Pediatric Investigation最新文献

Importance: Understanding the dynamic interplay between gut microbiota development and bilirubin metabolism may provide new insights into the pathophysiology of neonatal jaundice. Identifying microbial taxa associated with bilirubin fluctuations could help inform early prediction and microbiota-targeted interventions for hyperbilirubinemia.

Objective: To investigate the correlation between dynamic changes in the gut microbiota and bilirubin concentrations during the neonatal period.

Methods: Bilirubin concentrations were monitored daily throughout the neonatal period. Fecal samples were collected from neonates on days 1, 3, 7, 14, 21, and 28 after birth. The composition of the gut microbiome was assessed by 16S rRNA gene amplicon sequencing of the fecal samples. Within-subject, same-day associations between transcutaneous bilirubin (TcB) and genus-level abundance were quantified using a repeated-measures correlation.

Results: Thirty neonates were included in the final analysis. Among the top-30 genera, six exhibited false discovery rate significant, same-day within-subject associations with TcB under the repeated-measures correlation framework (|r_rm| ≥0.30). Changes in the abundances of the genera Streptococcus (r _rm = +0.416, 95% confidence interval [CI] 0.272-0.543, P = 2.084 × 10^-7; P-adj = 3.126 × 10^-6) and Rothia (r _rm = +0.340, 95% CI 0.187-0.476; P = 3.134 × 10^-5; P-adj = 1.567 × 10^-4) were positively correlated with bilirubin concentrations throughout the neonatal period. In complementary cross-sectional analyses centered on meconium, additional genus-bilirubin correlations were identified for TcB measured on postnatal days 3-7 and for the neonatal TcB peak, with multiplicity controlled separately for each endpoint.

Interpretation: A correlation was found between dynamic changes in the gut microbiome and bilirubin concentrations during the neonatal period. The identified genera might be potential markers or targets for intervention for neonatal jaundice.

Introduction: Infectious mononucleosis (IM) and Kawasaki disease (KD) can present with overlapping clinical features, occasionally complicating the differential diagnosis. Given the significant differences in their management, accurate distinction is critical. It is exceptionally rare for a single patient to simultaneously suffer from both IM and KD in clinical practice.

Case presentation: We report two cases of children over five years of age who initially presented with clinical manifestations suggestive of IM and serological evidence consistent with primary Epstein-Barr virus (EBV) infection, supporting an initial diagnosis of IM. Subsequently, both patients developed clinical features meeting the diagnostic criteria for KD. The final diagnosis was co-occurrence of IM and KD.

Conclusion: We describe two cases of concurrent IM and KD, offering further insight into a possible association between primary EBV infection and KD. Clinicians should be mindful of the potential co-occurrence of these disorders, strive to avoid conflicts in treatment strategies, and take proactive measures to prevent complications.

[This corrects the article DOI: 10.1002/ped4.12402.].

Importance: C-reactive protein (CRP) is a commonly used biomarker for sepsis.

Objective: This study aimed to evaluate CRP's diagnostic performance to detect neonatal early-onset sepsis (EOS), while accounting for both gestational and postnatal age.

Methods: We conducted a multicenter retrospective study of neonates born from January 2006 to December 2017 in public hospitals in Hong Kong. Neonates who had CRP tested within 72 h of birth, prior to antibiotics initiation, were included. CRP values were analyzed by gestational age and time after birth. Diagnostic performance was evaluated using receiver operating characteristic (ROC) curves, sensitivity, specificity, predictive values, and likelihood ratios (LRs).

Results: Among 100 327 tested neonates, 448 developed culture-confirmed EOS, and 34 had meningitis. In uninfected neonates, CRP concentrations rose naturally after 8 h of life, peaking at 24-32 h, with higher values in term neonates at 24-48 h (median 6.2 mg/L, interquartile range 2.9-14.3). Diagnostic performance was better in preterm neonates (e.g., the area under the ROC curve after 4 h of life: 0.88 in <34 weeks, 0.83-0.92 in 34-36 weeks, and 0.73-0.77 in term neonates). Sensitivity within the first 4 h was low across all groups. LRs increased with higher CRP values in preterm neonates. A CRP value of >12.0 mg/L was associated with increased risk of meningitis.

Interpretation: CRP is not recommended for EOS screening in term neonates, but it may be considered for assessing the risk of EOS in preterm neonates. Interpretation must account for gestational and postnatal age.

Importance: The incidence of pediatric inflammatory bowel disease (IBD) is increasing worldwide, particularly after the coronavirus disease 2019 pandemic. As children with IBD are at higher risk of infection, adherence to vaccination schedules is essential. However, data on the incidence of IBD and vaccination coverage in Italian children remain limited.

Objective: To assess the incidence of IBD in children aged 0-14 years in the Apulia region of Italy (2009-2023) and to evaluate their vaccination coverage for both mandatory and recommended vaccines.

Methods: A retrospective population-based study was conducted using hospital discharge records and a user fee exemption registry to identify incident IBD cases. Vaccination history was obtained from the regional immunization system. Age-standardized incidence rates (SIRs) were calculated. Vaccination coverage was assessed based on the receipt of all age-appropriate vaccines according to regional immunization schedules.

Results: Between 2009 and 2023, 1044 incident pediatric IBD cases were identified, with an average annual SIR of 12.7/100 000. A significant increase in incidence occurred after 2020 (P < 0.001), peaking in the 10-14 age group. Among the 259 patients assessed for vaccination coverage, the rates were high for hexavalent (100.0%) and pneumococcal vaccines (99.2%), moderate for rotavirus (82.5%) and meningococcal vaccines (79.9%), and lower for human papillomavirus (66.3% in females and 52.1% in males) and diphtheria-tetanus-acellular pertussis and inactivated polio vaccines (dTap-IPV) booster (30.2%). Influenza coverage in 2023/24 was 18.9%. Children with complex chronic conditions had lower uptake of measles, mumps, and rubella and dTap-IPV boosters.

Interpretation: The incidence of pediatric IBD is increasing in Apulia, whereas vaccination coverage remains below optimal levels. Targeted strategies are needed to enhance immunization in this vulnerable population.

Importance: Brain and central nervous system (CNS) cancers are the most common pediatric solid tumors, significantly affecting the patients' life expectancy and quality.

Objective: To examine the disease burden of brain and CNS cancer in children and adolescents from 1990 to 2021 across various age groups, sexes, and socio-demographic index levels, at the global, regional, and national levels.

Methods: Data, including the incidence, mortality, and disability-adjusted life years (DALYs) of brain and CNS cancer in children and adolescents, were obtained from the 2021 Global Burden of Diseases, Injuries, and Risk Factors Study. Temporal trends were evaluated using the Joinpoint regression model. The relationship between disease burden and socioeconomic development, as well as health inequality, was examined.

Results: In 2021, the global age-standardized incidence rate of brain and CNS cancers among patients aged 0-20 years was 1.55 per 100 000 population. From 1990 to 2021, the global age-standardized mortality rate (ASMR) declined from 1.14 to 0.76 per 100 000, and the age-standardized DALY rate (ASDR) decreased from 94.29 to 62.79 per 100 000. Over the past three decades, most regions and countries and territories have shown declining trends in ASMR and ASDR. Global inequality of disease burden persists, with regions possessing higher socioeconomic statuses exhibiting lower ASMR, ASDR, and mortality-to-incidence ratio.

Interpretation: The decline in ASMR and ASDR of pediatric brain and CNS cancer indicates improvements in disease management and patient outcomes. Enhancing diagnostic and therapeutic strategies, improving life quality, and promoting health equity are crucial directions for future research.

Importance: Asthma is a chronic condition characterized by airway inflammation. Dietary habits have been associated with allergic respiratory disorders, but the specific dietary preferences linked to childhood asthma remain unclear.

Objective: To investigate the relationship between dietary preferences and childhood asthma in Minhang District, Shanghai, China.

Methods: This cross-sectional study was conducted in 13 sub-districts/towns of Minhang District, Shanghai, in 2014. First-grade primary school students were surveyed during their annual physical examinations. Data on dietary preferences and health status were collected through questionnaires completed by the children's primary caregivers. Logistic regression analysis was used to assess the relationship between dietary preferences and asthma. Stratified analyses were conducted by sex and body mass index groups.

Results: A total of 8412 children, with an average age of 6.64 ± 0.29 years, participated in the survey. After adjusting for potential confounders, children who reported a preference for pickled and smoked foods exhibited a significantly elevated risk of asthma (odds ratio [OR] = 1.81; 95% confidence interval [CI]: 1.16-2.82). Subgroup analysis further revealed that girls with a preference for fried foods were at a higher risk of developing asthma (OR = 14.72; 95% CI: 1.89-114.65).

Interpretation: Our findings suggest that certain dietary preferences, particularly for pickled and smoked foods, may be significant risk factors for childhood asthma.

Importance: Pediatric human immunodeficiency virus (HIV) infection continues to pose a significant global health burden, especially in low- and middle-income countries. Despite advances in antiretroviral therapy (ART), children living with HIV face unique clinical, developmental, and systemic challenges.

Objective: To systematically review recent developments in pediatric HIV care, with a focus on treatment innovations, complications, and the transition from pediatric to adult care.

Methods: A comprehensive literature review was conducted across PubMed, Scopus, EMBASE, and the World Health Organization databases, covering studies published between 2012 and 2025. Inclusion criteria focused on original research, clinical trials, and guidelines addressing pediatric ART, long-acting therapies, prevention strategies, treatment complications, and transitional care.

Results: Early ART initiation was associated with improved neurodevelopment and reduced disease progression. Current pediatric ART regimens favor simplified combinations and weight-based dosing, but pharmacokinetic variability, toxicity, and adherence remain concerns. Long-acting injectable therapies, such as cabotegravir/rilpivirine and investigational agents like lenacapavir and islatravir, show promise for adolescents. Prevention of mother-to-child transmission has significantly reduced pediatric HIV incidence, largely through maternal ART and pre-exposure prophylaxis. However, stigma, poor awareness, and healthcare disparities hinder broader impact. Children on lifelong ART face increased risks of metabolic, cardiovascular, renal, and neurocognitive complications. Transitioning to adult care remains a vulnerable period with high rates of treatment disengagement.

Interpretation: Advances in pediatric HIV care are substantial but uneven. Continued investment in age-appropriate therapies, psychosocial support, and implementation research is essential to close persistent gaps and ensure equitable, lifelong care for children and adolescents living with HIV.

This is an evidence-based guideline for postoperative nutritional management of neonates with enterostomy. There were 10 clinical questions in enteral nutrition management, parenteral nutrition management, and post-discharge follow-up (including the closure of fistula). The Grading of Recommendations Assessment, Development and Evaluation method was used for constructing the recommendations. Domestic and international literature were systematically searched and reviewed. There were 22 recommendations in this guideline.