World journal of clinical pediatrics最新文献

Vitamin D deficiency is disproportionately prevalent among overweight and obese children, with conventional explanations such as poor dietary intake or reduced sun exposure offering only partial insight. Emerging evidence reveals a multifactorial pathophysiology, including sequestration of vitamin D in adipose tissue, altered hepatic metabolism, diminished bioavailability, and inflammation-induced resistance at the tissue level. These mechanisms contribute to a functional deficiency, wherein serum 25-hydroxyvitamin D levels may remain suboptimal despite adequate intake or sun exposure. Obesity-related alterations in vitamin D-binding proteins, receptor expression, and pro-inflammatory signaling further compromise biological activity. Current diagnostic criteria and supplementation guidelines do not fully reflect these physiological complexities, leading to underdiagnosis and insufficient treatment. Personalized approaches-incorporating higher, body composition-adjusted dosing and consideration of inflammatory status-are emerging as promising strategies to restore sufficiency and improve metabolic outcomes. While preliminary evidence supports the safety and efficacy of high-dose supplementation in this population, pediatric-specific clinical trials are lacking. This review synthesizes current understanding of the pathophysiological mechanisms underlying vitamin D deficiency in pediatric obesity and emphasizes the need for individualized, evidence-based interventions to optimize vitamin D status and overall health.

Autism is a heterogeneous condition with a rising prevalence and demand for specialized care. Autistic children are more likely than neurotypical peers to experience co-occurring conditions (CCs), including medical, psychiatric, and behavioral issues, highlighting the urgent need for autism-competent healthcare providers in general healthcare. This review aims to equip primary care providers (PCPs) with a concise summary of common CCs and strategies for effective identification. A panel of experts with extensive experience in caring for autistic children collaboratively summarized key literature, research evidence, and existing clinical trial outcomes, supplementing their clinical expertise. Autistic children consistently show higher rates of both medical and mental health issues. Despite greater healthcare utilization, many autistic individuals report unmet needs. CCs can impair behavior, functioning, and well-being, but are often treatable when recognized early. Timely identification and management of medical and psychiatric CCs are critical for improving outcomes for autistic children and their families. This evidence-based review supports PCPs in enhancing their knowledge, fostering early recognition, and delivering comprehensive, responsive care.

In pediatric patients, gallbladder polyps (GBPs) are lesions that are usually found incidentally on ultrasonography, which is the first-line modality for diagnosis. Though common in adults, GBPs are rare in children, and their prevalence remains unclear. Most GBPs in children are benign, and although the risk of malignancy is influenced by polyp size, growth rate, and morphology, specific criteria for the pediatric population are lacking. Management, therefore, is based on adult guidelines, with cholecystectomy being recommended only in symptomatic patients and for rapidly enlarging or 10-mm polyps and those with unfavorable morphology to avert the risk of malignant transformation, while surveillance is applied to asymptomatic patients with smaller polyps. Further research is needed to develop pediatric-specific guidelines for the management of GBPs. This review discusses the classification, diagnosis, risk factors, and management of pediatric GBPs.

Background: In our day-to-day practice, constipation is a common problem in the pediatric population and cause of frequent visit in outpatient and emergency department. But occult constipation (OC) remains as the most unaddressed problem.

Aim: To investigate the clinical profile of OC in children.

Methods: It was a prospective observational study, done in Bangladesh from January 2022 to December 2024. It included all consecutive children diagnosed as OC and were treated accordingly. Before diagnosis, secondary causes of the presenting symptoms were excluded with appropriate investigations. They were followed up monthly for 4 months and treatment response were measured by improvement of symptoms.

Results: A total of 404 children were included in this study with mean age group of 76.50 ± 36.62 months, and male-female ratio of 1.67:1. The most common presenting complaint was abdominal pain (66%), followed by anorexia (49%), vomiting (24%), nausea (17%), frequent defecation with small volume stool (17%), altered bowel habit (16%), failure to thrive (14%) and recurrent helminthiasis (12%). Interestingly, 2.5% children presented with persistent diarrhea.

Conclusion: Abdominal pain is the most common presentation of OC. When symptoms cannot be explained by other etiology, OC should be kept in mind.

Chronic pancreatitis (CP) is no longer considered a disease of adults alone; it is increasingly being recognized in children as well. It is a chronic inflammatory condition of the pancreas that can lead to exocrine and endocrine insufficiency over time. The clinical aspects and medical management of pediatric CP are often discussed; however, its impact on the quality of life (QOL) remains largely unaddressed in routine clinical care. The review focus on physical, emotional, educational, and social challenges experienced by children with CP and their families. Pain-related disability, frequent hospitalizations, and the risk of developing exocrine and endocrine insufficiency significantly affect daily functioning and mental well-being. Therefore, improving QOL in children with CP requires a multidisciplinary care strategy, including effective pain management, nutritional optimization, and psychological support.

Adolescent type 2 diabetes mellitus (T2DM) is on the rise in India and is commonly attributed to co-existence of overweight and obesity in adolescents. In this line, a study by Maheshwari et al titled 'Prevalence of obesity, determinants, and its association with hyperglycaemia among community dwelling older adolescents in India' concluded that overweight, obesity, socioeconomic factors and higher education status were responsible for hyperglycemia in adolescents aged 15-19 years in India. We highlight that there is a significant prevalence of T2DM even in normal body mass index (BMI) and below normal BMI subjects, as mentioned in their study. There is a high prevalence of normal weight obesity in Indian adolescents which often gets missed due to a large population with normal BMI in the country. In this letter, we analyze the importance of measurement of central adiposity beyond routine BMI measurements.

Background: The reference ranges for biochemical parameters can fluctuate due to factors like altitude, age, gender, and socioeconomic conditions. These values are crucial for interpreting laboratory data and guide clinical treatment decisions. Currently, there is no established set of reference intervals for cord blood biochemical parameters of newborns in India, particularly in Mumbai.

Aim: To create cord blood biochemical parameters reference intervals specifically for Mumbai, India.

Methods: A cross-sectional study was conducted in an Indian tertiary care hospital. This study focused on healthy newborns with normal birth weight, born to pregnant mothers without health issues. Cord blood samples, approximately 2-3 mL in volume, were collected from 210 term neonates. These samples were divided into fluoride (glucose) and clot activator (serum) tubes and were subsequently analyzed in the institute's biochemical laboratory. The data obtained from the analysis was then subjected to statistical analysis. The result of the Shapiro-Wilk test suggested non-normality in the data distribution. Consequently, non-parametric statistics were utilized for analysis. The Mann-Whitney U test was utilized to compare parameter distributions among different factors, including the infant's sex, delivery method, maternal age, and obstetric history. A significance level of P < 0.05 was considered to indicate statistical significance.

Results: The following represent the median figures and central 95 percentile reference intervals for biochemical parameters in umbilical cord blood of newborns: Serum direct bilirubin = (0.1-0.55) mg/dL, indirect bilirubin = (0.64-2.26) mg/dL, total bilirubin = (0.62-3.14) mg/dL, creatinine = (0.27-0.76) mg/dL, sodium = (128.19-143.26) mmol/L, chloride = (100.19-111.68) mmol/L, potassium = (1.62-9.98) mmol/L and plasma glucose = (24.75-94.23) mg/dL. Statistically significant differences were observed in serum sodium, potassium, and plasma glucose levels when comparing delivery modes.

Conclusion: This is the pioneering study in which first time, the biochemical reference intervals in cord blood for newborns are established in western India. The values are applicable for newborns from this area. Larger study throughout the country is required.

Background: Childhood nephrotic syndrome (NS) outcomes vary widely based on steroid responsiveness and complications.

Aim: To evaluate steroid response, outcomes, and the use of steroid-sparing medications in children with nephrotic syndrome in Jordan.

Methods: This retrospective study evaluated the demographics and outcomes of 122 children aged 1-18 years with NS between 2011 and 2021 across three centers in Jordan. The outcomes assessed included steroid sensitivity rates, dependence, frequent relapses, complications [chronic kidney disease (CKD), end-stage kidney disease (ESKD)], infections, and need for steroid-sparing treatment.

Results: Of 64% were boys; median age of disease onset was 4 years. Steroid-sensitive and steroid-resistant NS (SRNS) were observed in 81.1% and 18.9% of patients, respectively; 28.7% and 9% had steroid-dependent and frequently relapsing NS, respectively. Kidney biopsies were conducted in 46.7%, the most common finding was minimal change disease in 56.1%; 82.6% of biopsied SRNS cases showed focal segmental glomerulosclerosis. The median time to first relapse was 9 months. 41.8% of patients required steroid-sparing medications, with cyclosporine and mycophenolate mofetil being the most frequently used. Despite these treatments, relapse occurred in 11.5% of cases. Infections, primarily urinary tract infections, affected 24.6% of patients, 7.4% progressed to high-grade CKD, and 6.6% required dialysis. SRNS was significantly associated with hematuria, hypertension, and ESKD.

Conclusion: Most patients were steroid sensitive, with minimal change being the most common. Focal segmental glomerulosclerosis was the predominant histopathology in the steroid-resistant cases. SRNS patients had worse outcomes, with more infections, CKD, and ESKD.

Background: Unintended pregnancy occurs when an individual or couple conceives without planning or desire, which can potentially affect a child's physical, mental, and social well-being. This can then lead to long-term socioeconomic challenges for families and communities. Although its impact on child growth and development is a pressing concern, research remains limited particularly in multicenter settings.

Aim: To examine the long-term consequences of unintended pregnancy on the critical years of early childhood growth and development.

Methods: This analytical observational study employed a case-control design and was conducted in research centers across Indonesia, encompassing those located in Central Java, Lampung, Bali, and West Nusa Tenggara. A total of 700 children aged ≤ 5 years with histories of intended or unintended pregnancies participated. Data collection involved structured interviews and direct anthropometric and developmental assessments. Data analyses were conducted using multivariate statistics and partial least squares structural equation modeling.

Results: Unintended pregnancy was found to have a statistically significant effect on both child growth (t = 8.178; P < 0.001) and child development (t = 25.688; P < 0.001). Key growth problems identified included underweight, undernutrition, abnormal head circumference, and stunting. Developmental challenges prominently associated with unintended pregnancy included behavioral and emotional disorders, autism spectrum disorder, attention-deficit/hyperactivity disorder, social and motor skill deficits, as well as visual and hearing impairments.

Conclusion: Unintended pregnancy significantly affects child growth and development, underscoring the need for early intervention, quality prenatal care, and strengthened family planning policies.