Frontiers in Pediatrics最新文献

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

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

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

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

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

Systematic review registration: PROSPERO CRD420251016618.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Introduction: Toxic Epidermal Necrolysis (TEN) is a life-threatening dermatologic emergency, with particularly high morbidity and mortality in children due to their vulnerable skin barrier and propensity for systemic complications. When TEN is further complicated by respiratory failure, the competing demands of airway management and skin preservation pose a significant therapeutic challenge.

Case report: We report a case of a 6-year-old boy with TEN involving 70% body surface area and concurrent respiratory failure. The patient required endotracheal intubation and mechanical ventilation, which exacerbated facial skin injury. A structured, multidisciplinary, and phased nursing protocol was implemented, integrating respiratory support with meticulous skin, ocular, oral, and urogenital care.

Interventions & outcomes: A coordinated team comprising pediatric intensive care, dermatology, infectious diseases, and nutrition specialists guided management. Skin care was staged according to wound healing phases, utilizing non-adhesive dressings, topical recombinant bovine basic fibroblast growth factor (bFGF) gel, and innovative tube-securement techniques. Systemic and mucosal care protocols were rigorously applied. The patient achieved complete re-epithelialization by day 35, was successfully extubated, and discharged in stable condition on day 46 with no major sequelae.

Conclusion: This case demonstrates that a structured, phase-based, and multidisciplinary nursing approach can effectively balance life-sustaining interventions with tissue preservation in severe pediatric TEN. The strategy highlights the importance of adaptive wound staging, trauma-minimizing techniques, and proactive mucosal protection, offering a replicable framework for similar critical care scenarios.

Background: Pediatric flatfoot is a prevalent musculoskeletal condition that may impair gait patterns, posture, and quality of life. Despite its clinical importance, only a few studies have explored how its prevalence and risk factors vary across different sociocultural settings. To date, no study has directly compared pediatric flatfoot between the two countries. Therefore, this study aimed to determine the prevalence of pediatric flatfoot and identify the associated modifiable risk factors among schoolchildren from two different countries representing urbanized and resource-limited settings.

Methods: A cross-sectional study was conducted between December 2023 and February 2025 among the schoolchildren aged 7-14 years with a total number of 4,205 in Kunming, China, and Kandahar, Afghanistan. Foot morphology was assessed using an optical podoscope, and flatfoot was classified using a line-based footprint method. Anthropometric data and information on footwear, physical activity, and foot pain were collected using standardized questionnaires. Logistic regression analysis was used to identify the independent risk factors.

Results: The overall prevalence of flatfoot was 12.8%, with 11.0% in Kunming and 14.6% in Kandahar. Flatfoot is more common in boys, children aged 11-14 years, and urban residents. Obesity, insufficient physical activity, closed-toe footwear, and foot pain were significantly associated with higher odds of the flatfoot with consistent patterns across both sites. Most cases were bilateral, and approximately one-fifth were classified as severe.

Conclusion: Pediatric flatfoot remains a widespread condition among school-aged children in both urban and resource-limited settings. Its strong and consistent links with modifiable factors such as body mass index, physical activity, footwear, and foot pain highlight the need for early school-based screening and prevention programs that encourage active lifestyles, healthy body weight, and the use of proper footwear. These results offer valuable cross-cultural insights to support pediatric foot health and guide future preventive initiatives.

Background: ACTA1-related congenital myopathies are rare neuromuscular disorders with significant genotypic heterogeneity, often causing severe neonatal multisystem involvement. This study presents a severe neonatal case with a pathogenic ACTA1 variant and reviews literature to highlight diagnostic and management challenges.

Case presentation: A female infant was born via cesarean section at 39⁺¹ weeks to a non-consanguineous mother. Prenatal ultrasound showed polyhydramnios. She presented with severe birth asphyxia (Apgar 3 at 1 min, 5 at 5 min), requiring immediate resuscitation. Physical examination revealed profound hypotonia, absent spontaneous movements, respiratory insufficiency necessitating mechanical ventilation, expressionless facies, and bulbar dysfunction. Laboratory tests indicated metabolic acidosis and elevated lactate and creatine kinase. Electromyography (EMG) demonstrated reduced motor amplitudes and spontaneous fibrillations. Whole-exome sequencing identified a de novo heterozygous pathogenic variant in ACTA1 (c.227G>A, p. Gly76Asp), confirming ACTA1-related congenital myopathy. Care was withdrawn on day 18 due to poor neurologic recovery.

Conclusion: This case highlights three critical implications: (1) the significant clinical overlap between ACTA1 myopathy and perinatal asphyxia, underscoring the necessity of genetic testing in hypotonic neonates with atypical presentations; (2) the grave prognosis of early-onset ACTA1 mutations, which mandates early palliative care consultation; and (3) the essential role of a precise genetic diagnosis in defining phenotypes and informing future targeted therapies, such as gene therapy.

Childhood obesity is a global health crisis with limited effective therapies beyond lifestyle modification. This review examines the growing role of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in the management of pediatric obesity. Simultaneously, this study highlights the critical considerations for clinicians in administering these medications, including long-term safety, efficacy, potential adverse effects, and overall clinical utility. To enhance the effectiveness of GLP-1 RAs in managing pediatric obesity, we propose a comprehensive clinical medication use management process that includes review, screening, combination therapy, education, monitoring, and follow-up. We also present recommendations for policymakers and healthcare systems. In conclusion, GLP-1 RAs represent an emerging therapeutic paradigm for pediatric obesity, demonstrating notable efficacy in weight reduction for adolescents. Ongoing research is needed to determine long-term outcomes, optimal treatment duration, and strategies to ensure broad and equitable access to these therapies.