World Journal of Pediatrics最新文献

Background: Heart failure (HF) significantly impacts the cardiovascular health of children and adolescents. This study aims to assess epidemiologic trends in HF across sex, age, region, and time period.

Methods: The number and age-standardized rate (ASR) of prevalence and years lived with disability (YLDs) were derived from the Global Burden of Disease Study 2019. We applied descriptive estimates, correlation analysis, and joinpoint linear regression to determine the trends in HF burden and its etiologies across different dimensions.

Results: Globally, the number of children and adolescent HF patients exceeded 640,000 in 2019. A positive association was found between sociodemographic index (SDI) levels and HF burden, with higher SDI regions showing the greatest impact, especially in the 15-19-year-old group. The prevalence declined from 57.86 per 100,000 in 1990 to 56.17 in 2019, and YLDs decreased from 5.35 to 5.20 per 100,000 over the same period. Temporal burden trends varied among different SDI regions in the first two decades. Overall, children under 10 years old suffered a heavier burden and presented a more evident increasing trend compared to those aged 10-19 years. Males had a more severe HF burden than females across most regions, age groups, and underlying diseases. When exploring HF-related causes, congenital birth defects, cardiomyopathy and myocarditis were the most common etiologies of cardiac dysfunction.

Conclusion: Prompt and effective implementation of preventive and management policies worldwide among children and adolescents aged 0-19 years is a top priority to help curb the increasing burden of HF.

Background: We performed an umbrella review to synthesize evidence on the effects of physical activity (PA) interventions on indicators of physical and psychological health among children and adolescents, including body mass index (BMI), blood pressure (BP), depressive symptoms, and cognitive function.

Methods: PubMed, Embase, Web of Science, and the Cochrane Library were systematically searched from inception through 31 July 2023. We included meta-analyses of randomized controlled trials exploring the effects of PA interventions on BMI, BP, depressive symptoms, or cognitive function in healthy or general children and adolescents. Standard Mean Difference (SMD) was calculated for continuous outcome indicators, while Relative Risk (RR) was calculated for categorical outcome indicators.

Results: A total of 21 meta-analyses were included. The evidence for the effects of PA interventions on reducing BMI [n = 68,368, SMD = - 0.04, 95% confidence interval (CI) = - 0.07 to - 0.01, P = 0.012, I² = 46.6%], relieving diastolic BP (n = 8204, SMD = - 1.16, 95% CI = - 2.12 to - 0.20, P = 0.018, I² = 83.1%), preventing depressive symptoms (n = 5146, SMD = - 0.21, 95% CI = - 0.31 to - 0.12, P < 0.001, I² = 29.0%), and promoting cognitive function (n = 19,955, SMD = 0.40, 95% CI = 0.27-0.54, P < 0.001, I² = 88.0%) was all weak but significant (class IV evidence). Subgroup analyses demonstrated that school-based and after-school PA interventions, curricular PA interventions, and PA interventions emphasizing enjoyment were more effective in reducing BMI, while curricular PA and sports programs achieved greater executive function.

Conclusion: PA interventions could weakly reduce BMI, relieve BP, prevent depressive symptoms, and promote cognitive function in general children and adolescents. Targeted interventions on PA should be a priority to promote physical and psychological health for children and adolescents, especially the curricular PA emphasizing enjoyment in the school settings.

Background: Data on biosimilar use in pediatric inflammatory bowel diseases (IBD) are scarce compared to the status of studies in adults, resulting in limitations in its treatment. We compared effectiveness and safety of biosimilars versus originators in this population.

Methods: We used data from the French National Health Data System to identify children (less than 18 years old at treatment initiation) initiating treatment with a biosimilar or the originator infliximab or adalimumab for Crohn's disease (CD) or ulcerative colitis (UC), from first biosimilar launch (January 2015 and October 2018, respectively) to 31 December 2022. Patients' follow-up went until 30 June 2023. We compared the risks of treatment failure and overnight hospitalization in biosimilar versus originator new users using inverse harzard ratio (HR) of probability of treatment weighted Cox regressions (IPTW).

Results: We included 5870 patients (infliximab: n = 3491; adalimumab: n = 2379) in the study. Biosimilars represented, respectively, 76.0% (n = 2652) and 29.0% (n = 691) of infliximab and adalimumab initiations. CD represented 70.9% (n = 2476) and 69.0% (n = 1642) of infliximab and adalimumab initiations. Biosimilar use was not associated with increased risks of treatment failure [IPTW HR (95% confidence interval, CI): infliximab 0.92 (0.78-1.09) in CD, 0.98 (0.76-1.27) in UC; adalimumab 0.98 (0.85-1.14) in CD, 1.01 (0.82-1.24) in UC]. Occurrence of all-cause hospitalization was not different between exposure groups [IPTW HR (95% CI): infliximab 0.96 (0.78-1.18); adalimumab 1.03 (0.80-1.33)]. No difference in occurrence of serious infections, mainly gastro-intestinal or dermatological, was found.

Conclusion: We provide reassuring results on the use, effectiveness and safety of biosimilars in a large unselected pediatric population suffering from IBD.

Background: The impact of Prader-Willi syndrome (PWS) domain gene expression on the growth of healthy children is not well understood. This study investigated associations between PWS domain gene expression in umbilical cord tissue and prenatal and postnatal growth, considering potential sex differences.

Methods: Relative gene expression of paternally expressed MAGEL2, NDN, and SNURF-SNRPN, and the small nucleolar RNAs SNORD116 and SNORD115 were determined by real-time quantitative polymerase chain reaction in umbilical cord tissue from 122 healthy newborns (59 girls and 63 boys). Gene expression levels were correlated with auxological measures at birth, infancy, and childhood (ages 2, 4, and 6 years).

Results: MAGEL2, NDN, SNORD116, and SNORD115 expression in the umbilical cord was negatively associated with birth weight, length, and placental weight (P < 0.001). Postnatally, these genes were positively associated with weight and length at 3 months (P < 0.001) and weight gain from birth to ages 1, 2, and 4 years (P < 0.01). Negative associations at birth were stronger in girls (P < 0.001), while positive associations during infancy and childhood were stronger in boys (P < 0.001). MAGEL2, SNORD116, and SNORD115 expression predicted early-postnatal growth, explaining the higher growth rate in boys compared to girls and accounting for sex differences up to 1.5 kg in weight and 3 cm in height during infancy.

Conclusions: Paternally expressed PWS domain gene expression in the umbilical cord was negatively associated with prenatal growth and positively with early-postnatal growth in healthy infants. This gene expression may predict early human postnatal growth and promote the well-known sex dimorphism in growth. These results can also help in understanding the etiology of PWS, which remains unclear.

Background: Some studies have revealed various sleep patterns in adolescents and adults using multidimensional objective sleep parameters. However, it remains unknown whether these patterns are consistent from adolescence to young adulthood and how they relate to long-term obesity.

Methods: Seven-day accelerometry was conducted in German Infant Study on the influence of Nutrition Intervention PLUS environmental and genetic influences on allergy development (GINIplus) and Influence of Lifestyle factors on the development of the Immune System and Allergies in East and West Germany (LISA) birth cohorts during the 15-year and 20-year follow-ups, respectively. Five sleep clusters were identified by k-means cluster analysis using 12 sleep characteristics at each follow-up. Adjusted linear and logistic regression models using generalized estimating equations were examined. Further, the interaction effects with time of follow-ups and polygenic risk scores (PRS) for body mass index (BMI) were tested.

Results: Five sleep clusters were classified consistently in both adolescence (n = 1347, aged 14.3-16.4 years) and young adulthood (n = 1262, aged 19.5-22.4 years). Adolescents in the "good sleep", "delayed sleep phase", and "fragmented sleep" clusters displayed greater stability transitioning into young adulthood, while those in the "sleep irregularity and variability", and "prolonged sleep latency" clusters showed lower stability (n = 636). Compared to the "good sleep" cluster, the "prolonged sleep latency" cluster exhibited associations with higher BMI [β = 0.56, 95% confidence interval (CI) = (0.06, 1.05)] and increased odds of overweight/obesity [Odds ratio = 1.55, 95% CI = (1.02, 2.34)]. No significant PRS-sleep cluster interaction was found for BMI or overweight/obesity. Among males only, the "delayed sleep phase", "sleep irregularity and variability" and "fragmented sleep" clusters showed stronger associations with overweight/obesity as age increased.

Conclusion: Adolescents and young adults shared five consistent sleep patterns, with the "prolonged sleep latency" pattern linked to higher BMI and overweight/obesity.

Background: Digital technologies play an important role in improving the quality of healthcare services, however, many healthcare workers and students do not recognize this and have low levels of digital competencies and skills. Therefore, this paper aims to investigate digital perceptions and competencies among medical students in pediatrics and pediatric healthcare workers in China.

Methods: A questionnaire on digital competency was designed. The formal survey was carried out from  February to May 2024 in pediatric students and pediatricians. Data were analyzed by SPSS20.0 software.

Results: The study included 518 valid questionnaires; 199 medical students in pediatrics and 319 pediatric healthcare workers. In all five themes, pediatric healthcare workers and pediatric students had a mean score higher than 3.0, and the former scored higher. There was no significant difference in the digital competency in pediatricians (3.91) compared to pediatric students (3.82) (P > 0.05). Multivariable analysis revealed that gender and education level were related with digital competency, with male medical students (3.94 vs. 3.75, P = 0.021) and those with higher levels of education (3.99 vs. 3.75, P = 0.030) having better performance. In addition, medical students in pediatric surgery scored higher than those who majored in internal pediatrics (4.11 vs. 3.76, P = 0.017).

Conclusions: Pediatric students and pediatric healthcare workers had a good perception on information of digital technology in the medical field, but had limited ability in digital use and collaboration, digital capacity development, and digital content creation. Better medical education and training strategies should be developed for potential challenges in the coming artificial intelligence era.

Background: Type 2 diabetes mellitus (T2DM) poses an escalating public health challenge among adolescents and young adults worldwide. Despite the rising incidence, comprehensive data on the burden and trends of T2DM in this demographic remain scarce. This study aims to evaluate the burden of T2DM among individuals aged 10-24 years globally, regionally, and nationally from 1990 to 2021.

Methods: Utilizing data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021, we assessed incidence rates, disability-adjusted life-years (DALYs), and average annual percentage changes (AAPCs) for T2DM in the specified age group. Analyses accounted for variations by age, sex, and socio-demographic index (SDI). Joinpoint regression analysis identified years of significant trend shifts.

Results: The global incidence of T2DM among adolescents and young adults rose from 56.02 per 100,000 (95% UI 43.03-72.32) in 1990 to 123.86 per 100,000 (95% UI 100.43-149.79) in 2021, reflecting an AAPC of 3.01 (95% CI 2.78-3.23). Notable increases were recorded in 1995, 2002, and 2009, with joinpoints indicating significant trend stabilization post-2010 for prevalence and DALYs. The largest relative incidence increase was observed in the 15-19 age group [AAPC 2.97 (95% CI 2.71-3.24)]. Although T2DM mortality was 2.4 times higher in the 15-19 age group compared to the 20-24 age group, the latter exhibited a significantly higher overall mortality rate. Regionally, Oceania recorded the highest incidence rates in 2021, while North Africa and the Middle East showed the greatest AAPCs. High-SDI countries experienced the most substantial increase in T2DM burden, with males comprising 54.8% of cases.

Conclusions: From 1990 to 2021, the global burden of T2DM among adolescents and young adults has markedly increased, underscoring the necessity for targeted, region-specific interventions to address this issue. The observed demographic disparities in mortality rates necessitate the implementation of age-specific strategies. Furthermore, the emergent trends in T2DM indicators warrant urgent attention to mitigate the rising burden in this vulnerable population.

Background: Glucose transporter 1 deficiency syndrome (Glut1DS) was initially reported by De Vivo and colleagues in 1991. This disease arises from mutations in the SLC2A1 and presents with a broad clinical spectrum. It is a treatable neuro-metabolic condition, where prompt diagnosis and initiation of ketogenic dietary therapy can markedly enhance the prognosis. However, due to its rarity, Glut1DS is susceptible to misdiagnosis or missed diagnosis, which can lead to delayed treatment and irreversible dysfunction of the central nervous system. To promote diagnostic awareness and effective treatments, the recommendations for diagnosis and treatment have been developed.

Methods: The panel on Glut1DS included 28 participants from the members of the Ketogenic Diet Professional Committee of the Chinese Epilepsy Association and Chinese experts with extensive experience in managing Glut1DS. All authors extensively reviewed the literature, and the survey results were discussed in detail over several online meetings. Following multiple deliberative sessions, all participants approved the final manuscript for submission.

Results: Early diagnosis and timely treatment of Glut1DS are crucial for improving prognosis. Physicians should be alert to suspiction of this disease if the following clinical manifestations appear: seizures, episodic or persistent movement disorders (often triggered by fasting, fatigue, or exercise), delayed motor and cognitive development. Characteristic clinical presentations may include seizures combined with movement disorders, episodic eye-head movements, and paroxysmal exercise-induced dyskinesia (PED). In these cases, genetic testing should be promptly completed, and a lumbar puncture should be performed if necessary. The ketogenic diet is internationally recognized as the first-line treatment; the earlier it is started, the better the prognosis. It can effectively control seizures and improve motor disorders. Antiepileptic drug treatment is generally ineffective or provides limited symptom improvement before starting the ketogenic diet.

Conclusion: The recommendations provide clinicians with a relatively systematic guide for the rapid identification, diagnosis, and timely treatment of Glut1DS.