World Journal of Pediatrics最新文献

Background: Pediatric lung transplant (pLTX) is a rare procedure globally; its characteristics and survival outcomes in China remain unknown.

Methods: This retrospective study analyzed data from pLTX recipients aged ≤ 17 years between January 2019 and December 2023 from the China Lung Transplantation Registry. Pre-, intra-, and post-operative characteristics were described and compared between children aged 2-11 years and 12-17 years and between pLTX conducted in centers with high and low transplant volumes. The Kaplan‒Meier method was used to estimate the postoperative survival rates and 95% confidence intervals (CIs). One-year postoperative survival rates were compared between pediatric and adult lung transplant (LTX) patients via log-rank tests.

Results: Between 2019 and 2023, 63 transplants were performed in 62 pediatric patients, accounting for 1.8% of the total LTX in China. The primary indication for pLTX was bronchiolitis obliterans syndrome (46.0%), followed by cystic fibrosis (12.7%) and idiopathic pulmonary arterial hypertension (11.1%). Infection was the most common complication after pLTX (63.9%), and the incidence of bronchial anastomotic stenosis was slightly higher among recipients aged 2-11 years than among those aged 12-17 years (14.3% vs. 2.9%, P = 0.244). High-volume hospitals had a higher incidence of infections (72.7% vs. 41.2%, P = 0.021) and primary graft failure (20.0% vs. 5.9%, P = 0.260) among pediatric recipients. However, acute rejection was exclusively observed in low-volume hospitals (0.0% vs. 17.6%, P = 0.018). The in-hospital mortality rate was 16.1% (95% CI = 6.7-25.5). The 30-day and one-year survival rates after pLTX were 93.5% (95% CI = 87.6-99.9) and 80.6% (95% CI = 71.4-91.1), respectively, and were significantly higher than those of adult recipients (82.0% and 58.7%, all P < 0.05).

Conclusions: This research identified the trends, indications, donor and recipient characteristics, and complications of pLTX in China. Despite its small size, pLTX is growing gradually and has favorable outcomes. Future research on the long-term follow-up of pLTX recipients is needed to identify factors associated with the prognosis of pLTX patients.

Background: The upper airway morphology in children varies with age and body position. This study aimed to analyze the impact of lateral positioning on the upper airway of sedated children under five.

Methods: This retrospective study included pediatric patients who underwent MRI in both the supine and lateral positions at Children's Hospital, Zhejiang University School of Medicine. Upper airway morphology was reconstructed using 3D Slicer software. Python was employed to estimate cross-sectional areas via pixel analysis. The narrowest cross-sectional area, minimal transverse and anteroposterior diameters, airway length, and airway volume were measured and stratified by age for subgroup analysis.

Results: In sedated children under 5 years old and when compared to the supine position, lateral positioning increased minimal transverse diameter by 18.70% (P = 0.001), narrowest cross-sectional area by 49.21% (P < 0.001), anteroposterior diameter by 25.54% (P < 0.001), airway volume by 65.64% (P < 0.001), and airway length by 11.93% (P < 0.001). In all subgroups, lateral positioning significantly increased the narrowest cross-sectional area, airway length, and airway volume. However, minimal anteroposterior diameter in the 1-to 3-year age group and minimal transverse diameter in the 3 -to 5-year age group tended to increase in the lateral position but did not reach statistical significance.

Conclusions: Lateral position significantly enlarges the upper airway in sedated children under five. These findings support using lateral position to enhance airway patency in younger patients.

Background: The incidence of pediatric pulmonary embolism is increasing, with varying clinical characteristics, severity, and prognosis. Compared with data from adults, data and knowledge regarding the prognosis of pediatric pulmonary embolism are scarce. This study aims to study the overall prognosis of pediatric pulmonary embolism and explore its influencing factors.

Methods: The study included patients diagnosed with pulmonary embolism aged 1-18 years across eight tertiary referral hospitals from January 1, 2003, to December 31, 2023. Pulmonary embolism was diagnosed on the basis of clinical presentation with imaging evidence. The overall prognosis of children with pulmonary embolism was reported, and its influencing factors were analyzed.

Results: A total of 196 children were enrolled, with a median age of 11.8 (7.9, 15.4) years, 113 males (58%) and 186 Han (95%). The overall mortality rates were 2.2% at 30 days, 3.4% at 90 days, and 5.1% during the entire follow-up period. The pulmonary embolism-related mortality rates were 1.6% (30 days), 2.7% (90 days), and 2.6% (entire follow-up period). Deep vein thrombosis at other sites occurred in 2.7% (30 days), 4.1% (90 days), and 7.6% (entire follow-up period) of the children. Among the 148 children who underwent repeat imaging examinations, 119 (81%) achieved complete remission; 24 (16%) achieved partial remission; and 4 (3%) experienced recurrence or progression during the follow-up period. Multivariable logistic regression analysis revealed that tachypnea, co-infection, and underlying disease of the tumor were independent risk factors for compound adverse events (death, pulmonary embolism progression/recurrence, and at other sites) within 90 days.

Conclusions: The short-term mortality of children with pulmonary embolism was relatively low. Children with pulmonary embolism who had tachypnea, co-infection, or underlying disease of the tumor were at increased risk of compound adverse events within 90 days.