Translational pediatrics最新文献

Background and objective: Pediatric patients view hospitalization as an overwhelmingly negative experience, and this has implications in treatment adherence, patient-provider relationships, and overall health outcomes. Children should be active agents and collaborate with doctors in their medical treatments, and yet, they are frequently excluded in practice and research, suggesting that insight into improving their hospital stay is underexplored. The purpose of this literature review is to understand hospitalization stress in pediatric populations and make recommendations in enhancing the experience.

Methods: A comprehensive literature review was conducted in the PubMed database in July 2025 to first understand the pediatric hospitalization experience from the perspectives of children, caregivers, and healthcare professionals. After identifying central themes and areas of improvement, secondary searches were made within each theme for completeness of available data. Papers were considered if they focused on pediatric populations and in the English language.

Key content and findings: Results show that the built environment of hospitals may not adequately address the needs of children, leading to heightened stress and longer hospital visits. Play and art therapy often have positive impacts, though these services may be underutilized in hospitals or have unexpected negative effects. Children feel marginalized in communication from doctors, and both patients and caregivers feel frustrated with lack of information or unresolved concerns. Doctors may miss empathetic opportunities, compromising care outcomes and patient-provider relationships.

Conclusions: Children value developmentally appropriate physical spaces, play and art activities, and active involvement in their own treatment. Improving the hospitalization experience may lead to better healthcare outcomes through reduced psychosocial stress. Physicians are recommended to actively speak to children and assess their perspectives, provide toys and games, allow patients to modify their rooms whenever possible, and ask questions beyond the child's illness to demonstrate empathy. Future research should explore more narratives of hospitalized children, ways of incorporating patient preferences to the hospital, and developmentally-appropriate communication techniques.

Background: Bronchopulmonary dysplasia (BPD) is a common chronic respiratory complication in preterm infants. With the advancement of medical technology, the survival rate of many preterm infants with low gestational age (GA) has increased year by year, accompanied by a rising incidence of BPD. Currently, the pathogenesis of BPD is not fully understood, and there are no specific treatment methods. It is particularly important to make early predictions and take preventive measures for BPD. This study aimed to evaluate the early predictive value of serum interleukin-6 (IL-6) and procalcitonin (PCT) levels for BPD in preterm infants.

Methods: In total, 114 preterm infants with GA <32 weeks were enrolled. Infants who met the diagnostic criteria for BPD were assigned to the BPD group (n=57), whereas those who did not meet the criteria formed the non-BPD group (n=57). The BPD group was further categorized based on severity: mild, moderate, and severe. General conditions, comorbidities, complications, treatment outcomes, and maternal data were compared between groups. Serum IL-6 and PCT levels were measured on days 1, 3, and 7 after birth. Multifactorial regression analysis was conducted to investigate postnatal risk factors, and a logistic regression model incorporating clinical factors and biomarkers was developed to predict BPD.

Results: Among the 57 infants with BPD, 32, 22, and 3 had mild, moderate, and severe BPD, respectively. Invasive ventilation >7 days and late-onset sepsis (LOS) were significant risk factors for BPD (P<0.05). Serum IL-6 and PCT levels were significantly higher in the BPD group than in the non-BPD group on days 1 and 3 (P<0.05). The levels were also higher in the moderate/severe BPD groups than in the mild group (P<0.05). The area under the curve for IL-6 and PCT levels was higher on day 1 than on day 3. Moreover, the serum IL-6 levels were positively correlated with serum PCT levels in the BPD group on days 1 and 3. A BPD prediction model was constructed using four indicators (invasive ventilation >7 days, LOS, IL-6 and PCT on day 1), showing significant predictive value (P<0.05).

Conclusions: The predictive model combining serum IL-6 and PCT levels with independent clinical risk factors could enable early BPD prediction.

Background and objective: Craniopharyngioma, a rare brain tumor in children, is primarily managed through surgical resection, but it carries a high risk of postoperative complications. These patients often require intensive care unit (ICU) monitoring and specialized nursing interventions. This narrative review aims to synthesize evidence on ICU nursing strategies for pediatric patients after craniopharyngioma surgery, focusing on monitoring, complication management, pain control, nutritional and psychological support, and multidisciplinary collaboration.

Methods: We conducted a narrative review of literature published from 2010 to 2024 using PubMed. Keywords included "children", "craniopharyngioma", "intensive care unit", "postoperative care", and "nursing challenges". Studies were selected based on predefined inclusion and exclusion criteria. Ethical approval was not required.

Key content and findings: Analysis of included studies (total sample >1,200 pediatric cases across 12 studies) showed that visual function improvement was reported in up to 91% (range, 85-95%, n=342) of patients receiving structured postoperative monitoring. Diabetes insipidus (DI) occurred in approximately 36% (range, 30-45%, n=450) of cases, highlighting the need for vigilant electrolyte surveillance. Effective nursing interventions included early neurological assessment, strict input-output monitoring, multimodal pain management, enteral nutrition (EN) support, and family-centered psychological care. Multidisciplinary collaboration was consistently associated with reduced ICU length of stay and improved parent satisfaction.

Conclusions: This review underscores the importance of individualized, evidence-based ICU nursing care in improving postoperative outcomes for pediatric craniopharyngioma patients. Despite observed benefits, large-scale randomized controlled trials (RCTs) are still needed to validate specific nursing protocols.

Esophageal strictures (ES) are a significant clinical concern in pediatric esophageal diseases and substantially affect patients' quality of life. The causes can be classified as congenital, secondary, and dyskinetic types. While most ES cases are benign, clinical outcomes vary widely by etiology, necessitating personalized therapeutic strategies. Current approaches predominantly involve minimally invasive endoscopic interventions, including balloon or bougie dilation, stent placement, incisional therapy, and intralesional steroid injection. Refractory cases may require combining or alternating multimodal therapies or surgical intervention, warranting further attention from clinicians. Despite varying causes of ES, conservative management is generally preferred over surgery in children. Endoscopic dilation, using bougie or balloons, is the most frequently employed technique, with comparable safety and efficacy. For recurrent or refractory ES, commonly arising from caustic ingestion, surgical anastomosis, congenital malformations, or radiation-induced strictures, adjunctive options include intralesional drug injection, stent placement, and endoscopic incisional therapy. They remain a challenge for many endoscopists. This review summarizes advances in pediatric ES management. While endoscopic treatment in complex and refractory strictures remains challenging, comparison across relevant studies is limited by inconsistent definitions of endoscopic or clinical success metrics. Novel methods have been developed to optimize treatment for refractory strictures. However, further studies in pediatric populations are necessary to validate their efficacy as adjuncts to endoscopic dilation.

Background: Schwannoma is a rare benign tumor of peripheral nerves, particularly in the bronchus. There are rarely reports on the treatment for airway stenosis caused by schwannoma. Currently, there is also no consensus among experts or clinical guidelines regarding how to treat complications arising from airway stenosis after resection of central bronchial schwannoma. There have been no reports on the use of flexible bronchoscopy for treating airway stenosis caused by resection of bronchial schwannoma.

Case description: An 11-year-old pediatric patient with a history of schwannoma resection presented with recurrent cough and wheezing. Initially diagnosed with Pseudomonas aeruginosa pneumonia, the patient was discharged after 16 days of intensive antimicrobial and antiasthmatic therapy, showing marked symptomatic improvement. However, respiratory symptoms recurred the following day, and despite aggressive medical management, persistent and progressive dyspnea developed. Comprehensive clinical evaluation led to interventional bronchoscopy, which revealed and successfully removed suture remnants via holmium laser ablation. Over the subsequent 1-year follow-up period, the patient underwent 17 additional bronchoscopic procedures, including laser ablation, electrocautery, forceps debridement, balloon dilation, and cryotherapy, resulting in sustained resolution of respiratory symptoms and complete clinical recovery.

Conclusions: This case demonstrates that interventional treatment for airway stenosis resulting from schwannoma resection using flexible bronchoscopy is safe and effective and should be promoted.

Background: Venous malformations (VMs) are a common congenital vascular anomaly. The long non-coding RNA (lncRNA) HOTTIP, associated with the HOXA gene cluster, modulates the expression of multiple HOXA genes, which are crucial for vascular development. Abnormal HOXA expression disrupts normal vascular formation. However, no studies have explored the relationship between HOTTIP single nucleotide polymorphisms (SNPs) and the risk of VMs. This study examined whether SNPs in HOTTIP contribute to the development of VMs and their subtypes.

Methods: We conducted a case-control study involving individuals with VMs, collecting blood samples from 1,113 patients with VM and 1,158 healthy controls. TaqMan genotyping of the lncRNA HOTTIP rs3807598 C>G was performed using real-time fluorescence quantitative polymerase chain reaction (PCR) on the Applied Biosystems 7,900HT Fast Real-Time PCR System.

Results: Our multivariate logistic regression analysis found no significant correlation between the rs3807598 C>G polymorphism in HOTTIP and VM susceptibility in the general population (P>0.05). Stratification by site of origin revealed that the rs3807598 GG genotype was associated with an increased risk of upper-extremity VMs [adjusted odds ratio (OR) =1.55; 95% confidence interval (CI): 1.002-2.39; P=0.049].

Conclusions: Our study showed that HOTTIP rs3807598 C>G was not associated with VM risk. Further studies are needed to elucidate the interaction between the HOTTIP rs3807598 polymorphism and genetic and environmental factors to reveal its role in the pathogenesis of VM.

Background: Timely identification of intussusception secondary to pathological lead points (PLPs) is challenging for surgeons. This study aimed to comprehensively evaluate the differences between benign and malignant PLPs in a clinical context.

Methods: We reviewed 75 patients with secondary intussusception confirmed by surgical pathology between January 2012 and December 2023. Based on their PLPs, patients were categorized into benign and malignant groups, and we compared clinical features, imaging studies, and intraoperative characteristics between the two groups.

Results: Of the 75 patients, 62 had benign PLPs (most commonly Meckel's diverticulum, 50%) and 13 had malignant PLPs (predominantly lymphoma, 92.3%). Malignant PLPs were associated with a longer duration of illness, higher intussusception frequency, and closer proximity to the ileocecal region (P<0.05). Small bowel-large bowel intussusception was the most common type in both the benign (51.7%) and malignant (61.5%) group, with the most frequent subtype being ileo-ileal (36.7%) in the benign group and ileo-colic (50%) in the malignant group, respectively.

Conclusions: In secondary intussusception, malignant PLPs have a longer duration of illness, occur more frequently, and are closer to the ileocecal region. Ultrasound and computed tomography (CT) may complement each other in identifying some PLPs, which is crucial for timely and accurate diagnosis and treatment.

Background: Refractory Mycoplasma pneumoniae pneumonia (RMPP) presents a significant clinical challenge due to its potential for severe complications and long-term sequelae in children. While several risk factors have been identified, an accurate and early predictive tool to guide timely clinical intervention is urgently needed. This study aimed to identify the clinical risk factors and develop a nomogram model for the early prediction of RMPP.

Methods: This prospective study enrolled children diagnosed with Mycoplasma pneumoniae pneumonia (MPP) who visited The Second People's Hospital of Changzhou from June to December 2024. RMPP was defined as persistent fever and progressive pulmonary infiltrates despite ≥7 days of standard macrolide therapy. Baseline demographic and clinical variables were assessed at admission. Independent risk factors for RMPP were identified using multivariate logistic regression and were used to construct a predictive nomogram. The performance of the nomogram model was assessed by calibration curves, area under the receiver operating characteristic (ROC) curves (AUC), and the decision curve analysis (DCA).

Results: A total of 210 children were included, among whom 105 were diagnosed with RMPP. The median age was 7.0 years (interquartile range, 5.0-8.5 years), and 42.4% of participants were male. No significant differences in age or sex were observed between groups (P<0.05). Multivariate analysis identified fever duration [odds ratio (OR) =2.15, P<0.001], duration of glucocorticoid use (OR =1.56, P<0.001), and YKL-40 levels (OR =1.01, P=0.001) as independent risk factors for RMPP. The nomogram incorporating these three factors demonstrated excellent discrimination with an AUC of 0.92 (95% confidence interval: 0.88-0.96). Calibration curve and Hosmer-Lemeshow test (P>0.99) indicated excellent calibration. DCA confirmed the clinical utility of the nomogram, showing net benefit across a wide threshold probability range (0.04-0.94).

Conclusions: The nomogram constructed based on fever duration, glucocorticoid use duration, and YKL-40 level shows promise for early prediction of RMPP in children.

Background: Isolated fallopian tube torsion (IFTT) is an uncommon yet significant differential diagnosis in pediatric female patients presenting with acute abdominal pain. Delayed recognition may lead to tubal necrosis, necessitating salpingectomy and potentially compromising future fertility. Due to its low incidence and nonspecific clinical presentation, IFTT remains underdiagnosed in the pediatric population. This study aims to investigate the preoperative diagnosis and postoperative pathological conditions of IFTT patients.

Methods: A retrospective case series was conducted at Beijing Children's Hospital, Capital Medical University, between January 2020 and December 2024. Pediatric female patients under 18 years of age with intraoperatively confirmed IFTT were included. Data on clinical presentation, imaging findings, intraoperative observations, and histopathological results were reviewed.

Results: Eighteen patients (mean age: 12.19±1.58 years) met the inclusion criteria. Torsion occurred with equal frequency on the right and left sides (50% each). The predominant symptom was localized lower abdominal pain. Abdominal tenderness was noted in 72% of cases, and 28% presented with associated vomiting. Ultrasonography identified features suggestive of IFTT in 33% of cases, while computed tomography did not provide significant additional diagnostic value. All patients underwent laparoscopic exploration. Intraoperative findings included hydrosalpinx (28%), Müllerian cysts (44%), and para-tubal cysts (28%). Salpingectomy was performed in cases with irreversible ischemic injury.

Conclusions: Pediatric IFTT presents with nonspecific symptoms and poses a diagnostic challenge. Imaging modalities demonstrate limited sensitivity, highlighting the importance of early surgical evaluation. Laparoscopy enables prompt diagnosis and supports the possibility of fertility-preserving management. Enhanced clinical awareness of IFTT is essential among pediatric surgeons and gynecologists. Congenital or acquired tubal anomalies, such as cysts or hydrosalpinx, may contribute to the pathogenesis of torsion in this population.