Frontiers in Pediatrics最新文献

The incidence of prematurity-related complications has decreased due to advancements in medical preventive and supportive measures, but the rate of neurodevelopmental impairment secondary to prematurity continues to increase. Due to the high metabolic demand of the central nervous system during early development and the age-related sensitivity of the cerebral white matter, perinatal intermittent hypoxia can lead to significant cerebral pathology persisting into adulthood. Caffeine citrate is one of the mainstay medical treatments for apnea of prematurity and is widely used in many neonatal intensive care units. Caffeine citrate's benefits include reducing time on mechanical ventilation, enhancing extubation success, and decreasing the incidence of bronchopulmonary dysplasia. There is also mounting evidence that caffeine citrate benefits neurodevelopmental outcomes, attributable to its positive effect on respiratory status and other mechanisms. Research has shown that caffeine citrate exerts an anti-inflammatory effect via the antagonism of adenosine receptors, reduces the production of reactive oxygen species, and supports the plasticity of the central nervous system. This article aims to review the most up-to-date evidence on caffeine citrate's effects on neuroprotection and its role in reducing the severity of neurodevelopmental impairment associated with prematurity.

Background: Pediatric acute lymphoblastic leukemia (ALL), the most common childhood malignancy, achieves >95% 5-year survival with risk-adapted therapies. Nonetheless, 10%-15% of patients experience relapse, with post-relapse survival <50%. Challenges remain in optimizing minimal residual disease (MRD)-guided strategies and salvage therapies in ALL.

Aims: This study aimed to identify relapse predictors and assess post-relapse outcomes among 436 pediatric ALL patients treated according to the CCCG-ALL-2015 protocol.

Results: Of the 436 enrolled patients (median age: 3.9 years; 92.4% B-ALL), sixty-four patients (14.7%) relapsed, predominantly with isolated bone marrow involvement (71.9%). Independent predictors included thrombocytopenia at diagnosis (OR = 2.09, P = 0.037), BCR::ABL1(+) (OR = 3.85, P = 0.024), and positive MRD on day 19 (OR = 2.09) and day 46 (OR = 5.73, P < 0.001) of induction therapy. Post-relapse, isolated extramedullary cases showed higher OS (100% vs. 72.9%, P = 0.078) than bone marrow relapses. HSCT significantly improved OS in bone marrow relapse comparing to patients treated with chemotherapy or CAR-T alone (82.6% vs. 38.1%, P = 0.027).

Conclusion: Thrombocytopenia at diagnosis, BCR::ABL1(+), and persistent MRD are critical relapse predictors. HSCT remains pivotal for bone marrow relapse. Incorporating platelet counts into risk stratification and optimizing MRD-guided bridging therapies may enhance outcome. Future research should prioritize thrombocytopenia mechanisms and HSCT preconditioning strategies.

[This corrects the article DOI: 10.3389/fped.2024.1409264.].

Purpose: To determine the value of MRI-based cartilaginous acetabular coverage in assessing postoperative hip function in patients with DDH following open reduction surgery and to explore its potential compensatory role in cases of residual dysplasia.

Methods: This retrospective study evaluated 78 hips from 59 children who had undergone open reduction for DDH. The postoperative clinical function of each hip was assessed using the modified MacKay criteria, and hips were dichotomized into a Good-Function group (Grades I and II; n = 40) and a Poor-Function group (Grades III and IV; n = 38). For all hips, radiographic (Acetabular Head Index, AHI) and MRI-based cartilaginous parameters (anterior and lateral Cartilaginous Acetabular-Head Index, A-CAHI and L-CAHI) were measured. Receiver Operating Characteristic (ROC) curve analysis was utilized to assess the diagnostic performance of these parameters in discriminating between the functional outcome groups. Furthermore, a subgroup analysis was performed on hips with Residual Acetabular Dysplasia (RAD; defined as Acetabular Index >20°) to compare imaging parameters based on functional status.

Results: The diagnostic performance of MRI-based parameters A-CAHI and L-CAHI in discriminating between the two functional outcome groups was high, with Area Under the Curve (AUC) values of 0.893 and 0.881, respectively. A combined MRI model achieved the highest diagnostic performance (AUC = 0.918), significantly outperforming the radiographic AHI (AUC = 0.782; p = 0.002). In the subgroup analysis of hips with Residual Acetabular Dysplasia (RAD), those with satisfactory function exhibited significantly better cartilaginous coverage compared to the unsatisfactory group (p < 0.0001 for both A-CAHI and L-CAHI). Compared to non-dysplastic controls who also had good function, the RAD-Good subgroup demonstrated significantly inferior bony anatomy (e.g., mean AHI 71.88 vs. 80.42, p = 0.0030).

Conclusion: MRI-based assessment of cartilaginous acetabular coverage is a superior tool for evaluating functional status after DDH surgery compared to traditional radiography. Our findings demonstrate that excellent cartilage development can compensate for underlying residual bony dysplasia, playing an important role in maintaining good hip function. Therefore, incorporating MRI into the clinical assessment of this challenging patient population is valuable for guiding clinical decision-making.

Background: Low birth weight (LBW) is a leading risk factor for neonatal sepsis and other neonatal infections (NSNIs). However, the temporal and spatial trends in the global burden of NSNIs attributable to LBW have not been comprehensively estimated. This study aims to explore the global burden of NSNIs attributable to LBW from 1990 to 2021 and project future trends for the next decade.

Methods: Based on data from the Global Burden of Disease (GBD) Study 2021, we analyzed the global burden of LBW-related NSNIs by the numbers of deaths and disability-adjusted life years (DALYs), and the corresponding age-standardized mortality rate (ASMR) and age-standardized DALYs rate (ASDR) by gender, Socio-demographic Index (SDI), region and country. Trends were quantified by the estimated annual percentage change, and future projections were made with the Autoregressive Integrated Moving Average (ARIMA) model to 2031.

Results: Globally, there were approximately 136.83 thousand deaths and 12.31 million DALYs from NSNIs caused by LBW in 2021. From 1990 to 2021, the overall ASMR (2.75-2.21) and ASDR (247.28-198.94) per 100,000 population showed a downward trend. The burden was significantly higher in males than in females. Low and low-middle SDI quintiles had the highest burden, inversely related to SDI levels. Geographically, Western Sub-Saharan Africa and South Asia recorded the highest deaths and DALYs cases, while Central Europe and Australasia had the lowest. Projections indicate that by 2031, both ASMR and ASDR will continue to decline, expected to decrease by 11.49% compared to 2021.

Conclusion: Although the global burden of NSNIs attributable to LBW declined between 1990 and 2021, significant disparities persist, particularly among male neonates and in the Low SDI region, reflecting unequal access to healthcare. To mitigate the burden of LBW-related NSNIs, future efforts should prioritize enhancing targeted public health initiatives and healthcare interventions tailored to local contexts, while addressing the deficiency in health resource allocation and socioeconomic inequalities.

Background: Ascaris lumbricoides is one of the most common soil-transmitted helminth infections worldwide, particularly in tropical and subtropical regions with poor sanitation. While most cases are asymptomatic, heavy infections can lead to serious complications including intestinal obstruction, biliary colic, and pancreatitis. This article reports a case of melena in a 4-year-old child associated with ascariasis and explores the potential pathological mechanisms and management strategies through a comprehensive literature review.

Case description: A 4-year-old boy was admitted with a one-month history of cough, lethargy for 4 days, and coma lasting 10 h. He had been diagnosed with septic shock, severe pneumonia, acute respiratory failure, and multiple organ dysfunction syndrome (MODS) at a local hospital, where he received endotracheal intubation with mechanical ventilation, aggressive fluid resuscitation, and antimicrobial therapy before being transferred to our institution for further management. During hospitalization, he experienced recurrent melena, which required blood product transfusion to correct anemia. Further investigations eventually identified ascariasis as a potential underlying contributing factor. Melena in this patient was likely related to septic shock-induced coagulopathy or mucosal ischemia, rather than direct Ascaris injury. The patient was treated with albendazole, and ultimately made a full recovery and was discharged successfully.

Conclusions: Ascaris lumbricoides infection represents a rare yet critical associated factor in septic shock complicated by severe gastrointestinal bleeding in children. This case report and literature review demonstrate that successful management hinges on early identification of the parasitic infection coupled with timely anthelmintic therapy following hemodynamic stabilization. However, the severe clinical manifestations are often directly caused by secondary bacterial infections. Clinicians, particularly those in endemic regions, require heightened vigilance for this potential complication.

Objective: To evaluate the effects of developmental supportive care on growth, neurobehavioral function, and cognitive development in preterm infants.

Methods: In this retrospective study, a total of 104 preterm infants born in our hospital were enrolled and divided into the routine care group (n = 49) and the developmental supportive care group (n = 55) based on the nursing approach they received during their hospitalization. Both groups received nursing care during hospitalization for 7 days. Routine care included monitoring of vital signs, feeding management, environmental control, skin and oral care, positioning, management of clinical conditions, and parental education. Developmental supportive care was implemented on the basis of routine care and comprised individualized care plans, environmental and sensory regulation, clustered care, tactile stimulation, non-nutritive sucking training, kangaroo care, feeding optimization, pain and stress management, parental involvement, and systematic recording and evaluation of the care effects. Outcome measures included body weight, length, head circumference, and chest circumference before and after the care; neurobehavioral function (passive muscle tone, active muscle tone, primitive reflexes, behavioral state, and general status); and cognitive development assessed by the Mental Development Index (MDI) and Psychomotor Development Index (PDI).

Results: There were no statistically significant differences between the two groups in baseline characteristics, growth indices, neurobehavioral function, or cognitive development before the care (P > 0.05). After the care, growth parameters increased in both groups, with body weight, length, head circumference, and chest circumference significantly higher in the developmental supportive care group than in the routine care group (P < 0.05). Neurobehavioral scores as well as MDI and PDI scores improved in both groups, with significantly greater improvements observed in the developmental supportive care group (P < 0.05).

Conclusions: Developmental supportive care can effectively promote growth, neurobehavioral function, and cognitive development in preterm infants. Compared with routine care, this model offers systematic and individualized nursing approaches that enhance physiological stability and developmental outcomes, providing reliable evidence for clinical neonatal nursing practice.

Background: Bronchopulmonary dysplasia (BPD) remains common among preterm infants, yet diagnostic criteria rely on post-hoc oxygen requirements and radiography. Semiquantitative lung ultrasound (LUS) scoring offers a radiation-free, bedside alternative. We sought to determine the time-dependent diagnostic accuracy of LUS scores for BPD in preterm neonates.

Methods: We performed a systematic review and meta-analysis of studies reporting LUS scores in preterm neonates (born at <37 gestational weeks) with BPD. We searched five databases through June 2025. We stratified data into four postnatal age timepoints (days 1-3, 7, 14, and 21) and pooled them using bivariate random-effects models to estimate sensitivity, specificity, likelihood ratios, diagnostic odds ratios, and area under the hierarchical summary receiver-operating characteristic (HSROC) curve.

Results: We included data from 22 studies (n = 2,038 infants) in our analyses. Within days 1-3 (10 studies; n = 1,326), LUS scores yielded sensitivity of 0.75 (95% CI, 0.62-0.85), specificity of 0.74 (0.63-0.82), and AUROC of 0.81. At day 7 (15 studies; n = 1,790), sensitivity and specificity results improved to 0.78 (0.71-0.84) and 0.83 (0.78-0.87), respectively; and AUROC to 0.88. Day 14 performance was similar to that at day 7 (sensibility, 0.78; specificity, 0.84; AUROC, 0.87). By day 21 (4 studies; n = 619), the performance accuracy peaked [sensibility, 0.85 [0.73-0.92]; specificity, 0.86 [0.71-0.94]; and AUROC, 0.92]. Overall, positive likelihood ratios rose from 2.8 to 6.3 and negative ratios fell from 0.33 to 0.18. The heterogeneity decreased at the later intervals.

Conclusion: The diagnostic accuracy of LUS scoring for BPD improved from the first through the third weeks of life, approaching optimal levels by day 21. These findings support the integration of serial LUS assessments into neonatal care plans to enable earlier, non-invasive BPD diagnosis.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251085780, PROSPERO CRD420251085780.

Objective: Neonatal jaundice is a common condition affecting many newborns and often requires phototherapy to manage elevated bilirubin levels. This study aimed to evaluate the impact of optimized nursing care during phototherapy on treatment outcomes, investigating common nursing challenges and assessing whether enhanced interventions could accelerate recovery and improve overall effectiveness.

Methods: A total of 106 neonates with jaundice who underwent phototherapy between January 1 and December 1, 2023, were randomly assigned to a control group and an intervention group, with 53 cases in each. The control group received standard nursing care, while the intervention group received targeted nursing interventions addressing phototherapy-related issues. Relevant clinical and laboratory data were collected from hospital records and nursing assessments, and treatment outcomes were compared between the two groups.

Results: The intervention group exhibited significantly shorter times for symptom resolution, complete blood count recovery, first defecation, and meconium transition to yellow compared to the control group (P < 0.05). Moreover, total and indirect bilirubin levels were significantly lower in the intervention group than in the control group (P < 0.05), while direct bilirubin showed no significant difference. The rate of adverse nursing events was significantly lower in the intervention group (1.89%) compared to the control group (13.21%) (P < 0.05). Additionally, the quality-of-care score for the intervention group was significantly higher than that of the control group (P < 0.05).

Conclusions: Enhancing nursing interventions for phototherapy-related issues in neonatal jaundice significantly improves therapeutic outcomes, accelerates recovery, and optimizes the effectiveness of phototherapy.