International Journal of Pediatrics最新文献

Background: The aim was to obtain mental health profiles of caregivers of children with medical complexity (Co-CMC) during periods of adjustment and adaptation through embedded case study during shared isolation in 2020.

Methods: A sequential mixed-methods embedded case study of mental health adjustment from an online community-dwelling sample of Co-CMC, Canada. The quantitative 'unit of analysis' was collected prospectively to classify study participants as having 'well' or 'below-average' mental health, based on norm-referenced self-reported mental health trajectories using the PROMIS General Mental Health Scale. The qualitative 'unit of analysis' was conducted with a purposively selected subgroup of Co-CMC caregivers, from each trajectory group, to provide an inductive framework of mental health adjustment. Distinguishing features between caregivers who demonstrated well, from below-average mental health, were obtained through triangulating both units of analysis into 'profiles'.

Results: Over 70% of Co-CMC (n = 35) reported below-average (i.e., unwell) mental health, while caregivers with average or above average mental health (i.e., well) (n = 12) showed group declines after 6 months. Home care choices, positive orientations, familial support-adaptations, and adapted employment qualitatively distinguished members of the 'well' group from the 'unwell', while financial concerns were unique descriptions to Co-CMC in the 'unwell' group.

Conclusion: This study was the first in-depth profile of mental health of Co-CMC, based on prospective longitudinal data and qualitative descriptions to enhance understanding of the trajectories. The distinguishing factors can be used to screen and potentially prevent caregiver mental health problems, as well as identify interventions to promote thriving families.

Aim: Early childhood development is critically influenced by exposure to stressful life events. Identifying children with warning signs (WS) for developmental disorders early is essential for timely intervention.

Methods: Family pediatricians evaluated the neurodevelopment of 148 children from the NASCITA cohort using the CDC's Learn the Signs, Act Early Milestones checklist, whereas parents completed the Strengths and Difficulties Questionnaire (SDQ). Univariate and multivariate analyses evaluated associations between WS and maternal characteristics, data concerning pregnancy, delivery and the newborns' health, sleep disturbances and life habits.

Results: A total of 14% of children showed WS for developmental disorders at 36 months, a lower percentage than at 24 months (15.8%): for two out of three children, WS disappeared between 24 and 36 months. Persistent WS were noted in 5% of children. Key risk factors identified include older maternal age at delivery (OR 8.93, 95% CI: 1.87-42.62) and maternal unemployment (OR 4.75, 95%CI: 1.40-16.09). Reading aloud emerged as a protective practice, emphasizing its potential in early interventions.

Conclusions: These results highlight the need for continuous monitoring of WS and the importance of positive parental practices in mitigating developmental risks. Early identification by primary care practitioners is crucial in addressing developmental concerns early and improving long-term outcomes.

Necrotizing enterocolitis (NEC) remains one of the most devastating gastrointestinal emergencies in neonatology, primarily affecting preterm and low-birthweight infants. Despite advances in neonatal intensive care that have markedly improved survival among these high-risk populations, NEC continues to be associated with significant morbidity and mortality. It is a complex, multifactorial disease that develops at the crossroads of intestinal immaturity, gut microbiota dysbiosis, impaired mucosal immunity, and suboptimal nutritional practices-particularly the use of formula feeding versus breast milk. In high-income countries, the increasing survival of extremely preterm infants has contributed to a higher incidence of NEC. Moreover, low- and middle-income countries, including those in sub-Saharan Africa, must anticipate a similar rise in NEC cases as neonatal care systems evolve and survival rates improve. Proactive strategies are therefore essential to mitigate the burden of this disease. This narrative literature review synthesizes current evidence on NEC pathogenesis, diagnostic approaches, key risk factors, and evidence-based preventive interventions. Emphasis is placed on the role of enteral feeding practices, microbial colonization, and early identification of at-risk neonates. Furthermore, the review explores strategic clinical practices such as the promotion of exclusive breastfeeding, the cautious use of antibiotics, and the potential role of probiotics. Ultimately, reducing NEC incidence and improving outcomes is crucial for lowering neonatal mortality rates globally, particularly in vulnerable preterm populations.

Purpose: Human parechovirus (HPeV) is one of the major causes of viral meningitis in neonates. Following the COVID-19 pandemic, a resurgence of HPeV infections was reported worldwide. This exploratory case series is aimed at describing the symptoms of neonatal HPeV meningitis occurring after the lifting of large-scale quarantine measures.

Methods: We retrospectively reviewed eight neonates admitted between June 1, 2023, and September 30, 2023, with fever and HPeV detected in cerebrospinal fluid (CSF) using the FilmArray Meningitis/Encephalitis Panel. Demographic variables, clinical presentation, laboratory data, respiratory support requirements, and treatment courses were analyzed.

Results: Fever was the primary presenting symptom. Despite the absence of leukocytosis or pleocytosis, fever duration was prolonged (mean 4.3 days). Four patients (50%) exhibited respiratory symptoms requiring high-flow nasal cannula support. Hyponatremia occurred in two neonates without neurological manifestations-an observation not commonly described in previous cohorts. No patients required invasive ventilation.

Conclusion: This small, single-center series suggests possible variations in neonatal HPeV presentation after the COVID-19 pandemic; however, findings are preliminary and hypothesis-generating. Larger multicenter studies with subtype analysis and long-term neurodevelopmental follow-up are essential.

The objective of this study was to investigate the prevalence of deviations from normal body weight among students of secondary vocational educational institutions and their association with dietary and nondietary factors. The transition from adolescence to adulthood is a unique period during which lifelong eating habits are formed. The study involved 401 boys and 408 girls aged 15-17 years. Height and weight were measured; a questionnaire on diet, meal frequency, and portion size was completed to assess the set of consumed products, nutritional value of the diet, physical activity level, and smoking status. Descriptive statistics, Student's t-test, Mann-Whitney test, and multiple linear regression were used. The prevalence of underweight was 16% among boys and 15% among girls; the prevalence of overweight was 11.2% and 13.7%, and the prevalence of obesity was 4.2% and 5.1%, respectively. Overweight/obese young adults had higher median consumption of brown bread, dairy products, and eggs compared with normal weight young adults. Overweight girls ate more meat and potatoes. Our results add to the literature linking the prevalence of underweight among adolescents to dietary and nondietary factors. Our results suggest that improving nutrition among students may reduce the risk of chronic diseases in the future.

Introduction: In approximately 15% of cases undergoing surgery for acute appendicitis (AA), normal findings are observed in the histological examination of the appendix. Neurogenic appendicopathy (NA) is clinically indistinguishable from AA and is relatively less known. This retrospective study is designed to investigate the frequency of NA in patients operated on during the COVID-19 pandemic who were PCR-negative for COVID-19 and showed no histological evidence of appendicitis.

Materials and methods: Pediatric patients presenting with classic symptoms of AA (right lower quadrant pain, tenderness, and nausea/vomiting) and supporting laboratory/ultrasonographic findings underwent appendectomy based on standard clinical criteria.COVID-19 seronegative patients, who were operated on with a preliminary diagnosis of AA before and during the pandemic, were divided into two groups, each consisting of 20 randomly selected patients with similar age and equal gender distribution. The groups were defined as follows: Group 1: Patients who underwent surgery for AA before the pandemic and showed no histological evidence of appendicitis. Group 2: Patients who underwent surgery for AA during the pandemic, had no history of COVID-19, were PCR-negative, and showed no histological evidence of appendicitis.The examination and laboratory findings of both groups were recorded. All appendix sections were stained with hematoxylin-eosin and S-100. The slides were independently analyzed and scored by two different pathologists (Observers 1 and 2) who were blinded to the patients' clinical histories.

Results: The ages, genders, fevers, vomiting, diarrhea, dysuria findings, white blood cell counts, C-reactive protein levels, appendiceal diameters, and lengths of hospital stay of the 40 cases included in the study were recorded and compared. Statistically significant differences were found between the two groups in terms of fever, diarrhea, dysuria, and elevated white blood cell counts. In histological examination, both Observers 1 and 2's scores for Group 2 showed statistically significant differences in terms of NA.

Conclusion: NA is characterized by a concentration of nerve cells in the appendix. It is clinically indistinguishable from AA but can be identified through histopathological examination. During the pandemic, in cases with symptoms of AA but no histological evidence, S-100 staining of the samples revealed a concentration of nerve fibers in the region. These findings suggest that even PCR-negative cases may still be affected by the virus during the pandemic or that the virus may have a localized interaction with the gastrointestinal system.

Objectives: Right ventricular output (RVO) assessment can estimate systemic blood flow (SBF) in neonates but requires advanced echocardiography expertise. Pulmonary peak flow (PPF) could be an easier surrogate for RVO. This study is aimed at evaluating the correlation between RVO and PPF in neonates and assessing their intraobserver variability.

Methods: In this single-center, longitudinal, observational study, we included term and preterm neonates admitted to our Neonatal Intensive Care Unit between February and July 2022. A neonatologist with experience in functional echocardiography recorded targeted neonatal scans. Recordings were analyzed off-line for echocardiographic measurements. After 12 months, a second analysis of the recordings was performed by the same examiner to avoid recall bias. We compared the two analyses for intraobserver variability assessment.

Results: We analyzed a cohort of 33 term and preterm infants. We found a strong positive correlation between RVO and PPF (p < 0.001). RVO showed a mean intra-observer difference of 34.2 mL/kg/min; PPF showed a mean intraobserver difference of 2.2 cm/s.

Conclusions: Our findings support the use of PPF as a surrogate for RVO for cardiac output estimation in term and preterm neonates. Because of its simplicity, rapidity, and low intraobserver variability, PPF could be a useful tool for SBF assessment. Future studies should be performed to evaluate the correlation between PPF and other echocardiographic markers of low SBF.

Background: Currently, neonatal hypoglycemia is one of the most frequent metabolic disorders and is associated with an increased rate of neonatal morbidity and mortality. Although neonatal hypoglycemia is a common problem among hospitalized neonates, there is limited evidence about its incidence and predictors in Ethiopia, and no studies have been done in our study area. It is critical to consider the incidence and predictors of neonatal hypoglycemia to save neonates' lives from acute problems, long-term neurological impairments, and death. This study is aimed at assessing the incidence and predictors of neonatal hypoglycemia among neonates admitted to Wolaita Zone health institutions' neonatal intensive care units.

Methods: A hospital-based prospective follow-up study was conducted on a sample of 785 admitted eligible neonates between November 1, 2023, and June 1, 2024. The eligible neonates were included in the study consecutively. Data were collected using a pretested interview guide and checklist on sociodemographic, obstetric, and neonatal-related risk factors of hypoglycemia. The collected data were coded, edited, and imported to STATA Version 14 from Kobo toolbox for further analysis. The Kaplan-Meier survival curve was used to determine survival time, and the log-rank test was used to compare survival times across categorical factors. To identify predictors, both bivariable and multivariable Cox proportional hazard regression models were employed.

Results: Among the 785 neonates included in the final analysis, the overall incidence rate of neonatal hypoglycemia during the follow-up time was found to be 15.47 per 1000 neonate-days (95% CI: 12.55, 19.06). Maternal history of bad obstetrics (AHR: 2.26, 95% CI: 1.29, 3.96), gestational diabetes mellitus (AHR: 2.27, 95% CI: 1.27, 4.05), gestational age (AHR: 2.88, 95% CI: 1.35, 6.18), hypothermia (AHR: 2.55, 95% CI: 1.37, 4.77), and newborn type (AHR: 4.31, 95% CI: 1.03, 8.10) were predictors of neonatal hypoglycemia.

Conclusion: In this study, we found a high rate of neonatal hypoglycemia. Therefore, monitoring, identifying, and managing the aforementioned predictors is important to prevent as well as to control neonatal hypoglycemia.

Introduction: Acid-base management in neonates with hypoxic-ischemic encephalopathy (HIE) undergoing therapeutic hypothermia (TH) can use either the "alpha-stat" or the "pH-stat" method, which adjusts values based on temperature.

Objective: This study aimed to compare the efficacy of two blood gas analysis techniques in predicting the severity of brain injury in neonates with HIE.

Method: A retrospective study was conducted on neonates over 35 weeks' gestation who underwent TH between 2010 and 2015. Diagnostic, univariate, and multivariate analyses were performed to compare outcomes between the alpha-sat and pH-stat groups.

Results: Adjusting for sex and age, the odds ratios for being classified as hypocapnic were 4.40 (95% CI: 1.19-16.27) using the alpha-stat method and 2.94 (95% CI 1.15-26.48) using the pH-stat method. The classification of patients as hypocapnic, normocapnic, or hypercapnic differed significantly between the two methods (p < 0.0001), with 23% of patients reclassified from the alpha-stat to the pH-stat method.

Conclusion: Both blood gas analysis methods were similarly effective in predicting brain injury extent. However, the alpha-stat method significantly overestimated the lowest pCO₂ values during therapeutic hypothermia.

Background: Although carbohydrate counting is a recommended method for managing diabetes, it is not widely used by patients with Type 1 diabetes mellitus. Aiming to emphasize the importance of this method, this study is aimed at quantitatively assessing the effectiveness of carbohydrate counting in reducing HbA1c levels in children and adolescents with Type 1 diabetes mellitus.

Methods: Studies published between January 1993 and August 2024 were selected from the EMBASE, PubMed Central (PMC), Wiley Online Library, and ScienceDirect, without language restrictions. The primary outcome was to evaluate the reduction in HbA1c, comparing children and adolescents with Type 1 diabetes mellitus who did or did not use carbohydrate counting.

Results: The results were synthesized through a meta-analysis of the absolute mean difference in HbA1c between the groups. Seven studies were included in the meta-analysis, involving a total of 599 individuals, with 276 in the control group and 323 in the intervention group. When compared to the control group, all carbohydrate counting methods resulted in a reduction in HbA1c. The variation ranged from -1.35% for the greatest reduction to -0.73% for the smallest reduction, with a final mean of -0.94% (95% CI: -1.13, -0.74). Subgroup analysis showed that the greatest reduction in HbA1c was observed in patients who were experienced in carbohydrate counting and used the automated bolus calculator.

Conclusions: This study confirms the effectiveness of carbohydrate counting in reducing HbA1c levels in children and adolescents with Type 1 diabetes mellitus, reinforcing that even the basic form of this strategy represents a valuable and advantageous approach in the management of the disease.