Frontiers in Pediatrics最新文献

Background: The COVID-19 pandemic significantly influenced healthcare systems worldwide. The long-term consequences of the infection in children, the phenomenon of post-COVID-19 syndrome, have been attracting increasing attention of the scientific community. The present study is a bibliometric analysis of publications addressing post-COVID (long COVID) complications in pediatric population over the period 2020-2025.

Methods and materials: The analysis covers 1,292 records retrieved from Scopus and Web of Science (search date: June 2025). Records were retrieved using post-COVID condition/long COVID terminology combined with pediatric-related keywords; therefore, the corpus includes pediatric-focused studies as well as influential general PCC publications indexed with pediatric terms and frequently cited in pediatric research. The search strategy combined post-COVID condition/long COVID terminology with pediatric terms (child/infant/adolescent), applying filters for English language, publication years 2020-2025, and document type (articles and reviews). Data were merged and analyzed in R using bibliometrix/Biblioshiny to describe productivity, collaboration, citations, and thematic structure.

Results: The retrieved corpus included 1,292 publications from 84 countries/regions. The United States led productivity with 270 publications (20.9%), followed by the United Kingdom (114; 8.8%) and China (90; 7.0%). The most frequent author keywords included "COVID-19" (n = 900) and "long COVID" (n = 818). Highly cited items predominantly consisted of general or mixed-age PCC frameworks, indicating that foundational long COVID literature substantially shapes citation patterns within pediatric-tagged publications. Thematic mapping showed symptom-focused clusters as dominant, while MIS-C and cognitive impairment were less prominent in author-keyword frequency and thematic clustering within the retrieved dataset.

Conclusion: The findings describe the pediatric-term-indexed PCC research landscape and highlight substantial gaps in pediatric-specific evidence, definitions, and longitudinal data.

Introduction: Biotinidase enzyme is responsible for recycling biotin which is essential for metabolic functions. Loss of function mutations in the BTD gene causes biotinidase deficiency (BTD). It is diagnosed by measuring biotinidase activity and it can lead to severe neurological symptoms. We aimed to evaluate biotinidase activity changes in patients with BTD over time.

Methods: 194 patients with BTD were enrolled. Clinical, laboratory and genetic data of the patients were retrospectively evaluated. Patients with enzyme activity below 10% of normal were diagnosed with profound BTD while patients with enzyme activity between 10% and 30% were diagnosed with partial BTD.

Results: 104 (53.6%) patients were male, most patients were diagnosed at screening (n = 183, 94.3%) and the mean age at the time of diagnosis for symptomatic patients was 82.7 ± 22.8 (range: 1-216) months. Two (1%) patients had profound BTD, 168 (86.6%) patients had partial BTD, and 24 (12.4%) patients had more than 30% of normal biotinidase activity. Overall, the last measured biotinidase activity levels were significantly higher than the initial measurements (p < 0.0001). This finding was valid for all subgroups classified according to birth week, birth weight, and consanguineous marriage status. The increase in enzyme rate over time was slower in children of consanguineous marriages compared to children who were not.

Discussion: This study showed that biotinidase activity increased in BTD patients over time and repeated measurements of biotinidase would be a better approach to evaluate BTD. In addition, consanguineous marriage may be a risk factor for a worse prognosis in BTD.

Background: Gastrointestinal bleeding (GIB) is a common symptom of the pediatric digestive system, with acute upper gastrointestinal bleeding (AUGIB) being extremely dangerous for children. In the present study, we established a risk prediction model for the prognosis of children with AUGIB and provided a new method for early identification of poor prognosis, thereby reducing the disease burden.

Methods: Binary logistic regression analysis was conducted to identify independent risk factors influencing the outcomes of children with AUGIB. The receiver operating characteristic curve (ROC) was generated to assess the predictive efficacy of these risk factors. A nomogram prediction model was constructed, and its performance was evaluated using the consistency index (C-index) and calibration curve. Decision curve analysis (DCA) was applied to estimate the clinical benefits of the intervention.

Results: A total of 372 children who were diagnosed with AUGIB and met the inclusion criteria were enrolled in the study. Neutrophil to leukocyte ratio (NLR), platelet to lymphocyte ratio (PLR), hemoglobin (Hb), high-sensitivity C-reactive protein (hsCRP), and activated partial thromboplastin time (APTT) are independent influencing factors for the outcomes of AUGIB in children. The nomogram model was constructed by including the above independent influencing factors; the consistency index was 0.945 [95 confidence interval (CI): 0.931-0.959]. The DCA was used to assess the prediction performance of the model to obtain net clinical benefits.

Conclusion: A preoperative serum test was an effective and objective method to predict the prognosis of children with AUGIB. The established prognostic risk prediction model had a good prediction effect; it could provide a reference to clinically assess the risk of poor prognosis in children with AUGIB.

Introduction/objectives: Intrauterine exposure to the Zika virus (ZIKV) has been primarily associated with neurological outcomes, while its potential metabolic and nutritional consequences remain poorly understood. This study aimed to evaluate the association between anthropometric indicators body mass index (BMI)-for-age, waist circumference, and neck circumference and lipid profile alterations in school-aged children born during the ZIKV epidemic.

Methods: This retrospective cohort included 93 children aged 5-9 years (mean 6.5 ± 0.7 years; 58.1% boys) from the Belo Horizonte Region, Brazil. Participants were classified as exposed (59.1%) or unexposed to ZIKV in utero. Anthropometric measurements followed standardized protocols and included BMI-for-age, waist circumference, and neck circumference. Lipid profile assessment included total cholesterol, HDL-c, LDL-c, and triglycerides. Cardiovascular risk was estimated using Castelli indices I and II. Behavioral and sociodemographic factors, including screen time, caregiver education, and family income, were also recorded. Associations between anthropometric indicators and lipid outcomes were analyzed using Poisson regression models with robust variance, including interaction terms to assess the modifying effect of ZIKV exposure.

Results: Lipid abnormalities were common: low HDL-c (44.1%), high total cholesterol (33.3%), high LDL-c (26.9%), and high triglycerides (44.1%). Children exposed to ZIKV had a higher prevalence of low HDL-c compared with unexposed peers (54.6% vs. 29.0%; p = 0.015). BMI-for-age was inversely associated with low HDL-c (PR 0.87; 95% CI 0.78-0.97) and showed significant interactions with ZIKV exposure for total cholesterol (p interaction = 0.005) and triglycerides (p interaction = 0.008). Waist circumference interacted with ZIKV exposure regarding total cholesterol (p = 0.029; PR 1.09; 95% CI 1.03-1.16). Neck circumference was positively associated with total cholesterol, LDL-c, and triglycerides, with stronger associations among ZIKV-exposed children. Castelli Index I was higher in the exposed group (p = 0.0389), while Castelli Index II did not differ significantly (p = 0.1087).

Conclusions: Intrauterine ZIKV exposure influences the relationship between adiposity and lipid profile in children. Central adiposity measures including waist circumference, neck circumference, and BMI-provide complementary information for early metabolic risk assessment. These findings highlight the importance of longitudinal monitoring of children exposed to ZIKV in utero to detect early metabolic alterations and guide preventive interventions.

Background: Chronic Non-bacterial Osteomyelitis (CNO) is a rare autoinflammatory bone disease primarily affecting children and adolescents. The disease presents with a wide spectrum of severity, ranging from mild unifocal lesions to severe, recurrent multifocal bone inflammation. Its etiology remains unclear, making diagnosis challenging due to nonspecific symptoms.

Methods: We report the case of a 14-year-old girl who presented with recurrent swelling and pain in the left clavicle. After multiple admissions, the patient underwent extensive diagnostic workup, including laboratory tests, imaging, and biopsies, which showcased typical imaging and histopathological findings throughout the disease progression, helping to rule out infections and malignancies. Based on clinical findings and the exclusion of other conditions, she was diagnosed with CNO. Treatment included NSAIDs, intravenous antibiotics, and oral medications such as diclofenac sodium, naproxen, methotrexate, and calcitriol.

Results: During the one-year follow-up after initial treatment, the patient experienced recurrent symptoms, including swelling and pain in the left clavicle. After escalation to intravenous pamidronate and subcutaneous adalimumab, the patient achieved sustained clinical remission. During the subsequent two-year follow-up, no further symptom recurrence was observed.

Conclusion: CNO is generally diagnosed by exclusion, with MRI being the gold standard for detecting asymptomatic lesions and assessing disease activity. Treatment typically involves NSAIDs, with bisphosphonates and biologics increasingly used in refractory cases. This case underscores the complexity of diagnosing and managing CNO, highlighting the need for a multidisciplinary approach. Further research is essential to establish standardized diagnostic criteria and optimize treatment strategies for this rare condition.

Mucopolysaccharidosis (MPS) represents a group of rare inherited metabolic disorders characterized by abnormal accumulation of glycosaminoglycans (GAGs) due to deficiencies of lysosomal enzymes. Mucopolysaccharidosis type I (MPS I) is caused by biallelic pathogenic variants in the IDUA gene and is inherited in an autosomal recessive pattern. The IDUA gene is located on chromosome 4p16.3 and encodes the lysosomal enzyme α-L-iduronidase, which plays a critical role in the degradation of GAGs, particularly dermatan sulfate and heparan sulfate. Reduced or absent IDUA enzymatic activity leads to the progressive accumulation of undegraded substrates within lysosomes, resulting in multisystem organ involvement. Based on clinical severity, MPS I is traditionally classified into three phenotypic subtypes: the severe form (Hurler syndrome), the intermediate form (Hurler-Scheie syndrome), and the attenuated form (Scheie syndrome, MPS I-S). This report describes a 13-year-old female patient in whom compound heterozygous pathogenic variants in the IDUA gene were identified by genetic testing, and whose clinical manifestations were consistent with the MPS I-S. In addition to typical skeletal and joint abnormalities, the patient also presented with uterine developmental abnormality. Currently, there is no definitive evidence supporting a direct causal relationship between MPS I and uterine developmental abnormalities; however, this case suggests a potential association between MPS I and reproductive system developmental abnormalities. This case may help further expand the phenotypic spectrum of MPS I and enhance clinical awareness of its multisystem involvement.

Background: The triglyceride-glucose (TyG) index is widely recognized as a surrogate marker of insulin resistance and poor prognosis in adults. However, the relationship between the TyG index and outcomes in pediatric sepsis patients remains inadequately characterized. Elucidating this association could illuminate the metabolic dimension of sepsis pathophysiology and provide a simple, cost-effective tool for risk stratification in this vulnerable population. This study aims to investigate the relationship between the TyG index and 30-day mortality in pediatric sepsis and to explore its underlying biological significance.

Methods: We conducted a retrospective cohort study and enrolled 149 children who met the diagnostic criteria for sepsis from the PIC database of the Children's Hospital of Zhejiang University between 2010 and 2018. Participants were stratified by TyG level. The primary outcome was 30-day in-hospital all-cause mortality, and the secondary outcome was 30-day ICU all-cause mortality. Cox regression, restricted cubic splines (RCS), and Kaplan-Meier analyses were used to evaluate the association between the TyG index and 30-day mortality in pediatric sepsis patients.

Results: Among the 149 children with sepsis, higher TyG index levels were associated with a reduced 30-day mortality rate. In the multivariate Cox regression model, after adjusting for age, gender and key laboratory variables, the TyG index remained independently and negatively correlated with both in-hospital mortality and intensive care unit mortality. Restrictive cubic spline analysis revealed a linear negative correlation between the TyG index and the risk of death. Subgroup analysis indicated that the TyG index had a consistent protective effect across different age groups, genders and treatment subtypes. Although the Kaplan-Meier survival curve observed a trend of higher TyG index being associated with better survival rates, this association did not reach statistical significance in the sample of this study.

Conclusions: In pediatric patients with sepsis, a higher TyG index was associated with a lower 30-day mortality rate. This finding suggests that the TyG index shows potential for being related to short-term survival rates in children. Future studies need to further explore the interaction between the TyG index and other potential prognostic factors, and verify its value in larger or more diverse populations.

Introduction: Necrotizing enterocolitis (NEC) is a severe gastrointestinal disorder that primarily affects preterm infants, resulting in significant morbidity and mortality. The exact cause of NEC remains unclear, but it is believed to involve a combination of immune dysregulation, intestinal injury, and microbiota imbalance.

Methods: This scoping review examines existing human and animal studies that explore the role of myeloid cells (neutrophils, monocytes, macrophages, and myeloid-derived suppressor cells (MDSCs) in NEC pathogenesis.

Results: A reduction in peripheral blood monocytes, along with increased infiltration of proinflammatory monocytes and neutrophils into the intestine, are strongly associated with NEC severity. Immunoregulatory MDSCs may provide protective benefits; however, their activity appears impaired in preterm infants with NEC. Therapies targeting these immune pathways, including transforming growth factor-β2 (TGF-β2) and lactoferrin, show promise in preclinical models for mitigating inflammation and improving outcomes in infants with NEC.

Conclusions: Targeting myeloid cell immune responses represents a potential therapeutic strategy in NEC. Future research should focus on translating immune-modulating therapies to clinical practice, as such interventions may reduce NEC incidence and severity and offer new hope for vulnerable neonates.

Introduction: School bullying has become an important social problem among adolescents, it can influence the growth of individual, yet understanding of the impacts of school bullying is limited. The present study determined to investigate whether and how school bullying can influence adolescent social adaptation.

Methods: Structural equation modeling was used to assess the hypothesized model. A sample of 434 Chinese adolescents (56.9% females), with an average age of 13.07 years (SD = 0.93), participated the survey.

Results: The present study combined self-disclosure and school connectedness into a serial mediation model, highlighting the role of individual and environmental factors in the outcomes of school bullying.

Discussion: These findings suggest that adolescents who engage in bullying are less likely to disclose personal information, which in turn hinders their sense of belonging at school, ultimately impairing their positive social adaptation. The results highlight the interplay between individual (self-disclosure) and environmental (school connectedness) factors in the outcomes of school bullying. Both limitations and implications are discussed in the end.