Frontiers in Pediatrics最新文献

Introduction: Neurologic manifestations may be presenting signs of celiac disease (CD). Pediatric-onset paroxysmal non-epileptic events (PNEEs) are not included among them.

Cases presentation: We report the case of two children who presented with ocular PNEEs in association with mild symptoms evocative for CD, who were subsequently diagnosed with CD and experienced regression of PNEEs on a gluten-free diet. Data from 12 patients undergoing neurological evaluation in 2019-2023 for ocular PNEEs were reviewed: 3 (25%) had a subsequent diagnosis of CD.

Conclusions: Ocular PNEEs could be a presenting manifestation of CD. In the diagnostic work-up of PNEEs, screening for CD could be included, both to avoid unnecessary tests and to promptly start a gluten-free diet, which might lead to a favorable clinical response.

Introduction: The relevance of biodegradable implants has gained more importance in modern clinical practice. The study aimed to evaluate the effects and outcomes of ankle fracture treatment with absorbable implants compared to metal screws. These implants are made from poly l-lactic-co-glycolic acid (PLGA), however, there are several other materials available on the market.

Methods: In a retrospective review, a total of 128 patients were under observation, with distal tibial fracture types ranging from Salter-Harris II-IV. In the absorbable group, patients were treated with the implants (n = 76). The metal group included patients treated with titanium or steel screws (n = 52). The extremities were placed in a cast for six weeks after surgery and were utilized for another 6-8 weeks. Patients were followed up for 12-30 months and were evaluated accordingly. The authors examined several aspects such as age, gender, open or closed repair, mechanism of injury, length of hospitalization, type of fracture, time of recovery, and complications.

Results: There were no statistically significant differences between the groups regarding demographic qualities, such as age, type of fracture, side of injury, and length of cast application (p > 0.05 in all cases). Out of 76 patients in the PLGA group, only two presented with complications, so reoperation took place. The rest healed without complications or refractures. Two of those treated with metal screws (n = 52) had minor, and four had major complications with reoperation.

Discussion: In pediatric cases, PLGA implants may present excellent results for treating ankle fractures. They do not disturb the growth plate and do not require reoperation. For this reason, they reduce the burden on the patient and the healthcare provider while simultaneously decreasing the risk of complications, such as infections or problems due to general anesthesia.

[This corrects the article DOI: 10.3389/fped.2024.1396003.].

Long-term follow-up for individuals with hypospadias remains a critical area of need, yet evidence-based guidelines for such follow-up are lacking, and the role of involvement of relevant experts is not yet established. Using our hypospadias-specific health-related quality of life conceptual framework and a subsequent qualitative study of prepubertal males and parents of males with hypospadias, we identified potential priorities for long-term follow-up of youth with hypospadias. Using thematic codes from our patient and parent interviews, we searched PubMed for relevant articles and identified the specialties represented by all the authors of these articles. Our search strategy revealed consistent expertise across HRQOL themes and subthemes, including pediatric and adult urology, health psychology, psychiatry, endocrinology, genetics, and social work. Communication experts, as well as patients and families, were also represented in our literature search. Using these findings, we compiled a comprehensive list of potential stakeholders to inform the development of holistic care guidelines for individuals with hypospadias. By engaging these stakeholders, we aim to develop consensus-based, long-term follow-up guidelines and tools to address the evolving physical and psychosocial needs of people with hypospadias over a lifetime. The use of qualitatively derived thematic codes to search for relevant literature is an accessible approach to identifying relevant stakeholders. These findings underscore the importance of involving diverse, multidisciplinary expertise to ensure comprehensive, patient-centered care in complex genitourinary conditions.

Lipoma is a common benign tumor of the body surface, while scrotal lipoma is relatively rare. We report a case of scrotal lipoma in a 5-year-old boy, which presented as a progressively enlarging scrotal mass. Scrotal ultrasonography highly suggested a lipoma, and a scrotal mass resection was performed, leading to a final pathological diagnosis of benign scrotal lipoma.

Racial and ethnic disparities have long been studied in the delivery of healthcare. One such avenue is acute pediatric appendicitis, which continues to be an area of significant and continual research. Because of its routine clinical presentation and standardized management, acute pediatric appendicitis serves as an appropriate proxy for studying discrepancies in healthcare. Our review therefore aims to comprehensively highlight the various dimensions of its clinical management subject to disparities, their collective clinical impact, and future recommendations to mitigate it.

Background: Idiopathic intracranial hypertension (IIH) is defined as elevated intracranial pressure and consequent symptoms (mainly headache and visual deterioration) occurring in the absence of secondary causes. Surgical and interventional radiology procedures should be considered for refractory IIH and mainly include cerebrospinal fluid (CSF) diversion techniques, optic nerve sheath fenestration (ONSF), and venous sinus stenting (VSS). Our study aims to review the current literature on the application of these techniques in clinical practice.

Methods: A systematic literature review on the surgical and interventional radiology treatment of IIH was conducted, focusing on ONSF, VSS, and CSF diversion techniques. According to PRISMA guidelines, all reports published in PubMed in the last 30 years (1993-2023) were considered, and among 722 papers, 48 were included in the present study, resulting in a total study population of 454 children or adolescents (11 months-17 years old).

Results: Among 454 patients, 193 underwent an invasive approach, divided into CSF diversion (115/193), ONSF (65/193), VSS (11/193), cranial subtemporal decompression (8/193), and internal cranial expansion (9/193). Sixteen of the 193 patients (8%) required reintervention due to relapsing symptoms or surgical complications, particularly those who underwent CSF diversion. Furthermore, 9/115 required shunt revision due to shunt obstruction or malfunction. We extracted data on the outcome of each procedure: of the 193 patients, 71 experienced a positive outcome with symptom resolution or improvement, while 27 demonstrated a negative outcome.

Discussion and conclusions: Severe and refractory cases of IIH are eligible for invasive treatments. CSF diversion is the most frequently used technique, despite its high failure risk and need for reintervention. ONSF has shown good results in terms of outcome and safety, particularly in children with visual symptoms. VSS is the most recent approach, indicated in children with stenosis of the venous sinus. In our study population, VSS demonstrated good results in terms of symptom resolution and need for reintervention, but its use remains limited to a few centers.

Systematic review registration: https://www.crd.york.ac.uk/, PROSPERO (CRD42024504244).

Objective: National Institute for Clinical Excellence (NICE) guidance for the management of neonatal sepsis recommends a first-line antibiotic regimen containing an aminoglycoside (gentamicin). Aminoglycoside exposure causes sensorineural hearing loss in individuals with a specific mitochondrial genetic variant (m.1555A>G). This variant can be detected promptly (in <30 min) by a point of care test. NICE does allow for variation in antibiotic regimes depending on local microbiology guidance. As practices can vary, this survey aimed to determine the current use of first-line antibiotic agents within neonatal units and postnatal wards across the UK.

Design and setting: A telephone survey was conducted across all neonatal units in the United Kingdom. Responses were requested from a member of the neonatal team experienced in neonatal septic screening processes. One response was recorded per unit.

Results: Of the 187 neonatal units, 186 (99%) responded to the survey. One unit declined to participate. The survey results show most neonatal units (93%) and postnatal wards (74%) across the United Kingdom use aminoglycosides as first-line antibiotic agents. Antibiotic regimes varied between different units and between different locations within the same hospital (NICU vs. postnatal wards). In cases where there was a contraindication to aminoglycosides, the most common alternative antibiotic was cefotaxime.

Conclusions: Most neonatal units in the UK use an aminoglycoside antibiotic as first-line agent for suspected sepsis. This places infants with the m.1555A>G genetic variant at risk of iatrogenic hearing loss. There needs to be integration of point-of-care genetic testing within the neonatal septic screening pathway.

Aim: To provide a risk prediction for bronchopulmonary dysplasia (BPD) in premature infants under the new diagnostic criteria and establish a prediction model.

Methods: In this study, we retrospectively collected case data on preterm infants admitted to the NICU from August 2015 to August 2018. A lasso analysis was performed to identify the risk factors associated with the development of BPD. A nomogram predictive model was constructed in accordance with the new diagnostic criteria for BPD.

Result: A total of 276 preterm infants were included in the study.The incidence of BPD under the 2018 diagnostic criteria was 11.2%. Mortality was significantly higher in the BPD group than the non-BPD group under the 2018 diagnostic criteria (P < 0.05). Fourteen possible variables were selected by the Lasso method, with a penalty coefficient λ=0.0154. The factors that eventually entered the logistic regression model included birth weight [BW, OR = 0.9945, 95% CI: 0.9904-0.9979], resuscitation way (OR = 4.8249, 95% CI: 1.3990-19.4752), intrauterine distress (OR = 8.0586, 95% CI: 1.7810-39.5696), score for SNAPPE-II (OR = 1.0880, 95% CI: 1.0210-1.1639), hematocrit (OR = 1.1554, 95% CI: 1.0469-1.2751) and apnea (OR = 7.6916, 95% CI: 1.4180-52.1236). The C-index after adjusting for fitting deviation was 0.894.

Conclusion: This study made a preliminary exploration of the risk model for early prediction of BPD and indicated good discrimination and calibration in premature infants.

Introduction: Concurrent alterations in the metabolic profile and thyroid dysfunction, including non-thyroidal illness syndrome (NTIS) has been reported in multisystem inflammatory syndrome in children (MIS-C). Considering the influence of thyroid hormones (TH) on lipid metabolism, we explored the relationship between thyroid function and the atherogenic lipid profile in children with MIS-C at admission and during a 12-month follow-up.

Patients and methods: we considered children admitted for MIS-C. Total and HDL cholesterol, triglycerides (TG), fasting plasma glucose, fasting plasma insulin as well as free T3 (FT3), free T4 (FT4), and TSH were assessed at diagnosis within 24 h of admission and during follow-up. TG/HDL ratio, no-HDL/HDL ratio and atherogenic index of plasma was also considered as atherogenic risk markers.

Results: we monitored 56 children. On admission, pathological levels of FT3, FT4, TSH, TG, TC, HDL, TG/HDL ratio, no-HDL/HDL ratio, and AIP were detected. Correlation analyses revealed associations between FT3, FT4, and lipid markers and TSH with TG. During monitoring, while complete restoration of TH balance was achieved at 12 months, some patients still exhibited an altered lipid profile, without correlation between thyroid function and lipid markers.

Conclusions: we supported a relationship between thyroid function and an atherogenic lipid profile in children with MIS-C. This may result from interactions between adaptive and innate metabolic responses and genetic predisposition. Elucidating the relationship between TH and metabolic pathways during infections could help identify new biomarkers to prevent acute and fatal outcomes, improving patient prognosis and protecting long-term health.