BMC Pediatrics最新文献

Background: Turner syndrome (TS) is one of the important causes of short stature in girls, but there are cases of misdiagnosis and missed diagnosis in clinical practice. Our aim is to analyze the hand skeletal characteristics of TS patients and establish a disease screening model using deep learning.

Methods: A total of 101 pediatric patients with TS were included in this retrospective case-control study. Their radiation parameters from hand X-rays were summarized and compared. Receiver operating characteristic (ROC) curves for parameters with differences between the groups were plotted. Additionally, we used deep learning networks to establish a predictive model.

Results: Four parameters were identified as having diagnostic value for TS: the length ratio of metacarpal IV and metacarpal III, the distance between ulnoradial tangents, the carpal angle, and the ulnar-radial angle. When the cutoff value of the distance between the ulnoradial tangents was 0.40 cm, the specificity reached 92.57%. And for the ulnar- radius angle, according to the ROC analysis, the maximum value of Youden's index was obtained when the cut-off value was 170°, with a sensitivity of 66.34% and specificity of 61.38%. The ResNet50 deep neural network architecture was utilized, resulting in an accuracy of 78.89%, specificity of 76.67%, and sensitivity of 83.33% on a test dataset.

Conclusions: We propose that certain hand radiograph parameters have the potential to serve as diagnostic indicators for TS. The utilization of deep learning models has significantly enhanced the precision of disease diagnosis.

Background: Histiocytic sarcoma as a secondary malignancy following childhood leukemia is extremely uncommon with fewer than 20 cases reported worldwide. They often pose a diagnostic challenge and prognosis is dismal. There is a lack of well-established clinical treatment protocols owing to rarity of disease. Majority were managed with chemotherapy with variable outcomes.

Case presentation: Herein we report a rare case of an 8-year-old girl with secondary BRAF^V600-mutant histiocytic sarcoma following T-cell acute lymphoblastic leukemia. After poor disease control with salvage chemotherapy, she was treated with MAPK-targeted therapy with dabrafenib and trametinib. She demonstrated excellent response and remained in partial remission with no signs of disease progression 3 years later.

Conclusions: There is yet to be consensus on the optimal management for this neoplasm. Description of our successful clinical experience highlights that investigation for BRAF mutations in histiocytic sarcoma is potentially advantageous. It also adds to the growing evidence that precision medicine may be a promising avenue to target this aggressive tumor and lays the foundation for future research.

Background: Hepatitis B is a major global health concern, with chronic infections affecting approximately 296 million people yearly. A 2009 survey in East Africa showed a prevalence rate of 6.5%, with Uganda's rate at 10.3% and Northern Uganda at 20.7%. Therefore, this study sought to determine the immune response to Hepatitis B vaccination and associated factors among children under five attending outpatient care at Mulago Assessment Centre Pediatrics clinic.

Methods: A cross-sectional study involving 301 children aged 1 to under 5 years at Mulago National Referral's Pediatrics clinic was conducted in February 2023. Children were consecutively enrolled and screened for Hepatitis B core antibodies, with anti-HBs antibody titers measured. A pretested semi-structured questionnaire was administered to caregivers. Data analysis was conducted using STATA Version 13.0. Logistic regression analysis was done to determine factors associated with immune response, a binary outcome.

Results: All 301 children tested negative for Hepatitis B core antibodies. Children's ages ranged between 1 and 4 years with most aged 2 years, 89/301(29.6%). The immune response varied from 2 IU/ml to 1000 IU/ml, with a median of 86.2 IU/ml (IQR: 14.5-239.4). The prevalence of good immune response was 77.4% (233/301) (95% CI: 72.3-81.8%), with 58.4% (95% CI: 51.9-64.6%) classified as very good responders. The factors associated with immune response were child age (aOR = 0.40; 95% CI: 0.16-0.97; p = 0.044) and caregiver HIV status (aOR = 0.17; 95% CI: 0.04-0.71; p = 0.014).

Conclusion: Children had protective antibody levels against the Hepatitis B virus, but it is still below the expected level by the World Health Organization. The child's age and caregiver's HIV status were associated with immune response. Emphasis needs to be made on the Hepatitis B birth dose and booster vaccinations, especially for children over 1 year and at-risk groups, to lower transmission rates and enhance long-term Hepatitis B protection.

Introduction: Our study investigated the association between hematocrit in the first two hours (HCT2h) of life and retinopathy of prematurity (ROP).

Methods: Data were obtained from an observational study of the DRYAD database. The study was conducted at the Santa Clara Valley Medical Center (SCVMC). Data on preterm babies whose gestational age (GA) was < 34 weeks were collected prospectively from January 2008 to February 2014. Logistic regression was applied to explore the association between HCT2h and ROP.

Results: A total of 326 very preterm infants born at or earlier than 34 weeks were included. The incidence of any ROP was 23.9%, and the incidence of severe ROP was 4.6%. The HCT2h, birth weight, GA, Apgar1 min, and Apgar5 min of any ROP group were significantly lower than those of preterm babies without ROP (p < 0.001). Sex differences, the rate of multiples, and delivery mode between the two groups were not statistically significant (p > 0.05). We classified HCT2h into three levels, and after multivariate logistic regression, we found that high HCT2h remained a significant protective factor against ROP (p < 0.001). Through subgroup analysis, we observed that among preterm infants with a GA of 28 weeks or more, there was a significant inverse association between a 1% increase in HCT2h and a 17% reduction in the occurrence of ROP.

Conclusion: We found that HCT2h may be an effective biomarker for identifying the risk of ROP of very preterm infants born between 28 and 34 weeks of gestation.

Trial registration: This was a retrospective study and the data were from the DRYAD database. Santa Clara Valley Medical Center's (SCVMC) ethical committee reviewed and approved the studies involving human participants. Informed consent was waived for this study. We did not perform any extra interventions.

Background: Studies on physical activity (PA) and sedentary behavior (SB) patterns contribute to planning specifically-population-targeted health interventions. However, most do not assess PA and SB based on types. The current study identified patterns of PA and SB based on types and their association with demographic factors (age, school shift) and weekly attendance in physical education classes (PEC) among schoolchildren.

Methods: Students from 11 Brazilian public schools with part-time schedules participated in this cross-sectional study in 2019 (n = 2,477; 9.1 ± 1.38 years, 53.2% girls). Participants self-reported PA, SB, and weekly attendance PEC in an online questionnaire. Data on age and school shift were gathered from the Municipal Education Department. PA and SB patterns were identified through a two-step cluster analysis, stratified by sex. The associations between PA and SB patterns and age (7-9 years old; 10-12 years old), school shift (morning; afternoon), and weekly attendance PEC (0/week; 1/week; ≥2/week) were analyzed by Logistic Regression.

Results: Among girls, two distinct patterns emerged: "Active players" (n = 549, 44.1%) and "Sedentary/Household chores performers" (n = 697, 55.9%); and three patterns among boys: "Active play/Structured PA practitioners" (n = 322, 29.8%), "Sedentary on screen" (n = 369, 34.1%), and "Sedentary on academic tasks" (n = 390, 36.1%). Weekly attendance in PEC was associated with the composition of patterns for both girls and boys. Among boys, the 'Sedentary on screen' group was more likely to be in the 10-12 years age group.

Conclusions: Boys and girls exhibited different PA and SB patterns. Active play and household chores contributed to the cluster solution among girls, whereas sports contributed to the cluster solution among boys. Attending PEC increased the odds of participants belonging to clusters with higher PA and lower SB. Identifying patterns of PA and SB by type, along with their associated factors, could inform intervention studies and help shape actions at the school level to increase PA and reduce SB among schoolchildren.

Clinical trial number: Not applicable.

Introduction: Understanding the impact of the COVID-19 pandemic on child survival is crucial. Analysing COVID-19-related child deaths, even years after the pandemic, is critical for informing future pandemic preparedness and response efforts.

Methods: We conducted an analysis of all "SARS-CoV-2/COVID-19 positive deaths" among children and adolescents (aged < 18 years) recorded through a purposefully designed Child Death Surveillance and Response System (CDSRS) from October 2020 to September 2022. It included all deaths with a positive SARS-CoV-2. The analysis involved a thorough review of documents (bedhead tickets, field/institutional investigation and postmortem examination reports, and compiled case scenarios). Multivariable backward logistic regression was conducted to identify risk factors associated with deaths attributed to COVID-19 infection. Additionally, a comparison of socio-demographic characteristics was conducted between deaths due to all causes and those attributed to COVID-19 infection.

Results: A total of 111 deaths with a positive SARS-CoV-2 test were analyzed. Among these, 81 deaths (73%) were categorized as directly attributed to COVID-19 infection. Fourteen children (17.2%) had Multisystem Inflammatory Syndrome. Cardiovascular disease was the most common comorbidity (28.4%). The odds of deaths attributed to COVID-19 infection were eleven times higher with chronic diseases compared to incidental SARS-CoV-2 positive test (OR:11.22, 95% CI:1.735, 72.496). Tamil ethnicity appeared to be protective when compared to the Sinhalese (OR:0.07, 95% CI: 0.008, 0.598). The model explained 44.8% of the variance. When compared to national all-cause mortality data, females (p = 0.03), post-neonatal infants (p < 0.001), and > 5-18 years (p = 0.005) were identified as being at higher risk of death due to COVID-19 infection.

Conclusion: The proportion of COVID-19-positive deaths during the study period was higher than that reported in high-income countries, with most deaths directly attributed to SARS-CoV-2. Higher mortality rates were observed among post-neonatal infants, children over five years, females, those with Sinhalese ethnicity, and pre-existing chronic medical conditions, particularly cardiovascular disease.

Background: Few data are available on the interplay of antenatal and early inhaled postnatal corticosteroids. The NEuroSIS trial randomized extremely preterm infants to receive either early inhaled budesonide or placebo and analyzed the effect of study medication on bronchopulmonary dysplasia or death, as well as the effect on neurodevelopmental outcome at 18-22 months corrected age. Application of antenatal steroids may have had an influence on these outcomes.

Objective: To analyze if antenatal corticosteroids (ANS) influenced the short- (BPD and death before 36 weeks PMA) and long-term (disability at 18-22 months corrected age or death before time of assessment) effects of early inhaled postnatal budesonide in NEuroSIS study participants.

Methods: Post-hoc analysis of the intention-to-treat population of the NEuroSIS study. Generalized logits models were used to (1) predict risk of BPD, death before 36 weeks PMA and survival without BPD with application of ANS, NEuroSIS study treatment and gestational age as independent variables and (2) predict the risk of disability at 18-22 months corrected age, death before time of neurodevelopmental assessment and survival without disability, with ANS and gestational age as independent variables.

Results: Application of ANS, added as an independent variable, did not change the effect of study medication on developing BPD (OR 0.79, 95% CI 0.67-0.93) and there was no association with the risk of death (OR 1.03, 95% CI 0.84-1.27) at 36 weeks PMA. ANS added as an independent variable showed an association with a reduced risk of death before time of completion of neurodevelopmental assessment (OR 0.60, 95% CI 0.44-0.81) and was associated with a reduced risk of disability at 18-22 months corrected age(OR 0.63, 95% CI 0.49-0.81).

Conclusion: ANS did not alter the reduction of BPD risk by study medication and there was no association with increased mortality in NEuroSIS study participants.

Background: In the Malaysian primary healthcare setting, neonatal jaundice (NNJ) screening uses either Kramer's Rule (KR), a visual assessment, or a combination with non-invasive transcutaneous bilirubin (TcB). However, data on the quantification of the need for total serum bilirubin (TSB) sampling between these approaches are limited. This study aimed to compare the frequency of blood draws required between the two cohorts, alongside investigating disparities in phototherapy initiation and severe hyperbilirubinemia occurrences.

Methods: This multicentre retrospective cohort study enrolled neonates from six primary healthcare clinics, with three using KR plus TcB and three using KR only for NNJ screening. Neonates with a gestational age of ≥ 35 weeks and without prior phototherapy or exchange transfusion for hyperbilirubinemia were included in the study until reaching either day 10 of life or hospitalization for any reason, defining the study endpoint. The minimum sample size required was 379 neonates in each cohort. Generalized Poisson regression was used to compare the number of blood draws required for TSB sampling between the two cohorts.

Results: Of 765 neonates included, the cohort using KR alongside TcB showed a 74% reduction in blood draw risk compared to KR alone cohort (IRR 0.26, 95% CI 0.23-0.39). There were no significant differences between cohorts in phototherapy initiation (25.5% vs. 24.4%), severe hyperbilirubinemia occurrence (0.0% vs. 0.0%) or rapid bilirubin level rise (0.3% vs. 0.8%).

Conclusion: Incorporating TcB alongside KR for NNJ screening significantly reduces the need for TSB sampling without causing an escalation in phototherapy initiation or severe hyperbilirubinemia occurrences, suggesting the potential to optimize NNJ management in the local primary care setting.

Background: Kawasaki disease (KD), also known as mucocutaneous lymph node syndrome, is an acute febrile exanthematous illness primarily affecting children under 5 years of age. It is characterized by systemic vasculitis of medium and small arteries. KD can present with cervical lymphadenopathy and fever as initial symptoms, often making it difficult to distinguish from acute bacterial lymphadenitis, parapharyngeal abscess or other cervical cystic lesions.

Case presentation: This study reports the case of a 6-year-old child presenting with a fever and a neck mass. The patient was initially diagnosed with acute lymphadenitis with a parapharyngeal abscess, and was subsequently admitted for surgery, at which point computed tomography (CT) revealed a cystic lesion in the neck. Despite neck surgery, the child experienced persistent unexplained fevers. Lymph node biopsy indicated necrotizing lymphadenitis, and pathogen gene sequencing was negative for specific infections. During the disease course, the child developed conjunctival injection, strawberry tongue, and rash. After a thorough examination, the child was ultimately diagnosed with lymphadenopathy-first-presenting KD, with CT showing multiple cystic lesions in the soft tissues. Treatment with high-dose immunoglobulin and aspirin resulted in the rapid resolution of fever and other KD symptoms. A 2-year follow-up showed no recurrence or coronary artery abnormalities.

Conclusion: In this child presenting with fever and neck masses, CT revealed multiple cystic lesions in soft tissues. This experience suggests that careful examination and evaluation before and after neck abscess surgery are crucial to avoid misdiagnosis and unnecessary surgical trauma.

Background: Allergic rhinitis (AR) is a disease that has significant effects on the quality of life of people and exhibits different phenotypic features with different clinical findings. By analyzing the data of pediatric patients, we aimed to reveal the relationship between demographic and laboratory data and clinical features and to gain awareness about allergic rhinitis phenotypes in children.

Methods: Demographic data, clinical complaints, physical examination findings, and atopy biomarkers are retrospectively analyzed to assess the impact of aeroallergens on the disease phenotype.

Results: In a study of 301 AR patients (median age 11 years; 66.1% male), sneezing (79.1%) was the most common complaint, and pallor of the nasal mucosa was the primary examination finding (83.1%). Persistent symptoms were reported by 62.1%, and 60.5% were polysensitized. Notably, 42.5% had asthma, often associated with concurrent sensitization to mold or animal dander (p ≤ 0.05). Pollen was the most prevalent allergen (65.8%), with significant increases in sensitization to pollen (p < 0.001) and animal dander (p = 0.003) with age. Patients with pollen sensitization reported more sneezing (p = 0.026) and persistent symptoms (p ≤ 0.05). Nasal congestion was predominantly seen in house dust mite-sensitized patients (78.4% with concha hypertrophy, p < 0.001). Overall, it was found that 59.7% of monosensitized patients and 63.7% of polysensitized patients reported persistent complaints.

Conclusion: This study, conducted in Western Turkey with 301 allergic rhinitis patients, revealed a high prevalence of polysensitization, particularly to pollen and animal dander. Polysensitized patients were older, exhibited higher IgE levels, and more frequently reported sneezing and rhinorrhea. Furthermore, polysensitization was linked to more persistent and severe symptoms, emphasizing the need for personalized treatment strategies for these patients. Our findings highlight the importance of developing individualized and region-specific approaches to enhance the effectiveness of allergic rhinitis management.