Clinical and Experimental Pediatrics最新文献

Background: Breastfeeding has nutritional, immunological, and psychological benefits for infants. However, breastfeeding rates have recently declined in South Korea.

Purpose: This study aimed to investigate the breastfeeding trends and determinants in a nationwide birth cohort.

Methods: This retrospective cohort study used claims data from the National Health Insurance Service from 2007-2022. Infants born between 2007 and 2021 who underwent at least one National Health Screening Program for Infants and Children examination were included in this study. Breastfeeding rates were analyzed across eight age-specific sessions, and logistic regression models were used to identify factors associated with breastfeeding practices.

Results: At 4-6 months, the prevalence of breastfeeding decreased from 45.6% in 2007 to 15.4% in 2020, whereas that of formula feeding increased from 36.5% to 70.6%. Similarly, the breastfeeding rate at 9-12 months decreased from 22.7% in 2015 to 12.0% in 2020. In 2021, only 16.6% of neonates were exclusively breastfed at 14-35 days of life, and the rate of exclusive breastfeeding at 6 months further declined from 10.0% in 2020 to 8.8% in 2021. Factors negatively affecting breastfeeding were low birth weight (adjusted odds ratio [aOR], 0.636; 95% confidence interval [CI], 0.607-0.667), preterm birth (aOR, 0.72; 95% CI, 0.687-0.754), multiple births (aOR, 0.603; 95% CI, 0.570-0.638), rural residence (aOR, 0.788; 95% CI, 0.771-0.805), and lower household income (aOR, 0.783; 95% CI, 0.748-0.819) (P<0.001).

Conclusion: Breastfeeding rates in South Korea have declined significantly over the past decade, with disparities observed in preterm, low birth weight, and multiple-birth infants as well as and rural or lower-income households. Targeted interventions including enhanced prenatal education, postnatal support, and community-based initiatives are necessary to improve breastfeeding rates.

Background: Infection is a significant cause of death following chemotherapy-induced febrile neutropenia (FN). Neutropenia and compromised neutrophil function are the primary reasons for the decreased defense against infections.

Purpose: This study aimed to evaluate the significance of neutrophil elastase (NE) in predicting the outcomes of childhood hematological malignancies with FN.

Methods: The study included 64 patients with FN and 64 healthy children matched for age and sex as controls. The patients were selected from the Hematology and Oncology Unit, Menoufia University, Pediatric Department, and Tanta Oncology Institute. Complete blood counts, C-reactive protein (CRP) levels, NE levels, and blood cultures for bacteria and fungi were performed.

Results: The levels of CRP and NE were increased among children with FN; of them, 21.9% had Gram-negative bacteremia, 17.2% had Gram-positive bacteremia, and 3.1% had Candidemia. NE level was increased in patients with bacterial infections, with a significant positive correlation with duration of FN. NE level had a cutoff of 6.5, with an area under the curve of 0.899, sensitivity of 83.33%, and specificity of 87.50% signifying a higher risk of mortality compared to other variables.

Conclusion: NE levels were elevated in children with FN, suggesting its usefulness for the early detection of infection that could decrease infection-related morbidity and mortality.

Background: Preterm neonates exhibit gut dysbiosis, characterized by increased numbers of pathogenic bacteria and decreased Bifidobacterium and Lactobacillus levels. Supplementation with the probiotic Bifidobacterium bifidum/Lactobacillus acidophilus (BB/LA) may reverse gut dysbiosis.

Purpose: To study the effects of BB/LA on the gut microbiota of preterm neonates.

Methods: We enrolled neonates born between July 2022 and September 2023 with a gestational age of <33 weeks or birth weight of <1,500 g. After randomization into probiotic (PG) and control (CG) groups, stool samples were collected at 3 time points: birth (V1), 35 weeks' postmenstrual age (PMA) (V2), and 4 months of age (V3). BB/LA was administered to the PG until PMA 35 weeks. All neonates received a feeding protocol similar to that of predominant breast milk. Stool samples were stored at -80°C, a DNA extraction performed, and 16S rRNA gene sequencing used to define alpha and beta diversities and the relative abundances of the bacteria. Baseline characteristics and clinical outcomes were collected.

Results: We analyzed 68 neonates (33 in the PG, 35 in the CG). The alpha diversities did not differ significantly between the groups at any time point. At V1, beta diversity was not significantly different between the 2 groups. After BB/LA supplementation (V2), beta diversity was significantly greater in the PG versus CG (P=0.004). The relative abundances of Bifidobacterium and Lactobacillus were higher in the PG (both P<0.001), whereas that of Clostridium senso stricto 1 was higher in the CG (P=0.017). Growth parameters, necrotizing enterocolitis, and mortality rate did not differ between groups. No adverse events were observed.

Conclusion: BB/LA led to healthier gut microbiota in preterm neonates as demonstrated by a reversal of gut dysbiosis characterized by increased beta diversity, increased the relative abundances of Bifidobacterium and Lactobacillus, and decreased the relative abundance of Clostridium senso stricto 1.

Technological devices with screens-such as computers, smartphones, tablets, video game consoles, and televisions-have become essential in daily life, especially among the pediatric population. This widespread use has significant effects on their physical and mental health, prompting the development of guidelines for appropriate screen use based on age group. In this context, we conducted a narrative review to assess the impact of screen devices on this population, exploring how specific genes and their polymorphisms may act as risk factors for these effects. A systematic literature search was performed to evaluate the clinical and genetic impact of screen exposure, focusing on outcomes such as obesity and overweight, sedentary behavior, depression and anxiety, myopia, behavioral disorders, and sleep and memory disturbances. The findings indicate that screen exposure exceeding 2 hours per day is associated with these outcomes, with the strongest evidence supporting links to obesity and sedentary behavior. Additionally, polymorphisms in genes such as FTO, CACNA1D, and DRD2 were found to influence these outcomes. Overall, the evidence suggests that excessive screen use during childhood is associated with numerous adverse physical and mental health conditions. There is a significant relationship between screen time and increased risk of overweight and obesity, as well as sleep disturbances due to reduced resting hours. Strategies are urgently needed to mitigate these impacts in the pediatric population.

Background: Helicobacter pylori infection is a common gastrointestinal pathogen associated with gastritis and peptic ulcers. The early detection of H. pylori-related gastritis is crucial to its effective management, especially in pediatric patients with dyspepsia.

Purpose: This study aimed to assess the expression of miRNA-146a and miRNA-125b as potential indicators of H. pylori-associated gastritis in children.

Methods: This cross-sectional study included 70 H. pylori-positive children and 50 H. pylori-negative controls aged ≤18 years with recurrent abdominal pain who underwent upper gastrointestinal endoscopy. The miRNA-146a and miRNA-125b expression levels in gastric biopsies were determined using quantitative reverse transcriptase-polymerase chain reaction.

Results: H. pylori-positive children had significantly higher levels of miRNA-146a than H. pylori-negative children across all endoscopic findings (range, 2.2-2.7 vs. 1.07-1.2; P<0.001) and histologic grades of gastritis (range, 2.0-2.4 vs. 1.2-1.3; P<0.001). Conversely, the H. pylori-positive group showed consistently lower miRNA-125b levels across all parameters (range, 0.3-0.8 vs. 0.4-0.9; P<0.001). Both miRNAs differentiated H. pylori status with an area under the curve of >0.95.

Conclusion: The altered expression of miRNA-146a and miRNA-125b in gastric biopsies of H. pylori-positive children suggests their potential role as molecular markers of H. pylori-associated gastritis.

Background: Metabolic disorder-associated fatty liver disease (MAFLD) in children is an emerging global health concern, particularly in terms of obesity and metabolic disturbances. Inflammation plays a crucial role in the pathogenesis of MAFLD, with adenosine deaminase (ADA) and interleukin-1 receptor antagonist (IL-1Ra) being potential contributors.

Purpose: This study aimed to assess the association between ADA G22A and IL-1RN single nucleotide polymorphisms (SNPs) and MAFLD among a cohort of Egyptian children. It also aimed to evaluate the validity of very low-density lipoprotein (VLDL)/high-density lipoprotein cholesterol (HDL-C) and triglyceride-to-HDL-C ratios for predicting MAFLD in obese children.

Methods: One hundred obese children and 50 healthy controls were included. The obese group was further categorized into those with versus without MAFLD. IL-1Ra and ADA G22A SNPs were evaluated using conventional polymerase chain reaction (PCR) and restriction fragment length polymorphism-PCR, respectively. VLDL/HDL and triglyceride-to-HDL ratios were calculated from the lipid profiles of the included participants.

Results: The obese children had significantly higher weight, weight z score, body mass index (BMI), BMI z score, and waist circumference than the healthy controls. These parameters were considerably higher in children with versus without MAFLD P<0.05 all. The GG genotype and G allele of ADA G22A were significantly more frequent in the obese children versus controls (P<0.05 for both); however, no significant difference was observed between obese children with versus without MAFLD. Regarding IL-1RN polymorphisms, the *2/*2 genotype was more common in the controls and obese children without MFLD, whereas the *1/*2 genotype was prevalent in the obese children with MAFLD (P<0.05 all). A VLDL/HDL-C cutoff ratio of >0.6308 showed 80% sensitivity, 58% specificity, a 65.6% positive predictive value (PPV), a 74.4% negative predictive value, and 69% accuracy at differentiating among MAFLD cases. The triglyceride-to-HDL-C ratio cutoff of >3.0685 demonstrated high specificity (88%) and a high PPV (84.2%) but moderate sensitivity (64%) and overall accuracy (76%).

Conclusion: The current study's findings support the possible genetic role of ADA G22A in childhood obesity, with a significant role for the IL-1RN SNP in the development of MAFLD in obese children. The triglyceride-to-HDL-C ratio was more useful than the VLDL/HDL-C ratio for predicting pediatric MAFLD.

Background: Pediatric cardiologists (PCs) and pediatric cardiac surgeons (PedCSs) in Korea face growing workforce shortages due to declining birth rates, decreasing interest among trainees, and increasing burnout.

Purpose: This study investigated the working conditions, job satisfaction, and burnout levels among Korean PCs and PedCSs.

Methods: In June 2023, the Korean Pediatric Heart Society distributed a structured questionnaire via email to 149 members actively practicing pediatric cardiac care (115 PCs, 34 PedCSs). Responses from 122 members were analyzed. Descriptive statistics and regression analyses were performed to identify the factors associated with burnout (P<0.05).

Results: A total of 122 physicians (96 PCs, 26 PedCSs) completed the survey (response rates: overall, 81.9%; PCs, 83.5%; PedCSs, 76.5%). Among the PCs, 79.2% worked more than 51 hr/wk, 57.3% worked night shifts, and 70.8% experienced emergency callbacks at least once per month. PedCSs reported comparably heavy burdens, with 80.8% working >51 hr/wk and 88.5% experiencing monthly emergency callbacks. Regional disparities were notable: 48.2% of PCs in the Seoul metropolitan area (SMA) performed >51 catheterizations annually versus 7.1% in other regions, while 62.5% of PedCSs in the SMA performed >30 surgeries annually versus 20% elsewhere. Litigation, reported by 66.7% of PCs versus 84.6% of PedCSs, contributed to dissatisfaction and burnout. The key drivers included limited research time, legal risks, and nonspecialized duties. Overall, 64.0% of the PCs and 61.6% of the PedCSs reported experiencing burnout. In the multivariable analysis, answering ≥6 emergency callbacks/mo (adjusted odds ratio [aOR], 7.91; 95% confidence interval [CI], 1.28-48.79), occupational dissatisfaction (aOR, 2.57; 95% CI, 1.09-6.04), and work environment dissatisfaction (aOR, 2.74; 95% CI, 1.16-7.14) independently predicted burnout, whereas the working >51 hr/wk variable did not remain significant postadjustment.

Conclusion: Excessive workload, frequent emergency callbacks, regional maldistribution of case volumes, litigation pressure, and occupational dissatisfaction drive high burnout among Korean pediatric cardiac specialists. These findings highlight persistent workforce challenges in Korea's pediatric cardiac system. Regular surveys and ongoing research are essential to ensuring sustainable pediatric cardiac care.

Background: The role of vitamin C in children with community-acquired pneumonia (CAP) in children is controversial; moreover, a standard dose is lacking.

Purpose: This study aimed to evaluate the ability of vitamin C to reduce symptom severity and length of hospital stay among children with CAP as well as determine its optimal dose.

Methods: This randomized controlled clinical trial was conducted between July 2020 and October 2023. The participating patients were aged 6 months to 15 years, had CAP, and required hospitalization at Naresuan University Hospital. The patients were randomly assigned to placebo, low-dose vitamin C (15 mg/kg/dose every 6 hours), and high-dose vitamin C (30 mg/kg/dose every 6 hours) groups. Treatment was provided until discharge and doses maximized after 3 days. The patients' clinical symptoms and side effects were recorded every 12 hours.

Results: This study included 143 patients (median age, 3 years). The clinical severity score improved significantly in the low- and high-dose vitamin C versus placebo groups at 48-72 hours. Vitamin C supplementation did not reduce the length of hospital stay in any group.

Conclusion: Vitamin C supplementation did not reduce the length of hospital stay among patients with CAP who required hospitalization. However, it improved the mean clinical severity score, with the greatest reduction observed at 48-hour posttreatment. A dose of 15 mg/kg was demonstrated effective with minimal side effects.