Frontiers in Pediatrics最新文献

Background: Primary caregivers of children with epilepsy bear long-term care responsibilities and face multiple pressures, which affect their hope level. This survey aimed to evaluate the hope level and associated factors of primary caregivers of children with epilepsy, to provide insights for clinical nursing care.

Method: A cross-sectional survey was conducted among primary caregivers of children with epilepsy in a tertiary grade A children's hospital in China. Data were collected using a general information questionnaire and the hope scale, and analyzed via univariate analysis, Pearson correlation analysis, and multiple linear regression analysis.

Results: A total of 248 primary caregivers were included. The overall hope level of caregivers was moderate (total score: 26.25 ± 4.92), with the Intimate Relationship dimension having the lowest score (score rate: 50.44%). Pearson correlation analysis showed that age (r = 0.382), educational level (r = 0.459), and monthly household income (r = 0.417) were positively correlated with hope level (all P < 0.001), while the three scale dimensions (Positive Attitude, Positive Action, Intimate Relationship) all had strong positive correlations with total hope score (all r > 0.85, P < 0.001). Multiple linear regression showed that age (β = 0.193, P < 0.001), marital status (β = -2.876, P < 0.001), residence (β = -3.152, P < 0.001), educational level (β = 1.268, P < 0.001), and monthly household income (β = 1.054, P < 0.001) were independent influencing factors of hope level (model fit: R ² = 0.482, adjusted R ² = 0.467).

Conclusion: The hope level of primary caregivers of children with epilepsy was moderate. Younger age, divorced/widowed status, rural residence, lower educational level, and poorer economic conditions were the negative influencing factors. Targeted interventions should be implemented to elevate caregivers' hope levels.

Background: Tacrolimus is widely used as an immunosuppressant in the management of refractory nephrotic syndrome. Although effective, it may occasionally lead to rare but serious adverse effects such as posterior reversible leukoencephalopathy syndrome (PRES). PRES has traditionally been associated with hypertension and elevated drug concentrations.

Case presentation: In the present study, we describe the case of a 10-year-old Chinese girl who was diagnosed with steroid-resistant nephrotic syndrome (SRNS) and pathologically confirmed to have minimal change nephropathy. Following 40 days of full-dose glucocorticoid therapy with inadequate improvement in proteinuria, tacrolimus was initiated at 1.5 mg twice daily (0.09 mg/kg/day). Neurological symptoms, including headache and nausea, developed 18 h after the first dose-before steady-state drug levels were reached. Within 24 h, hypertension emerged, and magnetic resonance imaging (MRI) revealed abnormal signals in the bilateral parietal cortical and subcortical regions, consistent with PRES. Tacrolimus was immediately discontinued, and the patient was treated with nifedipine, low-dose furosemide, and vitamin B6. Symptoms resolved within 48 h, and blood pressure normalized. Immunosuppressive therapy was subsequently switched to mycophenolate mofetil (MMF). Follow-up brain MRI at three months demonstrated complete resolution of the detected abnormalities.

Conclusion: Tacrolimus-associated PRES may occur very early in treatment, even before stable drug concentrations are achieved. Vigilant clinical monitoring, prompt recognition of neurological symptoms, and timely intervention are critical to avoid long-term sequelae.

Non-Discoid meniscus injuries in children and adolescents are generally less common than in adults. However, with the increasing number of children participating in physical exercise and the intensification of exercise intensity, the frequency of meniscus injuries is gradually rising. Currently, research on the diagnosis and treatment of meniscus tears in adults is quite advanced, and some progress has also been made in the research on the repair of meniscus injuries in children. Nevertheless, there is a lack of consensus regarding the repair of meniscus injuries in this population. This study reviews relevant literature on the treatment of meniscus injuries in children in recent years, summarizing aspects such as meniscus vascular distribution, injury classification, mechanisms of injury, and repair methods, aiming to provide a reference for the repair of meniscus injuries in children. This narrative review focuses specifically on non-discoid meniscus injuries in children and adolescents; discoid meniscus lesions, which differ from non-discoid lesions in pathogenesis, morphology, therapeutic approach and outcomes, are excluded from detailed discussion.

The initiation of juvenile idiopathic arthritis (JIA) may be associated with an infection caused by unidentified pathogens. The prevalence or incidence rates of JIA differ markedly among populations. The constituent of microbiota of human species is influenced by age during childhood and differs among ethnic groups. On occasion, some strains in microbiota can invade the host and elicit inflammatory immune reactions, and dysbiosis has been observed in JIA. The microbial-infected cells contain inflammation-inducing substances including pathogen-origin substances such as toxins and pathogen-associated molecular patterns and host cell-origin substances such as damage-associated molecular patterns, biochemicals, and pathogenic proteins/peptides. The immune systems of mammals, especially adaptive immune system, mature along with ages in childhood and decline in old age. JIA has epidemiological and clinical characteristics including different incidence by ethnic groups with similar age and sex predilection in certain subtypes, an association with various infectious and immune-mediated diseases and physical trauma, and a different clinical nature as compared with arthritis in adults. Here, it is proposed that causal agents of JIA are certain strains in microbiota, and etiological or inflammation-inducing substances in JIA are derived from the infected or injured cells through the characteristics of JIA and the PHS hypothesis. Patients with JIA may have an immature or improper adaptive immune state for controlling of the substances.

Acquired syphilis, which is historically considered a condition with almost exclusive prevalence in adults, has shown, in recent evidence, an alarming increase amongst the pediatric population. The objective of this study is to analyze and compare the time trends and epidemiological profile of acquired syphilis in the Brazilian population from ages 0 to 19 from 2015 to 2023. It consists of a descriptive, ecological study that utilizes secondary data from the Notifiable Health Conditions Information System (SINAN). The trend analysis used Joinpoint regression to calculate the Annual Percent Change (APC). From 2015 to 2023, 135,699 cases of acquired syphilis were registered in the age group studies, with 78.5% of confirmed cases and a concentration of 94.1% in the 15-19 age group. The results suggest a complex epidemiological scene, with the advancement of syphilis in various groups within the young population, evidencing the urgent necessity to strengthen prevention, diagnosis, and surveillance policies.

Objective: To identify predictive factors for necrotizing pneumonia (NP) in children with refractory Mycoplasma pneumoniae pneumonia (RMPP) and develop a predictive nomogram.

Methods: A retrospective analysis was conducted on clinical data of children with RMPP admitted to the Affiliated Women and Children's Hospital of Dalian University of Technology between June 2023 and July 2024. The dataset was randomly split into a training set (70%, n = 197) for model development and a test set (30%, n = 77) for internal validation. The χ ² test and Mann-Whitney U test were used to screen potential predictors, and multivariate logistic regression analysis was applied to establish a clinical prediction model. The Hosmer-Lemeshow test was used to evaluate model fit, and variance inflation factor was calculated to assess multicollinearity. The discriminatory and calibrative performance of the nomogram was evaluated using the receiver operating characteristic (ROC) curve and calibration curve, respectively.

Results: A total of 274 children with RMPP were analyzed. Of these, 51 who developed NP formed the necrotizing group, while the remaining 223 without NP were designated as the non-necrotizing group. The χ ² text and Mann-Whitney U Test analysis indicated that ESR, CD4⁺ T cells, NK cells, IL-4, duration of fever, and pleural effusion were significant predictors of NP in children with MPP (P < 0.05). Internal validation using the test set showed a consistency rate of 87.01% (67/77) between predicted and actual outcomes. The model demonstrated a sensitivity of 0.833, specificity of 0.877, and a Kappa coefficient of 0.590. Although predictive accuracy slightly decreased in the test set compared to the training set, the model still retained satisfactory predictive performance, indicating its potential generalizability.

Conclusion: The prediction model incorporating ESR, CD4⁺ T cells, NK cells, IL-4, duration of fever, and pleural effusion showed good predictive value for NP in children with RMPP.

Objective: Multisystem inflammatory syndrome (MIS-C) is life-threatening complication of coronavirus disease 2019 (COVID-19) in children. The objective of this study is to compare the clinical features, and follow-up results of MIS-C patients between the first and second waves of the disease.

Methods: This study was conducted retrospectively in children with MIS-C who were hospitalized in Pamukkale University Hospital. The first wave was defined as October 2020-June 2021 and the second wave as August 2021-February 2022. The clinical characteristics of the patients were recorded. The patients were evaluated by echocardiography at the sixth and twelfth months.

Results: Seventy were diagnosed in the first wave and 32 were diagnosed in the second wave, with 102 children included in the study. Pulmonary system involvement was more common in the first wave (p = 0.043). In the second wave, IL-6 (p = 0.033), ESR (p = 0.001), ALT (p = 0.048), LDH (p = 0.009), lipase (p = 0.05), and D-Dimer (p = 0.027) were found higher. Elevated ESR (p < 0.001), LDH (p = 0.038), and ALT (p = 0.008), thrombocytopenia (p = 0.011), and pericardial effusion were more frequent in the second group (p = 0.024). At the 12th month evaluation, it was observed that coronary aneurysm persisted in one patient each in the first and second waves groups.

Conclusions: The findings of this study revealed a significant increase in laboratory parameters of the MIS-C patients in time throughout the COVID-19 waves. There was no significant difference between the cohorts about different waves in terms of clinical findings and treatments. The echocardiographic findings of the patients have also not differed significantly between follow-ups.

This study investigates the occurrence and antimicrobial susceptibility of Bacillus spp. in pediatric patients with viral respiratory infections admitted to intensive care units. Secondary bacterial infections are known to exacerbate the severity of viral respiratory diseases and represent a major cause of morbidity and mortality during pandemics, including COVID-19. A total of 659 respiratory samples from children with respiratory symptoms hospitalized in five hospitals were analyzed. Bacterial co-infections were identified by inoculation in BHI medium and confirmed by MALDI-TOF. Antimicrobial susceptibility testing was performed using the Kirby-Bauer method, following EUCAST guidelines. Among 166 cases of bacterial co-infection, 20 (12.05%) were attributed to Bacillus spp., with a predominance in patients infected with respiratory syncytial virus (55%). The isolates showed high susceptibility to vancomycin (85%), imipenem (80%), erythromycin (70%), and ciprofloxacin (65%). These findings reveal that Bacillus spp., often considered an environmental contaminant, may play a clinically relevant role in pediatric viral co-infections, particularly in severe respiratory cases. This study contributes novel data to a poorly explored area of pediatric infectious disease research, emphasizing the need for routine susceptibility testing to optimize antimicrobial therapy. The results provide a foundation for future molecular studies on Bacillus spp. virulence and resistance mechanisms, supporting evidence-based management and infection control practices in critical care settings.

Objective: Over the previous decade, fibroblast growth factor 23 (FGF23) has been identified as a key biomarker in the context of cardiovascular diseases(CVD). The primary goal of this investigation was to determine the association between FGF23 and the susceptibility to CVD among children and adolescents.

Methods: We performed an electronic search of the Cochrane Library, PubMed, Web of Science, and Embase databases, covering the period from their inception until August 4, 2022. The random effects model was applied. Additionally, we conducted stratified analyses and performed a sensitivity analysis as part of our further investigation.

Results: A total of 11 studies involving 1,428 participants, including 366 individuals with cardiovascular disease and 1,062 control subjects, were included in the analysis. Children and adolescents with cardiovascular disease exhibited significantly higher serum FGF-23 levels compared to the control group [standardized mean difference [SMD] = 1.28, 95% confidence interval [CI] 0.53-2.03; I ² = 93.0%], as determined using a random-effects model. In categorical analyses across six studies, the pooled odds ratio did not demonstrate a statistically significant association with disease risk [odds ratio (OR) = 1.64, 95% CI 0.86-3.12; I ² = 100.0%]. Meta-regression analysis, accounting for variables such as type of cardiovascular disease, assay type, chronic kidney disease (CKD) status, and CKD stage, yielded a restricted maximum likelihood (REML) estimate of (τ ² = 0.2321) for the SMD outcome, indicating residual heterogeneity (I ²_res ≈ 70.3%) and an adjusted R² of 83.6%. The joint test for covariates was not statistically significant (Knapp-Hartung corrected Prob > F = 0.3165). For the categorical outcome, the meta-regression analysis produced a boundary estimate (τ ² = 0) with I ²_res = 0% and a non-significant joint test (Prob > F = 0.3479); however, these findings are likely influenced by the limited number of studies and restricted degrees of freedom.

Conclusion: Serum FGF-23 levels are elevated in pediatric populations with cardiovascular disease, but study-specific thresholds have not shown a clear independent association with risk. The variability in findings, reliance on observational study designs, and differences in assay methods contribute to the uncertainty about its prognostic value. Therefore, standardized prospective studies reporting on renal function and mineral metabolism markers are needed.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD42023480899, PROSPERO CRD42023480899.

Atypical hemolytic uremic syndrome (aHUS) is a rare, life-threatening disease characterized by uncontrolled complement activation and is associated with various genetic factors, including multiple variants at the gene locus encoding the complement component 3 (C3). However, only a few functional amino acid substitutions have been identified in C3. We report a pediatric case of aHUS presenting with refractory hypertension and massive gastrointestinal bleeding. Comprehensive histopathological, immunohistochemical, genetic, and molecular structural analyses were performed. Biopsy specimens were stained for renin and the membrane-attack complex of the complement system (C5b-9). Plasma levels of the Ba fragment of complement factor B were measured to evaluate the alternative pathway activation. Genomic DNA was obtained with consent and analyzed by targeted next-generation sequencing using a custom gene panel, followed by Sanger sequencing for variant confirmation. The possible effects of the identified amino acid substitution on the molecular structure of C3 were analyzed using computer-aided simulation with MODELLER and DoGSiteScorer. As a result, the juxtaglomerular apparatus was hyperplastic and intensely stained for renin. Endothelial cells of renal and intestinal blood vessels were positive for C5b-9. The plasma Ba level was elevated compared to the control level. The ileal and colonic mucosae were denuded and highly edematous, with epithelial cells undergoing regenerative and metaplastic changes in the active phase. Mucosal blood vessels contained intraluminal red cell fragments and neutrophils attached to swollen endothelial cells. However, the colonic mucosa showed near-normal histology after disease convalescence. Genetic analyses identified a single nucleotide C3 variant NM_000064.4(C3):c.4811T>C (p.Met1604Thr), resulting in an M₁₆₀₄T substitution in the functional C345C domain. Molecular structural analyses indicated that this amino acid substitution can cause the formation of a large cavity within the hydrophobic core of the C-terminal domain, possibly destabilizing the spherical structure of C3. Our study highlights that the M₁₆₀₄T substitution in the C3 C345C domain may drive the observed excessive complement activation, C5b-9 deposition on endothelial cells, and severe circulatory disturbances in the intestinal mucosa.