World journal of clinical pediatrics最新文献

Background: The prevalence of metabolic syndrome (MetS) in adolescents is rising, correlating with the global increase in obesity and physical inactivity.

Aim: To examine the individual and combined associations of fitness, fatness, visceral adiposity index (VAI), and lipid ratios with MetS risk in Nigerian adolescents.

Methods: This cross-sectional study included a sample of 403 adolescents (201 girls and 202 boys) aged 11-19 years. Participants were assessed for cardiorespiratory fitness, body mass index (BMI), VAI, triglyceride-to-high-density lipoprotein cholesterol ratio (TG/HDL-C), and total cholesterol-to-high-density lipoprotein cholesterol ratio (TC/HDL-C). Regression models adjusted for age and sexual maturity were used to determine the associations between these health markers and MetS risk.

Results: Among the 177 high-risk adolescents, 56.6% were at risk of central obesity, 49.1% had low fitness, 33.3% had dyslipidemia, and 11.7% were obese. After controlling for confounding variables, all health markers were independently and jointly associated with MetS risk, with VAI displaying the strongest explanatory power (girls: β = 1.308, P < 0.001; boys: β = 2.300, P < 0.001). Unfit girls were 5.1% more likely to be at risk of MetS, while the odds of unfit boys being at risk of MetS is 3.6. Boys with elevated VAI were 22.3 times more likely to be at risk of MetS, while the likelihood of girls with elevated VAI developing MetS risk is 2.78.

Conclusion: Health markers were independently and jointly associated with MetS risk in adolescents, with VAI and dyslipidemia contributing most significantly. Promoting healthy eating and also aerobic activities among adolescents is crucial for improving metabolic health.

Background: It is expected that transfer of spinal accessory nerve to suprascapular nerve, which is widely used in the restoration of the shoulder function in brachial plexus birth injury (BPBI), impairs the trapezius function.

Aim: To hypothesize that the lower trapezius muscle remains functional after this neve transfer.

Methods: In a retrospective cross-sectional study, patients with BPBI who underwent nerve transfer from accessory nerve to supraclavicular were followed for at least six months following the operation and demographic data were extracted from the database. To assess the lower trapezius function, shoulder abduction and external rotation were examined, and electromyography and nerve conduction velocity (EMG-NCV) was performed.

Results: A total of 19 patients with a mean age of 2.69 ± 1.40 years and a mean follow-up of 10.5 months were included in the study. Shoulder abduction was disabled completely only in one patient (5.26%); 10 (52.63%) had good, 3 (15.78%) moderate, and 5 (26.31%) had poor shoulder abduction. Regarding external rotation, one (5.26%) was unable to externally rotate the shoulder; among 18 (94.73%) patients who had satisfactory results, 8 (42.10%) were evaluated to be good, 5 (26.31%) moderate, and 5 (26.31%) poor. EMG-NCV showed functional lower trapezius in all patients; its function was evaluated to be good in 11 (57.89%), moderate in 6 (31.57%), and poor in 2 (10.52%) cases.

Conclusion: This study supports the hypothesis that the lower trapezius muscle has a dual motor innervation which provides the possibility of further trapezius tendon transfer to restore a better shoulder function.

Glycogen storage diseases (GSDs) are a group of inherited disorders caused by genetic defects in various enzymes involved in glycogen production or breakdown. Hepatic GSDs often have overlapping clinical features, making subtyping or prognostication difficult. With the availability and advancement of next-generation sequencing, definitive molecular diagnosis is now available for most patients, with newer variants being increasingly identified. Molecular diagnosis could help in systematic follow-up, anticipating complications and prognostications. However, the mutations reported in the published literature display wide variations across racial and geographical groups. Hence, natural history, long-term outcome, and genotype-phenotypic correlation studies in patients with various hepatic GSDs are needed for a deeper understanding. Considering the emerging evidence of genetic profiling of patients with hepatic GSDs, including the recent study by Vanduangden et al, this editorial aims to review the various clinical subtypes, the spectrum of genetic mutations, and genotype-phenotype correlations for various hepatic GSDs.

Kawasaki disease (KD) is a systemic vasculitis primarily affecting children, and represents a major cause of acquired heart disease in this population. Although the etiology of KD remains incompletely understood, existing genome-wide association studies and genome-wide linkage studies have uncovered various susceptibility genes and their associated chromosomal regions as closely related to the onset and progression of KD. With the rapid advancement of high-throughput DNA sequencing technology, an increasing amount of genomic information pertinent to KD has been discovered, offering new perspectives to investigate the pathogenesis of KD. In particular, genetic polymorphisms play a pivotal role in the immune response, coronary artery lesions, and treatment responsiveness in KD, providing fresh insights into optimizing diagnostic and therapeutic strategies. This article aimed to review and summarize the crucial role of genetic polymorphisms in the pathogenesis of KD, analyze the latest advancements in current research, and discuss the potential applications of gene polymorphism studies in the future diagnosis and treatment of KD.

Background: Functional neurological disorder (FND) in children is a complex and multifaceted condition characterized by neurological symptoms that cannot be explained by organic pathology. Despite its prevalence, FND in pediatric populations remains under-researched, with challenges in diagnosis and management.

Aim: To synthesize the current literature on FND in children, focusing on clinical presentation, diagnostic approaches, treatment strategies, and outcomes.

Methods: A comprehensive literature search was conducted across multiple databases, including PubMed, Scopus, and Web of Science, for articles published up to August 2024. Studies were included if they addressed FND in pediatric populations, specifically focusing on review articles, research articles, systematic reviews, meta-analyses, case reports, guidelines, expert opinions, and editorials. Data extraction and quality assessment were performed according to PRISMA guidelines. A total of 308 articles were included in the final analysis.

Results: The analysis included 189 review articles, 57 research articles, 3 systematic reviews and meta-analyses, 5 case reports, 2 guidelines, 5 expert opinions, and 2 editorials. Key findings revealed a broad spectrum of symptoms, including motor and sensory disturbances and psychological factors contributing to the onset and persistence of FND. Diagnostic challenges were frequently highlighted, emphasizing the need for interdisciplinary approaches. Treatment strategies varied, with cognitive-behavioral therapy (CBT) and multidisciplinary care emerging as the most effective approaches. The outcomes varied, with early intervention being critical for a better prognosis.

Conclusion: Early diagnosis and multidisciplinary care, including CBT, are critical for improving outcomes in pediatric FND. Standardized diagnostic criteria and treatment protocols are needed to enhance clinical management.

Mucopolysaccharidoses (MPS) encompass a spectrum of inherited lysosomal storage disorders caused by deficiencies in enzymes required for glycosaminoglycan (GAG) degradation. These enzymatic deficits lead to GAG accumulation within lysosomes, resulting in progressive multiorgan damage, with skeletal abnormalities prominently affecting diagnostic imaging. Radiologists play a crucial role in identifying characteristic skeletal changes, including skull deformities like J-shaped sella turcica, cranial thickening, spinal abnormalities such as odontoid hypoplasia and kyphosis, and unique thoracic and pelvic malformations. This review synthesizes radiographic findings across MPS subtypes, underscoring the importance of early diagnosis and continual imaging to monitor disease progression, particularly in the context of enzyme replacement therapy (ERT). While ERT offers symptom stabilization, it provides limited reversal of established structural abnormalities. Comprehensive radiographic assessment remains indispensable for guiding both symptomatic management and potential surgical intervention, thereby enhancing clinical outcomes for MPS patients.

Background: Oral food challenge (OFC) is an integral part of confirming and evaluating the diagnosis of food allergy (FA), and most incidents of FA occur in children. FA significantly impairs the quality of life (QoL) and causes limited activities outside the home for children and their parents.

Aim: To evaluate the effect of OFC on QoL and family activities in children with FA.

Methods: This prospective study identified children suspected of FA using a skin prick test (SPT) between January 2022 and December 2024. These children conduct an elimination diet for 4 wk, followed by OFC under protocol. Rating scales evaluated QoL using pediatric QoL inventory and family activities using family activities impact scale (FAIS), in which data are collected before and after an elimination diet and OFC. Statistical analysis utilized χ ², Spearman , paired t, Wilcoxon, independent t, and Mann-Whitney tests, with P < 0.05 considered significant.

Results: Most participants were boys (137; 65.55%); 102 (64.56%) had a positive OFC and 35 (68.63%) a negative OFC. The average QoL before OFC was 69.13 ± 5.78, and 92.40 ± 4.22 after OFC (Z = 12.537; P < 0.001). In the FAIS score, the average result before OFC was 5.36 ± 0.68 and 4.10 ± 0.38 after OFC, which was a significant difference (Z = 12.162; P < 0.001). Although the difference in QoL before and after increased, and FAIS reduced, there was no significant difference. Additionally, most results of positive SPT are higher than positive OFC in each specific food allergen.

Conclusion: OFC may improve QoL and FAIS in children with FA and their families as it increases activities outside the home and reduces worry about allergen exposure.

Background: Functional gastrointestinal disorders (FGIDs), defined as 'Disorders of Gut-Brain Interaction', are now considered a global health problem. There is a dearth of concepts and scales to assess the severity of the different symptoms encountered while dealing with the variety of FGIDs as described in the ROME IV classification. We introduced a novel scoring system with the incorporation of 16 different symptoms called Bacharyya's Questionnaire Scale and started using it while dealing with children suffering from FGIDs.

Aim: To verify the usefulness and applicability of this recently developed scale, this study was undertaken with the objectives to establish the validity of this scoring system in assessing the severity of symptoms associated with a specific FGID in children and to determine the scoring system's applicability in assessing the treatment response.

Methods: The study included children aged 5 to 18 years diagnosed with any FGID based on ROME IV criteria. They completed the newly developed scale and a Visual Analog Scale at initial diagnosis and after a 2-month treatment period. A control group without FGID participated for comparative baseline purposes. Treatment response was defined as a less than or equal to 50% reduction in the total score, which is statistically significant.

Results: Results from a comprehensive cohort of 190 cases and 90 controls indicated a female preponderance (57.9%) and prevalent disorders such as functional constipation (28%) and functional abdominal pain, not otherwise specified (21%). The grade of FGID (mild, moderate, severe) experienced by the patients was also derived. Post-treatment, 96 children demonstrated symptom improvement. The Spearman rank correlation coefficient for pre (r = 0.72, 95%CI: 0.65-0.77, P value < 0.0001) and post (r = 0.49, 95%CI: 0.3-0.64, P value < 0.0001) treatment data showed positive results with significant P values.

Conclusion: The novel scoring system shows high comprehensibility and gives an objective view of the symptomatology of FGIDs. The use of this novel score in clinical settings will be helpful to typify the FGIDs and may significantly improve decision-making processes to initiate appropriate treatment.

Background: Overweight children exhibit a higher prevalence of functional gastrointestinal disorders compared with their normal-weight peers, yet the underlying reasons remain unclear. Gastrointestinal motility, a key pathophysiological factor in functional gastrointestinal disorders, may be influenced by body mass index (BMI).

Aim: To evaluate the impact of BMI on gastric motility parameters in children with functional abdominal pain disorders (FAPDs).

Methods: We assessed gastric motility in 176 children with FAPDs (61.4% females, mean age 7.94 years, SD 1.96 years) and 63 healthy controls (57.1% females, mean age 9.17 years, SD 1.90 years) at the Gastroenterology Research Laboratory, University of Kelaniya, Sri Lanka. FAPDs were diagnosed and subtyped using the Rome IV criteria: Functional abdominal pain 97 patients; irritable bowel syndrome 39 patients, functional dyspepsia (FD) 25 patients; and abdominal migraine 15 patients. Gastric motility was measured using a validated ultrasound method. Weight and height were measured using sensitive standard scales.

Results: The BMIs of children with FAPDs and controls were 15.04 and 15.46 kg/m², respectively (P = 0.33). Fasting antral area (FAA) and antral area at 1 min (AA1) and 15 min (AA15) were significantly greater in patients with FAPD with a higher BMI (2.71 cm², 12.57 cm², and 7.19 cm², respectively) compared with those with a lower BMI (2.12 cm², 10.68 cm², and 6.13 cm², respectively) (P < 0.01). BMI positively correlated with FAA and AA15 (r = 0.18 and r = 0.19, respectively) (P < 0.01) in those with FAPDs. In controls, only AA1 was greater in the higher BMI group (12.51 cm² vs 9.93 cm²) and had a positive correlation (r = 0.33) (P ≤ 0.01). Subgroup analysis revealed that in patients with FD, BMI negatively correlated with gastric emptying rate (GER) (r = -0.59) and antral motility index (MI) (r = -0.49), while in functional abdominal pain, MI positively correlated (r = 0.25) with BMI (P ≤ 0.01).

Conclusion: In children with FAPDs, higher BMI was associated with increased gastric antral distention during fasting and postprandial periods (as indicated by FAA, AA1, and AA15) but not with contractility and transit (MI, GER). However, in the FD subgroup, high BMI correlated with reduced GER and MI. This indicates the possible role of BMI in gastric hypomotility and the pathophysiology of FD. These findings underscore the importance of lifestyle and dietary interventions aimed at optimizing BMI in the management of FAPDs, particularly FD.

Background: Gastroesophageal reflux disease (GERD) is common among neonates, particularly those requiring mechanical ventilation. Pepsin, a reliable marker of gastric aspiration, may help detect GER episodes in ventilated neonates and assess associated clinical outcomes.

Aim: To determine the incidence of GERD, associated risk factors, and morbidities among full-term mechanically ventilated neonates by detecting pepsin in endotracheal aspirates (ETA).

Methods: This study included 97 full-term neonates admitted to the neonatal intensive care unit at Cairo University Hospitals from April 2023 to March 2024. ETA samples were collected at three intervals: Immediately post-intubation (Sample A), 48 hours after intubation (Sample B), and just before extubation (Sample C). Pepsin concentration was measured using enzyme-linked immunosorbent assay. Clinical data, including hospital stay duration and feeding parameters, were correlated with pepsin levels.

Results: Pepsin was detected in 76 (78.4%) of Sample A, 78 (81.3%) of Sample B, and 47 (68.1%) of Sample C. A significant positive correlation was found between pepsin levels and FiO₂ in Sample B (r = 0.203, P = 0.047). Prolonged hospital stay was also associated with pepsin detection in Samples B and C (P < 0.05). A negative correlation was observed between feeding amount and pepsin levels across all samples (P < 0.05).

Conclusion: The incidence of GERD in full-term mechanically ventilated neonates is high, correlating with pepsin levels, FiO₂, feeding intolerance, and hospital stay, highlighting the importance of early detection.