Children-Basel最新文献

Background: Pediatric respiratory disorders frequently necessitate clinical evaluation, often during sleep. Traditional polysomnography (PSG), while the gold standard for sleep-related respiratory assessment, is resource-intensive and can cause discomfort, particularly in children. Therefore, in a prior published study, we designed and technically validated a video-based prototype for contactless monitoring of respiratory movements.

Objective: Our present study aimed to clinically validate the contactless monitoring prototype in pediatric patients, with a primary focus on detecting respiratory rate and identifying abnormal breathing patterns.

Methods: Twenty-seven pediatric patients (aged 6 months to 12 years) were recruited from a pediatric sleep laboratory. To monitor thoracoabdominal movements in real time, the prototype employed a time-of-flight camera and a 3D imaging module, coupled with artificial-intelligence-based determination of the region of interest (ROI). Respiratory rates obtained from the prototype were compared to simultaneously recorded PSG data. Data were collected under various conditions, including different sleeping positions. A total of 296 h of respiratory data were acquired, of which selected 60 s segments (54 during N3 sleep and 27 during REM sleep) were analyzed using the prototype and compared with PSG-derived respiratory parameters.

Conclusion: The contactless prototype demonstrates that reliable and non-invasive respiratory monitoring is feasible in pediatric patients. It enables accurate detection of respiratory rate as well as abnormal breathing patterns under routine clinical conditions, while reducing patient burden compared with conventional approaches. Its usability and minimal patient discomfort suggest potential for broader clinical adoption. Future work should focus on full-night recordings across all sleep stages and the development of automated data analysis pipelines to facilitate routine clinical implementation.

Background/Objectives: Food allergy (FA) is a substantial health burden in children. FA is often associated with malnutrition and malabsorption, due to restrictive food avoidance diets, which can significantly impair the patient's and their family's quality of life. To this date, population-based data combining sensitization and clinical allergy remain limited. This study aimed to assess the patterns of sensitization rates to food and food allergy prevalence rates in Croatian children and to evaluate differences according to age, sex, and region of origin. Materials and Methods: In this cross-sectional study, 1948 preschool and school-aged children from three Croatian regions (Zagreb, Dalmatia, and Slavonia) were included. Participants underwent skin prick testing to common food and inhalant allergens. Data on personal and family medical history were collected using questionnaires and medical records. FA prevalence was evaluated using self-reported data in school-aged children and physician-diagnosed FA data in preschool children. Results: Overall, 41% of participants were sensitized to at least one allergen, while 13% were sensitized to at least one food allergen. Tree nuts-particularly hazelnut-were the most common food-derived sensitizers, followed by hen's egg, cow's milk, and fish. Boys exhibited higher total sensitization rates than girls (44.2% vs. 37.5%; p = 0.001), higher food allergen sensitization rates (14.7% vs. 11.4%; p = 0.037), and higher total polysensitization rates (30.7% vs. 22.6%; p < 0.001). School-aged children showed higher total sensitization (44.8% vs. 33.4%; p < 0.001) and polysensitization rates (29.8% vs. 20.5%; p < 0.001) than preschool children, while sensitization to food allergens did not differ between age groups. Food allergen sensitization rates differed by region, with higher prevalence in Zagreb compared with Dalmatia and Slavonia (p = 0.0055), whereas total sensitization rates did not differ regionally. The agreement between sensitization and self-reported FA among school-aged children was low (κ = 0.22; p < 0.001), as was the agreement between sensitization and physician-diagnosed FA in preschool children (κ = 0.13; p < 0.001), despite high specificity in both analyses (95% and 99%%, respectively). Conclusions: Allergic sensitization is common among Croatian children, but it poorly predicts clinically relevant food allergy. These findings highlight the multifactorial nature of allergen sensitization in children and emphasize the need for improvements in diagnostic pathways, targeted prevention strategies, and continued surveillance to optimize allergy prevention and management in children.

Background/Objectives: The present study explored the extent to which children's executive function (EF) mediates the relationship between maternal warm parenting and children's problem behaviors during the early school-age years. Methods: Using data from a nationally representative sample of 1516 mother-child dyads participating in the Panel Study on Korean Children, the analysis drew on parent-reported measures collected through standardized questionnaires. Results: Structural equation modeling indicated that warm, responsive maternal parenting contributed to lower levels of children's problem behaviors both directly and indirectly by fostering stronger EF skills. Conclusions: The findings highlight the developmental importance of warm parenting practices and identify children's EF as a central mechanism through which early caregiving environments promote behavioral adjustment.

Objectives: This study aimed to identify key predictors of prolonged hospitalization in children with community-acquired pneumonia by comparing demographic and clinical characteristics between patients with expected and extended hospital stays. Methods: A retrospective cohort study was conducted for children younger than 15 years hospitalized with pneumonia between May 2015 and March 2020. Patients with hospital-acquired pneumonia or additional diagnoses were excluded. Demographic and clinical variables were collected. Statistical analysis, including logistic regression, was performed using SPSS v28 to identify independent predictors of prolonged hospitalization. Results: A total of 455 pediatric patients were included, with a median age of 2 years and a median length of stay of 6 days. Prolonged hospitalization occurred in 27.5% (n = 125) of cases. Gender distribution did not differ significantly between groups (p = 0.727). Significant predictors of prolonged hospitalization included moderate-to-severe pneumonia (p < 0.001, OR = 9.7, 95% CI = 3.1-30.9), pneumonia complications (p = 0.019, OR = 15.16, 95% CI = 1.57-146.3), and underlying chronic conditions (p = 0.009, OR = 2.88, 95% CI = 1.3-6.4). While hypoxia, ventilatory support, and bacteremia were associated with prolonged stay, they did not emerge as independent predictors in the final multivariable model. Conclusion: Prolonged hospitalization in pediatric pneumonia is strongly associated with increased disease severity, complications, and chronic comorbidities. Early identification of high-risk patients may facilitate targeted management strategies, improve outcomes, and reduce healthcare burden.

Background: Laryngomalacia is the most common cause of inspiratory stridor in infancy. While most mild cases resolve spontaneously, severe cases may require surgical intervention. We report a case of severe laryngomalacia successfully treated with correction of glosso-larynx (CGL), a surgical procedure originally developed for ankyloglossia with deviation of the epiglottis and larynx (ADEL).

Methods: A 2-month-old infant with severe symptoms was evaluated using objective anatomical and functional metrics. The patient underwent CGL under local anesthesia to release restrictive tension on the hyoid-larynx complex.

Results: The patient showed rapid and sustained improvement in respiratory symptoms. At the one-month follow-up, endoscopic examination confirmed functional airway expansion with limited to no morbidity.

Conclusions: This case demonstrates that CGL may represent a feasible and minimally invasive therapeutic option for selected cases of severe laryngomalacia, particularly those involving complex tongue-larynx dynamics.

Background: Congenital heart diseases are the most common congenital malformations, affecting 4 to 9 per 1000 children, with increasing global prevalence. As surgical mortality rates decline, the focus has shifted toward improving the quality of life and perioperative outcomes for pediatric patients. Multidisciplinary rehabilitation, including osteopathic care, is increasingly incorporated into recovery programs. Osteopathic manipulative treatment combines manual techniques with lifestyle guidance to alleviate postoperative pain and promote recovery. This project report describes the impact of osteopathic manipulative treatment (OMT) on pain and somatic dysfunctions in hospitalized pediatric cardiac patients, using validated pain assessment tools. It presents a retrospective analysis of data collected as part of a humanitarian volunteer project.

Methods: The project report follows a retrospective descriptive study design, using patient note forms from children aged 0-18 years undergoing cardiac surgery at the Sri Sathya Sai Sanjeevani Center in India between October 2023 and March 2024. A total of 29 experienced osteopaths recorded pain assessments at three time points-pre-surgery, post-surgery, and pre-discharge-using age-appropriate pain scales (FLACC, Wong-Baker Faces, and Numerical Rating Scale). Somatic dysfunctions were evaluated and classified using ICD-10 M99 codes. Data analysis involved descriptive statistics and pre-post comparisons using statistical software (Excel and OPENEPI).

Results: The study included 564 children (60.5% male, mean age 5.8 ± 4.3 years). The most common congenital defects were ventricular septal defects (38.5%) and tetralogy of Fallot (21.6%). The average hospital stay was 15.9 ± 11.1 days. Significant reductions in pain scores were observed from the Intensive Care Unit to the postoperative ward (p < 0.001). Similarly, somatic dysfunction severity decreased significantly across hospitalization phases (p < 0.001). The thoracic region and rib cage were the most frequently affected areas. No adverse events related to osteopathic manipulative treatments were reported.

Conclusions: This project report indicates that osteopathic manipulative treatment is safe and feasible for pediatric patients undergoing surgery for congenital heart disease. Pain scores and somatic dysfunction severity decreased during hospitalization. However, the lack of a control group, the heterogeneity of the patient population, and the short observation period limit the ability to draw causal conclusions. These findings provide a descriptive framework for integrating OMT into multidisciplinary pediatric cardiac care. Future studies should involve prospective, multicenter designs with control groups and longer follow-up periods to assess clinical, functional, developmental, and quality-of-life outcomes.

Background/Objectives: Breastfeeding is widely acknowledged for its benefits to child development and maternal well-being. Yet breastfeeding practices often decline during early childhood transitions, particularly when children enter early childhood education and care (ECEC) services. Research has largely concentrated on healthcare contexts, leaving the educational domain comparatively underexplored in its potential to sustain or hinder breastfeeding continuation. This cross-sectional study examines associations between maternal beliefs regarding the value of breastfeeding and personal, relational, and contextual factors related to breastfeeding continuation within ECEC settings. It also incorporates educators' perspectives and situates breastfeeding practices within the broader framework of parental ethnotheories. Methods: The study formed part of a pilot parental engagement initiative involving 17 childcare centers in Northern Italy, designed to promote dialogue and supportive practices around breastfeeding within ECEC services. This context is acknowledged when interpreting findings related to organizational climate and educator perspectives. Participants included 490 mothers of children enrolled in ECEC services and 118 educators. Mothers completed questionnaires assessing breastfeeding beliefs and experiences, co-sleeping practices, perceived social support, and parental ethnotheories (independence versus interdependence). Educators reported on their experiences in supporting breastfeeding within the childcare context. Analyses included descriptive statistics, analyses of variance, chi-square tests, and binary logistic regression to examine factors associated with breastfeeding continuation. Results: Mothers strongly endorsed the developmental benefits of breastfeeding and expressed greater alignment with caregiving practices emphasizing interdependence and physical proximity. Continued breastfeeding within childcare settings correlated with interdependence-oriented ethnotheories, younger child age, and higher engagement in co-sleeping practices. Educators reported generally positive views of breastfeeding in childcare, highlighting its contribution to children's emotional security and maternal calm, alongside its negligible impact on educational organization. Conclusions: ECEC services play a crucial role in sustaining breastfeeding beyond the domestic sphere. Relational practices and organizational climates that welcome breastfeeding can foster continuity of care, strengthen parental engagement, and promote child well-being.

Background/objectives: Multiple sclerosis (MS) is a chronic, demyelinating, inflammatory, and degenerative disease of the nervous system that may present in childhood or adolescence, defined as Pediatric-Onset Multiple Sclerosis (POMS). Among its diverse clinical manifestations, neurogenic bowel dysfunction (NBD), including chronic constipation and fecal incontinence, represents a distressing condition with a substantial impact on quality of life (QoL). Despite its clinical relevance, the evidence on bowel dysfunction in pediatric MS remains limited. The objective of this case series was to evaluate bowel dysfunction and its management in a pediatric MS cohort, and to assess whether it is associated with QoL.

Methods: We reported the data on the urological and bowel conditions and on the quality of life of our pediatric patients affected by MS and urological dysfunction. We considered MS patients with urinary symptoms who were referred to our department between January 2019 and January 2024, only including individuals with symptoms onset before 18 years of age. In our series, the demographic and clinical data were reviewed, and patients were re-evaluated via telephone interview at least one year after initiation of treatment. The International Consultation on International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF), Pediatric Bowel Management Scoring Tool (PBMST), and Pediatric Quality of Life Inventory (PedsQL, young adults' version) were used to assess urinary and bowel function and related QoL outcomes.

Results: Six patients (four females, two males; median age 14.5 years) were included. Bowel symptoms were reported in four cases (66.6%), predominantly constipation. The PBMST scores indicated overall fair bowel management, while the mean PedsQL score was 62.8/100, with poorer scores observed for the non-adherent patients.

Conclusions: Bowel dysfunction constitutes an underrecognized but clinically significant manifestation in pediatric MS. Its early identification and adherence to a structured bowel management program seems to be crucial for optimizing symptom control and preserving quality of life. Standardized questionnaires represent effective, non-invasive tools for assessment and longitudinal monitoring.

Objectives: This study aimed to evaluate auditory cortical maturation in pediatric cochlear implant (CI) users using speech-evoked cortical auditory evoked potentials (CAEPs) and to compare P1 latency responses with age-matched normal-hearing (NH) peers. Secondary objectives included examining the relationship between P1 latency, age, and duration of implant use to assess experience-dependent cortical plasticity. Materials and Methods: Seventy children were enrolled, including 40 prelingually deaf CI users and 30 NH controls matched for age and sex. CAEPs were recorded using the HEARLab system with three speech tokens representing low (/m/), mid (/g/), and high (/t/) frequencies, presented at 55 dB SPL in a free-field setup. The P1 component was identified as the first positive deflection between 50 and 150 ms after stimulus onset. Group comparisons were performed using Student's t-test, and correlations between P1 latency, age, and implant-use duration were analyzed using the Pearson correlation test (p < 0.05). Results: Mean P1 latencies were significantly longer in CI users than in NH peers for the /m/ and /t/ stimuli (p = 0.036 and p = 0.045, respectively), while no significant difference was found for /g/ (p = 0.542). In NH children, P1 latency negatively correlated with age (r = -0.44, p < 0.05), indicating maturation-related shortening. Among CI users, longer implant-use duration was associated with shorter P1 latencies across all speech tokens (/m/: r = -0.37; /g/: r = -0.49; /t/: r = -0.43; p < 0.05 for all). Conclusions: Speech-evoked CAEPs provide a sensitive and objective measure of auditory cortical development in children with cochlear implants. P1 latency reflects both chronological and hearing-age-related maturation, supporting its clinical use as a biomarker for cortical plasticity and rehabilitation progress in pediatric CI care.

Background/objectives: Child vulnerability is a predictor for potentially adverse challenges for the child and family, but the term is used inconsistently across settings. Danish general practitioners (GPs) are centrally positioned as the front line of the health care system. Thus, the aim of this study is to explore Danish GPs' perspectives and assessment of child vulnerability, using an exploratory, sequential mixed-methods approach.

Methods: Eleven GPs were interviewed, focusing on perceptions and management of child vulnerability in the context of preventive child health examinations (PCHEs). Interviews were analyzed in two stages. From the first deductive analysis, a quantitative data recording chart was developed. This was distributed to 10 general practices, to collect GPs' perceptions and management of child vulnerability, and 197 recordings were completed. Secondly, to develop themes independently of the deductive coding, data was analyzed inductively, creating an in-depth understanding of GPs' perspectives. This resulted in four themes.

Results: GPs associated the concept of child vulnerability with a multitude of social, somatic, and psychological factors. To recognize child vulnerability, GPs found time and scope during PCHEs limited and knowledge of the family essential. Collaboration with social services was perceived as insufficient. The most frequent finding during PCHEs was related to somatic challenges (60%) and follow-up consultation was the most frequent response (64%).

Conclusions: GPs considered child vulnerability a complex term. Assessment of child vulnerability was strongly related to knowledge of the family, and usually based on several consultations, which underscores that PCHEs represent only one of several contexts where concerns are assessed and addressed.