World Journal of Pediatrics最新文献

Background: The diagnosis of central precocious puberty (CPP) relies on a gonadotropin releasing hormone stimulation test to assess the activation of the hypothalamic-pituitary-gonadal axis; this is costly and painful. Bile acids (BAs) have emerged as pivotal signaling molecules in the reproductive system. This study aimed to identify circulating BA profile signatures and explored if they may serve as biomarkers for CPP diagnosis in girls.

Methods: We enrolled 431 girls, including 241 in the training cohort and 190 in the validation cohort. Participants were divided into four groups based on their body mass index Z-score and whether they were diagnosed with CPP. Ultra-performance liquid chromatography coupled with tandem mass spectrometry was performed to quantify 38 serum BAs.

Results: There were 18 individual BAs that were statistically different between CPP and non-CPP counterparts. The majority of these BAs (14/18) correlated significantly with sex-related hormones (P < 0.05). In girls with normal weight (NW), a logistic regression model combining chenodeoxycholic acid, tauroα-muricholic acid, and 6-ketolithocholic acid achieved an area under the receiver operating characteristic curve (AUC) of 0.885. For girls who were overweight/obese (OB), hyocholic acid and taurohyocholic acid enhanced the diagnostic efficiency of basal luteinizing and follicle stimulating hormones to an AUC value 0.914. In validation cohort, 75.34% NW girls and 84.09% OB girls were accurately classified.

Conclusions: Serum BA profiles of CPP girls showed significant changes that were associated with serum sex-related hormone levels. BA profiles could be potential biomarkers in CPP diagnosis and screening. Video Abstract.

Background: Steroid-sensitive nephrotic syndrome is a prevalent glomerular disease in children. The 2021 guidelines for glomerular disease management by Kidney Disease: Improving Global Outcomes and the 2023 recommendations for steroid-sensitive nephrotic syndrome management by International Pediatric Nephrology Association recommend rituximab for frequently relapsing nephrotic syndrome and steroid-dependent nephrotic syndrome in children. However, there is considerable variation in rituximab application, including administration timing, dose, frequency, concomitant medications, and follow-up schedules. In addition, rituximab use for nephrotic syndrome remains off-label in most countries.

Data sources: The "Pediatric Nephrology Committee of the Chinese Medical Doctor Association", the "Pediatric Nephrology Society of the Chinese Medical Association", and the "Fudan University GRADE Center" collaborated to develop a clinical practice guideline for rituximab in pediatric steroid-sensitive nephrotic syndrome. Databases and starting/ending time for retrieval were as follows. Databases in English: PubMed, Embase, Cochrane, and Scopus; database in Chinese: Chinese Biomedical Literature Service provided by SinoMed. The publication dates were limited to those from 2004 to June 26, 2022.

Results: Through systematic reviews and meta-analyses covering nine clinically relevant patient or population covered, intervention, comparator, and outcome questions, seven recommendations were formulated and formally graded according to these guidelines.

Conclusions: This guideline aspires to serve as a pivotal resource for healthcare providers, offering guidance on administration timing, dosage, frequency, concomitant medications, and follow-up protocols.

Background: Children and adolescents with chronic physical conditions have an increased probability of mental health problems, which may be partly attributed to the variations in play behavior. This study explores the associations between having a chronic physical condition, play behavior, and having mental health problems.

Methods: Data from the Generation R Study were analyzed, a population-based, prospective cohort in the Netherlands. Chronic physical conditions were typically identified before six years of age. Play behavior was assessed at ages 6 and 10. Mental health problems were measured with the Child Behavior Checklist at 14 years of age. Logistic, ranked-order, and linear regression analyses were used to examine direct associations, and mediation analyses were used to investigate indirect paths. P values were false discovery rate adjusted.

Results: Of the 4043 included participants, 691 (17%) had a chronic physical condition. Having a chronic physical condition was associated with more mental health problems and limited activity at the age of six years. Playing sports and engaging in social interactions at age 10 were related to fewer mental health problems at age 14. Limited activity mediated the relationship between having a chronic physical condition and mental health problems (social: mediated_proportion = 8.33%, 95% CI = 2.02%; 15.7%, P_adj < 0.001; physical: mediated_proportion = 7.72%, 95% CI = 1.73%; 19.1%, P_adj = 0.040).

Conclusions: Health-related limitations in social and physical activities mediate the relationship between having a chronic physical condition and mental health problems in children. Participation in social and physical activities early in life may be crucial for the mental well-being of children with a chronic physical condition.

Background: Microbial colonization in the nasopharynx and nasal cavity plays a defensive role in children. The coronavirus disease 2019 (COVID-19) pandemic may have an influence on the nasopharynx and nasal cavity microbiota. This study aimed to identify and compare the microbiota in the nasopharynx and nasal cavity before and during the COVID-19 pandemic in a healthy pediatric population.

Methods: Separate mucosal swabs were collected from the nasopharynx and nasal cavity of healthy children before and during the COVID-19 pandemic. A 16S ribosomal RNA-based metagenomic approach was employed to characterize and analyze alterations in the nasopharyngeal and nasal microbiota to determine whether isolation measures, such as mask wearing, influence microbial ecology.

Results: The richness and diversity of the nasopharyngeal and nasal microbiota decreased during the COVID-19 pandemic compared with before the pandemic. Firmicutes and Proteobacteria were the most abundant phyla in the nasopharyngeal and nasal microbiota, respectively, both before and during the pandemic. Corynebacterium and Moraxella were the dominant genera in the nasopharyngeal and nasal microbiota during the COVID-19 pandemic, whereas Pseudomonas and Corynebacterium were dominant before the pandemic. Compared with pre-pandemic conditions, microbial colonization differed significantly for Cyanobacteria/Chloroplast and Bacteroidetes in the nasopharynx and for Planctomycetes in the nasal cavity during the COVID-19 pandemic.

Conclusions: This study revealed a lower microbiota diversity during COVID-19, possibly accompanied by microbiota dysbiosis, increased risk of respiratory infections and inflammatory responses in healthy children. This study underscores the importance of reestablishing microbiota balance and highlights the need for personalized treatment and prophylactic strategies in routine public health practice. Supplementary file3 (MP4 150533 KB).

Background: Venoarterial extracorporeal membrane oxygenation induces an inflammatory response upon initiation. The neutrophil percentage-to-albumin ratio is a promising biomarker for predicting mortality in patients with systemic inflammation. This study aimed to investigate the association between neutrophil percentage-to-albumin ratio and in-hospital mortality in pediatric patients with acute fulminant myocarditis undergoing extracorporeal membrane oxygenation and to develop a PEACE model for predicting mortality in these patients.

Methods: This retrospective study included pediatric patients diagnosed with acute fulminant myocarditis who underwent venoarterial extracorporeal membrane oxygenation between July 2015 and August 2022. Multivariable logistic regression analysis was used to investigate the independent association between the neutrophil percentage-to-albumin ratio and the risk of in-hospital mortality. In addition, we utilized least absolute shrinkage and selection operator regression to select predictive factors, ultimately developing a nomogram to predict outcomes in pediatric patients receiving venoarterial extracorporeal membrane oxygenation.

Results: A total of 125 patients eligible for analysis were included in this study, with an in-hospital mortality rate of 28.8%. Multivariable logistic regression revealed that the neutrophil percentage-to-albumin ratio was an independent risk factor for in-hospital mortality in venoarterial extracorporeal membrane oxygenation patients. Restricted cubic splines revealed a positive association between the two (P_nonlinearity = 0.84). Least absolute shrinkage and selection operator regression and backward stepwise logistic regression identified age, cardiopulmonary resuscitation, lactate levels, and the neutrophil percentage-to-albumin ratio as key predictive factors. Using these factors, a nomogram (PEACE model) was developed to predict in-hospital mortality in venoarterial extracorporeal membrane oxygenation patients. The area under the receiver operating characteristic curve was 0.83 [95% confidence interval (CI), 0.74-0.92], with the inclusion of the neutrophil percentage-to-albumin ratio significantly enhancing the model's predictive accuracy.

Conclusions: The neutrophil percentage-to-albumin ratio may serve as a potential predictor for venoarterial extracorporeal membrane oxygenation in-hospital mortality in pediatric patients with acute fulminant myocarditis, suggesting that inflammatory responses are associated with patient prognosis. The PEACE model is superior in predicting the prognosis of pediatric patients supported by venoarterial extracorporeal membrane oxygenation, and can help in clinical decision making.