Clinical and Experimental Pediatrics最新文献

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.

Background: Allogeneic stem cell transplantation (allo-SCT) and chimeric antigen receptor (CAR) T-cell therapy offer potential complementary benefits.

Purpose: This study aimed to ascertain whether incorporating consolidative allo-SCT after CAR T-cell therapy can augment the therapeutic outcomes of child and young adult patients with relapsed/refractory hematologic malignancy.

Methods: A comprehensive literature search of PubMed, ScienceDirect, Cochrane Library, EBSCOHost, ProQuest, and the grey literature repositories was performed for articles published between May 5, 2014, and May 5, 2024. We included studies reporting consolidative allo-SCT following CAR T-cell therapy for treating hematologic malignancies in subjects aged ≤25 years old. The outcomes of interest were complete remission, survival, relapse, and mortality rates. The estimates were pooled using random-effects meta-analysis. The risk of bias was evaluated using the Newcastle-Ottawa Scale, while the certainty of evidence was assessed using GRADE. This study follows the PRISMA 2020 criteria and is registered in the PROSPERO database (CRD42023433417).

Results: Twelve cohort studies involving 380 patients, primarily those with B-cell acute lymphoblastic leukemia (B-ALL), were included. The CAR T-cell+SCT group showed a trend toward higher complete remission (odds ratio [OR], 2.74; 95% confidence interval [CI], 0.88-8.54; P= 0.08; I2=57%; evidence, very low); lower mortality (OR, 0.58; 95% CI, 0.27-1.27; P=0.17; I2=0%; evidence, low), and decreased relapse (OR, 0.18; 95% CI, 0.06-0.56; P=0.003; I2=41%; evidence, low) rates than those who did not proceed to SCT. In addition, both overall survival and leukemia-free survival rates showed a favorable trend toward the CAR T-cell+SCT group, respectively (hazard ratio, 0.44; 95% CI, 0.25-0.77; P=0.005; I2=0%; evidence, low; and hazard ratio, 0.29; 95% CI, 0.17-0.49; P<0.00001; I2=0%; evidence, low). Common posttransplant toxicities include mild to moderate acute and chronic graft-versus-host diseases.

Conclusion: Although the current level of evidence remains low or very low, allo-SCT following CAR T-cell infusion potentially benefits patient survival. Further clinical studies are required to confirm these findings.

Background: Iron deficiency (ID) and iron deficiency anemia (IDA) are common complications of pediatric inflammatory bowel disease (IBD). Owing to questions regarding optimal iron formulation, dosage, route of administration, and safety, these complications are frequently overlooked and undertreated, negatively impacting patient development and quality of life.

Purpose: To assess the safety and efficacy of iron sucrose (IS) and ferric carboxymaltose (FCM) in the treatment of ID and IDA in pediatric IBD.

Methods: We retrospectively reviewed the medical records of pediatric patients with IBD treated for 10 years with IS (age <14 years) or FCM (age ≥14 years) in a single regional referral center. The Ganzoni formula was used to calculate the iron dose administered. Adverse reactions were monitored during treatment and after discharge. Efficacy was defined as a ≥2 g/dL rise in Hb or anemia resolution within 12 weeks after treatment in cases of IDA and transferrin saturation or ferritin normalization in cases of ID.

Results: Sixty-three patients were treated with IV iron (41 with Crohn disease, 15 with ulcerative colitis, 7 with IBD-unclassified; median age, 14.6 years; 104 treatment courses [63 FCM, 41 IS during the 10-year study period]). Retreatment was necessary after a median 1.4 years in 26 patients (41.3%). The median activity scores of patients with recurrent ID indicated inactive disease. The treatment efficacy was 66.7% (FCM) and 67.6% (IS) in patients with IDA and 77.8% in patients with ID but without anemia. One adverse reaction (hypotension and rash) was associated with IS treatment.

Conclusion: In one of the largest and longest follow-up cohorts, FCM and IS were safe and effective for correcting ID in pediatric patients with IBD. As ID recurs frequently, proactive screening and treatment are important.

Background: Bronchopulmonary dysplasia (BPD) is a major complication in extremely preterm (EP) infants. Postnatal systemic corticosteroids reduce inflammation and may help prevent or treat BPD. However, their use is limited because of concerns regarding neurodevelopmental outcomes. However, the optimal timing and criteria for steroid therapy initiation remain unclear.

Purpose: This study aimed to evaluate the effect of a respiratory severity score (RSS)-guided postnatal systemic corticosteroid protocol on BPD and neurodevelopmental outcomes in mechanically ventilated infants with EP.

Methods: A historical comparative study was conducted to compare the preprotocol (2010-2014; phase I) and postprotocol (2016-2022; phase II) periods. Infants born at <28 weeks' gestation and ventilated on postnatal day 14 were included in the study. The protocol implemented in 2015 used the RSS to guide corticosteroid initiation. Clinical outcomes including BPD severity and severe neurodevelopmental impairment (NDI) were compared.

Results: Among the 208 infants, those in phase II had higher dexamethasone use (17.6% vs. 33.0%, P=0.017) and earlier initiation (postmenstrual age, 31.1 vs. 29.0 weeks; P=0.027). In phase II, Jensen grade 0 was significantly increased (15.2% vs. 30.2%; adjusted odds ratio [aOR], 2.31; P=0.024), particularly among patients who did not receive steroids. In steroid-treated infants, Jensen grade 3 BPD was decreased (47.4% vs. 21.2%; aOR, 0.26; P=0.050), whereas grade 1 BPD was increased (5.3% vs. 33.3%; aOR, 12.22; P=0.035) in phase II. There were no significant intergroup differences in mortality or NDI.

Conclusion: The RSS-guided protocol enabled more targeted and earlier steroid administration, reducing severe BPD without worsening neurodevelopmental outcomes. This approach may refine postnatal corticosteroid treatment strategies for infants with EP.

Background: Testicular torsion is a urological emergency that requires prompt surgery to prevent orchiectomy. Pharmacological interventions may slow the progression of damage and reduce reperfusion injury after surgical correction.

Purpose: This study evaluated the protective effects of linezolid against testicular torsion-detorsion (T/D) injury in rats by focusing on the mechanisms involving the Toll-like receptor 4 (TLR-4) pathway.

Methods: Eighty-four male Wistar rats were allocated into 8 groups; of them, one was subjected to a sham operation and another was subjected to 4-hour ischemia via 720° of torsion followed by 24-hour reperfusion. Linezolid (3-100 mg/kg) was assessed for its effects on T/D injury using histopathological evaluation, oxidative stress markers (malondialdehyde [MDA], superoxide dismutase [SOD]), and inflammatory biomarker tumor necrosis factor-alpha (TNF-α). Mechanistic investigations have focused on TLR-4 the mitogen-activated protein kinase (MAPK)/nuclear factor kappa B (NF-κB) pathway. Molecular docking and in silico analyses were conducted to predict interactions with key inflammatory proteins.

Results: Linezolid 25, 50, and 100 mg/kg significantly reduced the histopathological damage, with 50 mg/kg being the most effective dosage. Within the 6-50 mg/kg range, linezolid reduced MDA, increased SOD, decreased TNF-α, and suppressed TLR-4/NF-κB pathway activity, with maximal reductions in MDA, TNF-α, NF-κB, and TLR-4 of 64%, 77%, 56%, and 53%, respectively, and an enhancement in SOD of 47%. In silico docking predicted strong binding interactions with TLR-4 pathway proteins, including p38 MAPK and JNK, with affinities of -7.4 to -8.3 kcal/mol.

Conclusion: Linezolid protects against testicular torsion by reducing oxidative stress and inflammation via modulating the TLR-4/NF-κB pathway, suggesting its therapeutic potential and need for further study.

Background: Thiamin deficiency (TD) manifesting clinically as wet beriberi can significantly impair a patient's cardiac function. Children with heart disease who are receiving diuretic treatment may be at increased risk for severe clinical manifestations of TD.

Purpose: This study aimed to determine the prevalence of TD and evaluate the association between various factors with thiamin status in pediatric patients with heart disease undergoing diuretic treatment.

Methods: Children with heart disease aged 1 month to 15 years who exhibited increased pulmonary blood flow or congestive heart failure (CHF) and had been taking diuretics for at least 1 month were recruited. Data regarding their heart condition, treatment, dietary intake, anthropometry, and symptoms and signs of TD were collected. An erythrocyte transketolase activity assay after the addition of exogenous thiamin pyrophosphate was used to assess thiamin status. Left ventricular ejection fraction and N-terminal pro-brain natriuretic peptide levels were indicators of cardiac function and laboratory evidence of CHF, respectively.

Results: A total of 68 participants were recruited, of whom 10 (15%) had TD. TD was not associated with a CHF exacerbation. An adequate dietary thiamin intake was associated with a better thiamin status (β=-0.37, P=0.003), while increasing age was linked to a poorer thiamin status (β=+0.40, P=0.001).

Conclusion: TD was present in 15% of pediatric patients with heart disease who were receiving diuretic treatment. An adequate dietary thiamin intake appeared to have a protective effect against TD, while increasing age was associated with a poorer thiamin status.

Background: In preterm newborns, neonatal respiratory distress syndrome (RDS) is among the main causes of respiratory failure and mortality. However, the effect of macrophage migration-inhibitory factor (MIF) on neonatal developmental lung disease is not well documented in the literature. Moreover, little is known about the effects of growth differentiation factor-15 (GDF-15) on lung maturity in preterm infants.

Purpose: To evaluate serum MIF and GDF-15 levels in preterm infants with and without RDS and analyze the genetic profile of single nucleotide polymorphisms (SNPs) for MIF rs755622 G>C and GDF-15 rs4808793 C>G.

Methods: In this case-control study, 90 preterm newborns were categorized into 3 groups: group A included 30 preterm newborns with mild to moderate RDS, group B included 30 preterm newborns with severe RDS, and group C included 30 healthy preterm newborns. Enzyme-linked immunosorbent assay methods were used to measure serum MIF and GDF-15 levels. The MIF rs755622 G>C and GDF-15 rs4808793 C>G SNPs were analyzed by restriction fragment length polymorphism-polymerase chain reaction.

Results: Significantly higher median MIF and GDF-15 blood levels were noted among neonates with severe RDS (17.32 μg/L and 3.19 pg/mL, respectively) versus those with mild to moderate RDS (5.50 μg/L and 0.71 pg/mL, respectively) (P<0.05 for both). A significantly higher frequency of a mutant C-allele of MIF rs755622 G>C was noted among cases (37.5%) versus controls (13.3%) (P=0.001; odds ratio [OR], 0.256; 95% confidence interval [CI], 0.112-0.589). A significantly higher frequency of a mutant G-allele of GDF-15 rs4808793 C>G SNPs was noted among cases (49.2%) versus controls (30%) (OR, 0.443; 95% CI, 0.229-0.856).

Conclusion: These findings suggest that serum MIF and GDF-15 levels are strongly associated with RDS severity among preterm neonates. Moreover, polymorphisms of MIF and GDF-15 could be genetic risk factors for the development of neonatal RDS among preterm babies.

Background: Syncope is a temporary loss of consciousness due to cerebral hypoperfusion associated with autonomic dysfunction. Vasovagal syncope (VVS) and postural orthostatic tachycardia syndrome (POTS) are the most common causes of syncope in adolescents.

Purpose: Here we conducted a comparative analysis of VVS and POTS in adolescents using transcranial doppler (TCD) and autonomic function tests to identify the mechanisms underlying the occurrence of each.

Methods: From August 2014 to July 2024, a tilt-table test was conducted on patients who presented with syncope or presyncope as the main symptom. Based on the head-up tilt test results, the patients were classified into the VVS or POTS groups and their medical records retrospectively analyzed.

Results: The study included 137 patients: 100 (73%) in the VVS group and 37 (27%) in the POTS group. There were no significant intergroup differences in patient characteristics. In the TCD, the diastolic blood flow velocity during symptom onset was significantly lower in the VVS versus POTS group (18.40±7.14 cm/sec vs. 22.32±8.48 cm/sec, P=0.008). Additionally, the pulsatility index was higher in the VVS group (1.51±0.41 vs 1.22±0.37, P<0.005). There were no intergroup differences in autonomic function tests results or composite autonomic severity scores.

Conclusion: The cerebral blood flow velocity during diastole differs between VVS and POTS, suggesting that it may be a determining factor in the pathogenesis of each.

Artificial intelligence (AI) has transformed pediatric healthcare by supporting diagnostics, personalized treatment strategies, and prognosis predictions. Although it offers significant promise in these areas, its application in pediatric settings poses distinct challenges compared with that in adults due to variable developmental status, the limited availability of pediatric data, and ethical concerns regarding bias and transparency. This narrative review summarizes the key concepts of AI and its clinical applications across clinical fields in the treatment of children and adolescents. Here we highlight the emerging role of large language models in performing administrative tasks and clinical documentation and supporting decision-making. We also address the evolving impact of AI integration in surgical care as an example while exploring ongoing concerns regarding reliability and diagnostic safety. Furthermore, we survey AI-enabled medical devices and discuss the current regulatory frameworks relevant to pediatric care. This review provides a balanced overview of opportunities and challenges from a pediatrician's standpoint and aims to facilitate effective alignment and collaboration with key stakeholders in pediatric healthcare. Pediatricians must implement AI solutions cautiously and accountably to avoid unintended harm and realize their potential.