Children-Basel最新文献

Background: Monochorionic (MC) twins are at risk for severe twin-to-twin transfusion syndrome (TTTS) or twin anemia-polycythemia sequence (TAPS). In the case of preterm delivery, cesarean section (CS) with immediate umbilical cord clamping (ICC) of both twins is usually performed. While the recipient is at risk for polycythemia and may benefit from ICC, this procedure may result in aggravation of anemia with increased morbidity in the anemic donor. The purpose of this study was to demonstrate that the novel approach of selective extrauterine placental perfusion (EPP) with delayed umbilical cord clamping (DCC) in the donor infant is feasible in neonatal resuscitation of MC twins and may prevent severe anemia in donor and polycythemia in the recipient.

Methods: Preterm MC twins with antenatal suspected severe anemia of the donor as measured by Doppler ultrasound, born with birthweights < 1500 g by CS, were transferred to the neonatal resuscitation unit with placenta and intact umbilical cords. In the donor, the umbilical cord was left intact to provide DCC with parallel respiratory support (EPP approach), while the cord of the recipient was clamped immediately after identification.

Results: Selective EPP was performed in three cases of MC twins with TAPS and acute peripartum TTTS. All donor twins had initial hemoglobin levels ≥ 13.0 g/dL, and none of them required red blood cell transfusion on the first day after birth.

Conclusions: Selective EPP may be a feasible strategy for neonatal resuscitation of MC preterm twins with high stage TAPS and TTTS to prevent anemia-related morbidities and may improve infant outcome.

Background: The multisystemic features of Down syndrome (DS) in children are accompanied by immunodeficiency, making them susceptible to infections and immune dysregulation with autoimmune, allergic, inflammatory, and hematological complications. This study was aimed at a better understanding of the abnormalities within the B and T cell compartments and their correlations with clinical immunophenotypes. Methods: Medical records of 35 DS children were retrospectively reviewed, referring to clinical symptomatology including history of infections, immune dysregulation disorders, and humoral and cellular immune response. Results: While the etiology of respiratory tract infections included typical viral and bacterial pathogens, SARS-CoV2-induced inflammatory disease and syndromic immunodeficiency contributed significantly to the deterioration of the clinical course. Allergic diseases in the form of asthma, allergic rhinitis, and alimentary allergy were the most frequent manifestations of immune dysregulation and were followed by autoimmune disorders, such as Crohn's disease, celiac disease, autoimmune thyroiditis, and alopecia, as well as inflammatory disorders, balanitis xerotica obliterans and lymphadenopathy, and a hematological disorder of myelopoiesis. Deficiency of serum immunoglobulin levels, reduced numbers of naïve B cells, and non-switched memory B cells along with low naïve T helper cells and significantly reduced regulatory T helper cells were the most prominent immune abnormalities. Conclusions: The loss of naïveté in B and T lymphocyte compartments with a deficiency of regulatory T cells may be underpinning pathomechanisms for the skewed immune response. The clinical immunophenotype in DS is complex and represents syndromic primary immunodeficiency with immune dysregulation.

Background: Depression is the most common mental illness in the world, found in nearly three in ten adolescents globally. This study aims to evaluate the prevalence of antidepressant prescriptions and the types of antidepressant therapy administered among adolescents diagnosed with depression in Germany.

Methods: This retrospective cohort study, based on data provided by 30 child and adolescent psychiatrists, included adolescents aged 13-17 years with an initial diagnosis of depression between 2010 and 2022 (index date) documented in the IQVIA^TM Disease Analyzer database. Kaplan-Meier curves were used to investigate the one-year cumulative incidence of antidepressant prescriptions stratified by age, sex, and depression severity. Multivariable Cox regression analyses were used to assess the association between age, sex, depression severity, co-diagnoses, and antidepressant drug prescription.

Results: A total of 6338 adolescents (mean age: 16 years, 67% female, 59% with moderate depression) were available. The cumulative incidence of antidepressant prescriptions was 61% and increased with age from 13 years old to 17 years old. Fluoxetine was the most prescribed drug, followed by Sertraline, Escitalopram, Serotonin and Norepinephrine reuptake inhibitors, herbal medications, and Mirtazapine. Obsessive-compulsive disorder and eating disorders were found to be significantly associated with antidepressant prescriptions within the spectrum of co-diagnosed conditions.

Conclusions: Higher age, depression severity, and a co-diagnosis of an obsessive-compulsive disorder or eating disorder were significantly positively associated with antidepressant prescriptions in adolescents. Fluoxetine was the most frequently prescribed drug for depression.

Background/objectives: It is vital to identify children whose weight status means that they may benefit from medical or behavioural support, but adult visual judgements of child weight status are inaccurate, and children are seldom routinely weighed and measured. Consequently, there is a need for validated visual tools for use in training, communication, and interventions relating to child weight.

Methods: This paper presents validation data for a set of innovative photo-realistic colour body size scales depicting boys and girls aged 4-5 and 10-11. Each age- and gender-specific scale consists of 7 figures based on three-dimensional (3D) scans of 388 children to accurately represent the change in body size caused by changing adiposity. To assess scale validity, 238 adult participants (105 men, 132 women, 1 non-binary individual) undertook two tasks: rating figure adiposity using a visual analogue scale and ranking figures in ascending order of adiposity (OSF Reference: gdp9j).

Results: Participants accurately estimated the relative adiposity of each figure, i.e., they were able to tell the difference between figures and correctly rank them by size. This demonstrates scale validity for use in body size tasks. One hundred and fifty-one participants also provided 3-day test-retest data, which demonstrates excellent short-term reliability.

Conclusions: Overall, the MapMe child body size scales provide an anthropometrically accurate, valid, reliable, and usable tool for size-related tasks and communication with adults regarding child weight.

Background/objectives: In paediatric liver transplantation, donor-recipient compatibility depends on graft size. We explored whether the graft weight can be predicted using the donor's biometric parameters.

Methods: We used seven easily available biometric variables in 142 anonymised paediatric and adult donors, with data collected between 2016 and 2022. The whole or partial liver was transplanted in our hospital from these donors. We identified the variables that had the strongest correlation to our response variable: whole liver graft weight.

Results: In child donors, we determined two linear models: using donor weight and height on the one hand and using donor weight and right liver span on the other hand. Both models had a coefficient of determination R² = 0.86 and p-value < 10^-5. We also determined two models in adult donors using donor weight and height (R² = 0.33, p < 10^-4) and donor weight and sternal height (R² = 0.38, p < 10^-4). The models proved valid based on our external dataset of 245 patients from two institutions.

Conclusions: In clinical practise, our models could provide rapidly accessible estimates to determine whole graft dimension compatibility in liver transplantation in children and adults. Determining similar models predicting the left lobe and lateral segment weight could prove invaluable in paediatric transplantation.

Objective: We aimed to describe the clinical characteristics associated with severity in children hospitalized with COVID-19.

Method: This was an epidemiological cohort study conducted in two hospitals, one of which was a reference center for the treatment of COVID-19 cases. Data were collected from the reports generated by the hospital epidemiology centers and the medical records of patients aged between 0 and 14 years with a diagnosis of COVID-19, hospitalized between March 2020 and June 2021. To analyze the association between the clinical profile and severity, the cases were classified as severe (severe and critical) and non-severe (asymptomatic, mild, and moderate).

Results: Of the 191 children followed up in the cohort, 73.3% developed the severe form. The percentage of children with oxygen saturation below 95% was 46.6%. In the multivariate analysis, a higher risk of severity was estimated among children with uncontrolled asthma (RR = 13.2), who were overweight or obese (RR = 3.21), who had cough symptoms (RR = 2.72), and those aged under one year (RR = 3.23).

Conclusions: This result underscores the need to improve healthcare at every level for children and for the management of asthma and nutrition when considering children with this clinical profile who are diagnosed with COVID-19.

Background: Previous studies demonstrated the influential role of sustained attention in the reading comprehension of alphabetic writing systems. However, there is limited understanding of how these cognitive functions contribute to reading comprehension in non-alphabetic systems, such as Japanese. This study seeks to explore this gap, focusing on how sustained attention and response inhibition function in a writing system where some of the characters represent meanings rather than sounds, introducing another layer of difficulty in the complex process of reading; Methods: Seventy-five Japanese 9th grade students performed a task to assess sustained attention and response inhibition. The cognitive test was carried out using tablets to enable feasible parallel group administration while maintaining high comparability with ecological classroom settings. Reading comprehension was measured using an exam that the participants took as part of their educational routine; Results: Our results indicate that both sustained attention and response inhibition significantly contributed to the reading comprehension of Japanese 9th grade students; Conclusions: These results replicate and expand previous studies documenting the contribution of sustained attention on the reading comprehension of alphabetic writing systems to a non-alphabetic system. Moreover, our findings unravel another important cognitive factor, namely response inhibition in reading comprehension. We suggest that response inhibition may play a crucial role in reading non-alphabetic writing systems that pose high cognitive demands, such as Japanese.

Introduction: Approximately 20% of Norwegian adolescents are frequently using Over-the-Counter Analgesics (OTCAs). The WHO emphasizes the need for research to identify the key determinants of health problems in adolescence. Thus, our aim was to describe and explore pain, stress, and Health-Related Quality of Life (HRQOL) in Norwegian adolescents and investigate possible associations upon high/low usage of OTCAs. Methods: This cross-sectional study included 315 adolescents (92 boys, 223 girls) with an average age of 14.1 years (13-15 years). All participants reported using OTCAs. Weekly usage was categorized as high and less than weekly as low. Using a validated questionnaire, we explored the following variables: pain, as measured using the Brief Pain Inventory, stress (Perceived Stress Questionnaire), and HRQOL (KIDSSCREEN-27). Binary logistic regression models were conducted using IBM SPSS Statistics (version 27). Results: Our descriptive findings reveal that high users of OTCAs reported higher pain intensity of 3.4 (SD = 1.9) and perceived stress of 0.38 (SD = 0.18) compared to low users, who reported 2.5 (SD = 1.9) and 0.32 (SD = 0.16), respectively. High OTCA users reported lower average scores than low users across all HRQOL subscales. Binary logistic regression revealed 30% higher odds for higher levels of pain intensity and 14 times higher odds of perceived stress associated with being a high user of OTCAs compared to a low user. Conclusions: Our study shows significantly higher odds for experiencing pain and stress among adolescents using OTCAs daily-to-weekly, compared to those seldom using such medicines. Health professionals should be aware of young people who have a high consumption of OTCAs and investigate whether the use is related to pain or stress. This might be important in designing a personalized and appropriate intervention. Parents and caregivers have an important responsibility in supporting adolescents' appropriate pain management. Longitudinal studies are needed to better explore predictive factors of OTCA use in adolescents, particularly in relation to psychological variables such as stress and quality of life.

Background: We investigated the predictors of poor SRH in a representative sample of Lithuanian mainstream school students in grades 7-8. We also checked for gender differences in the associations between SRH and depressive symptoms and other predictors.

Methods: A total of 2104 7th-8th-grade students participated (response rate 73.95%) and were asked about depressive symptoms, psychosomatic health complaints, negative acts at school, feeling at school, family stress and violence, sense of coherence, self-esteem, and lifestyle. We used a hierarchical regression analysis including a variety of self-rated health predictors.

Results: Boys scored significantly higher on physical activity and smoking, whereas girls scored significantly higher on SRH, depressive symptoms, psychosomatic health complaints, and family stress and violence, though the significance was lost in the hierarchical regression. Depressive symptoms were the strongest predictor of poor SRH (standardized β = 0.309, p < 0.001), though other investigated predictors were also significant but had lower effect sizes. Strong evidence was found supporting the buffering role of sense of coherence in the relationship between depressive symptoms and SRH (standardized β = -0.266, p < 0.001).

Conclusions: We can conclude that the magnitude of the relationship between depressive symptoms and self-rated health is dependent on the levels of sense of coherence. We did not find gender differences in those associations. As poor SRH is easy to determine, especially with a one-item question, the cases of poorly rated health should be detected early and corrected by interventions in order to prevent poor health outcomes in the future.

Objective: The aim of this study was to evaluate high-frequency percussive ventilation (HFPV) as a rescue strategy for extremely low gestational age neonates (ELGANs) with severe lung disease. Methods: This is a retrospective review of 16 ELGANs with severe lung disease who were placed on HFPV following a lack of improvement on other modes of conventional and high-frequency ventilation. Results: The gestational age of these 16 infants was 25 (24, 26) weeks and their birth weight was 640 (535, 773) grams [median (IQR)], with the survivors being more immature compared to those who died [24 (23, 26) and 26 (25, 28) weeks, respectively; (p = 0.04)]; and with an overall mortality of 31% (N = 5). Of those who died, 60% were SGA (p = 0.02). Following placement on HFPV, the survivors had a statistically significant decrease in their respiratory severity scores (RSSs) [11 (9, 14) to 6 (5, 13), p = 0.03] compared to those who did not survive [15 (11, 16) to 11 (6.8, 14.5), p = 0.32] due to an improvement in their oxygenation [FiO₂: 0.95 (0.85, 1) to 0.6 (0.4, 0.9), p = 0.01; compared to 1 (1, 1) to 1 (0.7, 1); survivors and non-survivors, respectively; p = 0.32]. Chest X-rays also showed significantly improved aeration due to decreased areas of atelectasis in those who survived. Conclusions: HFPV may be an appropriate rescue mode of high-frequency ventilation in the ELGAN population with severe lung disease, particularly for patients with impaired oxygenation and ventilation difficulties due to shifting atelectasis and mucous plugging.