International Journal of Pediatrics最新文献

Introduction: Neonatal hypoxic-ischemic encephalopathy (HIE) is a severe neurological disorder associated with high mortality and long-lasting complications in survivors. Umbilical cord-derived cells have emerged as promising therapeutic candidates, demonstrating positive results in experimental HIE research. This review systematically evaluates the current preclinical evidence on the efficacy of umbilical cord-derived cells in animal models of HIE, focusing on their effects on neurological function and identifying research gaps and constraints that need to be addressed for future preclinical and clinical studies. Methods: The present systematic review and meta-analysis, conducted in accordance with the Systematic Review Protocol for Animal Intervention Studies, synthesized the available evidence on the efficacy of umbilical cord-derived cells. Relevant studies were searched for in Medline's PubMed, Web of Science, Embase, and Cochrane databases up to May 1, 2024. Papers that included the interventional use of UC-derived cells were considered, regardless of the source, dose, timing, and frequency. Nevertheless, studies involving modified UC-derived cells or combination therapies were excluded. Functional neurological outcomes were extracted for meta-analysis to calculate standardized mean difference (SMD) with 95% confidence interval (CI), using a random effects model. The risk of bias was evaluated using SYRCLE. Forest plots and funnel plots were utilized to evaluate potential publication bias. Results: Twelve studies were incorporated into the systematic review. The meta-analysis indicated a significant positive impact of umbilical cord-derived cells on neurobehavioral outcomes post-HIE injury. Sensorimotor function showed an improvement of 0.80 SMD (95% CI, 0.58-1.03) in the negative geotaxis test, while cognitive function demonstrated a 1.44 SMD (95% CI, 1.21-1.67) improvement in the water maze test. The subgroup analysis demonstrated heterogeneous effect sizes contingent on distinct study characteristics, including animal age, cell type, cell dosage, delivery method, and timing method. Conclusions: Overall, these findings suggest a promising role for umbilical cord-derived cells in preclinical HIE studies. The treatment with umbilical cord-derived cells exhibited enhanced functional outcomes, showing promise for future translational research. Despite limitations such as bias risk and heterogeneity affecting the meta-analysis robustness, our results align with existing literature in this research domain. Trial Registration: ClinicalTrials.gov identifier: CRD42024551469.

Craniosynostosis surgery, addressing the premature fusion of cranial sutures, presents a unique challenge requiring standardized care, especially in rural settings, to optimize patient outcomes. This study evaluates surgical outcomes from 2012 to 2021, with a focus on 2020-2021, assessing intraoperative red cell-containing products, blood donor exposures, antifibrinolytic use, and ICU and hospital stays across various hospitals, with emphasis on our Rural Appalachian Institution (RAI). Primary outcomes include perioperative blood transfusion rates and hospital stay duration. Secondary outcomes include antifibrinolytic usage and blood donor exposures. Statistical analyses were performed using ANOVA and chi-square tests where applicable, with a significance threshold of p < 0.05. Results indicate that preoperative erythropoietin administration at RAI contributed to reduced perioperative blood transfusions. Increased antifibrinolytic use at RAI underscores efforts to minimize transfusions. Despite variations in ICU and hospital stays, RAI's standardized protocols address regional challenges and highlight the necessity for best practices in craniosynostosis care. Future research should explore the impact of erythropoietin on blood conservation, postoperative dexmedetomidine infusion on recovery, and tranexamic acid on perioperative blood management. This study, while acknowledging limitations, provides essential insights for refining surgical protocols in resource-limited settings.

Introduction: Kangaroo mother care (KMC) is one of the cost-effective interventions in low-resource settings for effective thermoregulation, supportive breastfeeding, and ensuring early hospital discharge of preterm and low birth weight babies. This study described the predictors of knowledge, attitude, and practice of KMC in a Tertiary Care Center in Ghana. Methods: A cross-sectional design using an online survey was conducted. The convenience sampling method was employed to select 385 mothers. Logistic regression models and path models were used to determine the factors influencing the knowledge, attitude, and practice of KMC. Results: The factors that predict a woman's knowledge of KMC are birthing a preterm or low birth weight baby, aged above 35 years, being a Christian, having health insurance, and giving birth at a health facility. The attitude of mothers toward KMC practice was significantly associated with education, ethnicity, health insurance, weight of newborn, and antenatal clinic (ANC) follow-up. Mothers who used the spontaneous vaginal delivery (SVD) type (aOR = 0.06, 95% CI: 0.01-0.28, p value = 0.001) are less likely to practice KMC than mothers who used the caesarean section (C/S) delivery type; however, mothers who used the SVD type and had health insurance (aOR = 16.02, 95% CI: 3.13-94.95, p value = 0.001) were more likely to practice KMC. Also, mothers who delivered at a private hospital (aOR = 0.42, 95% CI: 0.18-0.97, p value = 0.039) and newborns with weights 1000-1499 g (aOR = 0.32, 95% CI: 0.13-0.72, p value = 0.008) and 2000-2500 g (aOR = 0.31, 95% CI: 0.13-0.70, p value = 0.006) were less likely to practice KMC. In addition, mothers who are not married (aOR = 1.93, 95% CI: 1.10-3.49, p value = 0.025) are more likely to practice KMC. Conclusion: Given that numerous factors influence practice (SVD, having health insurance, not birthing in a private facility, and having a normal birth weight baby) of KMC, promoting health insurance registration, increasing pregnancy safety leading to SVD, and fostering normal birth weight births can limit the need to use KMC. However, given the positive benefits of KMC, ensuring a positive attitude among community members is crucial to its adoption, should it be needed.

Background: Scarce data on classical phenylketonuria diagnosis and outcome in low-income Middle Eastern countries is available. The effect of phenylketonuria diet on growth parameters is still controversial. This 15-year retrospective study is aimed at examining the diagnosis, outcome, and growth of classical phenylketonuria patients following a phenylalanine-restricted Mediterranean diet in Lebanon. Methods: A retrospective review of the charts of patients diagnosed and followed between 2008 and 2023 at the American University of Beirut Medical Center, Lebanon, was conducted. Age at diagnosis, molecular profile, neurological status, anthropometric measurements, diet, and metabolic control were analyzed. Results: Out of 82 patients, 35 met the inclusion criteria. The majority were late-diagnosed (average age: 4 years) with poor neurological outcome. The Mediterranean variant IVS10-11G>A in a homozygous state was identified in 63%. There was no statistically significant difference between body mass index or height for age z-scores at first and last encounter for all patients on phenylalanine-restricted Mediterranean diet. Conclusions: Phenylalanine-restricted Mediterranean diet seems to preserve growth parameters in classical phenylketonuria patients. However, achieving a neurotypical outcome remains challenging in the absence of systematic newborn screening in Lebanon, a resource-constrained country with high rates of consanguinity.

Aim: This study is aimed at evaluating the cumulative effect of postnatal risk factors on the survival of preterm neonates by examining key clinical parameters and complications across various gestational ages. Methods: A retrospective cohort study was conducted using data from 1109 neonates admitted to neonatal intensive care units at two tertiary regional hospitals in Kazakhstan between 2021 and 2024. Patients were classified into three groups based on gestational age: extremely preterm (< 28 weeks, n = 223), very preterm (28-31 weeks, n = 384), and moderate to late preterm (32-36 weeks, n = 502). Initially, to identify significant risk factors, categorical variables were analyzed using the χ ² test or Fisher's exact test with the Bonferroni correction, depending on whether the expected counts were ≥ 5 or < 5, while continuous variables were examined with the Kruskal-Wallis and Mann-Whitney U tests. Subsequently, multivariate logistic regression was applied to develop a prognostic model for each study group based on previously identified statistically significant risk factors for neonatal mortality. The predictive performance of these factors was further evaluated through ROC curve analysis with AUC. Finally, the Kaplan-Meier method was used to reflect overall mortality outcomes, illustrating their association with gestational age and the distribution of fatal cases over time in days. Results: The results of this study reveal significant differences in survival rates among preterm neonates based on gestational age, with mortality being most pronounced in infants born at less than 28 weeks of gestation. As gestational age increased among preterm infants, there was a marked reduction in the number of statistically significant independent risk factors identified in logistic models that influence survival. Disseminated intravascular coagulation consistently emerged as a significant predictor across all three logistic models. Neonatal depression, hyperbilirubinemia, and necrotizing enterocolitis were significant in both extremely preterm infants (less than 28 weeks) and very preterm infants (28-31 weeks). However, patent ductus arteriosus and bronchopulmonary dysplasia were statistically significant only in the extremely preterm group (less than 28 weeks). Conclusion: In a cohort of preterm neonates in Kazakhstan, the cumulative impact of various risk factors plays a critical role in determining survival outcomes, with increasing gestational age significantly enhancing the likelihood of survival. Further research is required to refine prognostic models and identify factors specific to different sociogeographical populations.

Background: Neonatal respiratory distress syndrome (NRDS) is a leading cause of morbidity and mortality in preterm infants. Minimally invasive surfactant therapy (MIST) has emerged as a promising alternative to traditional approaches, aiming to reduce mechanical ventilation while maintaining spontaneous breathing. This meta-analysis compares the efficacy and safety of MIST versus the intubation-surfactant-extubation (INSURE) method in preterm neonates with NRDS. Methods: We searched PubMed, Scopus, and Embase for eligible studies. Two independent reviewers screened studies via the Rayyan platform. We included randomized controlled trials and observational cohorts of preterm neonates (< 37 weeks) with NRDS requiring surfactant therapy, comparing MIST and INSURE. Data extraction included study characteristics, demographics, and clinical outcomes. Risk of bias was assessed using the Newcastle-Ottawa Scale and Cochrane tools. Risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Heterogeneity was evaluated via I ² statistics. Results: Then, 17 studies (n = 1931 neonates; MIST: 913, INSURE: 932) were included. Baseline characteristics were similar between groups. Mortality did not differ significantly (RR 0.62; 95% CI 0.38-1.01; p = 0.05). MIST was associated with reduced risks of bronchopulmonary dysplasia (RR 0.59; 95% CI 0.45-0.76), intraventricular hemorrhage (RR 0.66; 95% CI 0.48-0.92), patent ductus arteriosus (RR 0.75; 95% CI 0.61-0.93), and pneumothorax (RR 0.54; 95% CI 0.34-0.87). Rates of pulmonary hemorrhage and surfactant reflux were comparable. MIST also resulted in shorter oxygen day requirements (MD -2.45; p = 0.04) and need for mechanical ventilation (RR 0.54; p = 0.002). Duration of ventilation and NICU showed no significant differences. Conclusion: MIST proved to be a safer and more effective alternative to INSURE in preterm infants with NRDS, reducing several complications and mechanical ventilation needs. These findings highlight MIST's potential as a preferred approach, warranting further research to support broader implementation.

[This corrects the article DOI: 10.1155/2020/7912894.].

Background: Rapid growth is commonly found in children after experiencing poor nutritional status. In this context, growth retardation early in life is a major risk factor for developing noncommunicable diseases (NCDs). Therefore, this study is aimed at determining the impact of rapid growth after retardation at the first 1000 days of life (FDLs) on an increased risk of NCD in adolescents. Method: A longitudinal analysis of Indonesia Family Life Survey (IFLS) data was used for 1997, 2000, and 2014, respectively. Meanwhile, the initial data on subjects was taken in 1997 (Age 0-23 months) and observed at 3-5, then 17-19 years. This study used a generalized linear model with a 95% confidence interval for bivariate and multivariate analysis. Results: The results showed a significant association between rapid growth after retardation at the FDLs and an increased risk of hypertension, diabetes mellitus, and obesity in adolescents. Conclusion: The impact of rapid growth after retardation at the FDL increases the long-term risk of NCDs in later life. Early life interventions and policies focused on preventing undernutrition, ensuring a balanced diet, and regularly monitoring growth during the critical period.

Background: Newborn hypothermia is a critical global health challenge, particularly in low-resource settings, where it significantly contributes to neonatal morbidity and mortality. A mere one-degree drop in a newborn's body temperature can substantially increase the risk of death. Understanding hypothermia factors is key to developing strategies to reduce neonatal mortality. Despite its status as a leading cause of neonatal death, no studies have been conducted in the study area to determine the prevalence and associated factors of neonatal hypothermia. Method: An institution-based cross-sectional study of 237 participants employed systematic random sampling. Data collection involved interviews and chart reviews, analyzed using SPSS Version 27.0. Bivariable logistic regression identified associations with a p value < 0.25, and multivariate logistic regression determined significant factors with a p value < 0.05. Result: The prevalence of neonatal hypothermia among newborns in this study was 54% (128 cases). Mothers whose labor was induced were 2.3 times more likely to have a hypothermic newborn (AOR = 2.276, 95% CI: 1.019-5.081). Newborns delivered at home were seven times more likely to develop hypothermia (AOR = 7.031, 95% CI: 1.018-48.582). Additionally, mothers without pregnancy complications were 0.4 times less likely to have a hypothermic baby compared to those who experienced pregnancy complications (AOR = 0.464, 95% CI: 0.235-0.997). Conclusion: The prevalence of neonatal hypothermia in the study area was found to be 54%. Factors associated with neonatal hypothermia included labor induction, home delivery, and complications during pregnancy.

Background: Pediatric fever is considered one of the most common reasons for parents presenting to the emergency department (ED). As there is little information involving parental knowledge, management techniques, and consultation of medical professionals regarding complaints of pediatric fever in Lebanon, it is important to investigate whether the parents know how to deal with a febrile fever in child before bringing them to the ED in order to determine the need for parental educational programs for fever management and to possibly limit unnecessary hospital visits. Study Design: This study recruited 191 participants to fill a questionnaire of 21 questions divided into three sections assessing parental sociodemographic characteristics, knowledge, and attitudes towards pediatric fever during presentation to the ED in two medical centers in Lebanon. The participant population was then stratified and compared on the basis of gender and knowledge level. Results: When assessing participants' knowledge, 119 (62.3%) of participants had a high level of knowledge, and 72 (37.7%) had a low level of knowledge on pediatric fever. The two groups showed different approaches towards low-grade fevers with the high knowledge group presenting to the ED mostly during high-grade fevers of 39°C or more. Conclusion: While the population of the current study showed similar levels of knowledge as those in studies from different parts of the world, around 50% of the participants showed higher levels of knowledge, thus proving that there is still a need for parental awareness and education regarding the causes of fever, its risks and benefits during disease progression, and appropriate ways of management.