Background: Pediatric intensive care units (PICUs) have undergone significant evolution, resulting in a reduction in patient morbidity and mortality rates. Telemedicine has emerged as a valuable resource for services that optimize the care processes in PICUs. Despite growing interest in telemedicine for pediatric critical care, its impact on mechanically ventilated (MV) children in public health settings in Brazil remains underexplored.
Purpose: This study aimed to evaluate the effect of telemedicine on the care of MV patients in 2 public PICUs in Brazil.
Methods: This prospective pre-post interventional study was conducted in 2 public PICUs in the Northern and Northeastern regions of Brazil. Patients aged 0-18 years who received ventilatory support between January 1, 2019, and December 31, 2021, were included. The intervention consisted of daily synchronous telerounds conducted by pediatric intensivists from Hospital Moinhos de Vento who provided clinical consultation and ensured protocol adherence. The primary evaluated outcomes included mortality, ventilator-free days (VFD), and MV duration.
Results: A total of 790 patients were analyzed: 261 in the pretelemedicine period and 529 in the posttelemedicine period. The overall mortality rate decreased significantly from 20.7% to 10.4% (P<0.001). In center A, mortality decreased from 25.96% to 9.86% (P<0.001); in center B, mortality decreased from 17.2% to 11.06% (P=0.11). The overall VFD increased significantly from 3 days (interquartile range, 0-7) to 4 days (interquartile range, 2-8) (P<0.001). No significant differences were noted in total MV duration in the general analysis.
Conclusion: The implementation of telemedicine in public PICUs significantly reduced mortality and increased VFD among MV patients. These findings support telemedicine as a viable and promising strategy for enhancing pediatric critical care in public health systems, thereby contributing to improved patient outcomes.
Background: Childhood-onset lupus nephritis (cLN) is an aggressive disease. Although histological class has historically guided its treatment, its prognostic value remains limited. Although the National Institutes of Health (NIH)-modified activity index (AI) and chronicity index (CI) incorporate glomerular and tubulointerstitial changes and may provide better prognostic insight, their utility in cLN is not well established.
Purpose: Here we aimed to assess the utility of the NIH-modified-modified AI and CI for predicting kidney outcomes and identify histopathological features and treatment-related factors associated with the development of kidney function impairment in cLN.
Methods: We retrospectively analyzed 60 children with biopsy-proven proliferative lupus nephritis. Their baseline clinical and histological features, treatments, and outcomes were assessed. The association between AI and CI scores, along with individual histological components, and kidney function impairment, defined as an estimated glomerular filtration rate < 90 mL/min/1.73 m² sustained for ≥3 months, was evaluated.
Results: Over a median follow-up of 55.5 months, 30% of patients developed kidney function impairment. AI scores and glomerular lesions did not differ significantly between patients with and without kidney function impairment. However, the CI scores were significantly higher in patients who developed kidney function impairment, with tubular atrophy and interstitial fibrosis being the most predictive components. On a multivariate analysis, tubular atrophy was an independent predictor of kidney function impairment (hazard ratio [HR], 17.74; 95% confidence interval [CI], 1.94-162.5; P=0.01). Use of mycophenolate mofetil (MMF) as maintenance therapy was associated with a reduced risk of kidney function impairment (HR, 0.09; 95% CI, 0.02-0.47; P=0.003).
Conclusion: Chronic tubulointerstitial changes, particularly tubular atrophy, are a stronger predictor of longterm kidney function than glomerular findings or AI scores. These findings highlight the prognostic value of NIH-modified CI and the importance of MMF in maintenance therapy. The early identification of chronic lesions on biopsy may guide therapeutic decisions aimed at preserving kidney function and improving long-term outcomes in patients with cLN.
Background: Early adiposity rebound (AR) is a key predictor of later obesity and metabolic risk, yet modifiable factors related to early AR remain understudied in large populations.
Purpose: To quantify the prevalence of early AR at age 3 years and identify modifiable correlates in a population‑based cohort of Japanese preschool children.
Methods: We retrospectively analyzed health-check records for 74,466 children who attended both 1.5- and 3-year examinations (2014-2019). Body mass index (BMI) values were converted to World Health Organization z scores; early AR was defined as any increase in BMI between 1.5 and 3 years. Multivariable logistic regression adjusted for birth weight category, sex, household structure, sleep duration, and behavioral factors.
Results: Early AR occurred in 18,673 children (25%), whereas obesity (BMI z score ≥1.64) was present in 4% at 3 years. After controlling the adjustments, routine breakfast consumption (odds ratio [OR] 0.88; 95% confidence interval [CI], 0.81-0.97) and regular napping at 1.5 years (OR, 0.84; 95% CI, 0.79-0.90) were independently associated with reduced odds of early AR, while obesity at 1.5 years strongly predicted early AR (OR, 4.32; 95% CI, 4.00-4.67). Routine juice intake or fast-food consumption showed no significant associations.
Conclusion: In this population‑based cohort, one in 4 preschoolers had early AR by age 3. Simple daily routines-eating breakfast and maintaining regular sleep-may help delay AR and offer actionable targets for early obesity prevention.
Background: Although most neonatal disorders are preventable, their global burden has not been comprehensively investigated in the context of underlying epidemiological patterns. Thus, here we conducted the first comprehensive assessment of the global burden of neonatal disorders and their 5 subtypes in 1990-2021 with projections through 2050.
Purpose: To comprehensively assess the global burden of neonatal disorders in 1990-2021 and forecast trends through 2050 considering their significant contribution to infant mortality.
Methods: We estimated the global burden of neonatal disorders (preterm birth, encephalopathy due to birth asphyxia and trauma, hemolytic disease and other neonatal jaundice types, sepsis, and other neonatal infections) and their attributable risk factors, including low birthweight, short gestation, household air pollution, and ambient particulate matter, using data from the Global Burden of Disease Study (GBD) 2021. Population attributable fractions were used to calculate the rates of age-standardized incidence (ASIR), mortality (ASMR), and disability-adjusted life years (ASDR) stratified by age, sex, sociodemographic index (SDI), and region. The disease burden forecasted through 2050 was evaluated by projection modeling using the GBD framework.
Results: From 1990 to 2021, the ASIR, ASMR, and ASDR for neonatal disorders decreased: 466.94 (95% uncertainty interval, 461.65-473.62) to 437.43 (433.20-441.95), 46.06 (43.66-48.81) to 29.57 (25.37-34.26), and 4,343.25 (4,121.18-4,595.48) to 2,941.00 (2,547.76-3,384.20) per 100,000 population, respectively. Males (489.90 [484.15-495.69]) exhibited a higher rate of the age-standardized incidence for neonatal disorders. The burden of neonatal disorders was markedly higher in countries with lower SDI scores. Neonatal preterm birth is the leading cause of neonatal disorders in both sexes. Among 4 risk factors, a low birthweight contributed the most to the ASDR of neonatal disorders (2,227.54 [1,939.96-2,563.52]). The global ASDR for neonatal disorders is projected to decline from 2,022 (2,317.01 [1,982.04-2,700.43]) to 2,050 (1,230.57 [950.09-1,590.15]).
Conclusion: Although the overall burden of neonatal disorders has decreased, substantial disparities have persisted across SDI levels with the highest burden observed in low-SDI countries. Among the subtypes, a preterm neonatal birth accounted for the highest burden, whereas a low birthweight was the most significant risk factor. To achieve global child health targets, it is essential to address regional disparities and promote equity in access to healthcare services and health outcomes.
Background: Most children recover after an initial acute pancreatitis (AP) episode; however, some progress to recurrent AP (RAP) or chronic pancreatitis (CP).
Purpose: We aimed to quantify progression rates and identify the risk factors associated with these transitions.
Methods: PubMed/MEDLINE, Embase, and Cochrane databases were searched on December 21, 2024, for pediatric studies reporting progression to RAP or CP (PROSPERO number: CRD420251086520). All observational studies were included, while case reports and case series were excluded. To evaluate the differences in RAP rates, we conducted subgroup analyses of etiology and severity. We also assessed clinical, structural, and genetic risk factors for disease progression. A random-effects model was used to pool proportions and odds ratios (OR) with 95% confidence intervals (CI). Heterogeneity was assessed using the I² statistic.
Results: A total of 68 studies met the inclusion criteria. After the first AP attack, RAP developed in 18% (95% CI, 16-22%; I2=76%; k=39 studies) and CP developed in 10% (95% CI, 6-16%; I2=67%; k=5 studies) of patients. Among children with RAP, 35% (95% CI, 24-49%; I2=78%; k=7 studies) progressed to CP. The RAP rates varied according to etiology and severity: hypertriglyceridemia, 33%; idiopathic, 28%; biliary, 19%; traumatic, 16%; drug-induced, 14%; virus-induced, 3%; severe, 39%; moderate, 24%; and mild, 21%. Structural abnormalities were associated with a higher risk of RAP (OR, 3.15; 95% CI, 1.51-6.56; I2=0%; k=5 studies). Pancreas divisum (OR, 2.64; 95% CI, 1.51-4.63; I2=17%; k=7 studies) and PRSS1 mutation (OR: 4.56; 95% CI, 3.06-6.80; I2=0%; k=7 studies) were associated with CP.
Conclusion: Approximately one in five pediatric AP episodes recurred, and over one-third of the RAP cases progressed to CP. The risk of RAP is influenced by the underlying etiology and severity of the initial episode, whereas structural and genetic factors are associated with later progression.
Sacral dimples are the most common cutaneous anomalies in newborns. While usually benign anatomical variants, some dimples are indicative of occult spinal dysraphism, such as a tethered cord, dermal sinus tract, or lipomyelomeningocele, that, if undiagnosed, may cause irreversible neurological, orthopedic, and urological deficits. Distinguishing benign from high-risk dimples is essential for timely intervention. This review summarizes the embryological origins, diagnostic criteria, imaging approaches, and management strategies for sacral dimples to help clinicians identify cases requiring further evaluation. A comprehensive literature review examines the embryology of caudal spinal development, classification of spinal dysraphism, and studies of the diagnostic accuracy of ultrasonography and magnetic resonance imaging (MRI) in infants with sacral dimples. Guidelines and high-quality studies of the surgical outcomes of tethered cords and related anomalies were also analyzed. The literature search and study selection followed the Preferred Reporting Items for Systematic Reviews and Meta- Analyses flow. Simple sacral dimples-solitary midline depressions less than 5 mm in diameter, located within 2.5 cm of the anus, and lacking associated cutaneous stigmata-are not associated with spinal dysraphism and do not require imaging. In contrast, atypical dimples (large, deep, off-midline, or associated with skin markers such as hair tufts or hemangiomas) are significantly associated with occult anomalies and warrant imaging, beginning with spinal ultrasonography in neonates and MRI in older infants or equivocal cases. Conditions such as tethered cord, dermal sinus tract, lipomyelomeningocele, and split cord malformations are best visualized using MRI. Early surgical detethering improves neurological, orthopedic, and bladder outcomes, whereas delayed intervention risks permanent deficits. Applying standardized criteria and targeted imaging avoids unnecessary investigations while ensuring a timely diagnosis of occult spinal dysraphism. Early recognition and appropriate surgical management, when indicated, are critical for preventing neurological deterioration and improving the prognosis of affected infants.
Childhood and adolescent obesity represent critical global health issues with a rising prevalence and associated cardiometabolic and psychosocial consequences. Pharmacotherapy has emerged as an adjunct treatment to lifestyle modifications in patients with severe obesity or a poor response to behavioral interventions. However, the ethnic and racial variations in drug efficacy and safety remain poorly understood. This systematic review aimed to determine whether ethnicity influences the efficacy and adverse effects of pharmacological treatments for pediatric obesity. A comprehensive literature search was conducted using PubMed, Embase, Scopus, and Cochrane Library databases for studies published between January 2000 and December 2024. Eligible randomized controlled trials included participants aged ≤18 years and reported ethnicity-specific outcomes for antiobesity pharmacotherapy. Of the 3,979 identified records, 4 randomized trials met the inclusion criteria and investigated liraglutide, metformin, phentermine/topiramate, and sibutramine. Across all studies, pharmacotherapy significantly reduced body mass index compared with placebo. This review provides a complete and clearly articulated conclusion reflecting these findings. However, consistent evidence is lacking of ethnicity-based differences in efficacy or safety. One trial suggested a possible trend of reduced responses among African American adolescents receiving sibutramine, although the findings were underpowered and exploratory. Common limitations include minority group underrepresentation, small subgroup sizes, heterogeneous outcome measures, and post hoc analyses of ethnicity. The risk of bias across trials ranged from low to some concern, primarily due to post hoc analyses, incomplete outcome data, and a lack of prespecified ethnicity-stratified outcomes, and limited confidence in the findings. Overall, the current evidence does not support major ethnicity-related differences in the pharmacological management of pediatric obesity, although the certainty of this evidence is low. Larger prospectively designed trials with prespecified ethnic subgroup analyses are urgently needed to establish equitable personalized approaches to pharmacotherapy for childhood obesity. (registration number: CRD42025117631).
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