Frontiers in Pediatrics最新文献

This study aims to explore the impact of thyroid dysfunction (TD) during pregnancy on the neurodevelopmental outcomes of newborns. Participants were assigned to a thyroid dysfunction group (TDG, n = 92) or a normal control group (NCG, n = 150). Newborns underwent neonatal behavioral neurological assessment (NBNA), and serum thyroid hormone levels, including thyroid-stimulating hormone (TSH), free thyroxine (FT4), and free triiodothyronine (FT3), were measured. Within the TDG, subclinical hypothyroidism accounted for 43.48% (40/92), isolated hypothyroxinemia for 23.91% (22/92), subclinical hyperthyroidism for 17.39% (16/92), overt hypothyroidism for 9.78% (9/92), and overt hyperthyroidism for 5.43% (5/92). The total NBNA score, FT4, and FT3 levels were significantly lower in newborns from the TDG than those from the NCG (P < 0.001), whereas TSH levels were significantly higher (P < 0.05). Neurodevelopmental outcomes differed significantly among the various types of TD (P < 0.05). Correlation analysis showed that the total NBNA score of newborns in the TDG was negatively correlated with TSH level (r = -0.242, P < 0.05) and positively correlated with FT4 and FT3 levels (r = 0.464, r = 0.383, respectively; both P < 0.05). These findings indicate that TD during pregnancy significantly affects the neurodevelopmental outcomes of neonates, with the magnitude of effect varying according to the specific type of thyroid abnormality.

Introduction: Pediatric acute gastroenteritis (PAGE) is a common cause of morbidity and mortality, especially among children under 5 years of age. Standard treatments typically include rehydration therapy, dietary modifications, antimicrobials, and adjunctive treatments with smectite or specific probiotics. The efficacy of adding Saccharomyces boulardii to standard treatments, including regimens that already incorporate smectites, remains not well known. Most trials evaluating this combination have been published in Chinese, which has limited global awareness of this type of treatment.

Aim: This study aimed to meta-analytically examine whether the addition of S. boulardii CNCM I-745 to smectite is more effective in treating PAGE than smectite alone.

Methods: Systematic searches were conducted in PubMed, Google Scholar, China National Knowledge Infrastructure, and the China Biology Medicine database up to 20 February 2025 receiving smectites. Eligible studies were randomized controlled trials conducted in China that compared S. boulardii CNCM I-745 with controls in children with PAGE receiving smectites, with no language restrictions. Data were independently extracted using standardized forms, including outcomes related to PAGE (cured, duration of PAGE, length of hospitalization, and immune markers) and potential confounding variables (dose, disease etiology).

Results: Of 57 included trials (5,767 participants), S. boulardii CNCM I-745 significantly improved the cure rate (RR = 1.45, 95% CI 1.38, 1.53), reduced the duration of PAGE (SMD = -1.54 days, 95% CI -1.79, -1.29), improved the total effectiveness rating (RR = 1.21, 95% CI 1.18, 1.24), and reduced adverse events (RR = 0.64, 95% CI 0.43, 0.97).

Conclusion: S. boulardii CNCM I-745 significantly improved cure rates, reduced the duration of PAGE, decreased stool frequency and vomiting, and shortened hospitalization duration, while being well-tolerated.

Systematic review registration: http://www.crd.york.ac.uk/PROSPERO, PROSPERO #CRD42024567537.

Introduction: Hospitals are among the most important institutions providing healthcare services and contribute to public health through the coordination of various units. Although child development specialists also work in hospitals, this practice is generally unknown, because they are not directly involved in diagnosis and treatment processes, and therefore are not directly associated with healthcare services or the hospital environment.

Methods: In the present study conducted with 30 students from the Child Development Department of Çankırı Karatekin University, Faculty of Health Sciences, changes in Child Development Department students' perceptions of the hospital environment before and after their hospital practice were investigated. The data obtained were analyzed using thematic analysis.

Results: The comparison of their pre- and post-application drawings revealed that their perceptions of the hospital environment greatly changed, and their perspectives broadened. After the internship, their tendency to view the hospital as a child development specialist's workplace differed from their pre-implementation views, but not much.

Discussion: It is recommended that the theoretical course content should be further enriched with topics on hospitals, diseases, and healthcare services before the internship, and that field trips to healthcare institutions should be organized as part of the course.

Aims: Distal radius metaphyseal-diaphyseal transition zone fractures in children are challenging due to their distinct anatomical features and slower healing speed. Although both percutaneous long Kirschner wire (K-wire) intramedullary fixation and open reduction with plate and screw fixation are commonly employed, there is no clear consensus on the optimal surgical strategies. This study aimed to compare the clinical outcomes of percutaneous long K-wire intramedullary fixation and open reduction with plate and screw fixation.

Methods: We conducted an analysis of pediatric patients aged 8-14 years treated for distal radius metaphyseal-diaphyseal transition fractures between August 2021 and July 2023. Patients were stratified into two cohorts: the Long K-wire group, treated via closed reduction and percutaneous intramedullary fixation targeting the radial medullary isthmus, and the Plate group, treated via open reduction and internal fixation (ORIF). Perioperative metrics (operative time, incision length, hospital stay), functional outcomes (Gartland-Werley score), radiographic parameters, and complication rates were compared between the groups.

Results: Both surgical techniques achieved successful fracture union with no significant differences in radiographic alignment or functional recovery; the majority of patients in both groups achieved "Excellent" Gartland-Werley score six months after surgery. However, the Long K-wire group demonstrated statistically significant advantages, including shorter operative times, reduced incision lengths, and decreased length of hospital stay (P < 0.05). Additionally, the Long K-wire group avoided the need for a second inpatient surgery for hardware removal, which was required for the Plate group. Complication rates, including refracture, were low and comparable between groups.

Conclusion: Percutaneous long K-wire intramedullary fixation is an effective minimally invasive alternative in selected patients to plate fixation for treating distal radius metaphyseal-diaphyseal transition fractures. It offers minimal surgical trauma, accelerates recovery, and lowers risk of complications while ensuring comparable functional outcomes. Due to these advantages, this technique should be regarded as a clinically useful attempt for pediatric patients.

Introduction: The 2024-2025 winter season was the first in which Nirsevimab was adopted as universal prophylaxis for bronchiolitis in Friuli Venezia Giulia, a region in the northeastern Italy. This report describes the impact of Nirsevimab universal prophylaxis on bronchiolitis from the perspective of a tertiary-level, children's hospital, the Institute IRCCS Burlo Garofolo in Trieste, Italy.

Methods: We conducted a retrospective observational study reviewing the medical records of all children diagnosed with bronchiolitis during the 2024-2025 winter season, and the winter seasons of the seven preceding years. For each infant admitted, we collected data on age, gender, viral testing result, the need for ventilatory support, and the length of hospital stay. The primary outcome was the number of infant admissions for bronchiolitis during the 2024-2025 winter season, compared with previous years.

Results: During the study period, from 2016 to 2025, 695 infants were diagnosed with bronchiolitis, and 195 were hospitalized. In the 2024-2025 winter season, 597 neonates, 94% of the children born at the Institute, received Nirsevimab prophylaxis. Following the introduction of Nirsevimab, we observed a drastic decrease in the number of infants requiring hospitalization, a marked reduction in infants needing ventilatory support, and a considerable decrease in the cumulative length of hospital stay for bronchiolitis, compared to previous years. These results were clearly related to a substantial decrease in the number of RSV-positive infants arrived at the Institute.

Discussion: In our population, Nirsevimab prophylaxis was very effective and led to a considerable reduction in the number of infants infected with RSV and requiring hospitalization. The hospital burden of bronchiolitis was significantly reduced.

Objective: Automated analysis of Electronic Fetal Monitoring (EFM) is essential for the precise assessment of fetal health. However, the subjective interpretation and expertise-dependent nature of conventional cardiotocogram (CTG) analysis hinder diagnostic consistency. This study aims to develop an objective interpretation approach comprising a systematic preprocessing pipeline for signal reconstruction and an attention-guided convolutional neural network for pattern classification to mitigate the risk of missed diagnoses.

Methods: A computer vision-based deep learning approach was developed. The workflow begins with a systematic preprocessing pipeline, where raw CTG images undergo grid removal, resampling, and curve reconstruction to generate standardized signal inputs. These signals are analyzed by a classifier based on the EfficientNet-B0 architecture, enhanced with a Convolutional Block Attention Module (CBAM). This attention mechanism enables the model to focus on clinically significant morphological features. The model was trained on a private clinical dataset using clinician-labeled FIGO classifications (Normal vs. Suspicious/Abnormal) as the primary outcome. To evaluate its clinical utility and robustness, the model was externally validated on the public CTU-UHB dataset, using objective umbilical artery pH levels (pH $\ge 7.05$ vs. pH $<7.05$ ) as the benchmark.

Results: On the internal clinical dataset, the model achieved an accuracy of 92.66% and a macro-average F1-score of 92.14%. When tested on the external CTU-UHB dataset, the model maintained an accuracy of 95.65%. These results indicate that the proposed algorithm aligns with expert visual classification and remains consistent when validated against objective physiological outcomes (pH levels). This consistency across benchmarks supports the potential robustness and clinical relevance of the learned morphological features.

Conclusion: This study presents an objective method for intrapartum CTG analysis. By integrating signal standardization with automated feature learning, the proposed approach addresses the inherent subjectivity of manual interpretation. It serves as a potential clinical decision support tool to assist in the consistency of fetal status assessment.

Introduction: Sepsis in children with acute lymphoblastic leukemia (ALL) is associated with high mortality and a frequent need for advanced organ support; therefore, reliable scoring systems are required to stratify risk in the pediatric intensive care unit (PICU).

Objective: To compare the performance of the Phoenix-8 and PELOD-2 scales, measured at 24 and 72 h after admission, for predicting 28-day mortality in children with ALL and sepsis or septic shock.

Methods: A retrospective cohort study including 61 patients aged 1 month to 18 years with ALL admitted to the PICU of a quaternary-level hospital in Bogotá, Colombia, between 2022 and 2024. Phoenix-8 and PELOD-2 scores were calculated at 24 and 72 h after admission. Receiver operating characteristic (ROC) curves, optimal cutoff points, sensitivity, and specificity were analyzed.

Results: Twenty-eight-day mortality was 23.0%; 27.9% of patients required invasive mechanical ventilation and 63.9% required vasoactive support. At 72 h, a PELOD-2 score ≥7 showed an area under the ROC curve (AUC) of 0.945, with a sensitivity of 92.9% and specificity of 91.1%. A Phoenix-8 score ≥8 achieved an AUC of 0.976, with a sensitivity of 92.9% and specificity of 91.3%, and was significantly associated with the use of mechanical ventilation, vasoactive agents, and renal replacement therapy.

Discussion: Phoenix-8 and PELOD-2 demonstrated moderate discriminative ability at admission but excellent performance at 72 h, making them clinically useful and comparable tools for prognostic stratification in children with ALL and sepsis.

Background: Congenital heart defects (CHD) are the most common congenital malformations, and, although survival rates now exceed 90%, children remain at risk for long-term psychomotor, cognitive, and psychosocial difficulties. Routine integration of patient-reported outcome measures (PROMs) into pediatric cardiology offers the potential to detect vulnerabilities early, guide preventive interventions, and facilitate patient- and family-centered care. However, practical implementation in routine settings remains challenging.

Objectives: This pilot study describes the early feasibility and implementation experience, and process adaptations for embedding the Pediatric Quality of Life Inventory™ Cardiac Module (PedsQL CM) into routine pediatric cardiology care, with a focus on the development of a pragmatic implementation model, aiming to enable longitudinal health-related quality of life (HRQoL) monitoring in children with CHD following surgical or catheter-based interventions.

Methods: We are conducting a prospective, single-center, non-interventional study at the University Medical Center Freiburg, enrolling children aged 2-17 years undergoing cardiac surgery or catheterization. The PedsQL CM, available in eight languages in age-appropriate self- and parent-proxy versions, is administered at baseline (hospital admission) and at 3, 6, 9, and 12 months post-intervention. Surveys are implemented in REDCap and distributed via QR codes and automated invitations. Clinical data (diagnosis, intervention details, perioperative parameters) are extracted from the institutional research database for linkage with HRQoL trajectories. Implementation process data are collected systematically, capturing feasibility, acceptability, barriers, and facilitators.

Preliminary results: By mid-study, 77 families have been enrolled. Key facilitators include the visible study team presence, iterative adaptations (e.g., a user-friendly guidance document, filter questions), automation, and interdisciplinary psychosocial team involvement. Barriers comprise limited staff resources, partial IT integration, and variable clinician engagement. Early HRQoL data reflect evidence-based patterns, with generally high scores in younger children and a downward trend during adolescence.

Conclusion: Embedding systematic, longitudinal HRQoL assessment in pediatric cardiology is feasible but requires sustained institutional commitment, robust workflows, and interdisciplinary collaboration. Disease-specific PROMs such as the PedsQL CM provide clinically meaningful insights that support proactive, individualized care. Multicenter collaboration and the extension of PROM pathways across pediatric subspecialties will be key to addressing coverage gaps, optimizing lifelong outcomes, and establishing best practice frameworks to integrate PROMs.

Background: Vocal cord dysfunction (VCD) is an underrecognized differential diagnosis for asthma and is often influenced by psychological factors. The COVID-19 pandemic introduced new stressors and disrupted access to pediatric care, potentially affecting VCD incidence and recognition.

Objectives: This study aimed to determine whether the incidence of pediatric VCD at Nemours Children's Hospital in Orlando changed during the COVID-19 pandemic and to identify psychological diagnoses most associated with VCD.

Methods: A retrospective chart review was conducted for patients diagnosed with VCD between January 2017 and July 2022, including 2.5 years before and 2.5 years during the pandemic. Demographics, diagnostic methods, triggers, comorbidities, and psychological conditions were extracted from the electronic medical record.

Results: Among 74,022 patients (45,199 pre-pandemic; 28,823 pandemic), VCD incidence significantly decreased during the pandemic (0.7% vs. 0.3%, p < 0.001). Psychological diagnoses also declined modestly: anxiety (2.6% vs. 2.0%), depression (0.3% vs. 0.2%), and ADHD (4.4% vs. 3.5%). Compared with non-VCD patients, those with VCD were older (median 14 vs. 9 years), predominantly female (71% vs. 47%), and more often White/non-Hispanic. They had higher rates of asthma (41% vs. 16%), allergic rhinitis (20% vs. 11%), gastroesophageal reflux (31% vs. 4%), and psychological conditions, including anxiety (8.5% vs. 2.3%), depression (1.5% vs. 0.2%), and panic attacks (0.8% vs. 0.1%).

Conclusions: In contrast to prior reports, VCD incidence declined during the pandemic, likely reflecting reduced healthcare access or underdiagnosis. Persistent associations with psychological conditions highlight the biopsychosocial nature of VCD and the importance of multidisciplinary evaluation in pediatric populations.

Background: This study examined caregiver assessment of executive functioning (EF) in perinatally HIV-infected (PHIV) and perinatally HIV-exposed but uninfected (PHEU) Kenyan children, and explored the extent to which various biopsychosocial factors influence EF outcomes.

Methods: Children aged 3-5 years that were PHIV (n = 43), PHEU (n = 52), or HIV-unexposed uninfected (HUU, n = 58) and their caregivers were enrolled in this study. EF was measured using the Childhood Executive Functioning Inventory. Caregivers' common mental disorders (CMDs) and parenting behaviour were evaluated using the Shona Symptoms Questionnaire (SSQ) and a parenting behaviour scale, respectively. We used analyses of variance to assess group differences in EF scores and a hierarchal linear regression model to explore covariates associated with EF outcomes.

Results: Overall, we observed significant negative effects of HIV exposure on EF scores, F (2, 149) = 8.591, p < 0.001. Compared to HUU children, PHIV children performed worse in working memory [mean difference (MD), 2.89 [95% CI: 0.65-5.14] p = 0.008], inhibitory control [MD, 2.47 (95% CI: 0.55-4.40), p = 0.008], and composite EF [MD, 5.37 (95% CI: 1.97-8.76), p = 0.001]. PHEU children showed poorer performance in working memory [MD, 3.24 (95% CI: 1.11-5.37), p = 0.001] and composite EF [MD, 4.97 (95% CI: 1.75-8.19), p = 0.001]. The observed EF impairment was strongly associated with caregivers' CMDs and advanced HIV disease in children.

Conclusion: Our study suggests that caregivers can observe overt executive dysfunction in children perinatally exposed to HIV. These findings underscore the importance of antiretroviral therapy adherence in PHIV children and the provision of psychosocial support to caregivers of HIV-exposed children to improve EF outcomes.