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Growth plate closure and therapeutic interventions. 生长板闭合和治疗干预。
IF 3.2 Q1 PEDIATRICS Pub Date : 2024-11-01 Epub Date: 2024-10-28 DOI: 10.3345/cep.2023.00346
Ja Hyang Cho, Hae Woon Jung, Kye Shik Shim

Height gains result from longitudinal bone growth, which is largely dependent on chondrocyte differentiation and proliferation within the growth plates of long bones. The growth plate, that is, the epiphyseal plate, is divided into resting, proliferative, and hypertrophic zones according to chondrocyte characteristics. The differentiation potential of progenitor cells in the resting zone, continuous capacity for chondrocyte differentiation and proliferation within the proliferative zone, timely replacement by osteocytes, and calcification in the hypertrophic zone are the 3 main factors controlling longitudinal bone growth. Upon adequate longitudinal bone growth, growth plate senescence limits human body height. During growth plate senescence, progenitor cells within the resting zone are depleted, proliferative chondrocyte numbers decrease, and hypertrophic chondrocyte number and size decrease. After senescence, hypertrophic chondrocytes are replaced by osteocytes, the extracellular matrix is calcified and vascularized, the growth plate is closed, and longitudinal bone growth is complete. To date, gonadotropin-releasing hormone analogs, aromatase inhibitors, C-type natriuretic peptide analogs, and fibroblast growth factor receptor 3 inhibitors have been studied or used as therapeutic interventions to delay growth plate closure. Complex networks of cellular, genetic, paracrine, and endocrine signals are involved in growth plate closure. However, the detailed mechanisms of this process remain unclear. Further elucidation of these mechanisms will enable the development of new therapeutic modalities for the treatment of short stature, precocious puberty, and skeletal dysplasia.

身高的增长源于骨骼的纵向生长,而骨骼的纵向生长主要取决于长骨生长板内软骨细胞的分化和增殖。生长板(即骺板)根据软骨细胞的特征分为静止区、增殖区和肥厚区。静止区祖细胞的分化潜能、增殖区内软骨细胞的持续分化和增殖能力、骨细胞的及时替代以及肥厚区的钙化是控制骨骼纵向生长的三个主要因素。在骨骼纵向生长达到一定程度后,生长板的衰老会限制人的身高。在生长板衰老过程中,静止区内的祖细胞耗竭,增殖软骨细胞数量减少,肥大软骨细胞数量和体积缩小。衰老后,肥大软骨细胞被骨细胞取代,细胞外基质钙化和血管化,生长板闭合,纵向骨生长完成。迄今为止,已有促性腺激素释放激素类似物、芳香化酶抑制剂、C 型钠尿肽类似物和成纤维细胞生长因子受体 3 抑制剂被研究或用作延迟生长板闭合的治疗干预措施。生长板闭合涉及复杂的细胞、遗传、旁分泌和内分泌信号网络。然而,这一过程的详细机制仍不清楚。对这些机制的进一步研究将有助于开发治疗矮身材、性早熟和骨骼发育不良的新方法。
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引用次数: 0
Protecting our future: environmental hazards and children's health in the face of environmental threats: a comprehensive overview. 保护我们的未来:面对环境威胁的环境危害和儿童健康:全面概述。
IF 3.2 Q1 PEDIATRICS Pub Date : 2024-11-01 Epub Date: 2024-10-31 DOI: 10.3345/cep.2023.01578
Jungha Lee, Hyo-Bin Kim, Hun-Jong Jung, Myunghee Chung, So Eun Park, Kon-Hee Lee, Won Seop Kim, Jin-Hwa Moon, Jung Won Lee, Jae Won Shim, Sang Soo Lee, Yunkoo Kang, Young Yoo

Children face the excitement of a changing world but also encounter environmental threats to their health that were neither known nor suspected several decades ago. Children are at particular risk of exposure to pollutants that are widely dispersed in the air, water, and food. Children and adolescents are exposed to chemical, physical, and biological risks at home, in school, and elsewhere. Actions are needed to reduce these risks for children exposed to a series of environmental hazards. Exposure to a number of persistent environmental pollutants including air pollutants, endocrine disruptors, noise, electromagnetic waves (EMWs), tobacco and other noxious substances, heavy metals, and microplastics, is linked to damage to the nervous and immune systems and affects reproductive function and development. Exposure to environmental hazards is responsible for several acute and chronic diseases that have replaced infectious diseases as the principal cause of illnesses and death during childhood. Children are disproportionately exposed to environmental toxicities. Children drink more water, eat more food, and breathe more frequently than adults. As a result, children have a substantially heavier exposure to toxins present in water, food, or air than adults. In addition, their hand-to-mouth behaviors and the fact that they live and play close to the ground make them more vulnerable than adults. Children undergo rapid growth and development processes that are easily disrupted. These systems are very delicate and cannot adequately repair thetional development in children's environmental health was the Declaration of the Environment Leaders of the Eight on Children's Environmental Health by the Group of Eight. In 2002, the World Health Organization launched an initiative to improve children's environmental protection effort. Here, we review major environmental pollutants and related hazards among children and adolescents.

儿童面临着不断变化的世界所带来的刺激,但同时也遇到了环境对其健康的威胁,而这些威胁在几十年前既不为人所知,也不为人所怀疑。儿童尤其有可能接触到广泛散布于空气、水和食物中的污染物。儿童和青少年在家中、学校和其他地方都面临着化学、物理和生物风险。我们需要采取行动,降低儿童暴露于一系列环境危害中的风险。暴露于一些持久性环境污染物,包括空气污染物、内分泌干扰物、噪音、电磁波、烟草和其他有害物质、重金属和微塑料,会对神经和免疫系统造成损害,并影响生殖功能和发育。暴露于环境危害是多种急性和慢性疾病的罪魁祸首,这些疾病已取代传染病成为儿童期疾病和死亡的主要原因。儿童受环境毒物的影响尤为严重。儿童比成年人喝更多的水、吃更多的食物、呼吸更频繁。因此,与成人相比,儿童接触到的水、食物或空气中的毒素要多得多。此外,他们手口并用的行为以及他们贴近地面生活和玩耍的事实,也使他们比成年人更容易受到伤害。儿童的生长发育过程非常迅速,很容易受到干扰。这些系统非常脆弱,无法充分修复环境毒素造成的损害。儿童环境健康方面的第一个国际进展是八国集团发表的《八国集团环境领导人关于儿童环境健康的宣言》。2002 年,世界卫生组织发起了一项旨在改善儿童环境保护工作的倡议。在此,我们回顾了主要的环境污染物以及对儿童和青少年的相关危害。
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引用次数: 0
Efficacies of different treatment strategies for infants hospitalized with acute bronchiolitis. 针对急性支气管炎住院婴儿的不同治疗策略的疗效。
IF 3.2 Q1 PEDIATRICS Pub Date : 2024-11-01 Epub Date: 2024-10-28 DOI: 10.3345/cep.2023.01676
Hyeri Jeong, Dawon Park, Eun Kyo Ha, Ju Hee Kim, Jeewon Shin, Hey-Sung Baek, Hyunsoo Hwang, Youn Ho Shin, Hye Mi Jee, Man Yong Han

Background: Acute bronchiolitis is a common cause of hospitalization during infancy that carries significant morbidity and mortality rates.

Purpose: This study compared the efficacy of different treatment modalities for infants with bronchiolitis in terms of hospital stay and clinical severity scores.

Methods: The PubMed database was searched for relevant studies. Eligibility criteria included double-blind randomized controlled trial design, assessment of the effect of treatment on bronchiolitis in infants under 2 years of age, and publication in English from inception through July 31, 2020. The primary efficacy outcome was the length of hospital stay, while the secondary outcome was the clinical severity score. The standardized treatment effect and standard error of the effect size were calculated.

Results: We identified 45 randomized controlled trials of 24 pairwise comparisons. These 45 trials included 5,061 participants and investigated 13 types of interventions (12 active, 1 placebo). Inhalation therapy with epinephrine (standard mean difference [SMD], -0.41; 95% confidence interval [CI], -0.8 to -0.03) and hypertonic saline (SMD, -0.29; 95% CI, -0.55 to -0.03) reduced the length of hospital stay compared with normal saline. Hypertonic saline was the most effective at improving the clinical severity score (SMD, -0.52; 95% CI, -0.95 to -0.10).

Conclusion: Inhalation therapy with epinephrine and hypertonic saline reduced the length of hospital stay and the clinical severity of bronchiolitis among infants under 2 years of age.

背景: :急性支气管炎是婴儿期住院治疗的常见原因,其发病率和死亡率都很高:本研究从住院时间和临床严重程度评分方面比较了不同治疗方法对婴儿支气管炎的疗效:方法:在 PubMed 数据库中搜索相关研究。资格标准包括双盲随机对照试验设计、评估治疗对两岁以下婴儿支气管炎的影响、从开始到2020年7月31日以英语发表。主要疗效结果为住院时间,次要结果为临床严重程度评分。计算了标准化治疗效果和效果大小的标准误差:我们确定了 45 项随机对照试验,24 项成对比较。这 45 项试验包括 5,061 名参与者,研究了 13 种干预方法(12 种活性方法,1 种安慰剂)。与普通生理盐水相比,肾上腺素吸入疗法(标准平均差 [SMD],-0.41;95% 置信区间 [CI],-0.8 至 -0.03)和高渗盐水(SMD,-0.29;95% 置信区间 [CI],-0.55 至 -0.03)缩短了住院时间。结论:使用肾上腺素和高渗盐水进行吸入治疗可缩短住院时间,减轻两岁以下婴儿支气管炎的临床严重程度。
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引用次数: 0
Regional differences in diagnosis and management of cow's milk allergy. 牛奶过敏诊断和管理的地区差异。
IF 3.2 Q1 PEDIATRICS Pub Date : 2024-11-01 Epub Date: 2024-10-28 DOI: 10.3345/cep.2023.01550
Fabian Hendricx, Emma Robert, Jaime A Ramirez-Mayans, Karen Rubi Ignorosa Arellano, Erick M Toro Monjaraz, Yvan Vandenplas

Background: Various guidelines for the diagnosis and management of cow's milk allergy (CMA) have been published.

Purpose: This study aimed to compare voting outcomes of experts from Mexico, the Middle East, and the European Society of Pediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) on statements regarding CMA.

Methods: The 3 expert groups voted on the same 10 statements. Each participant voted anonymously using a score of 0-9 (≥6 meant agreement; <5 reflected disagreement). If <75% of the participants agreed with the statement, it was rejected. None of the groups was aware of the voting outcomes of another group.

Results: There was broad consensus amongst the 3 groups. Agreement was reached that infant colic as a single manifestation is not suggestive of CMA. All groups confirmed that an extensively hydrolysed formula is the preferred elimination diet in mild/moderate CMA cases; however, hydrolysed rice formula is an alternative. Amino acid-based formulas should be reserved for infants with severe symptoms. The discrepancy in voting outcomes regarding soy formulas highlights the differences in opinions. Two of 13 ESPGHAN experts (15%), 1 of 14 Middle East experts (7%), and 6 of 26 Mexican experts (23%) disagreed with the statement that soy formula should not be the first choice for the diagnostic elimination diet but can be considered in some cases for economic, cultural, and palatability reasons. All of the ESPGHAN and Mexican experts agreed that there was no added value of probiotics, prebiotics, or synbiotics to the efficacy of elimination diets on CMA, whereas 3 of 14 Middle East experts (21%) determined that there was sufficient evidence.

Conclusion: Although all statements were accepted by the 3 groups, there were relevant differences illustrating variations according to geography, culture, cost, and formula availability. These findings emphasize the need for region-specific guidelines.

背景: :目的: :本研究旨在比较墨西哥、中东和欧洲儿科胃肠病学、肝病学和营养学会(ESPGHAN)专家对 CMA 相关声明的投票结果:方法:3 个专家组就相同的 10 项陈述进行投票。每位参与者采用 0-9 分制进行匿名投票(≥6 分表示同意;结果:......):3 个专家组达成了广泛共识。大家一致认为,婴儿肠绞痛作为一种单一表现并不能提示 CMA。所有小组都确认,在轻度/中度 CMA 病例中,广泛水解配方奶是首选的消除饮食;不过,水解大米配方奶也是一种替代选择。以氨基酸为基础的配方奶应保留给有严重症状的婴儿。关于大豆配方奶粉的投票结果的差异凸显了意见分歧。13 位西班牙国家卫生与健康委员会专家中有 2 位(15%)、14 位中东专家中有 1 位(7%)、26 位墨西哥专家中有 6 位(23%)不同意以下说法:大豆配方奶粉不应作为诊断性消除饮食的首选,但在某些情况下出于经济、文化和适宜性等原因可以考虑。所有 ESPGHAN 和墨西哥专家都认为,益生菌、益生元或合成益生菌对消除性饮食对 CMA 的疗效没有附加价值,而 14 位中东专家中有 3 位(21%)认为有足够的证据:尽管三组专家接受了所有声明,但由于地域、文化、成本和配方奶粉的供应情况不同,三组专家的观点也存在相关差异。这些发现强调了制定地区性指南的必要性。
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引用次数: 0
Lifelong medical challenges and immunogenetics of Turner syndrome. 特纳综合征的终身医疗挑战和免疫遗传学。
IF 3.2 Q1 PEDIATRICS Pub Date : 2024-11-01 Epub Date: 2024-07-31 DOI: 10.3345/cep.2024.00430
Won Kyoung Cho

Turner syndrome (TS) is a female phenotypic condition characterized by one or more typical clinical features and the partial or complete absence of a second X chromosome as determined by karyotype analysis. TS, among the most common chromosomal abnormalities, has an estimated prevalence of approximately 1 in 2,500 live-born females, with ethnic and racial differences. TS encompasses a wide array of medical challenges, including cardiovascular, endocrine, autoimmune, and mental health issues, as well as a heightened cancer risk. The somatic stigmata of TS are thought to arise from haploinsufficiency of the X chromosomes. This review explores the lifelong medical challenges and immunogenetics of individuals with TS and aimed to investigate strategies for preventing and managing TS while considering the implications of immunogenetics.

特纳综合征(Turner Syndrome,TS)是一种女性表型疾病,其特征是具有一种或多种典型的临床特征,并且通过核型分析确定部分或完全没有第二条X染色体。TS 是最常见的染色体异常之一,估计发病率约为每 2500 名活产女性中就有一名 TS 患者,但存在种族和人种差异。TS 包含一系列医学难题,包括心血管、内分泌、自身免疫和心理健康问题,以及更高的癌症风险。TS 的躯体特征被认为是由 X 染色体的单倍体缺陷引起的。本综述探讨了 TS 患者的终身医疗挑战和免疫遗传学,旨在研究预防和管理 TS 的策略,同时考虑免疫遗传学的影响。
{"title":"Lifelong medical challenges and immunogenetics of Turner syndrome.","authors":"Won Kyoung Cho","doi":"10.3345/cep.2024.00430","DOIUrl":"10.3345/cep.2024.00430","url":null,"abstract":"<p><p>Turner syndrome (TS) is a female phenotypic condition characterized by one or more typical clinical features and the partial or complete absence of a second X chromosome as determined by karyotype analysis. TS, among the most common chromosomal abnormalities, has an estimated prevalence of approximately 1 in 2,500 live-born females, with ethnic and racial differences. TS encompasses a wide array of medical challenges, including cardiovascular, endocrine, autoimmune, and mental health issues, as well as a heightened cancer risk. The somatic stigmata of TS are thought to arise from haploinsufficiency of the X chromosomes. This review explores the lifelong medical challenges and immunogenetics of individuals with TS and aimed to investigate strategies for preventing and managing TS while considering the implications of immunogenetics.</p>","PeriodicalId":36018,"journal":{"name":"Clinical and Experimental Pediatrics","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141876194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Mortality of very low birth weight infants by neonatal intensive care unit workload and regional group status. 按新生儿重症监护室工作量和地区组别划分的极低出生体重儿死亡率。
IF 3.2 Q1 PEDIATRICS Pub Date : 2024-11-01 Epub Date: 2024-09-12 DOI: 10.3345/cep.2023.01613
Sung-Hoon Chung, Chae Young Kim, Yong-Sung Choi, Myung Hee Lee, Jae Woo Lim, Byong Sop Lee, Ki-Soo Kim

Background: Very low birth weight infants (VLBWIs) continue to face high mortality risk influenced by the care quality of neonatal intensive care units (NICUs). Under-standing the impact of workload and regional differences on these rates is crucial for improving outcomes.

Purpose: This study aimed to assess how the structural and staffing attributes of NICUs influence the mortality rates of VLBWIs, emphasizing the significance of the availability of medical personnel and the regional distribution of care facilities.

Methods: Data from 69 Korean NICUs collected by the Korean Neonatal Network between January 2015 and December 2016 were retrospectively analyzed. The NICUs were classified by various parameters: capacity (small, medium, large), nurse-to-bed ratio (1-4), and regional location (A, B, C). Pediatrician staffing was also analyzed and NICUs categorized by beds per pediatrician into low (≤10), medium (11-15), and high (≥16). The NICUs were classified by mortality rates into high-performance (1st and 2nd quartiles) and low-performance (3rd and 4th quartiles). Demographic, perinatal, and neonatal outcomes were analyzed using multivariate logistic regression to explore the association between NICU characteristics and mortality rates.

Results: This study included 4,745 VLBWIs (mean gestational age, 28.4 weeks; mean birth weight, 1,088 g; 55.4% male) and found significant variations in survival rates across NICUs linked to performance and staffing levels. High-performing NICUs, often with lower bed-to-staff ratios and advanced care levels, had higher survival rates. Notably, NICUs with 2 rather than 1 neonatologist were associated with reduced mortality rates. The study also underscored regional disparities, with NICUs in certain areas showing less favorable survival rates.

Conclusion: Adequate NICU staffing and proper facility location are key to lowering the number of VLBWI deaths. Enhancing staffing and regional healthcare equity is crucial for improving the survival of this population.

背景:受新生儿重症监护室(NICU)护理质量的影响,极低出生体重儿(VLBWI)仍然面临着很高的死亡率风险。目的:本研究旨在评估新生儿重症监护室的结构和人员属性如何影响极低出生体重儿的死亡率,强调医务人员的可用性和护理设施的区域分布的重要性:对韩国新生儿网络在 2015 年 1 月至 2016 年 12 月间收集的 69 所韩国新生儿重症监护室的数据进行了回顾性分析。新生儿重症监护室按各种参数分类:容量(小、中、大)、护士与床位比(1-4)和区域位置(A、B、C)。此外,还对儿科医生的配备情况进行了分析,并将新生儿重症监护室按儿科医生人均床位数分为低(≤10)、中(11-15)和高(≥16)。新生儿重症监护室按死亡率分为高绩效(第一和第二四分位数)和低绩效(第三和第四四分位数)。采用多变量逻辑回归分析了人口统计学、围产期和新生儿结局,以探讨新生儿重症监护室特征与死亡率之间的关系:这项研究共纳入了 4,745 例超低体重儿(平均胎龄 28.4 周;平均出生体重 1,088 克;55.4% 为男性),发现各新生儿重症监护室的存活率存在显著差异,这与绩效和人员配置水平有关。绩效高的新生儿重症监护室通常床位与工作人员的比例较低,护理水平较高,存活率也较高。值得注意的是,有两名而非一名新生儿科医生的新生儿重症监护室死亡率较低。研究还强调了地区差异,某些地区的新生儿重症监护室存活率较低:结论:充足的新生儿重症监护室人员配备和适当的设施位置是降低低体重儿死亡人数的关键。加强人员配备和地区医疗保健的公平性对于提高这一人群的存活率至关重要。
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引用次数: 0
Role of nonpharmacological concussion management in children: systematic review of randomized controlled trials. 儿童脑震荡非药物治疗的作用:随机对照试验的系统回顾。
IF 3.2 Q1 PEDIATRICS Pub Date : 2024-11-01 Epub Date: 2024-10-28 DOI: 10.3345/cep.2023.01256
Andre Marolop Pangihutan Siahaan, Alvin Ivander, Rr Suzy Indharty, Steven Tandean, Anastasia Grace Milenia Ginting, Masrini Ginting, Felix Khosasi, Elbert

Concussion is a global public health problem that affects many children worldwide. Most patients present with postconcussion syndrome and normal brain imaging findings. Despite the high incidence of concussion in children, published research on nonpharmacological management is lacking and much more often concerns pharmacological interventions. This systematic review aimed to evaluate the role of nonpharmacological interventions in managing concussion based on randomized controlled trials. The PubMed, Scopus, Web of Science, and Cochrane databases were extensively searched for articles published between January 2013 and July 2023. A modified patient intervention, comparison, and outcome framework was used to construct the search strategy and eligibility criteria. Risk of bias was assessed using the Risk of Bias-2 tool. A total of 16 studies conducted between January 2013 and July 2023 were analyzed. Three studies were conducted in an acute care setting (<24-hour postinjury) involving rest, computer time, and doing nothing, while the other 13 studies were conducted in a chronic care setting (>24-hour postinjury) and included aerobic exercise, collaborative care intervention, cervical spine rehabilitation, education by physiotherapists, a hyperbaric oxygen therapy protocol, family intervention therapy, virtual reality, traditional occupational therapy, virtual rehabilitation, oculomotor control exercises, vestibular rehabilitation, coordination exercises, and balance exercises. This systematic review highlights the importance of nonpharmacological therapy in pediatric concussion cases. Active rehabilitation may yield promising outcomes. Another interesting approach may be useful in pediatric concussion management. However, this systematic review shows a lack of high-quality literature supporting nonpharmacological pediatric concussion treatments.

脑震荡是一个全球性的公共卫生问题,影响着全世界许多儿童。大多数患者表现为脑震荡后综合征,脑成像结果正常。尽管儿童脑震荡的发病率很高,但已发表的有关非药物治疗的研究却很缺乏,更多的是涉及药物干预。本系统综述旨在根据随机对照试验,评估非药物干预在脑震荡治疗中的作用。我们在 PubMed、Scopus、Web of Science 和 Cochrane 数据库中广泛检索了 2013 年 1 月至 2023 年 7 月间发表的文章。在制定检索策略和资格标准时,使用了修改后的患者干预、比较和结果框架。使用 Risk of Bias-2 工具评估了偏倚风险。共分析了 2013 年 1 月至 2023 年 7 月期间进行的 16 项研究。其中三项研究是在急性护理环境(伤后 24 小时)中进行的,包括有氧运动、协作护理干预、颈椎康复、理疗师教育、高压氧治疗方案、家庭干预治疗、虚拟现实、传统职业疗法、虚拟康复、眼球运动控制练习、前庭康复、协调练习和平衡练习。本系统综述强调了非药物疗法在小儿脑震荡病例中的重要性。积极的康复治疗可能会产生良好的效果。另一种有趣的方法可能有助于小儿脑震荡的治疗。然而,本系统综述显示,缺乏高质量的文献支持非药物治疗小儿脑震荡。
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引用次数: 0
Impact of COVID-19 pandemic on healthcare provision in youth with systemic lupus erythematosus. COVID-19 大流行对患有系统性红斑狼疮的青少年医疗保健服务的影响。
IF 3.2 Q1 PEDIATRICS Pub Date : 2024-11-01 Epub Date: 2024-10-28 DOI: 10.3345/cep.2024.00689
Punchita Apisrinitirath, Nuanpan Siripen, Pornpimol Rianthavorn
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引用次数: 0
Short-term outcomes of oropharyngeal administration of colostrum in preterm neonates: a double-blind placebo-controlled randomized trial. 早产新生儿口咽初乳的短期疗效:双盲安慰剂对照随机试验。
IF 3.2 Q1 PEDIATRICS Pub Date : 2024-10-31 DOI: 10.3345/cep.2024.00591
Ameneh Lamsehchi, Maryam Shokouhi Solgi, Mohammad Kazem Sabzehei, Behnaz Basiri, Elahe Talebi Ghane, Kiana Kimiayi Asadi, Sina Azadnajafabad

Background: The oropharyngeal administration of colostrum (OAC) in neonates has several benefits.

Purpose: To investigate the short-term outcomes of OAC in preterm neonates.

Methods: We performed this two-arm, double-blind, placebo-controlled randomized trial at a tertiary neonatal center in Iran in 2021-2023. The intervention and control arms received 0.2 mL of their mother's colostrum or distilled water via oropharyngeal administration every 6 h for 3 days starting from birth until 72 h of age. The main study outcomes were neonatal death, the incidence of necrotizing enterocolitis (NEC), sepsis, retinopathy of prematurity (ROP), length of hospital stay, and period to full enteral feeding. A regression analysis was used to adjust for possible confounders.

Results: A total of 126 neonates (mean gestational age, 30.05 weeks) were randomized to the intervention and placebo groups (n=63 each) and had a mean ± SD weight of 1247 ± 193 vs 1156 ± 215 g (P=0.013) and 1- and 5-min Apgar scores of 6.35 vs 5.38 (P=0.003) and 7.84 vs 7.13 (P=0.001), respectively. The mortality rate was 12.7% in the intervention group versus 14.3% in the placebo group (P=0.794). The NEC rate was significantly lower in the intervention versus placebo arm (11.1% vs. 28.6%, respectively; P=0.010), as was the clinically suspected sepsis rate (15.9% vs. 39.7%, respectively; P=0.004). The ROP and bronchopulmonary dysplasia rates did not differ significantly between groups after the adjustment for confounders. The mean length of hospital stay was shorter in the intervention group (26.1 vs. 37.32; P=0.023). Moreover, the mean duration of antibiotic therapy and period to full feeding were significantly shorter in the intervention group.

Conclusion: OAC could effectively decrease the incidence of complications in preterm infants and facilitate earlier patient discharge.

背景:给新生儿口咽初乳(OAC)有多种益处:目的:研究早产新生儿口咽初乳(OAC)的短期疗效:我们于 2021-2023 年在伊朗的一家三级新生儿中心开展了这项双臂、双盲、安慰剂对照随机试验。干预组和对照组新生儿从出生到 72 小时内,每 6 小时口咽给药一次,连续 3 天,每次给药 0.2 毫升母亲初乳或蒸馏水。研究的主要结果是新生儿死亡、坏死性小肠结肠炎(NEC)发病率、败血症、早产儿视网膜病变(ROP)、住院时间和完全肠内喂养时间。采用回归分析法对可能的混杂因素进行了调整:共有126名新生儿(平均胎龄30.05周)被随机分配到干预组和安慰剂组(各63名),其平均体重(±SD)分别为1247±193克与1156±215克(P=0.013),1分钟和5分钟Apgar评分分别为6.35分与5.38分(P=0.003)和7.84分与7.13分(P=0.001)。干预组的死亡率为12.7%,安慰剂组为14.3%(P=0.794)。干预组与安慰剂组相比,NEC 发生率明显降低(分别为 11.1% 对 28.6%;P=0.010),临床疑似败血症发生率也明显降低(分别为 15.9% 对 39.7%;P=0.004)。在对混杂因素进行调整后,ROP 和支气管肺发育不良的发生率在组间没有显著差异。干预组的平均住院时间更短(26.1 对 37.32;P=0.023)。此外,干预组的平均抗生素治疗时间和完全进食时间也明显缩短:结论:OAC 可有效降低早产儿并发症的发生率,并有助于患者尽早出院。
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引用次数: 0
Nonpharmacological interventions for managing postoperative pain and anxiety in children: A randomized controlled trial. 控制儿童术后疼痛和焦虑的非药物干预措施:随机对照试验。
IF 3.2 Q1 PEDIATRICS Pub Date : 2024-10-31 DOI: 10.3345/cep.2023.01690
Edlin Mathias, Mamatha Pai, Vijay Kumar, Dinesh Narayanakurup, Malavika Kulkarni, Vasudeva Guddattu, Ann-Cathrine Bramhagen, Baby Nayak, Anice George

Background: Hospitalizations and surgical procedures are unpleasant for both children and their parents. Therefore, postoperative pain assessments and management are less commonly performed in younger children than in adults.

Purpose: To evaluate the effects of nonpharmacological interventions on postoperative pain and anxiety in children.

Methods: In this randomized controlled trial, 160 children were randomly allocated to experimental (n=80) and control (n=80) groups. The children in the experimental group received age-appropriate distraction interventions for 3 postoperative days along with usual care. Children in the control group received standard care only. Each patient's pain was assessed using the EVENDOL pain scale, while their anxiety was measured using the modified Yale Preoperative Anxiety Scale. The data were analyzed using SPSS 23.0. Descriptive statistics (frequency, percentage, mean, and standard deviation) and repeated-measures analysis of variance were used to analyze the data.

Results: The children in the experimental group showed significantly decreased pain, anxiety, and physiological parameters (heart rate, respiratory rate, and oxygen saturation) compared to those in the control group. Significant intergroup differences were noted in the mean and standard deviation values of the pain, anxiety, and physiological parameters.

Conclusion: The distraction interventions provided by nurses reduced the pain and anxiety levels and improved the postoperative recovery of pediatric surgical patients.

背景介绍住院和手术过程对儿童及其父母来说都是令人不快的。目的:评估非药物干预对儿童术后疼痛和焦虑的影响:在这项随机对照试验中,160 名儿童被随机分配到实验组(80 人)和对照组(80 人)。实验组儿童在接受常规护理的同时,在术后 3 天内接受与年龄相适应的转移注意力干预。对照组儿童只接受标准护理。使用 EVENDOL 疼痛量表评估每位患者的疼痛程度,同时使用改良的耶鲁术前焦虑量表测量他们的焦虑程度。数据使用 SPSS 23.0 进行分析。数据分析采用了描述性统计(频率、百分比、平均值和标准差)和重复测量方差分析:与对照组相比,实验组患儿的疼痛、焦虑和生理参数(心率、呼吸频率和血氧饱和度)明显减少。疼痛、焦虑和生理参数的平均值和标准差在组间存在明显差异:护士提供的分散注意力干预降低了儿科手术患者的疼痛和焦虑水平,改善了他们的术后恢复。
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Clinical and Experimental Pediatrics
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