Children-Basel最新文献

Background: Pediatric thoracic magnetic resonance imaging (MRI) has evolved into a valuable diagnostic modality that offers high-resolution morphological and functional assessment. While conventional radiography and computed tomography (CT) remain standard, their radiation exposure poses significant risks in children requiring repeated imaging. Technological innovations have addressed prior MRI limitations such as low lung proton density and motion artifacts, expanding its role in pediatric thoracic imaging.

Methods: A review of the recent literature was performed, focusing on technical advancements, key MRI sequences and clinical applications in pediatric thoracic imaging. Emphasis was placed on ultrashort echo time (UTE), phase-resolved functional lung (PREFUL) MRI, hyperpolarized xenon-129 MRI, radial imaging, compressed sensing, parallel imaging and respiratory gating techniques.

Results: Modern MRI sequences provide both detailed anatomic visualization and quantitative functional assessment of the pediatric thorax. UTE and PREFUL enable evaluation of lung parenchyma, ventilation, and perfusion, while hyperpolarized gas imaging offers high-resolution functional mapping. Radial, compressed sensing and parallel imaging reduce motion artifacts and acquisition times, enhancing feasibility in uncooperative children. Clinical indications include assessment of congenital malformations, chronic lung disease like cystic fibrosis, infectious and inflammatory disorders, tumors and selected traumatic injuries.

Conclusions: Recent technical advances have established pediatric thoracic MRI as a versatile, patient-friendly alternative, as well as a complementary method to CT in selected clinical scenarios. Ongoing developments in acquisition speed, motion compensation and functional imaging are expected to further improve diagnostic accuracy and clinical utility, supporting broader adoption in routine pediatric thoracic evaluation.

Background: Medical child abuse (MCA), previously known as Münchausen syndrome by proxy, involves the fabrication or induction of illness by caregivers-most commonly the mother-leading to unnecessary medical interventions and potential harm to the child.

Methods: This retrospective study analyzed cases of suspected or confirmed MCA managed by the GAIA multidisciplinary team at Meyer Children's Hospital, Florence, between 2010 and 2022. Cases were identified using Rosenberg diagnostic criteria and red flags outlined by the American Academy of Pediatrics (AAP) and the Royal College of Paediatrics and Child Health (RCPCH). Data were extracted from medical records and analyzed descriptively.

Results: Among 816 cases of child maltreatment, 8 (0.99%) were identified as MCA. The median age of affected children was 5 years (range: 4-12 years), with a female predominance (6/8, 75%). All perpetrators were biological mothers (8/8, 100%). Children had a median of 23 emergency department visits (range: 4-44), with the most frequent presentations being fever (6/8, 75%), minor trauma (7/8, 87.5%), respiratory complaints (5/8, 62.5%), and gastrointestinal symptoms (4/8, 50%). According to Rosenberg criteria, 5 cases (62.5%) were classified as "possible diagnosis," 1 (12.5%) as "definitive diagnosis," 1 (12.5%) as "diagnosis by exclusion," and 1 (12.5%) as "inconclusive."

Conclusions: Despite its low prevalence, MCA poses serious clinical and ethical challenges. Early detection requires thorough documentation, interdisciplinary collaboration, and improved access to shared medical records. The GAIA model offers a replicable framework for effective multidisciplinary management.

Introduction: Idiopathic gynecomastia is a common diagnosis among adolescents. Closed-suction drain placement after breast resection is traditionally performed to prevent complications such as seroma or hematoma, although its effectiveness remains controversial. Drains are also associated with patient discomfort and may require prolonged wound care. The aim of the present study is to describe our experience with the outpatient surgical treatment of adolescent gynecomastia without closed-suction drain placement and to assess its short- and long-term outcomes. Methods: We conducted a retrospective single-center cohort study including male patients under 18 years of age operated on for idiopathic gynecomastia between 2019 and 2023. Demographic data, clinical features (grade of gynecomastia according to Simon's classification before surgery), intraoperative variables, and postoperative outcomes were collected. Patients were followed in the outpatient setting, with assessment of early (<30 days) and late complications. Results: A total of 21 consecutive patients were included, with a median age of 14.5 years (range 13.6-17.4). Sixteen patients (76.2%) underwent bilateral mastectomies, and five (23.8%) underwent unilateral subtotal mastectomies. Gynecomastia grade was I in 6 cases (28.6%), II in 12 (57.1%), and III in 3 (14.3%). No intraoperative adverse events occurred. Compressive chest bandaging was performed without closed-suction drainage. All patients were discharged on the same day. Two patients (9.5%) developed mild seroma during follow-up, both resolving spontaneously without aspiration or surgery. Conclusions: Our preliminary findings suggest that outpatient gynecomastia surgery without closed-suction drains appears to be a safe and effective option in adolescents, minimizing discomfort and avoiding hospital admission. However, larger, multicenter comparative studies are warranted to confirm these results and to further evaluate patient satisfaction and long-term cosmetic outcomes.

Background: Metabolic bone disease (MBD) of prematurity predisposes extremely preterm and extremely low birth weight (ELBW) infants to atraumatic fractures. Evidence on fracture reduction after structured Bone Health Programs (BHPs) remains limited.

Methods: We conducted a single-center retrospective cohort of NICU admissions (2014-2024) with gestational age < 28 weeks and/or birth weight < 1000 g, comparing a pre-program era with a standardized BHP that incorporated protocolized biochemical surveillance, a week 4 screening radiograph, optimized mineral targets, pharmacist review of parenteral minerals, and "handle-with-care" practices. The study aimed to evaluate whether implementation of a structured BHP reduced fracture incidence and improved biochemical and clinical outcomes in extremely preterm and ELBW infants. Prespecified effect measures were risk ratio (RR), risk difference (RD) with 95% confidence intervals, Fisher's exact p values, and number needed to treat (NNT). Among infants with fractures, we compared clinical course and biochemical context across eras.

Results: Of 708 eligible infants, 221 were born pre-program and 487 post-program with similar baseline characteristics. Fracture incidence decreased from 9.5% (21/221) to 1.64% (8/487); RR 0.17 (95% CI 0.08-0.38); RD -7.86 percentage points; p < 0.001; NNT ≈ 13. Among infants who fractured, length of stay was lower post-program (104.1 ± 28.3 vs. 172.0 ± 91.5 days). Peak alkaline phosphatase and parathyroid hormone were also lower in the post-program era (ALP 501.3 ± 71.2 vs. 972.5 ± 93.5 IU/L, p = 0.032; PTH 23.1 ± 12.5 vs. 38.4 ± 21.7 pmol/L, p = 0.027), whereas serum phosphate and 25 OH vitamin D did not differ significantly. The fracture burden per infant decreased following the BHP (1.50 ± 0.53 vs. 3.19 ± 3.08, p = 0.024). Age at first fracture was earlier post-program, consistent with scheduled imaging (48.4 ± 34.9 vs. 83.9 ± 37.3 days, p = 0.031).

Conclusions: A structured BHP was associated with a large reduction in fracture incidence and more favorable biochemical profiles, together with shorter hospitalization among fracture cases. Program elements that combine scheduled imaging, biochemical triggers, nutritional optimization, parenteral mineral stewardship, and standardized handling may improve skeletal outcomes. Multicenter prospective evaluations should confirm generalizability and define core components.

Background/Objectives: The incidence of late-onset sepsis (LOS) has increased with improved survival rates in premature infants. Blood culture, the diagnostic "gold standard", requires at least 36-72 h for results, leading to empiric antibiotic use and potential resistance. MicroRNAs (miRNAs) have emerged as promising biomarkers for sepsis in adults, but their role in neonatal LOS remains unclear. The aim of this scoping review is to identify the miRNA expression profiles of bacterial LOS in neonates. Methods: A scoping review of the literature was performed between 1 November 2023 and 31 December 2024. Results: Twelve studies fulfilled our criteria and were included in the review. Despite the considerable heterogeneity among the studies, most focused on detecting and quantifying serum microRNAs using real-time PCR, while some examined correlations with other biomarkers, such as CRP. The few microRNAs identified as common across multiple studies showed similar patterns of regulation in LOS cases. Compared to controls (no LOS), neonates with LOS exhibited significant alterations in miRNA expression. More precisely, in LOS, miRNA-181a, miRNA-23b, miRNA-181b5p, miRNA-21-5p, miRNA-34a5p, miRNA-199a3p, miRNA-1184 and miRNA-1295p were downregulated, while miRNA-16, miRNA-146a, miRNA-101, miRNA-187, miRNA-21, miRNA-15a/16 and miRNA-455-5p were upregulated. Conclusions: Currently, there is limited data regarding miRNA expression in LOS. Many studies showed altered expression of specific miRNAs in septic neonates; however, these observations need further validation in larger cohorts and/or randomized controlled trials to confirm their diagnostic potential.

Background: Postoperative junctional ectopic tachycardia (JET) is a potentially life-threatening arrhythmia that may occur after congenital heart surgery, especially following tetralogy of Fallot (TOF) repair. It can cause hemodynamic instability due to atrioventricular dissociation. This study aimed to evaluate the incidence, risk factors, and outcomes of JET after TOF repair, with particular focus on management strategies and the impact of JET duration on recovery.

Methods: This retrospective study included 114 pediatric patients who underwent TOF repair between 2015 and 2023. The study was approved by the institutional ethics committee (File No: 2023/09-31, Date: 10 October 2023). Postoperative JET was diagnosed based on standard electrocardiographic criteria. Perioperative variables, surgical techniques, and postoperative outcomes were analyzed.

Results: JET occurred in 19 patients (16.7%). Compared with patients without JET, those with JET had higher complication rates (73.7% vs. 42.1%, p = 0.02), prolonged inotropic support, and increased mortality (15.8% vs. 2.1%, p = 0.024). Ionized calcium (p < 0.001) and pH levels (p < 0.037) were significantly lower in JET patients. Right ventricular outflow tract muscle resection was strongly associated with JET occurrence (p = 0.003). Although cardiopulmonary bypass and aortic cross-clamp times did not predict JET, both correlated with JET duration (p < 0.05).

Conclusions: Postoperative JET remains a major concern following TOF repair, leading to adverse outcomes and longer recovery. Optimizing perioperative management may help reduce JET-related complications, though further multicenter prospective studies are needed to confirm these findings.

Attention-deficit/hyperactivity disorder (ADHD) is the most common behavioral problem in children. Multiple risk factors, including prenatal substance exposure, have been associated with this disorder.

Objectives: We determined (1) the rate of ADHD in children with prenatal cocaine exposure (PCE) as compared to those non-exposed, (2) the association of ADHD with the infant's sex, race, and birth weight, maternal age and education, and other known risk factors, and factors that may mediate the relationship between these risk factors and ADHD.

Methods: This was a secondary analysis of data from the Maternal Lifestyle Study for a long-term follow-up. ADHD was defined as any diagnosis of attention deficit, hyperactivity disorder, or the combination, from the National Institute of Mental Health Diagnostic Interview Schedule for Children (NIMH DISC) administered to children, ages 11 or 14 years. The main exposure variable was PCE. Independent variables included infant and maternal characteristics, caretaker psychopathology, and maternal-child conflict. Mediators evaluated were the child's impulsivity at 4 years of age and attention problems at 5 years from the Child Behavior Checklist.

Results: Path analysis revealed that the effects of risk variables, including PCE, were mediated through the child's attention problems at age 5 years. Child's impulsivity, which was significantly associated with attention problems, was also a mediator between PCE and ADHD. Male sex had a direct path to ADHD.

Conclusions: Our findings lend support to early screening before 4 years of age in children with PCE or other risk factors for ADHD. Behavioral interventions provided during early childhood may mitigate the later diagnosis or severity of ADHD.

Background/Objectives: Adolescence is a developmental stage marked by profound transformations and heightened vulnerability to mental health difficulties, with peer relationships playing a central role, as they provide both protective and risk factors for adolescents' mental health and well-being. This study aims to characterize Portuguese adolescents' perceptions of how peers and friends influence their mental health, both positively and negatively. Methods: Participants were 99 adolescents aged 14-19 years old enrolled in a Portuguese secondary school. Data were collected through two open-ended questions and participants responses were analyzed using a mixed-methods approach, qualitative and quantitative. Results: Bullying and aggression were the most frequently reported negative influences, followed by peer pressure for inadequate behavior, toxic or false friendships, lack of support, criticism, and social exclusion. Conversely, social support was the most cited positive influence, alongside connection and belonging, promotion of emotional well-being, positive peer characteristics, and social learning. Conclusions: Findings support the dual role of peer relationships, which may either exacerbate vulnerability or strengthen resilience. The study underscores the importance of school-based prevention strategies that reduce bullying and peer aggression while fostering prosocial climates and supportive peer interactions.

Background: Cystic fibrosis-related diabetes (CFRD) is a frequent comorbidity in individuals with cystic fibrosis (CF). While insulin secretion defects are the primary mechanism in CFRD pathophysiology, insulin resistance may contribute as an additional risk factor. Early detection of insulin resistance may help identify patients at higher risk for earlier CFRD development. Objective: The aim of this study was to evaluate the ability of the Matsuda Index to identify insulin resistance in pediatric CF patients and to compare it with HOMA-IR as complementary indicators of glucose metabolism. Methods: In this cross-sectional study, fifty children with CF aged 6-16 years were included. The study involved measuring anthropometric data, fasting insulin, fasting glucose levels, glycated hemoglobin (HbA1c), and C-peptide. An assessment of glucose and insulin levels was performed on the patients through an oral glucose tolerance test (OGTT) at 0, 60, and 120 min. The Matsuda Index was computed, wherein a threshold of ≤4.5 signifies the presence of insulin resistance. Statistical analyses were conducted to compare insulin resistance and sensitivity across groups, using t-tests, correlation, and ANOVA. Results: Among the 50 observed patients, the average Matsuda index score was 17.08 with a standard deviation of 11.16. Eleven individuals (22%) exhibited insulin resistance with a Matsuda Index ≤ 4.5. These patients showed significantly higher insulin levels at 60 and 120 min during the OGTT, with statistically significant p-values of 0.008 and 0.002, respectively. Conclusions: The Matsuda Index may serve as a useful adjunctive tool to help identify insulin resistance in pediatric CF patients, particularly during puberty. Early detection of insulin resistance through the Matsuda Index may facilitate risk stratification and enable timely interventions that could potentially delay the onset or progression of CFRD. However, it should be noted that the ≤4.5 cut-off value was derived from adult studies, and its validity in pediatric CF populations has not been established, which represents a limitation of our finding.

Background: Recurrent urinary tract infections (rUTIs) in children are increasingly complicated by antimicrobial resistance, leading to limited treatment options and challenging prophylactic management. Continuous local monitoring of resistance trends is essential for evidence-based stewardship. Methods: This retrospective study analysed recurrent paediatric UTI recorded between 2020 and 2024 at a tertiary hospital in Romania. Data were extracted using the ICD-10 code N39.0 and included demographic, clinical, and microbiological variables. Antimicrobial susceptibility testing followed CLSI standards. Associations between multidrug resistance (MDR) and clinical factors were assessed with χ² tests and Cramer's V, and predictors of MDR were evaluated by multivariable logistic regression. Temporal trends in resistance were examined using logistic regression with year as a continuous variable, and results were validated with the non-parametric Cochran-Armitage linear-by-linear χ² trend test to strengthen analytical rigour. Proportions are presented with Wilson 95% confidence intervals (CIs). Results: A total of 134 children met inclusion criteria for rUTI, of whom 130 had complete demographic and microbiological data and were included in analyses. Each episode represented a distinct culture-confirmed infection occurring ≥30 days apart. MDR occurred in 48.5% of isolates (95% CI, 40.2-56.9) and ESBL in 20.9% (95% CI, 14.9-28.5). MDR was significantly associated with urinary tract malformations (χ² = 5.78, p = 0.016) and continuous antibiotic prophylaxis (χ² = 4.23, p = 0.040). Neither logistic nor Cochran-Armitage trend analyses demonstrated a significant temporal increase in MDR (OR per year = 0.94; 95% CI 0.75-1.17; p = 0.566; χ² = 0.89; p = 0.346). Conclusions: MDR and ESBL rates among children with recurrent UTIs remain high but stable. The combined use of parametric and non-parametric trend analyses confirmed the absence of a significant upward trajectory, underscoring the need for ongoing surveillance and stewardship to maintain antibiotic effectiveness in paediatric care.