Objective: The purpose of this narrative review is to introduce artificial intelligence (AI) and machine learning (ML) to pediatricians in the field of epilepsy. Background: There has been significant interest in AI and ML in the field of medicine. The number of AI research in the field of pediatrics is also increasing rapidly. AI research team often asks pediatricians to review and label the data for AI research and provide insights for planning the AI/ML algorithms. Ever-increasing medical data such as medical imaging data and digitalized physiologic monitoring data and advanced computing power enabled AI and ML research to increase rapidly. The chronic nature of epilepsy care is another reason AI/ML research is increasing using digitized big data such as magnetic resonance imaging (MRI) and electroencephalography (EEG). Methods: This review provides examples of AI/ML research in epilepsy, focusing on clinical implications. The purpose of AI/ML research in epilepsy encompasses increasing diagnostic accuracy and precision, detecting and predicting seizures, supporting treatment decisions, improving treatment outcomes, and predicting seizure and non-seizure outcomes. We will review various AI/ML research on automated EEG interpretation, seizure detection and forecasting. Conclusions: Understanding the strength and limitations of AI/ML research will help pediatricians understand and contribute to AI/ML research of their field of expertise. We must find useful clinical implications and suggestions that affect our medical knowledge and change our clinical practice from the research as clinicians participate in AI/ML research. rate is an essential measure of performance. In case of high false positive alarms, the patient will have to anticipate seizure unnecessarily, and lowering this false alarm rate is relevant. Many studies in seizure prediction and the sensitivity and specificity have increased remarkably for few decades (60-63). We developed deep convolutional neural network-based interictal/preictal EEG prediction and applied to 9 pediatric patients with surgically proven focal cortical dysplasia type II. The best accuracy was 5 minutes as preictal period, all intracranial channels for analysis, and 512 Hz sampling rate for EEG acquisition. When we change the preictal period from 2 hours before seizure to 1 minute, accuracy increased to 5 minutes and showed a small decline in 1 minute. These findings tell us that the best functioning was when we set the preictal period to 5 minutes before the seizure started. When we changed the analyzing electrode from whole intracranial to most relevant four electrodes, accuracy declined, but the amount was 2%. Increasing the sampling rate from 128 to 512 Hz, the increase of accuracy was trivial. We found that we could reduce the number of electrodes and sampling rate with a slight decline in performance. The decreasing number of electrodes helps reduce surgical risk, and sampling rate reduction is related to
{"title":"Application of artificial intelligence (AI) and machine learning (ML) in pediatric epilepsy: a narrative review","authors":"Hunmin Kim, H. Hwang","doi":"10.21037/pm-21-26","DOIUrl":"https://doi.org/10.21037/pm-21-26","url":null,"abstract":"Objective: The purpose of this narrative review is to introduce artificial intelligence (AI) and machine learning (ML) to pediatricians in the field of epilepsy. Background: There has been significant interest in AI and ML in the field of medicine. The number of AI research in the field of pediatrics is also increasing rapidly. AI research team often asks pediatricians to review and label the data for AI research and provide insights for planning the AI/ML algorithms. Ever-increasing medical data such as medical imaging data and digitalized physiologic monitoring data and advanced computing power enabled AI and ML research to increase rapidly. The chronic nature of epilepsy care is another reason AI/ML research is increasing using digitized big data such as magnetic resonance imaging (MRI) and electroencephalography (EEG). Methods: This review provides examples of AI/ML research in epilepsy, focusing on clinical implications. The purpose of AI/ML research in epilepsy encompasses increasing diagnostic accuracy and precision, detecting and predicting seizures, supporting treatment decisions, improving treatment outcomes, and predicting seizure and non-seizure outcomes. We will review various AI/ML research on automated EEG interpretation, seizure detection and forecasting. Conclusions: Understanding the strength and limitations of AI/ML research will help pediatricians understand and contribute to AI/ML research of their field of expertise. We must find useful clinical implications and suggestions that affect our medical knowledge and change our clinical practice from the research as clinicians participate in AI/ML research. rate is an essential measure of performance. In case of high false positive alarms, the patient will have to anticipate seizure unnecessarily, and lowering this false alarm rate is relevant. Many studies in seizure prediction and the sensitivity and specificity have increased remarkably for few decades (60-63). We developed deep convolutional neural network-based interictal/preictal EEG prediction and applied to 9 pediatric patients with surgically proven focal cortical dysplasia type II. The best accuracy was 5 minutes as preictal period, all intracranial channels for analysis, and 512 Hz sampling rate for EEG acquisition. When we change the preictal period from 2 hours before seizure to 1 minute, accuracy increased to 5 minutes and showed a small decline in 1 minute. These findings tell us that the best functioning was when we set the preictal period to 5 minutes before the seizure started. When we changed the analyzing electrode from whole intracranial to most relevant four electrodes, accuracy declined, but the amount was 2%. Increasing the sampling rate from 128 to 512 Hz, the increase of accuracy was trivial. We found that we could reduce the number of electrodes and sampling rate with a slight decline in performance. The decreasing number of electrodes helps reduce surgical risk, and sampling rate reduction is related to","PeriodicalId":74411,"journal":{"name":"Pediatric medicine (Hong Kong, China)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47653484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Neonatal jaundice holds significant morbidity including acute bilirubin encephalopathy and even death (1). Early identification of infants at risk for unconjugated hyperbilirubinemia has been the focus of much research. A 2006 study by Sgro et al., identified an overwhelming incidence of severe neonatal hyperbilirubinemia in Canada requiring admission for phototherapy (2). These findings resulted in several studies investigating methods and criteria for predicting infants at risk for longstanding consequences from delayed or missed treatment (1,3-14). Despite these efforts, failure to identify or monitor hyperbilirubinemia Original Article
{"title":"Factors associated to hospital re-admission of infants previously treated for hyperbilirubinemia","authors":"G. Bravo, Michael R. Miller, A. Zizzo","doi":"10.21037/pm-21-89","DOIUrl":"https://doi.org/10.21037/pm-21-89","url":null,"abstract":"Neonatal jaundice holds significant morbidity including acute bilirubin encephalopathy and even death (1). Early identification of infants at risk for unconjugated hyperbilirubinemia has been the focus of much research. A 2006 study by Sgro et al., identified an overwhelming incidence of severe neonatal hyperbilirubinemia in Canada requiring admission for phototherapy (2). These findings resulted in several studies investigating methods and criteria for predicting infants at risk for longstanding consequences from delayed or missed treatment (1,3-14). Despite these efforts, failure to identify or monitor hyperbilirubinemia Original Article","PeriodicalId":74411,"journal":{"name":"Pediatric medicine (Hong Kong, China)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43476098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
R. Prasad, A. Keir, M. Battin, J. Holberton, S. Chow, K. Lui
{"title":"The Australian and New Zealand Neonatal Network: past achievements and future directions","authors":"R. Prasad, A. Keir, M. Battin, J. Holberton, S. Chow, K. Lui","doi":"10.21037/pm-21-93","DOIUrl":"https://doi.org/10.21037/pm-21-93","url":null,"abstract":"","PeriodicalId":74411,"journal":{"name":"Pediatric medicine (Hong Kong, China)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45178883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sri Jayanti, J. Ghersi-Egea, N. Strazielle, C. Tiribelli, S. Gazzin
: The immature hepatic metabolism of bilirubin at birth is responsible for neonatal hyperbilirubinemia, present in more than 60% of otherwise healthy infants. Icterus (or jaundice), the most apparent features of the increased bilirubin level in the serum, testifies the entry of the pigment in the tissues and organs, brain included. The sensitivity of the central nervous system (CNS) to bilirubin toxicity is responsible for the potential neurologic damage, and even death. The symptoms in affected neonates suggest that selected brain areas are more specifically targeted by bilirubin, a hypothesis longer explained by the deposition of bilirubin in those areas, the “kern-icterus”. Most recently, a more complex picture and alternative explanations to the variability of the symptoms recapped by the terms bilirubin induced neurological dysfunction (BIND) or kernicterus spectrum disorder (KSD) are emerging, with pre-term neonates representing a new challenge. Here we will review what is known of the disease, from the dogma of the “kern-icterus” to the most recent findings bringing into play the stage of brain development at the time of bilirubin insult. Special emphasis will be given to the emerging population of pre-term neonates, especially sensitive to bilirubin toxicity. on the effect of free UCB on brain barriers integrity. A case report of a pre-term neonate with severe kernicterus indicates that signs of neurovascular network alteration was observed on autopsied brain tissue, possibly linked to an increase in vascular endothelial growth factor (VEGF) signaling (192). Given the comorbidities associated, whether UCB alone was responsible for these alterations remains to be understood. One study performed in Gunn rats, an animal model of jaundice characterized by a rapid postnatal increase in serum UCB evidenced a decrease in ABCC1 protein levels in CPs. This finding could be reproduced in vitro on choroidal epithelial cells chronically exposed to UCB, suggesting that ABCC1 downregulation results from a direct effect of UCB on the BCSFB
{"title":"Severe neonatal hyperbilirubinemia and the brain: the old but still evolving story","authors":"Sri Jayanti, J. Ghersi-Egea, N. Strazielle, C. Tiribelli, S. Gazzin","doi":"10.21037/PM-21-5","DOIUrl":"https://doi.org/10.21037/PM-21-5","url":null,"abstract":": The immature hepatic metabolism of bilirubin at birth is responsible for neonatal hyperbilirubinemia, present in more than 60% of otherwise healthy infants. Icterus (or jaundice), the most apparent features of the increased bilirubin level in the serum, testifies the entry of the pigment in the tissues and organs, brain included. The sensitivity of the central nervous system (CNS) to bilirubin toxicity is responsible for the potential neurologic damage, and even death. The symptoms in affected neonates suggest that selected brain areas are more specifically targeted by bilirubin, a hypothesis longer explained by the deposition of bilirubin in those areas, the “kern-icterus”. Most recently, a more complex picture and alternative explanations to the variability of the symptoms recapped by the terms bilirubin induced neurological dysfunction (BIND) or kernicterus spectrum disorder (KSD) are emerging, with pre-term neonates representing a new challenge. Here we will review what is known of the disease, from the dogma of the “kern-icterus” to the most recent findings bringing into play the stage of brain development at the time of bilirubin insult. Special emphasis will be given to the emerging population of pre-term neonates, especially sensitive to bilirubin toxicity. on the effect of free UCB on brain barriers integrity. A case report of a pre-term neonate with severe kernicterus indicates that signs of neurovascular network alteration was observed on autopsied brain tissue, possibly linked to an increase in vascular endothelial growth factor (VEGF) signaling (192). Given the comorbidities associated, whether UCB alone was responsible for these alterations remains to be understood. One study performed in Gunn rats, an animal model of jaundice characterized by a rapid postnatal increase in serum UCB evidenced a decrease in ABCC1 protein levels in CPs. This finding could be reproduced in vitro on choroidal epithelial cells chronically exposed to UCB, suggesting that ABCC1 downregulation results from a direct effect of UCB on the BCSFB","PeriodicalId":74411,"journal":{"name":"Pediatric medicine (Hong Kong, China)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45490007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
: Photobiomodulation and low level laser therapy have multiple clinical applications across medicine and dentistry and has been used, with varying degrees of success, in sleep medicine and dental sleep medicine. This case report describes the use of low level laser therapy with an Er:YAG laser for the immediate treatment of hypertrophic tonsils in a child with symptoms of a sleep airway disorder as recorded through pre-intervention screening with the pediatric sleep questionnaire and BEARS sleep screening tool. Immediate, 3-month post-intervention, and 1 year post-intervention clinical photos showed significant tonsil size reduction from the low level laser therapy with maintenance of tonsillar shrinkage over the following year. Post-intervention results on the pediatric sleep questionnaire and BEARS sleep screening tool showed a significant change in reported symptoms. No negative side effects were noted by the clinician or reported by the patient. The results of this case report indicate that low level laser therapy may be a potential treatment option for hypertrophic tonsils, with potential applications into the fields of sleep medicine and otolaryngology for both adults and children. Further research into the applications of low level laser therapy on hypertrophic tonsils should be conducted, with appropriate clinical protocols and patient selection criteria studied in detail.
{"title":"Photobiomodulation for pediatric hypertrophic tonsils: a clinical case report","authors":"Enoch T. Ng, M. Lagravère, A. David","doi":"10.21037/pm-21-18","DOIUrl":"https://doi.org/10.21037/pm-21-18","url":null,"abstract":": Photobiomodulation and low level laser therapy have multiple clinical applications across medicine and dentistry and has been used, with varying degrees of success, in sleep medicine and dental sleep medicine. This case report describes the use of low level laser therapy with an Er:YAG laser for the immediate treatment of hypertrophic tonsils in a child with symptoms of a sleep airway disorder as recorded through pre-intervention screening with the pediatric sleep questionnaire and BEARS sleep screening tool. Immediate, 3-month post-intervention, and 1 year post-intervention clinical photos showed significant tonsil size reduction from the low level laser therapy with maintenance of tonsillar shrinkage over the following year. Post-intervention results on the pediatric sleep questionnaire and BEARS sleep screening tool showed a significant change in reported symptoms. No negative side effects were noted by the clinician or reported by the patient. The results of this case report indicate that low level laser therapy may be a potential treatment option for hypertrophic tonsils, with potential applications into the fields of sleep medicine and otolaryngology for both adults and children. Further research into the applications of low level laser therapy on hypertrophic tonsils should be conducted, with appropriate clinical protocols and patient selection criteria studied in detail.","PeriodicalId":74411,"journal":{"name":"Pediatric medicine (Hong Kong, China)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45518524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
R. Platt, K. Priddis, B. Lawton, Daniel E. Hall, D. Roland
: At the heart of every paediatric consultation is the clinician’s responsibility to determine ‘is this child sick?’ In paediatrics illustrative language communicates a clinical picture of the child before us. When we define ‘sick’ we are thinking about a child, from the neonate to the adolescent up to eighteen years old, who will continue to decompensate without medical intervention. We are not concerned about a minor cold or cough, instead we think about the ex-premature infant with bronchiolitis who has the potential to rapidly deteriorate or the child who is ‘irritable’ whom we have to assume has meningitis until we can call them ‘miserable but consolable’. As health care professionals we rely on experience, evidence-based knowledge and clinical gestalt to determine whether we should be worried about our patients, and how we should approach the management of our patients whilst maintaining a holistic overview. This paper draws upon the global experience of our not-for-profit openly accessible ‘Don’t Forget the Bubbles’ (DFTB) website (https:// dontforgetthebubbles.com) to present a ‘meta-blog’ synthesis of approaches to recognition of the sick child. We explore how knowledge translation can guide our clinical skills in recognising which children are most at risk and address neonatal, cardiac, respiratory, head injury, metabolic and abdominal pain presentations.
{"title":"Identification of sick children in acute care settings","authors":"R. Platt, K. Priddis, B. Lawton, Daniel E. Hall, D. Roland","doi":"10.21037/pm-21-54","DOIUrl":"https://doi.org/10.21037/pm-21-54","url":null,"abstract":": At the heart of every paediatric consultation is the clinician’s responsibility to determine ‘is this child sick?’ In paediatrics illustrative language communicates a clinical picture of the child before us. When we define ‘sick’ we are thinking about a child, from the neonate to the adolescent up to eighteen years old, who will continue to decompensate without medical intervention. We are not concerned about a minor cold or cough, instead we think about the ex-premature infant with bronchiolitis who has the potential to rapidly deteriorate or the child who is ‘irritable’ whom we have to assume has meningitis until we can call them ‘miserable but consolable’. As health care professionals we rely on experience, evidence-based knowledge and clinical gestalt to determine whether we should be worried about our patients, and how we should approach the management of our patients whilst maintaining a holistic overview. This paper draws upon the global experience of our not-for-profit openly accessible ‘Don’t Forget the Bubbles’ (DFTB) website (https:// dontforgetthebubbles.com) to present a ‘meta-blog’ synthesis of approaches to recognition of the sick child. We explore how knowledge translation can guide our clinical skills in recognising which children are most at risk and address neonatal, cardiac, respiratory, head injury, metabolic and abdominal pain presentations.","PeriodicalId":74411,"journal":{"name":"Pediatric medicine (Hong Kong, China)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42585570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. X. Sotiropoulos, V. Kapadia, S. Ramachandran, J. Oei
Background and Objectives: The first 10 minutes of life is the most important for a newborn infant. For the 1% of infants that require extensive resuscitation measures, rapid evaluation of vital signs, including oxygen saturation and heart rate is vital. How a clinician achieves prompt and accurate assessment of the sick newborn infant within a few minutes remains one of the most important knowledge and practice gaps in modern newborn medicine. Over the last two decades, international newborn resuscitation practice has changed considerably. The most profound development is the focus on oxygenation within the first 10 minutes of life, with a global secular shift to using “lower oxygen strategies”. However, there is now emerging information of adverse consequences from low oxygenation during the first 5 minutes of life, especially in very preterm infants (<29 weeks’ gestation) who are already at highest risk of death. We aim to review delivery room practice aimed to provide best and most accurate assessment of the cardiorespiratory status of sick newborn infants. Methods: We performed a broad search of PubMed, MEDLINE, Google Scholar and scrutinized the reference lists of relevant English articles published before November 4th 2021, including systematic reviews, meta-analyses, randomized controlled trials, retrospective studies and previous narrative reviews. Key Content and Findings: This review outlines the clinical and biometric methods of assessing the newborn in the delivery room. We explore the strengths and weakness of each modality, and highlight that the resuscitation team must synthesize clinical and biometric information to guide their care. Conclusions: Clinicians must balance information gained from technology (e.g., pulse oximetry) with clinical judgement of the infant’s progress. Significantly more knowledge is needed to inform on the best assessment methods to guide resuscitation of the sick newborn infant. Failure to do so will prevent advances in research and stagnate efforts to improve outcomes for all sick newborn infants around the world. methods of assessing the infant’s response to resuscitation?
{"title":"Ten minutes to save a baby: a narrative review of newborn assessment during first minutes of life and relationship to outcomes","authors":"J. X. Sotiropoulos, V. Kapadia, S. Ramachandran, J. Oei","doi":"10.21037/pm-21-84","DOIUrl":"https://doi.org/10.21037/pm-21-84","url":null,"abstract":"Background and Objectives: The first 10 minutes of life is the most important for a newborn infant. For the 1% of infants that require extensive resuscitation measures, rapid evaluation of vital signs, including oxygen saturation and heart rate is vital. How a clinician achieves prompt and accurate assessment of the sick newborn infant within a few minutes remains one of the most important knowledge and practice gaps in modern newborn medicine. Over the last two decades, international newborn resuscitation practice has changed considerably. The most profound development is the focus on oxygenation within the first 10 minutes of life, with a global secular shift to using “lower oxygen strategies”. However, there is now emerging information of adverse consequences from low oxygenation during the first 5 minutes of life, especially in very preterm infants (<29 weeks’ gestation) who are already at highest risk of death. We aim to review delivery room practice aimed to provide best and most accurate assessment of the cardiorespiratory status of sick newborn infants. Methods: We performed a broad search of PubMed, MEDLINE, Google Scholar and scrutinized the reference lists of relevant English articles published before November 4th 2021, including systematic reviews, meta-analyses, randomized controlled trials, retrospective studies and previous narrative reviews. Key Content and Findings: This review outlines the clinical and biometric methods of assessing the newborn in the delivery room. We explore the strengths and weakness of each modality, and highlight that the resuscitation team must synthesize clinical and biometric information to guide their care. Conclusions: Clinicians must balance information gained from technology (e.g., pulse oximetry) with clinical judgement of the infant’s progress. Significantly more knowledge is needed to inform on the best assessment methods to guide resuscitation of the sick newborn infant. Failure to do so will prevent advances in research and stagnate efforts to improve outcomes for all sick newborn infants around the world. methods of assessing the infant’s response to resuscitation?","PeriodicalId":74411,"journal":{"name":"Pediatric medicine (Hong Kong, China)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46993003","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Intracranial germ cell tumors (IGCTs) are rare neoplasms occurring predominantly in pediatric and adolescent patients. They are rare in Western countries, but are more common in East Asia. We conducted this review and meta-analysis of existing evidence to evaluate the treatment condition and prognosis of IGCT in China and explore the associated problems and challenges. Methods: The analysis was carried out with a search of the PubMed, Embase, Wanfang Data, and CNKI databases for literature published until October 2020. Only clinical studies and case reports in China with a pathological diagnosis containing a treatment protocol and long-term survival data of at least 18 months were included in the review. All patients were children or adolescents younger than 24 years old. This meta-analysis examined overall survival (OS) and progression free survival (PFS) at 3 years. The outcomes were pooled using a random effects model. We used the standardized critical appraisal instrument from the Joanna Briggs Institute (JBI) to assess the risk of bias. Results: The final search included 9 studies with 218 patients. The pooled 3-year PFS of patients with germinomas was 98% and of non-germinomatous germ cell tumors (NGGCTs) was 68% in the included studies. For germinomas, the pooled 3-year PFS and OS revealed that combined chemotherapy has a higher efficacy than therapy with radiation alone (100% vs. 90%, P=0.0415; 100% vs. 92%, P=0.0396). Discussion: Patients with germinomas can receive satisfying outcomes, and combined chemotherapy can provide better survival than radiation therapy alone. Further effort is needed in the future to improve survival in the children with IGCTs, with multidisciplinary input being the key to achieving satisfactory outcomes.
{"title":"Intracranial germ cell tumors in pediatric and adolescent patients in China: systematic review and meta-analysis","authors":"A. Zhang, Yi-wen Gao","doi":"10.21037/pm-21-32","DOIUrl":"https://doi.org/10.21037/pm-21-32","url":null,"abstract":"Background: Intracranial germ cell tumors (IGCTs) are rare neoplasms occurring predominantly in pediatric and adolescent patients. They are rare in Western countries, but are more common in East Asia. We conducted this review and meta-analysis of existing evidence to evaluate the treatment condition and prognosis of IGCT in China and explore the associated problems and challenges. Methods: The analysis was carried out with a search of the PubMed, Embase, Wanfang Data, and CNKI databases for literature published until October 2020. Only clinical studies and case reports in China with a pathological diagnosis containing a treatment protocol and long-term survival data of at least 18 months were included in the review. All patients were children or adolescents younger than 24 years old. This meta-analysis examined overall survival (OS) and progression free survival (PFS) at 3 years. The outcomes were pooled using a random effects model. We used the standardized critical appraisal instrument from the Joanna Briggs Institute (JBI) to assess the risk of bias. Results: The final search included 9 studies with 218 patients. The pooled 3-year PFS of patients with germinomas was 98% and of non-germinomatous germ cell tumors (NGGCTs) was 68% in the included studies. For germinomas, the pooled 3-year PFS and OS revealed that combined chemotherapy has a higher efficacy than therapy with radiation alone (100% vs. 90%, P=0.0415; 100% vs. 92%, P=0.0396). Discussion: Patients with germinomas can receive satisfying outcomes, and combined chemotherapy can provide better survival than radiation therapy alone. Further effort is needed in the future to improve survival in the children with IGCTs, with multidisciplinary input being the key to achieving satisfactory outcomes.","PeriodicalId":74411,"journal":{"name":"Pediatric medicine (Hong Kong, China)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41541704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"National Very Preterm Infant Register imbedded in the Medical Birth Register in Finland","authors":"L. Lehtonen, Kjell Helenius, M. Gissler","doi":"10.21037/pm-21-63","DOIUrl":"https://doi.org/10.21037/pm-21-63","url":null,"abstract":"","PeriodicalId":74411,"journal":{"name":"Pediatric medicine (Hong Kong, China)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47817087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
: The Swiss Neonatal Network & Follow-up Group (SwissNeoNet) started as a paper based standardized data collection for very preterm born infants in 1995 for the purpose of research. It has since evolved into a sophisticated online medical registry with the chief aim of improving the quality of medical care for high-risk newborn infants through research, education and collaborative audit. In support of its aim, it collects primary hospitalization and neurodevelopmental follow-up data of various cohorts of newborns from all level III neonatal intensive care units (NICUs) and all peripheral intermediate care level IIB neonatal units (NUs) in Switzerland. It coordinates clinical, epidemiological and health-services research that provide orientation for Swiss neonatologists on how their performance compares with that of other networks, how different approaches in practices without clear evidence base associate with outcome, or how processes and outcomes evolve longitudinally. Its research also allowed former very preterm born children to express their own perception of their quality of life. SwissNeoNet closely monitors and compares NICUs and NUs and provides the infrastructure for quality improvement collaboratives. All units jointly and openly compare their performance and identify potential for changing clinical practices which has led to several local improvement projects as well as revisions of national treatment recommendations. To collaborate in research, to acquire benchmarks, and to serve as a benchmark, SwissNeoNet is actively engaged in several national and international collaborations. Receiving no governmental support, SwissNeoNet struggles with a limited budget to continuously operate a multifaceted, complex network with an electronically advanced, security sensitive infrastructure. Nevertheless, it plans expanding by connecting closer to the families and ultimately the former very preterm born children in the near future: building a patient reported outcome measure (PROM) repository and thus learning more about the parental/patient perspective will benefit clinical research, qualitative research, quality assessment, long-term follow-up recruitment and may even pave the way to later expand into citizen science and personalized health care.
{"title":"A narrative review of the Swiss Neonatal Network & Follow-up Group (SwissNeoNet)","authors":"M. Adams, G. Natalucci, D. Bassler","doi":"10.21037/pm-21-76","DOIUrl":"https://doi.org/10.21037/pm-21-76","url":null,"abstract":": The Swiss Neonatal Network & Follow-up Group (SwissNeoNet) started as a paper based standardized data collection for very preterm born infants in 1995 for the purpose of research. It has since evolved into a sophisticated online medical registry with the chief aim of improving the quality of medical care for high-risk newborn infants through research, education and collaborative audit. In support of its aim, it collects primary hospitalization and neurodevelopmental follow-up data of various cohorts of newborns from all level III neonatal intensive care units (NICUs) and all peripheral intermediate care level IIB neonatal units (NUs) in Switzerland. It coordinates clinical, epidemiological and health-services research that provide orientation for Swiss neonatologists on how their performance compares with that of other networks, how different approaches in practices without clear evidence base associate with outcome, or how processes and outcomes evolve longitudinally. Its research also allowed former very preterm born children to express their own perception of their quality of life. SwissNeoNet closely monitors and compares NICUs and NUs and provides the infrastructure for quality improvement collaboratives. All units jointly and openly compare their performance and identify potential for changing clinical practices which has led to several local improvement projects as well as revisions of national treatment recommendations. To collaborate in research, to acquire benchmarks, and to serve as a benchmark, SwissNeoNet is actively engaged in several national and international collaborations. Receiving no governmental support, SwissNeoNet struggles with a limited budget to continuously operate a multifaceted, complex network with an electronically advanced, security sensitive infrastructure. Nevertheless, it plans expanding by connecting closer to the families and ultimately the former very preterm born children in the near future: building a patient reported outcome measure (PROM) repository and thus learning more about the parental/patient perspective will benefit clinical research, qualitative research, quality assessment, long-term follow-up recruitment and may even pave the way to later expand into citizen science and personalized health care.","PeriodicalId":74411,"journal":{"name":"Pediatric medicine (Hong Kong, China)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49168979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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