BMC Pediatrics最新文献

Background: Catheter-related bloodstream infections (CRBSIs) are among the most common healthcare-associated infections in neonates and contribute substantially to morbidity and mortality. This study aimed to determine the incidence of CRBSIs and to examine the risk factors, clinical characteristics, and microbial profiles of CRBSIs, with emphasis on catheter type and birth weight classification.

Methods: A retrospective observational study was conducted at the neonatal intensive care unit (NICU) of the Mogadishu-Somalia-Turkey Recep Tayyip Erdoğan Training and Research Hospital. Medical records of neonates admitted between January 2022 and December 2024 were reviewed. Of 1,781 neonates admitted, 300 met the inclusion criteria according to the 2009 Infectious Diseases Society of America (IDSA) guidelines for CRBSI diagnosis, which include paired blood cultures, catheter tip cultures, or differential time to positivity. Statistical analyses were performed using SPSS version 23, including Spearman's correlation and multivariable logistic regression to identify independent risk factors.

Results: During the study period, 1,781 neonates were admitted to the NICU, of whom 300 developed CRBSIs, corresponding to an incidence of 16.8%. Of these, 60% were male and 40% female. The majority (53%) were born between 36 and 42 weeks of gestation, while 29.3% had birth weights > 2,500 g. Significant associations were observed between prognosis and parameters including birth weight, gestational age, catheter type, C-reactive protein (CRP) levels, and culture sample type (p < 0.005). Analysis of culture results showed that Klebsiella spp. was the most frequently isolated pathogen, followed by E. coli and Candida spp. A significant correlation was identified between cathetertype and isolate type (p = 0.008). Furthermore, the highest frequency of Gram-negative isolates was observed among preterm gestational age groups (p = 0.002). Regarding antimicrobial resistance, Gram-negative isolates exhibited high resistance to ceftriaxone, ceftazidime, ampicillin-sulbactam, amoxicillin-clavulanate, and trimethoprim-sulfamethoxazole. Gram-positive isolates, including MRSA and MRCNS, showed substantial resistance to clindamycin, erythromycin, and trimethoprim-sulfamethoxazole.

Conclusion: Among neonates in Mogadishu, low birth weight, preterm gestational age, catheter type, and elevated CRP levels were significantly associated with CRBSI prognosis. The high prevalence of antibiotic resistance among both Gram-negative and Gram-positive pathogens underscores the urgent need for strengthened antimicrobial stewardship and infection control measures in neonatal intensive care units.

Objective: This study aims to examine the incidence and clinical outcomes of critical congenital heart disease (CCHD) in neonates in China, with a specific focus on prognostic indicators following surgical intervention.

Methods: A retrospective analysis was conducted on neonates who underwent surgical correction of congenital heart disease (CHD) involving cardiopulmonary bypass (CPB) at a single tertiary care hospital between January 2022 and December 2024. Documented variables included patient weight, type of cardiac anomaly, duration of CPB, aortic cross-clamp time, and systemic circulation duration. Prognostic indicators, length of hospital stay, and duration of mechanical ventilation in the intensive care unit (ICU) were also recorded.

Results: A total of 234 neonates underwent cardiac surgery with CPB during the study period. The cohort comprised 146 males and 88 females, with a mean weight of 3.64 ± 3.43 kg and a mean age of 12.10 ± 7.77 days. The mean duration of CPB time was 159.19 ± 67.51 min, mean cross-clamp duration was 95.53 ± 44.20 min, and mean bypass duration was 37.54 ± 28.98 min. The mean length of hospital stay was 25.43 ± 13.61 days, and the mean mechanical ventilation duration was 3.64 ± 2.71 days. Among the patients, 139 were diagnosed with cyanotic CHD, and 95 with acyanotic CHD. Emergency procedures were performed in 39 cases, while 195 cases underwent elective surgery. Radical surgery was performed in 215 cases, single-stage palliation in 4 cases, and intrapartum surgery in 15 cases. 222 neonates were discharged following recovery, and 12 deaths were recorded.

Conclusion: In China, CCHD remains prevalent among newborns, posing a significant threat to their lives. With advancements in surgical and cardiopulmonary bypass techniques, the treatment system for these critically ill newborns is being progressively refined. This has led to continuously improving success rates and an increasingly diverse range of treatment options available.

Introduction: Valsalva maneuvers are the initial line in management of paroxysmal supraventricular tachycardia in hemodynamically stable children. This study aimed to compare the efficacy of modified versus standard Valsalva maneuvers on the clinical outcomes and satisfaction of children with paroxysmal supraventricular tachycardia.

Methods: The study used randomized controlled trial and recruited ninety children with paroxysmal supraventricular tachycardia from Pediatric Emergency Department and Pediatric Cardiac Intensive Care Unit at Tanta University Hospitals, El-Gharbia Governorate, Egypt. The researchers divided the studied children into three equal groups of thirty. A control group that received conventional hospital care, an intervention group I that received modified Valsalva maneuver plus conventional hospital care, and an intervention group II that received standard Valsalva maneuver plus conventional hospital care. The primary outcome was the return to sinus rhythm within the first 5 min of admission and the secondary outcomes were decreased dyspnea, decreased antiarrhythmic therapy use, length of stay time in hospital as well as children's satisfaction.

Results: More than half (53.3%) of the children who received the modified Valsalva maneuver returned to sinus rhythm within the first five minutes post-implementation compared to 33.3% of the children who received the standard Valsalva maneuver. Children within modified Valsalva maneuver group had a mean satisfaction score of 25.56 ± 1.67 that was significantly higher than those in the standard Valsalva maneuver group's score of 20.10 ± 2.57 (P = 0.0001).

Conclusion: The modified version of the Valsalva maneuver was significantly more effective than the standard Valsalva maneuver in terminating supraventricular tachycardia and improving children's clinical outcomes. This included a decrease in the degree of dyspnea within the first minute from severe to moderate and reducing the need for administering antiarrhythmic drugs for management of SVT episodes. Additionally, children in the MVM group had a higher mean satisfaction score than those in the SVM group, with highly statistically significant differences.

Trial registration: PACTR202407479098909. Registered 15/07/2024.

Background: Neonatal respiratory distress syndrome (NRDS) is one of the most common respiratory diseases in the neonatal period and a major cause of neonatal mortality. Prolonged mechanical ventilation (MV) is associated with adverse outcomes in NRDS patients, highlighting the need for effective early risk stratification tools. The Neonatal Sequential Organ Failure Assessment (nSOFA) score has emerged as a potential predictor of adverse outcomes, but its association with prolonged MV remains unclear.

Methods: This retrospective cohort study utilized data from the Medical Information Mart for Intensive Care III (MIMIC-III) database, analyzing 642 NRDS infants admitted to the neonatal intensive care unit (NICU) between 2001 and 2012. Patients were divided into two groups based on MV duration: prolonged MV (> 96 h) and non-prolonged MV (≤ 96 h). The highest nSOFA score within 24 h of admission was the primary exposure variable. Covariates included demographic data, clinical characteristics, and laboratory results. A multivariable logistic regression model was used to assess the association between nSOFA scores and prolonged MV. The predictive ability of nSOFA was evaluated using the area under the receiver operating characteristic curve (AUC).

Results: Of the 642 NRDS infants, 192 (29.9%) required prolonged MV. Each 1-point increase in the nSOFA score was associated with a 29% higher risk of prolonged MV (odds ratio [OR]: 1.29; 95% confidence interval [CI]: 1.16-1.44; p < 0.001). The nSOFA score demonstrated moderate predictive ability (AUC: 0.7245; 95% CI: 68.41%-76.49%), which was significantly better than its respiratory sub-score (AUC: 0.6936; p < 0.001) and comparable to the SOFA score (AUC: 0.7218; p = 0.89). Using an nSOFA cutoff of 3, the sensitivity and specificity for predicting prolonged MV were 64.06% and 70.22%, respectively.

Conclusion: The nSOFA score is an independent risk factor for prolonged MV in NRDS infants, with moderate predictive ability. Its simplicity and effectiveness make it a valuable tool for early risk stratification in NICUs. Future multicenter studies are needed to validate these findings and explore the potential of dynamic nSOFA monitoring in improving predictive accuracy.

Background: Vitamin D deficiency (VDD) is highly prevalent in children in India despite abundant sunlight. Multiple behavioral and dietary factors contribute to inadequate vitamin D status. We estimated the prevalence of vitamin D deficiency and insufficiency among apparently healthy children and explored associated sociodemographic, environmental, and dietary factors.

Methods: We conducted a cross-sectional study at the Department of Pediatrics, G.G. Hospital, Jamnagar (April 2023-June 2025). Every fourth eligible child aged 9 months-12 years attending the immunization clinic or accompanying as a healthy sibling was enrolled after consent. A structured proforma captured demographics, socioeconomic status, sun exposure (duration/body surface area), sunscreen use, and dietary practices (milk, eggs, vegetarian intake). Serum 25-hydroxyvitamin D [25(OH)D] was measured by chemiluminescent immunoassay. Vitamin D status followed IAP revised cut-offs: deficient < 20 ng/mL; inadequate 20-29 ng/mL; sufficient ≥ 30 ng/mL. Associations were analyzed using Chi-square or Fisher's exact tests (p < 0.05).

Results: Of 277 children (mean age 5.9 ± 3.3 years; 55.6% male), 34.7% were vitamin D deficient and 43.0% inadequate; only 22.4% were sufficient. Vitamin D status showed no significant association with age category (p = 0.757), gender (p = 0.652), or religion (p = 0.971). A strong dose-response was observed for sun exposure: <1 h/day (deficient 50.0%, sufficient 13.0%), 1-2 h/day (deficient 32.7%, sufficient 21.8%), and > 2 h/day (deficient 9.1%, sufficient 72.7%) (p < 0.01). Sunscreen use was associated with higher deficiency (50.0% vs. 31.8%, p = 0.018). Regular milk intake correlated with better status (p = 0.008); moderate egg consumption (3-5 days/week) showed the most favorable profile (p < 0.01). Socioeconomic class trended toward association (p = 0.08), with the small upper-class subgroup having highest deficiency.

Conclusions: Over three-quarters of children exhibited suboptimal vitamin D status. Modifiable correlates-including sun exposure duration, sunscreen use, milk intake, and moderate egg consumption-were significantly associated with 25(OH)D levels. Pragmatic strategies combining safe sun exposure guidance, dietary counseling, food fortification, and targeted supplementation are warranted.

Background: Despite the growing use of mobile applications in healthcare, few tools for children comprehensively support the entire nutritional care process. Novel technologies have been shown to encourage healthcare teams to initiate nutritional management and reduce the workload of nutrition support teams. This study aimed to assess the feasibility and initial impact of the iNutri application, compare its time efficiency for nutritional management with that of the conventional method, and assess user satisfaction and comfort.

Methods: The iNutri application, a comprehensive mobile platform for integrating nutritional assessment, management, and monitoring, was developed. In a prospective pilot study, pediatric residents, as members of the nutritional care team, used iNutri as a tool within the conventional nutritional care process for hospitalized children with malnutrition. The time to achieve the target energy and protein intakes, and the length of hospital stay were assessed. A structured satisfaction survey with a 5-point Likert scale was used to assess user feedback. User feedback on time efficiency, satisfaction, and comfort was analyzed.

Results: Sixty pediatric inpatients with malnutrition were included, with 14 achieving early nutrient requirements. Shorter hospital stays were observed in the early target achievement group (p = 0.003). Compared with the conventional method, the application was associated with a significant reduction in the time required for the nutritional care process by 16 min (p < 0.001). Positive feedback was received regarding the ease of using iNutri (4.4/5), the comprehensiveness of nutritional details (4.2/5), confidence in performing 24-hour dietary recall (4.1/5), initiating enteral or parenteral nutrition (4/5), and mastery in managing the nutritional care process (4/5).

Conclusions: The iNutri application suggests the potential to improve the efficiency of nutritional care for pediatric inpatients with malnutrition, demonstrating an observed reduction in the time required for the nutritional care process. Positive feedback emphasized its ease of usability and effectiveness. Early achievement of target nutrient intake may be associated with shorter hospital stays. These findings are valuable for informing the design of future, large-scale randomized controlled trials.

Trial registration: Thai Clinical Trials Registry TCTR20220319001. Registered 18 March 2022.

Multisystem inflammatory syndrome (MIS-C) is a rare but serious condition associated with SARS-CoV-2, the virus that causes COVID-19. We report a 16-year-old female who presented with seven days of fever, abdominal pain, headache, and fatigue. Physical examination revealed meningeal irritation. Laboratory findings showed pancytopenia, elevated inflammatory markers, and positive SARS-CoV-2 IgG with negative PCR. The patient had no history of COVID-19 vaccination or previous confirmed infection. Initially evaluated as MIS-C due to fever, multisystem involvement, and antibody positivity, she was subsequently diagnosed with visceral leishmaniasis after bone marrow aspiration revealed Leishmania amastigotes. This case highlights the diagnostic overlap between MIS-C and endemic infections such as leishmaniasis and underlines the importance of considering infectious etiologies in hyperinflammatory presentations, especially in endemic areas.

Background and aims: Cancer-Related cognitive impairment is a prevalent complication in cancer children. Nonetheless, little is known about the risk factors for cognitive impairment in this group. The aim of this study was to analyze and evaluate the risk factors for cognitive impairment in children and adolescent cancer patients in western China.

Methods: A cross-sectional study was conducted in a tertiary hospital in western China. A total of 105 cancer children and adolescents were enrolled in the study. Cognitive function was assessed using the Six-subtest short-form of Wechsler Intelligence Scale for Children-four Edition. Demographic and clinical data were collected using a questionnaire. Binary logistic regression analysis was used to identify the risk factors for cancer-related cognitive impairment.

Results: The mean age of the patients was 10.04 years, and 60% were male. The incidence rate of Cancer-Related cognitive impairment was 39%. Binary logistic regression analysis showed that gender (OR = 0.11, 95% CI: 0.02-0.48), disposition (OR = 3.15, 95% CI: 0.88-11.37), course of disease (OR = 3.01, 95% CI: 1.56-5.83), sleep duration (OR = 0.48, 95% CI: 0.31-0.76), chemotherapy (OR = 19.46, 95% CI: 1.20-315.24), and father's education level (OR = 0.04, 95% CI: 0.01-0.18), were independent risk factors for Cancer-Related cognitive impairment.

Conclusions: High prevalence of cognitive impairment among pediatric cancer patients. Key influencing factors included clinical factors, demographic characteristics, and sleep duration. These findings underscore the critical need to integrate routine cognitive and sleep assessments into standard clinical care. Early intervention targeting these modifiable factors, particularly sleep quality, is essential for mitigating cognitive decline in this vulnerable population.