Children-Basel最新文献

Background: Diagnosing peanut allergy (PA) in children without known exposure remains challenging due to the need to distinguish true clinical allergy from asymptomatic sensitization. This study aimed to evaluate the diagnostic performance of individual and combined in vitro markers, particularly sIgE to Ara h 2, and to develop a multistage decision pathway that may reduce reliance on oral food challenge (OFC). Methods: Eighty children with suspected peanut allergy were prospectively enrolled. All participants, including healthy controls, underwent skin prick testing (SPT), measurement of sIgE to peanut and Ara h 2, and basophil activation testing (BAT). A multistage diagnostic algorithm incorporating these markers was constructed, and its performance was assessed using ROC analysis, predictive values, and likelihood ratios. A secondary analysis evaluated a simplified decision pathway excluding BAT. Results: sIgE to Ara h 2 demonstrated excellent individual performance (AUC 0.889), with 96.6% PPV at the optimal cut-off. The full multistage decision pathway (SPT + sIgE + BAT when interpretable) achieved 100% specificity and avoided OFC in 28.6% of children. However, BAT feasibility was limited; over 25% of results were uninterpretable. The simplified decision pathway (SPT + sIgE to Ara h 2) preserved 100% specificity and enabled the avoidance of OFC in 27.5% of cases, with slightly lower sensitivity. Conclusions: A structured in vitro diagnostic approach using sIgE to Ara h 2 and SPT can reliably identify peanut allergy in selected pediatric patients, particularly those without a reliable peanut exposure history. BAT enhances specificity but should be considered a confirmatory tool due to feasibility limitations.

Background/Objectives: Dengue is one of the leading causes of morbidity in children in endemic regions. Capillary leakage is the pathophysiological hallmark of severe dengue, and ultrasound has established as a sensitive tool for its early detection. However, evidence in the pediatric population remains limited. The aim of this study was to identify the presence of capillary leakage detected by ultrasound and its associations in children with dengue. Methods: Observational/descriptive/cross-sectional/retrospective study conducted in patients between 6 months and 14 years old with confirmed dengue and warning signs or severe dengue, treated at the Hospital Universitario del Valle in Cali, Colombia, between July 2019 and June 2020. Ultrasound examinations were performed and interpreted by radiologists following an institutional standardized protocol. Associations with capillary leakage were evaluated using the chi-square test and their respective OR and 95% CI. Results: A total of 132 children were included. Ultrasound capillary leakage was identified in 95.5%, mainly ascites (83.3%), pleural effusion (46.2%), hepatomegaly (40.9%), and vesicular thickening (39.4%). Associated factors were belonging to school/adolescent group (OR = 13.52; 95% CI = 1.41-646.51; p = 0.0031), elevated alanine aminotransferase (OR = 11.06; 95% CI = 1.32-94.82; p = 0.0007), and aminotransferase levels grades C-D (OR = 6.87; 95% CI = 0.82-54.59; p = 0.0110). Thrombocytopenia and hypoalbuminemia were common. Three deaths (0.9%) occurred in the initially confirmed cohort prior to ultrasound-based inclusion, all of whom presented multiple risk factors for capillary leakage. Conclusions: In this cohort ultrasound showed high sensitivity for detecting capillary leakage in pediatric dengue and was associated with school-age/adolescents and liver involvement. Its systematic use could improve early identification of severe forms and optimize clinical management in resource-limited settings.

Background/objectives: Caffeine citrate represents the standard pharmacological intervention for apnea of prematurity (AOP) and episodes of intermittent hypoxia (IH). Despite its widespread use, consensus regarding the necessity of routine serum monitoring, optimal dosing protocols, and precise clinical indications remains elusive. The primary objective of this investigation was to evaluate the longitudinal trajectory of serum caffeine concentrations in preterm infants and to analyze their correlation with the incidence of AOP and IH episodes. Furthermore, we sought to determine whether blood caffeine concentrations varied significantly across gestational ages throughout the postnatal period.

Methods: This multicenter, prospective observational study enrolled preterm infants with a gestational age of ≤30 weeks. Participants were administered a standard loading dose of caffeine citrate within the first 24 h of life, followed by a standardized maintenance regimen. Serum caffeine levels were quantified on a weekly basis. The cohort was stratified into two distinct groups based on gestational age: Group 1 (23-27 weeks) and Group 2 (28-30 weeks).

Results: The study yielded 588 serum caffeine measurements from a cohort of 104 preterm infants, characterized by a median gestational age of 28 weeks (range: 23-30 weeks) and a mean birth weight of 1034 ± 296 g. Statistical analysis revealed no significant disparities in serum caffeine concentrations across gestational age groups (p > 0.05). Notably, during the third week of life, infants with apneic episodes demonstrated significantly lower caffeine levels than those without apnea (p = 0.016). Furthermore, a significant negative correlation was identified between serum caffeine concentrations and the frequency of IH episodes during the third, fourth, and fifth weeks of life across multiple oxygen saturation thresholds.

Conclusions: While serum caffeine concentrations in preterm infants did not vary significantly with gestational age, lower levels were associated with a higher incidence of AOP and IH episodes. These results suggest that while routine monitoring or dose adjustment based solely on gestational age may not be warranted, maintaining adequate serum levels is critical for symptom management. Future research should prioritize randomized controlled trials with expanded sample sizes, extended follow-up periods, and a rigorous analysis of adverse effects.

Background/Objectives: Although Tumor-Treating Fields (TTFields) therapy is an established treatment modality for adult glioblastoma, clinical data on its efficacy in pediatric brain tumors are extremely scarce. The present study aimed to evaluate the safety of TTFields therapy for pediatric diffuse high-grade glioma (HGG) and to conduct an exploratory analysis of its efficacy. Methods: A prespecified, interim analysis was performed to determine whether the study should be continued on the basis of safety and feasibility data on the first three patients. The target population was children aged 5 to 17 years with newly diagnosed, supratentorial HGG or its first recurrence following frontline therapy. After completion of initial, local treatment for the tumor (surgical removal and/or radiotherapy), all patients received TTFields therapy using Optune^TM for 28 days per course for up to 26 courses until disease progression. Results: The interim analysis, which was completed in October 2022, included three female patients aged 14, 17, and 9 years. All had a histological grade 4 tumor, two of which were radiation-induced, secondary HGG. No serious, treatment-related toxicities or device-related issues were observed. All three patients were able to continue using the device for 75% or more of the time in accordance with the protocol, suggesting that the treatment was feasible. The MRI findings of two patients indicated that the treatment has a potential antitumor effect. Based on these results, the study was resumed and is currently being continued at multiple centers. Conclusions: The initial results of the prespecified, interim analysis demonstrated that TTFields therapy was safe and feasible for children with HGG. This study was funded by the Japan Agency for Medical Research and Development (AMED) and was registered with the Japan Registry of Clinical Trials (jRCTs032200423).

Background: Childhood obesity and being overweight represent a global public health challenge; the consumption of sugar-sweetened beverages (SSBs) and ultra-processed foods (UPFs) contributes to this problem. In Mexico, public health policies have been implemented to improve school food environments.

Objective: To assess the school food environment before the implementation of the guidelines for the preparation, distribution, and sale of food and beverages (SFGs) in three primary schools in Mexico City.

Methods: A cross-sectional mixed method study was conducted, including structured non-participatory observation of selling points outside and inside of schools, and availability of drinking fountains and lunchboxes contents. A food waste audit assessment was performed to identify the most frequently consumed products, main ingredients, front-of-package labels, and colorants. Additionally, 23 semi-structured interviews were conducted with school authorities, teachers, and food vendors.

Results: SSBs and UPFs selling points were observed outside and inside in public schools, while in private schools, only inside, with use of delivery food apps. Public schools lacked functional drinking fountains. A total of 345 food waste items were collected across the schools, of which 46.3% were SSBs and 53.7% were UPFs. The main ingredient was sugar (15.6%), the principal front-of-package was excess sugar (37.5%), and the most frequently used colorants were red 40 (25.1%). Interview participants reported awareness of the SFGs; however, they identified barriers such as resistance from parents and students and the economic dependence of school cooperatives on UPFs sales.

Conclusions: These findings highlight structural and economic challenges for the effective implementation of public policies promoting healthier school food environments.

Background/Objectives: The Spinal Appearance Questionnaire (SAQ) assesses the self-perception of appearance of adolescents with idiopathic scoliosis (AIS). Due to originally scoring too many domains and producing prevalent ceiling effects when treated conservatively, the SAQv1.1, has been introduced. This study aimed to compare the test-retest reliability, convergent validity, and ceiling and floor effects of the two versions of the SAQ in patients with AIS. Methods: Conservatively treated females with AIS, aged 10-18 years old, were consecutively recruited from a scoliosis clinic. The Scoliosis Research Society-22 refined (SRS-22r), SAQ, and SAQv1.1 were collected, in English, with radiographic measurements (Cobb angle, Coronal Balance, and Vertebral Rotations). Nine domain scores were obtained from the original SAQ. Appearance, Expectations, and Total scores were calculated for SAQ v.1.1. Questionnaires were re-administered electronically after one week. Results: One hundred females, aged 13.9 ± 1.8 years with curve angles of 28.8° ± 13.9°, were included. The test-retest reliability for SAQ varied between domains (ICC_3,1 = 0.72 to 0.94). The Total, Appearance, and Expectation ICCs_3,1 for the SAQv1.1 were 0.92, 0.94, and 0.86, respectively. Convergent validity was demonstrated between seven SAQ domains and the SRS-22r Total and Cobb angle (|r| = 0.32 to 0.59). The SAQv1.1 Total correlated with the SRS-22r Total (r = -0.50) and with the Cobb angle (r = 0.56). All SAQ domains presented ceiling (Curve = 11% to Kyphosis = 68%) and floor effects (Chest = 8% and Waist = 4%). The SAQv1.1 Total and Appearance had low ceiling effects (≤5%), while Expectations presented both ceiling (14%) and floor effects (10%). Conclusions: The SAQv1.1 is recommended because of its stronger reliability, superior convergent validity, and fewer ceiling and floor effects in AIS.

Aim: This cross-sectional study aimed to evaluate and compare parents' and children's preferences for full-coverage restorative treatment options of primary molars, including stainless steel crowns (SSCs), zirconia crowns (ZCs), and BioFlx crowns. Additionally, the study evaluates the influence of providing a brief overview of the advantages and disadvantages of each full-coverage restorative treatment option on parental preference. Methods: The study was conducted at the pediatric dental clinics at King Abdulaziz University Faculty of Dentistry (KAUFD) in Jeddah, Saudi Arabia, from January to May 2024. Healthy Arabic-speaking children aged 6-12 years attending KAUFD for routine dental treatment, along with at least one parent who agreed to participate, were included. Three typodont models with a SSC, a ZC, and a BioFlx crown were prepared and cemented by an expert pediatric dentist. The participating children and their parents were simultaneously and independently shown the prepared typodont models and asked to indicate which treatment option they preferred most. Subsequently, a trained pediatric dentist presented a brief overview of the advantages and disadvantages of each treatment option to the parents. Then, parents were asked to re-evaluate their preferences. The threshold for significance was set at p < 0.05. Results: A total of 172 children and their parents were included. The most preferred full-coverage restorative treatment among children was SSC (39.0%), while among parents, ZC (60.5%) was the most preferred. After providing a brief overview, the most preferred option among parents was SSC (39.5%), with ZC and BioFlx crowns being equally preferred (30.2%). Significantly more children with no history of dental pain or discomfort (49.1%) (p = 0.023) or with a history of previous dental treatment involving SSC (40.2%) (p = 0.045) preferred SSC. The ZC was significantly more preferred by parents of female children (70.65%) (p = 0.027) and by parents of children with a history of dental treatment (60.6%) (p = 0.018). Conclusions: The study revealed that parental demands and expectations often differ from those of their children, leading to notable differences between children's and parents' preferences. After a brief overview, parental preference shifted from ZC to SSC, highlighting the importance of effective communication and education when making treatment decisions for pediatric patients.

Background: Juvenile Idiopathic Arthritis (JIA) is a chronic inflammatory condition that can disrupt joint function and biomechanics, often leading to altered gait patterns. When coexisting with secondary scoliosis-a common musculoskeletal complication in children with JIA-postural and movement impairments may be further exacerbated. However, limited research has investigated the combined impact of JIA and secondary scoliosis on gait characteristics. This study aimed to evaluate gait parameters in children diagnosed with JIA and secondary scoliosis and to compare them with age-matched healthy peers.

Methods: A total of 50 children (25 with JIA and secondary scoliosis, 25 healthy controls) were included. Demographic data, plantar pressure distribution, temporal gait parameters, and center of mass (CoM) displacement were assessed using computerized gait analysis. Group comparisons were performed using appropriate statistical methods.

Results: Children with JIA and secondary scoliosis exhibited significantly lower forefoot loading on both dominant and non-dominant sides compared to controls (p < 0.05). Maximum loading values were also reduced bilaterally in the JIA group (p < 0.001). The dominant side single-limb support duration was significantly shorter (p = 0.027), and CoM displacement was greater (p = 0.044) in the JIA group. No differences were observed in rearfoot loading or walking speed.

Conclusions: Children with coexisting JIA and secondary scoliosis demonstrate altered gait mechanics, likely reflecting compensatory adaptations due to joint inflammation and postural asymmetries. Gait analysis may offer valuable insights for tailoring rehabilitation strategies in this patient population.

Background: The COVID-19 virus is a source of both acute and chronic stress for many people. This stress could uniquely impact children and their mental health. Research has shown that children with neurodevelopmental disorders such as Attention-Deficit/Hyperactivity Disorder (ADHD) are at an increased risk of negative mental health symptoms due to stress, but high-quality sleep may be associated with a protective role against these symptoms. We, therefore, aimed to investigate whether the impacts of COVID-19 and sleep problems were independently linked with children's mental health and to examine whether sleep could mediate the relationship between COVID-19 impact and child mental health. Finally, we sought to compare the degree to which sleep problems could mediate this relationship in children without ADHD and in children with ADHD. Methods: In this cross-sectional study, a total of 304 parents of children were sampled from a larger study investigating the impact of the COVID-19 pandemic on Canadian families and children in the spring of 2021. Parents reported on their children's mental health, sleep, and the impacts of COVID-19 on their child. Of the total sample, 234 children were reported as having an ADHD diagnosis, and 70 children were reported to not have ADHD. Results: We found that both the impact of COVID-19 and sleep problems independently and positively contributed to the mental health symptoms (p < 0.001) experienced by children with ADHD and without ADHD. Children with ADHD were found to have higher scores for COVID-19 child impact, sleep problems, and negative mental health. However, sleep problems had a greater impact on the mental health of children without ADHD compared to ADHD children. Additionally, the results suggest that sleep problems mediated ~20% of the relationship between COVID-19 impact and child mental health in children with ADHD and ~51% of this relationship in children without ADHD. Conclusions: The findings emphasize the significant role of sleep in mediating child mental health symptoms during periods of stress in children without ADHD and in children with ADHD. We highlight the importance of considering sleep quality and supporting healthy sleep in times of stress to improve child mental health symptoms.