World journal of clinical pediatrics最新文献

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.

Background: Congenital hypothyroidism (CH) is a prevalent childhood endocrine disorder associated with irreversible neurological consequences. Its global incidence is on the rise.

Aim: To estimate CH incidence in Jordan and assess the potential utility of incorporating (fT4) measurements into the screening process.

Methods: This retrospective analysis examined thyroid function test results for infants born at our center between 2016 and 2020. Infants born before 28 weeks and those screened after 14 days of life were excluded. Screening occurred between days 3 and 7 of life, and thyroid-stimulating hormone (TSH) and T4 levels were measured concurrently from peripheral venipuncture blood samples. A TSH cutoff of < 5 mIU/L was considered normal. Values between 5 and 20 mIU/L were equivocal, requiring repeat tests. TSH levels exceeding 20 mIU/L were considered critical.

Results: A total of 10521 infants were included in the study, and 26 were diagnosed with CH, yielding an incidence of 1 in 400 live births. Females constituted 57.7% of CH cases. All CH cases had initial TSH values exceeding 5.0 mIU/L, with clustering above 20 mIU/L. Six CH infants had Down syndrome, accounting for 23.1% of CH cases.

Conclusion: Our study revealed a high incidence of CH in Jordan, marking a significant increase from previously reported rates. We recommend a national study to investigate risk factors and underlying causes of CH in our population. Furthermore, we advocate for the use of TSH alone with a cutoff value of < 5 mIU/L for screening purposes.

Background: Transition is a critical period for adolescents as they begin to assume responsibility for their own health. Similarly, the shift from pediatric to adult healthcare represents a vulnerable phase, marked by unique challenges in adolescent health care. Despite its importance, only a few studies have explored healthcare transition among adolescents in Uganda.

Aim: To identify factors associated with the transition to adult human immunodeficiency virus (HIV)-centered care among adolescents attending HIV/AIDS clinics in Uganda.

Methods: A cross-sectional mixed-methods study was conducted among 265 adolescents, randomly selected from three antiretroviral therapy (ART) clinics, using a structured questionnaire. Focus group discussions and key informant interviews were conducted. Individuals aged 10-20 years who were actively enrolled in the ART program between January 4, 2022 and January 30, 2023 were recruited. The primary outcome of interest was the transition to adult care. Bivariate and multivariate analyses were performed for quantitative data, while content analysis was used to analyze qualitative data.

Results: The prevalence of transition to adult care was 40.6%. Most participants were male (53.6%) and fell within the 13-15 age group (35.6%). Multivariate logistic regression analysis identified several factors significantly associated with transition to adult care: Age group 10-12 years [prevalence ratio (PR) = 2.525, 95%CI: 2.121-2.944, P = 0.002], Age group 13-15 years (PR = 1.900, 95%CI: 1.196-3.416, P = 0.001), successful viral load suppression (PR = 1.534, 95%CI: 1.173-1.648, P = 0.016), disclosure of HIV status to relatives (PR = 5.001, 95%CI: 3.411-3.611, P = 0.000), being prepared for transitioning (PR = 5.417, 95%CI: 3.468-7.135, P = 0.041) and having skilled pediatric caregivers (PR = 3.724, 95%CI: 2.084-4.105, P = 0.005).

Conclusion: Transition to adult care among adolescents was low. Improving transition outcomes may require strengthening individual support within the family context and integrating transition-focused care into existing specialized clinical settings to enhance the delivery of adolescent-friendly services.

Vitamin D, beyond its classical role in calcium homeostasis, has emerged as a key regulator of immune function and epithelial barrier integrity. Its deficiency during early childhood-a critical period for immune maturation-has been increasingly implicated in the development of atopic diseases. While extensively studied in asthma, its role in non-respiratory allergic conditions such as atopic dermatitis (AD) and allergic rhinitis (AR) remains comparatively underexplored. This minireview synthesizes current mechanistic and clinical evidence on vitamin D in pediatric AD and AR. In AD, vitamin D promotes epidermal barrier function through upregulation of filaggrin and ceramide synthesis, and enhances antimicrobial defense via induction of antimicrobial peptides. Observational studies consistently report lower serum 25-hydroxyvitamin D in affected children, particularly those with allergic sensitization. Select randomized controlled trials suggest clinical improvement with supplementation, especially at doses > 2000 IU/day in deficient individuals. In AR, epidemiological data indicate stronger inverse associations with seasonal (pollen-induced) disease. Proposed mechanisms include modulation of dendritic cells, regulatory T cells, T helper 2 cytokines, and mucosal barrier integrity. The shared immunopathogenesis of AD and AR underscores vitamin D's relevance. Although promising, clinical evidence remains heterogeneous. Future research should prioritize phenotype-stratified trials to clarify optimal dosing, timing, and individual response determinants, including genetics and microbiome composition.

The significance of gut microbiota (GM) in human health is being increasingly researched. An imbalance in GM composition, known as dysbiosis, is linked to various and other health issues. In addition, antibiotics are the primary and most significant factors leading to major changes in the composition and function of the GM, which may result in colonization by antimicrobial-resistant (AMR) pathogens. Therefore, alternative antibiotic strategies for combating AMR pathogens are urgently needed. This narrative review highlights current knowledge regarding various pertinent strategies for decolonizing bacterial pathogens from GM and emphasizes decolonization therapies' critical role in pediatric surgical disorders. Strategies such as decontamination of the digestive tract utilizing antibiotics, the use of probiotics, and particularly fecal microbiota transplantation have introduced new options for clinical treatment. These treatments show the potential to restore GM balance and have demonstrated advantages for intestinal disorders related to pediatric surgery, including inflammatory bowel disease, neonatal necrotizing enterocolitis, Hirschsprung-associated enterocolitis, and short bowel syndrome. Despite GM therapeutics, recent strategies are still in their developmental phase and exhibit challenges that need further research. Thus, potential future directions for GM-targeted decolonization therapies are under consideration. Innovative alternative strategies to combat AMR though GM modulation in disorders related to pediatric surgery appear to be promising and should continue to be prioritized for further research and development.

Background: Roberts syndrome (RS) is a rare autosomal recessive cohesinopathy caused by biallelic mutations in ESCO2, essential for sister chromatid cohesion and genomic stability. Clinically, RS manifests as severe pre- and postnatal growth restriction, tetraphocomelia, craniofacial anomalies, and variable visceral organ malformations. Prenatal suspicion is often raised by ultrasonographic evidence of limb reduction and fetal hypotrophy. However, diagnosis remains elusive without molecular confirmation. This case underscores the diagnostic and prognostic value of next-generation sequencing in suspected RS, particularly within consanguineous populations where autosomal recessive conditions are more prevalent.

Case summary: A four-month-old male infant, born to consanguineous parents, was referred for evaluation of multiple congenital anomalies. Prenatal ultrasonography demonstrated significant intrauterine growth restriction, bilateral upper limb absence of radius and ulna at 22 weeks, and unilateral renal pelvis dilation at 38 weeks. Postnatal findings included bilateral phocomelia, thumb aplasia, and flexion contractures at the elbows and knees. Physical examination revealed features consistent with cohesinopathy. Whole exome sequencing identified a homozygous pathogenic variant in ESCO2, confirming RS. Multisystemic involvement warranted early multidisciplinary coordination and genetic counseling for recurrence risk.

Conclusion: This case supports redefining isolated limb anomalies as early indicators warranting targeted prenatal genetic screening for cohesinopathies like RS.