Children-Basel最新文献

Acute respiratory failure (ARF) is a sudden failure of the respiratory system to ensure adequate gas exchanges. Numerous clinical conditions may cause ARF, including pneumonia, obstructive lung diseases (e.g., asthma), restrictive diseases such as neuromuscular diseases (e.g., spinal muscular atrophy and muscular dystrophy), and albeit rarely, interstitial lung diseases. Children, especially infants, may be more vulnerable to ARF than adults due to anatomical and physiological features of the respiratory system. Assessing respiratory impairment in the pediatric population is particularly challenging as children frequently present difficulties in reporting symptoms and due to compliance and cooperation in diagnostic tests. The evaluation of clinical and anamnestic aspects represents the cornerstone of ARF diagnosis: first level exams (e.g., arterial blood gas analysis) confirm and evaluate the severity of the ARF and second level exams help to uncover the underlying cause. Prompt management is critical, with supplemental oxygen, mechanical ventilation, and the treatment of the underlying problem. The aim of this review is to provide a comprehensive summary of the current state of the art in diagnosing pediatric ARF, with a focus on pathophysiology, novel imaging applications, and new perspectives, such as biomarkers and artificial intelligence.

Background: Multiparametric MRI markers of liver health corrected T1 (cT1) and proton density fat fraction (PDFF) have shown utility in the management of various chronic liver diseases. We assessed the normal population reference range of both cT1 and PDFF in healthy child and adult volunteers without any known liver disease.

Methods: A retrospective multi-centre pooled analysis of 102 child and young adult (9.1 years (6-18)) volunteers from three centres: Children's Memorial Health Institute (N = 21), University Hospital Southampton (N = 28) and Hospital Infantil de Mexico (N = 53). Sex and ethnic differences were investigated for both cT1 and PDFF. Age effects were investigated with comparison to a pooled adult cohort from the UK Biobank (N = 500) and CoverScan (N = 71), covering an age range of 21 to 81 years.

Results: cT1 values were normally distributed with a median of 748 ms (IQR: 725-768 ms; 2.5-97.5 percentiles: 683-820 ms). PDFF values followed a normal distribution with a median of 1.7% (IQR: 1.3-1.9%; 2.5-97.5 percentiles: 1-4.4%). There were no significant age and sex differences in cT1 and PDFF between children and young adults. No differences in cT1 and PDFF were found between ethnicities. Age comparisons showed statistically significant, but clinically negligible, cT1 (748 ms vs. 732 ms) and PDFF (2.4% vs. 1.9%) differences between paediatric and adult groups, respectively.

Conclusions: Median healthy cT1 and PDFF reference ranges in children and young adults fall within the reported limits for normal of 800 ms and 5%, respectively.

Background: Emerging evidence suggests that low socioeconomic status (SES) home environments may play a role by promoting excess energy intake through a lack of access to non-food reinforcers. Because of the deleterious effects of SES-related disparities on child health and development, feasible and culturally acceptable interventions are urgently needed. Community-based music enrichment programs may be an ideal intervention strategy.

Methods: In collaboration with a local non-profit organization and music studio, we conducted a pilot randomized controlled trial to assess the effects of a music enrichment program versus a play date control in a group of 9-24-month-old healthy infants (N = 16). The study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Review Board of Children's Mercy Hospital Kansas City. This study is registered with clinicaltrials.gov (NCT05868811).

Results: Overall, we found some intervention effects on the relative reinforcing value of food (RRV_food) and the home environmental enrichment measures (i.e., increased music use at home and the home language environment). Our intervention demonstrated large effects on the increased use of music at home. We did not find significant group differences in the RRV_food and home language environment, but some of the effect sizes were medium-to-large. Results also suggest that our intervention is feasible and acceptable. Parent feedback indicated that the intervention was well-liked and that the steps we took to help reduce barriers worked.

Conclusions: Music enrichment programs may be a high-impact, low-cost strategy to address socioeconomic disparities.

Background: A child's cancer is a highly stressful experience for the entire family. Childhood cancer disrupts family functioning and is one of the most stressful and challenging events parents face, often beyond their control. Parents play a crucial role in providing emotional support to children throughout their illness, and their ability to cope can help reduce the child's negative emotions. The aim of this study was to assess the prevalence of anxiety and depression among parents of children with cancer.

Methods: This cross-sectional study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines and included parents of children undergoing cancer treatment. Convenience sampling was used. The Beck Depression Inventory and the Hospital Anxiety and Depression Scale were utilized to assess the parents.

Results: This study included 270 participants (73% women, 27% men) with children at an average age of 8.75 ± 4.82 years. Diagnoses included leukemia (53%), lymphoma (29%), and other cancers. On the Beck Depression Inventory, 33% of parents were mildly depressed, 12% moderately depressed, and 32% severely depressed, with an average score of 20.63 ± 12.39 points. The HADS-M scale indicated anxiety at 48.43 ± 20.78%, depression at 45.01 ± 22.8%, and aggression at 54.72 ± 28.71%.

Conclusions: Most parents of children with cancer have symptoms of depression and anxiety, which are influenced by the duration of the child's illness. A strong correlation was observed between the level of anxiety and the tendency for depression.

Background/objectives: Obstructive Sleep Apnoea Syndrome (OSA) in children disrupts normal breathing patterns and sleep architecture, potentially leading to severe consequences. Early identification and intervention are crucial to prevent these issues. This study explored the relationships between waiting times for polysomnography (PSG), clinical history, patient age at the time of PSG, and PSG outcomes in children.

Methods: Two hundred and fourteen children were prospectively enrolled. Data were extracted from medical records regarding the patients' age at the time of a referral for PSG and their age at the time of its execution. Information on the waiting times for PSG, a diagnosis (primary snoring, mild, moderate, and severe OSA), and a history of snoring and apnoea were also collected. Additional data included medications, surgical interventions, passive smoke exposure, and allergies. The records also included the Paediatric Sleep Questionnaire (PSQ).

Results: The patient age at the time of a PSG prescription was lower for patients with a short history of sleep apnoeas (≤12 months; 4.6 (SD 2.6) years) compared to those with a long history (>12 months; 5.5 (SD 2.7) years; p = 0.027). The waiting time from prescription to PSG execution was shorter for patients with a short history of sleep apnoea (4.1 (SD 3.8) months) compared to those with a longer history (5.9 (SD 3.8) months; p = 0.001). A higher frequency of having an adenotonsillectomies before a PSG prescription was observed in the long-history group compared to the short-history group (13.3% vs. 6.9%). Conversely, a higher frequency of adenoidectomies before a PSG prescription was noted in the short-history group compared to the long-history group (9.7% vs. 1.3%).

Conclusions: This study found that younger children with a shorter history of OSA are diagnosed and evaluated earlier than older children with a longer history of the condition, suggesting that prolonged symptoms may delay a diagnosis. ENT surgeries also vary among patients, with less invasive procedures (adenoidectomy) being more common in younger children with shorter histories of OSA. The increasing awareness of OSA highlights the need for improved access to diagnostic and treatment resources.

Background: Inflammatory bowel disease (IBD) is associated with multiple factors that influence bone metabolism. This study aimed to compare the clinical manifestations and diagnostic parameters of patients with Crohn's disease (CD) and ulcerative colitis (UC) at the time of diagnosis, as well as to assess their relationship with subsequent bone disorders.

Methods: Blood tests (including calcium-phosphate metabolism) and fecal tests (including calprotectin) were performed in eighty children recently diagnosed with IBD. Additionally, the bone densitometry results were evaluated in 25 of them.

Results: Diarrhea (p = 0.02) and bloody stools (p < 0.001) were more frequent in patients with UC, whereas fever was more common in patients with CD (p = 0.003). Laboratory tests revealed anemia in 62.5% (50/80) and thrombocytosis in 36.3% (29/80). Higher calprotectin levels in the feces were found in girls at the time of diagnosis (p = 0.02). Osteopenia was detected in almost half of the examined patients (12/25), and 20% (5/25) met the criteria for osteoporosis. Low calcium levels at diagnosis were correlated with subsequent bone disorders (p = 0.005). Insufficient levels of vitamin D were detected in 77.8% (56/80).

Conclusions: Early disease detection and the appropriate monitoring of children with IBD may decrease the risk of serious consequences, including osteoporosis.

(1) Background: Visual acuity (VA) is essential for children's quality of life, and its relationship with socioeconomic status (SES) highlights disparities in healthcare. This study investigated the influence of SES on changes in schoolchildren's VA over one year. (2) Methods: Initial examinations were conducted on 1822 children (8-10 years). Follow-up was performed on 804 of these children a year later. Uncorrected (UCVA) and presenting (PVA) distance VA were measured monocularly using a decimal Snellen chart. Very reduced UCVA (<0.5) was considered a proxy of myopia. (3) Results: The prevalence of initially very reduced UCVA (myopia) was similar in children with low and high SES (12.6% vs. 12.4%) (χ²; p = 0.153). After one year, the prevalence of very reduced UCVA increased to 14.1% in children with a low SES compared with 11.1% in children with a high SES (p = 0.001). Significant disparities related to SES were also found in PVA so that children with a low SES exhibited a greater reduction in PVA than children with a high SES (5.2% vs. 3.5%) (χ²; p = 0.004). (4) Conclusions: Children with a low SES showed an increase in reduced UCVA values over one year and a higher number of children with very reduced PVA compared with those with a high SES.

Background/objectives: Molar Incisor Hypomineralization (MIH) is a prevalent multifactorial developmental dental defect with unclear etiology. This study aimed to identify potential risk factors for MIH among primary school children in Jeddah, Saudi Arabia.

Methods: A cross-sectional study including children aged 7 to 10 years old, recruited from twelve randomly selected schools located in three regions of Jeddah city, was carried out. The children were examined for MIH and dental caries using the European Academy of Pediatric Dentistry Criteria (2003) and the DMFT/dmft WHO index. Parents were asked to provide medical and socio-demographic information on their children from their first two years of life.

Results: A total of 2010 children were examined, with 888 parents responding to the survey (a 44.2% response rate). Lower maternal education was found to be significantly associated with a decreased adjusted odds ratio (AOR) of MIH (Model 1: p = 0.014, AOR = 0.646, and 95% CI = 0.456 to 0.915; Model 2: p = 0.019, AOR = 0.658, and 95% CI = 0.465 to 0.933). Being an only child, a child's birth order, type of delivery, breastfeeding, and medical conditions were not associated with MIH.

Conclusions: The significant association between MIH and maternal education suggests that further research is needed to explore the underlying mechanisms and identify other potential confounding variables.

Background/objectives: The prevalence of the diagnosis of autism spectrum disorder (ASD) has been increasing globally, necessitating updates to the Diagnostic and Statistical Manual of Mental Disorders with respect to ASD diagnosis. It is now recognised that ASD is related to sensory processing disorder, and sensory integration is considered a suitable intervention for treating children diagnosed with ASD.

Methods: This paper provides a systematic review on a timeline from 2013 to 2023, based on the PRISMA model. Evidence was sought in the academic search engines Pubmed, Scielo, Eric, Dialnet, Springer, Base Search and Google Scholar, which produced 16 articles according to the inclusion criteria.

Results: According to the results of this review, intervention with sensory integration in infants with ASD meets the criteria to be considered an evidence-based practice. The studies reviewed focused mainly on clinical settings and, therefore, we highlight the urgent need for further research to evaluate the effectiveness of sensory integration interventions in naturalistic settings such as homes and schools.

Conclusions: This will help to obtain more representative data on how these interventions affect the daily lives of children with ASD.

The case report shows the safety and efficacy of insulin treatment with Advanced Hybrid Closed Loop (AHCL) system in a young patient affected by permanent neonatal diabetes mellitus (PNDM) due to chromosome 8 deletion syndrome involving the GATA4 gene. In the first days of life, he presented hyperglycaemia and started an intravenous insulin infusion therapy, replaced by a continuous subcutaneous insulin infusion (CSII) with Medtronic Minimed 780G^® insulin pump (Medtronic, Northridge, CA, USA). At the age of 2 years, the off-label activation of SmartGuard^® automated insulin delivery mode led to a great improvement in glycaemic control, reaching all recommended targets. At the 1-month follow-up visit, Time in Range (TIR) increased from 66% to 79%, with a Time in Tight Range (TTIR) of 55% and a reduction of 11% in time in hyperglycaemia and of 2% in time in hypoglycaemia. During the entire follow-up, no episodes of ketoacidosis or severe hypoglycaemia were observed and the patient maintained the glycaemic recommended targets reached at 1 month. Maintaining optimal glycaemic control and reducing hyperglycaemia are essential for brain growth and neurocognitive development in young patients. AHCL use should be considered to ensure good glycaemic control in patients affected by neonatal diabetes.