BMC Pediatrics最新文献

Background: Childhood obesity is a major and increasing public health concern. Early prediction of the risk of childhood obesity may lead to targeted preventative interventions. To develop a prediction-toolbox that is suitable for clinical implementation, it is imperative to align it with the perceptions of health care professionals (HCPs), but this aspect remains relatively underexplored. This study aimed to explore the perceptions of Dutch HCPs regarding the concept of a childhood obesity prediction toolbox.

Methods: A qualitative study design comprising semi-structured interviews (n=15) with Dutch HCPs was used. HCPs included youth health care practitioners, youth health care nurses and policy advisors employed at the municipal health service of Amsterdam. Perceptions were explored regarding the concept of a three-element childhood obesity prediction toolbox of the EndObesity project, which consists of a prediction tool, prevention strategies to support families of high-risk infants, and communication tips for HCPs. The data were analysed through reflexive thematic analysis.

Results: HCPs were positive about early identification of the risk of future childhood obesity and the support of high-risk infants. They acknowledged the potential benefits of personalized care facilitated by such risk prediction, but concerns were raised regarding its validity and its added value compared with the clinical judgement of HCPs. HCPs also expressed some negative connotations regarding risk communication e.g. making parents feel insecure or judged, especially in vulnerable situations. Finally, HCPs acknowledged the complexity of childhood obesity prevention and emphasized the need for a complementary broader approach at both the municipal and national policy levels.

Conclusions: Dutch HCPs generally supported the potential use of a childhood obesity prediction toolbox, but they also expressed concerns regarding the validity, the added value of the toolbox and about risk communication. These concerns must be addressed in further development of the toolbox.

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.