Pediatric health, medicine and therapeutics最新文献

Background: Repeat teenage pregnancy is a global issue affecting low-, middle-, and high-income countries, with significant risks for both the mother and child. Despite the high prevalence of repeat teenage pregnancy in refugee or internally displaced persons camps, there are limited data on the phenomenon, particularly among teenage mothers residing in refugee settlements. We determined the prevalence and factors associated with repeat teenage pregnancies among teenage mothers in refugee settlements in Northern Uganda.

Methods: We performed a secondary analysis on data from a cross-sectional descriptive study conducted on conveniently sampled adolescent girls aged 15-19 years, from Bidi Bidi and Palorinya refugee settlement camps in Northern Uganda. Cluster sampling techniques, where each settlement represented one cluster was used. The prevalence of repeat teenage pregnancies was assessed by self-reported number of pregnancies of more than one. We performed multivariable logistic regression on all variables with p<0.2 to assess for factors independently associated with repeat teenage pregnancy.

Results: We included 131 participants with a median age of 18 (IQR: 18 to 19) years, the median age of sex debut was 16 (Range: 13-18), years, and 60.3% (n=79) were married. The prevalence of repeat teenage pregnancy was 24.4% (n=32). No factor was seen to be independently significant at the multivariable level.

Conclusion: The study reveals a 24.4% rate of repeat teenage pregnancies among girls in northern Uganda's refugee settlements. This prevalence shows a significant public health challenge, particularly in humanitarian contexts where access to reproductive health services is limited. While no specific independent risk factors were identified, bivariate analysis linked male-headed households and cohabitation with increased risk. These findings suggest that male-headed households and cohabitation may influence reproductive decision-making or access to contraception, potentially due to power dynamics or socio-cultural norms.

Objective: Neonatal hyperbilirubinemia is a prevalent condition characterized by elevated serum bilirubin levels, affecting approximately 50% of term and 80% of preterm infants. While mild cases often resolve without intervention, severe hyperbilirubinemia can lead to life-threatening complications such as bilirubin-induced neurological dysfunction (BIND) and kernicterus, resulting in permanent brain damage, developmental delays, and hearing impairment.

Materials and methods: A literature review was conducted by searching PubMed, Google Scholar, and UpToDate for English-language articles published between January 2010 and March 2025 on neonatal hyperbilirubinemia. Inclusion criteria were studies on mechanisms, clinical outcomes, and interventions in low- and middle-income countries (LMICs), with a focus on Uganda. Exclusion criteria included case reports, non-English studies, and articles without primary data.

Results: The condition arises from an imbalance between bilirubin production and elimination, influenced by immature liver function, increased red blood cell turnover, enhanced enterohepatic circulation, and genetic predisposition. In low-income countries such as Uganda, additional contributors include delayed postnatal care-seeking, limited availability of phototherapy units, and inadequate early screening programs. The low-income country has inappropriate early screening and poor treatment options, which further exacerbate the burden, contributing to preventable neonatal morbidity and mortality.

Conclusion: Timely screening, improved access to phototherapy and exchange transfusion, and increased awareness among healthcare providers and caregivers are essential for reducing the impact of neonatal hyperbilirubinemia. By integrating biological mechanisms, clinical consequences, and health-system challenges into a single synthesis, this review provides novel, actionable insights for policy-makers and clinicians in Uganda.

Background: Undernutrition remains a significant global public health concern, contributing to physical and cognitive impairment, as well as high morbidity and mortality rates, particularly in children under five years of age. The aim of the study was to determine the prevalence of undernutrition and its predictors among children under five admitted to Orotta National Referral and Teaching Hospital (ONRTH).

Methods: A cross-sectional study was conducted between February 1 and April 30, 2022, among pediatric patients at the ONRTH. A data collection tool adopted from WHO Child Growth Standards was used to capture the necessary data. Descriptive analysis and multivariable logistic regression were employed using SPSS (Version 26) and R (Version 4.2).

Results: A total of 218 children under the age of five were enrolled, with a median age of 12.0 months (Interquartile Range [IQR]=24.0). The overall prevalence of undernutrition was found to be 59.2% (95% CI: 52.6, 65.5), with severe acute undernutrition accounting for 39.9% and moderate acute undernutrition for 19.3%. Multivariable analysis revealed that children residing outside Asmara had significantly higher odds of undernutrition (Adjusted Odds Ratio [AOR]=2.81, 95% CI: 1.17, 6.73) compared to those within the city. Similarly, patients who received inadequate food servings per day were found to have substantially higher odds of undernutrition (AOR=12.55, 95% CI: 4.43, 35.52). In contrast, children admitted with infections had significantly lower odds of undernutrition compared to those with cardiac complications (AOR=0.14, 95% CI: 0.03, 0.78).

Conclusion: The prevalence of undernutrition among the hospitalized children in this study was found to be exceptionally high. This highlights undernutrition as a critical public health crisis requiring urgent intervention in this low-resource setting.

Background: Rheumatic heart disease (RHD), a chronic consequence of acute rheumatic fever, rarely presents with stroke as an initial manifestation in children. This report shows a rare scenario where ischemic stroke was the first clinical presentation of underlying RHD.

Case presentation: A 10-year-old boy presented with seizures, hemiplegia, and expressive aphasia. Echocardiography revealed rheumatic mitral valve disease with a vegetation. Neuroimaging showed multifocal cerebral infarctions suggestive of cardioembolism.

Conclusion: This case emphasizes the importance of echocardiographic screening in pediatric patients presenting with stroke, particularly in endemic regions where subclinical RHD may go undiagnosed.

Background: Nasal trauma resulting from non-invasive ventilation in neonates admitted to intensive care units is a commonly underestimated complication.

Objectives: To measure the incidence, risk factors, and severity of nasal trauma among pediatric patients admitted to intensive care units.

Methods: A retrospective cross-sectional study was performed. Consultations and referrals by intensive care unit physicians to the otolaryngology department at a tertiary children's hospital in Dammam, Saudi Arabia, from April 2019 through October 2023 were reviewed. All patients with documented nasal trauma were eligible. External nasal examinations and anterior nasal endoscopy (0° telescope) with documentation of findings were performed on each patient.

Results: The cumulative incidence of nasal trauma among ENT referrals was 10.7%. Males predominated (58%), with a median birth weight of 1.38 kg. NIPPV was the most common ventilation type (79%), and adhesions were the most common trauma (58%). The median duration on CPAP/NIPPV before trauma was 15 days. Medical management included topical ointments and saline rinses (37%), while surgical release was performed in 21% of patients; 42% received no intervention.

Conclusion: Nasal trauma is relatively common among neonates requiring non-invasive ventilation in NICU settings. Multi-center studies with larger samples are recommended to better estimate incidence and improve preventive strategies.

Objective: To investigate the clinical and genetic features of maturity onset diabetes of the young type 2 (MODY 2) in Chinese pediatric patients and optimize the screening strategy.

Methods: A total of 11 Chinese pediatric patients diagnosed with MODY2 were enrolled in this study. Detailed clinical data and follow-up outcomes were retrospectively collected and summarized. Genetic testing was conducted using next-generation sequencing (NGS), and all identified variations were verified by Sanger sequencing.

Results: All cases carried heterozygous mutations in the GCK gene. 9 pathogenic variations were identified, including 8 missense mutations, 1 frameshift mutation, and 1 splice-site mutation. Among these, the mutation c.456T>G was novel. The mean age at diagnosis was 8.1±2.7 (years). 10 of 11 cases had a family history of hyperglycemia or diabetes. 2 cases were overweight. Patients exhibited mild hyperglycemia. The median HbA1c was 6.3% (interquartile range [IQR]: 6.3%-6.4%). Glucose increment in OGTT was 1.68±0.95 mmol/L. Mean triglyceride level was 0.62±0.15 mmol/L. Two cases were positive for insulin antibodies. All cases were treated with a balanced diet after diagnosis. The follow-up period was 1.5-7 years, and the median HbA1c was 6.3% (IQR: 6.2%-6.4%).

Conclusion: MODY2 typically manifests with mild, stable fasting hyperglycemia and is predominantly caused by missense mutations in the GCK gene. Our findings support the inclusion of triglyceride levels as a screening marker and highlight that features like overweight status and autoantibody positivity may coexist in MODY2, warranting comprehensive evaluation to prevent misdiagnosis.

Objective: To examine the concentrations of cluster of differentiation CD40 ligand (CD40L) and neutrophil gelatinase-associated lipocalin (NGAL) in preterm infants with moderate to severe bronchopulmonary dysplasia (BPD), as well as to elucidate their clinical implications.

Methods: A cohort of 138 preterm infants admitted to the neonatal intensive care unit between January 2021 and October 2022 were enrolled and divided into two groups: moderate to severe BPD (n=14) and non-BPD controls (n=124). Clinical data were collected. CD40L and NGAL levels in umbilical cord blood were measured by ELISA. Pearson correlation analysis and multivariate logistic regression were performed to identify risk factors and evaluate diagnostic value using ROC curve analysis.

Results: Infants with moderate to severe BPD had lower 1-minute Apgar scores, prolonged mechanical ventilation, and higher prevalence of maternal smoking and intrauterine infection (all P<0.05). CD40L and NGAL levels were significantly higher in BPD infants (P<0.001). Pearson analysis showed a strong positive correlation between CD40L and NGAL (r=0.800, P<0.001). Multivariate logistic regression identified maternal smoking (OR=1.092, 95% CI: 1.030-1.158), intrauterine infection (OR=1.136, 95% CI: 1.027-1.256), elevated CD40L (OR=1.138, 95% CI: 1.042-1.242), and NGAL (OR=1.270, 95% CI: 1.063-1.518) as independent risk factors for BPD. ROC analysis confirmed the diagnostic utility of CD40L and NGAL, with combined assessment showing superior predictive performance.

Conclusion: Elevated levels of CD40L and NGAL in umbilical cord blood of preterm infants with moderate to severe BPD suggest that these biomarkers have high diagnostic value for moderate to severe BPD.

Objective: This study aimed to identify the risk factors for bronchiolitis obliterans (BO) development in children with severe adenovirus pneumonia (SAP) and to construct and validate a nomogram prediction model.

Methods: This retrospective study included 152 pediatric patients with SAP between January 2019 and December 2023. We categorized these patients as having developed BO (n=36) and non-BO (n=116) based on long-term follow-up outcomes. Key clinical features were optimized using the least absolute shrinkage and selection operator (LASSO) regression and a nomogram was developed using logistic regression. Model performance was assessed and validated through receiver operating characteristic (ROC) curve analysis, calibration curves, and decision curve analysis (DCA).

Results: The LASSO regression analysis initially identified nine potential clinical predictors. Subsequent univariable and multivariable logistic regression revealed four independent risk factors significantly associated with BO development, namely, younger age, Odds ratio (OR) =0.94, 95% CI, 0.90-0.99, p=0.010; longer duration of fever, OR=2.27, 95% CI, 1.52-3.39, p<0.001; requirement for tracheoscopy, OR=5.25, 95% CI, 1.06-26.09, p=0.040; and extended oxygen therapy, OR=1.64, 95% CI, 1.10-2.43, p=0.010. The final prediction model incorporated three key predictors (months of age, fever duration, and oxygen therapy duration) into a clinically practical nomogram. The model demonstrated excellent discrimination, with an area under the curve (AUC) of 0.95, 95% CI, 0.91-0.98, a sensitivity of 0.83, and a specificity of 0.93. The Hosmer-Lemeshow test, χ2=5.24, p=0.732 indicated good calibration, and the DCA demonstrated positive clinical benefits.

Conclusion: We developed and validated a clinically practical nomogram, incorporating three key predictors mainly, months of age, fever duration, and oxygen therapy duration in predicting BO in children with SAP.The model demonstrates strong discriminatory power, reliable calibration, and clinical utility. This tool enables early risk stratification, facilitating timely intervention for high-risk pediatric SAP patients.

Background: Pediatric sepsis is a complex and heterogeneous condition resulting from a dysregulated immune response to infection. Pyroptosis, a newly recognized form of programmed cell death, has been implicated in the progression of various inflammatory diseases. However, the role of pyroptosis-related genes in pediatric sepsis remains unclear.

Methods: Based on the GSE13904 dataset, we explored the pyroptosis-related differentially expressed genes (DEGs) in pediatric sepsis. We analyzed the molecular clusters based on pyroptosis-related DEGs. The WGCNA algorithm was performed to identify cluster-specific DEGs. The optimal machine model was identified by multiple machine learning methods (RF, SVM, GLM, XGB). The diagnostic value of hub genes in pediatric sepsis was verified in the training (GSE13904) and validation set (GSE26440) through ROC. qRT-PCR was used to verify the expression levels of 5 hub genes in whole blood between the pediatric sepsis and the control.

Results: The dysregulated pyroptosis-related DEGs were identified in pediatric sepsis. Three pyroptosis-related molecular clusters were determined in pediatric sepsis. SVM presented the best discriminative performance with relatively lower residual and root mean square error. The nomogram, calibration curve, and decision curve analysis indicated the accuracy of SVM model to predict pediatric sepsis. 5 hub genes based on SVM presented satisfactory performance in the training and validation sets. These hub genes expression levels in pediatric sepsis were significantly higher than those in healthy controls in clinical samples.

Conclusion: Our study systematically analyzed the relationship between pyroptosis and pediatric sepsis, and constructed a promising predictive model to evaluate the risk of pediatric sepsis.

Background: Postural tachycardia syndrome (POTS) is a common autonomic dysfunction in children. The head-up test (HUT) or head-up tilt test (HUTT) is typically required to confirm the diagnosis of POTS. This study describes a novel approach to diagnosing POTS in children by simultaneous measurement and analysis of heart sounds and electrocardiogram (ECG) signals using a wearable device.

Objective: To evaluate the diagnostic value of synchronous heart sound and ECG monitoring in identifying POTS in children.

Methods: This study included a total of 50 children. Twenty-five children with POTS were admitted to the hospital with symptoms of syncope or orthostatic intolerance, while twenty-five children who came to the hospital for a health checkup were included as the control group. All children underwent synchronous phonocardiography and ECG monitoring with wearable devices to simultaneously record heart sounds and ECG signals. Wavelet analysis was used to automatically analyze heart sounds and ECG signals to determine the Electromechanical Activity Time (EMAT).

Results: In the POTS group, EMAT decreased significantly from supine to upright position (75.71 ± 9.16 ms vs 70.90 ± 10.86 ms, P = 0.0051), while the change in the control group was not significant (58.92 ± 4.10 ms vs 55.50 ± 9.89 ms, P = 0.100). The difference in EMAT change (upright-supine) was significantly greater in the POTS group (3.39±5.91 ms) than in controls (0.58 ±5.70 ms, P = 0.038).Precision-recall curve (PRC) analysis demonstrated that the average precision (AP) for EMAT in the supine position was 0.84, while the AP for the upright position was 0.88.

Conclusion: Simultaneous heart sound and ECG analysis using a wearable device is a simple, noninvasive approach that aids in the diagnosis of pediatric POTS. EMAT serves as a valuable discriminative marker between patient groups.