Frontiers in Pediatrics最新文献

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.

Neuroblastoma is the most prevalent extracranial solid tumor in infancy and early childhood, accounting for 8%-10% of all pediatric malignancies and contributing significantly to cancer-related mortality. Its clinical spectrum ranges from spontaneous regression to aggressive metastatic disease, often influenced by underlying genetic aberrations such as MYCN amplification and chromosomal deletions (1p, 11q, and 17q). We present a rare case of a full-term male neonate diagnosed with stage 4 neuroblastoma originating from the left adrenal gland, exhibiting both MYCN amplification and 1p deletion. The patient had extensive liver metastases and supradiaphragmatic lymphadenopathy at diagnosis. Multimodal treatment, including intensive chemotherapy per the NB2004 protocol, surgical resection, high-dose consolidation chemotherapy, and autologous hematopoietic stem cell transplantation (AHSCT), led to complete remission by 11 months of age. Despite severe post-transplant complications such as sepsis and enteropathy, the patient remained disease-free with normal developmental milestones at follow-up. To the best of our knowledge, this is the first reported case of neonatal neuroblastoma with concurrent MYCN amplification and 1p deletion achieving favorable outcome through comprehensive multimodal therapy. This case underscores the importance of early diagnosis, genetic profiling, and aggressive treatment in managing high-risk neuroblastoma in neonates.

Background: Pulmonary artery sling (PAS) is a rare congenital vascular anomaly in which the left pulmonary artery (LPA) originates from the right pulmonary artery (RPA), forming a ring around the tracheobronchial tree. Due to non-specific respiratory symptoms, it is frequently misdiagnosed, leading to significant delays in diagnosis. This report emphasizes the crucial role of quantitative multimodal imaging in establishing a definitive diagnosis, stratifying risk, and guiding optimal surgical planning.

Case presentation: A 4-year-and-7-month-old boy presented with a 4-year history of recurrent cough and wheezing that was refractory to standard medical therapy. Echocardiography revealed a dilated main pulmonary artery (MPA) measuring 1.9 cm (Z-score +3.2) and an anomalous origin of the LPA from the RPA, with an elevated peak flow velocity of 1.75 m/s. Contrast-enhanced computed tomography angiography (CTA) subsequently confirmed a Type I PAS, enabling precise quantification of a severe focal stenosis of the LPA (minimal diameter 2.8 mm) and demonstrating the absence of significant intrinsic tracheobronchial stenosis. Based on these findings, the patient underwent successful reimplantation of the LPA onto the MPA with an autologous pericardial patch. The postoperative course was uneventful, with complete resolution of respiratory symptoms, and follow-up imaging confirmed a patent anastomosis with successful hemodynamic outcomes.

Conclusions: This case of isolated PAS underscores the indispensable role of a multimodal imaging strategy. While echocardiography can provide initial clues, quantitative CTA is paramount for definitive anatomical classification, precise stenosis quantification, and comprehensive preoperative planning. Early consideration of PAS in children presenting with refractory respiratory symptoms, coupled with advanced imaging, can prevent misdiagnosis and optimize outcomes.

Kyphoscoliotic Ehlers-Danlos syndrome (kEDS) is a rare autosomal connective tissue disorder characterized by progressive kyphoscoliosis, congenital muscular hypotonia, marked joint hypermobility, and severe skin hyperextensibility and fragility. Deficiency of lysyl hydroxylase due to variants of the PLOD1 gene has been identified as a pathogenic cause of the disease. Vascular fragility in kEDS has rarely been reported. Here, we report a 15-year-old Chinese boy with kEDS-PLOD1 who presented with a superior mesenteric aneurysm and severe vascular complications. The patient underwent emergency hybrid surgery combining hemostasis by laparotomy and stent graft placement superior to the bleeding artery by endovascular intervention. The patient's presentation improved postoperatively. Unfortunately, the patient died despite medical intervention. Whole exome sequencing identified compound heterozygous variants in the patient's PLOD1 gene: a reported variant, c.1095C > T, and a novel variant, c.1262delC. The c.1262delC variant is a frameshift variant that results in a premature stop codon and loss of gene function. Overall, this case report further expands the genetic landscape of kEDS and suggests that vascular intervention in these patients requires individualized assessment of vessel function and local perfusion status.

Background: Extravasation and infiltration are preventable complications of intravenous therapy that can cause severe tissue injury in pediatric patients. Nurses play a critical role in prevention and early management, yet studies have shown that their knowledge and skills in this area are often insufficient. Simulation-based training has been shown to improve clinical competence; however, evidence specific to pediatric extravasation management is limited.

Methods: This quasi-experimental study employed a single-group pretest-posttest design. A total of 475 pediatric nurses were invited, 436 participated, and 399 were included in the final analysis after missing data excluded. A half-day, scenario-supported training program was developed by expert clinicians, combining theoretical lectures with low-fidelity, case-based simulation activities. Pre- and post-training scores were compared using nonparametric tests, with significance set at p < 0.05 and effect sizes reported. Knowledge was assessed using a validated 55-item test, and skills were measured through a four-station ObjectiveStructured Practical Examination (OSPE).

Results: Participants were predominantly female (84.7%) and held a bachelor's degree (87.5%). The majority (77.9%) had never received prior extravasation training, while 88.5% expressed a need for education. Knowledge scores improved significantly post-training (p < 0.001, r = -0.26, small effect). Skill scores showed a marked improvement (p < 0.001, r = -0.84, large effect). Subgroup analyses revealed no significant differences by gender or educational level. Nurses with 5-8 years of experience demonstrated greater knowledge gains, while those with prior training achieved higher skill improvements.

Conclusion: Scenario-supported training effectively improved pediatric nurses' competencies in extravasation and infiltration management, with the strongest effect observed in clinical skills. These findings underscore the importance of structured and repeated training, particularly for early- and mid-career nurses. Low-cost, scalable training models represent a practical and sustainable strategy to strengthen pediatric nursing practice and enhance patient safety in diverse healthcare settings.

Aim: Chronic diseases in childhood and adolescence represent a growing global challenge, with families often seeking complementary strategies beyond pharmacological treatment. This systematic review aimed to evaluate the efficacy and safety of dietary and oral supplements in pediatric chronic diseases.

Materials and methods: The review was conducted in accordance with PRISMA guidelines. A systematic search of PubMed, Scopus, Web of Science, and Cochrane Library was performed (2005-2025). Eligible studies enrolled children and adolescents (<18 years) with chronic diseases and assessed oral dietary supplements against placebo, standard care, or no intervention. Thirteen studies were included.

Results: The studies investigated autism spectrum disorder (ASD), functional gastrointestinal disorders, cystic fibrosis (CF), type 1 diabetes (T1D), bronchopulmonary dysplasia (BPD) and juvenile idiopathic arthritis. Interventions included probiotics, omega-3/6 fatty acids, vitamins, minerals, glutathione, Kre-Celazine® and Dimercaptosuccinic Acid (DMSA). Most supplements demonstrated measurable bioactivity, such as modulation of the gut microbiota, changes in inflammatory markers, or improvements in functional indices, but clinical benefits were often inconsistent or limited to subgroups. Safety was generally favorable for probiotics, polyunsaturated fatty acids, magnesium, zinc, and vitamin A, whereas DMSA chelation raised significant safety concerns.

Conclusions: Dietary and oral supplements show promise as supportive interventions in pediatric chronic diseases but cannot yet be recommended for systematic clinical use. Larger multicenter trials with longer follow-up, standardized endpoints, and predictive biomarkers are needed to identify responder subgroups and establish evidence-based recommendations.

Background: This meta-analysis investigates the association between maternal anxiety/depression during pregnancy and the development of eczema/atopic dermatitis (AD) in offspring.

Methods: A literature search was conducted across four electronic databases (PubMed, Web of Science, Embase, and the Cochrane Library) for studies published from database inception until July 2025. In this study, maternal depression and anxiety were defined as conditions physician-diagnosed or assessed with standardized scales during pregnancy. The primary outcome was the incidence of eczema/AD in the offspring.

Result: A total of 12 cohort studies were included in this meta-analysis. Pooled results indicated that maternal depression [odds ratio (OR) = 1.06, 95% confidence interval (95% CI) = 1.01-1.11, p = 0.015] or anxiety (OR = 1.11, 95% CI = 1.03-1.19, p = 0.005) during pregnancy was potentially associated with a higher incidence of offspring eczema and AD. Subgroup analysis revealed that there was a higher incidence of AD in offspring with maternal anxiety during pregnancy (OR = 1.24, p = 0.028), while no significant difference was observed in the incidence of eczema (p = 0.286). A higher incidence of offspring eczema/AD was observed in offspring of both Eastern (OR = 1.13, p = 0.043) and Western (OR = 1.34, p = 0.049) countries. Moreover, the incidence was higher in offspring when maternal anxiety was identified in the first (OR = 1.13, p = 0.036) or second (OR = 1.25, p = 0.010) trimester, whereas no significant difference was found for exposure in the third trimester (p = 0.152). For maternal depression during pregnancy, offspring had a higher incidence of AD (OR = 1.17, p < 0.001), while no significant difference was observed for eczema (p = 0.145). Furthermore, the incidence of offspring eczema/AD was higher in Eastern countries (OR = 1.14, p = 0.035), while Western countries group showed no significant difference (p = 0.111). Additionally, when analyzed by timing of exposure, the incidence was higher when depression was identified in the second trimester (OR = 1.30, p = 0.027), with no significant difference found in the third trimester (p = 0.163).

Conclusion: This study suggests that maternal depression/anxiety during pregnancy is potentially associated with the development of eczema/AD in offspring.