BMC Pediatrics最新文献

Objective: Prematurity is the leading cause of under-five mortality worldwide. The first hours after birth (Golden Hours, GH), are critical for preterm infants, as early interventions impact morbidity and mortality. While GH-protocols aim to optimize stabilization and NICU admission, their components and outcomes vary. This study systematically reviews GH-protocols to identify common elements, implementation differences, and clinical outcomes, informing best practices and highlighting knowledge gaps.

Study design: JBI and PRISMA-ScR guidelines were followed to map GH-protocol content and outcomes for preterm infants. Three-step search strategy included database searches and reference screening. Two reviewers extracted data on study characteristics, GH-protocol components, and outcomes. Study quality was assessed using the QI-MQCS checklist.

Results: Of 2,656 records, 34 studies were included, mostly from the USA (n=17). Infants had gestational ages from 24.4-30.2 weeks, and birth weights from 670-1,418 grams. GH-protocol content varied, with respiratory support (31/34 studies), cardiovascular support (26/34), thermoregulation (24/34), and team-based interventions (24/34) being most common. Improved protocol adherence was reported, yielding decreased mechanical ventilation, and quicker GH completion. Clinical outcomes showed improvements in mortality, bronchopulmonary dysplasia, intraventricular hemorrhage, necrotizing enterocolitis, and sepsis. Additionally, 7/9 studies observed significant increase in delayed cord clamping.

Conclusion: GH-protocols for preterm infants demonstrate beneficial effects on morbidity and mortality, yet exhibit variability. Differences in populations, hospital resources, and methodologies hinder cross-study comparisons. Standardized guidelines and outcome measures are needed to refine GH-protocols and identify effective interventions. Future research should evaluate short- and long-term effects of GH-protocols across diverse healthcare settings to enhance neonatal outcomes.

Background: The purpose of this paper is to examine the relationship between target organ damage in children with primary hypertension and red cell distribution width (RDW) and related indices to elucidate their potential clinical implications.

Method: A cross-sectional retrospective study was conducted on data collected from patients with primary hypertension. Demographic variables, body mass index (BMI), hemoglobin, RDW, leukocyte count, platelet count and albumin results were recorded. RPR was defined as the ratio of RDW to platelet count and RAR was defined as the ratio of RDW to albumin. A comprehensive evaluation was conducted on all patients to ascertain the presence of target organ damage. This evaluation included echocardiography, retinal examination, and urine analysis.

Results: The study included 219 hypertensive children and 57 healthy controls. The majority of patients were male (61.6%) and had elevated BMI (69.4%). Overall, 45.7% had left ventricular hypertrophy (LVH), 5.5% had hypertensive retinopathy and 4.5% had proteinuria. The mean RDW level in patient group was higher than that of controls (13.1 ± 0.9% and 12.8 ± 0.7%, p < 0.05). The mean RDW level and RPR in children with LVH were higher than that of children without LVH (respectively, 13.3 ± 1% and 13 ± 0.7, p < 0.05 and 0.048 ± 0.012 and 0.044 ± 0.010, p < 0.01). An elevated white blood cell count was observed in children with a high BMI. However, the mean RDW and RAR values remained comparable. The RPR value was found to be higher in the patients with normal BMI. The male gender was identified as a significant risk factor for LVH.

Conclusion: Elevated RDW and RPR levels were associated with LVH in hypertensive children, suggesting their potential role as markers of target organ damage, whereas RAR showed limited utility. Male gender emerged as an independent risk factor for LVH. Obese children demonstrated higher leukocyte counts, indicating a link between obesity and systemic inflammation. However, RDW and RAR did not vary with BMI, and unexpectedly, RPR was higher in children with normal BMI. These findings suggest that hematological parameters may provide insights into both cardiovascular risk and obesity-related changes in pediatric populations.

Purpose: Celiac disease (CD) is an autoimmune disorder triggered by gluten ingestion, characterized by the development of specific autoantibodies. An increased incidence of type 1 diabetes mellitus (T1DM) and autoimmune thyroid disease (ATD) has been reported in patients with CD. However, there is a gap in the literature regarding the association between the severity of CD and the levels of these autoantibodies. This study aimed to evaluate the relationship between the severity of CD and autoantibody levels associated with T1DM and ATD.

Methods: Patients diagnosed with CD between 2010 and 2023 and followed for at least two years were included, provided that endocrine autoantibody levels were available. Patients were evaluated based on their demographic, clinical, biochemical, and pathological data.

Results: A total of 248 patients were analyzed, with a median age of 11 years (Range: 3-18); 159 (64.1%) were female. Endocrine autoantibodies were found to be positive in 51 patients (20.6%). All patients with positive autoantibodies were aged 10 years or older (p < 0.001). Total villous atrophy was observed in 94 patients (37.9%) and 94 patients (37.9%) had findings consistent with Marsh 3 C. In multivariate analysis, the presence of endocrine autoantibodies emerged as the only independent factor associated with an increased Marsh grade (p < 0.001).

Conclusion: Our study demonstrated that the presence of autoantibodies associated with T1DM and ATD was correlated with more severe histopathological findings in patients with CD. There is a need for prospective studies investigating the role of these autoantibodies in predicting the prognosis of CD.

Background: Peripheral intravenous cannulation is a common but complication-prone procedure in pediatric care. In Ethiopia, however, there is a critical lack of evidence on the timing and predictors of these complications, hindering the development of effective local preventive strategies.

Objective: To assess time to occurrence and predictors of peripheral intravenous cannula -induced complications among pediatric patients in Debre Birhan city public hospitals, Ethiopia, 2025.

Method: An institutional-based prospective cohort study was conducted at Debre Birhan public hospitals from March 1 to May 20, 2025. Participants were selected using a systematic random sampling technique (K = 2). The data were collected with Kobo Toolbox and analyzed using Stata-17. Descriptive statistics and Cox regression were fitted. The Cox proportional hazards assumptions were checked both graphically and statistically. Variables with p < 0.25 in bivariable cox regration were included in the multivariable Cox model. The strength of statistical association was assessed by adjusted hazard ratios and respective 95% confidence intervals.

Result: Of the 584 pediatric patients included, 35.8% (95% CI 32% - 40%) developed peripheral intravenous cannula-induced complications. The median time to develop these complications was 108 h (95% CI: 96-108). Parental education (unable to read and write) (AHR = 2.80, 95% CI: 1.70, 4.90, p < 0.001), no mask use during insertion (AHR = 2.3, 95% CI: 1.70, 3.09, p < 0.001), performing the procedure without insertion set kit (AHR = 4.34, 95% CI: 2.10, 8.93, p < 0.001), right side of cannulation (AHR = 1.96, 95% CI: 1.40, 2.72, p < 0.001), inappropriate cannula dressing (AHR = 1.45, 95% CI: 1.02, 2.37, p = 0.025) and blood administration (AHR = 1.54, 95% CI: 1.09, 2.15, p = 0.014) were predictors of time to occurrence of peripheral intravenous cannula induced complications.

Conclusion: Peripheral intravenous cannula induced complications tend to occur after a relatively prolonged dwell time. Parental education, mask use, insertion set kit, side of cannulation, cannula dressing, and blood administration were predictors for these complications. Therefore, targeted interventions like ensuring mask use, insertion kits, and proper dressing practices may reduce complications and improve pediatric outcomes.

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly nonalcoholic fatty liver disease (NAFLD), is a growing pediatric health concern. Liver biopsy remains the gold standard for grading steatohepatitis and staging fibrosis, but its invasive nature necessitates reliable non-invasive alternatives, particularly for children. While adult-derived scoring systems like the FIB-4 index are widely used, their validity in pediatric populations is not well established. This study aimed to evaluate the diagnostic utility of the FIB-4 index for detecting advanced fibrosis and to assess the performance of other biomarkers, including gamma-glutamyltransferase (GGT), for differentiating metabolic dysfunction-associated steatohepatitis (MASH) from simple steatosis in children with biopsy-proven MASLD.

Methods: This single-center, retrospective diagnostic accuracy study included 27 children (aged 5-18) with liver biopsy-confirmed MASLD. Histological staging was performed using the FLIP/SAF scoring system, with advanced fibrosis defined as stage ≥ 2. The diagnostic performance of non-invasive markers, including the FIB-4 index, AST to Platelet Ratio Index (APRI), and GGT, was evaluated using receiver operating characteristic (ROC) curve analysis to determine the area under the curve (AUC), sensitivity, and specificity for predicting advanced fibrosis and identifying MASH.

Results: The cohort had a mean age of 11.7 years and was predominantly male (96.2%). A high prevalence of advanced fibrosis was observed, with 14 of 27 patients (51.9%) having fibrosis stage ≥ 2. The FIB-4 index demonstrated fair discriminatory ability for detecting advanced fibrosis (AUC = 0.725; 95% CI: 0.530-0.921), with an optimal cut-off of 0.215 yielding a sensitivity of 57.1% and specificity of 84.6%. In contrast, GGT emerged as an excellent marker for differentiating MASH from MASLD (AUC = 0.914; 95% CI: 0.804-0.980). A GGT cut-off value of 20 IU/L provided a sensitivity of 77.3% and a specificity of 100% for identifying MASH.

Conclusion: The findings of this study suggest that the FIB-4 index may have some utility in identifying advanced fibrosis in pediatric MASLD, although its performance might be limited compared to adult cohorts. Furthermore, GGT shows promise as a simple and non-invasive biomarker for distinguishing MASH from simple steatosis in children. Integrating GGT into future screening protocols could contribute to improved risk stratification, potentially aiding in the identification of high-risk patients who may benefit from earlier, more intensive clinical interventions or prioritized consideration for liver biopsy.

Background: Viral infections of the upper airways are common in children and adolescents, often presenting with mild symptoms and typically resolving without the need for hospitalization. Epstein-Barr virus (EBV), a gammaherpesvirus, can cause diverse clinical syndromes and transient immune dysregulation, potentially predisposing to bacterial superinfection.

Case presentation: We report a 13-year-old girl with critical upper airway obstruction due to necrotizing ulcerative oropharyngitis in the context of an EBV infection, with superinfection by Prevotella oris and methicillin-sensitive Staphylococcus aureus (MSSA) isolated from operative tissue specimens. Within a very short time, the patient developed EBV-associated nephritis and pneumonia, severe sepsis, and acute respiratory distress syndrome (ARDS). Extensive soft-tissue necrosis precipitated life-threatening hemorrhage from the right external carotid artery followed by a second hemorrhage on the left, requiring coil embolization and ligation. Additionally, the patient experienced neurological complications due to thiamine deficiency, contributing to a complex and prolonged recovery process. Despite the severity of her illness, multidisciplinary management enabled stabilization and eventually discharge to a rehabilitation facility.

Conclusion: To our knowledge, fulminant necrotizing oropharyngitis with bilateral external carotid hemorrhage during acute EBV infection in an immunocompetent adolescent is exceedingly rare. This highlights the importance of considering anaerobic oral colonizers as potential pathogens in maxillofacial infections. Clinicians should reassess for bacterial superinfection when EBV courses are protracted or deteriorating.