Children

17 pages, 838 KiB

Open AccessEditor’s ChoiceReview

Maternal Infection and Preterm Birth: From Molecular Basis to Clinical Implications

by George Daskalakis, Alexandros Psarris, Antonios Koutras, Zacharias Fasoulakis, Ioannis Prokopakis, Antonia Varthaliti, Christina Karasmani, Thomas Ntounis, Ekaterini Domali, Marianna Theodora, Panos Antsaklis, Kalliopi I. Pappa and Angeliki Papapanagiotou

Children 2023, 10(5), 907; https://doi.org/10.3390/children10050907 - 22 May 2023

Cited by 23 | Viewed by 8293

Abstract

As the leading cause of neonatal morbidity and mortality, preterm birth is recognized as a major public health concern around the world. The purpose of this review is to analyze the connection between infections and premature birth. Spontaneous preterm birth is commonly associated [...] Read more.

As the leading cause of neonatal morbidity and mortality, preterm birth is recognized as a major public health concern around the world. The purpose of this review is to analyze the connection between infections and premature birth. Spontaneous preterm birth is commonly associated with intrauterine infection/inflammation. The overproduction of prostaglandins caused by the inflammation associated with an infection could lead to uterine contractions, contributing to preterm delivery. Many pathogens, particularly Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, Gardnerella vaginalis, Ureaplasma urealyticum, Mycoplasma hominis, Actinomyces, Candida spp., and Streptococcus spp. have been related with premature delivery, chorioamnionitis, and sepsis of the neonate. Further research regarding the prevention of preterm delivery is required in order to develop effective preventive methods with the aim of reducing neonatal morbidity. Full article

(This article belongs to the Section Global Pediatric Health)

► Show Figures

Figure 1

11 pages, 782 KiB

Open AccessEditor’s ChoiceArticle

Elevated Urinary Hepcidin Level and Hypoferremia in Infants with Febrile Urinary Tract Infection: A Prospective Cohort Study

by Yu-Chen Hsu, Hsin-Chun Huang, Kuo-Su Tang, Li-Ting Su, Ying-Hsien Huang, Hui-Chen Huang and I-Lun Chen

Children 2023, 10(5), 870; https://doi.org/10.3390/children10050870 - 12 May 2023

Cited by 6 | Viewed by 1895

Abstract

To evaluate the kinetics of serum and urinary hepcidin levels along with anemia-related parameters during the infection course of infants with febrile urinary tract infection (UTI), we enrolled febrile infants aged one to four months in this prospective study. Febrile patients with UTI [...] Read more.

To evaluate the kinetics of serum and urinary hepcidin levels along with anemia-related parameters during the infection course of infants with febrile urinary tract infection (UTI), we enrolled febrile infants aged one to four months in this prospective study. Febrile patients with UTI were allocated into Escherichia coli (E. coli) or non-E. coli groups according to urine culture results. Septic workup, blood hepcidin, iron profile, urinalysis, and urinary hepcidin–creatinine ratio were collected upon admission and 3 days after antibiotic treatment. In total, 118 infants were included. On admission, the febrile UTI group showed a significant reduction in serum iron level and a significant elevation of urinary hepcidin–creatinine ratio compared to the febrile control counterpart. Moreover, urinary hepcidin–creatinine ratio had the highest odds ratio, 2.01, in logistics regression analysis. After 3 days of antibiotic treatment, hemoglobin and the urinary hepcidin–creatinine ratio were significantly decreased. Patients with an E. coli UTI had a significantly decreased urinary hepcidin–creatinine ratio after 3 days of antibiotics treatment, whereas the non-E. coli group showed insignificant changes. Our study suggested that the urinary hepcidin–creatinine ratio elevated during acute febrile urinary tract infection and significantly decreased after 3 days of antibiotics treatment, especially in E. coli UTI. Full article

(This article belongs to the Section Pediatric Neonatology)

► Show Figures

Figure 1

20 pages, 9063 KiB

Open AccessEditor’s ChoiceArticle

Exploring the Potential of Three-Dimensional Imaging, Printing, and Modeling in Pediatric Surgical Oncology: A New Era of Precision Surgery

by Arnau Valls-Esteve, Núria Adell-Gómez, Albert Pasten, Ignasi Barber, Josep Munuera and Lucas Krauel

Children 2023, 10(5), 832; https://doi.org/10.3390/children10050832 - 3 May 2023

Cited by 15 | Viewed by 3930

Abstract

Pediatric surgical oncology is a technically challenging field that relies on CT and MRI as the primary imaging tools for surgical planning. However, recent advances in 3D reconstructions, including Cinematic Rendering, Volume Rendering, 3D modeling, Virtual Reality, Augmented Reality, and 3D printing, are [...] Read more.

Pediatric surgical oncology is a technically challenging field that relies on CT and MRI as the primary imaging tools for surgical planning. However, recent advances in 3D reconstructions, including Cinematic Rendering, Volume Rendering, 3D modeling, Virtual Reality, Augmented Reality, and 3D printing, are increasingly being used to plan complex cases bringing new insights into pediatric tumors to guide therapeutic decisions and prognosis in different pediatric surgical oncology areas and locations including thoracic, brain, urology, and abdominal surgery. Despite this, challenges to their adoption remain, especially in soft tissue-based specialties such as pediatric surgical oncology. This work explores the main innovative imaging reconstruction techniques, 3D modeling technologies (CAD, VR, AR), and 3D printing applications through the analysis of three real cases of the most common and surgically challenging pediatric tumors: abdominal neuroblastoma, thoracic inlet neuroblastoma, and a bilateral Wilms tumor candidate for nephron-sparing surgery. The results demonstrate that these new imaging and modeling techniques offer a promising alternative for planning complex pediatric oncological cases. A comprehensive analysis of the advantages and limitations of each technique has been carried out to assist in choosing the optimal approach. Full article

(This article belongs to the Special Issue New Research in Pediatric Surgical Oncology)

► Show Figures

Figure 1

25 pages, 1895 KiB

Open AccessEditor’s ChoiceReview

Ultra-Processed Food, Reward System and Childhood Obesity

by Valeria Calcaterra, Hellas Cena, Virginia Rossi, Sara Santero, Alice Bianchi and Gianvincenzo Zuccotti

Children 2023, 10(5), 804; https://doi.org/10.3390/children10050804 - 29 Apr 2023

Cited by 23 | Viewed by 9759

Abstract

Obesity and overweight are a major public health problem globally. Diet quality is critical for proper child development, and an unhealthy diet is a preventable risk factor for noncommunicable diseases (NCDs), such as obesity. Consumption of sugar-sweetened beverages and ultra-processed foods (UPFs) in [...] Read more.

Obesity and overweight are a major public health problem globally. Diet quality is critical for proper child development, and an unhealthy diet is a preventable risk factor for noncommunicable diseases (NCDs), such as obesity. Consumption of sugar-sweetened beverages and ultra-processed foods (UPFs) in childhood may increase the BMI/BMI z-score, body fat percentage, or likelihood of overweight. A strict feeding regulation system allows for sufficient food to be consumed to meet ongoing metabolic demands while avoiding overconsumption. This narrative review explores the issues of obesity and the regulation of food intake related to reward systems and UPF consumption. Nutrient composition alone cannot explain the influence of UPFs on the risk of obesity. Furthermore, the non-nutritional properties of UPFs may explain the mechanisms underlying the relationship with obesity and NCDs. UPFs are designed to be highly palatable, appealing, and energy dense with a unique combination of the main taste enhancer ingredients to generate a strong rewarding stimulus and influence the circuits related to feeding facilitation. How individual UPF ingredients influence eating behavior and reward processes remains not fully elucidated. To increase the knowledge on the relationship between UPFs and pediatric obesity, it may be useful to limit the rapid growth in the prevalence of obesity and subsequent related complications, and to develop new strategies for appropriate food and nutrition policies. Full article

(This article belongs to the Special Issue Food Intake and Nutrition Assessment in Children: Focus on Healthy Growth)

► Show Figures

Graphical abstract

12 pages, 794 KiB

Open AccessEditor’s ChoiceArticle

Incidence and Prevalence of Multisystem Inflammatory Syndrome in Children (MIS-C) in Southern Italy

by Francesco La Torre, Maria Pia Elicio, Viviana Anna Monno, Maria Chironna, Fulvio Moramarco, Angelo Campanozzi, Adele Civino, Valerio Cecinati, Ugo Vairo, Mario Giordano, Leonardo Milella, Daniela Loconsole and Fabio Cardinale

Children 2023, 10(5), 766; https://doi.org/10.3390/children10050766 - 23 Apr 2023

Cited by 9 | Viewed by 2690

Abstract

Multisystem inflammatory syndrome in children (MIS-C) is a pediatric hyperinflammatory syndrome related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection whose epidemiology is not very well known at present. The objective of the study was to better understand the incidence of MIS-C [...] Read more.

Multisystem inflammatory syndrome in children (MIS-C) is a pediatric hyperinflammatory syndrome related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection whose epidemiology is not very well known at present. The objective of the study was to better understand the incidence of MIS-C in the Apulia region in southern Italy. Our primary goal was to estimate the incidence of newly identified cases of MIS-C in children aged 0–18 years, during a period of six months, encompassing the second pandemic wave. We also analyzed the characteristics of our cohort in terms of clinical features, treatment, and outcomes. The cumulative incidence of MIS-C was 3.27 per 100,000 residents between 0 and 18 years of age. In our cohort, gastrointestinal, mucocutaneous, and cardiac involvement were the most common clinical features. With our step-up approach to therapy, no patients required intensive care unit (ICU) admission and no cardiac sequelae after 6 months of onset were found in echocardiograms. Conclusion: Our epidemiological study of MIS-C in southern Italy showed unexpectedly overlapping figures with other US studies. Full article

(This article belongs to the Section Global Pediatric Health)

► Show Figures

Figure 1

7 pages, 564 KiB

Open AccessEditor’s ChoiceBrief Report

Clinical Hematochemical Parameters in Differential Diagnosis between Pediatric SARS-CoV-2 and Influenza Virus Infection: An Automated Machine Learning Approach

by Dejan Dobrijević, Jelena Antić, Goran Rakić, Jasmina Katanić, Ljiljana Andrijević and Kristian Pastor

Children 2023, 10(5), 761; https://doi.org/10.3390/children10050761 - 22 Apr 2023

Cited by 8 | Viewed by 1980

Abstract

Background: The influenza virus and the novel beta coronavirus (SARS-CoV-2) have similar transmission characteristics, and it is very difficult to distinguish them clinically. With the development of information technologies, novel opportunities have arisen for the application of intelligent software systems in disease diagnosis [...] Read more.

Background: The influenza virus and the novel beta coronavirus (SARS-CoV-2) have similar transmission characteristics, and it is very difficult to distinguish them clinically. With the development of information technologies, novel opportunities have arisen for the application of intelligent software systems in disease diagnosis and patient triage. Methods: A cross-sectional study was conducted on 268 infants: 133 infants with a SARS-CoV-2 infection and 135 infants with an influenza virus infection. In total, 10 hematochemical variables were used to construct an automated machine learning model. Results: An accuracy range from 53.8% to 60.7% was obtained by applying support vector machine, random forest, k-nearest neighbors, logistic regression, and neural network models. Alternatively, an automated model convincingly outperformed other models with an accuracy of 98.4%. The proposed automated algorithm recommended a random tree model, a randomization-based ensemble method, as the most appropriate for the given dataset. Conclusions: The application of automated machine learning in clinical practice can contribute to more objective, accurate, and rapid diagnosis of SARS-CoV-2 and influenza virus infections in children. Full article

(This article belongs to the Section Pediatric Hematology & Oncology)

17 pages, 553 KiB

Open AccessEditor’s ChoiceSystematic Review

Motivation toward Physical Activity and Healthy Habits of Adolescents: A Systematic Review

by Javier Cachón-Zagalaz, Hanrriette Carrasco-Venturelli, María Sánchez-Zafra and María Luisa Zagalaz-Sánchez

Children 2023, 10(4), 659; https://doi.org/10.3390/children10040659 - 30 Mar 2023

Cited by 9 | Viewed by 5844

Abstract

Adolescence is a transformative period in which rapid physical, cognitive and psychosocial growth takes place. Laying the foundation for healthy behaviors is paramount during these formative years. The aim of this review is to determine which countries are leading in research on adolescents’ [...] Read more.

Adolescence is a transformative period in which rapid physical, cognitive and psychosocial growth takes place. Laying the foundation for healthy behaviors is paramount during these formative years. The aim of this review is to determine which countries are leading in research on adolescents’ motivation towards physical activity and healthy habits and their main findings. A systematic review was conducted following the PRISMA statement using the Web of Science and Scopus databases during the months of September to December 2022. The search terms used were: “Physical activity”, “Motivation” and “Adolescents”, in the following research areas: Education, Educational Research and Sport Sciences. A total of 5594 articles were identified, but only those that met the established criteria were included (32 articles). It is concluded that most of the research is led in Spain with 16 articles, followed by 3 in Chile, 2 in Portugal, 2 in Norway and the rest of the countries with 1. Likewise, most of the works include very similar aspects regarding the incidence of motivation towards the adherence to the practice of Physical Activity and healthy habits. Full article

(This article belongs to the Special Issue Early Childhood Education Development)

► Show Figures

Figure 1

13 pages, 700 KiB

Open AccessEditor’s ChoiceReview

PANDAS/PANS in the COVID-19 Age: Autoimmunity and Epstein–Barr Virus Reactivation as Trigger Agents?

by Stefano Pallanti and Michele Di Ponzio

Children 2023, 10(4), 648; https://doi.org/10.3390/children10040648 - 30 Mar 2023

Cited by 7 | Viewed by 6231

Abstract

COVID-19 impacted the entire world’s population, frequently resulting in long-lasting neuropsychiatric complications. Furthermore, social distancing, lockdowns and fear for one’s personal health worsen individual psychological wellbeing, especially in children and adolescents. Herein, we discuss the results of studies that specifically reported data about [...] Read more.

COVID-19 impacted the entire world’s population, frequently resulting in long-lasting neuropsychiatric complications. Furthermore, social distancing, lockdowns and fear for one’s personal health worsen individual psychological wellbeing, especially in children and adolescents. Herein, we discuss the results of studies that specifically reported data about the impact of the COVID-19 pandemic or infection on children with Pediatric Acute-Onset Neuropsychiatric Disorders (PANS). Furthermore, we present the cases of five adolescents with PANS whose symptomatology increased following SARS-CoV-2 infection. What emerged from this study was that COVID-19 resulted in the exacerbation of obsessions, tics, anxiety and mood symptoms and decreased wellbeing. Moreover, new symptoms, as well as new PANS cases, are reported to have arisen after COVID-19 infection. Here, we hypothesize that the pathogenic mechanisms of silent viruses, such as the Epstein–Barr virus, are related to neuroinflammation, immune responses and reactivation, with additional roles played by social-isolation-related inflammatory processes. The discussion of PANS, which represents a model of immune-mediated neuropsychiatric manifestations, is particularly relevant, with the aim of uncovering the mechanisms that lead to neuropsychiatric Post-Acute COVID-19 Syndrome (PACS). Prospects for future studies and treatment implications are discussed. Full article

(This article belongs to the Special Issue Focus on Children 2021: Challenges and Opportunities towards the Future)

► Show Figures

Figure 1

14 pages, 1202 KiB

Open AccessEditor’s ChoiceReview

Pediatric Bowel Management Options and Organizational Aspects

by Elizaveta Bokova, Wendy Jo Svetanoff, Marc Aaron Levitt and Rebecca Maria Rentea

Children 2023, 10(4), 633; https://doi.org/10.3390/children10040633 - 28 Mar 2023

Cited by 9 | Viewed by 3153

Abstract

A bowel management program (BMP) to treat fecal incontinence and severe constipation is utilized for patients with anorectal malformations, Hirschsprung disease, spinal anomalies, and functional constipation, decreasing the rate of emergency department visits, and hospital admissions. This review is part of a manuscript [...] Read more.

A bowel management program (BMP) to treat fecal incontinence and severe constipation is utilized for patients with anorectal malformations, Hirschsprung disease, spinal anomalies, and functional constipation, decreasing the rate of emergency department visits, and hospital admissions. This review is part of a manuscript series and focuses on updates in the use of antegrade flushes for bowel management, as well as organizational aspects, collaborative approach, telemedicine, the importance of family education, and one-year outcomes of the bowel management program. Implementation of a multidisciplinary program involving physicians, nurses, advanced practice providers, coordinators, psychologists, and social workers leads to rapid center growth and enhances surgical referrals. Education of the families is crucial for postoperative outcomes, prevention, and early detection of complications, especially Hirschsprung-associated enterocolitis. Telemedicine can be proposed to patients with a defined anatomy and is associated with high parent satisfaction and decreased patient stress in comparison to in-person visits. The BMP has proved to be effective in all groups of colorectal patients at a 1- and 2-year follow-up with social continence achieved in 70–72% and 78% of patients, respectively, and an improvement in the patients’ quality of life. A transitional care to adult program is essential to maintain the same quality of care, and continuity of care and to achieve desired long-term outcomes as the patient reaches adult age. Full article

(This article belongs to the Special Issue Advance in Pediatric Surgery)

► Show Figures

Figure 1

23 pages, 438 KiB

Open AccessEditor’s ChoiceReview

Efficacy and Safety of Elexacaftor-Tezacaftor-Ivacaftor in the Treatment of Cystic Fibrosis: A Systematic Review

by Nikoletta Kapouni, Maria Moustaki, Konstantinos Douros and Ioanna Loukou

Children 2023, 10(3), 554; https://doi.org/10.3390/children10030554 - 15 Mar 2023

Cited by 25 | Viewed by 6216

Abstract

Elexacaftor/Tezacaftor/Ivacaftor (ELX/TEZ/IVA) is a new CFTR (Cystic Fibrosis Transmembrane Conductance Regulator) modulator treatment, used over the last few years, which has shown an improvement in different clinical outcomes in patients with cystic fibrosis (CF). The objective of this study was a systematic research [...] Read more.

Elexacaftor/Tezacaftor/Ivacaftor (ELX/TEZ/IVA) is a new CFTR (Cystic Fibrosis Transmembrane Conductance Regulator) modulator treatment, used over the last few years, which has shown an improvement in different clinical outcomes in patients with cystic fibrosis (CF). The objective of this study was a systematic research of the literature on the efficacy and safety of this CFTR modulator on patients with CF. A search of Pubmed was conducted for randomized clinical trials and observational studies published from 2012 to September 2022. The included full manuscripts comprised nine clinical trials and 16 observational studies, whose participants were aged ≥12 years or were children 6–11 years old with at least one Phe508del mutation and/or advanced lung disease (ALD). These studies reported that ELX/TEZ/IVA has a significant positive effect on the lung function of patients with CF, by ameliorating parameters such as FEV₁, LCI, pulmonary exacerbations or sweat chloride concentration, increasing BMI and improving quality of their life. Its role in cystic fibrosis-related diabetes (CFRD) is not yet clear. It was found that this new CFTR modulator has an overall favorable safety profile, with mild to moderate adverse events. Further studies are needed for a deeper understanding of the impact of CFTR modulators on other CF manifestations, or the possibility of treating with ELX/TEZ/IVA CF patients with rare CFTR mutations. Full article

(This article belongs to the Section Pediatric Pulmonary and Sleep Medicine)

► Show Figures

Figure 1

32 pages, 1309 KiB

Open AccessEditor’s ChoiceSystematic Review

Components of Perinatal Palliative Care: An Integrative Review

by Laure Dombrecht, Kenneth Chambaere, Kim Beernaert, Ellen Roets, Mona De Vilder De Keyser, Gaëlle De Smet, Kristien Roelens and Filip Cools

Children 2023, 10(3), 482; https://doi.org/10.3390/children10030482 - 1 Mar 2023

Cited by 10 | Viewed by 4011

Abstract

When a severe diagnosis is made before or after birth, perinatal palliative care (PPC) can be provided to support the infant, parents and involved healthcare providers. An integrative and systematic overview of effectiveness and working components of existing PPC programs was needed. An [...] Read more.

When a severe diagnosis is made before or after birth, perinatal palliative care (PPC) can be provided to support the infant, parents and involved healthcare providers. An integrative and systematic overview of effectiveness and working components of existing PPC programs was needed. An integrative search was conducted in MEDLINE, Embase, CENTRAL, CINAHL, PsycInfo and Web of Science. Study designs examining the effect of PPC compared to regular care, and (empirical) articles describing the components of care included in existing PPC initiatives were included. Three independent authors reviewed titles, abstracts and full texts against eligibility criteria. PRISMA guidelines were followed; 21.893 records were identified; 69 publications met inclusion criteria. Twelve publications (17.4%) discussed the effect of a PPC program. Other publications concerned the description of PPC programs, most often by means of a program description (22/69; 31.9%), guidelines (14/769; 20.3%) or case study (10/69; 14.5%). Outcome measures envisioned four main target categories: care coordination, parents and family members, care for the fetus/neonate and healthcare providers. No trials exist to date. Analysis of working components revealed components related to changes directed to the policy of the hospital wards and components involving actual care being provided within the PPC program, directed to the fetus or infant, the family, involved healthcare providers or external actors. PPC is a growing research field where evidence consists mainly of descriptive studies and guidelines. The extensive list of possible PPC components can serve as a checklist for developing future initiatives worldwide. PPC includes several important actors: the fetus/infant and their family and included healthcare providers on both maternity and neonatal wards. This leads to a large variety of possible care components. However, while some studies show proof of concept, an evidence base to determine which components are actually effective is lacking. Full article

(This article belongs to the Special Issue Palliative Care for the Youngest: Hot Topics in Perinatal and Neonatal Palliative Care across the Globe)

► Show Figures

Figure 1

11 pages, 2128 KiB

Open AccessEditor’s ChoiceArticle

Masked Randomized Trial of Epinephrine versus Vasopressin in an Ovine Model of Perinatal Cardiac Arrest

by Munmun Rawat, Sylvia Gugino, Carmon Koenigsknecht, Justin Helman, Lori Nielsen, Deepika Sankaran, Jayasree Nair, Praveen Chandrasekharan and Satyan Lakshminrusimha

Children 2023, 10(2), 349; https://doi.org/10.3390/children10020349 - 10 Feb 2023

Cited by 7 | Viewed by 2622

Abstract

Background: Current neonatal resuscitation guidelines recommend the use of epinephrine for bradycardia/arrest not responding to ventilation and chest compressions. Vasopressin is a systemic vasoconstrictor and is more effective than epinephrine in postnatal piglets with cardiac arrest. There are no studies comparing vasopressin with [...] Read more.

Background: Current neonatal resuscitation guidelines recommend the use of epinephrine for bradycardia/arrest not responding to ventilation and chest compressions. Vasopressin is a systemic vasoconstrictor and is more effective than epinephrine in postnatal piglets with cardiac arrest. There are no studies comparing vasopressin with epinephrine in newly born animal models with cardiac arrest induced by umbilical cord occlusion. Objective: To compare the effect of epinephrine and vasopressin on the incidence and time to return of spontaneous circulation (ROSC), hemodynamics, plasma drug levels, and vasoreactivity in perinatal cardiac arrest. Design/Methods: Twenty-seven term fetal lambs in cardiac arrest induced by cord occlusion were instrumented and resuscitated following randomization to epinephrine or vasopressin through a low umbilical venous catheter. Results: Eight lambs achieved ROSC prior to medication. Epinephrine achieved ROSC in 7/10 lambs by 8 ± 2 min. Vasopressin achieved ROSC in 3/9 lambs by 13 ± 6 min. Plasma vasopressin levels in nonresponders were much lower than responders after the first dose. Vasopressin caused in vivo increased pulmonary blood flow and in vitro coronary vasoconstriction. Conclusions: Vasopressin resulted in lower incidence and longer time to ROSC compared to epinephrine in a perinatal model of cardiac arrest supporting the current recommendations for exclusive use of epinephrine in neonatal resuscitation. Full article

(This article belongs to the Section Pediatric Neonatology)

► Show Figures

Figure 1

27 pages, 5517 KiB

Open AccessEditor’s ChoiceReview

Patient-Specific 3D-Printed Models in Pediatric Congenital Heart Disease

by Zhonghua Sun

Children 2023, 10(2), 319; https://doi.org/10.3390/children10020319 - 7 Feb 2023

Cited by 15 | Viewed by 4397

Abstract

Three-dimensional (3D) printing technology has become increasingly used in the medical field, with reports demonstrating its superior advantages in both educational and clinical value when compared with standard image visualizations or current diagnostic approaches. Patient-specific or personalized 3D printed models serve as a [...] Read more.

Three-dimensional (3D) printing technology has become increasingly used in the medical field, with reports demonstrating its superior advantages in both educational and clinical value when compared with standard image visualizations or current diagnostic approaches. Patient-specific or personalized 3D printed models serve as a valuable tool in cardiovascular disease because of the difficulty associated with comprehending cardiovascular anatomy and pathology on 2D flat screens. Additionally, the added value of using 3D-printed models is especially apparent in congenital heart disease (CHD), due to its wide spectrum of anomalies and its complexity. This review provides an overview of 3D-printed models in pediatric CHD, with a focus on educational value for medical students or graduates, clinical applications such as pre-operative planning and simulation of congenital heart surgical procedures, and communication between physicians and patients/parents of patients and between colleagues in the diagnosis and treatment of CHD. Limitations and perspectives on future research directions for the application of 3D printing technology into pediatric cardiology practice are highlighted. Full article

(This article belongs to the Special Issue Advanced Research in Pediatric Radiology and Nuclear Medicine)

► Show Figures

Figure 1

24 pages, 1141 KiB

Open AccessEditor’s ChoiceArticle

Developmental Pathway Choices of Young People Presenting to a Gender Service with Gender Distress: A Prospective Follow-Up Study

by Joseph Elkadi, Catherine Chudleigh, Ann M. Maguire, Geoffrey R. Ambler, Stephen Scher and Kasia Kozlowska

Children 2023, 10(2), 314; https://doi.org/10.3390/children10020314 - 7 Feb 2023

Cited by 12 | Viewed by 12691

Abstract

This prospective case-cohort study examines the developmental pathway choices of 79 young people (13.25–23.75 years old; 33 biological males and 46 biological females) referred to a tertiary care hospital’s Department of Psychological Medicine (December 2013–November 2018, at ages 8.42–15.92 years) for diagnostic assessment [...] Read more.

This prospective case-cohort study examines the developmental pathway choices of 79 young people (13.25–23.75 years old; 33 biological males and 46 biological females) referred to a tertiary care hospital’s Department of Psychological Medicine (December 2013–November 2018, at ages 8.42–15.92 years) for diagnostic assessment for gender dysphoria (GD) and for potential gender-affirming medical interventions. All of the young people had attended a screening medical assessment (including puberty staging) by paediatricians. The Psychological Medicine assessment (individual and family) yielded a formal DSM-5 diagnosis of GD in 66 of the young people. Of the 13 not meeting DSM-5 criteria, two obtained a GD diagnosis at a later time. This yielded 68 young people (68/79; 86.1%) with formal diagnoses of GD who were potentially eligible for gender-affirming medical interventions and 11 young people (11/79; 13.9%) who were not. Follow-up took place between November 2022 and January 2023. Within the GD subgroup (n = 68) (with two lost to follow-up), six had desisted (desistance rate of 9.1%; 6/66), and 60 had persisted on a GD (transgender) pathway (persistence rate of 90.9%; 60/66). Within the cohort as a whole (with two lost to follow-up), the overall persistence rate was 77.9% (60/77), and overall desistance rate for gender-related distress was 22.1% (17/77). Ongoing mental health concerns were reported by 44/50 (88.0%), and educational/occupational outcomes varied widely. The study highlights the importance of careful screening, comprehensive biopsychosocial (including family) assessment, and holistic therapeutic support. Even in highly screened samples of children and adolescents seeking a GD diagnosis and gender-affirming medical care, outcome pathways follow a diverse range of possibilities. Full article

(This article belongs to the Section Pediatric Mental Health)

► Show Figures

Figure 1

15 pages, 303 KiB

Open AccessEditor’s ChoiceArticle

Telehealth Use in Pediatric Care during the COVID-19 Pandemic: A Qualitative Study on the Perspectives of Caregivers

by Gergana Damianova Kodjebacheva, Charlotte Tang, Faith Groesbeck, Loretta Walker, Jillian Woodworth and Jennifer Schindler-Ruwisch

Children 2023, 10(2), 311; https://doi.org/10.3390/children10020311 - 6 Feb 2023

Cited by 15 | Viewed by 3126

Abstract

This qualitative study surveyed caregivers regarding their perspectives on the benefits of, challenges with, and suggestions for improving telehealth during the COVID-19 pandemic. Caregivers who had the responsibility for caring for at least one child aged under 18 years of age in Genesee [...] Read more.

This qualitative study surveyed caregivers regarding their perspectives on the benefits of, challenges with, and suggestions for improving telehealth during the COVID-19 pandemic. Caregivers who had the responsibility for caring for at least one child aged under 18 years of age in Genesee County, MI, participated. The caregivers were biological parents, stepparents, foster parents, adoptive parents, and guardians. A total of 105 caregivers completed a survey with open-ended questions via Qualtrics. Two independent coders developed themes based on the responses using grounded theory. Participants were primarily biological parents and non-Hispanic White and African Americans. According to the participants, the benefits of telehealth included prevention of exposure to the COVID-19 virus, quality communication with physicians, savings in travel time, and cost-effective methods to receive care. The challenges included a lack of in-person interaction, fear of compromised confidentiality, and the potential for misdiagnosis. Suggestions for improvement by caregivers included increasing access to telehealth for poorer families, offering a media educational campaign to promote telehealth use, and creating a universal platform to share patient information. Future studies may test the effectiveness of interventions such as those suggested by caregivers in this study to improve telehealth. Full article

(This article belongs to the Section Pediatric Nursing)

15 pages, 670 KiB

Open AccessFeature PaperEditor’s ChoiceReview

Psychiatric Disorders and Obesity in Childhood and Adolescence—A Systematic Review of Cross-Sectional Studies

by Ioulia Kokka, Iraklis Mourikis and Flora Bacopoulou

Children 2023, 10(2), 285; https://doi.org/10.3390/children10020285 - 1 Feb 2023

Cited by 23 | Viewed by 5213

Abstract

Obesity and psychiatric disorders have high prevalence and are both considered major health problems. Within the last decades, the rates of obesity have risen over 6%, while the prevalence of psychiatric disorders is over 12% for children and adolescents. The aim of this [...] Read more.

Obesity and psychiatric disorders have high prevalence and are both considered major health problems. Within the last decades, the rates of obesity have risen over 6%, while the prevalence of psychiatric disorders is over 12% for children and adolescents. The aim of this study was to systematically review the evidence regarding the relation of obesity and psychiatric disorders in childhood and adolescence. This review, based on the PRISMA guidelines, included cross-sectional studies published within the last decade, pertaining to the relation between psychiatric disorders and obesity in children and adolescents up to the age of 19 years. Studies on eating disorders were excluded. A total of 14 studies of 23,442 children and adolescents that investigated the relation of obesity with anxiety, mood disorders, and psychosis were included in this systematic review. Nine of the included studies reported a significant relationship between the psychiatric disorder under investigation and obesity. Understanding the nexus between obesity and psychiatric disorders in children and adolescents is of great importance, given the alarming increase in both conditions in youth. Such findings could facilitate the development and implementation of targeted interventions. Full article

(This article belongs to the Special Issue Childhood and Adolescent Obesity and Weight Management: 3rd Edition)

► Show Figures

Graphical abstract

31 pages, 575 KiB

Open AccessEditor’s ChoiceSystematic Review

Loneliness and Well-Being in Children and Adolescents during the COVID-19 Pandemic: A Systematic Review

by Ann H. Farrell, Irene Vitoroulis, Mollie Eriksson and Tracy Vaillancourt

Children 2023, 10(2), 279; https://doi.org/10.3390/children10020279 - 31 Jan 2023

Cited by 48 | Viewed by 9525

Abstract

Concerns have been raised about the loneliness and well-being of children and adolescents during the COVID-19 pandemic. The extent to which the ongoing pandemic has impacted loneliness and the association between loneliness and well-being is unclear. Therefore, a systematic review of empirical studies [...] Read more.

Concerns have been raised about the loneliness and well-being of children and adolescents during the COVID-19 pandemic. The extent to which the ongoing pandemic has impacted loneliness and the association between loneliness and well-being is unclear. Therefore, a systematic review of empirical studies on the COVID-19 pandemic was conducted to examine the (1) prevalence of loneliness in children and adolescents, (2) associations between loneliness and indicators of well-being, and (3) moderators of these associations. Five databases (MEDLINE, Embase, PsycInfo, Web of Science, ERIC) were searched from 1 January 2020 to 28 June 2022 and 41 studies met our inclusion criteria (cross-sectional: n = 30; longitudinal: n = 11; registered on PROSPERO: CRD42022337252). Cross-sectional prevalence rates of pandemic loneliness varied, with some finding that over half of children and adolescents experienced at least moderate levels of loneliness. Longitudinal results reflected significant mean increases in loneliness compared to pre-pandemic levels. Cross-sectional results indicated that higher levels of loneliness were significantly associated with poorer well-being, including higher depression symptoms, anxiety symptoms, gaming addiction, and sleep problems. Longitudinal associations between loneliness and well-being were more complex than cross-sectional associations, varying by assessment timing and factors in the statistical analyses. There was limited diversity in study designs and samples, preventing a thorough examination of moderating characteristics. Findings highlight a broader challenge with child and adolescent well-being that predates the pandemic and the need for future research to examine underrepresented populations across multiple timepoints. Full article

(This article belongs to the Special Issue The Effect of COVID-19 on Youth Mental Health)

► Show Figures

Figure 1

11 pages, 309 KiB

Open AccessEditor’s ChoiceArticle

Prevalence of Burnout Syndrome and Fear of COVID-19 among Adolescent University Students

by Raimundo Aguayo-Estremera, Gustavo R. Cañadas, Luis Albendín-García, Elena Ortega-Campos, Tania Ariza, Carolina S. Monsalve-Reyes and Emilia Inmaculada De la Fuente-Solana

Children 2023, 10(2), 243; https://doi.org/10.3390/children10020243 - 30 Jan 2023

Cited by 8 | Viewed by 2951

Abstract

This study aimed to estimate the prevalence of burnout syndrome in adolescents entering university studies, to detect differences in burnout levels, personality factors and fear of coronavirus in a pandemic context due to COVID-19. A cross-sectional predictive study was performed with a sample [...] Read more.

This study aimed to estimate the prevalence of burnout syndrome in adolescents entering university studies, to detect differences in burnout levels, personality factors and fear of coronavirus in a pandemic context due to COVID-19. A cross-sectional predictive study was performed with a sample that comprised 134 individuals in their first year of a Psychology degree at Spanish universities. The Maslach Burnout Inventory Student Survey, the NEO Five-Factor Inventory and the Fear of COVID-19 Scale were applied. The prevalence of burnout is estimated according to three methods: Maslach and Jackson’s severity classification, Golembiewski’s phase model and Maslach et al.’s profile model. The estimates show significant differences. The results indicated that between 9 and 21% of students were at risk of developing burnout. On the other hand, students who reported having suffered psychological consequences of the pandemic showed greater emotional exhaustion, neuroticism and fear of COVID-19, and a lower level of personal accomplishment than those who did not suffer such consequences. Neuroticism was the only significant predictor for all burnout dimensions, and fear of COVID-19 did not contribute to any of them. Full article

(This article belongs to the Section Global Pediatric Health)

18 pages, 3180 KiB

Open AccessEditor’s ChoiceReview

Orthodontic Retainers—A Critical Review

by Ioannis Lyros, Ioannis A. Tsolakis, Michael P. Maroulakos, Eleni Fora, Theodoros Lykogeorgos, Maria Dalampira and Apostolos I. Tsolakis

Children 2023, 10(2), 230; https://doi.org/10.3390/children10020230 - 28 Jan 2023

Cited by 15 | Viewed by 13238

Abstract

The achievement of aesthetic, functional occlusion should not mark the end of the orthodontic intervention. To prevent relapse, retention needs advance planning, and may vary in duration. This review aims to present and comment on the available means of retention. The ever-popular, passive [...] Read more.

The achievement of aesthetic, functional occlusion should not mark the end of the orthodontic intervention. To prevent relapse, retention needs advance planning, and may vary in duration. This review aims to present and comment on the available means of retention. The ever-popular, passive Hawley-like removable appliances are credible in maintaining the desired occlusion. Modifications are the removable appliance Wrap Around, having the labial archwire extending to the premolars; the translucent retainer, Astics, a unique aesthetic Hawley-type device; and the reinforced removable retainer, which features a metallic grid reinforcing the acrylic base. Vacuum-formed retainers are easy to fabricate and are readily prescribed. By contrast, fixed retainers are made of orthodontic wire and composite resin bonded on the lingual or palatal surfaces of the anterior teeth. Patient-related variables need evaluation to select the appropriate retainer, while patients ought to realize the importance of retention and comply with offered guidance. Overall, the orthodontist is responsible for keeping the patient informed on the properties and the duration of retention, even before starting active orthodontic treatment. Full article

(This article belongs to the Section Pediatric Dentistry & Oral Medicine)

► Show Figures

Graphical abstract

28 pages, 3963 KiB

Open AccessEditor’s ChoiceReview

Nutrition Profile for Countries of the Eastern Mediterranean Region with Different Income Levels: An Analytical Review

by Hanna Leppäniemi, Eman T. Ibrahim, Marwa M. S. Abbass, Elaine Borghi, Monica C. Flores-Urrutia, Elisa Dominguez Muriel, Giovanna Gatica-Domínguez, Richard Kumapley, Asmus Hammerich and Ayoub Al-Jawaldeh

Children 2023, 10(2), 236; https://doi.org/10.3390/children10020236 - 28 Jan 2023

Cited by 8 | Viewed by 6774

Abstract

The World Health Organization’s (WHO) Eastern Mediterranean Region (EMR) is suffering from a double burden of malnutrition in which undernutrition coexists with rising rates of overweight and obesity. Although the countries of the EMR vary greatly in terms of income level, living conditions [...] Read more.

The World Health Organization’s (WHO) Eastern Mediterranean Region (EMR) is suffering from a double burden of malnutrition in which undernutrition coexists with rising rates of overweight and obesity. Although the countries of the EMR vary greatly in terms of income level, living conditions and health challenges, the nutrition status is often discussed only by using either regional or country-specific estimates. This analytical review studies the nutrition situation of the EMR during the past 20 years by dividing the region into four groups based on their income level—the low-income group (Afghanistan, Somalia, Sudan, Syria, and Yemen), the lower-middle-income group (Djibouti, Egypt, Iran, Morocco, Pakistan, Palestine, and Tunisia), the upper-middle-income group (Iraq, Jordan, Lebanon, and Libya) and the high-income group (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and United Arab Emirates)—and by comparing and describing the estimates of the most important nutrition indicators, including stunting, wasting, overweight, obesity, anaemia, and early initiation and exclusive breastfeeding. The findings reveal that the trends of stunting and wasting were decreasing in all EMR income groups, while the percentages of overweight and obesity predominantly increased in all age groups across the income groups, with the only exception in the low-income group where a decreasing trend among children under five years existed. The income level was directly associated with the prevalence rates of overweight and obesity among other age groups except children under five, while an inverse association was observed regarding stunting and anaemia. Upper-middle-income country group showed the highest prevalence rate of overweight among children under five. Most countries of the EMR revealed below-desired rates of early initiation and exclusive breastfeeding. Changes in dietary patterns, nutrition transition, global and local crises, and nutrition policies are among the major explanatory factors for the findings. The scarcity of updated data remains a challenge in the region. Countries need support in filling the data gaps and implementing recommended policies and programmes to address the double burden of malnutrition. Full article

(This article belongs to the Special Issue Food Intake and Nutrition Assessment in Children: Focus on Healthy Growth)

► Show Figures

Figure 1

18 pages, 3712 KiB

Open AccessEditor’s ChoiceReview

The Use of Stress Cardiovascular Imaging in Pediatric Population

by Sara Moscatelli, Francesco Bianco, Andrea Cimini, Mario Panebianco, Isabella Leo, Chiara Bucciarelli-Ducci and Marco Alfonso Perrone

Children 2023, 10(2), 218; https://doi.org/10.3390/children10020218 - 26 Jan 2023

Cited by 14 | Viewed by 3382

Abstract

Although not frequent in the pediatric population, ischemia could occur in children due to several congenital and acquired disease. Stress imaging is key for the non-invasive evaluation of myocardial abnormalities and perfusion defect in this clinical setting. Moreover, beyond ischemia assessment, it can [...] Read more.

Although not frequent in the pediatric population, ischemia could occur in children due to several congenital and acquired disease. Stress imaging is key for the non-invasive evaluation of myocardial abnormalities and perfusion defect in this clinical setting. Moreover, beyond ischemia assessment, it can provide complementary diagnostic and prognostic information in valvular heart disease and cardiomyopathies. When performed using cardiovascular magnetic resonance, it could detect, in addition, myocardial fibrosis and infarction, increasing the diagnostic yield. Several imaging modalities are currently available for the evaluation of stress myocardial perfusion. Advances in technologies have also increased the feasibility, safety and availability of these modalities in the pediatric age group. However, despite the established role of stress imaging and its increasing use in daily clinical practice, there are currently no specific guidelines, and little data are available in the literature on this topic. The aim of this review is to summarize the most recent evidence on pediatric stress imaging and its clinical application with a focus on the advantages and limitations of each imaging modality currently available. Full article

(This article belongs to the Special Issue Research Progress of the Pediatric Cardiology: 2nd Edition)

► Show Figures

Figure 1

12 pages, 636 KiB

Open AccessEditor’s ChoiceCase Report

Effects of the Whole-Body Vibration Exercise on Sleep Disorders, Body Temperature, Body Composition, Tone, and Clinical Parameters in a Child with Down Syndrome Who Underwent Total Atrioventricular Septal Defect Surgery: A Case-Report

by Luiza Torres-Nunes, Patrícia Prado da Costa-Borges, Laisa Liane Paineiras-Domingos, José Alexandre Bachur, Ana Carolina Coelho-Oliveira, Danúbia da Cunha de Sá-Caputo and Mario Bernardo-Filho

Children 2023, 10(2), 213; https://doi.org/10.3390/children10020213 - 25 Jan 2023

Cited by 7 | Viewed by 2838

Abstract

Background: The health and developmental issues of people with Down syndrome (DS) are complex and are associated with many medical, psychological, and social problems from childhood through into adulthood. DS children have an increased risk of multiorgan comorbidities, including congenital heart disease. Atrioventricular [...] Read more.

Background: The health and developmental issues of people with Down syndrome (DS) are complex and are associated with many medical, psychological, and social problems from childhood through into adulthood. DS children have an increased risk of multiorgan comorbidities, including congenital heart disease. Atrioventricular septal defect (AVSD) is a congenital heart malformation that often occurs in DS people. Aim: Physical activity and exercise are recommended for patients with cardiovascular disease and are considered to be the gold standard of cardiac rehabilitation. Whole-body vibration exercise (WBVE) is considered a form of exercises. The aim of this case report is to show the effects of WBVE on sleep disturbances, body temperature, body composition, tone, and clinical parameters in a child with DS with corrected total AVSD. The subject is a 10-year-old girl, with free-type DS, who underwent surgery to correct a total AVSD at 6 months. She underwent periodic cardiological monitoring and was released to perform any type of physical exercise, including WBVE. WBVE improved sleep quality and body composition. Conclusion: WBVE leads to physiological effects that benefit the DS child. Full article

(This article belongs to the Section Pediatric Neurology & Neurodevelopmental Disorders)

► Show Figures

Figure 1

20 pages, 377 KiB

Open AccessEditor’s ChoiceReview

Push and Pull Factors: Contextualising Biological Maturation and Relative Age in Talent Development Systems

by Liam Sweeney, Jamie Taylor and Áine MacNamara

Children 2023, 10(1), 130; https://doi.org/10.3390/children10010130 - 9 Jan 2023

Cited by 19 | Viewed by 4190

Abstract

In this conceptual paper, we contextualise ongoing attempts to manage challenge dynamics in talent systems in sport. Firstly, we review the broad literature base related to biological maturation, relative age, and the proposed interventions to mitigate effects. We suggest that the relative age [...] Read more.

In this conceptual paper, we contextualise ongoing attempts to manage challenge dynamics in talent systems in sport. Firstly, we review the broad literature base related to biological maturation, relative age, and the proposed interventions to mitigate effects. We suggest that the relative age effect may be a population level effect, indicative of deeper phenomena, rather than having a direct effect on challenge levels. In contrast, we suggest that biological maturation has a direct effect on challenge at the individual level. Therefore, our main critique of many existing approaches to the management of challenge is a lack of individual nuance and flexibility. We suggest the necessity for talent systems to adopt a more holistic approach, conceptualising biological maturation and relative age within a broader field of “push and pull factors” that impact challenge dynamics in talent development in sport. Finally, we provide practical guidance for talent systems in their approach to relative age and biological maturation, recognising that there is no “gold standard”. Instead, there is a need to recognize the highly individual and contextual nature of these concepts, focusing on strategic coherence through talent systems for the management of selection and development processes. Full article

(This article belongs to the Special Issue Sports Science in Children)

14 pages, 741 KiB

Open AccessEditor’s ChoiceArticle

The Relationship between Physical Fitness and Perceived Well-Being, Motivation, and Enjoyment in Chinese Adolescents during Physical Education: A Preliminary Cross-Sectional Study

by Wei Zheng, Hejun Shen, Mohammed B. Belhaidas, Yaping Zhao, Lei Wang and Jin Yan

Children 2023, 10(1), 111; https://doi.org/10.3390/children10010111 - 5 Jan 2023

Cited by 22 | Viewed by 6389

Abstract

Purpose: The purpose of this study is to investigate the relationship between physical fitness (PF) level and Chinese middle-school students’ perceived well-being, motivation, and enjoyment. Method: In this study, the participants were randomly selected from 16 Beijing-based middle schools in China. In addition [...] Read more.

Purpose: The purpose of this study is to investigate the relationship between physical fitness (PF) level and Chinese middle-school students’ perceived well-being, motivation, and enjoyment. Method: In this study, the participants were randomly selected from 16 Beijing-based middle schools in China. In addition to the collection of demographic data (i.e., gender, age, and parental education), tools including the Warwick-Edinburgh Mental Well-Being Scale, the Behavioural Regulation in Sport Questionnaire, and the Physical Activity Children’s Enjoyment Scale were employed for collecting data on other variables of well-being, motivation, and enjoyment, respectively. Results: A total of 1678 adolescents (M age = 14.66 years, SD = 1.80) participated in this study. According to the results, significant gender differences could be observed in the PF categories of mean age, BMI, vital capacity, 50-m sprint, muscular strength, and flexibility (all p < 0.05). In contrast, there was no significant gender difference in the levels of well-being, motivation, and enjoyment observed, with similar scores for boys and girls (p > 0.05). Indeed, adolescents with low BMI scores and high levels of vital capacity, muscular strength, and flexibility showed better well-being, motivation, and enjoyment. However, no association was observed between timed sit-ups and pull-ups and well-being, motivation, and enjoyment. Conclusions: This study produced preliminary findings on the relationship between PF and Chinese adolescents’ perceived well-being, motivation, and enjoyment. To improve the health of adolescents, it is necessary to adopt prospective and experimental research designs for advocating for fitness education in school-based programs in future research. Full article

(This article belongs to the Special Issue Physical Education, Physical Activity, and Health Education in Children and Adolescents)

► Show Figures

Figure 1

6 pages, 727 KiB

Open AccessEditor’s ChoiceCase Report

A Bizarre Cause of Acute Appendicitis in a Pediatric Patient: An Ingested Tooth

by Zenon Pogorelić and Tin Čohadžić

Children 2023, 10(1), 108; https://doi.org/10.3390/children10010108 - 4 Jan 2023

Cited by 14 | Viewed by 5230

Abstract

(1) Background: Among all possible causes, foreign bodies are the rarest cause of appendicitis in the pediatric population. In the majority of cases, ingested foreign bodies pass through the gastrointestinal tract without causing symptoms. However, those foreign bodies that pass through the lumen [...] Read more.

(1) Background: Among all possible causes, foreign bodies are the rarest cause of appendicitis in the pediatric population. In the majority of cases, ingested foreign bodies pass through the gastrointestinal tract without causing symptoms. However, those foreign bodies that pass through the lumen of the vermiform appendix cannot re-enter the colon and may cause acute appendicitis. So far, various foreign bodies have been described to enter the appendix and cause acute appendicitis, such as seeds, needles, toothpicks, plant material, or even hair. Tooth or dental implants as a cause of acute appendicitis have been described in only a few cases. To our knowledge, this is the first described case of the tooth causing acute appendicitis in the pediatric population. (2) Case presentation: A 14-year-old male patient presented to the emergency department complaining of pain in the right lower quadrant of the abdomen and vomiting that persisted for approximately 24 h. Until then, the patient was healthy and had no concomitant diseases. Physical examination revealed guarding and tenderness in the right lower abdominal quadrant. The white blood cell count was 17.1 × 10⁹/L with a neutrophil count of 91.1% and a C-reactive protein of 39.3 mg/dL. Ultrasonography of the abdomen revealed a thickened, inflamed appendix with a diameter of 11 mm and free periappendicular fluid. A 9 × 6 mm foreign body at the base of the appendix was visualized. The patient was diagnosed with acute appendicitis, and an emergency laparoscopic appendectomy was performed on the same day. Intraoperatively, gangrenous appendicitis was noted and removed without complications. Upon examination of the removed specimen, it was determined that the patient’s appendicitis had been caused by an ingested tooth. As it later turned out, the patient had broken a lateral incisor while playing sports the day before admission without knowing that he had swallowed it. The patient recovered well and was discharged the day after surgery. (3) Conclusion: Although an extremely rare event, acute appendicitis can be caused by a swallowed tooth. This case highlights the importance of a thorough history in pediatric patients who present to the emergency department with suspected acute appendicitis to determine if there is a precipitating event that may have caused acute appendicitis. Full article

(This article belongs to the Section Pediatric Surgery)

► Show Figures

Figure 1

8 pages, 243 KiB

Open AccessEditor’s ChoiceArticle

Assessment of Permanent First Molars in Children Aged 7 to 10 Years Old

by Gelengul Urvasizoglu, Aybike Bas, Fatma Sarac, Peris Celikel, Fatih Sengul and Sera Derelioglu

Children 2023, 10(1), 61; https://doi.org/10.3390/children10010061 - 27 Dec 2022

Cited by 7 | Viewed by 2709

Abstract

Background: Dental caries is a chronic, infectious and preventable disease that is very common around the world. It has been observed that dental caries affect not only the majority of adults but also 60% to 90% of children. Permanent first molars (PFM) are [...] Read more.

Background: Dental caries is a chronic, infectious and preventable disease that is very common around the world. It has been observed that dental caries affect not only the majority of adults but also 60% to 90% of children. Permanent first molars (PFM) are the most commonly decayed teeth observed in children. Aim: The aim of this study is to evaluate the decayed, missing filled teeth (DMFT) scores of PFMs in the early post-eruptive stage, within the scope of the United Nations Agenda for 2030 Sustainable Development Goals, thereby raising awareness for the prevention and treatment of permanent tooth decay. Methods: This descriptive cross-sectional epidemiological study was conducted in Erzurum between the years 2015–2016 by collecting data from children aged 7–10 years (17,208). In addition to the decayed, filled and missing data of the students’ 6-year-molars, their ages, genders, frequencies of both tooth brushing and dental office visits were evaluated. The relationship between the variables was analyzed with chi-square. Result: The present study analyzed the data of a total of 11,457 children, 5704 girls and 5753 boys with a mean age of 8.74 ± 1.18. There was a statistically significant difference between the PFMs 16, 26, 36 and 46 regarding the number of healthy, decayed, missing and restored teeth (p < 0.001). Conclusion: In this study, the prevalence of caries in the PFMs of children aged 7–10 years was 15.9% and the mean DMFT was 0.79 ± 1.39. This result showed that PFMs might develop carious lesions and even be lost within three years in the early post-eruptive stage. Full article

(This article belongs to the Special Issue Pediatric Dental Health: Prevalence, Diagnosis and Treatment)

31 pages, 4182 KiB

Open AccessEditor’s ChoiceArticle

Infodemiology of RSV in Italy (2017–2022): An Alternative Option for the Surveillance of Incident Cases in Pediatric Age?

by Matteo Riccò, Antonio Baldassarre, Sandro Provenzano, Silvia Corrado, Milena Pia Cerviere, Salvatore Parisi, Federico Marchesi and Marco Bottazzoli

Children 2022, 9(12), 1984; https://doi.org/10.3390/children9121984 - 16 Dec 2022

Cited by 12 | Viewed by 2859

Abstract

The aim of this study was to evaluate whether or not online queries for Respiratory Syncytial Virus (RSV) retrieved by means of Google Trends™ and the Italian Wikipedia analysis program mirror the occurrence of influenza-like illnesses (ILI), as reported by the Italian Influenza [...] Read more.

The aim of this study was to evaluate whether or not online queries for Respiratory Syncytial Virus (RSV) retrieved by means of Google Trends™ and the Italian Wikipedia analysis program mirror the occurrence of influenza-like illnesses (ILI), as reported by the Italian Influenza Surveillance network (InfluNet). Estimated rates for ILI in the general population and in the age groups 0–4 years and 5–14 years were obtained for the influenza seasons 2017–2018 to 2020–2021. Similarly, a weekly fraction of online searches was retrieved for a series of terms associated with Respiratory Syncytial Virus. Next, trends for daily visualization of Italian Wikipedia Pages for Human Respiratory Syncytial Virus, Pneumonia, Bronchiolitis, Influenza, and Respiratory Failure were similarly retrieved. The correlation of all search terms with ILI was analyzed by means of Spearman’s rank correlation analysis. Among search terms associated with the clinical diagnosis of Respiratory Syncytial Virus infections, the occurrence of ILI was highly correlated only with Bronchiolitis in the age group 0–4 years (β 0.210, p = 0.028), while more generic search terms, such as Bronchitis, fever, influenza, and Pneumonia, were identified as effective predictors of ILI, in general and by age groups. In a regression analysis modeled with ILIs as the outcome variable, daily visualizations for the Wikipedia pages on Bronchiolitis were identified as negative predictors for ILI in general (β = −0.152, p = 0.032), ILI in age group 0–4 years (β = −0.264, p = 0.001) and 5–14 years (β = −0.202, p = 0.006), while Influenza was characterized as a positive effector for ILIs in the age group 5–14 years (β = 0.245, p = 0.001). Interestingly, not only were the search terms extensively correlated with one another, but all of them were also characterized by autocorrelation through a Durbin-Watson test (all estimates DW < 2.0) In summary, our study identified a complicated pattern of data visualization as no clear association between rates of ILI in pediatric age group 0–4 and 5 to 14 years was actually found. Finally, our data stress that the infodemiology option may be quite problematic for assessing the time trend of RSV infections in Italy until more appropriate reporting will be made available, by sharing estimates of Lower Respiratory Tract Infections, and through a more accurate characterization of younger age groups. Full article

(This article belongs to the Special Issue Focus on Children 2021: Challenges and Opportunities towards the Future)

► Show Figures

Figure 1

19 pages, 1007 KiB

Open AccessEditor’s ChoiceReview

by Federica Di Spirito, Alessandra Amato, Maria Pia Di Palo, Giuseppe A. Ferraro, Adone Baroni, Rosario Serpico and Maria Contaldo

Children 2022, 9(12), 1942; https://doi.org/10.3390/children9121942 - 10 Dec 2022

Cited by 17 | Viewed by 3382

Abstract

In addition to the direct impact of the SARS-CoV-2 infection, the COVID-19 pandemic reports multiple effects on people’s health and psycho-physical well-being. In the dental field, oral hygiene sessions, regular dental check-ups, and aerosol-generating procedures were commonly postponed, thus resulting in repercussions on [...] Read more.

In addition to the direct impact of the SARS-CoV-2 infection, the COVID-19 pandemic reports multiple effects on people’s health and psycho-physical well-being. In the dental field, oral hygiene sessions, regular dental check-ups, and aerosol-generating procedures were commonly postponed, thus resulting in repercussions on oral health also favored by the changing eating and oral hygiene habits during the multiple lockdowns. Furthermore, dental settings and practices were generally perceived as at high risk for SARS-CoV-2 transmission, thus unsafe, and by general and pediatric dentists themselves. Last, the consequences of stress related to deprivation of social life and playful activities should not be underestimated in children, exposing them to the deleterious effects of bad oral habits, with repercussions on the balanced growth and development of the stomatognathic system. The present work intends to analyze the medium-term and long-term impact of COVID-19 on pediatric oral and dental care provision, reviewing pediatric dentistry practice and oral and dental needs of pedodontics patients during the first peak and the various waves of the COVID-19 pandemic, and lessons learned. Full article

(This article belongs to the Special Issue Oral Health Behaviours and Their Predictors in Children)

► Show Figures

Figure 1

20 pages, 6433 KiB

Open AccessFeature PaperEditor’s ChoiceReview

Role of Cardiovascular Imaging in the Follow-Up of Patients with Fontan Circulation

by Sara Moscatelli, Nunzia Borrelli, Jolanda Sabatino, Isabella Leo, Martina Avesani, Claudia Montanaro and Giovanni Di Salvo

Children 2022, 9(12), 1875; https://doi.org/10.3390/children9121875 - 30 Nov 2022

Cited by 14 | Viewed by 4209

Abstract

Since its first description in 1971, the Fontan procedure and its modifications have led to a substantial improvement in the survival rates of patients with a variety of types of complex Congenital Heart Disease (CHD) characterised by the presence of a single, dominant [...] Read more.

Since its first description in 1971, the Fontan procedure and its modifications have led to a substantial improvement in the survival rates of patients with a variety of types of complex Congenital Heart Disease (CHD) characterised by the presence of a single, dominant ventricle. However, despite the significant improvement of the prognosis over the years, Fontan patients are still exposed to several cardiovascular and systemic complications. It is, therefore, important to fully understand the pitfalls hidden behind a Fontan anatomy and the potential predictors of ventricular failure. Cardiovascular imaging plays a key role in this context, allowing for the early identification of complications with important prognostic implications. Echocardiography remains the first-line imaging modality for serial evaluation of Fontan patients. However, there is a growing role of cardiovascular magnetic resonance and cardiac computed tomography from pre-operative assessment to longitudinal follow-up. The aim of this paper will be to provide a comprehensive overview of the role, strengths, and weaknesses of each imaging modality in the assessment of congenital cardiac conditions palliated with the Fontan procedure. Full article

(This article belongs to the Special Issue Research Progress of the Pediatric Cardiology)

► Show Figures

Figure 1

15 pages, 1315 KiB

Open AccessEditor’s ChoiceReview

Cardiovascular Morbidities in Adults Born Preterm: Getting to the Heart of the Matter!

by Vasantha H. S. Kumar

Children 2022, 9(12), 1843; https://doi.org/10.3390/children9121843 - 28 Nov 2022

Cited by 12 | Viewed by 3431

Abstract

Advances in perinatal and neonatal care have led to improved survival of preterm infants into adulthood. However, the shift in focus to long-term health in adults born preterm requires a clear understanding of the impact of prematurity on developing organ systems and the [...] Read more.

Advances in perinatal and neonatal care have led to improved survival of preterm infants into adulthood. However, the shift in focus to long-term health in adults born preterm requires a clear understanding of the impact of prematurity on developing organ systems and the development of adult-oriented disease. A less well-recognized area of risk for surviving preterm infants is their cardiometabolic health. Epidemiologic evidence has linked preterm birth to the development of systemic hypertension, type 2 diabetes, metabolic syndrome, heart failure, and ischemic heart disease. Of more significant concern is that the risk of cardiometabolic disorders is higher in adults born preterm compared to full-term infants. The interconnected nature of the cardio-pulmonary system means worsening morbidity and mortality in adults born preterm. Addressing the problems of adults born preterm holistically would help promote cardiovascular health, wellness, and quality of life over their lifetime. Recognizing that adults born preterm are a unique subset of the population is a challenge in the current healthcare environment. Addressing issues relevant to adults born preterm in the clinically and research domain, using technology to characterize cardiopulmonary physiology and exercise tolerance, developing screening tools for early diagnosis and treatment, and robust follow-up of these infants with access to longitudinal data would improve both the quality and longevity of life in adults born preterm. Full article

(This article belongs to the Special Issue Advances in Healthcare for Neonates)

► Show Figures

Figure 1

12 pages, 271 KiB

Open AccessEditor’s ChoiceArticle

Knowledge and Practice of Pediatricians Regarding Hypovitaminosis D—A Survey across 33 European Countries

by Davor Petrović, Edita Runjić, Ivan Buljan, Antonia Jeličić Kadić and Joško Markić

Children 2022, 9(12), 1831; https://doi.org/10.3390/children9121831 - 26 Nov 2022

Cited by 7 | Viewed by 2054

Abstract

Hypovitaminosis D has been recognized as a worldwide pandemic, but there are disagreements regarding its diagnosis and treatment. This study aimed to evaluate the knowledge and practice of European pediatricians concerning vitamin D (VD) and hypovitaminosis D and their adherence to relevant guidelines. [...] Read more.

Hypovitaminosis D has been recognized as a worldwide pandemic, but there are disagreements regarding its diagnosis and treatment. This study aimed to evaluate the knowledge and practice of European pediatricians concerning vitamin D (VD) and hypovitaminosis D and their adherence to relevant guidelines. A cross-sectional study was conducted through an anonymous survey via SurveyMonkey on 304 European pediatricians. Most of the participants were general pediatricians, followed by endocrinologists and neonatologists. ESPGHAN’s and the national guidelines were the most frequently used. VD testing was mostly performed in patients with skeletal, chronic kidney, and autoimmune diseases. Participants predominantly answered the questions regarding the definition of hypovitaminosis D and VD supplementation correctly, especially in children younger than 12 months. They showed the least knowledge regarding the cut off-point for the initiation of the therapy and therapeutic doses used to treat confirmed hypovitaminosis D. Participants’ conflicting answers could be related to the differences between the guidelines. We consider that experts in this field should create uniform guidelines, and that those guidelines should also be promoted by national or local pediatric associations. Full article

(This article belongs to the Section Global Pediatric Health)

11 pages, 909 KiB

Open AccessEditor’s ChoiceReview

Metabolomics: A New Tool in Our Understanding of Congenital Heart Disease

by Pier Paolo Bassareo and Colin J. McMahon

Children 2022, 9(12), 1803; https://doi.org/10.3390/children9121803 - 24 Nov 2022

Cited by 12 | Viewed by 2504

Abstract

Although the genetic origins underpinning congenital heart disease (CHD) have been extensively studied, genes, by themselves, do not entirely predict phenotypes, which result from the complex interplay between genes and the environment. Consequently, genes merely suggest the potential occurrence of a specific phenotype, [...] Read more.

Although the genetic origins underpinning congenital heart disease (CHD) have been extensively studied, genes, by themselves, do not entirely predict phenotypes, which result from the complex interplay between genes and the environment. Consequently, genes merely suggest the potential occurrence of a specific phenotype, but they cannot predict what will happen in reality. This task can be revealed by metabolomics, the most promising of the “omics sciences”. Though metabolomics applied to CHD is still in its infant phase, it has already been applied to CHD prenatal diagnosis, as well as to predict outcomes after cardiac surgery. Particular metabolomic fingerprints have been identified for some of the specific CHD subtypes. The hallmarks of CHD-related pulmonary arterial hypertension have also been discovered. This review, which is presented in a narrative format, due to the heterogeneity of the selected papers, aims to provide the readers with a synopsis of the literature on metabolomics in the CHD setting. Full article

► Show Figures

Figure 1

12 pages, 1171 KiB

Open AccessEditor’s ChoiceArticle

Physical Fitness Variations between Those Playing More and Those Playing Less Time in the Matches: A Case-Control Study in Youth Soccer Players

by Ana Filipa Silva, Filipe Manuel Clemente, César Leão, Rafael Oliveira, Georgian Badicu, Hadi Nobari, Luca Poli, Roberto Carvutto, Gianpiero Greco, Francesco Fischetti and Stefania Cataldi

Children 2022, 9(11), 1786; https://doi.org/10.3390/children9111786 - 21 Nov 2022

Cited by 9 | Viewed by 2552

Abstract

The purpose of this study was (i) to compare two groups (players with more vs. less match play time) regarding body composition, vertical and horizontal jumping performance, and aerobic capacity; and (ii) to test the relationships between physical fitness and play time. This [...] Read more.

The purpose of this study was (i) to compare two groups (players with more vs. less match play time) regarding body composition, vertical and horizontal jumping performance, and aerobic capacity; and (ii) to test the relationships between physical fitness and play time. This study followed a case-control design in which the outcome was playtime, and the causal attribute was physical fitness. Sixty-six youth male soccer players from under-16 (n = 21), under-17 (n = 19), under-18 (n = 12), and under-19 (n = 14) age groups were monitored for match play time during five months of observation. Inclusion criteria consisted of (1) no absence of more than a week due to injury or other conditions during the five months of observation and (2) physical assessments having been done simultaneously with those of the other players (at the beginning of the season). The exclusion criteria were (1) not participating in one week or more of training sessions, and (2) not participating in the physical fitness assessments. At the beginning of the season, players were assessed for anthropometry (height, body mass, skinfolds), countermovement jump, triple hop bilateral and unilateral jump, and aerobic capacity using the Yo-Yo Intermittent Recovery Test, level 2 (YYIRT). The group that played more time had significantly greater YYIRT results (+28.2%; p = 0.009; Cohen’s d = 0.664). No other significant differences were found between those who played more and fewer minutes. Moderate and significant linear positive correlations were found between YYIRT and play time in the under-19 group (r = 0.423; p = 0.031) and overall (r = 0.401; p < 0.001). In the case of the under-17 group, moderate and significant linear positive correlations were found between TSA and play time (r = 0.473; p = 0.041). This suggests that aerobic and anaerobic capacity is related to play time while jumping performance and fat mass seem not to play an essential role in play time. Full article

(This article belongs to the Special Issue Focus on Children 2021: Challenges and Opportunities towards the Future)

► Show Figures

Figure 1

19 pages, 1288 KiB

Open AccessEditor’s ChoiceArticle

Problematic Internet Use among Adolescents 18 Months after the Onset of the COVID-19 Pandemic

by Frank W. Paulus, Jens Joas, Ida Gerstner, Anna Kühn, Markus Wenning, Thomas Gehrke, Holger Burckhart, Ulf Richter, Alexandra Nonnenmacher, Michael Zemlin, Thomas Lücke, Folke Brinkmann, Tobias Rothoeft, Thorsten Lehr and Eva Möhler

Children 2022, 9(11), 1724; https://doi.org/10.3390/children9111724 - 10 Nov 2022

Cited by 29 | Viewed by 5132

Abstract

Studies in recent years and especially since the beginning of the COVID-19 pandemic have shown a significant increase in the problematic use of computer games and social media. Adolescents having difficulties in regulating their unpleasant emotions are especially prone to Problematic Internet Use [...] Read more.

Studies in recent years and especially since the beginning of the COVID-19 pandemic have shown a significant increase in the problematic use of computer games and social media. Adolescents having difficulties in regulating their unpleasant emotions are especially prone to Problematic Internet Use (PIU), which is why emotion dysregulation has been considered a risk factor for PIU. The aim of the present study was to assess problematic internet use (PIU) in adolescents after the third wave (nearly 1.5 years after the onset in Europe) of the COVID-19 pandemic. In the German region of Siegen-Wittgenstein, all students 12 years and older from secondary-level schools, vocational schools and universities were offered a prioritized vaccination in August 2021 with an approved vaccine against COVID-19. In this context, the participants filled out the Short Compulsive Internet Use Scale (SCIUS) and two additional items to capture a possible change in digital media usage time and regulation of negative affect due to the COVID-19 pandemic. A multiple regression analysis was performed to identify predictors of PIU. The original sample consisted of 1477 participants, and after excluding invalid cases the final sample size amounted to 1268 adolescents aged 12–17 (x = 14.37 years, SD = 1.64). The average prevalence of PIU was 43.69%. Gender, age, digital media usage time and the intensity of negative emotions during the COVID-19 pandemic were all found to be significant predictors of PIU: female gender, increasing age, longer digital media usage time and higher intensity of negative emotions during the COVID-19 pandemic were associated with higher SCIUS total scores. This study found a very high prevalence of PIU among 12- to 17-year-olds for the period after the third wave of the COVID-19 pandemic, which has increased significantly compared to pre-pandemic prevalence rates. PIU is emerging as a serious problem among young people in the pandemic. Besides gender and age, pandemic-associated time of digital media use and emotion regulation have an impact on PIU, which provides starting points for preventive interventions. Full article

(This article belongs to the Special Issue The Effect of COVID-19 on Youth Mental Health)

► Show Figures

Figure 1

21 pages, 1368 KiB

Open AccessEditor’s ChoiceReview

Evaluation and Treatment of Pain in Fetuses, Neonates and Children

by Santiago Mencía, Clara Alonso, Carmen Pallás-Alonso, Jesús López-Herce and Maternal and Child Health and Development Network II (SAMID II)

Children 2022, 9(11), 1688; https://doi.org/10.3390/children9111688 - 3 Nov 2022

Cited by 14 | Viewed by 5414

Abstract

The perception of pain is individual and differs between children and adults. The structures required to feel pain are developed at 24 weeks of gestation. However, pain assessment is complicated, especially in neonates, infants and preschool-age children. Clinical scales adapted to age are [...] Read more.

The perception of pain is individual and differs between children and adults. The structures required to feel pain are developed at 24 weeks of gestation. However, pain assessment is complicated, especially in neonates, infants and preschool-age children. Clinical scales adapted to age are the most used methods for assessing and monitoring the degree of pain in children. They evaluate several behavioral and/or physiological parameters related to pain. Some monitors detect the physiological changes that occur in association with painful stimuli, but they do not yet have a clear clinical use. Multimodal analgesia is recommended for pain treatment with non-pharmacological and pharmacological interventions. It is necessary to establish pharmacotherapeutic protocols for analgesia adjusted to the acute or chronic, type and intensity of pain, as well as age. The most used analgesics in children are paracetamol, ibuprofen, dipyrone, opioids (morphine and fentanyl) and local anesthetics. Patient-controlled analgesia is an adequate alternative for adolescent and older children in specific situations, such as after surgery. In patients with severe or persistent pain, it is very important to consult with specific pain services. Full article

(This article belongs to the Section Pediatric Anesthesiology, Perioperative and Pain Medicine)

► Show Figures

Figure 1

13 pages, 1275 KiB

Open AccessEditor’s ChoiceArticle

Social, Academic and Health Status Impact of Long COVID on Children and Young People: An Observational, Descriptive, and Longitudinal Cohort Study

by Alba Gonzalez-Aumatell, Maria Victoria Bovo, Clara Carreras-Abad, Sara Cuso-Perez, Èlia Domènech Marsal, Roser Coll-Fernández, Aroia Goicoechea Calvo, Maria Giralt-López, Antonia Enseñat Cantallops, Sara Moron-Lopez, Javier Martinez-Picado, Paula Sol Ventura, Carlos Rodrigo and Maria Méndez Hernández

Children 2022, 9(11), 1677; https://doi.org/10.3390/children9111677 - 31 Oct 2022

Cited by 15 | Viewed by 3210

Abstract

There is a lack of evidence of the health impacts due to long COVID among children and young people (CYP). The objective of this study is to determine the main clinical characteristics of long COVID in CYP and to investigate the academic, social, [...] Read more.

There is a lack of evidence of the health impacts due to long COVID among children and young people (CYP). The objective of this study is to determine the main clinical characteristics of long COVID in CYP and to investigate the academic, social, and health status impacts of long COVID in this population. An observational, descriptive, and longitudinal study on CYP who presented COVID-19 symptoms for more than twelve weeks after SARS-CoV-2 infection was performed between December 2020 and May 2021. Fifty CYP were included, with a median age of 14.1 years, 33 (66%) were female, and 17 (34%) had a relative diagnosed with long COVID. Since the initial infection and up to the first visit, CYP had persisting symptoms for a median of 4.1 months, and for 18 (36%) CYP these symptoms persisted for more than 6 months. Fatigue (100%), neurocognitive disorders (74%), muscular weakness (74%), and headache (72%) were the most reported symptoms. A total of 9 (18%) CYP could not attend school, 17 (34%) had a reduced schedule, 33 (66%) showed a decreased school performance, and 68% had stopped extracurricular activities. This preliminary study shows the impact that long COVID has on the health, academic, and social life of CYP. Full article

(This article belongs to the Special Issue The Impact of COVID-19 in Children)

► Show Figures

Figure 1

13 pages, 541 KiB

Open AccessEditor’s ChoiceReview

Bracing Interventions Can Help Adolescents with Idiopathic Scoliosis with Surgical Indication: A Systematic Review

by Fabio Zaina, Claudio Cordani, Sabrina Donzelli, Stefano Giuseppe Lazzarini, Chiara Arienti, Matteo Johann Del Furia and Stefano Negrini

Children 2022, 9(11), 1672; https://doi.org/10.3390/children9111672 - 31 Oct 2022

Cited by 9 | Viewed by 3035

Abstract

There is a common agreement that bracing is appropriate for curves between 20 and 40° for the Cobb angle during growth, but for larger curves, the experts’ opinions are not consistent. We designed this systematic review to report the updated evidence about the [...] Read more.

There is a common agreement that bracing is appropriate for curves between 20 and 40° for the Cobb angle during growth, but for larger curves, the experts’ opinions are not consistent. We designed this systematic review to report the updated evidence about the effectiveness of bracing in scoliosis patients with curves ≥40° and a residual growth period. We included randomized controlled trials, non-randomized controlled trials, prospective and retrospective observational studies, and case series addressing the effect of bracing in patients with idiopathic scoliosis during growth with curves ≥40° for the Cobb angle, published from 2000 onwards. Outcome: The percentage of patients with surgery, curves above 45° or 50°, and a Cobb angle change are all included in the study. Nine papers (563 patients, average worst curve of 44.8°) are included: four are retrospective case series, two are retrospective and two are prospective cohort studies, and one is a prospective controlled study. The overall quality was good, with respect to the type of design. A total of 32% of the patients improved, 26% were stable, and 42% worsened. The rate of improvement ranged from 11% to 78%; the rate of worsening ranged from 4% to 64%. There are some studies suggesting the use of bracing even in the case of severe curves when patients are motivated by trying to avoid surgery. More and better-quality research with coherent outcome criteria is needed. Full article

(This article belongs to the Special Issue Evidence on Conservative Treatment and Assessment of Idiopathic Scoliosis and Other Spinal Deformities)

► Show Figures

Figure 1

22 pages, 2560 KiB

Open AccessEditor’s ChoiceReview

Association between Harmful and Addictive Perceptions of E-Cigarettes and E-Cigarette Use among Adolescents and Youth—A Systematic Review and Meta-Analysis

by Ameera Syafiqah Aly, Rokiah Mamikutty and Jamaludin Marhazlinda

Children 2022, 9(11), 1678; https://doi.org/10.3390/children9111678 - 31 Oct 2022

Cited by 12 | Viewed by 6682

Abstract

Background: Recognising the association between the perceived risks of e-cigarettes and e-cigarette usage among youth is critical for planning effective prevention and intervention initiatives; thus, a systematic review and meta-analysis were performed. Methods: Fourteen databases were searched for eligible studies from the Inception [...] Read more.

Background: Recognising the association between the perceived risks of e-cigarettes and e-cigarette usage among youth is critical for planning effective prevention and intervention initiatives; thus, a systematic review and meta-analysis were performed. Methods: Fourteen databases were searched for eligible studies from the Inception of database until March 2022 to examine the effect estimates of the association between perceptions of harmfulness and addictiveness and overall e-cigarette usage among adolescents and youth. Results: The meta-analysis showed that in comparison to non-users, young people who were ever e-cigarette users were two times more likely to disagree that e-cigarettes are harmful (OR: 2.20, 95% CI: 1.41–3.43) and perceived e-cigarettes as less harmful than tobacco cigarettes (OR: 2.01, 95% CI 1.47–2.75). Youths who were ever e-cigarette users were also 2.3 and 1.8 times more likely to perceive e-cigarettes as less addictive (OR: 2.28, 95% CI: 1.81–2.88) or perceive e-cigarettes as more addictive (OR: 1.82, 95% CI: 1.22–2.73) than tobacco cigarettes, as compared with non-users. The subgroup analysis reported that adolescents were more likely to believe that e-cigarettes are less harmful than tobacco cigarettes, while youth users perceived otherwise. Conclusion: the risk perceptions of e-cigarettes are associated with e-cigarette use among adolescents and youth and could be the focus of health promotion to prevent and curb the uptake of e-cigarettes among young people. Full article

► Show Figures

Figure 1

15 pages, 612 KiB

Open AccessEditor’s ChoiceReview

Parental Stress Assessment with the Parenting Stress Index (PSI): A Systematic Review of Its Psychometric Properties

by Mercedes Ríos, Sara Zekri, Yurena Alonso-Esteban and Esperanza Navarro-Pardo

Children 2022, 9(11), 1649; https://doi.org/10.3390/children9111649 - 28 Oct 2022

Cited by 19 | Viewed by 8209

Abstract

Parental stress is a construct related to people’s perception of difficulties and feelings of not being able to cope with the demands of parenting. This construct is often experienced as a negative or aversive response to parental obligations, and the available evidence also [...] Read more.

Parental stress is a construct related to people’s perception of difficulties and feelings of not being able to cope with the demands of parenting. This construct is often experienced as a negative or aversive response to parental obligations, and the available evidence also suggests that excessive parenting stress reduces the use of positive parenting behaviors and are related to dysfunctional parenting. Different instruments exist to assess parental stress. This article is part of a project to translate and adapt the Parenting Stress Index (PSI), fourth edition, in its two forms (full and short). The aim of this research is to identify the psychometric indicators obtained by this instrument and to review the evidence they can provide. Method: Following the PRISMA guide (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), the studies related to the PSI were identified in different databases (ERIC, PsycArticles, PubMed, Scopus and Web of Science). Results: The screening process resulted in 16 articles; four have analyzed the psychometric properties of the PSI-4 and the rest have studied the PSI-3. Although version 4 was published in 2012, the studies are scarce. However, they follow the line noted in the previous short version, a high internal consistency and a factor structure of three factors. Conclusions: The difficulties of working with a measurement instrument with 101 items means that the full version of the PSI has been little studied, except in translation and linguistic adaptation studies. Full article

► Show Figures

Figure 1

15 pages, 288 KiB

Open AccessEditor’s ChoiceArticle

The Moderating Role of Emotional Regulation on the Relationship between School Results and Personal Characteristics of Pupils with Attention Deficit/Hyperactivity Disorder

by Florentina Ionela Linca, Magdalena Budisteanu, Doru Vlad Popovici and Natalia Cucu

Children 2022, 9(11), 1637; https://doi.org/10.3390/children9111637 - 27 Oct 2022

Cited by 9 | Viewed by 2412

Abstract

This study aimed to explore the possible moderating role of emotional regulation in the relationship between problem-solving ability, visuomotor precision and visuospatial integration on the one hand and school results on the other in pupils with ADHD. A total of 241 pupils with [...] Read more.

This study aimed to explore the possible moderating role of emotional regulation in the relationship between problem-solving ability, visuomotor precision and visuospatial integration on the one hand and school results on the other in pupils with ADHD. A total of 241 pupils with ADHD (study group) and 207 children without ADHD (control group) were included in our research. Specific tests for the evaluation of the problem-solving ability, visuomotor precision, visuospatial integration, and emotional regulation were applied. The results showed that emotional regulation is a significant moderator of the relationship between school results and problem-solving ability, visuomotor precision, visuospatial integration, and working memory. There are statistically significant differences depending on emotional regulation, visuomotor precision, visuospatial integration, problem-solving ability and working memory in terms of school results of students with ADHD compared to children without this diagnosis. These results can be used in the development of intervention programs. Full article

► Show Figures

Graphical abstract

7 pages, 226 KiB

Open AccessEditor’s ChoiceReview

Children with Low Handgrip Strength: A Narrative Review of Possible Exercise Strategies to Improve Its Development

by Takashi Abe, Robert S. Thiebaud, Hayao Ozaki, Sakiya Yamasaki and Jeremy P. Loenneke

Children 2022, 9(11), 1616; https://doi.org/10.3390/children9111616 - 25 Oct 2022

Cited by 13 | Viewed by 4209

Abstract

Background: Handgrip strength (HGS) is a predictor of health in both children and adults. Evidence suggests that without a possible strategy, children with low HGS may become adults with low HGS. However, little is known about what strategies are effective for children with [...] Read more.

Background: Handgrip strength (HGS) is a predictor of health in both children and adults. Evidence suggests that without a possible strategy, children with low HGS may become adults with low HGS. However, little is known about what strategies are effective for children with low HGS to achieve a higher baseline level in adulthood. This narrative review aimed to investigate whether physical exercise interventions could improve HGS in children. Methods: The relevant databases/search engine was searched using keywords related to the main topics discussed throughout this review. Results: Our findings suggest that it may not be possible to improve HGS over that observed from normal development with physical education or traditional resistance-training programs. However, if the training program includes exercises that directly stimulate the forearm/hand muscle groups to grip, it may be possible to obtain changes in HGS that exceed the changes due to normal developmental growth. Conclusion: Although there are associations between HGS and markers of health, no research could be identified that examined whether increasing HGS would lead to an improvement in health. If an increase in HGS really does represent an improvement in long-term health, then gripping exercise may need to be included into physical activity programs during the growth/development phase. Full article

8 pages, 617 KiB

Open AccessEditor’s ChoiceArticle

Use of Virtual Reality in Children with Dyslexia

by Giuseppa Maresca, Simona Leonardi, Maria Cristina De Cola, Silvia Giliberto, Marcella Di Cara, Francesco Corallo, Angelo Quartarone and Alessandra Pidalà

Children 2022, 9(11), 1621; https://doi.org/10.3390/children9111621 - 25 Oct 2022

Cited by 13 | Viewed by 4465

Abstract

In recent years, the study of dyslexia has seen rapid progress in definition and classification, neuropsychological correlates, neurobiological factors, and intervention. However, there are few studies on how virtual reality can affect improving cognitive domains and cross-cutting pedagogical skills. We, therefore, tested intervention [...] Read more.

In recent years, the study of dyslexia has seen rapid progress in definition and classification, neuropsychological correlates, neurobiological factors, and intervention. However, there are few studies on how virtual reality can affect improving cognitive domains and cross-cutting pedagogical skills. We, therefore, tested intervention through the use of a virtual reality rehabilitation system (VRRS) in children with dyslexia. Twenty-eight patients diagnosed with dyslexia were enrolled in this study. One-half underwent conventional neuropsychological treatment, and the other half performed VR neurorehabilitation training using the VRRS. All patients were evaluated by neuropsychological assessment at baseline (T0) and at the end of the protocol (T1). The assessment included the administration of the Wechsler Intelligence Scale for Children-IV and the Italian Battery for the Assessment of Dyslexia and Dysorthography. Our results showed a significant difference in word-reading test scores as well as in homophonic writing. In addition, treatment type was found to affect some domains of the WISC. We believe that the VRRS led to improved outcomes through the use of VR, which encourages active exploration, improves engagement, and provides motivation and enjoyment, allowing longer training sessions and improving treatment adherence. Full article

► Show Figures

Figure 1

10 pages, 1091 KiB

Open AccessEditor’s ChoiceArticle

The Laparoscopic Cholecystectomy and Common Bile Duct Exploration: A Single-Step Treatment of Pediatric Cholelithiasis and Choledocholithiasis

by Zenon Pogorelić, Marko Lovrić, Miro Jukić and Zdravko Perko

Children 2022, 9(10), 1583; https://doi.org/10.3390/children9101583 - 19 Oct 2022

Cited by 17 | Viewed by 4420

Abstract

Background: In recent years, complicated biliary tract diseases are increasingly diagnosed in children. Laparoscopic exploration of the common bile duct (LCBDE) followed by laparoscopic cholecystectomy has gained popularity in children. The aim of this study was to investigate the outcomes of LCBDE in [...] Read more.

Background: In recent years, complicated biliary tract diseases are increasingly diagnosed in children. Laparoscopic exploration of the common bile duct (LCBDE) followed by laparoscopic cholecystectomy has gained popularity in children. The aim of this study was to investigate the outcomes of LCBDE in children and compare them with the treatment outcomes of previously used endoscopic retrograde cholangiopancreatography (ERCP). Methods: From January 2000 to January 2022, a total of 84 children (78.5% female) underwent laparoscopic cholecystectomy with a median follow-up of 11.4 (IQR 8, 14) years. Of these, 6 children underwent laparoscopic cholecystectomy (LC) + ERCP and 14 children underwent LCBDE for choledochiothiasis. The primary end point of the study was the success of treatment in terms of the incidence of complications, recurrence rate, and rate of reoperation. Secondary endpoints were stone characteristics, presenting symptoms, duration of surgery, and length of hospital stay. Results: The majority of patients were female in both groups (83.5% vs. 85.7%), mostly overweight with a median BMI of 27.9 kg/m² and 27.4 kg/m², respectively. Obstructive jaundice, colicky pain, acute pancreatitis, and obstruction of the papilla were the most common symptoms in both groups. The majority of patients (68%) had one stone, whereas two or more stones were found in 32% of patients. The median diameter of the common bile duct was 9 mm in both groups. The procedure was successfully completed in all patients in the ERCP group. In the group of patients treated with LCBDE, endoscopic extraction of the stone with a Dormia basket was successfully performed in ten patients (71.4%), while in the remaining four patients (28.6%) the stones were fragmented with a laser because extraction with the Dormia basket was not possible. The median operative time was 79 min in the LCBDE group (IQR 68, 98), while it was slightly longer in the ERCP group, 85 min (IQR 74, 105) (p = 0.125). The length of hospital stay was significantly shorter in the LCBDE group (2 vs. 4 days, p = 0.011). No complications occurred in the LCBDE group, while two (40%) complications occurred in the ERCP group: pancreatitis and cholangitis (p = 0.078). During the follow-up period, no conversions, papillotomies, or recurrences were recorded in either group. Conclusions: Exploration of the common bile duct and removal of stones by LCBDE is safe and feasible in pediatric patients for the treatment of choledocholithiasis. Through this procedure, choledocholithiasis and cholelithiasis can be treated in a single procedure without papillotomy or fluoroscopy. Compared with LC + ERCP, LCBDE is associated with a shorter hospital stay. The incidence of complications was rather low but not statistically significant. Full article

(This article belongs to the Section Pediatric Surgery)

► Show Figures

Figure 1

7 pages, 377 KiB

Open AccessEditor’s ChoiceReview

Ovarian Teratomas in Children and Adolescents: Our Own Experience and Review of Literature

by Fani Gkrozou, Orestis Tsonis, Anastasia Vatopoulou, Georgia Galaziou and Minas Paschopoulos

Children 2022, 9(10), 1571; https://doi.org/10.3390/children9101571 - 18 Oct 2022

Cited by 11 | Viewed by 3206

Abstract

Background: Ovarian teratomas are the most common type of ovarian mass during childhood and adolescence. There is no clear guidance for the management of the ovarian teratomas in children and adolescents. It is necessary, however, to understand the feature of these tumours [...] Read more.

Background: Ovarian teratomas are the most common type of ovarian mass during childhood and adolescence. There is no clear guidance for the management of the ovarian teratomas in children and adolescents. It is necessary, however, to understand the feature of these tumours and the indications for operating on them, and to put subjective criteria for the management in elective or emergency presentations. Methods: Medical records of patients between the age of 12 and 20 years old that underwent surgery for ovarian teratomas at the Department of Obstetrics and Gynaecology in University Hospital of Ioannina, between January 2000 and August 2022, were reviewed. A medical database was searched between January 2000 and August 2022 with the following keywords: ovarian teratoma, paediatrics and adolescents. Results: We present the results of forty patients, with a mean age of 11.8 years of age. All patients had surgery, where three out of four underwent oophorectomy and only one out of four underwent ovary-sparing operation; similar results were found in the literature. Conclusion: Ovary-sparing treatment is more common recently compared with the past, such as MIS compared with laparotomy. Better-organised and -planned prospective multi-centre studies are necessary to gain a deeper knowledge of the physiology and prognostic factors of teratomas in children. Full article

(This article belongs to the Special Issue New Research in Pediatric Surgical Oncology)

► Show Figures

Figure 1

20 pages, 5068 KiB

Open AccessEditor’s ChoiceArticle

Thyroid Function and Metabolic Syndrome in Children and Adolescents with Neuromotor Disability

by Valeria Calcaterra, Giacomo Biganzoli, Simona Ferraro, Alessandra Mari, Anna Mandelli, Valentina Fabiano, Patrizia Carlucci, Gloria Pelizzo, Elena Zoia, Giulia Lanfranchi, Silvana Castaldi, Patrizia Boracchi, Elia Biganzoli and Gianvincenzo Zuccotti

Children 2022, 9(10), 1531; https://doi.org/10.3390/children9101531 - 6 Oct 2022

Cited by 7 | Viewed by 2215

Abstract

Thyroid function plays a crucial role in nervous system integrity and metabolic homeostasis. We evaluated the pattern of TSH, FT4 and FT3 release in children with neuromotor impairment (NI) in relationship with metabolic syndrome (MS). We enrolled 55 patients with NI and 30 [...] Read more.

Thyroid function plays a crucial role in nervous system integrity and metabolic homeostasis. We evaluated the pattern of TSH, FT4 and FT3 release in children with neuromotor impairment (NI) in relationship with metabolic syndrome (MS). We enrolled 55 patients with NI and 30 controls. Clinical parameters, thyroid function and MS presence were recorded. Principal component analysis (PCA), cluster analysis, and logistic regression models were performed. MS was detected in 54.5% of patients. Four clusters were identified: the first one included only controls and, contrasting with cluster 4, was exclusively characterized by children with disability and MS. This latter showed increased FT4 and FT3 and decreased TSH levels. Cluster 2, characterized by disability without MS showed high FT4 and FT3, whereas cluster 3 with low FT4 and FT3 mainly included disability (90%) and showed prevalent MS (57%). The association between TSH and NI is represented by a U-shape structure. The TSH, FT3 and FT4 release patterns may reflect thyrotropic adaptation, allostatic response and compensatory mechanisms. These mechanisms, found in both MS and disability, show that the odds of having a condition of NI with or without MS increase as the TSH values deviate, in both directions, from a value of 2.5 mLU/mL. Full article

► Show Figures

Graphical abstract

19 pages, 4047 KiB

Open AccessEditor’s ChoiceArticle

Balance Rehabilitation Approach by Bobath and Vojta Methods in Cerebral Palsy: A Pilot Study

by Andreea Ungureanu, Ligia Rusu, Mihai Robert Rusu and Mihnea Ion Marin

Children 2022, 9(10), 1481; https://doi.org/10.3390/children9101481 - 28 Sep 2022

Cited by 13 | Viewed by 8368

Abstract

In cerebral palsy (CP) the basis for rehabilitation comes from neuroplasticity. One of the leading therapeutic approaches used in the management of CP is the NDT Bobath therapy and Vojta therapy consists in trying to program the ideal movement patterns for the age. [...] Read more.

In cerebral palsy (CP) the basis for rehabilitation comes from neuroplasticity. One of the leading therapeutic approaches used in the management of CP is the NDT Bobath therapy and Vojta therapy consists in trying to program the ideal movement patterns for the age. The aim of our research was to analyze, from a functional point of view, the evolution of the biomechanical parameters characterizing the balance, in children with CP. The group of 12 subjects average age of 7 ± 3.28 years. The subject’s evaluation included a functional clinical evaluation by Berg pediatric scale and a biomechanical evaluation performed using the “Stabilometry footboard PoData 2.00” for evaluation the body weight distribution on the foot level. The rehabilitation program was developed based on two methods, NDT Bobath and Vojta. A 90-min physiotherapy session starts with a Vojta therapy activation, for 20 min. Between the two therapies there is a 10-min break, then the session continues with NDT Bobath exercises within the 3 physical exercises proposed for 60 min. 5 days per week, 6 months. The analysis of the data collected before and after the application of the rehabilitation program, regarding the using the Berg scale indicates a progress of 32.35%, (p = 0.0001 < 0.05) and the effect size is large. The evolution of the data that indicate the distribution of body weight at the level of the two lower limbs, at the two moments pre/post, evaluation. For left side a progress of 8.39%, (p = 0.027 < 0.05) but a small effect size of 0.86. For right side a progress of 10.36% (p = 0.027 < 0.05) and also a small effect size of 0.86. Analyzing the results, we find that there is a left-right rebalancing in most patients. The favorable results that were obtained by drawing up a physiotherapy program composed of the combination of the two Vojta and NDT Bobath methods are proof of the fact that both methods are based on the creation of a stimulating peripheral pressure, which, if maintained, generates an extended stereotyped motor response. A pattern of symmetrical muscle contraction is thus created and thus balance and postural control can be achieved. The left-right rebalancing, proven by the percentage distribution analysis of the weight at the lower segmental level, demonstrated that the body alignment approach through the Vojta method on the one hand and the inhibitory facilitating postures/exercises promoted by the NDT Bobath method, allows obtaining a symmetry. Full article

(This article belongs to the Special Issue Monitoring and Promoting Physical Activity, Physical Fitness and Motor Competence in Children)

► Show Figures

Figure 1

18 pages, 427 KiB

Open AccessEditor’s ChoiceReview

Worldwide Prevalence and Risk Factors of Helicobacter pylori Infection in Children

by Reka Borka Balas, Lorena Elena Meliț and Cristina Oana Mărginean

Children 2022, 9(9), 1359; https://doi.org/10.3390/children9091359 - 6 Sep 2022

Cited by 30 | Viewed by 8744

Abstract

Helicobacter pylori is usually acquired during childhood. The reports from the last two decades pointed out a decrease in H. pylori prevalence across geographical areas worldwide compared to previously reported data. Most of the studies performed in America found an overall H. pylori [...] Read more.

Helicobacter pylori is usually acquired during childhood. The reports from the last two decades pointed out a decrease in H. pylori prevalence across geographical areas worldwide compared to previously reported data. Most of the studies performed in America found an overall H. pylori infection prevalence of approximately 50%. The most important risk factors in America include being male, poor adherence or difficult access to treatment, and the lack of in-home water service. Despite the descending trend in prevalence worldwide, the overall prevalence in Africa remains very high (70%). Nevertheless, the prevalence of H. pylori in children without gastrointestinal who underwent screening was reported to be only 14.2%. The main risk factors in Africa are having a traditional pit or no toilet, poverty, birth order, source of drinking water, or being a farmer. Asia seems to have the widest variations in terms of H. pylori prevalence. Several risk factors were reported in Asia to be associated with this infection, such as lower income and educational level, house crowding, rural residence, ethnicity, the use of tanks as water supplies, alcohol drinking, active smoking, eating spicy food or raw uncooked vegetables, poor living conditions and sanitation. The overall prevalence of H. pylori infection in European children is almost 25%. Portugal has the highest prevalence of all European countries at 66.2% in children 13 years of age. The risk factors in European individuals consist of living in rural areas, eating unwashed fruits and vegetables, not washing hands after school, low parental education and unemployment, and short education duration. Further studies are required to identify the precise mechanisms involved in the discrepancies of H. pylori prevalence worldwide. Full article

(This article belongs to the Special Issue Childhood Helicobacter pylori Infection: Treatment and Prevention)

28 pages, 522 KiB

Open AccessEditor’s ChoiceReview

Helicobacter pylori-Related Extraintestinal Manifestations—Myth or Reality

by Cristian Dan Mărginean, Cristina Oana Mărginean and Lorena Elena Meliț

Children 2022, 9(9), 1352; https://doi.org/10.3390/children9091352 - 4 Sep 2022

Cited by 17 | Viewed by 4425

Abstract

It is well documented that Helicobacter pylori (H. pylori) can cause both gastrointestinal and extraintestinal manifestations. The latter one represents a major burden in terms of diagnosis and treatment. H. pylori-associated systemic subclinical inflammation is mostly responsible for the development [...] Read more.

It is well documented that Helicobacter pylori (H. pylori) can cause both gastrointestinal and extraintestinal manifestations. The latter one represents a major burden in terms of diagnosis and treatment. H. pylori-associated systemic subclinical inflammation is mostly responsible for the development of extraintestinal manifestations, and its early eradication might result in preventing all adverse events related to their occurrence. Thus, it was suggested that H. pylori might be associated with iron deficiency anemia, thrombocytopenia (immune thrombocytopenic purpura), Schonlein Henoch purpura, failure to thrive, vitamin B12 deficiency, diabetes mellitus, body mass index, cardiovascular diseases, as well as certain neurological conditions. Nevertheless, studies showed both pros and cons in terms of the role of H. pylori in the development of previously mentioned clinical entity underlining the crucial need for further studies on these topics. Although most of these extraintestinal manifestations occur during adulthood, we must not forget that H. pylori infection is acquired mainly during childhood, and thus its early diagnosis and eradication might represent the cornerstone in the prevention of H. pylori-induced inflammatory status and consequently of all related extraintestinal conditions. Full article

(This article belongs to the Special Issue Childhood Helicobacter pylori Infection: Treatment and Prevention)

7 pages, 252 KiB

Open AccessEditor’s ChoiceArticle

Multidrug-Resistant Bacteria in Children and Adolescents with Cystic Fibrosis

by Valentina Fainardi, Cosimo Neglia, Maria Muscarà, Cinzia Spaggiari, Marco Tornesello, Roberto Grandinetti, Alberto Argentiero, Adriana Calderaro, Susanna Esposito and Giovanna Pisi

Children 2022, 9(9), 1330; https://doi.org/10.3390/children9091330 - 1 Sep 2022

Cited by 11 | Viewed by 2249

Abstract

In patients with cystic fibrosis (CF), multidrug-resistant (MDR) bacteria can predispose to exacerbations, limit the effectiveness of antibiotic treatments and promote the progression of lung disease. The aim of this retrospective study was to compare pulmonary exacerbations (Pex), hospitalizations, lung function and nutritional [...] Read more.

In patients with cystic fibrosis (CF), multidrug-resistant (MDR) bacteria can predispose to exacerbations, limit the effectiveness of antibiotic treatments and promote the progression of lung disease. The aim of this retrospective study was to compare pulmonary exacerbations (Pex), hospitalizations, lung function and nutritional status in a group of children and adolescents with CF colonized by MDR bacteria and in a noncolonized control group. Overall, 7/54 pediatric patients (12.9%) were colonized by MDR bacteria and enrolled (3 with Achromobacter xyloxidans, 3 with Stenotrophomonas maltophilia and 1 with Burkholderia cepacia). The control group included 14 sex- and age-matched CF patients (8/14 colonized by Staphylococcus aureus, 2/14 by Pseudomonas aeruginosa, 2/14 by both microorganisms and 2/14 germ free). At the time of enrollment and 12 months before the first detection of the MDR microorganism, children colonized by MDR bacteria showed lower body mass index (BMI) and lower FEV₁/FVC compared to the control group. Over the previous year before the first detection, children colonized with MDR had more Pex compared to control group; those colonized by S. maltophilia experienced the highest number of Pex. In the 12 months following the first detection of MDR bacteria, all seven patients colonized by MDR had at least one Pex and patients colonized by S. maltophilia had the highest number (mean ± SD: 6 ± 2.6 vs. 1.7 ± 2.3). Our study suggests that CF pediatric patients infected by MDR bacteria have lower BMI, more obstructive disease and experience more exacerbations than patients without MDR bacteria. These differences are present even before being infected, suggesting that children and adolescents with more severe disease are predisposed to be colonized by MDR bacteria. S. maltophilia appeared to be the most aggressive pathogen. Further studies and the implementation of antimicrobial stewardship programs are necessary to clarify when and how to treat patients with CF and MDR bacteria in order to avoid the improper use of antibiotics and the development of antibiotic resistance. Full article

(This article belongs to the Special Issue Cystic Fibrosis in Children)

9 pages, 1283 KiB

Open AccessEditor’s ChoiceArticle

Reappraisal of VEGF in the Pathogenesis of Kawasaki Disease

by Chun-Yu Chen, Shih-Hui Huang, Kuang-Jen Chien, Tsung-Jen Lai, Wei-Hsiang Chang, Kai-Sheng Hsieh and Ken-Pen Weng

Children 2022, 9(9), 1343; https://doi.org/10.3390/children9091343 - 1 Sep 2022

Cited by 8 | Viewed by 2364

Abstract

Vascular endothelial growth factor (VEGF) is an important factor in mediating the inflammation of Kawasaki disease (KD). The literature regarding the relationship between VEGF and KD is sparse. The purpose of this study was to investigate the correlation of VEGF and KD. In [...] Read more.

Vascular endothelial growth factor (VEGF) is an important factor in mediating the inflammation of Kawasaki disease (KD). The literature regarding the relationship between VEGF and KD is sparse. The purpose of this study was to investigate the correlation of VEGF and KD. In a prospective study of 42 Taiwanese KD patients (18.9 ± 12.2 months, M/F 22/20) treated with intravenous immunoglobulin (IVIG), a series of VEGF levels was measured from the acute to convalescent phases. KD patients were classified into two subgroups with (n =20) and without (n = 22) acute coronary artery lesions (CALs). Control samples were obtained from 30 febrile controls (19.1 ± 13.7 months, M/F 13/17). In KD patients, VEGF levels in the pre-IVIG acute phase were significantly higher than those in the subacute and convalescent phases (both p < 0.001). In KD patients with CALs, VEGF levels significantly increased immediately in the post-IVIG phase (p = 0.039), and then significantly decreased in the subacute phase (p = 0.002). KD patients with acute CALs had higher median VEGF levels than those without acute CALs from acute to convalescent phases. In the subacute phase, KD patients with acute CALs had significantly higher VEGF levels (p = 0.022) than those without acute CALs. Our data show that VEGF did not decrease after IVIG treatment, and increased significantly after IVIG treatment in KD patients with acute CALs in acute phase. VEGF might be related to the complications of CALs in KD patients. Full article

(This article belongs to the Special Issue Kawasaki Disease, MIS-C and COVID-19)

► Show Figures

Figure 1

Journal Menu

Journal Browser

Editor’s Choice Articles

Further Information

Guidelines

MDPI Initiatives

Follow MDPI