Pediatric Research最新文献

Background: The lack of centralized pediatric critical care data in Kuwait has limited benchmarking, outcome evaluation, and resource planning. This study describes the development and implementation of Kuwait's first nationwide PICU registry and evaluates its feasibility and early utility.

Methods: A centralized registry was implemented across seven governmental PICUs serving over 870,000 children. Demographics, diagnoses, interventions, outcomes, and infection data were retrospectively collected at discharge by site coordinators. Data were entered into a secure, encrypted platform using de-identified records and role-based access, with centralized validation performed every tercile.

Results: During the implementation phase, 2086 of 2364 admissions were captured. Registry accuracy compared with manual admission logs was 88.2%, demonstrating feasibility and data reliability. Inter-hospital variability in clinical practices and resource utilization was identified. The registry also enabled early detection of infection trends and supported proactive staffing and equipment planning.

Conclusion: Kuwait's national PICU registry is feasible, reliable, and operationally effective. It addresses critical data gaps, enhances transparency, supports evidence-based decision-making, and provides a foundation for national quality improvement and future benchmarking initiatives.

Impact: Demonstrates feasibility, reliability, and operational effectiveness of a national PICU registry in real-world pediatric critical care. Enables early detection of infection trends and supports strategic planning for staffing and equipment. Presents one of the first national PICU registry models in the Middle East, addressing fragmented data systems. Offers practical strategies for standardization, data validation, and inter-hospital coordination, supported by physician champions and stakeholder engagement. Bridges critical data gaps, strengthens quality monitoring and benchmarking, and provides a scalable framework for broader pediatric specialties and international research.

Background: The COVID-19 pandemic has altered the typical annual pattern of influenza. We aim to assess its impact on influenza outcomes, especially on mortality, cardiovascular, and non-cardiovascular complications.

Methods: This study utilized discharge records from the National Inpatient Sample (NIS) for 2019 and 2022. We analyzed the data of hospitalized influenza patients (20 years and younger) using descriptive statistics and logistic regression models.

Results: 29,270 influenza hospitalizations were identified in the pre-pandemic year and 29,860 in the post-mitigation year. The median age was 6 years (IQR: 2-12) in the post-mitigation year vs. 4 years (IQR: 1-9) in the pre-pandemic year, P < 0.001. Mortality and major cardiovascular complications, including myocarditis and tachyarrhythmias, showed no differences. Respiratory failure was more common in post-mitigation (21.4% vs. 12.7%), with nearly twice the risk in adjusted models [aOR = 1.92 (1.68-2.19), P < 0.001]. Invasive mechanical ventilation use decreased in the post-mitigation year by 30% [aOR = 0.7 (0.55-0.89), P = 0.004].

Conclusion: Mortality and cardiovascular complications remained stable in pre- and post-mitigation year; however, post-pandemic influenza showed an increased risk of respiratory failure with a decreased invasive mechanical ventilation use. This suggests a shift in disease presentation and clinical management strategies in the post-mitigation period.

Impact: Influenza's clinical profile in children has changed post-COVID, with increased respiratory failure and a shift to older affected age groups, while mortality and severe cardiovascular complications remain stable. This study is the first to systematically compare pediatric influenza outcomes, including all major complications and mortality, pre- and post-COVID-19, revealing specific shifts in disease presentation and demographics. Informs clinical vigilance, diagnostic strategies, and public health planning for pediatric influenza by highlighting shifts in hospitalization patterns and complications observed during the post-mitigation period. Findings support preparedness efforts recognizing temporal disruptions surrounding the pandemic.

Background: Phototherapy, involving therapeutic blue light, is essential for treating neonatal jaundice/hyperbilirubinemia. Kangaroo care involves prolonged skin to skin contact between the infant and parent, especially important for newborn infants. These experiments seek to investigate the ability of a novel medical device, BiliRoo, to deliver filtered sunlight phototherapy in a kangaroo care carrier, to assess whether harmful UV-A (and by extension UV-B) was filtered out while adequate therapeutic blue light was allowed to pass through at multiple caregiver angles.

Methods: In a bench model, the delivered UV-A radiation and therapeutic blue irradiance were measured for Air Blue and Gila Titanium filters from 10:00 a.m. to 8 p.m. at angles of 30°, 60°, and 90° from the ground.

Results: The mean values of irradiance for both filters at all three angles were above the threshold of intensive phototherapy (30 μW/cm²/nm). For both filters, over 99% of the mean UV-A radiation was filtered out at all three angles.

Conclusions: In a bench model, BiliRoo is able to filter harmful UV radiation while still delivering adequate average therapeutic blue light at a range of caregiver angles. Further testing on usability and clinical feasibility, safety and efficacy are warranted.

Impact: Introduces a novel non-electric medical device that combines filtered sunlight phototherapy and kangaroo care to treat infant jaundice. Demonstrates the ability of the device to provide adequate therapeutic blue irradiance to treat jaundice while blocking harmful UV sunlight for caregivers at multiple angles, enabling potential at-home and mobile care.

Background: Prolonged apneic time during tracheal intubation (TI) may increase the risk of oxygen desaturation in critically ill children. This study aimed to identify factors associated with long apneic times and examine the relationship between apneic duration and oxygen desaturation.

Methods: We conducted a prospective observational study of children <18 years undergoing oral TI in the pediatric intensive care unit and emergency department of a large academic children's hospital. Apneic time was measured and categorized as short or long using a 54-s cutoff. Desaturation was defined as SpO₂ <90% during the apneic period in children with baseline SpO₂ >90%.

Results: Among 204 TIs, the median apneic time was 54 s. Long apneic times were more common in infants than in younger children or older children. Apneic time did not differ by history of a difficult airway, provider type, laryngoscope type, or apneic oxygenation use. Oxygen desaturation rates were similar between long and short groups. There was no significant association between long apneic time and desaturation while apneic oxygenation significantly reduced desaturation risk.

Conclusions: Patient age was associated with long apneic times. While apneic time was not associated with desaturation, apneic oxygenation use was associated with lower occurrence of oxygen desaturation.

Impact: This study found that longer apneic times during pediatric tracheal intubation were not independently associated with oxygen desaturation after adjusting for patient age and apneic oxygenation use. Apneic oxygenation significantly reduced the risk of desaturation, supporting its routine use during tracheal intubation in critically ill children. These findings add evidence supporting age-specific airway strategies and highlight the importance of modifiable practices to improve the safety of pediatric airway management.

Background: Low-grade systemic inflammation and localized stomach inflammation are both brought on by Helicobacter pylori (H. pylori), which is a prevalent cause of chronic gastritis. The aim of this study was to assess the association between H. pylori positivity, severity, and both platelets/lymphocytes ratio (PLR) and neutrophils/lymphocytes (NLR) ratios in children.

Methods: One hundred consecutive children who underwent gastroscopy for upper gastrointestinal tract symptoms were analysed retrospectively. They were classified according to identification of the H. pylori antigen in stool before endoscopy and confirmed by gastric endoscopic biopsy into H. pylori positive and negative groups. Their complete blood count was analysed, and PLR and NLR ratios were calculated.

Results: H. pylori-positive group had significantly more prevalent erythema, nodularity, enlarged folds, and active chronic gastritis. Neutrophil count, NLR, and PLR were significantly higher in the H. pylori-positive group compared to the H. pylori-negative group, and this increase positively correlated with the severity of the infection.

Conclusion: H. pylori-positive patients have considerably higher NLR and PLR. Moreover, PLR and NLR were good predictors for the presence and severity of H. pylori infection in children with upper gastrointestinal tract symptoms.

Impact: Low-grade systemic inflammation and localized stomach inflammation are both brought on by Helicobacter pylori (H. pylori), which is a prevalent cause of chronic gastritis. Recent adult studies reported that there is an association between H. pylori infection and both platelets/lymphocytes ratio (PLR) and neutrophils/lymphocytes (NLR) ratio. This study aimed to assess the association between H pylori positivity, severity, and both PLR and NLR ratios in children. We found that H. pylori-positive patients have considerably higher NLR and PLR. Moreover, PLR and NLR were good predictors for the presence and severity of H. infection in children with upper gastrointestinal tract symptoms.

Background: Postural control is often impaired in children with spastic cerebral palsy (sCP), with inter-individual differences not fully explained by CP topography or functional level. While brain lesion characteristics are known determinants of upper limb function, their predictive value for postural control remains underexplored.

Methods: In this cross-sectional study, 43 children with uni- or bilateral sCP (GMFCS I-III), aged 5-12 years, underwent standardized postural control assessment using the Kids-BESTest-2 (in percent scores). Lesion type was classified using the MRI classification scale (MRICS), and lesion extent and location were retrospectively scored on clinical MRI using the semi-quantitative MRI (sqMRI) scale. Associations between lesion characteristics and postural control domains were analyzed using stepwise regression models.

Results: Children with predominant white or grey matter lesions performed similarly across all postural control domains. Greater lesion extent was significantly associated with poorer postural control in all domains (β = -0.8 to -1.8% per sqMRI point increase, p ≤ 0.02) except 'Sensory Orientation'. Lesions in the frontal lobe, anterior corpus callosum, PLIC, thalamus, and brainstem were the strongest predictors of domain-specific deficits, explaining up to 53% of variance.

Conclusion: Lesion extent and location, rather than type, determine the severity and domain-specificity of postural control deficits in sCP. Lesion-specific MRI scoring may support patient-tailored rehabilitation and prognosis.

Impact: This study demonstrates that semi-quantitative MRI-based scoring of brain lesion extent and location, rather than lesion type, is key to understanding domain-specific postural control deficits in children with spastic cerebral palsy. It provides novel evidence that damage to specific brain regions, including the frontal lobe, anterior corpus callosum, PLIC, thalamus, and brainstem, most strongly predicts impairments in distinct postural control domains. Lesion-specific MRI profiling has clinical value for identifying postural control deficits and guiding individualized rehabilitation in children with spastic cerebral palsy. Further longitudinal and multimodal research is needed to validate these findings and optimize intervention strategies.

Impact: Vitamin K supports neurodevelopment through sphingolipid regulation critical for myelination and neuronal integrity, anti-inflammatory effects via NF-κB pathway inhibition, and improved maternal glucose metabolism and insulin sensitivity. Current prenatal recommendations of vitamin K (70-90 µg/day), based solely on coagulation needs, may be insufficient for optimal brain development. A target of 140 µg/day warrants consideration in future guidelines. Routine assessment of vitamin K status in prenatal care offers a safe and low-cost opportunity to support neurodevelopment and reduce developmental inequities at the population level.

Background: The effects of different exercise intensities on cognitive outcomes and brain-derived neurotrophic factor (BDNF) concentrations in adolescents with overweight/obesity are not yet fully elucidated. This study aimed: (a) to compare the prevalence of responders to cognitive function and BDNF concentration in adolescents with overweight/obesity participating in a 12-week intervention with high-intensity interval training (HIIT) or moderate-intensity continuous training (MICT), and (b) to analyze whether cardiorespiratory fitness (CRF) can explain differences in inter-individual variability between responders and non-responders.

Methods: Adolescents with overweight/obesity were assigned to HIIT (n = 15), MICT (n = 14), or CG (n = 24). Anthropometrics, body composition, CRF, basal BDNF, and cognitive performance (Trial Making Test (TMT) and Stroop Test (ST)) were evaluated pre- and post-intervention. Training was performed on stationary bikes (3×/week for 12 weeks).

Results: The prevalence of responders in ST and TMT was higher in the HIIT group than in CG (93-62%, p = 0.029; 67-33%, p = 0.043), with no differences in MICT. No group differences were found for BDNF responders (HIIT:73%-MICT:71%-CG:46%, p = 0.263). ST and TMT responders had greater CRF improvements than non-responders.

Conclusion: HIIT elicited a higher prevalence of cognitive responders than CG. CRF improvements may partially explain individual variability in responsiveness to cognitive outcomes.

Impact: This is the first study to examine and compare inter-individual variability in cognitive function and BDNF levels following MICT and HIIT interventions in adolescents with overweight/obesity; Exercise intensity and improvements in cardiorespiratory fitness are key factors for optimizing the cognitive effects of interventions in youth with overweight; Twelve weeks of supervised HIIT and MICT training led to increased rates of cognitive responders among adolescents with overweight/obesity.