Frontiers in Pediatrics最新文献

Background: Understanding children's eating behaviors is crucial for elucidating the etiology of childhood obesity. However, the relationship between these behaviors and abdominal fat accumulation remains poorly understood. This study aims to investigate this association in primary school children.

Methods: This study included 1,475 children aged 8-10 years in Ningbo, China. Body composition was measured both at baseline (September 2022) and after 9 months of follow-up (June 2023). Primary caregivers completed the Children's Eating Behavior Questionnaire (CEBQ). A mixed-effects linear model was applied to analyze the relationships between children's eating behaviors and body composition.

Results: Greater visceral fat area (VFA) was associated with greater slowness in eating [β = 0.25 (0.02, 0.49)], greater food responsiveness [β = 0.29 (0.14, 0.43)], increased emotional undereating [β = 0.35 (0.17, 0.54)], and more emotional overeating [β = 0.21 (0.02, 0.39)]. Children with greater trunk fat mass (TrFM) tended to have greater food responsiveness [β = 0.02 (0.01, 0.03)] and greater enjoyment of food [β = 0.01 (0.00, 0.03)], increased emotional undereating [β = 0.02 (0.01, 0.03)] and emotional overeating [β = 0.02 (0.00, 0.03)]. Prospectively, positive correlations were observed between VFA and food responsiveness [β = 0.18 (0.02, 0.35)], as were emotional undereating [β = 0.31 (0.10, 0.52)] and emotional overeating [β = 0.24 (0.03, 0.46)]. Similarly, TrFM was positively correlated with food responsiveness [β = 0.02 (0.00, 0.03)], enjoyment of food [β = 0.02 (0.00, 0.04)], emotional undereating [β = 0.02 (0.01, 0.04)] and emotional overeating [β = 0.02 (0.01, 0.04)].

Conclusions: Our findings suggest that eating behaviors are significantly associated with abdominal fat accumulation in primary school children. Addressing specific eating behaviors may be crucial in mitigating abdominal fat and its related health risks.

Objective: To examine the correlation between C-reactive protein (CRP) levels at hospital admission and the length of stay (LOS) in pediatric patients with appendicitis who underwent laparoscopic appendectomy.

Methods: We retrospectively collected the clinical data from pediatric patients diagnosed with acute appendicitis and treated with laparoscopic appendectomy. Multivariate generalized linear regression analyses were performed to determine the independent relationship between CRP and LOS. Smooth curve fitting was constructed to examine the potential non-linear relationship between CRP and LOS. A segmented regression model was used to calculate threshold effects and determine the inflection point.

Results: A total of 815 participants were included in the study. Multiple linear regression analysis indicated that the higher the CRP levels, the longer the LOS. Fully adjusted smooth curve fitting suggested a non-linear relationship between CRP and LOS. A segmented regression showed that the inflection point value of CRP was 34.13 mg/L. A 1 mg/L increase in CRP levels was significantly associated with a 0.013-day increase in length of stay (95% CI: 0.009, 0.018; P < 0.001) when CRP levels > 34.13 mg/L. However, there was no significant association between CRP and LOS when CRP levels < 34.13 mg/L (P > 0.05).

Conclusion: There was a non-linear association and threshold effect between CRP levels and LOS. CRP levels above 34.13 mg/L were associated with longer LOS in pediatric appendicitis patients. These findings contribute to the understanding of inflammatory markers in recovery dynamics and underscore the necessity for further research to investigate their potential clinical implications.

Introduction: Chronic abdominal complaints are common in school-aged children. Most affected children do not have underlying organic diseases but suffer from functional gastrointestinal disorders. While many children with chronic abdominal complaints experience school problems, no prospective studies have examined if school absenteeism is more common among children suffering from functional as opposed to organic gastrointestinal disorders. The purpose of this study was to determine if there is an association between school absenteeism and functional gastrointestinal disorders in children presenting to a pediatric gastroenterology clinic with chronic gastrointestinal complaints.

Methods: Over a single year, families of school-aged children presenting to a pediatric gastroenterology clinic with gastrointestinal complaints were asked how many days of school their child had missed in the previous month due to their symptoms. At least six months after their visit, each child's final diagnosis was established and categorized as a functional disorder or an organic disease. Differences between children suffering from each diagnosis type were compared using unpaired t-tests.

Results: Children with functional gastrointestinal disorders were more likely to experience significant school absenteeism than children with gastrointestinal diseases. Missing more than three days of school in the month prior to their visit had a negative predictive value of 82% for a gastrointestinal disease and being homebound from school during the month prior to their visit had a negative predictive value of 88% for a gastrointestinal disease. As compared to children with functional disorders, those with organic diseases were more likely to have missed three or fewer days of school in the previous month (sensitivity = 93%) and to have attended any school in the previous month (sensitivity = 99%).

Discussion: Our data suggest children with functional gastrointestinal disorders are more likely to experience significance school absenteeism than children suffering from organic diseases. We suspect this may be due to higher perceived levels of pain and symptom catastrophizing caused by the duration and character of the diagnostic process, as well as biopsychosocial characteristics of these children.

Introduction: Globally, 2.4 million neonates died in their first month of life in 2019 with approximately 6,700 neonatal deaths every day. Ethiopia is 4th among the top 10 countries with the highest number of neonatal deaths. Yet, there are few prospective studies on neonatal mortality in the central region of Ethiopia. Hence, to develop evidence-based, locally tailored intervention strategies, it is necessary to evaluate neonatal survival status and mortality predictors, including birth weight. Therefore, the current study aims to assess survival status and factors predicting the survival of neonates in the Silt'e zone, Ethiopia.

Methods: An institution-based prospective cohort study design was employed from 1 May to 30 July 2022. Data were collected from term neonates who were enrolled according to their order of health facility visit and then followed by data collectors in their homes. Data were analyzed using STATA version 14.1. Neonatal survival was presented using the Kaplan-Meier survival curve. The crude and adjusted associations were evaluated using the Cox proportional-hazards model, presented with a 95% confidence interval (CI), and a P-value <0.05 was used to declare statistical significance.

Result: In total, 1,080 term neonates were followed for a total of 27,643.6 neonatal days. The study showed a 95% cumulative probability of surviving the neonatal period. The incidence rate of neonatal death was 2.02 per 1,000 neonatal days. Maternal history of neonatal death [adjusted hazard ratio (AHR) = 4.03; 95% CI: 2.28-9.52], complication during pregnancy (AHR = 3.08; 95% CI: 1.12-8.25), female sex (AHR = 0.45; 95% CI: 0.25-0.84), birth weight (AHR = 0.27; 95% CI: 0.11-0.63), and a low or intermediate APGAR score at 1 min (AHR = 3.11; 95% CI: 1.23-7.82 and AHR = 5.34; 95% CI: 1.63-17.51, respectively) were independent predictors of neonatal death.

Conclusion: It has been noted that neonatal mortality in this area is higher than results from national studies and other study areas and thus requires strict attention and interventions targeting both the pre and postnatal periods. Babies with low birth weight were found to struggle to survive the neonatal period. Promoting maternal nutrition for normal birth weight of the newborn would thereby improve neonatal survival, and should be followed as a strategy.

Objectives: This article aimed to investigate the correlation between blood immune cells and the prognosis in the early phase of pediatric sepsis and construct a prediction model for pediatric intensive care unit (PICU) mortality.

Methods: A total of 348 children admitted with sepsis to our PICU were retrospectively collected between January 2020 and June 2024. Of these, 242 children admitted from January 2020 to October 2022 were designated as the modeling group, while 106 children admitted between November 2022 and June 2024 were designated as the prospective validation group. Peripheral blood immune-related parameters, measured from the day of PICU admission to day 7, were analyzed in the modeling group. Risk factors were identified through multivariate logistic regression and integrated into a predictive nomogram. The nomogram was then applied to the prospective validation group to assess its discrimination and calibration. The nomogram's performance was evaluated using the area under the receiver operating characteristic curves (AUC), calibration plots, and decision curve analysis for both groups.

Results: Complicated with underlying diseases, invasive mechanical ventilation, increased pediatric risk of mortality score or pediatric sequential organ failure assessment score, and lymphopenia (d1) were independent risk factors for PICU mortality. The 90-day survival of patients with lymphopenia on the first day after admission was low. In addition, patients with persistent lymphopenia had higher mortality. The nomogram showed an AUC of 0.861 (95% CI: 0.813 to 0.909) in the modeling group and 0.875 (95% CI: 0.797 to 0.953) in the prospective validation group. The nomogram also performed well based on the calibration curve and decision curve analysis.

Conclusion: Assessing lymphocytes within seven days of PICU admission may be conducive to identifying children with sepsis at increased mortality risk. The nomogram performed well in predicting PICU mortality among patients of interest.

Objective: This study aims to summarize the clinical characteristics, diagnostic methods, and treatment experience of cecal diverticulitis in children.

Method: The clinical data of six pediatric patients with cecal diverticulitis, treated at Children's Hospital Affiliated to Shandong University from November 2021 to May 2023, were retrospectively analyzed.

Result: All patients presented with abdominal pain primarily in the lower right abdomen. Two cases had fever with a maximum body temperature not exceeding 38.0°C. Three cases exhibited elevated inflammatory markers such as white blood cell count and C-reactive protein (CRP) upon admission. Three children were misdiagnosed with acute appendicitis based on preoperative color Doppler ultrasound. Two children were treated with third-generation cephalosporins and ornidazole for anti-inflammatory therapy and were cured after 6 and 9 days of hospitalization, respectively. Four children underwent laparoscopic surgery with excision of the cecal diverticulum and cecal repair, all of whom recovered well without postoperative complications. The operation duration ranged from 100 to 170 min, with an average of 140 min. Intraoperative blood loss ranged from 5 to 10 ml, averaging 6.75 ml. The overall length of hospital stay was 8-12 days, with an average stay of 9.5 days. All patients were followed up until December 2023, with no recurrences observed.

Conclusion: Children with cecal diverticulitis, especially complex cecal diverticulitis, are easily misdiagnosed as acute appendicitis. Acute simple cecal diverticulitis can be treated with anti-inflammatory therapy. Laparoscopic cecal diverticulectomy combined with cecal repair is a feasible and effective method for treating acute complex cecal diverticulitis.

In patients affected by anorexia nervosa (AN) different endocrine abnormalities have been described, but, among them, hypothalamic-pituitary-adrenal (HPA) dysfunction, although associated to important side effects, is underestimated and has no therapeutical options. We present a narrative literature review to investigate the HPA axis in patients with AN, in order to highlight HPA dysfunction and its effects. We also described the crucial role of HPA monitoring, and to consider eventual therapeutic and preventive strategies in AN patients. The literature now available demonstrates that women and girls suffering from AN have higher measures of cortisol and lower levels of androgens as compared to controls. These endocrinological disturbances have deleterious effects on the subjects, both from the physical and from the psychological point of view. It's fundamental for physicians to consider these aspects when assessing AN patients. The mechanisms behind the adrenocortical dysfunctions in eating disorders patients remain an open question and there are no available treatments, thus research on this issue would be extremely useful and highly necessary, especially in the pediatric field.

Introduction: Down syndrome (DS) is linked to unique hematopoietic characteristics that affect complete blood count (CBC) parameters. Accurate reference ranges are essential for proper CBC interpretation in this population.

Methods: This retrospective study analyzed 2,627 CBCs from 481 DS patients, aged 31 days to 18 years, at a tertiary care center in Italy. Patients with significant comorbidities were excluded to ensure a homogeneous group.

Results: CBC parameters were assessed to establish age- and sex-specific reference ranges. Centile charts were developed for each parameter, and an online tool was created to allow clinicians to compare individual CBC results with the new ranges. Comparisons with the general pediatric population revealed significant differences, particularly in hemoglobin, hematocrit, and mean corpuscular volume, which were higher in DS (p < 0.001). In contrast, a significant percentage of CBCs showed white blood cell counts below the 2.5th centile of healthy controls (p < 0.001), except for the 31 days-1 year age group. A similar trend was observed for lymphocytes (p < 0.001) in the 1-18 years group.

Discussion: These newly established DS-specific reference ranges provide clinicians with a crucial tool for evaluating CBC results, potentially reducing unnecessary tests and emphasizing the need for tailored clinical assessment in managing this unique population.

Background: Childhood cardiovascular disease (CVD) is an emerging public health concern, with rising incidence linked to obesity and diabetes. Despite advancements in care, significant disparities persist across regions and socioeconomic groups. This study analyzed the global, regional, and national burden of childhood CVD from 1990 to 2021.

Methods: A cross-sectional study utilizing data from the Global Burden of Disease (GBD) 2021 was conducted. We analyzed children aged 0-14 years, categorizing them into age groups and assessing trends in incidence, mortality, and disability-adjusted life years (DALYs) across 204 countries. Statistical analyses included linear regression to calculate estimated annual percentage changes and assess temporal trends.

Results: The study revealed a 25% global increase in childhood CVD incidence over three decades, with significant disparities observed across different socioeconomic regions. Mortality and DALYs associated with CVD had decreased globally by 59% and 55% respectively, reflecting advances in medical technology and healthcare access. However, these improvements were not uniformly distributed, with low socio-demographic index regions exhibiting both the highest incidences and slowest declines in CVD-related health burdens. Environmental risks, such as extreme temperatures, also contributed to CVD mortality.

Conclusions: While mortality and DALYs due to childhood CVD have declined globally, rising incidence and persistent disparities highlight the need for targeted interventions. Addressing socio-economic factors and enhancing access to quality care are crucial for reducing the global burden of childhood CVD.