Pediatrics International最新文献

Background: Understanding infectious disease seasonality is crucial to inform immunization timing and risk communications. This study aimed to describe trends in respiratory syncytial virus (RSV) seasonality in Japan by determining thresholds across 47 prefectures using public health surveillance data.

Methods: Weekly RSV cases per sentinel (CPS) is the main indicator used in Japan. Data from approximately 3000 pediatric sentinel sites were extracted for 2012-2024. Seasonal, advisory, and alert thresholds were established via two globally utilized methods (moving epidemic methods [MEM] and fixed threshold method). Based on the established seasonal threshold, onset/duration was examined for each season during the study period.

Results: The fixed threshold method was finally chosen to establish the seasonal threshold, while medium and high-intensity thresholds under the MEM methods were chosen as advisory and alert thresholds. The threshold values were 0.23-0.80CPS for seasonal, 0.75-2.82CPS for advisory, and 1.11-4.20CPS for alert. The epidemic periods usually lasted less than 6 months, with distinct epidemic peaks in almost all prefectures over the 13-year observation. However, unlike other temperate countries/regions such as the United States and Europe, season onset shifted drastically from September-October in 2012/2013 to around March-April in 2024 with geographic variabilities. Calling season onset after 2 consecutive weeks above the threshold resulted in no false alarms in over half the prefectures.

Conclusions: In countries such as Japan and the tropics/subtropics where the RSV seasons are less predictable, a flexible prevention strategy, tailored for each region/prefecture, using thresholds as guides, would ensure optimal protection against RSV and maximize public health benefits regardless of seasonal variability.

Background: Bottom shuffling (BS) occurs in ordinary infants without developmental disorders; however, the incidence and the related factors have been unclear. This study aimed to investigate the occurrence of BS in ordinary developing infants and the potential effects of parental intervention on the BS occurrence.

Methods: A questionnaire survey on BS was conducted among 241 parents of 0-year-old and 1-year-old children in nursery schools, randomly selected from urban and rural areas in three prefectures in Japan.

Results: Of the 241 infants without developmental disorders, 52 infants (21.6%) exhibited BS from 6 to 18 months of age (average: 8.3 ± 2.0 months). The ages of starting creeping, crawling, and unsupported sitting were 6.9 ± 1.8, 8.6 ± 1.8, and 7.0 ± 1.4 months of age, respectively. While the age of acquisition for creeping, crawling, or sitting did not differ due to BS, a correlation was found between BS incidence and parents' understanding of sitting development. Of the 241 parents, 110 parents responded that the timing of their infant's learning of "how to sit" should come just after their start of rolling over. In the infants with the 110 parents, a significant high frequency of the BS occurrence (27.3%, 30 out of 110) was observed.

Conclusions: BS may lead to a decrease in opportunities for full-body prone activity resulting in reduced physical activity, which raises concerns about the infant's autonomy.

Background: Pulmonary exacerbations (PEs) are associated with a subsequent decline in lung function. We aim to evaluate lung function in cystic fibrosis (CF) patients with frequent PEs in their first 2 years of age using spirometry at age 6.

Methods: This retrospective cohort study included CF patients who were 6 years old from the CF registry of Turkey in 2019. According to the number of PEs, patients were classified: those who had two or fewer PEs in the first 2 years of age were defined as Group 1 and those who had more than two PEs were defined as Group 2. The patients' demographics and clinical characteristics were compared between Group 1 and Group 2.

Results: The study included 88 patients who had data on PE from their first 2 years and completed their sixth year by 2019. Fifty-nine patients were included in Group 1 and 29 in Group 2. The mean percent-predictive FEV1 (ppFEV1), percent-predictive FVC (ppFVC) values, and the mean age at first PE were lower in Group 2 than in Group 1 (p = 0.019, p = 0.017, p < 0.001). The patients with chronic Pseudomonas aeruginosa (PA) colonization had lower mean ppFEV1 and ppFVC values than those without (p = 0.001, p = 0.001). Patients with PA in respiratory-sample culture during their first PE had lower ppFEV1 and ppFVC values than those with SA (p = 0.046; 0.018).

Conclusions: This study showed that more frequent PEs in the first 2 years of age and chronic PA colonization were associated with poorer FEV1, FVC, and BMI values in CF patients.

Background: Neonatal resuscitation is crucial for transitioning to extrauterine life. The Neonatal Cardiopulmonary Resuscitation (NCPR) guidelines in Japan were first developed based on the 2005 International Liaison Committee on Resuscitation (ILCOR) recommendations and have since been revised approximately every 5 years. However, the extent of their implementation in clinical practice remains unclear. This study aimed to assess the current status of neonatal resuscitation practices.

Methods: We conducted a survey targeting 2297 delivery facilities in Japan. The questionnaire assessed equipment availability, provider training, and adoption of updated practices.

Results: In total, 1553 facilities responded, of which 1505 were actively conducting deliveries. Therefore, the analysis was performed based on the responses from 1505 delivery-performing facilities. Pulse oximeters were widely available, whereas electrocardiogram monitors and oxygen-air blenders were less common. T-piece resuscitators were used in 32% of the facilities. Only 11% of the facilities had experience using supraglottic airway devices. Although 81% reported that all or almost all staff had completed NCPR training, 23 clinics lacked trained personnel. Regarding umbilical cord management in infants born before 28 weeks of gestation, cut cord milking was the most common method, followed by intact cord milking, early cord clamping, and delayed cord clamping.

Conclusions: Neonatal resuscitation systems are generally established across delivery facilities in Japan. However, the implementation of revised guidelines varies based on facility type. These findings offer important insights for the upcoming 2025 NCPR guideline revision and emphasize the need for targeted training and equitable resource distribution to improve neonatal outcomes.

Background: This study evaluated the effect of modifying enteral feeding during cyclooxygenase inhibitor (COXI) treatment on patent ductus arteriosus (PDA) in preterm infants.

Methods: We searched MEDLINE, EMBASE, CENTRAL, CINAHL, and ICHUUSHI databases for randomized and nonrandomized controlled trials, checked the references lists and major clinical trials. Non-human and non-English studies were excluded. Evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation. Preterm infants born before 37 weeks of gestation are treated with COXIs for PDA, including indomethacin and ibuprofen. The primary outcomes were the composite outcome of necrotizing enterocolitis (NEC) or gastrointestinal perforation and its components (NEC and gastrointestinal perforation).

Results: Two randomized controlled trials (n = 303) and one retrospective cohort study (n = 261) were included (total: n = 564). No significant differences were observed in the composite gastrointestinal outcome (risk ratio [RR]: 1.10, 95% confidence interval [CI]: 0.51-2.37; 1 study, 177 infants, very low certainty of evidence [CoE]), NEC (RR: 1.01, 95% CI: 0.47-2.15; 2 studies, 300 infants, very low CoE), or gastrointestinal perforation (RR: 1.94, 95% CI: 0.25-14.81; 2 studies, 300 infants, very low CoE) between discontinuation and continuation of enteral feeding. Discontinuation of enteral feeding resulted in a significantly lower rate of surgical closure for PDA compared to continuation (RR: 0.56, 95% CI: 0.37-0.86; 1 study, 177 infants, low CoE).

Conclusions: Neither discontinuation nor continuation of enteral feeding significantly affected the composite gastrointestinal outcome and its components (NEC and gastrointestinal perforation).

Background: Iron deficiency anemia (IDA) in children poses significant health risks, necessitating effective treatment strategies. While daily oral iron therapy is standard, alternate-day therapy has emerged as a potential alternative to improve compliance and minimize side effects. This study aimed to compare the efficacy of daily and alternate-day iron supplementation in children with IDA.

Methods: This retrospective cohort study included 82 children with nutritional IDA receiving either daily (42 patients) or alternate-day (40 patients) oral ferrous sulfate therapy. Hematologic and iron parameters, including hemoglobin (Hb), ferritin, and total iron-binding capacity (TIBC), were evaluated at baseline, day 10, 1, and 3 months. Statistical analyses were performed using SPSS, with p ≤ 0.05 considered significant.

Results: No significant differences in Hb changes were observed based on the treatment regimens. When comparing Hb changes from diagnosis to the first month and from the first month to the third month, a significant increase was noted in the daily therapy group during the first month. At the beginning of the study, the mean corpuscular volume (MCV) values were higher in the alternate-day group, while the red cell distribution width (RDW) values at diagnosis were greater in the daily group. Throughout the first and third months, MCV and RDW values were similar between the two groups. Additionally, ferritin and TIBC levels showed no significant differences over the study period.

Conclusions: Alternate-day oral iron therapy is as effective as daily therapy in managing pediatric IDA, offering a viable alternative with similar hematologic and iron parameter improvements.