BMC Pediatrics最新文献

Background: Circulating serpinB1 levels are increased in obese mice and have been shown to promote β-cell proliferation in several species. However, the data on serum serpinB1 levels in children with obesity are scarce. This study aimed to determine serum serpinB1 levels in children with overweight/obesity, and to study its association with obesity-related parameters.

Methods: A total of 54 children with overweight/obesity and 36 normal-weight healthy controls aged 6-14 were recruited in this study. Anthropometric parameters, glucolipid metabolic biochemical parameters, sex hormones, and serum serpinB1 levels were measured in all subjects. The association of serum serpinB1 levels with obesity-related parameters and the risk of overweight/obesity were analyzed using correlation analysis and binary regression analysis, respectively.

Results: The serum serpinB1 level in overweight/obese children was notably greater than in normal-weight controls (2.03 ± 0.70 vs. 1.41 ± 0.58 ng/mL, p < 0.001). SerpinB1 levels were positively correlated with body mass index (BMI), BMI Z-score, triglyceride (TG), uric acid, fasting insulin, C-peptide, and homeostasis model assessment of insulin resistance (HOMA-IR) levels. Additionally, we found that elevated circulating serpinB1 levels were associated with the increased risk of childhood overweight/obesity even after adjustment for age, gender, and HOMA-IR (odds ratio, 4.132; 95% confidence interval, 1.315-12.983; p = 0.015).

Conclusions: Circulating serpinB1 level was significantly increased in children with overweight/obesity and positively associated with obesity-related glucolipid metabolic parameters. These results indicate a close association between serum serpinB1 concentrations and childhood overweight/obesity.

Background: Sierra Leone has reduced neonatal mortality rates(NMR) in recent years. Despite this progress, disparities in newborn survival persist across socio-economic and geographic areas. This study examined the inequalities in neonatal mortality rates in Sierra Leone between 2008 and 2019.

Methods: We utilized data from the Sierra Leone Demographic Health Survey rounds conducted in 2008, 2013, and 2019. We used the World Health Organisation Health Equity Assessment Toolkit to calculate simple measures of inequality (Difference, and Ratio), and complex measures of inequality (Population Attributable Risk, and Population Attributable Fraction). Inequality in neonatal mortality rate was calculated on six stratifiers: maternal age, maternal economic status, maternal level of education, place of residence, sex of the child, and sub-national province.

Results: Neonatal mortality rate decreased in Sierra Loene from 48.6 deaths per 1,000 live births in 2008 to 29.6 deaths per 1,000 live births in 2019. There was an increase in age-related inequality from a Difference of 0.7 deaths per 1,000 live births in 2008 to 4.3 deaths per 1,000 live births in 2019. Economic inequality decreased from a Difference of 26.8 deaths per 1,000 live births in 2008 to -3.4 deaths per 1,000 live births in 2019. Inequality in education decreased from a Difference of 4.6 deaths per 1,000 live births in 2008 to -4.2 deaths per 1,000 live births in 2019. Inequality increased from a Difference of - 0.5 deaths per 1,000 live births in 2008 to -4.2 deaths per 1,000 live births in 2019 for place of residence. For the child's sex, the inequality increased from a Difference of - 7.9 deaths per 1,000 live births in 2008 to -11.1 deaths per 1,000 live births in 2019. Provincial inequality increased slightly from a Difference of 14.0 deaths per 1,000 live births in 2008 to 14.4 deaths per 1,000 live births in 2019.

Conclusion: The findings show a decline in the national neonatal mortality rate from 2008 to 2019, indicating improvements in healthcare and maternal support. While economic and educational inequalities have decreased, especially in education, sustaining these gains is essential for equitable healthcare access. Despite this progress, inequalities based on age, residence, child's sex, and province still exist, and have increased between 2008 and 2019. Policymakers should focus on targeted programs for vulnerable age groups and sexes, and develop geographical strategies to ensure uniform improvements in neonatal health.

Introduction: Vaccination is a critical public health intervention that significantly reduces morbidity and mortality among children. Despite its importance, vaccination coverage remains suboptimal in many regions, including East Gojam, Amhara Region, Ethiopia. This study investigated the sociodemographic, economic, and cultural determinants of vaccination status among pediatric populations in East Gojam.

Methods: Using a cross-sectional design, data were collected from 1,900 respondents, categorizing vaccination status as not vaccinated, partially vaccinated, or fully vaccinated. Multinomial logistic regression was used to analyze the impact of predictors such as child age, gender, parental education level, household income, geographic location, access to healthcare, trust in healthcare providers, sources of vaccination information, cultural beliefs, and perceived government support for vaccination.

Results: The results revealed that higher parental education levels and urban residence positively influence vaccination status. Older children were less likely to be fully vaccinated, indicating a need for targeted outreach. Access to healthcare services and trust in healthcare providers significantly promoted vaccination, whereas negative cultural beliefs and misinformation adversely affected vaccination status. Perceived government support for vaccination was also a significant predictor.

Conclusion: This study concludes that addressing these multifaceted determinants through educational programs, improved healthcare access, trust-building initiatives, accurate information dissemination, stronger governmental support, targeted outreach for older children, community engagement, and multisectoral collaboration can enhance vaccination coverage and improve public health outcomes in East Gojam and similar settings.

Background: Distinguishing self-limiting ('trivial') from potentially consequential spinal pain in childhood and adolescence is crucial to prevent over- or under-medicalization. The aim of this study was to stratify participants for severity of spinal pain and to investigate associations of pain severity with potential consequences of pain and some psychophysical and clinical factors.

Methods: In 2020 and 2021, children and adolescents took part in a voluntary population-based spine screening event across Switzerland organized by the Swiss Chiropractors Association. The screening consisted of a questionnaire (14 questions) based on the Young Spine Questionnaire and a clinical examination by a chiropractor. Three subgroups of pain severity [no pain (including mild, occasional pain), one-sited moderate pain, one-sited severe or moderate/severe pain at multiple sites of the spine] were formed by combining the self-reported measures for pain intensity and pain frequency for two recall periods (lifetime, last week) according to literature. Multivariable logistic regression analyses were conducted to determine the associations between pain severity and potential pain consequences (impact of spinal pain on health and seeking medical advice because of spinal pain), as well as between pain severity and some psychophysical factors (head and/or belly pain, sleep problems, daytime tiredness) and clinical measures [trunk symmetry (rib hump), trunk muscle endurance (plank position)].

Results: Of all participants (N = 457; 6-16 years; mean age = 10.9 ± 3.0 years; 220 boys), those with most severe spinal pain and with one-sited moderate pain in the last week had higher odds for reporting an impact of spinal pain on their health (OR = 13.5, 95%CI = 4.9-36.8; OR = 4.7, 95%CI = 1.5-14.4) and for searching medical advice because of spinal pain (OR = 11.6, 95%CI = 4.5-30.1; OR = 3.9, 95%CI = 1.6-9.2). Headache and/or belly pain (OR = 2.6, 95%CI = 1.2-5.5) and daytime tiredness (OR = 3.2, 95%CI = 1.3-7.9) increased the odds for having most severe pain compared to having no pain. The clinical measures were not associated with pain severity.

Conclusion: Stratification by pain severity, particularly when asked for pain in the last week, might help to minimize over- and under-medicalization of spinal pain in childhood and adolescence. Prospective studies are needed to clarify the relevance of the investigated clinical tests in the context of adolescent spinal pain.

Background: Pulmonary hemorrhage (PH) in respiratory distress syndrome (RDS) in extremely preterm infants exhibits a high mortality rate and poor long-term outcomes. The aim of the present study was to develop a machine learning (ML) predictive model for RDS with PH in extremely preterm infants.

Methods: We performed a retrospective analysis of extremely preterm infants with RDS at the Children's Hospital of Soochow University between January 2015 and January 2021. We applied three ML algorithms-logistic regression (LR), random forest (RF), and extreme gradient boosting (XGBoost)-to evaluate the performance of each model using the area under the curve (AUC), and developed a predictive model based on the optimal model. We calculated SHapley Additive exPlanations (SHAP) values to determine variables importance and show visualization results, and constructed a nomogram for individualized prediction.

Results: A total of 309 patients with RDS were enrolled, including 48 (15.5%) with PH. A total of 29 variables were collected, including demographic and clinical characteristics, laboratory data, and image classification. According to the AUC values, the RF model performed best (AUC = 0.868). Based on the SHAP values, the top five important variables in the RF model were gestational age, PaO₂/FiO₂, birth weight, mean platelet volume, and Apgar score at 5 min.

Conclusions: Our study showed that the RF model could be used to predict the risk of PH in RDS in extremely preterm infants. The nomogram provides clinicians with an effective tool for early warning and timely management.

Background: Post-infectious bronchiolitis obliterans (PIBO) is a severe form of chronic obstructive lung disease secondary to severe respiratory tract infections. Knowledge of pediatric PIBO development-associated risk factors may improve selection of appropriate early therapeutic interventions.

Objective: The aim of this study was to describe the clinical characteristics of children diagnosed with PIBO, and identify the risk factors for development of PIBO after adenovirus pneumonia.

Methods: First, a retrospective observational study was performed of 308 pediatric patients with PIBO (ages < 5 years) that revealed high frequencies of non-invasive/invasive ventilation, co-infection, and atopic conditions. Subsequently, we retrospectively reviewed 131 patients (ages < 5 years) with adenovirus pneumonia who developed BO (included among the 308 children) or not. Logistic regression analysis revealed PIBO development-associated risk factors.

Results: Respiratory symptoms of 308 patients (median age of 18 months, range: 12-54 months; male predominance of 3.7:1) included wheezing (71%), dyspnea (66%), tachypnea (23%), and hypoxemia (18%). Etiologic agents (predominantly adenovirus, Mycoplasma pneumoniae) were detected in 236 patients, of whom 137 had co-infections. Notably, atopic disease history (of patients and/or family members) was associated with 78% of patients, and 15% of patients diagnosed with asthma before, at the time of PIBO diagnosis. In a subsequent study of 131 adenovirus pneumonia patients, multivariate analysis showed that co-infection (OR 4.20, 95% CI 1.29 to 13.63), atopic conditions (OR 29.67, 95% CI 12.16 to 81.67), and duration of fever (OR 1.42, 95% CI 1.10 to 1.83) were independent risk factors for PIBO development following adenovirus pneumonia.

Conclusions: Atopic conditions, co-infections, and duration of fever were identified as risk factors for pediatric post-infectious BO development following adenovirus pneumonia, and PIBO may overlap with asthma, warranting early aggressive treatment and further research to elucidate roles of atopic conditions in BO development.

Background: This study examined the relationship between parents' perceived social support and their children's psychological adjustment.

Methods: This cross-sectional survey study was conducted in 52 kindergartens and 78 preschools in Nagoya, Aichi, a major metropolitan area in Japan. Parents of eighth-grade children aged 13-14 years (N = 1,195) completed a questionnaire. A total of 602 valid responses were received. To accurately assess the relationship between parents' perceived social support and behavioral characteristics, respondents diagnosed with a developmental disability or who failed to answer the required questionnaire items were excluded from the analysis. Consequently, 536 (89.0%) of the 602 participants met the eligibility criteria.

Results: The results indicated that the stronger the social support for parents, the lower the scores for externalizing and internalizing problems, and the higher the scores for prosociality. Conversely, insufficient social support may pose a risk to parental mental health and lead to suboptimal parenting practices. Issues in parental mental health adversely affect parenting, leading to fewer positive interactions with young children, increased rates of negative interactions and hostility, diminished communication, and delayed responses to children's behaviors.

Conclusions: These results underscore the significant influence of parents' perceptions of social support on their parenting beliefs and behaviors, which may, in turn, affect the development of their children's mental health. Therefore, parents' perceptions of social support are likely positively associated with children's mental health.

The aim of this study was to assess the efficacy of GFR measured using ROI from ultrasound technique in diuretic renography for evaluating postoperative outcomes in infants under one year old with congenital hydronephrosis. A retrospective analysis was conducted on thirty infants who underwent abdominal ultrasound and diuretic renography before and after surgery, obtaining preoperative and postoperative gGFRs and uGFRs (measured using ROI from ultrasound technique) determined using the Gates method and ultrasonic-assisted drawing ROI technique, respectively. A comparative study was performed on total GFR as well as individual kidney GFR before and after intervention. The preoperative and postoperative total and single uGFRs were significantly lower than gGFRs, while the postoperative total and single renal function, along with relative renal function in the hydronephrotic kidneys, were also significantly higher than the preoperative results (p < 0.05). Among 30 infants, 23 cases exhibited substantial recovery of renal function in their hydronephrotic kidneys after surgery, 2 cases did not show significant improvement, while 5 cases continued to experience deterioration in renal function. The GFR measured using ROI from ultrasound technique provides a more accurate assessment of renal function changes before and after surgery in infants under one year old with congenital hydronephrosis, facilitating an effective evaluation of postoperative treatment efficacy.

Background: Novel, expanded valency pneumococcal conjugate vaccines (PCVs) are in development to reduce the burden of pneumococcal disease (PD) in children. To understand the potential value of new vaccines in Germany, this study estimated the residual burden of PD in children < 16 years old from 2014 to 2019, using administrative health data from a large German claims database.

Methods: Outpatient and inpatient cases of all-cause pneumonia (ACP), pneumococcal pneumonia (PP) and invasive pneumococcal disease (IPD) were identified in the InGef database. Incidence rates (IRs) with 95% confidence intervals (CI) were calculated as number of episodes/person-years (PY) at risk. The Mann-Kendall test assessed time trends in incidence.

Results: There were no significant trends in IRs of IPD or PP from 2014 to 2019. For ACP, IRs declined from 2014 to 2019; 2,213 (CI 2,176-2,250) to 1,503 (CI 1,472-1,534) per 100,000 PY (p = 0.017). IRs of ACP and PP were highest among children aged 12-23 months; 4,672 (CI 4,584-4,762) and 20.8 (CI 15.3-27.5) per 100,000 PY, respectively. For IPD, children 5-11 months-old had the highest IRs, at 14.7 (CI 9.0-22.7) per 100,000 PY.

Conclusions: From 2014 to 2019 there were no discernible trends in the IRs of PP or IPD, but the IRs of ACP declined in children aged < 16 years. The highest IRs of ACP, PP and IPD were observed in children < 2 years of age, highlighting the importance of infant pneumococcal vaccination in the prevention of pediatric PD. The clinical burden of pediatric PD in Germany persists. Continued surveillance of changing pneumococcal burden, serotype distribution, antimicrobial resistance and vaccination status is critical to better understand the factors driving incidence of PD and to inform future vaccination strategies.

Background: The SLCO2A1 gene encodes a prostaglandin transporter and we report a novel mutation causing hypoproteinaemia and refractory anaemia due to chronic enteropathy.

Case presentation: An 18-year-old boy of consanguineous parents was investigated for hypoproteinaemia and anaemia. He was short, pale and had generalised oedema. Investigations revealed haemoglobin 5.8 g/dL; hypochromic microcytic anaemia; low serum protein, albumin, globulin, ferritin and iron. Bone marrow aspiration revealed low iron stores. Upper and lower gastrointestinal endoscopies showed moderate gastritis, duodenitis, and non-specific patchy inflammation in the rectum. The whole exome sequencing revealed a homozygous missense mutation in SCLO2A1 gene (NP_005621.2:p.Arg97Cys; rs761212094). Sanger sequencing of the sibling with milder phenotype revealed same homozygous mutation, and carrier father was heterozygous.

Conclusion: We report a novel mutation of SLCO2A1 gene causing severe persistent hypoproteinaemia and refractory iron deficiency anaemia due to chronic enteropathy helping to delineate genotype-phenotype correlation of SLCO2A1 variants.