Frontiers in Pediatrics最新文献

Introduction: High-intensity interval training (HIIT) is an effective strategy for improving a variety of health and fitness outcomes within school settings. Incorporating HIIT into existing physical activity opportunities appears practically feasible, yet the process evaluation and effectiveness of this strategy needs to be further evaluated. Therefore, a PRO-HIIT intervention will be conducted to evaluate the effectiveness of a 12-week school-based HIIT intervention on cardiorespiratory fitness, physical activity, body composition, muscular strength, bone health, cognitive function, wellbeing and academic performance among 12-13-year-olds.

Methods and analysis: Eight classes of year 7 students (12-13-year-olds) from a secondary school in Ningbo, China, will be recruited and randomly allocated into an intervention or control group. While the control group maintains their usual activities, a 6 to 10 min HIIT session will be embedded in the physical education or physical activity lessons five days a week for 12 weeks for the intervention group. Training workshops will be conducted for participants, teachers, and research staff for facilitating the intervention. Outcome data will be collected at three time points: pre- and post-intervention, and two months (summer holiday) upon completion of the intervention. Linear mixed models will be used to analyse the impact of groups (intervention and control), timepoints (pre-, post- and two-month after intervention) and group by time interactions. The implementation process of the intervention will be evaluated using a process evaluation framework.

Ethics and dissemination: Ethics approval is obtained from the Ningbo University Ethics Committee (TY2024002). Results from PRO-HIIT study will be disseminated via peer-reviewed journals, scientific conferences as well as local education system. The study protocol has been retrospectively registered on ClinicalTrials.gov Protocol Registration and Results System (NCT06374732), https://clinicaltrials.gov/study/NCT06374732.

Background: Research on how the physical activity home environment affects fundamental movement skills (FMS) in preschool children in China is limited. However, the role of moderate-to-vigorous physical activity (MVPA) in this relationship is still unclear. This study aims to analyze gender differences in FMS, explore associations between the physical activity home environment, MVPA, and FMS, and investigate MVPA's mediating role in these relationships.

Methods: We recruited 169 preschool children (95 boys, 74 girls; mean age 4.9 years) from four kindergartens in Hengyang, China. The Family Environment Scale on Motor Development for Preschool Urban Children (FESMPD) assessed physical activity home environment. Objective measurement of MVPA used ActiGraph wGT3-BT accelerometers. The Test of Gross Motor Development-3 (TGMD-3) evaluated FMS. Statistical analyses were conducted using the PROCESS macro in SPSS, with sociodemographic variables as controls.

Results: Boys exhibited significantly higher levels of MVPA, parenting style, locomotor skills, and object control skills compared to girls (P < 0.05). MVPA, parenting style, and FMS showed positive correlations (R = 0.355-0.568, P < 0.05). Similarly, MVPA was positively correlated with the physical activity home environment (β = 0.237-0.568, P < 0.05). Parenting style emerged as a significant predictor of children's MVPA levels (β = 0.956, P < 0.001), and MVPA was a predictor of the development ofFMS and its subdomains (β = 0.097-0.207, P < 0.05). Furthermore, MVPA partially mediated the relationship between parenting style and the development of FMS in preschool children. The physical environment was also a significant predictor of children's MVPA (β = 0.637, P < 0.05), and in turn, MVPA predicted the development of FMS and its subdomains (β = 0.188-0.343, P < 0.01). Notably, MVPA fully mediated the relationship between the physical environment and the development of FMS.

Conclusion: Overall, this study highlights the important roles of physical activity home environments and individual levels of MVPA in developing FMS in preschool children, noting significant gender differences. Parenting style greatly affects both MVPA and FMS development, while the physical environment fully mediates this relationship. Collaborative efforts among kindergartens, families, and communities are essential to support MVPA and improve FMS development.

Introduction: Fluid accumulation, presently defined as a pathologic state of overhydration/volume overload associated with clinical impact, is common and associated with worse outcomes. At times, deresuscitation, the active removal of fluid via diuretics or ultrafiltration, is necessary. There is no consensus regarding deresuscitation in children admitted to the pediatric intensive care unit. Little is known regarding perceptions and practices among pediatric intensivists and nephrologists regarding fluid provision and deresuscitation.

Methods: Cross-sectional electronic survey of pediatric nephrologists and intensivists from academic societies in the United States designed to better understand fluid management between disciplines. A clinical vignette was used to characterize the perceptions of optimal timing and method of deresuscitation initiation at four timepoints that correspond to different stages of shock.

Results: In total, 179 respondents (140 intensivists, 39 nephrologists) completed the survey. Most 75.4% (135/179) providers believe discussing fluid balance and initiating fluid deresuscitation in pediatric intensive care unit (PICU) patients is "very important". The first clinical vignette time point (corresponding to resuscitation phase of early shock) had the most dissimilarity between intensivists and nephrologists (p = 0.01) with regards to initiation of deresuscitation. However, providers demonstrated increasing agreement in their responses to initiate deresuscitation as the clinical vignette progressed. Compared to intensivists, nephrologists were more likely to choose "dialysis or ultrafiltration" as a deresuscitation method during the optimization [10.3 vs. 2.9% (p = 0.07)], stabilization [18.0% vs. 3.6% (p < 0.01)], and evacuation [48.7% vs. 23.6% (p < 0.01)] phases of shock. Conversely, intensivists were more likely to utilize scheduled diuretics than nephrologists [47.1% vs. 28.2% (p = 0.04)] later on in the patient course.

Discussion: Most physicians believe that discussing fluid balance and deresuscitation is important. Nevertheless, when to initiate deresuscitation and how to accomplish it differed between nephrologist and intensivists. Widely understood and operationalizable definitions, further research, and eventually evidence-based guidelines are needed to help guide care.

Introduction: This study aims to estimate the validity and reliability of sound transmission tests using a tuning fork and stethoscope compared with the usual clinical procedures for the diagnosis of developmental dysplasia of the hip in newborns from the state of Guanajuato, Mexico.

Methodology: This is a cross-sectional study of newborns at the Guanajuato General Hospital of the Institute of Public Health from Guanajuato. The population under study comprised newborns born from April to May 2023. All parents of newborns were invited to participate. The Ortolani, Barlow, Peter-Baden, and sound transmission tests were performed with a tuning fork and stethoscope three times by two observers. Ultrasonography using the Graf technique was also applied to both hips. We evaluated the validity and repeatability of clinical procedures and sound transmission tests against ultrasonography as the gold standard. We calculated sensitivity, specificity, and predictive values for validity and Cohen's kappa for repeatability.

Results: The sample consisted of 100 newborns (56% male and 44% female); 65% born by vaginal delivery. Sound transmission test results for sensitivity, specificity, the positive predictive value, and the negative predictive value were 87.88%, 95.81%, 80%, and 97.53%, respectively. The intra-observer kappa was 0.89 (95% CI = 0.80-0.97) and the inter-observer kappa was 0.85 (95% CI = 0.73-0.97). The validity and repeatability of the Ortolani, Barlow, and Peter-Baden tests were low compared with the sound transmission test.

Conclusion: The sound transmission test using a tuning fork and stethoscope is helpful for the diagnosis of developmental dysplasia of the hip.

Background: Human rhinoviruses (HRVs) are among the most common pathogens of upper respiratory infections, and they are responsible for the common cold. An increasing number of studies have shown that HRV is associated with more severe illness. However, HRV-associated fulminant myocarditis has rarely been reported.

Patient presentation: A previously healthy 8-year-old boy developed fever, fatigue, and vomiting for 3 days, with a subsequent exacerbation accompanied by confusion lasting for 9 h. The day before admission, the patient presented with oliguria, confusion, and hypotension, and he was suspected of having myocarditis. The patient was transferred to our hospital for further diagnosis and treatment. On admission, rough and moist rales were detected, and the heart sounds were muffled, accompanied by an irregular heart rhythm and a gallop. An electrocardiogram (EKG) revealed a wide QRS complex, ST-segment depression, premature ventricular contractions, and complete right bundle branch block. Laboratory tests revealed that brain natriuretic peptide (BNP), N-terminal pro BNP (NT-pro BNP), and cardiac biomarkers, such as troponin I, creatinine kinase (CK), and creatinine kinase-MB (CK-MB) were elevated. Additionally, echocardiography revealed an ejection fraction of approximately 28%. The child developed severe cardiac dysfunction and tissue hypoperfusion, and the cardiogenic shock could not be corrected despite active drug therapy. He had indications for ECMO implantation. A rarely reported rhinovirus, namely, A66, was detected in his bronchoalveolar lavage fluid and oropharyngeal swabs via metagenomic next-generation sequencing and a PCR assay. Bacterial culture of all the samples yielded negative results.

Conclusions: This case presents a patient with severe human rhinovirus A66 infection, which is likely responsible for fulminant myocarditis. This report facilitates prompt diagnosis and treatment of fulminant myocarditis. Clinicians should consider rhinovirus as a possible pathogen of fulminant myocarditis, especially when patients present with symptoms or signs of heart involvement.

Background: Despite the critical role of the clavicle in understanding growth and development in early childhood, there remains a notable paucity of comprehensive studies investigating clavicle growth patterns during this crucial period. This hinders our ability to establish normative growth parameters during these early life stages. Our study sought to measure clavicle dimensions and subsequently construct growth curves spanning from preterm infants to toddlers up to the age of 6 years by measuring routine chest radiographs. Differences between both sides of the body and between the sexes should be analysed. This aimed to provide a nuanced understanding of clavicle growth dynamics and offering a foundation for the establishment of normative values in this understudied context. In this retrospective study, children aged 23 weeks of gestation to 6 years who underwent a chest radiography between January 2010 and June 2020 were enrolled. A total of 5.311 potential radiographs was screened. Clavicle length and width were measured in all radiographs using the Centricity™ Universal Viewer. Statistical analysis was performed using SPSS®.

Results: 1.340 images met the quality criteria to be included in our study. The growth curves of clavicle lengths and widths showed a steadily increasing trend with age. Inclusion of premature infants in the age group of one month resulted in a decrease in this age group. Significant differences between both sides of the body and between the sexes could be shown. Measurements of clavicle length and width, derived from routine chest radiographs, are highly accurate. This accuracy underscores the potential for utilizing thoracic radiographs as a reliable tool for assessing clavicle growth in clinical settings or even forensic analysts. The establishment of reference values derived from our measurements provides a basis for normative growth parameters.

[This corrects the article DOI: 10.3389/fped.2024.1397229.].

Aim of the study: To evaluate the clinical characteristics and treatment efficacy of patients with severe primary IGF-1 deficiency (PSIGFD) using a recombinant IGF-1 (rhIGF-1).

Objectives of the study: To examine the clinical characteristics of patients with PSIGFD before starting treatment with a rIGF-1. To assess the height changes in patients with PSIGFD, before and after treatment with a rhIGF-1. To analyze the clinical characteristics, side effect frequency, and treatment efficacy with a rhIGF-1 analog in patients with PSIGFD.

Methods: A retrospective analysis was conducted on patients with PSIGFD treated with the rhIGF-1 (mecasermin). Data were collected from patients' medical records, focusing on the impact of treatment on their growth and monitoring any side effects.

Results: The study showed that treatment with rhIGF-1 positively affects growth rate, especially in the first years of treatment. However, the growth rate decreases over time. The change in height from the beginning to the end of the treatment was 0.76 ± 0.64 SD, with the first quartile at 0.29 SD and the third quartile at 1.14 SD. During the treatment period, patients' average body mass increased by 0.37 ± 1.35 SD, with the first quartile at -0.33 SD and the third quartile at 0.92 SD. Side effects occurred in 50% of patients, with 40% of patients treated with rhIGF-1 experiencing hypoglycemia during treatment.

Conclusions: Treatment with rhIGF-1 is effective in treating patients with PSIGFD, causing significant improvement in growth, but requires continuous monitoring and treatment adjustment.

Background: Preventing neonatal mortality and morbidity in developing countries such as Ethiopia requires improved practices and knowledge among healthcare providers. Several studies have been conducted in Ethiopia, but the overall level has not been estimated based on essential newborn care practices, knowledge of health care providers, and associated factors. Therefore, the objective of this review is to assess the overall practice and knowledge of essential newborn care and associated factors among healthcare providers in Ethiopia.

Methods and materials: Only articles published in English were included in this review. Medline/PubMed, Web of Science, Google Scholar, EMBASE, and CINAHL, Scopus, Ethiopian University Repository Online, and the Cochrane Library are the main databases. The review included cross-sectional studies written in English that met the inclusion requirements. Using a random-effects model, the overall practice and knowledge level was estimated. Additionally, funnel plots and Eggers' test were used to assess publication bias. STATA version 14 was used to perform all statistical analysis.

Results: This review included 15 studies involving 3,210 health care providers in Ethiopia. In Ethiopia, overall health care providers had a good practice and knowledge level of essential newborn care of 57.38% [95% CI (49.56; 65.20); I ² = 95.3%, P < 0.001] and 54.06% [95% CI (45.07; 63.05); I ² = 95.5%, P < 0.001], respectively. Knowledge, training status, and material availability of healthcare professional were significantly associated with their practice of essential newborn care, while educational qualification and training status were significantly associated with the knowledge of healthcare providers of essential newborn care.

Conclusions: Overall, 57% and 54% of healthcare providers had good ENC practices and knowledge. So, the Ethiopian government and other stakeholders should take immediate measures to improve essential neonatal care practice and knowledge among healthcare providers, and improve identified factors.

Congenital portosystemic shunts (CPSS) are rare pediatric vascular malformations characterized by abnormal development of the portal vein, which is attributed to incomplete embryonic remodeling of the hepatic and surrounding vasculature. CPSS manifests in two main forms: intrahepatic and extrahepatic. This study details the management of a pediatric patient diagnosed with Congenital Intrahepatic Portosystemic Shunt (CIPS) who was referred to our institution. By using a computer-assisted surgical system, the right hepatectomy was successfully performed, guided by precise intraoperative navigation based on three-dimensional reconstructions of enhanced CT imagery. The patient exhibited a favorable postoperative recovery trajectory, with the absence of complications or recurrence throughout the monitoring period.