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Audiological and Vestibular Follow-Up for Children with Congenital Cytomegalovirus Infection: From Current Limitations to Future Directions. 先天性巨细胞病毒感染儿童的听力和前庭随访:从目前的局限到未来的方向。
IF 2 4区 医学 Q2 PEDIATRICS Pub Date : 2024-10-01 DOI: 10.3390/children11101211
Mirko Aldè, Virginia Fancello, Paola Di Mauro, Rachele Canelli, Sandra Zaouche, Chiara Falanga

Currently, the guidelines for audiological and vestibular follow-up in children with congenital cytomegalovirus (CMV) are not well-defined. The general recommendation is to evaluate hearing in all children with congenital CMV at the same intervals: once every 3-6 months up to 1 year of age, once every 6 months from 1 to 3 years of age, and once a year from 3 to 6 years of age. Additionally, there are no universally accepted protocols for the vestibular follow-up of children with congenital CMV, although video head impulse test (v-HIT) and cervical vestibular-evoked myogenic potentials (cVEMPs) are sometimes used. This narrative review critically evaluates existing audiological and vestibular follow-up approaches for children with congenital CMV, highlighting the need for personalized protocols. Tailoring follow-up schedules with different timing and methods based on risk factors, such as the trimester of maternal infection, CMV PCR results in amniotic fluid, and valganciclovir use, would indeed allow for more precise evaluations, timely interventions, and optimized resource allocation. This strategy would also alleviate the logistical and emotional burdens on families by ensuring that high-risk children receive more frequent and appropriate assessments and early interventions, while lower-risk children avoid unnecessary testing.

目前,先天性巨细胞病毒(CMV)患儿的听力和前庭随访指南尚不明确。一般建议是在相同的时间间隔内对所有先天性巨细胞病毒患儿的听力进行评估:1 岁前每 3-6 个月评估一次,1-3 岁每 6 个月评估一次,3-6 岁每年评估一次。此外,对于先天性巨细胞病毒(CMV)患儿的前庭随访,虽然有时会使用视频头脉冲测试(v-HIT)和颈前庭诱发肌源性电位(cVEMPs),但目前还没有公认的方案。这篇叙述性综述对先天性巨细胞病毒患儿现有的听力和前庭随访方法进行了严格评估,强调了个性化方案的必要性。根据风险因素(如母体感染的三个月、羊水中 CMV PCR 结果、缬更昔洛韦的使用情况等)定制不同时间和方法的随访计划,确实能让评估更精确、干预更及时、资源分配更优化。这一策略还将减轻家庭的后勤和情感负担,确保高风险儿童接受更频繁、更适当的评估和早期干预,而低风险儿童则避免不必要的检测。
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引用次数: 0
Online Sexual Risk Behaviors in Adolescents: Roles of Family Relationships, Impulsivity, and Attention-Deficit/Hyperactivity Disorder. 青少年的网络性行为风险:家庭关系、冲动和注意力缺陷/多动障碍的作用。
IF 2 4区 医学 Q2 PEDIATRICS Pub Date : 2024-09-30 DOI: 10.3390/children11101199
Wen-Jiun Chou, Tai-Ling Liu, Ray C Hsiao, Cheng-Fang Yen

Purpose: This study examined the associations of passive and active online sexual risk behaviors with perceived family relationships, impulsivity, and attention-deficit/hyperactivity disorder (ADHD).

Participants and methods: A total of 176 adolescents with ADHD and 173 adolescents without ADHD participated in this study. The participants' parents rated their parenting style on the Parental Bonding Instrument. The adolescents self-reported their lifelong experiences of passive and active online sexual risk behaviors, perceived family relationship quality on the family domain of the Taiwanese Quality of Life Questionnaire for Adolescents, and three domains of impulsivity on the Barratt Impulsiveness Scale version 11. Multivariable logistic regression was used to examine the associations of online sexual risk behaviors with perceived family relationships, impulsivity, and ADHD.

Results: Overall, 114 participants (32.7%) reported passive forms of online sexual risk behaviors, and 49 (14.0%) reported active online sexual risk behaviors. Lack of foresight and self-control was significantly associated with passive online sexual risk behaviors (p = 0.003). Good family relationship was significantly associated with a decreased risk of active online sexual risk behaviors (p = 0.011), whereas seeking novelty and making decisions hastily was significantly associated with an increased risk of active online sexual risk behaviors (p = 0.048). ADHD diagnosis and inability to plan were not significantly associated with online sexual risk behaviors (p > 0.05).

Conclusion: A high proportion of Taiwanese adolescents reported exhibiting online sexual risk behaviors. The factors related to the manifestation of these behaviors should be considered when designing relevant intervention programs.

目的:本研究探讨了被动和主动网络性行为风险与感知的家庭关系、冲动和注意力缺陷/多动症(ADHD)之间的关联:共有 176 名患有多动症的青少年和 173 名无多动症的青少年参与了本研究。参与者的父母在父母亲子关系问卷(Parental Bonding Instrument)中对他们的养育方式进行了评分。青少年自我报告了他们一生中被动和主动的网络性危险行为经历、台湾青少年生活质量问卷家庭领域的家庭关系质量感知,以及巴拉特冲动量表第11版的三个冲动领域。研究采用多变量逻辑回归法来检验网上性风险行为与感知家庭关系、冲动性和多动症之间的关联:总体而言,114 名参与者(32.7%)报告了被动形式的网络性危险行为,49 名参与者(14.0%)报告了主动的网络性危险行为。缺乏预见性和自制力与被动的网络性危险行为有显著关联(p = 0.003)。良好的家庭关系与主动性网络性行为风险的降低有明显相关性(p = 0.011),而追求新奇和草率决策与主动性网络性行为风险的增加有明显相关性(p = 0.048)。多动症诊断和缺乏计划性与网络性行为风险无明显关联(p > 0.05):结论:很高比例的台湾青少年表现出网络性行为风险。结论:有很高比例的台湾青少年表示有网络性危险行为,在设计相关干预方案时应考虑与这些行为表现相关的因素。
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引用次数: 0
Effectiveness of Respiratory Muscle Training in Pompe Disease: A Systematic Review and Meta-Analysis. 庞贝氏症患者呼吸肌训练的有效性:系统回顾与元分析》。
IF 2 4区 医学 Q2 PEDIATRICS Pub Date : 2024-09-30 DOI: 10.3390/children11101209
Mu-Yun Lin, Szu-Han Chen, Jen-Ting Lee, Po-Cheng Hsu

Background: Pompe disease is a rare metabolic myopathy caused by the lack or deficiency of the lysosomal acid alpha-glucosidase, resulting in skeletal muscle weakness and cardiomyopathy. The disease varies by onset age and genetic mutations and is categorized into infantile-onset and late-onset Pompe disease. Respiratory muscle weakness may persist regardless enzyme replacement therapy. This systemic review and meta-analysis aim to assess the effect of respiratory muscle training (RMT) on respiratory muscle strength, functional endurance, and pulmonary function in patient with Pompe disease. Methods: PubMed, EMBASE, and Cochrane databases were searched up until Aug 2024. Studies examining the therapeutic effects of RMT in patients with Pompe disease were included. Outcome measures included the change in maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), six-minute walking test (6MWT), pulmonary function before after RMT, quality of life and adverse events. Results: The meta-analysis consisted of 5 single-arm studies, including 31 patients in total. Regarding inspiratory muscle strength, RMT has significantly improving MIP (8.71 cmH2O; 95% CI, 6.23-11.19, p < 0.001) and MEP (12.15 cmH2O; 95% CI, 10.55-13.74, p < 0.001) in both types of Pompe disease. However, no significant change regarding 6MWT. No serious adverse events were reported. Conclusions: Our meta-analysis revealed that RMT may increase inspiratory muscle and expiratory muscle strength, but may not have an effect on 6MWT in patients with Pompe disease. RMT has potential to be integrated into the cardioplulmonary rehabilitation for patients with Pompe disease. Further large randomized controlled trials are needed to verify the efficacy and safety of RMT in patients with Pompe disease.

背景:庞贝病是一种罕见的代谢性肌病,由溶酶体酸α-葡萄糖苷酶缺乏或不足引起,导致骨骼肌无力和心肌病。该病因发病年龄和基因突变而异,分为婴儿发病型和晚期发病型庞贝氏症。无论采用何种酶替代疗法,呼吸肌无力都可能持续存在。本系统综述和荟萃分析旨在评估呼吸肌训练(RMT)对庞贝病患者呼吸肌力量、功能耐力和肺功能的影响。研究方法检索了截至 2024 年 8 月的 PubMed、EMBASE 和 Cochrane 数据库。纳入了研究 RMT 对庞贝病患者治疗效果的研究。结果指标包括最大吸气压(MIP)、最大呼气压(MEP)、六分钟步行测试(6MWT)、RMT 治疗前的肺功能变化、生活质量和不良事件。分析结果荟萃分析包括 5 项单臂研究,共涉及 31 名患者。在吸气肌力方面,RMT能显著改善两种类型庞贝氏症患者的MIP(8.71 cmH2O; 95% CI, 6.23-11.19, p < 0.001)和MEP(12.15 cmH2O; 95% CI, 10.55-13.74, p < 0.001)。但 6MWT 无明显变化。无严重不良事件报告。结论我们的荟萃分析表明,RMT 可增强庞贝病患者的吸气肌和呼气肌力量,但对 6MWT 可能没有影响。RMT 有可能被纳入庞贝病患者的心肺康复治疗中。要验证 RMT 对庞贝病患者的疗效和安全性,还需要进一步的大型随机对照试验。
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引用次数: 0
The Unconsidered Pathway: Suggestions for Physical Therapists to Facilitate Student Reintegration to Physical Education after a Concussion. 未经考虑的途径:物理治疗师促进学生在脑震荡后重返体育课的建议。
IF 2 4区 医学 Q2 PEDIATRICS Pub Date : 2024-09-30 DOI: 10.3390/children11101206
Pamela Maree Tucker, Jennifer Strizak, Brian Rieger, Steven Lounsbury, John Leddy

Background/Objectives: "Return-to-play" and "return-to-learn" after a concussion are familiar concepts due to guidelines proposed by the Concussion in Sport Group and Heads-Up Initiative. The purpose of this commentary is to expand upon the current consensus guidelines for treatment of concussed children and adolescents, as well as provide guidelines for returning to physical education (RT-PE) classes. Proposal: The authors propose one general and four subtype-specific guidelines post-concussion injury. This framework highlights the role of physical therapists in the management of children with prolonged recovery. The final RT-PE determination should occur with documented medical clearance from a licensed healthcare provider trained in the evaluation and management of a concussion. Conclusions: Despite significant gains regarding the management of concussed children and adolescents, confusion remains regarding RT-PE post-concussion. To eliminate ambiguity and promote adherence to a gradual return to activity protocols, the authors developed guidelines based on current evidence and recommendations.

背景/目标:由于 "运动脑震荡小组 "和 "抬头行动 "提出的指导方针,脑震荡后 "重返赛场 "和 "重返学习 "已成为耳熟能详的概念。本评论旨在扩充当前治疗脑震荡儿童和青少年的共识指南,并提供重返体育课(RT-PE)的指南。建议:作者提出了脑震荡损伤后的一个通用指南和四个亚型特定指南。这一框架强调了物理治疗师在管理恢复期较长的儿童中的作用。最终的复课决定应由接受过脑震荡评估和管理培训的持证医疗保健提供者出具医疗证明文件。结论:尽管在脑震荡儿童和青少年的管理方面取得了重大进展,但在脑震荡后的 RT-PE 方面仍然存在困惑。为了消除歧义并促进遵守逐步恢复活动的方案,作者根据当前的证据和建议制定了指导方针。
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引用次数: 0
Clinical Characteristics and Current Treatment Modality of Preterm Infants with Ureaplasma spp. Infection. 感染解脲脲原体的早产儿的临床特征和当前治疗方法
IF 2 4区 医学 Q2 PEDIATRICS Pub Date : 2024-09-30 DOI: 10.3390/children11101202
Zhenhai Zhang, Jian Wang, Wenwen Chen, Liping Xu

Background: The impact of and countermeasures for Ureaplasma spp. in neonates remain controversial. The aim of this study was to evaluate the associated perinatal factors that can predict the likelihood of respiratory tract Ureaplasma spp. colonization and analyze the subsequent clinical course of affected infants, thereby providing the rationale for their diagnosis, treatment, and future study.

Methods: This was a retrospective observational study of infants born at a gestational age (GA) of less than 32 weeks.

Results: The prevalence of respiratory tract Ureaplasma spp. colonization was 25.8% (75/291), and it increased with a decrease in GA and birth weight (BW). Maternal vaginal Ureaplasma spp. colonization increased the risk of neonatal Ureaplasma spp. colonization, with an OR of 7.8 (95% CI: 3.1, 20.0). Infants with Ureaplasma spp. colonization had a higher white blood cell (WBC) count, normal C-reactive protein (CRP) level, and higher failure rate of weaning from mechanical ventilation (30.7% vs. 17.1%, p = 0.014); they also suffered more from interstitial pneumonia (20.0% vs. 5.6%, p < 0.001) and bronchopulmonary dysplasia (36.0% vs. 13.4%, p < 0.001). Infants receiving anti-Ureaplasma spp. treatment had a lower GA, lower BW, and more severe respiratory syndromes. However, the difference in respiratory manifestation became insignificant after adjusting for GA.

Conclusions: GA and maternal vaginal Ureaplasma spp. colonization could be used to predict neonatal respiratory tract Ureaplasma spp. colonization. An elevated WBC count combined with normal CRP is a good marker of Ureaplasma spp. colonization/infection. It is conventional practice to start anti-Ureaplasma spp. treatment when infants present with a deteriorated respiratory condition. This practice warrants further investigation considering GA as a predominant intermediate variable.

背景:新生儿中解脲支原体的影响和对策仍存在争议。本研究旨在评估可预测呼吸道解脲支原体定植可能性的相关围产期因素,并分析受影响婴儿的后续临床过程,从而为其诊断、治疗和未来研究提供依据:这是一项回顾性观察研究,研究对象是胎龄(GA)小于 32 周的婴儿:结果:呼吸道解脲脲原体定植率为 25.8%(75/291),随着胎龄和出生体重(BW)的降低而增加。母体阴道解脲脲原体定植增加了新生儿解脲脲原体定植的风险,OR值为7.8(95% CI:3.1,20.0)。有解脲支原体定植的婴儿白细胞(WBC)计数更高,C反应蛋白(CRP)水平正常,机械通气断奶失败率更高(30.7% 对 17.1%,P = 0.014);他们患间质性肺炎(20.0% 对 5.6%,P < 0.001)和支气管肺发育不良(36.0% 对 13.4%,P < 0.001)的几率也更高;接受抗解脲支原体治疗的婴儿白细胞(WBC)计数更高,C反应蛋白(CRP)水平正常,机械通气断奶失败率更高(30.7% 对 17.1%,P = 0.014)。接受抗解脲原体治疗的婴儿GA值更低,体重更轻,呼吸综合征更严重。然而,在对GA进行调整后,呼吸系统表现的差异变得不显著:结论:GA和母体阴道解脲脲原体定植可用于预测新生儿呼吸道解脲脲原体定植。白细胞计数升高合并 CRP 正常是解脲支原体定植/感染的良好标志。传统的做法是,当婴儿出现呼吸状况恶化时,就开始抗解脲支原体治疗。考虑到 GA 是一个主要的中间变量,这种做法值得进一步研究。
{"title":"Clinical Characteristics and Current Treatment Modality of Preterm Infants with <i>Ureaplasma</i> spp. Infection.","authors":"Zhenhai Zhang, Jian Wang, Wenwen Chen, Liping Xu","doi":"10.3390/children11101202","DOIUrl":"10.3390/children11101202","url":null,"abstract":"<p><strong>Background: </strong>The impact of and countermeasures for <i>Ureaplasma</i> spp. in neonates remain controversial. The aim of this study was to evaluate the associated perinatal factors that can predict the likelihood of respiratory tract <i>Ureaplasma</i> spp. colonization and analyze the subsequent clinical course of affected infants, thereby providing the rationale for their diagnosis, treatment, and future study.</p><p><strong>Methods: </strong>This was a retrospective observational study of infants born at a gestational age (GA) of less than 32 weeks.</p><p><strong>Results: </strong>The prevalence of respiratory tract <i>Ureaplasma</i> spp. colonization was 25.8% (75/291), and it increased with a decrease in GA and birth weight (BW). Maternal vaginal <i>Ureaplasma</i> spp. colonization increased the risk of neonatal <i>Ureaplasma</i> spp. colonization, with an OR of 7.8 (95% CI: 3.1, 20.0). Infants with <i>Ureaplasma</i> spp. colonization had a higher white blood cell (WBC) count, normal C-reactive protein (CRP) level, and higher failure rate of weaning from mechanical ventilation (30.7% vs. 17.1%, <i>p</i> = 0.014); they also suffered more from interstitial pneumonia (20.0% vs. 5.6%, <i>p</i> < 0.001) and bronchopulmonary dysplasia (36.0% vs. 13.4%, <i>p</i> < 0.001). Infants receiving anti-<i>Ureaplasma</i> spp. treatment had a lower GA, lower BW, and more severe respiratory syndromes. However, the difference in respiratory manifestation became insignificant after adjusting for GA.</p><p><strong>Conclusions: </strong>GA and maternal vaginal <i>Ureaplasma</i> spp. colonization could be used to predict neonatal respiratory tract <i>Ureaplasma</i> spp. colonization. An elevated WBC count combined with normal CRP is a good marker of <i>Ureaplasma</i> spp. colonization/infection. It is conventional practice to start anti-<i>Ureaplasma</i> spp. treatment when infants present with a deteriorated respiratory condition. This practice warrants further investigation considering GA as a predominant intermediate variable.</p>","PeriodicalId":48588,"journal":{"name":"Children-Basel","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11505890/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142510739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Contrast-Enhanced Ultrasound (CEUS) and Ultra-Microangiography (UMA) in Critically Ill Children with Acute Kidney Injury. 急性肾损伤重症患儿的对比增强超声 (CEUS) 和超微血管造影 (UMA)。
IF 2 4区 医学 Q2 PEDIATRICS Pub Date : 2024-09-30 DOI: 10.3390/children11101205
Nace Ogorevc, Peter Slak, Stevan Nikšić, Gregor Novljan, Petja Fister, Domen Plut

Acute kidney injury (AKI) is an acute condition of impaired kidney function with decreased glomerular filtration rate, which results in dysregulation in volume, electrolyte, and acid-base equilibrium. AKI can be a life-threatening condition and can also lead to chronic kidney disease. It is important to diagnose AKI early in the course of the disease or to predict its development, as this can influence therapeutic decisions, outcome, and, consequently, the prognosis. In clinical practice, an elevated serum creatinine concentration remains the most common laboratory indicator for diagnosing AKI. However, due to the delay in its rise, creatinine levels are often insensitive and inaccurate for early diagnosis. Novel biomarkers of kidney tubular injury and the renal angina index have shown promise in predicting AKI earlier and more accurately. Contrast-enhanced ultrasonography (CEUS) and ultra-microangiography (UMA) are radiological methods that can quantify renal microperfusion and may be able to predict the development of AKI. They have not yet been used for quantifying renal perfusion in children with risk factors for developing AKI. Further research is needed to compare these sonographic techniques with the renal angina index and emerging kidney injury biomarkers for predicting acute kidney injury (AKI) in both children and adults.

急性肾损伤(AKI)是指肾功能受损,肾小球滤过率下降,导致容量、电解质和酸碱平衡失调的一种急性病症。AKI 可危及生命,也可导致慢性肾病。在病程早期诊断 AKI 或预测其发展非常重要,因为这会影响治疗决策、治疗效果,进而影响预后。在临床实践中,血清肌酐浓度升高仍然是诊断 AKI 最常见的实验室指标。然而,由于肌酐水平的升高具有滞后性,因此对早期诊断往往不敏感也不准确。肾小管损伤的新型生物标志物和肾心绞痛指数有望更早、更准确地预测 AKI。对比增强超声波造影术(CEUS)和超微血管造影术(UMA)是可以量化肾脏微灌注的放射学方法,或许可以预测 AKI 的发生。这两种方法尚未被用于量化有发生 AKI 风险因素的儿童的肾脏灌注。还需要进一步研究,将这些声像图技术与肾心绞痛指数和新出现的肾损伤生物标志物进行比较,以预测儿童和成人的急性肾损伤 (AKI)。
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引用次数: 0
Recent Challenges in Diagnosis and Treatment of Invasive Candidiasis in Neonates. 新生儿侵袭性念珠菌病诊断和治疗的最新挑战。
IF 2 4区 医学 Q2 PEDIATRICS Pub Date : 2024-09-30 DOI: 10.3390/children11101207
Maria Baltogianni, Vasileios Giapros, Niki Dermitzaki

Invasive Candida infections represent a significant cause of morbidity and mortality in the neonatal intensive care unit (NICU), particularly among preterm and low birth weight neonates. The nonspecific clinical presentation of invasive candidiasis, resembling that of bacterial sepsis with multiorgan involvement, makes the diagnosis challenging. Given the atypical clinical presentation and the potential detrimental effects of delayed treatment, empirical treatment is often initiated in cases with high clinical suspicion. This underscores the need to develop alternative laboratory methods other than cultures, which are known to have low sensitivity and a prolonged detection time, to optimize therapeutic strategies. Serum biomarkers, including mannan antigen/anti-mannan antibody and 1,3-β-D-glucan (BDG), both components of the yeast cell wall, a nano-diagnostic method utilizing T2 magnetic resonance, and Candida DNA detection by PCR-based techniques have been investigated as adjuncts to body fluid cultures and have shown promising results in improving diagnostic efficacy and shortening detection time in neonatal populations. This review aims to provide an overview of the diagnostic tools and the current management strategies for invasive candidiasis in neonates. Timely and accurate diagnosis followed by targeted antifungal treatment can significantly improve the survival and outcome of neonates affected by Candida species.

侵袭性念珠菌感染是新生儿重症监护室(NICU)发病率和死亡率的一个重要原因,尤其是早产儿和低出生体重新生儿。侵袭性念珠菌病的临床表现无特异性,类似于多器官受累的细菌性败血症,因此诊断难度很大。鉴于其不典型的临床表现以及延迟治疗可能带来的不利影响,临床高度怀疑的病例通常会启动经验性治疗。这凸显出,除了已知灵敏度低、检测时间长的培养外,还需要开发其他实验室方法来优化治疗策略。血清生物标记物,包括甘露聚糖抗原/抗甘露聚糖抗体和 1,3-β-D-葡聚糖(BDG)(两者均为酵母细胞壁的成分)、利用 T2 磁共振的纳米诊断方法和基于 PCR 技术的念珠菌 DNA 检测,已作为体液培养的辅助方法进行了研究,并在提高诊断效率和缩短新生儿检测时间方面取得了可喜的成果。本综述旨在概述新生儿侵袭性念珠菌病的诊断工具和现行管理策略。及时准确的诊断和有针对性的抗真菌治疗可显著提高受念珠菌感染的新生儿的存活率和预后。
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引用次数: 0
Comment on Alfageme-Garcia et al. Respectful Children's Shoes: A Systematic Review. Children 2024, 11, 761. 评论 Alfageme-Garcia 等人的《受人尊重的童鞋》:系统回顾》。Children 2024, 11, 761.
IF 2 4区 医学 Q2 PEDIATRICS Pub Date : 2024-09-30 DOI: 10.3390/children11101210
Gabriel Gijon-Nogueron

I recently received an alert regarding the publication of the article [...].

我最近收到了关于发表文章[......]的提示。
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引用次数: 0
Implication of Exclusive Breastfeeding in Early Childhood Dental Disorders: Large Cohort Evidence, US National Survey of Children Health. 纯母乳喂养对儿童早期牙科疾病的影响:大型队列证据》,美国全国儿童健康调查。
IF 2 4区 医学 Q2 PEDIATRICS Pub Date : 2024-09-30 DOI: 10.3390/children11101201
Laurens Holmes, Janille Williams, Neyha Thompson, Valescia John, Kerti Depeika, Benjamin Ogundele, Michael Enwere

Purpose/Objective: Frequent consumption of fermented carbohydrates and bottle feeding contribute to the development of early childhood caries (ECC). There are no substantial findings on the effects of breastfeeding patterns on oral health conditions in children in the United States. We aimed to assess the nexus between exclusive breastfeeding during the first 6 months and oral health disorders, namely toothache, decayed teeth, or unfilled cavities in early childhood. Materials and Methods: Design: Cross-sectional epidemiologic design of nationally representative data collected via telephone surveys in the United States was utilized. Setting: National Survey of Children's Health, 2012 Participants: Population-based random sample of parents/guardians of 24,655 children aged 6 months to 5 years. Main Outcome and Measure: The primary outcome was the presence of oral health disorders (OHD) in children, defined as the parent-reported occurrence of one or more of the following conditions in the past 12 months: toothache, decayed teeth, or an unfilled cavity. This was assessed through a single composite question in the survey, asking parents/guardians if their child had experienced any of these specific oral health issues within the previous year with a binary (yes/no) response option. Results: Among 24,655 children aged 6 months to 5 years, 2392 (9.7%) had experienced an oral health disorder (OHD) in the previous 12 months. In unadjusted analysis, children exclusively breastfed for 6 months were 28% less likely to present with OHD compared to never-breastfed children (OR = 0.72, 95% CI, 0.52-0.98). However, after adjusting for key factors, including maternal health and race/ethnicity, this association was no longer statistically significant (aOR = 1.11, 95% CI 0.79-1.57). Significant predictors of OHD included maternal health (aOR for fair/poor vs. excellent/very good maternal health = 1.79, 95% CI 1.08-2.69) and race/ethnicity, with a higher prevalence among non-Hispanic Black (12.9%) and multi-racial children (12.6%) compared to non-Hispanic White children (7.7%). Conclusions and Relevance: While exclusive breastfeeding for the first six months of life was not found to be a significant predictor of pediatric oral health outcomes after adjustment, maternal health and race/ethnicity were significant determinants of oral health disorders. These findings underscore the importance of comprehensive healthcare approaches that consider maternal well-being and socio-demographic factors. Future research should explore interventions targeting these factors to improve pediatric oral health outcomes.

目的/目标:经常食用发酵碳水化合物和奶瓶喂养会导致儿童早期龋齿(ECC)的发生。关于母乳喂养模式对美国儿童口腔健康状况的影响,目前还没有实质性的研究结果。我们的目的是评估头 6 个月纯母乳喂养与口腔疾病(即幼儿期牙痛、蛀牙或未填充的龋齿)之间的关系。材料与方法:设计:采用横断面流行病学设计,通过电话调查收集美国具有全国代表性的数据。地点:美国全国儿童健康调查,2012 年:对 24,655 名 6 个月至 5 岁儿童的父母/监护人进行人口随机抽样。主要结果和测量指标:主要结果是儿童是否患有口腔疾病(OHD),其定义是家长报告的在过去 12 个月中出现过以下一种或多种情况:牙痛、蛀牙或未填补的龋洞。该问题通过调查问卷中的一个综合问题进行评估,即询问家长/监护人其子女在过去一年中是否出现过上述特定口腔健康问题,回答选项为二进制("是"/"否")。结果:在 24,655 名 6 个月至 5 岁的儿童中,有 2392 人(9.7%)在过去 12 个月中经历过口腔疾病(OHD)。在未经调整的分析中,与从未母乳喂养的儿童相比,纯母乳喂养 6 个月的儿童出现口腔疾病的几率要低 28%(OR = 0.72,95% CI,0.52-0.98)。然而,在对包括产妇健康和种族/民族在内的关键因素进行调整后,这种关联不再具有统计学意义(aOR = 1.11,95% CI 0.79-1.57)。OHD的重要预测因素包括孕产妇健康状况(孕产妇健康状况一般/差与优秀/非常好的aOR = 1.79,95% CI 1.08-2.69)和种族/人种,与非西班牙裔白人儿童(7.7%)相比,非西班牙裔黑人儿童(12.9%)和多种族儿童(12.6%)的患病率更高。结论和相关性:虽然经过调整后发现,出生后头六个月的纯母乳喂养不是儿科口腔健康结果的重要预测因素,但产妇健康和种族/族裔是口腔健康失调的重要决定因素。这些发现强调了考虑到孕产妇健康和社会人口因素的综合保健方法的重要性。未来的研究应探索针对这些因素的干预措施,以改善儿科口腔健康状况。
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引用次数: 0
Standardized Ultrasound Protocol for Peripherally Inserted Central Catheters in Neonates: A Retrospective, X-ray Controlled Observational Study. 新生儿外周置入中心导管的标准化超声方案:一项回顾性 X 射线对照观察研究。
IF 2 4区 医学 Q2 PEDIATRICS Pub Date : 2024-09-30 DOI: 10.3390/children11101204
Oliver Firszt, Magdalena Maślanka, Agata Grabowska, Ewa Kluczewska

Objectives: Ultrasound (US) has been reported to be a reliable imaging modality for locating the tip of peripherally inserted central venous catheters (PICC) in neonates. However, its use requires a certain level of expertise, which may limit its application. Standardization of US examinations using designed protocols may improve their efficiency and ease of use. The objective of our study is to evaluate the effectiveness of introducing a standardized US protocol for PICC guidance. Methods: An expert panel was formed in order to develop a standardized US protocol for PICC assessment. Institutional review board agreement was obtained. This protocol was then used by participating clinicians to assess PICC position. Every assessment was followed by a radiographic control. The study group consisted of 262 US examinations of PICC lines in a level III neonatal intensive care unit (NICU) performed according to the designed protocol. Subsequent statistical analysis was made with the RStudio software, R version 4.3.1 (2023-06-16 ucrt). Results: Compared to the X-ray control, standardized US examinations showed 100% sensitivity, 81% specificity, an accuracy of 98% and a 98% precision for assessing catheter placement. The Cohen's Kappa value for the comparison of X-ray and US studies was 0.88, indicating good agreement between the two methods. Conclusions: Standardized US examinations have shown similar potential for evaluating the location of PICC lines when compared with radiographic studies. Implementing a standardized protocol in the NICU may facilitate the ultrasound assessment of PICC lines and reduce exposure to ionizing radiation.

目的:据报道,超声(US)是确定新生儿外周插入中心静脉导管(PICC)尖端位置的可靠成像方式。然而,使用这种方法需要一定的专业知识,这可能会限制其应用。使用设计好的方案对 US 检查进行标准化可提高其效率和易用性。我们的研究旨在评估在 PICC 引导中引入标准化 US 协议的效果。方法:我们成立了一个专家小组,以制定用于 PICC 评估的标准化 US 协议。并获得了机构审查委员会的同意。然后,参与的临床医生使用该方案评估 PICC 位置。每次评估后都会进行射线对照。研究组包括根据设计方案在三级新生儿重症监护病房 (NICU) 对 PICC 管路进行的 262 次 US 检查。随后使用 RStudio 软件(R 版本 4.3.1 (2023-06-16 ucrt))进行统计分析。结果与 X 光对照组相比,标准化 US 检查在评估导管位置方面显示出 100% 的敏感性、81% 的特异性、98% 的准确性和 98% 的精确性。X 射线和 US 研究比较的 Cohen's Kappa 值为 0.88,表明两种方法之间具有良好的一致性。结论:与 X 光检查相比,标准化 US 检查在评估 PICC 管路位置方面具有相似的潜力。在新生儿重症监护室实施标准化方案有助于对 PICC 管路进行超声评估,并减少电离辐射暴露。
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Children-Basel
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