Frontiers in Pediatrics最新文献

Objectives: The Apgar score remains subjective in key components despite its clinical importance. An objective method using infrared thermography could enhance neonatal assessment precision. To describe early surface thermal adaptation patterns during the first 10 min after birth using infrared thermography (IRT) and to benchmark these descriptive patterns against concurrently assigned Apgar scores. This feasibility study evaluates operational characteristics of IRT as a non-contact, objective adjunct to routine assessment; it does not establish prediction or clinical utility.

Study design: Prospective cohort of 223 full-term cesarean-delivered newborns at a tertiary maternity hospital (2021-2023). Whole-body IRT was captured at 1, 3, 5, and 10 min after birth (T1-T10). Infants were described by Apgar at 1 min (≤7 vs. ≥8).

Results: Descriptive visualizations showed observable differences in early surface temperature distributions for infants with lower Apgar scores at 1 min, with progressive warming and convergence between groups over time. Early rectal (central) temperatures in the low-Apgar group were sparsely recorded due to clinical priorities and are presented for transparency only.

Conclusions: IRT can visualize thermal adaptation during immediate neonatal transition and may serve as a non-contact, objective adjunct to clinical assessment. Further outcome-based validation in larger, more heterogeneous cohorts is needed before clinical implementation.Clinical Trial Registration: ClinicalTrials.gov, identifier NCT04483869.

Veno-venous extracorporeal membrane oxygenation (VV-ECMO) is an established rescue therapy for severe pediatric acute respiratory distress syndrome (ARDS), but prolonged support is rarely reported. We describe the case of a previously healthy 6-year-old boy who developed Stevens-Johnson syndrome (SJS), complicated by progressive respiratory failure and severe ARDS. Despite maximal ventilation, oxygenation remained insufficient, and VV-ECMO was initiated on day 11 of illness. Cannulation was performed via jugular and femoral access, followed by lung-protective ventilation, repeated surfactant administration, corticosteroid therapy according to the Meduri protocol, and angiotensin-converting enzyme inhibitor therapy. ECMO support was complicated by pulmonary fibrosis, cholestatic liver dysfunction with secondary hemochromatosis, and prolonged sedation-associated delirium with subsequent critical illness polyneuropathy. The first attempt to discontinue ECMO after 90 days failed due to presumed pulmonary embolism, requiring recannulation. Ultimately, successful weaning was achieved after 113 days of VV-ECMO. The patient was transferred to a specialized pulmonary and neurological rehabilitation center and discharged home after 6 months, still dependent on a tracheostomy cannula. At the 18-month follow-up, he required only nocturnal mechanical ventilation through the tracheostomy, was attending school, and led an otherwise normal life. A trial removal of the cannula with closure of the stoma is scheduled for spring 2026. This case illustrates that prolonged VV-ECMO can allow lung recovery in pediatric patients with ARDS secondary to SJS, despite complications. Careful multidisciplinary management and preserved neurological function were key factors supporting long-term survival.

Objectives: This pilot study aimed to investigate receptive and expressive grammatical abilities and functional hearing in everyday listening conditions among 4-6-year-old children with prelingual unilateral hearing loss (UHL), compared with peers with normal hearing (NH). A further aim was to explore whether grammatical abilities were associated with functional hearing and background factors such as severity and side of hearing loss, or parental education.

Methods: Eight children with UHL were recruited from hearing care clinics, and sixteen children with NH were recruited via social media. Data included questionnaires on hearing, development, and environment, and parent-reported functional hearing using PEACH+. Grammatical abilities were assessed with TROG-2 and the Swedish Gramba test. Group differences were analyzed with Mann-Whitney U-tests, and correlations were evaluated with Spearman's rank correlation.

Results: Children with UHL scored lower than NH peers on language tests, though the differences were not statistically significant. They scored significantly lower on three of four parent-reported measures of functional hearing, particularly in noisy environments. Grammatical ability did not correlate with functional hearing. Across the cohort, higher parental education was associated with better grammatical outcomes. Within the UHL group, right-sided hearing loss was associated with poorer expressive grammar, and greater severity of hearing loss was associated with increased difficulty hearing in noise.

Conclusions: Children with UHL demonstrated poorer functional hearing and tended to have slightly reduced grammatical abilities compared to peers with NH. Although the small sample size limits generalizability, these findings, together with previous research, suggest potential impacts of UHL on language development. The side and severity of hearing loss may influence outcomes, highlighting the need for further research and international consensus on assessment and management.

Objective: Autism Spectrum Disorder (ASD) is a complex neurodevelopmental condition influencyed by genetic and environmental factors. There is emerging evidence of an association between hereditary thrombophilia and ASD, potentially mediated by impaired placental perfusion and resultant neuroinflammatory processes. This study aimed to investigate the frequency of thrombophilia-related genetic polymorphisms in children diagnosed with ASD and their mothers.

Methods: A total of 24 children with ASD aged 2-6 and their mothers were compared with 24 age-matched healthy children and their mothers. Sociodemographic, developmental and genetic data were collected. A psychiatric evaluation was performed according to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), and the children were assessed using the Autism Behavior Checklist (ABC), the Modified Checklist for Autism in Toddlers (M-CHAT) and the Ankara Developmental Screening Inventory (ADSI). Thrombophilia-related polymorphisms, including FVL G1691A, FII G20210A, C677T MTHFR and 1298AC MTHFR, FXIII-Val34Leu and PAI-1 4G/5G, were analyzed using PCR-based methods. Statistical comparisons and logistic regression analyses were performed to evaluate associations with ASD.

Results: The FXIII-Val34Leu heterozygous variant was significantly more prevalent in children with ASD (37.5% vs. 8.3%, p = 0.036) and their mothers (54.2% vs. 16.7%, p = 0.015) than in the control group. Logistic regression analysis revealed that the presence of the FXIII-Val34Leu heterozygous polymorphism in either the mother or child was associated with an approximately 4.130-fold increase in the odds of ASD (adjusted odds ratio = 4.130, 95% confidence interval = 1.180-5.300, p = 0.027). Other thrombophilia polymorphisms did not differ significantly between groups. Additionally, children with ASD exhibited significant delays in speech development and lower developmental scores across several domains.

Conclusion: This study is among the first to examine the FXIII Val34Leu mutation in children with ASD and their mothers. Further large-scale, longitudinal studies are needed to investigate thrombophilia markers in relation to ASD.

Introduction: Spectral analysis of gastric aspirates obtained shortly after birth predicts the diagnosis of respiratory distress syndrome in neonates born <32 completed weeks gestation. We sought to determine whether this prototype point-of-care device measuring surfactant components in gastric aspirates could predict prolonged respiratory support needs in neonates ≥30 completed weeks gestation.

Methods: Gastric aspirates obtained within 30 min of birth were analyzed by spectroscopy to quantify surfactant components. These spectral data were entered into an existing algorithm to assess subjects' biochemical lung maturity. This algorithmic output was paired with clinical data to evaluate the performance of the algorithm in predicting subjects' need for respiratory support at six hours of life (prolonged respiratory support). Each element of the algorithm was adjusted via a machine learning framework to optimize predictive performance.

Results: Gastric aspirates from 179 subjects (median 36 weeks, range 31-41 weeks) were eligible for analysis. Spectral analysis of gastric aspirates predicted the need for prolonged respiratory support with 70% sensitivity and 92% specificity. Positive- and negative-predictive values were 86% and 82%, respectively, for the overall cohort. Among gestational age subgroups, positive prediction was highest among moderately preterm neonates (32-33 weeks), while negative prediction was highest among term neonates.

Discussion: Spectral analysis of surfactant components contained in the gastric fluid of neonates ≥30 completed weeks gestation predicts the need for prolonged respiratory support with good performance. Predictive performance varied according to subjects' gestational age at birth, suggesting that gestational age-specific algorithms may improve the performance of this point-of-care diagnostic test.

Background: Pediatric penile hamartoma is extremely rare. Preoperative imaging often cannot definitively characterize the lesion, and histopathology remains the diagnostic gold standard. We report a child with penile hamartoma and torsion, discuss management, and compare outcomes with the literature.

Methods: We retrospectively analyzed the clinical presentation, imaging, intraoperative findings, and pathology. Relevant reports were reviewed for comparison.

Results: Complete excision of a ventral hamartomatous appendage plus circumcision and release of a fibrous tethering band achieved immediate torsion correction in a single stage. Histopathology showed stratified squamous epithelium with proliferative fibrous and adipose tissue containing nerve bundles, ganglion cells, and focal smooth muscle-consistent with hamartoma. Recovery was uneventful; at 12 months no recurrence was observed.

Conclusion: Etiology-targeted, one-stage correction-degloving (circumcision), release of tethering bands, complete lesion excision, and simultaneous torsion repair-can be safe and effective. Long-term follow-up is advised.

Aim: This study comprehensively analyzed the characteristics and development trends of pediatric interventional drug clinical trials registered between 2015 and 2024, with a focus on pharmaceutical characteristics such as dosage form and administration route.

Methods: The ClinicalTrials.gov database was searched to identify trials involving pediatric participants. Interventional trials first posted between 2015 and 2024 were included if they used drugs as interventions and had treatment as the primary purpose.

Results: A total of 2,928 pediatric-only clinical trials were included, with annual registration numbers ranging from 257 to 339, exhibiting a declining trend. Among these, 1,975 (67.5%) enrolled no more than 100 participants, and 153 (5.2%) were restricted to either males or females, with this gender-specific enrollment correlated with disease epidemiology. Mental, behavioral, or neurodevelopmental disorders (319, 10.9%) represented the most studied therapy area, maintaining high proportions consistently across Phases 1-3. The most common dosage forms were liquid (53.3%) and solid (24.0%), and the most frequently reported administration routes were enteral (39.0%) and parenteral (35.6%). Drug formulations and administration routes varied by age group: the use of solid formulations (from 12.1% to 29.1%) and enteral administration (from 22.9% to 42.0%) increased with age, while the use of liquid formulation and parenteral administration declined.

Conclusion: In the last ten years, registered pediatric drug trials have either stayed stable or slightly decreased, often featuring small sample sizes and rarely using age-specific formulations. National regulatory bodies should boost policy support to encourage pediatric drug research and improve trial design quality.

This integrative literature review, conducted with a systematic approach, examined how a child's atopic dermatitis affects parental functioning. Fifty-four studies have been reviewed, identifying the key impacts, including work absenteeism, reduced quality of life, increased distress, sleep deprivation, and challenges in parent-child relationships. These dimensions were grouped into three focuses: Parents as workers, individuals, and caregivers. The review found that atopic dermatitis often disrupts parents' careers, causes emotional strain, family burden, and sleep issues. Parent-child interactions may also be affected, potentially impacting the attachment bond. Overall, the findings highlighted the interconnected nature of parental experiences and stressed the need to consider all family members' perspectives. A systemic approach in clinical practice, policy, and research is crucial to better support parents managing their child's condition.

Objective: This study examines the prevalence and predictors of first pregnancy and the use of long-acting reversible contraceptives (LARCs) among adolescent girls aged 12-17 involved in the child welfare system.

Methods: The study leverages linked longitudinal administrative data from the child welfare, juvenile legal, and Medicaid claims systems of Pennsylvania. The sample comprised 28,016 girls born between 2000 and 2005 who received Medicaid and were involved in the child welfare system during adolescence. Survival analysis was used to predict onset of first pregnancy and uptake of LARC.

Results: By age 18, 17% percent of adolescents had experienced pregnant, with 18% having a healthcare encounter to receive LARCs. Foster care placement was not associated with pregnancy but was associated with increased use of LARCs. Substance use disorder, juvenile legal involvement, and recent suspected sexual abuse victimization were positively associated with pregnancy. There was a reciprocal association between LARCs and pregnancy; although any previous encounter for LARCs was negatively associated with pregnancy, uptake of LARCs also increased following a pregnancy.

Conclusions: Despite broad reductions in teen pregnancy over time, adolescent girls with exposure to sexual abuse or engagement in substance use or delinquency face a persistently high risk for very early pregnancy. Medical providers and child welfare agencies need to coordinate service provision to address the sexual and reproductive health needs of at-risk teens.