Translational pediatrics最新文献

Childhood caries is a prevalent condition affecting nearly 50% of children globally across various age groups under 12 years, posing serious implications for their health and development. Understanding global research trends is essential for identifying knowledge gaps and guiding future studies aimed at developing effective intervention strategies. This study provides a comprehensive bibliometric review of childhood caries research from 2003 to 2023. Using CiteSpace, we analyzed 2,178 publications from the Web of Science (WOS) to map research trends, identify key challenges, and examine collaborative networks. The analysis revealed a threefold increase in research output, with the United States and Brazil leading contributions. Key challenges include persistent socioeconomic disparities influencing caries prevalence, limited access to effective treatments like silver diamine fluoride, and the complex role of the oral microbiome. International collaborations across 108 countries indicate a growing global effort to address these issues. Despite advancements, significant disparities in disease burden persist, especially in low- and middle-income countries, highlighting the urgent need to translate research into practice and develop targeted interventions. This review highlights the steady increase in research output on childhood caries over the past two decades, with the United States and Brazil leading contributions. Persistent disparities in disease burden and limited access to effective treatments remain critical challenges, particularly in low- and middle-income countries. These findings underscore the need for targeted research and policy efforts to address these inequities.

Background: Hypospadias is a prevalent pediatric urological condition. Perididymis covering is often used as a surgical procedure for the treatment of hypospadias. This study aims to investigate the risk factors associated with postoperative complications following perididymis covering in the treatment of hypospadias.

Methods: This study involved 204 patients with hypospadias who underwent perididymis cove ring at Tangshan Maternal and Child Health Hospital from May 2018 to May 2024. Patients were followed up for 1 year, with 63 experiencing complications (30.88%) and 141 not experiencing complications (69.12%). Baseline data from both groups were collected and compared. Binary logistic regression analysis was used to analyze the relationship between various factors and postoperative complications. The receiver operating characteristic (ROC) curve and the area under the curve (AUC) were utilized to evaluate the predictive value of the nomogram model for postoperative complications.

Results: The complication group had a higher mean age and longer formed urethra lengths compared to the non-complication group. The types of hypospadias were categorized as intermediate, proximal, and those associated with preoperative penile curvature. The AUC for the nomogram model in the prediction of the postoperative complications was 0.909 [95% confidence interval (CI): 0.866-0.952], with a sensitivity of 0.746, a specificity of 0.929, and a Youden's index of 0.675.

Conclusions: Age, length of the formed urethra, types of hypospadias, preoperative penile curvature, and surgical methods are significantly associated with postoperative complications following perididymis covering in patients with hypospadias. These indicators can guide the formulation of clinical treatment plans to reduce the incidence of postoperative complications.

Background: Posaconazole oral suspension is not approved for use in children younger than 13 years of age, and the optimal dosing regimen is unclear. The target trough concentration of posaconazole for the effective prevention of invasive fungal infections in adults is influenced by multiple factors, but reports in children aged <13 years remain limited. Therefore, the primary objective of this study was to evaluate potential risk factors affecting the steady-state trough concentration of oral posaconazole suspension in a large population of Chinese children.

Methods: This observational, single-center study retrospectively analyzed pediatric patients younger than 13 years of age who received posaconazole oral suspension for the prevention of invasive fungal disease and implemented therapeutic drug monitoring (TDM) from January 2020 to July 2022.

Results: A total of 132 children with 922 steady-state trough concentrations of posaconazole were included in this study. The median dosage of posaconazole by standardized body weight was 14.2 (range, 4.2-51.2) mg/kg/day, with considerable variability. The median posaconazole concentration was 0.81 (range, 0.05-4.5) µg/mL, and the proportion of children reaching the recommended target concentration (≥ 0.7 µg/mL) was 59.5%. The highest percentage of the target concentration (76.8%) was achieved at a median daily dosage of 18 (range, 17-19) mg/kg/day of posaconazole. Multivariate linear regression analysis revealed significant positive correlations between albumin levels (P=0.004) and weight (P<0.001) and posaconazole concentrations. Conversely, treatment with hematopoietic stem cell transplantation (P=0.004), the occurrence of diarrhea (P=0.003), and the coadministration of omeprazole (P<0.001), famotidine (P=0.001) and methylprednisolone (dosage ≥0.7 mg/kg/day) (P=0.006) were associated with significantly reduced posaconazole concentrations.

Conclusions: In children under 13 years of age, administration of a dosage regimen of 18 (range, 17-19) mg/kg/day of posaconazole suspension resulted in a higher proportion of children achieving the recommended target concentration. Multiple factors had significant effects on posaconazole trough concentrations. TDM is important for identifying suboptimal posaconazole exposure and making timely dose adjustments.

Background: The standards for diagnosing, monitoring, and treating endocrine diseases in pediatric patients often rely on laboratory assessments of children's growth and differentiation markers, among which sex hormones are pivotal. Nonetheless, due to the rapid development during childhood and adolescence and the substantial physiological differences between children and adults, sex hormone levels undergo significant fluctuations. Unfortunately, few laboratories in China currently provide reliable reference intervals (RIs) for children's sex hormones. Hence, it is imperative to establish age-, sex-, and assay-RIs for sex hormones. In this study, age- and sex-specific pediatric RIs for estradiol (E2), follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL), progesterone (PROG), and testosterone (TESTO) were established using a Mindray automatic chemiluminescence immunoassay analyzer (CL-6000i).

Methods: In this cross-sectional study, a total of 2,477 healthy children and adolescents from birth to 19 years were recruited in Wuhan Children's Hospital from September 2022 to August 2023, and serum samples were collected. Serum samples were analyzed on a Mindray analyzer (CL-6000i) for detection of sex hormones, including E2, FSH, LH, PRL, PROG, and TESTO. After sample analysis, age- and sex-specific differences were assessed. RIs were established according to guideline C28-A3 of the Clinical Laboratory Standards Institute (CLSI).

Results: We observed a complex pattern of changes in the concentrations of various hormones from the neonatal period through adolescence. Given the sex- and age-dependent variations in all sex hormones, we identified the need for establishing specific RIs for several subgroups to capture the fluctuations in hormone levels across this developmental spectrum. Notably, during the first month of life, significant variations were observed in all six hormones levels, necessitating further subdivisions within the first year. Additionally, age groups demonstrating nonsignificant differences in hormone concentrations were merged, resulting in different age subgroups for each of the six sex hormones.

Conclusions: We established specific pediatric RIs for sex hormones in both male and female children and adolescents, and also examined the age- and sex-specific differences, aligning them with medical literature, thereby facilitating the interpretation of patient results.

Background: Bacterial pathogens and Mycoplasma pneumoniae are the two main pathogens that cause community-acquired pneumonia complicated with pleural effusion (PE) in children, it is important to accurately differentiate between these two types of effusions. The aim of this study was to explore the feasibility and value of a radiomics approach based on non-contrast chest computed tomography (CT) scans in the differentiation of bacterial pneumonia PE (BPPE) and Mycoplasma pneumoniae parapneumonic effusion (MPPE) in children.

Methods: The clinical and CT imaging data of hospitalized children with PE detected by chest CT scans from December 2020 to December 2023 were retrospectively collected. A total of 167 cases of BPPE and 368 cases of MPPE were included, and all cases were randomly divided into a training set and a test set in the ratio of 7:3. The region of interest (ROI) was manually segmented in images of non-contrast chest CT scans to extract radiomics features. The optimal radiomics features were screened using Select K Best, max-relevance and min-redundancy (mRMR), least absolute shrinkage and selection operator (LASSO). Logistic regression (LR) was selected to construct the radiomics model. The receiver operating characteristic (ROC) curves were plotted, and the area under the curve (AUC), 95% confidence interval (CI), sensitivity, specificity, and accuracy were calculated to evaluate the model performance.

Results: A total of 2,264 radiomics features were extracted from each ROI, seven optimal features were finally selected. The AUC in the training set was 0.942 (95% CI: 0.917-0.967), with sensitivity, specificity, accuracy and precision of 89.9%, 82.1%, 87.4% and 91.7%, respectively. The AUC in the test set was 0.917 (95% CI: 0.868-0.965), with sensitivity, specificity, accuracy and precision of 87.4%, 80.0%, 85.1% and 90.7%, respectively.

Conclusions: The model based on CT radiomics demonstrates the potential to identify BPPE and MPPE in children and provides a new direction for future research.

Background: Congenital diaphragmatic hernia (CDH) and congenital diaphragmatic eventration (CDE) are rare congenital anomalies. They occur in approximately one in 2,000-3,000 and 2,500-5,000 children respectively. It is difficult to distinguish between CDE and right diaphragmatic hernia in fetal period, which can cause changes in the position of the heart and lead to dysplasia of the right lung; absence of the right lung can lead to secondary dextrocardia. These are common in dextrocardia and lung agenesis, which are the main obstacles for diagnosis.

Case description: This paper reports on three cases of fetal extracardiac structural abnormalities leading to secondary cardiac position changes. Two cases were identified with excessive left displacement of the fetal heart due to congenital right diaphragmatic hernia (right lobe of liver) and congenital right diaphragmatic eventration, respectively. The third case was diagnosed by prenatal echocardiography as having primary dextrocardia with an abnormal origin of the right pulmonary artery. Comparative analysis of pathological results after induced labor showed that two cases were in accordance with prenatal ultrasound diagnosis, and the third case showed that the absence of right lung resulted in secondary dextrocardia and persistent left superior vena cava.

Conclusions: CDH and severe diaphragmatic eventration involve three systems: respiration, circulation and digestion. When ultrasound finds that the fetal heart is abnormal, further check is needed to see whether there are lesions in the heart, lung, diaphragm and abdomen; secondary dextrocardia is more common in the absence or dysplasia of the right lung.

Background: Infections after cardiopulmonary bypass (CPB) represent a significant challenge in pediatric patients with congenital heart disease (CHD), impacting the length of hospital stay, treatment costs, and clinical outcomes. The present study aimed to investigate the risk factors associated with early secondary infections after CPB in CHD children, thereby providing a theoretical foundation for enhancing clinical strategies to prevent and manage postoperative secondary infections.

Methods: Clinical data of CHD children who underwent open-heart surgery with CPB at the First Affiliated Hospital of Guangxi Medical University between July 2020 and June 2023 were retrospectively analyzed. Patients were categorized into infected and non-infected groups based on the occurrence of secondary infections within one week following surgery.

Results: A total of 265 CHD children undergoing open-heart surgery under CPB during the period from July 2020 to June 2023 were enrolled in this study, including 118 children (44.5%) in the infected group and 147 (55.5%) in the non-infected group. Six children (2.3%) either abandoned treatment or died postoperatively, all of whom were from the infected group. The median interval from the completion of surgery to the diagnosis of infection was 17.0 hours [interquartile range (IQR), 12.0-21.5 hours]. The infection types included lung infection alone (n=88, 74.6%), pulmonary infection complicated by sepsis (n=26, 22.0%), sepsis alone (n=3, 2.5%), and pulmonary infection complicated by urinary tract infection (n=1, 0.8%). Multivariate logistic regression analysis revealed that younger surgical age [odds ratio (OR) =0.979, 95% confidence interval (CI): 0.970-0.987], higher preoperative New York Heart Association (NYHA) class (OR =1.874, 95% CI: 1.088-3.229), preoperative pulmonary hypertension (severe: OR =32.887, 95% CI: 6.105-177.157; moderate: OR =9.582, 95% CI: 3.950-23.245; and mild: OR =18.541, 95% CI: 6.667-51.559), American Society of Anesthesiologists (ASA) class ≥3 (OR =2.166, 95% CI: 1.093-4.290), longer operative time (OR =1.007, 95% CI: 1.001-1.012), and extended duration of aortic cross-clamping (ACC; OR =1.017, 95% CI: 1.008-1.026) were independent risk factors for early postoperative infections in children undergoing surgery with CPB for CHD.

Conclusions: Younger surgical age, higher preoperative NYHA class, severe preoperative pulmonary hypertension, ASA grade ≥3, prolonged ACC and operative time are independent risk factors for the development of early secondary infections in CHD children after CPB.

Background: The efficacy of family integrated care for preterm infants is not well established. This meta-analysis aims to assess the impact of family-integrated care on preterm infants to inform neonatal clinical practices.

Methods: We conducted a literature search in PubMed, Cochrane Library, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), Weipu, and Wanfang databases up to August 25, 2024. Two researchers independently screened articles, applying predefined inclusion and exclusion criteria, and performed quality assessments and data extraction. Meta-analysis was conducted using RevMan 5.3 software.

Results: Thirteen randomized controlled trials (RCTs) were included, encompassing 3,005 preterm infants, of which 1,390 received family-integrated care. Family-integrated care significantly improved breastfeeding rates [odds ratio (OR) =5.92, 95% confidence interval (CI): 2.37 to 14.82, P<0.001], weight gain [mean difference (MD) =3.16, 95% CI: 2.51 to 3.80, P<0.001], and sleep duration (MD =3.25, 95% CI: 2.05 to 4.44, P<0.001) in preterm infants and reduced the one-month readmission rate (OR =0.37, 95% CI: 0.22 to 0.61, P<0.001). Egger's regression test indicated no publication bias among the outcomes (all P>0.05).

Conclusions: Family-integrated care markedly improves breastfeeding rates, promotes weight gain, and extends sleep duration in preterm infants, while concurrently reducing the likelihood of hospital readmission. This approach offers substantial benefits to both the preterm infants and their families, highlighting its potential for wider implementation in neonatal nursing practice.

Background: Acute necrotizing encephalopathy (ANE) is a para-infectious neurological disorder with high mortality in children. There are limited studies evaluating predictive factors for mortality in ANE patients. This study aims to investigate the predictive value of independent risk factors and the ANE Severity Score (ANE-SS), combined with ferritin levels and Disseminated Intravascular Coagulation (DIC) scores, in assessing mortality risk in children with ANE.

Methods: We conducted a retrospective study of children with ANE in the pediatric intensive care unit of Beijing Children's Hospital from January 2016 to May 2024. The patients were divided into survival and non-survival groups, and clinical data were collected within 12 hours after admission. The predictive value of clinical indicators and a joint model for mortality in ANE patients was evaluated using receiver operating characteristic (ROC) curve analysis.

Results: Of 56 patients enrolled, the overall mortality rate was 51.8%. In the non-survival group, the levels of ANE-SS, DIC scores, ferritin, procalcitonin, interleukin-6, activated partial thromboplastin time, prothrombin time, D-dimer, and cerebrospinal fluid protein at admission were significantly higher than those in the survival group. Multivariate analysis identified ferritin, ANE-SS, and DIC scores as independent risk factors for mortality. Ferritin exhibited an area under the curve (AUC) of 0.827, with sensitivity of 84.6% and specificity of 87.5%, which were superior to those of ANE-SS (AUC 0.782, sensitivity 75.9%, specificity 66.7%) and the DIC scores (AUC 0.773, sensitivity 60.7%, specificity 81.5%). In combined analysis, ANE-SS, ferritin, and DIC scores demonstrated the strongest predictive performance, with an AUC of 0.99 (95% CI: 0.965-1.000), sensitivity and specificity of 92.3% and 100%, respectively.

Conclusions: This study indicates that the combination of ANE-SS with ferritin and DIC scores provides a superior predictive value for 28-day mortality in ANE patients.