BMC Pediatrics最新文献

Background: Pediatric coma is a critical emergency with high morbidity and mortality in sub-Saharan Africa, where limited data hinders effective management strategies. Understanding its epidemiology and prognostic factors is essential for improving outcomes.

Methods: A cross-sectional study with retrospective (1st January 2017 to 30 November 2018) and prospective (1st December 2018 to 30th April 2019) phases was conducted at Gyneco-Obstetric and Pediatric Hospital of Douala, Cameroon. Children aged 1 month to 15 years with Glasgow Coma Scale (GCS) ≤ 14 were included. Data on demographics, clinical presentation, etiology, and outcomes were collected. Statistical analysis used SPSS version 20.0 and CSPro with Chi-square, Fisher's exact tests, and multivariable logistic regression.

Results: Among 864 hospitalized children, 109 presented with coma (prevalence 12.6%), comprising 88 retrospective and 21 prospective cases. The male-to-female ratio was 1.4:1, with mean age 48.8 ± 47.5 months; 64.2% were under 5 years. Infectious causes predominated (62.4%, n = 68), with cerebral malaria accounting for 42.2% (46/109) and septicemia 15.6% (17/109). Other etiologies included metabolic/toxic causes (16.5%, 18/109), post-epileptic coma/status epilepticus (14.7%, 16/109), and traumatic brain injury (4.6%, 5/109); 12.8% (14/109) remained undiagnosed. Clinical features included fever (73.4%, 80/109) and seizures at admission (68.8%, 75/109). Overall mortality was 26.6% (29/109), with 30.9% (25/81) of survivors experiencing neurological sequelae, predominantly motor deficits (14.8%, 12/81). In multivariable analysis, significant mortality predictors included age under 2 years (adjusted OR 4.55, 95% CI: 1.23-16.82), female sex (adjusted OR 2.89, 95% CI: 1.23-6.79), direct home admission (adjusted OR 2.76, 95% CI: 1.02-7.47), and deeper coma stages (Stage III-IV: adjusted OR 6.92, 95% CI: 2.54-18.86).

Conclusion: Pediatric coma at this tertiary center in Douala predominantly affects young children and stems primarily from infectious etiologies, particularly cerebral malaria. The high mortality (26.6%) and substantial neurological morbidity among survivors underscore urgent needs for strengthened malaria prevention programs, improved community awareness, enhanced referral systems, and increased diagnostic and intensive care capabilities. Early recognition and prompt management of preventable causes could significantly reduce mortality and morbidity from pediatric coma in Central Africa.

Background: RBC distribution width is a key variable in complete blood counts, associated with immature RBC release into circulation due to various processes, including systemic inflammation. RDW correlates with elevated acute inflammatory markers like ESR, CRP, and interleukin-6, and is a biomarker in conditions like kidney disease and multiple myelomas. It independently predicts disease severity in critically ill adults and is associated with morbidity, mortality and length of stay in pediatric intensive care unit, though its potential as an early biomarker for detecting pediatric patients with multiple organ dysfunction (MODS) remains unknown.

Methods: The study retrospectively reviewed PICU patients admitted to Aga Khan University Hospital from September 2018 to December 2022, excluding those admitted for less than 48 h for elective procedures, received recent RBC transfusions, or were anemic. RDW > 14.0% was considered elevated. MODS, defined as dysfunction in two or more organs, was the primary outcome. Data included demographics, PRISM III scores, laboratory values (RDW, BUN, creatinine, CRP, etc.), and clinical outcomes. Patients were stratified into three RDW groups: <13.4%, 13.4-14.3%, and > 14.4%. Analysis focused on associations between RDW levels and MODS within the first 7 days of PICU admission.

Results: The study included 680 patients. Higher RDW was associated with younger age and higher PRISM III scores, but not with sex. RDW Group III had longer hospital stays, higher mortality, and higher incidence of MODS, but not significant. Hemoglobin and MCHC levels were lower in Group III, whereas BUN and creatinine levels showed no significant differences across groups. The OR for MODS was highest for Group II.

Conclusions: This retrospective study evaluated the prognostic value of RDW in predicting length of stay, mortality, and early identification of MODS within seven days. Among 680 pediatric patients, higher RDW levels were associated with increased mortality, longer LOS, and higher rates of sepsis and MODS, though these findings lacked statistical significance. Elevated RDW was linked to inflammation and critical illness severity but did not correlate well with pediatric severity scores or MODS trends. Future multicenter studies are recommended to explore RDW's utility in predicting early organ dysfunction and critical illness outcomes.

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.