Frontiers in Pediatrics最新文献

Congenital midline sinus of the upper lip is rarest malformation with or without other anomalies. Mostly the sinus opens below the white role on the vermilion and has no intra-oral communication. To date, there have been only several case reports of upper lip sinuses associated with other anomalies, such as cleft palate or transverse facial cleft in China. We herein present a case of congenital upper lip sinus in the middle of the philtrum presenting as whitish discharge used to come out of it and review the current literature on this condition.

Wilson disease (WD) and familial hypertriglyceridemia (FHTG) are both genetic metabolic diseases, and their comorbidity is extremely rare. This article reports a case of WD with FHTG in a 12-year-old Chinese boy. The patient was diagnosed due to elevated transaminase levels, combined with clinical manifestations, copper metabolism indexes, lipid profile analysis, and genetic testing results (pathogenic mutations of ATP7B and APOA5). The patient was treated using a copper chelating agent to lower copper levels and fibrate drugs to lower lipid levels, which resulted in improvements in his liver function and blood lipid indices. This case serves as a source of reference for the diagnosis and treatment of other similar cases. It not only reveals the potential interaction between copper metabolism disorders and lipid abnormalities, but also highlights the importance of systematic genetic testing to identify comorbid inheritance.

Objectives: To evaluate the long-term efficacy and safety of endoscopic low-temperature plasma radiofrequency ablation (coblation) for the treatment of pyriform sinus fistula (PSF) in children, and to identify risk factors associated with postoperative transient vocal cord paralysis.

Methods: A retrospective cohort study was conducted at a single tertiary pediatric center. Children with pyriform sinus fistula who underwent endoscopic coblation were consecutively enrolled. Demographic characteristics, perioperative variables, postoperative complications, and follow-up outcomes were collected. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for postoperative transient vocal cord paralysis.

Results: Endoscopic coblation was successfully performed in all patients. During follow-up, the majority of children experienced no recurrent cervical infection or fistula recurrence. Endoscopic examinations confirmed complete closure of the internal opening in the pyriform sinus, indicating favorable long-term outcomes and good procedural reproducibility. Transient vocal cord paralysis occurred in some patients but resolved completely in all affected cases, with no permanent nerve injury. Multivariate logistic regression analysis identified younger age and elevated preoperative white blood cell counts as independent risk factors for transient vocal cord paralysis.

Conclusions: Endoscopic coblation is a safe, effective, and repeatable minimally invasive treatment for pediatric PSF, with low recurrence rates and stable long-term outcomes. Postoperative transient vocal cord paralysis is a relatively common but reversible complication, closely associated with younger age and elevated preoperative inflammatory status. These risk factors suggest that intraoperative strategies, such as adjusting ablation depth in very young children and ensuring adequate thermal dissipation, may help mitigate this risk.

Introduction: Children who participate in recess interventions demonstrate increased upper- and lower-body muscular strength (MusS), neuromuscular control (NC), and resilience. However, to measure the effectiveness of recess interventions, identifying the relationship between physical and psychological assessments is necessary for reliability and consistency. Therefore, this study explores the relationships and variable predictions among MusS, NC, and resilience assessments in fourth- and fifth-grade children at two time points during one school year.

Methods: A total of 164 fourth- and fifth-grade children participated in MusS (standing broad jump, push-ups, single-leg three-hop, and average grip strength), NC (side-step), and resilience (Child and Youth Resilience Measure-Revised) assessments. A single intraclass correlation coefficient was calculated in September (Time 1) and January (Time 2) to evaluate the reliability of each assessment. Next, Pearson product correlations and multiple linear regression analyses were conducted to assess outcomes.

Results: Times 1 and 2 had positive, moderate, and significant correlations among the following MusS assessments: standing broad jump and average single-leg three-hop, standing broad jump and push-up, and average single-leg three-hop and push-up (p < 0.01). NC and resilience had no meaningful correlations with the other assessments. Regression analyses further revealed that push-up performance was a significant predictor of standing broad jump performance at Times 1 and 2 (p < 0.001).

Conclusions: MusS assessments were practical, reliable, time-efficient, and low cost for this age group. Therefore, these elements should be taken into consideration to measure the effectiveness of recess or physical activity interventions. In addition, the results revealed correlations between upper- and lower-body MusS assessments. The relationship between the standing broad jump and push-ups highlights the interconnective nature of the upper and lower MusS. This raises the question of why resilience and NC were not related to each other or to MusS assessments. Given the exploratory nature and short duration of this study, further research is needed to validate these findings and to determine whether there are more effective NC and resilience assessments to use with this age group.

Introduction: The quality of life (QoL) of parents and caregivers of children with disabilities in Saudi Arabia is examined in this systematic review.

Methods: Fourteen cross-sectional studies published between 2020 and 2024 are included, encompassing 1,841 caregivers, of whom 60.2% are mothers, 23.1% fathers, and 18.4% other caregivers, caring for 1,460 children with disabilities. QoL is primarily assessed using the WHOQOL-BREF in 10 studies, followed by the SF-36 in two studies and the Beach Center Family Quality of Life Scale in one study.

Results: Autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), cerebral palsy (CP), and Down syndrome (DS) are the most commonly reported conditions. Negative QoL outcomes are reported in at least one domain in 9 of the 10 WHOQOL-BREF studies. The physical domain is most frequently affected (50% of studies), followed by the social and environmental domains (40% each) and the psychological domain (30%). More than half of caregivers (53.6%) are reported to be unemployed, and poorer QoL is consistently associated with unemployment, lower income, limited education, and restricted access to support services.

Conclusion: Lower QoL is most frequently reported by mothers and by caregivers of children with severe or multiple disabilities, highlighting the need for targeted support interventions.

Background: Critical pertussis continues to cause significant morbidity and mortality in infants necessitating pediatric intensive care. Despite advances in supportive care, knowledge gaps persist. This study aimed to examine institutional capacity, physician knowledge, and practice variability in managing critical pertussis among pediatric intensive care units (PICUs) across the Gulf Cooperation Council (GCC) countries.

Methods: A cross-sectional internet-based survey was distributed to PICU physicians across the six GCC countries between December 1, 2024, and January 31, 2025. Demographic information, clinical experience, diagnostic resources, and therapeutic approaches were collected. A multivariable generalized linear regression (Gamma) model identified factors associated with pertussis knowledge scores.

Results: Among 185 respondents, almost 70% of participants were male, 62.7% were specialists or consultants, and around half (47%) were certified pediatric intensivists. Access to mechanical ventilation was almost universal (98.4%), yet extracorporeal membrane oxygenation was available in only 24.3% of centers. Polymerase chain reaction-based diagnosis was widely available, but more than one-third (36.2%) of participants reported a test turn-around-time of at least two days. A majority (66%) of physicians used exchange transfusion for hyperleukocytosis, but white blood cell thresholds varied widely. Institutional protocols were lacking in over 40% of centers. The average pertussis knowledge score was 9.52 out of 13 questions (SD ±1.72). Physician's clinical experience showed a strong and graded association with pertussis knowledge.

Conclusions: This study highlights the heterogeneity in pertussis management practices across the GCC PICUs, compounded by variability in resources and different institutional guidelines. Findings highlight the urgent need for standardized protocols to harmonize pertussis care.

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.