Clinical and Experimental Pediatrics最新文献

The endocrine system is a complex network of glands that produce and release hormones that regulate various physiological processes. In the past few decades, the human skin has been identified as an important peripheral endocrine organ that is the main site for the synthesis of vitamin D through exposure to sunlight. Mutations in downstream vitamin D-related gene pathways are associated with disease development. The vitamin D receptor (VDR) gene, which regulates the pleiotropic effects of vitamin D, has been extensively studied in adult populations. Several studies have reported the prevalence of vitamin D deficiency in children and adolescents. With changes in socioeconomic status and lifestyle, vitamin D-deficient individuals are prone to developing the disease at a young age. However, geographical and racial differences affect the association between VDR gene polymorphisms and vitamin D endocrine disorders, explaining the nonconsensus effects of polymorphisms and their association with disease development across populations. In this review, we discuss the connection between the vitamin D endocrine system and polymorphisms in the gene encoding VDR in children and adolescents, focusing on its effects on growth, puberty, insulin resistance, and the immune system.

Background: Early development is characterized by considerable variability.

Purpose: This study aimed to examine the stability of developmental classifications using the revised Korean Developmental Screening Test (K-DST) in healthy term infants aged 4-6 and 10-12 months.

Methods: Data were obtained from the Korean Children's Environmental Health Study, a nationwide prospective birth cohort. Sixty-nine healthy term infants (26 boys, 43 girls) underwent serial K-DST assessments at 4-6 and 10-12 months of age, between August 2017 and December 2019.

Results: At 4-5 months, over 50% of infants were categorized in the ≥-1 standard deviation (SD) group, with the lowest prevalence in the gross motor domain (52.7%). Seven infants (10.1%) scored below -2 SD in at least one domain, most commonly in gross and fine motor domains (7.3%). At 10-12 months, over 70% of infants scored in the ≥-1 SD group, except in the language domain. Six infants (9.5%) scored below -2 SD in at least one domain, (cognition 4.8%, language 3.2%, gross motor 3.2%). Serial follow-up showed significant improvement, with many infants moving to the ≥-1 SD group, particularly in the gross motor domain (33.3%). Of the seven infants scoring below -2 SD at 4-5 months, only two remained in this category at 10-12 months.

Conclusion: Infants scoring below -2 SD on the revised K-DST 4-5 months questionnaire, especially in the gross motor domain, should undergo close monitoring and repeated evaluations in the absence of neurological abnormalities or developmental red flags.

Although humans are highly dependent on plastics from infancy to adolescence, these materials can degrade into ubiquitous microplastics (MPs) that affect individuals at every stage of life. However, information on the sources, mechanisms, detection techniques, and detrimental effects of MPs on children's health from infancy to adolescence is limited. Hence, here we identified and reviewed original research papers published in 2017-2023 across 11 database categories in PubMed, Google Scholar, Scopus, and Web of Science to improve our understanding of MPs with a focus on pediatric well-being. These studies found that milk and infant formulas are common sources of MP exposure in infants. Infant formula is the dominant source of MPs in babies, while plastic toys are a common source of MPs in toddlers. Adolescents are frequently exposed to MPs through the consumption of food contaminated with MPs and the use of plastics in food packaging. Water and air are sources of MP exposure in children from infancy through adolescence. This study thoroughly summarized how MP exposure in children of all ages causes cell damage and leads to adverse health effects such as cancer. With appropriate authorization from the relevant authorities, small amounts of human biological samples (10 g of feces) were collected from volunteers to assess the amounts of MPs in children with the aim of promoting pediatric well-being. The samples were then treated with Fenton's reagent, stored in glass jars, and filtered through nonplastic filters. Finally, MPs in children were quantified using stereomicroscopy and characterized using micro-Fourier transform infrared spectroscopy.

With recent rapid improvements in neonatal intensive care, the limit of viability has shifted downward to 22-23 weeks' gestation. The younger the gestational age of preterm infants, the higher the risk of survival despite severe neurodevelopmental impairments. For infants born at 22-23 weeks' gestation, the limit of viability, neurodevelopmental outcomes, and survival rates may be determined by the quality of proactive care. Owing to the high risk of severe neurodevelopmental impairment in 22-23 weeks' gestation, proactive care is sometimes withheld according to ethical or legal considerations, and there are significant differences in the provision of proactive care and survival rates across countries or institutions. Additionally, there are differing or even lacking guidelines regarding the care of these infants across countries and institutions. Japan and Sweden are countries with well-established national guidance and proactive care for infants born at 22-23 weeks' gestation, resulting in higher survival rates among them. In Korea, where there is an extreme shortage of neonatologists, maternal transfer before delivery at 22-23 weeks' gestation to high-activity regions with appropriate neonatal intensive care unit resources, such as adequate personnel and facilities similar to the centralized care model seen in Sweden, is crucial for improving the survival rates of infants born at 22-23 weeks' gestation. The survival of these infants largely depends on the quality of proactive care provided. This rate is not static and can be improved through proactive care based on national guidance and the implementation of enhanced neonatal intensive care practices, including centralization of care.

Background: Few studies have explored the polysomnographic features of children with obesity.

Purpose: This study aimed to explore the demographic and polysomnographic features of obese children and determine whether body mass index (BMI) could predict severe obstructive sleep apnea (OSA).

Methods: This cross-sectional study recruited obese children who underwent diagnostic polysomnography between January 2019 and March 2022. We explored demographic and anthropometric measures as well as polysomnographic abnormalities among them. We used receiver operating characteristic curves and logistic regression analyses to determine the optimal cutoff values of anthropometric variables for predicting severe OSA.

Results: A total of 132 children with obesity (76.5% male; mean age, 12.5±3.2 years) were included. Severe OSA was identified in 64 children (48.5%). Desaturation was observed in 59.8%, while 23.5% had hyperarousal, 20.5% had sleep-related hypoventilation, 60.6% had positional OSA, 40.2% had rapid eye movement-related OSA, and 5.0% had obesity hypoventilation syndrome. Among them, BMI (odds ratio [OR], 1.11; 95% confidence interval [CI], 1.05-1.17; P<0.001), neck circumference (OR, 1.15; 95% CI, 1.07-1.25; P<0.001), and waist circumference (OR, 1.04; 95% CI, 1.02- 1.07; P=0.001) were significantly associated with severe OSA. These findings suggest a cutoff BMI for predicting severe OSA of greater than 29.2 kg/m2 with 81.3% sensitivity and 48.5% specificity.

Conclusion: Severe OSA is common in children with obesity; thus, we recommend screening children with obesity and a BMI greater than 29.2 kg/m2 for severe OSA.

Background: The widespread dissemination of carbapenem- resistant gram-negative bacteria poses a significant threat to global public health.

Purpose: This study aimed to investigate the prevalence of carbapenem resistance in gram-negative bacteria isolated from patients at the Children's Medical Center Hospital, Tehran, Iran, to understand the molecular mechanisms underlying this resistance.

Methods: During the period spanning from June 2019 to June 2020, 777 gram-negative bacterial strains were isolated. Antibiotic susceptibility testing was performed according to Clinical and Laboratory Standards Institute. Polymerase chain reaction was used to detect carbapenem resistance genes including bla OXA23, bla OXA24, bla OXA48, bla OXA51, bla OXA58, bla OXA143, bla KPC, bla IMP, bla VIM, and bla NDM.

Results: Among the total bacterial isolates, 141 (18.1%) exhibited carbapenem resistance. Escherichia coli was the most prevalent (57.4%), followed by Klebsiella pneumoniae (11.3%), and Acinetobacter baumannii (10.6%). Other notable contributors included Enterobacter spp. (5.7%), Salmonella spp. (3.5%), and Stenotrophomonas maltophilia (2.8%). Citrobacter spp., Proteus mirabilis, and Pseudomonas aeruginosa contributed to the distributions of 2, 1, and 3 isolates, respectively. Notably, bla OXA48 showed the highest prevalence (33%), followed by bla OXA143 and bla OXA5 8 (27% and 24%, respectively). In addition, bla OXA24 was present in 11% of the total isolates, bla OXA23 in 10%, and bla NDM in 10%, whereas bla KPC, bla VIM, and bla IMP were not detected.

Conclusion: Our study highlights the prevalence of carbapenemase- producing gram-negative isolates among pediatric patients. Notable resistance patterns, especially in K. pneumoniae and E. coli, underline the urgent need for proactive interventions, including appropriate antibiotic prescription practices and strengthening of antibiotic stewardship programs.

Background: Central precocious puberty (CPP) is typically treated with gonadotropin-releasing hormone (GnRH) agonists. Although numerous GnRH agonist variants are available, limited research has compared the efficacy of leuprolide acetate and triptorelin pamoate administered at 3-month intervals.

Purpose: This study aimed to assess the efficacy of CPP treatment with triptorelin pamoate and leuprolide acetate administered at 3-month intervals.

Methods: This retrospective cohort study included 116 girls with CPP: 71 treated with leuprolide acetate every 3 months and 45 treated with triptorelin pamoate every 3 months. Anthropometric measurements were compared before and after therapy. At 6 months after the therapy, luteinizing hormone (LH) suppression was evaluated.

Results: When administered every 3 months, leuprolide acetate and triptorelin pamoate significantly suppressed LH. The predicted adult height (PAH) and degree of bone age advancement at the end of treatment were comparable.

Conclusion: Treatment with leuprolide acetate and triptorelin pamoate every 3 months did not have significantly different effects on LH suppression or PAH.

Background: Diagnosing and predicting neonatal sepsis is challenging because of its nonspecific symptoms, lack of diagnostic criteria consensus, and absence of early, sensitive, and specific diagnostic laboratory tests.

Purpose: To evaluate the diagnostic and prognostic potential of adrenomedullin (ADM), interleukin-6 (IL-6), and C-reactive protein (CRP) in late-onset neonatal sepsis (LOS).

Methods: We studied 53 neonates with culture-proven LOS by sampling at admission and on antibiotic treatment days 3 and 7. These data were compared with those of 22 healthy full-term controls sampled on day 3 before hospital discharge. Survivors and non-survivors in the sepsis group were analyzed separately.

Results: Coagulase-negative Staphylococcus was the most commonly detected pathogen. ADM (cutoff, 0.5 ng/mL) and CRP (cutoff, <5 mg/L) values aligned with manufacturer recommendations, while IL-6 levels (cutoff, 10 pg/mL) were higher than expected, likely due to labor stress. The median biomarker levels significantly distinguished neonates with sepsis from controls (p < 0.0001) at all time points with ADM and IL-6 levels elevated at admission, indicating their potential as early diagnostic markers. CRP level was diagnostically useful starting on day 3. Prognostically, IL-6 (p < 0.001) and ADM (p < 0.05) differentiated survivors from non-survivors; however, only IL-6 consistently predicted mortality at all time points (area under the curve [AUC] > 0.90). ADM and CRP levels showed poor prognostic value (AUC < 0.70). ADM and IL-6 demonstrated strong diagnostic utility in early LOS, whereas CRP became relevant later. IL-6 was the only reliable biomarker for predicting mortality, supporting its integration into clinical protocols. Combining IL-6 with CRP may enhance early detection and management, potentially improving neonatal outcomes.

Conclusion: IL-6 is a robust biomarker for the early diagnosis and prognosis of LOS. Incorporating IL-6 into clinical practice with CRP could improve early neonatal LOS diagnosis and patient outcomes.