Pub Date : 2024-10-30DOI: 10.1016/S2352-4642(24)00260-8
Jiali Zhou MPH , Jing Wu MPH , Denan Jiang MPH , Shan Cai MPH , Chenhao Zhang MS , Jiayao Ying MPH , Jin Cao MPH , Prof Yi Song PhD , Peige Song PhD
<div><h3>Background</h3><div>Childhood hypertension is a growing health concern in China. Accurate estimation of prevalence is essential but challenging due to the variability of blood pressure and the need for multiple occasions for confirmation. This study aimed to estimate the national, regional, and provincial prevalence of childhood hypertension in China in 2020.</div></div><div><h3>Methods</h3><div>For this systematic review and modelling study, we did a comprehensive literature search of epidemiological studies reporting the prevalence of elevated blood pressure (EBP) or hypertension among Chinese children (aged 18 years or younger) that were published between Jan 1, 1990 and June 20, 2024 in PubMed, Embase, MEDLINE, China National Knowledge Infrastructure, Wanfang Data, and Chinese Science and Technology Journal Database. EBP was defined as blood pressure greater than or equal to the 95th percentile on a single occasion, and childhood hypertension as blood pressure greater than or equal to the 95th percentile consistently across three occasions. First, we estimated the prevalence of childhood EBP using a multi-level mixed-effects meta-regression and the pooled odds ratios (ORs) for factors associated with childhood EBP through random-effects meta-analysis. Second, the ratio of childhood EBP to childhood hypertension was calculated via random-effects meta-analysis, based on which the national and regional prevalence of childhood hypertension was imputed. Finally, we derived the provincial prevalence of childhood hypertension using an associated factor-based model. The review protocol was registered in PROSPERO (CRD42024537570).</div></div><div><h3>Findings</h3><div>We identified 8872 records, of which 134 articles covering 22 431 861 children were included. In 2020, the overall prevalence of hypertension among Chinese children aged 6–18 years was 3·11% (95% CI 2·35–4·04), equivalent to 6·80 million (5·13–8·83) affected children. The prevalence of childhood hypertension ranged from 2·25% (1·54–2·75) for children aged 6 years to 2·01% (1·36–3·37) for those aged 18 years, peaking at 3·84% (2·97–4·94) for those aged 14 years. The overall prevalence was higher in boys (3·34% [2·53–4·35]) than in girls (2·85% [2·13–3·69]). Associations between four factors (overweight, obesity, salted food intake, and family history of hypertension) and childhood EBP were graded as highly suggestive evidence.</div></div><div><h3>Interpretation</h3><div>This study reveals substantial regional and provincial variations in the prevalence of childhood hypertension in China. Our findings could inform targeted public health initiatives and optimise resource allocation to address this public health concern.</div></div><div><h3>Funding</h3><div>This study was supported by the National Natural Science Foundation of China (72104211 and 82273654) and the Chao Kuang Piu High-tech Development Fund (2022RC019).</div></div><div><h3>Translation</h3><div>For the Chinese translat
{"title":"National, regional and provincial prevalence of childhood hypertension in China in 2020: a systematic review and modelling study","authors":"Jiali Zhou MPH , Jing Wu MPH , Denan Jiang MPH , Shan Cai MPH , Chenhao Zhang MS , Jiayao Ying MPH , Jin Cao MPH , Prof Yi Song PhD , Peige Song PhD","doi":"10.1016/S2352-4642(24)00260-8","DOIUrl":"10.1016/S2352-4642(24)00260-8","url":null,"abstract":"<div><h3>Background</h3><div>Childhood hypertension is a growing health concern in China. Accurate estimation of prevalence is essential but challenging due to the variability of blood pressure and the need for multiple occasions for confirmation. This study aimed to estimate the national, regional, and provincial prevalence of childhood hypertension in China in 2020.</div></div><div><h3>Methods</h3><div>For this systematic review and modelling study, we did a comprehensive literature search of epidemiological studies reporting the prevalence of elevated blood pressure (EBP) or hypertension among Chinese children (aged 18 years or younger) that were published between Jan 1, 1990 and June 20, 2024 in PubMed, Embase, MEDLINE, China National Knowledge Infrastructure, Wanfang Data, and Chinese Science and Technology Journal Database. EBP was defined as blood pressure greater than or equal to the 95th percentile on a single occasion, and childhood hypertension as blood pressure greater than or equal to the 95th percentile consistently across three occasions. First, we estimated the prevalence of childhood EBP using a multi-level mixed-effects meta-regression and the pooled odds ratios (ORs) for factors associated with childhood EBP through random-effects meta-analysis. Second, the ratio of childhood EBP to childhood hypertension was calculated via random-effects meta-analysis, based on which the national and regional prevalence of childhood hypertension was imputed. Finally, we derived the provincial prevalence of childhood hypertension using an associated factor-based model. The review protocol was registered in PROSPERO (CRD42024537570).</div></div><div><h3>Findings</h3><div>We identified 8872 records, of which 134 articles covering 22 431 861 children were included. In 2020, the overall prevalence of hypertension among Chinese children aged 6–18 years was 3·11% (95% CI 2·35–4·04), equivalent to 6·80 million (5·13–8·83) affected children. The prevalence of childhood hypertension ranged from 2·25% (1·54–2·75) for children aged 6 years to 2·01% (1·36–3·37) for those aged 18 years, peaking at 3·84% (2·97–4·94) for those aged 14 years. The overall prevalence was higher in boys (3·34% [2·53–4·35]) than in girls (2·85% [2·13–3·69]). Associations between four factors (overweight, obesity, salted food intake, and family history of hypertension) and childhood EBP were graded as highly suggestive evidence.</div></div><div><h3>Interpretation</h3><div>This study reveals substantial regional and provincial variations in the prevalence of childhood hypertension in China. Our findings could inform targeted public health initiatives and optimise resource allocation to address this public health concern.</div></div><div><h3>Funding</h3><div>This study was supported by the National Natural Science Foundation of China (72104211 and 82273654) and the Chao Kuang Piu High-tech Development Fund (2022RC019).</div></div><div><h3>Translation</h3><div>For the Chinese translat","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"8 12","pages":"Pages 872-881"},"PeriodicalIF":19.9,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142565289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-29DOI: 10.1016/S2352-4642(24)00298-0
Nuria Sanchez Clemente , Kirsty Le Doare , Ezekiel Mupere , Jean B Nachega , Stephen Rulisa , Boghuma Titanji
{"title":"Hidden in plain sight: the threat of mpox to children and adolescents","authors":"Nuria Sanchez Clemente , Kirsty Le Doare , Ezekiel Mupere , Jean B Nachega , Stephen Rulisa , Boghuma Titanji","doi":"10.1016/S2352-4642(24)00298-0","DOIUrl":"10.1016/S2352-4642(24)00298-0","url":null,"abstract":"","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"8 12","pages":"Pages 849-851"},"PeriodicalIF":19.9,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142565283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-21DOI: 10.1016/S2352-4642(24)00232-3
Victoria O Oyenuga BSc , Gioia Mosler PhD , Prof Emmanuel Addo-Yobo MD , Prof Olayinka O Adeyeye FMCP , Bernard Arhin BSc , Prof Farida Fortune PhD , Prof Christopher J Griffiths DPhil , Marian Kasekete MMed , Elizabeth Mkutumula MPH , Reratilwe Mphahlele PhD , Prof Hilda A Mujuru MMed , Sofia Muyemayema MPH , Rebecca Nantanda PhD , Lovemore M Nkhalamba MSc , Oluwafemi T Ojo MBBS FMCP , Sandra Kwarteng Owusu MPhil , Ismail Ticklay MMED , Peter O Ubuane MBChB FWACPaed , Rafiuk C Yakubu FWACP , Lindsay Zurba BCur , Prof Jonathan Grigg MD
<div><h3>Background</h3><div>Rapid urbanisation and population growth in sub-Saharan Africa has increased the incidence of asthma in children and adolescents. One major barrier to achieving good asthma control in these adolescents is obtaining a clinical diagnosis. To date, there are scant data on prevalence and severity of asthma in undiagnosed yet symptomatic adolescents. We therefore aimed to assess symptom prevalence and severity, the effect of symptoms on daily life, and objective evidence of asthma in young adolescents from sub-Saharan Africa with and without a clinical diagnosis of asthma by spirometry and fractional exhaled nitric oxide (FeNO).</div></div><div><h3>Methods</h3><div>We designed a two-phase, multi-country, school-based, cross-sectional study to assess symptom prevalence and severity in sub-Saharan African adolescents. In phase 1 we surveyed young adolescents aged 12–14 years who were attending selected primary and secondary schools in Blantyre in Malawi, Durban in South Africa, Harare in Zimbabwe, Kampala in Uganda, Kumasi in Ghana, and Lagos in Nigeria. The adolescents were screened for asthma symptoms using the International Study of Asthma and Allergies in Children (ISAAC) questionnaire. Then, after opt-in consent, symptomatic adolescents were invited to complete a detailed survey on asthma severity, treatment, and exposure to environmental risk factors for phase 2. Adolescents performed the European Respiratory Society's diagnostic tests for childhood asthma. A positive asthma test was classified as a forced expiratory volume in 1 sec (FEV<sub>1</sub>) predicted under 80%, a FEV<sub>1</sub> under the lower limits of normal, or FEV<sub>1</sub> divided by forced vital capacity (FEV<sub>1</sub>/FVC) under the lower limits of normal; positive bronchodilator responsiveness or reversibility was defined as either an increase in absolute FEV<sub>1</sub> of 12% or more, or an increase of 200 mL or more, or both, after 400 μg of salbutamol (shortacting β2 agonist) administered via a metered-dose inhaler and spacer, or FeNO of 25 parts per billion or higher, or any combination of these. The study was registered with <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span> (<span><span>NCT03990402</span><svg><path></path></svg></span>) and is complete.</div></div><div><h3>Findings</h3><div>Between Nov 1, 2018, and Nov 1, 2021, we recruited 149 schools from six regions in six sub-Saharan countries to participate in the study. We administered phase 1 asthma questionnaires from Jan 20, 2019 to Nov 11, 2021, and from 27 407 adolescents who were screened, we obtained data for 27 272 (99·5%). Overall, 14 918 (54·7%) adolescents were female and 12 354 (45·3%) adolescents were male, and the mean age was 13 years (IQR 12–13); nearly all recruited adolescents were of black African ethnicity (26 821 [98·3%] of 27 272). In phase 1, a total of 3236 (11·9% [95% CI 11·5–12·3]) reported wheeze in the past 12 months, and 644 (19·9%) of 3
{"title":"Asthma symptoms, severity, and control with and without a clinical diagnosis of asthma in early adolescence in sub-Saharan Africa: a multi-country, school-based, cross-sectional study","authors":"Victoria O Oyenuga BSc , Gioia Mosler PhD , Prof Emmanuel Addo-Yobo MD , Prof Olayinka O Adeyeye FMCP , Bernard Arhin BSc , Prof Farida Fortune PhD , Prof Christopher J Griffiths DPhil , Marian Kasekete MMed , Elizabeth Mkutumula MPH , Reratilwe Mphahlele PhD , Prof Hilda A Mujuru MMed , Sofia Muyemayema MPH , Rebecca Nantanda PhD , Lovemore M Nkhalamba MSc , Oluwafemi T Ojo MBBS FMCP , Sandra Kwarteng Owusu MPhil , Ismail Ticklay MMED , Peter O Ubuane MBChB FWACPaed , Rafiuk C Yakubu FWACP , Lindsay Zurba BCur , Prof Jonathan Grigg MD","doi":"10.1016/S2352-4642(24)00232-3","DOIUrl":"10.1016/S2352-4642(24)00232-3","url":null,"abstract":"<div><h3>Background</h3><div>Rapid urbanisation and population growth in sub-Saharan Africa has increased the incidence of asthma in children and adolescents. One major barrier to achieving good asthma control in these adolescents is obtaining a clinical diagnosis. To date, there are scant data on prevalence and severity of asthma in undiagnosed yet symptomatic adolescents. We therefore aimed to assess symptom prevalence and severity, the effect of symptoms on daily life, and objective evidence of asthma in young adolescents from sub-Saharan Africa with and without a clinical diagnosis of asthma by spirometry and fractional exhaled nitric oxide (FeNO).</div></div><div><h3>Methods</h3><div>We designed a two-phase, multi-country, school-based, cross-sectional study to assess symptom prevalence and severity in sub-Saharan African adolescents. In phase 1 we surveyed young adolescents aged 12–14 years who were attending selected primary and secondary schools in Blantyre in Malawi, Durban in South Africa, Harare in Zimbabwe, Kampala in Uganda, Kumasi in Ghana, and Lagos in Nigeria. The adolescents were screened for asthma symptoms using the International Study of Asthma and Allergies in Children (ISAAC) questionnaire. Then, after opt-in consent, symptomatic adolescents were invited to complete a detailed survey on asthma severity, treatment, and exposure to environmental risk factors for phase 2. Adolescents performed the European Respiratory Society's diagnostic tests for childhood asthma. A positive asthma test was classified as a forced expiratory volume in 1 sec (FEV<sub>1</sub>) predicted under 80%, a FEV<sub>1</sub> under the lower limits of normal, or FEV<sub>1</sub> divided by forced vital capacity (FEV<sub>1</sub>/FVC) under the lower limits of normal; positive bronchodilator responsiveness or reversibility was defined as either an increase in absolute FEV<sub>1</sub> of 12% or more, or an increase of 200 mL or more, or both, after 400 μg of salbutamol (shortacting β2 agonist) administered via a metered-dose inhaler and spacer, or FeNO of 25 parts per billion or higher, or any combination of these. The study was registered with <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span> (<span><span>NCT03990402</span><svg><path></path></svg></span>) and is complete.</div></div><div><h3>Findings</h3><div>Between Nov 1, 2018, and Nov 1, 2021, we recruited 149 schools from six regions in six sub-Saharan countries to participate in the study. We administered phase 1 asthma questionnaires from Jan 20, 2019 to Nov 11, 2021, and from 27 407 adolescents who were screened, we obtained data for 27 272 (99·5%). Overall, 14 918 (54·7%) adolescents were female and 12 354 (45·3%) adolescents were male, and the mean age was 13 years (IQR 12–13); nearly all recruited adolescents were of black African ethnicity (26 821 [98·3%] of 27 272). In phase 1, a total of 3236 (11·9% [95% CI 11·5–12·3]) reported wheeze in the past 12 months, and 644 (19·9%) of 3","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"8 12","pages":"Pages 859-871"},"PeriodicalIF":19.9,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142515693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Recent advances in genetic testing technologies have revolutionised the identification of genetic abnormalities in early onset developmental and epileptic encephalopathies (DEEs). In this Review, we provide an update on the expanding landscape of genetic factors contributing to DEEs, encompassing over 800 reported genes. We focus on the cellular and molecular mechanisms driving epileptogenesis, with an emphasis on emerging therapeutic strategies and effective treatment options. We explore noteworthy, novel genes linked to DEE phenotypes, such as gBRAT-1 and GNAO1, and gene families such as GRIN and HCN. Understanding the network-level effects of gene variants will pave the way for potential gene therapy applications. Given the diverse comorbidities associated with DEEs, a multidisciplinary team approach is essential. Despite ongoing efforts and improved genetic testing, DEEs lack a cure, and treatment complexities persist. This Review underscores the necessity for larger international prospective studies focusing on both seizure outcomes and developmental trajectories.
基因检测技术的最新进展彻底改变了对早发性发育性和癫痫性脑病（DEEs）基因异常的鉴定。在本综述中，我们将介绍导致 DEEs 的遗传因素不断扩展的最新情况，包括已报道的 800 多个基因。我们将重点放在驱动癫痫发生的细胞和分子机制上，同时强调新出现的治疗策略和有效的治疗方案。我们探讨了与 DEE 表型相关的值得注意的新基因，如 gBRAT-1 和 GNAO1，以及基因家族，如 GRIN 和 HCN。了解基因变异的网络级效应将为潜在的基因治疗应用铺平道路。鉴于与 DEE 相关的合并症多种多样，因此必须采用多学科团队方法。尽管我们一直在努力改进基因检测，但 DEE 仍无法治愈，治疗的复杂性依然存在。本综述强调，有必要开展更大规模的国际前瞻性研究，重点关注癫痫发作结果和发育轨迹。
{"title":"The expanding field of genetic developmental and epileptic encephalopathies: current understanding and future perspectives","authors":"Nicola Specchio MD , Marina Trivisano MD , Prof Eleonora Aronica MD , Simona Balestrini MD , Prof Alexis Arzimanoglou MD , Gaia Colasante PhD , Prof J Helen Cross MD , Sergiusz Jozwiak MD , Prof Jo M Wilmshurst MD , Federico Vigevano MD , Prof Stéphane Auvin MD , Prof Rima Nabbout MD , Prof Paolo Curatolo MD","doi":"10.1016/S2352-4642(24)00196-2","DOIUrl":"10.1016/S2352-4642(24)00196-2","url":null,"abstract":"<div><div>Recent advances in genetic testing technologies have revolutionised the identification of genetic abnormalities in early onset developmental and epileptic encephalopathies (DEEs). In this Review, we provide an update on the expanding landscape of genetic factors contributing to DEEs, encompassing over 800 reported genes. We focus on the cellular and molecular mechanisms driving epileptogenesis, with an emphasis on emerging therapeutic strategies and effective treatment options. We explore noteworthy, novel genes linked to DEE phenotypes, such as <em>gBRAT-1</em> and <em>GNAO1</em>, and gene families such as <em>GRIN</em> and <em>HCN</em>. Understanding the network-level effects of gene variants will pave the way for potential gene therapy applications. Given the diverse comorbidities associated with DEEs, a multidisciplinary team approach is essential. Despite ongoing efforts and improved genetic testing, DEEs lack a cure, and treatment complexities persist. This Review underscores the necessity for larger international prospective studies focusing on both seizure outcomes and developmental trajectories.</div></div>","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"8 11","pages":"Pages 821-834"},"PeriodicalIF":19.9,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142437895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-11DOI: 10.1016/S2352-4642(24)00233-5
Peter B Sporns MD MHBA , Kartik Bhatia MD , Prof Todd Abruzzo MD , Lisa Pabst MD , Stuart Fraser MD , Melissa G Chung MD , Prof Warren Lo MD , Prof Ahmed Othman MD , Sebastian Steinmetz MD , Ulf Jensen-Kondering MD , Stefan Schob MD , Daniel P O Kaiser MD , Wolfgang Marik MD , Prof Christina Wendl MD , Ilka Kleffner MD , Prof Hans Henkes MD , Hermann Kraehling MD , Thi Dan Linh Nguyen-Kim MD , Prof René Chapot MD , Umut Yilmaz MD , Prof Moritz Wildgruber MD PhD
<div><h3>Background</h3><div>Emerging evidence suggests that endovascular thrombectomy is beneficial for treatment of childhood stroke, but the safety and effectiveness of endovascular thrombectomy has not been compared with best medical treatment. We aimed to prospectively analyse functional outcomes of endovascular thrombectomy versus best medical treatment in children with intracranial arterial occlusion stroke.</div></div><div><h3>Methods</h3><div>In this prospective registry study, 45 centres in 12 countries across Asia and Australia, Europe, North America, and South America reported functional outcomes for children aged between 28 days and 18 years presenting with arterial ischaemic stroke caused by a large-vessel or medium-vessel occlusion who received either endovascular thrombectomy plus best medical practice or best medical treatment alone. Intravenous thrombolysis was considered part of best medical treatment and therefore permitted in both groups. The primary outcome was the difference in median modified Rankin Scale (mRS) score between baseline (pre-stroke) and 90 days (±10 days) post-stroke, assessed by the Wilcoxon rank test (α=0·05). Efficacy outcomes in the endovascular thrombectomy and best medical treatment groups were compared in sensitivity analyses using propensity score matching. The Save ChildS Pro study is registered at the German Clinical Trials Registry, DRKS00018960.</div></div><div><h3>Findings</h3><div>Between Jan 1, 2020, and Aug 31, 2023, of the 241 patients in the Save ChildS Pro registry, 208 were included in the analysis (115 [55%] boys and 93 [45%] girls). 117 patients underwent endovascular thrombectomy (median age 11 years [IQR 6–14]), and 91 patients received best medical treatment (6 years [3–12]; p<0·0001). The median Pediatric National Institutes of Health Stroke Scale (PedNIHSS) score on admission was 14 (IQR 10–19) in the endovascular thrombectomy group and 9 (5–13) in the best medical treatment group (p<0·0001). Both treatment groups had a median pre-stroke mRS score of 0 (IQR 0–0) at baseline. The change in median mRS score between baseline and 90 days was 1 (IQR 0–2) in the endovascular thrombectomy group and 2 (1–3) in the best medical treatment group (p=0·020). One (1%) patient developed a symptomatic intracranial haemorrhage (this patient was in the endovascular thrombectomy group). Six (5%) patients in the endovascular thrombectomy group and four (5%) patients in the best medical treatment group had died by day 90 (p=0·89). After propensity score matching for age, sex, and PedNIHSS score at hospital admission (n=79 from each group), the change in median mRS score between baseline and 90 days was 1 (IQR 0–2) in the endovascular thrombectomy group and 2 (1–3) in the best medical treatment group (p=0·029). Regarding the primary outcome for patients with suspected focal cerebral arteriopathy, endovascular thrombectomy (n=18) and best medical treatment (n=33) showed no difference in 90-day media
{"title":"Endovascular thrombectomy for childhood stroke (Save ChildS Pro): an international, multicentre, prospective registry study","authors":"Peter B Sporns MD MHBA , Kartik Bhatia MD , Prof Todd Abruzzo MD , Lisa Pabst MD , Stuart Fraser MD , Melissa G Chung MD , Prof Warren Lo MD , Prof Ahmed Othman MD , Sebastian Steinmetz MD , Ulf Jensen-Kondering MD , Stefan Schob MD , Daniel P O Kaiser MD , Wolfgang Marik MD , Prof Christina Wendl MD , Ilka Kleffner MD , Prof Hans Henkes MD , Hermann Kraehling MD , Thi Dan Linh Nguyen-Kim MD , Prof René Chapot MD , Umut Yilmaz MD , Prof Moritz Wildgruber MD PhD","doi":"10.1016/S2352-4642(24)00233-5","DOIUrl":"10.1016/S2352-4642(24)00233-5","url":null,"abstract":"<div><h3>Background</h3><div>Emerging evidence suggests that endovascular thrombectomy is beneficial for treatment of childhood stroke, but the safety and effectiveness of endovascular thrombectomy has not been compared with best medical treatment. We aimed to prospectively analyse functional outcomes of endovascular thrombectomy versus best medical treatment in children with intracranial arterial occlusion stroke.</div></div><div><h3>Methods</h3><div>In this prospective registry study, 45 centres in 12 countries across Asia and Australia, Europe, North America, and South America reported functional outcomes for children aged between 28 days and 18 years presenting with arterial ischaemic stroke caused by a large-vessel or medium-vessel occlusion who received either endovascular thrombectomy plus best medical practice or best medical treatment alone. Intravenous thrombolysis was considered part of best medical treatment and therefore permitted in both groups. The primary outcome was the difference in median modified Rankin Scale (mRS) score between baseline (pre-stroke) and 90 days (±10 days) post-stroke, assessed by the Wilcoxon rank test (α=0·05). Efficacy outcomes in the endovascular thrombectomy and best medical treatment groups were compared in sensitivity analyses using propensity score matching. The Save ChildS Pro study is registered at the German Clinical Trials Registry, DRKS00018960.</div></div><div><h3>Findings</h3><div>Between Jan 1, 2020, and Aug 31, 2023, of the 241 patients in the Save ChildS Pro registry, 208 were included in the analysis (115 [55%] boys and 93 [45%] girls). 117 patients underwent endovascular thrombectomy (median age 11 years [IQR 6–14]), and 91 patients received best medical treatment (6 years [3–12]; p<0·0001). The median Pediatric National Institutes of Health Stroke Scale (PedNIHSS) score on admission was 14 (IQR 10–19) in the endovascular thrombectomy group and 9 (5–13) in the best medical treatment group (p<0·0001). Both treatment groups had a median pre-stroke mRS score of 0 (IQR 0–0) at baseline. The change in median mRS score between baseline and 90 days was 1 (IQR 0–2) in the endovascular thrombectomy group and 2 (1–3) in the best medical treatment group (p=0·020). One (1%) patient developed a symptomatic intracranial haemorrhage (this patient was in the endovascular thrombectomy group). Six (5%) patients in the endovascular thrombectomy group and four (5%) patients in the best medical treatment group had died by day 90 (p=0·89). After propensity score matching for age, sex, and PedNIHSS score at hospital admission (n=79 from each group), the change in median mRS score between baseline and 90 days was 1 (IQR 0–2) in the endovascular thrombectomy group and 2 (1–3) in the best medical treatment group (p=0·029). Regarding the primary outcome for patients with suspected focal cerebral arteriopathy, endovascular thrombectomy (n=18) and best medical treatment (n=33) showed no difference in 90-day media","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"8 12","pages":"Pages 882-890"},"PeriodicalIF":19.9,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142484784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：