International Journal of Pediatrics最新文献

Background: Food allergies, characterized by immune reactions to food proteins, have emerged as an increasing global concern, impacting over 10% of the population. This study investigates the prevalence of food allergies among schoolchildren aged 5-14 years in northern and central Jordan. Methods: A randomized cross-sectional online questionnaire was administered to students aged 5-14 years residing in the central and northern regions of Jordan. Parents of these students (n = 1629) completed the questionnaire, which comprised information on demographics, dietary habits, food allergies, and allergy history. Results: The parent-reported food allergies exhibited a prevalence of 11.5% (95% confidence interval = 10-13%). Of these reported allergies, 10.1% (95% CI = 8.6-11.7%) were classified as convincing, while only 5.7% (95% CI = 4.5-6.8%) received a formal diagnosis from a healthcare professional. The most commonly reported allergens included eggs (17.8%), cow's milk (15.8%), peanuts (14.5%), and strawberries (13.8%). The majority of children (67.1%) had a single reported allergen, while 15.8% had two, and 17.2% had more than two allergens identified. Food allergies were significantly more prevalent among children with comorbid atopic conditions and those with a family history of allergies. Additionally, regional variations were observed, with high prevalence rates in metropolitan regions. Conclusion: This study emphasizes the significance of considering persuasive food allergy (FA) data in addition to parent-reported information. The findings highlight the considerable burden of food allergies and their relationship with other atopic disorders. Comprehensive management strategies and further research to elucidate the underlying causes of food allergies are necessary.

Background: Intussusception is the most common cause of acute intestinal obstruction in children. It can be initial idiopathic intussusception or a recurrent intussusception (RI), and in this latter case, there is not a validated algorithm for optimal treatment. The aim of the study is to review the international literature to evaluate the incidence of RI, to determine the rates of surgical intervention and pathological leading point (PLP), and to define the most appropriate management for children with RI. We included English-written papers with pediatric population, excluding case reports, papers with adult or mixed cases, studies focusing on ileo-ileal or colo-colic intussusception, meta-analysis studies, or papers with unclear or replaced data. Results: A total number of 23 articles were included for a total of 26,731 patients affected by intussusception and 3164 recurrent patients (11.8%). The number of attempts of nonsurgical reduction ranged from 3 to 10 (median 5). On 2965 RI, 358 underwent surgery (12.1%). A pathologic leading point was found in 99 patients (3.95%). Conclusions: The presence of a PLP does not seem to be associated with the recurrence of intussusception. More than 85% of RI underwent successful nonsurgical management. RI should be safely approached in the same way as primary intussusception, and surgery should be reserved to cases where a PLP has been suspected. In cases of multiple episodes, surgery can be considered an effective way to avoid recurrences, and this possibility should be discussed with parents.

Background: Acute appendicitis (AA) is the most prevalent surgical emergency in the pediatric population, with the complicated form leading to various adverse outcomes. Our study is aimed at evaluating the incidence and associated risk factors of complicated AA among children presenting with this condition. Methods: Employing a cross-sectional design, we included all children suspected of having AA who were admitted to a tertiary pediatric center in Iran from 2020 to 2021. Pathologists examined all surgically removed appendices, and only cases with histopathological confirmation of AA were included. We classified AA into complicated and uncomplicated categories. We recorded and analyzed demographic, clinical, and laboratory data of patients admitted with AA. Analyzed laboratory parameters included white blood cell (WBC) count, neutrophil count and percentage, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). Results: The study comprised 98 pediatric patients with AA, including 60 males (61.2%) and 38 females (38.8%), with a median age of 9.0 (interquartile range: 7.0-11.0) years. Eighteen (18.4%) cases were diagnosed with complicated AA. Mean WBC count, neutrophil count, and CRP levels were significantly higher in patients with complicated AA (p values: 0.048, 0.018, and 0.014, respectively). After adjusting for relevant clinical factors, CRP (odds ratio: 1.02 [95% CI: 1.00-1.04]), WBC count (1.18 [1.03-1.37]), and neutrophil count (1.23 [1.06-1.45)]) were significantly associated with complicated AA. Receiver operating characteristic (ROC) curve analysis indicated a CRP cut-off of 19.5 mg/dL, with an area under the curve of 0.687 (95% CI: 0.551-0.823), a sensitivity of 72.2%, and a specificity of 68.4% for predicting complicated AA. Conclusions: Laboratory parameters, specifically WBC count, neutrophil count, and CRP levels, are significant independent predictors of complicated AA in pediatric patients. These findings could assist in the timely diagnosis and management of children suspected of having AA in clinical practice.

Aim: Bubble continuous positive airway pressure (bCPAP) is recommended by WHO for the treatment of neonatal respiratory distress; however, considerable challenges hinder global access. The objective of this study was to evaluate the feasibility of the use and integration of Vayu bCPAP systems into the neonatal intensive care unit of a public regional referral hospital in the Philippines. Methods: We conducted a mixed-methods study from March 2021 to May 2022. Demographic and clinical characteristics of 150 consecutive neonates treated with a Vayu bCPAP system were collected and analyzed. Forty-seven healthcare workers participated in a survey, and 5-point Likert scales were used to assess the usability and integration of Vayu bCPAP systems into the hospital. Results: The mean duration of bCPAP treatment was 2.5 days (range, 1.0-7.0). Of the neonates treated with a Vayu bCPAP system, 89.3% survived to discharge. Most healthcare workers reported that Vayu bCPAP systems are easy to use. The main themes included positive perceptions of usability, accessibility of the devices, and improved neonatal outcomes. There were mixed perceptions about training on the use of the device, and improvements were suggested. Conclusion: Implementation of Vayu bCPAP systems at a regional referral hospital in the Philippines was feasible. Vayu bCPAP systems were perceived to be easy to use and to improve neonatal outcomes.

Background: Preterm infants are at risk of impaired growth and prolonged hospitalization due to their immature organ systems and treatment complications. Infant massage therapy, as a nonpharmacological intervention, has been recognized as a potential strategy to mitigate these challenges. This study is aimed at evaluating the efficacy of infant massage therapy in comparison to standard care. Method: Participants were allocated into two groups: the intervention group (infants who received massage therapy) and the control group (infants who received standard care). Inclusion criteria were newborn infants with a postmenstrual age (PMA) of 30-36 + 6 weeks and a body weight of ≥ 1500 g. Infants with congenital anomalies, such as heart disease, congestive heart failure, lung and airway anomalies, other congenital anomalies, endotracheal intubation, and unstable vital signs, were excluded. The intervention group received massage therapy for 14 consecutive days, with sessions lasting 15 min each. Metrics for growth and length of hospital stay were collected. Results: Infants born with very low birth weight (VLBW) who received massage therapy exhibited significant weight gain, with an average increase of 63.04 g per day (95% confidence interval (CI): 11.72-114.35), significantly higher than the control group (p = 0.02). Additionally, the duration from birth to achieving full feeding was significantly reduced in the intervention group compared to the control group, with durations of 18.75 (± 10.86) and 41.88 (± 23.09) days, respectively (p = 0.01). Conclusion: Infant massage therapy significantly enhances weight gain and reduces the time to achieve full feeding in VLBW preterm infants. Moderate-pressure massage is recommended for stable VLBW infants in neonatal intensive care units (NICUs).

Background: Anemia and growth impairment are major health problems in children under 5 years in countries with ongoing crises. Aim: The aim of this study is to investigate the prevalence of anemia; low z scores for height for age, weight for age, and weight for height; and elevated plasma total homocysteine (tHcy) and low folate and vitamin B₁₂ concentrations in Syrian children aged 12-60 months. Methods: This cross-sectional study included 344 children of whom physical growth was measured. Blood count and circulating biomarkers of folate and B₁₂ and blood count were measured in a subgroup of the children. Data were collected on sociodemographic and contextual factors. Results: Anemia (age-specific cutoff values for hemoglobin according to the World Health Organization) was detected in 24.4% of the children. The height-for-age z score was < -2 in 32.0%, the weight-for-age z score was < -2 in 16.3%, and the weight-for height z sore< -2 in 1.5% of the children. The concentrations of tHcy, folate, and vitamin B₁₂ were (median and (10th, 90th percentiles)) 8.4 (5.6, 12.3) μmol/L, 24.0 (9.3, 34.7) nmol/L, and 198 (123, 367) pmol/L, respectively. Anemia and child anthropometric measures were not associated with elevated tHcy, low folate, or low B₁₂ concentrations. Conclusion: Anemia and low height- or weight-to-age z scores are highly prevalent among Syrian preschool children. Low folate or vitamin B₁₂ status was common, but they did not explain these conditions. Future studies may investigate whether early life multinutrient interventions may improve child growth and anemia.

Inappropriate birth weight for gestational age (IBWGA) is linked with obstetric complications like birth asphyxia, hypothermia, and postpartum hemorrhage. This study was aimed at determining the prevalence of IBWGA with factors associated with newborns born at Dessie Referral Hospital, northeast of Ethiopia. We used a retrospective cohort study design and systematic random sampling method to select charts of women giving birth at the hospital from January 2013 to December 2017. Binary logistic regression analysis was used to check the association of selected variables with the outcome variable IBWGA. The prevalence of IBWGA was found to be 145 (34.36%), with 52 (12.32%) and 93 (22.04%) for large for gestational age (LGA) and small for gestational age (SGA), respectively. A higher prevalence of IBWGA was found among women who use substances during pregnancy, such as chewing chat (43, 49.4%), smoking (14, 53.8%), and those with a history of giving birth to an infant with IBWGA (31, 50.0%). Furthermore, maternal age less than 35 years old (p < 0.05), antenatal care initiation at or before the second trimester (p < 0.05), gestational age less than 37 weeks (p < 0.05), and chewing chat during pregnancy (p < 0.05) were found to be statistically significantly associated with IBWGA. The high prevalence of IBWGA revealed by this study suggests a need for interventions focusing on its predicting factors: maternal age, prenatal care, gestational age, and substance use during pregnancy.

Aim: The aim is to examine whether using a portable spring-infusor device to deliver antibiotics compared with a standard infusion pump (SIP) translated to (i) improve health outcomes, (ii) reduce the length of stay (LoS), and (iii) reduce cost for treatment of exacerbations of cystic fibrosis (CF). Methods: An observational cohort study was conducted between December 2020 and June 2022 with participants aged 8-19 years admitted for exacerbation of CF. An activity monitor was fitted to participants to measure physical activities for the final 5 days of hospital admission. LoS was measured (days). Group allocation was according to participant preference. Costs were compared between the two groups for LoS, pump cost, and preparation and administration of antibiotics. Results:Twenty-seven of 30 eligible participants were approached, and 22 consented. Data were captured for 16 participants (spring-infusor n = 9): 10 female; mean (SD) age 14.5 (2.1) years. Average step count was negatively associated with age (rho = 0.50), and greater overall in participants using spring-infusors (mean 5324 (SD 2873) steps) versus SIPs (4806 (3116) steps) - mean (95% CI) increase in the spring-infusor group of 3246 (54-6438) for participants of the same age. LoS was longer on average in the SIP group, (mean (SD) LoS: 16.1 (4.3) versus 12.4 (1.7)). The estimated cost saving for a child using a spring-infusor was AUS$12,000. Conclusion:Results from the study suggest that children hospitalised for exacerbations of CF are more active if they receive antibiotics via a spring-infusor device compared with a SIP, and have reduced hospital stay that results in cost saving to the hospital. What is already known? Spring-infusors are small, portable, and mechanical devices to deliver intravenous antibiotics to patients. Spring-infusors are preferred by patients with CF at Perth Children's Hospital Physical activity in children with CF is recommended, including during hospital admissions to promote wellbeing, quality of life, and health outcomes. What this paper adds? Children hospitalised for exacerbations of CF may be more active if they receive antibiotics via a portable spring-infusor device compared with a SIP. Children using spring-infusors had reduced hospital stays that results in cost saving to the hospital. Children hospitalised for exacerbations of CF step on average, fewer than 5000 steps per day, which is well below recommendations.

Aim: This study was aimed at comparing the positive predictive value of a high-risk cell-free fetal DNA test result for sex chromosome aneuploidies (45,X0, 47,XXX, 47,XXY, and 47,XYY) and autosomal trisomies (T21, T18, and T13) with confirmatory tests in singleton pregnancies. Additionally, we identify the main reason for discordant and inconclusive results. Methods: PubMed, Web of Science, and Scopus were searched from 2017 for primary research articles on cell-free fetal DNA testing of autosomal trisomies and sex chromosome aneuploidies in singleton pregnancies. The methodological characteristics and the statistical results of the studies were collected, and the risk of bias was assessed. Results: Fourteen studies were included. Among the autosomal trisomies, T21 had the highest, whereas T13 showed the lowest positive predictive values. As for the sex chromosome aneuploidies, the lowest values were found with 45,X0. Although discordant and inconclusive results were reported inconsistently, false positives were mainly caused by mosaicism, and inconclusive results were mostly secondary to a low fetal DNA fraction. Conclusion: Cell-free fetal DNA is a reliable screening tool for autosomal trisomies. It is also useful for sex chromosome aneuploidies, although the positive predictive values are lower. A positive screening result should be followed with a confirmatory test.

Background: Food allergy affects 1%-10% of children under five worldwide, with genetic and early-life factors playing a primary role. Reported factors include a family history of allergic diseases, personal atopic dermatitis, cesarean section, dietary restrictions during pregnancy and lactation, and the timing of introducing solid foods. This study was aimed at identifying various factors associated with food allergy and evaluate each food allergy's clinical features. Methods: We conducted a case-control study with a participant ratio of 1:2 between cases and controls. Data were gathered from both groups of participants, and questionnaires included living area, sex, and natal history (birth details, maternal diet during pregnancy and breastfeeding, feeding history during infancy, family history of atopic diseases, and household smoking). Results: All 72 cases with food allergy and 145 controls were included in the study. Term birth comprised a protective factor for developing food allergy (adjusted odds ratio [aOR] 0.213, p value 0.022). In contrast, personal atopic dermatitis (aOR 20.097, p value 0.001) and a family history of allergic disease constituted risks (aOR 3.183, p value 0.002). Food allergy was unrelated to cesarean section, low birth weight, dietary restrictions during lactation and pregnancy, exclusive breastfeeding, or the early introduction of complementary foods. The three most common food allergens were egg white (40.2%), wheat (34.7%), and cow's milk (30.5%), respectively. Conclusions: In this study, risk factors associated with food allergy comprised a personal history of atopic dermatitis and a family allergic disease, which may be used as predictive factors for developing food allergy among Thai children.