Introduction: There is a critical need for evidence-based and manualized interventions targeting water competency including swim and water safety skills tailored to meet the needs of children on the autism spectrum, a group that is at a high risk of drowning. This study examined the efficacy of AquOTic-a 10-week occupational therapy-based aquatic intervention to improve water competency among children on the autism spectrum.
Methods: A total of 37 children on the autism spectrum (ages 5-9 years) were randomized to a waitlist control group (n = 24) or AquOTic intervention group (n = 37; 28 males). Blinded assessors administered the standardized Water Orientation Test-Alyn (WOTA) 1 and 2 and a Swim Skills Checklist to all participants pre- and post-AquOTic/control. Repeated measures mixed effects models were used to examine intervention effects.
Results: Average WOTA 1 scores increased significantly after participants received AquOTic (Δ = 5.7; 95% CI: 3.7-7.8; p < 0.001), and average WOTA 2 scores increased significantly after participants received AquOTic (Δ = 9.0; 95% CI: 5.7-12.3; p < 0.001). Average swim skills increased significantly after participants received AquOTic (Δ = 7.6; 95% CI: 5.3, 10.0; p < 0.001).
Conclusion: Our results highlight the efficacy of AquOTic to improve water competency among children on the autism spectrum. Further research is needed to examine long-term effects, dosage requirements to achieve water competency, and the impact of aquatic therapy on other health outcomes.
{"title":"Improving water competency among children on the autism spectrum: the AquOTic randomized controlled trial.","authors":"Erika Kemp, Melica Nikahd, Mequeil Howard, Amy Darragh, Jewel E Crasta","doi":"10.3389/fped.2024.1473328","DOIUrl":"10.3389/fped.2024.1473328","url":null,"abstract":"<p><strong>Introduction: </strong>There is a critical need for evidence-based and manualized interventions targeting water competency including swim and water safety skills tailored to meet the needs of children on the autism spectrum, a group that is at a high risk of drowning. This study examined the efficacy of AquOTic-a 10-week occupational therapy-based aquatic intervention to improve water competency among children on the autism spectrum.</p><p><strong>Methods: </strong>A total of 37 children on the autism spectrum (ages 5-9 years) were randomized to a waitlist control group (<i>n</i> = 24) or AquOTic intervention group (<i>n</i> = 37; 28 males). Blinded assessors administered the standardized Water Orientation Test-Alyn (WOTA) 1 and 2 and a Swim Skills Checklist to all participants pre- and post-AquOTic/control. Repeated measures mixed effects models were used to examine intervention effects.</p><p><strong>Results: </strong>Average WOTA 1 scores increased significantly after participants received AquOTic (Δ = 5.7; 95% CI: 3.7-7.8; <i>p</i> < 0.001), and average WOTA 2 scores increased significantly after participants received AquOTic (Δ = 9.0; 95% CI: 5.7-12.3; <i>p</i> < 0.001). Average swim skills increased significantly after participants received AquOTic (Δ = 7.6; 95% CI: 5.3, 10.0; <i>p</i> < 0.001).</p><p><strong>Conclusion: </strong>Our results highlight the efficacy of AquOTic to improve water competency among children on the autism spectrum. Further research is needed to examine long-term effects, dosage requirements to achieve water competency, and the impact of aquatic therapy on other health outcomes.</p><p><strong>Clinical trials registration: </strong>clinicaltrials.gov, NCT05524753.</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/PMC11491375/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142463091","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}
Pub Date : 2024-10-03eCollection Date: 2024-01-01DOI: 10.3389/fped.2024.1443066
Stephanie Zipf, Ingmar Fortmann, Christoph Härtel, Oliver Andres, Eric Frieauff, Pia Paul, Anna Häfke, Heiko Reutter, Patrick Morhart, Ursula Weller, Amrei Welp, Henry Kipke, Egbert Herting, Alexander Humberg, Wolfgang Göpel, Kathrin Hanke
Background: Serum lactate levels are used as biomarkers for perinatal asphyxia, while their value for outcome prediction in preterm infants is uncertain. It was the aim of this observational study to determine the association of the first postnatal serum-lactate levels on day 1 of life and short-term outcome in preterm infants less than 29 gestational weeks.
Methods: We analysed data in a population-based cohort of German Neonatal Network (GNN) preterm infants with available first postnatal lactate levels enrolled at 22-28 weeks of gestational age (GA) between 1st of April 2009 and 31st December 2020. We hypothesized that high lactate levels as measured in mmol/L increase the risk of intraventricular haemorrhage (IVH) and bronchopulmonary dysplasia (BPD) in infants with VLBW regardless of small-for-gestational-age (SGA) status. Hypotheses were evaluated in univariate analyses and multiple logistic regression models.
Results: First postnatal lactate levels were available in 2499 infants. The study population had a median GA of 26.7 [IQR 25.2-27.9] weeks and birth weight of 840 g [IQR 665-995]. Infants with short-term complications such as IVH and BPD had higher initial lactate levels than non-affected infants. The positive predictive value of a lactate cut-off of 4 mmol/L was 0.28 for IVH and 0.30 for BPD. After adjustment for known confounding variables, each 1 mmol/L increase of day 1 lactate levels was associated with a modestly increased risk of IVH (OR 1.18; 95% CI 1.03-1.37; p = 0.002) and BPD (OR 1.23; 95% CI 1.06-1.43; p = 0.005) but not with sepsis or mortality. Notably, SGA was associated with lower risk of any grade and severe IVH (OR 0.70; 95% CI 0.54-0.85; p = 0.001).
Conclusions: In our observational cohort study higher initial lactate levels were associated with adverse outcome regardless of SGA status. However, the predictive value of lactate cut-off levels such as 4 mmol/L is low.
{"title":"First postnatal lactate blood levels on day 1 and outcome of preterm infants with gestational age <29 weeks.","authors":"Stephanie Zipf, Ingmar Fortmann, Christoph Härtel, Oliver Andres, Eric Frieauff, Pia Paul, Anna Häfke, Heiko Reutter, Patrick Morhart, Ursula Weller, Amrei Welp, Henry Kipke, Egbert Herting, Alexander Humberg, Wolfgang Göpel, Kathrin Hanke","doi":"10.3389/fped.2024.1443066","DOIUrl":"https://doi.org/10.3389/fped.2024.1443066","url":null,"abstract":"<p><strong>Background: </strong>Serum lactate levels are used as biomarkers for perinatal asphyxia, while their value for outcome prediction in preterm infants is uncertain. It was the aim of this observational study to determine the association of the first postnatal serum-lactate levels on day 1 of life and short-term outcome in preterm infants less than 29 gestational weeks.</p><p><strong>Methods: </strong>We analysed data in a population-based cohort of German Neonatal Network (GNN) preterm infants with available first postnatal lactate levels enrolled at 22-28 weeks of gestational age (GA) between 1st of April 2009 and 31st December 2020. We hypothesized that high lactate levels as measured in mmol/L increase the risk of intraventricular haemorrhage (IVH) and bronchopulmonary dysplasia (BPD) in infants with VLBW regardless of small-for-gestational-age (SGA) status. Hypotheses were evaluated in univariate analyses and multiple logistic regression models.</p><p><strong>Results: </strong>First postnatal lactate levels were available in 2499 infants. The study population had a median GA of 26.7 [IQR 25.2-27.9] weeks and birth weight of 840 g [IQR 665-995]. Infants with short-term complications such as IVH and BPD had higher initial lactate levels than non-affected infants. The positive predictive value of a lactate cut-off of 4 mmol/L was 0.28 for IVH and 0.30 for BPD. After adjustment for known confounding variables, each 1 mmol/L increase of day 1 lactate levels was associated with a modestly increased risk of IVH (OR 1.18; 95% CI 1.03-1.37; <i>p</i> = 0.002) and BPD (OR 1.23; 95% CI 1.06-1.43; <i>p</i> = 0.005) but not with sepsis or mortality. Notably, SGA was associated with lower risk of any grade and severe IVH (OR 0.70; 95% CI 0.54-0.85; <i>p</i> = 0.001).</p><p><strong>Conclusions: </strong>In our observational cohort study higher initial lactate levels were associated with adverse outcome regardless of SGA status. However, the predictive value of lactate cut-off levels such as 4 mmol/L is low.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11484003/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142463089","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}
Pub Date : 2024-10-03eCollection Date: 2024-01-01DOI: 10.3389/fped.2024.1440625
Ayodele Faleye
Pediatric rheumatology is a relatively new subspecialty in Nigeria. For many years, rheumatic disease had not been well-recognized or studied in Nigeria, so there has been a low suspicion index. The clinical presentation of most pediatric rheumatic diseases (PRDs) mimics non-rheumatic diseases making it a diagnostic challenge most of the time. The story has changed in Lagos since the creation of a pediatric rheumatology unit at the Lagos State University Teaching Hospital. There is now a high index of suspicion for these diseases in the hospital but no one knows about what is happening in the other 35 states of the country who do not have a pediatric rheumatologist. Major challenges being faced presently are poor awareness among healthcare workers and the community, high cost of investigations and medications, lack of pediatric rheumatologists in most hospitals in the country, lack of pediatric rheumatology training centers for both undergraduate and postgraduate training, and lack of research data. The healthcare community in Nigeria is looking forward to a future where pediatric rheumatology will be highly recognized and established.
小儿风湿病学在尼日利亚是一个相对较新的亚专科。多年来,风湿病在尼日利亚一直未得到充分认识或研究,因此怀疑指数较低。大多数小儿风湿病(PRDs)的临床表现都与非风湿性疾病相似,因此在大多数情况下都是诊断难题。自从拉各斯州立大学教学医院(Lagos State University Teaching Hospital)成立了小儿风湿病科后,拉各斯的情况发生了变化。现在,该医院对这些疾病的怀疑指数很高,但没有人知道全国其他 35 个没有儿科风湿病医生的州的情况如何。目前面临的主要挑战包括:医护人员和社区的认识不足、检查和药物费用高昂、国内大多数医院缺乏小儿风湿病专家、缺乏小儿风湿病培训中心进行本科生和研究生培训以及缺乏研究数据。尼日利亚医疗界期待着未来儿科风湿病学能够得到高度认可和建立。
{"title":"Paediatric rheumatology in Nigeria: history, challenges and the future.","authors":"Ayodele Faleye","doi":"10.3389/fped.2024.1440625","DOIUrl":"https://doi.org/10.3389/fped.2024.1440625","url":null,"abstract":"<p><p>Pediatric rheumatology is a relatively new subspecialty in Nigeria. For many years, rheumatic disease had not been well-recognized or studied in Nigeria, so there has been a low suspicion index. The clinical presentation of most pediatric rheumatic diseases (PRDs) mimics non-rheumatic diseases making it a diagnostic challenge most of the time. The story has changed in Lagos since the creation of a pediatric rheumatology unit at the Lagos State University Teaching Hospital. There is now a high index of suspicion for these diseases in the hospital but no one knows about what is happening in the other 35 states of the country who do not have a pediatric rheumatologist. Major challenges being faced presently are poor awareness among healthcare workers and the community, high cost of investigations and medications, lack of pediatric rheumatologists in most hospitals in the country, lack of pediatric rheumatology training centers for both undergraduate and postgraduate training, and lack of research data. The healthcare community in Nigeria is looking forward to a future where pediatric rheumatology will be highly recognized and established.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11484408/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142463093","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}
Pub Date : 2024-10-03eCollection Date: 2024-01-01DOI: 10.3389/fped.2024.1454657
Yonghan Luo, Xiaotao Yang, Jun Zhou, Shuangqiong Pu, Yanchun Wang
The clinical symptoms of tuberculosis infection in children are not typical and need to be distinguished from many diseases, and the tumor is one of them. We present a case of cervical lymphadenopathy in a child with positive purified protein derivative (PPD) and Interferon-Gamma Release Assay results, ultimately diagnosed with Hodgkin's lymphoma via cervical lymph node biopsy. We learned some lessons from the case: First, Pathological biopsy remains the "gold standard" for diagnosing tuberculosis. Second, there are limitations of sampling in lump fine needle aspiration biopsy, surgical methods for lymph node are preferred to obtain larger tissues and improve tuberculosis detection sensitivity.
{"title":"Case Report: Reiterating the importance of tissue biopsy in the diagnosis of tuberculosis: lessons from a case of pediatric pulmonary tuberculosis complicated by Hodgkin's lymphoma.","authors":"Yonghan Luo, Xiaotao Yang, Jun Zhou, Shuangqiong Pu, Yanchun Wang","doi":"10.3389/fped.2024.1454657","DOIUrl":"https://doi.org/10.3389/fped.2024.1454657","url":null,"abstract":"<p><p>The clinical symptoms of tuberculosis infection in children are not typical and need to be distinguished from many diseases, and the tumor is one of them. We present a case of cervical lymphadenopathy in a child with positive purified protein derivative (PPD) and Interferon-Gamma Release Assay results, ultimately diagnosed with Hodgkin's lymphoma via cervical lymph node biopsy. We learned some lessons from the case: First, Pathological biopsy remains the \"gold standard\" for diagnosing tuberculosis. Second, there are limitations of sampling in lump fine needle aspiration biopsy, surgical methods for lymph node are preferred to obtain larger tissues and improve tuberculosis detection sensitivity.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11484245/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142463072","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}
Pub Date : 2024-10-03eCollection Date: 2024-01-01DOI: 10.3389/fped.2024.1452862
Albert Fabregat-Sanjuan, Ángel Rodríguez-Ballabriga, Agnès Rigo-Vidal, Rosa Pàmies-Vilà, Susana Larrosa-Capaces, Vanesa Rius-Costa, Vicenç Pascual-Rubio
Background: Neonatologists and clinical neurophysiologists face challenges with the current electrodes used for long-duration amplitude-integrated electroencephalography (aEEG) in neonatal intensive care units (NICU), limiting the capacity to diagnose brain damage.
Objectives: The objectives of this study were to develop methods for comparing the performance of different electrodes to be used in aEEG. The comparison was done between a newly designed neonate-specific electrode, aCUP-E, with commercial liquid gel electrodes used in amplitude-integrated electroencephalography (aEEG). The comparison included impedance stability, electrode survival, recording quality, usability, and satisfaction of NICU staff.
Methods: aEEG recordings with bipolar montage was used, with one hemisphere fitted with commercial electrodes and the other with aCUP-E electrodes, alternated among subjects. Continuous impedance and raw EEG data were collected over a minimum of 24 h, and signal processing was performed using Python and MATLAB.
Main results: aCUP-E electrodes demonstrated superior performance, including: Increased impedance stability and electrode survival, enhanced recording quality with fewer artifacts, high correlation in signal capture between electrodes during optimal brain activity segments, higher signal-to-noise ratio (SNR) across varying impedance levels, greater staff satisfaction and ease of use. Moreover, Kaplan-Meier curves indicated a higher survival rate for aCUP-E electrodes over 24 h compared to commercial electrodes. Impedance variability analysis showed statistically significant stability improvements for aCUP-E.
Conclusion: aCUP-E electrodes outperform commercial liquid gel electrodes in impedance stability, electrode survival, and recording quality. These results suggest that aCUP-E electrodes could significantly enhance aEEG utilization in diagnosing and treating neonatal brain conditions in NICUs. Future improvements to the aCUP-E electrode may further reduce artifacts and increase electrode longevity, potentially leading to a significant improvement in neonatal brain monitoring by means of aEEG.
{"title":"Analysis of electrode performance on amplitude integrated electroencephalography in neonates: evaluation of a new electrode aCUP-E vs. liquid gel electrodes.","authors":"Albert Fabregat-Sanjuan, Ángel Rodríguez-Ballabriga, Agnès Rigo-Vidal, Rosa Pàmies-Vilà, Susana Larrosa-Capaces, Vanesa Rius-Costa, Vicenç Pascual-Rubio","doi":"10.3389/fped.2024.1452862","DOIUrl":"https://doi.org/10.3389/fped.2024.1452862","url":null,"abstract":"<p><strong>Background: </strong>Neonatologists and clinical neurophysiologists face challenges with the current electrodes used for long-duration amplitude-integrated electroencephalography (aEEG) in neonatal intensive care units (NICU), limiting the capacity to diagnose brain damage.</p><p><strong>Objectives: </strong>The objectives of this study were to develop methods for comparing the performance of different electrodes to be used in aEEG. The comparison was done between a newly designed neonate-specific electrode, aCUP-E, with commercial liquid gel electrodes used in amplitude-integrated electroencephalography (aEEG). The comparison included impedance stability, electrode survival, recording quality, usability, and satisfaction of NICU staff.</p><p><strong>Methods: </strong>aEEG recordings with bipolar montage was used, with one hemisphere fitted with commercial electrodes and the other with aCUP-E electrodes, alternated among subjects. Continuous impedance and raw EEG data were collected over a minimum of 24 h, and signal processing was performed using Python and MATLAB.</p><p><strong>Main results: </strong>aCUP-E electrodes demonstrated superior performance, including: Increased impedance stability and electrode survival, enhanced recording quality with fewer artifacts, high correlation in signal capture between electrodes during optimal brain activity segments, higher signal-to-noise ratio (SNR) across varying impedance levels, greater staff satisfaction and ease of use. Moreover, Kaplan-Meier curves indicated a higher survival rate for aCUP-E electrodes over 24 h compared to commercial electrodes. Impedance variability analysis showed statistically significant stability improvements for aCUP-E.</p><p><strong>Conclusion: </strong>aCUP-E electrodes outperform commercial liquid gel electrodes in impedance stability, electrode survival, and recording quality. These results suggest that aCUP-E electrodes could significantly enhance aEEG utilization in diagnosing and treating neonatal brain conditions in NICUs. Future improvements to the aCUP-E electrode may further reduce artifacts and increase electrode longevity, potentially leading to a significant improvement in neonatal brain monitoring by means of aEEG.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11484018/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142463071","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}
Pub Date : 2024-10-03eCollection Date: 2024-01-01DOI: 10.3389/fped.2024.1352879
Xinyi Luo, Huan Wang, Huixia Liu, Yue Chen, Li Tian, Qing Ji, Dengpiao Xie
Background and aim: Recent studies have demonstrated the anti-allergic effects of probiotics in humans. However, their role in preventing and treating pediatric allergic rhinitis has not been thoroughly investigated. This study aimed to systematically review the efficacy and preventive effects of probiotics on pediatric allergic rhinitis.
Methods: We systematically searched PubMed, Embase, the Cochrane Central Register of Controlled Trials, and Web of Science databases for all relevant studies on probiotics and pediatric allergic rhinitis. Studies meeting the inclusion criteria were included, data were extracted, and meta-analyses were performed.
Results: A total of 28 studies with 4,765 participants were included in this study. The pooled results showed that the use of probiotics was associated with a significant improvement in total nose symptom scores (SMD, -2.27; 95% CI, -3.26 to -1.29; P < 0.00001), itchy nose scores (SMD, -0.44; 95% CI, -0.80 to -0.07; P = 0.02), sneezing scores (SMD, -0.47; 95% CI, -0.84 to -0.10; P = 0.01), eye symptoms (SMD, -3.77; 95% CI, -5.47 to -2.07; P < 0.00001), and Pediatric Rhinoconjunctivitis Quality of Life Questionnaire (SMD, -2.52; 95% CI, -4.12 to -0.92; P < 00001). However, the use of probiotics was not associated with the incidence of allergic rhinitis (RR, 0.9; 95% CI, 0.74-1.08; P = 0.26).
Conclusions: The present study demonstrated that probiotics were effective and safe for improving pediatric allergic rhinitis symptoms and quality of life. However, probiotics could not prevent pediatric allergic rhinitis.
背景和目的:最近的研究表明,益生菌对人类具有抗过敏作用。然而,它们在预防和治疗小儿过敏性鼻炎方面的作用尚未得到深入研究。本研究旨在系统回顾益生菌对小儿过敏性鼻炎的疗效和预防作用:我们系统地检索了 PubMed、Embase、Cochrane Central Register of Controlled Trials 和 Web of Science 数据库中所有与益生菌和小儿过敏性鼻炎相关的研究。纳入符合纳入标准的研究,提取数据并进行荟萃分析:结果:本研究共纳入 28 项研究,4,765 人参与。汇总结果显示,使用益生菌可显著改善鼻部症状总分(SMD,-2.27;95% CI,-3.26 至-1.29;P P = 0.02)、打喷嚏得分(SMD,-0.47;95% CI,-0.84 至-0.10;P = 0.01)、眼部症状(SMD,-3.77;95% CI,-5.47 至-2.07;P P = 0.26):本研究表明,益生菌对改善小儿过敏性鼻炎症状和生活质量有效且安全。然而,益生菌并不能预防小儿过敏性鼻炎。
{"title":"Effects of probiotics on the prevention and treatment of children with allergic rhinitis: a meta-analysis of randomized controlled trials.","authors":"Xinyi Luo, Huan Wang, Huixia Liu, Yue Chen, Li Tian, Qing Ji, Dengpiao Xie","doi":"10.3389/fped.2024.1352879","DOIUrl":"https://doi.org/10.3389/fped.2024.1352879","url":null,"abstract":"<p><strong>Background and aim: </strong>Recent studies have demonstrated the anti-allergic effects of probiotics in humans. However, their role in preventing and treating pediatric allergic rhinitis has not been thoroughly investigated. This study aimed to systematically review the efficacy and preventive effects of probiotics on pediatric allergic rhinitis.</p><p><strong>Methods: </strong>We systematically searched PubMed, Embase, the Cochrane Central Register of Controlled Trials, and Web of Science databases for all relevant studies on probiotics and pediatric allergic rhinitis. Studies meeting the inclusion criteria were included, data were extracted, and meta-analyses were performed.</p><p><strong>Results: </strong>A total of 28 studies with 4,765 participants were included in this study. The pooled results showed that the use of probiotics was associated with a significant improvement in total nose symptom scores (SMD, -2.27; 95% CI, -3.26 to -1.29; <i>P</i> < 0.00001), itchy nose scores (SMD, -0.44; 95% CI, -0.80 to -0.07; <i>P</i> = 0.02), sneezing scores (SMD, -0.47; 95% CI, -0.84 to -0.10; <i>P</i> = 0.01), eye symptoms (SMD, -3.77; 95% CI, -5.47 to -2.07; <i>P</i> < 0.00001), and Pediatric Rhinoconjunctivitis Quality of Life Questionnaire (SMD, -2.52; 95% CI, -4.12 to -0.92; <i>P</i> < 00001). However, the use of probiotics was not associated with the incidence of allergic rhinitis (RR, 0.9; 95% CI, 0.74-1.08; <i>P</i> = 0.26).</p><p><strong>Conclusions: </strong>The present study demonstrated that probiotics were effective and safe for improving pediatric allergic rhinitis symptoms and quality of life. However, probiotics could not prevent pediatric allergic rhinitis.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11484092/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142463078","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}
Background and study design: Limited data exists on noradrenaline therapy in neonatal septic shock. We compared the efficacy of noradrenaline with adrenaline in neonatal septic shock. This single center, open label, pilot randomized controlled trial included neonates with clinical evidence of sepsis and shock.
Study outcomes: Primary outcomes were: 1) resolution of shock one hour after treatment, and 2) mortality during hospital stay. Secondary outcomes included: need for additional vasopressors; hemodynamic stability without further administration of vasopressors for ≥2 h; changes in blood pressure and heart rate after 1 h of vasopressor treatment; and morbidities during the hospital stay.
Results: Of 65 eligible neonates, 42 were randomized (21 each in adrenaline and noradrenaline treatment arms) between August 2020 and January 2022, at level III neonatal intensive care unit (NICU) of Bharati Vidyapeeth Deemed University Medical College and Hospital (BVDUMCH). The mean (SD) gestational age and mean (SD) birth weight were 36.1(4.2) weeks and 1.8 (0.2) kilograms birth weight for noradrenaline and 36.9 (4.1) weeks and 1.7 (0.7) kilograms for adrenaline. Shock resolved within 1 h of vasopressor therapy in 76.2% neonates in the noradrenaline arm and 61.9% in adrenaline arm (p value-0.53). Mortality during hospital stay was 28.6% (6/21) in noradrenaline group and 33.3% (7/21) in adrenaline group (p value- 0.58). Additional vasopressors were required in 23.8% neonates of the noradrenaline group compared to 38.1% neonates in adrenaline arm (p value-0.53). Median (SD) duration of intensive care stay was 6 (SD) days in the noradrenaline group and 10 (SD) days in the adrenaline group (p value-0.045).
Conclusion: Among neonates with septic shock, the efficacy of noradrenaline was comparable to adrenaline in resolving septic shock after one hour of infusion and on the mortality during hospital stay.
Clinical trial registration: https://ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid=NDI2NTc=&Enc=&userName=noradrenaline, Clinical Trials Registry - India with identifier CTRI/2020/08/027185 (17/08/2020).
{"title":"A pilot randomized controlled trial comparing noradrenaline and adrenaline as a first-line vasopressor for fluid-refractory septic shock in neonates.","authors":"Reema Garegrat, Suprabha Patnaik, Sonali Suryawanshi, Chinmay Chetan, Nishant Banait, Pari Singh, Aditya Kallimath, Naharmal B Soni, Yogen Singh, Pradeep Suryawanshi","doi":"10.3389/fped.2024.1443990","DOIUrl":"https://doi.org/10.3389/fped.2024.1443990","url":null,"abstract":"<p><strong>Background and study design: </strong>Limited data exists on noradrenaline therapy in neonatal septic shock. We compared the efficacy of noradrenaline with adrenaline in neonatal septic shock. This single center, open label, pilot randomized controlled trial included neonates with clinical evidence of sepsis and shock.</p><p><strong>Study outcomes: </strong>Primary outcomes were: 1) resolution of shock one hour after treatment, and 2) mortality during hospital stay. Secondary outcomes included: need for additional vasopressors; hemodynamic stability without further administration of vasopressors for ≥2 h; changes in blood pressure and heart rate after 1 h of vasopressor treatment; and morbidities during the hospital stay.</p><p><strong>Results: </strong>Of 65 eligible neonates, 42 were randomized (21 each in adrenaline and noradrenaline treatment arms) between August 2020 and January 2022, at level III neonatal intensive care unit (NICU) of Bharati Vidyapeeth Deemed University Medical College and Hospital (BVDUMCH). The mean (SD) gestational age and mean (SD) birth weight were 36.1(4.2) weeks and 1.8 (0.2) kilograms birth weight for noradrenaline and 36.9 (4.1) weeks and 1.7 (0.7) kilograms for adrenaline. Shock resolved within 1 h of vasopressor therapy in 76.2% neonates in the noradrenaline arm and 61.9% in adrenaline arm (<i>p</i> value-0.53). Mortality during hospital stay was 28.6% (6/21) in noradrenaline group and 33.3% (7/21) in adrenaline group (<i>p</i> value- 0.58). Additional vasopressors were required in 23.8% neonates of the noradrenaline group compared to 38.1% neonates in adrenaline arm (<i>p</i> value-0.53). Median (SD) duration of intensive care stay was 6 (SD) days in the noradrenaline group and 10 (SD) days in the adrenaline group (<i>p</i> value-0.045).</p><p><strong>Conclusion: </strong>Among neonates with septic shock, the efficacy of noradrenaline was comparable to adrenaline in resolving septic shock after one hour of infusion and on the mortality during hospital stay.</p><p><strong>Clinical trial registration: </strong>https://ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid=NDI2NTc=&Enc=&userName=noradrenaline, Clinical Trials Registry - India with identifier CTRI/2020/08/027185 (17/08/2020).</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11484266/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142463059","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}
Pub Date : 2024-10-02eCollection Date: 2024-01-01DOI: 10.3389/fped.2024.1453778
Dan Feng, Ye Li, Ya-Ting Zhang, Yan-Jun Song, Dong-Yuan Qin, Fan Wang
Background: WWOX-related epileptic encephalopathy is an autosomal recessive disorder caused by mutations in the WW-containing oxidoreductase gene, characterized by the onset of refractory seizures in infants. Early-onset epilepsy, electroencephalography abnormalities, and developmental delay or degeneration are the main clinical manifestations. Early death can occur in severe cases. In the present study, a novel variant in WWOX was detected in a patient with epilepsy and his healthy parents.
Case presentation: A 5-month-old boy presented with epilepsy. The main manifestations were intractable seizures, mental and motor retardation and hearing impairment. Subsequent genetic testing revealed the presence of an epilepsy-associated novel mutation: c.991C>A (amino acid change: p.Ser304Tyr) in the WWOX gene. Variants were inherited from parents with healthy phenotypes. Finally, a patient died at 6 months of age.
Conclusion: The discovery of novel variants has enriched the existing database of WWOX gene variants and may expand the range of clinical options for treating WWOX-related disorders.
{"title":"<i>WWOX</i>-related epileptic encephalopathy caused by a novel mutation in the <i>WWOX</i> gene: a case report.","authors":"Dan Feng, Ye Li, Ya-Ting Zhang, Yan-Jun Song, Dong-Yuan Qin, Fan Wang","doi":"10.3389/fped.2024.1453778","DOIUrl":"https://doi.org/10.3389/fped.2024.1453778","url":null,"abstract":"<p><strong>Background: </strong><i>WWOX</i>-related epileptic encephalopathy is an autosomal recessive disorder caused by mutations in the WW-containing oxidoreductase gene, characterized by the onset of refractory seizures in infants. Early-onset epilepsy, electroencephalography abnormalities, and developmental delay or degeneration are the main clinical manifestations. Early death can occur in severe cases. In the present study, a novel variant in <i>WWOX</i> was detected in a patient with epilepsy and his healthy parents.</p><p><strong>Case presentation: </strong>A 5-month-old boy presented with epilepsy. The main manifestations were intractable seizures, mental and motor retardation and hearing impairment. Subsequent genetic testing revealed the presence of an epilepsy-associated novel mutation: c.991C>A (amino acid change: p.Ser304Tyr) in the <i>WWOX</i> gene. Variants were inherited from parents with healthy phenotypes. Finally, a patient died at 6 months of age.</p><p><strong>Conclusion: </strong>The discovery of novel variants has enriched the existing database of <i>WWOX</i> gene variants and may expand the range of clinical options for treating <i>WWOX</i>-related disorders.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11479972/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142463058","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}
Objective: To explore the risk factors of delivery room (DR) resuscitation and assess the association of DR resuscitation with neonatal outcomes in very preterm infants (VPIs).
Methods: A multicenter retrospective cross-sectional study included VPIs with gestational age (GA) <32 weeks born between January, 2022 and June, 2023 and admitted to neonatal intensive care units of six tertiary hospitals in Shenzhen within 24 h after birth. They were divided into routine care group, positive-pressure ventilation (PPV) group, and endotracheal intubation (ETT) group based on the highest intensity of resuscitation received at birth. The association of antepartum and intrapartum risk factors and short-term outcomes with the intensity of DR resuscitation was evaluated.
Results: Of 683 infants included in this study, 170 (24.9%) received routine care, 260 (38.1%) received bag and mask ventilation or T-piece ventilation and 253 (37%) received ETT. Among the antepartum and intrapartum factors, exposure to antenatal steroids (ANS) decreased the likelihood of ETT. Increasing GA decreased the likelihood of receiving a higher level of DR resuscitation. Among the neonatal outcomes, increasing intensity of DR resuscitation was associated with a raise in the risk of Bronchopulmonary dysplasia. Higher levels of DR resuscitation were associated with the risk of early-onset sepsis. ETT was significantly associated with an increased risk of death.
Conclusion: Among VPIs, low GA and no ANS use increased the risk of high-intensity DR resuscitation interventions; and those who receiving ETT were associated with an increased risk of adverse clinical outcomes.
目的探讨产房复苏(DR)的风险因素,并评估DR复苏与极早产儿(VPIs)新生儿预后的关系:多中心回顾性横断面研究纳入了胎龄(GA)的极早产儿:在纳入研究的 683 名婴儿中,170 名(24.9%)接受了常规护理,260 名(38.1%)接受了袋罩通气或 T 片通气,253 名(37%)接受了 ETT。在产前和产中因素中,接触产前类固醇(ANS)会降低接受 ETT 的可能性。GA的增加降低了接受更高程度DR复苏的可能性。在新生儿结局中,DR复苏强度的增加与支气管肺发育不良风险的增加有关。更高水平的DR复苏与早发败血症的风险有关。ETT与死亡风险增加密切相关:结论:在自愿住院患者中,低GA和未使用ANS会增加高强度DR复苏干预的风险;接受ETT的患者与不良临床结果的风险增加有关。
{"title":"Delivery room resuscitation and short-term outcomes in very preterm infants: a multicenter cross-sectional study in China.","authors":"Hanni Lin, Zhangbin Yu, Jinjie Huang, Ting Yang, Shitao Duan, Yanping Guo, Shujuan Zeng, Ping Jiang, Rui Wang, Jing Zhang, Lu Ding, Jiebo Liu","doi":"10.3389/fped.2024.1438780","DOIUrl":"https://doi.org/10.3389/fped.2024.1438780","url":null,"abstract":"<p><strong>Objective: </strong>To explore the risk factors of delivery room (DR) resuscitation and assess the association of DR resuscitation with neonatal outcomes in very preterm infants (VPIs).</p><p><strong>Methods: </strong>A multicenter retrospective cross-sectional study included VPIs with gestational age (GA) <32 weeks born between January, 2022 and June, 2023 and admitted to neonatal intensive care units of six tertiary hospitals in Shenzhen within 24 h after birth. They were divided into routine care group, positive-pressure ventilation (PPV) group, and endotracheal intubation (ETT) group based on the highest intensity of resuscitation received at birth. The association of antepartum and intrapartum risk factors and short-term outcomes with the intensity of DR resuscitation was evaluated.</p><p><strong>Results: </strong>Of 683 infants included in this study, 170 (24.9%) received routine care, 260 (38.1%) received bag and mask ventilation or T-piece ventilation and 253 (37%) received ETT. Among the antepartum and intrapartum factors, exposure to antenatal steroids (ANS) decreased the likelihood of ETT. Increasing GA decreased the likelihood of receiving a higher level of DR resuscitation. Among the neonatal outcomes, increasing intensity of DR resuscitation was associated with a raise in the risk of Bronchopulmonary dysplasia. Higher levels of DR resuscitation were associated with the risk of early-onset sepsis. ETT was significantly associated with an increased risk of death.</p><p><strong>Conclusion: </strong>Among VPIs, low GA and no ANS use increased the risk of high-intensity DR resuscitation interventions; and those who receiving ETT were associated with an increased risk of adverse clinical outcomes.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11483606/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142463077","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}
Pub Date : 2024-10-02eCollection Date: 2024-01-01DOI: 10.3389/fped.2024.1465785
Kavita Patel, Sharon Thomson, Meera Vijayan, Marjorie Makoni, Peter N Johnson, Katy Stephens, Stephen B Neely, Jamie L Miller
Objectives: Vasopressin is used for shock and acute pulmonary hypertension in the neonatal intensive care unit (NICU) and is associated with hyponatremia. The purpose of this study was to determine the incidence, severity, contributing risk factors associated with vasopressin-induced hyponatremia in neonates and infants <3 months of age in the NICU. The primary objective was to determine the incidence of hyponatremia (<130 mEq/L) and severe hyponatremia (<125 mEq/L). The secondary objectives were to compare clinical characteristics and the vasopressin regimen between those with and without hyponatremia.
Methods: This retrospective cohort study included neonates and infants <3 months from 1/1/2017-12/31/2022 receiving vasopressin for >6 h. Analyses were performed using SAS v9.4, with a priori less than 0.05. A multiple variable logistic regression was employed to assess odds of hyponatremia.
Results: Of the 105 patients included, 57 (54.3%) developed hyponatremia, and 17 (29.8%) were classified as severe hyponatremia. Overall, the median (interquartile range, IQR) gestational and postnatal age at vasopressin initiation were 35.4 (27-38.7) weeks and 2 (1-12) days. There was no difference in vasopressin dose, but duration of treatment was longer in those with hyponatremia. Higher baseline serum sodium was associated with decreased odds of hyponatremia [adjusted odds ratio (OR): 0.90 (95% CI: 0.83-0.99), p = 0.03], and increased vasopressin duration was associated with increased odds of hyponatremia [aOR: 1.02 (95% CI: 1.01-1.03), p < 0.001].
Conclusions: Hyponatremia occurred in half of patients included. The pre-vasopressin sodium value and the vasopressin duration were independently associated with hyponatremia.
{"title":"Vasopressin induced hyponatremia in infants <3 months of age in the neonatal intensive care unit.","authors":"Kavita Patel, Sharon Thomson, Meera Vijayan, Marjorie Makoni, Peter N Johnson, Katy Stephens, Stephen B Neely, Jamie L Miller","doi":"10.3389/fped.2024.1465785","DOIUrl":"https://doi.org/10.3389/fped.2024.1465785","url":null,"abstract":"<p><strong>Objectives: </strong>Vasopressin is used for shock and acute pulmonary hypertension in the neonatal intensive care unit (NICU) and is associated with hyponatremia. The purpose of this study was to determine the incidence, severity, contributing risk factors associated with vasopressin-induced hyponatremia in neonates and infants <3 months of age in the NICU. The primary objective was to determine the incidence of hyponatremia (<130 mEq/L) and severe hyponatremia (<125 mEq/L). The secondary objectives were to compare clinical characteristics and the vasopressin regimen between those with and without hyponatremia.</p><p><strong>Methods: </strong>This retrospective cohort study included neonates and infants <3 months from 1/1/2017-12/31/2022 receiving vasopressin for >6 h. Analyses were performed using SAS v9.4, with <i>a priori</i> less than 0.05. A multiple variable logistic regression was employed to assess odds of hyponatremia.</p><p><strong>Results: </strong>Of the 105 patients included, 57 (54.3%) developed hyponatremia, and 17 (29.8%) were classified as severe hyponatremia. Overall, the median (interquartile range, IQR) gestational and postnatal age at vasopressin initiation were 35.4 (27-38.7) weeks and 2 (1-12) days. There was no difference in vasopressin dose, but duration of treatment was longer in those with hyponatremia. Higher baseline serum sodium was associated with decreased odds of hyponatremia [adjusted odds ratio (OR): 0.90 (95% CI: 0.83-0.99), <i>p</i> = 0.03], and increased vasopressin duration was associated with increased odds of hyponatremia [aOR: 1.02 (95% CI: 1.01-1.03), <i>p</i> < 0.001].</p><p><strong>Conclusions: </strong>Hyponatremia occurred in half of patients included. The pre-vasopressin sodium value and the vasopressin duration were independently associated with hyponatremia.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11479961/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142463115","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}