Pediatric Reports最新文献

Objectives: Preterm infants are at higher risk for developmental delays (DDs) and long-term complications compared with term infants. With the high prevalence of preterm births in Arabic-speaking countries, an Arabic-language screening tool is crucial. The aim of the study is to examine the feasibility of utilizing an Arabic version of the Ages and Stages Questionnaire, Third Edition (A-ASQ-3), at 4 months corrected age (CA).

Methods: Infants born at or after 28 weeks of gestational age were recruited in this longitudinal study. A total of 48 infants underwent the developmental assessment at 4 months CA using the A-ASQ-3. The primary outcome was identifying the infants at risk for DDs. Descriptive statistics, t-tests, and Firth's logistic regression were used for analysis.

Results: Of the 48 infants, 37 (77.1%) had a DD at in least one of the five A-ASQ-3 domains at 4-months CA. None of the risk factors assessed in this study were associated with a high risk of DDs among preterm infants.

Conclusions: The A-ASQ-3 is a feasible tool for identifying infants at risk for DDs at 4 months CA. This finding underscores the need for early screening and tailored intervention programs for preterm infants in Saudi Arabia. The A-ASQ-3 can help identify infants at high risk of DDs and enable prompt referral to healthcare providers.

Anesthesia for children with a current respiratory infection or a history of infection within the last two weeks is always associated with a high risk of respiratory complications. However, this risk decreases significantly when the interval between the last symptoms of the infection and the planned anesthesia and medical procedure is extended to at least 2-4 weeks. The most common adverse events include bronchospasm, laryngospasm, and apnea. For children requiring unplanned procedures-such as emergency, urgent, or immediate general anesthesia-guidelines should be followed to maximize their safety and minimize the risk of complications.

Over the past century of research, it has become increasingly evident that glucagon should no longer be regarded solely as a counter-regulatory hormone to insulin. Its role in the pathophysiology of metabolic disorders-including diabetes, obesity, and non-alcoholic fatty liver disease-appears to be critical. Hyperglucagonemia is a common feature across several metabolic conditions, not only in adults but also in pediatric populations, suggesting that glucagon may represent both a pathogenic factor and a potential therapeutic target in metabolic disease. Accordingly, therapeutic strategies have been developed that either inhibit or enhance glucagon activity, depending on the clinical context, and some of these approaches are being applied in pediatric care as well. This review aims to provide a comprehensive overview of the pathophysiological role of glucagon in metabolic diseases, synthesizing recent findings that support novel hypotheses for the management and prevention of these conditions.

Background/objectives: This review article highlights the role of the nucleotide-binding domain, leucine-rich repeat, pyrin domain-containing 3 protein (NLRP3) inflammasomes in various gastrointestinal and hepatic disorders in the pediatric age group. NLRP3 inflammasomes are one of the principal intracellular innate immune sensors. During inflammation, molecules such as caspase-1 and the release of IL-1β and IL-18 are produced. The NLRP3 inflammasome participates in the preservation of intestinal homeostasis and mucosal immune response. The objective is to evaluate the published articles related to the role of NLRP3 inflammasomes in common pediatric gastrointestinal and hepatic disorders in order to identify the future perspective regarding their possible therapeutic values.

Methods: We searched Medline for NLRP3 inflammasomes and disorders of the digestive system during childhood.

Results: Although the majority of articles were related to various disorders of adults, such as Alzheimer's disease, Parkinson's disease, atherosclerosis, as well as neurodevelopmental disorders, such as schizophrenia, a few published datasets were related to the roles of NLRP3 in the pediatric age group: they addressed autism, rheumatoid arthritis, and other autoimmune diseases, as well as inflammatory bowel diseases (IBD) and hepatic infection. Some research demonstrated that the NLRP3 inflammasome has a protective role; however, it also has a pathogenic function.

Conclusions: This review focused on the comprehensive role of inflammasome NLRP3 in the most common pediatric and neonatal gastrointestinal and hepatic diseases, including clinical and experimental studies, as well as the pharmacological inhibitors for NLRP3 inflammasomes, which may provide future therapy for GIT problems, such as IBD.

Background: Hemangiomatosis is a rare condition characterized by the presence of multiple benign vascular tumors that may affect various organs, including the skin, liver, and spleen. Complications are closely linked to the location and size of the lesions.

Case presentation: We describe a rare presentation of infantile hemangiomatosis with widespread cutaneous and oral mucosal lesions, further complicated by splenic and hepatic involvement and secondary cholestasis. The initial progression was unfavorable, with an increase in both the number and size of the lesions. Cardiologic evaluation identified minor valvular insufficiencies, but no secondary cardiac failure. Treatment with propranolol and prednisone was initiated, with a slow favorable evolution. There were no new hemangiomas developed, and those on the face and limbs decreased in size, some disappearing entirely. Hepatic and splenic hemangiomas regressed more slowly, but their reduction and the improvement of cholestasis were progressive. Due to significant iatrogenic Cushing's syndrome, prednisone was gradually tapered. Transient subclinical hypothyroidism occurred during treatment, resolving spontaneously.

Conclusions: The present case illustrates the rarity and complexity of multifocal infantile haemangiomatosis and highlights the importance of early diagnosis, comprehensive organ evaluation, and tailored multidisciplinary management. It clearly demonstrates that prompt intervention and careful therapy adjustment can lead to favorable outcomes even in the setting of extensive visceral involvement.

Background: Noninfectious complications of peritoneal dialysis (PD) are common in infants. Mechanical dysfunctions with abdominal compartment syndrome, hydrothorax with respiratory failure, and medication-induced chyloperitoneum are rare during PD. In this case report, we aim to present several life-threatening events and the timely management of a PD infant. Case Presentation: This male infant is a case of infantile nephronophthisis, NPHP3/renal-hepatic-pancreatic dysplasia type 1, with end-stage kidney disease, and he received PD therapy at 4 months of age. Because of the young age with low body weight and hepatosplenomegaly with a limited abdominal cavity, intra-abdominal pressure-associated noninfectious complications frequently occurred. Acute respiratory failure with abdominal dullness was detected at 5 months of age. Abdominal compartment syndrome caused by PD catheter outflow obstruction from omental wrapping was diagnosed via laparoscopic revision surgery. Hyperkalemia, decreased PD drainage volume, and sudden respiratory distress occurred at 10 months old. Hydrothorax due to pleuroperitoneal communication was confirmed by scintigraphy. After thoracoscopic diaphragmatic bleb repair and plication surgery were performed, no recurrence of hydrothorax was observed. Calcium channel blocker-induced chyloperitoneum was observed at 13 months of age. Chylous ascites disappeared after tapering off the calcium channel blocker in 3 days. After the patient grew up with a larger peritoneal cavity, no more pressure-associated complications of PD occurred. Conclusions: The key to successful treatment of rare and life-threatening noninfectious complications of PD in young infants lies in early detection and timely intervention. A limited abdominal cavity is not a contraindication for PD therapy, especially in very young infants with low body weight, because hemodialysis is not a choice of long-term dialysis modality.

Background and Clinical Significance: Extremely premature infants face complex medical challenges requiring comprehensive multidisciplinary care. Gastrointestinal malformations, while rare, pose significant diagnostic and therapeutic challenges in this vulnerable population. Case Presentation: We report a case of an extremely premature infant born at 26 weeks gestation with very low birth weight (950 g) who developed a digestive pathology rarely encountered in neonatal intensive care: microcolon, which required surgical consultation and intervention, followed by an atypical postoperative course. Conclusions: The early recognition of gastrointestinal malformations in extremely premature infants requires high clinical suspicion and prompt multidisciplinary intervention. Despite complex postoperative course, favorable outcomes are achievable with coordinated care.

Background: The use of technological devices by children has increased in recent years, as several Italian studies have shown, even if limited studies assessed the possible effects on sleep and psychological wellbeing in preschool and schoolchildren.

Objectives: This cross-sectional study seeks to examine the prevalence and typology of usage, as well as the potential socio-demographic factors associated with it. Additionally, it aims to assess emotional behavior and sleeping difficulties, and their possible correlations with children's attitudes towards technological devices.

Methods: The study included 314 children (52.2% males), with an average age of 7.86 years (SD = 2.02) and mainly their mothers (80.2%). Participants were given a series of self- and proxy-report questionnaires about the digital age, type of activities, hours of sleep, and their behavioral/emotional difficulties (CBCL and SDQ questionnaires). The analyses were descriptive and correlational because of the explorative nature of this study.

Results: Parents declared tablets as the device most used by children (49.8%), with an average daily use time of 22.86 min (SD = 33.62). Their digital starting age was on average 5.91 years (SD = 2.25) with mostly recreational activities (Mean = 3.15; SD = 0.72). Parents and children agreed on the time spent with the technological devices reports, while they discorded on the means of creative activities use (t₁₀₉ = -8.86; p < 0.001), with children reporting a higher frequency (M = 2.45; SD = 0.69) than their parents (M = 1.89; SD = 0.76). The tablet time was significantly different by gender (t₃₀₉ = -2.34; p = 0.02), with boys using tablets for a longer mean time than girls (27.8 versus 18.22) and having more ADHD problems (t₃₁₂ = -3.11; p = 0.002; 2.68 versus 1.74). Parents declared an average of 9.55 (SD = 0.55) hours of sleep per night for their children. A significant correlation was found between PC usage time and sleep hours duration (r = -0.13; p = 0.019). The frequency of tablet use was correlated with both the Behavioral Problems Scale (r = 0.15; p = 0.010) and the ADHD Scale (r = 0.11; p = 0.049).

Conclusions: Based on these empirical results, preventive programmes and educational activities should be established.

Background/Objectives: Adolescence is a critical developmental phase marked by rapid cognitive, emotional, and social changes that influence how individuals experience psychological energy and exhaustion. Self-Determination Theory recently proposed a dual-process model, based on two distinct, yet related, constructs: Subjective Vitality, associated with well-being and positive health outcomes, and Subjective Depletion, associated with illbeing and negative emotions. Since, to date, no study has investigated vitality and depletion during adolescence, this study aims to validate the Subjective Vitality/Depletion Scale (SVDS) in a large sample of adolescents. Methods: A total of 1111 Italian adolescents (Mage = 14.49, SDage = 1.49; 48% females) completed the SVDS and other validated self-report measures. Specifically, the psychometric properties of the SVDS across biological sex and age groups and latent mean differences across these groups were assessed. Results: Findings supported the dimensionality of the SVDS with two correlated factors, and its construct validity through associations with positive and negative affect and basic psychological needs satisfaction. Full invariance for the SVDS was achieved across biological sex and age groups. Latent mean analyses indicated that males reported higher levels of vitality compared to females (Cohen's d = 0.46), with no significant differences for depletion; older adolescents reported lower levels of vitality (d = -0.23) and higher levels of depletion (d = 0.20) compared to younger adolescents. Conclusions: These findings support the SVDS as a valid and reliable instrument for assessing energy-related experiences in adolescence. The results suggest meaningful sex differences and a potential developmental trend of declining subjective energy from early to later adolescence.

Acute appendicitis is a common cause of acute abdominal pain but is rare in infants because of anatomical and physiological characteristics that reduce the risk of the luminal obstruction of the appendix. However, when it occurs in infants, it is often difficult to diagnose clinically and may progress rapidly to a fatal outcome. We report a forensic autopsy case of an 11-month-old infant who died 2 d after developing fever and decreased oral intake, without antemortem diagnosis. Autopsy revealed fibrinous ascitic fluid and an edematous, dark-red appendix with fibrin deposits, but no macroscopic luminal obstruction or perforation. Histopathological examination showed diffuse inflammatory cell infiltration and hemorrhage across all layers of the middle and peripheral portions of the appendix, along with lymphoid hyperplasia in the middle portion. Intestinal bacteria were detected in the ascitic fluid. The cause of death was identified as acute appendicitis with subsequent generalized peritonitis. Although luminal obstruction is a common cause of appendicitis, it was not observed macroscopically in this case. However, histopathological findings suggested that lymphoid hyperplasia in the middle portion of the appendix caused luminal narrowing and impaired circulation in the appendiceal wall, triggering appendicitis. This case demonstrates that infantile appendicitis can be fatal even without perforation and highlights the potential role of lymphoid hyperplasia in the pathogenesis. It also underscores the importance of considering appendicitis in the differential diagnosis of infants with nonspecific symptoms and illustrates the value of postmortem histopathological investigation in elucidating the disease mechanism.