BMC Pediatrics最新文献

Purpose: The main goal of this study is to identify the associated factors with avoidable admissions in ED, comparing pre-COVID and COVID periods.

Methods: This was retrospective study that took place in a Paediatric Emergency Department of a metropolitan, university-affiliated hospital in Portugal. All visits to paediatric emergency department between 2014 and 2020 were considered.

Results: There was a decrease of 7.2% points in avoidable visits between pre-COVID and COVID periods. Considering both periods, this study identifies older ages, being admitted to the paediatric emergency department between 4 and 7 a.m., referral and having visited the emergency department previously within 72 h as major factors associated with a reduced likelihood for avoidable visits. On the other hand, it identifies an increased likelihood of avoidable visits in the 3 to 5 years old age group, visits that occurred during the Summer and visits that occurred between 8 and 11 p.m. When considering what changed between pre-COVID and COVID periods, while having visited the paediatric emergency department 72 h prior made it less likely for the patient to be an avoidable visit during the pandemic period, this tendency has inverted, making it more likely for return visits to be avoidable.

Conclusions: The relatively low decrease in avoidable visits' ratios between pre-COVID and COVID periods, associated with the similar distribution of attendance during the day and lower odds ratio of avoidable visits during periods when primary care is available, suggests that avoidable visits are a chronical problem of the National Health system's structure and its usage, not having a single factor nor a combination of factors as a driving force. Nevertheless, this study identified several factors associated with avoidable visits to the emergency department. Therefore, it can aid policy makers to create targeted interventions to mitigate this problem.

Background: Interest in social-emotional skills in the context of school maladjustment is growing, and social-emotional learning can help develop such skills. Second Step is a social-emotional skills approach prevalent in several countries. In Asian countries, including Japan, preventive interventions for school maladjustment in young children are scarce, and their effectiveness is not adequately validated. This study examines the effectiveness of the social-emotional learning "Second Step program" among children aged 4 to 5 years.

Methods: In 2022, the Second Step program was implemented on a class-by-class basis for children aged 4 to 5 years enrolled in middle grades of a kindergarten in Japan. The program included 25 sessions, each lasting one hour on average, approximately once a week. To test the effectiveness of the program, kindergarten teachers assessed the children's social skills. Parents assessed their children's behaviors. Data of 73 children in the intervention group and 91 in the control group were analyzed. The intervention group participated in the Second Step program, while the control group did not participate in any program. Evaluations were conducted before and after the intervention program.

Results: Children in the intervention group displayed significantly greater assertiveness, self-control, and cooperation scores following program implementation compared with those in the control group. They also showed significantly lower scores on behavioral problems compared with those in the control group and before the program. The intervention had a meaningful impact on both social competencies and behavioral outcomes. Specifically, the effect sizes for social competencies in the intervention group were moderate to large, reflecting substantial improvements.

Conclusions: The social-emotional learning Second Step program implemented on a classroom basis may be effective in early childhood. An early approach targeting kindergarten-aged children is necessary to prevent school maladjustment.

Background: Management of pelvic fracture-related urethral injury (PFUI) in children remains debated due to various complications. Patients typically receive either primary realignment (PR) or suprapubic cystostomy with delayed urethroplasty (SCDU), but optimal outcomes are unclear. This study evaluates these two surgical techniques by reviewing 20 years of case data and existing literature.

Methods: We retrospectively analyzed patients treated for PFUI from 2004 to 2023, with a median follow-up of 2 years (1-15 years). Additionally, we performed a meta-analysis of relevant literature, searching PubMed, Web of Science, and Cochrane databases. Eight studies, including ours, were included in the analysis.

Results: Sixty-eight boys with PFUI (median age: 7.3 years; range: 4.8-10.8) underwent PR (39) or SCDU (29). Postoperative complications-urethral strictures, urinary incontinence, calculus, infections, and erectile dysfunction-occurred in PR vs. SCDU groups as follows: 38.5% vs. 51.7% (p = 0.276); 12.8% vs. 3.45% (p = 0.360); 7.7% vs. 13.8% (p = 0.678); 56.4% vs. 93.1% (p < 0.001); and15.4% vs. 3.5% (p = 0.231), respectively. PR was associated with lower costs and higher quality of life. The meta-analysis of eight studies involving 432 patients showed no significant differences between PR and SCDU in urethral stricture rates (OR = 0.60, 95% CI 0.33-1.10, p = 0.10), urinary incontinence (OR = 0.94, 95% CI 0.52-1.70, p = 0.84), and erectile dysfunction (OR = 0.85, 95% CI 0.41-1.76, p = 0.65).

Conclusion: There was no difference in complications between the two surgical modalities at long-term follow-up, however, PR presents more advantages in reduce operative times, frequency of postoperative infections, cost, and long-term quality of life.

Clinical trial number: Not applicable.

Background: Clinical decision aids (CDA) play an important role in the management of young febrile infants (under 90 days of age) who are at risk of serious or invasive bacterial infections (SBI/IBI). Since 2010, a number of tailored CDAs have been developed that allow for lower-risk infants to be managed safely while undergoing fewer investigations and not receiving parenteral antibiotics. We aimed to map the CDAs developed since 2010, their derivation methodology, and their variable components.

Methods: A scoping review based on the Joana Briggs Institute framework was conducted for studies published between 2010 and 2025. A database search was conducted using Medline, Embase, Scopus, Web of Science, Google Scholar, and the Cochrane library. Studies evaluating the derivation, validation, and application of CDAs for the assessment of febrile infants were eligible for inclusion. Two reviewers independently screened, analysed, and extracted data from the literature.

Results: A total of 32 studies met the inclusion criteria. The majority of studies were conducted in North America and Canada (56%), followed by Europe (28%), and Asia (16%). Of the 32 studies, 14 were retrospective, 9 prospective and 9 secondary analysis of an available dataset. There were 32 CDAs that were either derived or validated across 32 studies. The derivation methodology was classified into four themes: (i) expert consensus and evidence synthesis; (ii) regression analysis; (iii) recursive partitioning; and (iv) machine learning. CDAs typically either identified a low-risk cohort through sequential assessment (n = 12) or predicted the risk of IBI/SBI using prediction models (n = 20). CDA sensitivity and specificity ranged from 46 - 100% and 9 - 95% respectively for SBI/IBI. The majority (n = 18) of the more complex CDA prediction models have been published in the last five years. The most common variables included within the CDAs were age, urinalysis, height of fever, C-reactive protein, and absolute neutrophil count.

Conclusion: This scoping review highlights a wide range of CDAs with a trend towards prediction modelling rather than sequential assessment in the last five years. There is still variability in CDA properties, applicability, and diagnostic performance, necessitating further validation of common CDA and prediction models.

Background: The increasing hypertension (HTN) prevalence in children, largely driven by obesity, highlights the need to investigate its risk factors, including the role of abdominal obesity.

Methods: We analysed data from the Korea National Health and Nutrition Examination Survey (2007-2021) to assess the prevalence of overweight and obesity (OW-OB), elevated blood pressure (EBP), and HTN among 11,554 participants aged 10-18 years. EBP and HTN were defined according to the 2017 American Academy of Pediatrics guidelines, and abdominal obesity was defined as a waist-to-height ratio (WHtR) of ≥ 0.5. Secular trends in the prevalence of OW-OB and EBP-HTN were examined across five time periods, and risk factors for EBP-HTN were evaluated in OW-OB children stratified by abdominal obesity status.

Results: The prevalence of EBP, HTN, and OW-OB was 8.22% (95% confidence interval [CI], 7.60-8.86), 10.46% (95% CI, 9.72-11.20), and 25.11% (95% CI, 24.17-26.05), respectively. Among the 3,015 participants with OW-OB, 13.53% (95% CI, 12.03-15.04) and 17.64% (95% CI, 15.98-19.31) were diagnosed with EBP and HTN, respectively. Although the prevalence of OW-OB and EBP-HTN had increasing trends from 2007 to 2009 to 2019-2021, these trends were not statistically significant. In the children with OW-OB, obesity severity, male sex, older age, and paternal HTN were associated with EBP-HTN. The HTN risk factors differed according to abdominal obesity status. In participants with abdominal obesity, male sex (OR 2.32, 95% CI 1.643-3.299; p < 0.0001), older age (OR 1.16, 95% CI 1.102-1.233; p < 0.0001), and severe obesity (OR 3.12, 95% CI 1.991-4.895; p < 0.0001) were significant risk factors; whereas, in those without abdominal obesity, paternal HTN (OR 1.66, 95% CI 1.207-2.303; p = 0.0025), hypercholesterolemia (OR 1.85, 95% CI 1.114-3.083; p = 0.0178), male sex (OR 1.83, 95% CI 1.329-2.530; p = 0.0002), and older age (OR 1.11, 95% CI 1.036-1.198; p = 0.0038) were significant risk factors.

Conclusions: In children with overweight or obesity, the risk factors for EBP-HTN vary depending on the presence of abdominal obesity. These findings highlight the need for differentiated surveillance and prevention strategies based on abdominal obesity status in this high-risk population.

Clinical trial number: Not applicable.

Background: Severe neonatal thrombocytopenia, as a rare but life-threatening disease with multiple etiologies, has limited relevant reports in China. The single-center study was performed in a severe thrombocytopenic cohort to improve the prognosis of this disease.

Methods: We included all the patients diagnosed with severe thrombocytopenia (platelet counts ≤ 50 × 10³/µL) in our institution between October 2016 and February 2021, and retrospectively reviewed their electronic records. Comparisons were made according to etiology and outcome.

Results: Among the 5819 inpatients, 194 with severe thrombocytopenia were included in this study, with 64.4% of the cases manifesting thrombocytopenia within 72 h of life. The highest incidence was recorded among extremely low birth weight neonates (6.5%). The main etiologies included sepsis (22.2%), genetic syndromes (14.4%), perinatal asphyxia (9.8%), necrotizing enterocolitis (NEC; 8.8%), and cytomegalovirus infection (6.7%). The median platelet nadir was 5.0 × 10³/µL [IQR:2.0 × 10³/µL-16.0 × 10³/µL], and 112 patients developed very severe thrombocytopenia (platelet counts ≤ 30 × 10³/µL), of which 21.4% were associated with late-onset sepsis. In 45 culture-positive cases, the gram-negative group had a lower level of platelets (mean [SD]: 28 [11]×10³/µL) as compared to the gram-positive group (mean [SD]: 39 [12]×10³/µL). A total of 120 cases (61.9%) exhibited evidence of hemorrhage, with patients diagnosed with NEC demonstrating the highest incidence of hemorrhage at 58.8%. The platelet counts took a median of 10 days to recover: 11 and 7 days for early and late-onset cases; 15 days without and 21 days with platelet transfusions, respectively. The overall mortality rate was 26.8%. The causes of severe thrombocytopenia in 32.7%, 19.2%, and 17.3% of patients who died were identified as sepsis, birth asphyxia, and NEC, respectively. The levels of PT (P = 0.025), APTT (P = 0.046), and lactate (P = 0.028) were lower among surviving patients.

Conclusions: Sepsis, genetic syndromes, and perinatal asphyxia are the predominant etiologies of severe neonatal thrombocytopenia in China. The overall prognosis of severe neonatal thrombocytopenia is poor, but its severity and outcome were related to laboratory results (PT, APTT, and lactate) and the underlying etiology.

Background: Double alimentary tract obstruction due to congenital anomalies is a rare clinical occurrence, with limited cases published in medical literature. This article presents a unique case of coexisting retroesophageal right subclavian artery (RRSA) and congenital colonic stenosis (CCS), conditions that have not been previously documented together in pediatric population.

Case presentation: A Thai male newborn was born by cesarean section at gestational age of 41 weeks. One week before birth, intrauterine asphyxia and idiopathic bilateral intracerebral hemorrhage were diagnosed by prenatal ultrasonography. Despite postnatal interventions including a ventriculoperitoneal shunt and subsequent external ventricular drain, the intracerebral hemorrhage recurred and progressed. Concurrently, the patient experienced multiple episodes of post-feeding vomiting, intermittent abdominal distension, and regular defecation without constipation. Sepsis secondary to an infected shunt occurred, accompanied by marked abdominal distension. The physician clinically suspected non-IgE-mediated cow's milk protein allergy and ileus associated with sepsis. Tragically, the patient succumbed at seven months due to a brain abscess stemming from an infected external ventricular drain. Ultimately, postmortem examination unraveled double alimentary tract obstruction, consisting of RRSA and CCS. The RRSA, originating from proximal thoracic aorta, caused notable esophageal compression and functional stenosis which led to the frequent vomiting and reflux. The CCS involved the distal transverse colon, descending colon and proximal sigmoid colon, accounting for nearly 50% of the colon. The CCS was therefore the exact cause of intermittent abdominal distension. The stenotic colon contained submucosal and myenteric plexuses, excluding Hirschsprung disease.

Conclusion: This case highlights the diagnostic complexities of RRSA and CCS resulting in double gut obstruction and masquerading as non-IgE-mediated cow's milk protein allergy and sepsis-induced ileus. Awareness of these rare coexisting congenital anomalies can aid in early recognition, prevent misdiagnosis, enable timely management and improve outcomes for affected pediatric patients.

Introduction: The association of inflammation and iron deficiency could be related to up to 40% of anemia in young children.

Objective: To describe the anemia and iron deficiency in children and verify possible associations with dietary practices, nutritional status and inflammatory markers.

Methods: This cross-sectional study was conducted with one hundred and twelve children aged between 6 months and 3 years in Early Childhood Education Centers in Minas Gerais, Brazil. Nutritional status regarding iron and inflammatory markers was assessed using the reference values proposed by the World Health Organization.

Results: Anemia and iron deficiency were observed in 58 (51.8%) and 89 (79.5%), respectively, of children evaluated. Hemoglobin values were directly associated with the z-score of height for age after adjusting for high-sensitivity C-reactive protein values (β-adjusted = 0.375; 95% CI 0.088 to 0.662; p = 0.011). The values of high-sensitivity C-reactive protein correlated directly with RDW (r = 0.202; p = 0.033), ferritin (r = 0.425; p < 0.001) and soluble transferrin receptor (r = 0.446; p < 0.001), and inversely with hemoglobin (r = -0.287; p = 0.002), serum iron (r = -0.580; p < 0.001) and transferrin saturation index (r = -0.528; p < 0.001). The ROC curve shows that RDW (AUC = 0.708; CI 95% 0.612 to 0.803) and soluble transferrin receptor (AUC = 0.588; 95% CI 0.481 to 0.694) were the variables that showed the better level of discrimination of anemia.

Conclusions: The prevalence of anemia was higher than in national studies, and there was a correlation between inflammatory markers and biomarkers of iron nutritional status.

Background: Using non-pharmacological methods to reduce the pain of hospitalized infants is one of the most important priorities in the health of newborns. Pain relief during painful procedures can help prevent unwanted physical and psychological effects. This study was conducted with the aim of investigating the effect of combined non-pharmacological interventions on venous blood sampling pain in preterm infants.

Methods: In this clinical trial study, 88 preterm infants admitted to the Neonatal Intensive Care Unit of Rouhani Hospital was randomly assigned to four groups of sucrose (S), the combined group of sucrose and non-nutritive sucking (NS), the combined group of swaddle and sucrose (SS) and the combined group of sucrose, non-nutritive sucking and swaddling (NSS). In order to collect information, were used the premature Infant Pain Profile Scale (PIPP) and demographic characteristics questionnaire.

Results: This study showed that during blood sampling, the difference in the mean pain score of two groups of S and NS was equal to 3.54 (95% CI = 1.85, 5.24) and in two groups S and NSS was equal to 4.68 (95% CI = 2.99, 6.38), and these differences were significant (P < 0.001). In addition, the mean pain difference in all study groups was significant in two time periods before-during and during-after blood sampling (P < 0.001). Also, the mean pain difference in the two time periods before-during and during-after in NS and NSS groups was significant compared to the control group (sucrose) (P < 0.001).

Conclusions: Based on the results of this study, the use of combined non-pharmacological interventions of NSS has been more effective in reducing the pain caused by venous blood sampling than other conditions where two or one non-pharmacological intervention were used.

Background: Right lateral thoracotomy is increasingly used because of its cosmetic benefits, shorter hospital stays, rapid return to full activity, and ease of reoperation in pediatric patients with uncomplicated congenital heart disease. Currently, one-lung ventilation (OLV) is used in these children to facilitate surgical exposure. We aimed to assess the effect of OLV on postoperative outcomes.

Methods: Children aged 6 months to 6 years undergoing right lateral thoracotomy cardiac surgery with cardiopulmonary bypass (CPB) were randomized into an OLV group or a control group. For the OLV group, the tidal volume was 5 ml/kg with 6 cmH₂O positive end-expiratory pressure from the incision until the end of CPB, whereas patients in the control group received two-lung ventilation, except during vena cava occlusion. Lung ultrasonography was performed twice in the supine position for each patient: first, 3 min after intubation before surgery (T₁), and second, 3 min after lung recruitment maneuvers at the end of surgery (T₂). The primary outcome was the incidence of postoperative pulmonary complications within 72 h of surgery and significant atelectasis (defined by a consolidation score of ≥ 2 in any region) at T₂.

Results: Overall, 54/96 (56.3%) children developed postoperative pulmonary complications after lateral thoracotomy cardiac surgery with CPB. The incidence of postoperative pulmonary complications was 52.1% (25/48) and 60.4% (29/48) in the OLV and control groups, respectively (odds ratio: 0.712; 95% confidence interval: 0.317-1.600; p = .411). At the end of surgery, the incidence of significant atelectasis was 37.5% in the OLV group compared to 64.6% in the control group (odds ratio: 0.329; 95% confidence interval: 0.143-0.756; p = .008). The consolidation score of the left lung (dependent lung) in the OLV group was significantly lower than that in the control group (p = .007); there was no significant difference in the right lung's postoperative consolidation score between the two groups (p = .051).

Conclusions: There was no significant difference in the incidence of postoperative pulmonary complications within 72 h of surgery between the two groups. However, children who underwent right lateral thoracotomy cardiac surgery with CPB in the OLV group showed a low incidence of atelectasis at the end of surgery.

Trial registration: ChiCTR, ChiCTR2100048720. Registered on July 13, 2021, www.chictr.org.cn .