Frontiers in Pediatrics最新文献

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.

Objective: The objective of this study was to evaluate the feasibility of use and integration of a novel bubble CPAP (bCPAP) system into the PICU of the Mysore Medical College and Research Institute, India.

Study design: We conducted an explanatory sequential prospective mixed-methods study using questionnaire-based surveys, focus group discussions (FGDs), and patient records. Survey and FGD participants included nurses, pediatric postgraduates, and pediatricians who worked in the PICU and used the bCPAP system. The FGDs were transcribed, coded, and systematically analyzed for emergent themes using the COM-B framework.

Results: From July 31, 2023, to July 24, 2024, 81 children were treated with the bCPAP system. The median age was 6.5 months (IQR: 3-11), the median weight was 6.5 kg (IQR: 4.9-7.8), and the median treatment duration was 24 h (IQR: 18-38). Most (n = 72, 89%) patients treated with the bCPAP system were discharged home. Forty-eight healthcare workers completed the survey, and 29 participated in the FGDs. Survey respondents rated the bCPAP system as more effective (67%) or much more effective (17%) than previous treatments for respiratory distress. They found the integration of the bCPAP system into the PICU feasible (63%) or very feasible (35%). FGD participants reported that the bCPAP system was easy to use, portable, and required minimal training. They also noted rapid patient improvement and a reduction in the number of patients requiring mechanical ventilation.

Conclusion: The bCPAP system was integrated and adopted into the PICU of this public referral facility in Mysuru, India. Further research is needed in additional settings.

Purpose: This study aimed to assess cognitive processing in children with autism spectrum disorder (ASD) without co-occurring attention-deficit/hyperactivity disorder (ADHD) (ASD-alone), children with ADHD without co-occurring ASD (ADHD-alone), and children with ASD with co-occurring ADHD (ASD + ADHD).

Methods: Children were divided into four groups: ASD-alone (n = 57), ADHD-alone (n = 89), ASD + ADHD (n = 56), and typical development (TD) (n = 58). The Das-Naglieri Cognitive Assessment System (D-N CAS) was applied to evaluate planning, attention, simultaneous, and successive cognitive processes.

Results: Children with ASD-alone scored less on planning processing. Children with ADHD-alone scored lower on planning and attention processing. Children with ASD + ADHD scored lower on all four processes. Planning and attention exhibited satisfactory stratification precision in identifying ASD + ADHD among children with ASD, with area under the curve (AUC) values of 0.7426 and 0.8061, respectively. Successive processing had medium diagnostic value in diagnosing ASD + ADHD among children with ADHD, with an AUC of 0.618. Inattention symptoms were associated with planning and attention processing. Social affects and inattention symptoms were associated with the total D-N CAS score.

Conclusion: Children with ASD-alone, ADHD-alone, and ASD + ADHD exhibited distinct cognitive profiles. The D-N CAS, particularly its planning and attention scales, provided an approach for differential diagnosis in clinical settings.

Background: IgA nephropathy (IgAN) is a common primary glomerular disease in children. The efficacy and safety of glucocorticoid (GC) and immunosuppressive therapies remain debated. This study aimed to evaluate their clinical effectiveness and safety in pediatric IgAN.

Methods: A systematic search was conducted in six databases (PubMed, Web of Science, Cochrane, Embase, CNKI, Wanfang, and VIP), yielding 404 studies, of which eight met inclusion criteria. Eligible studies included RCTs or retrospective studies involving pediatric patients (≤18 years) treated with immunosuppressants plus GC. Outcomes assessed included proteinuria, hematuria, serum creatinine, and adverse events. Two researchers independently extracted and analyzed data. Network meta-analysis (NMA) was performed using R software, incorporating network plots, forest plots, and SUCRA rankings.

Results: Network topology showed strong links between GC monotherapy and regimens such as "tacrolimus + GC" and "mycophenolate mofetil (MMF) + GC." SUCRA rankings indicated superior efficacy of combination therapies in reducing proteinuria and hematuria. Forest plots revealed that all combination regimens significantly reduced proteinuria compared to GC alone (P < 0.05), with only MMF + GC significantly improving hematuria (P < 0.05). No significant differences in adverse event rates were found among treatment groups (P > 0.05). Funnel plots suggested minimal publication bias.

Conclusion: Combination therapies, especially tacrolimus + GC and MMF + GC, offer greater efficacy than GC monotherapy in pediatric IgAN, without increasing adverse events. These findings support their clinical application, though larger studies are needed to validate results and optimize treatment strategies.

Background: Lower urinary tract symptoms (LUTS) are common functional urinary disorders in children and can markedly impair quality of life. Attention-deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental condition, and emerging evidence suggests that affected children are at increased risk of LUTS. Nevertheless, systematic investigations into the relationship between ADHD and urodynamic characteristics in pediatric LUTS remain limited. This study aimed to evaluate the association between ADHD and urodynamic features in children with LUTS using a case-control design.

Methods: We conducted a retrospective case-control study including 144 children with LUTS, of whom 36 were diagnosed with ADHD. All participants underwent standardized urodynamic testing, with assessments of bladder capacity, detrusor pressure at maximum filling, and detrusor overactivity (DO). Children were categorized into ADHD and non-ADHD groups, and intergroup comparisons of urodynamic parameters were performed. Multivariable regression analysis was used to assess the independent association between ADHD and urodynamic abnormalities.

Results: Compared with the non-ADHD group (n = 108), children with ADHD (n = 36) exhibited significantly reduced volumes at first urge, strong urge, and maximum cystometric capacity (all p < 0.05). Conversely, detrusor pressure at maximum filling and the prevalence of DO were significantly higher in the ADHD group (both p < 0.05). Multivariable regression analysis identified DO as an independent predictor of urodynamic abnormalities in children with ADHD (OR = 3.43, 95% CI: 1.32-8.91, p = 0.012).

Conclusions: Children with ADHD display significant functional bladder abnormalities on urodynamic testing, particularly reduced bladder capacity, increased detrusor pressure during filling, and heightened detrusor activity. ADHD may influence bladder function, at least in part, through neurobehavioral mechanisms. These findings provide valuable clinical insights for the management of LUTS in children with ADHD and underscore the importance of early screening and intervention. Further research is needed to elucidate the underlying mechanisms and to develop effective therapeutic strategies.

Objective: This study aimed to summarize the clinical experience of Endoscopic Retrograde Cholangiopancreatography (ERCP) in a pediatric population, analyzing the disease spectrum, procedural characteristics, and clinical outcomes to contribute to the understanding of its application in children.

Methods: This study reviewed the clinical data of children who presented to our hospital and underwent ERCP and related procedures between January 2021 and December 2024. Collected data encompassed patient demographics, specific disease indications, detailed endoscopic techniques employed, procedural success rates, and the incidence and management of related complications.

Results: The study cohort had a mean age of 8.31 ± 3.63 years. The primary indication for ERCP was pancreatic disease, accounting for 72% (134/186) of procedures. These included chronic pancreatitis (n = 75), pancreatic trauma (n = 17), and acute pancreatitis with pseudocysts (n = 17). Biliary diseases constituted 28% (52/186), mainly choledocholithiasis (n = 33) and pancreatobiliary maljunction (n = 9). Commonly performed endoscopic interventions were pancreatic duct stent placement (n = 95), biliary stent placement (n = 50), and stone extraction from both ducts (n = 70 and 33, respectively). The overall procedural success rate was 90.5% (171/186). A significant difference was noted when stratified by operation time: procedures completed within 60 min had a 96.7% (115/119) success rate, compared to 80.0% (56/70) for those lasting 60 min or longer (P < 0.001). Post-procedure complications were recorded in 11 cases (5.9%), including post-pancreatitis (n = 6), infection (n = 4), and gastrointestinal bleeding (n = 1).All complications were all resolved with conservative medical management.

Conclusion: This study confirms that pancreatic diseases (accounting for 72%) are the main indication. Endoscopic Retrograde Cholangiopancreatography (ERCP) has a high success rate (90.5%) in the diagnosis and treatment of biliary and pancreatic diseases in children. However, prolonged procedure time (>60 min) significantly reduces the success rate.

Aim: We seek to elucidate the prevalence, types of respiratory symptoms experienced, and potential early-life risk factors of asthma in adolescence.

Methods: We performed a prospective cohort study including 294 adolescents [130 moderately-late preterm (MLP), 81 early preterm (EP), and 83 full-term (FT)]. Asthma, asthma-like symptoms, and smoking in early childhood and adolescence were self-reported. We collected prenatal and postnatal characteristics, including maternal smoking, bronchopulmonary dysplasia, and respiratory syncytial virus (RSV) infections.

Results: In 11% of EP, 4% of MLP, and 4% of FT adolescents, a formal asthma diagnosis was made. Asthma-like symptoms were reported in 14%, 14%, and 7% of the cases, respectively. Being hospitalized for an RSV infection was associated with a four times higher risk of asthma in adolescence (odds ratio 3.68 and 95% confidence interval 1.04-13.0), while other predictors did not contribute.

Conclusion: MLP adolescents have similar rates of asthma and asthma-like symptoms as their FT peers, while EP adolescents might have a higher risk of asthma but have similar rates of asthma-like symptoms. RSV infections that require hospitalization are associated with an asthma diagnosis in adolescence.

Clinical trial registration: https://www.controlled-trials.com, identifier ISRCTN 80622320.

Objectives: To describe the clinical characteristics, management, and outcomes of children with Mycoplasma pneumoniae pneumonia (MPP) complicated by pulmonary embolism (PE).

Methods: We conducted a retrospective review of eight children diagnosed with Mycoplasma pneumoniae pneumonia complicated by pulmonary embolism between January 2023 and December 2024 at our hospital. The diagnosis of pulmonary embolism was confirmed by computed tomography pulmonary angiography (CTPA). Demographic characteristics, clinical manifestations, laboratory findings, imaging features, treatment strategies, and outcomes were systematically collected.

Results: The cohort included six males and two females, with a mean age of 7.81 ± 3.64 years. The median interval from pneumonia onset to PE diagnosis was 14 days. All patients had severe or refractory MPP. Common symptoms included chest pain (n = 6), hemoptysis (n = 4), and dyspnea (n = 2). CTPA demonstrated pulmonary arterial filling defects in all cases. All patients received anticoagulation therapy with low-molecular-weight heparin followed by rivaroxaban, resulting in favorable clinical outcomes. During 3-6 months of follow-up, complete resolution of emboli was observed, thrombophilia-related laboratory abnormalities normalized, and no recurrence occurred.

Conclusions: Early diagnosis and timely anticoagulation are crucial for favorable outcomes in children with MPP-related PE. Although the small sample size limits generalizability, this case series provides a structured clinical dataset that captures demographic, laboratory, immunological, and imaging features. These data may serve as a reference for future studies aiming to better understand host susceptibility and immunothrombotic mechanisms in pediatric PE.

Introduction: Art and humanities-based approaches have been incorporated in Diversity, Equity and Inclusion (DEI) training and anti-bias curriculum to address structural racism and personal biases via reflection. Research has shown that the use of visual art or texts via narrative medicine workshops results in improved communication with patients and colleagues and increased commitment to interrupting bias.

Methods: Using members of a hospital-based Child Abuse Bias Mitigating Task Force, this study tests the hypothesis that narrative medicine workshops provide a space where conversations of race and bias in the context of child abuse evaluations can take place.

Results: Workshops participants noted the unique group experience that, through sharing and communal support, helped build compassion, function more effectively as a team, and even find confidence in their own voice. Intertwined with the ability to connect with and support each other as a team was the common thread of understanding differences in perspectives and personal histories. Most participants agree that the workshops increased their ease in having conversations about privilege and bias in clinical assessment.

Conclusion: We conclude that the use of art and creativity allows for personal and structural insights on racism and social advocacy with significant promise for reducing bias in child abuse evaluations.