Clinical and Experimental Pediatrics最新文献

Very preterm infants (VPIs) often experience extrauterine growth failure. Therefore, aggressive nutritional management of VPIs is recommended with the goal of achieving the postnatal growth of an equivalent fetus. However, VPIs frequently present postnatal length growth restriction at term-corrected age that remains lower than the standard weight and have greater fat mass and lower lean and bone mass than term-born infants. This condition differs from the classic pattern of infant undernutrition defined as a significantly lower weight for a given length. Moreover, it suggests that non-nutritional factors play a key role in length growth restriction. While weight faltering has been extensively studied, the significance of length growth failure in VPIs has only recently emerged. The non-nutritional factors underlying poor length growth in VPIs are currently not fully understood. In this review, we address recent advances in our understanding of the pathophysiology of length growth restriction, which has been identified as a major predictor of adverse neurodevelopmental and cognitive outcomes in VPIs. First, we review the short- and long-term consequences of poor length growth in VPIs; next, we highlight the effects of non-nutritional factors on postnatal length growth with focus on sustained neonatal inflammation; and finally, we discuss hypothesis and future lines of research attempting to understand the complex inflammatory-endocrine interactions and pathophysiological changes during early postnatal life, appropriately guide and apply clinical strategies aimed at optimizing length growth of VPIs, and identify evidence of the associations between sustained neonatal inflammation, stunting, and long-term health risks and the potential implications thereof.

Background: Acute infectious diarrhea is among the leading causes of morbidity and mortality worldwide, particularly in developing countries and among children younger than 5 years of age.

Purpose: To determine the causative microorganisms in diarrhea and elucidate their epidemiological trajectory among children younger than 5 years of age to establish successful preventive measures.

Methods: This cross-sectional study was conducted in Al-Musayyib District, Babil Governorate, Iraq, using data from January 2023 to January 2024 provided by the information system of Ibn Saif Children's Hospital and Al-Musayyib General Hospital. Data from 300 children under 5 years of age with infectious diarrhea were collected to determine the causative pathogens. Patient data including sex, age, treatment, and post-treatment clinical condition, were collected from the hospital archive and analyzed.

Results: Overall, 56% of males and 44% of females had diarrhea. The 1-2-year age group was the most susceptible to diarrhea (33.3%). This rate gradually decreased with age, reaching 9.9% in the 4-5-year age group. Furthermore, bacteria were the causative organisms in 43% of cases, followed by viruses, parasites, and fungi at 24.7%, 12%, and 7.7%, respectively. Mixed infections were detected in 12.6%. Post-treatment, 89.7% of patients completely recovered, 8% experienced physiological disorders, and 2.3% died.

Conclusion: Bacteria were the most common causative organisms of infectious diarrhea among children younger than 5 years of age. Children in the 1-2-year age group were the most commonly affected. This study highlights that diarrhea continues to threaten the lives and well-being of children.

Background: Pediatric patients infected with coronavirus disease 2019 (COVID-19) have unique clinical characteristics. Tumor necrosis factor (TNF) is a proinflammatory cytokine that greatly contributes to tumor pathogenesis.

Purpose: To describe the presenting characteristics of COVID-19 infection among pediatric patients, and investigate the possible role of the TNF-α signaling pathway.

Methods: This prospective case-control study included 50 Egyptian pediatric patients with COVID-19 and 50 healthy controls. Clinical, laboratory, and radiological assessments were performed. Serum TNF-alpha (TNF-α), TNF-α-converting enzyme (TACE), and angiotensin-converting enzyme 2 (ACE2) were measured using enzyme-linked immunosorbent assay. ACE (I/D) (rs4646994), ACE2 rs2285666, and TNF-α-308G/A single nucleotide polymorphisms (SNPs) were performed using conventional polymerase chain reaction techniques with or without restriction fragment length polymorphism.

Results: The median age was 1 year (interquartile range [IQR], 0.31-2.50 years) in the case group and 1.45 years (IQR, 1.00-3.00) in the control group. The main presenting symptoms were fever (92%), dry cough (74%), and dyspnea (72%). The lymphocytic count was normal in 14 patients (28%), decreased in 16 patients (32%), and increased in 20 patients (40%) of the case group. Positive chest computed tomography finding of COVID-19 infection were demonstrated among 40% of patients using COVID-19 Reporting and Data System categories (ground-glass opacity with or without consolidations in the lungs). There were significant increased serum TACE and TNF-α with decreased ACE2 levels among cases versus controls (P< 0.001). The GG genotype and G allele of the TNF-α-308G/A SNP were significantly higher in patients than in controls (P<0.05 for both), with insignificant differences in genotype and allelic frequencies in the ACE (I/D) (rs4646994) and ACE2 rs2285666 SNPs.

Conclusion: The TNF signaling pathway was significantly activated in pediatric COVID-19 infection. Only the TNF-α-308G/A SNP was significantly associated with pediatric COVID-19 infection.

Background: Definitions of childhood and adolescent hypertension (HTN) do not precisely elucidate the relationship between HTN and cardiovascular outcomes. Carotid intima-media thickness (CIMT), as a substitute for cardiovascular outcomes, enables the early identification of cardiovascular events throughout early adulthood.

Purpose: This study aimed to compare the ability of childhood HTN definitions to predict a high CIMT in early adulthood.

Methods: This prospective cohort study included 921 individuals aged 10-17 years from the Tehran Lipid and Glucose Study. The CIMT was measured after 18 years of follow-up. Participants were categorized into normal blood pressure (BP), high-normal BP, HTN stage 1, and HTN stage 2 groups based on the childhood HTN definitions of the 4th report, European Society of Hypertension (ESH), and American Academy of Pediatrics Clinical Practice Guidelines (AAP-CPG). Akaike information criterion (AIC) and relative efficiencies (RE) were calculated to compare the ability of each to predict a high CIMT (≥95th percentile) during early adulthood.

Results: The highest and lowest prevalence of stage 1 HTN was observed with the AAP-CPG (17.7%) and ESH (8.8%), respectively. Similarly, the highest and lowest prevalence of stage 2 HTN was noted with the AAP-CPG (1.5%) and ESH (0.8%), respectively. According to the RE values, the highest to lowest predictive abilities belonged to the 4th report, ESH, and AAP-CPG, respectively. In all models, the 4th report's pediatric HTN definition had the lowest AIC value and offered the best predictive ability.

Conclusion: Among the various definitions of pediatric HTN, the 4th report offered the best ability to predict a high CIMT during early adulthood, followed by the ESH and AAP-CPG. Because the reference population of the 4th report includes overweight, obese, and normal- weight individuals, our findings suggest that excessive adiposity is among the main predictors of early adulthood atherosclerosis risk.

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 effect 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 standard care. Children in the control group received standard care only. Each child was assessed for pain using EVENDOL pain scale, while their anxiety was measured using the modified Yale Preoperative Anxiety Scale. The 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 among children.

Unhealthy diet-related behaviors and poor diet quality during childhood and adolescence are the main factors contributing to noncommunicable diseases such as obesity, dyslipidemia, diabetes, hypertension, and cardiometabolic syndrome. Unhealthy diet-related behaviors can become lifelong habits associated with mental health problems, including depression, anxiety, attention deficit hyperactivity disorder, and substance abuse issues such as smoking, drinking, and other chemical compounds. Children and adolescents are in the developmental stages of brain structure, function, and neurotransmission systems, which can make them more susceptible to substance abuse (tobacco, alcohol, and drugs). Thus, mental health problems and substance use in children and adolescents may originate from unhealthy diet-related behaviors and poor diet quality. Here we reviewed the impact of diet-related behaviors and diet quality on children's and adolescents' physical and mental health and substance use by scrutinizing the 2021 Korean Youth Risk Behavior Survey (54,848 participants) and other relevant studies.

Double-negative (CD4-CD8-) T (DNT) cells have been implicated in autoimmune lymphoproliferative syndrome (ALPS), where their expansion inside the circulating pool of T cells represents a diagnostic criterion. Recent experimental evidence has supported the immunomodulatory roles of DNT cells, and studies in adult patients have suggested that they may be altered in some immune-mediated conditions. This study aimed to retrieve available data on circulating DNT cells in pediatric rheumatic disorders that do not arise in the context of ALPS through a systematic literature review of 3 scientific databases (PubMed, Scopus, and Web of Science). The final output of the systematic literature search consisted of 8 manuscripts, including cross-sectional (n=6) and longitudinal (n=2) studies. Overall, the pooled population of patients includes children affected with pediatric systemic lupus erythematosus (n= 104), juvenile idiopathic arthritis (n=92), Behçet's disease (n=15), mixed connective tissue disease (n=8), juvenile dermatomyositis (n=6), and Kawasaki disease/multisystem inflammatory disease in children (n=1 and n=14, respectively); moreover, one study also included 11 children with a high titer of antinuclear antibody but no diagnosis of rheumatic disease. All studies except one included a control group. The number of DNT cells were increased in most studies of children with rheumatic diseases. Even if such a limited number of studies and their great heterogeneity in several methodological aspects do not allow for reliable conclusions about the relevance of DNT cells in specific rheumatic conditions in children, this cell population deserves further investigation in this pathological setting through well-designed clinical studies.

Background: Children's ability to achieve an appropriate motor development is largely associated with their capacity to control balance. Furthermore, accomplishing balance tasks with a narrowed base of support is a necessary precursor to engaging in everyday functional activities and developing more complex balance abilities.

Purpose: To investigate the relationship between the tandem stance (TS) and the single-limb stance (SLS) items of the Pediatric Balance Scale (PBS) assessment tool with the PBS total score in children with impaired balance.

Methods: Forty-two children (22 with neurological disabilities, 10.7±3.1 years; 20 typically developing [TD], 8.3±2.7 years) performed all 14 PBS items. Linear regressions separately determined the impact of TS and SLS on total PBS score in both groups. Bland-Altman plots expressed agreement between the balance measurements.

Results: For children with disabilities, only the SLS entered the model, explaining 64.5% of the variance in total PBS score. A high level of agreement was observed between the SLS and total PBS scores. For TD children, only the TS entered the model, explaining 45.2% of the variance in the total PBS score. A high level of agreement was observed between the TS and total PBS scores.

Conclusion: Our findings support the practical and efficient use of a single balance task to assess balance ability in children with disabilities.