World Journal of Pediatrics最新文献

Background: Gastrointestinal bleeding (GIB) is a prevalent clinical condition in pediatric populations that is characterized by etiological heterogeneity across age groups with potentially life-threatening risks in critical cases. Current management strategies predominantly extrapolate from adult-based studies and guidelines. This is despite substantial differences between pediatric and adult patients regarding bleeding etiology, risk stratification, peri-endoscopic pharmacotherapy, hemostatic technique selection, and salvage interventions after initial hemostasis failure.

Data sources: A systematic literature review was conducted via PubMed, Embase, and the Chinese Journal Full-text Database up to February 2025. Search terms included "pediatric", "upper gastrointestinal bleeding", "peptic ulcer", "lower gastrointestinal bleeding" and "endoscopic diagnosis and treatment". This review synthesizes current evidence to optimize standardized management of pediatric GIB.

Results: Early and comprehensive assessment of children with GIB, early identification of high-risk factors for GIB, timely use of endoscopic examination, proactive treatment, optimization of diagnosis and treatment processes, and multidisciplinary consultation have important impacts on the outcome of GIB in children.

Conclusions: Ensuring hemodynamic stability and vital signs in children with GIB, early identification of disease cause and timely, and effective hemostatic treatment are key to improving treatment success, reducing complications and lowering mortality.

Background: Respiratory syncytial virus infection is one of the leading causes of morbidity and mortality in children under two years of age. Thus, the objective of this consensus document is to analyze and discuss current scientific evidence and generate recommendations that reflect the position of a prominent national pediatric professional association regarding the benefits and impact of immunoprophylaxis in pregnant women and infants on the burden of respiratory syncytial virus-related respiratory disease in Mexico and Latin America.

Data sources: Following an academic consensus model, the available scientific literature on current or controversial topics was compiled and critically analyzed. The process adhered to the Guidelines for the Development of Consensus Documents and incorporated recommendations and critical appraisal criteria from the European Appraisal of Guidelines for Research and Evaluation initiative. Multidisciplinary and representative teams were formed from several national professional associations. The studies and manuscripts included in this review were selected via keywords such as respiratory syncytial virus, vaccine, monoclonal antibodies, maternal vaccine, safety and efficacy in vaccine, and vaccine compliance across databases, with priority given to articles published between January 2019 and May 2025. The process included one in-person meeting and one virtual meeting.

Results: A total of nine questions, which were considered unresolved in previous respiratory syncytial virus-related consensus documents, were formulated, covering the time, dose, cost-effectiveness and other perspectives. Each one was addressed through an updated literature review and critical appraisal. The findings and resulting recommendations were presented along with their corresponding level of evidence according to Grading of Recommendations Assessment, Development, and Evaluation.

Conclusions: Both maternal respiratory syncytial virus vaccination (RSVpreF) and passive immunization with nirsevimab demonstrate robust efficacy and favorable safety, protecting newborns and infants from severe respiratory syncytial virus infections. The document provides actionable, evidence-based recommendations tailored for the Latin American healthcare context, aiming to reduce severe respiratory syncytial virus disease incidence and improve national infant health outcomes.

Background: Immediate kangaroo mother care, a continuous skin-to-skin contact initiated within 24 hours after birth, often before full clinical stabilization, has emerged as a recommended approach to improve outcomes in preterm and low-birth-weight neonates. Unlike delayed kangaroo mother care, which begins after clinical stabilization, immediate kangaroo mother care promotes early exclusive breastfeeding and early discharge with follow-up support, which has been endorsed by the World Health Organization following evidence of reduced morbidity and mortality. This narrative review synthesizes the current literature comparing immediate kangaroo mother care to delayed kangaroo mother care across implementation practices, benefits, and challenges to inform future recommendations for optimizing kangaroo mother care delivery and consistency in neonatal care.

Methods: A comprehensive search across Medline (PubMed), Scopus, EuropePMC, and Google Scholar up to June 2024 was conducted. Studies comparing immediate and delayed kangaroo mother care in premature or low-birth-weight infants reporting on at least one of the major clinical outcomes or implementation barrier were included. Review quality was assessed via the Scale for the Assessment of Narrative Review Articles.

Results: Evidence from the included trials, including five major randomized controlled trials conducted in low- and high-resource settings, revealed that immediate kangaroo mother care significantly reduces 28-day neonatal mortality, the risk of hypothermia, and the incidence of sepsis. Immediate kangaroo mother care improves exclusive breastfeeding and growth outcomes in infants, and has shown benefits not only for infants but also for their mothers. It also demonstrated greater cost-effectiveness, especially in low-resource settings. While immediate kangaroo mother care is associated with numerous benefits, its implementation remains constrained by several barriers, including sociocultural, medical, logistical, and financial factors.

Conclusions: While immediate kangaroo mother care offers substantial potential to improve neonatal outcomes, addressing the barriers in implementing immediate kangaroo mother care is essential.

Background: Bedtime problems and night wakings are common in children under six, particularly in China. The current study summarizes the core tenets of the "Chinese guideline for the treatment of bedtime problems and night wakings in children under 6 years of age (2023)", and discusses the associated challenges and suggestions for practices relevant to both domestic and international contexts.

Data sources: This review draws on literature from PubMed and Web of Science, published up to 2025, combined with evidence from the guide itself, as well as relevant consensus statements and expert recommendations.

Results: The guideline provides three strong recommendations, including behavioral intervention, early sleep hygiene education, and bedtime massage; four conditional recommendations under professional supervision, including separate sleeping arrangements, white noise, melatonin and iron supplementation; and three non-recommended interventions, including pacifier use, early complementary feeding, and daytime physical activity. Challenges in assessment and treatment involve the absence of standardized diagnostic criteria, reliance on subjective reports, multifactorial etiology with frequent comorbidities, and culturally embedded family sleep practices. Comprehensive evaluation requires integrating both subjective and objective measures while accounting for medical, behavioral, and environmental factors within cultural frameworks. Intervention should be individualized through shared decision-making with parents, combining modalities based on etiological profiling, with non-pharmacological strategies constituting first-line management.

Conclusions: Effective management for bedtime problems and night wakings in young children requires standardized tools, and culturally adaptable, and family-centered interventions according to evidence-based guidelines. Strengthening professional training and parental education is crucial for guideline implementation and improved pediatric sleep health.

Background: Sleep-related movement disorders (SRMDs), such as restless legs syndrome (RLS) and periodic limb movement disorder (PLMD), are common in pediatric sleep practice. There is increasing literature on RLS, PLMD, and a newly described sleep disorder called "restless sleep disorder (RSD)". We aimed to review and provide recent updates on SRMDs.

Data sources: A comprehensive search for relevant English-language peer-reviewed publications focused on three common SRMDs, namely, RLS, PLMD and RSD, in a variety of indices in PubMed and SCOPUS. Both relevant databases and systematic reviews are included.

Results: SRMDs, especially RLS and PLMD, are common in children and adolescents. However, they are underrecognized. Genetics, abnormal dopaminergic functions, and iron deficiency are the main pathophysiologies of RLS and PLMD. RLS and RSD may share common pathophysiologic mechanisms, as evidenced by low iron stores in both conditions. The diagnoses of RLS, PLMD, and RSD require specific clinical criteria and polysomnographic features. Several comorbid conditions have been associated with RLS, PLMD, and RSD. Iron therapy has been shown to be effective for treating RLS, PLMD, and RSD. There is increasing evidence on the effectiveness of specific medications in children with RLS and PLMD, but the data are still limited.

Conclusions: This review summarizes the pathophysiology, clinical manifestations, diagnostic criteria, and management of RLS, PLMD, and RSD in children based on relevant and recent literature. It is important for pediatricians to recognize the clinical presentation of RLS, PLMD, and RSD to facilitate early diagnosis. Further studies are needed to examine the pathogenesis, long-term consequences, and pharmacologic therapy of RSD in children.

Background: The impact of melatonin on pediatric populations has not yet been widely researched. This narrative review is intended to summarize the current literature regarding the efficacy and safety of melatonin for children and potential pitfalls in its clinical use, in order to assist pediatric practitioners in making evidence-based recommendations that serve the best interests of their patients and families.

Data sources: A literature review of melatonin in the pediatric population was conducted using PubMed search terms: melatonin, pediatrics, child/adolescent.

Results: Melatonin use in the pediatric population world-wide has increased significantly over the past several decades. While a number of studies, largely in children with neurodevelopmental disorders with insomnia, have suggested that melatonin is generally safe and well-tolerated, a similar body of evidence is overall lacking for typically developing children and prospective studies regarding long-term adverse events are lacking. In addition, recent studies have raised concerns regarding the variable content of melatonin in over-the-counter products, as well as safety issues relating to accidental ingestions.

Conclusions: Due to a number of concerns regarding inappropriate use, lack of efficacy and safety data across pediatric populations and variability in actual content, melatonin should be used with caution in children and only under medical supervision.

Background: The relationship between daily affective states and subjective sleep measures is known to be reciprocal in both adults and children. However, its consistency across infancy to early adolescence and varying sociocultural contexts remain unclear. We investigated the bidirectional relationship between happiness and sleep quality in children from the U.S. and China and examined the predictive role of maternal prenatal psychosocial support.

Methods: A total of 1300 children aged 11-12 years in the U.S. Healthy Brain and Behavior Study (HBBS) and China Jintan Child Cohort (CJCC) studies were included in the analyses. Happiness and sleep quality from infancy to early adolescence were retrospectively reported by mothers. Prenatal psychosocial factors were recalled by mothers through a structured interview. Random-intercept cross-lagged panel modeling was conducted to analyze the data.

Results: Happiness and sleep quality trajectories differed significantly between U.S. adolescents in the HBBS and Chinese adolescents in the CJCC (P < 0.001). In both cohorts, cross-lagged effects showed consistent associations between happiness and subsequent sleep quality across the five time points (coefficients: 0.086-0.154, P < 0.01). The relationship between sleep quality and subsequent happiness was significant from 1-3 to 11 years. The bidirectional relationship was stronger in the Chinese cohort. Maternal prenatal psychosocial support positively predicted children's happiness (β = 0.072, P < 0.001) and sleep quality (β = 0.056, P < 0.001) trajectories.

Conclusions: A bidirectional relationship exists between children's happiness and sleep quality, with potential cultural variations. Maternal prenatal psychosocial support plays a key role in fostering children's long-term emotional well-being and sleep quality.