World journal of clinical pediatrics最新文献

Background: Children with autism spectrum disorder (ASD) face unique challenges in maintaining oral health due to sensory sensitivities, communication difficulties, and behavioral barriers. These factors, along with limited access to ASD-trained dental professionals, increase their risk of dental caries, periodontal disease, bruxism, and other oral health issues. Despite growing awareness of these challenges, a comprehensive synthesis of evidence-based solutions remains lacking.

Aim: To review synthesizes existing research on dental problems in ASD, barriers to care, management strategies, and future directions for improved oral health outcomes.

Methods: A systematic search of PubMed, Cochrane Library, and Scopus was conducted using predefined search terms. Related to ASD, dental health, and management strategies. Inclusion criteria encompassed studies focusing on children with ASD, dental health issues, and interventions. Data extraction included study design, participant characteristics, key findings, and intervention outcomes. The quality of studies was assessed using appropriate tools such as the Cochrane Risk of Bias Tool and the Newcastle-Ottawa Scale. A narrative synthesis approach, incorporating thematic analysis, was utilized to evaluate the findings.

Results: A total of 165 studies met the inclusion criteria. Children with ASD exhibited a higher prevalence of dental caries, gingivitis, bruxism, and malocclusion compared to neurotypical peers. Barriers to dental care included sensory sensitivities, communication difficulties, financial constraints, and a shortage of ASD-trained dental professionals. Effective interventions included desensitization programs, behavioral therapy, digital applications, and interdisciplinary collaboration. Parental education and professional training were crucial for improving oral health outcomes.

Conclusion: Tailored dental care strategies, including sensory adaptations, behavioral interventions, and interdisciplinary collaboration, are essential for children with ASD. Standardized guidelines and long-term studies are needed to refine evidence-based protocols. Future research should explore digital interventions and probiotic applications in ASD dental care.

Background: Patients with inflammatory bowel diseases (IBD) often miss the scheduled vaccines and have a higher risk of infection susceptibility, including vaccine-prevented diseases.

Aim: To evaluate the vaccine coverage and levels of the post-vaccine antibodies against measles, mumps, rubella, and hepatitis B in children with IBD.

Methods: Total 98 patients: 46 females (47.2%) and 52 males (52.8%) with IBD (Crohn's disease-75% and ulcerative colitis-25%) with disease onset age-11.0 (6.0; 14.0) years whom clinical data, vaccination status and levels of the post-vaccination antibodies (IgG) for measles, rubella, mumps, hepatitis B, measured with ELISA were prospectively evaluated. The control group consisted of 88 healthy peers from the biobank data.

Results: Patients with IBD had lower levels of measles, rubella, and hepatitis B, except mumps, compared to controls. Incomplete vaccination/non-protective titer of the antibodies against measles, mumps rubella, and hepatitis B had 33 (33.7%)/52.3%, 21 (21.4%)/50.4%, 26 (25.8)/25.6% and 26 (25.8%)/55.2%, respectively. Patients with incomplete vaccination had a lower age at the diagnosis for all vaccines. The age of the IBD diagnosis ≤ 6 years was the predictor of incomplete vaccination for measles [odds ratio (OR) = 4.6, P = 0.001], mumps (OR = 5.0, P = 0.001), rubella (OR = 5.4, P = 0.0005) and hepatitis B (OR = 5.4, P = 0.0005) and corticosteroid treatment for measles (OR = 2.2, P = 0.074) and mumps (OR = 3.0, P = 0.047) vaccines. Incomplete vaccination was the predictor of non-protective titer of antibodies against rubella (OR = 6.8, 95%CI: 2.3-19.9, P = 0.0002)/mumps (OR = 7.0, 95%CI: 2.4-20.8; P = 0.0002).

Conclusion: Patients with IBD had low vaccine coverage and lower levels of anti-vaccine antibodies against measles, rubella, and hepatitis B. Nearly half of the IBD patients require revaccination.

Background: For over half a century, the administration of maternal corticosteroids before anticipated preterm birth has been regarded as a cornerstone intervention for enhancing neonatal outcomes, particularly in preventing respiratory distress syndrome. Ongoing research on antenatal corticosteroids (ACS) is continuously refining the evidence regarding their efficacy and potential side effects, which may alter the application of this treatment. Recent findings indicate that in resource-limited settings, the effectiveness of ACS is contingent upon meeting specific conditions, including providing adequate medical support for preterm newborns. Future studies are expected to concentrate on developing evidence-based strategies to safely enhance ACS utilization in low- and middle-income countries.

Aim: To analyze the clinical effectiveness of antenatal corticosteroids in improving outcomes for preterm newborns in a tertiary care hospital setting in Kazakhstan, following current World Health Organization guidelines.

Methods: This study employs a comparative retrospective cohort design to analyze single-center clinical data collected from January 2022 to February 2024. A total of 152 medical records of preterm newborns with gestational ages between 24 and 34 weeks were reviewed, focusing on the completeness of the ACS received. Quantitative variables are presented as means with standard deviations, while frequency analysis of qualitative indicators was performed using Pearson's χ ² test (χ²) and Fisher's exact test. If statistical significance was identified, pairwise comparisons between the three observation groups were conducted using the Bonferroni correction.

Results: The obtained data indicate that the complete implementation of antenatal steroid prophylaxis (ASP) improves neonatal outcomes, particularly by reducing the frequency of birth asphyxia (P = 0.002), the need for primary resuscitation (P = 0.002), the use of nasal continuous positive airway pressure (P = 0.022), and the need for surfactant replacement therapy (P = 0.038) compared to groups with incomplete or no ASP. Furthermore, complete ASP contributed to a decrease in morbidity among preterm newborns (e.g., respiratory distress syndrome, intrauterine pneumonia, cerebral ischemia, bronchopulmonary dysplasia, etc.), improved Apgar scores, and reduced the need for re-intubation and the frequency of mechanical ventilation. However, it was associated with an increased incidence of uterine atony in postpartum women (P = 0.0095).

Conclusion: In a tertiary hospital setting, the implementation of ACS therapy for pregnancies between 24 and 34 weeks of gestation at high risk for preterm birth significantly reduces the incidence of neonatal complications and related interventions. This, in turn, contributes to bette

Pediatric emergency care (PEC) encompasses the specialized medical care delivered to infants, children, and adolescents facing urgent medical situations, addressing critical conditions such as infections, allergic responses, seizures, respiratory distress, and trauma. PEC calls for prompt, focused interventions to address each child's developmental and physiological needs. The literature was searched using Google Scholar, PubMed, and the Cochrane Library to retrieve studies assessing quality indicators and outcomes in pediatric emergencies. The search was limited to papers published in peer-reviewed journals between 01 Jan 2000 and 15 Dec 2024. This review evaluates current PEC standards such as patient safety, diagnostic precision, timeliness, and patient and family satisfaction. Patient safety is vital because children are particularly vulnerable to medical errors, such as inappropriate doses of medication. The provision of high-quality PEC is hampered by systemic issues such as inadequate training, a lack of resources, and restricted access to treatment. Telemedicine, pediatric transport units, artificial intelligence applications for diagnostics, and simulation-based training are suggested approaches to overcome these challenges. Research networks and quality improvement initiatives are important steps to improve PEC care.

Background: Organophosphate (OP) poisoning is common in sub-Saharan Africa. It is associated with high mortality and morbidity. Affected individuals often exhibit cholinergic symptoms and respiratory distress. Moreover, other complications, such as pancreatitis, arrhythmias, and hepatic dysfunction, have been reported. However, paralytic ileus is an exceedingly rare complication.

Case summary: We report a case of a 5-year-old boy who presented with altered sensorium and abdominal distension following suspected OP exposure. Physical examination and imaging revealed features of intestinal obstruction and neurological deficits. He was managed with atropine, pralidoxime, and other supportive measures and had a successful recovery. Paralytic ileus is an atypical complication of acute OP poisoning. The resultant intestinal obstruction manifests as cholinergic overactivity, leading to bowel dysmotility. This case emphasizes the need for awareness and prompt management of such atypical presentations, especially in the pediatric population.

Conclusion: Timely recognition and multidisciplinary management of atypical presentations, such as paralytic ileus, are crucial in improving outcomes in pediatric OP poisoning.

The diagnosis of gastroesophageal reflux (GERD) in children is a complex and challenging task that requires meticulous attention to detail and a deep understanding of pediatric physiology. It is absolutely crucial to distinguish between the benign chalasia of infancy and the more serious pathologic GERD. Recent advancements have shown that Combined Multichannel Intraluminal Impedance and pondus hydrogenii measurement offer superior diagnostic accuracy. The role of nuclear scans in diagnosing GERD remains an area of ongoing research. The management of GERD in children follows a stepwise approach, starting with medical therapy and progressing to surgical intervention if necessary.

Background: Hypertension (HTN) is a significant global health concern due to its rising prevalence and associated risks of cardiovascular disease, chronic kidney disease, and other comorbidities. The increasing rates of HTN among youth have been partly attributed to the global rise in childhood obesity, lipid abnormalities, and sedentary lifestyles.

Aim: To investigate the independent associations of aerobic fitness (AF), the triglyceride-to-high-density lipoprotein cholesterol (TG/HDL-C) ratio, visceral adiposity index (VAI), and resting blood pressure (BP) in Nigerian adolescents.

Methods: A multistage sampling technique was used to select 403 in-school adolescents aged 11-19 years in Kogi East, Nigeria. Participants were assessed for AF, TG/HDL-C ratio, VAI, systolic BP (SBP), and diastolic BP (DBP). The associations between the independent variables and the risk of systolic and diastolic HTN were examined using multivariate regression models, controlling for age and maturity status. Receiver operating characteristics curve (ROC) and area under the curve (AUC) were employed to determine the predictive capacities of the independent variables.

Results: The overall prevalence of systolic HTN was 5.5% (girls: 7%; boys: 4%) while diastolic HTN was 12.7% (girls: 16.9%; boys: 8.4%). Among girls, all independent variables showed significant associations with SBP, including fitness (P < 0.001), TG/HDL-C (P < 0.001), and VAI (P < 0.001), with VAI showing the strongest association. In boys, all independent variables except VAI (P = 0.063) were significantly associated with SBP, with fitness showing the stronger predictive power (Fitness, P < 0.001; TG/HDL-C, P = 0.029). For DBP, all independent variables, except fitness in girls (P = 0.099), were significantly associated (P < 0.001) in both sexes. Unfit boys were 1.1 times more likely to develop systolic HTN (95%CI: 1.01-1.15, P = 0.018) and had 1.1 times higher odds of developing diastolic HTN (95%CI: 1.03-1.13, P = 0.001). Only the ROC for DBP turned up significant (P < 0.001) AUCs for TG/HDL-C and VAI in girls only, with 0.6 and 1.0 thresholds respectively.

Conclusion: AF, dyslipidemia, and visceral adipose tissue dysfunction were independently associated with the risk of HTN in Nigerian adolescents. These findings highlight the importance of promoting a healthy diet and encouraging aerobic physical activity among adolescents to reduce the risk of HTN.

Background: Mucopolysaccharidosis type II (MPS II) is a chronic inherited disease with multiorgan involvement, a progressive course, and restricted life expectancy.

Aim: To evaluate the predictors of fatal outcomes in MPS II patients.

Methods: In the retrospective cohort study, the clinical, laboratory data and enzyme replacement therapy (ERT) (84.2%) of about 160 patients were extracted and analyzed from the Russian MPS II registry, with death as a primary outcome. We compared patients who died (n = 20; 12.5%) with severe form (n = 13; 68.4%) and attenuated form (n = 6, 31.6%) to 140 alive patients.

Results: Fatal outcomes occurred in 5%, 35%, 20%, and 40% of patients before 10, 10-14, 15-19, and ≥ 20 years. The most common causes of death were cardiovascular (29.4%), respiratory failure (17.6%), including pneumonia (17.6%), and their associations (17.6%) and MPS II progression (11.8%). Acute or chronic respiratory failure was in 53%. Died patients had higher birth weight, higher age of diagnosis, and start of ERT. Hydrocephalus, hydrocephalus bypass surgery, epilepsy, difficulty swallowing, and impaired movement after 12 years of age were significantly more common in the deceased patients. Cox regression analysis has revealed the following time-dependent covariates of the lethal outcome: 1^st-year psychomotor development delay, delayed mental and speech development, hydrocephalus, swallow disorders, impossible walking at age > 12 years, respiratory disorders, tracheostomy, neuronopathic form.

Conclusion: Increased birth weight, delayed diagnosis and the start of ERT, and development of neuronopathic form with impossible walking after 12 years were the main predictors of the fatal outcome.

Background: Point-of-care ultrasound (POCUS) is the use of portable ultrasound devices by trained healthcare professionals to diagnose and monitor medical conditions directly at the patient's bedside, such as in emergency settings. We described a case where POCUS use, in Pediatric Emergency Department, allowed an early diagnosis and timely management in the surgical department, with a favorable outcome for child. Therefore we write this case because it is desirable to popularize ultrasound as the fifth pillar of clinical examination especially in Emergency Department.

Case summary: A 13-year-old girl with acute gastrointestinal symptoms, such as vomit and abdominal and lumbar pains. Upon physical examination, the patient had localized abdominal pain in the left lower quadrant. Ultrasonography performed at the bedside revealed an enlarged left ovary with an irregular structure containing a 3 cm cyst. These findings raised suspicion of ovarian torsion. The child transferred to Gynecology Surgery Unit, where she was taken emergently to the operating room.

Conclusion: It is desirable to spread POCUS in emergency settings where it allows a significant saving of time in patient management.

Background: Measles is a highly contagious disease that caused by a measles virus. While measles vaccination is highly effective in preventing the disease, those who are unvaccinated or have not completed the vaccine series are at significant risk.

Aim: To assess the clinical characteristics and outcomes of measles in vaccinated vs unvaccinated children in Ramadi city.

Methods: Clinically confirmed cases of measles at Al-Ramadi Teaching Hospital for Maternity and Children, identified between June and December 2023, were enrolled in this prospective cohort study. The cases were divided into two groups (vaccinated and unvaccinated). The clinical characteristics and outcomes were compared between unvaccinated and vaccinated children.

Results: Of 289 kids, there were 222 (76.8%) children under 5 years old, and 161 (55.7%) boys. Around 2/3^rd children were unvaccinated. Besides, only 5 (4.9%) kids from the vaccinated group received three doses. Fever, maculopapular rashes, and cough were the most common manifestations. Unvaccinated children had higher rate of developing complications (pneumonia and diarrhea with P values 0.001 and 0.01 respectively), longer hospital admission period (P value = 0.008), and the need for respiratory care unit (RCU) admission comparing with the vaccinated children (4 cases for unvaccinated group vs 1 case for vaccinated group).

Conclusion: Unvaccinated kids were associated with more complications, longer admission hospital stays, and RCU admission. We recommend that public health directors utilize artificial intelligence tools to help control future measles epidemics.