Frontiers in Pediatrics最新文献

Background: Continuous kidney replacement therapy (CKRT) is an essential supportive therapy for children with acute kidney injury. Nevertheless, a considerable proportion of patients fail to recover kidney function and present with major adverse kidney events (MAKE), a composite outcome including death, dialysis dependence, or persistent kidney dysfunction. Recent international pediatric collaborative studies, mainly from North America, have reported on MAKE following pediatric CKRT. However, such data from Japan remain limited.

Methods: We conducted a single-center retrospective study of patients under 16 years of age who received CKRT for renal indications in a tertiary pediatric center between July 2014 and June 2023. The primary outcome was MAKE at 90 days after CKRT initiation (MAKE-90). We used univariate logistic regression analysis to evaluate the association between MAKE-90 and clinical characteristics.

Results: Of the 51 eligible patients, 28 (55%) experienced MAKE-90. The components of MAKE-90 were death in 14 patients (27%), dialysis dependence in 10 (20%), and persistent kidney dysfunction in 4 (8%). Univariate logistic regression analysis revealed that CKRT duration (days) [odds ratio (OR) 1.06, 95% confidence interval (CI) 1.00-1.12] and urine output (mL/kg/h) at 14 days after CKRT initiation (OR 0.33, 95% CI 0.14-0.80) were significantly associated with MAKE-90.

Conclusion: The incidence of MAKE-90 in our Japanese cohort was over half of the children requiring CKRT, comparable to rates reported in international multicenter studies. Longer CKRT duration and lower urine output on day 14 were associated with MAKE-90, suggesting that these factors may serve as potential prognostic markers.

Background: The relationship between homocysteine (HCY) and ejection fraction (EF) has been demonstrated in diseases such as coronary artery disease, but the relationship between HCY and EF in pediatric patients with myocarditis remains unclear. The aim of this study was to investigate the relationship between HCY and EF in pediatric patients with myocarditis.

Methods: This single-center cross-sectional study included 164 pediatric myocarditis patients aged 1-18 years, including 104 males and 60 females, at Anzhen Hospital (2023-2024) in Beijing. Patient demographic characteristics were collected, and blood tests were performed to assess HCY, routine blood tests, and markers of myocardial damage. EF was measured using 3.0T cardiac magnetic resonance (CMR), and patients were grouped using EF < 55% as the cutoff value. Statistical analyses were performed using t-tests, Binary logistic regression and Restrict cubic spline (RCS), and subgroup analyses [age, sex, body mass index (BMI)].

Results: Of the 164 patients, 31% (n = 51) had EF values < 55%. High HCY concentration demonstrated a statistically positive relationship with the risk of occurrence of EF < 55% (OR = 1.033, P = 0.034). Subgroup analysis showed a stronger correlation in men (OR = 1.045, P = 0.016) and in those with a BMI ≥ 24 kg/m² (OR = 1.083, P = 0.010). The RCS showed a non-significant trend of increasing EF < 55% (P > 0.05).

Conclusion: The findings suggest that elevated HCY levels are a risk factor for EF < 55% in pediatric patients with myocarditis, especially in males and overweight individuals.

Background: Preterm birth (PTB) remains a major clinical and public health challenge worldwide. Gestational diabetes mellitus (GDM), complicating 14%-25% of pregnancies, elevates PTB risk via metabolic dysregulation. Although various early-pregnancy exposures are associated with PTB, their differential contributions in GDM-affected and unaffected pregnancies remain inadequately explored. This study aimed to identify distinct first-trimester modifiable risk factors for PTB in these two populations and to quantify the accurately preventable burden using an advanced estimation approach that accounts for interdependencies among risk factors.

Methods: In this prospective cohort study conducted in Central China (2019-2024), 2,825 pregnant women were stratified into GDM (n = 554) and non-GDM (n = 2,271) groups. Assessed early-pregnancy exposures included advanced maternal age, smoking, depressive symptoms, physical inactivity, insufficient sleep, and pre-pregnancy overweight or obesity. Multivariable logistic regression and principal component analysis-adjusted population attributable fractions (PAFs) were employed to estimate the preventable PTB proportion, adjusting for overlap among risk factors.

Results: Six modifiable risk factors were identified for GDM pregnancies, with a combined PAF of 73.7% and an adjusted combined PAF of 50.5%. For non-GDM pregnancies, four factors yielded a combined PAF of 44.2% and an adjusted combined PAF of 21.5%. Shared significant factors included smoking (PAF 27.4%, adjusted PAF 11.7% in GDM vs. PAF 22.7%, adjusted PAF 9.1% in non-GDM), depressive symptoms (22.7%, 11.6% vs. 15.0%, 6.0%), and overweight or obesity (18.1%, 7.7% vs. 11.9%, 4.8%). Risk factors specific to GDM pregnancies were advanced maternal age (11.6%, 4.9%), physical inactivity (19.3%, 8.2%), and insufficient sleep (14.9%, 6.4%). Low education was uniquely associated with PTB in non-GDM pregnancies (3.7%, 1.5%).

Conclusion: This study delineates distinct early-pregnancy modifiable risk profiles for PTB in GDM and non-GDM populations, supporting the development of targeted preventive strategies. Subsequent studies are warranted to validate these findings across diverse populations and to assess the effectiveness of tailored first-trimester interventions based on this risk stratification.

Background: Advancements in cancer therapies have markedly increased survival rates among patients. However, this progress has also led to a growing number of pediatric cancer patients requiring admission to intensive care units due to the severity of their disease and complications arising from treatment. It is essential to identify the predictors of mortality within this population to enhance clinical outcomes effectively.

Methods: A retrospective study included patients younger than or aged 18 years old at diagnosis of malignancy who were admitted to the medical ICU in The Children Cancer Hospital, Egypt, from January 1, 2019, to August 1, 2021. The primary objectives were to determine the mortality rate, identify the common causes of ICU admissions, and analyze the predictors of mortality among the pediatric cancer patients admitted to the ICU.

Results: A total of 1,501 ICU admissions were included. The most common causes of admission were sepsis (39%) and respiratory failure (31%). The mortality rate for the whole cohort was 32%. The most common causes of death were sepsis (46%) and disease progression/relapse (28.6%). Multivariable analysis identified higher mortality for patients admitted with septic shock (OR =  6.01, 95%CI 3.97-9.23, P < 0.001) and respiratory failure (OR =  6.35, 95%CI 4.13-9.97, P < 0.001), patients with progressive disease (OR =  1.86, 95%CI 1.38-2.50, P < 0.001), those transferred from inpatient wards (OR =  1.63, 95%CI 1.20-2.22, P = 0.002) and patients with longer ICU stay (OR =  1.04, 95%CI 1.04-1.06, P < 0.001).

Conclusion: Pediatric cancer patients admitted to the ICU in LMICs have a high mortality rate, which confirms the need for targeted strategies to improve outcomes in this vulnerable population. Key approaches suggested by our research include early cancer diagnosis, optimized identification of early warning signs of critical illness, and decreasing sepsis-related mortalities by strict infection control, early diagnosis, and antimicrobial stewardship programs.

Background: High-grade pancreatic injury is rare but associated with significant mortality and morbidity. There is no consensus on whether nonoperative or operative treatment could result in good clinical outcomes. Minimally invasive surgery has been introduced to manage cases of abdominal trauma, but no application in high-grade pancreaticoduodenal injury has been reported.

Case presentation: An 8-year-old boy complained of severe abdominal pain after a bicycle injury. On admission, the patient was hemodynamically stable with elevated serum amylase and lipase levels. Thoracoabdominal computed tomography revealed massive disruption of the pancreatic head with pancreatic duct disruption and gas accumulation in the posterior part of the pancreas indicating localized duodenal perforation. Surgery was indicated and our surgical team chose to perform in a minimally invasive way with robotic assisted laparoscopic system based on the previous successful experience. A massive disruption of the pancreatic head (AAST-OIS grade V in pancreatic injury) and a laceration involving 30% of the circumference of the first part of the duodenum (AAST-OIS grade II in duodenal injury) without biliary system involvement were confirmed during surgery. A partial resection of the devitalized pancreatic head, primary suture of the duodenal laceration, and Roux-en-Y pancreaticojejunostomy with preservation of the pancreatic tail was performed in robotic-assisted laparoscopy. The patient resumed oral feeding on postoperative day 10 and was discharged 14 days postoperatively. At the 1-year follow-up, the patient demonstrated satisfactory recovery without any significant complications.

Conclusion: For hemodynamically stable patients with high-grade pancreaticoduodenal injury, operative management is an appropriate therapeutic strategy. Application of robotic surgery may be a potentially optimal choice for primary repair in pediatric severe pancreaticoduodenal injury.

Objective: To explore the illness experience and coping strategies of young adults with inflammatory bowel disease (IBD) to inform patient management.

Methods: 20 IBD patients aged 18-29 presenting for outpatient or inpatient treatment at the Gastroenterology Department of a tertiary hospital in Jiangsu Province between September 2023 and January 2024 were identified by purposive and snowball sampling and enrolled. A phenomenological approach was taken, semi-structured interviews conducted and interview data analyzed by Colaizzi's method.

Results: Three themes were identified: (1) complex negative emotions arising from disrupted daily life, restricted self-development, uncertainty and anxiety about the future and conflicts between the desire for independence vs. the reality of dependence, (2) coping strategies that ranged from active coping to passive avoidance and (3) a multi-level need for external support from family, professionals and a wider social network.

Conclusion: Young adults with IBD experience complex negative emotional responses. Active coping strategies may fostered personal development that transcended their pre-illness sense of self in young adults with IBD. The need for multi-level external support was clearly expressed. A patient-centered approach which encourages self-sufficiency and self-management and promotes external support systems is recommended.

Aim: Existing recommendations for nasotracheal endotracheal tube (ETT) insertion depth in neonates have shown remarkable consistency over decades and have recently been prospectively evaluated in clinical practice. However, large prospective datasets systematically validating biometric predictors and quantifying expected variability remain limited. This study aimed to confirm established nasotracheal ETT depth recommendations using a large prospective cohort and to translate these findings into a standardized, evidence-based bedside reference.

Methods: We analyzed 497 nasotracheal intubations performed between 2017 and 2023 in a tertiary neonatal intensive care unit. Tube position was prospectively assessed after each intubation using standardized chest radiography. Optimal ETT placement was defined as the tube tip located between the clavicles and at least 1 cm above the tracheal carina. Clinical and biometric parameters were systematically recorded, and their associations with insertion depth were evaluated using LOESS curves and linear regression models.

Results: Across a wide range of gestational ages and body weights, body weight at the time of intubation showed the strongest and most consistent association with optimal nasotracheal ETT insertion depth (adjusted R² = 0.88; RMSE = 0.52). Based on these findings, an evidence-based chart with defined tolerance ranges and a complementary web-based decision-support tool were developed to facilitate standardized bedside estimation.

Conclusion: In this large prospective cohort, body weight at the time of intubation was confirmed as the most reliable single predictor of optimal nasotracheal endotracheal tube insertion depth in neonates. Our findings support established reference ranges and provide quantitative confirmation across a broad spectrum of gestational ages and body weights. By translating these data into a concise, evidence-based bedside chart and a complementary digital reference, this study strengthens confidence in existing recommendations and supports standardized clinical practice, while emphasizing the need for clinical judgement and post-intubation verification.

Introduction: This study aimed to present rare findings encountered during laparoscopic inguinal hernia repair in children.

Methods: The study included children who underwent laparoscopic surgery for inguinal hernia (IH). The focus was on unexpected intraoperative findings other than a typical inguinal hernia. These included direct and femoral hernias, various hernia variants, and other unusual presentations.

Results: A total of 790 children were included in the study. Unexpected laparoscopic findings were observed in 22 cases. The mean age of the patients was 33 months (range: 1-168 months), and the mean weight was 12.5 kg (range: 2-46 kg). Direct hernias were identified in seven children. Four children had an incarcerated appendix within the hernia sac, one of whom required an appendectomy. Omental incarceration was noted in three children, and no hernia was found in two cases. Additionally, single cases of femoral hernia, Spigelian hernia, pantaloon hernia, intraabdominal spermatic cord cyst, suspicious gonadal structure, and incarcerated uterus with ovary was observed. Direct inguinal hernia was identified in seven children; four were repaired laparoscopically, whereas three underwent open repair. No intraoperative or postoperative complications were reported.

Conclusions: The advantages provided by the laparoscopic approach include comprehensive visualization of the intraabdominal cavity allowing for prompt identification and safer management of rare or atypical findings.

Background: Coronary artery lesions (CALs) in Kawasaki disease (KD) are thought to arise from aberrant immune activation and an amplified inflammatory cascade triggered by an unidentified etiologic factor. Interleukin-23 (IL-23)-a pivotal modulator of chronic inflammatory responses and immune-mediated vascular damage-has lately garnered interest regarding its putative role in cardiovascular pathological processes.

Aim: To explore the correlation between circulating IL-23 concentrations and the occurrence of CALs in pediatric patients with KD.

Methods: Peripheral blood samples were obtained from 103 pediatric patients with KD prior to administration of intravenous immunoglobulin. Using Enzyme-Linked Immunosorbent Assay (ELISA), we quantified circulating cytokine levels in a total of 211 study participants, who were stratified into four distinct cohorts: 47 KD cases with coronary artery lesions, 56 cases without vascular involvement, 58 febrile controls, and 50 healthy controls.

Results: Serum IL-23 concentrations were markedly elevated in children with KD [279.69 pg/mL (132.67-693.32)] compared with both febrile controls [161.02 pg/mL (81.50-338.60)] and healthy controls [132.41 pg/mL (61.74-274.28)] (P < 0.001), indicating a disease-specific elevation. Among KD patients, 47 (45.63%) developed CALs. The KD individuals presenting with CAL (KD-CALs) group exhibited markedly higher IL-23 levels [395.76 pg/mL (221.62-1,217.19)] compared with KD individuals without CAL (KD-NCALs) [222.81 pg/mL (100.18-388.58), P < 0.001], accompanied by higher Erythrocyte Sedimentation Rate (ESR) and increased Interleukin-6 (IL-6), matrix metalloproteinase-1 (MMP-1), vascular endothelial growth factor (VEGF) levels. IL-23 displayed significant positive associations with multiple inflammatory indices, including white blood cell count (WBC), C-reactive protein (CRP), IL-6, Interleukin-10 (IL-10), Interleukin-17A (IL-17A), MMP-1, and VEGF. Receiver operating characteristic (ROC) analysis showed that IL-23 effectively discriminated KD from controls [area under the curve (AUC) = 0.71, cutoff = 202.3 pg/mL, sensitivity = 66.0%, specificity = 68.0%] and KD-CAL from KD-nCAL (AUC = 0.69, cutoff = 661.2 pg/mL, sensitivity = 42.6%, specificity = 87.5%).

Conclusion: Elevated serum IL-23 is associated with heightened inflammatory activity and the presence of coronary artery lesions in KD, suggesting that IL-23 may contribute to CAL pathogenesis and represent a potential biomarker of vascular involvement.

Background: Ralstonia pickettii has gained relevance in pediatric healthcare due to its persistence in water systems, biofilm formation and contamination of medical solutions. This review summarizes current evidence on its epidemiology, environ-mental reservoirs, clinical features, diagnostic limitations and therapeutic considera-tions in children.

Methods: A narrative search was conducted in PubMed, Scopus, Web of Science and Embase for studies published from January 1990 to 30 November 2025. Pediatric cases, outbreak reports, environmental studies with clinical relevance and microbiological reviews were included. Heterogeneity in design and reporting justified a narrative synthesis.

Results: R. pickettii is the predominant Ralstonia species in pedi-atric infections and is closely linked to contaminated aqueous products and respiratory equipment. Neonates and immunocompromised children are most affected, with man-ifestations ranging from colonization to severe sepsis. Diagnostic systems frequently misidentify the organism, and molecular tools improve accuracy when combined with clinical assessment. Susceptibility patterns are variable and influenced by intrinsic re-sistance mechanisms and biofilm. Effective treatment often requires targeted therapy and device removal. Outbreak investigations consistently identify contaminated solu-tions and water systems as primary sources.

Conclusions: R. pickettii is an emerging pathogen in pediatric care. Improving diagnostic accuracy, strengthening environ-mental control and ensuring safe handling of water-based solutions and medical devices are essential to reduce its clinical impact.