Children

12 pages, 811 KiB

Open AccessArticle

Relationships between Dietary Patterns and Indices of Arterial Stiffness and Central Arterial Wave Reflection in 9–11-Year-Old Children

by Pouya Saeedi, Jillian Haszard, Lee Stoner, Sheila Skeaff, Katherine E. Black, Brittany Davison, Harriet Harrex, Kim Meredith-Jones, Robin Quigg, Jyh Eiin Wong and Paula M.L. Skidmore

Children 2020, 7(6), 66; https://doi.org/10.3390/children7060066 - 25 Jun 2020

Cited by 3 | Viewed by 3049

Abstract

Arterial stiffness is an important marker of vascular damage and a strong predictor of cardiovascular diseases (CVD). Given that pathophysiological processes leading to an increased arterial stiffness begin during childhood, the aim of this clustered observational study was to determine the relationship between [...] Read more.

Arterial stiffness is an important marker of vascular damage and a strong predictor of cardiovascular diseases (CVD). Given that pathophysiological processes leading to an increased arterial stiffness begin during childhood, the aim of this clustered observational study was to determine the relationship between modifiable factors including dietary patterns and indices of aortic arterial stiffness and wave reflection in 9–11-year-old children. Data collection was conducted between April and December 2015 in 17 primary schools in Dunedin, New Zealand. Dietary data were collected using a previously validated food frequency questionnaire and identified using principal component analysis method. Arterial stiffness (carotid-femoral pulse wave velocity, PWV) and central arterial wave reflection (augmentation index, AIx) were measured using the SphygmoCor XCEL system (Atcor Medical, Sydney, Australia). Complete data for PWV and AIx analyses were available for 389 and 337 children, respectively. The mean age of children was 9.7 ± 0.7 years, 49.0% were girls and 76.0% were classified as “normal weight”. The two identified dietary patterns were “Snacks” and “Fruit and Vegetables”. Mean PWV and AIx were 5.8 ± 0.8 m/s and −2.1 ± 14.1%, respectively. There were no clinically meaningful relationships between the identified dietary pattern scores and either PWV or AIx in 9–11-year-old children. Full article

(This article belongs to the Special Issue Cardiometabolic Health in Children: Correlates, Determinants, Methodology, and Policy)

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8 pages, 748 KiB

Open AccessCommentary

Current Status and Challenges of Safety Education for Children, Including Those Requiring Medical Care, in Japanese General Schools: Focusing on Disasters

by Tomoko Yamamoto

Children 2020, 7(6), 65; https://doi.org/10.3390/children7060065 - 21 Jun 2020

Cited by 2 | Viewed by 3219

Abstract

This paper discusses school safety mainly in relation to safety education and examines measures for the comprehensive development of systems to ensure the safety of children at school, including those requiring medical care. The number of children requiring medical care is increasing in [...] Read more.

This paper discusses school safety mainly in relation to safety education and examines measures for the comprehensive development of systems to ensure the safety of children at school, including those requiring medical care. The number of children requiring medical care is increasing in general schools following the promotion of inclusive education. The government of Japan has established the School Health and Safety Act and Guidelines on School Curricula. Municipalities have developed education systems that cover the safety education specified in disaster preparedness plans for schools. Safety education has been promoted through problem-oriented and experience-based methods as well as other methods of learning to date. Considering the outcomes of these systems and approaches, it is expected that safety management systems in schools, especially general schools that include children requiring medical care, will also develop in combination with safety education. Full article

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10 pages, 5894 KiB

Open AccessArticle

Effect of Action Observation Training on Spasticity, Gross Motor Function, and Balance in Children with Diplegia Cerebral Palsy

by Young-a Jeong and Byoung-Hee Lee

Children 2020, 7(6), 64; https://doi.org/10.3390/children7060064 - 18 Jun 2020

Cited by 8 | Viewed by 4263

Abstract

This study evaluated the effect of action observation training on spasticity, gross motor function, and balance in children with spastic diplegia cerebral palsy. Eighteen children with cerebral palsy participated in this study. The participants were randomized into the action observation training group ( [...] Read more.

This study evaluated the effect of action observation training on spasticity, gross motor function, and balance in children with spastic diplegia cerebral palsy. Eighteen children with cerebral palsy participated in this study. The participants were randomized into the action observation training group (n = 9) and a control group (n = 9). The action observation training group repeatedly practiced the action with their motor skills, while the control group practiced conventional physical therapy. Both groups received 30 min sessions, 3 days a week, for 6 weeks. To confirm the effects of intervention, the spasticity, gross motor function measurement (GMFM), and pediatric reaching test (PRT) were evaluated. The results showed that in the plantar flexor contracture test of both sides, the Modified Tardieu Scale (MTS) of the right side of knee joints, GMFM-B, C, and D were significantly increased between pre- and post-intervention within both groups (p < 0.05). PRT was significantly increased between pre- and post-intervention within the both groups (p < 0.05), and there was a significant difference between the two groups (p < 0.05). These results suggest that action observation training is both feasible and beneficial for improving spasticity, gross motor function, and balance in children with spastic diplegia cerebral palsy. Full article

(This article belongs to the Special Issue Disorders of Motor, Somatic and Cognitive Development in Children with Neurodysfunctions)

19 pages, 320 KiB

Open AccessArticle

Infant Care Practices among Resettled Refugee Mothers from East and Central Africa

by Lauren R. Bader, Jennifer Ward, Hillary N. Fouts and Julia Jaekel

Children 2020, 7(6), 63; https://doi.org/10.3390/children7060063 - 17 Jun 2020

Cited by 6 | Viewed by 4402

Abstract

Refugees often parent under extreme circumstances. Parenting practices have implications for child outcomes, and parenting in the context of refugee resettlement is likely to be dynamic as parents negotiate a new culture. This study examined African origin mothers’ infant care values and practices [...] Read more.

Refugees often parent under extreme circumstances. Parenting practices have implications for child outcomes, and parenting in the context of refugee resettlement is likely to be dynamic as parents negotiate a new culture. This study examined African origin mothers’ infant care values and practices related to feeding, carrying, and daily activities following resettlement in the Southeastern region of the U.S. Ten African origin mothers were asked about their infant care practices through semi-structured interviews. Results indicated that mothers valued breastfeeding but often chose to use formula as a supplement or instead of breastfeeding. In addition, participants valued carrying their infants close to the body but used equipment such as strollers. Mothers expressed that perceptions of American culture and rules, social support, interactions with community agencies, and the need to engage in formal employment were factors that influenced their infant care practices. Full article

(This article belongs to the Section Global and Public Health)

7 pages, 1986 KiB

Open AccessCase Report

Bilateral Pulmonary Embolism in a 12-Year-Old Girl with Steroid-Resistant Nephrotic Syndrome

by Osama Y. Safdar, Rahaf H. Rajab, Rand G. Alghanemi, Gazal A. Tantawi, Noora A. Alsulami, Aeshah A. Alsayed and Abdullah K. Habiballah

Children 2020, 7(6), 62; https://doi.org/10.3390/children7060062 - 15 Jun 2020

Cited by 1 | Viewed by 3324

Abstract

Nephrotic syndrome is the most common glomerular disease among children. Although most cases respond to steroid therapy, approximately 10–20% of patients exhibit resistance to conventional steroid therapy and are labeled as steroid-resistant. Such patients are at risk of complications, including infection, thrombosis, and [...] Read more.

Nephrotic syndrome is the most common glomerular disease among children. Although most cases respond to steroid therapy, approximately 10–20% of patients exhibit resistance to conventional steroid therapy and are labeled as steroid-resistant. Such patients are at risk of complications, including infection, thrombosis, and chronic kidney disease. Nephrotic syndrome is considered a thrombogenic condition. Pulmonary embolism is associated with high mortality, and early treatment is essential for the survival of patients. Here, we report the case of a 12-year-old girl with late steroid resistance who developed bilateral pulmonary embolism. Full article

(This article belongs to the Collection Development of Medicines for Paediatric and Rare Diseases)

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12 pages, 225 KiB

Open AccessArticle

Women’s Perceptions about Breastfeeding: A Preliminary Study

by Cecilia Obeng, Stephanie Dickinson and Lilian Golzarri-Arroyo

Children 2020, 7(6), 61; https://doi.org/10.3390/children7060061 - 12 Jun 2020

Cited by 1 | Viewed by 3101

Abstract

Background: Breastfeeding rates are low in many communities in the United States and require attention to come up with ideas that will help increase breastfeeding. This study investigated the effects of income, age, race and education on mothers’ perceptions about breastfeeding and whose [...] Read more.

Background: Breastfeeding rates are low in many communities in the United States and require attention to come up with ideas that will help increase breastfeeding. This study investigated the effects of income, age, race and education on mothers’ perceptions about breastfeeding and whose needs and views should be considered in a women’s breastfeeding journey. Methods: A survey was distributed via email and Facebook to 525 participants; 453 participants (86.3%) responded to the survey. Results: Younger adults were more likely to agree that fathers should have some say about breastfeeding. Those earning USD 0–USD 50,000 were more likely to agree relative to those with higher incomes on children being entitled to mother’s milk, and children’s needs over-riding those of others. There was a statistically significant difference by education about women's wishes about breastfeeding being considered more important than those of their spouses. However, there was no statistically significant difference for any demographic group for breastfeeding decisions coming from women only. On women’s breasts being primarily for infant's nutrition, people who earned USD 0–USD 50,000 were more likely to agree relative to those who earned more than USD 50,000; younger adults were significantly more likely to agree. Those who earned USD 0–USD 50,000 were more likely to agree relative to those in other income brackets that extended family members should have input regarding babies being breastfed; minority participants were significantly more likely to agree relative to white participants; those with less than 4-year college education were more likely to agree relative to those with a minimum of four-year college education. Younger adults were more likely to agree that employers must provide extended maternity leave to make it easier for mothers to breastfeed. On women having the right to breastfeed in public places, younger adults were significantly more likely to agree compared to older adults. Conclusion: Women have favorable views about breastfeeding and prefer being in charge about decisions to breastfeed. Full article

5 pages, 212 KiB

Open AccessBrief Report

Acute Maternal Fasting or Fluid Abstention Does Not Significantly Affect the Macronutrient Composition of Human Milk: Clinical and Clinical Research Relevance

by Karel Allegaert and Anne Smits

Children 2020, 7(6), 60; https://doi.org/10.3390/children7060060 - 10 Jun 2020

Cited by 5 | Viewed by 3523

Abstract

There are guidelines on lactation following maternal analgo-sedative exposure, but these do not consider the effect of maternal fasting or fluid abstention on human milk macronutrient composition. We therefore performed a structured search (PubMed) on ‘human milk composition’ and screened title, abstract and [...] Read more.

There are guidelines on lactation following maternal analgo-sedative exposure, but these do not consider the effect of maternal fasting or fluid abstention on human milk macronutrient composition. We therefore performed a structured search (PubMed) on ‘human milk composition’ and screened title, abstract and full paper on ‘fasting’ or ‘abstention’ and ‘macronutrient composition’ (lactose, protein, fat, solids, triglycerides, cholesterol). This resulted in six papers and one abstract related to religious fasting (n = 129 women) and observational studies in lactating women (n = 23, healthy volunteers, fasting). These data reflect two different ‘fasting’ patterns: an acute (18–25 h) model in 71 (healthy volunteers, Yom Kippur/Ninth of Av) women and a chronic repetitive fasting (Ramadan) model in 81 women. Changes were most related to electrolytes and were moderate and mainly in the chronic repetitive fasting model, with no clinical significant changes in macronutrients during acute fasting. We therefore conclude that neither short-term fasting nor fluid abstention (18–25 h) affect human milk macronutrient composition, so that women can be reassured when this topic was raised during consulting. Besides the nutritional relevance, this also matters, as clinical research samples—especially estimating analgo-sedative exposure by lactation—are commonly collected after maternal procedural sedation and maternal fasting. Based on these results, it is reasonable to assume stable human milk composition when such data are used in physiology-based pharmacokinetic (PBPK) models. Full article

(This article belongs to the Section Global and Public Health)

11 pages, 956 KiB

Open AccessArticle

Neurological Complications and Associated Risk Factors in Children Affected with Chronic Kidney Disease

by Osama Safdar, Sulafa Sindi, Njood Nazer, Asmaa Milyani and Abdulrahman Makki

Children 2020, 7(6), 59; https://doi.org/10.3390/children7060059 - 08 Jun 2020

Cited by 2 | Viewed by 3516

Abstract

To investigate the correlation between chronic kidney disease (CKD) and the development of neurological disease among pediatric patients in Saudi Arabia. The present retrospective study recruited patients admitted to King Abdulaziz University Hospital during 2018. We reviewed electronic records to collect data on [...] Read more.

To investigate the correlation between chronic kidney disease (CKD) and the development of neurological disease among pediatric patients in Saudi Arabia. The present retrospective study recruited patients admitted to King Abdulaziz University Hospital during 2018. We reviewed electronic records to collect data on essential demographics including age, gender, and nationality; history of prior CNS disease or related symptoms; results of neurological physical examination; and findings of radiological investigations such as abdominal ultrasound, dimercaptosuccinic acid scan, micturating cystourethrogram, diethylene triamine pentaacetic acid scan, brain computed tomography, and magnetic resonance imaging. The most commonly diagnosed renal pathologies were neurogenic bladder and cystic kidney disease. The most common neurological manifestation was seizure disorder. Males were more frequently affected with neurological sequelae than females. The prevalence of neurological disorders was higher in patients over two years old. The most frequently observed stage of chronic kidney disease was stage 5. Most children who were affected with a neurological disorder required hemodialysis as part of their management plan. Patients with chronic kidney disease are at a high risk of neurocognitive defects. The type of management and renal diagnosis are significant factors that should be considered when anticipating central nervous system involvement in the case of chronic kidney disease. Full article

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10 pages, 226 KiB

Open AccessReview

Allergen Immunotherapy in Pediatric Asthma: A Pragmatic Point of View

by Michele Miraglia Del Giudice, Amelia Licari, Ilaria Brambilla, Maria Angela Tosca and Giorgio Ciprandi

Children 2020, 7(6), 58; https://doi.org/10.3390/children7060058 - 08 Jun 2020

Cited by 11 | Viewed by 4903

Abstract

To date, the only disease-modifying treatment strategy for allergic rhinitis and asthma is allergen immunotherapy (AIT). There is evidence that AIT improves allergic rhinitis and asthma, such as reducing symptom severity and medication use and improving of quality of life, with a long-lasting [...] Read more.

To date, the only disease-modifying treatment strategy for allergic rhinitis and asthma is allergen immunotherapy (AIT). There is evidence that AIT improves allergic rhinitis and asthma, such as reducing symptom severity and medication use and improving of quality of life, with a long-lasting effect after the end of the course. The recent clinical trials evidenced AIT effectiveness and safety in allergic asthma. Consequently, the current version of the GINA (Global Initiative for Asthma) guidelines recommend AIT as an add-on therapy for asthma. There is also evidence that AIT may exert preventive activity on the possible progression from allergic rhinitis to asthma in children and the onset of new sensitizations. The present review provides a pragmatic summary of the clinical indications of AIT in pediatric asthma, including the immunological mechanisms, the predictive biomarkers, and the safety issues in clinical practice. Full article

13 pages, 285 KiB

Open AccessArticle

Family Socioeconomic Status and Exposure to Childhood Trauma: Racial Differences

by Shervin Assari

Children 2020, 7(6), 57; https://doi.org/10.3390/children7060057 - 03 Jun 2020

Cited by 35 | Viewed by 11358

Abstract

Background: Minorities’ diminished returns (MDRs) refer to weaker effects of socioeconomic status (SES) indicators such as parental educational attainment and family income in generating tangible childhood outcomes for racial and ethnic minorities compared to the majority group, a pattern prevalent in the US. [...] Read more.

Background: Minorities’ diminished returns (MDRs) refer to weaker effects of socioeconomic status (SES) indicators such as parental educational attainment and family income in generating tangible childhood outcomes for racial and ethnic minorities compared to the majority group, a pattern prevalent in the US. Our existing knowledge is minimal, however, about diminished returns of family SES on reducing exposure to childhood trauma. Aim: To determine if there was a difference between non-Hispanic whites (NHW) and non-Hispanic blacks (NHB) in the effect of SES on exposure to childhood trauma among children ages 8–11 years old. Materials and methods: In this cross-sectional study, we analyzed data from 4696 NHW or NHB American 8–11-year-old children who were participants in the Adolescent Brain Cognitive Development (ABCD) Study. The independent variables were parental educational attainment and family income. The primary outcome was exposure to 1 or 2+ childhood traumas, measured by the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS) semi-structured interview. Polynomial regression was used for data analysis. Results: Parental education and family income had statistically significant protective (negative) effects on childhood trauma, indicating children from high income and highly educated families were exposed to a lower level of childhood trauma. However, race/ethnicity showed statistically significant interactions with parental education and family income on exposure to childhood trauma, indicating weaker protective effects of parental education and family income on reducing exposure to trauma for NHB compared to NHW children. Race-specific models showed protective effects of parental education and family income on exposure to childhood trauma for NHW but not NHB children. Conclusion: The protective effects of parental education and family income against exposure to childhood trauma are systematically diminished for NHBs compared to NHWs. To minimize the racial/ethnic health gaps, diminished returns of parental education and family income should be addressed. There is a need for programs and interventions that equalize not only SES but also the marginal returns of SES for ethnic groups. Such efforts require addressing structural and societal barriers that hinder NHB families from translating their SES resources into tangible outcomes. There is a need for studies that can minimize MDRs for NHB families, such that SES can similarly secure tangible outcomes in the presence of SES resources. Full article

12 pages, 253 KiB

Open AccessArticle

The Impact of Posttraumatic Stress Disorder on Clinical Presentation and Psychosocial Treatment Response in Youth with Functional Abdominal Pain Disorders: An Exploratory Study

by Sarah Nelson and Natoshia Cunningham

Children 2020, 7(6), 56; https://doi.org/10.3390/children7060056 - 02 Jun 2020

Cited by 14 | Viewed by 3393

Abstract

Youth with functional abdominal pain disorders (FAPDs) may report high rates of trauma and/or posttraumatic stress disorder (PTSD), which could impact both physical and psychosocial functioning, in addition to psychosocial treatment response. The current study aimed to examine the rates of PTSD in [...] Read more.

Youth with functional abdominal pain disorders (FAPDs) may report high rates of trauma and/or posttraumatic stress disorder (PTSD), which could impact both physical and psychosocial functioning, in addition to psychosocial treatment response. The current study aimed to examine the rates of PTSD in a sample of 89 youth with FAPDs and examine the association between PTSD with physical and psychosocial functioning. The impact of PTSD on psychosocial treatment response in a subsample of youth with FAPDs was also explored. Participants were youth with FAPDs (ages 9–14) enrolled in a larger study examining the effect of a short-term pain and anxiety focused cognitive behavioral therapy (CBT) treatment (Aim to Decrease Anxiety and Pain Treatment (ADAPT)) for youth with FAPDs. Youth were administered a semi-structured diagnostic interview by a trained clinician to confirm the presence of psychological diagnoses, including PTSD. Measures of physical and psychosocial functioning were also completed. Results revealed a high rate of PTSD in youth with FAPDs with 12.4% meeting diagnostic criteria for the disorder. PTSD was associated with several indicators of increased psychosocial impairment and one indicator of physical impairment. Exploratory analyses revealed comorbid PTSD may impact response to a brief CBT intervention targeting pain and anxiety, but more rigorous controlled studies are needed. Full article

15 pages, 798 KiB

Open AccessArticle

Quantitative Sensory Testing in Adolescents with Co-Occurring Chronic Pain and Obesity: A Pilot Study

by Keri R. Hainsworth, Pippa M. Simpson, Omar Ali, Jaya Varadarajan, Lynn Rusy and Steven J. Weisman

Children 2020, 7(6), 55; https://doi.org/10.3390/children7060055 - 02 Jun 2020

Cited by 1 | Viewed by 3007

Abstract

Factors such as gender, ethnicity, and age affect pain processing in children and adolescents with chronic pain. Although obesity has been shown to affect pain processing in adults, almost nothing is known about pediatric populations. The aim of this pilot study was to [...] Read more.

Factors such as gender, ethnicity, and age affect pain processing in children and adolescents with chronic pain. Although obesity has been shown to affect pain processing in adults, almost nothing is known about pediatric populations. The aim of this pilot study was to explore whether obesity alters sensory processing in adolescents with chronic pain. Participants were recruited from a chronic pain clinic (Chronic Pain (CP), n = 12 normal weight; Chronic Pain + Obesity (CPO), n = 19 overweight/obesity) and from an obesity clinic (Obesity alone (O), n = 14). The quantitative sensory testing protocol included assessments of thermal and mechanical pain thresholds and perceptual sensitization at two sites with little adiposity. The heat pain threshold at the hand was significantly higher in the CPO group than in either the CP or O groups. Mechanical pain threshold (foot) was significantly higher in the CPO group than the CP group. No differences were found on tests of perceptual sensitization. Correlations between experimental pain and clinical pain parameters were found for the CPO group, but not for the CP group. This preliminary study provides important lessons learned for subsequent, larger-scale studies of sensory processing for youth with co-occurring chronic pain and obesity. Full article

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14 pages, 3399 KiB

Open AccessArticle

Using the Edinburgh Visual Gait Score to Compare Ankle-Foot Orthoses, Sensorimotor Orthoses and Barefoot Gait Pattern in Children with Cerebral Palsy

by Clare MacFarlane, Wayne Hing and Robin Orr

Children 2020, 7(6), 54; https://doi.org/10.3390/children7060054 - 01 Jun 2020

Cited by 5 | Viewed by 4638

Abstract

Gait analysis is one aspect of evaluation in ambulatory children with cerebral palsy (CP). Ankle-foot orthoses (AFOs) improve gait and alignment through providing support. An alternative and under-researched orthosis are sensomotoric orthoses (SMotOs). The Edinburgh Visual Gait Score (EVGS) is a valid observational [...] Read more.

Gait analysis is one aspect of evaluation in ambulatory children with cerebral palsy (CP). Ankle-foot orthoses (AFOs) improve gait and alignment through providing support. An alternative and under-researched orthosis are sensomotoric orthoses (SMotOs). The Edinburgh Visual Gait Score (EVGS) is a valid observational gait analysis scale to measure gait quality. The aim of this study was to use the EVGS to determine what effect AFOs and SMotOs have on gait in children with CP. The inclusion criteria were: mobilizing children with a CP diagnosis, no surgery in the past six weeks, and currently using SMotOs and AFOs. Eleven participants were videoed walking 5 m (any order) barefoot, in SMotOs and AFOs. Of the participants (age range 3–13 years, mean 5.5 ± 2.9), two were female and six used assistive devices. Seven could walk barefoot. Participants had spastic diplegia (4), spastic quadriplegia (6), and spastic dystonic quadriplegia (1). Gross Motor Functional Classification System (GMFCS) levels ranged I–IV. The total score for SMotOs (7.62) and AFOs (14.18) demonstrated improved gait when wearing SMotOs (no significant differences between barefoot and AFOs). SMotOs may be a viable option to improve gait in this population. Additional study is required but SMotOs may be useful in clinical settings. Full article

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8 pages, 436 KiB

Open AccessArticle

Variability in the Method of Gastrostomy Placement in Children

by Jose H. Salazar, Charles Spanbauer, Manu R. Sood, John C. Densmore and Kyle J. Van Arendonk

Children 2020, 7(6), 53; https://doi.org/10.3390/children7060053 - 01 Jun 2020

Cited by 6 | Viewed by 2875

Abstract

Although gastrostomy placement is one of the most common procedures performed in children, the optimal technique remains unclear. The purpose of this study was to evaluate variability in the method of gastrostomy tube placement in children in the United States. Patients <18 years [...] Read more.

Although gastrostomy placement is one of the most common procedures performed in children, the optimal technique remains unclear. The purpose of this study was to evaluate variability in the method of gastrostomy tube placement in children in the United States. Patients <18 years old undergoing percutaneous endoscopic gastrostomy (PEG) or surgical gastrostomy (SG) (including open or laparoscopic) from 1997 to 2012 were identified using the Kids’ Inpatient Database. Method of gastrostomy placement was evaluated using a multivariable mixed-effects logistic regression model with a random intercept term and a patient-age random-effect term. A total of 67,811 gastrostomy placements were performed during the study period. PEG was used in 36.6% of entries overall and was generally consistent over time. PEG placement was less commonly performed in infants (adjusted odds ratio [aOR] 0.30, 95%CI 0.26–0.33), children at urban hospitals (aOR: 0.38, 95%CI 0.18–0.82), and children cared for at children’s hospitals (aOR 0.57, 95%CI 0.48–0.69) and was more commonly performed in children with private insurance (aOR 1.17, 95%CI 1.09–1.25). Dramatic variability in PEG use was identified between centers, ranging from 0% to 100%. The random intercept and slope terms significantly improved the model, confirming significant center-level variability and increased variability among patients <1 year old. These findings emphasize the need to further evaluate the safest method of gastrostomy placement in children, in particular among the youngest patients in whom practice varies the most. Full article

(This article belongs to the Section Pediatric Surgery)

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5 pages, 188 KiB

Open AccessCase Report

Transient Abnormal Myelopoeisis and Mosaic down Syndrome in a Phenotypically Normal Newborn

by Zachary Prudowsky, HyoJeong Han and Alexandra Stevens

Children 2020, 7(6), 52; https://doi.org/10.3390/children7060052 - 28 May 2020

Cited by 7 | Viewed by 4252

Abstract

Transient abnormal myelopoiesis (TAM) is a common and potentially fatal neonatal complication of newborn babies with Down syndrome (DS). Children born with mosaic DS are also at risk of developing TAM. However, due to their variable phenotypes, early identification of patients with mosaic [...] Read more.

Transient abnormal myelopoiesis (TAM) is a common and potentially fatal neonatal complication of newborn babies with Down syndrome (DS). Children born with mosaic DS are also at risk of developing TAM. However, due to their variable phenotypes, early identification of patients with mosaic DS may be difficult; thus, early diagnosis of TAM is just as challenging. In this report, we describe a case of a phenotypically normal newborn who presented with concerns for neonatal leukemia. The diagnosis of mosaic DS and TAM was confirmed with abnormal GATA1 mutation testing, highlighting the importance of early GATA1 mutation testing in newborn leukemia with high suspicion for TAM. Full article

(This article belongs to the Special Issue Pediatric Acute Myeloid Leukemia: Current Management and Future Directions)

9 pages, 217 KiB

Open AccessArticle

Genesis, Procedures, Attrition Rate and Major Reasons for Missing Measurement Session by the Study Participants in the Ellisras Longitudinal Study

by Phuti Makgae, Betty Sebati, Hlengani Siweya and Kotsedi Monyeki

Children 2020, 7(6), 51; https://doi.org/10.3390/children7060051 - 27 May 2020

Cited by 1 | Viewed by 2569

Abstract

The noncommunicable diseases’ (NCDs) profile is changing rapidly from one country to another. A well-formulated cohort study in Africa could answer major questions relating to the changing profile of NCDs risk in Africa. The aim of the present study was to outline the [...] Read more.

The noncommunicable diseases’ (NCDs) profile is changing rapidly from one country to another. A well-formulated cohort study in Africa could answer major questions relating to the changing profile of NCDs risk in Africa. The aim of the present study was to outline the genesis, procedures, attrition rate and major reasons for study participants to miss measurement sessions in the Ellisras Longitudinal Study (ELS). Method: The ELS followed multiple longitudinal designs comprising repeated measurements in more than one cohort with overlapping ages. Age cohort and time of measurement effects could be identified. A cluster random sampling method was used to sample 2255 participants (1201 males and 1054 females), aged 2 to 10.9 years at baseline (November 1996). Information on lifestyle (tobacco and smoking, alcohol intake, physical activity and socioeconomic status) and biological risk factors for NCD and educational achievements were collected over time. The participants were followed 17 times over the past 25 years with measurements (blood pressure and anthropometry) collected twice during the first consecutive 8 years to account for growth dynamics and other health-related variables. The attrition rate for ELS sample for boys (14%–27.3%) was significantly (p < 0.05) higher than girls (7.9%–18.6%) from May 1999 to November 2003. There was a significant (p < 0.05) increase (25.3%–70.3%) in attrition rate from November 2009 to December 2015. The ELS participant migration to urban areas provided a unique opportunity to investigate the effect of urban life on these rural young adults given the previous data collected on the same subjects at a younger age (3–10 years at baseline in 1996). Conclusion: A well-formulated ELS study in Africa could answer major questions relating to the changing magnitude of NCDs risk factor profiles in Africa. Full article

(This article belongs to the Section Global and Public Health)

18 pages, 367 KiB

Open AccessReview

The Role of the Microbiome in Food Allergy: A Review

by Christina L. Nance, Roman Deniskin, Veronica C. Diaz, Misu Paul, Sara Anvari and Aikaterini Anagnostou

Children 2020, 7(6), 50; https://doi.org/10.3390/children7060050 - 26 May 2020

Cited by 37 | Viewed by 9636

Abstract

Food allergies are common and estimated to affect 8% of children and 11% of adults in the United States. They pose a significant burden—physical, economic and social—to those affected. There is currently no available cure for food allergies. Emerging evidence suggests that the [...] Read more.

Food allergies are common and estimated to affect 8% of children and 11% of adults in the United States. They pose a significant burden—physical, economic and social—to those affected. There is currently no available cure for food allergies. Emerging evidence suggests that the microbiome contributes to the development and manifestations of atopic disease. According to the hygiene hypothesis, children growing up with older siblings have a lower incidence of allergic disease compared with children from smaller families, due to their early exposure to microbes in the home. Research has also demonstrated that certain environmental exposures, such as a farming environment, during early life are associated with a diverse bacterial experience and reduced risk of allergic sensitization. Dysregulation in the homeostatic interaction between the host and the microbiome or gut dysbiosis appears to precede the development of food allergy, and the timing of such dysbiosis is critical. The microbiome affects food tolerance via the secretion of microbial metabolites (e.g., short chain fatty acids) and the expression of microbial cellular components. Understanding the biology of the microbiome and how it interacts with the host to maintain gut homeostasis is helpful in developing smarter therapeutic approaches. There are ongoing trials evaluating the benefits of probiotics and prebiotics, for the prevention and treatment of atopic diseases to correct the dysbiosis. However, the routine use of probiotics as an intervention for preventing allergic disease is not currently recommended. A new approach in microbial intervention is to attempt a more general modification of the gut microbiome, such as with fecal microbiota transplantation. Developing targeted bacterial therapies for food allergy may be promising for both the treatment and prevention of food allergy. Similarly, fecal microbiota transplantation is being explored as a potentially beneficial interventional approach. Overall, targeted bacterial therapies for food allergy may be promising for both the treatment and prevention of food allergy. Full article

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Children, Volume 7, Issue 6 (June 2020) – 17 articles

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