primary caregivers at a tertiary care children's hospital in Zhejiang, China. The family management styles of children with asthma and their influencing factors were assessed using a general information questionnaire, the Childhood Asthma Control Test (C-ACT, for children aged five and above), the Test for Respiratory and Asthma Control in Kids (TRACK, for children under five), and the Family Management Scale for Children with Asthma.

Results: The Family Management Scale for Children with Asthma scores were (239.30 ± 20.38) points, above average. Univariate analysis revealed that the child's nutritional status and the caregiver's educational level significantly influence asthma management styles (P < 0.05). Multiple linear regression analysis found child's wasting was associated with higher FMSCA scores (Beta = 0.16, P < 0.05), indicating better management styles. However, child's obesity was associated with lower scores (Beta = -0.13, P < 0.05), indicating worse management styles. Regarding educational level, caregivers with junior high school education or below were associated with lower scores (Beta = -0.19, P < 0.05) compared to those with junior college qualifications, indicating worse management styles.

Conclusion: The family management style for pediatric asthma patients (children aged 1-7 years) was adaptive and primarily influenced by the child's nutritional status and the caregiver's level of education. Specifically, child's obesity and a caregiver education level of junior high school or below were associated with worse family management styles, whereas child's wasting was linked to better family management styles.

Background: Surgical intervention after air enema for paediatric intussusception is very common, and prompt surgical treatment after failure of air enema therapy is the key to reducing serious complications, such as intestinal perforation and intestinal necrosis caused by intussusception. The aim of this study was to develop and validate a prediction model for surgical intervention after air enema in paediatric intussusception to reduce the incidence of serious complications.

Methods: A retrospective study was performed on 843 children who were successfully reduced by air enema and 120 children who underwent surgical intervention after air enema in our hospital from January 2011 to December 2021. Baseline information, clinical presentation and test results of the children on admission were recorded. Univariate and multivariate logistic regression analyses were used to identify independent risk factors for surgical intervention after air enema for paediatric intussusception. Meanwhile, we developed a predictive model to predict surgical intervention after air enema for paediatric intussusception based on independent risk factors and validated the model using receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA).

Results: Age, duration of symptoms, bloody stools, body temperature, lymphocyte percentage and basophil percentage were independently associated with the composite endpoint (p < 0.05). The patients were randomly divided into a training set and a validation set at a ratio of 7:3 for model construction and validation, respectively. A logistic regression model was constructed based on the above six factors and integrated into the nomogram. The area under the ROC curve of the nomogram constructed by 6 independent risk factors reached 0.879, and the calibration curve was close to the ideal diagonal. In addition, DCA analysis revealed significant net benefits of the model.

Conclusions: Our predictive model for surgical intervention after air enema in pediatric intussusception, developed using objectively measurable indicators, demonstrates reliable predictive capability. It provides clinicians with an effective and dependable tool for early decision-making regarding post-enema treatment strategies-whether to continue with enema or proceed to surgery.

Background: Feeding intolerance (FI) is common in very preterm infants and often leads to unnecessary interruptions in enteral nutrition (EN), delaying full enteral feeding (FEF). The absence of standardized criteria contributes to inconsistent management. We evaluated the impact of a structured protocol-Rapid Assessment of Feeding Intolerance (RAFI)-on FEF achievement in preterm infants.

Methods: This single-center, retrospective-prospective superiority cohort study included infants <30 weeks' gestation. Two cohorts were defined: a historical control group (pre-RAFI) and a RAFI group (first implementation phase). The primary outcome was time to FEF (150 mL/kg/day of EN). One-sided statistical tests were used to assess the superiority of RAFI. Stratified analysis was performed for infants with intrauterine growth restriction (IUGR).

Results: Sixty infants were included (30 per group). RAFI infants achieved FEF significantly earlier than controls [median 23.0 (IQR 18.0-30.0) vs. 30.0 (24.0-34.5) days; p = 0.041]. Among IUGR infants (n = 14), RAFI group achieved FEF earlier [27.00 (24.00-32.00) vs. 35.00 (34.00-61.00) days; p = 0.036] at earlier post-menstrual age [33.0 (32.5-34.0) vs. 34.0 (34.0-37.5) weeks; p = 0.028] and with a lower weight [1,280 (1,130-1,382) vs. 1,535 (1,325-2,002) g; p = 0.048]. A trend towards a shorter duration of central venous catheter (p = 0.059) and hospital stay (p = 0.064) was observed.

Conclusions: RAFI implementation was associated with earlier achievement of FEF, particularly in IUGR infants. These findings suggest that a structured and standardized approach to feeding intolerance assessment may facilitate nutritional advancement in very preterm neonates.

Human milk oligosaccharides (HMOs) are the third most abundant solid component of human breast milk, with well-established prebiotic and immunomodulatory functions. HMOs serve as selective substrates to support the growth of beneficial microbes in the developing gastrointestinal tract. At the same time individual HMOs have been shown to also exert selection against pathogens via direct anti-adhesive mechanisms. A longstanding hypothesis has held that HMOs act in concert and with other bioactive components of milk, and that this complex matrix of milk components collectively accounts for both the benefits to microbiome development and reduced risk of infectious disease associated with breastfeeding. The prebiotic activity of a diverse blend of fucosylated, acetylated, and sialylated HMOs was examined using microbiota cultured in an ex vivo model of the infant gastrointestinal tract before, during and after the supplementation of common childhood antibiotics. The anti-adhesive activity of this blend against infant-prevalent bacterial pathogens was tested using in vitro cultured intestinal epithelial cells. Taken together, this data suggests that a blend of 5 specific HMOs acts through multiple selection mechanisms to shape the development of the microbiota and interrupt opportunistic microbial pathogenesis.

Objectives: This study aimed to compare the positive detection rates of RNA Isothermal Amplification-Gold Probe Lateral Flow Technology (RGT) and Targeted Next-Generation Sequencing (tNGS) for Mycoplasma pneumoniae (MP) and Influenza A/B viruses in children with acute respiratory infections (ARIs), and to explore their respective advantages and disadvantages.

Methods: Clinical and laboratory data of pediatric patients with ARIs undergoing concurrent RGT and tNGS testing (Jan-Sep 2024) were collected. McNemar's test compared detection rates, and Cohen's kappa coefficient assessed the agreement of the result of between the two methods.

Results: For detecting MP and Influenza B virus, tNGS showed a significantly higher positivity rate than RGT. However, there is no difference between tNGS and RGT in the positive detection rate of Influenza A. The agreement between tNGS and RGT was good for MP detection, but only moderate for Influenza A/B virus detection.

Conclusions: tNGS offers high-throughput, high-sensitivity screening, while RGT is rapid, user-friendly, cost-effective and superior for identifying active infections and monitoring treatment responses. Optimal method selection is dependent on clinical scenarios and diagnostic priorities.

Introduction: To preliminarily describe the dynamic changes and clinical characteristics of serum C-reactive protein (CRP) in giant omphalocele (GO) neonates with delayed repair during the early postnatal period.

Methods: A retrospective study included 15 neonates with GO who underwent delayed repair at our hospital. CRP was collected at 0, 5, 7, 10, 14, 21 days after birth and before discharge. Data on hospital stay duration, complications, and anti-infection treatment were recorded. Descriptive statistics were used to present the trend of CRP changes, and the relationship with clinical indicators was preliminarily analyzed.

Results: Among the 15 full-term neonates (average gestational age 38.5 weeks, birth weight 2,821 g), CRP reached a peak value on the 5th day after birth (median 87.1 mg/L), followed by a decreasing trend but remaining at a high level (78.0, 67.2, and 48.0 mg/L on the 7th, 10th, and 14th days, respectively). The peak CRP level was positively correlated with the hospital stay duration (R = 0.78, p = 0.001). 73.3% (11/15) of the GO neonates received empirical antibiotic treatment (average course of 11 days), while the pathogen positivity rate was only 20% (3/15), and all were cultured from the sac membrane secretions. Based on the duration of continuous CRP elevation as the classification criterion, it was found that neonates with a longer duration of elevated CRP had larger defects, longer hospital stays, and longer time to achieve full enteral nutrition.

Conclusion: Neonates with GO undergoing delayed repair exhibit significant CRP elevation in the early postnatal period, but this rise correlates poorly with proven infection. Clinicians need to carefully interpret the changes in CRP and avoid excessive anti-infection treatment. This retrospective study provides preliminary data and hypothesis basis for subsequent large-sample studies.

Chylous ascites (CA) is a condition characterized by the accumulation of lymphatic fluid in the peritoneal cavity. Although congenital malformations are the most common cause in newborns, infectious agents represent a clinically significant, potentially reversible etiology that benefits from specific therapy. Various pathogens, including bacteria, viruses, fungi, and parasites, can alter the lymphatic system and lead to the leakage of chyle into the peritoneal cavity, resulting in nutritional, immunological, and metabolic deficiencies. We describe the case of a 5-month-old infant presenting with acute abdomen (vomiting, irritability, and abdominal distension) associated with elevated lipase levels. He underwent emergency laparotomy, which revealed chylous ascites in the absence of structural abnormalities. Initial empiric management, centered on the diagnosis of CA, included fasting and total parenteral nutrition (TPN), followed by a gradual dietary transition from a lipid-free milk formula to a formula enriched in medium-chain triglycerides (MCTs) and reduced in long-chain triglycerides, which was well tolerated. Cytomegalovirus (CMV) infection was identified as the underlying cause and confirmed by PCR on blood, urine, ascitic fluid, and gastric biopsies. The etiological diagnosis allowed for specific antiviral therapy, which, combined with nutritional support, led to complete resolution of the case. We also review published cases of infectious CA in children, analyzing the clinical presentation, diagnostic approaches, and therapeutic strategies. Particular attention is paid to nutritional management. Interventions including the use of TPN, fat-free formulas, or MCT-enriched formulas are also important in infectious etiologies for temporarily controlling the chyle loss mechanism while awaiting complete lymphatic restitution. This review emphasizes the importance of recognizing infectious etiologies in chylous ascites and emphasizes the critical role of personalized nutritional support in optimizing recovery.

Background: Pediatric lupus nephritis (LN) remains a major cause of morbidity and mortality, yet data from Latin American populations are limited. This study aimed to describe the clinical, laboratory, and histopathological characteristics of pediatric LN and identify prognostic factors associated with renal replacement therapy (RRT).

Methods: We conducted a retrospective cross-sectional study including patients <18 years of age with LN diagnosed between 2020 and 2024 at a national referral center in Mexico. Demographic, clinical, immunological, histopathological, and therapeutic variables at diagnosis were analyzed. Multivariable logistic regression was performed to identify predictors of RRT.

Results: Eighty patients were included (83% female; mean age 15.1 ± 2.8 years). Median proteinuria was 41 mg/m²/h; hematuria and leukocyturia were present in 46% and 26% of patients, respectively. All patients were ANA positive, with frequent hypocomplementemia and elevated anti-double-stranded DNA titers. Among biopsied patients, class IV was the most common histological subtype (60%). Proliferative forms were associated with reduced glomerular filtration rate (<90 mL/min/1.73 m²; p = 0.012) and higher activity index scores (p = 0.04), while chronicity indices were low. Fifteen patients (18.8%) required RRT, and mortality was 6.25%. In multivariable analysis, hypoalbuminemia (<2.5 g/dL) was independently associated with RRT (OR 6.04; 95% CI 1.33-27.50; p = 0.020).

Conclusions: This study represents one of the largest pediatric LN cohorts reported from Mexico. Proliferative forms were associated with greater inflammatory activity and impaired renal function at diagnosis. Hypoalbuminemia emerged as a simple and accessible biomarker for early risk stratification of severe renal outcomes.

Objective: This mini-review synthesizes evidence for safe and effective pediatric joint mobilization, discussing red flags, offering clinical recommendations, and addressing current research limitations.

Methods: A PubMed and PEDro search, supplemented by foundational pediatric musculoskeletal resources, identified peer-reviewed articles and guidelines, which experts collaboratively evaluated.

Results: Pediatric musculoskeletal systems, with open growth plates and lower bone mineral density, are vulnerable to shear forces. Safe force thresholds remain undefined. Therefore, thorough history taking, systematic red flag screening, and adherence to International Federation of Manual and Musculoskeletal Physical Therapists guidelines are crucial.

Discussion: The refined Pediatric Utilization of Manual Therapy tool (PUMT-2, combined with the proposed modified three-tier red flag framework, supports individualized, developmentally appropriate assessment and care. Future research should establish force guidelines and age-based technique modifications, alongside specialized clinician training to address pediatric-specific needs.