BMC Pediatrics最新文献

Background: Timely diagnosis of malignancies in children is very important. Knowing the clinical manifestations of malignancies help in timely diagnosis. The aim of this study is to investigate the prevalence of musculoskeletal manifestations of malignancies in children.

Methods: we searched the manuscript databases including Scopus, Web of science, Google scholar, Medline, and Cochrane for all studies in accordance with the relevant keywords. The nine-star Newcastle-Ottawa Scale (NOS) scoring system was employed to assess the methodological quality of all eligible studies. Statistical analysis was performed using the Comprehensive Meta-Analysis (CMA) software.

Results: Of 96 articles initially collected by database searching, 13 articles were eligible for the final analysis. The major musculoskeletal manifestations related to childhood malignancies include bone pain, bone swelling, bone tenderness, bone fracture, vertebral collapses, joint effusion and joint tenderness. Manifestations related to these malignancies also include septic arthritis-type symptoms, osteomyelitis-type symptoms, and osteomyelitis. The overall pooled prevalence of musculoskeletal manifestations in children suffering hematopoietic tumors (acute lymphoblastic leukemia and acute myeloid leukemia) was 32.1% (95%CI: 24.0-41.3%). The overall prevalence of musculoskeletal manifestations due to neuroblastoma was also 30.5% (95%CI: 19.2-44.9%). The rate of musculoskeletal manifestations due to other childhood cancers range from 23.5 to 80.3%.

Conclusion: A significant part of childhood malignancies are associated with musculoskeletal manifestations. Clinicians should carefully evaluate and closely follow children with musculoskeletal manifestations to timely diagnosing of malignancies.

Trial registration number: Not applicable.

Background: High-risk neuroblastoma (HR-NB) is associated with high metastatic and relapse rates that require intensive multimodal treatment. We evaluated the efficacy and safety of dinutuximab beta as first-line maintenance immunotherapy in pediatric patients with HR-NB in real-world clinical settings in China.

Methods: We retrospectively reviewed the clinical records of pediatric patients with newly diagnosed HR-NB in the hospital from October 2021 to November 2023. Patients treated with dinutuximab beta in combination with granulocyte-macrophage colony-stimulating factor (GM-CSF) and isotretinoin as the first-line maintenance therapy were included in this study. Among patients with residual disease after completing induction and consolidation treatment, those with partial response (PR) or very good partial response (VGPR) except for bone marrow (BM) residue were also administrated vincristine/irinotecan/temozolomide (VIT) chemotherapy.

Results: Fifty-one patients with newly diagnosed HR-NB who achieved at least PR before immunotherapy were evaluated. At the end of immunotherapy, the objective response rate (ORR) in 33 patients with evidence of disease was 60.6% (95% confidence interval (CI), 42.1-77.1%) and the complete response rate (CRR; n = 18) was 54.5% (95% CI, 36.4-71.9%). The 2-year event-free survival (EFS) rate and overall survival (OS) rate were 80.1% (95% CI, 66.2-88.8%) and 97.6% (95% CI, 84.3-99.7%), respectively. The 2-year EFS rate was higher in patients with CR (94.4%; 95% CI, 66.6-99.2%) than in non-CR patients (72.6%; 95% CI, 53.9-84.7%). Dinutuximab beta was well tolerated in patients and had fewer side effects, which decreased over time. Co-treatment of dinutuximab beta with VIT chemotherapy did not require discontinuation in patients undergoing immunochemotherapy.

Conclusion: The study showed promising efficacy and safety of dinutuximab beta as the first-line maintenance immunotherapy for pediatric patients with HR-NB. Notably, the combination of dinutuximab beta with GM-CSF and VIT chemotherapy could be used for treating patients who did not achieve CR after previous multimodal therapy.

Background: COVID-19 has become a global pandemic. However, studies examining the outcomes for pediatric patients after hospital discharge, post-COVID-19, and the predictive factors influencing their high mortality rates, are still limited, especially in Indonesia. Therefore, this study aimed to determine the predictor that predict mortality six months after hospitalization for COVID-19.

Methods: A retrospective cohort study was performed. The participants were children who were admitted to Dr. Sardjito General Hospital from February-April 2022. The inclusion criteria were pediatric patients who were hospitalized in the pediatric ward and discharged after recovering or completing isolation. COVID-19 hospitalization deaths and incomplete medical records were omitted from the study. Bivariate analysis was performed with chi-square log rank test. Kaplan-Meier method was used for calculating the cumulative survival between comparison groups of the predictor variables. Multivariate analysis was performed with a Cox regression. The relationships between the variables are presented as the Hazard ratios (HRs), confidence intervals of 95% (95%CI), and statistical significance levels, with p < 0.05.

Results: Among the 114 patients studied, the mortality rate during the six months after COVID-19 was 29.8%. The multivariate analysis revealed that mortality was correlated with comorbidities (p < 0.021; HR 11.415; CI 95% 1.449-89.912) and obesity (p = 0.032; HR 4.617; CI 95% 1.139-18.721).

Conclusion: The presence of comorbidities and obesity are significant predictors of mortality in pediatric patients with COVID-19 within six months following hospital discharge.

Clinical trial number: Not applicable.

Background: Umbilical venous catheterization (UVC) is commonly performed in neonates, but improper catheter tip may lead to hepatic complications.

Aim: This study aims to retrospectively analyze the relationship between UVC tip position and the occurrence of hepatic complications, utilizing ultrasound for early detection and characterization of hepatic injury.

Methods: We conducted a retrospective study of 206 preterm neonates who underwent UVC insertion in a NICU from January 2021 to December 2023. All patients with complete post‒UVC insertion abdominal ultrasound follow‒up records were included. According to the UVC tip position, neonates were divided into two groups: the Central Group and the Non-central Group. Within the non-central group, cases with the tip located in the ductus venosus (DV) formed the DV Subgroup. The incidence of hepatic complications, including portal venous gas, portal vein thrombosis, and hepatic parenchymal injury, was compared across these groups.

Results: Hepatic complications were observed in 23 neonates (11.2%, 23/206), including portal venous gas (6.3%), portal vein thrombosis (1.9%), and hepatic parenchymal injury (2.9%). Among these, 9 cases (39.1%) occurred in the Central Group, while 14 cases (60.9%) were in the Non-Central Group, with 8 of these (57.1%) belonging to the DV Subgroup. The Non-Central Group accounted for the majority of complications, including all cases of hepatic parenchymal injury, with a proportion involving the DV Subgroup. These findings suggest an elevated risk of complications associated with non-central catheter tip position.

Conclusion: Non-central catheter tip positions increase the risk of hepatic complications. Regular ultrasound follow-up is crucial for ensuring proper tip position and early complication detection.

Background: Sepsis is a major cause of neonatal mortality worldwide. However, its risk factors, clinical characteristics, laboratory findings, and bacterial etiology vary across countries. Therefore, this study compared these factors between early-onset sepsis (EOS) and late-onset sepsis (LOS) in Sana'a city, Yemen.

Methods: A prospective, cross-sectional study was conducted among 156 neonates with suspected sepsis in Sana'a. Data about risk factors, clinical characteristics, and laboratory findings were collected using a data collection sheet, and blood samples were collected for culture according to established procedures. The data were then analyzed at a significance level of < 0.05.

Results: Of neonates with suspected sepsis, 65.4% had LOS and 34.6% had EOS. However, sepsis was confirmed in 62.2% of cases. Compared to EOS, preterm birth (OR = 4.1, 95% CI: 1.27-13.02; P = 0.013), and exteremely low birthweight (ELBW) and very low birthweight (VLBW) (OR = 4.7, 95% CI: 1.02-22.19; P = 0.033) were significantly associated with a higher risk of LOS, while premature rupture of membranes (PROM) was significantly associated with a lower risk of LOS (OR = 0.2, 95% CI: 0.03-0.99; P = 0.043). Jaundice was significantly more common in neonates with EOS, while apnea was significantly more common in those with LOS. However, no significant differences were found between EOS and LOS in terms of other clinical characteristics, leukocyte and platelet counts, or C-reactive protein (CRP). Gram-positive cocci were the most frequent bacterial isolates (63.9%), with coagulase-negative staphylococci (CoNS) being the predominant species (63.6% in EOS and 42.2% in LOS). Gram-negative bacilli were isolated from 36.1% of cases and were more common in LOS (77.1%) than in EOS (22.9%), with Klebsiella species being the most predominant (19.6%).

Conclusion: Most neonatal sepsis cases in Sana'a are LOS, mostly commonly caused by Gram-positive cocci and associated with preterm birth and ELBW and VLBW. Differences in risk factors associated with EOS and LOS highlight the need for targeted preventive measures in neonatal care settings.

A retrospective analysis was conducted to evaluate the clinical characteristics, diagnostic challenges, and management strategies in a child with congenital long QT syndrome (cLQTS) caused by a KCNH2 gene pathogenic variant presenting as "motor seizures". The case involved a 10-year-old boy with a two-year history of recurrent loss of consciousness, which had worsened during the preceding week. Clinical manifestations included sudden episodes of unconsciousness, rightward strabismus of both eyes, cyanosis of the lips, guttural vocalizations, rigidity and shaking of the upper limbs, and urinary incontinence. These events typically lasted approximately two minutes, initially occurring semiannually but escalating to daily episodes over the past week, affecting both awake and sleep states. Video electroencephalography (VEEG) showed generalized slow waves and low voltage activity, while electrocardiography (ECG) demonstrated QTc prolongation, paired, and multi-source ventricular ectopy preceding torsades de pointes. Genetic testing identified a pathogenic c.1697G > A mutation in the KCNH2 gene corroborating the clinical diagnosis of cLQTS. Following confirmation, the patient was initiated on long-term oral therapy with propranolol and nicorandil. Under this regimen, the patient was seizure-free for 7-month. For patients with seizures or seizure-like episodes, such as extremity movement or rigidity, it is necessary to perform an ECG examination. Additionally, dynamic ECG and electrolyte assessments should be conducted when necessary to minimize the risk of misdiagnosis and inappropriate treatment. When VEEG shows a "slow-flat-slow" pattern, differentiation from A-S syndrome caused by malignant arrhythmias is critical. Once cLQTS is diagnosed, it is imperative to initiate prompt and aggressive treatment to mitigate the risks of syncope and sudden cardiac death.

Background: Exclusive enteral nutrition (EEN) is recommended as first-line therapy for children with mild to moderate Crohn's disease (CD), given its effectiveness in inducing clinical remission (CR) and promoting mucosal healing (MH). However, the identification of reliable early predictors of EEN response remains an area requiring further investigation.

Methods: Patients with CD diagnosed between 2015 and 2024 were divided into training and validation cohorts. Baseline clinical and laboratory covariates were analyzed separately to evaluate their associations with CR and MH after 8 weeks of EEN therapy. Significant covariates were identified through univariate analysis and correlation tests, followed by their inclusion in stepwise logistic regression to develop separate predictive models for CR and MH. Model performance was evaluated using receiver operating characteristic (ROC) curves.

Results: A total of 56 patients were included in the derivation cohort, and 28 were included in the validation cohort. The CR diagnostic model achieved an Area Under Curve (AUC) of 0.93 in the derivation cohort (95% confidence interval (CI) 0.87-1.00; p < 0.05) and 0.82 in the validation cohort (95% CI 0.62-1.02; p < 0.05). Higher baseline levels of IBIL (> 4.95 µmol/L), T-cell cluster of differentiation 3 (CD3) (> 76.78%), and iron (> 9.025 mmol/L) were associated with reduced CR rates. The MH diagnostic model yielded an AUC of 0.87 in the derivation cohort (95% CI 0.73-1.00; p < 0.05) and 0.66 in the validation cohort (95% CI 0.43-0.89; p = 0.231). Factors associated with lower MH rates included an Interleukin 10 (IL-10) level > 4.35 µmol/L and a red cell distribution width (RDW) > 14.55%.

Conclusion: IBIL, CD3 and iron levels are reliable predictors of the induction of CR with EEN, whereas the IL-10 level and RDW serve as early predictors of MH.

Background: Routine childhood vaccination (RCV) has demonstrated its effectiveness, saving millions of lives globally and reducing childhood mortality. However, several factors impede mothers from completing their children's vaccination schedule. The purpose of this study was to determine factors influencing RCV among children aged 12-23 months in the Adansi South District (ASD) of Ghana.

Methods: A cross-sectional community-based survey with a census approach was conducted involving 3,312 mothers with children aged 12-23 months. Frequency and percentage, bivariate, and hierarchical binary logistic regression analyses were used to identify the factors related to RCV.

Results: The number of fully vaccinated children was 56.8% with partially vaccinated being 43.2%, indicating a low full RCV. The factors that influenced RCV included the child's birth order (AOR = 0.653, [0.452--0.945], p = 0.024), maternal religious affiliation (AOR = 1.315, [1.098-1.575], p = 0.003), Antenatal care (ANC) contacts (AOR = 2.045, [1.315-3.179], p = 0.001), number of times ANC contacted (AOR = 0.597, [0.502-0.710], p = 0.000), and child (AOR = 1.842, [1.566-2.166], p = 0.000) and mother's age (AOR = 2.346, [1.369-4.019], p = 0.002). Maternal (AOR = 1.461, [1.143-1.866], p = 0.002) and spousal income adequacy (AOR = 1.590, [1.081-2.337], p = 0.018), spouse's income irregularity (AOR = 2.292, [1.757-2.987], p = 0.000), and if spouse's income is the sole source of livelihood (AOR = 1.751, [1.271-2.414], p = 0.001), type of material used for house construction (AOR = 1.459, [1.046-2.033], p = 0.026), and the type of housing for dwelling (AOR = 1.570, [1.310-1.881], p = 0.000), as well as mothers' perception of vaccines, and vaccination activities (AOR = 1.333, [1.137-1.562], p = 0.000) influence RCV in the district.

Conclusions: The relatively low uptake of RCV is indicative of low herd immunity among these children and posing a potential risk of causing vaccine-preventable diseases (VPD) outbreaks and subsequent health issues among children. The Ghana Health Service should offer flexible scheduling and reminder systems for vaccination appointments in the district. The GHS should prioritise targeted interventions during child welfare clinics (CWC), ANC contacts, and community gatherings to educate mothers on the importance of childhood vaccinations.

Background: Pediatric healthcare professionals facilitate children to enhance and maintain a physically active lifestyle. Activity monitors (AM) can help pediatric healthcare professionals assess physical activity in everyday life. However, validation research of activity monitors has often been conducted in laboratories and insight into physical activity of children in their own everyday environment is lacking. Our goal was to study the criterion validity of a prototype AM (AM-p) model in a natural setting.

Methods: Cross-sectional community-based study with ambulatory children (2-19 years) with and without developmental disability. Children wore the AM-p on the ankle and were filmed (gold standard) while performing an activity protocol in a natural setting. We labelled all videos per 5-second epoch with individual activity labels. Raw AM-p data were synchronized with activity labels. Using machine learning techniques, activity labels were subdivided in three pre-defined categories. Accuracy, recall, precision, and F1 score were calculated per category.

Results: We analyzed data of 93 children, of which 28 had a developmental disability. Mean age was 11 years (SD 4.5) with 55% girls. The AM-p model differentiated between 'stationary', 'cycling' and 'locomotion' activities with an accuracy of 82%, recall of 78%, precision of 75%, and F1 score of 75%, respectively. Children older than 13 years with typical development can be assessed more accurately than younger children (2-12 years) with and without developmental disabilities.

Conclusion: The single ankle-worn AM-p model can differentiate between three activity categories in children with and without developmental disabilities with good accuracy (82%). Because the AM-p can be used for a heterogenous group of ambulatory children with and without developmental disabilities, it may support the clinical assessment for pediatric healthcare professionals in the future.

Background: The Omicron variant of SARS-CoV-2 has been associated with unique clinical presentations in children, including croup-like symptoms such as barking cough, hoarseness, and respiratory distress. This study aimed to compare the clinical, laboratory, and treatment characteristics of hospitalized pediatric patients with croup who tested positive or negative for COVID-19 during the Omicron wave.

Methods: A retrospective, descriptive-analytical study was conducted on 111 pediatric patients hospitalized with croup at Bahrami Children's Hospital and the Children's Medical Center in Iran from January 21 to March 20, 2022. Patients were categorized into two groups: PCR-positive (Omicron group, n = 30) and PCR-negative (non-Omicron group, n = 81). Data on demographics, clinical severity, laboratory indices, treatments, and outcomes were extracted and analyzed using SPSS version 20.

Results: The mean age of the Omicron group was significantly younger (16.93 ± 24.80 months) compared to the non-Omicron group (32.58 ± 37.26 months; p = 0.049). Symptom severity was higher in the Omicron group, with moderate to severe symptoms observed in 73.4% of patients, compared to 32.1% in the non-Omicron group (p = 0.001). The Omicron group had longer hospital stays (2.59 ± 3.93 vs. 2.11 ± 2.75 days; p = 0.016) and required more nebulized epinephrine (2.47 ± 1.27 vs. 1.77 ± 1.003 days; p = 0.003) and repeat corticosteroid doses (83.3% vs. 38.3%; p = 0.0001). Laboratory findings showed no significant differences between the groups (all p > 0.05).

Conclusion: Children with croup during the Omicron surge exhibited increased symptom severity, required more intensive treatment, and experienced longer hospital stays compared to those without COVID-19. These findings emphasize the need for heightened clinical awareness and tailored management strategies for Omicron-related croup in pediatric populations.