Clinical and Experimental Pediatrics最新文献

Background: Temper tantrums are common behavioral difficulties in children. Although they are generally considered a normal part of development, certain characteristics-such as aggression, prolonged duration, and frequent occurrences-have been linked to psychological issues and can negatively impact both the child and their caregivers.

Purpose: To study the prevalence and characteristics of temper tantrums in children aged 1-6 years at daycare and in kindergarten in Thailand as well as the impact of problematic and non-problematic tantrums on their caregivers' emotional well-being.

Methods: This cross-sectional descriptive study was conducted in 2021. The main caregivers of the participants completed self-reported questionnaires that collected their demographic information and the temper tantrum characteristics and impacts on the caregivers' emotions.

Results: Data from 211 children were included in this study. The mean child age was 4.4 ± 1.2 years. Two hundred and one (95.3%) parents reported that their children had at least one tantrum behavior, of which verbal were the most common (94.5%). One hundred and eleven (55.2%) children had tantrums defined as problematic: exhibiting aggressive physical behavior, duration >15 min, frequency > 3 days/week. The mean emotional burden scores of the children's problematic and non-problematic temper tantrums on their parents were 23.3 ± 8.4 and 17.7 ± 8.3 (maximum, 55; p = 0.001), respectively, showing a statistically significant difference.

Conclusion: Tantrums are common in children aged 1-6 years, but their expression varies. Problematic tantrums were reported for approximately half of the children and significantly impacted their caregivers' emotions. Therefore, children with problematic tantrums and their families should receive assistance.

Background: High-frequency oscillatory ventilation (HFOV) minimizes ventilator-induced lung injuries. Spontaneous sigh breathing may augment the functional residual capacity, increase lung compliance, and recruit atelectatic alveoli.

Purpose: To evaluate the difference in the partial pressure of carbon dioxide (PaCO2) in neonates receiving invasive HFOV as the primary mode of respiratory support before versus after sigh breaths (Sighs).

Methods: This prospective study was conducted between January and December 2023. Intubated preterm and term neonates who underwent HFOV with an available arterial line were enrolled in this study after informed parental consent was obtained. Sighs were set at a frequency of 3 breaths/min and pressure of 5 cm H2O above the mean airway pressure for 2 hours. Arterial blood gas was collected before and after Sighs and analyzed using two dependent tests.

Results: Thirty neonates with a mean gestational age of 33.6±4.1 weeks and median date of intervention of 1.88 (interquartile range, 0.87-3.79) days were enrolled. The mean PaCO2 level was significantly lower in the HFOV with Sighs group (45.2±6.6 mm Hg) versus the HFOV alone group (48.8±3.1 mm Hg) with a mean difference (MD) of -3.6 mm Hg (95% confidence interval [CI], -6.3 to -0.9; P=0.01). Subgroup analyses indicated the ability of Sighs to reduce the PaCO2 level in neonates with respiratory distress syndrome (n=15; MD [95% CI] = -4.2 [-8.2 to -0.2] mm Hg; P=0.04).

Transabdominal ultrasonography is increasingly used as a novel modality for detecting pediatric functional constipation (FC). This systematic review and meta-analysis aimed to assess the diagnostic parameters of FC including rectal diameter (RD) and anterior rectal wall thickness. A systematic search was conducted of the Ovid MEDLINE, EMBASE, Scopus, and PubMed databases through September 29, 2023, to identify studies comparing RD and anterior wall thickness using transabdominal ultrasonography in children with versus without FC. Meta-analyses were performed using random-effects models to calculate the weighted mean differences in RD and anterior wall thickness. Comprehensive Meta-Analysis ver. 3, R, and Review Manager ver. 5.4.1 software were used to assess the optimal cutoff, sensitivity, specificity, and area under the curve (AUC). Fourteen studies involving 1,255 children (mean age, 6.21  2.3 years) were included. The mean RD was significantly larger in constipated children versus controls (mean difference [MD] = 10.35 mm; 95% confidence interval [CI], 6.97-13.74; P < 0.001; I2 = 94%). A meta-regression showed no significant effects of age, weight, or height on RD. An optimal RD cutoff point of 31 mm was suggested by a pooled analysis with an AUC of 0.86 (95% CI, 0.8-0.91; P < 0.001), sensitivity of 0.75 (95% CI, 0.59-0.86), and specificity of 0.84 (95% CI, 0.68-0.93). The mean anterior rectal wall thickness was greater among constipated children than among controls (MD = 0.44; 95% CI, -0.26 to 1.13; P = 0.22), but this difference was not statistically significant. RD measured using transabdominal ultrasonography with a cutoff point of 31 mm exhibited good diagnostic accuracy for diagnosing FC in children.

Background: Epidemiological data on pediatric inflammatory bowel disease (PIBD) have been reported in Asian countries. However, short-term follow-up data, especially in Southeast Asian countries, are limited.

Purpose: Analyze and compare the baseline and 1-year follow-up (1FU) data for PIBD in Asian children.

Methods: The multinational network included patients with PIBD (aged <19 years) in five Asian countries (Malaysia, Philippines, Singapore, Sri Lanka, and Thailand). The diagnosis of PIBD requires gastrointestinal endoscopy. The patients' demographics, clinical information, disease-related outcomes, and treatment data at 1FU were collected.

Results: In 1995-2021, 368 patients were enrolled (CD, 56.8%; UC, 38%; and IBD-unclassified, 5.2%). At 1FU, symptoms including diarrhea, bloody stools, and nausea/vomiting subsided in <3%, while abdominal pain persisted in 10.5% of patients with CD and 7.1% of patients with UC. Assessment endoscopy was performed at 1FU in 38% of CD and 31% of UC cases, of which 21% and 23% showed mucosal healing, respectively. Oral prednisolone was administered to 55.3% of patients at diagnosis and 26.8% at 1FU, while infliximab was administered to 2.5% and 7.2% of patients at diagnosis and 1FU, respectively. Independent factors of 1-year clinical remission for CD were oral prednisolone (odds ratio [OR], 0.20; 95% confidence interval [CI], 0.06-0.68), antibiotic use (OR, 0.09; 95% CI, 0.01-0.54), and immunomodulator use (OR, 5.26; 95% CI, 1.52-18.22). A history of weight loss at diagnosis was the only independent risk factor of an IBD flare by 1FU (OR, 2.01; 95% CI, 1.12-3.63).

Conclusion: The proportion of children with PIBD and abdominal pain at 1FU remained high. The rates of repeat endoscopy and infliximab use were suboptimal with high rates of systemic corticosteroid use. Quality improvement based on the aforementioned predictors may enhance PIBD care in this geographic region or similar settings.

Eosinophilic gastrointestinal disorders (EGIDs) are emerging as significant concerns in the Korean pediatric population and transitioning from rare to more commonly diagnosed conditions. This review discusses the increasing prevalence of EGID among children and adolescents and highlights the complexities involved in its diagnosis and management. This review begins with a thorough examination of the diverse clinical presentations of EGIDs in Korean children, with a special focus on common gastrointestinal symptoms such as abdominal pain, diarrhea, and bloody stool. Additionally, we explored extraintestinal manifestations, including growth failure, malnutrition, and associated allergic comorbidities, highlighting their importance in the clinical landscape of EGIDs. Because of its subtle and overlapping symptoms with those of other gastrointestinal disorders, EGID is frequently underdiagnosed. Addressing this challenge requires maintaining a high index of suspicion and employing a comprehensive diagnostic approach to differentiating EGID from functional gastrointestinal disorders (FGIDs) and other inflammatory or systemic diseases such as inflammatory bowel disease. The optimal management of EGID requires a collaborative multidisciplinary strategy that includes dietary management, regular monitoring, and tailored medical interventions. This review emphasizes the importance of proactive patient and caregiver education and regular follow-ups to improve long-term outcomes in affected children. Enhanced awareness among healthcare providers and better educational resources for families are critical for the early identification and effective management of EGID among pediatric patients.

Cultivating a 24-hour movement behavioral profile conducive to health and well-being, marked by adequate levels of physical activity, limited screen time, and sufficient sleep, has emerged as an important avenue for promoting pediatric health. We aimed to provide evidence of this potential, this multiphase, multimethod, and integrative review comprehensively investigated the global trends in health promotion initiatives and status of the Korean pediatric population. This integrative review comprised three phases employing various review methods: an environmental scan of existing guidelines for 24-hour movement behaviors worldwide, a rapid review of physical activity-related indicators from Global Matrix data, and a systematic review of 24-hour movement behaviors among children and adolescents in South Korea. The growing recognition of a holistic approach to the 24-hour movement behavior paradigm in pediatric health promotion has led to the establishment and adoption of 24-hour movement guidelines in different countries and by the World Health Organization (WHO). Korean health authorities have also responded to this need by releasing a translated report of the WHO guidelines for physical activity and sedentary behavior as well as the 2024 update of the Physical Activity Guidelines for Koreans. Accordingly, actions must be followed in policy, research, and practice. This is critical considering that Korean children and adolescents exhibit an unfavorable profile of 24-hour movement behaviors compared to the global average. Among those aged 0-6 years, the weighted averages for guideline adherence were 18.2% for physical activity, 38.1% for sedentary behavior, and 76.2% for sleep. For those aged 12-18 years, the weighted averages for guideline adherence were 20.4% for physical activity, 55.9% for sedentary behavior, and 26.2% for sleep. Building on these current findings, this integrative review provides three priorities for pediatric health promotion policy and practice and three recommendations for future research.

Background: Early development is characterized by considerable variability.

Purpose: To investigate the stability of the revised Korean Developmental Screening Test (K-DST) classification of the development of healthy term 4-6 and 10-12 month-old infants.

Methods: This study used data from the Korean Children's Environmental Health study, a nationwide prospective birth cohort study. Sixty-nine healthy term infants (26 boys, 43 girls) underwent two serial tests at 4-6 and 10-12 months of age between August 2017 and December 2019. We divided the entire group into three categories according to the revised K-DST cut-off points.

Results: At 4-5 months, more than 50% of infants were categorized into the ≥-1 standard deviations (SD) group. The lowest prevalence (52.7%) was observed in the gross motor domain. Seven infants (10.1%) scored below -2 SD in at least one domain. The prevalence of scores below -2 SD was 7.3% in the gross and fine motor domains. At 10-12 months, >70% were as categorized into the ≥-1 SD group except in the language domain. Six infants (9.5%) scored below -2 SD in at least one domain. The prevalence of scores below -2SD was 4.8%, 3.2%, 3.2% in the cognition, language, and gross motor domains, respectively. On serial follow-up for 4-12 months, a significant number of infants improved to the peer and high-level group (≥-1 SD), especially in the gross motor domain (33.3%). Among the seven infants who scored below -2 SD at 4-5 months, only two had -2 SD scores at 10-12 months.

Conclusion: For infants presenting with suspected developmental delay on the revised K-DST 4-5 months questionnaire, especially in the gross motor domain, in the absence of any abnormal neurological findings or developmental red flags, close monitoring and repeated assessments should be performed.

Background: In the clinic, pediatric acute necrotizing encephalopathy (ANE) primarily affects children under five years of age and is characterized by severe brain damage and high mortality. However, some challenges remain regarding the diagnosis and treatment of ANE. In the present study, we analyzed the clinical characteristics and related factors of ANE with the aim of providing improved diagnostic and treatment strategies.

Methods: Thirty-four pediatric ANE patients admitted to Zhejiang University School of Medicine Hospital between February 2019 and December 2023 were included in this study. To identify the factors associated with mortality, clinical, laboratory and imaging data were analyzed with independent-sample t tests, Mann‒Whitney U tests, Fisher's exact probability tests and receiver operating characteristic (ROC) curve analyses.

Results: In this cohort of 34 patients, the most common symptoms were fever, seizures, altered consciousness, vomiting, diarrhea and shock. The mortality rate was 55.9%. Laboratory tests revealed that patients who died had higher creatinine, lactate, activated partial thromboplastin time (APTT), thrombin time (TT), interleukin-6 (IL-6), interleukin-10 (IL-10), creatine kinase (CK), and D-dimer than survivors. Imaging examinations predominantly revealed symmetrical lesions in the thalamus. The fatal group displayed lower Glasgow Coma Scale (GCS) scores and severe complications. Other factors related to mortality included the arterial pH, GCS score and hospitalization duration.

Conclusion: The most common symptoms of ANE are fever, seizures, altered consciousness, vomiting, diarrhea and shock, and ANE has a high mortality rate. The GCS score and arterial pH are critical biomarkers for assessing the severity of ANE.

Background: Pediatric migraines are primarily treated with medications. However, recognizing the triggers related to patient behaviors and lifestyle is also important.

Purpose: This study aimed to evaluate the factors that trigger pediatric migraines.

Methods: This study included 102 pediatric patients with migraine diagnosed using the third edition of the International Classification of Headache Disorders who visited our pediatric headache clinic between November 2021 and October 2022. We reviewed the patients' clinical features, imaging studies, screening tests for behaviors and emotions, and questionnaires regarding triggers. Statistical analyses were performed using the independent sample Student's t-test and linear-by-linear association test.

Results: The 102 patients (44 male, 58 female; mean age, 12.0 ± 2.9 years) were classified into migraine without aura (n = 58) and migraine with aura (n = 44) groups. Sleep disturbances were the most frequent trigger (76.5%). Other triggers included academic stress (66.7%), motion sickness (62.7%), and fatigue (52.9%). Academic stress was the most significant trigger for pain severity in 44.1% of patients. Abnormal behavioral or psychiatric assessment results were associated with a higher number of triggers.

Conclusion: This study identified sleep disturbance and academic stress as common triggers of pediatric migraine, with academic stress being the most intense. Clinicians should understand these triggers and advise patients to avoid them by changing their lifestyles, if possible.