Pediatric Investigation最新文献

Importance: The closed-loop infusion system can automatically adjust and maintain the depth of anesthesia by using the propofol target-controlled infusion (TCI) model under the feedback guidance of the bispectral index (BIS).

Objective: To evaluate the safety and superiority of closed-loop TCI of propofol guided by BIS during maintenance of generalized intravenous anesthesia for preschool children.

Methods: A total of 120 children aged 1-6 years were enrolled and were divided into a closed-loop feedback group (Group C) and an open-loop manual control group (Group O), with 60 participants in each group. For anesthesia maintenance, the propofol infusion rate was adjusted by the injection system under the guidance of BIS in Group C and was manually adjusted by anesthesiologists according to the BIS and clinical experience in Group O, to maintain a BIS level of 50. The time ratio of adequate anesthesia (40 ≤ BIS ≤ 60), light anesthesia (BIS > 60), and deep anesthesia (BIS < 40) were recorded.

Results: A total of 119 patients (59 in Group C and 60 in Group O) were enrolled in the study. Group C demonstrated a higher time ratio of adequate anesthesia (P = 0.014) compared to Group O. The time ratio of light anesthesia and the global score was lower in Group C than in Group O (P = 0.010, P = 0.015, respectively). The frequency of adjustment per unit of time was higher in Group C for propofol (P < 0.001), while it was lower for remifentanil (P = 0.010).

Interpretation: BIS-guided closed-loop infusion of propofol is safe and effective for preschool children. The depth of anesthesia is controlled more accurately and smoothly.

Importance: Nutrition is associated with neurodevelopment. Infants at high risk of cerebral palsy (CP) usually suffer from undernutrition, yet the relationship between nutritional status and neurodevelopmental levels is unclear.

Objective: To describe the nutritional status characteristics of infants at high risk of CP, and to explore the relationship between neurodevelopmental levels and nutritional status.

Methods: This single-center cross-sectional study enrolled infants at high risk of CP, with corrected age from 0 days to 12 months. Weight and height were measured and calculated into z-scores, which were used to classify the nutritional status based on the World Health Organization growth charts and American Society for Parenteral and Enteral Nutrition standards. The Bayley Scales of Infant and Toddler Development were used to evaluate the developmental levels of gross motor, fine motor, cognition, receptive communication, and expressive communication.

Results: A total of 479 infants at high risk of CP were recruited, with 43.4% classified as undernutrition. Compared to those with normal neurodevelopment, the odds of moderate and severe undernutrition were about 1.8 and 3.9 times higher in gross motor delay, 2.2 and 3.1 times higher in fine motor delay, 2.5 and 9.4 times higher in cognition delay, 2.2 and 3.9 times higher in receptive communication delay, and 3.0 and 5.6 times higher in expressive communication delay. There were significant positive correlations between nutritional status and neurodevelopmental levels (P < 0.001).

Interpretation: Undernutrition and neurodevelopmental delays are prevalent among infants at high risk of CP. Worse nutritional status was correlated with lower neurodevelopmental levels.

Importance: Viral encephalitis is one of the main causes of the perisylvian syndrome, which can cause damage to children's language-speech, feeding, and swallowing functions. Comprehensive assessment of language-speech and swallowing function and comorbidity research on these children will help children's rehabilitation workers to better understand the disease and strengthen the systematic management of comorbid disorders.

Objective: To describe speech and language pathology and the occurrence of comorbid disorders in children with perisylvian syndrome induced by viral encephalitis.

Methods: Twenty-two children with acquired perisylvian syndrome were recruited in this study. Language and speech functions, including oral motor function, swallowing function, language ability, and dysarthria were assessed in these patients. Craniocerebral magnetic resonance imaging (MRI), electroencephalogram examination, and intelligence evaluation were performed to determine brain lesions and comorbid disorders.

Results: All children exhibited different degrees of oral movement, dysphagia, and speech and language disorders. There was a significant difference between expressive and receptive language ability (P < 0.05). There were 10, 8, and 12 children who had an intellectual disability, limb disability, and epilepsy, respectively. In addition to the damage of the peri-tegmental cortex found in MRI, thalamus lesions occurred in 19 cases and white matter involvement in six cases.

Interpretation: Children with acquired perisylvian syndrome caused by viral encephalitis are characterized by persistent pseudobulbar dysfunction, speech and language impairment, and orofacial diplegia. They have a high probability of secondary epilepsy and are prone to motor and cognitive impairment, which need systematic management.

The tuberous sclerosis complex (TSC)-associated neuropsychiatric disorders (TAND) Checklist is a reliable global screening tool for TAND in clinical settings, with six dimensions and 12 sections. For Chinese individuals with TSC, the implementation of the TAND Checklist provides a comprehensive approach to evaluating potential manifestations across various domains.

Importance: The diagnosis of congenital auricular deformity often relies on the clinical experience of clinicians, leading to a high incidence of misdiagnosis and missed diagnosis due to the lack of quantitative diagnostic criteria.

Objective: To characterize auricle morphology in newborns from southern China and explore the underlying etiology of congenital auricle deformity.

Methods: A total of 636 neonates (1272 ears) with less than seven days old were included. The auricles of each infant were measured and photographed. The relationship between maternal factors and the occurrence of congenital auricle deformity was analyzed.

Results: The incidence of auricular deformity in southern China was 79.87%. Helical rim deformity and mixed deformity had the highest incidence (17.30% each), while cryptotia had the lowest incidence (0.31%). Among mixed deformities, lop ear with conchal crus ear was the most common (22.73%). Each type of auricle deformity had distinct measurement indicators: the vertical distance of cephalo-auricular was 73.97% longer and cephalo-superaurale was 70.00% longer in protruding ears compared to normal auricle; the vertical distance of cephalo-auricular was 10.96% less in lop ears, 15.07% less in conchal crus ears, and 41.1% longer in cup ears; the distance between helix and antihelix was 22.35% less in constricted ear, 12.94% greater in helical rim deformity, and 43.53% greater in Stahl's ear. Family history of hereditary ear deformity and paternal smoking were significant factors associated with ear deformity in southern China.

Interpretation: The incidence of auricle deformities is high in southern China, with significant differences in the morphometric structures of different auricle types.

Importance: Gastrointestinal complications are common perioperative complications in children with congenital heart disease (CHD), and as near-infrared reflectance spectroscopy (NIRS) provides a non-invasive, real-time monitoring of regional tissue oxygenation, we envisioned monitoring and preventing the development of gastrointestinal complications through the use of NIRS.

Objective: To assess the utility of NIRS for predicting gastrointestinal complication risks and determining optimal initial feeding times in infants post-cardiac surgery.

Methods: This retrospective study included 65 infants with CHD treated at our hospital from January 2021 to January 2022. We collected and analyzed data on mesenteric regional venous and arterial oxygen saturation, arterial partial pressure of oxygen, first lactic acid levels, timing of initial enteral feeding, and incidence of gastrointestinal complications.

Results: Out of 65, 61 infants were eligible for inclusion (four cases were excluded). Infants with gastrointestinal complications post-surgery showed significantly lower mesenteric NIRS values and earlier feeding times compared to those without complications (55.5 ± 3.3 vs. 59.6 ± 6.3, P = 0.029; and 59.8 ± 6.7 vs. 66.9 ± 5.7, P = 0.002, respectively). Multivariable binary logistic regression analysis revealed that mesenteric NIRS readings at the time of initial feeding independently predicted gastrointestinal complications (odds ratio, 0.802; 95% confidence interval, 0.693-0.928; P = 0.003). receiver operating characteristic curve analysis indicated a significant predictive value of mesenteric NIRS at initial feeding time (area under the curve: 0.799), with a suggested critical threshold of 63.1% (93% sensitivity, 70% specificity). Pearson correlation test confirmed a significant association between mesenteric NIRS at initial feeding time and the establishment of enteral feeding.

Interpretation: Mesenteric NIRS measurements at the time of initial feeding provide a reliable method for identifying infants at risk of gastrointestinal complications following cardiac surgery and can inform decisions regarding the timing of initial postoperative feeding.