Clinical and Experimental Pediatrics最新文献

Background: Adequately powered studies in children are scarce and there are reports on the risk of carbon dioxide (CO2) retention after colonoscopy.

Purpose: This study investigated the efficacy and safety of CO2 insufflation in children undergoing colonoscopy.

Methods: This prospective randomized clinical trial was conducted at a tertiary care hospital between March 2023 and July 2024. We recruited 200 consecutive children (age, 5-18 years; n=100 in each arm) who underwent colonoscopy under conscious sedation. Patients were randomized to receive CO2 or room air using a random number table. The primary outcome measure was postprocedural pain assessed by using a visual analogue scale (VAS). Secondary outcome measures included time to reach the cecum, total procedure duration, abdominal distension, and end-tidal (ET) CO2 level. Complications were recorded.

Results: Pain scores at 2 and 4 hours postprocedure were significantly lower in the CO2 versus room-air group (1.12 vs. 1.66, P=0.001 at 2 hours and 0.37 vs. 0.61, P=0.002 at 4 hours). The time to reach the cecum was significantly higher in the CO2 group (39.6 vs. 26.6 min, P=0.01). A greater proportion of children in the room-air group (29% vs. 19%, P=0.04) reported significant pain (VAS score, ≥3). The subgroup analysis revealed a significantly longer time to reach the cecum and total procedure duration in the CO2 group among first-year trainees. ET-CO2 levels were significantly higher in the CO2 group (36 [interquartile range, 35-37] mmHg vs. 34 [interquartile range, 32-35] mmHg, P=0.001), but none developed any signs of CO2 retention. No significant intergroup differences were noted in abdominal girth, bloating sensation, analgesic requirements, or procedure-related complications.

Conclusions: CO2 insufflation is safer and makes the procedure less painful but slower than room-air insufflation, especially in first-year trainees, without an increased risk of retention.

Background: Functional gastrointestinal disorders (FGIDs) are associated with various gastrointestinal (GI) and non-GI symptoms, risk factors for which commonly include psychosocial and physical stresses.

Purpose: This study aimed to compare somatic symptom severity between children with FGIDs and healthy controls during acute illnesses.

Methods: This was a prospective descriptive cross-sectional study whose inclusion criterion was age 4-18 years. Children were classified into FGID and control groups using the Rome IV diagnostic criteria. Somatic symptom severity was estimated using a visual analogue scale (VAS) and the Children's Somatic Symptoms Inventory-24 (CSSI-24) questionnaire and compared between groups.

Results: Ninety-three children, including 40 with FGIDs (43%), were enrolled. The FGID group had statistically significantly higher VAS scores for abdominal pain than controls (2.93±3.68 vs. 0.72±2.08, P<0.001). However, no significant intergroup differences were noted in VAS scores for nausea (P=0.493) or headache (P=0.311). For somatization symptoms, the CSSI-24 total (20.58±18.32 vs. 7.06±10.49, P<0.001), GI symptom (9.60±7.48 vs. 2.43±3.39, P≤0.001) and non-GI symptom (10.98±11.67 vs. 4.62±7.88, P< 0.001) scores were significantly higher for the FGID versus control groups, respectively.

Conclusion: Children with FGIDs exhibited more significant somatic symptoms than controls during acute illnesses. GI and non-GI manifestations were significantly more common in children with FGIDs.

Background: To evaluate the outcomes of jaundiced neonates using 2 different total serum bilirubin (TSB) thresholds for discontinuing phototherapy.

Purpose: The study aims to evaluate the outcomes of jaundiced neonates by comparing 2 different TSB thresholds for discontinuing phototherapy.

Methods: All consecutive jaundiced neonates in a tertiary care hospital with a gestational age of ≥35 weeks and ≥3 days postnatal age were randomly assigned to 2 groups.

Results: Eighty neonates were included. The mean±standard deviation TSB at the time of phototherapy discontinuation was 13.1±2.2 mg/dL in the recommended threshold group and 10.5±2.5 mg/dL in the low threshold group. After discontinuing phototherapy, 17 infants in the recommended threshold group and 21 in the low threshold group experienced an increased TSB, with 3 and 9 crossing the treatment threshold, respectively. Following the National Institute for Health and Clinical Excellence (NICE) guidelines, there was a 14.3% increase in the reinstitution of treatment, averaging 28.11 hours with no reported adverse outcomes.

Conclusion: Discontinuation of phototherapy in neonates led to increased TSB levels, with a reinstitution rate of 14.3%. While adherence to the NICE guidelines is important, careful posttreatment monitoring is essential. Incorporating the 2022 American Academy of Pediatrics guidelines into future research could provide a more comprehensive understanding of safe practices in this area.

Background: Autoimmune hemolytic anemia (AIHA) is rare and characterized by hemolytic anemia with a positive direct antiglobulin test result after the exclusion of other causes. While adults often relapse within 1 year of first-line steroid therapy, children generally respond well. However, current treatment approaches lack substantial evidence and are primarily expert opinion-based.

Purpose: This study aimed to contribute our single-center experience to pediatric AIHA treatment guidelines.

Methods: Between January 2012 and June 2024, 475 children were diagnosed with anemia; of them, 18 had immune hemolytic anemia, including 6 with neonatal alloimmune hemolytic anemia, 2 who were treated at other centers, and 2 with transient bone marrow suppression due to a viral infection. Thus, this study retrospectively analyzed the treatment responses of 8 patients with AIHA.

Results: The median age at diagnosis was 5.2 years (range, 2.3-11.8 years); 62.5% (5 of 8) were male. Median hemoglobin (Hb) at diagnosis was 6.3 g/dL (range, 3.4-9.5 g/dL), median reticulocyte index was 6.53% (range, 1.64%-22.07%), median total bilirubin was 2.75 mg/dL (range, 0.98-7.23 mg/dL), and median lactate dehydrogenase was 1,662 U/L (range, 790-2,921 U/L). All haptoglobin levels were <10 mg/dL. Treatments included steroids (8 of 8), red blood cell transfusions (5 of 8), and intravenous immunoglobulins (2 of 8). Half of the steroid-treated patients received intravenous methylprednisolone for 1-5 days, while half received oral prednisolone (median, 1.78 [range, 0.79-3.39] mg/kg/day). The median time to age-adjusted normal Hb levels was 16.5 days (range, 9.0-22.0 days). Steroids were administered for a median 37.5 days (range, 14.0-119.0 days). Excluding one patient later diagnosed with systemic lupus erythematosus, no relapses occurred during the 3- to 19-month follow-up period.

Conclusion: Patients with pediatric AIHA showed relapsefree rapid hematological improvement and sustained steroid responses within 2 months, suggesting that systematic steroid treatment is feasible and highlighting the need for multicenter trials to establish standardized guidelines.

Background: Although national population-based birth defect prevalence estimates are unavailable for Bangladesh specifically, data extrapolated from the March Dimes Global Birth Defects Report indicate a prevalence of neural tube defects (NTDs) of 4.7 per 1,000 live births.

Purpose: This study aimed to determine the prevalence of NTD among infants born at a tertiary care multidisciplinary referral hospital in Bangladesh.

Methods: Live born infants with NTD were prospectively enrolled in 2015-2021. Each enrolled NTD case was examined for type, location, and associated anomalies. The overall and annual prevalence rates were then calculated.

Results: A total of 10,372 newborns were enrolled; of them, 68 had NTD (incidence, 6.4 [range, 4.59-11.2] per 1,000 live births). The mean maternal age was 27.49± 4.72 years. Three-quarters of the NTD cases were detected at birth, and 94% of the mothers reported not taking periconceptional folic acid supplements. The meningomyelocele complex was the most frequent location. Two peaks in incidence were noted in 2017 and 2021 (10.28 and 11.2 per 1,000 live births, respectively). The distribution of different NTD types included meningomyelocele at 53%, encephalocele at 26.6%, meningocele at 16%, and anencephaly at 4.4%. A male predominance was noted overall except for anencephaly. The most common location was the lumbosacrum (47%). The NTD was isolated in 20.59% (14 of 68) of cases and associated with other malformations in 80% (54 of 68) of cases.

Conclusion: The incidence of NTD was 6.4 per 1,000 live births at a leading tertiary care multidisciplinary referral center in Bangladesh. However, this figure might not reflect the incidence of NTD in the wider population.

Among neonates, hypoxic-ischemic encephalopathy is the most significant cause of mortality and hypoxia-ischemia is among the leading causes of brain damage. The microglia are primary mediators of neuroinflammation. NOD-like receptor family pyrin domain containing 3 (NLRP3) inflammasome activation is the first line of defense in the central nervous system. Numerous studies have shown that the NLRP3 inflammasome is activated and proinflammatory cytokines are upregulated upon hypoxia-ischemia-induced brain damage. However, aberrant activation of the NLRP3 inflammasome results in cell death and brain tissue damage. Given that neonates are particularly vulnerable to neuroinflammation, which may cause lifelong disabilities, it is important to target the pathways involved in its complex nature to improve their prognosis. The potential use of compounds or drugs that target inflammasome activation to relieve hypoxia-induced brain damage has become significant. This review describes the NLRP3 inflammasome in neonates to contribute to the development of therapeutic approaches.

Background: The neutrophil-to-lymphocyte ratio (NLR) is a marker of systemic inflammation associated with various diseases including respiratory conditions. However, the relationship between NLR and asthma in the pediatric population remains underexplored.

Purpose: This study aimed to explore the association between NLR and asthma in children and adolescents and assess its potential role as a predictive biomarker for pediatric asthma.

Methods: We retrospectively analyzed the medical records of 12,974 children and adolescents from the National Health and Nutrition Examination Survey in 2011-2020. NLR was defined as the ratio of NLR counts. Asthma was diagnosed using a structured questionnaire. Multivariate logistic regression models were used to evaluate the association between NLR and asthma. A restricted cubic spline was used to explore nonlinear relationships, and a threshold analysis was conducted to identify potential cutoff values for the NLR.

Results: A total of 12,974 children and adolescents were included (male: 6,686 [51.5%]; mean [interquartile range] age, 10 [5.0-14.0 years]). After the adjustment for confounders, participants with the highest versus lowest NLR exhibited a significantly elevated risk of asthma (odds ratio [OR], 1.39; 95% confidence interval [CI], 1.13-1.71). Additionally, a multivariate restricted cubic spline analysis revealed a nonlinear relationship between NLR and asthma (P=0.023). A threshold analysis revealed that an NLR<2.23 was significantly associated with an increased risk of asthma (OR, 1.23; 95% CI, 1.05-1.45), while an NLR≥2.23 showed no significant association. A subgroup analysis revealed no interactive role of NLR and asthma.

Conclusion: Our findings indicate a nonlinear saturation-effect relationship between NLR and asthma in children and adolescents.