World Journal of Pediatrics最新文献

Background: While international evidence suggests seasonal variations may influence outcomes of interventions for pediatric obesity, data for Aotearoa New Zealand are limited. We examined seasonal variations in changes in body mass index standard deviation score (BMI SDS) in young people with obesity enrolled in an intervention programme.

Methods: We studied 397 children and adolescents (median = 10.1 years; range 3.7-16.8 years) from Whānau Pakari, a multidisciplinary community-based healthy lifestyle programme (initially a randomised clinical trial that subsequently transitioned into the regional childhood obesity service). Participants were stratified by season at entry and 6-month BMI SDS changes (Δ) were evaluated. Lifestyle factors were also assessed. Data were analysed using traditional linear models and machine learning (random forest).

Results: 68% of participants had BMI SDS reductions at 6 months (mean = - 0.16 SDS; P < 0.0001). Linear models showed seasonal variations in programme effectiveness, with BMI SDS reductions among summer (- 0.17 SDS), autumn (- 0.19 SDS) and winter (- 0.18 SDS) but not among spring entrants. Random forest modelling identified higher baseline BMI SDS and younger age as the most influential predictors of greater 6-month reductions in BMI SDS. Season of entry was more important than any single lifestyle factor; spring entrants exhibited attenuated reductions relative to other seasons.

Conclusions: The season at programme entry was an important factor associated with intervention effectiveness. Spring entry was associated with attenuated BMI SDS reductions, likely due to the inclusion of the summer holidays within the 6-month intervention. These findings highlight the need for targeted support during such unstructured periods to improve participant outcomes.

Background: MKRN3 gene loss-of-function mutations cause central precocious puberty (CPP), whereas its deletion in Prader-Willi syndrome (PWS) paradoxically leads to hypogonadism. The mechanistic basis for these opposing reproductive phenotypes remains largely unclear.

Methods: We performed whole-exome sequencing in 98 Chinese CPP patients along with a systematic review of previously reported MKRN3 pathogenic and likely pathogenic variants to summarize genotype-phenotype correlations. Subsequently, genome-wide DNA methylation profiling was performed in CPP patients with the MKRN3 pathogenic variant, and the results were compared with those of patients with PWS, idiopathic CPP, and healthy controls.

Results: A pathogenic frameshift MKRN3 variant [c.476dupC (p.Ala159fs*15)], representing the first frameshift mutation reported within the inter-C3H1 hotspot region in an Asian cohort, was identified. Patients with severe MKRN3 variants exhibited significantly earlier pubertal onset (5.80 vs. 7.50 years, P = 0.029) and higher GnRH-stimulated peak LH levels (34.55 vs. 11.00 IU/L, P = 0.047) than those with missense mutations. Methylation analysis revealed no differences in MKRN3 but identified 18,609 differentially methylated positions between MKRN3-CPP and PWS. Key findings included hypermethylation of IGSF10 (Δβ = 0.37), ZC3H18 (Δβ = 0.27), SH3RF3 (Δβ = 0.36), and PTH1R (Δβ = 0.28), alongside hypomethylation of MAGEL2 (Δβ = - 0.19), and PTPA (Δβ = - 0.23), where Δβ represents the difference in DNA methylation β values between groups.

Conclusions: We identified a first frameshift pathogenic variant localized to the inter-C3H1 region in Asia, further confirming its functional significance. Our study suggests an epigenetic framework that could potentially explain how divergent pubertal phenotypes in MKRN3 deficiency might arise from dysregulated epigenetic programming of downstream neuroendocrine pathways.

Background: Transcranial Doppler (TCD) detects characteristic waveforms indicating cerebral circulatory arrest and has been widely applied as an ancillary test for adult brain death or death by neurologic criteria. However, its application in children remains controversial due to anatomical differences and limited evidence. This review outlines the current role of transcranial Doppler in confirming pediatric brain death or death by neurologic criteria, offering practical insights and directions for future research.

Methods: A literature review was conducted on the use of transcranial Doppler to confirm pediatric brain death or death by neurologic criteria. This included original studies, meta-analyses, reviews, clinical guidelines, consensus statements, position papers, and legislation. Databases searched included PubMed, Embase, Cochrane Library, Web of Science, Google Scholar, China National Knowledge Infrastructure and Wanfang, covering records from inception to July 5, 2025. Search terms included "transcranial Doppler", "TCD", "cerebral circulatory arrest", "death by neurologic criteria", and "brain death".

Results: The use of transcranial Doppler varies across countries for confirming pediatric brain death or death by neurologic criteria. Some recommend transcranial Doppler, while others do not. Diagnostic criteria, including vessel selection, interpretation of absent blood flow signals and the number of tests, also vary. Pediatric studies support the clinical value of transcranial Doppler in the determination of brain death or death by neurologic criteria, but small sample sizes, methodological inconsistencies, and false results due to hemodynamic instability, open fontanelles or skull defects limit firm conclusions. Transcranial color-coded Doppler may improve diagnostic accuracy in certain cases.

Conclusions: Transcranial Doppler demonstrates considerable potential in confirming pediatric brain death or death by neurologic criteria, particularly in resource-limited or bedside settings. Given the current variability in clinical practice and the limitations of existing evidence, further large-scale, prospective studies are warranted to validate its role in this indication.

Background: The use of oral home antibiotics after discharge in children undergoing surgery for complicated acute appendicitis remains controversial. This systematic review and meta-analysis aimed to evaluate whether oral home antibiotics reduces the risk of infectious complications or readmissions compared to patients discharged without antibiotics.

Methods: This systematic review was prospectively registered in PROSPERO (CRD420251049919). We searched PubMed, Web of Science, Scopus, Ovid and Cochrane CENTRAL from inception to March 2025. Two independent reviewers screened the identified studies, extracted the data and assessed the methodological quality using the risk of bias in non-randomized studies-of intervention tool. Eight random-effects meta-analyses and four leave-one-out meta-analyses were conducted for intra-abdominal abscesses, surgical site infections, organ/space infections and hospital readmissions. Two exploratory random-effects meta-regression models were performed for readmissions. Certainty of evidence for all outcomes was formally assessed using Grading of Recommendations Assessment, Development, and Evaluation.

Results: Fourteen studies comprising 26,174 pediatric patients with complicated acute appendicitis were included. Meta-analyses showed no significant differences between intervention and comparator groups for intra-abdominal abscesses [risk ratio (RR) 1.23; 95% confidence interval (CI) 0.62-2.46], organ/space infections (RR 1.19; 95% CI 0.73-1.93), or readmissions (RR 1.07; 95% CI 0.78-1.45). In exposure-restricted analyses, no home antibiotic patients had a modestly lower risk of readmission (RR 0.78; 95% CI 0.61-1.01, P = 0.05). The risk of surgical site infections was significantly higher among patients in the control group (RR 0.77; 95% CI, 0.61-0.96; P = 0.02). However, this apparent association was not robust and was lost in sensitivity analyses restricted to studies with crude patient-level exposure data, where the effect reversed direction (RR > 1), consistent with protocol-based confounding. Across all outcomes, certainty of evidence was rated very low, primarily driven by potential confounding by indication and non-randomized designs.

Conclusions: Oral home antibiotics after discharge does not appear to reduce the risk of postoperative complications in children treated surgically for complicated acute appendicitis. Given the lack of consistent benefit and potential for unnecessary harm, routine use of post-discharge oral home antibiotics is not supported. Exposure-restricted analysis also raises a plausible signal of harm in terms of readmissions. Because certainty of the evidence is very low, further high-quality prospective studies are needed to define the true effect of oral home antibiotics in this context.

Background: Neurodevelopmental disorders are a group of conditions that affect key areas of development and may significantly impact a child's quality of life. This underscores the importance of accurate diagnostic tools to improve outcomes. Artificial intelligence (AI) has shown measurable effectiveness for enhancing the diagnosis and monitoring of neurodevelopmental disorders. This scoping review aims to summarize the current evidence on the use of AI technologies, including deep learning, supervised machine learning, decision support systems, and biosignal analysis, in improving diagnostic accuracy for pediatric neurodevelopmental disorders.

Data sources: A systematic search was conducted across PubMed, LILACS, MEDLINE, Google Scholar, and psychology-indexed journals, covering publications from 2000 to January 2025. Keywords and Medical Subject Headings terms were used to search for and select studies, applying specific inclusion and exclusion criteria. Selection followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines and included clinical studies, reviews, and validation research. The data were extracted and synthesized descriptively.

Results: Twenty-two studies were included. Deep learning models achieved diagnostic accuracies exceeding 85% in most studies in neuroimaging interpretation, whereas supervised machine learning improved the subtype classification of autism spectrum disorder and attention deficit hyperactivity disorder. Decision support systems have increased diagnostic efficiency, and biosignal-based AI has shown potential in identifying physiological markers related to neurodevelopmental disorders.

Conclusions: AI technologies may significantly contribute to improving early diagnosis and clinical decision-making in pediatric neurodevelopment. However, variability in study design, population, and algorithm standardization remains a challenge. AI technologies are also facing ethical concerns such as data privacy and security, interpretability, equity and access, and algorithmic bias. Further multicenter validation and regulatory frameworks are essential for clinical translation.

Background: Clean intermittent catheterization (CIC) is an effective method of bladder emptying in children with neurogenic and non-neurogenic disorders that cause difficulty in urination. However, there is a lack of expert consensus on the standardized application of CIC in pediatric populations. This guideline intends to outline recommendations for standardizing CIC in children.

Methods: A comprehensive literature review was performed by searching key academic databases, specifically PubMed, Embase, the Cochrane Library, and Web of Science. Eligible literature-including peer-reviewed clinical trials, cohort studies, case series, and expert consensus statements-was systematically identified, screened, and critically appraised. This guideline was developed according to the "WHO Handbook for Guideline Development (2nd edition)".

Results: For children with symptoms of increased post-void residual (PVR) that may threaten the upper urinary tract, CIC is recommended regardless of the cause. Safe bladder capacity (SBC) and maximum bladder capacity measurement could guide optimal CIC frequency. When infants or young children require CIC, their caregivers should receive specialized training. The CIC procedure includes thorough hand and genital area cleansing, followed by careful catheter insertion to avoid contamination of surrounding tissues. Depending on the individual's ability to void, CIC will be either partial or complete. Partial CIC is recommended for individuals who are able to void partially. When implementing CIC, a collaborative model involving the patient, caregivers, and a multidisciplinary pediatric team specializing in lower urinary tract management should be adopted, and regular follow-up and efficacy assessments are required. Urodynamic study to determine the PVR and SBC in conjunction with a voiding/catheterization diary provides an objective basis for adjusting the frequency of catheterization and for determining whether to continue catheterization.

Conclusion: This guideline established a standardized protocol for children who require CIC to facilitate bladder emptying.

Background: Despite the rise of adolescent video gaming, evidence-based parenting guidelines and research on its specific behavioral impacts remain limited. This study evaluated whether media parenting practices are prospectively associated with video game use in adolescents 1 and 2 years later.

Methods: We analyzed 7407 adolescents (51.6% male, age: 12.9 ± 0.6 years) from the Adolescent Brain Cognitive Development Study (year 3: 2019-2021 to year 5: 2021-2023). Multiple mixed-effects ordinal logistic regression and generalized linear models assessed the associations between parent media practices (screen time modeling, mealtime screen use, bedroom screen use, use to control behavior, monitoring and limiting) and video game behaviors (mature-rated games, problematic use and weekend video game time) 1 and 2 years later, adjusting for covariates.

Results: Higher parental screen time modeling, mealtime screen use and bedroom screen use were associated with higher odds of playing mature-rated video games, whereas higher parental monitoring of screen time and limiting screen time were associated with lower odds of playing mature-rated video games and less total video game use 1 and 2 years later. Higher mealtime screen use, bedroom screen use and use of screens to control behavior were associated with greater total video game use 1 and 2 years later.

Conclusions: This study demonstrates that certain media parenting practices can reduce adolescent video game use, while low parental involvement is linked to more problematic video game use behaviors. This study shows that parenting practices, including screen modeling, may influence adolescents' video game behaviors.