Children-Basel最新文献

Background: Preterm birth is a significant risk factor for neurodevelopmental delays, but the appropriate use and timing of age correction for developmental assessment remain debated.

Objective: This study investigated psychomotor development in preterm children at two years of age, with the aim of clarifying whether age correction remains necessary at this stage, particularly across different gestational age groups.

Methods: A total of 161 preterm infants were assessed at a mean chronological age of 25.4 months (mean corrected age: 23.3 months) and compared with two control groups of typically developing children matched for gender and either corrected age (Control-Corr, N = 88) or chronological age (Control-Chron, N = 87). The preterm group was further stratified by gestational age: extremely preterm (<28 weeks), very preterm (28-31 weeks), and moderate-to-late preterm (32-36 weeks). Cognitive, Language (Receptive, Expressive), and Motor (fine, gross) scales of Bayley-III were analysed using t-tests and MANOVAs.

Results: Using corrected age, preterm children showed a selective profile, with deficits in Receptive Language, borderline mean score in Gross Motor, and preserved performance in Cognitive, Expressive Communication, and Fine Motor. When compared with controls of the same age, significant differences emerged in the Cognitive, Language, and Gross Motor, but not Fine Motor, domains. In contrast, scoring by chronological age produced a generalised delay, with preterm children performing significantly worse than chronological-age controls across all domains. Subgroup analyses further showed that extremely preterm children already displayed marked Language vulnerabilities at corrected age, which became more severe with chronological scoring and extended to other domains. Very preterm children also fell into the deficit range in Cognitive, Language, and Gross Motor scales/subscales when chronological age was applied, whereas moderate-to-late preterm children performed comparatively better.

Conclusions: Developmental assessment using corrected age remains essential at least until 24 months, especially for extremely and very preterm children, to avoid substantial overestimation of developmental difficulties. Chronological scoring, while helpful to highlight persistent vulnerabilities, may inflate delay classification if used too early. Tailoring correction strategies by gestational age and developmental domain could provide a more accurate and clinically meaningful representation of preterm children's developmental trajectories.

Purpose: This study aimed to investigate the association between lactate dehydrogenase-to-albumin ratio (LAR) and the clinical characteristics and overall survival (OS) of patients with neuroblastoma (NB).

Methods: We conducted a retrospective data analysis of 443 patients diagnosed with neuroblastoma. The optimal cut-off value for the LAR was determined using receiver operating characteristic (ROC) curves. We utilized Kaplan-Meier curves and Cox regression analysis to evaluate the relationship between LAR and OS. Independent factors identified through multivariate analysis were employed to construct a nomogram. The performance of the nomogram model was assessed using calibration curves, ROC curves, concordance index (C-index), and decision curve analysis (DCA).

Results: The 2-year time-dependent ROC curve indicated that the optimal cut-off value for the LAR was 21.814. Kaplan-Meier survival curve analysis revealed that the prognosis for the high LAR group was significantly worse than that for the low LAR group. Results from multivariate Cox analysis identified INSS stage, bone metastasis, MYCN, and LAR as independent prognostic factors for OS. A nomogram for predicting the prognosis of NB was established based on multivariate Cox regression analysis. Internal validation through the Bootstrap method revealed that the nomogram's C-index was 0.727. Both the calibration curve and ROC curve suggested that the model possessed significant predictive potential. DCA further demonstrated that the nomogram model exhibited substantial clinical applicability.

Conclusions: LAR served as an aussichtsreich prognostic indicator for neuroblastoma, and the nomogram model based on LAR can predict the OS of patients with this condition.

Background and objectives: Little is known about the final week of life for inpatient pediatric oncology patients. The purpose of this study was to describe inpatient pediatric oncology deaths.

Methods: Retrospective chart review of all patients who died in a large pediatric cancer center between 2007 and 2017. Demographic, diagnostic, and proximate cause of death information was extracted. Intensive care unit (ICU) admissions, chemotherapy receipt, medical interventions, and cardiopulmonary resuscitation (CPR) events one week, 48 h, and 24 h prior to death were obtained. Analysis included descriptive and statistical correlations.

Results: 344 decedent pediatric oncology patients were included. Half of the patients died in the ICU (51%). The average age was 11.3 years (range 0.13-27.7 years). Most had ongoing evidence of disease (86%) with 20% receiving cure-directed chemotherapy during their final week. Receiving cure-directed chemotherapy was not associated with age, race, ethnicity, or diagnosis but was associated with a significantly increased likelihood of receiving CPR on the last day of life (p = 0.011). The majority (84%) of children did not receive CPR on their final day of life. Receipt of CPR was not associated with race/ethnicity. CPR was associated with younger age (p = 0.006), hematologic malignancies (p = 0.037), and ICU location (p < 0.001). Most patients were not on dialysis (84%), pressors (72%), or ventilated (60%) during the final 24 h of life. Compassionate extubation occurred in <6% of deaths.

Conclusions: Most deaths in a pediatric cancer center occur in children with active disease. Continuation of cure-directed chemotherapy, age, diagnosis, and location of death has potential to influence end-of-life inpatient care.

Background/Objectives: Regional disparities in neonatal care capacity may have a disproportionate impact on the smallest and most vulnerable infants. In South Korea, where specialized perinatal resources are concentrated in the Seoul Capital Area (Seoul, Gyeonggi, and Incheon), it remains unclear how these disparities vary by birth weight and time since birth. Methods: We conducted a nationwide, population-based cohort study of preterm infants (<37 weeks gestation) born between 2002 and 2021 using the Korean National Health Insurance Service database. Residential address at birth classified infants into Seoul Capital Area or regions outside the Seoul Capital Area. We examined 28-day and one-year all-cause mortality using multivariable logistic regression, adjusting for sex, birth weight category, early transfer, medical aid status, maternal age, and antenatal visits. Birth weight-stratified analyses assessed effect modification. Major morbidities were evaluated with multivariable Cox models. Results: Among 204,245 preterm infants, those residing outside the Seoul Capital Area had higher adjusted odds of mortality at both 28 days (odds ratio 1.46; 95% confidence interval [CI], 1.30-1.64) and one year (odds ratio 1.25; 95% CI, 1.17-1.34) than those residing in the Seoul Capital Area. Disparities were minimal in infants ≥2500 g but increased progressively in lower birth weight strata, peaking among extremely low birth weight infants (<1000 g) (28-day odds ratio 1.67; 95% CI, 1.40-1.97; one-year odds ratio 1.54; 95% CI, 1.37-1.73). Conclusions: Regional survival disparities among preterm infants in South Korea widen with decreasing birth weight, underscoring the need for targeted neonatal care and post-discharge support in underserved regions.

Background/objectives: Research on the relationship between digital media use in adolescence and mental health outcomes in young adulthood remains unclear. This study aims to (1) assess how trajectories of digital media use from adolescence to young adulthood predict mental health outcomes and (2) identify factors in adolescence that contribute to digital media use trajectories.

Methods: Participants (M_age = 15.53 years; 56.86% female; 66.89% White) from the National Longitudinal Study of Adolescent and Adult Health database provided digital media use data across Waves I-IV. At Wave I, participants self-reported parental support, family connectedness, face-to-face interactions with peers, and self-esteem. At Wave IV, participants self-reported anxiety and depression diagnoses, depressive symptomology, suicidal ideation and attempts, and short-term and working memory. General linear and logistic regression models assessed the relationships.

Results: Four trajectory groups emerged: Group 1 "increase" (9.97%), Group 2 "low" (73.36%), Group 3 "decrease" (13.94%), and Group 4 "high" (2.73%). Individuals in Group 4 experienced decreased short-term memory compared to individuals in Group 2. The odds of a suicide attempt in the past 12 months were significantly higher for individuals in Groups 3 and 4 compared to Group 2.

Conclusions: Patterns of digital media use from adolescence to young adulthood may contribute to suicide attempts and short-term memory in young adulthood, highlighting the need for interventions to reduce screen time. Non-significant findings highlight the need for additional research aimed at clarifying these relationships and identifying factors in early adolescence that may contribute to digital media use trajectories.

Background and objectives: Early identification of cardiac dysfunction in multi-system inflammatory syndrome in children (MIS-C) is crucial for effective management. Our primary objective was to predict left ventricular systolic dysfunction (LVSD) through a multicenter collaborative assessing admission laboratory data and echocardiogram findings.

Methods: Laboratory and clinical data were collected by retrospective chart review from a cohort of pediatric patients admitted and treated for MIS-C in our institutions. Laboratory data including absolute lymphocyte count, albumin, sedimentation rate, C-reactive protein, procalcitonin, d-dimer, fibrinogen, ferritin, interleukin-6 level, and lymphocyte subsets (T, B and NK quantitation, TBNK) were collected. We built a LASSO logistic regression model to predict which MIS-C patients would have left ventricular systolic dysfunction LVSD using only laboratory data obtained within the first 24 h of admission.

Results: Of the 1474 MIS-C patients evaluated, 297 had LVSD. The linear kinetic analysis found differences in albumin, lymphocyte count, C-reactive proteins and fibrinogen for systolic dysfunction patients, and of these C-reactive proteins, fibrinogen and procalcitonin were more predictive earlier. The best model for coronary artery abnormalities (CAAs) performed poorly, with a mean cross-validated AUC of 0.57. The model performed well with a cross-validated AUC of 0.845.

Conclusions: This model identified widely available biomarkers to successfully predict systolic dysfunction in MIS-C patients. Those at high risk of systolic dysfunction had higher peak laboratory values for C-reactive protein, fibrinogen, and procalcitonin early on. A regularized logistic regression model was validated to provide excellent discrimination for LVSD.

Background: Childhood obesity is a growing public health concern globally and is associated with a wide spectrum of comorbidities, including sleep-disordered breathing (SDB). SDB remains under-recognized in pediatric population with obesity, particularly in Middle Eastern settings, despite its significant impact on cognitive, behavioral, and metabolic health.

Objectives: To assess the prevalence of SDB among children with obesity aged 6-12 years attending King Faisal University polyclinics in Saudi Arabia and to identify key demographic and anthropometric predictors, with particular emphasis on the mediating role of neck circumference.

Methods: A cross-sectional study was conducted involving 130 children with obesity aged 6-12 years. Data collection included sociodemographic characteristics, anthropometric measurements (BMI percentile, neck and waist circumference), and screening for SDB using the validated Arabic version of the Pediatric Sleep Questionnaire Sleep-Related Breathing Disorder (PSQ-SRBD) scale. Logistic regression and mediation analyses were performed to examine associations and pathways between obesity parameters and SDB risk.

Results: Of the 130 participants, 37.7% screened positive for SDB risk. SDB prevalence was higher among males and older children. Neck circumference and BMI percentile were independently associated with SDB risk, with neck circumference mediating the relationship between BMI and SDB. The mediation model indicated that increased BMI contributes to SDB risk both directly and indirectly through increased neck circumference.

Conclusions: SDB is highly prevalent among obese Saudi children, and neck circumference is a significant mediator of risk. Incorporating SDB screening and neck circumference measurements into routine pediatric obesity care can facilitate early detection and management. These findings support the need for integrated, multidisciplinary approaches to improve pediatric health outcomes.

Background: Atopic dermatitis (AD) is a chronic, pruritic and relapsing inflammatory skin disorder affecting children's quality of life (QoL). Despite rising global prevalence, data on its impact on QoL in low-resource settings remain limited. This study aimed to assess the impact of AD and associated factors on the QoL of children and assesses the effect of educational intervention in Ethiopia.

Methods: A prospective cohort study was conducted among 461 AD children and their caregivers across four randomly selected hospitals dermatology clinics in Ethiopia from October 2022 to March 2024. Assessments included AD Severity using Scoring Atopic Dermatitis (SCORAD), Infants' Dermatitis Quality of Life Index (IDLQI) for children aged 0-4, and Children's Dermatology Life Quality Index (CDLQI) for children aged 5 to 16. Participants received educational guidance from trained nurses during follow-up beyond routine AD treatment. Trained personnel collected clinical and sociodemographic data. AD severity and QoL were reassessed after 6 months. Descriptive, univariate, and linear regression analyses identified factors influencing QoL, with associations reported as odds ratios (95% CI) and significance set at p < 0.05.

Results: Of 461 children, 424 (92%) completed follow-up. Most were under five (67%) with a median age of 3 years; 72.2% had AD onset before age two. Most caregivers were female (68.9%). After six months, clinical signs of AD, including dryness, erythema, excoriation, and lichenification, improved notably. Mild AD increased by 33.5%, while moderate and severe cases decreased by 17.5% and 16%, respectively. QoL significantly improved across all domains (p = 0.001). Baseline disease severity (β = 0.11), change in severity (ΔSCORAD) (β = 0.043), number of dependents (β = -0.71), and age at disease onset (β = 0.005) as significant predictors of QoL.

Conclusions: AD significantly impairs QoL in Ethiopian children, with greater severity causing more disruption. Routine treatments with educational interventions significantly improve disease severity and QoL. Integrated clinical and psychosocial care approaches for pediatric AD are crucial in resource-limited settings.

Background: This research explores the complex relationship between Attention Deficit Hyperactivity Disorder (ADHD) and language skills, focusing on the impact of the disorder on children's language development. It is designed as a systematic literature review to synthesize and evaluate existing evidence on this topic. Based on the existing literature, ADHD affects multiple dimensions of language, including phonological awareness, pragmatic comprehension, morphosyntactic structure, narrative skills, and written expression. The difficulties that children with ADHD exhibit at the language level are directly related to their deficits in working memory, attention, and organization, which make it challenging for them to acquire and use language at both educational and social levels.

Methods: This study followed the PRISMA methodology, with a systematic selection process across four stages (identification, screening, eligibility, and inclusion). During the identification phase, 475 records were identified (450 from database searches and 25 through reference screening). After screening and applying inclusion criteria, 15 studies met all eligibility requirements and were included in the final synthesis.

Results: The present research highlighted the important role that occupational therapists and psychologists can play in the language development of children with ADHD. Strategic interventions to alleviate the language difficulties of children with ADHD are designed to enhance phonological awareness, executive function, speech and language, the use of technological tools, and social skills training.

Conclusions: The importance of early diagnosis and implementation of holistic, individualized interventions targeting the language, executive, and social difficulties manifested by children with ADHD is considered influential in addressing the barriers to improving language skills as effectively as possible.

Aim: To investigate the impact of pain on some electroencephalographic (EEG) features at term equivalent age (TEA) and, second, to assess if the proposed EEG analysis may be predictive of the neurodevelopmental outcome at 24 months corrected age. Methodology: Infants born < 32 weeks of gestational age, without major brain injury, were studied with an 8-channel EEG recording at TEA. The number of skin-breaking procedures from birth to the EEG recording was collected, as well as opioid administration. The following EEG-based indexes were investigated: Brain Simmetry Index (BSI) and Circular Omega Complexity (COC). Multivariate statistical analysis was performed. Results: Seventy-seven preterm newborns were enrolled. The multivariate models showed that higher pain exposure resulted in higher BSI, lower COC μ (mean), and lower COC values related to δ waves (all p < 0.05). Fentanyl was associated with increased BSI values related to α and β waves (all p < 0.05). Morphine showed a positive effect on BSI and a negative effect on OC μ and COC on all frequency bands (all p < 0.05). COC related to δ waves was positively associated with cognitive outcomes (p = 0.034). Conclusions: Pain and opioids might impact brain dynamics in preterm infants. Quantitative multivariate EEG indexes may be helpful to characterize the neurodevelopmental outcomes.