Children-Basel最新文献

Background and objective: Clavicular pain and swelling in children can have multiple causes and often require a multidisciplinary approach. We aimed to describe the characteristics and final diagnoses of children with clavicular involvement and to review the literature on this topic.

Methods: We retrospectively reviewed patients younger than 18 years who were evaluated for clavicular symptoms at two pediatric rheumatology centers and one pediatric oncohematology center. These data were then descriptively compared with findings from 63 patients reported across 7 published articles.

Results: Twelve patients (9 females, median age 10 years [IQR 9.4-10.5]) were included. Final diagnoses were chronic nonbacterial osteomyelitis (CNO; 8), Langerhans cell histiocytosis (LCH; 2), reactive arthritis (1), and Tietze syndrome (1). Clavicular involvement was mostly unilateral and localized to the medial clavicle in CNO. The most frequent presenting symptom was local swelling (11/12), followed by pain (9/12). Diagnostic delay was a median of 4 months (IQR 1-10.5). Whole-body MRI revealed multifocal lesions in 6/8 CNO patients. Biopsy was often required for diagnosis primarily to exclude malignancy and to clarify atypical or unifocal presentations. The literature review confirmed CNO as the most frequent cause, followed by rare tumors.

Conclusions: CNO predominates among pediatric non-traumatic clavicular lesions, but LCH and rare conditions are not uncommon, underscoring the need for careful differential diagnosis and targeted imaging.

Purpose: Aeromonas species are emerging pathogens associated with a range of human infections, particularly gastroenteritis in the paediatric population. However, data on their molecular characteristics in Latvia and the wider Baltic region remain limited. This study aimed to describe the distribution and genetic diversity of Aeromonas isolates from paediatric patients in Latvia using multilocus sequence typing (MLST). Methods: Stool samples were collected from children aged 0-18 years who presented with gastroenteritis at the Children's Clinical University Hospital between 2020 and 2021. A subset of 30 non-duplicate Aeromonas isolates was randomly selected for molecular characterisation and analysed by MLST. Sequence type data were deposited in the PubMLST.org database. Results: MLST analysis revealed substantial genetic diversity, with 25 novel sequence types (STs) being identified and three isolates matching previously reported STs. Two novel STs were detected in duplicate, with an epidemiological link being confirmed in one case. The local distribution of Aeromonas species and STs differed from global PubMLST datasets, suggesting a distinct local population of Aeromonas strains in Latvian paediatric patients. Conclusions: This study provides the first MLST-based description of paediatric Aeromonas isolates in Latvia and establishes a regional baseline for future comparative and epidemiological research. Although limited by a small sample size, the findings contribute to the molecular characterisation of Aeromonas spp. in the Baltic region and support the value of continued surveillance rather than direct public-health inference at this stage.

Background/Objectives: Cyber bystanders can choose from several different strategies during cyberbullying incidents and have a significant effect on the situation. Hence, cyber bystanders are specifically targeted by prevention programmes and research investigating variables influencing cyber bystander responses is crucial for such programmes. The aim of our study was (1) to explore contextual factors' effect on cyberbullying incidents' perceived severity and (2) the most frequent cyber bystander responses. We also aimed (3) to learn how the context of cyberbullying incidents affects cyber bystander responses and the joint effect of individual and contextual variables on cyber bystander responses. Methods: In total, 314 Hungarian high school students participated in our online survey (mean age = 16.15, SD = 3.28). The respondents filled in self-administered questionnaires that measured cyber bystander responses, severity of different cyberbullying incidents, empathy, moral disengagement, social desirability, and cyberbullying engagement. Results: First, our results showed that the respondents perceived public and visual cyberbullying, and when the victim was upset by it the most severe incidents. Second, in almost every condition, the two most likely cyber bystander responses were ignorance and emotional support for the victim. Third, the individual and contextual variables had a joint effect influencing cyber bystander responses except for emotional support to the victim that was only influenced by individual variables, i.e., empathy, moral disengagement, and social desirability. Conclusions: All in all, our results showed that all cyberbullying contexts were associated with cyber bystander responses and the prominent association between moral disengagement, social desirability, empathy, and prosocial cyber bystander responses. Moreover, these results could guide cyberbullying prevention to focus on cyber bystanders' empathy training, decreasing their moral disengagement, and educating them about the effects of online contextual variables.

Background/objectives: The cognitive processes underlying learning are critical for educational practices. While mindfulness-based approaches to strengthening these cognitive processes have become widespread, studies focusing on game-based development of executive functions, particularly in preschool settings, are limited. The primary objective of this study is to develop a play-based mindfulness intervention program for preschool children and to examine the effects of this program on preschool children's resilience, emotion regulation skills, and executive functions.

Methods: The study employed a pretest-post-test control-group experimental design. The study group consisted of 40 children (20 experimental and 20 control) aged 5-6 years, attending a kindergarten in Malatya province, Türkiye. The Devereux Early Childhood Assessment Scale (DECA-P2), Emotion Regulation Scale (ERS), and Childhood Executive Functions Inventory (CHEXI) were used as data collection tools. Independent-samples t-tests were used for baseline analysis, and a two-way repeated-measures ANOVA was used to evaluate the program's effects.

Results: Findings showed that there was a statistically significant difference between the pre-test and post-test mean scores of the children in the experimental group compared with those in the control group for resilience, emotion regulation, and executive function (p < 0.05).

Conclusions: Strong evidence was obtained that play-based mindfulness training has positive effects on the cognitive and emotional development of preschool children.

Background: In adult patients, rocuronium shows interindividual variability related to weight, sex, and age, but paediatric data are limited. This study aimed to evaluate clinical factors influencing the duration of action of rocuronium in children. Methods: Patients aged between 0 and 18 years undergoing planned general anaesthesia were eligible. The primary objective was to compare the duration of clinical action of rocuronium after a single dose, measured until the return of TOF (Train of Four) 1, across three-group age categories. Secondary objectives explored the relationship between TOF recovery and sex, weight, height, initial body temperature, as well as the occurrence of postoperative complications related to general anaesthesia. Results: Among 96 analysed patients, no clinically relevant association was found between the duration of rocuronium action and the studied clinical factors. TOF 1 occurred at 18.1 ± 9.5 min in those aged 1 to 5 years (n = 26), 16.8 ± 14.5 min in those aged 6 to 10 years (n = 33), and 18.2 ± 13.8 min in those aged 10 to 17 years (n = 37), p = 0.626. A post hoc analysis revealed high variability in recovery times across TOF levels, both in the per-protocol population (e.g., TOF 1: 17.7 ± 12.9 min) and in patients who did not receive sugammadex. Conclusions: In paediatric patients, the duration of rocuronium action after a single dose demonstrated substantial interindividual variability, which was not explained by age, sex, weight, height, or body temperature.

Traumatic brain injury (TBI) is a leading cause of critical illness and mortality in children. Transfusion of blood products, a common intervention in the management of pediatric TBI, has important implications for related principles, including trauma-induced coagulopathy, cerebral perfusion, and cerebral oxygen delivery. Knowledge gaps persist due to the limited availability of pediatric-specific data regarding blood product transfusion in TBI. In particular, there is a lack of prospective studies defining appropriate specific laboratory thresholds and transfusion targets, as well as insufficient evidence to guide the weighing of potential benefits against transfusion-related risks in this population. Although blood product transfusion in pediatric TBI has been associated with worse clinical outcomes, the underlying mechanisms and contributing factors remain poorly understood. In this review, we aimed to describe the pediatric literature on component and whole blood product transfusion in children with TBI and the pathophysiological mechanisms underlying the development of coagulopathy in this population. In addition, we incorporated available pediatric guidelines and recommendations specific to the setting of acute brain injury.

Objective-Partial do-not-resuscitate (DNR) orders, directives specifying limited resuscitative efforts, are intended to align medical interventions with patient preferences. However, their complexity may introduce ambiguity, inconsistent care, and ethical challenges. Design-A retrospective review was conducted of inpatient partial code order entries over a three-year period at a single institution with a pediatric oncology and immunology cohort. Partial DNR orders were identified and categorized based on included or excluded interventions (chest compressions, defibrillation, intubation, mechanical ventilation, medications). Data was analyzed to assess the frequency, variation, and internal consistency of documented preferences as well as alignment with institutional definitions and clinical feasibility. Results-Partial DNR orders represented a small (n = 15, 7%) but notable proportion of total code status entries. Wide variability was observed in the combinations of permitted and withheld interventions, with orders containing internally conflicting instructions. Documentation of inconsistencies and unclear terminology were common, raising concerns about interpretability during emergent situations. Conclusions-Partial DNR orders demonstrate heterogeneity and potential for miscommunication. These findings suggest that while partial codes may reflect nuanced patient preferences, they pose operational and ethical risks that could compromise care clarity. Clinical implications are reviewed. These findings will guide institutional deliberations regarding whether to refine, restrict, or eliminate partial code order options to enhance patient safety and decision-making transparency.

Background: Red cell distribution width (RDW) and the RDW-to-platelet ratio (RPR) have emerged as readily available hematologic markers reflecting systemic inflammation in neonates with hypoxic-ischemic encephalopathy (HIE); however, their early postnatal trajectories across the clinical spectrum of HIE remain insufficiently characterized. Methods: This retrospective cohort study included 229 term or near-term infants diagnosed with HIE. Among them, 166 infants received therapeutic hypothermia, whereas 63 infants who did not undergo cooling served as the reference group. RDW and RPR values were measured at birth and at 72 h of life (after completion of cooling in the hypothermia group). Results: In the reference group, RDW values significantly decreased at 72 h, reflecting normal postnatal hematologic adaptation. In contrast, the hypothermia group demonstrated a blunted decline, with RDW levels remaining relatively stable over the first 72 h, consistent with a blunted early postnatal RDW decline. RPR values showed a mild, non-significant upward trend during the first 72 h of life; however, exploratory analyses suggested an association between higher RPR levels and increasing HIE severity. Conclusions: Across the spectrum of hypoxic-ischemic encephalopathy, RDW demonstrated a blunted postnatal decline, whereas RPR showed a mild, non-significant increase during the early neonatal period. These readily available hematologic markers may provide complementary insights into early systemic inflammatory and hematologic responses in HIE. Prospective multicenter studies are needed to determine their prognostic value and relationship with clinical and neurodevelopmental outcomes.

Pediatric cardiology remains a fascinating yet challenging niche within medicine [...].

Introduction: Nocturnal enuresis is defined as involuntary urination during sleep in children, particularly those aged 5 years or older. Primary monosymptomatic nocturnal enuresis (PMNE) involves nighttime wetting without daytime symptoms, and although factors like reduced bladder capacity, nocturnal polyuria, and impaired arousal contribute, predictors of long-term relapse remain uncertain.

Methods: This retrospective cohort study included 227 children aged ≥5 years with strictly defined PMNE who achieved complete remission following a standardized 3-month treatment protocol (alarm therapy, desmopressin, or desmopressin plus oxybutynin). All children underwent ICCS-based assessment, including physical examination, urinalysis, ultrasonography, UFM, a 48 h frequency/volume (F/V) diary, and post-void residual measurement. One year after treatment discontinuation, patients were reassessed using a 14-day wet-night diary. Predictors of relapse were analyzed using comparative statistics.

Result: At 1-year follow-up, 48.5% of children experienced relapse. Age, sex, treatment modality, family history, and baseline wet-night frequency were not associated with relapse (p > 0.05). Diary-based FBC was significantly higher than UFM-based capacity (p < 0.001). Reduced diary-based mean FBC/EBC ratios were significantly more common among relapsing children (p < 0.001), whereas UFM-derived ratios showed no significant difference (p = 0.052). ROC analysis demonstrated moderate discriminatory performance for diary-based FBC/EBC (AUC 0.671). A ratio > 79% predicted sustained remission with 83.6% specificity and a positive predictive value of 73.5%.

Conclusions: Diary-derived bladder capacity is the strongest predictor of long-term relapse in PMNE and outperforms UFM-based assessment. A mean FBC/EBC ratio > 79% provides a clinically useful threshold for identifying children at low risk of recurrence. Those with reduced diary-based capacity may benefit from closer follow-up or extended maintenance therapy.