Children-Basel最新文献

Placental insufficiency and gestational diabetes, which are both serious pregnancy complications, are linked to altered fetal growth, whether restricted or excessive, and result in metabolic dysfunction, hypoxic/oxidative injury, and adverse perinatal outcomes. Although much research has been carried out in this field, the underlying pathogenetic mechanisms have not as yet been fully elucidated. Particularly because of the role it plays in cardiovascular performance, glucose metabolism, inflammation, and oxidative stress, the adipokine apelin was recently shown to be a potential regulator of fetal growth and metabolic programming. This review investigated the numerous biological actions of apelin in utero and aimed to shed more light on its role in fetal growth and metabolic programming. The expression of the apelinergic system in a number of tissues indicates its involvement in many physiological mechanisms, including angiogenesis, cell proliferation, energy metabolism, inflammation, and oxidative stress. Moreover, it appears that apelin has a major function in disorders such as diabetes mellitus, fetal growth abnormalities, fetal hypoxia, and preeclampsia. We herein describe in detail the regulatory effects exerted by the adipokine apelin on fetal growth and metabolic programming while stressing the necessity for additional research into the therapeutic potential of apelin and its mechanisms of action in pregnancy-related disorders.

Objective: We aimed to develop an algorithm that accurately identifies children with Down syndrome (DS) using administrative data.

Methods: We identified a cohort of children born between 2000 and 2017, enrolled in the Tennessee Medicaid Program (TennCare), who either had DS coded on their birth certificate or had a diagnosis listed using an International Classification of Diseases (ICD) code (suspected DS), and who received care at Vanderbilt University Medical Center, a comprehensive academic medical center, in the United States. Children with suspected DS were defined as having DS if they had (a) karyotype-confirmed DS indicated on their birth certificate; (b) karyotype-pending DS indicated on their birth certificate (or just DS if test type was not specified) and at least two healthcare encounters for DS during the first 6 years of life; or (c) at least three healthcare encounters for DS, with the first and last encounter separated by at least 30 days, during the first six years of life. The positive predictive value (PPV) of the algorithm and 95% confidence interval (CI) were reported.

Results: Of the 411 children with suspected DS, 354 (86.1%) were defined as having DS by the algorithm. According to medical chart review, the algorithm correctly identified 347 children with DS (PPV = 98%, 95%CI: 96.0-99.0%). Of the 57 children the algorithm defined as not having DS, 50 (97.7%, 95%CI: 76.8-93.9%) were confirmed as not having DS by medical chart review.

Conclusions: An algorithm that accurately identifies individuals with DS using birth certificate data and/or ICD codes provides a valuable tool to study DS using administrative data.

Background: The literature highlights the profound psychological impact of war on children, families, and communities, emphasizing the prevalence of Post-Traumatic Stress Disorder (PTSD), anxiety, and other symptoms among affected individuals. Interventions, such as Child-Parent Psychotherapy (CPP) and music therapy, show promise in mitigating trauma effects, underscoring the need for holistic approaches that address familial and community dynamics alongside individual well-being.

Methods: Aiming to explore the influences of dyadic music therapy sessions on parents' capacity to support their children, this study involved four families displaced from their home-kibbutz as result of a terrorist attack. All dyads participated in music therapy sessions with a focus on parent-child interactions and trauma processing (CPP informed). Embedded in a qualitative, phenomenological approach, the research utilized interpretative phenomenological analysis (IPA) and micro-analytic methods to explore meaningful moments in the music therapy sessions.

Results: Findings identified four central categories: (1) Discovering the child's grounding song: identifying resources; (2) Musical improvisation sets the grounds for parent-child mutual recognition of the child's traumatic experience; (3) Musical performance empowers child and parent; (4) A sense of agency is gained through controlling the musical environment.

Conclusions: The significance of restoring the children's freedom of play, the parents' sense of competency, and of enhancing families' capacity to connect to their traumatic experiences through the musical environment is discussed.

Background/objectives: Iron deficiency anemia (IDA) and stunting are prevalent global health issues, particularly in developing countries, where previous studies have suggested a potential relationship between them. This systematic review aims to analyze the relationship between iron deficiency anemia and stunting in pediatric populations in developing countries.

Methods: Literature searches were conducted on PubMed, EMBASE, Cochrane Library, and EBSCO Host. The primary outcome was the association between IDA and stunting. Risk of bias was assessed using the Newcastle-Ottawa Scale (NOS) for cohort studies and the Effective Public Health Practice Project (EPHPP) for other observational studies. Meta-analysis was performed with a random-effects model and heterogeneity assessment. A Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) assessment was performed to determine the certainty and importance of the study.

Results: Out of 19,095 articles, 15 studies were included in the systematic review, and 4 studies were included in the meta-analysis, encompassing 21,936 subjects aged 0 to 12 years. IDA prevalence ranged from 3.6 to 58.8%, while stunting prevalence varied from 6.6 to 44.5%. Nine articles supported a significant relationship between IDA and stunting, revealing that stunted children had a 1.31-6.785 times higher risk of developing IDA. The odds ratio of children with IDA to be stunted was 2.27 (95% CI = 1.30-3.95). All studies exhibited a moderate risk of bias. GRADE assessment suggested that the evidence's certainty is low but important.

Conclusions: The high IDA prevalence in developing countries, including Indonesia, is associated with stunting in children, suggesting a synergistic relationship.

It has become increasingly common for researchers to partner with patients as members of the research team and collaborate to use their lived experiences to shape research priorities, interventions, dissemination, and more. The patient-oriented research (POR) model has been adopted by both adult and pediatric health researchers. This cultural change to conducting pediatric health research brings with it new methodologies, tools, challenges, and benefits. In this review, we aim to provide guidance on how to conduct POR for pediatric populations using examples from the literature. We describe considerations for engagement before the project begins, for engagement across the research cycle, and for measurement and evaluation. We aim to show that conducting POR is feasible, beneficial, and that many common challenges and barriers can be overcome with preparation and usage of specific tools.

Objectives: The COVID-19 pandemic has had a profound effect on the pediatric population worldwide. The consequences of the lockdown and the reallocation of hospital resources have caused notable changes in the presentation of pediatric orthopedic injuries. Through our use of patient records, we were able to display the epidemiological trends, as well as analyze the changes in the type and mechanism of various injuries. Our purpose is to further understand the considerable effects of the COVID-19 pandemic on pediatric orthopedic trauma and help guide the allocation of future healthcare resources.

Methods: We conducted a retrospective cohort study on pediatric patients admitted for any orthopedic injury over a 3-year period (September 2018 to August 2021) at a Midwest level 1 trauma center. Cases were stratified into two groups based on the United States' COVID-19 lockdown (19 March 2020): Pre-COVID-19 cases were any cases prior to the lockdown and Intra-COVID-19 which are cases following the lockdown. Numerical data and categorical variables were summarized and differences between the case groups were examined using either two-Proportion Z-Test, Independent Two-Sample t-test, Pearson's chi-squared, or Fisher's exact tests.

Results: A total of 3179 pediatric orthopedic referrals occurred between the Pre-COVID-19 and Intra-COVID-19 study periods. We observed a general decrease in orthopedic injuries following the COVID-19 lockdowns with 1235 injuries compared to 1606 Pre-COVID-19. Patterns in the locations of injuries changed; notably, fractures of the humerus, tibia, and fibula decreased significantly (p < 0.05). Several mechanisms of injuries decreased significantly following the onset of COVID-19 including injuries caused by monkey bars, basketball, and automobiles (p < 0.01). There was a significant increase in the overall injury severity during the Intra-COVID-19 period (p < 0.05).

Conclusions: Although there was a reduction in acute orthopedic trauma referrals, many injury mechanisms displayed similar trends regardless of restrictions. We clinically observed an overall increase in the severity of pediatric orthopedic injuries during the COVID-19 pandemic.

Background: Malnutrition and poor weight gain has been reported in infants with congenital heart defects (CHDs); however data in older children with CHDs are limited. In order to obtain representative data on the nutritional status, dietary behavior, and potential influencing factors in school-aged children with CHDs, we performed a nationwide online survey. Methods: Patients aged 6 to 17 years registered in the German National Register for CHDs were asked to participate in this study by completing the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) eating study questionnaire in order to assess their self-reported dietary habits. The use of the same questionnaire enabled a comparison with a representative subset of 4569 participants of the KiGGS study. Results: A total of 894 patients (mean age 12.5 ± 3.0 years; 47.2% female) were enrolled. Patients were allocated according to anatomic complexity into simple (23.8%), moderate (37.8%), and complex CHDs (38.4%). The consumption of sugar-containing food (p < 0.001) and fast food (p < 0.05) was significantly lower among the CHD patients than in the healthy children. Children with CHDs showed significantly lower body mass index (BMI) percentiles (p < 0.001) compared with their healthy peers, while children with complex and moderate CHDs had the lowest BMI. While in CHD patients, the BMI percentiles were not related to unhealthy food, there was a strong correlation with the CHD severity and number of previous interventions (p < 0.01). Conclusions: According to this nationwide survey, school-aged children with complex CHD are at risk of undernutrition, which is not due to dietary habits but to CHD severity and repeated surgery.

Background: Congenital toxoplasmosis leads to severe complications in childhood and presents significant global health challenges. In Brazil, the prevalence of toxoplasmosis during pregnancy and congenital cases ranges from 0.3 to 8 per 1000 live births. The clinical manifestations of congenital toxoplasmosis can include neurological and ocular damage, among other health issues, which place significant burdens on affected families.

Objective: This study aims to investigate the experiences and motivations of mothers of children with congenital toxoplasmosis who share their journeys on social media, particularly Instagram.

Methods: A qualitative virtual ethnography was used that explored the content shared by mothers of children diagnosed with congenital toxoplasmosis, aiming to understand how social media aids in their coping strategies and the support networks they create.

Results: Fifteen Instagram accounts were analyzed, and twelve mothers participated in in-depth interviews. Thematic analysis revealed three main themes: the initial search for information and support, the evolving role of social media in advocacy and education, and the creation of a supportive online community.

Conclusions: This study highlights the potential of social media to provide emotional support, disseminate information, and foster communities among mothers facing similar challenges, ultimately contributing to better care strategies and professional awareness for supporting families dealing with congenital toxoplasmosis.

Background: Patella instability is one of the most common knee injuries in the adolescent patient. There are several pathoanatomic risk factors which should be assessed via several modalities, including X-rays, magnetic resonance imaging (MRI), or even CT scan.

Objectives: We intend to review these risk factors along with the nonsurgical and surgical techniques used to prevent recurrent dislocations.

Methods: We completed an extensive review of the recent literature concerning pediatric and adolescent patellar dislocation and subsequent treatment modalities.

Results: We review in detail the risk factors such as patella alta, trochlear dysplasia, lateralization of the tibial tubercle or medialization of the trochlear groove (increased tibial tubercle to trochlear groove (TT-TG) distance), lower limb malalignment, excessive femoral anteversion and/or tibial torsion, and hyperlaxity. There are classification systems for dislocators, and a natural progression of instability that patients often proceed through. Only after a patient has continued to dislocate after bracing and physical therapy is surgical treatment considered. Surgical techniques vary, with the workhorse being the medial patellofemoral ligament (MPFL) reconstruction. However, there are a variety of other techniques which add onto this procedure to address other anatomic risk factors. These include the tibial tubercle osteotomy to address a large TT-TG distance or trochleoplasty to address the lack of a trochlear groove.

Conclusions: Nonsurgical and surgical treatments for patella dislocators are tailored to the pathoanatomic risk factors in each patient.

Background: A Norwood procedure performed after 14 days of life is notably burdened by a high mortality. We analysed the real risk and which other factors influence the mortality in late Norwood procedures.

Methods: A single-centre, retrospective review of a series of consecutive patients who underwent a surgical Norwood procedure from January 2019 until December 2023. The patients' characteristics were considered to identify the factors associated with in-hospital and interstage mortality.

Results: 35 patients were included and 71% (25) of the patients underwent the Norwood procedure after 14 days of life. The median age was 27 days (6-259 days). The in-hospital mortality was 26% (9/35) with 89% (8) of the deceased being older than 15 days at the time of the surgery. Other factors that negatively affected the outcome were a restrictive interatrial septum defect (ASD) in 66% of all patients (23), the need for mechanical ventilation in 46% (16) and systemic infection prior to surgery in 43% (15).

Conclusions: Age at the time of Norwood was not associated with a higher risk of mortality, but other factors such as restrictive ASD, preoperative infection and the need for mechanical ventilation prior to surgery are even more important in predicting the short-term outcome.