Children-Basel最新文献

Background: The urinary microbiota of healthy children has rarely been studied, and potential differences between boys and girls have not been addressed. Thus, this study aimed to compare the urinary microbiota of healthy prepubescent girls and boys.

Methods: We included healthy children aged between 4 and 10 years who were free of functional or organic urinary tract diseases and had no history of urinary tract infection. We collected the mean portion of morning urine during natural micturition and determined aerobic and anaerobic microbiota using HiCrome™ chromogenic growth media. We identified microorganisms on the basis of morphotinctural properties and analyzed α- and β-diversity of microorganisms isolated from the urine of boys and girls.

Results: Mean age of the children was 6.1 ± 3.2 years. In general, four-component (28.1%) as well as two-component (15.6%), three-component (15.6%), and six-component (12.5%) combinations of microorganisms prevailed in the urine of children. The urine of boys exhibited four-component combinations significantly more often than that of girls (p ˂ 0.05), while the urine of girls contained seven-component microbial combinations significantly more often than that of boys (p ˂ 0.05). Comparison of multicomponent combinations of microorganisms in boys and girls revealed an overrepresentation of Enterococcus spp. in girls (p < 0.05). Furthermore, there was a trend towards higher microbial α-diversity in the urine of girls, but the difference between girls and boys was not significant.

Conclusions: The urine of healthy prepubescent children contained various aerobic-anaerobic combinations of microorganisms. Their diversity in the urine of girls and boys did not differ significantly. However, the level of α-diversity of microorganisms was higher in girls than in boys. We noted differences in the prevalence of certain taxa of microorganisms in the urine of boys and girls. Our study showed a close functional relationship between aerobic and anaerobic microorganisms detected in the urine of children in more than half of the cases.

Objectives: This systematic review assesses and compares the presence and relative abundance of periodontal pathogens, human herpesviruses (HHVs), and fungi in subgingival and/or saliva samples from pediatric subjects (≤18 years of age) with periodontally healthy status and with gingivitis and/or periodontitis. Methods: The study protocol was conducted under the PRISMA statement and registered on PROSPERO (CRD42024593007). Data from seven studies were descriptively analyzed and qualitatively assessed through the ROBINS-1 and JBI tools. Results: Pediatric subjects with clinically healthy periodontium exhibited a balanced microbiome, with early colonizers (Streptococcus species) supporting biofilm development and late colonizers like Fusobacterium nucleatum, Treponema denticola (82.35%), and Porphyromonas gingivalis (29.7%) present at low levels, suggesting subclinical dysbiosis. Viruses such as HSV-I (100%), CMV (17.8%), and EBV-I (22.09%) coexisted in a likely latent state, maintained by effective immune responses. In pediatric periodontitis, biofilms were more diverse and pathogenic, with increased prevalence of A. actinomycetemcomitans (56.09%), P. gingivalis (55.4%), and T. forsythia (35.9%). Generalized periodontitis showed higher CMV (36.36%) and EBV-I (36.24%) prevalence than gingivitis (HSV-I 18.75%). Coinfections were frequent in periodontitis, suggesting bacterial-viral synergy in exacerbating inflammation and tissue destruction. Fungi, although not studied, may also contribute under specific conditions. Conclusions: These findings highlight the role of microbial interactions in periodontal health and disease progression.

Background: Screening for cardiovascular disease (CVD) and its associated risk factors in childhood facilitates early detection and timely preventive interventions. However, limited data are available regarding screening tools and their diagnostic yield when applied in unselected pediatric populations.

Aims: To evaluate the performance of a CVD screening program, based on history, 12-lead ECG and phonocardiography, applied in primary school children.

Methods: The methods used were prospective study, with voluntary participation of third-grade primary school children in the region of Crete/Greece, over 6 years (2018-2024). Personal and family history were collected by using a standardized questionnaire and physical evaluation (including weight, height, blood pressure measurement), and cardiac auscultation (digital phonocardiography (PCG)) and 12-lead electrocardiogram (ECG) were recorded at local health stations (Phase I). Following expert verification of responses and obtained data, assisted by designated electronic health record with incorporated decision support algorithms (phase II), pediatric cardiology evaluation at the tertiary referral center followed (phase III).

Results: A total of 944 children participated (boys 49.6%). A total of 790 (83.7%) had Phase I referral indication, confirmed in 311(32.9%) during Phase II evaluation. Adiposity (10.8%) and hypertension (3.2%) as risk factors for CVD were documented in 10.8% and 3.2% of the total population, respectively. During Phase III evaluations (n = 201), the majority (n = 132, 14% of total) of children were considered as having a further indication for evaluation by other pediatric subspecialties for their reported symptoms. Abnormal CVD findings were present in 69 (7.3%) of the study population, including minor/trivial structural heart disease in 23 (2.4%) and 17 (1.8%), respectively, referred due to abnormal cardiac auscultation, and ECG abnormalities in 29 (3%), of which 6 (0.6%) were considered potentially significant (including 1 case of genetically confirmed channelopathy-LQT syndrome).

Conclusions: CVD screening programs in school children can be very helpful for the early detection of CVD risk factors and of their general health as well. Expert cardiac auscultation and 12-lead ECG allow for the detection of structural and arrhythmogenic heard disease, respectively. Further study is needed regarding performance of individual components, accuracy of interpretation (including computer assisted diagnosis) and cost-effectiveness, before large-scale application of CVD screening in unselected pediatric populations.

Background: In pediatric surgery, a comprehensive knowledge of the child's anatomy is crucial to optimize surgical outcomes and minimize complications. Recent advancements in medical imaging and technology have introduced innovative tools that enhance surgical planning and decision-making.

Methods: This study explores the integration of mixed reality technology, specifically the HoloLens 2 headset, for visualization and interaction with three-dimensional (3D) anatomical reconstructions obtained from computed tomography (CT) scans. Our prospective observational study, conducted at IRCCS (Scientific Hospitalization and Care Institute) Sant'Orsola-Malpighi University Hospital in Bologna, engaged ten pediatric surgeons, who assessed three types of anatomical malformations (splenic cysts, pulmonary cystic adenomatoid malformations, and pyelo-ureteral junction stenosis) and planned surgeries using both traditional 2D CT scans and 3D visualizations via HoloLens 2, followed by completing a questionnaire to evaluate the utility of each of these imaging techniques in surgical planning.

Results: The statistical analysis revealed that the 3D visualizations significantly outperformed the 2D CT scans in clarity and utility (p < 0.05). The results indicated significant improvements in anatomy understanding and surgical precision. The immersive experience provided by HoloLens 2 enabled surgeons to better identify critical landmarks, understand spatial relationships, and prevent surgical challenges. Furthermore, this technology facilitated collaborative decision-making and streamlined surgical workflows.

Conclusions: Despite some challenges in ease of use, HoloLens 2 showed promising results in reducing the learning curve for complex procedures. This study underscores the transformative potential of mixed reality technology in pediatric surgery, advocating for further research and development to integrate these advancements into routine clinical practice.

Background/objectives: Static upright tasks, including standing unsupported (SU), eyes closed (SEC), feet together (SFT), tandem (TS), and single limb (SLS), are routinely examined in children and are included in many norm-referenced measures. Existing normative values for these standing tasks may not apply to contemporary children and have not been established across wide age ranges. The primary purpose of this study was to investigate developmental trajectories of and relationships between four static standing positions (SPs [SU, SFT, TS, SLS]) in children aged 2 through 13 years who are developing typically. The effects of altered sensory input, including floor surface (firm and compliant) and vision (eyes open [SU] and eyes closed [SEC]), as well as influences of sex, height, weight, and BMI on static standing were also examined.

Methods: Children (n = 807) developing typically performed two trials of each task up to 2 minutes per trial using standardized procedures. A total of 482 children were also tested on a compliant surface.

Results: Descriptive statistics were calculated by age, height, weight, task, and floor surface. Two-way ANOVA showed no significant effects (p > 0.05) of sex on standing times; however, age was significant for all standing tasks. Repeated-measure ANOVA and Tukey post hoc tests identified significant effects (p < 0.05) of age and floor surface on standing times. SU, SEC, and SFT times increased up to 8 years, with most children achieving the 2 minute maximum by age 8. TS and SLS times improved up through 13 years, with wide variations in performance noted in children 8 years and older.

Conclusions: Contemporary normative performance values are provided for five common standing tasks on firm and compliant surfaces by age in one-year increments.

Background/Objectives: Our research aimed to assess if correlations could be found between items evaluated at the cerebral ultrasound performed at term-equivalent age (TEA) and neuro-motor outcomes evaluated at 12 and 24 months of corrected age in a group of preterm infants. Methods: The following were assessed: the Levine Index, the diagonals of the lateral ventricles, the size of the ventricular midbody, the sinocortical distance, the width of the basal ganglia, the cortical depth at the level of the cingular sulcus and the maturation of the gyral folding. The neurologic evaluation was performed at 12 and 24 months of corrected age, according to the Amiel Tison neurologic examination, and the items from the calendar of motor acquisitions were used as outcome measures of the study-gross and fine motor subsets. The comparisons between the different groups were performed using the FANOVA test, with a statistically significant association for a p < 0.05. Results: The abnormal gross motor acquisitions at 12 months were significantly associated with an increased size of the ventricular midbody (p < 0.009) and a significantly decreased diameter of the basal ganglia (p < 0.011) on the TEA cerebral ultrasound. At 24 months, a significant association was found with increased size of the ventricular midbody (>10.33 mm) (p < 0.001), a decreased diameter of the basal ganglia (<12.9 mm) (p < 0.016), a decreased cortical depth (p < 0.021) and an immature gyral maturation pattern (p < 0.001). In the case of severely abnormal fine motor outcomes, at 12 months, there were statistically significant associations with an increased size of the ventricular midbody (p < 0.001) and an immature gyral folding pattern (p < 0.0180); at 24 months, significant associations were noted with the size of ventricular midbody (p < 0.001), a decreased diameter of the basal ganglia (p < 0.016), a decreased cortical depth (p < 0.021) and an immature gyration folding (p < 0.001). Conclusions: The abnormal gross and fine motor outcome in former premature infants at 12-24 months corrected age is significantly associated with abnormal findings in the head ultrasound examination performed at TEA reflecting both white matter (increased midbody distance) and grey matter (decreased diameter of the basal ganglia, decreased cortical depth and an immature gyration pattern) involvement.

Background/objectives: Systemic autoimmune rheumatic diseases (SARDs) pose diagnostic challenges, particularly in pediatric populations, due to their diverse presentations and overlapping symptoms. This study aimed to evaluate the diagnostic concordance between indirect immunofluorescence (IIF) at different dilution levels (1/80 and 1/640) and immunoblot findings for anti-centromere antibody (ACA) positivity. Additionally, the clinical significance of ACA positivity and its association with SARDs in pediatric patients was assessed.

Methods: This retrospective, cross-sectional study included 58 pediatric patients evaluated for anti-nuclear antibody (ANA) testing at Ege University Hospital from 2019 to 2021. IIF was performed using HEp-20-10 cells and immunoblot testing was conducted to assess CENP-B reactivity. Statistical analyses included chi-square tests, correspondence analysis, and regression modeling to explore the relationship between IIF titers, immunoblot findings, and SARD diagnoses.

Results: Among the patients, 62.1% were diagnosed with SARD. Higher IIF titers (≥1/640) were strongly associated with CENP-B 3+ immunoblot positivity, while lower titers (1/80 and 1/320) correlated with CENP-B 1+. Patients with IIF positivity at 1/80 were 15.89 times more likely to have SARD (p < 0.001). Correspondence analysis revealed significant associations between IIF dilution levels and immunoblot reactivity (χ² = 37.574, p < 0.000). Gender and age were not significant predictors of SARD positivity.

Conclusions: This study highlights the diagnostic value of higher IIF dilution levels (≥1/640) in improving ACA detection and SARD diagnosis in pediatric patients. Incorporating complementary diagnostic tools, such as immunoblot testing, can enhance diagnostic accuracy. These findings support adopting higher IIF cutoff levels in clinical practice for pediatric populations.

Background: Recent advances in childhood acute lymphoblastic leukemia (ALL) and lymphoblastic lymphoma (LL) management provide higher survival rates at the cost of increased toxicities. Acute neurotoxicity affects up to 10% of patients, requiring rapid recognition and treatment. Methods: A retrospective observational study was performed to determine the frequency, clinical manifestations, radiological characteristics, treatment options and outcome of acute neurological adverse events in pediatric patients with lymphoid malignancies at the Department of Oncology and Hematology, Children's Hospital Zagreb, Croatia. Results: A total of 56 patients (48 ALL and 8 LL, male/female ratio 1:1, average age 5.4 years) were treated mainly according to the ALL-IC BFM 2009 protocol. The B-immunophenotype was the most frequent (85.7%). Most patients were stratified to the intermediate risk group (39.3%), and two were initially diagnosed with central nervous system infiltration. Acute neurotoxic events were registered in 11 patients (19.6%), most commonly in the 6-10-year age group (66.7%), predominately in females (72.7%) and high-risk group (54.5%). The most frequent clinical presentation was seizures (83.3%), with status epilepticus in four cases. We detected electroencephalogram (EEG) irregularities in almost all patients and various morphological changes in the brain magnetic resonance imaging (MRI), most often consistent with posterior reversible encephalopathy syndrome and leukoencephalopathy. Approximately half the patients received prolonged antiepileptic therapy. No apparent residual neurologic manifestations have been observed. Conclusions: Acute neurotoxicity is a rather frequent treatment-related adverse event, associated with high-risk disease. Early recognition and timely management are essential for rapid recovery and optimal outcomes.

(1) Background: Children with medical complexity (CMC) and neurologic impairment (NI) are a growing population in pediatric intensive care units (PICUs). (2) Objective: Our aim was to explore and describe the experiences and beliefs of PICU providers caring for CMC with NI. (3) Methods: A qualitative interview-based study was conducted. Participants were 20 providers (12 attendings and 8 nurse practitioners) who met inclusion criteria of being a faculty, fellow, or advanced practice provider who worked in a PICU; residents were excluded. Participants were recruited via purposive and snowball sampling until information power was reached, and came from seven PICUs across six states, with 10 participants from the authors' home institution and 10 from external PICUs. Data were collected via recorded videoconference interviews, which were transcribed. Analysis was conducted and relevant themes were identified using the analytic technique of thematic analysis. Rigor was assured by using two coders. (4) Results: Four main themes were identified: (i) providers view CMC with NI as a distinct population of growing importance; (ii) CMC with NI have care needs that challenge traditional perceptions of PICU practice; (iii) PICU providers expressed ambivalence towards caring for CMC with NI; and (iv) some PICU providers have developed adaptive strategies. (5) Conclusions: This population challenges the typical notion of what pediatric critical care represents. Providers display ambivalence about caring for these patients but can develop strategies to make this work meaningful. Understanding PICU clinicians' views about CMC with NI can provide insights for improved patient care and reduced provider burnout as the field adapts to this population.

Background/Objectives: Autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), and Tourette syndrome (TS) are neurodevelopmental disorders (NDDs) with overlapping symptoms, suggesting a partially shared genetic origin. This study investigates the prevalence of connective tissue-related conditions in individuals with ASD, ADHD, or TS. Methods: A questionnaire was administered to families of 120 individuals with ASD, ADHD, or TS, collecting sociodemographic data and examining 10 types of disorders affecting various organs and systems. Statistical analyses were performed using STATA 16.0, with the significance level set at 5%. Results: Among the 120 patients, 48 had ASD, 36 had ADHD, and 36 had TS. Flat feet were significantly more common in individuals with ASD (52.1%; OR 7.20; p < 0.001), ADHD (52.8%; OR 6.73; p = 0.001), and TS (38.9%; OR 3.70; p = 0.034) compared to controls (13.6%). Hypersensitivity was more frequent in individuals with ASD (56.3%; OR 5.90; p = 0.001), ADHD (50.0%; OR 4.11; p = 0.011), and TS (58.3%; OR 5.35; p = 0.003) compared to controls (18.2%). Myopia and ptosis were more common in ADHD (30.6%). There was a possible trend towards orthodontic device use in TS (OR 3.20; p = 0.076). Flat feet and hypersensitivity were also common in fathers (31.0% and 36.4%, respectively), mothers (31.0% and 15.2%), and patients (43.8% and 55%). Conclusions: The findings of this study highlight the significant associations between ASD, ADHD, and TS and specific physical symptoms, such as flat feet, sensory hypersensitivity, and other connective tissue-related manifestations. The familial prevalence of these symptoms suggests a potential genetic underpinning, further supporting the hypothesis of shared aetiological pathways. These insights underscore the need for interdisciplinary research to explore the mechanisms linking neurodevelopmental and connective tissue disorders, aiming to improve diagnosis and management strategies.