BMC Pediatrics最新文献

Background: Pediatric palliative care (PPC) provides holistic and family-centered support that extends beyond end-of-life care. Children living with life-limiting or life-threatening conditions frequently experience significant emotional distress, psychosocial burden, and symptom related challenges. Early access to psychological interventions may help address their complex needs and enhance overall well-being. This systematic review and meta-analysis aimed to synthesize the evidence on psychological interventions delivered to children eligible for PPC.

Methods: Five electronic databases were searched for randomized-controlled trials including children (< 18 years) eligible for PPC who received a psychological intervention were included. Eligible studies reported quantitative outcomes related to psychological symptoms. Risk of bias was assessed using Cochrane risk-of-bias tool (RoB-2) and meta-analyses were conducted when at least two trials reported comparable outcomes for post-treatment.

Results: Thirty studies met inclusion criteria, focusing on children with cancer (25 studies), sickle cell disease (4 studies), or cystic fibrosis (1 study). Most psychological interventions were cognitive-behavioral approaches. The results of the meta-analysis were associated with significant reductions in symptoms of anxiety (p < 0.00001) and depression (p < 0.005). Significant improvements were also observed in physical outcomes, such as overall pain intensity (p = 0.0003). In addition, psychological interventions significantly reduced distress, anxiety, and pain associated with invasive medical procedures (p < 0.00001). Although heterogeneity across studies was moderate to high, most interventions demonstrated beneficial effects, particularly those incorporating cognitive-behavioral and coping-based strategies.

Conclusions: The available evidence suggests that psychological interventions, especially those grounded in cognitive-behavioral approaches, may offer meaningful benefits for children eligible for PPC, improving emotional well-being and reducing symptom burden. Integrating such interventions into routine PPC could enhance comprehensive care. Further high-quality trials across a wider range of life-limiting conditions are needed to expand the evidence base and strengthen clinical implementation.

Clinical registration: This study is registered in PROSPERO (CRD42024594171).

Background: Rituals with spiritual or symbolic meaning form an integral part of pediatric intensive care, yet their timing, initiators, and contextual functions remain insufficiently described. In secularizing and religiously diverse societies, understanding how such practices are documented and enacted is essential for ethically grounded care. This study characterizes sacramental and symbolic rituals in a German tertiary neonatal and pediatric intensive care unit (NICU/PICU), examining initiation patterns, faith alignment, and survival-related timing.

Methods: We conducted a retrospective descriptive analysis of 135 neonates and infants who received a documented ritual between 2013 and 2024. Rituals were categorized as sacramental or symbolic. Initiators, performers, clinical context, and survival category were recorded. Faith alignment was defined by the correspondence between family affiliation and ritual performer. Data from chaplaincy and clinical documentation were analyzed descriptively.

Results: Most rituals were initiated by healthcare staff (≈ 67%) and performed by clergy (≈ 70%). Rituals occurred across the full range of survival outcomes but clustered in intermediate prognostic categories, where uncertainty was greatest. Symbolic and staff-led rituals were used predominantly in time-critical situations, particularly when clergy were unavailable or denominational alignment was unclear. Cross-faith rituals were rare and mainly observed in acute phases. Ritual-faith congruence increased with longer survival trajectories. No distinct non-sacramental religious rituals were documented, likely reflecting under-capture of informal practices.

Conclusions: Ritual practice in pediatric intensive care extends well beyond last rites, encompassing symbolic, anticipatory, and adaptively tailored acts integrated into routine clinical care. These patterns reflect the influence of urgency, availability, and cultural diversity on ritual expression. Documentation gaps limit full quantification and underscore the need for prospective, mixed-methods studies and inclusive institutional frameworks for culturally and spiritually responsive care.

Background: Childhood obesity is a major and increasing public health concern. Early prediction of the risk of childhood obesity may lead to targeted preventative interventions. To develop a prediction-toolbox that is suitable for clinical implementation, it is imperative to align it with the perceptions of health care professionals (HCPs), but this aspect remains relatively underexplored. This study aimed to explore the perceptions of Dutch HCPs regarding the concept of a childhood obesity prediction toolbox.

Methods: A qualitative study design comprising semi-structured interviews (n=15) with Dutch HCPs was used. HCPs included youth health care practitioners, youth health care nurses and policy advisors employed at the municipal health service of Amsterdam. Perceptions were explored regarding the concept of a three-element childhood obesity prediction toolbox of the EndObesity project, which consists of a prediction tool, prevention strategies to support families of high-risk infants, and communication tips for HCPs. The data were analysed through reflexive thematic analysis.

Results: HCPs were positive about early identification of the risk of future childhood obesity and the support of high-risk infants. They acknowledged the potential benefits of personalized care facilitated by such risk prediction, but concerns were raised regarding its validity and its added value compared with the clinical judgement of HCPs. HCPs also expressed some negative connotations regarding risk communication e.g. making parents feel insecure or judged, especially in vulnerable situations. Finally, HCPs acknowledged the complexity of childhood obesity prevention and emphasized the need for a complementary broader approach at both the municipal and national policy levels.

Conclusions: Dutch HCPs generally supported the potential use of a childhood obesity prediction toolbox, but they also expressed concerns regarding the validity, the added value of the toolbox and about risk communication. These concerns must be addressed in further development of the toolbox.

Background: Coronary angiography (CAG) plays a critical role in the detailed anatomical assessment of coronary artery lesions (CALs) during the early recovery phase of Kawasaki disease (KD) in children. However, its practical experience and reported outcomes in pediatric populations remain limited.

Objective: To summarize the coronary angiographic features and evaluate the safety and feasibility of CAG in children with KD complicated by CALs.

Methods: We retrospectively analyzed the clinical and angiographic data of 15 consecutive children with KD complicated by CAL (KD-CAL) who underwent CAG during the recovery phase (3-6 months after disease onset) at our center between June 2020 and June 2024. Preoperative transthoracic echocardiography was performed for CAL assessment, followed by selective CAG under general anesthesia. Procedural parameters, lesion characteristics, and clinical outcomes were systematically reviewed.

Results: All 15 children (median age 1.5 years) successfully completed CAG without immediate complications. A total of 21 CALs were identified, predominantly located in the left main stem (38.1%, 8/21) and the proximal left anterior descending branch (38.1%, 8/21). Lesion distribution included small aneurysms/dilatations (47.4%), medium aneurysms (31.6%), and giant aneurysms (21.0%). CAG detected one case of coronary stenosis with collateral vessel formation and one case of intra-aneurysmal thrombosis, both missed by preoperative echocardiography. No significant differences were observed in aneurysm dimensions (inlet, widest, outlet diameters, and length) or in Z-scores between echocardiography and CAG (all P > 0.05). Median fluoroscopy time was 3.1 min, radiation dose-area product was 42 Gy·cm², and contrast volume was 1.5 mL/kg. During a median follow-up of 33 months, no coronary events occurred.

Conclusion: In children with high-risk KD-CAL, invasive coronary angiography (CAG) is a safe and feasible procedure that provides superior anatomical detail for detecting critical complications such as stenosis and thrombosis. Echo-cardiography remains the first-line modality for aneurysm sizing and serial monitoring. However, for comprehensive coronary assessment following echocardiography, CT coronary angiography (CTCA) is the preferred non-invasive imaging standard. Invasive CAG should be reserved for selected high-risk or complex cases where it provides decisive anatomical and functional information to guide definitive management.