Pediatric Reports

11 pages, 1467 KiB

Open AccessArticle

Elevation of NT-proBNP Levels in Pediatric and Young Adult Hematopoietic Stem Cell Transplant Patients with Endotheliopathy

by Kimberly Uchida, Xiaomeng Yuan, Jennifer McArthur, Rebekah Lassiter, Haitao Pan, Dinesh Keerthi, Katherine Tsai, Yvonne Avent, Melissa Hines, Hugo R. Martinez, Amr Qudeimat and Saad Ghafoor

Pediatr. Rep. 2024, 16(4), 934-944; https://doi.org/10.3390/pediatric16040080 - 30 Oct 2024

Abstract

Background/Objectives: Hematopoietic stem cell transplantation (HSCT) in pediatric and young adult (YA) patients can lead to endotheliopathy, such as thrombotic microangiopathy (TMA), sinusoidal obstruction syndrome (SOS), and diffuse alveolar hemorrhage (DAH). Natriuretic peptides have been studied as markers of endotheliopathy and critical illness. [...] Read more.

Background/Objectives: Hematopoietic stem cell transplantation (HSCT) in pediatric and young adult (YA) patients can lead to endotheliopathy, such as thrombotic microangiopathy (TMA), sinusoidal obstruction syndrome (SOS), and diffuse alveolar hemorrhage (DAH). Natriuretic peptides have been studied as markers of endotheliopathy and critical illness. We hypothesized that an elevation in NT-proBNP was associated with the development of endotheliopathy (DAH, SOS, or TMA) in the first 100 days following HSCT in pediatric and YA patients. Methods: IRB-exempt status was obtained. This retrospective case–control study reviewed HSCT at our institution from 2016 to 2020. Cases were selected based on an endotheliopathy diagnosis in the first 100 days after HSCT. Cases were matched with controls. Baseline and near-event NT-proBNP levels were compared between cases and matched controls. The effect of NT-proBNP levels on developing endotheliopathy was estimated using conditional logistic regression. Results: Sixty-two patients were included (31 cases, 31 controls). Near-event NT-proBNP was significantly higher in cases compared to controls (median: 473 vs. 187 pg/mL, p = 0.03, Wilcoxon rank–sum test), in contrast to comparison in baseline NT-proBNP (median: 86 vs. 86 pg/mL, p = 0.51). After adjusting for covariates, an association between near-event NT-proBNP and odds of developing endotheliopathy did not achieve statistical significance. However, trends from most common transplant indications suggested an association between an elevated near-event NT-proBNP level and endotheliopathy, particularly in acute lymphoblastic leukemia (ALL) patients. Conclusions: NT-proBNP should be studied further as a biomarker for endotheliopathy in pediatric and YA patients undergoing HSCT. This may be particularly relevant for patients undergoing HSCT for ALL. Full article

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9 pages, 1002 KiB

Open AccessReview

High-Flow Oscillatory Ventilation: A Possible Therapeutic Option for Pediatric Patients with Cardiovascular Diseases

by Stefano Scollo, Luigi La Via, Piero Pavone, Marco Piastra, Giorgio Conti and Carmelo Minardi

Pediatr. Rep. 2024, 16(4), 925-933; https://doi.org/10.3390/pediatric16040079 - 24 Oct 2024

Abstract

High-flow oscillatory ventilation (HFOV) is a common rescue treatment in infants and children with respiratory failure. This type of ventilation is an effective technique in numerous diseases that affect a child in the postnatal period, such as ARDS, meconium aspiration syndrome (MIS), postnatal [...] Read more.

High-flow oscillatory ventilation (HFOV) is a common rescue treatment in infants and children with respiratory failure. This type of ventilation is an effective technique in numerous diseases that affect a child in the postnatal period, such as ARDS, meconium aspiration syndrome (MIS), postnatal pulmonary bleeding and idiopathic pulmonary hypertension (IPH). Although this ventilation technique is commonly recognized as a valuable therapeutic option in the general pediatric population, this is not the same for children with congenital cardiovascular diseases. The key mechanism of oscillatory ventilation is continuous positive pressure administered within the airways via a small tidal volume at high frequency. Tidal volumes are between 1 and 3 mL/kg delivered at 5–15 Hz, equivalent to 300–900 breaths per minute. A few older studies conducted on humans and animals highlight that HFOV may be dangerous for congenital heart patients. According to these evidences, hemodynamic parameters such as blood pressure, wedge pressure, central venous pressure, heart rate and inotrope level can be dangerously changed for patients with congenital heart disease; therefore, oscillatory ventilation should be avoided. Numerous retrospective studies have pointed out how oscillatory ventilation constitutes a valid therapeutic option in children with congenital heart disease. Recently, new evidences have highlighted how hemodynamic parameters are modified in a non-significant way by this type of ventilation, remaining beneficial as in the normal pediatric population. This narrative review aims to describe the mechanisms of oscillatory ventilation and collect all the available evidences to support its use in pediatric patients with congenital heart problems. Full article

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4 pages, 193 KiB

Open AccessEditorial

Respiratory Syncytial Virus in Pregnancy: An Obstetrics View

by Mattia Dominoni, Barbara Gardella and Arsenio Spinillo

Pediatr. Rep. 2024, 16(4), 921-924; https://doi.org/10.3390/pediatric16040078 - 17 Oct 2024

Abstract

Respiratory syncytial virus (RSV) represents one of the most prevalent causes of lower respiratory tract infection in newborns and children by the time they are two years old, with a peak rate of hospitalization in those between two and three months of age [...] Read more.

Respiratory syncytial virus (RSV) represents one of the most prevalent causes of lower respiratory tract infection in newborns and children by the time they are two years old, with a peak rate of hospitalization in those between two and three months of age and a high risk of morbidity and mortality, especially under the age of six months of life [...] Full article

19 pages, 486 KiB

Open AccessArticle

Parents’ Knowledge and Attitudes Toward Pediatric Ophthalmic Disorders in Saudi Arabia: A Cross-Sectional Study

by Saja Radhi G. Alanazi, Haneen Wadi H. Alanazi, Wasan Ghathwan Alanazi, Nawal Surhuj Q. Alanazi, Dareen Owaid B. Alenezi, Maisa Al-Sweilem, Maram Hassan Alqattan, Iftikhar Lafi N. Alanazi, Jumanah Mohammed Tirksstani, Reem Saeed AlSarhan, Saleh Ghulaysi, Hanan A. Elgendy and Manal S. Fawzy

Pediatr. Rep. 2024, 16(4), 902-920; https://doi.org/10.3390/pediatric16040077 - 17 Oct 2024

Abstract

Recognizing pediatric eye health issues at an early stage, along with ensuring that parents are well informed, is crucial. This study measures parents’ knowledge and perspectives on pediatric ophthalmic disease. The study utilized a cross-sectional design, and participants included Saudi parents of children [...] Read more.

Recognizing pediatric eye health issues at an early stage, along with ensuring that parents are well informed, is crucial. This study measures parents’ knowledge and perspectives on pediatric ophthalmic disease. The study utilized a cross-sectional design, and participants included Saudi parents of children residing in Saudi Arabia. Data were collected using a pre-validated self-administered questionnaire with a scoring system. Sociodemographic characteristics and factors associated with knowledge/attitude were collected and analyzed. Initially, 425 respondents participated in this study. Excluding the participants whose work was related to healthcare and those with incomplete data yielded 370 responses on which the subsequent analyses were performed. The analysis revealed that only half of the parents recognized the need for annual eye examinations for children. Most of them showed gaps in knowledge regarding the frequency of routine eye exams and indicators of visual problems. Notably, parents with good/excellent knowledge were more proactive in their eye care practices, such as adherence to recommended eye examination schedules and accepting corrective measures like glasses for common conditions such as refractive errors and amblyopia. However, parental willingness to permit surgical interventions did not correlate significantly with their level of knowledge, signaling the influence of other factors. In conclusion, this study underscores the need for enhanced public health education to improve parental awareness of pediatric eye diseases in Saudi Arabia. Given the link between knowledge and proactive eye health practices, targeted interventions should distribute comprehensive, culturally sensitive information accessible to all demographics. Full article

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10 pages, 746 KiB

Open AccessArticle

Growth Parameters and Prevalence of Obesity in PKU Patients and Peers: Is This the Right Comparison?

by Giulia Paterno, Vito Di Tullio, Rosa Carella, Giada De Ruvo, Fabrizio Furioso, Aleksandra Skublewska-D’Elia, Donatella De Giovanni and Albina Tummolo

Pediatr. Rep. 2024, 16(4), 892-901; https://doi.org/10.3390/pediatric16040076 - 16 Oct 2024

Abstract

Background: One of the main objectives of Phenylketonuria (PKU) management is represented by optimising the growth trend under restricted protein diet regimen. The data on long-term growth in PKU children are limited and mostly based on earlier studies. Methods: The data for this [...] Read more.

Background: One of the main objectives of Phenylketonuria (PKU) management is represented by optimising the growth trend under restricted protein diet regimen. The data on long-term growth in PKU children are limited and mostly based on earlier studies. Methods: The data for this twelve-year longitudinal study were collected from 34 PKU children and 37 healthy peers, whose auxological parameters were taken at 7 time-points over the follow-up. The weight-for-length ratio (WLR) z-score and body mass index (BMI) z-score were considered according to age. Prevalence of overweight/obesity was evaluated at last assessment. Results: The median BMI z-score of PKU children was normal and not statistically different from that of controls on all the seven time-point assessments. Their distributions tended to be wider than those of peers, with the upper limit exceeding the normal range since 12 months old, with a peak specifically at 3 years of age. In controls, there was a tendency to approach the BMI z-score values of overweight in later childhood. The prevalence of overweight was comparable (29% vs. 25%, p: 0.78) between the two groups at last assessment, and obese subjects (3/37) were only detected in the control group. Conclusions: In this study, we report data from a long-term follow-up on growth, highlighting that the median BMI z-score of PKU children was normal and not statistically different from that of controls. Also, the prevalence of obesity at 12 years of age was overlapping. However, the high prevalence of overweight children in the general population may explain the lack of difference and does not reassure about patients’ nutritional risk. Full article

(This article belongs to the Section Inborn Errors and Neonatal Screening)

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12 pages, 309 KiB

Open AccessArticle

Beyond Reading: Psychological and Mental Health Needs in Adolescents with Dyslexia

by Manuel-Ramón Morte-Soriano and Manuel Soriano-Ferrer

Pediatr. Rep. 2024, 16(4), 880-891; https://doi.org/10.3390/pediatric16040075 - 15 Oct 2024

Abstract

Background. Overall, children and adolescents diagnosed with dyslexia or ADHD show an increased risk for psychological and mental health problems, and dyslexia and ADHD tend to coexist frequently. Thus, the main objective of this study was to examine psychological and mental health problems [...] Read more.

Background. Overall, children and adolescents diagnosed with dyslexia or ADHD show an increased risk for psychological and mental health problems, and dyslexia and ADHD tend to coexist frequently. Thus, the main objective of this study was to examine psychological and mental health problems in dyslexia. Method. Participated 95 adolescents with dyslexia (DG), comorbid dyslexia + attention-deficit hyperactivity disorder, combined subtype (D + ADHD-CG), and a comparison group with typical development (TDCG). Self-reported measures of anxiety and depression, and parent and teacher versions of the Strengths and Difficulties Questionnaire (SDQ) were used. Results. Self-reports of internalizing problems showed that adolescents in the GD and D + ADHD-CG groups had more depression and stated anxiety problems with a very high percentage above the clinical cut-off point than the CG. Both the parent and teacher reports showed that the DG and D + ADHD-CG groups obtained higher mean values and a higher number of adolescents above the clinical cut-off of internalizing, externalizing, and total problems than the TDCG. The comorbid D + ADHD-CG group had the highest internalizing and externalizing problems. Conclusions. In conclusion, our findings indicate that the internalizing and externalizing problems experienced by adolescents with dyslexia and comorbid ADHD should be recognized early and treated promptly by education professionals. Full article

(This article belongs to the Special Issue Mental Health and Psychiatric Disorders of Children and Adolescents)

8 pages, 1384 KiB

Open AccessArticle

Trends in Marijuana Use among Adolescents in the United States

by Jack Yang, Maria C. Mejia, Lea Sacca, Charles H. Hennekens and Panagiota Kitsantas

Pediatr. Rep. 2024, 16(4), 872-879; https://doi.org/10.3390/pediatric16040074 - 15 Oct 2024

Abstract

Background: Marijuana is a widely used substance in the United States (US) and worldwide. We explored trends in self-reported marijuana use among US adolescents overall as well as by gender, race/ethnicity, and school grade. Methods: Biennial data from the Youth Risk Behavior Survey [...] Read more.

Background: Marijuana is a widely used substance in the United States (US) and worldwide. We explored trends in self-reported marijuana use among US adolescents overall as well as by gender, race/ethnicity, and school grade. Methods: Biennial data from the Youth Risk Behavior Survey from 2011 to 2021 included 88,183 adolescents in grades 9th through 12th. We used percentage change as a measure of effect and the chi-square test for significance. All analyses were conducted at the national level. Results: The percentage of adolescents who reported current marijuana use dropped significantly from 23.1% in 2011 to 15.8% in 2021 (p < 0.05). The self-report of trying marijuana for the first time before age 13 also decreased significantly from 8.1% in 2011 to 4.9% in 2021 (p < 0.05). For current use, there were similar significant decreases by race/ethnicity, with Asian, Hispanic, and White adolescents experiencing the steepest declines. In 2021, the percentage of Black adolescents self-reporting marijuana use was significantly higher (20.5%) compared to White (14.8%), Hispanic (16.7%), and Asian (5.1%) adolescents. Although current marijuana use declined significantly for both girls and boys over time, in 2021 girls were more likely (17.8%) to currently use marijuana than boys (13.6%). In 2011, the opposite was true, with boys (25.9%) being more likely to use marijuana than girls (20.1%). Conclusions: In US adolescents in 2021, there were decreases in self-reports of marijuana use compared to 2011. Behavioral interventions within school and family environments may be critical in mitigating the risk of marijuana use. Full article

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18 pages, 910 KiB

Open AccessArticle

Embedding Physical Therapy in the Pediatric Primary Care Setting: Qualitative Analysis of Pediatricians’ Insights on Potential Collaborative Roles and Benefits

by Ryan P. Jacobson and Rebecca R. Dobler

Pediatr. Rep. 2024, 16(4), 854-871; https://doi.org/10.3390/pediatric16040073 - 9 Oct 2024

Abstract

The growing need for collaborative healthcare teams to meet complex health challenges has led to physical therapists (PTs) being embedded in adult primary care settings for many years now. However, this model of care has not been found in pediatrics. This qualitative study [...] Read more.

The growing need for collaborative healthcare teams to meet complex health challenges has led to physical therapists (PTs) being embedded in adult primary care settings for many years now. However, this model of care has not been found in pediatrics. This qualitative study sought to gain insights from pediatricians on the potential of embedding pediatric PTs in primary care. Participants were nine pediatricians practicing in both urban and rural, hospital-based and private settings. Semi-structured interviews were recorded, transcribed, and analyzed via thematic analysis per published methods, assuring trustworthiness. Three overarching themes emerged: pediatricians’ priorities aligned with the Quadruple Aim of Healthcare, embedded PTs could fill multiple roles in pediatrics, and they could see a wide variety of patients, highlighting real potential benefits in primary care. Participants endorsed in-office focused treatments, screening to determine optimal care pathways, and ongoing patient follow-up as potential PT roles in this setting. Providers thought that PTs could help manage care for musculoskeletal complaints, high-risk infants, medically complex children, autism, and obesity. An advanced-trained PT having attributes of confidence, adaptability, and open-mindedness was desired. All participants endorsed pediatric primary care PTs as having potentially high value in their practice. This is the first known study on the potential of embedding a PT in the pediatric primary care setting, offering valuable insights from pediatricians to be leveraged in implementation planning. Full article

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10 pages, 1738 KiB

Open AccessReview

Acute Onset of Peripheral Facial Nerve Palsy in Children: An Overview

by Virginia Fancello, Andrea Ciorba, Daniele Monzani, Elisabetta Genovese, Francesco Bussu and Silvia Palma

Pediatr. Rep. 2024, 16(4), 844-853; https://doi.org/10.3390/pediatric16040072 - 1 Oct 2024

Abstract

Background The facial nerve (FN) plays a pivotal role in human life; apart from its sensory and parasympathetic functions, it innervates the facial muscles, and it is therefore involved in non-verbal communication, allowing us to express emotions and reactions. Especially in the case [...] Read more.

Background The facial nerve (FN) plays a pivotal role in human life; apart from its sensory and parasympathetic functions, it innervates the facial muscles, and it is therefore involved in non-verbal communication, allowing us to express emotions and reactions. Especially in the case of childhood onset, FN dysfunction can severely affect the quality of life. Methods The aim of this review is to analyze the most recent literature, focusing on the acute onset of peripheral FN palsy among pediatric patients, discussing the different etiologies, prognoses, and management strategies. A total of 882 papers were initially identified, but only 7 met the selection criteria. Therefore, data on 974 children in total were pooled and analyzed. Results According to the findings of this review, FN palsy is idiopathic in most cases, while an infective etiology was identified as the second most common. The main pathogen agents identified were Borrelia Burgdorferi, especially in endemic areas, and Herpesviridae. Respiratory tract infections and/or ear infections were also described. Head trauma or direct injury of the FN accounted for 2% of all cases. Conclusions The overall FN recovery rate is high, even though the etiology remains unknown for most patients. Therapeutic indications are still lacking, especially in the case of non-recovering FN palsy. In our opinion, large, prospective studies are necessary for improving our knowledge of this disorder and establishing evidence-based approaches. Full article

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11 pages, 3357 KiB

Open AccessCase Report

Complicated Pneumonia in a Child: Hydropneumothorax Associated with MIS-C and GAS Superinfection

by Snezhina Lazova, Nadzhie Gorelyova-Stefanova, Yoanna Slabakova, Iren Tzotcheva, Elena Ilieva, Dimitrina Miteva and Tsvetelina Velikova

Pediatr. Rep. 2024, 16(4), 833-843; https://doi.org/10.3390/pediatric16040071 - 30 Sep 2024

Abstract

A hydropneumothorax is an uncommon complication of pneumonia, particularly in pediatric patients, and typically arises secondary to conditions such as malignancies, esophageal-pleural fistula, thoracic trauma, or thoracocentesis. While pneumothorax is rarely reported in adults with COVID-19 and is even less common in children, [...] Read more.

A hydropneumothorax is an uncommon complication of pneumonia, particularly in pediatric patients, and typically arises secondary to conditions such as malignancies, esophageal-pleural fistula, thoracic trauma, or thoracocentesis. While pneumothorax is rarely reported in adults with COVID-19 and is even less common in children, isolated cases have been noted in those with Multisystem Inflammatory Syndrome in Children (MIS-C). A recent alert has also been issued about increased Group A Streptococcus (GAS) infections in Europe. Against this background, the primary aim of this case report is to describe a rare and severe complication of pneumonia in a previously healthy child with MIS-C and a positive throat culture for GAS. Full article

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10 pages, 1444 KiB

Open AccessArticle

Comparison of One-Year Post-Operative Evolution of Children Born of COVID-19-Positive Mothers vs. COVID-19-Negative Pregnancies Having Congenital Gastrointestinal Malformation and Having Received Proper Parenteral Nutrition during Their Hospital Stay

by Timea Elisabeta Brandibur, Nilima Rajpal Kundnani, Kakarla Ramakrishna, Alexandra Mederle, Aniko Maria Manea, Marioara Boia and Marius Calin Popoiu

Pediatr. Rep. 2024, 16(4), 823-832; https://doi.org/10.3390/pediatric16040070 - 25 Sep 2024

Abstract

Background: The long-term effects on neonates born of COVID-19-positive pregnancies are still unclear. Congenital gastrointestinal malformations (CGIMs) often require urgent surgical intervention and antibiotic coverage. We aim to compare the health status at one-year post-surgical follow-up of cases of CGIM born of COVID-19-positive [...] Read more.

Background: The long-term effects on neonates born of COVID-19-positive pregnancies are still unclear. Congenital gastrointestinal malformations (CGIMs) often require urgent surgical intervention and antibiotic coverage. We aim to compare the health status at one-year post-surgical follow-up of cases of CGIM born of COVID-19-positive pregnancies to those of non-COVID-19 pregnancies. Methods: We conducted a comparative, observational study of 41 patients who underwent surgery at our hospital for congenital gastrointestinal malformations in 2022. They were initially treated with antibiotics and parenteral nutrition, which was later replaced with enteral nutrition gradually after the surgery. We then analyzed the data related to their growth and development during their 12-month follow-up visit at our outpatient clinic. We classified the children born of COVID-19-positive mothers as Group 1 (n = 14) and those born of mothers without COVID-19 symptoms or with unconfirmed status as Group 2 (n = 33). Results: Forty-one patients showed up for a one-year follow-up (between 11 and 13 months of life). Hence, the final Group 1 comprised 12 and Group 2 comprised 29 children. The patients were categorized based on their anatomical location. Of the cohort, 56.09% were preemies, and 43.91% were full-term newborns. We used seven parameters to evaluate both groups based on growth and developmental milestones: verbal skills, cognitive development, weight gain, height achieved, fine motor movements, gross motor movements, and social/emotional behavior. Group 1 children showed a significant decrease in height and weight compared to Group 2 children. In Group 1, 83.33% of patients were prescribed antibiotics, while only 10.34% in Group 2 were in the same situation. There were no cases of malabsorption syndrome in Group 2, but 16.66% of patients in Group 1 had it, with patients being operated on for duodenal malformations. None of the infants had necrotizing enterocolitis, post-surgical complications, or sepsis. All the children received antibiotics to prevent infection before and after surgery. No mortality was noted. Conclusions: In our one-year follow-up study, it was seen that even after surgical correction of congenital gastrointestinal malformations, children born of COVID-19-positive pregnancies can suffer serious growth and developmental delays, and gastrointestinal health issues might be more common. Since the long-term effects of COVID-19-positive pregnancies are not yet clear, larger cohort-based studies are required in this domain. Antibiotics destroy gut microbiota, especially in cases of gastrointestinal malformations and surgical resections. Growth and developmental milestones can not only be affected by CGIMs but also be further delayed by COVID-19 infections. Full article

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7 pages, 838 KiB

Open AccessArticle

Preferred Treatment Patterns of Retinopathy of Prematurity: An International Survey

by Amy T. Wang and Shuan Dai

Pediatr. Rep. 2024, 16(3), 816-822; https://doi.org/10.3390/pediatric16030069 - 13 Sep 2024

Abstract

This paper assesses the preferred treatment patterns for retinopathy of prematurity (ROP) and examine trends in anti-vascular endothelial growth factor (VEGF) use for ROP. Methods: A retrospective survey consisting of 14 questions was distributed to paediatric ophthalmology interest groups internationally. Main outcome [...] Read more.

This paper assesses the preferred treatment patterns for retinopathy of prematurity (ROP) and examine trends in anti-vascular endothelial growth factor (VEGF) use for ROP. Methods: A retrospective survey consisting of 14 questions was distributed to paediatric ophthalmology interest groups internationally. Main outcome measures included treatment patterns, proportion of anti-VEGF use in different stages of ROP; and comparison of first-line treatments as well as repeat anti-VEGF treatments. Results: Fifty-four ophthalmologists from 11 different countries responded to the survey. The number of respondents per question, except one, ranged between 50–54. Per annum, there was an average number of 394 infants screened by each respondent. Anti-VEGF was the preferred treatment method for aggressive (A)-ROP (64.1%), Type 1 ROP in zone 1 (71.7%), and Type 1 ROP in posterior zone 2 (56.6%). The majority used laser as the first-line treatment of Type 1 ROP in anterior zone 2 (73.6%) and Type 1 ROP in zone 3 (79.2%). Laser was the preferred treatment modality utilised in infants requiring repeat treatment following anti-VEGF injection. The preferred anti-VEGF agent was bevacizumab administered at a dose of 0.625 mg. Conclusions: Anti-VEGF as first-line therapy has been increasing. Anti-VEGF appears to be the first-line treatment of choice for A-ROP, Type 1 ROP in zone 1 and posterior zone 2 and laser for Type 1 ROP in anterior zone 2 and zone 3. Full article

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10 pages, 9549 KiB

Open AccessCase Report

Successful Treatment of Multiple Large Intrarenal Stones in a 2-Year-Old Boy Using a Single-Use Flexible Ureteroscope and High-Power Laser Settings

by Vasileios Tatanis, Theodoros Spinos, Zoi Lamprinou, Elisavet Kanna, Francesk Mulita, Angelis Peteinaris, Orthodoxos Achilleos, Ioannis Skondras, Evangelos Liatsikos and Panagiotis Kallidonis

Pediatr. Rep. 2024, 16(3), 806-815; https://doi.org/10.3390/pediatric16030068 - 11 Sep 2024

Abstract

The standard treatment procedures for managing renal calculi in the pediatric population are similar to those in adults. The application of flexible ureteroscopy has contributed to the increased popularity of retrograde intrarenal surgery (RIRS) as an alternative therapeutic modality that can be successfully [...] Read more.

The standard treatment procedures for managing renal calculi in the pediatric population are similar to those in adults. The application of flexible ureteroscopy has contributed to the increased popularity of retrograde intrarenal surgery (RIRS) as an alternative therapeutic modality that can be successfully applied in children. One of the most significant innovations of the last decade is the introduction of single-use flexible ureteroscopes (fURSs). In this case report, we present the case of a 2-year-old boy with multiple large calculi in his right kidney, which were successfully removed after a single session of RIRS using a 7.5 F single-use fURS and high-power laser settings. The total operative and lithotripsy times were estimated at 90 and 75 min, respectively. No complications were recorded. The hemoglobin loss was calculated at 0.3 mg/dL, while the creatinine level was decreased by 0.1 mg/dL. The urethral catheter was removed on the first postoperative day, and the patient was discharged. The management of multiple or large kidney stones is very challenging in the pediatric population under the age of three years. Convenient preoperative planning and the appropriate use of available equipment may lead to excellent outcomes accompanied by a reduced risk for complications. Full article

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12 pages, 1319 KiB

Open AccessArticle

Artificial Intelligence (AI) Assessment of Pediatric Dental Panoramic Radiographs (DPRs): A Clinical Study

by Natalia Turosz, Kamila Chęcińska, Maciej Chęciński, Karolina Lubecka, Filip Bliźniak and Maciej Sikora

Pediatr. Rep. 2024, 16(3), 794-805; https://doi.org/10.3390/pediatric16030067 - 11 Sep 2024

Abstract

This clinical study aimed to evaluate the sensitivity, specificity, accuracy, and precision of artificial intelligence (AI) in assessing permanent teeth in pediatric patients. Over one thousand consecutive DPRs taken in Kielce, Poland, with the Carestream CS9600 device were screened. In the study material, [...] Read more.

This clinical study aimed to evaluate the sensitivity, specificity, accuracy, and precision of artificial intelligence (AI) in assessing permanent teeth in pediatric patients. Over one thousand consecutive DPRs taken in Kielce, Poland, with the Carestream CS9600 device were screened. In the study material, 35 dental panoramic radiographs (DPRs) of patients of developmental age were identified and included. They were automatically evaluated with an AI algorithm. The DPRs were then analyzed by researchers. The status of the following dichotomous variables was assessed: (1) decay, (2) missing tooth, (3) filled tooth, (4) root canal filling, and (5) endodontic lesion. The results showed high specificity and accuracy (all above 85%) in detecting caries, dental fillings, and missing teeth but low precision. This study provided a detailed assessment of AI performance in a previously neglected age group. In conclusion, the overall accuracy of AI algorithms for evaluating permanent dentition in dental panoramic radiographs is lower for pediatric patients than adults or the entire population. Hence, identifying primary teeth should be implemented in AI-driven software, at least so as to ignore them when assessing mixed dentition (ClinicalTrials.gov registration number: NCT06258798). Full article

(This article belongs to the Special Issue Modern Solutions for Diagnosis and Treatment Planning in Pediatric Dentistry and Orthodontics)

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8 pages, 276 KiB

Open AccessArticle

Association of Methylenetetrahydrofolate Reductase (MTHFR) Polymorphism with Osteosarcoma in a Mexican Population

by Irma G. Enriquez-Maldonado, Daniel A. Montes-Galindo, Rocio Ortiz-Lopez, Jesus Ojeda-Ibarra, Margarita L. Martinez-Fierro, Iram P. Rodriguez-Sanchez, Augusto Rojas-Martinez, Angel Zavala-Pompa, Carmen Alicia Sanchez-Ramirez, Alejandra E. Hernandez-Rangel, Karmina Sanchez-Meza, Idalia Garza-Veloz, Alejandrina Rodriguez-Hernandez and Ivan Delgado-Enciso

Pediatr. Rep. 2024, 16(3), 786-793; https://doi.org/10.3390/pediatric16030066 - 9 Sep 2024

Abstract

The methylenetetrahydrofolate reductase (MTHFR) gene 677C➔T polymorphism is capable of altering folate metabolism and can modify certain neoplasia risk. Reports have suggested that folate can have an influence on bone development and so it is of interest to know if the [...] Read more.

The methylenetetrahydrofolate reductase (MTHFR) gene 677C➔T polymorphism is capable of altering folate metabolism and can modify certain neoplasia risk. Reports have suggested that folate can have an influence on bone development and so it is of interest to know if the MTHFR 677C➔T polymorphism is associated with the malignant transformation process of this tissue. The polymorphism was determined in 55 patients with osteosarcoma and in 180 healthy individuals. Compared with C/T+C/C genotypes, a 3.7-fold reduction in osteosarcoma probability is possible with the T/T genotype (OR 0.27, CI 95% 0.07–0.82). Undoubtedly, further studies, utilizing large samples and carried out on different populations, are necessary to confirm these results. Full article

7 pages, 2360 KiB

Open AccessCase Report

Case Report of a Neonate with Complex Gastroschisis: A Multidisciplinary Approach

by Palanikumar Balasundaram, Timothy B. Lautz, Rhonda Gale and Kimberly G. Remedios-Smith

Pediatr. Rep. 2024, 16(3), 779-785; https://doi.org/10.3390/pediatric16030065 - 9 Sep 2024

Abstract

Gastroschisis is a congenital anomaly characterized by herniation of abdominal contents via a defect in the anterior abdominal wall. Gastroschisis can manifest as simple or complex, with additional complications such as atresia, perforation, ischemia, necrosis, or volvulus. While prenatal screening and advancements in [...] Read more.

Gastroschisis is a congenital anomaly characterized by herniation of abdominal contents via a defect in the anterior abdominal wall. Gastroschisis can manifest as simple or complex, with additional complications such as atresia, perforation, ischemia, necrosis, or volvulus. While prenatal screening and advancements in surgical techniques have improved outcomes, infants with complex gastroschisis cases pose significant challenges in neonatal care. Vanishing gastroschisis, a rare but dreaded complication with a mortality rate ranging from 10 to 70%, occurs when the abdominal wall closes around the herniated bowel, leading to strangulation. We present a case report focusing on the management of neonatal gastroschisis in a 36-week-old female infant with vanishing gastroschisis. The infant’s clinical course, including surgical interventions, complications, and multidisciplinary management, is discussed in detail. This case underscores the importance of a multidisciplinary approach in optimizing outcomes for infants with complex gastroschisis. Via this case report, we aim to provide insights into the complexities of neonatal gastroschisis management and advocate for a collaborative approach involving neonatology, pediatric surgery, infectious disease, and palliative care to improve outcomes and quality of life for affected infants. Full article

(This article belongs to the Special Issue Global Neonatal Screening: Expanding Horizons in Diagnostic Technologies)

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16 pages, 827 KiB

Open AccessReview

Diagnostic Biomarkers of Microvascular Complications in Children and Adolescents with Type 1 Diabetes Mellitus—An Updated Review

by Naser A. Alsharairi

Pediatr. Rep. 2024, 16(3), 763-778; https://doi.org/10.3390/pediatric16030064 - 5 Sep 2024

Abstract

Type 1 diabetes mellitus (T1DM) is regarded as the most chronic autoimmune disease affecting children and adolescents that results from a destruction of pancreatic β-cell and leads to insulin insufficiency and persistent hyperglycemia (HG). Children and adolescents with T1DM are at an increased [...] Read more.

Type 1 diabetes mellitus (T1DM) is regarded as the most chronic autoimmune disease affecting children and adolescents that results from a destruction of pancreatic β-cell and leads to insulin insufficiency and persistent hyperglycemia (HG). Children and adolescents with T1DM are at an increased risk of developing microvascular complications, including diabetic nephropathy (DNE), diabetic retinopathy (DR), and diabetic neuropathy (DNU). The risk factors and prevalence of these complications differ greatly in pediatric studies. Screening for T1DM microvascular complications undergoes different stages and it is recommended to identify early symptoms and clinical signs. The identification of biomarkers in T1DM microvascular complications is needed to provide optimal treatment. Despite several studies on early biomarkers for DNE in children, the potential biomarkers for predicting DR and DNU have not been completely illustrated. This review fills this gap by identifying biomarkers of T1DM microvascular complications in children and adolescents through searches in the PubMed/Medline database. Full article

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10 pages, 1037 KiB

Open AccessArticle

Effect of the Duration of Deep Hypothermic Circulatory Arrest on the Neurodevelopmental Outcomes in Children Undergoing Cardiac Surgery

by Abdullah H. Ghunaim, Basma Aljabri, Ahmed Dohain, Ghassan S. Althinayyan, Abdulaziz I. Aleissa, Ahmad T. Alshebly, Rayan A. Alyafi, Tareg M. Alhablany, Ahmed M. Nashar and Osman O. Al-Radi

Pediatr. Rep. 2024, 16(3), 753-762; https://doi.org/10.3390/pediatric16030063 - 31 Aug 2024

Abstract

Background/Objectives: Deep hypothermic circulatory arrest (DHCA) is safe, but subtle neurodevelopmental deficits may persist far beyond the perioperative period. We aimed to investigate the relationship between DHCA duration and neurodevelopmental outcomes in young children undergoing cardiac surgery with DHCA. Methods: Children aged < [...] Read more.

Background/Objectives: Deep hypothermic circulatory arrest (DHCA) is safe, but subtle neurodevelopmental deficits may persist far beyond the perioperative period. We aimed to investigate the relationship between DHCA duration and neurodevelopmental outcomes in young children undergoing cardiac surgery with DHCA. Methods: Children aged < 42 months, including neonates who underwent cardiac surgery using DHCA without regional perfusion techniques, were included as the DHCA group. Children in the same age range who underwent cardiac surgery without DHCA were included as the control group. All enrolled patients underwent neurodevelopmental assessment using the Bayley Scales of Infant and Toddler Development (BSTID) by a trained pediatrician, and 17 DHCA patients and 6 control patients completed the BSTID assessment. Results: Both groups showed no significant preoperative, operative, or postoperative differences. Adjusted multivariable analysis revealed that prematurity and age at assessment were significant changing predictors of each of the BSTID components (p < 0.001), except for the gross motor component, where only age at assessment was a significant adjusting predictor. Longer DHCA was associated with lower fine and gross motor BSTID components; however, the association was not statistically significant (p = 0.06). Conclusions: Long-duration DHCA without regional perfusion techniques may be associated with less optimal neurodevelopmental outcomes. Full article

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17 pages, 1051 KiB

Open AccessReview

Prenatal Tobacco Exposure and Behavioral Disorders in Children and Adolescents: Systematic Review and Meta-Analysis

by Stephanie Godleski, Shannon Shisler, Kassidy Colton and Meghan Leising

Pediatr. Rep. 2024, 16(3), 736-752; https://doi.org/10.3390/pediatric16030062 - 31 Aug 2024

Abstract

Prenatal tobacco exposure has been implicated in increased risk of the development of behavioral disorders in children and adolescents. The purpose of the current study was to systematically examine the association between prenatal tobacco exposure and diagnoses of Attention Deficit/Hyperactivity Disorder, Oppositional Defiant [...] Read more.

Prenatal tobacco exposure has been implicated in increased risk of the development of behavioral disorders in children and adolescents. The purpose of the current study was to systematically examine the association between prenatal tobacco exposure and diagnoses of Attention Deficit/Hyperactivity Disorder, Oppositional Defiant Disorder, and Conduct Disorder in childhood and adolescence. We searched Medline, Psychinfo, ERIC, Proquest, Academic Search Complete, PsychArticles, Psychology and Behavioral Sciences Collection, Web of Science, CINAHL Plus, and Google Scholar databases through October 2022. The authors screened studies and extracted data independently in duplicate. Ten clinical studies examining diagnoses of Attention Deficit/Hyperactivity Disorder, Oppositional Defiant Disorder, and Conduct Disorder between the ages of 4 and 18 years old were included. There was insufficient evidence to synthesize outcomes related to Conduct Disorder and Oppositional Defiant Disorder. The meta-analysis found a significant effect of prenatal tobacco exposure in increasing the likelihood of an Attention Deficit/Hyperactivity Disorder diagnosis in childhood and adolescence. Implications for future research are discussed. Full article

(This article belongs to the Special Issue Mental Health and Psychiatric Disorders of Children and Adolescents)

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