Frontiers in Pediatrics最新文献

Introduction: Infantile hemangiomas, the commonest benign vascular tumors of infancy, often cluster on the head and neck where early treatment can avert permanent disfigurement, prompting us to evaluate 0.5% timolol maleate wet compresses as a non-invasive alternative to oral propranolol.

Methods: We conducted a study of 359 consecutive infants treated at Sichuan Provincial People's Hospital between December 2018 and January 2024. Baseline demographics, lesion site and size, age at initial treatment, treatment duration, and follow-up period were recorded. Treatment outcomes were graded as excellent (complete regression), good (≥50% shrinkage), fair (<50% shrinkage), or poor (no change/growth). Eexcellent/good outcomes were defined as a positive therapeutic effect, while fair/poor outcomes were classified as negative therapeutic effect.

Results: 267 infants (74.37%) achieved positive therapeutic effect, with 117 excellent and 150 good, whereas 92 infants (25.63%) achieved negative therapeutic effect including 53 were fair and 39 poor. Treatment outcomes were significantly better when therapy began before 3 months (early age) (U = 9954, Z = - 3.256, P = 0.001) and for lesions ≤3 cm diameter (small size) (U = 2,869.5, Z = - 13.952, P < 0.001), and multivariate analysis confirmed early age (OR = 0.784, P = 0.024) and small size (OR = 0.113, P < 0.001) as independent predictors of positive therapeutic effect. Adverse events were mild: 24 (6.69%) local irritation, 41 (11.42%) transient systemic symptoms. Skin sequelae were observed in 12 (3.34%) cases.

Discussion: Topical timolol compresses offer a safe, effective first-line option for superficial head-and-neck infantile hemangiomas, especially when started early and directed at smaller lesions.

Objective: To analyze the clinical characteristics and etiological spectrum of retropharyngeal space abnormalities in children, stratifying by age to improve diagnostic and therapeutic strategies.

Methods: We retrospectively analyzed the clinical data of 77 pediatric patients with imaging-confirmed retropharyngeal space abnormalities admitted to Wuhan Children's Hospital between January 2015 and March 2024. Patients were divided into two groups based on age: younger group (<6 years, n = 51) and older group (≥6 years, n = 26). Demographics, clinical presentations, imaging findings, etiologies, and treatment outcomes were compared between the groups using Chi-square or Fisher's exact tests for categorical data and independent samples t-tests for continuous data.

Results: The most common presenting symptoms were fever (49.4%) and neck mass (33.8%). The primary CT finding was retropharyngeal hypodensity or fluid collection (68.8%). No significant differences were observed in sex ratio, clinical symptoms, or imaging findings between the two age groups (p > 0.05). However, children <6 years old had a significantly higher rate of requiring transoral incision and drainage for retropharyngeal abscess (23.5% vs. 3.8%, p = 0.041). Etiologically, infectious diseases were significantly more prevalent in the older group (92.3% vs. 70.6%, p = 0.030), whereas congenital malformations were a more common underlying cause in the younger group, however, this trend did not reach statistical significance (p = 0.051).

Conclusion: The etiology and management of pediatric retropharyngeal abnormalities are age-dependent; infectious causes dominate in children ≥6 years, while congenital malformations are key considerations in those <6 years, who are at higher risk for abscess formation requiring surgical intervention.

Background: The rising incidence of infectious diseases underscores the necessity for vaccination such as COVID-19. Beyond examining the side effects in healthy individuals, it is crucial to investigate the vaccination experiences of vulnerable populations, particularly those with Henoch-Schönlein purpura (HSP).

Methods: A questionnaire study was conducted during the period of rapid outbreak following the relaxation of travel restrictions in China towards the latter stages of the COVID-19 pandemic.

Results: Despite non-HSP individuals exhibiting more pronounced symptoms of cough, fatigue, dizziness, and headache compared to HSP patients, the HSP group displayed significantly lower rates of vaccination post-matching. Specifically, only 63% of HSP individuals completed the full vaccination regimen, with no significant association found between vaccination status and improved recovery or mitigation of HSP symptoms. Among HSP individuals, only improvement in diarrhea symptoms was positively correlated with recovery time, while fully vaccinated HSP children exhibited more abnormal symptoms during the recovery period.

Conclusion: Results from this study on COVID-19 vaccination status among pediatric patients who required hospital visits during the peak of the pandemic indicated that vaccination rates were comparatively lower among patients with HSP, even amidst severe outbreaks. HSP patients who completed the full vaccination regimen appeared to experience more pronounced adverse symptoms. This observation suggests that their increased vaccine hesitancy relative to the general population may be justified and warrants careful consideration.

Background: This study explored the predictive value of the pediatric early warning scores (PEWS) in recognizing clinical deterioration and identifying children with influenza with unplanned readmission to the emergency observation room (EOR) within 72 h.

Methods: A total of 196 children were included in this single-center case-control study conducted between 1 January and 30 June 2024. PEWS scores and receiver operating characteristic curves were used to evaluate the correlations between the scores and the likelihood of influenza necessitating readmission.

Results: For each 1-point increase in PEWS score, the risk of unplanned readmission significantly increased with unadjusted PEWS of [OR 9.98 (1.54-64.73); P = 0.016] and adjusted PEWS of [OR 10.53 (3.47-31.98); P < 0.001], respectively. The time to reach the highest PEWS was significantly longer in patients who experienced unplanned readmissions (P < 0.01). Among the non-readmitted patients, 100 out of 147 (68.03%) took oseltamivir orally, compared with only 10 out of 49 (20.41%) patients with unplanned readmissions within 72 h (P < 0.001). A PEWS cutoff score of 3 indicated a relatively high sensitivity of 61.2% and specificity of 96.6%, with a positive likelihood ratio (PLR) of 18.0 and a negative likelihood ratio of 0.4.

Conclusions: PEWS is potential for predicting unplanned readmissions with similar symptoms in children with influenza, demonstrating it may be an essential tool for enhancing patient care and outcomes.

Background: Emergency Medical Services (EMS) play a vital role in pediatric care by providing timely interventions that can influence outcomes. However, there is limited national evidence from Saudi Arabia describing the profile and patterns of pediatric EMS use. Understanding these patterns is essential to guide paramedic preparedness, system planning, and public health strategies. This study aimed describe the nature of characteristics of emergency calls responded by emergency medical services in Saudi Arabia for pediatric patients aged <18 years during the year of 2022.

Methods: A retrospective, descriptive study was conducted using data from the Saudi Red Crescent Authority (SRCA) for the year 2022. All pediatric cases (<18 years) attended by SRCA were included. Demographic, clinical, temporal, and geographic variables were analysed using descriptive and comparative statistics.

Results: A total of 58,554 pediatric EMS cases were included. Adolescents (47.1%) and children aged 4-12 years (38.9%) formed the largest groups, with a predominance of males (66.2%) and Saudi nationals (81.7%). Most calls were received between 9:00 pm and 1:00 am, with higher frequencies observed during weekends. Regional distribution showed the highest proportions in the Western (37.2%) and Central (30.7%) regions. Among the chief complaint, the most frequent complaints were trauma (21.8%), musculoskeletal (13.3%), bleeding (10.5%), and neurological (10.1%). Most EMS activations were initiated through the 997-call line (79.0%), followed by 911 (11.1%) and mobile applications (9.9%). The majority were managed by basic life support crews (75.1%), while advanced life support attended 22.5% of cases. The median dispatch-to-scene arrival time was 11.71 min, and the median on-scene time was 12.35 min.

Conclusion: This national study provides the first comprehensive profile of pediatric EMS use in Saudi Arabia. The findings highlight the predominance of adolescents and males, the significant burden of medical emergencies alongside trauma, and the broad spectrum of pediatric conditions requiring EMS response. These results emphasise the need to strengthen pediatric-focused training, optimise EMS system planning, and integrate EMS data into public health strategies to improve child health and safety in the Kingdom.

Childhood obesity is a growing public health concern with long-term physical and psychological consequences. Parents, as primary caregivers, play a central role in shaping children's eating habits and physical activity behaviours. This cross-sectional study examined how parental feeding perceptions and practices relate to family nutrition and physical activity patterns, and whether these associations vary according to parental demographic characteristics, particularly age. The sample comprised 268 parents of children aged 8-11 years in Türkiye, recruited from primary schools using purposive sampling. Data were collected via the Child Feeding Questionnaire (CFQ) and the Family Nutrition and Physical Activity Screening Tool (FNPA), both of which showed acceptable internal consistency in this sample. Pearson correlations, one-way ANOVA, and multiple linear regression with effect size estimates were used to analyse the data. Parental age showed no significant correlations with most CFQ subscales, except for a small negative association with restriction (r = -0.12, p < .05), indicating that older parents report slightly lower use of restrictive feeding practices. General obesity-related parental perceptions (perceived parent and child weight, concern about child's weight) were not significantly related to FNPA scores, and differences in CFQ and FNPA scores by parental gender, education level, and child age were statistically non-significant and negligible in magnitude. In contrast, FNPA scores were positively associated with parental responsibility (r = 0.32, p < .01) and monitoring (r = 0.41, p < .01). Regression analysis showed that higher responsibility and monitoring predicted more favourable family nutrition and physical activity patterns, whereas restriction was a negative predictor, with the model explaining approximately one quarter of the variance in FNPA scores. These findings underscore the importance of strengthening parental responsibility and monitoring, rather than restrictive feeding, in interventions designed to promote healthier lifestyle patterns in middle childhood.

Objective: This study aims to analyze the global research landscape of robot-assisted surgery in pediatric urology, identify developmental trends through visualization methods, and provide references and recommendations for future research directions.

Methods: A retrospective bibliometric analysis was conducted using literature retrieved from PubMed and Web of Science Core Collection, covering the period from January 2005 to March 2025. CiteSpace 6.4.R1 software was used for data processing and visualization. Analyses included publication trends, keyword co-occurrence, keyword clustering, and burst detection to construct knowledge maps and explore research dynamics.

Results: A total of 498 publications were included in the analysis. The number of publications showed a clear upward trend. The author collaboration network was relatively dense, with an identifiable core research team. The University of Chicago emerged as the leading institution in terms of publication volume in the field of robot-assisted surgery in pediatric urology. Gundeti MS was the most productive author, contributing 51 published papers to the field. Keyword clustering analysis revealed 10 clusters, and burst detection identified 20 keywords with significant citation bursts.

Conclusions: Current international research primarily focuses on disease classification and surgical techniques in robot-assisted surgery in pediatric urology. Future studies should continue to explore the clinical potential of robot-assisted surgery, broaden its application scope, and promote the diversified development of pediatric urology.

Introduction: Extremely premature infants (EPIs) are at significant risk for early mortality and severe intraventricular hemorrhage. This study aimed to investigate the risk factors associated with early mortality and severe intraventricular hemorrhage in EPIs with a gestational age of less than 28 weeks and to evaluate the predictive value of these risk factors in determining adverse outcomes.

Methods: A retrospective analysis was conducted on clinical data from EPIs admitted to the Neonatal Intensive Care Unit at Maternal and Child Health Hospital of Hubei Province between January 2019 and December 2024. Infants were categorized into two groups based on their early outcomes: an adverse outcome group (n = 110) and a favorable outcome group (n = 183). Binary logistic regression analysis was used to identify high-risk factors for adverse outcomes in EPIs, and receiver operating characteristic (ROC) curve analysis was performed to assess the predictive value of these factors.

Results: This study revealed that the maximum vasoactive-inotropic score (Max VIS) (OR: 1.136, 95% CI: 1.070, 1.216) and middle cerebral artery resistance index (MCA-RI) (OR: 450.489, 95%CI: 36.163, 5,611.780) and vaginal delivery (OR: 3.684, 95%CI: 2.005, 6.768) were independent risk factors for adverse outcomes in EPIs, while gestational age was a protective factor (OR: 0.568, 95% CI: 0.415, 0.778). ROC curve analysis indicated that Max VIS > 9.5, MCA-RI > 0.81, vaginal delivery, and small gestational age had predictive value for adverse outcomes in EPIs (P < 0.05), with area under the curves (AUC) of 0.680 (95% CI: 0.615, 0.745), 0.693 (95%CI: 0.628, 0.758), 0.653 (95% CI: 0.588, 0.718), and 0.660 (95% CI: 0.275, 0.404), respectively. The combination of all four factors yielded the highest predictive performance, with an AUC of 0.833 (95%CI: 0.783, 0.883), sensitivity of 72.7%, and specificity of 81.4%.

Conclusion: Elevated Max VIS, increased MCA-RI, vaginal delivery, and small gestational age are independent risk factors for early mortality and severe intraventricular hemorrhage in EPIs. Each is a valuable predictor of adverse outcomes, and their combination demonstrates the highest predictive value, providing significant clinical reference for the early management of these high-risk neonates.

Protocols concerning classification, monitoring and treatment were developed for the oligoarticular form of juvenile idiopathic arthritis (JIA) as part of a consensus process. The aim was to establish standardized, evidence-based protocols for managing persistent oligoarticular JIA. The group of authors initially formulated 23 statements and circulated them in an online survey to medical members of the Society for Paediatric and Adolescent Rheumatology (GKJR). A total of 80 of the 124 paediatric and adolescent rheumatologists took part in the survey, which corresponds to just under 65% of the paediatric and adolescent rheumatologists active at the time. In a final online meeting, comments from the survey were incorporated into the statements and then agreed upon by the group of authors. Finally, for newly occurring oligoarticular JIA, 20 statements and a summary consensus treatment protocol were developed to optimise the treatment of persistent oligoarticular JIA.

Purpose: To investigate clinical heterogeneity in pediatric secondary intussusception and to develop four simplified, etiology-specific scoring systems to facilitate preoperative etiologic prioritization after intussusception has been confirmed.

Methods: This retrospective study analyzed 92 pediatric patients diagnosed with secondary intussusception from 2018 to 2023. Disease patterns across PLP subtypes were analyzed using a four-dimensional framework including etiology, age, sex, and clinical features. Candidate variables were selected based on clinical plausibility and univariable screening before being entered into etiology-specific OvR models. Etiology-specific scoring models for IgA vasculitis (IgAV), Meckel's diverticulum (MD), intestinal polyps (IP), and intestinal duplication (ID) were constructed using binary logistic regression and a one-vs.-rest strategy. Each score was internally validated according to ROC curves, with discrimination assessed by AUC as well as sensitivity and specificity.

Results: The IgAV score incorporated hematochezia (+2), age ≥6 years (+1), and absence of abdominal mass (+1), with an AUC of 0.85, sensitivity of 80%, and specificity of 75.4%. The AUCs for Meckel's diverticulum, intestinal polyps, and intestinal duplication were 0.780, 0.925, and 0.851, respectively. The remaining etiology-specific scores similarly comprised two to three bedside-available variables (e.g., demographic features and key clinical manifestations), allowing for practical use in the preoperative setting.

Conclusion: These simple, non-invasive scoring systems may assist early etiologic prioritization and support more targeted diagnostic assessment in pediatric intussusception. Their simplicity and internal performance characteristics suggest potential utility in acute care settings. Future studies are warranted to validate their generalizability and to explore integration into routine clinical workflows.