Journal of paediatrics and child health最新文献

Aim: Molar-incisor hypomineralisation is a developmental enamel defect characterised by lower mineral content in the tooth's outer layer, discoloured and structurally fragile teeth that are more prone to sensitivity, breakdown and caries. This review aims to summarise current knowledge on molar-incisor hypomineralisation and highlight key clinical considerations relevant to paediatricians.

Methods: A comprehensive narrative review of the literature was performed to describe the condition's epidemiology, aetiological hypotheses, clinical features, diagnostic challenges and implications for early recognition in paediatric practice.

Results: Findings show that this pathology affects up to one in five children worldwide, with causes likely multifactorial and involving prenatal, perinatal and environmental factors. Clinically, molar-incisor hypomineralisation may be presented as demarcated opacities, colour alterations or post-eruptive enamel loss. Paediatricians, who are often the first clinicians to observe affected children, play a crucial role in identifying early signs and ensuring timely referral to a paediatric dentist.

Conclusions: Increasing paediatricians' awareness of molar-incisor hypomineralisation is essential to promote early diagnosis, prevent complications and encourage interdisciplinary collaboration that improves children's oral health and quality of life.

Background: Children with febrile urinary tract infection (UTI) are at increased risk of kidney scarring which can be identified by a late dimercaptosuccinic acid (DMSA) scan performed ≥ 3 months after the febrile UTI. In this study, we developed a clinical risk prediction model to identify children at risk of an abnormal late DMSA scan after the first febrile UTI.

Methods: This is a retrospective cohort study of all children diagnosed with their first febrile UTI between January and July 2017, scheduled for a late DMSA scan. Patient characteristics and laboratory findings were compared between patients with and without abnormalities on the DMSA scan. A clinical risk prediction model was developed using the odds ratio of variables in a multivariable logistic regression model to obtain a score for each covariate.

Results: There were 581 children diagnosed with their first febrile UTI, of which 208 (36%) underwent DMSA scan. Overall, 40 (19%) children had abnormal DMSA scans. A higher proportion of boys with phimosis compared to those without phimosis had DMSA abnormalities (67% vs. 38%, p = 0.019). C-reactive protein (CRP) (108.0 [interquartile range, IQR 41.4-198.4] vs. 32.6 [IQR 11.4-85.2] mg/L, p < 0.001), procalcitonin (10.98 [IQR 0.40-43.72] vs. 0.13 [IQR 0.10-0.24] ng/mL, p < 0.001) and creatinine (41 [IQR 37-46] vs. 37 [IQR 35-40] μmol/L, p < 0.001) were higher in patients with DMSA abnormalities. The clinical risk prediction model included procalcitonin ≥ 4.07 μg/L, creatinine ≥ 43 μmol/L and CRP ≥ 90.4 mg/L.

Conclusion: Serum creatinine, procalcitonin and CRP may be useful in identifying paediatric patients with first febrile UTI at risk of an abnormal late DMSA scan.

Aims: This study describes the location, mode of death, palliative care and advance care planning (ACP) use amongst children who died at KK Women's and Children's Hospital (KKH), Singapore, between 2011 and 2020.

Methods: Medical records of all children who died in the general ward, high dependency unit and paediatric intensive care unit (PICU) were reviewed. Data collected included: demographics, diagnosis, cause, location, mode of death, palliative care and ACP use. Trends were analysed using the Mann-Kendall test and compared using logistic regression. A p-value of < 0.05 was considered statistically significant.

Results: Amongst 326 372 hospital admissions, 412 children (0.13%) died, of whom 270 (65.5%) had at least one complex chronic condition (CCC). Most deaths occurred in the PICU (319/412, 77.4%), and 188 children (45.6%) died following non-escalation of care. Palliative care consultations were provided in 119 cases (28.9%), and ACP was documented in 25 cases (6.1%). From 2011 to 2020, palliative care consultations increased from 20.4% to 39.3% (p = 0.06) and ACP use increased from 0% to 15.2% (p < 0.05). Over the same period, deaths after withdrawal of life-sustaining measures (WLSM) increased from 14.3% to 30.3% (p = 0.09), whilst deaths in the general ward decreased from 12.2% to 6.1% (p = 0.36).

Conclusions: Most hospitalised children died in the PICU following non-escalation of care without palliative care or ACP use. Future research is needed to identify the barriers and facilitators to their use.

Aim: This retrospective cohort study reviewed medical records of 84 children diagnosed with infantile epileptic spasm syndrome (IESS) between 2015 and 2024 at the Douala Gyneco-Obstetric and Pediatric Hospital. Patients were invited for follow-up clinical assessment, with 67 children (79.8%) completing follow-up evaluations under a child neurologist's supervision.

Methods: The study reviewed medical records and conducted follow-up examinations. Data on socio-demographic, clinical and therapeutic features were analysed using SPSS 30.0.

Results: The prevalence of IESS was 0.34%, with mean symptom onset at 6.73 ± 4.02 months. The most common presentation was epileptic spasms (77.4%), predominantly flexion type (73%). Median diagnostic delay was 2.0 months (IQR: 1-3 months), with 65.5% of families initially seeking traditional medicine. The primary etiologies were perinatal asphyxia (64.3%), cerebral malformations (11.9%) and prematurity-associated brain injury (8.3%). Notably, 72.6% of infants had documented neonatal infections, which may have contributed to the pathophysiology in conjunction with other etiological factors. Electroencephalography revealed hypsarrhythmia in 97.6% of cases. Corticosteroids were the most frequent treatment (78.6%). Outcomes were poor, with high mortality (25.4%) and persistent developmental delays (90.0%).

Interpretation: The high mortality and developmental delays highlight the need for urgent interventions in low-resource settings, including: early diagnostic algorithms, discouraging delays due to traditional medicine, improving neonatal infection control, ensuring corticosteroid availability and implementing paediatric neurology teleconsultation to improve outcomes.

Background and aim: Early prediction of necrotising enterocolitis (NEC) in preterm infants is important given its significant health, economic and social-emotional burden. We aimed to validate a clinical risk score (Check-NEC Score [CNS]) for this purpose in preterm infants.

Methods: A case-control study was conducted using data (January 2020-December 2023) from very preterm infants (VP: gestation < 32 weeks) with confirmed NEC≥Stage II. CNS was calculated for cases and controls (matched for key confounders) at baseline (T1), 7 days (T2), and 72 h (T3) before NEC diagnosis. Receiver operating characteristic (ROC) analysis was used to determine the sensitivity, specificity, and area under the curve (AUC).

Results: Twenty-two cases of NEC≥Stage II diagnosed at a median (IQR) age of 17 (11-24) days were matched with 22 controls. Median CNS was significantly higher in cases compared to controls at T2 (8 vs. 7, p = 0.025) and T3 (8 vs. 7, p = 0.005). T3 CNS had the highest AUC (0.64, 95% CI 0.48-0.81). A cut-off score of ≥ 11 at T2 had the highest specificity (95%, 95% CI 75%-99%). At T3, a cut-off score of either ≥ 8 or ≥ 9 was best.

Conclusion: CNS demonstrated acceptable predictive ability at 72 h with high specificity 7 days before NEC diagnosis, depending on the cut-off score chosen.