BMC Pediatrics最新文献

Background: Neonates with CCHD remain at high risk for mortality. This study aimed to evaluate the impact of the prenatal-postnatal integrated management model (PPIMM) on perioperative outcomes and mortality in neonates with CCHD, and to identify factors associated with mortality.

Methods: This retrospective cohort study enrolled 274 neonates with CCHD undergoing cardiac surgery from January 2018 to August 2024. Patients were categorized into the PPIMM group (n = 140) and the non-PPIMM group (n = 134). The primary outcome was all-cause mortality, including operative mortality and late mortality. The secondary outcome was unplanned reoperation. Kaplan-Meier survival and Cox regression analyses were performed.

Results: The PPIMM group underwent surgery at a younger age (8.00 vs. 16.00 days, P < 0.001), with lower rates of preoperative intubation (11.43% vs. 20.90%, P = 0.047), emergent procedures (5.71% vs. 14.18%, P = 0.032), and operative mortality (5.71% vs. 13.43%, P = 0.036) compared to the non-PPIMM group. The median follow-up was 20.70 months (IQR 9.00-30.30) in the PPIMM group and 20.40 months (IQR 7.00-37.50) in the non-PPIMM group. Late mortality (3.57% vs. 4.48%, P = 0.702) and unplanned reoperation rates (P>0.05) were comparable between the PPIMM and non-PPIMM groups. Kaplan-Meier analysis showed a significant survival advantage for all-cause mortality in the PPIMM group (log-rank P = 0.038). Twelve neonates underwent immediate postnatal surgery, with no deaths or reoperations during a median follow-up of 13.00 months. PPIMM was a protective factor for operative mortality in the overall cohort, and prenatal diagnosis was protective within the non-PPIMM subgroup, while preoperative intubation, postoperative ECMO use, and elevated lactate level at 24 h postoperatively were risk factors.

Conclusions: PPIMM was associated with earlier surgery, better preoperative status, and lower operative mortality in neonates with CCHD. In selected neonates, immediate postnatal surgery appeared feasible and was not associated with increased mortality. PPIMM and prenatal diagnosis were protective factors, whereas preoperative intubation, postoperative ECMO, and elevated lactate at 24 h postoperatively were risk factors for operative mortality.

Trial registration: Retrospectively registered at ClinicalTrials.gov (NCT06768008), 2025-01-03.

Introduction: Kawasaki disease (KD) is an acute, self-limiting vasculitis that primarily affects children under five years of age. Its classic clinical features include prolonged fever, bilateral conjunctival injection, changes in the lips and oral cavity, cervical lymphadenopathy, rash, and extremity changes. Acute jaundice and liver dysfunction are atypical manifestations of KD. Cases in which jaundice is the initial presenting symptom-especially when accompanied by Torque Teno Virus (TTV) infection-are rarely reported.

Case presentation: We describe a 17-month-old boy diagnosed with incomplete Kawasaki disease (IKD), who initially presented with persistent fever, jaundice, and elevated liver enzymes. At disease onset, characteristic mucocutaneous signs of KD were absent. As the illness progressed, the patient developed dorsal foot edema, erythematous lips, and cervical lymphadenopathy. On the ninth day of illness, echocardiography revealed dilation of the left coronary artery, confirming a retrospective diagnosis of IKD. Additionally, high-throughput sequencing of peripheral blood identified TTV type 28. The patient was treated with intravenous immunoglobulin, methylprednisolone, and hepatoprotective agents. Following treatment, his fever resolved, jaundice subsided, liver function normalized, and coronary artery dimensions gradually returned to within the normal range.

Conclusions: This case highlights an atypical presentation of IKD, characterized by early-onset jaundice and later development of coronary artery dilation, in a patient also infected with TTV. To our knowledge, this is the first reported case of IKD associated with acute icteric hepatitis and TTV infection. This case may inform clinical evaluation in similar presentations and contribute to future research on the etiology of KD.

Purpose: Small-for-gestational-age (SGA) infants represent major global health challenges, contributing significantly to neonatal mortality and long-term developmental morbidity. When compounded by preterm birth, the risks for adverse neonatal and long-term outcomes escalate dramatically. Research on preterm SGA neonates remains limited. This study aims to explore the prevalence and factors associated with preterm SGA neonates in China to break through the bottleneck of disease prevention and treatment.

Methods: A retrospective descriptive cross-sectional study was conducted in 23 provinces in China from 2011 to 2017. Detailed information on maternal characteristics, medical history was collected from medical records. The χ² test was used to compare the frequencies among categorical data and multinomial multivariate logistic regression was used to compare SGA preterm subgroups (< 32weeks, 32^+ 0~33^+ 6weeks, 34^+ 0~36^+ 6weeks) with appropriate-for-gestational-age(AGA) preterm group.

Results: The prevalence of preterm SGA infants was 7.9%(1267/15734) in all singleton live-birth preterm infants. 159 preterm SGA infants at < 32weeks, 124 preterm SGA infants at 32 ~ 33weeks, 984 preterm SGA infants at 34 ~ 36weeks compared with 12,973 AGA infants. Hypertension disorders in pregnancy (HDP) and Category III fetal heart rate tracings were strongly associated with three preterm SGA subgroups. HDP was the strongest factor for preterm SGA at < 32weeks( aOR = 8.180, 95% CI 5.778 ~ 11.582). Category III fetal heart rate tracings was the factor with the highest OR value for preterm SGA at 32 ~ 33weeks (aOR = 4.785, 95% CI 3.049-7.508). Placental abruption was strongly associated with preterm SGA at < 32weeks (aOR = 7.073, 95% CI 3.102 ~ 16.127) and 32 ~ 33weeks(aOR = 6.055, 95% CI 2.309 ~ 15.878). Oligohydramnios(aOR = 6.526, 95% CI 2.309 ~ 16.887) was strongly associated with preterm SGA at 32 ~ 33weeks. GDM was a protective factor for preterm SGA at 34 ~ 36weeks(aOR = 0.516, 95% CI 0.343 ~ 0.778).

Conclusion: Different preterm SGA subgroups had different risk profiles. HDP and placenta abruption were more predictive of early preterm SGA. Category III fetal heart rate tracings and oligohydramnios were more predictive of moderate preterm SGA. GDM was a protective factor for late preterm SGA. Consequently, we underscore the importance of creating interventions that are tailored to particular gestational ages, rather than adopting a generalized approach, in order to effectively prevent preterm SGA outcomes.

Background: The Improvement of Neonatal Intensive Care Unit (NICU) Practices and Team Approach Cluster-randomized Controlled Trial (INTACT) tested a multidisciplinary quality improvement (QI) program but did not show improved survival without neurodevelopmental impairment at 3 years among infants with very low birthweight. However, the program's potential effect on acute-phase outcomes in extremely preterm infants (< 28 weeks of gestation) warrants further evaluation. This secondary analysis aimed to assess the effect of the INTACT study's QI intervention based on participatory learning and action on acute morbidities during the NICU stay and outcomes at 3 years of age.

Methods: We performed a secondary analysis of data from the INTACT trial, a cluster-randomized controlled trial conducted in 40 Japanese NICUs from 2012-2014. Infants were stratified into two gestational age groups (22-24 weeks and 25-27 weeks). The primary outcome was a composite of seven acute morbidities (pulmonary air leak syndrome, pulmonary hemorrhage, sepsis, severe intraventricular hemorrhage, intestinal perforation, necrotizing enterocolitis, or circulatory collapse) between the intervention (QI program) and control groups. Secondary outcomes included chronic morbidities diagnosed before NICU discharge and long-term outcomes at 3 years of age. Multivariable logistic regression and Holm's correction for multiple comparisons were applied.

Results: In the 25-27-week subgroup, the intervention group showed a significantly lower rate of composite acute morbidity than the control group (31.3% vs. 40.3%; adjusted odds ratio [OR] 0.67; 95% confidence interval 0.50-0.90; p = 0.008). In the 22-24-week subgroup, composite acute morbidity did not differ significantly; however, sepsis (adjusted OR: 0.44, Holm-adjusted p = 0.010) and pulmonary hemorrhage (adjusted OR: 0.27, Holm-adjusted p = 0.028) were significantly reduced. After multivariable adjustment and Holm correction, no differences in neurodevelopmental outcomes at 3 years of age were observed between groups.

Conclusions: This secondary analysis of a cluster-randomized controlled trial demonstrated that the intervention group receiving a NICU-specific QI program had reduced acute-phase morbidities, particularly among infants born between 22 and 27 weeks of gestation. Our findings highlight the potential for widespread clinical implementation of QI programs based on participatory learning and action in neonatal intensive care.

Background: Contributing to the growing need for adolescent school-based mental health interventions in Hong Kong, the "Suicide Help Intervention through Education and Leadership Development for Students" (S.H.I.E.L.D.S.) programme was developed to train secondary school students to become gatekeepers and lay leaders in mental health for their school communities. It involved both education - through mental health and suicide prevention training - and leadership development - through the design and implementation of student-led projects to encourage help-seeking behaviours and promote mental wellbeing to their peers.

Methods: Using a mixed-methods approach, we examined the impact of two rounds of S.H.I.E.L.D.S. that ran between June 2022 and June 2023 on three groups of participants across eight participating schools: 89 student leaders (M_age = 15.2) who underwent training, 33 staff advisors who supported the student leaders, and 423 general students (M_age = 14.3) who participated in student-led project activities. Questionnaires were disseminated to each group of participants before and after relevant programme activities, while interviews were conducted after the conclusion of all programme activities.

Results: Quantitative analyses demonstrated that there were no significant changes in both student leaders' and general students' knowledge of and attitudes towards mental health. However, qualitative feedback revealed that leaders did feel that their mental health-related knowledge and ability to help their peers improved. This was supported by the staff advisors, who also developed a greater appreciation for the role of students' input in co-creating school-based mental health promotion initiatives. General students similarly appreciated the peer-led nature of project activities. General observations on the impact of S.H.I.E.L.D.S. on the schools' mental health culture are also discussed.

Conclusions: This study highlights the importance of recognising student perspectives and integrating new mental health programmes with existing school efforts, which were instrumental in the successful implementation of S.H.I.E.L.D.S. in the intervention schools. Future implications for the continuity and scaling-up of S.H.I.E.L.D.S. and similar school-based mental health promotion initiatives are also given.

Trial registration: Not applicable.

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: 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.

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.

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.