Global pediatrics最新文献

During COVID-19 pandemic pediatricians have been challenged by the occurrence of the multisystem inflammatory syndrome in children (MIS-C). This condition displays some features similar to those of Kawasaki disease (KD), but was is characterized by clinical signs and symptoms that are infrequent in this illness, such as diarrhea, abdominal pain, neurologic dysfunction and cardiac involvement, especially myocarditis. Many children with MIS-C necessitated ICU admission due to development of multiorgan failure and circulatory shock, usually of myocardial origin. Management is based on the administration of intravenous immunoglobulin, glucocorticoids and, in the most severe forms, anakinra. The clinical similarities between MIS-C and KD have raised an intense debate about whether they represent different illnesses with overlapping clinical features or are part of the same disease spectrum. Most authorities favor the assumption that MIS-C is distinct from KD, based on epidemiological, clinical and immunological differences between the two entities. Others argue that the two disorders may represent a continuum, with some differences in phenotype and severity being related to viral load or strain or magnitude or kinetics of immune response. The present article is aimed to analyze critically the rationale and evidence in favor of the second hypothesis.

Objectives

Unintentional child poisoning is a significant health issue worldwide, and while most cases are not severely toxic, some require specific medical interventions.The aim of this study is to examine thecorrelation between the lockdown following the COVID-19 pandemic and the incidence of acute child poisoning.

Methods

To better understand the problem, we conducted a retrospective study of 103 children examined from 2019 to 2021 at the Penteli Children's General Hospital.

Results

The findings revealed that drugs (37.9 %) and cigarettes (32.0 %) were the most common poisons, followed by detergents (5.9 %) and insecticides (4.9 %). Interestingly, the number of poisoned children increased significantly in 2020 (N = 46) compared to 2019 (N = 25). Most of the cases occurred during the COVID-19 lockdown, accounting for 44.7 % of all cases.

Conclusion

In conclusion, pediatric poisoning remains a global emergency and should be prevented through proper storage and adult supervision of chemicals to avoid accidents.

The first 1000 days before or after birth are pivotal for the establishment of early-life microbial communities and the development of the immune system. During this critical period, alterations in the microbial composition within the gastrointestinal tract significantly impact various host developmental pathways, including those related to immunity, endocrine function, and metabolism.

The term "first 1000 days" encompasses the period from conception to 2 years of age. Disturbances to the microbiota within this timeframe can have enduring consequences for an infant's health, contributing to the onset of inflammatory and autoimmune disorders, neurological issues, and obesity.

Several maternal factors, including gestational age, delivery mode, maternal vaginal microbiota, maternal health, diet, and exposure to antibiotics during pregnancy and lactation, exert a profound influence on the infant's gut microbiota. Environmental factors such as delivery mode, gestational age, and breastfeeding also play a crucial role. Ongoing research aims to explore early-life interventions that can modify both gut microbiota and immune system development. Ensuring a healthy intestinal microbial community during pregnancy and infancy is indispensable for securing favorable long-term health outcomes for the infant.

The microbiome undergoes significant transformations during this developmental period, primarily influenced by changes in diet and environmental factors. Epigenetic modifications emerge as crucial mechanisms through which environmental factors impact early cellular differentiation, giving rise to new phenotypic traits within the neonatal period, without altering the DNA sequence.

Implementing measures to minimize dysbiosis, a condition linked to the severity of Food Allergies (FAs), is essential. Breastfeeding emerges as a fundamental practice in reducing intestinal inflammation, with Human Milk Oligosaccharides (HMOs) playing a prebiotic role in this context. Future strategies may include interventions to positively modulate the composition of the gut microbiota, especially in children with a family history of atopy.

Wilson's disease (WD) is a rare disorder of the copper metabolism with an autosomal recessive transmission. In children, the most frequent clinical presentation is liver disease, variable from increased transaminases to liver cirrhosis or acute liver failure. In young adulthood, the main forms could be neurological and psychiatric.

A high level of suspicion should be present for an early diagnosis of WD, as the diagnosis is based on a combination of clinical signs, biochemical tests, histology, and genetics. The Kayser-Fleisher ring is not as frequent in children as in adults. In children, 24-hour urinary copper excretion could be in the normal range, and the d-penicillamine challenge test should be used. During the last few years, genetic tests have become more affordable, helping with the final diagnosis of WD.

An early diagnosis and treatment could improve the evolution of WD in children, but in some cases, the only option for long-term survival could be liver transplantation. Besides the zinc salts and chelating agents (d-penicillamine and trientine), other molecules have been researched to improve the treatment of WD. Also, gene therapy could represent the solution in the future, but there are issues regarding the vectors and the gene dimensions before this therapy may be used on a large scale. Studies regarding the screening for WD lead to evidence of possible ATP7B peptides that could be measured for an early diagnosis.

Besides all the possible advances in diagnosis and treatment, the patient's adherence to treatment influences the long-term prognosis. Increasing awareness and improving policies for rare diseases may give WD patients access to adequate care and services throughout Europe.

The primary objective of this research is to delve into the correlation between suboptimal dietary habits and the body weight of children residing in Mostar city, Bosnia and Herzegovina. By examining the dietary patterns prevalent among the youth in this specific urban setting, the study seeks to uncover how these habits may be linked to variations in body weight. Through a comprehensive investigation, the aim is to contribute valuable insights into the intricate relationship between eating behaviors and the physical well-being of children in Mostar, thereby informing potential interventions or strategies for promoting healthier lifestyles within this population. In conclusion this pattern of dietary habits not only influences physical health but also has implications for overall well-being and may pose challenges for the long-term health trajectory of school-age boys. It underscores the importance of promoting healthier dietary choices and lifestyle habits from an early age to mitigate the potential adverse effects on children's health.

The article provides an update on infant supplementation with vitamin D3, vitamin K1, and DHA. Breastfeeding is generally the most effective way to support infant growth, development, and overall health. In cases where breastfeeding is not possible, infant formula is the only appropriate alternative that provides adequate energy and nutrients to facilitate infant growth, development, and long-term health. It has long been known that mother's milk is insufficient in vitamin D and vitamin K, which is why supplementation from the first days of life is recommended. Infant intake of polyunsaturated long-chain fatty acids, specifically docosahexaenoic acid (DHA) and eicosapentaenoic acid, largely depends on the mother's dietary intake. Global dietary patterns have changed significantly over the past 30 years or more, especially in developed countries. In conclusion, there are studies showing that maternal supplementation does not have a significant impact on concentrations of docosahexaenoic acid in infant erythrocytes, especially in preterm infants. Moreover, direct supplementation of both preterm and term infants showed significantly better outcomes in terms of mental and psychomotor development, as well as eyesight. Currently, aside from the recommendation for infant formula supplementation with DHA, formal international recommendations are not available.

This case report describes a patient harboring TARS2 mutations where chronic kidney disease stands out as the predominant clinical feature. The distinct manifestation observed in this case underscores the importance of continual exploration and documentation of diverse clinical presentations associated with TARS2 mutations, contributing to an enriched comprehension of the spectrum of effects linked to this genetic variation

Pediatric inflammatory bowel diseases (PIBD) are autoinflammatory, multifactorial diseases that can affect children at any age. There are three types of PIBD: Crohn's disease, ulcerative colitis and unclassified colitis Both genetic and environmental factors are involved in the onset of PIBD. It is suspected that diet composition significantly contributes to IBD risk. On the other hand, in clinical presentation, malnutrition and growth retardation are one of the key signs and they are caused by anorexia and increased metabolism rate. We can say that diet is an important hallmark of PIBD in pathogenesis as well as in the therapy. Exclusive enteral nutrition (EEN) is the most widely used dietary intervention for the treatment of Crohn's disease, but is affected by a low tolerability, especially in pediatric patients. Promising alternative regimens are represented by Crohn's Disease Exclusion Diet (CDED), and other elimination diets, whose use is gradually spreading. The aim of the review is to provide an overview on the latest evidence about the role of nutrition and diet in pediatric IBD.

High quality early childhood education programs can positively impact children's development. A growing body of research has used technology to measure aspects of quality in childcare environments, including sensors to measure the indoor built environment (temperature, light, and noise), physical activity in children and caregivers, and language environments. However, while sensors may generate significant research insights into childcare quality, little work has explored the acceptability of sensors for wide scale use in childcare quality improvement efforts. This study explored childcare staff's experiences with and perceptions of different sensors that could be used to measure parameters of quality indicators in early childcare programs. Research questions were addressed by applying a mixed methods approach using the Unified Theory of Acceptance and Use of Technology framework. Data was collected through online surveys and interviews. Results indicate that childcare staff have little experience with sensors, but most would be comfortable with sensor use in their programs and about half were interested in using them to measure various aspects of quality of childcare environments. Privacy and security issues such as data storage and use were raised as critical to address prior to implementation, along with clear communication with parents and childcare professionals on reasons for using sensors and the documentation of the value of sensor data in predicting child development. The findings highlight the need to include childcare staff and parents in the design of sensor systems and to consider how information will be shared and used.