Pediatrics and Neonatology最新文献

Background: Although encephalopathy and encephalitis are uncommon complications of SARS-CoV-2 infection in children, they can lead to significant morbidity and mortality. Therefore, the aim of the study is to assess heart rate variability in children with SARS-CoV-2 infection and determine those at risk of progressing to SARS-CoV-2-associated encephalopathy.

Methods: Children with confirmed SARS-CoV-2 infection between September 1, 2022 and December 8, 2023 were prospectively enrolled and divided into encephalopathic and non-encephalopathic groups. The non-encephalopathic group was further classified into mild, moderate, and severe/critical disease groups. One-minute electrocardiography was recorded on the first day of admission. Heart rate variability indices were compared between the encephalopathic and non-encephalopathic groups.

Results: A total of 72 children (30 girls [41.7 %] and 42 boys [58.3 %]) with SARS-CoV-2 infection were enrolled, with age ranging from 1 month to 18 years. Of these children, 15 (20.8 %) were classified into the encephalopathic group, and 57 (79.2 %) were classified into the non-encephalopathic group. We compared heart rate variability indices and found that both time domain analysis (SDNNc and RMSSDc) and nonlinear Poincaré plot analysis (SD1/SD2 ratio) were lower in the encephalopathic group and severe/critical disease group than in the mild and moderate severity non-encephalopathic groups.

Conclusions: Heart rate variability parameters were significantly lower in the severe/critical disease group and the encephalopathic group compared to the mild to moderate severity groups. The implications of heart rate variability, particularly when considering neurological symptoms, as a predictor of disease progression to encephalopathy require further evaluation.

Background: Preterm babies born with very low birth weight (VLBW, birth weight <1500 g) have inferior long-term neurodevelopmental outcomes to term babies. This study aimed to identify early predictive neurodevelopmental factors for future cognitive outcomes that could serve as indicators for early intervention strategies.

Methods: This longitudinal cohort study enrolled 146 VLBW preterm infants, identified between 2011 and 2020. Each child underwent four neurodevelopmental assessments (at ages 6,12, 24, and 60 months) using the Bayley-III and Wechsler Preschool and Primary Scale of Intelligence-IV examinations. Correlation and linear regression analyses were performed to determine the correlation between early neurodevelopmental status and late cognitive outcomes. We concurrently considered neonatal medical complications and socioeconomic variables as risk factors to develop a prediction model of cognitive outcomes at five years old.

Results: A total of 146 VLBW children, born with a mean weight of 1090.4 ± 229.6 g and a mean gestational age of 28.2 ± 2.0 weeks, were evaluated. At 6 months of age, motor outcome was the only factor that exhibited a significant correlation with cognitive development at 5 years of age (p < 0.01, r = 0.242). The strength of the correlation between motor and cognitive function increased with age, reaching greater significance at 12 and 24 months (p < 0.001, r = 0.409 and 0.472, respectively). The linear regression model demonstrated that neonatal medical conditions and Bayley motor score at six months old predicted 26% of the variance in the Full-Scale Intelligence Quotient (FSIQ) at five years old.

Conclusion: The results of the present study show that motor function was the earliest and persistent predictor of FSIQ. This underscores the importance of prioritizing motor development in interventions as early as six months of age, which could substantially advance the timing of early intervention programs.

Background: Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in children. Several tools are available for evaluating the efficacy of ADHD treatment, such as, for example, the Swanson, Nolan, and Pelham (SNAP-IV) questionnaire; and the Vanderbilt ADHD Diagnostic Rating Scale. However, these scales are subjective. In this study, we developed an objective method by using load cells for evaluating the efficacy of ADHD treatment.

Methods: A situational classroom was prepared to simulate a real classroom. The setup included a desk, a chair, and a large screen. The four legs of the chair were equipped with load cells-materials that deform under force. These cells are used to detect the activity of patients with ADHD. This study included 13 patients with ADHD (12 boys and 1 girl). Before and after 1-month treatment with methylphenidate 10 mg p.o. QD, the patients were instructed to watch an age-appropriate educational video on Mathematics while sitting. Their movements were indicated by data gathered from the load cells under the chair. The average trajectory length (ATL) was measured to analyze the signal from the load cells. SNAP-IV questionnaires were completed by parents and teachers before and after treatment.

Results: The ATL values before and after treatment were 0.0316 ± 0.0139 and 0.0208 ± 0.0127 (p = 0.0055), respectively. The patients' SNAP-IV scores assigned by parents before and after treatment were 38.89 ± 8.07 and 23.67 ± 16.87 (p = 0.0167) and those provided by teachers were 44.11 ± 11.47 and 22.22 ± 13.50 (p = 0.0048), respectively. The coefficients of the correlations between ATL values and SNAP-IV hyperactivity-impulsivity scores from parents and from teachers were 0.109 and 0.200, respectively.

Conclusion: In conclusion, the smart chair equipped with load cells is an effective tool for objectively evaluating the efficacy of ADHD treatment on hyperactivity of children with ADHD.

Background: Kidney transplantation represents a therapeutic option for individuals with end-stage renal disease due to lupus. However, the influence of lupus activity and immunosuppressive medications on graft survival remains a matter of concern and it has not been thoroughly elucidated.

Methods: In this study, we conducted a retrospective review of 45 lupus patients who underwent kidney transplantation, with the aim of analyzing graft survival and identifying factors influencing the outcome of kidney transplantation in lupus patients.

Results: Graft survival rates at 1, 5, 10, 15, and 20 years were 98%, 98%, 88%, 85%, and 78%, respectively. Univariate logistic regression revealed hypertension, positive panel reactive antibodies against HLA class II antigens, retransplant, young age at lupus nephritis onset, low postoperative C4 levels, and HBsAg and/or anti-HBe antibody presence were significantly correlated with decreased graft survival (p < 0.05). Multiple regression confirmed the significant association of HBsAg and/or anti-HBe antibody with graft failure (p = 0.0161), with all patients testing negative for anti-HBc antibody. Preoperative markers (C3, C4, anti-dsDNA antibody) and recurrent lupus nephritis did not impact graft failure.

Conclusion: In lupus patients undergoing kidney transplantation, hepatitis B serology emerges as a potential singular predictor for graft failure, while preoperative lupus activity markers and recurrent lupus nephritis do not affect outcomes.

Background: Considerable research has shown brain injury during surgery for patients with cyanotic congenital heart disease (CHD), but the preoperative neurodevelopment and brain injury in children with non-cyanotic CHD are not well understood. The aim of this study is to investigate changes in global and local grey matter (GM) volumes of pediatric patients with non-cyanotic CHD before catheter-based procedure using voxel-based morphometry (VBM).

Methods: One-to three-year-old toddlers with acyanotic CHD (n = 54) hospitalized for treatment were prospectively enrolled. Each toddler underwent a 3D T1-weighted brain Magnetic Resonance Imaging (MRI) scan before catheter-based procedure. Meanwhile, 3D T1-weighted brain MR images of age- and sex-matched healthy controls (n = 35) were retrospectively analyzed. The volume of GM and total intracranial volume (TIV) were assessed by VBM within the SPM 12 (Statistical Parametric Mapping software), and regional differences in GM volume were analyzed by two-sample t-test and familywise error (FWE) rate correction.

Results: There was no difference in gross GM volume and TIV between the two groups (p > 0.05), but VBM analysis showed reduced structures of GM in middle frontal gyrus (both sides), inferior frontal gyrus, orbital gyrus, subcallosal gyrus, thalamus (both sides), medial globus pallidus (both sides) and culmen (both sides) of the non-cyanotic CHD group compared with the controls (p < 0.05, FWE correction).

Conclusion: Toddlers aged 1-3 years with acyanotic CHD suffer a decrease in local GM volume before catheter-based procedure, which tends to be distributed across the bilateral frontal lobe, thalamus, globus pallidus, and cerebellum.