Frontiers in Pediatrics最新文献

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.

Background: Neonatal encephalopathy (NE) remains a significant cause of mortality and long-term disability in children under five, with pronounced global disparities in incidence and outcomes despite available interventions. This study aims to identify inequalities in the NE burden, with the goal of informing strategies to promote health equity and well-being in children.

Methods: Using data from the GBD 2021 study, we analyzed NE incidence, mortality, and disability-adjusted life years (DALYs) across 204 countries from 1990 to 2021. Data were assessed by age, sex, region, and Sociodemographic Index (SDI). Trends were quantified using estimated annual percentage change (EAPC).

Result: Globally, NE incidence declined by 18.1%, mortality by 31.6%, and DALYs by 27.7% from 1990 to 2021. Males had a higher burden. A substantial disparity was observed: the age-standardized mortality rate in low-SDI regions was 22 times that of high-SDI regions. Western Sub-Saharan Africa and South Asia carried the highest burden. Low birth weight accounted for 58.4% DALYs of NE globally, with a disproportionate effect in low- and middle-SDI regions.

Conclusion: Despite an overall reduction in the global NE burden, it remains disproportionately concentrated in resource-limited settings. Persistent disparities in low- and middle-SDI regions necessitate urgent, targeted interventions-including scaled-up perinatal care, strengthened health infrastructure, and region-specific strategies-to mitigate inequities. Middle- to high-SDI countries must address evolving epidemiological patterns. Equitable expansion of rehabilitation resources is critical to improving long-term outcomes and reducing disease burden.

Background: Diagnosing neonatal early-onset sepsis (EOS) is challenging, making it difficult to determine infection indicator characteristics and cutoff values in full-term infants. This study retrospectively analyzed full-term infants with high-risk factors for neonatal EOS but tested negative for EOS, aiming to identify infection indicator characteristics and their association with perinatal factors without antibiotic intervention.

Methods: Full-term infants at high risk for EOS who were admitted to rooming-in from 1 July 2023 to 29 February 2024 were included in the study. Blood routine examinations and C-reactive protein (CRP) levels were dynamically monitored after birth. All demographic data and medical records were collected from the electronic medical records system.

Results: Among 103 neonates, only 2 had normal infection indicators. Within 24-48 h after birth, an additional 28 displayed normal infection indicators. Although most of the infants exhibited normal WBC within 24-48 h, 33 patients still had higher neutrophil percentages, and 62 had higher CRP levels. Moreover, several high-risk perinatal factors for abnormal infection indicators have been identified.

Conclusions: This study demonstrates that infection indicators frequently showed abnormalities in full-term infants at high risk for EOS who tested negative. Few infants had normal infection indicators within 24 h, and although WBC levels normalized by 24-48 h, CRP levels remained elevated. Specific perinatal factors were also associated with abnormal infection markers. These findings reinforce the need for cautious interpretation of isolated biomarker elevations and support antimicrobial stewardship by highlighting the high frequency of abnormal indicators in uninfected infants, thereby reducing unnecessary antibiotic exposure.

Background: Glucose transporter 1 deficiency syndrome (Glut1DS), caused by SLC2A1 gene variants, is a rare neurological disorder with diverse clinical features and is highly susceptible to misdiagnosis or missed diagnosis. This article described two infant cases of Glut1DS misdiagnosed as bacterial meningitis due to atypical presentations, emphasizing the importance of early recognition.

Method: Retrospective analysis of two patients with Glut1DS admitted to our hospital between July 2023 and July 2025. Clinical features, cerebrospinal fluid (CSF) profiles, genetic testing, and responses to ketogenic diet (KD) were evaluated. Both cases were preliminarily diagnosed with bacterial meningitis in local hospitals based on low CSF glucose levels.

Results: Case 1: A 15-day-old male infant with fever and lethargy had persistently low CSF glucose (1.2-1.64 mmol/L; CSF/blood glucose ratio: 0.22-0.32). He was diagnosed as atypical bacterial meningitis and underwent empirical antibiotic therapy lasting over 30 days. Genetic testing confirmed SLC2A1 variant and KD greatly improved neurodevelopment. Case 2: A 4-month-old infant with fever and recurrent seizures showed persistent CSF hypoglycorrhachia (1.1-1.37 mmol/L; CSF/blood glucose ratio: 0.19-0.36). Following unsuccessful empirical antibiotic therapy, genetic analysis revealed a pathogenic variant in SLC2A1. Seizure resolution and EEG improvement were achieved after KD therapy.

Conclusion: low CSF glucose is a critical diagnostic clue for Glut1DS, not exclusive to CNS infections. In infants with seizures, developmental delays, or motor dysfunction, CSF analysis and targeted SLC2A1 testing are essential. Early KD initiation upon clinical suspicion may significantly improve outcomes and prevents neurological deterioration.

Urethral strictures that are not related to urological procedures or severe urethral trauma are rare in the pediatric population. Potential etiological factors include bladder catheterization during advanced surgical procedures and in intensive care units. We present the first reported off-label, minimally invasive treatment of a long-segment anterior urethral stricture in a teenager following cardiac surgery, using a paclitaxel-coated balloon (Optilume™). During the diagnosis of urethral stricture, cystoscopy and urethral biopsy were performed, which ruled out balanitis xerotica obliterans on histopathological examination. After mechanical dilation of the urethra to 18Fr over a period of two months, restenosis was observed, confirmed by uroflowmetry, with a Q _max of 4.6 mL/s and a voided volume of 202.9 mL. An 18Fr (6 mm) balloon with a length of 50 mm was used during the treatment. The procedure was performed under fluoroscopic guidance, without the use of a cystoscope sheath, using a 0.038″ OTW guidewire. The balloon was inflated to a pressure of 10 atm for 5 min. After the procedure, a 14Fr Foley catheter was left in place for 72 h. The perioperative course was uneventful, with no local or systemic reactions. Uroflowmetry performed 72 h after the procedure showed a Q _max of 20.7 mL/s with a voided volume of 283.5 mL. At the 3-month follow-up, Q _max was 19.6 mL/s with a voided volume of 219.7 mL, and at 8 months follow-up, Q _max was 18.4 mL/s with a voided volume of 160.5 mL, without post-void residual urine. There are currently no published studies in the pediatric literature evaluating treatment with drug-coated balloons (DCBs). According to the EAU/ESPU guidelines, there are no dedicated recommendations for the management of urethral strictures in children, as this condition is rare in the pediatric population and requires individualized treatment, especially in children with significant comorbidities. Optilume™ may represent a potential safe, minimally invasive therapeutic option to consider only in exceptional, carefully selected pediatric cases. However, this off-label use requires careful counseling, and long-term follow-up to assess the durability and late safety outcomes.

Background: Retinopathy of prematurity (ROP) is one of the leading causes of childhood blindness. Routine ROP screening in high-risk preterm infants is a fundamental and effective measure to prevent ROP; however, this screening process could cause pain to infants. This study aims to summarize the best evidence for pain management during ROP screening and provide a reference for the clinical practice of medical staff.

Methods: We systematically searched the literature on pain management during ROP screening, including clinical practice guidelines, evidence summaries, systematic reviews, meta-analyses, clinical decision support tools, and expert consensus statements. The search period was from inception to 31 October 2024. Four reviewers independently evaluated the quality of guidelines, and two reviewers independently assessed the quality of systematic reviews and expert consensus statements. Subsequently, evidence was extracted and graded.

Results: Eighteen articles were included: six guidelines, three clinical decision support tools, six systematic reviews, and three expert consensus statements. 92 pieces of evidence were extracted and categorized into five dimensions: multidisciplinary pain management teams for ROP screening, pain assessment, non-pharmacological interventions, pharmacological interventions and pain documentation. Twenty-five evidence-based recommendations were finally formulated.

Conclusion: The best evidence-based strategies for pain management during ROP screening in preterm infants provide actionable guidance for clinical practice. Medical staff should strengthen training in neonatal pain management and implement combined pharmacological and non-pharmacological interventions to alleviate procedural pain during ROP screening.