BMC Pediatrics最新文献

Background: Paediatric cancer patients are highly susceptible to bloodstream infections (BSIs), which are a leading cause of morbidity and mortality in this population. However, data focusing on BSI pathogens and resistance profiles in paediatric oncology patients in Ghana are lacking. This study aimed to characterize the spectrum of bacterial pathogens and their antibiotic susceptibility patterns among paediatric cancer patients with BSIs at the national tertiary referral centre, to inform empiric therapy and infection control strategies.

Methods: A prospective cross-sectional study was conducted at Korle Bu Teaching hospital from April to September 2023. Paediatric cancer patients (ages 1-18) presenting with fever on admission were consecutively sampled and enrolled, excluding those on antibiotics for BSI. Blood cultures were performed using standard microbiological techniques, and isolates were identified by conventional biochemical tests. Antimicrobial susceptibility testing was done using the modified Kirby-Bauer disk diffusion method on Mueller-Hinton agar, interpreted according to Clinical and Laboratory Standards Institute (CLSI) 2021 guidelines. Patient demographics and clinical data were collected, and infection prevalence was calculated. Associations were analysed by chi-square tests, with significance at p < 0.05.

Results: BSIs were confirmed in 22% of patients (22/100). Gram-positive organisms predominated (59.1% of isolates), chiefly Staphylococcus aureus (31.8%), coagulase-negative staphylococci (22.7%) and Streptococcus pneumoniae (4.5%). Gram-negatives (40.9%) included Klebsiella pneumoniae (18.2%), Pseudomonas aeruginosa (13.6%), and Escherichia coli (9.1%). No significant difference in BSI occurrence was observed by gender (p > 0.5). All Gram-negative isolates were susceptible to meropenem and amikacin, whereas over half of all isolates were resistant to gentamicin. For Gram-positives, cefoxitin susceptibility was 85.7% and S. aureus showed high resistance to penicillin (71.4% resistant) and gentamicin (85.7% resistant). Overall, 18.2% of isolates were multi-drug resistant (MDR) bacteria which were more common in Gram-negatives (75%) than Gram-positives (25%).

Conclusion: BSIs constitute a significant complication in paediatric cancer patients in this Ghanaian centre. Meropenem and amikacin were highly effective against Gram-negative bacteria, whereas substantial resistance was observed to gentamicin and ceftriaxone. There is the need to revise the empiric fever protocol at the centre to consider amikacin instead of gentamicin, The emergence of MDR organisms underscores the need for robust antibiotic stewardship and infection control measures at the oncology clinic.

Background: Non-suicidal self-injury (NSSI) among adolescents is a growing concern in global adolescent mental health. This study examines psychosocial correlates of NSSI in adolescents presenting to a pediatric emergency department in Shanghai.

Methods: A total of 612 adolescents (aged 12-18) presenting with unintentional injuries to the emergency department from July 2019 to July 2024 were enrolled. Structured interviews and validated questionnaires assessed demographic, familial, and school-related variables. NSSI behaviors were identified based on the DSM-5 criteria. Logistic regression analysis was used to examine associations with NSSI.

Results: Of the participants, 283 (46.2%) reported NSSI behaviors within the past 12 months, representing the past-year prevalence of NSSI. Female gender (OR = 7.130, junior high; OR = 6.000, high school), prior history of NSSI (OR = 8.452), single-parent household (OR = 2.934), higher parental education (OR = 2.476), and school bullying (OR = 3.195) were positively associated with NSSI. Living in suburban areas (OR = 0.581) and being cared for by non-parental caregivers (OR = 0.357) were inversely associated with NSSI.

Conclusion: NSSI was common in this emergency department sample, and several psychosocial characteristics were found to be associated with NSSI. These findings are descriptive and should not be interpreted causally, but they may contribute to hypothesis generation for future longitudinal research.

Background: Epidemiological research has suggested that exposure to mercury in pregnancy may negatively affect birth weight (BW). However, the results were inconclusive. This meta-analysis aimed to provide a quantitative summary of evidence for the relation of prenatal mercury exposure to BW.

Methods: We performed a systematic search in the PubMed and Scopus databases until March 2024. The pooled effects of prenatal mercury exposure on birth weight (BW) were assessed using a random-effects model, using the standardized regression coefficients (β) along with their corresponding 95% confidence intervals (CI). Stratified analysis by type of specimen, sample size, method of mercury assessment, Hg concentration, and trimester of sampling was conducted to investigate possible sources of heterogeneity.

Results: Forty-one studies, including 128,487 participants, were analyzed. In the overall analysis, no significant relationship was revealed between prenatal mercury exposure and BW (β= -0.002, 95%CI: -0.003 to 0.0001; P = 0.06) with substantial heterogeneity (I² = 63.0, P = 0.001). However, in the stratified analysis, exposure to mercury was inversely linked to the neonatal BW in studies on placental exposure (β= -0.144, 95%CI: -0.272 to -0.016; P = 0.02) and exposure at delivery (β= -0.010, 95%CI: -0.020 to -0.002; P = 0.01) and at the third trimester (β= -0.0003, 95%CI: -0.0005 to -0.0001; P = 0.004) of pregnancy. Mercury was also negatively associated with BW in studies that measured mercury using atomic absorption spectroscopy (β= -0.010, 95%CI: -0.020 to -0.001; P = 0.02). Furthermore, blood Hg levels ≥ 2.09 µg/L (β = -0.029, 95% CI: -0.052 to -0.006; P = 0.01) and placental Hg levels ≥ 10 µg/kg (β = -0.193, 95% CI: -0.293 to -0.094; P = 0.001) were significantly associated with lower BW.

Conclusion: This meta-analysis revealed that mercury exposure may be negatively associated with birth weight, especially when higher concentrations are present in the blood and placenta, as well as during the late stages of pregnancy, which significantly correlates with lower neonatal BW.

Objective: This study aimed to investigate the correlation between intestinal flora characteristics and serum zinc and iron levels, as well as related inflammatory markers, in paediatric patients with M. pneumoniae pneumonia (MPP).

Methods: Faecal and serum samples were collected from 30 children with M. pneumoniae pneumonia (MPP group), 30 children with non-M. pneumoniae pneumonia (NMP group), and 30 healthy children (N group) who met the study criteria and were treated at our hospital between November 2024 and March 2025. These samples underwent 16S rRNA sequencing and trace element detection analyses.

Results: Alpha diversity showed no significant differences (P > 0.05). Beta diversity analysis revealed significant intergroup differences (P < 0.05). At the phylum level, all three groups were dominated by Firmicutes, Bacteroidetes, Actinobacteria, and Proteobacteria. The MPP group exhibited the lowest abundance of Firmicutes and the highest abundance of Bacteroidetes. At the genus level, the MPP group showed higher abundances of Bacteroides, Enterococcus, and Escherichia-Shigella compared to the control group. Analysis of intestinal flora differences revealed that the abundances of Prevotella and Lachnoclostridium in the MPP group were higher than those in both the NMP and N groups, whereas the abundance of Enterococcus was higher than that in the N group (P < 0.05). The NMP group exhibited higher abundances of Eubacterium, Anaerostipes, and Collinsella than the MPP and N groups (P < 0.05). The N group demonstrated higher abundances of Roseburia, Lachnospiraceae, and Subdoligranulum than the MPP and NMP groups (P < 0.05). Blood zinc and iron levels were lower in the MPP group than in the NMP and N groups. The heatmap of intestinal flora correlations with clinical parameters showed positive associations between Faecalibacterium, Parabacteroides, and Blautia with blood zinc and iron levels. Among these, the correlation between Parabacteroides and blood zinc levels was statistically significant (r = 0.370, P < 0.05). Escherichia-Shigella and Intestinibacter showed negative correlations with serum zinc and iron levels.

Conclusion: Paediatric patients with MPP exhibit disrupted intestinal flora composition alongside reduced serum zinc and iron levels, with specific bacterial genera correlating with alterations in serum zinc and iron concentrations.

Background: Blau syndrome (BS) is an early-onset autoinflammatory disease, typically characterized by a clinical triad of granulomatous polyarthritis, uveitis and skin lesion. Tumor necrosis factor (TNF) antagonists (TNF inhibitor, TNFi) are used routinely according to treatment guidelines for several refractory BS therapy. However, peripheral nervous system demyelination related to TNFi is being increasingly recognized. Here, we report a case of Guillain-Barré syndrome probably secondary to an TNFi, Yisaipu, one kind of etanercept biosimilars, which is a rare and usually unpredictable adverse drug reaction of TNFi in BS patients.

Case presentation: A 10-year-old girl was diagnosed with BS due to present with skin rash, multiple joint activity limits, NOD2 gene mutation, granulomatous disorders identified from the pathology of skin and synovium biopsy 6 years ago, and treated by corticosteroids and methotrexate (MTX). Then, she discontinued all treatments and follow-up by herself in 2021. Due to a recurrence of BS, Yisaipu and MTX were given again. After 9 months treatment, the patient developed limb pain, a mouth askew with slurred speech, positive nuchal vigidity, muscle weakness, absent knee jerk and ankle reflexes. Laboratory investigations showed a raised protein level and normal cellular count of CSF, positive anti-sulfatides antibody IgM in CSF and peripheral nerve damage of electromyography. Imaging investigations illustrated enhancement signal of ventral roots, dorsal roots and cauda equina of lumbar MRI.

Conclusions: TNFi therapy is increasing every year, so more attention should be paid to the safety of TNF inhibitor therapy, especially nervous system demyelination. The assessment about nervous system should be recommended in regular follow-up among patients receiving TNFi therapy.

Background: Laughter yoga is a non-pharmacological and non-invasive therapeutic approach that integrates voluntary laughter with controlled breathing exercises. This systematic review aimed to evaluate research investigating the impact of laughter yoga on children's health outcomes.

Methods: This systematic review included studies with randomized controlled trial (RCT) and quasi-experimental designs, adhering to the PRISMA guidelines. This systematic review, conducted between December 18, 2023, and October 31, 2024, was guided by the PRISMA guidelines and a predefined protocol based on the PICOS-based protocol. Eligible studies included randomized controlled trials (RCTs) and quasi-experimental designs. A comprehensive literature search was conducted in Google Scholar, Medline/PubMed, Cochrane Library, Science Direct, CINAHL Complete, and OVID databases. Study selection was based on the PICOS framework, and methodological quality was assessed using the Joanna Briggs Institute-Meta Analysis Statistical Assessment and Review Instrument (JBI-MAStARI). Based on the inclusion criteria, six studies were incorporated into the review.

Results: The total sample across the included studies was 305 participants, with 66% of the studies involving at least 50 participants. Findings indicated that laughter yoga contributed to a reduction in anxiety and stress levels in children (p < 0.05), while no statistically significant effect was observed on depression scores (p > 0.05). Although no substantial improvement in self-esteem was reported, positive changes in self-concept were noted. Furthermore, laughter yoga was associated with an increase in salivary IgA levels (p < 0.01), whereas no significant influence on cortisol levels was found (p > 0.05). Additionally, the intervention was reported to alleviate pain, fatigue, and burnout while enhancing hope and overall happiness.

Conclusions: Study results showed that laughter yoga promoted the increase in happiness and self-concept in children and improved their ability to cope with stress. It also provided a physiological improvement by positively affecting pain and fatigue. In light of these results, it is recommended that laughter yoga be used more widely in children's daily lives and clinical practices.

Background: Balance training on different surfaces is important in the rehabilitation of children with spastic cerebral palsy. However, the impact of balance training on different surfaces on ankle proprioception has not yet been investigated. This study aims to investigate the effects of balance exercises performed on rough and smooth unstable surfaces on ankle proprioception and dynamic balance in children with spastic cerebral palsy.

Methods: The study included 16 children aged 5-10 years with spastic hemiplegic and diplegic type cerebral palsy who were at the Gross Motor Function Classification System Level I and II. The children participating in the study were randomly assigned to two groups. One group performed balance exercises comprising six movements on a balance board for an average of 10 min following a 45-minute physical therapy session on a smooth surface, while the other group performed the same exercises on a rough surface. The intervention was conducted twice weekly for a duration of eight weeks. Balance was assessed using the Pediatric Balance Scale, the Functional Reach Test, and the Single Leg Stance Test. A digital goniometer was used to assess ankle joint proprioception.

Results: Significant improvement was observed in balance test scores in both groups. However, in the joint position sense tests for 15° dorsiflexion and plantar flexion on both the dominant and non-dominant sides, significant improvement was observed only in children who performed exercises on the rough balance surface (p < 0.05).

Conclusions: Balance training on unstable surfaces was found to be effective in improving balance parameters, with training on rough surfaces demonstrating greater efficacy than training on smooth surfaces in enhancing ankle proprioception.

Trial registration: NCT05676983 (03/01/2023; retrospectively).