World journal of clinical pediatrics最新文献

Background: Parental presence in neonatal units (NUs) is essential for infant development and family well-being. A deeper understanding of the factors influencing parental presence is vital and will contribute to the development of targeted interventions and policies that enhance parental engagement in neonatal care, thereby improving outcomes for infants and their families.

Aim: To identify and analyze primary factors influencing parental involvement in their child's care in a neonatal intensive care unit (NICU).

Methods: A literature search was conducted using the PubMed, MEDLINE, and Cochrane Library for systematic reviews databases, with the following search terms: "parental presence neonatology", "couplet care", "zero separation neonatal care", "family integrated care", "couplet care intervention", "mother-child separation", "parents newborn togetherness", "mother-baby care", "closeness and separation NICU", "mother-infant interaction NICU", "kangaroo care", "dyad mother-infant", and "newborn integrated care". The database search for this literature review began on December 10, 2024, with the final search conducted on April 10, 2025.

Results: The literature search yielded 281 articles, out of which 23 were selected for a detailed review. The factors associated with parental presence in NUs were grouped into five main categories: Parents' socio-demographic and cultural traits; the physical layout and care model of the NUs; the quality of parents' relationships with the healthcare staff; their active involvement in neonatal care; and the newborn's health status.

Conclusion: The identification of factors that affect parental presence in NUs is critical for developing effective strategies aimed at encouraging increased parental involvement and ultimately improving neonatal and family outcomes.

Background: The management of immature permanent teeth with open apices in pediatric patients presents unique challenges, particularly in cases of nonvital pulp. Modern advancements in materials and techniques have significantly improved the predictability and success of apexification procedures. In this case, a 16-year-old patient presented with an immature necrotic tooth requiring apexification. Contemporary approaches incorporate calcium silicate-based materials such as mineral trioxide aggregate (MTA), Biodentine, and bioceramic putty, along with bioceramic sealers and enhanced canal cleaning including internal heating and ultrasonic activation with sodium hypochlorite (NaOCl) for disinfection, and sealing. Additionally, magnification tools such as dental operating microscopes ensure precise visualization for accurate material placement, while a micro-apical placement (MAP) system guarantees void-free MTA delivery. These advancements improve procedural outcomes and minimize the risk of iatrogenic errors, making apexification a more predictable and reliable treatment option in pediatric patients with immature teeth.

Case summary: A 16-year-old patient presented with a nonvital maxillary central incisor with an open apex, secondary to trauma. Due to the lack of apical closure, traditional root canal obturation was not feasible. Apexification was chosen as the treatment modality to induce the formation of a calcified apical barrier, allowing for proper root canal sealing. Historically, calcium hydroxide was the material of choice for apexification, requiring multiple visits and prolonged treatment duration. However, the introduction of bioceramic materials such as MTA has revolutionized the procedure, offering superior outcomes with reduced treatment time. In this case, the apexification procedure involved thorough canal disinfection using NaOCl, enhanced by internal heating, ultrasonic activation, and double-sided vented needle irrigation. Under the dental operating microscope, MTA was precisely placed at the apex using a MAP system, ensuring a dense, void-free apical barrier. The remaining canal space was subsequently sealed with a bioceramic sealer to promote long-term stability and healing.

Conclusion: This case highlights the effectiveness of a modern approach for apexification in a pediatric patient. The use of advanced materials and techniques facilitated the formation of a stable apical barrier, ensuring long-term tooth retention and function. By incorporating precise irrigation protocols, internal heating, ultrasonic activation, and magnification tools, the treatment achieved thorough disinfection and optimal material placement. These advancements make apexification a predictable and reliable treatment option for young patients with immature necrotic teeth, preserving their natural dentition and preventing future complications.

Background: Uveitis associated with juvenile idiopathic arthritis (U-JIA) is a vision-threatening condition. Estimates of prevalence of uveitis in patients with known juvenile idiopathic arthritis range from 11.6% to 30.0%. First-line treatment includes topical glucocorticoids; methotrexate (MTX) is used if topical corticosteroids are ineffective. In severe cases biological therapy like adalimumab may be prescribed. Complications, including vision loss, may be related to the disease and the ongoing treatment (topical corticosteroids). In severe cases surgical intervention is often necessary and is typically associated with poor vision outcomes.

Aim: To highlight the characteristics of operated U-JIA and to identify predictors of treatment failure.

Methods: A retrospective cohort study analyzed data from 68 pediatric patients (under 18 years old) with U-JIA between 2007 and 2023. The study focused on demographic, clinical, treatment, and outcome variables. Survival analysis using Kaplan-Meier curves and the Cox proportional hazards model was performed to estimate the impact of surgical intervention on the course of uveitis and to identify predictors of treatment failure.

Results: Eye surgery was performed on 17 (25%) patients with U-JIA. It was associated with an earlier onset of uveitis (P = 0.017), lower uveitis remission rate [odds ratio = 5.29, 95% confidence interval (CI): 1.23-24.90, P = 0.015], longer time to remission (P = 0.036), reduced probability of achieving remission on MTX (P = 0.033), and the necessity of the following treatment with biological disease-modifying antirheumatic drugs (odds ratio = 5.60; 95%CI: 1.11-55.19, P = 0.021) with similar efficacy with biological treatments in operated and non-operated cases. Kaplan-Meier curves showed a borderline difference in time to surgical intervention based on the MTX initiation cutoff (P = 0.065) although earlier MTX initiation might be associated with a higher likelihood of deferred surgery.

Conclusion: Operated patients exhibited an aggressive early-onset uveitis profile that needed early and more intensive treatment. Delayed and failed MTX treatment as well as delayed switching to biologics often required subsequent eye surgery.

Background: Pediatric candiduria is a frequently overlooked manifestation of healthcare-associated fungal infections. Candida species are increasingly being identified in the urine of neonates and infants, with non-albicans Candida (NAC) species being more prevalent than Candida albicans.

Aim: To determine the rate of Candida species isolation among pediatric patients with suspected urinary tract infections (UTI) at a tertiary care hospital.

Methods: A total of 436 children with a clinical suspicion of UTI were enrolled in this laboratory-based descriptive observational study. The samples were then subjected to urine mounting and subcultured on Sabouraud dextrose agar. Candida isolates were identified based on the color of the colonies on CHROM agar, Dalmau plate culture, and germ tube formation. The results were confirmed by matrix-assisted laser desorption ionization-time of flight mass spectrometry, followed by Antifungal susceptibility testing using Vitek^® 2 AST-YS07 cards.

Results: A total of 79 Candida isolates (18.12%) were identified. Of these, 39 (49.37%) were neonates, with a male-to-female ratio of 3.39:1. The intensive care unit (ICU) recorded 52 patients (65.82%). Of the 79 patients, 57 (72.15%) received broad-spectrum antibiotics for more than 7 days. Our study revealed a higher prevalence of NAC species, with Candida tropicalis accounting for 34 cases (43.04%). Amphotericin B showed the highest susceptibility, with 68 isolates (86.08%) being susceptible to this Antifungal agent.

Conclusion: Pediatric patients with Candiduria present atypical and vague symptoms. This may be the initial symptom of disseminated Candidiasis in the presence of predisposing factors. Isolation of these pathogens, along with their Antifungal susceptibility patterns, aids in a better prognosis.

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders of childhood, yet its diagnosis remains complex and fraught with challenges. Pediatricians, often the first point of contact for concerned families, play a pivotal role in the diagnostic process. However, they face numerous obstacles that can hinder accurate and timely diagnosis, particularly in resource-limited or culturally diverse settings such as the Middle East and North Africa (MENA) and Arabian Gulf regions. This narrative review explores the key challenges pediatricians face in diagnosing ADHD and highlights practical and emerging solutions. The article offers both a global perspective and a contextualized view relevant to the MENA region. A narrative literature review was conducted using PubMed, Scopus, and Google Scholar, focusing on peer-reviewed studies, clinical guidelines, and epidemiological data from 2010 to 2025 related to pediatric ADHD diagnosis, especially in MENA regions. The review identifies six major diagnostic barriers: (1) Symptom overlap with other conditions [e.g., autism spectrum disorder (ASD), anxiety, learning disabilities]; (2) Reliance on subjective informant reports; (3) Cultural and societal influences including stigma and gender bias; (4) Variability in ADHD training and time constraints in clinical practice; (5) Limited access to multidisciplinary evaluations; and (6) Systemic referral and communication inefficiencies. Comorbidities are highly prevalent and frequently complicate the diagnostic picture. Delayed or inaccurate diagnosis can lead to academic underperformance, family stress, missed interventions, and long-term psychological consequences. Emerging solutions include digital screening tools, artificial intelligence-assisted analysis, structured reporting platforms, and improved training and referral models. Regional data from the Arabian Gulf highlight variable prevalence rates (1.3%-22%) and underscore the need for culturally sensitive diagnostic strategies. To improve diagnostic accuracy and patient outcomes, pediatricians must be supported through better training, interdisciplinary collaboration, validated tools, and policy-level reforms. Tailoring these approaches to local contexts will be key to addressing the growing burden of ADHD, particularly in the MENA region.

Background: A diagnosis of a chronic disease has been shown to predispose patients to the development of feeding and eating disorders (FEDs).

Aim: To screen children and adolescents with type 1 diabetes mellitus (T1DM) for FEDs and compare them to their counterparts with short stature.

Methods: A total of 110 children and adolescents (55 with T1DM and 55 with short stature) were enrolled in the study. The SCOFF questionnaire was used to screen for possible FEDs, while anthropometric and dietary data were also collected.

Results: Approximately 60% of the children with T1DM screened positive for FEDs compared to 30.9% of the children with short stature. Having a T1DM tripled the chances of screening positive for FEDs and halved the annual growth rate of children with T1DM. No differences were noted in the dietary intake between groups.

Conclusion: The results necessitate the education of pediatric endocrinologists and diabetologists on proper screening and identification of children at risk for developing FEDs. A prompt diagnosis might help children catch up growth and attain their genetically predisposed height.

Background: Neonatal sepsis is a serious health problem, with high morbidity and mortality during the first 28 days of life. Clinical diagnosis at presentation is challenging due to the nonspecific signs and symptoms. Although blood culture is the gold standard for diagnosis, it is not always positive.

Aim: To evaluate the diagnostic and prognostic utility of D-dimer and heparin-binding protein (HBP) in neonatal sepsis.

Methods: This prospective case-control study included 90 neonates in two groups: A sepsis group (n = 45) and a control group (n = 45) without sepsis. Sepsis group was further subdivided based on blood culture results into proven sepsis (n = 28 culture-positive sepsis) and suspected sepsis (n = 17 culture-negative sepsis). All neonates underwent complete history taking, thorough clinical examination and investigations [complete blood count, C-reactive protein (CRP), liver and kidney function tests, plasma D-dimer and HBP].

Results: Levels of CRP, D-dimer and HBP were significantly higher in the sepsis group compared to the controls. At a cutoff value above 517.9 ng/mL, D-dimer outperformed CRP and HBP in distinguishing sepsis group from controls with 95.6% sensitivity and 97.8% specificity. D-dimer was also a better prognostic marker than the neonatal sequential organ failure assessment (nSOFA) for predicting mortality, with 100% sensitivity and 92.5% specificity vs 80% sensitivity and 82.5% specificity. There was a significant positive correlation between CRP, D-dimer and HBP.

Conclusion: D-dimer demonstrated superior diagnostic accuracy compared to CRP and HBP in predicting sepsis, and demonstrated superior prognostic accuracy compared to nSOFA in predicting the outcome of neonatal sepsis.

Background: Acute respiratory infections (ARI) and diarrhoea are among the leading causes of infant and under-five mortality worldwide. Zinc, the second most abundant trace element in the human body, is widely used in the treatment of both conditions. It mitigates diarrhoea by restoring mucosal integrity and enhancing enterocyte brush border enzyme activity. In ARI, zinc boosts immune function, promotes epithelial regeneration, and inhibits the replication of respiratory viruses.

Aim: To assess the effectiveness of prophylactic intermittent zinc supplementation in preventing acute diarrhoea and ARI in infants.

Methods: This open-label, randomized controlled trial with a 1:1 allocation ratio was conducted over 15 months (October 2022 to December 2023) at a tertiary care hospital in Eastern India. A total of 320 infants attending the outpatient department for routine vaccinations were enrolled and randomly assigned to intervention and control groups. The intervention group received zinc drops for two weeks, with the regimen repeated one month later and again at six months during subsequent vaccination visits. The control group received no placebo or alternative treatment. Outcomes were assessed after the final follow-up at nine months.

Results: The mean annual incidence of ARI and diarrhoea was significantly lower in the zinc group than in the control group [ARI: 0.25 ± 0.61 vs 0.92 ± 1.22; mean difference = -0.67 (95%CI: -0.88 to -0.45), P < 0.001, Cohen's d = -0.69] and [diarrhoea: 1.04 ± 1.30 vs 2.07 ± 2.09; mean difference = -1.03 (95%CI: -1.42 to -0.65), P < 0.001, Cohen's d = -0.59], respectively. Additionally, the zinc group showed significantly greater gains in length [10 ± 0.6 cm vs 8.6 ± 0.4 cm; mean difference = 1.4 (95%CI: 1.3-1.5), P < 0.001, Cohen's d = 2.74] and weight [3150 ± 108 g vs 2818 ± 76 g; mean difference = 332 (95%CI: 310-352), P < 0.001, Cohen's d = 3.56].

Conclusion: Prophylactic intermittent zinc supplementation administered alongside routine immunization substantially reduces the incidence of ARI and diarrhoea in infants and promotes improved growth. This affordable strategy holds promise for reducing infant morbidity and mortality without increasing healthcare burdens.

Background: Hyponatremia is a prevalent and serious electrolyte imbalance in pediatric pneumonia and is linked to increased disease severity and adverse outcomes. Oral rehydration solution (ORS) is an available, inexpensive, safe, and ready-to-use oral solution that can supplement sodium in such cases.

Aim: To assess the impact of prophylactic sodium supplementation via ORS on clinical and hospital outcomes in infants and children admitted with pneumonia.

Methods: A randomized, interventional controlled trial was conducted on 140 infants and children admitted with pneumonia (70 per group). The primary outcome was hospital length of stay, with secondary outcomes including serum sodium and potassium levels, clinical respiratory scores, modified shock index, and nutritional/inflammatory markers. The hospital length of stay and both the laboratory and clinical parameters of the interventional and control groups were compared.

Results: The hospital stay was longer in the control group than in the intervention group (P value = 0.001; effect size = 0.59). Clinical respiratory scores on day 4 were significantly lower in the intervention group than in the control group (P value = 0.001). Sodium levels were significantly lower in the control group than in the intervention group at discharge (P value = 0.002).

Conclusion: Prophylactic oral sodium supplementation through ORS may have a health-promoting effect on infants and children admitted with pneumonia.