BMC Pediatrics最新文献

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.

Background: Mixed infection with influenza A virus (IAV) and Staphylococcus aureus (S. aureus) is a serious concern in children. S. aureus, particularly Panton-Valentine Leucocidin (PVL)-producing strains, is a known cause of severe, necrotizing complications. We reported three cases of severe necrotizing pneumonia caused by PVL-positive S. aureus and IAV infection from March to April in 2023.

Case presentation: Three previously healthy children presented with acute onset of high fever and dyspnea following IAV infection. Microbiological workup confirmed mixed infection with PVL-positive S. aureus (two methicillin-resistant, one methicillin-sensitive). Radiographic findings included necrotizing pneumonia, atelectasis and pleural effusion in all patients. All three developed necrotizing laryngotracheobronchitis, and one case was complicated by plastic bronchitis. All required intensive care unit admission, with two needing mechanical ventilation. The mainstay of successful management involved a combination of oseltamivir, linezolid, glucocorticoids, therapeutic bronchoscopy, and closed thoracic drainage.

Conclusion: This study firstly documented successful treatment of three cases of severe necrotizing laryngotracheobronchitis and necrotizing pneumonia caused by PVL-positive S. aureus and IAV infection. Clinicians should raise awareness of this mixed infection in children with sudden clinical worsening after influenza to provide timely and effective treatment to decrease mortality.

Background: Gut microbiota modulation has been proposed as a potential intervention for managing obesity. This meta-analysis aimed to evaluate the effects of prebiotic/probiotic/synbiotic supplementation on metabolic syndrome risk factors in obese pediatrics.

Methods: A comprehensive search was conducted in databases up to January 2025. Randomized controlled trials (RCTs) evaluating prebiotics/probiotics/synbiotics in children and adolescents with overweight/obesity were included. The outcomes were body weight (BW), body mass index (BMI), BMI-z score, fasting blood sugar (FBS), homeostatic model assessment for insulin resistance (HOMA-IR), insulin, total cholesterol (TC), triglycerides (TG), low-density lipoprotein-cholesterol (LDL-C), and high-density lipoprotein-cholesterol (HDL-C). Data were pooled using a random-effects model.

Results: Prebiotic supplementation was associated with significant reductions in weight (SMD = - 0.81; 95% CI: - 1.44 to - 0.19) and BMI (SMD = - 0.76; 95% CI: - 1.38 to - 0.14), whereas BMI z-scores remained unchanged (p > 0.05). Probiotics and synbiotics did not significantly affect weight, BMI, or BMI z-scores (p > 0.05). Glycemic and lipid profile parameters were not significantly altered by any biotic supplementation (p > 0.05). Subgroup analyses by intervention type, duration, sample size, or baseline BMI did not reveal consistent effects (p > 0.05).

Conclusion: Biotic supplementation has not been shown to consistently improve metabolic syndrome risk factors in overweight and obese children, except for a modest beneficial effect of prebiotics on weight and BMI (with very-low certainly of evidence); however, alternative probiotic organisms or formulations not tested to date may have different effects.

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.