Minerva Pediatrics最新文献

Nowadays, pediatric cardiology is still a very complex topic. Children are not small adults and very little is known about how heart diseases can affect their metabolic profile both in the acute phase and in the long term. In this context, metabolomics analysis could provide multiple information in the field of pediatric cardiology. For instance, it could be used to predict the occurrence of fetal cardiac abnormalities or predict the outcomes of complex open-heart surgeries for each patient to improve the survival rate and provide better treatment. In this review, the authors describe all the metabolomics applied to pediatric cardiology studies from 2013 to 2024. We noted that the most discussed topics are congenital heart diseases, probably due to the complexity of these patients. Nevertheless, even if the number of studies is limited, they highlight the multiple possibilities provided by metabolomics for the management of neonates and children with heart diseases.

Immunoglobulin A (IgA) vasculitis (IgAV, also known as Henoch-Schoenlein purpura, HSP) is a small vessel vasculitis, most commonly presenting in childhood. In most, it has a straightforward, self-limiting disease course, however some children may develop kidney involvement (IgAV-N) which occurs 4-12 weeks following disease onset and remains the biggest contributor to long-term morbidity. Therefore, children undergo a six-month period of kidney monitoring to identify nephritis via surrogate markers including urinalysis and blood pressure measurements. On-going efforts aim at earlier identification and prevention of nephritis during the window of opportunity between disease onset and established nephritis. By identifying those at highest risk of developing poorer kidney outcomes, the number of children developing chronic kidney disease stage 5 (CKD5) as a result of IgAV-N may be reduced. This review summarizes the latest scientific evidence that support the use of novel biomarkers which may allow nephritis to be identified earlier compared to traditional markers, as well as the risk stratification of children with established IgAV-N. These biomarkers may also enhance the evolving understanding of underlying inflammatory pathways. Promising novel urinary markers of early nephritis include angiotensinogen, Gd-IgA1, various complement proteins, and MCP-1, and serum markers such as α-SMA, C-Met, PTX-3, MMP-9, MRP 8/14, and adiponectin may help identify those at risk of developing CKD5. Prospective, longitudinal, international validation studies are required to investigate these markers further, including exploration of implementation into clinical practice.

Background: The postnatal management of pulmonary malformations is still controversial, especially in terms of indication and timing for surgery. Despite being rare, neonatal lung tumors should be included in the differential diagnosis in case of neonatal pulmonary abnormalities. The aim of this study is to evaluate if the absence of antenatal findings should be considered a risk factor for malignancy in patients with lung abnormalities at postnatal imaging.

Methods: The medical records of neonatal patients undergone surgery for pulmonary abnormalities in our hospital, over a period of 5 years (2017-2021), were retrospectively reviewed. Histological diagnosis and presence of findings at prenatal scans were recorded. A literature review on this topic was also conducted.

Results: Histological diagnosis was pulmonary primary malignancy in 3 cases (2 pulmonary blastomas, 1 fetal lung interstitial tumor), the remaining 20 were diagnosed as pulmonary malformations. We recorded that 100% of our patients affected by lung tumor had no abnormalities at prenatal scans. Three papers reporting similar results were found in literature.

Conclusions: Differential diagnosis among neonatal cystic abnormalities is challenging. When a cystic lung lesion is present in infants who had no abnormalities at standard antenatal scans, a malignancy should be considered.

Background: The aim of this study was to determine whether there was an association between platelet parameters and the presence of pulmonary hemorrhage (PH) in very low birth weight infants.

Methods: Fifty preterm infants who developed PH with gestational age ≤30 weeks and birth weight ≤1500 g were analyzed retrospectively. The infants with PH were matched for gestational age and birthweight with infants without PH, who served as control group. Groups were compared in terms of demographic, clinical characteristics and for the platelet parameters. Red cell distribution width to platelet ratio (RPR) and platelet mass were also calculated.

Results: A total of 150 premature infants were analyzed in the study, including 50 infants with PH and 100 controls. In terms of platelet parameters, the PH group had significantly lower platelet count, mean platelet volume (MPV) and RPR (P=0.025, P<0.001, P=0.003; respectively). Multiple logistic regression analysis showed that respiratory distress syndrome (OR: 8.69; 95%[CI]: 2.71- 27.7; P<0.001) and MPV>8.1fL (OR: 2.60; 95% CI: 1.11-6.06; P=0.019) were independent risk factors for PH.

Conclusions: Our data indicated that PH was associated with the presence of RDS and higher MPV in preterm infants.

Background: Ethanol-based hand sanitizer (EBHS) is used repeatedly in neonatology. Inadequately dried hands can increase ambient ethanol concentrations in air, especially in a small, enclosed space as isolette. We sought to better document the potential exposure to alcohol vapors on a newborn placed in an isolette, by mimicking common neonatal situations.

Methods: EBHS were rubbed on hands for 10 or 30 seconds, before inserting hands in the isolette of 1 or 2 experimenters for 6 minutes. Ethanol concentrations were measured every 30 seconds with photoionization detector.

Results: Twenty-six trials were made, with 286 measurements. With four hands, the concentration peak was in mean about 700 (±900) ppm and with two hands about 300 ppm. With 10-second rubbing time, the concentrations peak was in mean about 850 ppm, and with 30-second rubbing time, mean concentrations were about 100 pm. When respecting normal use (rubbing time 30 seconds), observed ethanol concentrations were low, always below 200 ppm with 2 or 4 hands.

Conclusions: Concentrations of ethanol are very high when drying of EHBS is incomplete. The exposure is of short duration, but ethanol inhalation may be negatively experienced by the child during procedures, especially since they may be frequent and repeated. To minimize the child's exposure to ethanol, we suggest the hands should be completely dried before being inserted into the isolette.

Introduction: Obstetric brachial plexus palsy (OBPP), a condition resulting from the stretching of nerve structures in an infant's upper limb during childbirth, necessitates early physiotherapy intervention. Continuation of rehabilitative activities at home is critical for optimal recovery, highlighting the need for effective caregiver education in managing this condition. This scoping review seeks to consolidate and examine existing research on physiotherapy treatments for OBPP, with a specific focus on the educational support provided to caregivers. The ultimate objective is to develop an informative booklet for caregivers, offering essential guidance for home management of affected children.

Evidence acquisition: A comprehensive search was conducted across PubMed, Cochrane Library, Scopus and PEDro from May to October 2023, with no restrictions on study design, evidence level, publication date, geography, or language. Articles were selected based on preset eligibility criteria.

Evidence synthesis: The search yielded 13 relevant studies, encompassing a diverse range of research designs including reviews, systematic reviews, case reports, controlled trials, and a retrospective study.

Conclusions: This review underscores the necessity of a personalized rehabilitation approach in treating OBPP, with parental involvement being crucial. It also identifies a gap in research regarding the long-term effectiveness of these interventions, suggesting the need for further studies to ascertain optimal treatment modalities.