Pediatric health, medicine and therapeutics最新文献

Objective: This study aimed to assess the association between sleep bruxism (SB) among children and parental sociodemographic characteristics and SB risk factors (eg, nose obstruction).

Methods: A cross-sectional survey was conducted with 250 parents of children under the age of 13 who visited pediatric dental clinics. Data were collected through a questionnaire completed by parents. Sociodemographic characteristics, the child's medical history, sleep patterns and parents' awareness of bruxism and its symptoms were investigated. Descriptive, bivariate and binary logistic regression analyses were performed.

Results: The response rate was 85.2% (55% females, 45% males) and 25.8% of the parents self-reported that their children had bruxism. The regression analysis revealed that parents reporting SB among their children were significantly more likely to have SB themselves (8.62 [3.68-20.16], p = 0.001). While children whose mothers had lower education level and were unaware of bruxism-related symptoms (such as teeth, jaw, or face pain) were less likely to be reported as having SB (0.35 [0.16-0.75], p = 0.007; 0.36 [0.14-0.97], p = 0.043, respectively). Parents who identified nose obstruction as a cause of bruxism also had children with a higher likelihood of having SB (5.49 [1.04-29.08], p = 0.045).

Conclusion: The findings highlighted that parental sociodemographic characteristic and SB risk factors associated signficantly with the prevalence of childhood SB.

Purpose: Tanzania is the fifth country with the highest sickle cell disease (SCD) prevalence globally. Although hydroxyurea (HU) is available, only 25% of persons with SCD are reported to use it in Tanzania. Perceived disease threat is associated with medication usage in patients with chronic diseases. We assessed the factors associated with caregivers' perceived threat of SCD complications and its relationship with HU use among children with SCD in Dar-es-Salaam.

Methods: We conducted a cross-sectional hospital-based study from May to August 2023. We enrolled 374 caregivers of health-insured children with SCD from 4 public SCD clinics. We adapted the modified original and revised Champion's Health Belief Model Scales to derive perceived threat scores. We used Mann-Whitney and Kruskal-Wallis tests to compare the outcomes across sociodemographic characteristics and regression analysis for factors associated with perceived SCD threat.

Results: The median score (InterQuartile Range) for perceived threat of SCD complications was 559 (175, 598). Sixty-one percent of caregivers had a high SCD perceived threat. The caregivers of under-five children had 141 lower median SCD threat scores than those of children aged 13-17 years, p-value < 0.001. Participants from Regional Referral Hospitals (RRH) had lower median threat scores compared to participants attending Muhimbili National Hospital (MNH), 177 for Amana RRH, 325 Temeke RRH, 585 MNH Mloganzila, and 557 MNH Upanga, p-value <0.001. Children of caregivers with high perceived SCD threat were 3.4 times more likely to use HU compared to those with low SCD threat perception (Incidence Rate Ratio 3.4, 95% CI: 2.7-4.5).

Conclusion: The perceived threat of SCD predicts the likelihood of SCD patients using HU in Dar-es-Salaam, Tanzania. We recommend health education to caregivers aiming to improve their SCD threat perception and thus improve the use of HU among children with SCD in similar settings.

Objective: To investigate the predictive value of T-lymphocyte activation-related cytokines in non-responsive Kawasaki disease.

Methods: Eighty-two children with Kawasaki disease, hospitalized from June 2022 to December 2023, were divided into two groups based on treatment response: the sensitive Kawasaki disease group (n=71) and the non-responsive Kawasaki disease group (n=11). Serum levels of T-lymph activation-related cytokines, including interleukin-2, 6, 7, 12, 15, 17, and tumor necrosis factor alpha, were measured before and after IVIG treatment in both groups. The differences in cytokine levels between the two groups were compared pre- and post-treatment. The ability of these cytokines to discriminate non-responsive Kawasaki disease was evaluated using ROC curves to determine the cut-off value.

Results: Before initial treatment, IL-2, IL-6, IL-7, IL-12, IL-15, IL-17, and tumor necrosis factor-α values were significantly higher in the non-responsive Kawasaki disease group compared to the sensitive Kawasaki disease group. Comparisons before and after initial treatment showed significant decreases in IL-6 and 17 in the sensitive Kawasaki disease group and significant decreases in IL-6 and 7 in the non-responsive Kawasaki disease group. IL-6 and 17 significantly increased in the sensitive group compared to the non-responsive group after initial treatment. The ROC curves indicated that IL-6 predicted the area under the curve (AUC) for non-responsive Kawasaki disease to be 0.859 before treatment and 0.920 after treatment. Similarly, IL-17 had AUC values of 0.699 before treatment and 0.884 after treatment.

Conclusion: Reassessing IL-6 and IL-17 following the initial treatment for Kawasaki disease may improve early warning signals for unresponsive Kawasaki disease.

Purpose: Rotavirus is the leading cause of severe and fatal diarrhea in African children. The aim of this study is to investigate the prevalence of rotavirus in children with acute gastroenteritis admitted to a tertiary hospital in Somalia.

Patients and methods: 5804 children who applied with complaints of acute gastroenteritis between January 2020 and December 2023 were examined retrospectively. Rotavirus antigens were detected in the feces of 1324 patients by qualitative immunochromatographic analysis. The frequency of rotavirus gastroenteritis was evaluated according to age, gender and seasonal distribution. Statistical analysis was done using SPSS version 22.0.

Results: In the years, an increase in the number of patients tested with suspicion of rotavirus and an increase in rotavirus positivity was observed. While the positivity rate was 8.1% (n = 107) in 2020, it increased to 41.4% (n = 548) in 2023. Viral antigens were identified in 1324 of 5804 patients (22.8%). 743 (56.1%) of the children were boys and 581 (43.9%) were girls. The incidence of rotavirus positive cases was higher in the summer and spring months and in children aged 0-2 years (78.6%) (p<0.001). Diarrhea due to rotavirus was seen throughout the year. The monthly rotavirus antigen positivity rate in patients admitted to the hospital due to acute gastroenteritis reached its peak in May with 17.2%.

Conclusion: The results of this study showed us that rotavirus is a common cause of acute gastroenteritis in infants. Rotavirus gastroenteritis, which causes significant mortality and morbidity all over the world, is still seen at a high rate of 22.8% in Somalia. We are of the opinion that public health education, good hygiene practices and an effective vaccination program can reduce rotavirus infection.

Objective: To establish the noninferiority of the rapid and sensitive multiplex polymerase chain reaction (M-PCR) method versus standard urine culture (SUC) in pediatric urinary tract infection (UTI) diagnostic testing.

Methods: A United States of America (USA)-based single-center prospective observational study of 44 female and four male patients aged 3-21 years old presenting to a Pediatric Emergency Department in New Jersey with clinically suspected UTI. Urine specimens were primarily collected via midstream voiding. Patients with antibiotic exposure within the week prior to presentation were excluded. Patient demographic data, clinical manifestations, and urinalysis results were recorded. Noninferiority testing comparing M-PCR and SUC was conducted using a method for paired binary data, with a noninferiority margin set at 5%. Noninferiority was concluded if the lower bound of the 95% confidence interval of the difference in detection rates between M-PCR and SUC lies entirely to the right of the value minus the noninferiority margin. All statistical calculations were performed using Python 3.10.12.

Results: The two methods were concordant in two-thirds of cases. Of the 14 M-PCR-positive/SUC-negative discordant specimens, 13 (93%) contained a fastidious and/or emerging uropathogen (A. urinae, A. schaalii, G. vaginalis, C. riegelii, U. urealyticum, Viridans group Streptococci (VGS), and/or Coagulase-negative Staphylococci (CoNS)). Neither symptom presentation nor urinalysis results differed significantly between participants with concordant positive results for UTI diagnosis and those with concordant negative results (non-UTI group).

Conclusion: In this pediatric population, similar to previous findings in an older adult population, M-PCR established not only noninferiority but also superiority over SUC in detecting microorganisms in the urine.

Background: The presence of abnormal vision during early childhood has been shown to have a substantial impact on the development of visual, motor, and cognitive functions, potentially resulting in long-term adverse psychosocial outcomes. The objective of this study was to examine the prevalence and associated risk factors of abnormal vision among preschool children aged 4-6 years in Shaoxing, China.

Methods: A cross-sectional study was conducted from March to May 2023 in Shaoxing, involving a sample of 9913 children within the specified age range. Parents were interviewed using a structured questionnaire that gathered information on sociodemographic characteristics and other relevant factors.

Results: The study revealed that 14.4% of participants had abnormal vision. Logistic regression analysis indicated that individuals who watched TV for more than 3 hours daily had a 2.206 times higher likelihood of developing abnormal vision (P<0.05). Additional risk factors for abnormal vision included watching TV at a distance of less than 3 meters, misalignment of eyes and screen while watching TV, early exposure to electronic devices before the age of 2, parents are unaware of the impact of chewing on eye development, and lack of promotion of good eye habits in children (P < 0.05). An association was found between parent's and children's refractive error (P < 0.05), with good family lighting and a balanced dietary structure being identified as protective factors against abnormal vision.

Conclusion: The study concluded that exposure to electronic products was a significant factor in the development of abnormal vision among children aged 4-6. Furthermore, family environment and genetic predisposition were also found to influence vision. Regular ocular screenings and early interventions may be effective in preventing abnormal vision.

Since aspirin resistance is rarely assessed in pediatric patients and thrombosis might cause damage in vital organs, such as the myocardium or brain, we aimed to determine its incidence and the pivotal role of routine screening. The point-of-care test by platelet function analyzer (PFA-200) and bedside bleeding time (BT) was compared to standard whole blood impedance aggregometry (IA), the time-consuming and sophisticated assays. This single-center cross-sectional study was investigated in Thai children (≤15 years). All participants received at least five-day administrations of aspirin (3 to 5 mg/kg/day or equivalent to a single tablet of 81 mg) for any prior thrombotic risks. Platelet aggregation >5 ohms on IA with 0.5 mM arachidonic acid, closure time <180 seconds on collagen/epinephrine PFA-200, and modified Ivy BT ≤7 minutes, defined resistance. Of 37 patients, 2.7% had confirmed aspirin resistance to IA. Despite the 100% sensitivity, PFA-200 showed higher specificity than BT (83.3% vs 36.1%). However, both were not comparable (exact McNemar P < 0.05), with a slight/fair reliability (ĸ=0.215 vs ĸ=0.030 respectively). Aspirin resistance is uncommon in Thai children. Routine screening is discouraged but recommended only in cases with recurrent thrombosis despite good aspirin compliance or the presence of resistant risk factors. Although the gold standard IA could not be replaced, the rapid assay of PFA-200, not bedside BT, can potentially be considered a point-of-care alternative screening test to detect aspirin resistance in children.

Background: Globally, >1.1 million children had tuberculosis (TB) and >214,000 died in 2022. The integration of pediatric TB screening should help in the identification and management of cases among children attending clinics at entry points. This study aimed to establish the extent of integrating pediatric TB screening into mainstream childcare activities and the factors affecting integration of TB screening among children.

Methods: A cross-sectional design using both quantitative and qualitative methods. Simple random sampling was used to select and observe 40 participants for integration of TB screening in the routine assessment of children. Twenty key informants were interviewed and two focus group discussions conducted on the integration of pediatric TB screening.

Results: Of the 302 children assessed, only 41.1% underwent pediatric TB screening integrated in their assessment. A binary logistic regression model using Wald chi-square showed that a cadre having worked at outpatient department (OPD) and young child clinic (YCC) significantly affected integration, with a p-value of 0.002 and 95% CI (1.040-1.152) and a p-value of 0.002 and 95% CI (1.000-1.519). Participants who had 3 to 5 years in service were 7.05 times more likely to integrate pediatric TB screening at the OPD and Cadres who had over 6 years in service were 6.32 times more likely at the YCC. Being a nurse or a midwife was associated with an increased likelihood of integrating pediatric tuberculosis screening. Knowledge, skills, and confidence gaps in screening and assessing for tuberculosis in children among staff and lack of necessary logistics were identified barriers.

Conclusion: The integration of pediatric TB screening in routine assessments at the OPD/YCC was low. Focus more on HC IIIs to improve health workers' involvement and capacity to integrate TB screening at entry points in health facilities and provide logistics.

Background: The respiratory system, traditionally considered antiseptic, harbors a diverse and dynamic bacterial microbiome. Recent advancements in microbiome research have revealed its significant influence on both innate and adaptive immunity, particularly in the context of respiratory infections in children. This article also provides an overview of the types of bacteria that commonly affect the respiratory system, including Streptococcus pneumoniae, Moraxella catarrhalis and Haemophilus influenzae. These bacteria are prevalent in pediatric populations and significantly contribute to the development and severity of respiratory tract infections (RTIs).

Purpose: This review aims to evaluate the impact of the oral cavity and upper respiratory microbiome on the susceptibility and severity of respiratory infections in pediatric populations. We specifically focus on how early colonization patterns of bacteria such as Moraxella and Streptococcus contribute to the development of respiratory tract infections in children from birth through adolescence.

Methods: A thorough literature review was performed, focusing on studies publishing between 2004 and 2023. The review included research exploring the role of the upper respiratory microbiome in pediatric populations, with a specific focus on children aged birth to 18 years. Emphasis was placed on microbial characterization, the modulation of immune responses in respiratory tract infections, and the potential therapeutic applications of microbiome-targeted interventions.

Results: The findings suggest that the composition and disruption of the upper respiratory microbiome significantly influence clinical outcomes in children with respiratory infections. Notably, dysbiosis in the microbiome has been linked to increased susceptibility to repeated infections, highlighting the importance of maintaining microbial balance for optimal respiratory health.

Conclusion: Understanding the impact of oral cavity and upper respiratory microbiome could lead to improved management and prevention strategies for respiratory infections in children. This review underscores the potential of microbiome modulation, including the use of probiotics as a therapeutic approach to enhance clinical outcomes in pediatric respiratory infections.

Background: Congenital heart disease (CHD), characterized by anatomical and functional abnormalities of the heart, can impair an individual's quality of life and, if not treated with appropriate interventions, it can result in early death. Morbidity and mortality from CHD are greatly reduced by early diagnosis and timely therapy. Therefore, this study aimed to determine the frequency of various forms of CHD among affected children in Eastern Afghanistan considering age, gender, and region of distribution (countryside and city).

Patients and methods: A retrospective hospital-based study was conducted on 1323 patients with a confirmed diagnosis of CHD who were referred for echocardiography to public and private hospitals in Jalalabad City, Afghanistan, from July 2018 to June 2022. Patients from day one of life till 18 years were included. The study participants were chosen using a non-probability convenience sampling technique, and the data were analyzed using the statistical package for social sciences (SPSS) version 27.0.

Results: In this study, males comprised 60.4% of the participants, while females made up 39.6%. More than three-quarters (86.4%) of the diagnoses were in children below 1 year of age. 86.5% of them were patients with acyanotic, and 13.5% had cyanotic CHD. The most common acyanotic heart disease was patent ductus arteriosus (PDA; 252.6%), followed by ventricular septal defect (VSD; 18.4%) and atrial septal defect (ASD; 8.5%). The most frequent cyanotic heart disease was Tetralogy of Fallot (TOF). 79.9% of the total cases were patients with simple CDH lesions, and 20.1% had complex CHD lesions. In addition, participants from rural areas had a higher (78.9%) frequency of CHD compared to those from urban areas (21.1%).

Conclusion: The study concluded that over 85% of CHD-diagnosed cases were under 1 year of age, with PDA, VSD, ASD, and TOF being the most commonly diagnosed acyanotic and cyanotic lesions. Participants from rural residence had a higher frequency of CHD compared to those from urban residence. Additionally, our study found that more males were affected by CHD compared to females. In order to avoid serious complications, reduce mortality, and improve quality of life, early identification and correction of disease is crucial.