BMC Pediatrics最新文献

Background: Participation in sports is the main manifestation/subdomain of physical exercise in adolescents and affects cardiovascular health in different ways.

Objectives: To analyze the relationship between body fatness and arterial wall thickness as well as the mediating role of sports participation in this relationship among adolescents.

Methods: This cross-sectional study is linked to the ABCD-Growth Study conducted in Presidente Prudente, Brazil. The study sample included 402 adolescents (275 boys and 127 girls) aged 11-17 years recruited from schools (non-sport group) and sports clubs (sports group). Sex-stratified multivariate model was created using structural equation modelling (SEM) with carotid (CIMT) and femoral arterial wall thickness (FIMT) as dependent variables were assessed by an ultrasound device. Body fatness percentage (BF) as the independent variable and was assessed by whole-body dual-energy X-ray absorptiometry, and sports participation as a moderator was assessed by face-to-face interviews. The maturity offset and dyslipidemia were treated as confounders in the mediation models.

Results: In girls, body fatness was positively associated with FIMT (r = 0.210 [95%CI: 0.035; 0.372]) but not with CIMT (r= -0.148 [95%CI: -0.314; 0.027]), whereas sports participation was not associated with vascular structure. In boys, body fatness was inversely related to CIMT (r= -0.285 [95%CI: -0.390; -0.172]) and positively to FIMT (r = 0.129 [95%CI: 0.011; 0.244]), whereas sports participation was inversely related to FIMT (r= -0.142 [95%CI: -0.256; -0.024]). Among boys, sports participation mediated 7.4% of the relationship between body fatness and FIMT, and the association between body fatness and FIMT remained significant (r = 0.168 [95%CI: 0.037; 0.299]).

Conclusions: Sports participation mediates the relationship between BF and arterial thickness in adolescent boys.

Background: A road traffic accident is a collision between vehicles, between pedestrians and vehicles, between vehicles and animals, or between fixed obstacles and vehicles that leads to fatal human injury and premature death. Children are highly vulnerable to road traffic accident death. Yet, evidence is scarce concerning it in this study area. This study aimed to determine the magnitude of mortality and associated factors among road traffic accident victim children.

Methods: An institution-based cross-sectional study was conducted among 391 victimized children using simple random sampling techniques from March 1st, 2021, to April 30th, 2021. The sample size was calculated using a single population proportion formula, and the data were collected retrospectively using a structured checklist. The data were checked for completeness and consistency, coded, entered into EPI Data version 3.1, and then transferred to STATA version 14 statistical software for analysis. Bivariate and multivariable binary logistic regression analyses were conducted to identify the association between dependent and independent variables. An adjusted odds ratio with a 95% CI was used to measure the strength of the association, and a P-value ≤ 0.05 was considered statistically significant.

Result: The overall mortality was 10.7% (95% CI: 8- 14). Patients' age within 1- 4 years (AOR (95%CI: 7(2.0-24.6)), urgent need of blood transfusion (AOR (95%CI: 3.2(1.03-9.8)), Glasgow coma scale < 8 (AOR (95%CI: 6.7(2.1-20.8)), surgery done (AOR (95%CI: 4.7(1.6-14.1)), and length of stay < 5 days (AOR (95%CI: 4.7(1.6-13.3)) were significantly associated with mortality of road traffic accident victim children.

Conclusion: The overall mortality was high compared with other countries' findings. Being young, in urgent need of blood transfusion, Glasgow coma scale < 8, undergoing surgery, and short length of stay were significantly associated with mortality of road traffic accident victim children. This study recommended prioritizing young children and timely blood transfusions for emergency cases.

Purpose: Neonatal activity is an important physiological parameter in the neonatal intensive care unit (NICU). The degree of neonatal activity is associated with under and over-sedation and may also indicate the onset of disease. Activity may also cause motion noise on physiological signals leading to false readings of important parameters such as heart rate, respiratory rate or oxygen saturation or, in extreme cases, a failure to calculate the parameter at all. Here we report on a novel neonatal activity monitoring technology we have developed using a Random Forest machine learning algorithm trained on features extracted from a depth video stream from a commercially available depth sensing camera.

Methods: A cohort of twenty neonates took part in the study where depth information was acquired from various camera locations above and to the side of each neonate. Depth data were processed to provide features indicating changes corresponding to the activity of the neonate and then input into a Random Forest model which was trained and tested using a leave-one-out cross validation paradigm.

Results: Applying the thresholds found in training the Random Forest model during testing with leave-one-out cross validation, the mean (standard deviation) of the sensitivity and specificity of the optimal points and the corresponding area under the receiver operator curve (ROC-AUC) were 92.0% (8.8%), 93.2% (11.1%) and 97.7% (2.5%) respectively. The activity identified by the model also appeared to match well with noisy segments on the corresponding respiratory flow signal.

Conclusions: The results reported here indicate the viability of continuous non-contact monitoring of neonatal activity using a depth sensing camera system.

Background: Intraventricular hemorrhage (IVH) is one of the critical complications of prematurity with severe forms, associated with irreversible brain damage. We hypothesized that infants born in South Africa may have different modifiable risk factors and outcomes for severe IVH compared to that reported in studies in neonatal populations in higher resource settings. Our study aimed to define the prevalence of IVH with further characterization of risk factors based on IVH severity, with the goal of providing guidance on modification of protocols for the management and prevention of severe IVH.

Methods: This was a retrospective cohort study of very low birth weight infants admitted to the NICU of Charlotte Maxeke Academic Hospital in Johannesburg (CMJAH) from January 1, 2016, to December 31, 2020. Our study included all infants, weighing less than 1500 g, admitted to the hospital regardless of place of birth who had had at least one cranial ultrasound in the first week of life. Infants with other intracranial malformations than IVH, birth weights greater than 1500 g, and significant amount of missing data were excluded from the study. Maternal and neonatal information were extracted from an existing neonatal database and analyzed using R statistical software. Multivariable logistic regressions were used to investigate risk factors associated with increased odds of having IVH and its impact on mortality.

Results: A total of 2,217 very low birthweight (VLBW) infants admitted to the NICU at CMJAH during the study period met eligibility criteria. Median gestational age (GA) and birth weight (BW) were 28 weeks and 900 g, respectively. IVH prevalence was 22.6% with high grade IVH (grade 3 or 4) accounting for 6.8% of the cases. Infants with high grade IVH had 4-fold increase odds of dying (OR = 4.843, 95% CI = 2.984; 7.86, p < 0.001). Acidosis was associated with increased odds of high grade IVH (OR = 2.27; 95%CI: 1.42; 3.64). Similarly, infants with early onset sepsis had higher odds of high grade IVH (OR = 2.22; 95%CI: 1.04; 4.75).

Conclusions: Acidosis and sepsis had a significant association with the occurrence of severe IVH. Antenatal steroids showed an association with occurrence and severity suggesting it may play an important role, but did not reach significance so must be further evaluated. Having severe IVH substantially increased the odds of death. Based on these findings, future directions could include collaborative QI projects with obstetricians to improve uptake of antenatal steroids and promotion of neonatology led QI projects to reduce risk factors associated with severe IVH.

Background: Multisystem inflammatory syndrome in children (MIS-C), a complication of COVID-19, is frequently associated with cardiac involvement. Although most affected children recover, the extent and duration of myocardial abnormalities remain uncertain. This study evaluates mid-term cardiac function in MIS-C patients, with and without cardiac involvement, using transthoracic echocardiography (TTE) and speckle-tracking echocardiography (STE).

Methods: This case-control study (2022-2023) included 90 children: 30 with MIS-C and cardiac involvement, 30 with MIS-C without cardiac involvement, and 30 healthy controls. TTE and STE were used to assess left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) at diagnosis and at three months, comparing outcomes across groups.

Results: The cardiac involvement group exhibited significantly elevated ferritin and C-reactive protein levels (P = 0.006 and P = 0.017, respectively) and a higher prevalence of troponin positivity (56.67% vs. 20%, P = 0.009). At baseline, these patients had markedly reduced LVEF (56.5 ± 4.3) and GLS (-21.6 ± 3.21) compared to healthy controls (LVEF: 68.2 ± 5.21; GLS: -24.8 ± 1.48; both P < 0.001). Notably, the basal segment showed significant longitudinal strain reduction (-18.75 ± 3.89 vs. -23.58 ± 0.27, P = 0.027), while differences in the apical and mid segments were not significant. By three months, LVEF (69 ± 4.21, P = 0.53) and GLS (-24.13 ± 2.39, P = 0.17) normalized. Heart failure and coronary artery brightness resolved in all affected patients, and most structural abnormalities improved; only two cases exhibited persistent mild left ventricular dilation. Regional strain analysis at follow-up revealed values comparable to those of healthy controls across all segments.

Conclusion: Cardiac dysfunction in MIS-C largely resolves within three months, with LVEF and GLS returning to normal. However, persistent myocardial abnormalities in a few cases highlight the need for long-term cardiac monitoring to detect and manage potential sequelae.

Introduction: Childhood stunting is a significant public health challenge in Tanzania, affecting over one-third of the children. It has long-term consequences for growth, development, and the overall health status. The high prevalence of stunting in Tanzania necessitates an understanding of its severity levels and determinants. Therefore, this study aimed to explore the varying severity levels of stunting and its associated factors among under-5 children in Tanzania, using data from the Demographic and Health Survey.

Materials and methods: A cross-sectional study utilizing secondary data from Tanzanian Demographic and Health Survey (TDHS) 2022 was employed. A weighted sample of 4,866 children under-5 years of age was included in the analysis. A multilevel ordinal logistic regression model was employed to account for the ordinal nature of stunting and hierarchical structure of the TDHS data. The Brant test was used to assess whether the proportional odds assumption was met, with a p-value greater than 0.05 indicating that the assumption was satisfied. The deviance measure was used to compare the fitness of the different models. A multilevel proportional odds model was used to investigate the impact of risk factors contributing to stunting.

Results: The prevalence of stunting among Tanzanian under-5 children was 29.66%. Of these, 22.16% were moderately stunted, and 8.67% were severely stunted. Being Male, children aged 6-23 months, those born as part of multiple births, children from low- or middle-income households, those whose mothers have no formal or only primary education, and those living in areas with high poverty rates, children residing in the southern and southwestern highland administrative regions are more likely to experience severe stunting.

Conclusion: This study revealed that stunting among under-5 children in Tanzania remains a significant public health concern. By addressing these determinants, such as ensuring access to proper nutrition, improving maternal education, and promoting community awareness, Tanzania can make significant strides toward reducing the burden of stunting and improving the health and well-being of children under-5 years of age.

Clinical trial number: Not applicable.

Purpose: Fetal lower urinary tract obstruction (LUTO) is a rare congenital disease associated with high morbidity and mortality due to pulmonary hypoplasia and renal insufficiency. Fetal management includes early vesicoamniotic shunting (VAS), a technique that has evolved in recent years to preserve kidney function. Previous publications have focused on intrauterine shunt complications, such as dislocation and preterm premature rupture of membranes (PPROM). In our study we aimed to assess postnatal shunt related complications that became obvious after birth.

Materials and methods: We describe our preliminary experience with 25 fetuses who underwent VAS with a Somatex^® shunt as well as postnatal shunt removal at two experienced centers for fetal medicine. The intrauterine course, underlying pathology, postnatal outcome and details on shunt explantation and related complications were assessed. The data were retrospectively analysed in relation to the intrauterine course, underlying pathology, further malformations, and perioperative characteristics with a focus on the complication spectrum and type of intervention.

Results: Twenty-five fetuses underwent VAS at a median of 17 weeks. Two newborns were excluded because they died within the first 24 hours of life secondary to fulminant lung hypoplasia. In ten (43%) newborns, shunt removal was performed under local anaesthesia. In 13 (57%) neonates, the shunt was explanted surgically, and five (22%) of these operations were defined as complex.

Conclusion: Intrauterine VAS with a Somatex^® shunt is feasible, and in the majority of cases, shunt explantation can be easily performed after birth. However, the umbrellas may cause intraabdominal tissue damage, peritoneal adhesions or skin defects, and early surgical management of VAS associated complications might be necessary.

Background: The signaling pathway of C-type natriuretic peptide (CNP) and its receptor (natriuretic peptide receptor 2, NPR2) is implicated in the process of endochondral ossification, which is crucial for the linear growth of long bones. Loss-of-function mutations in the NPR2 gene cause short stature. This study aimed to identify and characterize truncating mutations in NPR2 among Chinese families with short stature.

Methods: Whole-exome sequencing and Sanger sequencing were conducted to identify potential mutations. Bioinformatic analysis was utilized to assess the pathogenicity of two mutations. The effects of candidate mutation on gene expression, subcellular localization, protein stability, and protein function were further assessed through in vitro assays.

Results: In this study, A novel mutation, c.2629_2630delAG, p.S877Hfs*10 and a previously reported mutation, c.1162 C > T, p.R388* (ClinVar database) in NPR2, were identified in the individuals, and these variants were inherited from the mother and father, respectively. Both mutations were predicted to be deleterious and have a significant impact on protein structure based on bioinformatics analysis. In vitro experiments demonstrated that mutant mRNAs evaded nonsense-mediated mRNA decay (NMD) to produce truncated NPR2 proteins with reduced stability and increased degradation. Furthermore, two truncated NPR2 proteins exhibited impaired localization at the cell membrane and severely reduced ability to stimulate cyclic guanosine monophosphate (cGMP) production in HEK293T cells compared to wild-type (WT) NPR2 (p < 0.05).

Conclusion: Our study identified two loss-of-function mutations of the NPR2 gene in two Chinese families and offered new insights on the pathogenesis of short stature caused by NPR2 truncating mutations.

Background: Inborn babies in many Ghana facilities who need any monitoring or therapy above Essential Newborn Care (ENC) are often separated from postnatal ward dyadic care and sent to Neonatal Units (NUs) due to personnel workload, training gaps or both.

Objectives: Describe (1) care of inborn newborns in NUs at 2 hospitals in Ghana and (2) outcomes, including breastfeeding. We identified stable babies who could potentially be managed by midwives in postnatal wards with appropriate additional training and staffing.

Methods: We conducted a retrospective study from January to December 2022 on inborn newborns in NUs at Greater Accra Regional Hospital (GARH) and Tamale Teaching Hospital (TTH), and the Special Baby Ward at TTH. Data collected included monitoring (glucose), interventions (phototherapy, intravenous antibiotics, thermal and fluid support, oxygen, tube feeds, transfusions) and outcomes (breastfeeding, length of stay, mortality). We used a two-proportion z-test and t-test to test the difference between two proportions and means respectively, with alpha-error of 5% and beta-error 20%. Breastfeeding outcomes were compared between GARH and TTH NUs, and also between babies admitted to the NUs but received no NU interventions and those admitted to the TTH SBW.

Results: Of 2978 inborn newborns admitted to NUs, 11.5% received no NU Interventions. (GARH NU 6.2% (n = 1995) vs. TTH NU 22.1%, (n = 983) p < 0.001). In TTH NU, 3.3% received no listed interventions at all. TTH NU, which administered iv fluids instead of formula to babies during separation, had significantly higher exclusive breastfeeding at discharge. (TTH NU 91.1% vs. GARH NU 66.3%, p < 0.001) Breastfeeding rates were also higher in infants in the TTH SBW vs. infants who received no NU interventions in the TTH NU (TTH SBW 99.3% (n = 261) vs. TTH NU No Intervention group 96.3% (n = 217), p < 0.05).

Conclusions: Overall, 11.5% of babies admitted to the two neonatal units did not receive any intensive interventions, including 4.8% of infants < 1800 g. Designing dyadic Intermediate Care between Essential Newborn Care and Special/Intensive care could result in lower census in NUs to permit greater focus on preterm, low-birthweight and sick newborns with higher acuity, and also reduce separation and promote breastfeeding.

Background: Pediatric hydrocele is a congenital pathology commonly diagnosed in newborns. Also, untreated pediatric hydrocele can induce adverse permanent consequences in adulthood. This study aimed to investigate the global prevalence of pediatric hydrocele in infants and children, as a necessary factor for health policymakers.

Methods: Databases of PubMed, Scopus, Web of Science, Embase, ScienceDirect, and Google Scholar search engine were systematically searched for studies reporting the prevalence of pediatric hydrocele in infants and children. The main keywords of "Prevalence", "Outbreak hydrocele", "Infant", and "Child" were used in this regard. Screenings were applied to achieve eligible papers and a quality control process was conducted to select middle to high-quality papers. Finally, the random effect model was used to perform meta-analysis, and heterogeneity was checked by the I² index. Data analysis was applied with CMA (v.2) software.

Results: Following the assessment of 5 eligible studies with a sample size of 70,961 infants (1-2 weeks), the global prevalence of hydrocele in infants was found 0.001% (95%CI:0.00007-0.018, 1 per 1000 live births). In the review of 3 studies with a sample size of 278,597 children (7-12 years), the global prevalence of hydrocele in children was reported 0.0034% (95%CI:0.00004-0.21), 3.4 per 1000 children).

Conclusion: According to the analyzed studies, a relatively high prevalence of hydrocele in infants was reported, globally. Besides, there were undiagnosed or recurrent pediatric hydrocele cases in children which need more precise medical screening. Thus, it is necessary to implement health policies to reduce the prevalence of pediatric hydrocele and associated adverse consequences.