Pediatric Reports最新文献

The growing need for collaborative healthcare teams to meet complex health challenges has led to physical therapists (PTs) being embedded in adult primary care settings for many years now. However, this model of care has not been found in pediatrics. This qualitative study sought to gain insights from pediatricians on the potential of embedding pediatric PTs in primary care. Participants were nine pediatricians practicing in both urban and rural, hospital-based and private settings. Semi-structured interviews were recorded, transcribed, and analyzed via thematic analysis per published methods, assuring trustworthiness. Three overarching themes emerged: pediatricians' priorities aligned with the Quadruple Aim of Healthcare, embedded PTs could fill multiple roles in pediatrics, and they could see a wide variety of patients, highlighting real potential benefits in primary care. Participants endorsed in-office focused treatments, screening to determine optimal care pathways, and ongoing patient follow-up as potential PT roles in this setting. Providers thought that PTs could help manage care for musculoskeletal complaints, high-risk infants, medically complex children, autism, and obesity. An advanced-trained PT having attributes of confidence, adaptability, and open-mindedness was desired. All participants endorsed pediatric primary care PTs as having potentially high value in their practice. This is the first known study on the potential of embedding a PT in the pediatric primary care setting, offering valuable insights from pediatricians to be leveraged in implementation planning.

Background The facial nerve (FN) plays a pivotal role in human life; apart from its sensory and parasympathetic functions, it innervates the facial muscles, and it is therefore involved in non-verbal communication, allowing us to express emotions and reactions. Especially in the case of childhood onset, FN dysfunction can severely affect the quality of life. Methods The aim of this review is to analyze the most recent literature, focusing on the acute onset of peripheral FN palsy among pediatric patients, discussing the different etiologies, prognoses, and management strategies. A total of 882 papers were initially identified, but only 7 met the selection criteria. Therefore, data on 974 children in total were pooled and analyzed. Results According to the findings of this review, FN palsy is idiopathic in most cases, while an infective etiology was identified as the second most common. The main pathogen agents identified were Borrelia Burgdorferi, especially in endemic areas, and Herpesviridae. Respiratory tract infections and/or ear infections were also described. Head trauma or direct injury of the FN accounted for 2% of all cases. Conclusions The overall FN recovery rate is high, even though the etiology remains unknown for most patients. Therapeutic indications are still lacking, especially in the case of non-recovering FN palsy. In our opinion, large, prospective studies are necessary for improving our knowledge of this disorder and establishing evidence-based approaches.

A hydropneumothorax is an uncommon complication of pneumonia, particularly in pediatric patients, and typically arises secondary to conditions such as malignancies, esophageal-pleural fistula, thoracic trauma, or thoracocentesis. While pneumothorax is rarely reported in adults with COVID-19 and is even less common in children, isolated cases have been noted in those with Multisystem Inflammatory Syndrome in Children (MIS-C). A recent alert has also been issued about increased Group A Streptococcus (GAS) infections in Europe. Against this background, the primary aim of this case report is to describe a rare and severe complication of pneumonia in a previously healthy child with MIS-C and a positive throat culture for GAS.

Background: The long-term effects on neonates born of COVID-19-positive pregnancies are still unclear. Congenital gastrointestinal malformations (CGIMs) often require urgent surgical intervention and antibiotic coverage. We aim to compare the health status at one-year post-surgical follow-up of cases of CGIM born of COVID-19-positive pregnancies to those of non-COVID-19 pregnancies. Methods: We conducted a comparative, observational study of 41 patients who underwent surgery at our hospital for congenital gastrointestinal malformations in 2022. They were initially treated with antibiotics and parenteral nutrition, which was later replaced with enteral nutrition gradually after the surgery. We then analyzed the data related to their growth and development during their 12-month follow-up visit at our outpatient clinic. We classified the children born of COVID-19-positive mothers as Group 1 (n = 14) and those born of mothers without COVID-19 symptoms or with unconfirmed status as Group 2 (n = 33). Results: Forty-one patients showed up for a one-year follow-up (between 11 and 13 months of life). Hence, the final Group 1 comprised 12 and Group 2 comprised 29 children. The patients were categorized based on their anatomical location. Of the cohort, 56.09% were preemies, and 43.91% were full-term newborns. We used seven parameters to evaluate both groups based on growth and developmental milestones: verbal skills, cognitive development, weight gain, height achieved, fine motor movements, gross motor movements, and social/emotional behavior. Group 1 children showed a significant decrease in height and weight compared to Group 2 children. In Group 1, 83.33% of patients were prescribed antibiotics, while only 10.34% in Group 2 were in the same situation. There were no cases of malabsorption syndrome in Group 2, but 16.66% of patients in Group 1 had it, with patients being operated on for duodenal malformations. None of the infants had necrotizing enterocolitis, post-surgical complications, or sepsis. All the children received antibiotics to prevent infection before and after surgery. No mortality was noted. Conclusions: In our one-year follow-up study, it was seen that even after surgical correction of congenital gastrointestinal malformations, children born of COVID-19-positive pregnancies can suffer serious growth and developmental delays, and gastrointestinal health issues might be more common. Since the long-term effects of COVID-19-positive pregnancies are not yet clear, larger cohort-based studies are required in this domain. Antibiotics destroy gut microbiota, especially in cases of gastrointestinal malformations and surgical resections. Growth and developmental milestones can not only be affected by CGIMs but also be further delayed by COVID-19 infections.

This paper assesses the preferred treatment patterns for retinopathy of prematurity (ROP) and examine trends in anti-vascular endothelial growth factor (VEGF) use for ROP. Methods: A retrospective survey consisting of 14 questions was distributed to paediatric ophthalmology interest groups internationally. Main outcome measures included treatment patterns, proportion of anti-VEGF use in different stages of ROP; and comparison of first-line treatments as well as repeat anti-VEGF treatments. Results: Fifty-four ophthalmologists from 11 different countries responded to the survey. The number of respondents per question, except one, ranged between 50-54. Per annum, there was an average number of 394 infants screened by each respondent. Anti-VEGF was the preferred treatment method for aggressive (A)-ROP (64.1%), Type 1 ROP in zone 1 (71.7%), and Type 1 ROP in posterior zone 2 (56.6%). The majority used laser as the first-line treatment of Type 1 ROP in anterior zone 2 (73.6%) and Type 1 ROP in zone 3 (79.2%). Laser was the preferred treatment modality utilised in infants requiring repeat treatment following anti-VEGF injection. The preferred anti-VEGF agent was bevacizumab administered at a dose of 0.625 mg. Conclusions: Anti-VEGF as first-line therapy has been increasing. Anti-VEGF appears to be the first-line treatment of choice for A-ROP, Type 1 ROP in zone 1 and posterior zone 2 and laser for Type 1 ROP in anterior zone 2 and zone 3.

The standard treatment procedures for managing renal calculi in the pediatric population are similar to those in adults. The application of flexible ureteroscopy has contributed to the increased popularity of retrograde intrarenal surgery (RIRS) as an alternative therapeutic modality that can be successfully applied in children. One of the most significant innovations of the last decade is the introduction of single-use flexible ureteroscopes (fURSs). In this case report, we present the case of a 2-year-old boy with multiple large calculi in his right kidney, which were successfully removed after a single session of RIRS using a 7.5 F single-use fURS and high-power laser settings. The total operative and lithotripsy times were estimated at 90 and 75 min, respectively. No complications were recorded. The hemoglobin loss was calculated at 0.3 mg/dL, while the creatinine level was decreased by 0.1 mg/dL. The urethral catheter was removed on the first postoperative day, and the patient was discharged. The management of multiple or large kidney stones is very challenging in the pediatric population under the age of three years. Convenient preoperative planning and the appropriate use of available equipment may lead to excellent outcomes accompanied by a reduced risk for complications.

This clinical study aimed to evaluate the sensitivity, specificity, accuracy, and precision of artificial intelligence (AI) in assessing permanent teeth in pediatric patients. Over one thousand consecutive DPRs taken in Kielce, Poland, with the Carestream CS9600 device were screened. In the study material, 35 dental panoramic radiographs (DPRs) of patients of developmental age were identified and included. They were automatically evaluated with an AI algorithm. The DPRs were then analyzed by researchers. The status of the following dichotomous variables was assessed: (1) decay, (2) missing tooth, (3) filled tooth, (4) root canal filling, and (5) endodontic lesion. The results showed high specificity and accuracy (all above 85%) in detecting caries, dental fillings, and missing teeth but low precision. This study provided a detailed assessment of AI performance in a previously neglected age group. In conclusion, the overall accuracy of AI algorithms for evaluating permanent dentition in dental panoramic radiographs is lower for pediatric patients than adults or the entire population. Hence, identifying primary teeth should be implemented in AI-driven software, at least so as to ignore them when assessing mixed dentition (ClinicalTrials.gov registration number: NCT06258798).

Gastroschisis is a congenital anomaly characterized by herniation of abdominal contents via a defect in the anterior abdominal wall. Gastroschisis can manifest as simple or complex, with additional complications such as atresia, perforation, ischemia, necrosis, or volvulus. While prenatal screening and advancements in surgical techniques have improved outcomes, infants with complex gastroschisis cases pose significant challenges in neonatal care. Vanishing gastroschisis, a rare but dreaded complication with a mortality rate ranging from 10 to 70%, occurs when the abdominal wall closes around the herniated bowel, leading to strangulation. We present a case report focusing on the management of neonatal gastroschisis in a 36-week-old female infant with vanishing gastroschisis. The infant's clinical course, including surgical interventions, complications, and multidisciplinary management, is discussed in detail. This case underscores the importance of a multidisciplinary approach in optimizing outcomes for infants with complex gastroschisis. Via this case report, we aim to provide insights into the complexities of neonatal gastroschisis management and advocate for a collaborative approach involving neonatology, pediatric surgery, infectious disease, and palliative care to improve outcomes and quality of life for affected infants.

The methylenetetrahydrofolate reductase (MTHFR) gene 677C➔T polymorphism is capable of altering folate metabolism and can modify certain neoplasia risk. Reports have suggested that folate can have an influence on bone development and so it is of interest to know if the MTHFR 677C➔T polymorphism is associated with the malignant transformation process of this tissue. The polymorphism was determined in 55 patients with osteosarcoma and in 180 healthy individuals. Compared with C/T+C/C genotypes, a 3.7-fold reduction in osteosarcoma probability is possible with the T/T genotype (OR 0.27, CI 95% 0.07-0.82). Undoubtedly, further studies, utilizing large samples and carried out on different populations, are necessary to confirm these results.

Type 1 diabetes mellitus (T1DM) is regarded as the most chronic autoimmune disease affecting children and adolescents that results from a destruction of pancreatic β-cell and leads to insulin insufficiency and persistent hyperglycemia (HG). Children and adolescents with T1DM are at an increased risk of developing microvascular complications, including diabetic nephropathy (DNE), diabetic retinopathy (DR), and diabetic neuropathy (DNU). The risk factors and prevalence of these complications differ greatly in pediatric studies. Screening for T1DM microvascular complications undergoes different stages and it is recommended to identify early symptoms and clinical signs. The identification of biomarkers in T1DM microvascular complications is needed to provide optimal treatment. Despite several studies on early biomarkers for DNE in children, the potential biomarkers for predicting DR and DNU have not been completely illustrated. This review fills this gap by identifying biomarkers of T1DM microvascular complications in children and adolescents through searches in the PubMed/Medline database.