Pediatrics International最新文献

Background: The COVID-19 pandemic that started in 2020 led to a significant reduction of many respiratory tract infections, including respiratory syncytial virus (RSV) infection.

Methods: With the cooperation of all 16 pediatric inpatient facilities in Fukushima Prefecture, we actively investigated the total numbers of RSV hospitalizations and severe lower respiratory tract infections (LRTIs) requiring respiratory support during a 10-year period from 2014 to 2023. In addition, the number of sentinel RSV reports was obtained. We compared the disease burden of RSV infection between the period of 2014 and 2019 (defined as pre-pandemic) and that of 2021 to 2023 (defined as post-pandemic).

Results: The annual number of sentinel RSV reports per 10,000 children aged <5 years after the pandemic increased to 611 from 445 compared to the pre-pandemic period. In contrast, the number of RSV-related hospitalizations decreased from 175 to 104, and the number of severe RSV-related LRTI cases decreased from 59 to 43. Analysis of sentinel reports and hospitalization numbers by age group showed a higher hospitalization rate in children aged <1 year compared to those aged ≥1 year. The age distribution of sentinel RSV reports was higher post-pandemic than pre-pandemic.

Conclusion: Although the number of sentinel RSV reports increased after the pandemic, the number of RSV cases requiring hospitalization decreased compared to before the pandemic due mainly to an increase in the age of the infected children. This indicates the importance of preventing initial infection in children aged <1 year.

Background: A gluten-free diet is currently the only treatment for Celiac Disease (CD). Many factors can affect gluten-free diet compliance. This study aims to evaluate the empathy levels of children with CD and their healthy siblings, the impact of sociodemographic data on dietary compliance, and the emotional and behavioral effects of CD on patients and their siblings.

Method: The patients who were diagnosed with CD at least 6 months ago and their healthy siblings were included. Healthy children from different families were included as the control group. Sociodemographic data of the CD cases and questionnaire data, including questions about gluten-free diet and compliance, were obtained. A questionnaire including questions about gluten-free diets and CD was administered to their siblings. Bryant Empathy Scale and Strengths and Difficulties Questionnaire (SDQ) were administered to all cases.

Results: A total of 153 children were included in the study, with 51 (33.3%) being cases of CD. The comparison of empathy and SDQ levels of the three groups is that CD cases had the lowest empathy. Emotional, behavioral, and social problems were found to be high in the CD cases. The level of maternal education was found to be low in diet-noncompliant CD patients. No significant difference was found in the empathy and SDQ levels of diet-compliant and noncompliant CD patients and their siblings.

Conclusion: It is seen that empathy levels of patients with celiac disease and their siblings are significantly affected, and emotional, behavioral, and social problems are higher. A low educational level of the mother may be effective in dietary noncompliance.

Background: Headaches in children are caused by a variety of factors. Despite the numerous reports on secondary headache in the emergency department, details on pediatric headache outpatients are scarce.

Methods: We retrospectively reviewed the medical records of patients who first visited our outpatient headache clinic between May 2022 and October 2023 and were considered to have secondary headache.

Results: Twenty-seven of 68 patients (39%) were diagnosed as having secondary headache as the main illness. The gender breakdown of 20 boys and 7 girls represented a significant difference. Patient age range was 5-17 years (median: 13 years and 8 months), and a family history of headache was noted in 20 patients (74%). Headache frequency was described as "almost daily" in 18 patients (67%). The main diagnosis of secondary headache was psychiatric disorders (social anxiety disorder; SAD) in 13 patients, homeostatic disorders (orthostatic dysregulation; OD) in 9 patients, facial organ-related headache (FORH) in 3 patients, and nonvascular intracranial disease in 2 patients. Comorbidities included autism spectrum disorder (ASD) in 18 patients and school refusal (SR) in 8 patients. Nine of the ASD patients were diagnosed after their headache outpatient visit.

Conclusion: Our analysis of secondary headache patients in a tertiary facility revealed that roughly half of the patients had SAD, all of whom harbored ASD as a comorbidity. Many of the patients were adolescents, which coincided with the age of OD onset. When examining pediatric secondary headache patients, extra attention is warranted to developmental characteristics, particularly those of adolescents.

Background: Serum alkaline phosphatase (ALP), a biomarker of bone and liver metabolism, is often elevated in children; however, the lower reference limit is rarely considered. Hypophosphatasia (HPP) is characterized by low ALP levels and impaired mineralization of bone and teeth. Although enzyme replacement therapy is available, mild forms are diagnosed late owing to subtle symptoms and ALP levels falling within the adult reference range. In Japan, ALP analysis methods were updated in 2020 and now require value conversion. Pediatricians unfamiliar with these standards may overlook low ALP levels. We investigated whether the disease distribution varies by age and identified key features critical for diagnosis.

Methods: We analyzed serum ALP levels of patients aged <18 years who visited three Nippon Medical School hospitals between January 2020 and December 2022. The inclusion criteria were ALP levels within the adult reference range but below age- and sex-specific pediatric norms. Patient age, sex, and medical history were recorded.

Results: Among 16,125 ALP measurements from 5513 individuals, 239 cases (132 males and 107 females) met the inclusion criteria. In neonates, preterm birth or low birth weight was common, and 55.6% of the infants had infections. School-age children frequently present with a history of corticosteroid use, while adolescents often exhibit signs of malnutrition or chronic diarrhea. One patient had a prior HPP diagnosis, and two were newly diagnosed.

Conclusions: Our findings underscore the importance of recognizing low ALP levels in pediatric patients and maintaining a high index of suspicion for HPP and other treatable conditions.

Background: Alarm therapy is the recommended first-line treatment for nocturnal enuresis (NE). This study aimed to investigate the effectiveness of alarm monotherapy, identify predictors of treatment success, and examine factors contributing to self-discontinuation in Japanese patients with NE.

Methods: We retrospectively analyzed the treatment course of 112 patients with NE who received alarm monotherapy between January 2017 and September 2024. The primary outcome was the predictors of treatment effectiveness, and the secondary outcome was factors contributing to self-discontinuation of alarm therapy.

Results: At 3 months after initiating alarm monotherapy, treatment was effective in 49 patients (≥50% reduction in NE), while 41 showed poor response (<50% reduction in NE), 10 switched to pharmacotherapy, and 4 self-discontinued alarm therapy. By 6 months, only 9 of 41 patients who had shown poor response at 3 months achieved an effective outcome, while 11 self-discontinued alarm therapy. No factors predicting effectiveness were identified in the per-protocol analyses. During the entire study period, 30 patients self-discontinued alarm therapy, with 12 citing reluctance to wear the device. Refusal and self-discontinuation rates were higher among patients with daytime urinary incontinence (DUI) (p = 0.006), developmental disabilities (p = 0.004), no prior NE treatment (p = 0.011), and ineffective treatment at 3 and 6 months (p = 0.001 and 0.045, respectively).

Conclusions: Alarm monotherapy can be recommended for any patient as no factors predicting effectiveness were identified. However, patients with no prior treatment, DUI, neurodevelopmental disorders, or ineffective alarm therapy may struggle to continue treatment with alarm monotherapy.