Frontiers in Pediatrics最新文献

Despite availability of multiple FDA approved therapies, many children with juvenile idiopathic arthritis (JIA) suffer pain and disability due to uncontrolled disease. The term JIA includes a heterogeneous set of conditions unified by chronic inflammatory arthritis, collectively affecting 1:1,000 children. When reviewing treatment options with families the rheumatologist currently refers to the experience of the average patient in relatively small controlled clinical trials, to consensus-based treatment plans, or increasingly the choice is dictated by the formulary restrictions of insurance payers. The current paradigm for treatment selection does not incorporate real-world evidence of treatment effectiveness centered to the individual patients with whom decisions are to be made. Treatment decisions based on the evidence of the average patient are not optimized to reflect the unique clinical characteristics of an individual with JIA and their disease course, nor does it account for heterogeneous treatment effects. To guide treatment choices centered around each patient, we describe a novel concept of utilizing digital health technology to bring patient-centered information into shared decision-making discussions based on comparative effectiveness analysis of electronic health record or observational clinical registry data of patients with similar characteristics. The envisioned digital tool will organize and present data relevant to the individual patient and enable evidence-based individualized treatment decision making when used in a collaborative manner with the patient family and rheumatologist. Capabilities in digital health technology, data capturing, and analytical methodologies are ripe for this endeavor. This brings the concept of a learning health system directly to the point of care.

Purpose: Sleep disturbances are prevalent in autistic children. The emergence of telehealth offers new possibilities for remote professional intervention. By combining telehealth with parental support, this study aims to explore a novel family-based model to enhance moderate-to-vigorous physical activity (MVPA) and improve sleep quality in children with autism.

Methods: Thirty-four autistic children (mean age = 15.7 years) were randomly assigned to either a 6-month intervention group or a control group. Both groups received standard physical education classes at school. The intervention group received additional after-school telehealth support. MVPA and sleep quality were assessed 1 week before the intervention and at the 6-month follow-up.

Results: After 6 months, children in the intervention group nearly doubled their daily MVPA compared to the control group (Cohen's d = 8.34, CI_95% = 6.17-10.52). Actigraphy-assessed sleep efficiency was notably higher (d = 2.35, CI_95% = 1.44-3.26), and there were reductions in wake time (d = 1.65, CI_95% = 0.84-2.46), sleep fragmentation (d = 0.80, CI_95% = 0.07-1.52), and sleep latency (d = 0.82, CI_95% = 0.09-1.54) were all reduced. These improvements in objective sleep metrics were corroborated by subjective assessments using the Sleep Disturbance Scale for Children (d = 0.86, CI_95% = 0.13-1.59).

Conclusions: Telehealth combined with parental support addresses barriers to enhancing health behaviors at home. This innovative model not only improves after-school MVPA and sleep quality in autistic children but also holds significant potential for benefiting other populations requiring remote support.

Clinical trial registration: https://clinicaltrials.gov/study/NCT06444659?id=NCT06444659&rank=1 (NCT06444659).

Introduction: There are few reports of severe hematological involvement in children with neonatal lupus erythematosus (NLE) treated with exchange transfusion. In this case report, we present a female patient with NLE admitted to the Children's Hospital of Soochow University. The main clinical manifestations were pancytopenia and congenital heart block (CHB). Her condition was serious and could not be improved by conventional treatment; however, she responded well to exchange transfusion therapy.

Case presentation: A female infant, aged 1 month and 3 days, was admitted to the Children's Hospital of Soochow University owing to the "discovery of thrombocytopenia over 1 month." She tested positive for anti-SSA IgG, anti-Ro-52 IgG, and anti-mitochondrial M2 antibodies. In contrast, her mother tested positive for ANA (1:320) and anti-Ro/SSA antibodies. The patient was diagnosed with NLE and presented with pancytopenia and CHB. Her cardiac function was normal and no intervention was performed; however, her hematological involvement was more severe, without significant improvement after steroid, intravenous immunoglobulin, and transfusion treatments. After exchange transfusion therapy, the patient significantly improved, and the short-term follow-up prognosis was good.

Conclusion: For patients with NLE presenting with hematological involvement that cannot be improved by conventional treatment or whose condition is serious, exchange transfusion therapy should be considered to reduce antibody titers and improve their condition.

Aims: To investigate the epidemiological and clinical characteristics of children with Mycoplasma pneumoniae pneumonia (MPP) in Hubei, China.

Methods: We retrospectively analyzed inpatients with MPP from 20 hospitals in Hubei, China from January 2021 to December 2022. The co-detected pathogens of Mycoplasma pneumoniae (M. pneumoniae) were investigated using targeted next-generation sequencing (tNGS), and 23S rRNA gene mutations were analyzed to assess the macrolide resistance.

Results: M. pneumoniae infected 20.7% of patients with CAP, with cough (96.59%) and fever (80.28%) being the most prevalent symptoms. The infection rates in children younger than 1, 1-2, 3-6, 7-12, and older than 12 years were 6.17%, 19.98%, 26.97%, 43.93%, and 2.95%, respectively. Among 1,349 patients undergoing tNGS, the overall co-detection rate was 59.45%, with Streptococcus pneumoniae (29.30%), Haemophilus influenzae (23.57%), and Human rhinovirus (17.21%) being the most commonly co-detected pathogens. In 635 patients undergoing the 23S rRNA gene mutation test, 86.30% exhibited positive mutations (A2063G, 98.00%; A2064G, 1.50%; A2067G, 0.50%). Despite a significant age difference (P = 0.037) between macrolide-resistant M. pneumoniae and macrolide-sensitive M. pneumoniae groups, there were no significant differences in symptoms, lab data, or disease severity.

Conclusions: In Hubei Province, the prevalence of exhibited consistent changes during the COVID-19 pandemic. MPP was prevalent year-round, particularly in summer and autumn, with school-age children being more susceptible. Co-detections of viruses and bacteria were frequent in MPP cases, and macrolide resistance exceeded 85%. Ongoing surveillance of M. pneumoniae in children is crucial for understanding the healthcare impact of MPP.

Objective: It is well-established that overweight/obesity is a major risk factor for left ventricular hypertrophy (LVH) in childhood. However, it is still unclear if reversing from overweight/obesity to normal weight is associated with decreased LVH in children. This study aimed to examine the association between weight status change during four years and LVH among Chinese children based on a prospective cohort study.

Methods: Data were obtained from the Huantai Childhood Cardiovascular Health Cohort Study in China. A total of 1,178 children without LVH at baseline (mean age: 8.3 years) were included in this study. According to weight status [normal weight or overweight (including obesity)] at baseline (2017) and follow-up (2021), children were divided, based on sex- and age-adjusted body mass index (BMI), into four groups: persistent normal weight (normal weight at both baseline and follow-up), incident overweight (normal weight at baseline but overweight at follow-up), reversal to normal weight (overweight at baseline but normal weight at follow-up), persistent overweight (overweight at both baseline and follow-up).

Results: After adjustment for potential confounding factors, children with incident overweight (n = 114, 30.63 ± 4.74 g/m^2.7) and those with persistent overweight (n = 363, 31.56 ± 6.24 g/m^2.7) had higher left ventricular mass index (LVMI) at the end of the follow-up period than those with persistent normal weight (n = 632, 28.46 ± 7.64 g/m^2.7), while those who reversed from overweight to normal weight had a non-significantly lower LVMI (n = 69, 28.51 ± 4.28 g/m^2.7). Compared to children with persistent normal weight, those with persistent overweight [odds ratio (OR) = 5.14, 95% confidence interval (CI) = 3.33-7.95] and those with incident overweight (OR = 3.34, 95% CI = 1.77-6.30) had an increased risk of LVH. The risk of LVH tended to decrease, although not significantly, in those who reversed from overweight to normal weight (OR = 0.76, 95% CI = 0.22-2.55).

Conclusion: Our findings demonstrate a positive association between overweight and left ventricular mass in children and suggest that LVH in childhood could be attenuated by weight loss.

Background: Children with moderate-to-severe obstructive sleep apnea (OSA) require specific management. However, the risk factors associated with this level of severity in pediatric OSA remain poorly defined. This study aimed to identify clinical predictors of moderate-to-severe pediatric OSA.

Methods: This retrospective study enrolled children aged 1-18 years who underwent respiratory polygraphy or nocturnal oximetry between January 2013 and December 2017. Patient history, demographics, and sleep study data were analyzed. Logistic regression analysis was conducted to assess risk factors associated with moderate-to-severe pediatric OSA. The STROBE checklist was followed in reporting this research.

Results: Among 818 children with a median age of 5 years (IQR: 3, 9), 69.4% were male, and 96.7% were diagnosed with OSA. Of those diagnosed, 542 (66.3%) had moderate-to-severe cases. Independent predictors of moderate-to-severe OSA, with their adjusted odds ratios (95% CI), included: age 1-5 years; 6.16 (3.98-9.53), obesity; 2.08 (1.35-3.19), adenotonsillar hypertrophy; 1.58 (1.05-2.36), frequent snoring (>5 nights/week); 6.86 (4.40-10.67), stopped breathing during sleep; 2.34 (1.50-3.63), awakening during sleep; 2.04 (1.32-3.12), and excessive daytime somnolence; 2.10 (1.28-3.43).

Conclusions: Children referred to a sleep center demonstrated an increased risk of being diagnosed with moderate-to-severe OSA. Key clinical predictors of moderate-to-severe OSA included age 1-5 years, frequent snoring, episodes of stopped breathing or awakening during sleep, excessive daytime somnolence, obesity, and adenotonsillar hypertrophy. Prioritizing early sleep investigations and appropriate management for children exhibiting these predictors may enhance clinical outcomes and mitigate the risk of long-term complications.

Introduction: Severe acute malnutrition (SAM) is a critical public health concern in Ethiopia, contributing to high morbidity and mortality rates among children. Despite the improvement in hospital coverage and the development of standardized WHO treatment guidelines, recent reviews indicated a wide range in recovery rates (34%-88%) due to several context-specific factors. Understanding the factors influencing the recovery time can help inform targeted interventions and improve the overall management of SAM cases. Therefore, this study aimed to assess the time to recovery and predictors of children aged 6-59 months with severe acute malnutrition in Addis Ababa, Ethiopia, in 2023.

Methods: An institutional-based retrospective follow-up study was conducted among children aged 6-59 months who were admitted to Tirunesh Beijing Hospital (TBH), Addis Ababa, Ethiopia, from July 2019 to June 2023. The Kaplan-Meir estimate and survival curve were used to compare the time to recovery using a log-rank test among different characteristics. A Cox proportional hazard regression analysis model was used to identify significant predictors of time to recovery. Finally, a p-value of <0.05 was used to declare a significant association.

Results: The median survival time to recovery was 17 (95% CI: 16.39-17.60) days, and the incidence rate of recovery from SAM was 37.8 per 1,000 child days. Moreover, exclusive breastfeeding [adjusted hazard ratio (aHR): 1.97, 95% CI: 1.45-2.68], amoxicillin provision (aHR = 1.62, 95% CI: 1.11-2.35), and deworming (aHR = 2.14, 95% CI: 1.48-3.09) were protective factors. However, complications at admission (aHR = 0.41, 95% CI: 0.23-0.73) and diarrhea during admission (aHR = 0.64, 95% CI: 0.45-0.91) were identified as risk factors of recovery from SAM.

Conclusion: The time to recovery among the current study participants was low compared with the sphere standard. Besides, exclusive breastfeeding, complications at admission, diarrhea, amoxicillin provision, and deworming were independent predictors. Therefore, appropriate provision of routine medication and early management of medical comorbidity as per the national SAM management protocol can reduce the mortality of children with severe acute malnutrition significantly.

Background: Unlike in developed countries, neonatal morbidity and mortality are the leading challenges associated with easily preventable and treatable disorders during the neonatal period in low- and middle-income countries. However, evidence-based data about prolonged transitional hypoglycemia and associated factors are highly limited in Ethiopia and resource-limited countries.

Methods: An institution-based prospective cross-sectional study was conducted at public hospitals in South Gondar in neonatal intensive care units (NICUs). The data were entered and analyzed using SPSS version 23. Descriptive statistics were used to summarize maternal characteristics. Multivariate binary logistic regression at a p value <0.05 was used.

Results: A total of 400 neonates, admitted to NICUs in public hospitals within 48-72 h of birth between October 2, 2021, and June 30, 2022, were included in the study. The incidence of prolonged transitional neonatal hypoglycemia (PTHG) was 23.5% (19.3%-28%). The factors associated with PTHG were hypothermia (AOR = 4.41; 95% CI = 2.72-10.92), preterm birth (AOR = 3.5; 95% CI = 1.69-11.97), perinatal asphyxia (AOR = 2.5; 95% CI = 1.34-9.67), and pathological jaundice (AOR = 2.3; 95% CI = 1.21-10.34). In contrast, spontaneous vaginal delivery (SVD) was a protective factor (AOR = 0.72; 95% CI = 0.35-0.88).

Conclusions: The incidence of (PTHG) was nearly one-fifth. Factors increasing the risk of PTHG were hypothermia, preterm birth, perinatal asphyxia (PNA), early onset of sepsis (EONS), and pathological jaundice. Spontaneous vaginal delivery (SVD) was also a protective factor. Preventing neonatal hypothermia was the main measure used to reduce PTHG in the study area. Special attention could be given to neonates with prematurity, early onset neonatal sepsis (EONS), birth asphyxia, and pathological jaundice, as monitoring their RBS could lead to a significant change in reducing PTHG.

Background: Pediatric kidney transplantations are rarely performed, and there is limited knowledge about the diversity in current clinical practices across Europe. This study aims to explore the utility of clinical snapshot studies in identifying these disparities, establishing a foundation for future snapshot studies and standardization efforts.

Methods: A pilot clinical snapshot study was conducted, with invitations extended to all 109 pediatric kidney transplant centres in Europe. Each participating centre provided pre-, peri-, and postoperative data concerning their most recent thirty transplantations. The primary outcomes encompassed the evaluation of disparities in donor-recipient selection, surgical techniques, post-operative drainage procedures, and immunosuppressive therapy protocols. Secondary outcomes involved the analysis of rejection rates, incidence of infections, and graft survival.

Results: The study involved 439 patients from fifteen centres (14%) in twelve countries, with varying transplant volumes (range 1-29 transplantations per year) and follow-up periods. Significant differences were found among centres in terms of donor types, cold and warm ischemia time, pre-emptive transplant rates, and kidney transplant drainage methods. The rate of living donors varied between 3% and 90% and the median duration of cold ischemia ranged was 770 min after deceased donation and 147 min after living donation. Basiliximab was the dominant induction therapy, yet steroid withdrawal varied widely. Infection, rejection, and graft survival rates also varied significantly between centres.

Conclusion: This study revealed substantial variation in clinical practices among European centres performing pediatric kidney transplantations. These findings could serve as a stimulus for international dialogue and collaboration.

Objective: We aimed to investigate the clinical features of children with plastic bronchitis caused by pneumonia, and assess the risk factors for pleural effusion (PE) in plastic bronchitis.

Methods: A retrospective study was conducted on children with plastic bronchitis and hospitalized in Xiamen Children's Hospital from January 2017 to April 2023. Participants were categorized based on the presence of PE. Their clinical manifestations and laboratory findings were analyzed.

Results: Sixty-nine children with plastic bronchitis were enrolled: 34 cases (49.27%) in the non-PE group and 35 cases (50.72%) in the PE group. No significant differences were found in sex, age, and etiology between the two groups. Significant differences were found in fever duration, C-reactive protein (CRP), albumin and lactate dehydrogenase (LDH) ( $p<0.05$ ). A receiver operating characteristic (ROC) curve analysis showed that the cut-off values for higher risk of PE were CRP $>31.66$  mg/L or LDH $>551$  U/L. The prediction of PE was performed with the combination of CRP $>31.66$  mg/L and LDH $>551$  U/L, using multivariate logistic regression analysis. The area under the curve (AUC) for logistic regression was 0.797. Elevated CRP increased the risk of PE (odds ratio [OR] 8.358, 95% confidence interval [CI] 2.179-42.900, $p=0.0042$ ), elevated LDH increased the risk of PE (OR 5.851 [95% CI 1.950-19.350], $p=0.0023$ ).

Conclusion: The combined detection of CRP and LDH helps predict the risk of PE in children with plastic bronchitis caused by pneumonia.