World journal of clinical pediatrics最新文献

This mini-review explores the transformative potential of artificial intelligence (AI) in improving the diagnosis, management, and long-term care of congenital heart diseases (CHDs). AI offers significant advancements across the spectrum of CHD care, from prenatal screening to postnatal management and long-term monitoring. Using AI algorithms, enhanced fetal echocardiography, and genetic tests improves prenatal diagnosis and risk stratification. Postnatally, AI revolutionizes diagnostic imaging analysis, providing more accurate and efficient identification of CHD subtypes and severity. Compared with traditional methods, advanced signal processing techniques enable a more precise assessment of hemodynamic parameters. AI-driven decision support systems tailor treatment strategies, thereby optimizing therapeutic interventions and predicting patient outcomes with greater accuracy. This personalized approach leads to better clinical outcomes and reduced morbidity. Furthermore, AI-enabled remote monitoring and wearable devices facilitate ongoing surveillance, thereby enabling early detection of complications and provision of prompt interventions. This continuous monitoring is crucial in the immediate postoperative period and throughout the patient's life. Despite the immense potential of AI, challenges remain. These include the need for standardized datasets, the development of transparent and understandable AI algorithms, ethical considerations, and seamless integration into existing clinical workflows. Overcoming these obstacles through collaborative data sharing and responsible implementation will unlock the full potential of AI to improve the lives of patients with CHD, ultimately leading to better patient outcomes and improved quality of life.

Background: Disorders of gut-brain interaction (DGBI) are defined as a variable combination of chronic or recurrent gastrointestinal symptoms. Early-life stressors have been implicated as possible contributing factors.

Aim: To determine if prematurity and neonatal factors influence the development of DGBI in adults.

Methods: A case-control study was carried out at a tertiary referral center from July 2019 to July 2021. Cases (adults born with extremely premature < 29 weeks of gestation) were recruited from the Health of Adults Born Preterm Investigation cohort. Control subjects were recruited from the general population. All participants completed the Rome IV diagnostic questionnaire online. Cases completed anxiety and depression questionnaires (Patient-Reported Outcomes Measurement Information System-29 items, Generalized Anxiety Disorder-7 items, Patient Health Questionnaire-9 items). Neonatal data and sociodemographic status were collected.

Results: A total of 79 cases and 124 controls were enrolled in the study. The group of adults born preterm exhibited a significantly higher prevalence of functional bowel disorders (P = 0.01) and a trend suggesting a higher prevalence of functional gastroduodenal disorders (P = 0.06). Among women born prematurely, the prevalence of functional gastroduodenal disorders, functional bowel disorders, and functional constipation was significantly higher compared to the female control group (P = 0.02 for all). The identified risk factors are categorized as directly linked to prematurity (e.g., chorioamnionitis), indirectly related to prematurity (e.g., anxiety, depression, and social skills as consequences of prematurity), or independent of prematurity (e.g., female sex).

Conclusion: This is the first case-control study reporting the prevalence of DGBI in a cohort of well-characterized adults born prematurely. We confirm that prematurity is a risk factor for developing a DGBI.

Cow milk protein allergy (CMPA) is a prevalent food allergy in infancy. It often presents with symptoms that overlap with other conditions, such as gastroesophageal reflux disease, lactose intolerance, food protein-induced enterocolitis syndrome, and eosinophilic esophagitis. This diagnostic overlap makes distinguishing CMPA from its mimics difficult, resulting in potential misdiagnoses and unnecessary dietary restrictions. This review aims to comprehensively analyze CMPA and its mimicking conditions, highlighting their clinical presentations, diagnostic approaches, and management strategies to enhance diagnostic accuracy and optimize patient care. A systematic literature search was conducted using PubMed, Scopus, Web of Science, and Google Scholar, focusing on studies published within the last 20 years. Articles addressing CMPA and its mimicking conditions were selected, with data synthesized into comparative analyses of diagnostic methods and management strategies. Accurate differentiation between CMPA and its mimics requires a thorough clinical evaluation supported by diagnostic tests such as skin prick tests, serum-specific IgE, and oral food challenges. Misdiagnosis can lead to nutritional deficiencies, psychological stress, and increased healthcare costs. Emerging diagnostic technologies, including component-resolved diagnostics and cytokine profiling, offer promising avenues for improving accuracy. A multidisciplinary approach involving pediatricians, allergists, and dietitians is essential for precise diagnosis and effective management. Ongoing research and education are crucial to enhancing clinical outcomes and reducing the burden on families.

Background: Eosinophilic gastrointestinal (GI) disease (EGID) beyond eosinophilic esophagitis is not commonly reported in the developing world.

Aim: To estimate the prevalence of EGID in a selected group of pediatric patients suffering from non-functional chronic abdominal pain (CAP).

Methods: A retrospective analysis was conducted on case records of children with CAP. Those exhibiting clinical or laboratory alarming features underwent endoscopic evaluation. Histopathology reports from upper GI endoscopy and ileo-colonoscopy determined the diagnosis of EGID. Subsequent analyses included clinical presentations, presence of atopy in the children or family, hemoglobin, albumin, serum immunoglobulin E (IgE), fecal calprotectin levels, endoscopic appearances, treatment methods, and outcomes.

Results: A total of 368 children with organic CAP were subjected to endoscopic evaluation. Among them, 19 (5.2%) patients with CAP were diagnosed with EGID. The median age of the children was 11.1 years (interquartile range = 8.4-14.4). The estimated prevalence of EGID in children with organic CAP was 520/10000 children over 5 years. Periumbilical pain was the most common site (63%). Family history of atopy, peripheral blood eosinophilia, and elevated serum IgE were the three parameters significantly associated with EGID. Clinical remission was obtained in all children at 6 months. The 47% had microscopic remission and maintained remission until a 1-year follow-up. The 53% had a fluctuating clinical course after 6 months.

Conclusion: EGID beyond the esophagus is not an uncommon entity among the children of India. It can contribute significantly to the etiology of pediatric CAP.

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.

Background: Phocomelia is a rare congenital disorder characterized by the absence or underdevelopment of the proximal limbs. Phocomelia can occur as a syndrome or a limb-specific deformity. While historically linked to thalidomide, non-thalidomide causes include genetic mutations, vascular disruptions, and teratogenic exposures. This case highlights the diagnostic and therapeutic challenges in a neonate with bilateral phocomelia, low birth weight, asphyxia and jaundice.

Case summary: We report a 2-week-old term neonate with bilateral phocomelia, micrognathia, jaundice, and low birth weight. The pregnancy was unremarkable, with no thalidomide exposure. The mother had a history of early pregnancy losses. Clinical evaluation revealed absent humeri and radii bilaterally, with hands attached proximally to the trunk. Genetic testing was not performed, limiting the identification of underlying etiology. The patient was managed with supportive care, parental counseling, and planning for long-term rehabilitation. This case underscores the importance of multidisciplinary care in managing congenital anomalies. Genetic evaluation is crucial in unexplained congenital anomalies. Routine detailed ultrasounds in high-risk pregnancies aid in early diagnosis and parental preparedness.

Conclusion: Bilateral phocomelia presents significant functional challenges. Comprehensive diagnostic workups and early rehabilitation strategies are essential for optimizing patient outcomes.