Frontiers in Pediatrics最新文献

Fournier's gangrene (FG) is a form of necrotizing fasciitis affecting the perineal and external genital regions. It is a rare urological emergency, particularly uncommon in children. Accurate diagnosis, early administration of broad-spectrum antibiotics, and timely surgical debridement are essential for effective management. In this study, we present three distinct pediatric cases of FG. The first case involved a 10-month-old boy with no underlying health conditions who was successfully treated with favorable outcomes. The second case was a 12-year-old boy with dengue fever and extensive scrotal gangrene, who recovered well after a challenging postoperative course. The third case was a 4-year-old boy who developed necrotizing scrotal infection following a second-stage hypospadias repair. All three patients were promptly diagnosed and managed with early intervention.

Background: Pediatric severe sepsis (PSS) is one of the leading causes of morbidity and mortality in children, incurring substantial social costs. Acute kidney injury (AKI) plays a critical role in determining PSS severity and prognosis. However, existing literature provides limited data regarding the risk factors associated with AKI in pediatric sepsis patients and the impact of AKI on hospital outcomes for these patients. This study aimed to analyze the temporal trends in incidence and outcomes of AKI among hospitalized PSS patients from 2010 to 2019, and identify associated risk factors; and assess the impact of AKI on in-hospital mortality and healthcare resource utilization.

Methods: This study utilized the nationally representative National Inpatient Sample (NIS) database of the United States to conduct a retrospective analysis. All children aged 0 (infants) to 18 years who were diagnosed with severe sepsis between 2010 and 2019 were included. Patients were grouped by AKI status, and in-hospital mortality and medical resource utilization (length of stay and inflation-adjusted costs) were compared. Multivariate regression identified AKI risk factors.

Results: The incidence rate of AKI among hospitalized PSS patients increased from 2.7% in 2010 to 8.0% in 2019. However, in-hospital mortality declined from 32.40% to 17.90% over the same period. The incidence of AKI was significantly higher in patients with comorbidities. Studies have shown that hospitalizations associated with AKI have a higher likelihood of involving infection sites and a variety of pathogenic flora.

Conclusion: While the incidence of AKI increased from 2010 to 2019, associated mortality decreased. This likely reflects advancements in critical care that are improving survival, even as more cases are recognized. AKI, affecting 5% of PSS patients, remained a potent marker of severity, was associated with a sevenfold increased risk of mortality and driven by identifiable risk factors like specific comorbidities and infections. Enhanced early identification of at-risk children is crucial to further improve outcomes.

Extracorporeal Shock Wave Lithotripsy (ESWL) has been a cornerstone in treating pediatric urinary stones for nearly four decades, but requires tailored approaches due to anatomical and physiological differences from adults. This review synthesizes current evidence on ESWL efficacy predictors in children, integrating multicenter data and emerging technologies. Key traditional predictors include favorable stone characteristics [density ≤600 Hounsfield units [HU], size ≤15 mm, skin-to-stone distance [SSD] ≤6.6 cm, upper/middle calyx or ureteral location] and patient factors (age ≤3 years, male sex); conversely, urinary tract infections (UTIs), BMI >22, and multiple stones correlate with poorer outcomes. Innovations like dual-energy CT (DECT), AI-based models, shear wave elastography (SWE), and bioelectric impedance analysis (BIA) offer promising non-invasive preoperative assessment. We highlight the need for standardized multifactorial predictive models to optimize pediatric ESWL outcomes. Future directions emphasize AI, big data, and multidisciplinary collaboration to enhance personalized treatment and reduce complications. This analysis provides clinicians with evidence-based tools to refine pediatric ESWL protocols.

Background: Femoral head chondroblastoma is a rare benign tumor in adolescents (10-20 years). Traditional surgeries face difficulties like poor exposure, high trauma, and risks of physeal injury/avascular necrosis (AVN). The DAA-SHD approach (no greater trochanteric osteotomy) is proposed for direct tumor resection, vascular preservation, and articular cartilage repair.

Methods: A literature review (2005-2025) on adolescent femoral head chondroblastoma was conducted. Retrospective analysis of 4 cases (2014-2025) treated with supine DAA-SHD (same senior surgeon) autologous iliac bone grafting. Hip function was assessed via MSTS scale.

Results: Mean follow-up: 64.75 months (9-124 months). All 4 cases had excellent/good MSTS scores (25-29 points). Imaging showed satisfactory bone graft healing; no AVN, recurrence, or limp/pain occurred.

Conclusion: Supine DAA-SHD (no trochanteric osteotomy) is effective for adolescent femoral head chondroblastoma, enabling complete resection, anatomical reconstruction, and vascular protection. It enriches pediatric hip tumor treatment options but needs validation via large-scale prospective studies.

Clostridioides difficile infection (CDI) represents a significant and increasingly recognized complication in children with inflammatory bowel disease (IBD), contributing to prolonged hospitalization and risk of adverse outcomes. Children with IBD are particularly susceptible due to frequent antibiotic exposure, healthcare system contact, immunosuppressive therapy, and underlying gut dysbiosis, all of which promote colonization and toxin-mediated intestinal injury. Distinguishing CDI from an IBD flare is challenging, as gastrointestinal symptoms and systemic inflammation overlap, and asymptomatic toxigenic colonization is common. Management recommendations for pediatric IBD-associated CDI are largely extrapolated from adult studies, with prompt initiation of targeted antibiotics being critical. Immunosuppressive therapy is generally continued, with escalation considered if diarrhea persists despite CDI-directed therapy. Fecal microbiota transplantation (FMT) has emerged as a safe and promising option for recurrent CDI in children with IBD, although careful patient selection, donor choice, and timing remain crucial. Key challenges persist in differentiating true CDI from IBD flares, understanding the clinical impact of asymptomatic colonization, and optimizing microbiome-targeted interventions. Future research should prioritize biomarker-driven diagnosis, individualized therapeutic strategies, and longitudinal evaluation of microbiome-based treatments to improve outcomes in pediatric patients with concurrent CDI and IBD.

Background: Residual acetabular dysplasia (RAD) is a common complication following closed reduction (CR) for developmental dysplasia of the hip (DDH). This study aims to perform a meta-analysis to identify predictive factors for RAD in order to provide a theoretical basis for early clinical identification and prevention.

Methods: A comprehensive literature search was conducted in PubMed, Embase, Web of Science, and the Cochrane Library databases, covering the period from database inception to November 2024. The quality of the included studies was assessed using the Newcastle-Ottawa Scale, and data analysis was performed using StataSE-64 and RevMan 5.4 software. The odds ratio (OR) and 95% confidence interval (CI) were used for data synthesis. Evidence for all outcomes was graded according to the GRADE system.

Results: This meta-analysis included 16 studies, including a total of 1,338 children who underwent CR for DDH. The analysis identified female sex (OR: 1.96; 95% CI: 1.01-3.81; p = 0.05) and femoral head coverage (FHC) (OR: 0.95; 95% CI: 0.92-0.97; p = 0.0002) as risk factors for RAD after CR. However, acetabular index (AI) (OR: 1.11; 95% CI: 0.94-1.31; p = 0.21), treatment age (<1 year vs. ≥1 year) (OR: 1.16; 95% CI: 0.95-1.42; p = 0.13), side of DDH occurrence (OR: 0.84; 95% CI: 0.52-1.36; p = 0.48), and number of affected sides (OR: 0.76; 95% CI: 0.05-12.72; p = 0.85) were not identified as risk factors for RAD. According to the GRADE assessment, all indicators were rated as "very low-quality evidence," except for FHC, which was classified as "low-quality evidence."

Conclusion: The results of this study indicate that female sex and FHC are the primary risk factors for RAD after CR treatment of DDH. Given the inherent limitations of this study, further multicenter prospective clinical studies are needed to clarify the factors contributing to RAD after CR in children with DDH and to implement preventive measures to improve the long-term prognosis of these children.

Systematic review registration: PROSPERO CRD420251016618.

Background and aim: The effective management of a child with cancer by their family depends on their coping strategies, the child's treatment outcomes, and their quality of life. For families of children with retinoblastoma, this study aims to use latent profile analysis to categorize family management patterns, understand their traits, explore influencing factors, and provide a theoretical basis for targeted interventions.

Methods: From February to April 2024, a cross-sectional study was conducted with the parents of 608 children with retinoblastoma. These parents completed a survey assessing family management, comprehensive needs, coping tendencies, family functioning, social support and levels of depression, anxiety and stress.

Results: Three family management categories were defined as: high-level (n = 93), moderate-level (n = 268), and low-level functioning (n = 247). Multiple logistic regression analysis showed that better family functioning (odds ratio [OR] = 0.821, P = 0.004), unilateral diseased eyes (OR = 0.286, P = 0.001) and high social support (OR = 0.972, P = 0.023) increased the likelihood of high-level functioning group. Factors linked to the low-level family management group included severe depression (OR = 1.320, P = 0.005), severe stress (OR = 1.210, P = 0.033), high comprehensive needs (OR = 1.025, P = 0.001), junior high school and below education (OR = 4.021, P = 0.005).

Conclusions: The family management characteristics of parents of children with retinoblastoma exhibit group heterogeneity, and key factors affecting this heterogeneity have been identified. These include family functioning, comprehensive needs, educational background, depression, stress, and social support. Healthcare professionals can use this information to develop targeted intervention strategies and improve family management.

A male infant born vaginally with clear amniotic fluid at a gestational age of 24 weeks had Apgar scores of 6 at 1 and 5 min and 7 at 10 min and a birth weight of 600 g. After receiving pulmonary surfactant therapy administered through an endotracheal tube at the local hospital, he continued to exhibit severe respiratory distress and hypoxemia; moreover, obtaining peripheral venous access remained difficult despite mechanical ventilation. Consequently, the neonatal transport team from our hospital was called to assist with treatment and transfer. Upon arrival, the transport team used point-of-care critical ultrasound for dynamic assessment and obtained the following findings: (1) the lung ultrasound assessments excluded pneumothorax and helped optimize the ventilator parameters to achieve patient-ventilator synchrony; (2) endotracheal tube placement was confirmed; (3) cranial ultrasound was performed to screen for intracranial hemorrhage; and (4) ultrasound-guided umbilical arterial and venous catheterization was successfully performed to establish vascular access. Under mechanical ventilation support and continuous monitoring, the infant was successfully transported to our neonatal intensive care unit (NICU), requiring no repeat invasive procedures upon admission and maintaining a stable condition throughout transport. This case demonstrates the effectiveness of point-of-care critical ultrasound for real-time guidance during the resuscitation and transport of extremely preterm infants. By enabling multi-system evaluation that included lung, airway, vascular, and cranial assessments, this approach substantially enhanced management efficiency, reduced complications, and offered reliable technical support for the transport of high-risk neonates.

Background: This study evaluates the diagnostic efficacy of next-generation sequencing (NGS) in pediatric patients with suspected pneumonia and unidentified etiologies.

Objective: This retrospective study encompassed pediatric patients with suspected pneumonia, spanning the period from January 2022 to December 2023. Nasal swabs and blood samples were collected for a comprehensive diagnostic panel, including NGS, blood culture, complete blood count, and serum biomarkers.

Methods: Routine diagnostic tests were compared with NGS for turnaround time and diagnostic accuracy. Patients were categorized based on clinical diagnosis into non-pneumonia and pneumonia groups. Logistic regression analysis was performed to identify independent predictors of pneumonia.

Results: NGS provided results within 24 h, significantly faster than conventional bacterial cultures (3-5 days). The positivity rate for pathogen identification increased from 55.3% with traditional methods to 86.2% with NGS (p < 0.05). Serum levels of procalcitonin, creatinine, and C-reactive protein were elevated in pneumonia patients, while albumin levels were decreased. Logistic regression identified C-reactive protein and albumin as independent predictors of pneumonia. The area under the receiver operating characteristic curve for NGS was superior to conventional methods and serum biomarkers alone or in combination.

Conclusion: NGS is a promising tool for rapid and accurate etiologic diagnosis of pneumonia in children. The combination of NGS with albumin levels may serve as an effective screening strategy, potentially enhancing clinical management through earlier intervention and targeted therapy. Further validation in larger cohorts is warranted to establish the clinical utility of this approach.

Objective: To evaluate the surgical treatment strategies and clinical efficacy in patients with cutaneous skeletal hypophosphatemia syndrome (CSHS).

Methods: A retrospective analysis was conducted on three cases of CSHS treated at our institution. Clinical data included medical history, physical examination, laboratory tests (hypophosphatemia-related biomarkers and genetic testing), and imaging studies (x-ray and CT). Pre- and postoperative limb deformity correction and functional recovery were assessed.

Results: All three patients presented with multiple skeletal deformities and cutaneous melanocytic nevi. Laboratory tests confirmed persistent hypophosphatemia, while imaging revealed widespread osseous abnormalities and long-bone bowing deformities. Following corrective osteotomy with internal fixation, significant improvement in mechanical alignment was achieved.

Conclusions: Surgical intervention can effectively correct limb deformities, restore biomechanical alignment, and improve function in patients with CSHS. Hence, it represents a critical component of multidisciplinary management.