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Children, Volume 9, Issue 6 (June 2022) – 161 articles

Cover Story (view full-size image): To address the increase in demands for pediatric procedural sedation, the PROSA team initiative was started in the Leuven University Hospitals in 2014. In this study, we assessed the efficacy and safety of this project since its initiation. The median age was 4.8 years. The sedation was successful in 98% of patients, albeit classified as ‘technically difficult’ in 3.3%. Of the 2% of failed procedures, 69% were due to inadequate sedation and 31% to logistic reasons unrelated to sedation (such as puncture problem, suboptimal bowel preparation). The overall adverse event incidence was 2%. Pethidine/midazolam was used in 81 cases, nitrous oxide in 10 cases. A saturation decrease with oxygen supply was the documented adverse event in 83 cases. With the current training and implementation, PROSA is effective with a success rate of 98% and an adverse event rate of 2%. View this paper
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10 pages, 235 KiB  
Article
Children’s Health Literacy in Relation to Their BMI z-Score, Food Intake, and Physical Activity: A Cross-Sectional Study among 8–11-Year-Old Children in The Netherlands
by Jany Rademakers, Marla T. H. Hahnraths, Onno C. P. van Schayck and Monique Heijmans
Children 2022, 9(6), 925; https://doi.org/10.3390/children9060925 - 20 Jun 2022
Cited by 6 | Viewed by 2486
Abstract
Overweight and obesity in children are an increasing public health problem. Health literacy (HL) is a determinant of obesity and body mass index (BMI) rates in adults, but few studies have addressed the impact of children’s own HL on their weight and lifestyle. [...] Read more.
Overweight and obesity in children are an increasing public health problem. Health literacy (HL) is a determinant of obesity and body mass index (BMI) rates in adults, but few studies have addressed the impact of children’s own HL on their weight and lifestyle. In this study, we aim to assess the impact of Dutch children’s HL on (1) their BMI z-score, (2) dietary behaviour, and (3) the amount of physical activity (PA) they engage in. A sample of 139 children (age 8–11 years) filled out a digital questionnaire, including an HL measurement instrument and questions regarding their food intake and PA. Furthermore, the height and weight of the children were measured, and background information was collected using a parental questionnaire. Multiple regression revealed a significant positive relation between children’s HL and their PA. No significant association between children’s HL and their BMI z-score or dietary behaviour was found. HL of children in primary school thus has an impact on some aspects of children’s lifestyle, although more research in a larger, more diverse sample is needed to further investigate this. Full article
(This article belongs to the Special Issue Health Literacy and Health Equity in Children)
7 pages, 360 KiB  
Article
Hospital Admission in the Latent versus the Active Phase of Labor: Comparison of Perinatal Outcomes
by Viola Seravalli, Noemi Strambi, Enrica Castellana, Maria Alessia Salamina, Chiara Bettini and Mariarosaria Di Tommaso
Children 2022, 9(6), 924; https://doi.org/10.3390/children9060924 - 20 Jun 2022
Cited by 1 | Viewed by 1571
Abstract
Background: Admission in the latent phase of labor has been associated with increased risk of obstetric interventions compared to admission in the active phase. We aimed to investigate the relationship between labor phase at admission and obstetric and neonatal outcomes. Methods: A retrospective [...] Read more.
Background: Admission in the latent phase of labor has been associated with increased risk of obstetric interventions compared to admission in the active phase. We aimed to investigate the relationship between labor phase at admission and obstetric and neonatal outcomes. Methods: A retrospective cohort study was conducted on 1005 women with uncomplicated singleton pregnancy admitted for spontaneous labor. Cesarean section rate and other perinatal outcomes were compared between women admitted in the latent phase and those admitted in the active phase. Results: Admission occurred in the active phase of labor for 331 women (32.9%) and in the latent phase for 674 (67.1%). Admission in the latent phase was more frequent in nulliparous than in multiparous (p < 0.01) and for Italian patients compared to foreigners. The incidence of caesarean section was similar between groups. Admission in the latent phase increased the likelihood of epidural analgesia (OR 3.47, 95% CI 1.96–6.14, in nulliparous, and OR 2.58, 95% CI 1.37–4.84, in multiparous) and increased the rate of augmentation of labor with oxytocin in multiparous (OR 2.87, 95% CI 1.05–7.85), without difference in neonatal outcomes. Conclusions: Admission in the latent phase is associated with more frequent use of epidural analgesia, without an increase in cesarean section or adverse neonatal outcomes. Full article
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11 pages, 268 KiB  
Article
Externalizing and Internalizing Behaviors in Children with ADHD during Lockdown for COVID-19: The Role of Parental Emotions, Parenting Strategies, and Breaking Lockdown Rules
by Maria Grazia Melegari, Pietro Muratori, Oliviero Bruni, Enrica Donolato, Martina Giallonardo and Irene Mammarella
Children 2022, 9(6), 923; https://doi.org/10.3390/children9060923 - 20 Jun 2022
Cited by 3 | Viewed by 2371
Abstract
Lockdown experience for COVID-19 pandemic significantly affected children and adolescents with Attention-Deficit/Hyperactivity Disorder (ADHD) exacerbating or promoting the onset of externalizing and internalizing symptoms. However, few studies have considered how externalizing and internalizing behaviors changed in relation to parental emotions and parenting strategies. [...] Read more.
Lockdown experience for COVID-19 pandemic significantly affected children and adolescents with Attention-Deficit/Hyperactivity Disorder (ADHD) exacerbating or promoting the onset of externalizing and internalizing symptoms. However, few studies have considered how externalizing and internalizing behaviors changed in relation to parental emotions and parenting strategies. In the present study, 992 caregivers of children and adolescents with ADHD from 5 to 18 years were presented with an online survey evaluating youths’ externalizing and internalizing behaviors, their non-compliance with lockdown rules, and parental factors related to parental emotions and parenting strategies. Two hierarchical linear regression models were performed to examine the contribution of children’s non-compliance with lockdown rules, parental emotions, and parenting strategies on children’s externalizing and internalizing behaviors. Results revealed that externalizing behaviors were higher in children and adolescents with ADHD non-compliant with lockdown rules. Moreover, positive parenting strategies moderated the relationship between non-compliance with lockdown rules and externalizing behaviors. Differently, higher internalizing behaviors were observed in children with ADHD who had parents reporting more negative emotions and positive parenting strategies. In this case, parents’ negative emotions had a moderator effect in the association between internalizing behaviors and non-compliance to lockdown measures. The clinical implications of these two different patterns of relations are discussed. Full article
16 pages, 1532 KiB  
Article
Relationship Aspects of Mothers and Their Adolescents with Intellectual Disability as Expressed through the Joint Painting Procedure
by Tami Gavron, Rinat Feniger-Schaal and Adi Peretz
Children 2022, 9(6), 922; https://doi.org/10.3390/children9060922 - 20 Jun 2022
Cited by 4 | Viewed by 2020
Abstract
The quality of the interaction between mothers and their children with an Intellectual Disability (ID) plays a crucial role in their development and in particular during adolescence. This qualitative study was designed to provide a better understanding of aspects of the relationships between [...] Read more.
The quality of the interaction between mothers and their children with an Intellectual Disability (ID) plays a crucial role in their development and in particular during adolescence. This qualitative study was designed to provide a better understanding of aspects of the relationships between mothers and their adolescents with ID through an art-based tool, the Joint Painting Procedure. The qualitative analysis of six dyads of mothers and adolescents with severe, moderate and mild ID was based on the principles of narrative and phenomenological inquiry. The findings yielded three key themes that emerged from the relational dynamics during the JPP: (1) from dependency to autonomy, (2) the joint painting as a way to foster verbal communication, and (3) playfulness and enjoyment. The JPP appeared to serve as a meaningful art-based assessment of the implicit and explicit aspects of the relationships which evolved during the interaction. The findings underscore the potential of the JPP as a non-verbal, art-based tool that allows researchers and clinicians to learn more about the dynamics of relationships between mothers and their adolescents with ID. It also enables a context where the expression of relational issues can be communicated and even transformed. Full article
(This article belongs to the Special Issue Arts Therapies with Children and Adolescents)
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16 pages, 599 KiB  
Article
Visual Function and Neuropsychological Profile in Children with Cerebral Visual Impairment
by Federica Morelli, Giorgia Aprile, Chiara Martolini, Elena Ballante, Lucrezia Olivier, Elisa Ercolino, Eleonora Perotto and Sabrina Signorini
Children 2022, 9(6), 921; https://doi.org/10.3390/children9060921 - 19 Jun 2022
Cited by 11 | Viewed by 2620
Abstract
Cerebral Visual Impairment (CVI) has become the leading cause of children’s visual impairment in developed countries. Since CVI may negatively affect neuropsychomotor development, an early diagnosis and characterization become fundamental to define effective habilitation approaches. To date, there is a lack of standardized [...] Read more.
Cerebral Visual Impairment (CVI) has become the leading cause of children’s visual impairment in developed countries. Since CVI may negatively affect neuropsychomotor development, an early diagnosis and characterization become fundamental to define effective habilitation approaches. To date, there is a lack of standardized diagnostic methods to assess CVI in children, and the role of visual functions in children’s neuropsychological profiles has been poorly investigated. In the present paper, we aim to describe the clinical and neuropsychological profiles and to investigate the possible effects of visual functions on neuropsychological performance of a cohort of children diagnosed with CVI. Fifty-one children with CVI were included in our retrospective analysis (inclusion criteria: verbal IQ > 70 in Wechsler scales; absence of significant ocular involvement). For each participant, we collected data on neuropsychological assessment (i.e., cognitive, cognitive visual, and learning abilities), basic visual functions (e.g., Best Corrected Visual Acuity—BCVA, contrast sensitivity, and ocular motor abilities) and global development features (e.g., neurological signs and motor development delay) based on standardized tests, according to patients’ ages. The results showed that oculomotor dysfunction involving saccades and smooth pursuit may be a core symptom of CVI and might have a significant impact on cognitive visual and other neuropsychological abilities. Furthermore, visual acuity and contrast sensitivity may influence cognitive, cognitive visual, and academic performances. Our findings suggest the importance of a comprehensive assessment of both visual and neuropsychological functions in children when CVI is suspected, which is needed to provide a more comprehensive functional profile and define the best habilitation strategy to sustain functional vision. Full article
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11 pages, 645 KiB  
Article
Application of a Cold Dry Air Provocation Test in Pediatric Patients with Asthma
by Ji Young Ahn and Bong Seok Choi
Children 2022, 9(6), 920; https://doi.org/10.3390/children9060920 - 19 Jun 2022
Viewed by 1485
Abstract
Asthma is a chronic inflammatory airway disease characterized by reversible airway obstruction and airway hyperreactivity. We proposed a cold dry air (CDA) provocation test and investigated its application in pediatric patients with asthma. We enrolled 72 children and adolescents older than 5 years [...] Read more.
Asthma is a chronic inflammatory airway disease characterized by reversible airway obstruction and airway hyperreactivity. We proposed a cold dry air (CDA) provocation test and investigated its application in pediatric patients with asthma. We enrolled 72 children and adolescents older than 5 years who presented to our hospital with chronic cough, shortness of breath, and wheezing. We analyzed the results of allergy, pulmonary function, methacholine provocation, and CDA provocation tests. The FEV1 change 5 min after the provocation was recorded as CDA5 dFEV1; that after 15 min was recorded as CDA15 dFEV1. PT10 was the provocation time causing a 10% decrease in FEV1; a decrease of >10% in dFEV1 was considered a positive CDA test. Among the 72 subjects, 51 were diagnosed with asthma. A positive CDA test in patients with asthma correlated with non-eosinophilic asthma. In patients with asthma, sputum eosinophils and eosinophil cationic protein (ECP) levels of the patients with a positive CDA test were significantly lower than those of patients with a negative test. CDA5 dFEV1 correlated with PC20 and total immunoglobulin E. CDA15 dFEV1 correlated with PC20, sputum eosinophils, and ECP. PT10 became shorter as the peripheral blood eosinophil, FVC, FEV1, FEV1/FVC, and FEF25-75 decreased. The CDA provocation test showed airway hyperreactivity to non-specific stimuli, a high correlation with non-eosinophilic asthma, and the possibility of assessing asthma severity via PT10. Full article
(This article belongs to the Special Issue Asthma and Its Impact in Adolescents)
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10 pages, 2934 KiB  
Article
High Prevalence of Astigmatism in Children after School Suspension during the COVID-19 Pandemic Is Associated with Axial Elongation
by Suei-Cheng Wong, Chea-Su Kee and Tsz-Wing Leung
Children 2022, 9(6), 919; https://doi.org/10.3390/children9060919 - 19 Jun 2022
Cited by 6 | Viewed by 2701
Abstract
During the COVID-19 pandemic, the Hong Kong Government enforced a “school from home” policy between February and September 2020. This cross-sectional epidemiological study was conducted to investigate the prevalence of astigmatism and visual habits after the home confinement period. Vision screenings were conducted [...] Read more.
During the COVID-19 pandemic, the Hong Kong Government enforced a “school from home” policy between February and September 2020. This cross-sectional epidemiological study was conducted to investigate the prevalence of astigmatism and visual habits after the home confinement period. Vision screenings were conducted at three local government-funded primary schools in Hong Kong from October 2020 to December 2020. A total of 418 ethnically Chinese primary school children completed the eye examination and returned questionnaires concerning demographic information and visual habits. It was found that 46.5% (95% CI, 41.7–61.4%) of the children aged 8 to 11 years had astigmatism ≥ 0.75 D, which was predominately With-The-Rule astigmatism. The prevalence of astigmatism reported in these children is generally higher than that of studies conducted before COVID. Compared to their non-astigmatic peers, astigmatic children had a longer axial length (p < 0.001) and engaged in fewer outdoor activities (p = 0.04). Multiple linear regression analyses also revealed significant relationships between axial length and both cylindrical error and J0 astigmatism. Due to the high astigmatism prevalence, there is a pressing need for further studies on the long-term impact of the pandemic on children’s vision. Full article
(This article belongs to the Special Issue Prevalence and Progression of Myopia in Children and Adolescents)
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16 pages, 1497 KiB  
Article
Plasma Brain Natriuretic Peptide Levels in Children with Chronic Kidney Disease and Renal Transplant Recipients: A Single Center Study
by Anastasia Garoufi, Aikaterini Koumparelou, Varvara Askiti, Panagis Lykoudis, Andromachi Mitsioni, Styliani Drapanioti, Georgios Servos, Maria Papadaki, Dimitrios Gourgiotis and Antonios Marmarinos
Children 2022, 9(6), 916; https://doi.org/10.3390/children9060916 - 19 Jun 2022
Cited by 1 | Viewed by 1414
Abstract
Pediatric chronic kidney disease (CKD) patients, as well as kidney transplant patients, are at an increased risk of developing cardiovascular disease. BNP measurement, as a biomarker of cardiovascular risk, has been recommended to this high-risk population. Plasma BNP levels were measured in 56 [...] Read more.
Pediatric chronic kidney disease (CKD) patients, as well as kidney transplant patients, are at an increased risk of developing cardiovascular disease. BNP measurement, as a biomarker of cardiovascular risk, has been recommended to this high-risk population. Plasma BNP levels were measured in 56 CKD children in either pre-dialysis stage, hemodialysis (HD) or renal transplant recipients (RTRs) and in 76 sex- and age-matched healthy controls. BNP levels were investigated in HD children, before and after the completion of their HD session. BNP levels in total CKD population, in pre-dialysis stage patients and on HD were significantly higher, compared to the respective controls. HD children had higher BNP levels compared to CKD patients in the pre-dialysis stage. Moreover, post-HD BNP concentration was slightly higher than pre-HD, with the difference being marginally statistically significant. BNP was positively correlated with eGFR, creatinine, cystatin-C and parathormone and negatively with albumin and 25-hydroxyvitamin D. A positive correlation between BNP concentration and the ratio of E/A in pulse-wave Doppler echocardiography was also observed. In conclusion, CKD pediatric patients, mainly those undergoing HD, have high plasma BNP levels which do not decrease after the HD session. This is indicative of a greater risk for future cardiovascular disease. Full article
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8 pages, 1865 KiB  
Article
The Effect of Music Intervention on Fetal Education via Doppler Fetal Monitor
by Liza Lee, Yu-Hsin Chang, Wei-Ju Liang and Yao-Cing Huang
Children 2022, 9(6), 918; https://doi.org/10.3390/children9060918 - 18 Jun 2022
Cited by 2 | Viewed by 2528
Abstract
This study focused on the effects of music intervention on fetal education in pregnant women. The fetal heart rate of the fetus at 30–38 weeks of gestational age was monitored by an ultrasound Doppler fetal monitor, and differences in the frequency of fetal [...] Read more.
This study focused on the effects of music intervention on fetal education in pregnant women. The fetal heart rate of the fetus at 30–38 weeks of gestational age was monitored by an ultrasound Doppler fetal monitor, and differences in the frequency of fetal movement responses to familiar and unfamiliar music courses were recorded and analyzed. The analysis results showed that the fetuses had less fetal movement to fixed singing activities, with a mean of 0.7 and a standard deviation of 0.79. On the contrary, the fetuses had significant fetal movement responses to irregular singing, with a mean of 1.73 and a standard deviation of 1.37. The results showed that the fetus receives external sounds through hearing, and a pregnant woman singing fixed music to her fetus can stabilize the frequency of fetal movement, promote the health of herself and the fetus, and establish maternal-fetal bonding. Full article
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11 pages, 555 KiB  
Article
Advanced Echocardiographic Analysis in Medium-Term Follow-Up of Children with Previous Multisystem Inflammatory Syndrome
by Massimo Garbin, Irene Raso, Alessandra Piersanti, Laura Gianolio, Annalisa De Silvestri, Valeria Calcaterra, Carla G. Corti, Luisa F. Nespoli, Sara Santacesaria, Giulia Fini, Dario Dilillo, Gianvincenzo Zuccotti and Savina Mannarino
Children 2022, 9(6), 917; https://doi.org/10.3390/children9060917 - 18 Jun 2022
Cited by 8 | Viewed by 1664
Abstract
Multisystem inflammatory syndrome in children (MIS-C) is a severe hyperinflammatory disease related to SARS-CoV2 infection, with frequent cardiovascular involvement in the acute setting. The aim of the study was to evaluate the cardiac function at 6 months. Thirty-two patients diagnosed with MIS-C were [...] Read more.
Multisystem inflammatory syndrome in children (MIS-C) is a severe hyperinflammatory disease related to SARS-CoV2 infection, with frequent cardiovascular involvement in the acute setting. The aim of the study was to evaluate the cardiac function at 6 months. Thirty-two patients diagnosed with MIS-C were enrolled and underwent advanced echocardiogram at discharge and at 6 months. According to the left ventricular ejection fraction (LVEF) at admission, the patients were divided into group A (LVEF < 45%) and group B (LVEF ≥ 45%) and the follow-up results were compared. At discharge, all patients had normal LV and RV systolic function (LVEF 61 ± 4.4%, LV global longitudinal strain −22.1%, TAPSE 20.1mm, s’ wave 0.13m/s, RV free wall longitudinal strain −27.8%) with normal LV diastolic function (E/A 1.5, E/e’ 5.7, and left atrial strain 46.5%) and no significant differences at 6 months. Compared to group B, the group A patients showed a reduced, even if normal, LV global longitudinal strain at discharge (−21.1% vs. −22.6%, p-value 0.02), but the difference was no longer significant at the follow-up. Patients with MIS-C can present with depressed cardiac function, but if treated, the cardiac function recovered without late onset of cardiac disease. This favorable result was independent of the severity of acute LV dysfunction. Full article
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12 pages, 288 KiB  
Review
Eating Disorders and Disordered Eating Behaviors in Cystic Fibrosis: A Neglected Issue
by Anastasia Petropoulou, Georgia Bakounaki, Maria G. Grammatikopoulou, Dimitrios P. Bogdanos, Dimitrios G. Goulis and Tonia Vassilakou
Children 2022, 9(6), 915; https://doi.org/10.3390/children9060915 - 18 Jun 2022
Cited by 4 | Viewed by 3026
Abstract
As with the majority of chronic diseases having specific nutrition recommendations, in cystic fibrosis (CF), the emphasis placed on patients regarding their diet and ideal body weight status often increases the risk of developing disordered eating behaviors and by inference, eating disorders (EDs). [...] Read more.
As with the majority of chronic diseases having specific nutrition recommendations, in cystic fibrosis (CF), the emphasis placed on patients regarding their diet and ideal body weight status often increases the risk of developing disordered eating behaviors and by inference, eating disorders (EDs). Body weight appears to be an important concern for patients with CF, with many patients struggling to lose weight. Between sexes, women appear more preoccupied with dieting compared to men, but exhibit a better body image, mainly due to their preference for a lower weight. Several comorbidities appear to change these dynamics, and visibly apparent factors, including scars, ports, and tubes, and the need for supplementary oxygen supply, may also influence body image perception. Disordered eating is usually initiated during a bout of pulmonary infection, with the patient feeling unwell to eat. Regarding the prevalence of EDs, research appears conflicting on whether it is higher among individuals with a CF diagnosis or not. As for comorbidities, anxiety and depression consist of the most common psychiatric diagnoses in CF, also greatly prevalent in EDs. Despite the plethora of studies, non-specific CF tools, small samples, and lack of data regarding important outcomes, including lung health, indicate the need for more research. Full article
9 pages, 1116 KiB  
Article
Analysis of Physeal Fractures from the United States National Trauma Data Bank
by Joseph R. Fuchs, Romie F. Gibly, Christopher B. Erickson, Stacey M. Thomas, Nancy Hadley Miller and Karin A. Payne
Children 2022, 9(6), 914; https://doi.org/10.3390/children9060914 - 18 Jun 2022
Cited by 6 | Viewed by 3042
Abstract
Background: Pediatric long-bone physeal fractures can lead to growth deformities. Previous studies have reported that physeal fractures make up 18–30% of total fractures. This study aimed to characterize physeal fractures with respect to sex, age, anatomic location, and Salter–Harris (SH) classification from a [...] Read more.
Background: Pediatric long-bone physeal fractures can lead to growth deformities. Previous studies have reported that physeal fractures make up 18–30% of total fractures. This study aimed to characterize physeal fractures with respect to sex, age, anatomic location, and Salter–Harris (SH) classification from a current multicenter national database. Methods: A retrospective cohort study was performed using the 2016 United States National Trauma Data Bank (NTDB). Patients ≤ 18 years of age with a fracture of the humerus, radius, ulna, femur, tibia, or fibula were included. Results: The NTDB captured 132,018 patients and 58,015 total fractures. Physeal fractures made up 5.7% (3291) of all long-bone fractures, with males accounting for 71.0% (2338). Lower extremity physeal injuries comprised 58.6% (1929) of all physeal fractures. The most common site of physeal injury was the tibia comprising 31.8% (1047), 73.9% (774) of which were distal tibia fractures. Physeal fractures were greatest at 11 years of age for females and 14 years of age for males. Most fractures were SH Type II fractures. Discussion and Conclusions: Our analysis indicates that 5.7% of pediatric long-bone fractures involved the physis, with the distal tibia being the most common. These findings suggest a lower incidence of physeal fractures than previous studies and warrant further investigation. Full article
(This article belongs to the Special Issue Pediatric Fractures)
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11 pages, 4232 KiB  
Article
Combination of Hemoglobin-for-Age Z-Score and Plasma Hepcidin Identified as a Novel Predictor for Kawasaki Disease
by Ya-Ling Yang, Ho-Chang Kuo, Kuang-Den Chen, Chi-Hsiang Chu, Kuang-Che Kuo, Mindy Ming-Huey Guo, Ling-Sai Chang and Ying-Hsien Huang
Children 2022, 9(6), 913; https://doi.org/10.3390/children9060913 - 18 Jun 2022
Cited by 6 | Viewed by 1903
Abstract
Kawasaki disease (KD) is a febrile coronary vasculitis that affects younger children and includes complications such as coronary artery aneurysm. KD diagnoses are diagnosed based on clinical presentations, a process that still poses a challenge for front-line physicians. In the current study, we [...] Read more.
Kawasaki disease (KD) is a febrile coronary vasculitis that affects younger children and includes complications such as coronary artery aneurysm. KD diagnoses are diagnosed based on clinical presentations, a process that still poses a challenge for front-line physicians. In the current study, we developed a novel predictor using the hemoglobin-for-age z-score (HbZ) and plasma hepcidin to differentiate Kawasaki disease (KD) from febrile children (FC). There were 104 FC and 115 KD subjects (89 typical KD; 26 incomplete KD) for this study, and data were collected on the biological parameters of hemoglobin and plasma hepcidin levels. A receiver operating characteristic curve (auROC), multiple logistics regression, and support vector machine analysis were all adopted to develop our prediction condition. We obtained both predictors, HbZ and plasma hepcidin, for distinguishing KD and FC. The auROC of the multivariate logistic regression of both parameters for FC and KD was 0.959 (95% confidence interval = 0.937–0.981), and the sensitivity and specificity were 85.2% and 95.9%, respectively. Furthermore, the auROC for FC and incomplete KD was 0.981, and the sensitivity and specificity were 92.3% and 95.2%, respectively. We further developed a model of support vector machine (SVM) classification with 83.3% sensitivity and 88.0% specificity in the training set, and the blind cohort performed well (78.4% sensitivity and 100% specificity). All data showed that sensitivity and specificity were 81.7% and 91.3%, respectively, by SVM. Overall, our findings demonstrate a novel predictor using a combination of HbZ and plasma hepcidin with a better discriminatory ability for differentiating from WBC and CRP between children with KD and other FC. Using this predictor can assist front-line physicians to recognize and then provide early treatment for KD. Full article
(This article belongs to the Section Pediatric Infectious Diseases)
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9 pages, 624 KiB  
Article
Progression of Obstructive Sleep Apnea Syndrome in Pediatric Patients with Prader–Willi Syndrome
by Shi-Bing Wong, Mei-Chen Yang, I-Shiang Tzeng, Wen-Hsin Tsai, Chou-Chin Lan and Li-Ping Tsai
Children 2022, 9(6), 912; https://doi.org/10.3390/children9060912 - 17 Jun 2022
Cited by 4 | Viewed by 2060
Abstract
Obstructive sleep apnea syndrome (OSAS) is one of the most common comorbidities in patients with Prader–Willi syndrome (PWS) and causes significant consequences. This observational study was conducted to investigate the progression of OSAS in pediatric patients with PWS, who had not undergone upper [...] Read more.
Obstructive sleep apnea syndrome (OSAS) is one of the most common comorbidities in patients with Prader–Willi syndrome (PWS) and causes significant consequences. This observational study was conducted to investigate the progression of OSAS in pediatric patients with PWS, who had not undergone upper airway surgery, through a longitudinal follow-up of their annual polysomnography results. Annual body mass index (BMI), BMI z-score, sleep efficiency and stages, central apnea index (CAI), obstructive apnea–hypopnea index (OAHI), and oxygen saturation nadir values were longitudinally analyzed. At enrollment, of 22 patients (10 boys and 12 girls) aged 11.7 ± 3.9 years, 20 had OSAS. During the 4-year follow-up, only two patients had a spontaneous resolution of OSAS. The average BMI and BMI z-score increased gradually, but CAI and OAHI showed no significant differences. After statistical adjustment for sex, age, genotype, growth hormone use, and BMI z-score, OAHI was associated with the BMI z-score and deletion genotype. In conclusion, OSAS is common in patients with PWS, and rarely resolved spontaneously. Watchful waiting may not be the best OSAS management strategy. Weight maintenance and careful selection of surgical candidates are important for OSAS treatment in patients with PWS. Full article
(This article belongs to the Special Issue Sleep Disorders in Children with Neurodevelopmental Disorders)
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10 pages, 444 KiB  
Article
The Influence of Parenting Styles on Eating Behavior and Caries in Their Children: A Cross-Sectional Study
by María José González-Olmo, Ana Ruiz-Guillén, María Moya-López, Martín Romero-Maroto and María Carrillo-Díaz
Children 2022, 9(6), 911; https://doi.org/10.3390/children9060911 - 17 Jun 2022
Cited by 1 | Viewed by 2148
Abstract
The type of parenting style influences the way children cope with problems and can create states of anxiety that can even alter their eating habits, which can cause problems in their oral health. The present study aimed to find out which parenting style [...] Read more.
The type of parenting style influences the way children cope with problems and can create states of anxiety that can even alter their eating habits, which can cause problems in their oral health. The present study aimed to find out which parenting style is more favorable for the oral health of their children. In this cross-sectional study, 186 children (aged 8–15 years) were examined to assess the mean Decayed/Missing/Filled teeth (DMFT + dmft) index, and they were asked to complete the State–Trait Anxiety Inventory, the Parenting Style Scale, and questions about their oral hygiene habits. On the other hand, their parents answered the Parental Feeding Style Questionnaire and the Children’s Eating Behavior Questionnaire. Results showed that a worse oral health status was associated with a higher state of anxiety, more overeating, more emotional eating, and higher psychological control. A higher rate of missing teeth was associated with increased undereating and overeating. Emotional eating was positively related to psychological control. State of anxiety, overeating, and parental psychological control predicted 24.6% of DMFT + dmft. In addition, emotional eating had a moderating effect in DMFT + dfmt only in those with low levels of affection and communication. In conclusion, high psychological control and low levels of parental affection and communication will increase the state of anxiety in children, influencing their caries rate. Full article
(This article belongs to the Section Pediatric Dentistry)
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9 pages, 2178 KiB  
Article
A Comparison between Three Different Techniques Considering Quality Skills, Fatigue and Hand Pain during a Prolonged Infant Resuscitation: A Cross-Over Study with Lifeguards
by Roberto Barcala-Furelos, Martín Barcala-Furelos, Francisco Cano-Noguera, Martín Otero-Agra, Alejandra Alonso-Calvete, Santiago Martínez-Isasi, Silvia Aranda-García, Sergio López-García and Antonio Rodríguez-Núñez
Children 2022, 9(6), 910; https://doi.org/10.3390/children9060910 - 17 Jun 2022
Cited by 2 | Viewed by 2612
Abstract
The aim of the study was to compare the quality of CPR (Q-CPR), as well as the perceived fatigue and hand pain in a prolonged infant cardiopulmonary resuscitation (CPR) performed by lifeguards using three different techniques. A randomized crossover simulation study was used [...] Read more.
The aim of the study was to compare the quality of CPR (Q-CPR), as well as the perceived fatigue and hand pain in a prolonged infant cardiopulmonary resuscitation (CPR) performed by lifeguards using three different techniques. A randomized crossover simulation study was used to compare three infant CPR techniques: the two-finger technique (TF); the two-thumb encircling technique (TTE) and the two-thumb-fist technique (TTF). 58 professional lifeguards performed three tests in pairs during a 20-min period of CPR. The rescuers performed compressions and ventilations in 15:2 cycles and changed their roles every 2 min. The variables of analysis were CPR quality components, rate of perceived exertion (RPE) and hand pain with numeric rating scale (NRS). All three techniques showed high Q-CPR results (TF: 86 ± 9%/TTE: 88 ± 9%/TTF: 86 ± 16%), and the TTE showed higher values than the TF (p = 0.03). In the RPE analysis, fatigue was not excessive with any of the three techniques (values 20 min between 3.2 for TF, 2.4 in TTE and 2.5 in TTF on a 10-point scale). TF reached a higher value in RPE than TTF in all the intervals analyzed (p < 0.05). In relation to NRS, TF showed significantly higher values than TTE and TTF (NRS minute 20 = TF 4.7 vs. TTE 2.5 & TTF 2.2; p < 0.001). In conclusion, all techniques have been shown to be effective in high-quality infant CPR in a prolonged resuscitation carried out by lifeguards. However, the two-finger technique is less efficient in relation to fatigue and hand pain compared with two-thumb technique (TF vs. TTF, p = 0.01). Full article
(This article belongs to the Special Issue Pediatric Intensive Care – Practice and Research)
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13 pages, 1645 KiB  
Article
Adolescent and Juvenile Idiopathic Scoliosis: Which Patients Obtain Good Results with 12 Hours of Cheneau–Toulouse–Munster Nighttime Bracing?
by Gautier De Chelle, Virginie Rampal, Imad Bentellis, Arnaud Fernandez, Carlo Bertoncelli, Jean-Luc Clément and Federico Solla
Children 2022, 9(6), 909; https://doi.org/10.3390/children9060909 - 17 Jun 2022
Viewed by 1773
Abstract
Background: The results of 12 h nighttime Cheneau–Toulouse–Munster (CTM) brace wear on adolescent idiopathic scoliosis are poorly described. Objective: The main objective was to analyze the efficiency of 12 h nighttime CTM brace wear on adolescent idiopathic scoliosis. The secondary objective was to [...] Read more.
Background: The results of 12 h nighttime Cheneau–Toulouse–Munster (CTM) brace wear on adolescent idiopathic scoliosis are poorly described. Objective: The main objective was to analyze the efficiency of 12 h nighttime CTM brace wear on adolescent idiopathic scoliosis. The secondary objective was to identify the factors influencing good results. Methods: One hundred and fifty consecutive patients treated between 2006 and 2017 were retrospectively analyzed with subgroup analysis for the main curve pattern (main thoracic or main lumbar). The inclusion criteria were evolutive scoliosis, 12 h nighttime CTM brace wear, Risser stages 0-1-2 at the time of the prescription, and Cobb angle below 45 degrees. Success was defined as no surgery, and the main curve Cobb angle (CA) progression ≤5°. The overcurve was defined as the proximal thoracic curve above the main thoracic and mid-thoracic above the main lumbar curves. A logistic regression model was built to assess the predictors of success. RESULTS: Overall success was 70%: 60% for main thoracic (MT) and 84% for main lumbar scoliosis (ML) (p = 0.003). Efficacy was 62% at Risser stage 0 and 78% at Risser stage 1–2 (p = 0.054). For MT, failure was associated with high in-brace sagittal C7 tilt (Odds Ratio = 0.72, p = 0.014) and low initial overcurve CA (Odds Ratio = 0.42, p = 0.044). For ML, a high standing height was associated with success (OR = 1.42, p = 0.035), and frontal unbalanced C7 tilt was associated with failure (OR = 0.43, p = 0.02). Conclusion: Twelve-hour nighttime CTM brace wear provided good results for main lumbar curves with balanced frontal C7 tilt. For MT, this treatment is indicated if the in-brace sagittal C7 tilt is well balanced from Risser stage 2. Full article
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11 pages, 1598 KiB  
Brief Report
VEGF Pathway Gene Expression Profile of Proliferating versus Involuting Infantile Hemangiomas: Preliminary Evidence and Review of the Literature
by Rodica Elena Heredea, Eugen Melnic, Laura Elena Cirligeriu, Patricia Lorena Berzava, Maria Corina Stănciulescu, Călin Marius Popoiu and Anca Maria Cimpean
Children 2022, 9(6), 908; https://doi.org/10.3390/children9060908 - 17 Jun 2022
Cited by 2 | Viewed by 1713
Abstract
Background. Infantile hemangiomas may have unexpected behavior. Initial regression (spontaneously or drug-induced) may be followed by unexplained recurrences. At this moment, there are no well-established criteria to predict infantile hemangioma reccurrences. Methods. We compared the VEGF pathway gene expression profile for [...] Read more.
Background. Infantile hemangiomas may have unexpected behavior. Initial regression (spontaneously or drug-induced) may be followed by unexplained recurrences. At this moment, there are no well-established criteria to predict infantile hemangioma reccurrences. Methods. We compared the VEGF pathway gene expression profile for one case of involuting infantile hemangioma versus one case of recurrent proliferative infantile hemangioma using TaqMan Array. Results. We found ten genes upregulated for both involuting and recurrent proliferative hemangiomas: ACTB, KRAS, MAP2K1, HRAS, NOS3, BAD, HSPB1, HPRT1, GUSB, and CASP9. Thirteen genes were downregulated for both involuting and proliferative hemangiomas: FIGF, ACTG1, GRB2, MAPKAPK2, ACTG2, MAP2K2, MAPK3, HSP90AA1, MAP2K6, NRAS, ACTA1, KDR, and MAPK1. Three genes showed divergent expression between proliferating and involuting hemangiomas. Proliferating hemangioma had MAPK14 and AKT1 gene upregulation and ACTA2 downregulation. Involuting infantile hemangioma was characterized by ACTA2 upregulation and AKT1 and MAPK14 downregulation. Conclusions. Three genes, AKT1, p38/MAPK14, and ACTA2, were found to have divergent expression in proliferating and involuting infantile hemangiomas. Excepting AKT1, which was mentioned in the last ISSVA classification (strictly related to Proteus Syndrome), none of the other genes were reported. An accurate gene expression profile mapping of infantile hemangiomas together with a gene expression-based hemangioma classification is stringently needed. Full article
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12 pages, 1363 KiB  
Article
The Effects of Verbal Encouragement during a Soccer Dribbling Circuit on Physical and Psychophysiological Responses: An Exploratory Study in a Physical Education Setting
by Bilel Aydi, Okba Selmi, Mohamed A. Souissi, Hajer Sahli, Ghazi Rekik, Zachary J. Crowley-McHattan, Jeffrey Cayaban Pagaduan, Antonella Muscella, Makram Zghibi and Yung-Sheng Chen
Children 2022, 9(6), 907; https://doi.org/10.3390/children9060907 - 17 Jun 2022
Cited by 10 | Viewed by 2940
Abstract
Verbal encouragement (VE) can be used by physical education (PE) practitioners for boosting motivation during exercise engagement. The purpose of this study was to investigate the effects of VE on psychophysiological aspects and physical performance in a PE context. Twenty secondary school male [...] Read more.
Verbal encouragement (VE) can be used by physical education (PE) practitioners for boosting motivation during exercise engagement. The purpose of this study was to investigate the effects of VE on psychophysiological aspects and physical performance in a PE context. Twenty secondary school male students (age: 17.68 ± 0.51 yrs; height: 175.7 ± 6.2 cm; body mass: 67.3 ± 5.1 kg, %fat: 11.9 ± 3.1%; PE experience: 10.9 ± 1.0 yrs) completed, in a randomized order, two test sessions that comprised a soccer dribbling circuit exercise (the Hoff circuit) either with VE (CVE) or without VE (CNVE), with one-week apart between the tests. Heart rate (HR) responses were recorded throughout the circuit exercise sessions. Additionally, the profile of mood-state (POMS) was assessed pre and post the circuit exercises. Furthermore, rating of perceived exertion (RPE), traveled distance, and physical activity enjoyment (PACES) were assessed after the testing sessions. Furthermore, the CVE trial resulted in higher covered distance, %HRmax, RPE, PACES score, (Cohen’s coefficient d = 1.08, d = 1.86, d = 1.37, respectively; all, p < 0.01). The CNVE trial also showed lower vigor and higher total mood disturbance (TMD) (d = 0.67, d = 0.87, respectively, p < 0.05) and was associated with higher tension and fatigue, compared to the CVE trial (d = 0.77, d = 1.23, respectively, p < 0.01). The findings suggest that PE teachers may use verbal cues during soccer dribbling circuits for improving physical and psychophysiological responses within secondary school students. Full article
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10 pages, 290 KiB  
Perspective
Mediterranean Diet in Developmental Age: A Narrative Review of Current Evidences and Research Gaps
by Ilaria Farella, Francesca Miselli, Angelo Campanozzi, Francesca Maria Grosso, Nicola Laforgia and Maria Elisabetta Baldassarre
Children 2022, 9(6), 906; https://doi.org/10.3390/children9060906 - 16 Jun 2022
Cited by 4 | Viewed by 2087
Abstract
Numerous studies in recent decades have shown that Mediterranean diet (MD) can reduce the risk of developing obesity in pediatric patients. The current narrative review summarizes recent evidence regarding the impact of MD across the different stages of child development, starting from fetal [...] Read more.
Numerous studies in recent decades have shown that Mediterranean diet (MD) can reduce the risk of developing obesity in pediatric patients. The current narrative review summarizes recent evidence regarding the impact of MD across the different stages of child development, starting from fetal development, analyzing breastfeeding and weaning, through childhood up to adolescence, highlighting the gaps in knowledge for each age group. A literature search covering evidence published between 1 January 2000 and 1 March 2022 and concerning children only was conducted using multiple keywords and standardized terminology in PubMed database. A lack of scientific evidence about MD adherence concerns the age group undergoing weaning, thus between 6 months and one year of life. In the other age groups, adherence to MD and its beneficial effects in terms of obesity prevention has been extensively investigated, however, there are still few studies that correlate this dietary style with the incidence of non-communicable diseases. Furthermore, research on multi-intervention strategy should be implemented, especially regarding the role of education of children and families in taking up this healthy dietary style. Full article
(This article belongs to the Special Issue Complementary Feeding in Newborns)
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8 pages, 1839 KiB  
Case Report
Rapid Weight Loss and Severe Failure to Thrive Mimicking Lipodystrophy Syndrome in a 1-Year-Old Taiwanese Girl with Costello Syndrome
by Yu-Min Syu, Hung-Chang Lee, Jui-Hsing Chang, Chung-Lin Lee, Chih-Kuang Chuang, Huei-Ching Chiu, Ya-Hui Chang, Hsiang-Yu Lin and Shuan-Pei Lin
Children 2022, 9(6), 905; https://doi.org/10.3390/children9060905 - 16 Jun 2022
Cited by 1 | Viewed by 2029
Abstract
Costello syndrome (CS) is a type of RASopathy caused mainly by de-novo heterozygous pathogenic variants in the HRAS gene located on chromosome 11p15.5. The phenotype of CS is characterized by prenatal overgrowth, postnatal failure to thrive, curly or sparse fine hair, coarse facial [...] Read more.
Costello syndrome (CS) is a type of RASopathy caused mainly by de-novo heterozygous pathogenic variants in the HRAS gene located on chromosome 11p15.5. The phenotype of CS is characterized by prenatal overgrowth, postnatal failure to thrive, curly or sparse fine hair, coarse facial features, and multisystem involvement, including cardiovascular, endocrine, and gastroenterological disorders. We present a one-year-old girl with rapid weight loss and severe failure to thrive. She had gastroesophageal reflux at the age of four months with subsequent rapid weight loss. The loss of fat tissue over the whole body, refractory to a hypercaloric diet, mimicked the presentation of progressive lipodystrophy and masked the dysmorphic features of CS. The final diagnosis of CS was made by whole exome sequencing, which demonstrated a hot-spot, heterozygouspathogenic variant in the HRAS gene (c.34G > A, rs104894229). Our patient illustrates that the excessive energy needs in CS patients may lead to severe failure to thrive and cause challenges in diagnosing CS. This case also highlights the importance of recognizing CS in patients with a history of prenatal overgrowth, polyhydramnios presenting with severe failure to thrive refractory to pharmacotherapy and tube feeding. Full article
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11 pages, 270 KiB  
Review
Posterior Fossa Tumor Rehabilitation: An Up-to-Date Overview
by Daniela Pia Rosaria Chieffo, Federica Lino, Valentina Arcangeli, Federica Moriconi, Paolo Frassanito, Luca Massimi and Gianpiero Tamburrini
Children 2022, 9(6), 904; https://doi.org/10.3390/children9060904 - 16 Jun 2022
Cited by 6 | Viewed by 2248
Abstract
This narrative review highlights the latest achievements in the field of post-surgical rehabilitation of posterior fossa tumors. Studies investigating the effects of cognitive rehabilitation programs have been considered, following a comprehensive literature search in the scientific electronic databases: Pubmed, Scopus, Plos One, and [...] Read more.
This narrative review highlights the latest achievements in the field of post-surgical rehabilitation of posterior fossa tumors. Studies investigating the effects of cognitive rehabilitation programs have been considered, following a comprehensive literature search in the scientific electronic databases: Pubmed, Scopus, Plos One, and ScienceDirect. This review investigates the effects of cognitive remediation, with specific highlights for single cognitive domains. The results revealed that in spite of the increasing number of children who survive into adulthood, very few studies investigated the effects of rehabilitation programs in this specific population. This study details new, promising therapeutic opportunities for children after brain surgery. More research in this filed is needed to identify the most effective protocols for clinical use. Full article
(This article belongs to the Section Child Neurology)
11 pages, 435 KiB  
Article
Dental Caries, Oral Health Behavior, and Living Conditions in 6–8-Year-Old Romanian School Children
by Ramona Dumitrescu, Ruxandra Sava-Rosianu, Daniela Jumanca, Octavia Balean, Lia-Raluca Damian, Guglielmo Giuseppe Campus, Laurentiu Maricutoiu, Vlad Tiberiu Alexa, Ruxandra Sfeatcu, Constantin Daguci, Mariana Postolache and Atena Galuscan
Children 2022, 9(6), 903; https://doi.org/10.3390/children9060903 - 16 Jun 2022
Cited by 10 | Viewed by 3415
Abstract
Dental caries still have a high prevalence in Romania. The aim of this paper is to determine the prevalence of caries in children (aged 6 to 8 years) correlated with individual-level predictors and socio-economic variables. A stratified, randomized nationally representative sample was established, [...] Read more.
Dental caries still have a high prevalence in Romania. The aim of this paper is to determine the prevalence of caries in children (aged 6 to 8 years) correlated with individual-level predictors and socio-economic variables. A stratified, randomized nationally representative sample was established, taking into consideration the total number of preschool children and based on administrative units and residence. Self-assessment was performed by means of the Oral Health Questionnaire for Children (WHO). Examinations were conducted by 10 standardized examiners, with International Caries Detection and Assessment System (ICDAS) caries codes higher than 3 considered as dentinal caries, missing teeth as MT, and restorations as FT. DMFT and SiC indexes were calculated accordingly. The dataset for each outcome variable was analyzed by the Hurdle approach analyzed. The gender distribution was similar (47.22% male and 52.78% female), with 42.65% residing in rural areas. The mean DMFT value for the sample was 4.89 and SiC index 9.83. A negative association could be seen between DMFT and the father’s level of education (β = −0.33, SE = 0.07, p < 0.01) as well as the mother’s education (β = −0.25, SE = 0.07, p < 0.01). In conclusion, caries prevalence is very high in Romania as compared to the World Health Organization (WHO) recommendation for this age group in correlation with socio-economic factors and oral health behavior. Full article
(This article belongs to the Special Issue Pediatric Oral Health)
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15 pages, 3207 KiB  
Article
Antimicrobial Stewardship Improvement in Pediatric Intensive Care Units in Spain—What Have We Learned?
by Elena Fresán-Ruiz, Ana Carolina Izurieta-Pacheco, Mònica Girona-Alarcón, Juan Carlos de Carlos-Vicente, Amaya Bustinza-Arriortua, María Slocker-Barrio, Sylvia Belda-Hofheinz, Montserrat Nieto-Moro, Sonia María Uriona-Tuma, Laia Pinós-Tella, Elvira Morteruel-Arizcuren, Cristina Schuffelmann, Yolanda Peña-López, Sara Bobillo-Pérez, Iolanda Jordan and on behalf of the Pediatric-ENVIN-HELICS Study Group
Children 2022, 9(6), 902; https://doi.org/10.3390/children9060902 - 16 Jun 2022
Cited by 3 | Viewed by 1887
Abstract
Antibiotic misuse in pediatric intensive care units (PICUs) can lead to increased antimicrobial resistance, antibiotic-triggered side effects, hospital costs, and mortality. We performed a multicenter, prospective study, analyzing critically ill pediatric patients (≥1 month to ≤18 years) admitted to 26 Spanish PICUs over [...] Read more.
Antibiotic misuse in pediatric intensive care units (PICUs) can lead to increased antimicrobial resistance, antibiotic-triggered side effects, hospital costs, and mortality. We performed a multicenter, prospective study, analyzing critically ill pediatric patients (≥1 month to ≤18 years) admitted to 26 Spanish PICUs over a 3-month period each year (1 April–30 June) from 2014–2019. To make comparisons and evaluate the influence of AMS programs on antibiotic use in PICUs, the analysis was divided into two periods: 2014–2016 and 2017–2019 (once 84% of the units had incorporated an AMS program). A total of 11,260 pediatric patients were included. Total antibiotic prescriptions numbered 15,448 and, overall, 8354 patients (74.2%) received at least one antibiotic. Comparing the two periods, an increase was detected in the number of days without antibiotics in patients who received them divided by the number of days in PICUs, for community-acquired infections (p < 0.001) and healthcare-associated infections (HAIs) acquired in PICUs (p < 0.001). Antibiotics were empirical in 7720 infections (85.6%), with an increase in appropriate antibiotic indications during the second period (p < 0.001). The main indication for antibiotic adjustment was de-escalation, increasing in the second period (p = 0.045). Despite the high rate of antibiotic use in PICUs, our results showed a significant increase in appropriate antibiotic use and adjustment following the implementation of AMS programs. Full article
(This article belongs to the Special Issue Diagnostic and Antimicrobial Stewardship in Pediatrics)
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7 pages, 205 KiB  
Article
Caregiver Perspectives on Patient Participation in Biological Pediatric Cancer Research
by Nicole E. Kendel, Jennifer A. Belsky, Joseph R. Stanek, Keri A. Streby and Nilay Shah
Children 2022, 9(6), 901; https://doi.org/10.3390/children9060901 - 16 Jun 2022
Viewed by 1439
Abstract
Adolescent cancer patients and their caregivers have demonstrated willingness to participate in invasive biological sampling, either for their own potential benefit or for research purposes. However, many malignancies occur primarily in prepubescent patients and there are no similar studies in this population. Our [...] Read more.
Adolescent cancer patients and their caregivers have demonstrated willingness to participate in invasive biological sampling, either for their own potential benefit or for research purposes. However, many malignancies occur primarily in prepubescent patients and there are no similar studies in this population. Our study objective was to assess the willingness of caregivers to consent to research studies involving invasive biological sampling in children ≤ 13 years of age. Participants completed a survey assessing their willingness to allow various procedures both with and without clinical benefit to their children. Most respondents were willing to allow additional blood draws regardless of potential benefit to their children (95.6% were willing when there would be benefits and 95.6% were willing when there would not). Although the overall willingness was lower with other hypothetical procedures, the majority of respondents were still willing to allow additional biopsies for research purposes. Caregivers of young children with cancer will allow their children to undergo additional invasive procedures for research purposes. This willingness decreased with more invasive procedures without potential direct benefit, but interest remained in more than half of participants. Caregivers for young patients with cancer should be approached for participation in future biological/correlative studies. Full article
(This article belongs to the Section Oncology and Hematology)
12 pages, 603 KiB  
Article
Parent-Reported Perceived Cognitive Functioning Identifies Cognitive Problems in Children Who Survived Neonatal Critical Illness
by Yerel Ilik, Hanneke IJsselstijn, Saskia J. Gischler, Annabel van Gils-Frijters, Johannes M. Schnater and Andre B. Rietman
Children 2022, 9(6), 900; https://doi.org/10.3390/children9060900 - 16 Jun 2022
Cited by 4 | Viewed by 1469
Abstract
Children with congenital anatomical foregut anomalies and children treated with neonatal extracorporeal membrane oxygenation (ECMO) are at risk for neurocognitive morbidities. We evaluated the association between the parent-reported pediatric perceived cognitive functioning (PedsPCF) questionnaire and the parent-reported behavior rating inventory of executive function [...] Read more.
Children with congenital anatomical foregut anomalies and children treated with neonatal extracorporeal membrane oxygenation (ECMO) are at risk for neurocognitive morbidities. We evaluated the association between the parent-reported pediatric perceived cognitive functioning (PedsPCF) questionnaire and the parent-reported behavior rating inventory of executive function (BRIEF) as well as neuropsychological assessments (NPA). We included 8-, 12- and 17-year-old participants who had joined a prospective follow-up program between 2017 and 2019. Self- and parental proxy-reported PedsPCF and proxy-reported BRIEF scores and their mutual association were evaluated. In total, 168 participants were included. Self- and proxy-reported PedsPCF scores were significantly below normal (mean (SD) z-score: −0.35 (0.88), p < 0.001; −0.36 (1.06), p < 0.001, respectively). Total BRIEF scores were significantly above normal (mean (SD) z-score 0.33 (0.98), p < 0.001). Proxy-reported PedsPCF scores and the Metacognition Index subscores of the BRIEF correlated strongly (τ = 0.551, p < 0.001). Self-reported PedsPCF scores were not associated with NPA test scores. Proxy-reported PedsPCF scores were positively associated with multiple NPA test scores, especially intelligence (R2 = 0.141). The proxy-reported PedsPCF revealed cognitive problems more often than the BRIEF in school-aged children who had survived neonatal critical illness. The proxy-reported PedsPCF may support clinical decision-making regarding the need for extensive neuropsychological assessments. Full article
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10 pages, 959 KiB  
Article
Diagnostic Performance of Height-Estimated Baseline Creatinine in Diagnosing Acute Kidney Injury in Children with Type 1 Diabetes Mellitus Onset
by Stefano Guarino, Giulio Rivetti, Anna Di Sessa, Maeva De Lucia, Pier Luigi Palma, Emanuele Miraglia del Giudice, Cesare Polito and Pierluigi Marzuillo
Children 2022, 9(6), 899; https://doi.org/10.3390/children9060899 - 16 Jun 2022
Cited by 3 | Viewed by 1573
Abstract
At type 1 diabetes mellitus (T1DM) onset, acute kidney injury (AKI) is very common. To diagnose AKI, the availability of a baseline serum creatinine (bSCr) is pivotal. However, in most hospitalized children the bSCr is unknown. We aimed to test whether the bSCr [...] Read more.
At type 1 diabetes mellitus (T1DM) onset, acute kidney injury (AKI) is very common. To diagnose AKI, the availability of a baseline serum creatinine (bSCr) is pivotal. However, in most hospitalized children the bSCr is unknown. We aimed to test whether the bSCr estimated on the basis of height (ebSCr) could be a reliable surrogate for AKI diagnosis compared with the measured bSCr (mbSCr). As the mbSCr, we considered the creatinine measured 14 days after T1DM onset while ebSCr (mg/dL) = (k × height [cm])/120 mL/min/1.73 m2, where k = 0.55 for children and adolescent girls and k = 0.7 for adolescent boys. AKI was defined as serum creatinine values >1.5 times the baseline creatinine. Kappa statistics and the percentage of agreement in AKI classification by ebSCr–AKI versus mbSCr–AKI definition methods were calculated. Bland–Altman plots were used to show the agreement between the creatinine ratio (highest/baseline creatinine; HC/BC) calculated with mbSCr and ebSCr. The number of 163 patients with T1DM onset were included. On the basis of mbSCr, 66/163 (40.5%) presented AKI while, on the basis of ebSCr, 50/163 (30.7%) accomplished AKI definition. ebSCr showed good correlation with mbSCr using both the Spearman test (rho = 0.67; p < 0.001) and regression analysis (r = 0.68; p < 0.001). Moreover, at the Bland–Altman plots, the bias of the highest/baseline creatinine ratio calculated on the basis of the mbSCr compared to ebSCr was minimal (bias = −0.08 mg/dL; 95% limits of agreement = −0.23/0.39). AKI determined using ebSCr showed 90% agreement with AKI determined using mbSCr (kappa = 0.66; p < 0.001). Finally, we compared the area under a receiver–operating characteristic curve (AUROC) of HC/BC ratio calculated on the basis of ebSCr with AUROC of the gold standard HC/BC ratio calculated on the basis of mbSCr. As expected, the gold standard had an AUROC = 1.00 with a 95% confidence interval (CI) between 0.98 and 1.00, p < 0.001. The HC/BC ratio calculated on the basis of ebSCr also had significant AUROC (AUROC = 0.94; 95% CI: 0.90–0.97; p < 0.001). The comparison of the two ROC curves showed a p < 0.001. In conclusion, when mbSCr is unknown in patients with T1DM onset, the ebSCr calculated on the basis of height could be an alternative to orientate clinicians toward AKI diagnosis. Full article
(This article belongs to the Section Pediatric Nephrology)
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7 pages, 395 KiB  
Article
pFOE or pFTOE as an Early Marker for Impaired Peripheral Microcirculation in Neonates
by Nina Hoeller, Christina H. Wolfsberger, Daniel Pfurtscheller, Corinna Binder-Heschl, Bernhard Schwaberger, Berndt Urlesberger and Gerhard Pichler
Children 2022, 9(6), 898; https://doi.org/10.3390/children9060898 - 16 Jun 2022
Cited by 1 | Viewed by 2187
Abstract
Background: Peripheral-muscle-fractional-oxygen-extraction (pFOE) and peripheral-muscle-fractional-tissue-oxygen-extraction (pFTOE) are often equated, since both parameters are measured with near-infrared-spectroscopy (NIRS) and estimate oxygen extraction in the tissue. The aim was to investigate the comparability of both parameters and their potential regarding detection of impaired microcirculation. Methods: [...] Read more.
Background: Peripheral-muscle-fractional-oxygen-extraction (pFOE) and peripheral-muscle-fractional-tissue-oxygen-extraction (pFTOE) are often equated, since both parameters are measured with near-infrared-spectroscopy (NIRS) and estimate oxygen extraction in the tissue. The aim was to investigate the comparability of both parameters and their potential regarding detection of impaired microcirculation. Methods: Term and preterm neonates with NIRS measurements of upper (UE) and lower extremities (LE) were included. pFOE was calculated out of peripheral-muscle-mixed-venous-saturation (pSvO2), measured with NIRS and venous occlusion, and arterial oxygen saturation (SpO2). pFTOE was calculated out of peripheral-muscle-tissue-oxygen-saturation and SpO2. Both parameters were compared using Wilcoxon-Signed-Rank-test and Bland–Altman plots. Results: 341 NIRS measurements were included. pFOE was significantly higher than pFTOE in both locations. Bland–Altman plots revealed limited comparability, especially with increasing oxygen extraction with higher values of pFOE compared to pFTOE. Conclusion: The higher pFOE compared to pFTOE suggests a higher potential of pFOE to detect impaired microcirculation, especially when oxygen extraction is elevated. Full article
(This article belongs to the Special Issue Stabilization and Resuscitation of Newborns: 2nd Edition)
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6 pages, 199 KiB  
Article
Laryngeal Mask Ventilation during Neonatal Resuscitation: A Case Series
by Lauren White, Katelyn Gerth, Vicki Threadgill, Susan Bedwell, Edgardo G. Szyld and Birju A. Shah
Children 2022, 9(6), 897; https://doi.org/10.3390/children9060897 - 16 Jun 2022
Cited by 4 | Viewed by 1996
Abstract
Positive pressure ventilation via a facemask is a critical step in neonatal resuscitation but may be a difficult skill for frontline providers or trainees to master. A laryngeal mask is an alternative to endotracheal intubation for some newborns who require an advanced airway. [...] Read more.
Positive pressure ventilation via a facemask is a critical step in neonatal resuscitation but may be a difficult skill for frontline providers or trainees to master. A laryngeal mask is an alternative to endotracheal intubation for some newborns who require an advanced airway. We present the first case series in the United States in which a laryngeal mask was successfully utilized during resuscitation of newborns greater than or equal to 34 weeks’ gestation following an interdisciplinary quality improvement collaborative and focused training program. Full article
(This article belongs to the Special Issue Advances in Neonatal Resuscitation)
10 pages, 2308 KiB  
Article
Parathyroid Hormone-Related Peptide (PTHrP): Evaluation of Pediatric, Covariate-Stratified Reference Intervals
by Vincenzo Brescia, Antonietta Fontana, Roberto Lovero, Carmela Capobianco, Stella Vita Marsico, Tiziana De Chirico, Carla Pinto, Elisa Mascolo, Angela Pia Cazzolla, Maria Felicia Faienza and Francesca Di Serio
Children 2022, 9(6), 896; https://doi.org/10.3390/children9060896 - 15 Jun 2022
Cited by 2 | Viewed by 1926
Abstract
Parathyroid hormone-related peptide (PTHrP) is expressed at a wide range of sites in the body and performs different functions including vasodilation, relaxation of smooth muscle cells, and regulation of bone development. PTHrP also mediates hypercalcemia related to neoplastic diseases. However, reference ranges specific [...] Read more.
Parathyroid hormone-related peptide (PTHrP) is expressed at a wide range of sites in the body and performs different functions including vasodilation, relaxation of smooth muscle cells, and regulation of bone development. PTHrP also mediates hypercalcemia related to neoplastic diseases. However, reference ranges specific method and age were not evaluated. We establish PTHrP reference ranges in apparently healthy, normocalcemic, normophosphatemic pediatric individuals. In this observational prospective, study we measured PTHrP in serum from 178 samples (55.06% male 44.94% female) from apparently healthy pediatric subjects [median age 10 years (range 1–18)] subunit ELISA method The statistical analysis performed provided for the calculation of the 95% reference interval, right-sided, with a non-parametric percentile method (CLSI C28-A3). Upper reference limits (URL) for PTHrP was 2.89 ng/mL (2.60 to 3.18; 90% CI). No significant differences were found between the median PTHrP concentrations in males vs females and in the age range categories selected. Comprehensive normal values for PTHrP are indispensable to the assessment of calcium phosphorus dysfunction in children. Severe hypercalcemia is a rare, but clinically significant condition, in infancy and childhood. PTHrP values higher than the reference value may help to distinguish the hypercalcemic product of a malignancy, paraneoplastic syndromes mediated by PTHrP, from other causes. Full article
(This article belongs to the Special Issue Bone Development and Disease in Infants (Volume II))
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