Pediatric Reports最新文献

Introduction: In this single-center retrospective analysis, we present case data and insights gathered over the past eight years. Additionally, we computed postnatal, pre-therapy lesion-to-lung ratios of Congenital Pulmonary Airway Malformations (CPAMs) to retrospectively assess potential outcome prediction using lesion-to-lung ratios.

Methods: Data were collected between 2015 and 2022. Information such as chosen therapy, surgical duration, postoperative hospital stay, and follow-up was obtained from electronic case records. Pre-therapy pulmonary lesion volumes [mm³], lesion-to-ipsilateral-lung ratio, and lesion-to-both-lungs ratio of CPAMs were retrospectively calculated from computed tomography images using specialized software.

Results: Of the 40 identified cases, 27 had CPAM, 7 had pulmonary sequestration, 4 had bronchogenic cysts, and 2 had congenital lobar emphysema. Histological examinations of resected specimens revealed no malignancy. For CPAMs, the median surgery age was 7 months (interquartile range (IQR): 0.45-11), averaging 9.54 ± 15.01 months. The CPAM surgery lasted on average 126 ± 53 min (median 124 min (IQR 108-172)). The mean length of hospital stay was 6 ± 1.41 days for thoracoscopic surgery and 17 ± 18.23 days for open surgery. No clear link was found between the lesion ratio and management choice or surgical length. Notably, larger lesions tended to result in longer postoperative stays. CPAMs with a lesion-to-ipsilateral-lung ratio of ≤0.11 were asymptomatic.

Discussion and conclusions: If patients present no symptoms, mild symptoms, or smaller CPAM lesions, "wait and watch" and a CT scan of the thorax up to approximately six months of age remain a reasonable approach. The true risk of malignancy remains ambiguous, especially since there was no evidence of malignancy in our biopsies. On the other hand, prophylactic surgery before symptoms arose led to earlier discharge and overall low intraoperative complications compared to symptomatic counterparts. Ultimately, the adopted therapy pathway remains a parental choice. For CPAMs, an increased lesion-to-lung ratio correlated with extended hospital stay and symptomatic presentation. However, there was no cut-off value for conservative or surgical treatment.

Background: Motor skills in early and middle childhood are essential for physical play, social interactions, and academic development. Children with autism spectrum disorder (ASD) often exhibit atypical sensory responses, which can impact self-care and other developmental areas. This study explores the impact of sensory and motor rehabilitation using a Motor Sensory Room to stimulate motor development in children with ASD. Methods: Twenty-five children with ASD, preschool and school-aged (2-10 years), were divided into three groups based on the DSM-5 severity levels. The PEP-3 scale was used to assess cognitive, language, motor, emotional, social, and behavioral development. Ten children underwent a 3-month Motor Sensory Room intervention, and data were collected longitudinally. A control group of ten children, matched in age, sex, and diagnosis, did not receive the intervention. A 12-month follow-up is planned for all participants. Results: Children exhibited diverse profiles. Type B subjects displayed more severe symptoms, while Type A showed milder symptoms with better language and interpersonal skills. After the 3-month intervention, improvements were noted in several PEP-3 areas. For sensory levels (hypo-reactivity), the percentage of individuals at medium levels increased from 44% to 50%. For hyper-reactivity, the percentage at medium levels rose from 30% to 40%. Motor skills improved, with the percentage of individuals with high motor abilities rising from 20% to 25%. Relational behaviors also saw gains, with an increase from 50% to 55% in medium-level behaviors. The experimental group demonstrated better outcomes compared to the control group, particularly in sensory and motor skills. Conclusions: Preliminary findings suggest that sensory and motor training in a Motor Sensory Room improves sensory integration, motor coordination, and social interaction in children with ASD. Further research is needed to confirm long-term benefits.

Background: Congenital diaphragmatic hernia (CDH) is a complex congenital disorder often accompanied by long-term feeding difficulties. There is a paucity of published data regarding the impact of swallowing difficulties on long-term patient outcomes. Our study attempts to evaluate this phenomenon. Methods: A retrospective chart review of infants born with CDH between 2021 and 2022 identified 45 patients. The following variables were identified: need for swallow study, stomach location, defect type, need for anti-reflux therapy, need for nasogastric tube (NG) or gastric tube (GT) at time of discharge, poor growth, and frequency of respiratory infections during the first 12 months of life. Results: Thirty-one percent of patients (n = 14) underwent a swallow study, 20% (n = 9) required long-term anti-reflux medications, 18% (n = 8) had a GT and 59% (n = 26) had an NG in place at time of discharge, 44% (n = 17) experienced poor growth as an outpatient, and 35% (n = 16) had respiratory infections in the first 12 months of life requiring hospitalization. Infants with a Type D defect commonly required GT at discharge (40%), experienced respiratory infections in the first 12 months (67%), and had poor growth as an outpatient (67%). Conclusions: Our findings underscore the need for routine dysphagia screening in CDH infants during NICU admission. Differences in outcomes based on defect type suggest that early identification and targeted interventions for feeding and swallowing issues may improve long-term growth and respiratory outcomes for CDH patients. Further studies are warranted to develop standardized dysphagia management guidelines for this population.

Background/objectives: Aquatic exercise is attracting attention as a method of rehabilitation for children with cerebral palsy (CP). The purpose of this systematic review was to evaluate whether aquatic exercise for children with CP improves their walking ability and quality of life (QOL) and is enjoyable for them.

Methods: A literature search was conducted on 2 August 2024 using three databases: PubMed, Web of Science, and the Cochrane Central Register of Controlled Trials through Evidence-Based Medicine Reviews. Studies included in the review focused on aquatic exercise interventions for children with CP, with outcomes related to walking ability, QOL, or enjoyment. Studies that did not isolate the effects of aquatic exercise (except when combined with conventional interventions) were excluded. Two reviewers independently conducted screening and risk of bias assessments.

Results: Seven studies involving 94 participants in total were included in the review. Three of these studies had a control group. All four studies reported improvements in walking ability, including walking endurance and efficiency. One of two studies showed improvement in health-related QOL (HRQOL) compared to the control group, whereas the other did not show significant differences between groups. All three studies that assessed enjoyment reported high levels of enjoyment of aquatic exercise. However, all studies were at risk of bias.

Conclusions: The reviewed studies suggest that aquatic exercise for children with CP may be enjoyable and may improve walking ability. Further research is needed to accurately assess the effects of aquatic exercise and compare it to other interventions.

Background/objectives: Upper respiratory tract infections (URTIs) are a significant global health burden, and understanding the immune response is crucial for developing effective diagnostic tools and treatment strategies.

Methods: This study investigated the levels of specific biomarkers in 188 patients with URTIs and their association with demographic factors, comorbidities, and clinical outcomes. Immunoglobulin A (IgA), immunoglobulin E (IgE), neutrophils, serum iron, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) were measured.

Results: The median age of the patients was 5 years, with 46% being female and 63% from urban areas. Adenoiditis (37%), otitis (25%), and rhinitis (20%) were the most common diagnoses. While most biomarkers did not vary significantly by gender, neutrophil levels were significantly higher in females (p = 0.020). IgE levels were significantly elevated in rural patients compared to urban counterparts (p = 0.034).

Conclusions: ESR was significantly associated with rhinitis diagnosis, and IgE and ESR were predictive of otitis in multivariate models. However, many biomarkers did not significantly correlate with other diagnoses, contradicting previous research focusing on individual biomarkers. This study highlights the complexity of immune responses in URTIs and the need for more effective diagnostic tools. The findings can inform the development of tailored treatment strategies based on gender, area of origin, and infection type.

Background: Global research has reported that the number of children and adolescents suffering from mental health issues has increased over the past decades. In Jordan, there has been a growing interest in investigating mental health among these groups in the most recent decade; nevertheless, only a few studies have covered behavioral and emotional problems. This study aimed to estimate the prevalence of behavioral and emotional problems among children and adolescents in Jordan and investigate their associated factors.

Methods: A large-scale, national, school-based cross-sectional study was conducted between December 2022 and April 2023 on children and adolescents living in Jordan aged between 8 and 18 years. The study included public schools, private schools, UNRWAs schools, Zaatrai camp schools, and non-formal education centers. The Strengths and Difficulties Questionnaire was used to measure behavioral and emotional problems.

Results: About 13.9% of the children had abnormal difficulty scores, and they suffered the most from emotional symptoms (17.9%). Syrian children in refugee camps had the highest rate of total difficulty (19.3%). In the adolescents, 19.7% had high levels of total difficulty, where conduct problems were the most reported (17.6%), and Syrian adolescents in refugee camps were highly affected (22.2%). The number of traumatic events, physical activity, problematic internet use, and family affluence were significantly associated with an increased risk of having behavioral and emotional problems in both the children and adolescents.

Conclusions: A significant proportion of children and adolescents struggle with emotional and behavioral problems in Jordan, and serious efforts are needed to enhance the status of mental health for adolescents and children.

Background: Mediterranean diet (MD) constitutes a commonly examined dietary model. It includes a plethora of bioactive ingredients with strong antioxidant, anti-inflammatory, antithrombotic and anticancer properties. Several substantial studies support strong evidence that MD can exert preventing actions against human morbidity and mortality, promoting human well-being and quality of life. The present study aims to evaluate whether childhood MD compliance may be associated with socio-demographic, anthropometric, and lifestyle factors in children at the age of 6-9 years.

Methods: This is a cross-sectional survey on 3875 children aged 6-9 years old with their matched mothers. Qualified questionnaires were used to evaluate and collect by one-to-one interviews with trained professionals the above data.

Results: Elevated MD adherence was observed only in 22.2% of the enrolled children, while 37.5% of children maintained intermediate MD adherence and 40.3% of children adopted lower MD levels. Children MD compliance was related at an independent manner with maternal education level, childhood anthropometric factors such as Body Mass Index (BMI), Waist circumference to Height ratio (WtHR), quality of life, and exclusively breastfeeding behaviors after adjusting for several possible confounders (p ˂ 0.05).

Conclusions: Elevated MD adherence of children aged 6-9 years old showed a lower obesity of overweight/obesity, including abdominal obesity. A higher maternal educational status and adopting exclusively breastfeeding practices were associated with greater levels of children's MD adherence, promoting their quality of life and well-being. Based on the present results, future prospective surveys need to be performed to evaluate if there is a causality relation concerning this topic.

Background: Houge-Janssens syndrome 1 is a condition with onset in early childhood caused by heterozygous pathogenic variants in the PPP2R5D gene, which encodes a B56 regulatory subunit of the serine/threonine protein phosphatase 2A (PP2A). There is evidence that the PP2A-PPP2R5D complex is involved in regulating the phosphatidylinositol 3-kinase (PI3K)/AKT signalling pathway, which is crucial for several cellular processes, including the pathogenesis and progression of haemangiomas.

Case presentation: We report the first PPP2R5D-related neurodevelopmental disorder case from Sardinia, a child with transient hypoglycaemia, facial dysmorphisms, and multiple haemangiomas. Whole Exome Sequencing analysis confirmed the clinical suspicion, detecting the presence of the de novo missense variant c.592G>A in the PPP2R5D gene.

Conclusions: Haemangiomas have never been linked to the syndromic phenotype of the PPP2R5D-associated disorder. The close correlation between the PP2A enzyme and the PI3K/AKT signalling pathway suggests the possible correlation between its dysfunction and activation of haemangiogenesis. Our report highlights a possible link between the PPP2R5D-related disorder and altered angiogenesis, characterizing diffuse haemangiomas as a possible novel phenotypic trait of this condition.

Background: Insulin pumps coupled with continuous glucose monitoring sensors use algorithms to analyze real-time blood glucose levels. This allows for the suspension of insulin administration before hypoglycemic thresholds are reached or for adaptive tuning in hybrid closed-loop systems. This longitudinal retrospective study aims to analyze real-world glycemic outcomes in a pediatric population transitioning to such devices.

Methods: We evaluated children with type 1 diabetes mellitus (T1D) admitted to the Pediatric Diabetes Department from a major University Hospital in Bucharest, Romania, who transitioned to hybrid closed-loop or predictive low-glucose suspend system from either non-automated insulin pumps or multiple daily injections. The primary outcome was assessing the change in glycated hemoglobin (HbA1c) after initiating these devices. Secondary outcomes analyzed changes in glucose metrics from the 90 days prior to the baseline and follow-up visit.

Results: 51 children were included (58.8% girls), the mean age was 10.3 ± 3.7 years, and the mean follow-up duration was 13.2 ± 4.5 months. The analyzed parameters, such as HbA1c (6.9 ± 0.7% vs. 6.7 ± 0.6%, p = 0.023), time in range (69.3 ± 11.2% vs. 76 ± 9.9%, p < 0.001), time in tight range (47.4 ± 10.9% vs. 53.7 ± 10.7%, p < 0.001), time below range (5.6 ± 2.9% vs. 3.5 ± 1.9%, p < 0.001), time above range (25 ± 11.2% vs. 20.4 ± 9.4%, p = 0.001), and coefficient of variation (37.9 ± 4.8% vs. 35.6 ± 4.6%, p = 0.001), showed significant improvements.

Conclusions: The application of these sensor-integrated insulin pumps can significantly enhance metabolic control in pediatric populations, minimizing glycemic variations to mitigate complications and enrich the quality of life.

Background/objectives: Routine screening electrocardiograms (ECGs) prior to starting medications for attention-deficit/hyperactivity disorder (ADHD) remain controversial. This real-world study assessed corrected QT (QTc) interval data from pediatric patients who had a baseline ECG performed prior to initiating treatment with ADHD medications and ≥6 months of clinical follow-up.

Methods: A retrospective chart review of children aged 2-18 years diagnosed with ADHD with/without autism spectrum disorder (ASD) at child neurology clinics in Jordan (June 2019 and June 2021) was performed, and children were prescribed with ADHD medications to manage symptoms. Patients had ≥6 months of follow-up and no known cardiac disease/family history. A baseline ECG and regular clinical exams were performed for each child.

Results: Of 458 patients with baseline ECGs, 362 met the study inclusion criteria. Overall, 286 (79.0%) patients were diagnosed with ASD/comorbid ADHD and 76 (21.0%) with ADHD alone; 61 (16.9%) were prescribed atomoxetine, 38 (10.5%) methylphenidate, 134 (37.0%) risperidone, and 129 (35.6%) aripiprazole. The patients' mean ± SD age was 6.4 ± 3.5 years, and most were male (n = 268, 74.0%). The mean baseline QTc interval was 400 ± 22 ms (median, 400 ms); one patient had a QTc interval >460 ms and was excluded from initiating treatment with any ADHD medications. During the ≥6-month follow-up, none of the patients had any signs or symptoms of adverse cardiac effects.

Conclusions: Routine screening ECGs prior to treatment with ADHD medications may not be necessary in healthy children with no family history of cardiac disease. However, further studies are needed to evaluate the long-term effects of ADHD medications in low-risk pediatric patients.