BMC Pediatrics最新文献

Introduction: Although the risk factors of neonatal mortality are currently known, it was necessary to know the risk factors of mortality in neonatal preterm birth. The present study was conducted to find and investigate the potential maternal, fetal and neonatal risk factors of neonatal mortality among the cases of preterm birth.

Methods: A retrospective cohort study was conducted with a secondary analysis of existing data of a national registry. All premature infants born in Iran from March 21^st 2019 to March 21^st 2020 were included in the study using census. Mixed model logistic regression was used to identify the potential risk and protecting factors from a selected groups of the variables of the national registry with reporting odds ratio (OR) and 95% confidence interval (CI).

Results: A total of 120,688 cases of preterm labor were studied with GA in the range of 22-36 weeks. A total of 5458 neonatal deaths (4.52% of total cases) were recorded. The most effective protecting factor was increased gestational age (GA) (adjusted OR = 0.664 per week, 95% CI: 0.658-0.669). The risk factors remained in the multivariable modeling were maternal hypertension, eclampsia / preeclampsia, addiction, placental abruption, meconium staining, impaired fetal heart rate, previous neonatal death, intrauterine growth restriction, lack of corticosteroid administration, rural and nomadic residency, cesarean delivery, malformation, public hospital (vs. private), and out-of-hospital delivery (P < 0.1). The protecting factors remained in the multivariable modeling were gestational diabetes mellitus, premature rupture of membrane for more than 18 h, female sex, GA, and mother age (P < 0.1).

Conclusion: The present study showed that many maternal and neonatal related variables were potential risk and protecting factors of neonatal death among the preterm birth neonates. The main predictor of the outcome was GA, and using corticosteroid before birth was a modifiable protecting factor.

Background: This study focuses on determining the relationships between gestational weight gain(GWG) that falls within, below, or exceeds the Institute of Medicine(IOM) guidelines and negative perinatal outcomes. We additionally evaluated if insufficient GWG is linked to negative outcomes in pregnant women with gestational diabete mellitus(GDM).

Methods: A Population-based retrospective cohort was conducted using data from the Sina Health Information System (SINAEHR) between 05/01/2018 and 28/12/2024 on the 18,575 Iranian women with GDM from Mashhad University affiliated centers. GWG assigned categories based on IOM guidelines according to pre pregnancy BMI. Multivariable logistic regression was employed to examine the association between gestational weight gain (GWG) categories and adverse pregnancy outcomes.

Results: A total of 18,575 pregnant patients participated in the study. After adjusting for confounders, analysis revealed that excessive GWG was associated with increased odds of cesarean delivery (adjusted OR 1.62, 95% CI 1.49-1.77), NICU admission (adjusted OR 1.86, 95% CI 1.67-2.06) and macrosomia (adjusted OR 1.98, 95% CI 1.75-2.24) and insufficient GWG, was also correlated with increased risks of preterm birth (adjusted OR 2.32, 95% CI 2.05-2.63), NICU admission (adjusted OR 1.69, 95% CI 1.53-1.88) and lower odds of macrosomia. Additionally, inadequate GWG was associated with lower odds of hypertension disorders of pregnancy whereas excessive GWG significantly increased its risk (adjusted OR 2.23, 95% CI 1.94-2.57). These findings underscore the importance of optimal GWG for favorable pregnancy outcomes and highlight the differential risks associated with deviations from IOM guidelines.

Conclusion: Inadequate or excessive gestational weight gain relative to IOM guidelines is associated with significant adverse pregnancy outcomes, including preterm birth, NICU admission, macrosomia, cesarean delivery and hypertension disorders of pregnancy. These findings highlight the necessity for careful monitoring and management of weight gain during pregnancy to optimize maternal and neonatal health. Implementing targeted counseling and interventions can help ensure women achieve recommended GWG, ultimately improving pregnancy outcomes.

Background: The global rise in allergic diseases has made accurate identification of atopy increasingly important. The skin prick test is the most common diagnostic tool, and both its correct performance and standardized interpretation are essential for reliability. Reliability, defined as the consistency of measurements across different observers and instruments, was evaluated by comparing ruler- and caliper-based wheal measurements. This study aimed to assess the consistency and reliability of skin prick test measurements performed with two different instruments and by two different nurses in a pediatric allergy clinic.

Methods: This prospective study included 100 children aged 6-18 years at Erciyes University Faculty of Medicine. For each participant, skin prick test wheal diameters were measured using both a standard ruler and a digital caliper, each by two different nurses. Measurement times were recorded by an independent observer using a stopwatch. Consistency between observers and instruments was evaluated by comparing ruler- and caliper-based results.

Results: Measurements obtained with the digital caliper showed stronger agreement between the two nurses than those taken with the ruler. The mean inter-observer difference for caliper-based measurements was 0.03 mm (p > 0.05), whereas ruler-based measurements differed by 0.22 mm between the two nurses (p < 0.05), indicating reduced inter-observer variability. The digital caliper provided more precise, consistent, and reliable readings of wheal size, underscoring its advantage in standardized test evaluation.

Conclusion: Measurement techniques and instrument types significantly affect the accuracy and sensitivity of skin prick test interpretation. Despite being a reliable method for confirming IgE-mediated sensitization, manual reading introduces variability. Using a digital caliper minimizes potential errors and enhances the precision and reproducibility of results, contributing to more standardized and reliable allergy testing practices.

Background: Parental illness uncertainty significantly impacts the quality of life of caregivers of ill children, particularly for those whose children require mechanical ventilation due to severe pneumonia-a population facing unique clinical and psychological stressors. This study aimed to describe the current status of illness uncertainty and analyze its influencing factors among parents of children with pneumonia undergoing mechanical ventilation.

Methods: A cross-sectional survey design was used. Consecutive sampling was adopted to recruit parents of children with pneumonia receiving mechanical ventilation in the Pediatric Intensive Care Unit (PICU) of a tertiary A-level children's hospital in Jiangsu, China. Data were collected using the Chinese version of the Parental Perception of Uncertainty Scale (PPUS) and a self-designed general information questionnaire. Questionnaires were administered 48-72 h after mechanical ventilation initiation, with independent completion by parents or researcher assistance for those with reading difficulties. Statistical analyses included Pearson/Spearman correlation and multivariate linear regression.

Clinical trial number: not applicable.

Results: A total of 208 parents were included in the final analysis. The total score of parental illness uncertainty was (122.41 ± 18.06). Parental illness uncertainty scores were significantly correlated with parental age, place of residence, educational level, marital status, per capita monthly household income, and number of children (all p < 0.05). Multivariate linear regression analysis identified these six variables as independent influencing factors, collectively explaining 59.2% of the variance in illness uncertainty (R²=0.592, F = 24.688, p < 0.001).

Conclusions: Parents of children with pneumonia undergoing mechanical ventilation exhibit a high level of illness uncertainty, with unpredictability and ambiguity as the primary contributing dimensions. Clinical nursing interventions should target these high-risk groups, implementing individualized strategies such as simplified health education (for low-education parents), one-on-one emotional counseling (for single-child and divorced parents), and social resource linkage (for rural and low-income families) to reduce illness uncertainty and enhance family coping capacities.

Background: This study examines the longitudinal effects of COVID-19 pandemic regulations on health-related quality of life (HrQoL), glycaemic control and lifestyle characteristics and describes the epidemiology of COVID-19 in children with type 1 diabetes (T1D).

Methods: This monocentric, prospective study included, from May to November 2020, pediatric outpatients up to 18 years with T1D. During the first 16 weeks, COVID-19-associated symptoms were assessed weekly, while HrQoL, COVID-19 affectedness and appraisal, screen time, and physical activity were assessed monthly. Body-mass-index standard deviation scores (BMI-SDS), HbA1c, and glycaemic monitoring data were collected at clinical visits three monthly. All parameters were reassessed at final visit after 10 months and assigned to the pandemic restriction phases. Estimates of correlation (est) were tested by a linear mixed-effects model.

Results: 55 children with T1D were included, with a median age of 11 years and 56.4% male. HrQoL remained normal and stable throughout the pandemic, but showed significant associations with physical activity (est 3.63, p < 0.01), screen time (est - 1.66, p < 0.01) and financial situation (est - 9.15, p < 0.05). During the pandemic, BMI-SDS increased (p < 0.01), but mean HbA1c remained at about 7.5% and glucose time in range improved (p < 0.01). During the lockdown phases, screen time tended to be highest (p < 0.1), while physical activity was lowest (p < 0.01). At baseline, one of 55 patients (1.8%) was COVID-19 seropositive from infection. At the study's end 20.5% were positive from infection, and 4.9% from vaccination.

Conclusions: In children with T1D, HrQoL and metabolic control remained stable under pandemic regulations, but BMI-SDS and physical activity worsened. Continuation of outpatient care and opening of schools may have contributed to a healthy lifestyle and resilience.

Trial registration: Not applicable.

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.