BMC Pediatrics最新文献

Objective: To assess whether specific parent media practices are associated with the consumption of R-rated (restricted) movies and mature-rated video game use in early adolescents.

Methods: Data from the Adolescent Brain Cognitive Development (ABCD) Study (N = 10,054, 12-13 years, Year 3, 2019-2021) were analyzed. Ordinal logistic regression models were used to assess associations among media parenting practices and R-rated movies or mature-rated video game use, adjusting for potential confounders.

Results: Parental allowance of bedroom screen use (adjusted odds ratio [AOR] 1.44, 95% confidence interval [CI] 1.36-1.53), family mealtime screen use (AOR 1.19, 95% CI 1.13-1.25), and parent screen use (AOR 1.11, 95% CI 1.03-1.20) were positively associated with watching R-rated movies. Parental allowance of bedroom screen use (AOR 1.44, 95% CI 1.36-1.52), family mealtime screen use (AOR 1.26, 95% CI 1.19-1.32), and parent screen use (AOR 1.11, 95% CI 1.02-1.20) were positively associated with playing mature-rated video games. Greater parental monitoring and limiting of screen time were negatively associated with watching R-rated movies (AOR 0.81, 95% CI 0.77-0.85 and AOR 0.73, 95% CI 0.68-0.79 respectively) and playing mature-rated video games (AOR 0.81, 95% CI 0.77-0.86 and AOR 0.72, 95% CI 0.67-0.77). Restricting screen time as a punishment for misbehavior was linked to a higher odds of watching R-rated movies (AOR 1.06, 95% CI 1.01-1.11) and playing mature-rated video games (AOR 1.12, 95% CI 1.07-1.17) while offering screen time to reward for good behavior was negatively associated with watching R-rated movies (AOR 0.95, 95% CI 0.90-0.99).

Conclusions: Media parenting practices such as monitoring or limiting screen use are significantly associated with playing mature-rated video games and watching R-rated movies. Punitive measures, such as restricting screen time as a punishment are slightly associated with increased engagement with such content. These findings highlight the importance of intentional and thoughtful parental strategies in managing children's media consumption effectively.

Introduction: Escherichia coli (E. coli) causes infections in neonates admitted to neonatal intensive care units (NICUs). Although β-lactam antibiotics are commonly used for neonatal infectious diseases, E. coli has exhibited resistance to them. Therefore, we investigated the resistance of E. coli strains isolated from a NICU to β-lactam antibiotics.

Methods: E. coli isolates were collected from patients admitted to a NICU from 2020-2023. The clinical characteristics of the patients were analyzed. The antimicrobial susceptibility was determined using the agar dilution method, and the distribution of β-lactamase genes was analyzed using PCR. Conjugation experiments were conducted to analyze the horizontal transferability of resistance genes on plasmids. Genomic DNA was extracted for whole genome sequencing, construction of plasmid physical maps, locating resistance genes, and analyzing flanking regions and the resistance gene-related sequences.

Results: Throughout the study period, 110 distinct E. coli strains were collected. Among these, 62 cases presented strains, which were resistant against at least one of seven ß-lactam antibiotics associated with conditions such as ventilator-associated pneumonia (35/62), catheter-associated urinary tract infection (14/62), necrotizing enterocolitis (7/62), skin infection (1/62), and neonatal septicemia (5/62). Resistance of E. coli isolates to seven β-lactam antibiotics ranged from 2.73-56.36%. In 62 strains (56.36%, 62/110), six genotypes (11 sub-genotypes) of 111 β-lactamase genes were identified. Conjugation experiments revealed two transconjugants carrying the bla_KPC-2 gene and two carrying the bla_OXA-1 gene, exhibiting resistance to carbapenems and other β-lactams. The plasmids of four strains were successfully conjugated and transferred to recipient E. coli C600. PCR of the transconjugant resistance genes revealed that two carried a bla_KPC-2 gene with a MIC increased up to 32-fold relative to the recipients, and the other two carried a bla_OXA-1 gene with a 32-fold increased MIC. For isolate ECK03 carrying bla_KPC-2, bla_CTX-M-64, bla_CTX-M-65, and bla_TEM-1, sequencing results showed that bla_KPC-2, bla_CTX-M-64, and bla_TEM-1 were harbored on a 114-kb pECK03_KPC-2 plasmid, whereas two identical bla_CTX-M-64 genes were harbored in E. coli isolate ECF13.  CONCLUSION: These findings highlight the existence of E. coli β-lactam resistance within NICU populations, emphasizing the need for continual monitoring of β-lactamase isolates to facilitate effective antibiotic selection.

Background: Steroid resistant nephrotic syndrome (SRNS) is a clinical phenotype of nephrotic syndrome (NS) that does not respond to steroid therapy and usually results in kidney failure. The aim of this study was to determine whether children with SRNS have subclinical left ventricular systolic dysfunction and, if so, to identify the risk factors for myocardial involvement in those children.

Methods: This prospective case-control study included of 35 children with SRNS, 40 children in the healthy control group, and 40 children with NS during the initial episode as the diseased control group. Conventional echocardiography, tissue Doppler imaging (TDI), and speckle tracking echocardiography (STE) were performed on all the studied children.

Results: No statistically significant difference in conventional echocardiography's parameters were detected between the patient and control groups. TDI revealed that the E/E' ratio was significantly greater in the SRNS group than in both the healthy and diseased control groups (P = 0.001). The left ventricle global longitudinal strain (LV GLS) was markedly lower in children with SRNS than in healthy controls and NS patients (the diseased controls) (P = 0.001). Multiple binary regression analysis for the predictors of systolic dysfunction in SRNS patients revealed that the serum albumin is the only variable that predicts systolic dysfunction in these children.

Conclusions: Subclinical systolic and diastolic LV dysfunction should be screened in NS especially SRNS children.

Background: Floating Harbor syndrome (FHS) is a rare genetic disorder with over 100 reported cases worldwide and less than 30 treated with recombinant human growth hormone (rhGH). This article reports the clinical characteristics of a child with FHS and the effect of rhGH on height increase. The patient in this case exhibits the most typical features of FHS. Whole exome sequencing (WES) detected a pathogenic variant (c.7303 C > T, p.R2435X) in the SRCAP gene of this patient, which is a denovo variant. Has good sensitivity to rhGH treatment. The literature review included 28 children who received rhGH treatment, most of whom showed an increase in height SDS without any adverse reactions.

Conclusion: For patients with characteristic clinical manifestations, the diagnosis of FHS should be considered, and further pathogenic gene sequencing analysis should be performed to assist in the diagnosis. The genetic characteristic is a heterozygous nonsense mutation of the SRCAP gene. rhGH treatment is an effective treatment method for FHS.

Background: This study aimed to compare the response to growth hormone (GH) therapy according to the presence of GH deficiency (GHD) in short-stature children born small for gestational age (SGA) in Korea and to present appropriate GH dose criteria.

Methods: We evaluated 27 children born SGA with short stature and GHD (GHD group) and 23 without GHD (non-GHD group) registered in the LG Growth Study. Growth responses and changes in GH dose over a 2-year GH therapy period were compared, and the factors affecting growth response were investigated.

Results: The standard deviation scores (SDSs) for baseline weight and body mass index (BMI) were significantly lower in boys without GHD than in boys with GHD. The SDS for insulin-like growth factor-1 (IGF-1) was lower among boys without GHD than among boys with GHD, while the SDS for insulin-like growth factor-binding protein-3 (IGFBP-3) was higher among girls without GHD than among girls with GHD; however, there was no significant difference when comparing all children with GHD to those without GHD. Regardless of the presence of GHD, the difference between chronological age and bone age decreased annually. Notably, there was significantly rapid bone age progression among patients without GHD. The findings showed differences in GH dose according to GHD starting from the 2nd year of therapy, with the non-GHD group receiving a significantly higher dose. Regarding the factors affecting growth response, younger age and bone age, higher height SDS, BMI SDS and MPH SDS were related to higher growth response (Δheight SDS and Δgrowth velocity), but there was no statistically significant correlation.

Conclusion: GHD is rare among children born SGA. Nonetheless, if there are any signs of decreased growth velocity or hypopituitarism, the presence of GHD should be assessed before GH therapy, and personalized therapy based on the results is required.

Background: Pediatric sedation clinics are rare in low-income countries. Our aim is to describe the establishment of the first-ever pediatric sedation clinic in Ethiopia and provide an assessment of its safety and efficacy over the 5 years since its establishment.

Methods: A multi-phase approach was undertaken. In the first phase, we analyzed barriers to procedural pain management through repeated focus group discussions with stakeholders. Subsequently, we conducted a modified sedation provider course from the Society for Pediatric Sedation (SPS) with pre and post-training testing to document course effectiveness. Finally, we developed a procedural sedation clinic at Tikur Anbessa Specialized Hospital. In the second phase, we prospectively collected outcome data over a 5-year period from patients receiving procedural sedation at the clinic. This included assessing the efficacy of sedation and documenting any adverse events that occurred during the procedures.

Result: One hundred three providers completed the procedural sedation course. There was a 13.4% improvement in knowledge between baseline and post-course testing. A total of 2,820 patients underwent procedural sedation over the 5-year period from 2016 through 2021, and data selected from 475 (16.8%) patients were analyzed. The most common procedure performed was bone marrow aspiration/biopsy in 384 subjects (80.8%). The most common procedural sedation used was the combination of ketamine and propofol in 60.6%. The mean pain score during the procedure was 0.28/10, which was significantly lower than the pre-procedural pain score (p-value < 0.001). A total of 9 (1.9%) patients had adverse events and there was no mortality.

Conclusion: Based on our experience, development of a safe and effective sedation clinic is possible in resource-limited settings as evidenced by low procedural pain scores, and low adverse events rates. Provider training based on a modification of the SPS course improved overall procedural sedation knowledge.

Objective: The aim of the study was to describe the control of acute chemotherapy-induced nausea and vomiting (CINV) in children with solid tumors receiving highly emetogenic chemotherapy (HEC) at our center. Additionally, the study aimed to explore the risk factors for chemotherapy-induced vomiting (CIV) with the ultimate goal of enhancing CINV management for children.

Methods: Children aged 1-18 years with solid tumors treated with HEC were enrolled. A structured diary was used to record CINV data, and the pediatric nausea assessment tool (PeNAT) was employed to assess the degree of nausea. The primary outcome was achieving complete CIV control in the acute phase for all children, and secondary outcomes included the control of acute phase CINV, CIV, and chemotherapy-induced nausea (CIN) in children aged ≥ 4 years. Data on children were prospectively collected, and univariate and multivariate logistic regression was used to explore risk factors for complete CIV control.

Results: A total of 181 children were included, with 52.5% (95/181) experiencing acute phase complete CIV control. Eighty-six children aged ≥ 4 years could be evaluated for acute phase CINV control, and complete CINV control was achieved in 27.9% (24/86), with CIV, CIN complete control rates were 41.9% (36/86) and 34.9% (30/86), respectively. The results of multivariate logistic regression showed age (< 2 years vs. >6 years: OR = 0.186, 95% CI 0.062 ~ 0.56; 2 ~ 6 years vs. >6 years: OR = 0.322, 95% CI 0.145 ~ 0.715), female (OR = 2.034, 95% CI 1.035 ~ 3.994), duration of chemotherapy block (OR = 1.611, 95%CI 1.039 ~ 2.499), and antiemetic regimen (5-hydroxytryptamine-3 receptor antagonists (5HT3RA) vs. 5HT3RA + dexamethasone: OR = 0.395, 95% CI 0.171 ~ 0.914) were statistically significant in complete CIV control (P < 0.05).

Conclusions: Children with solid tumors treated with HEC at our center experienced suboptimal control of CINV. Older age, female, and a longer duration of the chemotherapy block were identified as risk factors for complete CIV control. Receipt of 5HT3RA plus dexamethasone had a higher likelihood of acute phase complete CIV control versus 5HT3RA. In the future, individualized management of nausea and vomiting, based on existing CINV guidelines and the unique characteristics of children, will be necessary to reduce the incidence of CINV and improve the quality of life for these children.

Background: Thalassemia major is a significant public health concern, passed from parents to children, which can be mitigated through screening programs. Inconsistencies in blood transfusions and iron chelation therapy result in physical changes that can cause psychological problems, with anxiety being the most prominent. This study aimed to examine the factors influencing anxiety levels among adolescent thalassemia major survivors.

Methods: The research utilized a quantitative approach with a correlational analytic design and cross-sectional method. It included a population of 122 adolescent survivors, all of whom were included using a total sampling technique. Data analysis involved univariate analysis by frequency distribution, bivariate analysis using the chi-square test, and multivariate analysis with logistic regression.

Results: The findings of the study showed that adolescent thalassemia survivors experienced varying levels of anxiety: mild anxiety in 70.5%, moderate anxiety in 9.8%, and severe anxiety in 19.7%. Significant associations were observed between anxiety levels and factors such as body image (p < 0.001), self-esteem, and coping strategies, while social support did not show a significant relationship. Body image was identified as the most impactful factor, with poor body image raising the risk of severe anxiety by 11.6 times.

Conclusions: Anxiety is common among adolescent thalassemia survivors, with body image, self-esteem, and coping skills being key factors. Poor body image notably increases the risk of severe anxiety, emphasizing the need for psychological support focused on body image, self-esteem, and coping strategies to improve mental health in this group.