Frontiers in Pediatrics最新文献

Introduction: Child development must be carefully evaluated, requiring assessment instruments to assess different areas of development. Griffiths Scales of Child Development 3rd Edition (Griffiths III) is used to assess different areas of development in children. This study normalized Griffiths III for the Brazilian population from 0 to 72 months.

Methods: 445 typically developing children from 0 to 72 months, divided into eight groups (from 0 to 6 months; 7 to 12 months; 13 to 18 months; 19 to 24 months; 25 to 36 months; 37 to 48 months; 49 to 60 months; 61 to 72 months) participated. Their tutors answered the anamnesis protocol. Denver II Developmental Screening Test and Griffiths III were applied. Statistical analysis was performed using the Mann-Whitney Test and Spearman's rank correlation coefficient. Normalization followed the criteria of the original scale.

Results: There was a direct and statistically significant correlation between maternal schooling and socioeconomic status; a direct correlation in the performance between the subscales. The normalization table of Griffiths III with the developmental age of children from 0 to 72 months was elaborated through linear progression, calculated using a specific formula.

Discussion: The data collected for the Brazilian population from 0 to 72 months were normalized, following the guidelines and norms of the original Griffiths III.

Background: Genomic or exome sequencing is beneficial for identifying more than one pathogenic variation causing blended atypical and/or severe phenotypes. Herein, we are the first to report a 5-year-old boy with the blended phenotypes of infantile hypotonia, severe neurodevelopmental disorder, patent ductus arteriosus, cryptorchidism, obesity, distinctive facial features, and elevated isovaleryl carnitine.

Methods: Trio-based whole-exome sequencing was performed on genomic DNA from peripheral blood samples from the boy and his parents. Functional analysis of the IVD variant in vitro was performed. Mutant IVD gene pcDNA3.1(+)-MUT-3xFlag and control pcDNA3.1(+)-WT-3xFlag mammalian expression vectors were constructed. Both vectors were transformed into HEK293T cells. The assays of relative IVD gene mRNA expression, IVD protein expression, and enzymatic activity were used.

Results: Whole-exome sequencing identified a novel homozygous missense variant in the IVD gene (NM_002225.5) c.1006T>C (p.Cys336Arg) within a region of homozygosity of 15q11.2-q21.3. Our in vitro functional and computer simulation findings revealed that this variant was associated with haploinsufficiency, which resulted in dramatically reducing the formation of IVD protein due to unstable mutant protein and not a lack of mRNA expression.

Conclusion: The boy was diagnosed with the dual genetic disorders of Prader-Willi syndrome and isovaleric acidemia. This case provides a useful reference for genetic counseling for complex and diverse clinical phenotypes. The presence of two or more likely pathogenic or pathogenic variations in an individual with neurodevelopmental phenotypes is not an "exceptional" phenomenon.

Alopecia areata (AA) is the third most common reason for dermatological consultations among children. Despite the availability of numerous therapies for AA, including topical and systemic modalities, management options for children diagnosed with severe AA are limited due to the lack of safe and effective treatments suitable for long-term use. Herein, a case involving a 5-year-old boy with severe ophiasis-pattern AA and moderate atopic dermatitis (AD), who was successfully treated with dupilumab, is reported.

Recurrent respiratory tract infections (RRTIs) are a common condition in pediatrics and significantly impact children's quality of life; however, their pathogenesis and contributing factors are not yet fully elucidated. Probiotics have recently emerged as promising agents for modulating intestinal microecology and have gained considerable attention in clinical research on preventing and treating RRTIs in children. This article provides an initial overview of the concept, classification, and mechanisms underlying probiotics. It emphasizes their beneficial effects on respiratory health by modulating intestinal microbial equilibrium, augmenting immune system functionality, and attenuating inflammatory responses. Subsequently, we examine existing research regarding the use of probiotics in pediatric RRTIs. Numerous clinical trials have unequivocally demonstrated that supplementing with probiotics can significantly reduce both the frequency and severity of RRTIs in children while also simultaneously decreasing antibiotic usage. However, there are ongoing controversies and challenges in current research concerning the influence of probiotic type, dosage, duration of use, and other factors on efficacy. Furthermore, variations have been observed across different studies. Additionally, it is crucial to further evaluate the safety and potential long-term side effects associated with probiotic use in children with RRTIs. In conclusion, we propose future research directions including conducting more high-quality randomized controlled trials to optimize application strategies for probiotics alongside other treatments while considering variations based on age and health conditions among pediatric populations. Finally, in summary although probiotics exhibit promising benefits in preventing and treating RRTIs in children; additional studies are necessary to refine their application strategies ensuring both safety and effectiveness.

Background: Physical activity (PA) protects against cardiovascular disease. However, previous research has shown that high PA is associated with an increased carotid intima-media-thickness (cIMT), an independent predictor for future cardiovascular disease. Our aim was to further investigate this unexpected association with two different measurement methods of PA and two established markers for Early Vascular Ageing: cIMT and carotid-femoral pulse-wave velocity (cfPWV).

Methods: The community-based Early Vascular Ageing-Tyrol cohort study included adolescents in western Austria and northern Italy. Medical examinations included anthropometric measurements, fasting blood analysis, a physician guided interview to assess lifestyle factors, measurement of cIMT and cfPWV. PA was rated by an in-person interview on the basis of average minutes of moderate- or vigorous sports per day and by the Baecke questionnaire expressed as Baecke score (BS).

Results: Complete data set was available for 1,001 adolescents with a mean age of 17.8 years (standard deviation ±0.9 years). 558 (55.7%) of participants were female. cIMT was positively associated with both measures of PA in univariate (minutes sports per day: p < 0.001; BS: p < 0.001) as well as multivariable analysis adjusting for established cardiovascular risk factors (minutes sports per day: p = 0.001; BS: p = 0.002). Using cfPWV in a multivariate model an inverse correlation with the BS (p = 0.023) was observed, but not for minutes sports per day (p = 0.554).

Conclusion: In our large community-based cohort of adolescents, PA was associated with an increased cIMT but shows a trend towards lower aortic stiffness measured by cfPWV. We hypothesize that the association of PA with increased cIMT is not caused by early atherosclerotic vessel wall changes but is rather a physiologic adaptive process of the vessel wall.

Trial registration number: The EVA-Tyrol Study has been registered at clinicaltrials.gov under NCT03929692 since April 29, 2019.

Objective: The aim of this study was to investigate the characteristics of Kawasaki disease (KD) in patients demonstrating pneumonia-like changes and pulmonary complications, as well as the subsequent impact on coronary artery lesions, by comparing them with those of KD patients with normal pulmonary imaging.

Method: From January 1, 2013 to October 1, 2022, this study included paediatric patients diagnosed with KD who were registered in the KD database at Yuying Children's Hospital affiliated with Wenzhou Medical University. Patients were divided into three distinct groups based on the presence and severity of abnormalities observed via lung imaging. We first compared the demographic and clinical characteristics across these groups. The imaging characteristics of KD patients with pneumonia-like changes and pulmonary complications were identified via chest radiography (x-ray) and chest computerized tomography (CT). Logistic regression models and stratified analyses were employed to further identify factors influencing coronary artery lesions (CALs).

Results: Among the 2,686 KD children admitted to our centre in recent years, 115 presented with pneumonia-like changes, 366 presented with pulmonary complications, and 495 presented with no evident abnormalities on chest radiographs. In KD patients with pneumonia-like changes, there were significant elevations in inflammatory markers including the C-reactive protein (CRP) (P = 0.011), white blood cell (WBC) (P = 0.027), NT-proBNP (P = 0.007), and D-dimer (D-D) (P = 0.002) levels. Imaging studies have frequently revealed bilateral lung infections, predominantly in the mid-lower lung fields. Bronchitis-related changes were the most common manifestation of pulmonary complications in KD patients. A significant difference was observed in the incidence of CALs among patients with pneumonia-like changes. After adjusting for confounding variables, patients with pneumonia-like changes had a greater likelihood of developing CALs, with an adjusted odds ratio (OR) of 1.94 [95% confidence interval (CI): 1.21, 3.11]. Similar findings were obtained through stratification and sensitivity analyses.

Conclusion: Patients diagnosed with KD who develop pneumonia-like changes and related pulmonary complications can be identified based on their clinical manifestations and imaging characteristics. Moreover, patients with KD and pneumonia-like changes had a significantly increased risk of developing CALs.

Aim: This study aimed to evaluate a clinical project aiming to address gaps in healthcare for young children in an immigrant, low-resource district from early identification of regulatory problems, autism, and other neurodevelopmental symptoms by child health services to assessment and interventions in specialist care.

Methods: A mixed-model design was employed, consisting of a description of the clinical project and data from healthcare statistics to evaluating the care chain. Qualitative in-depth interviews were conducted to capture the perspectives of participating child health nurses. Data were analyzed using content analysis.

Results: The mean age for referral from primary to specialist care for suspected autism decreased from 38 to 27 months at (n = 59). A total of 55 children were diagnosed with autism. The mean age at autism diagnosis decreased from 44 to 31 months. Waiting times from referral to intervention were shortened. Interventions were already initiated in primary care at the time of referral. Qualitative analyses of nurse experiences revealed three main categories: (1) new and increased knowledge, (2) great importance for every child and family, and (3) an efficient method with fewer gaps, which holds further potential for development.

Conclusion: Professionals' increased knowledge of early symptoms in children, combined with novel healthcare methods for close collaboration, made it possible to bridge the gaps and provide young children and their families with early assessments and essential early interventions. The study results point to opportunities for integrated healthcare and collaboration with families and preschools.

Background: Since children cannot express pain, postoperative pain treatment for them is relatively lacking. In this meta-analysis, we compared the postoperative analgesic effects of quadratus lumborum block (QLB) and caudal block (CB) in surgeries involving the lower abdomen, inguinal region, and urogenital system in children.

Objective: This review examined the postoperative analgesic effects of QLB and CB in pediatric patients (0-18 years of age) undergoing abdominal surgery. The primary endpoint was the rate of postoperative rescue analgesia, defined as the proportion of patients who returned to acetaminophen, ibuprofen, and other analgesics when the pain score was greater than the protocol preset value within 24 h after surgery. Secondary outcomes included resting pain scores (0-10) at 30 min, 4 h, 12 h, and 24 h after surgery. Other secondary outcome measures were the time of first rescue analgesia, the incidence of PONV, and the incidence of postoperative complications, such as post-block infection, anaphylaxis to local anesthesia and hematoma.

Evidence review: We systematically reviewed Pubmed, Central, EMBASE, Google Scholar, Web of Science citation index, the US clinical trials register, and abstracts for randomized controlled trials that compared these blocks and reported the rate of postoperative rescue analgesia.

Findings: Seven RCTs (444 patients) were included in the final analysis. In pediatric abdominal surgery, compared with CB, QLB could reduce the rate of postoperative rescue analgesia within 24 h after surgery (RR = 0.37; 95% CI = 0.26 to 0.51; P < 0.01). The pain score in the QLB group at 4 (SMD = -0.11; 95% CI = -0.21 to -0.01; P = 0.02) and 12 h (SMD = -0.11; 95% CI = -0.22 to 0.00; P = 0.06) after surgery was lower, but at 0.5(SMD = 0.42; 95% CI = 0.34 to 0.50; P < 0.01) and 24 h (SMD = 0.30; 95% CI = 0.03 to 0.58; P = 0.03) was higher than that in the CB group. Of note, these pain score differences were not clinically significant. In addition, there was no significant difference in the incidence of complications or side effects between the QLB and the CB group (RR = 0.94; 95% CI = 0.59 to 1.48; P = 0.77).

Conclusion: In conclusion, QLB might have a better postoperative analgesic effect for lower abdominal surgery than CB in pediatric patients. However, due to the relatively few RCTs identified and significant heterogeneity, further research in the future is needed to prove these findings.

Systematic review registration: identifier (CRD 42023441447).