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Research progress of biomarkers in evaluating the severity and prognostic value of severe pneumonia in children. 生物标志物在评估儿童重症肺炎严重程度和预后价值方面的研究进展。
IF 2.1 3区 医学 Q2 PEDIATRICS Pub Date : 2024-10-01 eCollection Date: 2024-01-01 DOI: 10.3389/fped.2024.1417644
Weihua Gong, Kaijie Gao, Zhiming Shan, Liu Yang, Panpan Fang, Ci Li, Junmei Yang, Jiajia Ni

Pneumonia is a serious and common infectious disease in children. If not treated in time, it may develop into severe pneumonia. Severe pneumonia in children is mainly characterized by hypoxia and acidosis, often accompanied by various complications such as sepsis and multiple organ dysfunction. Severe pneumonia has a rapid onset and progression, and a high mortality rate. Biomarkers assist clinicians in the early diagnosis and treatment of patients by quickly and accurately identifying their conditions and prognostic risks. In this study, common clinical and novel biomarkers of severe pneumonia in children were reviewed, and the application value of biomarkers related to the severity and prognosis of severe pneumonia in children was evaluated to provide help for early identification and precise intervention by clinicians.

肺炎是一种严重的儿童常见传染病。如不及时治疗,可能发展为重症肺炎。儿童重症肺炎主要表现为缺氧和酸中毒,常伴有各种并发症,如败血症和多器官功能障碍。重症肺炎起病急、病情发展快、死亡率高。生物标志物可以快速准确地识别患者的病情和预后风险,从而帮助临床医生对患者进行早期诊断和治疗。本研究综述了儿童重症肺炎常见的临床生物标志物和新型生物标志物,评估了与儿童重症肺炎严重程度和预后相关的生物标志物的应用价值,为临床医生早期识别和精确干预提供帮助。
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引用次数: 0
Comparative analysis of different methods for protein quantification in donated human milk. 对捐赠母乳中蛋白质定量的不同方法进行比较分析。
IF 2.1 3区 医学 Q2 PEDIATRICS Pub Date : 2024-10-01 eCollection Date: 2024-01-01 DOI: 10.3389/fped.2024.1436885
Elisabet Navarro-Tapia, Ana Herranz Barbero, Maribel Marquina, Cristina Borràs-Novell, Vanessa Pleguezuelos, Rafael Vila-Candel, Óscar García-Algar, Vicente Andreu-Fernández

Background: Human milk is the best option for feeding newborns, especially premature infants. In the absence of breast milk, milk from a human milk bank can be a suitable alternative. However, the nutritional content of human milk may be insufficient to meet these high requirements and milk fortification is needed. To facilitate the implementation of simpler and faster analyzers in neonatal healthcare facilities, this study focuses on the concordance analysis of two different analyzers, one based on mid-infrared and the other on ultrasound, in comparison to the Bradford method for determining protein concentration in human milk.

Methods: Mature milk samples from donor mothers were collected and pasteurized at the Human Milk Bank of Barcelona and protein quantification was performed using mid-infrared (MIRIS-HMA), ultrasound (MilkoScope Julie27), and the classical Bradford reference methods. The intraclass correlation coefficient (ICC) with 95% confidence interval and Bland-Altman plots were used to assess the agreement between methods.

Results: The mean protein concentration of 142 milk samples calculated using MIRIS-HMA, MilkoScope, and the Bradford assay were 1.38, 1.15, and 1.19 g/100 ml, respectively. The ICC was 0.70 for MIRIS-HMA vs. Bradford and 0.37 for MilkoScope vs. Bradford.

Conclusion: MIRIS-HMA obtained a better agreement with the Bradford technique and is a promising method for developing new devices based on MIR transmission spectroscopy principles. This study confirms how MIRIS-HMA can be used to accurately calculate the protein concentration of human milk.

背景:母乳是喂养新生儿,尤其是早产儿的最佳选择。在没有母乳的情况下,母乳库中的母乳可作为合适的替代品。然而,人乳的营养成分可能不足以满足这些高要求,因此需要进行牛奶强化。为了促进新生儿医疗机构采用更简单、更快速的分析仪,本研究重点分析了两种不同分析仪(一种基于中红外线,另一种基于超声波)与布拉德福德法测定母乳中蛋白质浓度的一致性:方法:在巴塞罗那母乳库收集了捐赠母亲的成熟母乳样本并进行了巴氏灭菌,然后使用中红外(MIRIS-HMA)、超声波(MilkoScope Julie27)和传统的布拉德福德参考方法进行了蛋白质定量分析。使用带 95% 置信区间的类内相关系数 (ICC) 和 Bland-Altman 图评估不同方法之间的一致性:结果:使用 MIRIS-HMA、MilkoScope 和 Bradford 检测法计算出的 142 份牛奶样本的平均蛋白质浓度分别为 1.38、1.15 和 1.19 克/100 毫升。MIRIS-HMA 与 Bradford 相比,ICC 为 0.70;MilkoScope 与 Bradford 相比,ICC 为 0.37:结论:MIRIS-HMA 与 Bradford 技术的一致性更好,是一种基于近红外透射光谱原理开发新设备的有前途的方法。这项研究证实了 MIRIS-HMA 可用于准确计算母乳中的蛋白质浓度。
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引用次数: 0
Structural development and brain asymmetry in the fronto-limbic regions in preschool-aged children. 学龄前儿童大脑前边缘区域的结构发展和不对称。
IF 2.1 3区 医学 Q2 PEDIATRICS Pub Date : 2024-10-01 eCollection Date: 2024-01-01 DOI: 10.3389/fped.2024.1362409
Gang Yi Lee, Young-Ah Youn, Yong Hun Jang, Hyuna Kim, Joo Young Lee, Young Jun Lee, Minyoung Jung, Hyun Ju Lee

Early-life experiences play a crucial role in the development of the fronto-limbic regions, influencing both macro- and microstructural changes in the brain. These alterations profoundly impact cognitive, social-emotional functions. Recently, early limbic structural alterations have been associated with numerous neurological and psychiatric morbidities. Although identifying normative developmental trajectories is essential for determining brain alterations, only a few studies have focused on examining the normative trajectories in the fronto-limbic regions during preschool-aged children. The aim of this study was to investigate the structural-developmental trajectory of the fronto-limbic regions using the cortical thickness, volume, and subcortical volume in 57 healthy and typical preschool-aged children between 1 and 5 years and examined the early lateralization patterns during the development of the fronto-limbic regions. Regarding brain lateralization, remarkable asymmetry was detected in the volume of thalamus and the cortical regions excluding the lateral orbitofrontal cortex in the fronto-limbic regions. This study of preschool-aged children may fill the knowledge gaps regarding the developmental patterns and hemispheric asymmetries of the fronto-limbic regions between newborns and adolescents.

早年的生活经历对前部-边缘区域的发育起着至关重要的作用,影响着大脑宏观和微观结构的变化。这些变化对认知和社会情感功能产生了深远影响。最近,早期边缘结构的改变与许多神经和精神疾病有关。尽管确定正常的发育轨迹对于确定大脑的改变至关重要,但只有少数研究集中于研究学龄前儿童前肢区域的正常轨迹。本研究的目的是利用 57 名 1 至 5 岁健康和典型学龄前儿童的皮层厚度、体积和皮层下体积来研究前肢区域的结构-发育轨迹,并考察前肢区域发育过程中的早期侧化模式。在大脑侧化方面,发现丘脑和皮层区域的体积明显不对称,但前肢区域的外侧眶额皮层除外。这项针对学龄前儿童的研究可以填补有关新生儿和青少年前部-边缘区域发育模式和半球不对称的知识空白。
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引用次数: 0
What about sex, race(ism), and social determinants of health in neonatal outcomes? 新生儿结局中的性别、种族和健康的社会决定因素如何?
IF 2.1 3区 医学 Q2 PEDIATRICS Pub Date : 2024-10-01 eCollection Date: 2024-01-01 DOI: 10.3389/fped.2024.1378370
Neha Chaudhary, Arushi Meharwal

Neonatal outcomes encompass a range of outcome measures, including mortality rates, physical and mental health morbidities, and long-term neurodevelopmental statistics. These outcomes are influenced by non-modifiable factors, such as sex and race, and modifiable factors, such as social determinants of health and racism. There is a known bias toward worse outcomes for male infants in terms of preterm birth, low birth weight, and mortality, with several biological and physiological factors contributing to these sex-related differences. In relation to racial disparities, wherein race is a social construct, maternal and infant healthcare continues to lag behind for minority populations compared with the white population, despite advances in medical care. Infants born to Black women have higher infant mortality rates and lower birth weights than infants of white women. These differences can be largely attributed to social and environmental factors, rather than racial and ethnic differences. Furthermore, we emphasize the role of social determinants of health in neonatal outcomes. Factors such as economic stability, education access and quality, healthcare access and quality, the physical neighborhood environment, and the social and community context all contribute to these outcomes. Overall, this article highlights the complex interactions between sex, race(ism), and social determinants of health in neonatal outcomes. It underscores the need for a comprehensive understanding of these factors to improve maternal-neonatal care and reduce disparities in outcomes. Healthcare providers, policymakers, and communities need to work together to combat these complex issues and improve neonatal outcomes for all infants, while understanding the complex interplay between sex, racism, and/or social determinants of health.

新生儿结果包括一系列结果衡量指标,包括死亡率、身心健康发病率和长期神经发育统计数据。这些结果受性别和种族等不可改变因素以及健康的社会决定因素和种族主义等可改变因素的影响。众所周知,在早产、出生体重过轻和死亡率方面,男婴的结果更差,而这些与性别有关的差异是由多种生物和生理因素造成的。在种族差异方面,种族是一种社会建构,尽管医疗保健取得了进步,但与白人相比,少数民族的母婴保健仍然落后。黑人妇女所生的婴儿比白人妇女所生的婴儿死亡率更高,出生体重更轻。这些差异主要归因于社会和环境因素,而非种族和民族差异。此外,我们强调健康的社会决定因素在新生儿结局中的作用。经济稳定性、教育机会和质量、医疗保健机会和质量、物理邻里环境以及社会和社区背景等因素都会对这些结果产生影响。总之,本文强调了新生儿结局中性别、种族和健康的社会决定因素之间复杂的相互作用。它强调了全面了解这些因素的必要性,以改善孕产妇-新生儿护理并减少结果差异。医疗保健提供者、政策制定者和社区需要共同努力解决这些复杂的问题,改善所有婴儿的新生儿预后,同时了解性别、种族主义和/或社会健康决定因素之间复杂的相互作用。
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引用次数: 0
Neonatal encephalopathy multiorgan scoring systems: systematic review. 新生儿脑病多器官评分系统:系统综述。
IF 2.1 3区 医学 Q2 PEDIATRICS Pub Date : 2024-10-01 eCollection Date: 2024-01-01 DOI: 10.3389/fped.2024.1427516
Noor Adeebah Mohamed Razif, Aidan D'Arcy, Sarah Waicus, Alyssa Agostinis, Rachelle Scheepers, Yvonne Buttle, Aidan Pepper, Aisling Hughes, Basem Fouda, Panya Matreja, Emily MacInnis, Mary O'Dea, Eman Isweisi, Philip Stewart, Aoife Branagan, Edna F Roche, Judith Meehan, Eleanor J Molloy

Introduction: Neonatal encephalopathy (NE) is a condition with multifactorial etiology that causes multiorgan injury to neonates. The severity of multiorgan dysfunction (MOD) in NE varies, with therapeutic hypothermia (TH) as the standard of care. The aim is to identify current approaches used to assess and determine an optimum scoring system for MOD in NE.

Methods: The systematic review conformed to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. An electronic search was conducted using PubMed, EMBASE, MEDLINE, Cochrane Central Register of Controlled Trials, Scopus, and CINAHL for studies of scoring systems for MOD in NE.

Results: The search yielded 628 articles of which 12 studies were included for data extraction and analysis. Five studies found a positive correlation between the severity of NE and MOD. There was significant heterogeneity across the scoring systems, including the eligibility criteria for participants, the methods assessing specific organ systems, the length of follow-up, and adverse outcomes. The neurological, hepatic, cardiovascular, respiratory, hematological, and renal systems were included in most studies while the gastrointestinal system was only in three studies. The definitions for hepatic, renal, and respiratory systems dysfunction were most consistent while the cardiovascular system varied the most.

Discussion: A NE multiorgan scoring system should ideally include the renal, hepatic, respiratory, neurological, hematological, and cardiovascular systems. Despite the heterogeneity between the studies, these provide potential candidates for the standardization of MOD scoring systems in NE. Validation is needed for the parameters with adequate length of follow-up beyond the neonatal period. Additionally, the evaluation of MOD may be affected by TH considering its multiorgan effects.

导言:新生儿脑病(NE)是一种具有多因素病因的疾病,会对新生儿造成多器官损伤。新生儿多器官功能障碍(MOD)的严重程度各不相同,治疗性低温(TH)是护理的标准。本文旨在确定目前用于评估 NE 多器官功能障碍的方法,并确定最佳评分系统:该系统性综述符合系统性综述和荟萃分析首选报告项目(PRISMA)指南。我们使用 PubMed、EMBASE、MEDLINE、Cochrane Central Register of Controlled Trials、Scopus 和 CINAHL 对 NE 中 MOD 评分系统的研究进行了电子检索:搜索结果:共搜索到 628 篇文章,其中 12 项研究被纳入数据提取和分析。五项研究发现 NE 的严重程度与 MOD 呈正相关。各评分系统之间存在明显的异质性,包括参与者的资格标准、评估特定器官系统的方法、随访时间和不良结果。大多数研究纳入了神经系统、肝脏、心血管、呼吸系统、血液系统和肾脏系统,而只有三项研究纳入了胃肠道系统。肝、肾和呼吸系统功能障碍的定义最为一致,而心血管系统的定义差异最大:讨论:东北多器官评分系统最好包括肾、肝、呼吸、神经、血液和心血管系统。尽管各研究之间存在异质性,但这些研究为标准化 NE 的 MOD 评分系统提供了潜在的候选方案。需要对新生儿期以后的参数进行充分的随访验证。此外,考虑到TH对多器官的影响,MOD的评估可能会受到TH的影响。
{"title":"Neonatal encephalopathy multiorgan scoring systems: systematic review.","authors":"Noor Adeebah Mohamed Razif, Aidan D'Arcy, Sarah Waicus, Alyssa Agostinis, Rachelle Scheepers, Yvonne Buttle, Aidan Pepper, Aisling Hughes, Basem Fouda, Panya Matreja, Emily MacInnis, Mary O'Dea, Eman Isweisi, Philip Stewart, Aoife Branagan, Edna F Roche, Judith Meehan, Eleanor J Molloy","doi":"10.3389/fped.2024.1427516","DOIUrl":"https://doi.org/10.3389/fped.2024.1427516","url":null,"abstract":"<p><strong>Introduction: </strong>Neonatal encephalopathy (NE) is a condition with multifactorial etiology that causes multiorgan injury to neonates. The severity of multiorgan dysfunction (MOD) in NE varies, with therapeutic hypothermia (TH) as the standard of care. The aim is to identify current approaches used to assess and determine an optimum scoring system for MOD in NE.</p><p><strong>Methods: </strong>The systematic review conformed to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. An electronic search was conducted using PubMed, EMBASE, MEDLINE, Cochrane Central Register of Controlled Trials, Scopus, and CINAHL for studies of scoring systems for MOD in NE.</p><p><strong>Results: </strong>The search yielded 628 articles of which 12 studies were included for data extraction and analysis. Five studies found a positive correlation between the severity of NE and MOD. There was significant heterogeneity across the scoring systems, including the eligibility criteria for participants, the methods assessing specific organ systems, the length of follow-up, and adverse outcomes. The neurological, hepatic, cardiovascular, respiratory, hematological, and renal systems were included in most studies while the gastrointestinal system was only in three studies. The definitions for hepatic, renal, and respiratory systems dysfunction were most consistent while the cardiovascular system varied the most.</p><p><strong>Discussion: </strong>A NE multiorgan scoring system should ideally include the renal, hepatic, respiratory, neurological, hematological, and cardiovascular systems. Despite the heterogeneity between the studies, these provide potential candidates for the standardization of MOD scoring systems in NE. Validation is needed for the parameters with adequate length of follow-up beyond the neonatal period. Additionally, the evaluation of MOD may be affected by TH considering its multiorgan effects.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11481038/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142463092","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}
引用次数: 0
Policy and practice review consensus statements and clinical guidelines on managing pediatric trauma and orthopedics during the COVID-19 pandemic: a systematic review on the global response for future pandemics and public health crises. 关于在 COVID-19 大流行期间管理儿科创伤和矫形外科的政策和实践审查共识声明和临床指南:关于未来大流行病和公共卫生危机全球应对措施的系统审查。
IF 2.1 3区 医学 Q2 PEDIATRICS Pub Date : 2024-10-01 eCollection Date: 2024-01-01 DOI: 10.3389/fped.2024.1453574
Kapil Sugand, Chang Park, Arash Aframian, Chinmay M Gupte, Khaled M Sarraf

Introduction: The COVID-19 pandemic has been recognized as an unprecedented global health crisis. Over 7 million mortalities have been documented with many paediatric fatalities. Trauma and orthopaedic care, much like other specialities, were marginalized due to resource allocation during the pandemic which affected paediatric care. This is the first systematic review to centralise and compile the recommended published guidelines from professional bodies in principally English speaking countries on managing paediatric trauma and orthopaedic care. These guidelines will be required to be implemented sooner and more effectively in case of future pandemics with similar impact.

Methods: A search was conducted on PubMed/MedLine, Cochrane Library and Embase using terms including p(a)ediatric or child* and/or COVID* or coronavirus or SARS-CoV-2 and/or trauma and/or orthop(a)edic* with a simplified MeSH heading [mh] in order to make the search as comprehensive as possible. General terminology was utilized to make the search as exhaustive as possible for this systematic review. Another search was conducted on resources available in the public domain from professional bodies publishing on consensus statements and clinical practice guidelines in countries where English is the principal language managing pediatric trauma and orthopedics. The review adhered to PRISMA guidance.

Results: The search revealed a total of 62 results from both databases and professional bodies. Duplicates were removed. This was then reviewed to identify a total of 21 results which fit the inclusion criteria and included within the main analysis. The guidelines from professional bodies were outlined and categorized into aspects of clinical care.

Discussion: The impact of COVID-19 pandemic has compelled for changes in clinical practice and pediatric management. The systematic review highlights the relevant guidelines on service provision for pediatric patients including indications for urgent referrals, surgical prioritization, reasons for follow-up and trauma guidelines. The rationale for care during the unpredictable evolution of the COVID-19 pandemic may have the potential to be translated and replicated in future pandemics of similar significance.

导言:COVID-19 大流行已被视为一场前所未有的全球健康危机。据记录,有 700 多万人死亡,其中许多是儿童。在大流行期间,由于资源分配问题,创伤和骨科护理与其他专科一样被边缘化,影响了儿科护理。这是首次对主要英语国家的专业机构发布的儿科创伤和矫形护理管理指南进行集中和汇编的系统性回顾。在未来发生具有类似影响的流行病时,需要更快、更有效地实施这些指南:在 PubMed/MedLine、Cochrane Library 和 Embase 上进行了搜索,使用的术语包括儿科或儿童*和/或 COVID* 或冠状病毒或 SARS-CoV-2 和/或创伤和/或矫形*,并使用简化的 MeSH 标题 [mh],以使搜索尽可能全面。为了使本系统综述的搜索尽可能详尽,使用了通用术语。另一项搜索是在以英语为主要语言的国家中,针对专业机构发布的共识声明和临床实践指南进行的公共领域资源搜索,这些共识声明和临床实践指南是管理儿科创伤和矫形的主要语言。综述遵循了 PRISMA 指南:搜索结果显示,数据库和专业机构共提供了 62 项结果。重复内容已被删除。然后对这些结果进行了审查,共确定了 21 项符合纳入标准的结果,并将其纳入主要分析中。对专业机构的指南进行了概述,并按临床护理的各个方面进行了分类:讨论:COVID-19 大流行的影响迫使临床实践和儿科管理发生变化。系统性回顾强调了为儿科患者提供服务的相关指南,包括紧急转诊指征、手术优先顺序、随访原因和创伤指南。在 COVID-19 大流行不可预测的演变过程中,护理的基本原理有可能在未来类似的大流行中得到转化和复制。
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引用次数: 0
Surgical aspects of pediatric abdominal pain in the era of COVID-19: clinical consideration and outcomes. COVID-19 时代小儿腹痛的外科治疗:临床考虑和结果。
IF 2.1 3区 医学 Q2 PEDIATRICS Pub Date : 2024-09-30 eCollection Date: 2024-01-01 DOI: 10.3389/fped.2024.1400638
Nezar Abo-Halawa, Mohamed A Negm, Mohamed Arafa, Mohamed Fathy

Background: Acute abdominal pain in pediatrics is a medical emergency that requires special attention. During COVID-19 pandemic, this disease presented in pediatric age by different presentations including abdominal presentations.The affected children are presented with abdominal pain, which may be caused by surgical causes or by the virus itself that necessitate surgical consultation.

Purpose: This study highlights the impact of the coronavirus pandemic on pediatric patients with acute abdominal pain regarding the presentation, clinical evaluation, and surgical management.

Methods: A retrospective cohort study was done through the collection of data from medical records and authors' data repositories of pediatric patients presented with acute abdomen from March 2020 to March 2022, in three pediatric surgery tertiary centers.

Results: Eighty-four pediatric patients with acute abdominal pain were included in this study. The diagnosis of acute appendicitis was found in 31 patients (36.9%). Generalized abdominal pain was noted in 17 patients (20.2%) and presentation mimicked acute cholecystitis was occured in 14 patients (16.7%). ultrasonography revealed intussusception in 12 cases (14.3%). Multisystem inflammatory syndrome in children (MIS-C) was present in 9 cases (10.7%) and only one case of pancreatitis (1.2%). Conservative management was successful in 66 cases (78.6%), while operative intervention was needed in18 cases (21.4%).

Conclusion: During the COVID-19 pandemic, acute abdominal pain in children was frequently observed. Careful follow up is critically important as most cases do not necessitate surgical intervention. It is crucial to consider COVID-19 as a differential diagnosis in children presenting with acute abdominal pain, particularly in cases of atypical appendicitis and intussusception to prevent unnecessary surgical procedures.

背景:儿科急性腹痛是一种需要特别关注的急症。目的:本研究强调了冠状病毒大流行对急性腹痛儿科患者在表现、临床评估和手术治疗方面的影响:方法:通过收集三家儿科外科三级中心 2020 年 3 月至 2022 年 3 月期间儿科急腹症患者的病历数据和作者的数据存储库,进行了一项回顾性队列研究:本研究共纳入84名急性腹痛的儿科患者。31名患者(36.9%)被诊断为急性阑尾炎。17例患者(20.2%)出现全身性腹痛,14例患者(16.7%)出现模仿急性胆囊炎的表现,12例患者(14.3%)超声波检查发现肠套叠。9例患者(10.7%)出现儿童多系统炎症综合征(MIS-C),仅有1例出现胰腺炎(1.2%)。保守治疗成功的有 66 例(78.6%),需要手术治疗的有 18 例(21.4%):结论:在COVID-19大流行期间,经常观察到儿童急性腹痛。结论:在 COVID-19 大流行期间,经常观察到儿童急性腹痛。由于大多数病例无需手术治疗,因此仔细随访至关重要。对于出现急性腹痛的儿童,尤其是非典型性阑尾炎和肠套叠病例,将 COVID-19 作为鉴别诊断至关重要,以避免不必要的外科手术。
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引用次数: 0
Perinatal risk factors for late neonatal severe acute kidney injury in very low birth weight infants: a retrospective study. 极低出生体重儿新生儿晚期严重急性肾损伤的围产期风险因素:一项回顾性研究。
IF 2.1 3区 医学 Q2 PEDIATRICS Pub Date : 2024-09-30 eCollection Date: 2024-01-01 DOI: 10.3389/fped.2024.1412400
Hyun Ho Kim, Jihye You, Esther Park, Jin Kyu Kim

This study aimed to identify the perinatal risk factors of severe acute kidney injury (AKI) occurring after the first week of birth in very low birth weight (VLBW) infants who survived up to the first week. We conducted a single-center, retrospective cohort study on VLBW infants (birth weight, <1,500 g) delivered at <32 weeks of gestational age (GA) from January 2012 to December 2022. We classified AKI based on changes in serum creatinine and urine output based on the modified The Kidney Disease: improving Global Outcomes (KDIGO) neonatal AKI criteria. Stage 2-3 AKI were considered as severe AKI (sAKI). We performed logistic regression analysis to evaluate risk factors for late neonatal severe AKI identified in the second week after birth. We included 274 VLBW infants. The prevalence of late neonatal severe AKI (sAKI) was 27.4%, with the diagnosis rate of sAKI being higher early after birth. Logistic regression analysis revealed that the factors associated with late neonatal sAKI were small for gestational age (SGA) (OR, 3.02; P = 0.032), endotracheal intubation in the delivery room (OR, 2.79; P = 0.022), necrotizing enterocolitis (NEC) (OR, 12.41; P = 0.029), and decreased minimum weekly fluid balance <0 (OR, 2.97; P = 0.012). SGA, intubation in the delivery room, and NEC were associated factors for late neonatal sAKI in VLBW infants. The association of no weekly weight gain with increased late neonatal sAKI risk indicates its use in guiding fluid therapy and aids in biomarker research.

本研究旨在确定出生一周后发生严重急性肾损伤(AKI)的围产期危险因素,这些婴儿均为存活至出生一周的超低出生体重儿(VLBW)。我们对 VLBW 婴儿(出生体重,P = 0.032)、产房气管插管(OR,2.79;P = 0.022)、坏死性小肠结肠炎(NEC)(OR,12.41;P = 0.029)和每周最低体液平衡下降(P = 0.012)进行了单中心回顾性队列研究。SGA、产房插管和坏死性小肠结肠炎是导致低体重儿晚期新生儿 sAKI 的相关因素。每周体重不增加与新生儿晚期sAKI风险增加有关,这表明它可用于指导液体疗法,并有助于生物标记物研究。
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引用次数: 0
Precision measurement of rehabilitation interventions-a secondary analysis of motor error in a clinical trial with young children with cerebral palsy. 康复干预措施的精确测量--对脑瘫幼儿临床试验中运动误差的二次分析。
IF 2.1 3区 医学 Q2 PEDIATRICS Pub Date : 2024-09-30 eCollection Date: 2024-01-01 DOI: 10.3389/fped.2024.1457329
Julie C Skorup, Samuel R Pierce, Athylia C Paremski, Morgan Alcott, Laura A Prosser

Introduction: The delivery of precision medicine in rehabilitation will require not only precise measurement of participant response, but also precise measurement of the "ingredients" of intervention and their dose. As an example, we report the measurement of motor error in two treatment groups from a randomized controlled trial in toddlers (mean age 26.3 months) with cerebral palsy (CP). Our objective was to measure the type and amount of motor error during physical therapy sessions in young children with CP.

Methods: Participants were stratified by motor function and age and randomly allocated to "conventional" physical therapy that generally prevented falls or to an intervention that encouraged error experience by not preventing falls (experimental group). Baseline motor and cognitive function were measured using the Gross Motor Function Measure-66 (GMFM-66) and Bayley 3 cognitive subscale (B3-C) prior to randomization. Randomly selected video recorded therapy sessions were manually coded to identify losses of balance defined as falls (child contacted floor), rescues (therapist prevented fall) or saves (child recovered their balance independently).

Results: Average number of losses of balance per session were higher in the experimental group than the conventional group due to significantly greater falls. Saves were infrequent in both groups but were also significantly higher in the experimental group. Average number of rescues did not differ between groups. In the experimental group, greater frequency of falls was significantly related to GMFM-66. In both groups, greater frequency of saves was related to GMFM-66. Neither total losses of balance per session nor rescues were related to GMFM-66 in either group. There were no significant relationships between losses of balance and baseline cognition in either group, except greater frequency of saves was related to higher cognitive ability in the experimental group.

Discussion: Our observations suggest that motor error experience is lower in toddlers with CP compared to peers with typical development but can be manipulated to higher doses of error during therapy sessions. Future work should investigate the relationship between type and amount of error experience and rehabilitation outcomes, as well as other "ingredients" of rehabilitation therapy. Tools to automate the precise measurement of intervention content are necessary for broad scale implementation.

导言:在康复领域提供精准医疗不仅需要精确测量参与者的反应,还需要精确测量干预的 "成分 "及其剂量。举例来说,我们报告了一项随机对照试验中两个治疗组对脑瘫幼儿(平均年龄 26.3 个月)运动误差的测量结果。我们的目标是测量脑瘫幼儿在物理治疗过程中运动误差的类型和数量:根据运动功能和年龄对参与者进行分层,并将他们随机分配到一般可防止跌倒的 "传统 "物理治疗中,或分配到通过不防止跌倒来鼓励错误体验的干预中(实验组)。随机分配前,使用粗大运动功能测量-66(GMFM-66)和贝雷3认知分量表(B3-C)测量运动和认知功能基线。对随机选取的治疗过程录像进行人工编码,以确定失去平衡的情况,并将其定义为跌倒(儿童触地)、抢救(治疗师阻止了跌倒)或挽救(儿童独立恢复了平衡):结果:实验组每次治疗失去平衡的平均次数高于常规组,原因是摔倒的次数明显多于常规组。两组的挽救次数都不多,但实验组的挽救次数也明显高于常规组。两组的平均挽救次数没有差异。在实验组中,摔倒次数较多与 GMFM-66 有明显关系。在两组中,救人次数的增加都与 GMFM-66 有关。在两组中,每节课失去平衡的总次数和获救次数都与 GMFM-66 无关。在两组中,平衡损失与基线认知之间都没有明显的关系,只是在实验组中,更高的挽救频率与更高的认知能力有关:讨论:我们的观察结果表明,与发育正常的同龄人相比,患有先天性脑瘫的学步儿童的运动失误经验较少,但在治疗过程中,可以通过操控来增加失误的剂量。未来的工作应研究错误体验的类型和数量与康复结果之间的关系,以及康复治疗的其他 "成分"。要广泛实施干预措施,就必须有自动精确测量干预内容的工具。
{"title":"Precision measurement of rehabilitation interventions-a secondary analysis of motor error in a clinical trial with young children with cerebral palsy.","authors":"Julie C Skorup, Samuel R Pierce, Athylia C Paremski, Morgan Alcott, Laura A Prosser","doi":"10.3389/fped.2024.1457329","DOIUrl":"https://doi.org/10.3389/fped.2024.1457329","url":null,"abstract":"<p><strong>Introduction: </strong>The delivery of precision medicine in rehabilitation will require not only precise measurement of participant response, but also precise measurement of the \"ingredients\" of intervention and their dose. As an example, we report the measurement of motor error in two treatment groups from a randomized controlled trial in toddlers (mean age 26.3 months) with cerebral palsy (CP). Our objective was to measure the type and amount of motor error during physical therapy sessions in young children with CP.</p><p><strong>Methods: </strong>Participants were stratified by motor function and age and randomly allocated to \"conventional\" physical therapy that generally prevented falls or to an intervention that encouraged error experience by not preventing falls (experimental group). Baseline motor and cognitive function were measured using the Gross Motor Function Measure-66 (GMFM-66) and Bayley 3 cognitive subscale (B3-C) prior to randomization. Randomly selected video recorded therapy sessions were manually coded to identify losses of balance defined as <i>falls</i> (child contacted floor), <i>rescues</i> (therapist prevented fall) or saves (child recovered their balance independently).</p><p><strong>Results: </strong>Average number of losses of balance per session were higher in the experimental group than the conventional group due to significantly greater falls. Saves were infrequent in both groups but were also significantly higher in the experimental group. Average number of rescues did not differ between groups. In the experimental group, greater frequency of falls was significantly related to GMFM-66. In both groups, greater frequency of saves was related to GMFM-66. Neither total losses of balance per session nor rescues were related to GMFM-66 in either group. There were no significant relationships between losses of balance and baseline cognition in either group, except greater frequency of saves was related to higher cognitive ability in the experimental group.</p><p><strong>Discussion: </strong>Our observations suggest that motor error experience is lower in toddlers with CP compared to peers with typical development but can be manipulated to higher doses of error during therapy sessions. Future work should investigate the relationship between type and amount of error experience and rehabilitation outcomes, as well as other \"ingredients\" of rehabilitation therapy. Tools to automate the precise measurement of intervention content are necessary for broad scale implementation.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11472820/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142463096","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}
引用次数: 0
Sustained decline in birth weight and increased rate of preterm infants born small for gestational age in Japan. 日本出生体重持续下降,胎龄小的早产儿比例上升。
IF 2.1 3区 医学 Q2 PEDIATRICS Pub Date : 2024-09-30 eCollection Date: 2024-01-01 DOI: 10.3389/fped.2024.1480527
Akinori Moriichi, Erika Kuwahara, Narumi Kato

Background: Birth weights have continued to decline in Japan in recent years. However, secular trend changes such as the birth weight relative to the week of gestation remain to be explored. This study aimed to determine the trends over time in mean birth weight and small for gestational age (SGA) rate for each gestational week.

Methods: We used a large dataset of 27,015,792 births obtained from birth certificates between 1997 and 2021. Births from 22 to 41 weeks of gestation were evaluated in six groups (22-24, 25-27, 28-31, 32-33, 34-36, and 37-41 weeks of gestational age). For each group, secular trend changes in the z-scores calculated from standard birth weight values were assessed. Time trends in the proportion of SGA and mean birth weight z-scores were evaluated using the Cochran-Armitage trend test and linear regression analysis. Binomial logistic regression was performed to ascertain the effects of gestational age, sex, primiparity, number of births, and maternal age on the likelihood of SGA.

Results: The mean birth weight of preterm infants continued to decrease, and the z-score for mean birth weight decreased linearly, falling to -0.7 at 25-27 weeks of gestation from 1997-2001 (first period) to 2017-2021 (final period). Maternal age continued to increase from the first period to the last period for all weeks of gestation. There was a linear increase in the SGA rate in preterm infants born at <34 weeks. Odds ratios for the likelihood of SGA were 1.3 times higher for maternal age ≥40 years than that for 25-29 years (95% CI: 1.29-1.33, p < 0.001).

Conclusions: In Japan, there has been a continuous decline in birth weight and an increase in the rate of preterm SGA infants.

背景:近年来,日本的出生体重持续下降。然而,出生体重相对于孕周的长期趋势变化仍有待探索。本研究旨在确定每个孕周的平均出生体重和小于胎龄儿(SGA)率随时间变化的趋势:我们使用了 1997 年至 2021 年间从出生证明中获得的 27,015,792 例新生儿的大型数据集。我们将妊娠 22 至 41 周的新生儿分为六组(妊娠 22 至 24 周、25 至 27 周、28 至 31 周、32 至 33 周、34 至 36 周和 37 至 41 周)进行评估。对于每个组别,均评估了根据标准出生体重值计算出的 Z 值的长期趋势变化。使用 Cochran-Armitage 趋势检验和线性回归分析评估了 SGA 比例和平均出生体重 z 值的时间趋势。为了确定胎龄、性别、初产妇、分娩次数和产妇年龄对 SGA 发生可能性的影响,进行了二项式逻辑回归:早产儿的平均出生体重持续下降,平均出生体重的 Z 值呈线性下降,从 1997-2001 年(第一阶段)到 2017-2021 年(最后阶段),在孕 25-27 周时下降至-0.7。在所有妊娠周数中,孕产妇年龄从第一期到最后一期持续增加。在得出 p 结论时出生的早产儿中,SGA 比率呈线性增长:在日本,出生体重持续下降,早产儿 SGA 率上升。
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引用次数: 0
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Frontiers in Pediatrics
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