Pediatric Reports最新文献

Extremely premature newborns are predisposed to cardiovascular complications due to a number of factors, including myocardial immaturity, hemodynamic changes, and iatrogenic effects. There are few studies on myocardial strain in extremely premature infants during the early neonatal period. The objective of study was to assess the left ventricular (LV) segmental strain in extremely premature newborns during the early neonatal period by employing speckle-tracking echocardiography (STE). This prospective study examined 65 newborns with no signs of hemodynamic impairment during the first 72 h of life. The cohort had a range of birth weights (600-1500 g) and gestational ages (24-35 weeks). The peak strain in 18 LV segments during systole (peak S and time to peak S), and throughout the cardiac cycle (peak G and time to peak G), and during early systolic pre-stretch (peak P and time to peak P) were assessed in the longitudinal, circumferential, and radial directions. We obtained percentile tables of segmental strain characteristics in the longitudinal, circumferential, and radial directions. No dependence of segmental strain on the birth weight, gestational age, or arterial duct closure was found. A positive gradient of the longitudinal strain magnitude was observed from the base to the apex. The highest circumferential and radial strain were observed in LV septum. This study is the first to register and compare the longitudinal, circumferential, and radial LV strain using STE in extremely premature infants with no signs of hemodynamic disturbances during the first 72 h of life. Reference values for segmental strain were established.

Background/Objectives: Premature births below 32 weeks of gestation generally require respiratory oxygen support, leading to a relatively hyperoxic environment compared to in utero conditions. Transient hyperoxia exposure has been linked to an elevated risk of chronic lung disease and retinopathy of prematurity; however, its effects on skeletal muscles remain elusive. This study aimed to investigate the effects of hyperoxic exposure in rats as a model of premature infants receiving supplemental oxygen (30-60% O₂ for several weeks). We hypothesized that rats exposed to postnatal hyperoxia would exhibit muscle fiber atrophy and alterations in fiber type. Methods: We used a rat model in which newborns were exposed to 80% oxygen from birth until postnatal day 12. We assessed the gastrocnemius muscles of rat legs at 12 weeks. Results: Rats exposed to hyperoxia showed substantially increased protein expression of Atrogin-1, along with elevated levels of adipophilin, myogenic differentiation factor 1, and myogenin. No significant changes were observed in the expression of slow or fast myosin heavy chain proteins. However, myofiber size in the gastrocnemius muscle was reduced in the hyperoxia-exposed group compared to the control group. Conclusions: Thus, transient hyperoxia exposure during early life can impede skeletal muscle development, potentially extending into adulthood.

Background: Acute respiratory infections (ARIs) pose a significant clinical challenge in paediatric populations, especially in children with comorbidities who may exhibit underlying immune dysregulation. Inosine pranobex (IP) is an immunomodulatory agent that enhances T-lymphocyte and Natural Killer (NK) cell function, offering a targeted therapeutic rationale for such cases. Objective: This study aimed to retrospectively describe the clinical characteristics, immunological profiles, and outcomes of paediatric patients with complex, PCR-confirmed viral ARIs and significant comorbidities, for whom adjunctive therapy with IP was initiated based on clinical judgment. Methods: This retrospective case series analysed data from 14 paediatric patients hospitalised at a specialised centre (National Institute of Paediatric Tuberculosis and Respiratory Diseases in Dolny Smokovec, Slovakia). Cases were selected based on PCR-confirmed viral ARI, a history of recurrent infections, significant comorbidities, and initiation of IP therapy. The indication for IP was guided by the treating physician in cases of severe, prolonged, or recurrent disease course, where immune dysregulation was suspected, often supported by prior immunophenotyping. Results: A frequent observation in this cohort was the presence of baseline cellular immune alterations with a frequent observation of baseline cellular immune alterations, most notably the depletion of natural killer (NK) cells. NK cell depletion was identified in half of the patients (7/14). Following the initiation of treatment regimens that included adjunctive IP, clinical stabilisation or improvement was observed in all 14 patients included in the study. The therapy was well tolerated, with no reported adverse events attributable to IP. Conclusions: This case series highlights the common presence of cellular immune alterations in children with complex ARIs. While the observational nature of this study precludes any conclusions about causality, the favourable clinical course, safety profile, and strong immunological rationale support the need for prospective controlled trials to evaluate the role of IP in this specific high-risk paediatric population.

Background: Infantile hypertrophic pyloric stenosis represents one of the most prevalent gastrointestinal disorders in infants. It presents with severe persistent vomiting and electrolyte imbalance. Pyloromyotomy is the gold standard approach in the management of pyloric stenosis. The laparoscopic approach provides a reliable and safe alternative to the open technique. We aimed to compare the surgical outcomes of both approaches and determine which approach is superior to the other. Methods: We searched for relevant articles by searching Scopus, Web of Science, PubMed, and the Cochrane Library until January 2025. The Cochrane risk of bias tool was utilized to assess the quality of the clinical trials, whereas the ROBINS-I tool was used in the observational studies. Our primary outcomes were operation time, length of hospital stay, time needed for full feeding, incidence of incomplete pyloromyotomy, mucosal perforation, wound infection, postoperative vomiting, postoperative incisional hernia, postoperative seroma or hematoma formation, need for reoperation, and rate of conversion to P in the laparoscopic group. Results: We included 12 eligible articles that compared laparoscopic pyloromyotomy with open pyloromyotomy in infants with hypertrophic pyloric stenosis. Our analysis revealed comparable results for both procedures in terms of operation time (p = 0.83), hospitalization duration (p = 0.06), mucosal perforation (p = 0.49), postoperative complications such as vomiting (p = 0.10), incisional hernia (p = 0.60), seroma (p = 0.52), and reoperation rates (p = 0.17). Patients who underwent LP achieved full feeding in less time (p = 0.007) and had fewer wound infections (p = 0.01) compared to OP. However, the incidence of incomplete pyloromyotomy was lower in the OP group than in the LP group (p = 0.03). Conclusions: Both open and laparoscopic pyloromyotomy are effective for treating hypertrophic pyloric stenosis. The laparoscopic approach offers the advantages of a faster return to full feeding and lower wound infection rates but increases the risk of incomplete pyloromyotomy compared to the open technique. Surgeon preference and experience play crucial roles in surgical outcomes, provided that there is a thorough understanding of the benefits and limitations of both techniques.

Objectives: This study evaluated changes in serum sodium (S Na) 24 h after the administration of isotonic versus hypotonic intravenous fluids (IVFs) and the incidences of dysnatremia and hyperchloremic metabolic acidosis.

Methods: This double-blind, randomized controlled trial involved children aged 3 months to 5 years who were admitted to a general ward between November 2020 and September 2022 and required IVF. We randomly assigned patients (1:1) to receive either an isotonic solution (D₅0.9%NaCl) or hypotonic solution (D₅0.45%NaCl). Serum electrolyte and venous blood gas levels were obtained at the time of IVF administration and 24 and 48 h after IVF administration. During this study, all participants were monitored for vital signs, body weight, fluid intake and output, and clinical symptoms of dysnatremia.

Results: Totals of 69 and 68 patients received isotonic and hypotonic solutions, respectively. The mean age was 1.95 ± 1.25 years in the isotonic group and 1.91 ± 1.32 years in the hypotonic group. The initial degrees of dehydration and biochemical indicators were not different. The change in serum sodium level at 24 h was 2.97 (2.32-3.62) mmol/L in the isotonic group and 2.19 (1.54-2.84) mmol/L in the hypotonic group. In both groups, no significant hyponatremia nor hypernatremia occurred. The incidence of hyperchloremic metabolic acidosis was not different between the groups. Neither group showed any complications.

Conclusions: Isotonic fluids may be a preferred option for IVFs in pediatric patients under 5 years of age with medical conditions on a general ward, especially within 24 h, due to their potential to better maintain serum sodium levels without increasing the risk of fluid overload or electrolyte complication.

Background: Poland is one of six countries implementing the Finnish Smart Family practice under the Joint Action Health4EUKids, aimed at supporting families in adopting lifestyle counseling methods and preventing childhood obesity across the European Union. Material and method: Since March 2024, Poland has implemented Smart Family tools through training sessions for professionals who work or will work with families of children with excess body weight. A total of 295 individuals have been trained, including 52.2% dietitians, 34.9% nurses, and 12.9% school staff such as teachers, school counselors, and psychologists. Before and after the training sessions, participants completed a survey assessing their knowledge of the Smart Family Practice, and familiarity with supportive tools. Results: Among 295 participants, nearly half reported no prior experience with family-based lifestyle change interventions. Post-training, over 70% expressed readiness to implement the SMART FAMILY method, with high interest (80.7%), motivation (76.5%), and satisfaction (83.6%). Most recognized its potential to support healthy lifestyles and parental engagement (>85%). Key barriers included lack of family cooperation (87.8%), staff shortages (81.0%), limited training (78.4%), and insufficient resources (43%). Conclusions: A high level of acceptance and motivation among participants indicates that the SMART FAMILY method has the potential for effective adaptation in Poland. Its implementation requires strengthening specialists' skills and providing appropriate organizational resources. Overcoming barriers such as lack of experience, limited time, and difficulties in engaging families is crucial to achieving lasting intervention outcomes.

Background/Objectives: Children who have received hematopoietic cell transplants (HCTs) often face complex clinical courses and complications that increase their risk of functional impairments. Because of this, pediatric HCT recipients may benefit from early mobilization efforts to reduce long-term functional issues. However, early ambulation can be limited by clinical complexity and concerns about infectious transmission in HCT patients. Some patients are under contact precautions due to colonization with bacteria that produce extended-spectrum beta-lactamase (ESBL) enzymes. Our goal was to significantly increase ambulation in pediatric HCT recipients at our institution within three months of the intervention. We aimed to raise the number of ambulation events per day, the number of physical therapy (PT) visits per week, and the distance patients walked with PT per session. Methods: From January to October 2022, data on mobilization, demographics, and clinical characteristics were retrospectively collected from electronic health records. Starting in June 2022, we permitted ESBL-colonized patients to leave their rooms while wearing personal protective equipment (PPE), and we trained clinical staff about this in our QI initiative. Results: In Group 1, the ambulation rate was 1.36 times higher before the intervention than after, with an effect size of 0.3042 (p = 0.004 *). The ambulation rate in Group 2, admitted before the intervention, was 1.33 times higher than in Group 3, admitted after the intervention, with an effect size of 0.2856 (p = 0.016 *). Conclusions: The initiative did not increase ambulation among the targeted group. Patients ambulated more before the intervention, though these results lack statistical power. The lack of success of the intervention may be due to various factors, including the short monitoring period, retrospective data collection, difficulties with PPE use among young patients, and uncollected confounding variables related to clinical status.

Objective: Pediatric cancer, though less prevalent than adult malignancies, constitutes a significant public health concern due to its long-term effects on survival, development, and quality of life. This study aimed to investigate spatial patterns and temporal trends of pediatric cancer in Romania over a ten-year period (2008-2017), identifying persistent and emerging geographic hotspots using Geographic Information Systems (GIS)-based modelling and spatial statistics. Methods: A national pediatric cancer registry provided by the Ministry of Health was analyzed for cases among individuals aged 0-18 years, categorized by administrative-territorial units (ATUs), ICD-10 codes, sex, and year. Spatial indicators of persistence (recurrent prevalence across multiple years) and continuity (uninterrupted recurrence) were computed. Hotspot analysis was conducted using Local Moran's I, and trend patterns were assessed through temporal modeling. Additionally, fractal and complexity metrics were applied to characterize the spatial structure and heterogeneity of cancer persistence and continuity across regions. Results: Although national pediatric cancer prevalence exhibited a modest decline from 3.57‱ in 2008 to 3.44‱ in 2017, GIS-based spatial modeling revealed stable high-risk clusters in Central and South-Eastern Romania, particularly in historically industrialized counties such as Hunedoara, Prahova, and Galați. These correspond to regions with past heavy industry and chemical pollution. Male children presented a higher frequency of malignant tumors (48,502 cases in males vs. 36,034 in females), while benign and uncertain-behavior neoplasms increased more prominently among females (from 3847 to 4116 cases, compared with 3141 to 3199 in males). Several rural localities showed unexpected prevalence spikes, potentially associated with socioeconomic deprivation, limited health literacy, and reduced access to pediatric oncology services. Regional disparities in diagnostic and reporting capacities were also evident. Conclusion: GIS-based spatial epidemiology proved effective in revealing localized, sex-specific, and persistent disparities in pediatric cancer across Romania. The integration of spatial indicators and complexity metrics into national cancer control programs could strengthen early detection, optimize resource allocation, and reduce health inequities. These findings highlight the value of combining geospatial analysis and fractal modeling to guide evidence-based public health strategies for pediatric oncology.

Background: Tracheal stenosis in children is a rare but potentially life-threatening condition. We report a case of multilevel tracheal stenosis in a child who sustained blunt chest trauma in a car accident.

Case presentation: The patient is an 11-year-old previously healthy boy who presented to the pediatric emergency room unconscious after being rolled over while seated unstrained inside a vehicle. A chest CT scan showed bilateral pulmonary contusions. He required intubation and mechanical ventilation initially but was noted to have biphasic stridor after extubation. He presented to the pediatric pulmonary clinic 2 weeks after discharge from the hospital with persistent stridor and shortness of breath on exertion. Spirometry revealed flattening of the inspiratory and expiratory limbs of the flow-volume loop, suggestive of fixed large airway obstruction. Direct laryngoscopy and bronchoscopy were performed and revealed multilevel tracheal stenosis. He was successfully treated with repeated bronchoscopic balloon dilatation with sustained improvement in symptoms and spirometry findings 8 months post final procedure.

Conclusion: Tracheal stenosis should be suspected in children who sustain blunt chest trauma. Early recognition and treatment with bronchoscopic balloon dilatation can prevent long-term complications.

Background/Objectives: Autism Spectrum Disorder (ASD) is a neurodevelopmental condition characterized by impairments in social interaction and communication, as well as by repetitive behaviors, with a rising global prevalence. Concurrently, the use of Assisted Reproductive Technologies (ART) has increased among couples experiencing infertility. This study aimed to compare the frequency of ART-conceived children between those diagnosed with ASD and those with other neurodevelopmental disorders (nASD), and to examine differences in prenatal, perinatal and medical histories of ART- and spontaneously (non-ART)-conceived children within an ASD group. Methods: We retrospectively analyzed data from 507 children with a neurodevelopmental disorders (NDDs) diagnosis, classified into ASD (n = 234) and nASD (n = 273) groups. Subsequent analyses focused on the ASD group, further divided into an ART and non-ART group according to the conception mode. Results: ART-conceived children were more frequent in the ASD group than in the nASD group. Moreover, within ASD, ART was significantly associated with potential risk factors such as twin pregnancy, cesarean delivery, low birth weight and parental age. Logistic Binary Regression confirmed these results, suggesting that ART co-occurs with a cluster of perinatal and familial risk factors. Conclusions: Our results indicate that ART is not an independent causal exposure; however, given the retrospective design and the absence of a general population control group, causal inference cannot be drawn. The observed association with ASD appears to be mediated by perinatal and parental variables. These findings underscore the importance of improving obstetric management and care, and ensuring early developmental monitoring for ART-conceived children.