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Case Report: Tadpole pupil and concurrent migraine in an adolescent patient is a novel correlation. 病例报告:青少年患者的蝌蚪瞳和并发偏头痛是一种新的相关性。
IF 2.1 3区 医学 Q2 PEDIATRICS Pub Date : 2024-10-08 eCollection Date: 2024-01-01 DOI: 10.3389/fped.2024.1446691
Alexander Scheid, Rebecca Lise Gammelgaard Henneberg, Jonas Kjeldbjerg Hansen

Background: Tadpole pupil is a rare phenomenon characterized by a brief and irregular deformation of the pupil caused by segmental contraction of the iris dilator muscle. It is most prevalent in adult women and is, in these cases, often associated with migraine.

Case presentation: We present a unique case of a 16-year-old girl who presented with recurrent episodes of tadpole pupil and vestibular migraine. This association has not been previously demonstrated in pediatric patients. During a thorough clinical examination, a thyroid carcinoma was found which due to its localization was not causative of the tadpole pupil and was considered an incidental finding.

Conclusions: The association between migraine and tadpole pupil in this patient, which has not previously been described in pediatric patients, adds to the demographics of tadpole pupil. A possible pathophysiological link between the two conditions is discussed but further research is needed to understand the pathophysiology underpinning it.

背景:蝌蚪瞳是一种罕见的现象,其特征是虹膜扩张肌节段性收缩导致瞳孔短暂而不规则的变形。蝌蚪状瞳孔多见于成年女性,在这些病例中,蝌蚪状瞳孔通常与偏头痛有关:我们介绍了一例独特的病例:一名 16 岁女孩反复发作蝌蚪瞳孔和前庭性偏头痛。这种关联以前从未在儿童患者中证实过。在全面的临床检查中,发现了甲状腺癌,但由于其位置并不是蝌蚪瞳孔的致病原因,因此被认为是偶然发现:结论:该患者的偏头痛与蝌蚪瞳孔之间的关联以前从未在儿童患者中描述过,这增加了蝌蚪瞳孔的人口统计学意义。本文讨论了这两种疾病之间可能存在的病理生理学联系,但还需要进一步研究以了解其病理生理学基础。
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引用次数: 0
Case Report: Fetomaternal hemorrhage and its association with pronounced neonatal anemia. 病例报告:孕产妇大出血及其与新生儿明显贫血的关联。
IF 2.1 3区 医学 Q2 PEDIATRICS Pub Date : 2024-10-08 eCollection Date: 2024-01-01 DOI: 10.3389/fped.2024.1423786
Peng Li, Hua Shu, Peng Lin, Jishui Wang, Di Zhang, Dongmei Man, Fengge Wang

Fetomaternal hemorrhage (FMH) is a perplexing obstetric condition that predominantly occurs during the third trimester or at the time of delivery. Its insidious and non-specific onset often leads to diagnostic challenges. The underlying pathophysiology of FMH remains incompletely understood, though it is primarily attributed to compromise of the placental barrier. The severity of the condition is intrinsically associated with the volumn of blood loss, the hemorrhage rate, and the presence of alloimmunity. Upon the occurrence of severe FMH, it can rapidly lead to intrauterine distress, fetal anemia, and the possibility of fetal demise, presenting a considerable threat to both maternal and neonatal well-being. In this article, I present a substantial case of FMH and conduct a systematic review of the current scientific literature regarding the etiology, clinical manifestations, diagnostic approaches, treatment highlights, and prognosis of this condition. The objective of this work is to improve clinicians' comprehension and diagnostic proficiency concerning FMH.

孕产妇出血(Fetomaternal hemorrhage,FMH)是一种令人困惑的产科疾病,主要发生在妊娠三个月或分娩时。它起病隐匿且无特异性,常常给诊断带来困难。尽管主要归因于胎盘屏障受损,但对 FMH 的基本病理生理学仍不完全清楚。病情的严重程度与失血量、出血率和异体免疫有内在联系。一旦发生严重的 FMH,就会迅速导致宫内窘迫、胎儿贫血和胎儿死亡的可能性,从而对产妇和新生儿的健康构成巨大威胁。在这篇文章中,我介绍了一例大量的 FMH 病例,并对目前有关该病症的病因、临床表现、诊断方法、治疗要点和预后的科学文献进行了系统回顾。这项工作旨在提高临床医生对 FMH 的理解和诊断能力。
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引用次数: 0
Effect of teduglutide, a glucagon-like peptide-2 analog, in eosinophilic enterocolitis: a case report. 胰高血糖素样肽-2 类似物 Teduglutide 对嗜酸性粒细胞性小肠结肠炎的疗效:一份病例报告。
IF 2.1 3区 医学 Q2 PEDIATRICS Pub Date : 2024-10-08 eCollection Date: 2024-01-01 DOI: 10.3389/fped.2024.1457824
Shoko Ogawa, Ken-Ichiro Konishi, Kiyoshi Tanaka, Hajime Takayasu, Yoshimasa Uematsu, Takashi Ito, Hiroyuki Takahashi, Yusuke Kumamoto

We successfully treated a 4-year-old girl with short bowel syndrome and eosinophilic enterocolitis with teduglutide, a glucagon-like peptide-2 analog. Her eosinophilic enterocolitis was cured without relapse, and we were able to increase enteral nutrition. We found that teduglutide had an anti-inflammatory effect in this patient with eosinophilic gastrointestinal disease associated with short bowel syndrome. This report is the first to describe use of teduglutide in the treatment of eosinophilic gastrointestinal disease.

我们使用胰高血糖素样肽-2 类似物 Teduglutide 成功治疗了一名患有短肠综合征和嗜酸性粒细胞性小肠结肠炎的 4 岁女孩。她的嗜酸性粒细胞性小肠结肠炎治愈了,而且没有复发,我们还增加了肠内营养。我们发现,在这名嗜酸性粒细胞胃肠病伴短肠综合征的患者身上,泰度鲁肽具有抗炎作用。本报告首次描述了使用泰度鲁肽治疗嗜酸性粒细胞性胃肠病的情况。
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引用次数: 0
The application of whole-exome sequencing in the early diagnosis of rare genetic diseases in children: a study from Southeastern China. 全外显子组测序在儿童罕见遗传病早期诊断中的应用:一项来自中国东南部的研究。
IF 2.1 3区 医学 Q2 PEDIATRICS Pub Date : 2024-10-08 eCollection Date: 2024-01-01 DOI: 10.3389/fped.2024.1448895
Guihua Lai, Qiying Gu, Zhiyong Lai, Haijun Chen, Junkun Chen, Jungao Huang

Background: Genetic diseases exhibit significant clinical and genetic diversity, leading to a complex and challenging diagnostic process. Exploiting novel approaches is imperative for the molecular diagnosis of genetic diseases. In this study, we utilized whole-exome sequencing (WES) to facilitate early diagnosis in patients suspected of genetic disorders.

Methods: This retrospective analysis included 144 patients diagnosed by singleton-WES Trio-WES between January 2021 and December 2023. We investigated the relevance of diagnosis rates with age, clinical presentation, and sample type.

Results: Among the 144 patients, 61 were diagnosed, yielding an overall diagnostic rate of 42.36%, with Trio-WES demonstrating a significantly higher diagnostic rate of 51.43% (36/70) compared to singleton-WES at 33.78% (25/74) (p < 0.05). Global developmental delay had a diagnosis rate of 67.39%, significantly higher than muscular hypotonia at 30.43% (p < 0.01) among different clinical phenotypic groups. Autosomal dominant disorders accounted for 70.49% (43/61) of positive cases, with autosomal abnormalities being fivefold more prevalent than sex chromosome abnormalities. Notably, sex chromosome abnormalities were more prevalent in males (80%, 8/10). Furthermore, 80.56% (29/36) of pathogenic variants were identified as de novo mutations through Trio-WES.

Conclusions: These findings highlight the effectiveness of WES in identifying genetic variants, and elucidating the molecular basis of genetic diseases, ultimately enabling early diagnosis in affected children.

背景:遗传性疾病在临床和遗传方面表现出显著的多样性,导致诊断过程复杂且具有挑战性。利用新方法对遗传病进行分子诊断势在必行。在这项研究中,我们利用全外显子组测序(WES)来帮助早期诊断疑似遗传疾病患者:这项回顾性分析纳入了 2021 年 1 月至 2023 年 12 月期间通过单基因组-全外显子测序-三基因组测序确诊的 144 例患者。我们研究了诊断率与年龄、临床表现和样本类型的相关性:在 144 名患者中,61 人确诊,总诊断率为 42.36%,与单WES 的 33.78%(25/74)相比,Trio-WES 的诊断率明显更高,为 51.43%(36/70)(p p 通过 Trio-WES发现的新突变):这些研究结果凸显了 WES 在识别基因变异和阐明遗传疾病分子基础方面的有效性,最终实现了对患儿的早期诊断。
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引用次数: 0
Comparison of intestinal and pharyngeal microbiota in preterm infants on the first day of life and the characteristics of pharyngeal microbiota in infants delivered by cesarean section or vaginally. 早产儿出生后第一天肠道和咽部微生物群的比较,以及剖腹产或阴道分娩婴儿咽部微生物群的特点。
IF 2.1 3区 医学 Q2 PEDIATRICS Pub Date : 2024-10-08 eCollection Date: 2024-01-01 DOI: 10.3389/fped.2024.1411887
Jing He, Lijuan Wang, Ying Ruan, Xinyan Yan, Qingju Liu, Boren Chen, Sen Yang, Lijun Du

Background: This study aimed to explore the distribution of intestinal and pharyngeal microbiota on the first day of life in preterm infants and compare the composition of microbiota in infants delivered by cesarean section or vaginally.

Methods: This study included 44 late preterm infants with a gestational age of 34-36 + 6 weeks. Stool and throat swab samples were collected from the preterm infants on the first day of life. The infants were divided into cesarean section and vaginal delivery groups. Illumina NovaSeq high-throughput sequencing technology was used to sequence the V3-V4 hypervariable region of the 16S rRNA gene of all bacteria in the samples. Venn diagram was used to identify shared operational taxonomic units (OTUs) in the intestines and pharynges. Microbial analysis was conducted at the phylum and genus levels, and α and β diversity comparisons were performed.

Results: (1) Gestational age may have significantly affected the microbial colonization of the intestines and pharynges of preterm infants on the first day after birth (p ≤ 0.001). (2) More OTUs were detected in the pharynx than in the intestines, both have a total of 819 shared OTUs. Proteobacteria, Firmicutes, and Bacteroidota were the dominant phyla in both. At the genus level, Streptococcus had a lower relative abundance in stool samples (0.5%) compared to throat samples (0.5% vs. 22.2%, p = 0.003). 3) The relative abundance of Streptococcus in pharyngeal samples was 26.2% in the cesarean section group much higher than the 3.8% in the vaginal delivery group (p = 0.01).

Conclusion: The early postnatal period is a critical time for the establishment of an infant's microbiota. Gestational age at birth may influence microbial colonization, while birth weight, gender, and mode of delivery do not. The intestinal and pharyngeal microbiota composition of preterm infants on the first day after birth showed high similarity, but larger samples are needed for further validation.

背景:本研究旨在探讨早产儿出生第一天肠道和咽部微生物群的分布情况,并比较剖宫产儿和阴道分娩儿的微生物群组成:本研究包括 44 名胎龄为 34-36+6 周的晚期早产儿。在早产儿出生后的第一天采集其粪便和咽拭子样本。婴儿分为剖宫产组和阴道分娩组。采用 Illumina NovaSeq 高通量测序技术对样本中所有细菌的 16S rRNA 基因 V3-V4 超变区进行测序。利用维恩图确定了肠道和咽喉中共有的操作分类单元(OTU)。结果:(1)妊娠年龄可能对出生后第一天早产儿肠道和咽部的微生物定植有显著影响(p ≤ 0.001)。(2)在咽部检测到的 OTU 多于肠道,两者共有 819 个共用 OTU。咽部和肠道都有 819 个共用 OTU。在属一级,粪便样本中链球菌的相对丰度(0.5%)低于喉咙样本(0.5% 对 22.2%,p = 0.003)。3)剖宫产组咽部样本中链球菌的相对丰富度为 26.2%,远高于阴道分娩组的 3.8%(P = 0.01):结论:产后早期是建立婴儿微生物群的关键时期。出生时的胎龄可能会影响微生物定植,而出生体重、性别和分娩方式则不会。早产儿出生后第一天的肠道和咽部微生物群组成显示出高度的相似性,但需要更大的样本来进一步验证。
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引用次数: 0
Children with sickle cell disease: are they protected from serious COVID-19? 患有镰状细胞病的儿童:他们会受到严重 COVID-19 的保护吗?
IF 2.1 3区 医学 Q2 PEDIATRICS Pub Date : 2024-10-07 eCollection Date: 2024-01-01 DOI: 10.3389/fped.2024.1337377
Walaa Aboulkasem Shahin, Hayam Aldeeb, Majed Alsulami, Abdullah Tammas, Fatma Albatniji, Aljawhara Almanea, Abdalla Mohamed Zayed, Fahad Alabbas, Azzah Alzahrani, Tahani Bin Ali, Ghaleb Elyamany, Rana Hassan Almaghrabi, Huda Elfaraidi

Background: COVID-19, the pandemic that hit the world in 2020, resulted in millions of deaths, with the elderly and adults succumbing to the disease more often than children. However, the presence of underlying morbidities increased the risk of death. Sickle cell disease (SCD) was previously classified as a major risk factor for severe COVID-19 disease. However, presently, there are only a limited number of studies that identify the clinical course of children with SCD and COVID-19.

Methods: We conducted a retrospective observational study on children with SCD admitted due to COVID-19 at three different institutions in Saudi Arabia between March 2020 and March 2022. We studied the demographic and clinical characteristics of patients admitted to the hospital.

Results: Seventy-six patients with SCD had PCR-confirmed SARS-CoV-2 during the study period; 50.0% of our patient population were children (6-12 years old). Gender was evenly distributed, with 53.9% girls and 46.1% boys. Symptoms more commonly related to the COVID-19 infection included fever, cough, malaise, and vomiting. Chest x-ray findings revealed mild and non-specific symptoms only in approximately one-third (28) of the included children. The most common symptoms associated with SCD were vaso-occlusive crisis (47.4%) and abdominal pain (11.8%). The overall general appearance of most of the patients was reassuring. The median length of hospital stay was 4.2 ± 2.7 days. The mean white blood cell count was 11.4 ± 5.2 × 109/L, and the mean hemoglobin level was 8.3 ± 1.5 g/dl. Despite the fact that higher levels of mean D-dimer, lactate dehydrogenase, and ferritin were reported in these patients, the clinical outcome was not affected. All recruited patients received hydroxyurea as maintenance therapy. The outcome of our study was reassuring, with no significant morbidity or mortality observed among the recruited patients.

Conclusion: Despite SCD being a chronic disease with known specific complications, there has been a claim that COVID-19 infection adds further risk. The results of this study suggest that the overall outcome of COVID-19 was favorable, with no reported mortality. Further research is needed to understand the factors that contributed to this favorable outcome. In children with SCD, it is still questionable whether hydroxyurea is one of the protective factors against severe COVID-19. Validation through large-scale research is recommended.

背景:COVID-19 是 2020 年袭击全球的大流行病,导致数百万人死亡,其中老年人和成年人比儿童更容易感染该疾病。然而,潜在疾病的存在会增加死亡风险。镰状细胞病(SCD)曾被列为严重 COVID-19 疾病的主要风险因素。然而,目前只有少数研究能确定 SCD 和 COVID-19 儿童的临床病程:我们对 2020 年 3 月至 2022 年 3 月期间沙特阿拉伯三个不同机构收治的 COVID-19 SCD 患儿进行了一项回顾性观察研究。我们研究了入院患者的人口统计学和临床特征:研究期间,76 名 SCD 患者经 PCR 证实感染了 SARS-CoV-2;50.0% 的患者为儿童(6-12 岁)。性别分布均匀,女孩占 53.9%,男孩占 46.1%。更常见的与 COVID-19 感染有关的症状包括发烧、咳嗽、乏力和呕吐。胸部X光检查结果显示,只有约三分之一(28名)的患儿有轻微的非特异性症状。与 SCD 相关的最常见症状是血管闭塞性危象(47.4%)和腹痛(11.8%)。大多数患者的总体外观令人欣慰。住院时间中位数为 4.2 ± 2.7 天。平均白细胞计数为 11.4 ± 5.2 × 109/L,平均血红蛋白水平为 8.3 ± 1.5 g/dl。尽管这些患者的平均 D-二聚体、乳酸脱氢酶和铁蛋白水平较高,但临床结果未受影响。所有招募的患者都接受了羟基脲作为维持治疗。我们的研究结果令人欣慰,在招募的患者中未观察到明显的发病率或死亡率:结论:尽管 SCD 是一种慢性疾病,有已知的特殊并发症,但有人认为 COVID-19 感染会增加更多风险。本研究结果表明,COVID-19 的总体疗效良好,无死亡报告。需要进一步研究以了解导致这一良好结果的因素。在 SCD 患儿中,羟基脲是否是预防严重 COVID-19 的保护因素之一仍存在疑问。建议通过大规模研究进行验证。
{"title":"Children with sickle cell disease: are they protected from serious COVID-19?","authors":"Walaa Aboulkasem Shahin, Hayam Aldeeb, Majed Alsulami, Abdullah Tammas, Fatma Albatniji, Aljawhara Almanea, Abdalla Mohamed Zayed, Fahad Alabbas, Azzah Alzahrani, Tahani Bin Ali, Ghaleb Elyamany, Rana Hassan Almaghrabi, Huda Elfaraidi","doi":"10.3389/fped.2024.1337377","DOIUrl":"10.3389/fped.2024.1337377","url":null,"abstract":"<p><strong>Background: </strong>COVID-19, the pandemic that hit the world in 2020, resulted in millions of deaths, with the elderly and adults succumbing to the disease more often than children. However, the presence of underlying morbidities increased the risk of death. Sickle cell disease (SCD) was previously classified as a major risk factor for severe COVID-19 disease. However, presently, there are only a limited number of studies that identify the clinical course of children with SCD and COVID-19.</p><p><strong>Methods: </strong>We conducted a retrospective observational study on children with SCD admitted due to COVID-19 at three different institutions in Saudi Arabia between March 2020 and March 2022. We studied the demographic and clinical characteristics of patients admitted to the hospital.</p><p><strong>Results: </strong>Seventy-six patients with SCD had PCR-confirmed SARS-CoV-2 during the study period; 50.0% of our patient population were children (6-12 years old). Gender was evenly distributed, with 53.9% girls and 46.1% boys. Symptoms more commonly related to the COVID-19 infection included fever, cough, malaise, and vomiting. Chest x-ray findings revealed mild and non-specific symptoms only in approximately one-third (28) of the included children. The most common symptoms associated with SCD were vaso-occlusive crisis (47.4%) and abdominal pain (11.8%). The overall general appearance of most of the patients was reassuring. The median length of hospital stay was 4.2 ± 2.7 days. The mean white blood cell count was 11.4 ± 5.2 × 10<sup>9</sup>/L, and the mean hemoglobin level was 8.3 ± 1.5 g/dl. Despite the fact that higher levels of mean D-dimer, lactate dehydrogenase, and ferritin were reported in these patients, the clinical outcome was not affected. All recruited patients received hydroxyurea as maintenance therapy. The outcome of our study was reassuring, with no significant morbidity or mortality observed among the recruited patients.</p><p><strong>Conclusion: </strong>Despite SCD being a chronic disease with known specific complications, there has been a claim that COVID-19 infection adds further risk. The results of this study suggest that the overall outcome of COVID-19 was favorable, with no reported mortality. Further research is needed to understand the factors that contributed to this favorable outcome. In children with SCD, it is still questionable whether hydroxyurea is one of the protective factors against severe COVID-19. Validation through large-scale research is recommended.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11491405/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142463073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Risk factors affecting relapse after discontinuation of biologics in children with Crohn's disease who maintained deep remission. 影响保持深度缓解的克罗恩病患儿停用生物制剂后复发的风险因素。
IF 2.1 3区 医学 Q2 PEDIATRICS Pub Date : 2024-10-07 eCollection Date: 2024-01-01 DOI: 10.3389/fped.2024.1479619
Hansol Kim, Yoon Zi Kim, Seon Young Kim, Yon Ho Choe, Mi Jin Kim

Objectives: Biologics are important therapeutic agents for pediatric Crohn's disease. Discontinuation of biologics is known to increase the relapse rate up to 71.4% in these patients; however, their long-term use increases the risk of opportunistic infections and causes economic burden and psychological fatigue. Therefore, taking a drug holiday is meaningful, even if the biologics cannot be completely discontinued. This study aimed to analyze the risk factors affecting relapse after discontinuation of biologics in children with Crohn's disease.

Methods: We retrospectively reviewed the data of 435 children with Crohn's disease who visited a single health center between March 2013 and March 2021. Subsequently, we analyzed data from the patients who discontinued biologics after deep remission.

Results: Among the enrolled patients, 388 were followed up for ≥2 years, and of these, 357 were administered biologics. A total of 103 patients discontinued biologics after deep remission, subsequently 31 maintained remission and 72 relapsed. The shorter the duration of biologic treatment (odds ratio of 0.444, P = 0.029), the higher the ESR (odds ratio of 1.294, P = 0.009) and fecal calprotectin (odds ratio of 1.010, P = 0.032), and the less histological remission at the time of discontinuation of biologics (odds ratio of 0.119, P = 0.026), the greater the risk of relapse after discontinuation of biologics.

Conclusions: We identified factors associated with relapse after discontinuation of biologics. The results suggest that biologics can be discontinued in the absence of these factors after deep remission. However, because the relapse rate may increase after the discontinuation of biologics, close monitoring is important, and if necessary, re-administration of biologics should be actively considered.

目的:生物制剂是治疗小儿克罗恩病的重要药物。众所周知,停用生物制剂会增加这些患者的复发率,最高可达 71.4%;然而,长期使用生物制剂会增加机会性感染的风险,并造成经济负担和心理疲劳。因此,即使不能完全停用生物制剂,休药假也是有意义的。本研究旨在分析影响克罗恩病患儿停用生物制剂后复发的风险因素:我们回顾性分析了2013年3月至2021年3月期间在一家医疗中心就诊的435名克罗恩病患儿的数据。随后,我们分析了深度缓解后停用生物制剂的患者数据:在登记的患者中,有 388 人接受了≥2 年的随访,其中 357 人接受了生物制剂治疗。共有 103 名患者在深度缓解后停用了生物制剂,其中 31 人维持缓解,72 人复发。生物制剂治疗时间越短(几率比为 0.444,P = 0.029),ESR(几率比为 1.294,P = 0.009)和粪便钙蛋白(几率比为 1.010,P = 0.032),停用生物制剂时组织学缓解程度越低(几率比0.119,P = 0.026),停用生物制剂后复发的风险就越大:我们发现了与停用生物制剂后复发相关的因素。结果表明,在深度缓解后,如果没有这些因素,可以停用生物制剂。然而,由于停用生物制剂后复发率可能会增加,因此密切监测非常重要,必要时应积极考虑重新使用生物制剂。
{"title":"Risk factors affecting relapse after discontinuation of biologics in children with Crohn's disease who maintained deep remission.","authors":"Hansol Kim, Yoon Zi Kim, Seon Young Kim, Yon Ho Choe, Mi Jin Kim","doi":"10.3389/fped.2024.1479619","DOIUrl":"10.3389/fped.2024.1479619","url":null,"abstract":"<p><strong>Objectives: </strong>Biologics are important therapeutic agents for pediatric Crohn's disease. Discontinuation of biologics is known to increase the relapse rate up to 71.4% in these patients; however, their long-term use increases the risk of opportunistic infections and causes economic burden and psychological fatigue. Therefore, taking a drug holiday is meaningful, even if the biologics cannot be completely discontinued. This study aimed to analyze the risk factors affecting relapse after discontinuation of biologics in children with Crohn's disease.</p><p><strong>Methods: </strong>We retrospectively reviewed the data of 435 children with Crohn's disease who visited a single health center between March 2013 and March 2021. Subsequently, we analyzed data from the patients who discontinued biologics after deep remission.</p><p><strong>Results: </strong>Among the enrolled patients, 388 were followed up for ≥2 years, and of these, 357 were administered biologics. A total of 103 patients discontinued biologics after deep remission, subsequently 31 maintained remission and 72 relapsed. The shorter the duration of biologic treatment (odds ratio of 0.444, <i>P</i> = 0.029), the higher the ESR (odds ratio of 1.294, <i>P</i> = 0.009) and fecal calprotectin (odds ratio of 1.010, <i>P</i> = 0.032), and the less histological remission at the time of discontinuation of biologics (odds ratio of 0.119, <i>P</i> = 0.026), the greater the risk of relapse after discontinuation of biologics.</p><p><strong>Conclusions: </strong>We identified factors associated with relapse after discontinuation of biologics. The results suggest that biologics can be discontinued in the absence of these factors after deep remission. However, because the relapse rate may increase after the discontinuation of biologics, close monitoring is important, and if necessary, re-administration of biologics should be actively considered.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11491326/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142463107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Construction and evaluation of a risk model for adverse outcomes of necrotizing enterocolitis based on LASSO-Cox regression. 基于 LASSO-Cox 回归的坏死性小肠结肠炎不良后果风险模型的构建与评估。
IF 2.1 3区 医学 Q2 PEDIATRICS Pub Date : 2024-10-07 eCollection Date: 2024-01-01 DOI: 10.3389/fped.2024.1366913
HaiJin Zhang, RongWei Yang, Yuan Yao

Objective: This study aimed to develop a nomogram to predict adverse outcomes in neonates with necrotizing enterocolitis (NEC).

Methods: In this retrospective study on neonates with NEC, data on perinatal characteristics, clinical features, laboratory findings, and x-ray examinations were collected for the included patients. A risk model and its nomogram were developed using the least absolute shrinkage and selection operator (LASSO) Cox regression analyses.

Results: A total of 182 cases of NEC were included and divided into a training set (148 cases) and a temporal validation set (34 cases). Eight features, including weight [p = 0.471, HR = 0.99 (95% CI: 0.98-1.00)], history of congenital heart disease [p < 0.001, HR = 3.13 (95% CI:1.75-5.61)], blood transfusion before onset [p = 0.757, HR = 0.85 (95%CI:0.29-2.45)], antibiotic exposure before onset [p = 0.003, HR = 5.52 (95% CI:1.81-16.83)], C-reactive protein (CRP) at onset [p = 0.757, HR = 1.01 (95%CI:1.00-1.02)], plasma sodium at onset [p < 0.001, HR = 4.73 (95%CI:2.61-8.59)], dynamic abdominal x-ray score change [p = 0.001, HR = 4.90 (95%CI:2.69-8.93)], and antibiotic treatment regimen [p = 0.250, HR = 1.83 (0.65-5.15)], were ultimately selected for model building. The C-index for the predictive model was 0.850 (95% CI: 0.804-0.897) for the training set and 0.7880.788 (95% CI: 0.656-0.921) for the validation set. The area under the ROC curve (AUC) at 8-, 10-, and 12-days were 0.889 (95% CI: 0.822-0.956), 0.891 (95% CI: 0.829-0.953), and 0.893 (95% CI:0.832-0.954) in the training group, and 0.812 (95% CI: 0.633-0.991), 0.846 (95% CI: 0.695-0.998), and 0.798 (95%CI: 0.623-0.973) in the validation group, respectively. Calibration curves showed good concordance between the predicted and observed outcomes, and DCA demonstrated adequate clinical benefit.

Conclusions: The LASSO-Cox model effectively identifies NEC neonates at high risk of adverse outcomes across all time points. Notably, at earlier time points (such as the 8-day mark), the model also demonstrates strong predictive performance, facilitating the early prediction of adverse outcomes in infants with NEC. This early prediction can contribute to timely clinical decision-making and ultimately improve patient prognosis.

研究目的本研究旨在开发一种提名图,用于预测新生儿坏死性小肠结肠炎(NEC)的不良预后:在这项关于新生儿坏死性小肠结肠炎的回顾性研究中,收集了纳入患者的围产期特征、临床特征、实验室检查结果和 X 光检查数据。采用最小绝对收缩和选择算子(LASSO)Cox回归分析法建立了风险模型及其提名图:结果:共纳入 182 例 NEC,分为训练集(148 例)和临时验证集(34 例)。八个特征,包括体重[P = 0.471,HR = 0.99 (95% CI: 0.98-1.00)]、先天性心脏病史[P P = 0.757,HR = 0.85 (95%CI:0.29-2.45)] 、发病前抗生素暴露[P = 0.003,HR = 5.52 (95% CI:1.81-16.83)]、发病时的 C 反应蛋白(CRP)[p = 0.757,HR = 1.01(95%CI:1.00-1.02)]、发病时的血浆钠[p p = 0.001,HR = 4.90(95%CI:2.69-8.93)]和抗生素治疗方案[p = 0.250,HR = 1.83(0.65-5.15)],最终被选中用于建立模型。训练集预测模型的 C 指数为 0.850(95% CI:0.804-0.897),验证集为 0.7880.788(95% CI:0.656-0.921)。训练组 8 天、10 天和 12 天的 ROC 曲线下面积(AUC)分别为 0.889(95% CI:0.822-0.956)、0.891(95% CI:0.829-0.953)和 0.893(95% CI:0.832-0.训练组分别为 0.812(95% CI:0.633-0.991)、0.846(95% CI:0.695-0.998)和 0.798(95%CI:0.623-0.973)。校准曲线显示预测结果与观察结果之间具有良好的一致性,DCA显示了足够的临床效益:结论:LASSO-Cox 模型能有效识别所有时间点上不良结局风险较高的 NEC 新生儿。值得注意的是,在较早的时间点(如 8 天),该模型也表现出很强的预测能力,有助于早期预测 NEC 新生儿的不良预后。这种早期预测有助于及时做出临床决策,并最终改善患者的预后。
{"title":"Construction and evaluation of a risk model for adverse outcomes of necrotizing enterocolitis based on LASSO-Cox regression.","authors":"HaiJin Zhang, RongWei Yang, Yuan Yao","doi":"10.3389/fped.2024.1366913","DOIUrl":"10.3389/fped.2024.1366913","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to develop a nomogram to predict adverse outcomes in neonates with necrotizing enterocolitis (NEC).</p><p><strong>Methods: </strong>In this retrospective study on neonates with NEC, data on perinatal characteristics, clinical features, laboratory findings, and x-ray examinations were collected for the included patients. A risk model and its nomogram were developed using the least absolute shrinkage and selection operator (LASSO) Cox regression analyses.</p><p><strong>Results: </strong>A total of 182 cases of NEC were included and divided into a training set (148 cases) and a temporal validation set (34 cases). Eight features, including weight [<i>p</i> = 0.471, HR = 0.99 (95% CI: 0.98-1.00)], history of congenital heart disease [<i>p</i> < 0.001, HR = 3.13 (95% CI:1.75-5.61)], blood transfusion before onset [<i>p</i> = 0.757, HR = 0.85 (95%CI:0.29-2.45)], antibiotic exposure before onset [<i>p</i> = 0.003, HR = 5.52 (95% CI:1.81-16.83)], C-reactive protein (CRP) at onset [<i>p</i> = 0.757, HR = 1.01 (95%CI:1.00-1.02)], plasma sodium at onset [<i>p</i> < 0.001, HR = 4.73 (95%CI:2.61-8.59)], dynamic abdominal x-ray score change [<i>p</i> = 0.001, HR = 4.90 (95%CI:2.69-8.93)], and antibiotic treatment regimen [<i>p</i> = 0.250, HR = 1.83 (0.65-5.15)], were ultimately selected for model building. The C-index for the predictive model was 0.850 (95% CI: 0.804-0.897) for the training set and 0.7880.788 (95% CI: 0.656-0.921) for the validation set. The area under the ROC curve (AUC) at 8-, 10-, and 12-days were 0.889 (95% CI: 0.822-0.956), 0.891 (95% CI: 0.829-0.953), and 0.893 (95% CI:0.832-0.954) in the training group, and 0.812 (95% CI: 0.633-0.991), 0.846 (95% CI: 0.695-0.998), and 0.798 (95%CI: 0.623-0.973) in the validation group, respectively. Calibration curves showed good concordance between the predicted and observed outcomes, and DCA demonstrated adequate clinical benefit.</p><p><strong>Conclusions: </strong>The LASSO-Cox model effectively identifies NEC neonates at high risk of adverse outcomes across all time points. Notably, at earlier time points (such as the 8-day mark), the model also demonstrates strong predictive performance, facilitating the early prediction of adverse outcomes in infants with NEC. This early prediction can contribute to timely clinical decision-making and ultimately improve patient prognosis.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11491366/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142463076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Hygienic practice during complementary feeding and associated factors among mothers of children aged 6-24 months in Borecha Woreda, southwestern Ethiopia: a community-based cross-sectional study. 埃塞俄比亚西南部 Borecha Woreda 地区 6-24 个月婴儿母亲在添加辅食时的卫生习惯及相关因素:一项基于社区的横断面研究。
IF 2.1 3区 医学 Q2 PEDIATRICS Pub Date : 2024-10-07 eCollection Date: 2024-01-01 DOI: 10.3389/fped.2024.1321558
Rabira Tariku Birdida, Erean Shigign Malka, Efrem Negash Kush, Fikadu Tolesa Alemu

Introduction: Complementary feeding is a critical transitional phase in the life of an infant, and complementary foods should be prepared, stored, and fed hygienically, with clean hands, dishes, and utensils to prevent diseases. However, the prevalence and risk factors associated with hygienic complementary feeding practice have not been well addressed in Ethiopia, especially in the study area.

Objective: This study aimed to assess hygienic practices and associated factors during complementary feeding among mothers with children aged 6-24 months in Borecha Woreda, Buno Bedele Zone, southwestern Ethiopia, in 2022.

Methods: A community-based cross-sectional study was conducted using a multistage sampling technique. The study was conducted on 536 mothers of children aged 6-24 months in Borecha Woreda from 1 March to 1 April 2022. Data were collected using an interviewer-administered questionnaire. The data were coded, cleaned, edited, and entered into Epi-Data version 4.6 and then exported to SPSS version 20.0 for further analysis. Both bivariate and multivariable logistic regression models were fitted. Moreover, crude (for bivariate) and adjusted (multivariable) odds ratios (AORs) with 95% confidence intervals (CIs) were computed to assess the association between independent factors and outcome variables. A p-value of <0.05 was considered statistically significant.

Result: Out of 536 respondents, 350 (65.3%) exhibited poor hygienic practices during complementary feeding. The risk of poor hygienic practices was about two times higher among women over 30 than those under 25 (AOR: 1.8; 95% CI: 1.11-2.90). Mothers whose husbands had primary education or higher had a 50% reduced risk (AOR: 0.50; 95% CI 0.31-0.83) of poor hygienic care practices during complementary feeding compared to their counterparts. The odds of poor hygiene practice among mothers with poor knowledge of hygienic care were 2.71 times higher than those with good knowledge (AOR: 2.71; 95% CI: 1.60-4.61).

Conclusion: The prevalence of poor hygienic practices during the preparation and handling of complementary foods among mothers in Borecha Woreda is high compared to other studies. Therefore, improving hygiene practices during complementary food preparation requires the involvement and responsibility of policymakers, the community, and families.

导言:辅食喂养是婴儿生命中的一个关键过渡阶段,辅食的准备、储存和喂养都应讲究卫生,使用干净的手、餐具和用具,以预防疾病。然而,在埃塞俄比亚,尤其是在研究地区,与卫生辅食喂养做法相关的流行率和风险因素尚未得到很好的解决:本研究旨在评估 2022 年埃塞俄比亚西南部 Buno Bedele 区 Borecha Woreda 地区有 6-24 个月婴儿的母亲在添加辅食时的卫生习惯和相关因素:采用多阶段抽样技术进行了一项社区横断面研究。研究于 2022 年 3 月 1 日至 4 月 1 日在 Borecha Woreda 对 536 名 6-24 个月儿童的母亲进行了调查。数据采用访谈者发放的调查问卷收集。数据经过编码、清理、编辑后输入 Epi-Data 4.6 版,然后导出到 SPSS 20.0 版进行进一步分析。对数据进行了二元和多元逻辑回归分析。此外,还计算了粗略(二元)和调整(多变量)几率比(AORs)及 95% 置信区间(CIs),以评估独立因素与结果变量之间的关联。结果在 536 名受访者中,350 人(65.3%)在辅食喂养过程中表现出不良卫生习惯。30 岁以上妇女出现不良卫生习惯的风险是 25 岁以下妇女的两倍(AOR:1.8;95% CI:1.11-2.90)。与同龄人相比,丈夫受过小学或以上教育的母亲在辅食喂养期间卫生习惯不良的风险降低了 50%(AOR:0.50;95% CI 0.31-0.83)。卫生保健知识贫乏的母亲出现不良卫生习惯的几率是知识丰富母亲的 2.71 倍(AOR:2.71;95% CI:1.60-4.61):与其他研究相比,博雷查县母亲在准备和处理辅食时卫生习惯不良的比例较高。因此,改善辅食制作过程中的卫生习惯需要政策制定者、社区和家庭的参与和责任。
{"title":"Hygienic practice during complementary feeding and associated factors among mothers of children aged 6-24 months in Borecha Woreda, southwestern Ethiopia: a community-based cross-sectional study.","authors":"Rabira Tariku Birdida, Erean Shigign Malka, Efrem Negash Kush, Fikadu Tolesa Alemu","doi":"10.3389/fped.2024.1321558","DOIUrl":"10.3389/fped.2024.1321558","url":null,"abstract":"<p><strong>Introduction: </strong>Complementary feeding is a critical transitional phase in the life of an infant, and complementary foods should be prepared, stored, and fed hygienically, with clean hands, dishes, and utensils to prevent diseases. However, the prevalence and risk factors associated with hygienic complementary feeding practice have not been well addressed in Ethiopia, especially in the study area.</p><p><strong>Objective: </strong>This study aimed to assess hygienic practices and associated factors during complementary feeding among mothers with children aged 6-24 months in Borecha Woreda, Buno Bedele Zone, southwestern Ethiopia, in 2022.</p><p><strong>Methods: </strong>A community-based cross-sectional study was conducted using a multistage sampling technique. The study was conducted on 536 mothers of children aged 6-24 months in Borecha Woreda from 1 March to 1 April 2022. Data were collected using an interviewer-administered questionnaire. The data were coded, cleaned, edited, and entered into Epi-Data version 4.6 and then exported to SPSS version 20.0 for further analysis. Both bivariate and multivariable logistic regression models were fitted. Moreover, crude (for bivariate) and adjusted (multivariable) odds ratios (AORs) with 95% confidence intervals (CIs) were computed to assess the association between independent factors and outcome variables. A <i>p</i>-value of <0.05 was considered statistically significant.</p><p><strong>Result: </strong>Out of 536 respondents, 350 (65.3%) exhibited poor hygienic practices during complementary feeding. The risk of poor hygienic practices was about two times higher among women over 30 than those under 25 (AOR: 1.8; 95% CI: 1.11-2.90). Mothers whose husbands had primary education or higher had a 50% reduced risk (AOR: 0.50; 95% CI 0.31-0.83) of poor hygienic care practices during complementary feeding compared to their counterparts. The odds of poor hygiene practice among mothers with poor knowledge of hygienic care were 2.71 times higher than those with good knowledge (AOR: 2.71; 95% CI: 1.60-4.61).</p><p><strong>Conclusion: </strong>The prevalence of poor hygienic practices during the preparation and handling of complementary foods among mothers in Borecha Woreda is high compared to other studies. Therefore, improving hygiene practices during complementary food preparation requires the involvement and responsibility of policymakers, the community, and families.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11491354/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142463090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Questionnaire-based subjective evaluation and analysis of factors influencing the effectiveness of treatment with the vacuum bell in children with pectus excavatum: a cross-sectional observational study. 基于问卷的主观评价和影响真空钟治疗乳房下垂儿童有效性的因素分析:一项横断面观察研究。
IF 2.1 3区 医学 Q2 PEDIATRICS Pub Date : 2024-10-07 eCollection Date: 2024-01-01 DOI: 10.3389/fped.2024.1467215
Lihuan Zhou, Fang Deng, Yunfei Tian, Jiayi Lin, Guihong Yang, Yunfei Li, Jos M Latour, Xicheng Deng

Background: Vacuum bell (VB) is a technique to treat pectus excavatum in children. Its effectiveness and influencing factors, however, remain under investigated. The aim of this study was to examine the therapeutic effect and its influencing factors of VB in children with pectus excavatum.

Methods: A cross-sectional observational study was conducted. Parents of children with pectus excavatum who underwent treatment with a VB between January 2018 and December 2019 were recruited. A survey was designed based on previously related studies and delivered to the parents in September-October 2021. The therapeutic effect was analyzed using subjective experiences by parents. Factors related to effectiveness were analyzed through univariate analysis and multivariate logistic regression.

Results: Of the 77 surveys distributed, 65 (84%) were returned. The mean duration of VB was 23.20 (SD 9.86) months. Caregivers rated the effect of VB treatment as moderate (41.5%), good (46.2%), excellent (12.3%). There were 39 children (60%) who had at least one pause of using VB for more than two weeks. Univariate analysis showed no significant difference between age, height, weight, duration of VB (months) and the effectiveness of VB therapy as defined by caregivers (p > 0.05) and significant difference were observed of the variables "complication of petechiae" (p = 0.034) and "device returned to manufacturer for repair" (p = 0.011). The multivariate logistic regression showed that the occurrence of complication petechiae (p = 0.046) was an influential factor for the effectiveness of VB.

Conclusions: The evaluations reported by the parents suggested that the VB treatment was effective, although with varying degrees. The complication of petechiae seems an influencing factor to successful VB treatment in children with pectus excavatum. Further studies are needed to assess the long-term outcome and effect of VB and to improve the device and to reduce complications in order to enhance compliance and improve effectiveness.

背景:真空钟(VB)是一种治疗儿童鸡胸的技术。然而,其有效性和影响因素仍未得到充分研究。本研究的目的是探讨真空钟治疗儿童胸肌下垂的疗效及其影响因素:方法:本研究采用横断面观察法。招募了在 2018 年 1 月至 2019 年 12 月期间接受 VB 治疗的鸡胸症患儿的家长。根据之前的相关研究设计了一份调查问卷,并于 2021 年 9 月至 10 月间发放给家长。通过家长的主观体验分析治疗效果。通过单变量分析和多变量逻辑回归分析了与疗效相关的因素:在发放的 77 份调查问卷中,有 65 份(84%)被收回。自愿咨询的平均持续时间为 23.20 个月(标准差为 9.86 个月)。照护者对 VB 治疗效果的评价为中等(41.5%)、良好(46.2%)和优秀(12.3%)。有 39 名儿童(60%)至少有一次暂停使用 VB 超过两周。单变量分析显示,年龄、身高、体重、使用 VB 的时间(月)与护理人员定义的 VB 治疗效果之间无显著差异(P > 0.05),而 "瘀斑并发症"(P = 0.034)和 "设备退回制造商维修"(P = 0.011)这两个变量之间存在显著差异。多变量逻辑回归显示,并发症瘀斑的发生(p = 0.046)是影响 VB 效果的一个因素:结论:家长的评估结果表明,VB 治疗是有效的,尽管程度不一。瘀斑并发症似乎是影响乳房下垂儿童成功进行 VB 治疗的一个因素。需要进一步开展研究,评估VB的长期疗效和效果,并改进设备和减少并发症,以提高依从性和有效性。
{"title":"Questionnaire-based subjective evaluation and analysis of factors influencing the effectiveness of treatment with the vacuum bell in children with pectus excavatum: a cross-sectional observational study.","authors":"Lihuan Zhou, Fang Deng, Yunfei Tian, Jiayi Lin, Guihong Yang, Yunfei Li, Jos M Latour, Xicheng Deng","doi":"10.3389/fped.2024.1467215","DOIUrl":"10.3389/fped.2024.1467215","url":null,"abstract":"<p><strong>Background: </strong>Vacuum bell (VB) is a technique to treat pectus excavatum in children. Its effectiveness and influencing factors, however, remain under investigated. The aim of this study was to examine the therapeutic effect and its influencing factors of VB in children with pectus excavatum.</p><p><strong>Methods: </strong>A cross-sectional observational study was conducted. Parents of children with pectus excavatum who underwent treatment with a VB between January 2018 and December 2019 were recruited. A survey was designed based on previously related studies and delivered to the parents in September-October 2021. The therapeutic effect was analyzed using subjective experiences by parents. Factors related to effectiveness were analyzed through univariate analysis and multivariate logistic regression.</p><p><strong>Results: </strong>Of the 77 surveys distributed, 65 (84%) were returned. The mean duration of VB was 23.20 (SD 9.86) months. Caregivers rated the effect of VB treatment as moderate (41.5%), good (46.2%), excellent (12.3%). There were 39 children (60%) who had at least one pause of using VB for more than two weeks. Univariate analysis showed no significant difference between age, height, weight, duration of VB (months) and the effectiveness of VB therapy as defined by caregivers (<i>p</i> > 0.05) and significant difference were observed of the variables \"complication of petechiae\" (<i>p</i> = 0.034) and \"device returned to manufacturer for repair\" (<i>p</i> = 0.011). The multivariate logistic regression showed that the occurrence of complication petechiae (<i>p</i> = 0.046) was an influential factor for the effectiveness of VB.</p><p><strong>Conclusions: </strong>The evaluations reported by the parents suggested that the VB treatment was effective, although with varying degrees. The complication of petechiae seems an influencing factor to successful VB treatment in children with pectus excavatum. Further studies are needed to assess the long-term outcome and effect of VB and to improve the device and to reduce complications in order to enhance compliance and improve effectiveness.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11491394/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142463097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Frontiers in Pediatrics
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