Pediatrics International最新文献

Background: Our study aims to investigate the relationship between autistic traits, social media addiction, and loneliness among adolescents diagnosed with attention-deficit/hyperactivity disorder (ADHD) and to compare our findings with healthy controls.

Methods: A total of 90 adolescents aged 14-18 years, 50 of them diagnosed with ADHD and 40 healthy controls, were included in our study. Adolescents participating in our study were evaluated with the Conners' Parent Rating Scale-Revised: Short Form (CPRS-R:S), the Autism Spectrum Quotient-Adolescent Version (AQ-Adolescent), the 9-item Social Media Disorder Scale (SMD) and the UCLA Loneliness Scale Short Form (ULS-8). The SPSS 25.0 program was used in the analysis. p < 0.05 was accepted as the significance level.

Results: It is found that adolescents diagnosed with ADHD had statistically significantly higher scores on the communication, social skill, imagination, attention switching subscales, and total score of the AQ-Adolescent compared to healthy controls. Moreover, adolescents diagnosed with ADHD obtained statistically significantly higher scores from the SMD and the ULS-8 compared to healthy controls. The ULS-8 showed a significant positive correlation with the AQ-Adolescent and the SMD in the ADHD group. It was also found that only loneliness may be associated with the risk of developing social media addiction in adolescents with ADHD.

Conclusions: The results of our study indicate that adolescents diagnosed with ADHD are susceptible to encountering challenges regarding social difficulties, feelings of loneliness, and social media addiction. It is believed that it may be essential to address these factors when dealing with social media addiction, which is prevalent among adolescents diagnosed with ADHD.

Background: Intractable vascular anomalies (VAs), including vascular tumors and venous, lymphatic, and mixed malformations, often have severe symptoms and a poor prognosis, highlighting the need for new treatments. We conducted a prospective trial of sirolimus (tablet and granule forms) for the treatment of VAs.

Methods: In this open-label, single-arm, multicenter trial across four Japanese institutions, patients with VAs received oral sirolimus daily, targeting a trough concentration of 5-15 ng/mL. We evaluated response rates (radiological volume changes in lesions), skin lesions, performance status, respiratory function, visceral symptoms (bleeding, pain), laboratory data, quality of life, and safety at 12, 24, and 52 weeks.

Results: Thirteen patients with VAs were treated with sirolimus. Seven patients (53.8%; 95% confidence interval: 25.1%-80.8%) showed a partial radiological response at 24 weeks, with no complete responses, and 61.5% had a partial response by 12 weeks, with little subsequent change in patients who had stable disease thereafter. Improvements in skin lesions, blood coagulation, and activities of daily living were noted. Common adverse events included stomatitis, dermatitis, diarrhea, and fever.

Conclusions: Sirolimus may reduce VA tissue volume and potentially improve symptoms and activities of daily living in patients with VAs.

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.

Background: Patient care ownership (PCO) has become of great concern in worldwide physician training and the National Center for Child Health and Development (NCCHD) in Japan. There are only a few reports on PCO in Japan. We previously reported work time reduction and mental improvements in relation to implementing shiftwork and work style reform at the NCCHD. This study aimed to measure the baseline of PCO and explore the relationships between PCO and mental well-being and work conditions in pediatric training at the NCCHD.

Methods: We conducted questionnaire-based cross-sectional surveys of 15 pediatric trainees soon to complete their training in March 2024 and 42 ongoing pediatric trainees in September 2024. Data were obtained regarding demographics, work conditions, the Center for Epidemiologic Studies Depression Scale (CES-D), Maslach Burnout Inventory (MBI), and the Japanese version of the Patient Care Ownership Scale (J-PCOS).

Results: The response rate for each survey was 100% (15/15) in March 2024 and 81% (34/42) in September 2024. The mean J-PCOS scores were 5.4 in the former and 5.3 in the latter survey. The combined analyses of these data indicated that J-PCOS was significantly associated with compliance with daytime off before nightwork (β, 0.6-0.7) and the personal accomplishment subscale of MBI (correlation coefficient, -0.34; β, -0.1).

Conclusions: Shiftwork, mental well-being, and PCO might be positively related to one another. A feeling of accomplishment, or a sense of meaning in work, can be a target of intervention to enhance PCO while promoting trainees' well-being.

Objectives: Point-of-care ultrasound (POCUS) requires technical expertise, making quality assurance (QA) a major challenge. We evaluated POCUS utilization and quality in the pediatric emergency department of the National Center for Child Health and Development (NCCHD).

Methods: We retrospectively reviewed patients aged <18 years who underwent POCUS or radiology-performed ultrasound (RADUS) between June 2023 and May 2024. We mainly evaluated POCUS metrics-image storage, documentation, protocol-specific appropriate storage, and diagnostic delays-and compared them across provider categories and scanning protocols. Diagnostic delay cases were additionally reviewed.

Results: Of 2004 patients, 1683 underwent POCUS and 384 RADUS. For POCUS, the rates of overall image storage, documentation, protocol-specific appropriate image storage, and diagnostic delay were 97.4%, 83.6%, 90.8%, and 0.4%, respectively. Documentation rates were significantly lower among nondedicated physicians than among pediatric emergency medicine (PEM) physicians and fellows (both p < 0.01); their protocol-specific appropriate image storage rate was also significantly lower than that of PEM fellows (p = 0.03). Across scanning protocols, the rates of documentation and protocol-specific appropriate image storage differed significantly (both p < 0.01). Among six diagnostic delays, two resulted from acquisition errors, two from interpretation errors, and two from early scans in the disease course; four of these six delays involved the abdominal emergency screening protocol.

Conclusion: This study identified challenges in POCUS implementation at NCCHD, including quality gaps among nondedicated physicians, the need for clearer follow-up in early presentations, and the importance of protocol design aligned with clinical indications. Sharing QA practices may help refine POCUS strategies for diverse pediatric emergency settings.

Background: Premature infants are at high risk for medical adhesive-related skin injuries. It is crucial to establish reliable methods for non-contact monitoring. This study aimed to identify the optimal piezoelectric sensor placement (chest, abdomen, and hips) for respiratory rate estimation in each body position (supine, lateral, and prone) and demonstrate that body movements affect respiratory estimation accuracy.

Methods: Respiratory rates were estimated for 30 infants admitted to the Growing Care Unit for each body position. Body positions, movements (categorized by the Neonatal Behavioral Assessment Scale), and sensor placements were recorded and analyzed for their effects on accuracy. Estimation accuracy was defined as the percentage of time during which the error between the estimated and reference (respiratory rate displayed on the monitor) was within 5 breaths/min.

Results: The most improved estimation accuracies were achieved in the supine position with the chest sensor, in the lateral position with the abdominal sensor. The prone position was limited to a single case, thus rendering it inappropriate to draw comparisons. Accuracy declined progressively as the infants' state changed from sleeping to crying. Moreover, substantial reductions in accuracy were observed during full-body movements (quiet and active alert state) as well as during arm movements (drowsy and quiet alert state).

Conclusion: This study demonstrated that the accuracy of non-contact respiratory rate estimation using piezoelectric sensors is highly impacted by body position, movement, and sensor placement. Optimizing the algorithm to systematically account for these variables is essential for improving the robustness and accuracy of non-contact vital sign monitoring.