World journal of clinical pediatrics最新文献

Background: Autism spectrum disorder (ASD) is a neurodevelopmental disorder that manifests in the first years of life, with a complex pathogenesis influenced by biological, genetic and epigenetic factors. Many children with ASD display marked food selectivity, often restricting themselves to a narrow range of foods. The problems associated with feeding children with ASD can vary widely, from mild cases that pose no immediate health risks, to more severe situations with a risk of malnutrition or, conversely, overeating. This scoping review aims to provide an in-depth overview of the frequency, nature and factors related to food selectivity in children with autism.

Aim: To comprehensively review the literature on food selectivity in ASD.

Methods: A systematic review of the literature was conducted using the PubMed, Web of Science and EBSCO databases, to identify articles published in English from 2014 until 2024. Studies on a sample diagnosed with ASD and food selectivity were included. The selected databases were chosen for their broad coverage of the scientific literature. These databases represent reliable sources of high-quality articles, ensuring a comprehensive and up-to-date search.

Results: We evaluated 222 studies on food selectivity in autism, from which duplicates were removed and unrelated titles were filtered out. Finally, 9 articles were included in the review. Five articles provide a general overview of the phenomenon, analysing its nature and factors. Two studies delve into sensory sensitivity, in particular the impact of food textures, tastes and smells. Finally, two studies focus on problem behaviour during mealtimes.

Conclusion: Children with ASD have greater food selectivity than the neurotypical population. The diet should contain a greater variety of fruit, vegetables, yoghurt, while reducing the consumption of rice and pasta.

Background: Congenital scoliosis (CS) is a spinal deformity caused by defective segmentation and development of vertebrae during early embryogenesis. It occurs in 0.5%-1% in 1000 births and may rarely occur with congenital defects affecting the heart or genitourinary system. Truncus arteriosus (TA) is a life-threatening cardiac defect in which a single arterial trunk supplies both systemic and pulmonary circulation, leading to complications such as pulmonary hypertension, heart failure, and severe hypoxia. Although rare individually, the co-occurrence of both conditions poses unique diagnostic and therapeutic challenges, with limited documentation in medical literature.

Case summary: We present a 36-week preterm neonate with CS associated with TA type 1, presenting with respiratory distress, cyanosis, and altered spinal curvature. This case demonstrates the complexity of managing neonates with multiple congenital defects. Here, the patient was managed with oxygen supplementation, heart failure medication, nasogastric feeding, and multidisciplinary care to optimize her for surgical corrections. A coordinated, interdisciplinary approach was employed to optimize outcomes, particularly in a resource-limited setting. Immediate respiratory and cardiovascular stabilization and long-term orthopedic and cardiac interventions were central to improving the patient's quality of life and survival.

Conclusion: Recognizing co-existing congenital anomalies and their embryological interrelation is critical in holistic patient care, particularly during neonatal and infancy.

Digestive endoscopy is widely performed in clinical practice, including in children, and has revolutionized the diagnosis and treatment of many gastrointestinal (GI) disorders. Interventional procedures are increasingly utilized, particularly for hepatobiliary and pancreatic diseases. However, only a limited number of gastroenterologists are trained and experienced to perform endoscopic retrograde cholangiopancreatography and endoscopic ultrasound in pediatric patients. While GI endoscopic emergencies in children are uncommon, they can be serious. Effective care demands true multidisciplinary teamwork, with close and ongoing collaboration between gastroenterologists, anesthetists, and the pediatric team especially in centres where pediatric endoscopy specialists are not available. This mini-review outlines current practices in pediatric digestive endoscopy and explores recent advances in interventional endoscopy compared to adult patients.

Anophthalmia is defined as a complete absence of one eye or both the eyes, while microphthalmia represents the presence of a small eye within the orbit. The estimated birth prevalence for anophthalmia is approximately 3 per 100000 live births, and for microphthalmia, it is around 14 per 100000 live births. However, combined evidence suggests that the prevalence of these malformations could be as high as 30 per 100000 individuals. Microphthalmia is reported to occur in 3.2% to 11.2% of blind children. Anophthalmia and microphthalmia (A/M) are part of a phenotypic spectrum alongside ocular coloboma, hypothesized to share a common genetic basis. Both A/M can occur in isolation or as part of a syndrome. Their complex etiology involves chromosomal aberrations, monogenic inheritance pattern, and the contribution of environmental factors such as gestational-acquired infections, maternal vitamin A deficiency (VAD), exposure to X-rays, solvent misuse, and thalidomide exposure. A/M exhibit significant clinical and genetic heterogeneity with over 90 genes identified so far. Familial cases of A/M have a complex genetic basis, including all Mendelian modes of inheritance, i.e., autosomal dominant, recessive, and X-linked. Most cases arise sporadically due to de novo mutations. Examining gene expression during eye development and the effects of various environmental variables will help us better understand the phenotypic heterogeneity found in A/M, leading to more effective diagnosis and management strategies. The present review focuses on key genetic factors, developmental abnormalities, and environmental modifiers linked with A/M. It also emphasizes at potential research areas including multiomic methods and disease modeling with induced pluripotent stem cell technologies, which aim to create innovative treatment options.

Antituberculosis drug-induced hepatotoxicity (ATDIH) is a significant concern while managing pediatric tuberculosis. There is limited data on pediatric ATDIH, and much of the management practices are extrapolated from adult experiences. This article provides a comprehensive overview of the incidence, risk factors, clinical presentation, and management strategies for ATDIH in children. Pyrazinamide, isoniazid, and rifampicin are the most hepatotoxic first-line antituberculosis therapy (ATT). Though pyrazinamide has the highest potential for ATDIH, isoniazid is most frequently implicated. Hepatotoxicity typically manifests within the first 2-8 weeks of treatment, particularly during the intensive phase. Risk factors include younger age, female gender, malnutrition, hypoalbuminemia, and baseline liver dysfunction. Extra-pulmonary TB, particularly tuberculous meningitis, and concomitant hepatotoxic medications such as antiretro viral therapy or antiepileptic drugs further increase susceptibility. Genetic predisposition, including N-acetyltransferase 2 and cytochrome P4502E1 polymorphisms and specific HLA alleles also contribute to the increased risk. Clinically, ATDIH ranges from asymptomatic transaminase elevation to severe acute liver failure (ALF), necessitating prompt recognition and intervention. Diagnosis relies on the temporal association of liver injury with ATT initiation, supported by liver function tests, improvement upon ATT cessation, and recurrence upon reintroduction. Management involves discontinuing hepatotoxic drugs, initiating non-hepatotoxic regimens, and sequential reintroduction of ATT under close monitoring. For children with ALF, care in a tertiary center with liver transplantation expertise is essential. While pediatric ATDIH generally has favorable outcomes with timely intervention, delays can result in significant morbidity and mortality. Improved understanding of risk factors, vigilant monitoring protocols, and standardized pediatric management strategies are critical for optimizing outcomes in pediatric ATDIH.

Recently, the gut microbiota has been identified as a significant risk factor associated with metabolic disorders related to obesity. Advances in high-throughput sequencing technology have clarified the relationship between childhood obesity and changes in the gut microbiota. This commentary focuses on analyzing the study by Li et al, which utilized 16S rRNA molecular markers to compare differences in gut microbiota between obese and normal-weight children. Additionally, the review by Pan et al is referenced to supplement perspectives and evaluate the findings of this study. We also analyze the strengths and limitations of the original study and suggest potential research directions to elucidate the complex relationship between gut microbiota and childhood obesity, thereby providing a scientific basis for developing effective prevention and treatment strategies.

Background: Human milk oligosaccharides (HMOs) are bioactive components of breast milk with diverse health benefits, including shaping the gut microbiota, modulating the immune system, and protecting against infections. HMOs exhibit dynamic secretion patterns during lactation, influenced by maternal genetics and environmental factors. Their direct and indirect antimicrobial properties have garnered significant research interest. However, a comprehensive understanding of the secretion dynamics of HMOs and their correlation with antimicrobial efficacy remains underexplored.

Aim: To synthesize current evidence on the secretion dynamics of HMOs during lactation and evaluate their antimicrobial roles against bacterial, viral, and protozoal pathogens.

Methods: A systematic search of PubMed, Scopus, Web of Science, and Cochrane Library focused on studies investigating natural and synthetic HMOs, their secretion dynamics, and antimicrobial properties. Studies involving human, animal, and in vitro models were included. Data on HMO composition, temporal secretion patterns, and mechanisms of antimicrobial action were extracted. Quality assessment was performed using validated tools appropriate for study design.

Results: A total of 44 studies were included, encompassing human, animal, and in vitro research. HMOs exhibited dynamic secretion patterns, with 2'-fucosyllactose (2'-FL) and lacto-N-tetraose peaking in early lactation and declining over time, while 3-fucosyllactose (3-FL) increased during later stages. HMOs demonstrated significant antimicrobial properties through pathogen adhesion inhibition, biofilm disruption, and enzymatic activity impairment. Synthetic HMOs, including bioengineered 2'-FL and 3-FL, were structurally and functionally comparable to natural HMOs, effectively inhibiting pathogens such as Pseudomonas aeruginosa, Escherichia coli, and Campylobacter jejuni. Additionally, HMOs exhibited synergistic effects with antibiotics, enhancing their efficacy against resistant pathogens.

Conclusion: HMOs are vital in antimicrobial defense, supporting infant health by targeting various pathogens. Both natural and synthetic HMOs hold significant potential for therapeutic applications, particularly in infant nutrition and as adjuncts to antibiotics. Further research, including clinical trials, is essential to address gaps in knowledge, validate findings, and explore the broader applicability of HMOs in improving maternal and neonatal health.

Today's youth in rich and poor countries faces comparable health risks and challenges. There is the temptation to enjoy too much food that is advertised as delicious and to eat too little healthier food. An increasingly sedentary lifestyle makes physical activity voluntary, no longer based on the daily need for physical activity in rural production. This is a serious medical problem, as today's young people are threatened tomorrow (and sometimes, already today) by cardiovascular disease and type 2 diabetes mellitus, later by further challenges including arthritis, stroke, and more. But this is a challenge far beyond medicine. Young people need to be empowered to distinguish between good and bad lifestyles and be strengthened in their willingness to make an effort for future health. It may not seem very sexy to eat mostly fruits and high-fiber traditional foods instead of hamburgers, snacks, sweets, or to eat in posh restaurants. Everyone needs a certain resistance to advertising today, whether they grow up in Nigeria, Europe or anywhere else. Medical doctors, teachers, and many other professionals with responsibilities for young people have a key role in this endeavour.

Breast milk represents the gold standard for neonatal nutrition, especially for preterm and term infants with a low birthweight. This awareness is based not only on the nutritional properties of human milk, which is specifically designed for the growth of humans but also on breast milk's non-nutritional properties, such as protection against infection. In fact, breast milk should be considered a heterogeneous ecosystem, including a wide range of cells in addition to those involved in immune function; growth factors, such as vascular endothelial growth factor; multiple noncoding microRNAs; immune cells; epithelial cells and multipotent mesenchymal stem cells. This recent identification of a pool of progenitor stem cells in human milk is the driving force behind the growing research aimed at identifying the nature of these stem/progenitor cells and their sources.

Background: Ureteroneocystostomy (UNC) is considered the gold standard for pediatric vesicoureteral reflux (VUR) treatment. While UNC lowers the likelihood of needing additional VUR procedures within 12 months, patients also have high 30-day and 90-day readmission rates and emergency department (ED) visits. The most common causes of an ED visit following any urologic procedure are urinary tract infections (UTIs) and catheter/drain concerns. Prior studies are limited in identifying predisposing factors to help mitigate complications of UNC and improve patient outcomes.

Aim: To identify modifiable characteristics at the time of discharge after UNC that predict subsequent unplanned ED visits.

Methods: The 2020 American College of Surgeons National Surgical Quality Improvement Program Pediatric data was analyzed for patients undergoing UNC for VUR. A total of 1742 patients were evaluated, with 1495 meeting inclusion criteria. Patients with an ED visit within 30 days following an anti-reflux procedure (n = 164) were compared to those who did not return to the ED (n = 1331). Basic statistics and logistic regression analysis were performed to find predictive factors associated with postoperative ED visits after UNC.

Results: Among the 1495 patients, 11.0% visited the ED within the 30-day postoperative period. Patients who returned to the ED visit following UNC were more likely to have had a longer mean operative time, surgical site infection, postoperative UTI, postoperative sepsis, history of prior readmission, unplanned reoperation, blood transfusion, or unplanned urinary catheter placement. Multivariate analysis revealed postoperative UTI (P < 0.001), superficial surgical site infection (P = 0.022), unplanned procedure (P < 0.001), unplanned urinary catheter (P < 0.001), and prematurity (35-36 weeks gestation) (P = 0.004) as independent risk factors for postoperative ED visits.

Conclusion: Utmost caution is needed prior to discharge after UNC to forestall a return to the ED. Postoperative infection remains a primary risk for ED visits in the acute postoperative period.