World Journal of Pediatrics最新文献

Background: Spinal cord injury is a catastrophic medical condition and a growing global public health priority, with divergent etiologies, risk factors, and epidemiology. Comprehensive analyses of trends in pediatric spinal cord injury burden both in China and globally are lacking.

Methods: We investigated temporal trends in pediatric spinal cord injury burden [incidence, prevalence, and years lived with disability (YLDs)] from 1990 to 2021 and projected future burden to 2045 using Global Burden of Disease (GBD) 2021 data. The year with the most significant changes in trends was identified via joinpoint regression analysis. Age-standardized rates, average annual percentage changes (AAPC), and subgroup analyses by injury location, sex, age, and sociodemographic index were calculated. To project burden data to 2045, we employed a Bayesian age‒period‒cohort model.

Results: Our analyses revealed that global pediatric spinal cord injury incidence [AAPC: - 1.13; 95% confidence interval (CI): - 1.49 to - 0.76], prevalence (AAPC: - 1.13; 95% CI: - 1.16 to - 1.11), and YLDs rates (AAPC: - 1.37; 95% CI: - 1.41 to - 1.35) decreased significantly from 1990 to 2021. The highest burden was observed in males, adolescents (15-19 years), and high-sociodemographic index regions; falls were the leading cause. China exhibited similar declining trends (e.g., incidence AAPC: - 1.33; 95% CI: - 1.71 to - 0.83). It is predicted that by 2045, the global trend of pediatric spinal cord injury will decline; China will exhibit an upward trend.

Conclusions: Persistent disparities in pediatric spinal cord injury disease burden and causes necessitate targeted prevention strategies, optimized rehabilitation services, and equitable resource allocation. This is particularly important in high-risk groups and regions with rising burdens.

Background: Major depressive disorder is a major cause of disability and health-related burden globally. Repetitive transcranial magnetic stimulation (rTMS) has emerged as a promising alternative therapy for major depressive disorder in adults, but its efficacy and safety in 10-25 years (youth) with depression remains inconclusive. We aim to evaluate the efficacy and safety of rTMS in youth with depression in randomized sham-controlled trials.

Methods: A comprehensive search of nine databases was conducted from inception to April 30, 2025. Trials using random assignment with a sham control group were selected. Heterogeneity among studies was assessed using the I² and Cochran Q test. A random-effects model was employed when I² > 50%. Standard mean deviation (SMD) for depression rating scale scores and risk difference (RD) with corresponding 95% confidence intervals (CIs) of adverse event were used to evaluate efficacy and safety, respectively.

Results: Sixteen studies with 1295 patients aged 10-25 years were included. Meta-analysis showed that active rTMS significantly reduced depression scale scores (SMD = - 0.93, 95% CI = - 1.31 to - 0.55). Subgroup analysis revealed significant relief of depressive symptoms at the second week (SMD =  - 0.66, 95% CI = - 1.25 to - 0.07) and persisting at the fourth week (SMD =  - 1.28, 95% CI = - 1.82 to - 0.75) when compared to sham stimulation. Pooled RR was 1.24 (95% CI = 1.06-1.45) for response rate and 1.63 (95% CI = 1.11-2.39) for remission rate (with an associated number needed to treat of 10).

Conclusions: Evidence indicates that rTMS is effective, safe and exhibits a relatively rapid onset of action for treating youth depression. Larger-scale studies with longer treatment durations and extended follow-up periods are essential to understand and characterize the short- and long-term neuromodulatory effects within this vulnerable population. The effect of rTMS in treatment-resistant depression and its use across diverse populations also need further investigation.

Background: Epilepsy affects millions of patients worldwide, and approximately one-third of patients are resistant to antiepileptic drugs. Dietary therapies, such as ketogenic diet (KD), modified Atkins diet (MAD), and low glycemic index treatment, have shown potential in seizure control. This review aims to evaluate the effectiveness and safety of these dietary interventions in reducing seizure frequency and improving related outcomes in individuals with drug-resistant epilepsy.

Methods: A comprehensive search of PubMed, Scopus, the Cochrane Library, and Web of Science was conducted up to December 2024 and updated in May 2025. Eligible studies were randomized controlled trials and prospective cohort studies evaluating KDs in patients with drug-resistant epilepsy. The primary outcomes included seizure reduction (≥ 50%, ≥ 90%, or complete cessation), whereas the secondary outcomes included cognitive function, quality of life, and adverse events. The risk of bias was assessed via the Cochrane Risk of Bias 2 tool. Meta-analyses were performed via R (version 4.3.2), with odds ratios (ORs) and 95% confidence intervals (CIs) calculated. Fixed- or random-effects models were applied on the basis of heterogeneity levels.

Results: Dietary interventions significantly increased ≥ 50% seizure reduction [odds ratio (OR) = 3.46, 95% CI = 1.83-6.56] compared with standard care, with stronger effects in pediatric patients (OR = 10.93 vs. 2.54 in adults, P = 0.007). MAD outperformed standard care (OR = 4.04), whereas KD did not (OR = 1.83). For a ≥ 90% reduction, KD had greater efficacy (OR = 6.23) than MAD did (OR = 1.98). No significant difference was found for complete seizure resolution (OR = 1.19). Adverse events varied: constipation was most common with MAD (30.97%), whereas KD had higher rates of respiratory infections (42.77%, P < 0.0001 vs. MAD) and diarrhea (13.75% vs. 8.11%, P = 0.0017). Heterogeneity was substantial in most analyses (I² > 75%).

Conclusions: KDs and MADs are effective in reducing seizures in patients with drug-resistant epilepsy, especially in children. However, claims of seizure freedom remain uncertain. Further high-quality trials are needed to compare diets and assess long-term safety.

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: 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.