Frontiers in Pediatrics最新文献

Background: Low birth weight is a key determinant of child survival, significantly influencing rates of infant and childhood mortality, morbidity, and disability. While some studies have been conducted in our region, there is still a gap in evidence regarding the maternal characteristics associated with low birth weight. Hence, this study aimed to determine the proportion of newborns with low birth weight and determinant factors, particularly focusing on maternal characteristics.

Method: A facility-based cross-sectional study was conducted from 21 March to 20 April 2020 involving mothers and their newborns at selected public health facilities in Mekelle City. The sample included 447 participants, with two public hospitals and three health centers chosen by a lottery method. Systematic random sampling was applied to select mother-newborn pairs. Data were collected using a structured, interviewer-administered questionnaire and analyzed using the Statistical Package for Social Sciences version 21. Bivariate and multivariate logistic regression analyses, with a 95% confidence interval (CI), were used to identify factors associated with low birth weight.

Results: The study included 447 mothers of newborns, achieving a 100% response rate. The proportion of low birth weight was 14.3%. Significant factors associated with low birth weight included attending the first antenatal care (ANC) visit in the third trimester [adjusted odds ratio (AOR) = 3.66, 95% CI: 1.28-10.44], not receiving additional nutrition during pregnancy (AOR = 4.16, 95% CI: 1.38-12.58), experiencing obstetric complications during the current pregnancy (AOR = 7.72, 95% CI: 2.76-21.59), and a gestational age at birth of less than 37 weeks (AOR = 5.36, 95% CI: 1.96-14.67).

Conclusion and recommendation: This study revealed a substantial incidence of low birth weight. The initiation of the first antenatal care visit in the third trimester, failure to supplement nutrition during pregnancy, the occurrence of obstetric complications during pregnancy, and a gestational age at birth less than 37 weeks were all found to be significantly correlated with this condition. It is recommended that policymakers strengthen maternal and child health services, especially through the focused ANC program, to improve outcomes. Health facilities should promote awareness of the importance of initiating ANC visits early, with an emphasis on nutritional counseling throughout pregnancy.

Background: Premature births has imposed substantial burdens on medical resources. Consequently, a specialized team was established and a model focused on early intervention, namely the Delivery Room Intensive Care Unit (DICU) emphasizing "care, support, and treatment" was introduced and its impact on the morbidity and mortality outcomes of newborns was assessed. Additionally, we aimed to develop a nomogram model for predicting the risk of intraventricular hemorrhage (IVH) in preterm infants.

Methods: A retrospective study involving 2,788 infants was conducted to compare the characteristics and outcomes of infants admitted following the transition from the previous "neonatal intensive care unit (NICU)-centered" approach to the current early "care, support, and treatment" model. Clinical and laboratory data were recorded from birth until their discharge. The primary outcome was IVH, with additional evaluation of mortality and morbidities related to the neurological, respiratory, circulatory, and digestive systems.

Results: The DICU approach significantly declined the incidence of IVH [OR: 0.16, 95% CrI (0.11,0.23)], hypothermia [OR: 0.33, 95% CrI (0.21,0.50)], apnea [OR: 0.60, 95% CrI (0.47,0.75)], perinatal respiratory diseases [OR: 0.63, 95% CrI (0.52,0.75)] and metabolic acidosis [OR: 0.24, 95% CrI (0.16,0.34)]. Five predictors were selected: DICU exposure, gestational age, birth weight, ventilation mode within seven days, and ibuprofen use (d). The model built by these predictors displayed good prediction ability with the area under the ROC curve of 0.793 in the training set and 0.803 in the validation set.

Conclusions: The standardized DICU model had significantly reduced the incidences of morbidities. The risk nomogram is useful for prediction of IVH risk in eligible infants, with a high accuracy, sensitivity, consistency, and practicability. This study emphasizes the shift in early intervention concepts and team collaboration sets "neonatologists, neonatal nurse practitioners, and respiratory therapists", which advocates for standardized decision-making for treatment from the delivery room to improve the success rate of resuscitation and enhance the prognosis of these infants.

Congenital melanocytic nevus (CMN) syndrome is a rare, non-familial neural ectodermal dysplasia characterized by CMN combined with extracutaneous abnormalities, predominantly involving the central nervous system (CNS). The pathogenesis of CMN syndrome is thought to result from early post-zygotic somatic mutations. CNS melanosis frequently affects the anterior temporal lobes, brainstem, cerebellum, and cerebral cortex. Magnetic resonance imaging typically demonstrates T1 hyperintensity associated with CNS melanosis, while ultrasound often reveals abnormal echogenicity. We report a case of a fetus diagnosed with CMN syndrome, presenting with abnormal echogenicity in the cerebellar and amygdaloid complexes and a posterior fossa cyst. Autopsy identified two melanocytic nevi on the lumbosacral region of the fetus. Reports linking CMN syndrome to fetal intracranial abnormalities remain exceedingly rare.

Immune thrombocytopenia (ITP) is a disease characterized by platelet destruction, presenting substantial challenges in clinical practice. The classic first line therapeutic management includes corticosteroids and intravenous immunoglobulins. Although it is less frequent in children than in adults, there is a significant percentage of patients, up to 47% according to the Pediatric and Adult Registry on Chronic ITP, who require second-line or further treatment, due to non-response to the first line treatment or persistence of disease, among other reasons. Several second line approaches for its treatment are currently in use, including increasing platelet production with thrombopoietin receptor agonists. We report the case of a 16-year-old patient with ITP and alopecia areata successfully treated with baricitinib, a reversible and selective JAK 1/2 inhibitor. Baricitinib is currently in use for the treatment of several autoimmune conditions and has been shown to increase platelet counts in these patients. This phenomenon has been linked to increased TPO signaling and reduced platelet destruction. There are promising preliminary results of adult ITP patients treated with baricitinib. This case report is the first reported use of baricitinib in ITP in the pediatric and adolescent setting, potentially leading to its use in this condition.

The sleep disorder nocturnal enuresis (NE) affects children's health and quality of life, as well as places a heavy burden on their families. Treatment improves the child's quality of life. Unfortunately, some parents do not seek treatment for their children because they are unaware or misinformed about NE. The goal of health education is to enhance or maintain the patient's health status, thereby enhancing the patient's quality of life through positive coping strategies. Educating children and parents about NE is an effective way for nurses to raise their awareness. Furthermore, they can improve the quality of life of children by promoting their active participation in treatment. The purpose of this paper is to review information about NE and explore the role of health education in improving children's and parents' quality of life.

This case is the first reported patient with a MEIS2 gene mutation who primarily exhibits pronounced inattention as the main manifestation and is diagnosed with ADHD, requiring methylphenidate treatment. It is characterized by unique clinical features that set it apart from previously reported cases with mutations in the MEIS2 gene. Here, we report a female child with a diagnosis of ADHD and comorbidities. She received treatment with methylphenidate, starting at a dose of 18 milligrams per day, which was gradually increased to 45 milligrams per day based on her attention performance, while also undergoing physical and language rehabilitation training. In addition, the parents involved the child in reading and retelling stories at home every day. After 2 years of treatment, the scale results indicated that the child still had a moderate degree of attention deficit. Therefore, she underwent whole exome sequencing (WES) showing that her MEIS2 gene carries a de novo frameshift mutation (c.934_937del, p. Leu312Argfs*11). After comparing the patient's features with those of other patients who also had the MEIS2 mutation, we discovered that the patient's cleft palate, heart abnormalities, and minor facial dysmorphism were all extremely comparable. A broad forehead, elongated and arched eyebrows, and a tent-shaped upper lip were examples of mild facial dysmorphic traits. Subtypes with phenotypes such as cleft palate, cardiac anomalies, or facial malformations were presented in all previously reported cases of MEIS2 mutations. Furthermore, less common characteristics include ADHD, learning difficulties, hearing loss, recurring respiratory infections, asthma, rhinitis, enuresis, and dental cavities. This case further supports the critical role of genetic testing in patients with ADHD who exhibit a suboptimal response to methylphenidate and present with multiple comorbidities. Furthermore, this case report expands the clinical symptom spectrum associated with MEIS2 gene mutations, providing a broader understanding of the condition.

Introduction: Given the challenges in diagnosing children with long COVID, we sought to explore diagnostic practices and preferences among clinicians.

Methods: A ten-question survey assessed pediatric providers' clinical decision making for identifying and evaluating long COVID in children. Of the 120 survey respondents, 84 (70%) were physicians, 31 (26%) nurse practitioners, and 5 (4%) physician assistants.

Results: The most common categories of symptoms identified as raising suspicion for long COVID in children included cardiopulmonary symptoms, selected by 119 (99%) of pediatric providers, and neurocognitive symptoms, selected by 118 (98%) of providers. However, there was more ambiguity on the primary feature of long COVID, with providers selecting a range of key symptoms. Of all physical exam findings, postural orthostatic tachycardia, was most suggestive of long COVID [identified by 49 (41%) of pediatric providers], whereas one-third of providers reported no specific identifiable exam finding.

Discussion: Pediatric providers report variable decision making in the clinical evaluation of long COVID, with patient demographics and clinical factors impacting whether a diagnosis of long COVID is considered. This variation in diagnosing pediatric long COVID reflects ambiguity in the definition of long COVID in children and the absence of clinical guidelines to support providers in the identification of disease and treatment. This study highlights an area of need for future clinical advances in pediatric long COVID.

Background: There is a lack of information on the current healthcare systems for children with kidney diseases across Europe. The aim of this study was to explore the different national approaches to the organization and delivery of pediatric nephrology services within Europe.

Methods: In 2020, the European society for Paediatric Nephrology (ESPN) conducted a cross-sectional survey to identify the existing pediatric nephrology healthcare systems in 48 European countries covering a population of more than 200 million children.

Results: The reported three most important priorities in the care of children with kidney diseases were better training of staff, more incentives for physicians to reduce staff shortages, and more hospital beds. Positive achievements in the field of pediatric nephrology included the establishment of new specialized pediatric nephrology centers, facilities for pediatric dialysis and transplant units in 18, 16, and 12 countries, respectively. The most common problems included no access to any type of dialysis (12), inadequate transplant programs for all ages of children (12), lack of well-trained physicians and dialysis nurses (12), inadequate reimbursement of hospitals for expensive therapies (10), and lack of multidisciplinary care by psychologists, dieticians, physiotherapists, social workers and vocational counsellors (6). Twenty-five of 48 countries (52%) expected to have a shortage of pediatric nephrologists in the year 2025, 63% of clinical nurses and 56% of dialysis nurses. All three groups of health care professionals were expected to be lacking in 38% of countries. Prenatal assessment and postnatal management of renal malformations by a multidisciplinary team including obstetricians, geneticists, pediatricians, and pediatric surgeons was available in one third of countries.

Conclusions: Our study shows that there are still very marked differences in pediatric health care systems across the European countries and highlights the need need for appropriate services for children with kidney disease in all European countries.

Background: Nephrotic syndrome (NS) is a prevalent kidney disease in children. Acute kidney injury (AKI) is a severe complication of NS and has the potential to be life-threatening.

Objective: The aim of this study was to analyze the prevalence and risk factors of AKI in children with NS, and to provide an evidence-based medical basis for the early identification of high-risk children in the clinic.

Methods: A comprehensive search was conducted in publicly available databases, namely PubMed, Embase, Web of Science, Scopus, and the Cochrane Library, covering the period from the inception of each database until May 2024. The analysis involved examining basic characteristics (age, sex), the concomitant diseases (hypertension, infections), NS disease characteristics (steroid susceptibility classification, pathologic classification), laboratory test (e.g., serum albumin), and the use of nephrotoxic drugs. Traditional and network meta-analyses were performed for analysis.

Results: A total of 11 studies were included in the analysis, revealing an incidence of AKI of 29% (95% CI: 23%-37%). The analysis of factors indicated that the age of NS onset [standardized mean difference (SMD): 0.31; 95% confidence interval (CI): 0.08, 0.54; p = 0.009], sex [odds ratio (OR): 1.49; 95% CI: 1.03, 2.16; p = 0.035], serum albumin level (SMD: -0.43; 95% CI: -0.85, -0.02; p = 0.041), response to steroid treatment (OR: 0.52; 95% CI: 0.33, 0.80; p = 0.003), infection (OR: 3.60; 95% CI: 1.91, 6.78; p < 0.001), hypertension (OR: 4.02; 95% CI: 2.94, 5.51; p < 0.001), and nephrotoxic drug application (OR: 4.43; 95% CI: 1.86, 10.53; p = 0.001), were all significantly associated with the incidence of AKI. Furthermore, the results of the network meta-analysis suggested that the pathologic type of minor glomerular abnormalities (MGA)/diffuse mesangial proliferation (DMP), the type of infrequent relapses (IFRNS)/steroid-sensitive NS (SSNS), and the use of diuretic medications were associated with a relatively low risk of AKI occurrence.

Conclusion: Factors upon admission of children with NS are associated with the onset of AKI. Emphasis should be placed on populations with a heightened risk of AKI in clinical practice. Further research is warranted to confirm the findings due to the limitations of this study.

Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024571170, PROSPERO (CRD42024571170).