Pediatric Reports最新文献

Background/objectives: Eating disorders (EDs) often affect fertility, yet many women with ED still become mothers. The pattern of ED symptoms during pregnancy and postpartum, along with their effects on maternal and child health, is not yet fully understood. This longitudinal study aimed to (1) examine the course of ED symptoms from conception to postpartum, (2) evaluate pregnancy outcomes and children's health and developmental milestones, and (3) assess ED status approximately four years after the initial evaluation.

Methods: Thirty women with a prior ED diagnosis (21 with anorexia nervosa, 9 with bulimia nervosa) were evaluated at two time points. Time 1 with the Eating Disorders Examination and the Oxford Risk Factors for Eating Disorders: Interview Schedule; Time 2, approximately four years later, with the Eating Disorders Examination and the Clinical Interview on Reproductive History and Eating Behavior that also included clinical data related to mother's health and baby's health and development accessed through the Pregnant Women's Health Bulletin and the Child and Youth Health Bulletin using the national health records.

Results: ED symptoms (dietary restriction, self-induced vomiting, laxative misuse) persisted from conception through postpartum. BN participants reported more severe symptoms and higher rates of pregnancy complications (hyperemesis gravidarum, gestational diabetes, preeclampsia), while premature births occurred only in AN participants. Children of mothers with AN more frequently showed delays in developmental milestones (sitting, walking, speaking, sphincter control) compared to those of BN mothers.

Conclusions: A substantial proportion of women with prior ED continued to experience symptoms during and after pregnancy, and nearly half still met diagnostic criteria four years later and are still in treatment. Cognitive features such as body dissatisfaction persisted despite partial symptom remission. These findings highlight the chronicity of ED and underscore the need for systematic screening, psychological support, and interdisciplinary follow-up during pregnancy and early motherhood.

Background/Objective: Accurate determination and documentation of causes of death in children are essential for generating reliable mortality statistics and guiding public health strategies. Previous studies have reported frequent inaccuracies in pediatric death certificates (DCs), including the use of vague terms, omissions of relevant conditions, and variability across physician specialties. This study evaluated the accuracy of pediatric DCs in Shiga Prefecture, Japan; identified common errors in these DCs; and examined changes in the underlying causes of pediatric death before and after the COVID-19 pandemic. Methods: We performed a population-based retrospective review of 391 DCs for individuals under 18 years issued between 2015 and 2023. Two pediatricians and two forensic pathologists independently reviewed each DC, assessed accuracy, and classified errors using predefined criteria. Error rates were compared by physician specialty. Underlying causes of death were reassessed into ten categories, and their distributions were compared between 2015-2019 and 2020-2023. Results: Overall, 30.9% of DCs contained errors. The error rates differed by physician specialty: obstetricians had the highest error rate (92.9%), whereas forensic physicians had the lowest (8.4%). The most common error type was the use of non-specific mechanisms such as "cardiac arrest" or "respiratory failure", rather than the actual causes of death. Congenital anomalies were often listed under other significant conditions contributing to death and not as an underlying cause of death. After the onset of the COVID-19 pandemic, deaths from acute diseases declined from 16.8% to 4.0%, while deaths from congenital disorders increased from 12.6% to 24.3%. Conclusions: Pediatric DCs often contain errors, particularly those completed by obstetricians. Misclassifying mechanisms as causes of death and underreporting congenital anomalies remain the main challenges. Strengthening physician education and introducing systematic review processes are essential to improve accuracy, clarify regional mortality trends, and guide effective public health interventions.

Background: Persistent pulmonary hypertension of the newborn (PPHN) remains a life-threatening condition resulting from failure of postnatal circulatory adaptation. Inhaled nitric oxide (iNO) is the standard first-line therapy; however, limited access or inadequate response highlight the need for alternative treatments. Milrinone, a selective phosphodiesterase-3 inhibitor with nitric oxide-independent vasodilatory and inotropic properties, has been proposed as one such option.

Methods: In this study we present a case series of three neonates with PPHN-term (41 weeks), late preterm (35 weeks), and extremely preterm (23 weeks)-treated with intravenous milrinone in a neonatal unit without immediate access to iNO. A narrative literature review was also conducted, focusing on clinical outcomes, safety, and therapeutic applicability.

Results: Milrinone was initiated within the first 24 h of life. In the term and late-preterm infants, oxygenation and echocardiographic parameters improved within 48 h, with normalization of shunt direction and successful extubation by days 4-10. Transient systemic hypotension occurred in both cases and required dose adjustment or vasoactive support. In the extremely preterm neonate, only temporary hemodynamic improvement was achieved, followed by severe intraventricular hemorrhage and coagulopathy, possibly exacerbated by vasodilatory and antiplatelet effects of milrinone.

Conclusions: Milrinone may serve as a feasible adjunct or bridging therapy for PPHN when iNO is unavailable. However, its use requires careful hemodynamic and neurological monitoring, particularly in very preterm infants. Further studies are needed to confirm safety and define optimal dosing across gestational ages.

Beta ketothiolase deficiency is a hereditary metabolic disorder caused by the pathogenic variants of the ACAT gene, which encodes for the mitochondrial enzyme acetoacetyl-CoA thiolase. Patients with a deficiency of the enzyme experience recurrent episodes of metabolic ketoacidosis. Knowledge of the clinical course of this entity, together with the available diagnostic tests, allows for its early diagnosis and prompt intervention to avoid complications or death of the infant. In this study, we present a case of a 9-month-old girl that attended the emergency room and diagnosis was made at the first episode of metabolic ketoacidosis.

Bosch-Boonstra-Schaaf optic atrophy syndrome (BBSOAS) is an extremely rare neurological condition caused by a disruption in the NR2F-1 gene. The most common clinical features are optic atrophy and intellectual and developmental delay. This case report aims to describe the cognitive and language profile of a six-year-old girl diagnosed with BBSOAS, with a focus on the syndrome's impact on her developmental outcomes. A detailed assessment of her cognitive and speech-language abilities is provided. Given the limited number of published case studies on BBSOAS, this report integrates relevant findings from the literature, including information on epidemiology, diagnostics, clinical manifestations, and developmental outcomes. It contributes to the expansion of the known mutational spectrum of BBSOAS, in addition to documenting its phenotypic presentation of cognitive and speech-language development. The case is analyzed within the context of current evidence, emphasizing the importance of early assessment, individualized intervention, ongoing developmental monitoring, and the potential for tailored support to promote optimal developmental outcomes.

Objectives: Myelomeningocele is one of the most common dysraphic defects. Does shortening the time of exposure to the toxic effects of amniotic fluid and mechanical trauma in utero on the herniated spinal cord and spinal nerves, thanks to prenatal surgery, reduce the risk of hydrocephalus with improved musculoskeletal function and better function of the urinary and digestive systems? The aim of the study was to compare the clinical effects of prenatal and postnatal surgery for myelomeningocele in pediatric patients. Methods: Comparison of urological, digestive and motor function in children following prenatal versus postnatal repair of myelomeningocele. The study group consisted of 110 children- 46 operated prenatally and 64 patients postnatally. Information about the children's assessment of shunt-dependent hydrocephalus, motor skills, bladder and bowel function was obtained from a validated survey questionnaire completed by the children's parents. Results: In the prenatal group, there was a significantly (p = 0.011) lower percentage of hydrocephalus treated with a shunt (45.71%) compared to the postnatal group (78.26%). The prenatal group revealed a lower percentage of paresis (p = 0.0422) and contractures of the lower limbs (p = 0.0108) and varus deformity (p = 0.0272). Also, in the prenatal group, fewer children move with only the use of a wheelchair (p = 0.0280) and more move independently or with orthopedic equipment (p = 0.0280). In prenatal children, the overall grade of vesico-ureteral reflux was significantly lower (p = 0.0105) and there was also a higher percentage of children with self-controlled defecation (p = 0.0395) and fewer children using enemas (p = 0.0269) and oral pharmacological agents (p = 0.0026). Conclusions: In children with myelomeningocele operated prenatally, compared to the postnatal group, shunt-dependent hydrocephalus and bladder and bowel incontinence were observed with significantly less frequency, and there was better musculoskeletal function. More children operated prenatally moved independently or with orthopedic equipment, and fewer used an orthopedic wheelchair. Further studies, particularly in even larger patient groups, are required to assess clinical benefits of prenatal surgery for children with myelomeningocele.

Background/Objectives: Respiratory syncytial virus (RSV) is one of the main pathogens causing infections of the respiratory system. In our study, we investigated whether breastfeeding, compared to feeding with formula milk, has an effect on RSV infection in newborns and infants. Methods: We analyzed 51 patients hospitalized at Department of Pediatrics, Newborn Pathology and Bone Metabolic Diseases, University of Lodz, with RSV infection. The infants were divided into two groups by the type of the feeding mode: breast milk or formula milk. Results: Breastfed infants were hospitalized for less time compared to those fed with milk formula (8 days vs. 11 days, p < 0.05). A multivariate linear regression model showed that babies fed with formula milk spent an average of 1.7 days longer in hospital than those fed with breast milk (95% Cl 0.247-3.209). Conclusions: Breastfeeding could reduce the risk, and in some cases, also the severity of RSV infection.

Over the past decade, the management of childhood acute lymphoblastic leukemia (ALL) has undergone remarkable advancements. This review explores the transition from conventional chemotherapy protocols to precision medicine approaches, highlighting improvements in diagnostic techniques, therapeutic strategies, and personalized treatments within front-line protocols. Key developments include enhanced minimal residual disease detection, the advent of immunotherapies, targeted therapies, and the integration of artificial intelligence. Despite these advancements, challenges remain in ensuring global access and equity. This article discusses the current state of ALL treatment and anticipates future directions in the field.

Background/objectives: Respiratory syncytial virus (RSV) is the most common cause of bronchiolitis and infant hospitalization in the US. RSV prevention evolved in 2023 as nirsevimab and maternal RSV pre-fusion vaccine became available for healthy newborns and infants. This study investigates sociodemographic characteristics associated with RSV immunoprophylaxis.

Methods: A cross-sectional survey was conducted from November 2023 through March 2024 among a convenience sample of parents of infants aged <8 months who received newborn care or pediatric ambulatory care at a single academic institution in Central Pennsylvania, USA. Logistic regression examined sociodemographic factors associated with RSV immunoprophylaxis uptake. Given the nirsevimab shortage during the 2023-2024 RSV season, a sensitivity analysis was completed for intended immunoprophylaxis.

Results: Among 118 participants, 66.9% received RSV immunoprophylaxis while 74.5% intended to receive nirsevimab. Higher income, private insurance, out-of-home childcare, and an adult/partner working in healthcare were associated with intended nirsevimab receipt. Participation in the Women, Infants and Children program was associated with lower rates of intended nirsevimab receipt. Out-of-home childcare was associated with both RSV immunoprophylaxis uptake and intended nirsevimab receipt.

Conclusions: Sociodemographic factors significantly influence the intent to receive nirsevimab and RSV immunoprophylaxis uptake. Having an adult/partner in healthcare was the most significant predictor for intent, suggesting that greater health literacy drives immunization intention. Enrollment in out-of-home childcare was the sole predictor of RSV immunoprophylaxis uptake. These findings highlight the importance of policy initiatives that promote equitable access to RSV immunoprophylaxis, including strategies to address socioeconomic barriers, improve health literacy, and ensure consistent availability of preventive agents for all infants.

Background: Serious bacterial infections (SBIs) in neonates present a significant diagnostic challenge due to nonspecific symptoms and immature immune responses. Early identification is essential to ensure timely treatment and prevent adverse outcomes. This study investigates clinical, laboratory, and epidemiological parameters associated with SBI in febrile neonates. Methods: A retrospective analysis was conducted on neonates hospitalized for suspected SBI at University Hospital Split from 1 January 2023 until 31 December 2024). The data was analyzed using descriptive statistics, Mann-Whitney U test and Chi-square test. Results: The study included 71 neonates hospitalized with suspected SBI, of whom 38 (53.5%) had a confirmed SBI. Neonates with SBI had a significantly longer hospital stay (p < 0.001). C-reactive protein (CRP) levels at admission were significantly higher in the SBI group (p = 0.020), while other laboratory parameters showed no significant differences. The most common diagnosis in the SBI group was urinary tract infection (50%). In urine analysis, abundant bacterial presence, strongly positive leukocyte esterase (3+), and positive nitrite findings were significantly associated with the presence of urinary tract infection (UTI). Conclusions: In neonates with suspected SBI, elevated CRP levels and prolonged hospital stay were significantly associated with confirmed SBI. Among specific diagnoses, UTI were most frequent, with urinalysis parameters (bacteria, leukocyte esterase, and nitrites) proving useful in identifying affected cases. However, individual clinical signs showed limited diagnostic value, highlighting the importance of combining clinical and laboratory data in early recognition of SBI.