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The cardiopulmonary benefits of physiologically based cord clamping persist for at least 8 hours in lambs with a diaphragmatic hernia. 对患有膈疝的羔羊来说,基于生理学的脐带钳夹术对心肺功能的益处可持续至少 8 小时。
IF 2.1 3区 医学 Q2 PEDIATRICS Pub Date : 2024-10-11 eCollection Date: 2024-01-01 DOI: 10.3389/fped.2024.1451497
Paige J Riddington, Philip L J DeKoninck, Marta Thio, Calum T Roberts, Risha Bhatia, Janneke Dekker, Aidan J Kashyap, Benjamin J Amberg, Karyn A Rodgers, Alison M Thiel, Ilias Nitsos, Valerie A Zahra, Ryan J Hodges, Stuart B Hooper, Kelly J Crossley

Introduction: Infants with congenital diaphragmatic hernia can suffer severe respiratory insufficiency and pulmonary hypertension after birth. Aerating the lungs before removing placental support (physiologically based cord clamping, PBCC) increases pulmonary blood flow (PBF) and reduces pulmonary vascular resistance (PVR) in lambs with a diaphragmatic hernia (DH). We hypothesized that these benefits of PBCC persist for at least 8 h after birth.

Methods: At ∼138 days of gestation age (dGA), 21 lambs with a surgically induced left-sided DH (∼86 dGA) were delivered via cesarean section. The umbilical cord was clamped either before ventilation onset (immediate cord clamping, ICC, n = 9) or after achieving a tidal volume of 4 ml/kg, with a maximum delay of 10 min (PBCC, n = 12). The lambs were ventilated for 8 h, initially with conventional mechanical ventilation, but were switched to high-frequency oscillatory ventilation after 30 min if required. Ventilatory parameters, cardiopulmonary physiology, and arterial blood gases were measured throughout the study.

Results: PBF increased after ventilation onset in both groups and was higher in the PBCC DH lambs than the ICC DH lambs at 8 h (5.2 ± 1.2 vs. 1.9 ± 0.3 ml/min/g; p < 0.05). Measured over the entire 8-h ventilation period, PBF was significantly greater (p = 0.003) and PVR was significantly lower (p = 0.0002) in the PBCC DH lambs compared to the ICC DH lambs. A high incidence of pneumothoraces in both the PBCC (58%) and ICC (55%) lambs contributed to a reduced sample size at 8 h (ICC n = 4 and PBCC n = 4).

Conclusion: Compared with ICC, PBCC increased PBF and reduced PVR in DH lambs and the effects were sustained for at least 8 h after ventilation onset.

导言患有先天性膈疝的婴儿出生后会出现严重的呼吸功能不全和肺动脉高压。在去除胎盘支持前给肺部通气(生理脐带夹闭,PBCC)可增加膈疝(DH)羔羊的肺血流量(PBF)并降低肺血管阻力(PVR)。我们假设,PBCC 的这些益处至少会在出生后 8 小时内持续存在:方法:21 只妊娠 138 天(dGA)的左侧膈疝(86 dGA)羔羊通过剖腹产分娩。脐带在通气开始前夹闭(立即夹闭脐带,ICC,n = 9)或在潮气量达到 4 毫升/千克后夹闭,最长延迟 10 分钟(PBCC,n = 12)。羔羊通气时间为 8 小时,最初使用常规机械通气,但在 30 分钟后根据需要改用高频振荡通气。在整个研究过程中测量了通气参数、心肺生理学和动脉血气:结果:通气开始后,两组羔羊的 PBF 都有所增加,8 h 时,PBCC DH 组羔羊的 PBF 高于 ICC DH 组羔羊(5.2 ± 1.2 vs. 1.9 ± 0.3 ml/min/g;p p = 0.003),PBCC DH 组羔羊的 PVR 显著低于 ICC DH 组羔羊(p = 0.0002)。PBCC(58%)和ICC(55%)羔羊的气胸发生率都很高,导致8小时的样本量减少(ICC n = 4,PBCC n = 4):结论:与 ICC 相比,PBCC 可增加 DH 羔羊的 PBF 并降低 PVR,其效果在通气开始后至少持续 8 小时。
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引用次数: 0
Feasibility of clinical EEG for music recognition in children aged 1-12 years. 临床脑电图对 1-12 岁儿童进行音乐识别的可行性。
IF 2.1 3区 医学 Q2 PEDIATRICS Pub Date : 2024-10-11 eCollection Date: 2024-01-01 DOI: 10.3389/fped.2024.1427118
Janeen Bower, Sebastian John Corlette, Mengmeng Wang, Wendy L Magee, Cathy Catroppa, Felicity Anne Baker

Introduction: Musicality is an innate capability and the fundamental architectures necessary for music processing are present from birth. However, there is a notable gap in pediatric specific music neuroscience research and research that employs ecologically valid musical stimuli.

Methods: This pragmatic feasibility study aimed to assess the utility of EEG collected via pre-existing clinical monitoring to describe the processing of familiar song as an ecologically valid stimulus, in the underrepresented pediatric population. Three comparative auditory conditions (song, speech, and noise) were utilized to assess the changes in EEG across these conditions compared to a baseline silence.

Results: Analysis of EEG data from a pilot sample of four children revealed distinct changes in the underlying frequency components of the EEG during the song condition that were not observed in either the speech or noise conditions. To extend this analysis, a uniquely hypothesis-driven, multivariate statistical analysis method (generalized eigendecomposition [GED]) was employed, however in this study we did not isolate a consistent source responsible for the observed changes in the frequency components of the EEG during the song condition.

Discussion: The study is limited by the small sample size but nevertheless demonstrated feasibility of collecting EEG data in the imperfect auditory environment of an acute clinical setting to describe a response to an ecologically valid stimulus in the underrepresented pediatric population. Further research with a more restrictive study design and greater participant numbers is needed to extend these preliminary findings.

简介音乐性是一种与生俱来的能力,音乐处理所需的基本架构从出生时就已存在。然而,儿科音乐神经科学研究和采用生态学上有效的音乐刺激的研究还存在明显差距:这项实用的可行性研究旨在评估通过已有的临床监测收集的脑电图的效用,以描述代表性不足的儿科人群对熟悉的歌曲作为生态有效刺激的处理过程。研究采用了三种比较听觉条件(歌曲、语音和噪音),以评估与基线静默相比,这些条件下的脑电图变化:结果:对四名试点样本儿童的脑电图数据进行分析后发现,在歌曲条件下,脑电图的基本频率成分发生了明显变化,而在语音或噪音条件下均未观察到这种变化。为了扩展这一分析,我们采用了一种独特的假设驱动型多元统计分析方法(广义多重分解法 [GED]),但在这项研究中,我们并未分离出导致在歌曲条件下观察到的脑电图频率成分变化的一致来源:讨论:这项研究因样本量较小而受到限制,但还是证明了在急性期临床环境不完善的听觉环境中收集脑电图数据的可行性,以描述代表性不足的儿科人群对生态有效刺激的反应。要扩展这些初步研究结果,还需要进行更严格的研究设计和更多的参与者。
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引用次数: 0
Case Report: Esophageal squamous cell carcinoma in a 13-year-old boy with a history of esophageal atresia with tracheoesophageal fistula. 病例报告:食管闭锁伴气管食管瘘病史的 13 岁男孩患食管鳞状细胞癌。
IF 2.1 3区 医学 Q2 PEDIATRICS Pub Date : 2024-10-11 eCollection Date: 2024-01-01 DOI: 10.3389/fped.2024.1438242
B Bernar, C Mayerhofer, T Fuchs, G Schweigmann, E Gassner, R Crazzolara, B Hetzer, U Klingkowski, A Zschocke, G Cortina

In adults, esophageal cancers are a global health concern. Esophageal squamous cell carcinoma (ESCC) accounts for approximately 90% of esophageal carcinomas. The prognosis of esophageal cancers remains dismal, with a five-year survival rate below 20%. It typically affects older patients, and for now, ESCC after esophageal atresia has not been reported in patients younger than 18 years. We present an exceptional case of an ESCC in a 13-year-old boy with a history of esophageal atresia and corrective surgery in infancy. After the surgery the patient was lost to surgical follow up for over ten years and then presented to our emergency department with respiratory distress requiring antibiotic therapy and supplemental oxygen. Radiologic imaging revealed a volume reduction of the right lung with bronchiectasis, as well as esophageal stenosis at the level of the previous anastomosis, with an adjacent abscess in the right lung. These changes may have arisen due to a chronic fistula from the esophagus to the right lung. Initial interventional therapy with a stent implantation had no lasting success and, in an effort to prevent further aspiration into the right lung, a cervical esophagus stoma was established, and the patient received prolonged antibiotic treatment. However, a thoracic CT scan performed 4 months later revealed a large, retrospectively progressive prevertebral mass originating from the distal portion of the esophagus below the stenosis, compressing the trachea and the right main bronchus. The patient's condition rapidly worsened and he developed respiratory failure, requiring veno-venous extracorporeal membrane oxygenation. Unfortunately, an endoscopic biopsy revealed an advanced ESCC. With no rational treatment options available, we changed the goals of care to a palliative setting. The key message of this case is that in adolescents with chronic infections, an abscess can potentially mask a malignant transformation. Therefore, in adolescents, with an history of corrective surgery for esophageal atresia and chronic complications, consideration should also be given to the possibility of squamous cell carcinoma of the esophagus.

成人食管癌是全球关注的健康问题。食管鳞状细胞癌(ESCC)约占食管癌的 90%。食管癌的预后仍然不容乐观,五年生存率低于 20%。食管癌通常发生在年龄较大的患者身上,目前还没有关于 18 岁以下患者食管闭锁后发生 ESCC 的报道。我们介绍了一例特殊的 ESCC 病例,患者是一名 13 岁男孩,曾患食道闭锁,并在婴儿期接受过矫正手术。手术后,患者失去了十多年的手术随访机会,随后因呼吸困难到我们的急诊科就诊,需要抗生素治疗和补充氧气。放射成像显示,患者右肺体积缩小并伴有支气管扩张,之前吻合处的食管狭窄,右肺邻近有脓肿。这些变化可能是由于食管到右肺的慢性瘘管造成的。最初植入支架的介入治疗没有取得持久的成功,为了防止进一步吸入右肺,患者接受了颈部食管造口术,并长期接受抗生素治疗。然而,4 个月后进行的胸部 CT 扫描显示,一个巨大的、呈进行性发展的椎管前肿块源自狭窄处下方的食管远端,压迫气管和右主支气管。患者病情迅速恶化,出现呼吸衰竭,需要静脉体外膜肺氧合。不幸的是,内窥镜活检发现了晚期 ESCC。由于没有合理的治疗方案,我们将治疗目标改为姑息治疗。本病例的关键信息是,在患有慢性感染的青少年中,脓肿有可能掩盖恶性转化。因此,对于有食道闭锁矫正手术史和慢性并发症的青少年,还应考虑食道鳞状细胞癌的可能性。
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引用次数: 0
A systematic review of the effect of sandplay therapy on social communication deficits in children with autism spectrum disorder. 沙盘游戏疗法对自闭症谱系障碍儿童社交沟通障碍影响的系统性综述。
IF 2.1 3区 医学 Q2 PEDIATRICS Pub Date : 2024-10-11 eCollection Date: 2024-01-01 DOI: 10.3389/fped.2024.1454710
Ren Yuxi, Jia Shuqi, Liu Cong, Li Shufan, Long Yueyu

Objective: To explore the efficacy of sandplay therapy in intervening social communication deficits in children with autism spectrum disorders (ASD), and whether this efficacy is influenced by the age of the children and the dosage of sandplay therapy intervention.

Methods: Following the PICOS principle, randomized controlled trials (RCTs) related to sandplay therapy for social communication deficits in ASD children were retrieved from seven databases: PubMed, WOS, The Cochrane Library, Embase, CNKI, Wanfang, and VIP, from the inception of each database to November 10, 2023. Two experimenters independently conducted study screening and excluded studies with concomitant diseases, incomplete data, unextractable data, and non-randomized controlled trials. The PEDro scale was used for methodological quality assessment, and the GRADEprofiler method was employed to evaluate the quality of evidence. Stata17 software was used for meta-analysis, subgroup analysis, sensitivity analysis, and publication bias testing. The standardized mean difference (SMD) and 95% confidence interval (CI) were used as the effect statistics.

Results: A total of 12 RCTs (791 cases) were included. Sandplay therapy had a positive impact on the social communication deficits of ASD children [SMD = -1.42, 95%CI (-1.79, -1.04), P < 0.001]. Subgroup analysis revealed that sandplay therapy administered during the early school age (449 cases, SMD = -1.44, P < 0.05), for a duration of 22-28 weeks (208 cases, SMD = 1.69, P < 0.05), and with a frequency of once per week (218 cases, SMD = -1.67, P < 0.05) was most effective in improving on social communication deficits of ASD children.

Discussion: The quality of evidence in this study was rated as high, with good methodological quality, including 12 studies with better quality and no detection of bias risk. The study had high heterogeneity, which was attributed to the measurement tools and intervention duration through subgroup analysis, with no inconsistency found. Additionally, no downgrade factors related to imprecision, publication bias, or indirectness were identified. In conclusion, sandplay therapy is an effective measure to improve social communication deficits in children with ASD, and current evidence recommends early intervention using an individual sandplay therapy or integrated sandplay therapy intervention program once a week for 22-28 weeks, which can serve as evidence-based clinical guidance.

Systematic review registration: www.crd.york.ac.uk, identifier (CRD420234821750).

目的探讨沙盘游戏疗法在干预自闭症谱系障碍(ASD)儿童社交沟通障碍方面的疗效,以及这种疗效是否受儿童年龄和沙盘游戏疗法干预剂量的影响:按照 PICOS 原则,从七个数据库中检索了与沙盘游戏疗法治疗 ASD 儿童社交沟通障碍相关的随机对照试验(RCT):PubMed、WOS、The Cochrane Library、Embase、CNKI、万方和VIP,检索时间从各数据库建立之初至2023年11月10日。两名实验员独立进行研究筛选,排除了伴有疾病、数据不完整、无法提取数据和非随机对照试验的研究。方法学质量评估采用 PEDro 量表,证据质量评估采用 GRADEprofiler 方法。Stata17软件用于荟萃分析、亚组分析、敏感性分析和发表偏倚测试。采用标准化平均差(SMD)和95%置信区间(CI)作为效应统计:结果:共纳入了 12 项 RCT(791 个病例)。沙盘游戏疗法对 ASD 儿童的社交沟通障碍有积极影响[SMD = -1.42, 95%CI (-1.79, -1.04), P P P P 讨论:本研究的证据质量被评为高,具有良好的方法学质量,其中包括 12 项质量较好且无检测偏倚风险的研究。该研究的异质性较高,通过亚组分析可归因于测量工具和干预持续时间,未发现不一致性。此外,没有发现与不精确、发表偏倚或间接性有关的降级因素。总之,沙盘游戏疗法是改善ASD儿童社会交往障碍的有效措施,目前的证据建议采用个体沙盘游戏疗法或综合沙盘游戏疗法干预方案进行早期干预,每周一次,持续22-28周,可作为循证临床指导。系统综述注册:www.crd.york.ac.uk,标识符(CRD420234821750)。
{"title":"A systematic review of the effect of sandplay therapy on social communication deficits in children with autism spectrum disorder.","authors":"Ren Yuxi, Jia Shuqi, Liu Cong, Li Shufan, Long Yueyu","doi":"10.3389/fped.2024.1454710","DOIUrl":"10.3389/fped.2024.1454710","url":null,"abstract":"<p><strong>Objective: </strong>To explore the efficacy of sandplay therapy in intervening social communication deficits in children with autism spectrum disorders (ASD), and whether this efficacy is influenced by the age of the children and the dosage of sandplay therapy intervention.</p><p><strong>Methods: </strong>Following the PICOS principle, randomized controlled trials (RCTs) related to sandplay therapy for social communication deficits in ASD children were retrieved from seven databases: PubMed, WOS, The Cochrane Library, Embase, CNKI, Wanfang, and VIP, from the inception of each database to November 10, 2023. Two experimenters independently conducted study screening and excluded studies with concomitant diseases, incomplete data, unextractable data, and non-randomized controlled trials. The PEDro scale was used for methodological quality assessment, and the GRADEprofiler method was employed to evaluate the quality of evidence. Stata17 software was used for meta-analysis, subgroup analysis, sensitivity analysis, and publication bias testing. The standardized mean difference (SMD) and 95% confidence interval (CI) were used as the effect statistics.</p><p><strong>Results: </strong>A total of 12 RCTs (791 cases) were included. Sandplay therapy had a positive impact on the social communication deficits of ASD children [SMD = -1.42, 95%CI (-1.79, -1.04), <i>P</i> < 0.001]. Subgroup analysis revealed that sandplay therapy administered during the early school age (449 cases, SMD = -1.44, <i>P</i> < 0.05), for a duration of 22-28 weeks (208 cases, SMD = 1.69, <i>P</i> < 0.05), and with a frequency of once per week (218 cases, SMD = -1.67, <i>P</i> < 0.05) was most effective in improving on social communication deficits of ASD children.</p><p><strong>Discussion: </strong>The quality of evidence in this study was rated as high, with good methodological quality, including 12 studies with better quality and no detection of bias risk. The study had high heterogeneity, which was attributed to the measurement tools and intervention duration through subgroup analysis, with no inconsistency found. Additionally, no downgrade factors related to imprecision, publication bias, or indirectness were identified. In conclusion, sandplay therapy is an effective measure to improve social communication deficits in children with ASD, and current evidence recommends early intervention using an individual sandplay therapy or integrated sandplay therapy intervention program once a week for 22-28 weeks, which can serve as evidence-based clinical guidance.</p><p><strong>Systematic review registration: </strong>www.crd.york.ac.uk, identifier (CRD420234821750).</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11502332/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142498919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Measurements of enteral feeding intolerance in critically ill children: a scoping review. 重症儿童肠内喂养不耐受的测量方法:范围综述。
IF 2.1 3区 医学 Q2 PEDIATRICS Pub Date : 2024-10-10 eCollection Date: 2024-01-01 DOI: 10.3389/fped.2024.1441171
Yan Li, Cong-Hui Fu, Min-Jie Ju, Ji Liu, Xiao-Ya Yang, Ting-Ting Xu

Objective: To examine the measurements on enteral feeding intolerance (EFI) in critically ill children.

Methods: The Joanna Briggs Institute methods for conducting a scoping review were followed. Articles published since 2004 which assessed EFI in critically ill children were identified. A full search strategy was executed in seven English databases (MEDLINE, EMBASE, PubMed, Web of Science, Cochrane Central Register of Controlled Trials, JBI EBP, CINAHL) and four Chinese databases (CNKI, VIP, Wanfang, Sinomed). Two reviewers screened records according to our inclusion and exclusion criteria, and conducted a full-text review of selected articles. The reference lists of all studied selected were screened for additional sources. Relevant data was extracted using a researcher-developed tool.

Results: Of the 627 articles identified, 32 were included in this scoping review. Most articles focused on the measurement of high gastric residual volume (n = 22), followed by diarrhea (n = 20), and vomiting (n = 9). Most of the studies were of observational-analytic design (13/32) and experimental design (8/32).

Conclusion: This scoping review addressed the complexity and diversity of EFI measurements. Given the importance of adequacy of enteral nutrient intake, we highlighted the necessary to develop individual measurements of EFI, taking the age of children and disease condition into consideration. Further studies can also investigate accurate and objective physiological measurements of EFI to advance EN and improve outcomes in critically ill children.

目的:研究危重症儿童肠内喂养不耐受(EFI)的测量方法:研究重症儿童肠内喂养不耐受(EFI)的测量方法:采用乔安娜-布里格斯研究所(Joanna Briggs Institute)的方法进行范围审查。确定了自 2004 年以来发表的评估危重症儿童肠内喂养不耐受的文章。我们在七个英文数据库(MEDLINE、EMBASE、PubMed、Web of Science、Cochrane Central Register of Controlled Trials、JBI EBP、CINAHL)和四个中文数据库(CNKI、VIP、万方、中国医药网)中执行了全面检索策略。两名审稿人根据纳入和排除标准筛选记录,并对所选文章进行全文审阅。对所有入选研究的参考文献目录进行了筛选,以寻找更多来源。使用研究人员开发的工具提取相关数据:在确定的 627 篇文章中,有 32 篇被纳入此次范围界定综述。大多数文章侧重于高胃剩余容积的测量(22 篇),其次是腹泻(20 篇)和呕吐(9 篇)。大多数研究采用观察-分析设计(13/32)和实验设计(8/32):本次范围界定综述探讨了 EFI 测量的复杂性和多样性。鉴于肠内营养摄入充足性的重要性,我们强调有必要在考虑儿童年龄和疾病状况的基础上,制定个性化的肠内营养摄入量(EFI)测量方法。进一步的研究还可以对 EFI 进行准确、客观的生理学测量,以促进肠内营养的摄入并改善危重症儿童的预后。
{"title":"Measurements of enteral feeding intolerance in critically ill children: a scoping review.","authors":"Yan Li, Cong-Hui Fu, Min-Jie Ju, Ji Liu, Xiao-Ya Yang, Ting-Ting Xu","doi":"10.3389/fped.2024.1441171","DOIUrl":"https://doi.org/10.3389/fped.2024.1441171","url":null,"abstract":"<p><strong>Objective: </strong>To examine the measurements on enteral feeding intolerance (EFI) in critically ill children.</p><p><strong>Methods: </strong>The Joanna Briggs Institute methods for conducting a scoping review were followed. Articles published since 2004 which assessed EFI in critically ill children were identified. A full search strategy was executed in seven English databases (MEDLINE, EMBASE, PubMed, Web of Science, Cochrane Central Register of Controlled Trials, JBI EBP, CINAHL) and four Chinese databases (CNKI, VIP, Wanfang, Sinomed). Two reviewers screened records according to our inclusion and exclusion criteria, and conducted a full-text review of selected articles. The reference lists of all studied selected were screened for additional sources. Relevant data was extracted using a researcher-developed tool.</p><p><strong>Results: </strong>Of the 627 articles identified, 32 were included in this scoping review. Most articles focused on the measurement of high gastric residual volume (<i>n</i> = 22), followed by diarrhea (<i>n</i> = 20), and vomiting (<i>n</i> = 9). Most of the studies were of observational-analytic design (13/32) and experimental design (8/32).</p><p><strong>Conclusion: </strong>This scoping review addressed the complexity and diversity of EFI measurements. Given the importance of adequacy of enteral nutrient intake, we highlighted the necessary to develop individual measurements of EFI, taking the age of children and disease condition into consideration. Further studies can also investigate accurate and objective physiological measurements of EFI to advance EN and improve outcomes in critically ill children.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11499133/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142498940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Short-term outcomes in early term infants (born at 37 or 38 weeks): a retrospective investigation. 早产儿(37 或 38 周出生)的短期预后:一项回顾性调查。
IF 2.1 3区 医学 Q2 PEDIATRICS Pub Date : 2024-10-10 eCollection Date: 2024-01-01 DOI: 10.3389/fped.2024.1430364
Tsubasa Kitamura, Kyosuke Tabata, Yayoi Murano, Daisuke Yoneoka, Tomoyuki Nakazawa, Ken Sakamaki, Hiromichi Shoji

Introduction: Recently, researchers have introduced the concept of 'early term' infants, defined as infants born at 37 or 38 weeks of gestation, and their outcome has been discussed. Although the complications experienced by early term are less severe than those in preterm infants, this group accounts for a much larger proportion of newborns, making the assessment of outcomes important in clinical practice.

Methods: This observational study of term infants born at Tokyo Metropolitan Toshima Hospital aimed to understand the short-term outcomes in early term infants. Data extracted from the medical records were analyzed.

Results: Among 4,669 eligible participants, 463 (9.9%) were born at 37 weeks and 1,270 (27.2%) were born at 38 weeks. The remaining 2,936 infants were born after 39 weeks of gestation. Logistic regression analysis showed higher odds ratio of hospitalization (1.56, 95% CI: 1.37-1.79, p < 0.05), apnea (2.23, 95%CI: 1.08-4.60, p < 0.05), and hypoglycemia (3.13, 95%CI: 1.95-5.03, p < 0.05) in early term infants. In detail, infants born at 37 weeks of gestational age had higher odds ratio for hospitalization (2.07, 95%CI: 1.68-2.35, p < 0.05) and hypoglycemia (4.11, 95%CI 2.22-7.60, p < 0.05) than infants born at 38 weeks of gestational age (1.40, 95%CI: 1.20-1.62, p < 0.05, and 2.78, 95%CI: 1.66-4.67, p < 0.0 respectively).

Discussion: This study revealed complicated clinical course in early term infants, and represents one of the largest contributions to understanding the outcomes of early term infants, and could help to determine strategies for elective cesarean section. According to this result, elective cesarean sections would be better planned at 38 weeks of gestational age. Moreover, in clinical practice, it is important to be aware of the complicated clinical course in early term infants.

导言最近,研究人员提出了 "早产儿 "的概念,即妊娠 37 或 38 周时出生的婴儿,并对其预后进行了讨论。虽然早产儿的并发症没有早产儿严重,但这一群体在新生儿中所占的比例要大得多,因此对其预后的评估在临床实践中非常重要:这项观察性研究的对象是在东京都丰岛医院出生的足月儿,目的是了解早产儿的短期疗效。研究分析了从病历中提取的数据:在 4,669 名符合条件的参与者中,463 名(9.9%)在 37 周时出生,1,270 名(27.2%)在 38 周时出生。其余 2936 名婴儿在妊娠 39 周后出生。这项研究揭示了早产儿复杂的临床过程,是对了解早产儿结局的最大贡献之一,有助于确定选择性剖宫产的策略。根据这一结果,选择性剖宫产最好在胎龄 38 周时进行。此外,在临床实践中,了解早产儿复杂的临床过程也很重要。
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引用次数: 0
Deferasirox-induced hyperammonemia and Fanconi syndrome: a case report. 地拉罗司诱发的高氨血症和范可尼综合征:一份病例报告。
IF 2.1 3区 医学 Q2 PEDIATRICS Pub Date : 2024-10-10 eCollection Date: 2024-01-01 DOI: 10.3389/fped.2024.1461867
Houfu Zhou, Daoxue Xiong, Yan Feng, Jianyu Jiang

Background: The exact mechanism of hyperammonemia is thought to be multifactorial, but is not yet fully understood. No studies have yet reported hyperammonemia combined with Fanconi syndrome caused by deferasirox.

Case presentation: A 10-year-old girl was admitted for vomiting and altered consciousness. Blood testing revealed hyperammonemia and normal liver and coagulation functions. During hospitalization, the patient also exhibited hyperchloremic metabolic acidosis, hypokalemia, hyponatremia, and hypophosphatemia. Additionally, urinalysis revealed glucose and protein levels clinically consistent with Fanconi syndrome. The patient had a history of severe beta-thalassemia and had received intermittent blood transfusions for approximately ten years. The patient had been administered oral deferasirox at a 400 mg/day dose at the age of four, which had been gradually increased to the current 750 mg/day dosage. Upon admission, deferasirox was discontinued and treatment including mechanical ventilation, continuous blood purification therapy for ammonia reduction and acidosis, and electrolyte imbalance corrections was administered. Subsequently, serological markers returned to normal, urine test findings improved. To the best of our knowledge, this is the first report of a case of hyperammonemia with Fanconi syndrome owing to deferasirox.

Conclusions: For effective management and long-term follow-up of chronic diseases in children, pediatricians must master standardized treatments and the adverse reactions of various drugs. When symptoms are difficult to explain clinically, we must trace the source and adjust the treatment plan to maximize improving the patient's prognosis.

背景:高氨血症的确切机制被认为是多因素的,但尚未完全清楚。目前还没有研究报道地拉罗司引起的高氨血症合并范可尼综合征:一名 10 岁女孩因呕吐和意识改变入院。血液检测显示患者患有高氨血症,肝功能和凝血功能正常。住院期间,患者还出现了高氯代谢性酸中毒、低钾血症、低钠血症和低磷血症。此外,尿液分析显示葡萄糖和蛋白质水平与范可尼综合征临床相符。患者有严重的β-地中海贫血病史,大约十年来一直接受间歇性输血。患者四岁时开始口服地拉羅司,剂量为 400 毫克/天,之后逐渐增加到目前的 750 毫克/天。入院后,患者停用了地拉羅司,并接受了包括机械通气、持续血液净化治疗以降低氨氮和酸中毒,以及纠正电解质失衡在内的治疗。随后,血清学指标恢复正常,尿检结果也有所改善。据我们所知,这是首例因服用地拉罗司而导致高氨血症并发范可尼综合征的病例:为了对儿童慢性病进行有效管理和长期跟踪,儿科医生必须掌握标准化治疗方法和各种药物的不良反应。当临床症状难以解释时,我们必须追根溯源,调整治疗方案,最大限度地改善患者的预后。
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引用次数: 0
Facilitators and barriers of adherence to rectal interventions by parents of young children with functional constipation: a qualitative study. 功能性便秘幼儿家长坚持直肠干预的促进因素和障碍:一项定性研究。
IF 2.1 3区 医学 Q2 PEDIATRICS Pub Date : 2024-10-09 eCollection Date: 2024-01-01 DOI: 10.3389/fped.2024.1417389
Haiyan Shen, Li Zhang, Yu Zhang, Yan Huang, Banghong Xu, Mingming Yu

Background: Functional constipation in children is a worldwide problem that impacts both children's gastrointestinal function and the quality of family life. The treatment of this condition often depends on parental involvement to administer rectal interventions to their children to stimulate defecation. However, adherence to rectal interventions is currently suboptimal. We sought to explore the factors that facilitate and hinder parents from adherence to rectal interventions.

Methods: A descriptive qualitative study was conducted involving semi-structured interviews with parents of infants and young children with functional constipation requiring rectal interventions from March to May 2023. The data were analyzed using content analysis.

Results: Fourteen parents participated in the study. Parents reported the main facilitators of adherence to prescribed rectal interventions as recognition of illness severity, support from family and friends, and medical resource support and e-health literacy. Parents reported the primary barriers as information barriers, family conflict, cognitive misalignment, and difficulties in accessing healthcare services.

Conclusion: Rectal interventions are often essential in managing constipation in young children, with parental compliance being crucial for effective treatment. Healthcare providers must consider the psychosocial aspects of parents' perceptions, adhere to guidelines to standardize communication, and ensure comprehensive education to improve medication literacy.

背景:儿童功能性便秘是一个世界性问题,既影响儿童的肠胃功能,也影响家庭生活质量。这种情况的治疗通常依赖于家长的参与,对孩子进行直肠干预以刺激排便。然而,目前直肠干预的依从性并不理想。我们试图探索促进和阻碍家长坚持直肠干预的因素:我们在 2023 年 3 月至 5 月期间对需要进行直肠干预的功能性便秘婴幼儿的家长进行了半结构式访谈,并对访谈内容进行了描述性定性研究。研究采用内容分析法对数据进行分析:14位家长参与了研究。家长们表示,坚持遵医嘱进行直肠干预的主要促进因素是认识到疾病的严重性、家人和朋友的支持以及医疗资源支持和电子健康知识。家长们报告的主要障碍是信息障碍、家庭冲突、认知偏差以及难以获得医疗服务:直肠干预通常是治疗幼儿便秘的关键,而家长的依从性是有效治疗的关键。医疗服务提供者必须考虑到家长的社会心理因素,遵守规范沟通的指南,并确保开展全面的教育以提高用药知识。
{"title":"Facilitators and barriers of adherence to rectal interventions by parents of young children with functional constipation: a qualitative study.","authors":"Haiyan Shen, Li Zhang, Yu Zhang, Yan Huang, Banghong Xu, Mingming Yu","doi":"10.3389/fped.2024.1417389","DOIUrl":"https://doi.org/10.3389/fped.2024.1417389","url":null,"abstract":"<p><strong>Background: </strong>Functional constipation in children is a worldwide problem that impacts both children's gastrointestinal function and the quality of family life. The treatment of this condition often depends on parental involvement to administer rectal interventions to their children to stimulate defecation. However, adherence to rectal interventions is currently suboptimal. We sought to explore the factors that facilitate and hinder parents from adherence to rectal interventions.</p><p><strong>Methods: </strong>A descriptive qualitative study was conducted involving semi-structured interviews with parents of infants and young children with functional constipation requiring rectal interventions from March to May 2023. The data were analyzed using content analysis.</p><p><strong>Results: </strong>Fourteen parents participated in the study. Parents reported the main facilitators of adherence to prescribed rectal interventions as recognition of illness severity, support from family and friends, and medical resource support and e-health literacy. Parents reported the primary barriers as information barriers, family conflict, cognitive misalignment, and difficulties in accessing healthcare services.</p><p><strong>Conclusion: </strong>Rectal interventions are often essential in managing constipation in young children, with parental compliance being crucial for effective treatment. Healthcare providers must consider the psychosocial aspects of parents' perceptions, adhere to guidelines to standardize communication, and ensure comprehensive education to improve medication literacy.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11496162/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142498938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Automated mental health screening in pediatric lupus: associations with disease features and treatment. 小儿狼疮的自动心理健康筛查:与疾病特征和治疗的关联。
IF 2.1 3区 医学 Q2 PEDIATRICS Pub Date : 2024-10-08 eCollection Date: 2024-01-01 DOI: 10.3389/fped.2024.1427543
Lauren Harper, Stacy P Ardoin, Alana Leever, Kyla Driest, Vidya Sivaraman, Alysha J Taxter

Introduction: Patients with childhood-onset systemic lupus erythematosus (c-SLE) have higher rates of depression than their peers, which has been associated with worse medical outcomes. Therefore, it is imperative that their mental health be addressed. We utilized quality improvement (QI) methodology to automate mental health screening for patients with lupus within a pediatric rheumatology clinic. The retrospective cohort study aims to evaluate the association between mental health screening outcomes and demographics, medications, and disease activity measures in patients with childhood lupus.

Methods: The mental health QI team at a quaternary pediatric rheumatology center implemented an automated process for mental health screening in patients with c-SLE. Patients seen between 2017 and June 2023 with a diagnosis of c-SLE were identified using International Classification of Disease -Clinical Modification (ICD-CM) codes. Disease activity was assessed with the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI 2K). Medications were identified on outpatient and inpatient orders for conventional synthetic and biologic disease-modifying anti-rheumatic drugs, hydroxychloroquine, corticosteroids, and aspirin. Mental health screening was accomplished with the Patient Health Questionnaire (PHQ). Descriptive statistics, univariate and multivariate linear regression were used.

Results: Between January 2017 and June 2023, 117 patients with c-SLE (41% with lupus nephritis) completed 534 total screenings. Each patient completed PHQ screenings, a median of 5 [interquartile range 2, 6] times. Screening increased when the screening process was automated. Those who were Black, female, or prescribed leflunomide, mycophenolate, and corticosteroids had higher PHQ scores.

Conclusions: Mental health support is essential for patients with chronic rheumatologic diseases such as SLE. Sustainable processes for quickly identifying depression are needed for optimal care of patients with SLE. Our process of automated, streamlined mental health screening successfully increased the screening of patients with SLE at every visit and led to timely interventions for positive PHQ scores. Higher PHQ scores were correlated with patients on leflunomide, mycophenolate, and corticosteroids. Future research should identify modifiable risk factors for high PHQ scores that the medical team can target.

简介儿童期系统性红斑狼疮(c-SLE)患者的抑郁率高于同龄人,而抑郁与较差的医疗效果有关。因此,当务之急是解决他们的心理健康问题。我们利用质量改进(QI)方法,在儿科风湿病诊所对狼疮患者进行了自动心理健康筛查。这项回顾性队列研究旨在评估儿童狼疮患者的心理健康筛查结果与人口统计学、药物和疾病活动指标之间的关联:一家四级儿科风湿病学中心的心理健康 QI 团队对系统性红斑狼疮患者实施了自动化的心理健康筛查流程。2017年至2023年6月期间就诊的诊断为狼疮的患者均使用《国际疾病分类-临床修正》(ICD-CM)代码进行识别。疾病活动性通过系统性红斑狼疮疾病活动指数2000(SLEDAI 2K)进行评估。在门诊和住院病人的医嘱中确定了常规合成和生物改良抗风湿药物、羟氯喹、皮质类固醇和阿司匹林的用药情况。心理健康筛查通过患者健康问卷(Patient Health Questionnaire,PHQ)完成。研究使用了描述性统计、单变量和多变量线性回归:2017年1月至2023年6月期间,117名狼疮患者(41%患有狼疮性肾炎)共完成了534次筛查。每位患者完成PHQ筛查的中位数为5次[四分位距为2-6]。筛查过程自动化后,筛查次数有所增加。黑人、女性或服用来氟米特、霉酚酸盐和皮质类固醇的患者的 PHQ 得分更高:心理健康支持对系统性红斑狼疮等慢性风湿病患者至关重要。要想为系统性红斑狼疮患者提供最佳护理,就需要有快速识别抑郁症的可持续流程。我们的自动化、简化的心理健康筛查流程成功地提高了系统性红斑狼疮患者每次就诊时的筛查率,并对PHQ评分呈阳性的患者进行及时干预。PHQ得分较高的患者与使用来氟米特、霉酚酸盐和皮质类固醇激素有关。未来的研究应找出PHQ高分的可改变风险因素,以便医疗团队有针对性地进行治疗。
{"title":"Automated mental health screening in pediatric lupus: associations with disease features and treatment.","authors":"Lauren Harper, Stacy P Ardoin, Alana Leever, Kyla Driest, Vidya Sivaraman, Alysha J Taxter","doi":"10.3389/fped.2024.1427543","DOIUrl":"https://doi.org/10.3389/fped.2024.1427543","url":null,"abstract":"<p><strong>Introduction: </strong>Patients with childhood-onset systemic lupus erythematosus (c-SLE) have higher rates of depression than their peers, which has been associated with worse medical outcomes. Therefore, it is imperative that their mental health be addressed. We utilized quality improvement (QI) methodology to automate mental health screening for patients with lupus within a pediatric rheumatology clinic. The retrospective cohort study aims to evaluate the association between mental health screening outcomes and demographics, medications, and disease activity measures in patients with childhood lupus.</p><p><strong>Methods: </strong>The mental health QI team at a quaternary pediatric rheumatology center implemented an automated process for mental health screening in patients with c-SLE. Patients seen between 2017 and June 2023 with a diagnosis of c-SLE were identified using International Classification of Disease -Clinical Modification (ICD-CM) codes. Disease activity was assessed with the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI 2K). Medications were identified on outpatient and inpatient orders for conventional synthetic and biologic disease-modifying anti-rheumatic drugs, hydroxychloroquine, corticosteroids, and aspirin. Mental health screening was accomplished with the Patient Health Questionnaire (PHQ). Descriptive statistics, univariate and multivariate linear regression were used.</p><p><strong>Results: </strong>Between January 2017 and June 2023, 117 patients with c-SLE (41% with lupus nephritis) completed 534 total screenings. Each patient completed PHQ screenings, a median of 5 [interquartile range 2, 6] times. Screening increased when the screening process was automated. Those who were Black, female, or prescribed leflunomide, mycophenolate, and corticosteroids had higher PHQ scores.</p><p><strong>Conclusions: </strong>Mental health support is essential for patients with chronic rheumatologic diseases such as SLE. Sustainable processes for quickly identifying depression are needed for optimal care of patients with SLE. Our process of automated, streamlined mental health screening successfully increased the screening of patients with SLE at every visit and led to timely interventions for positive PHQ scores. Higher PHQ scores were correlated with patients on leflunomide, mycophenolate, and corticosteroids. Future research should identify modifiable risk factors for high PHQ scores that the medical team can target.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11493741/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142498920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Bone mineral density determinants in adolescents and young adults with congenital adrenal hyperplasia. 患有先天性肾上腺皮质增生症的青少年的骨质密度决定因素。
IF 2.1 3区 医学 Q2 PEDIATRICS Pub Date : 2024-10-08 eCollection Date: 2024-01-01 DOI: 10.3389/fped.2024.1456679
Ruta Navardauskaite, Aurika Vanckaviciene, Rasa Verkauskiene

Background: The effects of long-term glucocorticoid (GC) treatment on bone mineral density (BMD) in patients with congenital adrenal hyperplasia (CAH) remain controversial.

Objectives: This cross-sectional study aimed to evaluate BMD in relation to genotype, growth, vitamin D status, cumulative GC doses, and other relevant factors in youths with CAH.

Methods: Thirty-two patients with classical CAH (13 males; mean age 26.0 ± 7.1 years) were compared with 32 healthy controls matched by age and sex. BMD was measured using dual-energy x-ray absorptiometry, and statistical analyses, including the Mann-Whitney U-test and Spearman's correlation coefficient, were performed to evaluate differences and associations.

Results: Median whole-body and lumbar BMD Z-scores were similar between CAH patients and controls (p = 0.27 and 0.15, respectively). Low bone density was observed in 12.5% of CAH patients and 18.75% of controls (p = 0.5), and osteoporosis was confirmed in 12.5% of CAH patients and 0% of controls (p = 0.04). BMD did not correlate with cumulative GC doses, estradiol, renin, phosphate, sodium levels, or anthropometric parameters in CAH patients. There was no significant difference in BMD between severe and non-severe genotypes of CAH. However, a positive correlation was found between the whole-body BMD Z-score and growth velocity during infancy (r = 0.776, p = 0.021) in CAH patients. Vitamin D deficiency was noted in 56.25% of CAH patients, although vitamin D levels did not correlate with BMD or genotype. No history of bone fractures was reported among study participants.

Conclusions: CAH patients are at risk of developing osteoporosis, but in this study, BMD Z-scores were not associated with cumulative GC doses. The study did not identify an association between genotype and BMD. Poor growth during infancy was linked to decreased BMD in adulthood.

背景:长期糖皮质激素(GC)治疗对先天性肾上腺皮质增生症(CAH)患者骨矿物质密度(BMD)的影响仍存在争议:本横断面研究旨在评估先天性肾上腺皮质增生症(CAH)青少年患者的骨密度与基因型、生长、维生素 D 状态、累积 GC 剂量及其他相关因素的关系:将 32 名典型 CAH 患者(13 名男性;平均年龄为 26.0 ± 7.1 岁)与 32 名年龄和性别匹配的健康对照者进行比较。采用双能 X 射线吸收测量法测量 BMD,并进行曼-惠特尼 U 检验和斯皮尔曼相关系数等统计分析,以评估差异和关联:结果:CAH 患者和对照组的全身和腰椎骨密度 Z 值中位数相似(p = 0.27 和 0.15)。12.5%的CAH患者和18.75%的对照组观察到低骨密度(p = 0.5),12.5%的CAH患者和0%的对照组证实了骨质疏松症(p = 0.04)。CAH 患者的 BMD 与 GC 累积剂量、雌二醇、肾素、磷酸盐、钠水平或人体测量参数无关。重度和非重度 CAH 基因型之间的 BMD 没有明显差异。不过,CAH 患者全身 BMD Z 值与婴儿期生长速度之间存在正相关(r = 0.776,p = 0.021)。56.25%的CAH患者存在维生素D缺乏症,但维生素D水平与BMD或基因型无相关性。研究参与者中没有骨折史:结论:CAH 患者有患骨质疏松症的风险,但在本研究中,BMD Z 值与累积 GC 剂量无关。该研究并未发现基因型与 BMD 之间的关联。婴儿期发育不良与成年后骨密度降低有关。
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引用次数: 0
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