BMC Pediatrics最新文献

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.

Background: Renal Doppler can measure intrarenal vascular resistance and may help determine the degree of intrarenal damage, as well as predict subsequent kidney function impairment. However, its utility in children with an underlying kidney disease such as nephrotic syndrome has not been widely examined. This work aimed to measure serial renal resistive index (RI) in pediatric patients with idiopathic nephrotic syndrome to assess its predictive value for steroid resistance and disease outcome.

Methods: This prospective cohort study included 60 patients with idiopathic nephrotic syndrome aged 5 to < 18 years. Renal Doppler was performed on all children, and renal RI was measured at diagnosis, after 1, 3, and 6 months of diagnosis.

Results: The average interlobar renal RI of the right and left kidneys at diagnosis, during follow-up at 1, 3, and 6 months, was significantly higher in steroid-resistant nephrotic syndrome than in the steroid-sensitive nephrotic syndrome. Meanwhile, the estimated glomerular filtration rate (GFR) was significantly lower in steroid-resistant nephrotic syndrome than in steroid-sensitive nephrotic syndrome after 6 months, with no significant difference at diagnosis, after 1 month, or 3 months. The average interlobar RI at diagnosis can predict steroid resistance at a cutoff > 0.60 with 92.31% sensitivity and 85.32% specificity. Moreover, the average interlobar RI after 3 months of follow-up can predict short disease outcome at a cutoff > 0.63 with 84.62% sensitivity and 82.98% specificity.

Conclusions: Renal RI might be an effective non-invasive tool for early prediction and risk stratification of steroid resistance in pediatric patients with idiopathic nephrotic syndrome. Its utility lies in supporting earlier clinical decisions rather than replacing established diagnostic methods.

Background: Preterm infants are at high risk for neurodevelopmental delays, and hence habilitation in the Neonatal Intensive Care Unit (NICU) in a timely manner is a priority. In India, however, standardized habilitation pathways are underdeveloped, and the role of neonatal therapists, particularly physiotherapists is discrepant and ill-defined. There is scarce literature from the ground-level perception of therapists on providing structured development care, especially in resource-limited NICU settings. This study aims to explore therapist-informed barriers and context-specific solutions affecting the provision of habilitation services for preterm infants in Indian NICUs.

Methods: This qualitative study follows a constructivist paradigm. In-depth semi-structured interviews were conducted with 16 NICU physiotherapists from diverse backgrounds across India. Thematic analysis was performed with Braun and Clarke's six-phase reflexive framework. Codes were inductively established and themes iteratively refined.

Results: The two overall themes were: (1) Practice-Informed Barriers, including fractured professional identity, institutional bounds, poor training, and maternal disempowerment; and (2) Therapist-Driven Solutions, consisting of mother-inclusive graduated engagement, culture-congruent approaches, streamlined gestational protocols, and urgent appeals for curriculum and policy change. The therapists portrayed the necessity for habilitation practices to be salient, collaborative, and consistent with Indian contextual realities.

Conclusion: Despite systemic constraints, Indian NICU physiotherapists reflect adaptive, culturally appropriate approaches to facilitate early habilitation. Overcoming structural barriers and institutionalization of therapist roles in interdisciplinary NICU teams are essential steps toward equitable and developmentally beneficial care for preterm infants. These findings provide a foundational input into the development of India-specific early stimulation protocols based on practice realities.

Trial registration: The trial has been registered under Clinical Trials Registry-India (CTRI/2025/02/081483) on February 28 2025.