Frontiers in Pediatrics最新文献

{"title":"Invasive procedures and atraumatic care in pediatric nursing practice: nurses' perceptions.","authors":"Júlia Neto, Rita Fernandes, Luísa Andrade, Ilda Fernandes, Teresa Martins, Maria do Céu Barbieri-Figueiredo, Fernanda Carvalho, Lígia Lima","doi":"10.3389/fped.2025.1543138","DOIUrl":"https://doi.org/10.3389/fped.2025.1543138","url":null,"abstract":"<p><strong>Introduction: </strong>Invasive procedures in pediatric nursing practice require a child-centered approach to minimize pain levels associated with manifestations of stress, anxiety, and long-term traumatic reactions.</p><p><strong>Method: </strong>This cross-sectional study aimed at identifying nurses' perception of stress, anxiety, and pain levels in children and adolescents (0-18 years) undergoing invasive procedures, and strategies used to minimize the associated distress. Based on a literature review, an online questionnaire was developed that evaluates the distress associated with frequent invasive procedures and strategies used to reduce discomfort.</p><p><strong>Results: </strong>Participants were 157 nurses who provided nursing care to children in all types of healthcare settings, such as hospitals and community health centers. Nurses evaluated lumbar puncture and catheter insertion as the procedures that caused more stress, anxiety, and pain in all age groups. ANOVA and <i>post-hoc</i> analyses indicate that nurses perceived adolescents as experiencing less stress than children in all the invasive procedures. Pediatric specialist nurses perceived a significantly higher total level of distress (an index that indicates stress, anxiety or pain in the whole group of procedures) compared to nurses with other specialties or generalist nurses, in all age groups. Non-pharmacological strategies were the most frequently used strategies used by nurses for minimizing distress in children, including distraction (51.2%), preparation (30.7%), and sensory techniques (14.6%). Pharmacological strategies, such as topical anesthetics and light sedation, were less frequently used.</p><p><strong>Conclusion: </strong>This study highlights the importance of specialized training and knowledge concerning strategies to reduce distress in pediatric invasive procedures, suggesting the need for more significant investment in education and support for nursing professionals to improve patient experience.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"13 ","pages":"1543138"},"PeriodicalIF":2.1,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12119488/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144180225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A structured comparison and reflection on international position statements and professional guidance for the management of periviable infants.","authors":"J Peterson, G Southwood, D M Smith, E D Johnstone, A Mahaveer","doi":"10.3389/fped.2025.1553033","DOIUrl":"https://doi.org/10.3389/fped.2025.1553033","url":null,"abstract":"<p><strong>Background: </strong>Survival rates and clinical approach to periviable infants are rapidly evolving at certain centres, but there remains variation in definition, approach and management of these infants worldwide. This review aims to narratively review and discuss professional guidelines, position statements and frameworks for management of periviable infants (22 + 0-25 + 0 weeks gestation) born in countries with the highest relative spending on healthcare.</p><p><strong>Methods: </strong>Eligible countries were determined using the Organisation for Economic Co-operation and Development database. The top 10 countries with highest spend on healthcare as a proportion of their gross domestic profit were selected. A comprehensive search of relevant databases and search engines (MEDLINE, Embase, CINAHL, PsycINFO, Google Scholar) was performed to identify professional guidance documents for each eligible country. The primary outcome was the delivery room management recommendation (survival-focused or end of life care). The secondary outcomes were survival rates, disability rates and whether shared decision-making with parents was recommended.</p><p><strong>Results: </strong>There was variation in definition of periviable and approach to management across the 10 professional guidelines. There was a four-week difference across countries for where the limits of viability lie (22 + 0-25 + 6 weeks). At 22-weeks, eight guidelines recommended comfort care and only one country recommending active care as the default management position at birth. By 24-weeks gestation, no country recommended comfort care as the standard approach at birth.</p><p><strong>Discussion: </strong>Despite the included countries having the highest spend on healthcare as a proportion of their GDP, there is marked international variation in recommended practice in relation to the definition of and management for periviable infants. The majority of included guidelines recommended a shared decision-making approach between professionals and parents facing periviable birth, however, there were scant details about how this should be actualized and only two guidelines included decision-making aids for use with parents. The pre-birth discussion between perinatal professionals and parents facing periviable labour is complex and challenging for all involved. Further research is required to explore how best to facilitate parental understanding and involvement in these discussions to ensure parents are empowered to make the most appropriate decisions for their baby and their family.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"13 ","pages":"1553033"},"PeriodicalIF":2.1,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12119558/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144179956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A network analysis of timing and conditions present at time of death for periviable infants (22+0-23+6 weeks) admitted to neonatal intensive care after receiving survival-focused care at birth.","authors":"J Peterson, D M Smith, E D Johnstone, K Harvey, A Mahaveer","doi":"10.3389/fped.2025.1552352","DOIUrl":"https://doi.org/10.3389/fped.2025.1552352","url":null,"abstract":"<p><strong>Introduction: </strong>Advances in neonatal care have resulted in improved survival rates for periviable infants (22 + 0-23 + 6 weeks) with increasing numbers being admitted to neonatal intensive care units across the United Kingdom. Qualitative research evidences the conflict perinatal professionals experience traversing the line between providing life-sustaining treatment to these infants, whilst not wanting to inflict a prolonged period of suffering to infants who will ultimately die. Professionals currently lack adequate prognostic tools to accurately predict pre-birth which infants will survive.</p><p><strong>Methods: </strong>This study utilises an anonymised dataset from the North West Neonatal Network to delineate time of death profiles for periviable infants admitted to neonatal intensive care units (NICU) and explores the demographics, timing and diagnoses recorded at the time of the death.</p><p><strong>Results: </strong>The data show that most periviable infants who died following admission to NICU died within the first seven days after birth [24 infants born at 22 weeks (65%) and 55 infants born at 23 weeks (52%)]. For infants born at 22 weeks who subsequently died on NICU, 89% had died within 14 days after birth. Reorientation of care was recorded as a relevant factor at the time of death in a minority of patients [23 infants (16%)].</p><p><strong>Discussion: </strong>Where active, survival-focused care has been initiated, the response of the infant to intensive care and the likelihood of their survival emerges over a relatively short timeframe after admission. This lends support to a trial of therapy approach for suitable periviable infants balancing the need to avoid iatrogenic harm to infants who will ultimately die despite intensive care, whilst not denying them the chance at survival. Management of periviable deliveries requires coordinated parallel planning and a high-quality palliative care approach throughout.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"13 ","pages":"1552352"},"PeriodicalIF":2.1,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12120172/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144179948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Congenital duodenal diaphragm with heterotopic pancreas: a case report and literature review.","authors":"Jinghui Song, Suolin Li, Weili Xu, Chi Sun, Yanbin Fang, Bingzheng Gao, Meng Li","doi":"10.3389/fped.2025.1590865","DOIUrl":"https://doi.org/10.3389/fped.2025.1590865","url":null,"abstract":"<p><p>This case report presents a laparoscopic surgery performed at The Second Hospital of Hebei Medical University for a patient with congenital duodenal diaphragm complicated by heterotopic pancreas (HP). The utilization of indocyanine green (ICG) molecular fluorescent imaging technology and the suspension traction method for duodenal obstruction points during the procedure demonstrates the potential for reducing operational complexity and enhancing surgical success rates. Postoperative feeding via a nasojejunal tube is shown to facilitate rapid restoration of enteral nutrition, mitigate postoperative complications, and decrease the duration of hospitalization.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"13 ","pages":"1590865"},"PeriodicalIF":2.1,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12121369/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144180111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Two case reports of B-cell lymphopenia associated with <i>IGLL1</i> variants identified through newborn screening in Ukraine.","authors":"Oksana Boyarchuk, Yaryna Romanyshyn, Ihor Savchak, Volodymyr Kravets, Ivanna Shymanska, Halyna Makukh","doi":"10.3389/fped.2025.1566867","DOIUrl":"https://doi.org/10.3389/fped.2025.1566867","url":null,"abstract":"<p><p>Before the implementation of newborn screening (NBS), only a few cases of agammaglobulinemia associated with <i>IGLL1</i> variants had been reported. The <i>IGLL1</i> gene encodes the surrogate light chain components <i>λ</i>5 and VpreB, which form a crucial part of the pre-B cell receptor complex. A recently published study reported 17 cases of agammaglobulinemia caused by <i>IGLL1</i> variants, the vast majority of which were identified through NBS. Here, we report two cases of B-cell lymphopenia along with <i>IGLL1</i> variants identified through NBS in Ukraine. Both neonates had undetectable KREC and normal TREC levels at birth. Despite the presence of B-cell lymphopenia, only one patient exhibited a transient decline in IgG levels. IgA and IgM levels remained normal during the first year of follow-up, which had not been reported in previous <i>IGLL1</i> cases. Both children presented with mild upper respiratory tract infections. Genetic analysis revealed that both patients carried the c.425C > T variant, with one patient also harboring the c.258del variant. These variants have been linked to B-cell lymphopenia and low KREC levels in prior studies. Two additional variants were identified on the second chromosome: c.368C > G, which is predicted to be tolerated, and c.377T > C, which is likely disruptive. This study highlights the potential underdiagnosis of B-cell lymphopenia caused by <i>IGLL1</i> variants. Moreover, the comparison between clinically diagnosed cases and those identified through NBS underscores the importance of early diagnosis that facilitates close monitoring of affected patients from birth, timely initiation of immunoglobulin replacement therapy, and the prevention of complications and severe manifestations.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"13 ","pages":"1566867"},"PeriodicalIF":2.1,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12119295/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144179973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Partial quadrate lobectomy improves early outcomes of laparoscopic Kasai surgery in type III biliary atresia.","authors":"Chunhui Gu, Jian Sun, Lihong Ding, Bing Li, Guoqing Jiang, Youcheng Zhang","doi":"10.3389/fped.2025.1541455","DOIUrl":"https://doi.org/10.3389/fped.2025.1541455","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the early efficacy and safety of partial quadrate lobectomy during laparoscopic Kasai surgery for type III biliary atresia.</p><p><strong>Methods: </strong>This retrospective study included 25 children diagnosed with type III biliary atresia, who underwent laparoscopic Kasai surgery between February 2018 and July 2022. Patients were divided into two groups: one with partial quadrate lobectomy and the other without. Data collected included age, gender, weight, incidence of cholangitis before and after surgery, one-year native liver survival, intraoperative blood loss, surgery duration, and jaundice clearance at 6 and 12 months. Follow-up results were compared between the groups.</p><p><strong>Results: </strong>The partial quadrate lobectomy group (14 patients) had a mean weight of 5.50 kg and average age of 66.79 days, while the control group (11 patients) had a similar weight (5.50 kg) and a mean age of 71.09 days. Weight comparison showed no significant difference (5.50 kg vs. 5.50 kg, <i>P</i> = 0.427). One-year postoperative native liver survival was 9/14 in the partial quadrate lobectomy group vs. 6/11 in the control group (<i>P</i> = 0.654).Intraoperative blood loss was similar between groups (<i>P</i> > 0.05), but the shorter operative time (301 vs. 347 min) associated with partial quadrate lobe resection may reduce anesthesia-related risks in infants, particularly given their limited physiological reserve. The reduced cholangitis rate (29% vs. 73%) aligns with prior reports suggesting that improved hilar exposure facilitates more precise dissection of fibrotic remnants, potentially minimizing postoperative bile stasis and infection. Jaundice clearance (defined as TBIL <20 μmol/L) was achieved in 8/14 (57.1%) of the partial quadrate lobectomy group vs. 3/11 (27.3%) in the control group at 6 months (<i>P</i> = 0.025), and 10/14 (71.4%) vs. 4/11 (36.4%) at 12 months (<i>P</i> = 0.031). The lower TBIL levels (5.11 vs. 9.67 mg/dl) at 6 months suggest enhanced bile drainage efficacy, which is critical for delaying or avoiding liver transplantation in this population.</p><p><strong>Conclusion: </strong>Partial quadrate lobectomy during laparoscopic Kasai surgery reduces operation time, lowers cholangitis incidence, and improves jaundice clearance rates without increasing intraoperative blood loss or adversely affecting one-year native liver survival. It is a safe and feasible adjunct to improve early postoperative outcomes.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"13 ","pages":"1541455"},"PeriodicalIF":2.1,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12116595/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144173485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The health-related quality of life in children with IgA vasculitis.","authors":"Juan Zhou, Min Nie, Zixia Song, Xing Shen","doi":"10.3389/fped.2025.1534687","DOIUrl":"https://doi.org/10.3389/fped.2025.1534687","url":null,"abstract":"<p><strong>Introduction: </strong>The objective of this study was to investigate the health-related quality of life (HRQOL) in children diagnosed with IgAV and explore factors influencing it, aiming to provide insights for rehabilitation of these children.</p><p><strong>Methods: </strong>This study enrolled 114 children diagnosed with IgAV at Bazhong Central Hospital between January 2019 and January 2023. 51 healthy children undergoing health check-ups during the same period were enrolled in control group. Data on sociodemographic and clinical characteristics, as well as health-related quality of life scores, were collected. The Pediatric Quality of Life Inventory Measurement Models 4.0 (PedsQL™ 4.0) was utilized to assess the HRQOL of these children and to explore correlations among different dimensions of quality of life. General linear regression models were applied to analysis of influencing factors of the HRQOL of children with IgAV.</p><p><strong>Results: </strong>The health-related quality of life scores in all dimensions for children with IgAV were lower compared to those of healthy children. Recurrence of IgAV was negatively correlated with all dimension scores and the total HRQOL score (<i>P</i> < 0.05). Children with exercise-induced onset showed lower physiological functioning scores compared to those without exercise-induced onset. Emotional functioning scores were lower in children with self-funded medical care compared to those with Medicare. Children with medication duration longer than 1 week exhibited higher social functioning scores.</p><p><strong>Conclusions: </strong>The HRQOL of IgAV children is lower than that of healthy children. Relapse, exercise, the payment method and regularity of medications affect children's health-related quality of life.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"13 ","pages":"1534687"},"PeriodicalIF":2.1,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12116574/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144173525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial: Reviews in neonatology 2024.","authors":"Thangaraj Abiramalatha, Giuseppe De Bernardo","doi":"10.3389/fped.2025.1619870","DOIUrl":"https://doi.org/10.3389/fped.2025.1619870","url":null,"abstract":"","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"13 ","pages":"1619870"},"PeriodicalIF":2.1,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12116339/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144173497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Erratum: Prenatal echocardiographic diagnosis of a discontinuous left pulmonary artery with Taussig-Bing syndrome: a case report and literature review.","authors":"","doi":"10.3389/fped.2025.1620408","DOIUrl":"https://doi.org/10.3389/fped.2025.1620408","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.3389/fped.2024.1437500.].</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"13 ","pages":"1620408"},"PeriodicalIF":2.1,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12118466/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144173437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The influence of left-behind experiences on depression in single-parent adolescents: the mediating role of family satisfaction and the moderating effects of exercise frequency.","authors":"Wang-Cheng Cen, Jing Liang, Xiao-Han Zhang, Wen-Jing Yan, Jun Qian","doi":"10.3389/fped.2025.1573630","DOIUrl":"https://doi.org/10.3389/fped.2025.1573630","url":null,"abstract":"<p><p>With the rise of rural-to-urban labor migration, the number of left-behind children in single-parent families has increased, raising concerns about their mental health. This study examines the impact of left-behind experiences on depression in single-parent left-behind adolescents, particularly focusing on the mediating role of family satisfaction and the moderating effects of exercise frequency and separation age. Using cross-sectional data from the China Psychological Health Guardian Project (CPHG), which includes 23,523 single-parent left-behind adolescents aged 12-18, we collected data on left-behind experiences, depressive symptoms, family satisfaction, exercise frequency, and separation age through questionnaires. Correlation analysis, multiple regression, and moderated mediation models were employed to test the hypotheses. The findings indicate that left-behind experiences significantly predict depressive symptoms (<i>t</i> = 7.77, <i>p</i> < 0.001), and family satisfaction serves as a significant mediator in this relationship (Indirect effect = 0.261, <i>t</i> = 4.971, <i>p</i> < 0.001). Additionally, exercise frequency moderates the effect of family satisfaction on depression (<i>B</i> = 0.42, <i>t</i> = 3.681, <i>p</i> < 0.001), where higher exercise frequency lessens the negative impact of low family satisfaction on depression. These results highlight the crucial roles of family satisfaction and exercise frequency in reducing depressive symptoms among single-parent left-behind adolescents, suggesting that emotional support and regular exercise can enhance their mental health.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"13 ","pages":"1573630"},"PeriodicalIF":2.1,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12116426/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144173551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}