Pediatric Reports最新文献

Background: This study examined treatment outcomes for cannabis use disorder (CUD) among adolescents (12-17 years old) in the United States. Methods: Data from the 2018-2021 Treatment Episode Data Set-Discharges (TEDS-D) included 40,054 adolescents diagnosed with CUD. Descriptive statistics, Chi-square tests, and multivariable logistic regression assessed treatment outcomes and factors associated with treatment completion. Results: Only 36.8% of adolescents completed treatment. The most common reasons for not completing treatment were dropping out (28.4%) and transferring to another facility/program (17.0%). Males and Black non-Hispanic adolescents had lower odds of completing treatment (OR = 0.79, 95%CI: 0.75-0.84), while Hispanic (OR = 1.13, 95%CI: 1.08-1.18), Asian (OR = 1.56, 95%CI: 1.3-1.86) and Native Hawaiian/Pacific Islander adolescents (OR = 2.31, 95%CI: 2.04-2.61) had higher odds of completion compared to their White counterparts. Independent living arrangements, homelessness, arrests in the past 30 days and younger age (<15 years old) decreased the likelihood of treatment completion. Adolescents with co-occurring mental health and substance use disorders also had lower completion rates (OR = 0.79, 95%CI: 0.77-0.86). Referral from schools/employers and treatment settings were associated with a higher success, particularly with stays of 4-6 months and 7-12 months. Conclusion: This study highlights the need for targeted CUD treatment programs that support at-risk adolescents, especially those experiencing homelessness or facing legal issues. High dropout and transition rates suggest a need for continuity of care and program integration between facilities. Strengthening coordination among public health officials, community organizations, and stakeholders is essential to developing culturally responsive treatment interventions that address social determinants of health, substance use, and mental health in this vulnerable population.

Objectives/Background: Aarskog-Scott syndrome (AAS), also known as faciogenital dysplasia, is a rare X-linked genetic disorder primarily characterized by its diverse physical manifestations. Previous evidence suggests a potential association between AAS and neurodevelopmental disorders, including autism spectrum disorder (ASD). Methods: This case study presents a male adolescent with ASD and a novel genetic variant in FGD1 underlying AAS. We conducted comprehensive clinical, genetic, and behavioral assessments to characterize the neurodevelopmental presentation. Moreover, we examined the existing literature on AAS and comorbid neurodevelopmental disorders. Results: The patient demonstrated features consistent with both AAS and ASD, presenting with characteristic physical features of AAS and meeting diagnostic criteria for ASD on both ADI-R and ADOS-2. Cognitive assessment revealed above-average nonverbal IQ (Leiter-3, NVIQ = 115), while adaptive functioning was notably impaired (Vineland composite score = 65). Executive function deficits were identified through several assessments, though ADHD diagnostic criteria were not met. The literature review considered 64 studies, including 151 individuals with AAS. ASD was observed in 4.0%, Attention Deficit/Hyperactivity Disorder (ADHD) in 10.6%, and Intellectual Disability (ID) in 14.2% of cases. Conclusions: The combination of ASD with preserved nonverbal intelligence but impaired adaptive functioning in this AAS case demonstrates the complex neurodevelopmental manifestations possible in this rare genetic condition. The prevalence of neurodevelopmental disorders among people with AAS may be higher than their prevalence in the general population. However, a comprehensive assessment of developmental progress was rarely performed in previous studies, which may lead to systematic underestimation of co-occurring neurodevelopmental difficulties in AAS.

Purpose: Suicide is a leading cause of death among children and adolescents worldwide. This study examined the prevalence and characteristics of suicides among children and adolescents (aged ≤ 19 years) over a 13-year period in the broader area of Athens, Greece. Key aspects analyzed included victim demographics, circumstances surrounding the incidents, and methods employed.

Methods: A retrospective analysis was conducted on autopsy cases performed at the Department of Forensic Medicine and Toxicology, National and Kapodistrian University of Athens, from 1 January 2011, to 31 December 2023.

Results: Out of 5819 autopsies conducted between 2011 and 2023, 371 were classified as suicides. Among these, 12 cases (representing 3.2% of suicides) involved children and adolescents aged ≤ 19 years and met the study's inclusion criteria for detailed forensic analysis. The average age of the victims was 17.7 ± 2.1 years (range: 14-19), with males representing 58.3% of cases. Hanging was the most common method of suicide (9 cases, 75.0%), followed by firearm use, falls from height, and hydrogen sulfide inhalation (one case each). Death occurred in the home in 10 cases (83.3%), with 6 specifically taking place in the bedroom. Scars indicative of prior self-harming behavior were present in two cases (16.7%), while suicide notes were found in three cases (25.0%). Toxicological analysis revealed alcohol and cannabis use in one case, cannabis alone in one case, and alcohol alone in two cases. Four victims (33.3%) had a documented psychiatric diagnosis, with two of them under antidepressant treatment at the time of death.

Conclusions: This study highlights the forensic value of autopsy-based investigations in unveiling hidden patterns of adolescent suicidality and informs targeted prevention strategies. Integrating medico-legal findings into public health responses may enhance early identification and intervention in vulnerable youth populations.

Objectives: To assess the safety and efficacy of adenotonsillectomy (AT) for treating uncomplicated pediatric obstructive sleep apnea (OSA) in children of different ages. Methods: A systematic search was conducted in four electronic databases, and 71 studies with a total of 9087 participants were included in the analysis. The studies were all before-and-after studies, cohort studies, and randomized controlled trials. Surgical results were analyzed according to age, disease severity, and follow-up duration. Results: Children younger than 7 years at the time of AT had a significantly greater decrease in disease severity, a greater decrease in hypoxemic burden, improved sleep quality, and improved cardiovascular function than children older than 7 years. Both cognitive and behavioral performance improved postoperatively, although these changes were more significantly associated with the duration of follow-up than with age at surgery. Notably, the rate of surgical complications was much greater in children under the age of 3. Conclusions: The current evidence indicates that AT is performed optimally between the ages of 3 and 7 years, offering the greatest chance of disease resolution and remission of associated conditions, balanced with a reduction in surgical risk. We highly recommend conducting high-quality randomized controlled trials to further inform the clinical guidelines for pediatric AT.

Background: Antenatal ultrasonography measurements of the estimated fetal weight (EFW) are a critical point in the decision-making process of obstetric planning and management to preserve the safety of both the newborn and the mother. This study aims to investigate the accuracy of ultrasonography to measure the EFW in comparison with the actual birth weight (BW) measured immediately after delivery.

Methods: In this retrospective study, electronic records of 270 newborns who fulfilled the inclusion criteria were retrieved. A structured data sheet was used to collect the EFW, calculated by the Hadlock A formula using real-time ultrasound imaging on the day of delivery or the day before, and the actual BW immediately after delivery.

Results: Out of 270 fetuses, 53.7% (145) were female, and 46.3% (125) were male. The mean BW was 2918.1 ± 652.81 g (range: 880 to 5100). The mean EFW was 3271.55 ± 691.47 g (range: 951 to 4942). The mean gestational age was 38 ± 2.48 weeks (range: 29 to 42). Spearman's rho correlation test revealed strong compatibility between EFW and BW (r = 0.82, p < 0.001). Linear regression analysis showed a strong correlation between EFW and BW (R = 0.875, R² = 0.766, and p < 0.001). The cross-tabulation test showed 86.8%, 78.4%, and 26.9% compatibility between measurements of EFW and the true BW in group-1 (<2500 g), group-2 (2500-4000 g), and group-3 (>4000 g) fetuses (p< 0.001).

Conclusions: EFW using ultrasonography yields high compatibility with the actual BW. Despite the slight overestimation, ultrasonography provides high clinical value in obstetric assessment and subsequent management.

Background/objectives: Increased burdens on caregivers of infants and toddlers significantly affect caregivers' quality of life and health. Although adequate care during infancy contributes to child development and special health care needs affect caregiver burden, the risk factors for and protective factors against increased caregiver burden remain unclear. We aimed to evaluate children's health care needs and required caregiving time and identify factors associated with increased caregiver burden.

Methods: We conducted an online survey of 287 Japanese caregivers who were randomly selected from a web panel and were raising children aged <4 years. The survey comprised a sociodemographic data form, Children with Special Health Care Needs (CSHCN) Screener, caregiving time survey form, and questions on increased burden. Needs and caregiving time were evaluated by dividing the participants into CSHCN and non-CSHCN groups. Related factors were analyzed using increased burden as the dependent variable. The chi-square test, Mann-Whitney U test, and modified Poisson regression were used for data analysis.

Results: Among the children of the 287 participating caregivers, 16.4% were identified as CSHCN, while 96.9% had no specific diagnosis. Overall, 38.3% of the CSHCN group met only one of the five CSHCN Screener items. The CSHCN group spent significantly more time providing and arranging/coordinating health care. The non-CSHCN group spent significantly more time providing daily care. After adjusting for covariates, increased caregiver burden was significantly associated with a younger age of the child, more caregiving time required 6 months prior to the survey, and providing care for CSHCN.

Conclusions: To help reduce the burden of childcare on caregivers of infants and young children, children's needs should be identified and generous childcare provided from an early age. Early identification of CSHCN and appropriate support for families may help reduce caregiver burden during early childhood.

Background/Objectives: In research on the relationship between pubertal timing and adolescent health, more attention is typically given to early rather than late maturation, as well as the associated risk of engaging in health-compromising behaviors. The aim of this study was to assess changes in HRQL (health-related quality of life) depending on subjectively perceived pubertal timing, measured in five categories. Methods: A cross-sectional online survey was conducted in spring 2024 in a western region of Poland (N = 9411; mean age 15.15 ± 1.56 years). Mean KIDSCREEN-27 index scores were compared according to self-reported pubertal timing, and five relevant general linear models were estimated, adjusting analyses for respondents' age, sex, and the remaining four HRQL scores. Results: In the study group, 49.0% of students assessed their pubertal timing as typical, 28.5% as earlier, and 22.5% as later compared to peers of the same sex. For all five KIDSCREEN-27 dimensions, adolescents who matured at a pace perceived as typical achieved the highest quality-of-life index scores. Significantly earlier or significantly later pubertal timing was associated with a notable decrease in these indices. Some significant interactions were identified between sex or age and pubertal timing as predictors of HRQL. The strongest association with pubertal timing was observed for the Psychological Well-being dimension, where differences unfavorable to older age groups were additionally linked to delayed pubertal timing. Conclusions: Greater awareness of the relationship between perceived pubertal timing and adolescents' well-being is warranted among preventive care physicians, parents, and school psychologists and educators.

Background: The maternal microbiota serve as a key regulator of neonatal immune development and early-life health outcomes. This systematic review aims to find out how the makeup of the maternal microbiota affects newborn immunity and the risk of allergies, identify which microbes are linked to a higher or lower chance of allergies, and assess treatments that could improve newborn immune health. Methods: We conducted a systematic search in PubMed, MEDLINE, and Web of Science, adhering to the PRISMA guidelines. We included randomized controlled trials (RCTs), cohort studies, and observational studies that looked at how the makeup of the maternal microbiota affects newborn immune responses or allergic outcomes in early life. We conducted a systematic search, and the quality of the studies was evaluated using the GRADE system and tools to check for bias (RoB 2, Newcastle-Ottawa Scale, MINORS). Results: We included a total of 74 studies. The main findings showed that having a cesarean delivery and using certain antibiotics during pregnancy increased the risk of allergies, while breastfeeding, taking probiotics, and changing the mother's diet helped to protect against allergies. Maternal stress had a negative association with the microbiota composition (OR = 1.9-2.4) and neonatal immune regulation. Moreover, the study noted significant geographic variation in the microbiota's influence, underscoring the importance of contextualized interventions. Conclusions: The composition of the maternal microbiota has a major impact on neonatal immunity and the risk of early-life allergy. Adverse factors include cesarean birth, antibiotic exposure, and maternal stress, all of which have been associated with alterations in neonatal immunity. More studies are required to validate promising microbiota-targeted strategies and develop evidence-based guidelines to improve maternal and neonatal immune health.

Background/Objectives: Emotional eating has been recognized as the tendency to eat in response to emotions, being recognized as a crucial risk factor for recurrent weight gain. Emotional eating has been interrelated with obesity/overweight, depression, anxiety, stress, and specific dietary habits at any stage of human life, negatively affecting human quality of life. The present study aims to summarize and explore the effects of emotional eating on children and how these effects may, in turn, influence their mental and physical health at the next stages of their lives. Methods: This is a narrative review of the presently existing clinical evidence concerning the impact of emotional eating in children. A comprehensive search of the most reliable online databases, e.g., PubMed, Scopus, Web of Science, and Google Scholar, was performed utilizing relevant keywords. Several inclusion and exclusion criteria were used to collect only cross-sectional, longitudinal, descriptive, and case-control surveys in children's populations. Results: The current clinical evidence suggests that parental behavior may increase the risk of emotional eating in children. Several pieces of evidence also implied potential associations of emotional eating with overweight/obesity and mental disorders in children. Children's dietary habits may also affect their risk of developing emotional eating. Conclusions: The prevalence of emotional eating is gradually increasing in the general population, and especially in children. Public strategies should be performed to educate parents to recognize potential emotional eating behaviors in their children and to adopt more healthy dietary habits for their children, even in the first months of their life. Educational programs should be organized in school communities to directly educate children on the benefits of healthy dietary patterns.

To evaluate and compare the awareness and implementation of children's rights in pediatric hospital settings from the perspectives of parents and children, this study emphasizes ethical considerations in healthcare, focusing on communication practices, privacy, and participation rights. Methods: A cross-sectional study was conducted in the largest pediatric hospital in Greece between February and April 2023. A total of 250 parents and 150 children participated. Data were collected using a structured questionnaire assessing six domains of children's rights: access to information, participation, privacy, non-discrimination, play and recreation, and parental support. Statistical analysis included chi-square tests for categorical variables, with significance set at p < 0.05. Results: Significant discrepancies were identified between parents and children in their awareness of children's rights. Only 2.9% of children were aware of printed lists of rights, and 46.3% of parents reported not knowing of their existence (p = 0.005). Children evaluated communication practices, such as the use of child-friendly language, more positively than parents (p = 0.02). Parents reported higher satisfaction with explanations of health conditions, treatments, and medication side effects (p < 0.001). Regarding privacy, children rated room allocation and privacy practices during examinations less positively than parents (p = 0.02). Conclusions: The study highlights critical gaps in the communication and implementation of children's rights within pediatric hospitals. Tailored interventions, including staff training, development of child-friendly materials, and policy adjustments, are necessary to bridge these gaps and ensure an ethically sound healthcare environment that prioritizes the rights and well-being of both children and their families.