Pediatric health, medicine and therapeutics最新文献

Background: Nontuberculous mycobacteria (NTM) are Mycobacterial pathogens that cause pulmonary infections among children, particularly those with underlying lung conditions or immunosuppression. Clinical presentations include chronic cough, weight loss, and fatigue. Diagnosis involves clinical assessment, radiographic imaging, and microbiological confirmation, while treatment often requires prolonged, multidrug antibiotic regimens. This study aimed to analyze the epidemiology and clinical outcomes of pulmonary NTM infections in a non-cystic fibrosis pediatric population from four distinct age groups.

Methods: A retrospective study as cross-sectional design for data collection from the TriNetX platform, a global electronic health record database. Inclusion criteria targeted pediatric patients aged 0-18 years with pulmonary NTM, while exclusion criteria included cystic fibrosis, tuberculosis, smoking history, and cutaneous NTM infections. The cohort comprised 109 cases among 0-2 years (mean age 2 years), 401 cases among 3-5 years (mean age 4 years), 1,074 cases among 6-12 years (mean age 9 years), and 760 cases among 13-18 years (mean age 15 years). Demographics, comorbidities, and inflammatory markers were analyzed. Logistic and binomial regression models were used to evaluate associations between age group and five-year outcomes of pediatric pulmonary NTM, reporting odds ratios (OR), risk ratios (RR), 95% confidence intervals (CI), and p-values.

Results: Of the total 2,344 records of pediatric patients examined, the most common comorbidities included malignancies (36%), acute pharyngitis (78%), asthma (46%), unspecified pneumonia (46%), and immunodeficiencies (22%). Female patients represented 53.31% of cases. Key inflammatory markers (eg C-reactive protein (CRP), mean white blood cell count, ferritin) were elevated among older age groups.

Conclusion: This study highlights age-specific variations in risk factors, clinical outcomes, and inflammatory responses, offering potential insights for improved diagnosis and management of NTM in children. These results underscore the importance of further research in pediatric cohorts with NTM to better understand its role in pediatric pulmonary conditions and comorbidities.

Sickle cell disease (SCD) is a genetically inherited group of hemoglobinopathies characterized by the polymerization of hemoglobin S, chronic hemolytic anemia, and vaso-occlusion. The interplay between inflammation and hypoxia is central to the pathophysiologic manifestations of SCD and drives many of its complications. In this narrative review, we explore the bidirectional relationship between inflammatory pathways and hypoxic stress, with a focus on immune dysregulation, endothelial activation, and redox imbalance. The paper also highlights how mitochondrial dysfunction, reactive oxygen species (ROS) generation, glycolytic shifts affecting 2,3-diphosphoglycerate (2,3-DPG), and complement activation contribute to disease exacerbation. The review critically examines limitations of in vitro and animal models in mimicking the complex human pathophysiology, underscoring the need for translational research and clinical studies, especially in low- and middle-income countries (LMICs). Additionally, the paper evaluates emerging therapeutic interventions targeting inflammatory and hypoxia-related pathways, including small molecules, biologics, and gene-modifying strategies. Recognizing the heterogeneity in disease severity, this narrative review emphasizes the importance of personalized treatment approaches, integration of non-invasive biomarkers, and enhanced infrastructure for clinical trials in resource-limited settings.

Objective: Mediastinal teratomas are rare in the pediatric population and are even more infrequent in neonates and young infants. Early detection and appropriate surgical intervention are critical to avoid complications associated with airway compression. Minimally invasive thoracoscopic resection has emerged as a viable approach, though its application in infants remains technically challenging.

Materials and methods: We present the case of a two-month-old male infant who was referred with progressive respiratory distress. Imaging revealed a well-circumscribed middle mediastinal mass compressing the left main bronchus. Thoracoscopic resection was performed after multidisciplinary planning. Intraoperatively, a cystic teratoma was identified, and decompression of its contents facilitated excision. A small bronchial perforation was noted and successfully repaired thoracoscopically.

Results: Histopathological analysis confirmed a mature cystic teratoma without malignant features. The postoperative course was uneventful, and follow-up imaging at four months showed no recurrence. This case demonstrates that thoracoscopic resection is a safe and effective option for managing mediastinal mature cystic teratomas in very young infants.

Conclusion: This case contributes to the growing evidence supporting thoracoscopy as a preferred approach in selected pediatric mediastinal lesions. With meticulous planning, technical expertise, and postoperative care, minimally invasive surgery can provide excellent clinical and cosmetic outcomes.

Background: Neural tube defects are a collection of intricate congenital abnormalities that affect the central nervous system. Neural tube defects cause 88,000 deaths globally and 29% in developing countries. Neural tube defects take a significant portion of the congenital anomalies in Ethiopia. This study aimed to assess the time to death, as hazard and predictors among neonates with neural tube defects in two public hospitals, Addis Ababa, Ethiopia.

Methods: A retrospective cohort study was conducted by reviewing medical charts of 410 randomly selected neonates with neural tube defects, registered from 2018 to 2022 in Addis Ababa, Ethiopia. Data collection and entry was done from February 20 to March 20/2023 using KoboCollect v2022.4.4. STATA/14 was used for data screening, and SPSS/27 was used for analysis. The Kaplan-Meier survival analysis and Cox proportional hazards model were used for inferential analysis. Findings with p ≤ 0.05 were observed as statistically significant.

Results: A total of 410 neonates were followed for 4100 person-days of risk time and 35 (8.54%) of neonates expired. The overall incidence rate of mortality was 8.54 per 1000 neonate days of observation with a median survival time of 25 days (95% CI: 22.7-27.3). Being preterm, Adjusted Hazard Ratio (AHR) = 2.62, (95% CI 1.12, 6.14), having low birth weight (AHR: 2.62, 95% CI 1.13, 6.10), encephalocele (AHR: 3.77, 95% CI 1.65, 8.62), cervical and occipital lesion level (AHR: 3.97, 95% CI, 1.17, 13.49), presence of hydrocephalus (AHR: 3.98, 95% CI 1.55, 10.21), and Chiari-II malformation (AHR: 2.40, 95% CI 1.03, 5.57) were demonstrated to be statistically significant predictors of time to death.

Conclusion: The cumulative incidence of death of neonates diagnosed with neural tube defects was observed. Early diagnosis and timely management of patients is decisive in lowering the mortality.

Compared to adults, the skin of newborns and infants is more prone to trauma and infection and requires appropriate care for proper maturation and function. Efforts are ongoing to comprehend how skin care practices and products affect the healthy development of newborn skin. The situation in India is more difficult because newborns and infants' skin is often treated with both conventional and modern methods. Additionally, there is a lack of substantial scientific evidence regarding some of the skin care practices for newborns and infants in India. Here, we present a comprehensive analysis of the current state of skin care in Indian newborns and infant populations. This review article was developed after conducting an in-depth literature analysis on the current skincare practices for newborns and infants. It focuses on the evidence supporting the best skin care practices in various settings, including hospital and intensive care units, home practices for massage and bathing, selection and use of emollients and other skin care products, and diaper area care. The role of Anganwadi workers in neonatal or infant care is also reviewed. Hence, there is need for standardized guidelines that incorporate both traditional and modern practices to ensure the health and safety of infants. Moreover, addressing the cultural and regional variations in skin care practices can promote better adherence to recommendations among caregivers. In conclusion, further research is required to establish evidence-based practices tailored to suit the Indian scenario and enhance skin care outcomes for newborns and infants. This review aims to inform Indian pediatricians, dermatologists, and primary care physicians about appropriate skin care practices, ultimately improving the overall health and well-being of newborns and infants.

Purpose: The prevalence of pulmonary nontuberculous mycobacteria (NTM) infection and disease is increasing globally. Pediatric studies on treatment of pulmonary NTM disease in immunocompetent infants are limited, and adult guidelines lack details regarding age-specific management strategies. This systematic review analyzes pharmaceutical, procedural, and supportive management strategies for pulmonary NTM infections in immunocompetent infants based on published case reports and series.

Methods: A systematic review of PubMed for case reports on pulmonary NTM infections in immunocompetent infants (≤24 months) until December 2023 was conducted. Demographic information, therapeutic interventions, procedural details, and patient outcomes were extracted to Covidence. Data on therapeutic strategies were summarized descriptively.

Results: Twenty-six case reports describing 33 infants with pulmonary NTM were identified. Study demographics included: 55% female, median age at diagnosis was 12 months, and Mycobacterium avium complex (58%) was the most common NTM strain. Most patients (94%) received antibiotic therapy, with a median treatment duration of 30 weeks. Common regimens included combined ethambutol with rifampin (n=9) or clarithromycin (n=6), and clarithromycin with amikacin (n=6). Most patients started on therapy for tuberculosis before switching treatment courses after NTM diagnosis. Common antibiotic classes after NTM diagnosis were macrolides, antituberculous, and aminoglycosides. Non-pharmaceutical therapies included 79% undergoing diagnostic bronchoscopy, 39% receiving tissue debulking, 33% undergoing surgical biopsy for diagnostic confirmation, and 12% requiring lung resection. Two patients underwent surgical interventions without antibiotics. Supportive therapies included non-invasive supplemental oxygen (12%) and mechanical ventilation (6%), with three patients admitted to intensive care units. Overall survival rate was 94%.

Conclusion: This study reports diverse therapeutic approaches to management of immunocompetent infants with diagnosed pulmonary NTM disease, which utilized varying antibiotics and procedural interventions. Although few patient deaths were reported, these results suggest a need for additional prospective studies to compare efficacy of treatment regimens and establish tailored pediatric guidelines for disease management.

Background: Childhood immunization is crucial for reducing morbidity and mortality from vaccine-preventable diseases. Despite global efforts, Nigeria faces persistently low immunization uptake with significant regional and socioeconomic disparities. This study investigated the prevalence, regional disparities, and sociodemographic determinants of full immunization coverage among children aged 12-23 months in Nigeria.

Methods: This secondary analysis utilized data from the 2018 Nigeria Demographic and Health Survey (NDHS), focusing on 2453 mothers with children aged 12-23 months. Full immunization coverage was defined per World Health Organization (WHO) guidelines. Descriptive statistics, bivariate analysis, and multivariable logistic regression identified predictors of coverage.

Results: Only 26% of children were fully immunized nationwide. Marked regional disparities were observed, with the North West (13%) and North East (18%) exhibiting the lowest rates, while the South East (42%) and South South (41%) had the highest. Multivariable analysis revealed that maternal education, household wealth, and region of residence were significant predictors. Children of mothers with higher education were more likely to be fully immunized (AOR: 1.87, 95% CI: 1.10-3.18, p = 0.022), as were those from the richest households compared to the poorest (AOR: 3.20, 95% CI: 1.95-5.25, p < 0.001). Children in the South East (AOR: 2.00, 95% CI: 1.16-3.46, p = 0.013) and South South (AOR: 1.73, 95% CI: 0.99-3.02, p = 0.052) also showed significantly higher odds of full immunization compared to the North West.

Conclusion: Full immunization coverage in Nigeria remains critically low, driven by pronounced regional and socioeconomic inequities. Targeted interventions focusing on improving maternal education, expanding equitable healthcare access in underserved regions, and providing financial support to low-income families are essential. Policy efforts must prioritize these vulnerable groups to enhance child health outcomes and achieve universal immunization coverage in Nigeria.

Background: Diffuse splenic hemangiomatosis (DSH) is an extremely rare benign vascular disorder characterized by the proliferation of multiple blood vessels within the spleen. It is even rarer in pediatric and adolescent patients, with only a few cases reported in medical literature, which was performed as scientific literature review.

Case presentation: We observed a 14-year-old male who presented with intermittent abdominal discomfort and slight splenomegaly. Laboratory tests revealed no abnormalities. Computed tomography (CT) revealed diffuse splenomegaly with round or oval low-density lesions, suggestive of hemangiomatosis or lymphoma. Magnetic resonance imaging (MRI) revealed multiple lesions with slightly prolonged T1 and T2 signals. A CT-guided percutaneous biopsy of a splenic lesion was performed to address splenomegaly and diagnostic uncertainty. Histopathological examination confirmed diffuse splenic hemangiomatosis with lymphocytic infiltration.

Conclusion: A rare case of DSH in a childhood was presented. This case underscores the importance of integrating imaging and histopathology for an accurate diagnosis. While the condition is typically benign, tissue biopsy remains the definitive diagnostic method when malignancy cannot be excluded.

Purpose: Developmental dysplasia of the hip (DDH) is a malformation of the hip joint that can lead to subluxation or dislocation. Early diagnosis is crucial for effective non-surgical management. The reported prevalence of DDH varies across studies.

Objective: To determine the cumulative incidence of DDH based on clinical examination and diagnostic ultrasonography and to identify associated risk factors.

Patients and methods: Between January 2020 and June 2023, 279 ultrasound studies were retrieved from the Security Forces Hospital in Makkah, Saudi Arabia. From the patients' files, we identified risk factors for DDH, including prematurity, gender, breech presentation, mode of delivery, and family history using the Chi-square test and odds ratios (OR).

Results: After excluding two cases with chromosomal abnormalities, the final cohort included 277 neonates (60.6% female) and 39.4% males. A positive family history was present in 5%, and 31.5% had a breech presentation. The Ortolani and Barlow tests indicated a DDH incidence of 8.05 per 1000 live births, while selective ultrasound confirmed an incidence of 2.13 per 1000 live births. Prematurity was significantly associated with DDH (P = 0.046), and breech presentation increased the risk approximately fourfold, OR = 3.95, P = 0.016.

Conclusion: DDH incidence in Makkah aligns with global averages. Prematurity significantly increases DDH risk, and breech presentation increases the risk by approximately four times.

Introduction: Cardiac arrest is defined by a lack of central pulse, unresponsiveness, and apnea, indicating the termination of effective mechanical heart activity. Although rare in pediatrics, it results in poor outcomes. Results concerning the survival rates of pediatrics after cardiopulmonary resuscitation (CPR) in Jordan are absent, making this study crucial knowledge for implication of hospital protocol.

Material/method: A retrospective study was conducted at a tertiary hospital in Jordan. This study included 411 pediatric patients, aged over one day to under 12 years, who underwent CPR either during an emergency department (ED) visit or during hospitalization. The Mann-Whitney U-test, Chi-Square test, and Fisher's exact tests were used for analysis. Survival-associated factors were analyzed using univariate and multivariate logistic regression, and p < 0.05 was considered significant.

Results: Patients were separated into a less than one year age group and a greater than one year age group, with similar gender distributions. Survival was significantly associated with age; the survivors were older than the non-survivors. Furthermore, the presence of any neurological manifestation was associated with a higher risk of mortality with an odds ratio of 3.97 (95% CI: 1.46-10.86, p = 0.007). After adjusting for all covariates, each 1% rise in oxygen saturation increased the adjusted odds ratio (AOR) of survival (AOR = 1.08, 95% CI 1.01-1.15; p = 0.031). In the same model, every additional minute of CPR sharply decreased the likelihood of survival (AOR = 0.38, 95% CI 0.21-0.72; p = 0.003).

Conclusion: The survival rates after CPR in pediatrics were poor overall, suggesting a need for better pediatric CPR strategies and further studies. Many factors could affect the outcomes, most importantly, the duration of CPR and the oxygen saturation.