BMC Pediatrics最新文献

Background: Inguinal hernia is a common condition in children, and day-case surgery has been widely implemented in pediatric specialty hospitals, benefiting patients and their families. However, overnight hospital stays pose various inconveniences to children and parents. In this study, we aimed to optimize the day-case surgery model for inguinal hernia repair, evaluate the effectiveness and safety of day-case surgery in children with inguinal hernias, and compare the effects of different surgical methods on hospitalization duration and medical cost.

Methods: A retrospective cohort study was conducted to analyze surgical data from 14,197 children with inguinal hernias admitted from January 2019 to December 2023 using statistical methods, including independent sample t-tests, analysis of variance, and multiple linear regression analysis.

Results: The results showed that the day-case surgery model significantly shortened hospitalization duration and reduced medical cost. The hospitalization duration and medical cost in the laparoscopic percutaneous internal ring suturing group were significantly higher than those in the open traditional high ligation of the hernia sac group (P < 0.05). However, the recurrence rate in the laparoscopic percutaneous internal ring suturing group was 0.035%, which was lower than that (0.107%) observed in the open traditional high ligation of the hernia sac group. Laparoscopic percutaneous internal ring suturing aided the detection of hidden hernia at a rate of 49.61%.

Conclusions: Day-case surgery offers significant benefits by reducing hospitalization duration and medical cost, whereas laparoscopic percutaneous internal ring suturing is better for detecting hidden hernias and shows excellent performance in reducing recurrence rates. Future research should focus on the promotion and optimization of day-case laparoscopic percutaneous internal ring suturing to enhance the treatment outcomes in pediatric inguinal hernias.

Background: The role of incidental appendectomy (IA) during surgery for idiopathic intussusception in children remains controversial. This study evaluated the potential benefits and risks of performing IA during laparotomy.

Methods: We performed a dual-center retrospective cohort study of children who underwent open reduction for idiopathic intussusception (2014-2021). Patients were grouped by whether IA was performed. Primary outcomes were perioperative complications (PCs) and recurrent intussusception (RI); secondary outcomes were operative time, time to postoperative oral intake (PO time), length of stay (LOS), and hospitalization cost. Univariable and multivariable analyses were applied, with subgroup analysis for ileocolic cases.

Results: A total of 177 children were included, of whom 114 underwent IA and 63 did not. Baseline demographics were similar, but non-IA patients had more air enema attempts (median 2 vs. 1; P < 0.001) and a higher proportion of ileocolic intussusception (85.7% vs. 69.3%; P < 0.001). Intraoperatively, red or swollen appendices were more frequently removed (86.0% vs. 3.2%). Histopathology revealed acute inflammation in 60%, chronic inflammation in 25%, and no abnormalities in 15%. Rates of PCs (11.4% vs. 14.3%) and RI (6.1% vs. 11.1%) did not differ significantly between groups. In adjusted analyses, IA was associated with longer operative time (exp(β) = 1.292, 95% CI: 1.048 - 1.593; P = 0.016) and higher total costs (exp(β) = 1.350, 95% CI: 1.176 - 1.550; P < 0.001), without significant effects on PO time or LOS. Subgroup analysis of ileocolic cases (n = 133) yielded consistent results.

Conclusions: In pediatric idiopathic intussusception, IA did not decrease recurrence or perioperative complications but prolonged surgery and increased costs. As most resected appendices showed only minor inflammatory changes, routine IA should be reconsidered. Prospective multicenter studies are needed to validate these findings and guide surgical decision-making.

Introduction: Treacher Collins syndrome type 2 (TCS2; OMIM# 613717) is a rare genetic disorder of craniofacial development caused by pathogenic variants in the POLR1D gene. The characteristic clinical features include downward-slanting palpebral fissures, micrognathia, hypoplastic zygomatic arches, lower eyelid coloboma, and malformations of the external and middle ears.

Case presentation: In this study, we report a 2-year-and-3-month-old male of Miao ethnicity with TCS2 caused by a novel heterozygous pathogenic POLR1D variant (NM_015972.4: c.220dup, p.His74ProfsTer8), inherited from his unaffected father. He presented with downward slanting of bilateral palpebral fissures, low-set ears, and microretrognathia, along with middle ear deformities, both confirmed by CT with 3D reconstruction, accompanied by conductive hearing loss. During the neonatal period, he exhibited severe neonatal airway compromise due to combined tongue-based obstruction and laryngomalacia, necessitating a tracheostomy. Based on the above clinical manifestations and genotype, he met the diagnosis of TCS2. The tracheostomy tube was successfully decannulated at approximately 10 months of age. His prognosis was good.

Conclusion: This study expands the mutational spectrum of POLR1D-related TCS2 and underscores the vital role of multidisciplinary airway intervention in severe presentations. As an exceptionally rare disorder, this case provides crucial genotype-phenotype correlations that advance both clinical management strategies and molecular understanding of TCS2 pathogenesis.

This case report documents a rare case of scrub typhus with multiple serious complications in a 8-year-old patient. Scrub typhus is usually more prevalent in adults, but serious complications in children are uncommon. This report examines a severe pediatric case involving septic shock, acute respiratory distress syndrome (ARDS), and hemophagocytic lymphohistiocytosis (HLH). The patient initially presented with erythema of the umbilicus, which then progressed to characteristic crusting with high fever, hepatosplenomegaly, and enlarged lymph nodes. Metagenomic next-generation sequencing (mNGS) confirmed the presence of Scrub typhus in the patient's blood sample. Notably, this is the first case of scrub typhus found in lung using mNGS, providing strong evidence for early detection. Treatment included a combination of antibiotics, particularly doxycycline and rifampicin, as well as supportive measures such as invasive mechanical ventilation, plasma exchange, continuous renal replacement therapy (CRRT) and chemotherapy. With this comprehensive treatment approach, the patient's condition gradually improved and he was eventually discharged with complete recovery. This case emphasizes the importance of timely and accurate diagnosis and multidisciplinary supportive care in the treatment of severe scrub typhus in children.

Background: Mixed infection with influenza A virus (IAV) and Staphylococcus aureus (S. aureus) is a serious concern in children. S. aureus, particularly Panton-Valentine Leucocidin (PVL)-producing strains, is a known cause of severe, necrotizing complications. We reported three cases of severe necrotizing pneumonia caused by PVL-positive S. aureus and IAV infection from March to April in 2023.

Case presentation: Three previously healthy children presented with acute onset of high fever and dyspnea following IAV infection. Microbiological workup confirmed mixed infection with PVL-positive S. aureus (two methicillin-resistant, one methicillin-sensitive). Radiographic findings included necrotizing pneumonia, atelectasis and pleural effusion in all patients. All three developed necrotizing laryngotracheobronchitis, and one case was complicated by plastic bronchitis. All required intensive care unit admission, with two needing mechanical ventilation. The mainstay of successful management involved a combination of oseltamivir, linezolid, glucocorticoids, therapeutic bronchoscopy, and closed thoracic drainage.

Conclusion: This study firstly documented successful treatment of three cases of severe necrotizing laryngotracheobronchitis and necrotizing pneumonia caused by PVL-positive S. aureus and IAV infection. Clinicians should raise awareness of this mixed infection in children with sudden clinical worsening after influenza to provide timely and effective treatment to decrease mortality.

Background: Gut microbiota modulation has been proposed as a potential intervention for managing obesity. This meta-analysis aimed to evaluate the effects of prebiotic/probiotic/synbiotic supplementation on metabolic syndrome risk factors in obese pediatrics.

Methods: A comprehensive search was conducted in databases up to January 2025. Randomized controlled trials (RCTs) evaluating prebiotics/probiotics/synbiotics in children and adolescents with overweight/obesity were included. The outcomes were body weight (BW), body mass index (BMI), BMI-z score, fasting blood sugar (FBS), homeostatic model assessment for insulin resistance (HOMA-IR), insulin, total cholesterol (TC), triglycerides (TG), low-density lipoprotein-cholesterol (LDL-C), and high-density lipoprotein-cholesterol (HDL-C). Data were pooled using a random-effects model.

Results: Prebiotic supplementation was associated with significant reductions in weight (SMD = - 0.81; 95% CI: - 1.44 to - 0.19) and BMI (SMD = - 0.76; 95% CI: - 1.38 to - 0.14), whereas BMI z-scores remained unchanged (p > 0.05). Probiotics and synbiotics did not significantly affect weight, BMI, or BMI z-scores (p > 0.05). Glycemic and lipid profile parameters were not significantly altered by any biotic supplementation (p > 0.05). Subgroup analyses by intervention type, duration, sample size, or baseline BMI did not reveal consistent effects (p > 0.05).

Conclusion: Biotic supplementation has not been shown to consistently improve metabolic syndrome risk factors in overweight and obese children, except for a modest beneficial effect of prebiotics on weight and BMI (with very-low certainly of evidence); however, alternative probiotic organisms or formulations not tested to date may have different effects.