Frontiers in Pediatrics最新文献

{"title":"A case of complicated parapneumonic pleural effusion caused by paragonimus infection in a child was successfully treated by intrapleural injection of urokinase: a case report and literature review.","authors":"Yangyi Shi, Yan Li, Yu Hu","doi":"10.3389/fped.2025.1557273","DOIUrl":"10.3389/fped.2025.1557273","url":null,"abstract":"<p><strong>Objective: </strong>The clinical data of a child with complex parapneumonic effusion (PPE) caused by pneumofluke infection were analyzed, and the diagnosis and treatment of the disease were discussed through literature review. The effectiveness and safety of urokinase in the treatment of complex PPE and empyema caused by multiple pathogens were emphasized.</p><p><strong>Methods: </strong>A 3-year-old male child with pneumofluke infection was admitted to the pediatric department of Mianyang Central Hospital. Chest CT and chest ultrasound showed a right pleural effusion with dense septum formation. The condition was relieved after treatment with praziquantel for anti-infection, thoracic catheter drainage, and urokinase injection into pleural cavity. Through systematic literature search of Pubmed, Embase, CNKI, Wanfang and VIP Chinese databases, no cases of urokinase treatment of pleural effusion caused by pneumofluke infection were found.</p><p><strong>Results: </strong>A total of 150 ml thick yellow turbidous fluid was drained out of the pleural cavity, and the patient's symptoms and signs were significantly relieved. Reexamination of the chest CT showed that the right pleural effusion was significantly reduced and the right lung was significantly reexpanded. There were no complications such as bronchopleural fistula, pneumothorax, abnormal coagulation function, bleeding and fever during treatment.</p><p><strong>Conclusion: </strong>Thoracic catheter drainage combined with injection of urokinase is an effective and safe method for the treatment of complex PPE and empyema caused by pneumofluke infection in children. At the same time, the literature review showed that urokinase injection into pleural cavity was effective in the treatment of complex PPE and empyema caused by infection, trauma, tumor and other causes, and no obvious side effects occurred.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"13 ","pages":"1557273"},"PeriodicalIF":2.1,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12176747/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144332972","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":"Case Report: From diagnosis to therapy: a lung ultrasound-driven precision strategy for neonatal atelectasis management.","authors":"Qi Chen, Wei Xiong, Li Jun","doi":"10.3389/fped.2025.1584262","DOIUrl":"10.3389/fped.2025.1584262","url":null,"abstract":"<p><strong>Objective: </strong>To examine the clinical value of lung ultrasound (LUS) in the individualized management of neonatal atelectasis and assess its effectiveness in directing condition-specific treatment strategies.</p><p><strong>Methods: </strong>Three neonatal atelectasis cases with differing causes, pneumonia, pulmonary hemorrhage, and meconium aspiration syndrome, were treated with LUS-guided, personalized interventions. These included ultrasound-directed airway clearance, selective bronchoalveolar lavage, and high-frequency chest wall oscillation.</p><p><strong>Results: </strong>LUS enabled continuous, real-time assessment of atelectasis severity and distinct pathological signs such as hepatization and the shred sign. This imaging guidance allowed targeted therapies that shortened hospitalization by an average of 40%. In all cases, lung re-expansion was achieved without adverse events.</p><p><strong>Conclusion: </strong>Due to its lack of radiation, high sensitivity, and real-time feedback, LUS offers a valuable tool for guiding individualized, etiology-specific therapies in neonatal atelectasis. It presents a clinically adaptable approach for optimizing outcomes in this population.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"13 ","pages":"1584262"},"PeriodicalIF":2.1,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12176736/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144332974","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":"Case Report: Uncommon complications of central catheters in newborns: two cases of parenteral nutrition extravasation.","authors":"Carolina Coramusi, Jessica F Toro, Ramón G Pabón, Mario Barreto, Giovanni Di Nardo, Pasquale Parisi, Claudia C M Marín","doi":"10.3389/fped.2025.1602098","DOIUrl":"10.3389/fped.2025.1602098","url":null,"abstract":"<p><p>Central venous catheters (CVCs) are essential in neonatal care units to ensure prolonged venous access. Despite experienced CVC placement, managing fragile and small newborn vessels involves the risk of traumatic and iatrogenic complications. The most common include phlebitis, thrombosis, sepsis, and catheter displacement. Rarely, catheter displacement may lead to fluid accumulation around serous membranes and adjacent organs, which, if not identified early, can even result in neonatal death. We report two cases: one of neonatal hydrothorax with subsequent lung cystic formation after a parenteral nutrition leakage caused by the displacement of an Epicutaneo-Caval Catheter in the basilic vein of the left arm; the second involves a peritoneal collection of parenteral nutrition from the umbilical venous catheter.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"13 ","pages":"1602098"},"PeriodicalIF":2.1,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12176860/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144332976","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":"Heart rate variability and amplitude-integrated electroencephalography measured shortly after birth and time to reach clinical milestones: a pilot study in late preterm infants.","authors":"Birju A Shah, Samantha Latremouille, Sanjay Chawla, Martin Keszler, Richard Tucker, Abbot Laptook, Guilherme M Sant'anna","doi":"10.3389/fped.2025.1579197","DOIUrl":"10.3389/fped.2025.1579197","url":null,"abstract":"<p><strong>Background: </strong>Among late preterm (LPT) infants, there is significant variability in reaching milestones for safe discharge. We examined the associations of early measures of heart rate variability (HRV) and amplitude-integrated electroencephalogram (aEEG) with time to wean to an open-air cot and to achieve full oral feeds.</p><p><strong>Methods: </strong>This is a prospective, multicenter observational cohort study that enrolled infants between 34^0/7 and 34^6/7 weeks gestational age (GA). Infants with growth restriction and major congenital anomalies were excluded. Electrocardiogram (ECG) for 1 h and cross-cerebral aEEG for 6 h were recorded within 96 h after birth. Correlations of HRV and aEEG parameters with outcomes were evaluated using stepwise linear regression.</p><p><strong>Results: </strong>Of the 26 infants from three centers, 23 were included for analysis for time to an open-air cot. The analysis for time to full oral feeds was limited to 19 infants from two centers with similar feeding policies. Including HRV parameters (<i>time domain</i>, median and standard deviation of <i>R</i>-wave to <i>R</i>-wave interval; <i>frequency domain</i>, ratio of the low frequency to high frequency power and their interaction) and aEEG parameters (total and immature <i>cycles</i>/hour) strengthened associations with time to open-air cot (adjusted <i>R</i> ² = 0.72) and time to full oral feeds (adjusted <i>R</i> ² = 0.53) compared with each parameter alone.</p><p><strong>Conclusions: </strong>Early measurements of HRV and aEEG parameters correlate with time to an open-air cot and to achieve full oral feeds in LPT infants born between 34^0/7 and 34^6/7 weeks GA.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"13 ","pages":"1579197"},"PeriodicalIF":2.1,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12176856/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144332937","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":"Long-term outcomes and influencing factors following pediatric kidney transplantation: a single-center cohort study from China.","authors":"Junhao Yu, Xiaoju Sheng, Yuhong Li, Mingxing Sui, Jiazhao Fu, Li Zeng, Yanhua Li, Wenyu Zhao","doi":"10.3389/fped.2025.1599111","DOIUrl":"10.3389/fped.2025.1599111","url":null,"abstract":"<p><strong>Background: </strong>Kidney transplantation is recognized as the optimal treatment for end-stage kidney disease (ESKD) in children, which significantly improves growth delay, pubertal development, and social prognosis in pediatric patients. This study analyzed the long-term prognosis and influencing factors following pediatric kidney transplantation at our center.</p><p><strong>Methods: </strong>A total of 101 pediatric recipients who underwent kidney transplantation at our center were enrolled in this study. Post-transplant outcomes, including renal function, height development, pubertal progression, and social adaptation, were systematically analyzed.</p><p><strong>Results: </strong>The height-for-age Z-score (HAZ) significantly improved from -2.27 ± 1.64 at transplantation to -0.76 ± 1.13 after achieving post-transplant stability. The graft survival rates were 100% and 93.4% at 5 and 10 years post-transplantation, respectively, while patient survival rates remained 100% at both 5 and 10 years. At the last follow-up, the mean serum creatinine level was 83.85 ± 38.34 μmol/L, with an estimated glomerular filtration rate (eGFR) of 79.49 ± 27.25 ml/min/1.73 m². Among school-aged recipients, 93.75% successfully returned to school, while only 33.3% of those who completed their education achieved employment. Among male adolescents (13 years, <i>n</i> = 43), 37 cases (86.0%) experienced spermarche, with a mean age of 14.5 years in prepubertal transplant recipients. In the female cohort (<i>n</i> = 45), 42 patients (12 years) reached puberty, demonstrating a mean menarche age of 12.5 years in prepubertal recipients vs. 13.2 years in postpubertal transplants (<i>P</i> > 0.05). Menstrual irregularities were observed in 8 cases, accounting for 19.51% of menstruating females.</p><p><strong>Conclusion: </strong>This study demonstrates significant improvements in height development, pubertal progression, and social adaptation following kidney transplantation in pediatric recipients. While recipient gender, pre-transplant dialysis modality, and dialysis duration showed no significant impact on near-final height (NFH), both transplantation age and height at transplantation significantly influenced NFH attainment. These findings emphasize that early transplantation and maintaining optimal graft function are crucial for ameliorating growth delay and pubertal development, while also positively influencing long-term social outcomes in pediatric transplant recipients.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"13 ","pages":"1599111"},"PeriodicalIF":2.1,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12176831/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144332938","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":"Prevalence of sub-optimal feeding practices and associated factors in very low birth weight infants admitted to the special care unit, Kawempe Hospital in Uganda.","authors":"Lucy Amaniyo, Benbella Dektar, Victoria Nakibuuka, Jolly Nankunda, Robert Opoka, Sarah Kiguli","doi":"10.3389/fped.2025.1558163","DOIUrl":"10.3389/fped.2025.1558163","url":null,"abstract":"<p><strong>Background: </strong>Over 60% of Very Low Birth Weight (VLBW) infants worldwide are born in Sub-Saharan Africa and South Asia. VLBW infants are born nutritionally disadvantaged, as they are suddenly and prematurely moved from a nutrient-rich to a nutrient-deficient environment. Therefore, appropriate feeding during the early neonatal period is essential for the survival and growth of VLBW infants admitted to the special care unit of a Ugandan tertiary referral hospital.</p><p><strong>Methods: </strong>We conducted a prospective cohort study among VLBW infants admitted to the Special Care Unit at Kawempe National referral hospital in Kampala, Uganda. Stable infants with no gross abnormalities or in need of resuscitation were recruited on day two of life and followed up until day seven or to discharge or death, whichever came first. Data were collected on socio-demographic and clinical characteristics, including birth weight initiation of enteral feeds, type of feeds received, and method of feeding. Observed feeding practices were compared to recommended VLBW feeding standards for appropriateness. Infants were followed up until day 7 of life. Logistic regression analysis was used to determine the factors associated with sub-optimal feeding.</p><p><strong>Results: </strong>A total of 370 VLBW infants, with a mean gestational age of 32 weeks were enrolled. Overall, 333 (90%) had sub-optimal feeding and this was significantly associated with a sub-optimal rate of early weight change (growth velocity) [OR = 6.81, 95%, CI (2.74 to 16.97)]. Factors associated with sub-optimal feeding included: early initiation of enteral feeds [AOR = 11.03, 95%, CI (1.34 to 90.77)] and low scores on social support scale for the mother [AOR = 2.78, 95%, CI (1.14 to 6.82)].</p><p><strong>Conclusions: </strong>There is a very high prevalence of sub-optimal feeding practices for VLBW infants in this population. This calls urgent need for improved feeding practices, including early enteral feeding. Future studies should explore the long terms effects of this early sub-optimal feeding practices on growth and development within the first 48 h, barring contraindications.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"13 ","pages":"1558163"},"PeriodicalIF":2.1,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12176886/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144332940","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 value of DHR-enzyme-linked immunosorbent assay in the diagnosis of chronic granulomatous disease by detecting NADPH oxidase complex activity.","authors":"Wen Xiaohui, Zhao Shunying, Zhang Xiaoyan, Tang Xiaolei, Shen Yuelin, Liu Jinrong, Li Huimin, Liu Hui, Yang Haiming","doi":"10.3389/fped.2025.1483173","DOIUrl":"10.3389/fped.2025.1483173","url":null,"abstract":"<p><strong>Background: </strong>A rapid, easy, and accurate method for screening Chronic Granulomatous Disease (CGD) is crucial. This study aimed to propose and evaluate the effectiveness of the DHR-Enzyme-linked immunosorbent assay (DHR-ELISA) for assessing NADPH oxidase complex activity in the early screening of CGD.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of 72 children suspected of having CGD who underwent NADPH oxidase activity assessment and genetic testing at Beijing Children's Hospital between July 2015 and January 2022.</p><p><strong>Results: </strong>Of the subjects, 57 were male and 15 were female, resulting in a male-to-female ratio of 3.8:1. The median age at onset was 6 months, and the median age at diagnosis was 15 months. Thirty-eight patients were diagnosed with CGD based on typical clinical manifestations and genetic testing, exhibiting symptoms such as left lymphadenopathy or calcification (65.8%), a large Calmette-Guérin scar (60.5%), a history of skin or other lymph node infections (52.6%), and specific pulmonary infections (23.7%). Thirty-one patients exhibited normal enzyme activity, whereas 41 showed reduced activity. The DHR-ELISA method demonstrated a specificity of 90% and a sensitivity ranging from 90.5% to 100% in detecting CGD.</p><p><strong>Conclusion: </strong>The DHR-ELISA is a rapid, easy, cost-effective, and efficient method for screening CGD, making it suitable for early diagnosis and potentially improving prognosis.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"13 ","pages":"1483173"},"PeriodicalIF":2.1,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12176808/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144332988","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":"Differentiating primary bone marrow failure syndromes in children: a retrospective analysis of early clinical and laboratory features.","authors":"Yan-Li Leng, Yu-Qi Zhao, Hong-Juan Li, Yan Gu, Yan Han, GuYu Ding, Xiaoyue Zhang, Xu Li, Hui-Di Feng, ZiYun Lin, Xiao-Wei Zhao, Hong-Mei Wang","doi":"10.3389/fped.2025.1557212","DOIUrl":"10.3389/fped.2025.1557212","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the early clinical characteristics of different subtypes of primary bone marrow failure syndrome (BMFS) in children and identify predictive factors for early diagnosis, thereby improving the ability to differentiate BMFS at an early stage.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on the clinical and laboratory data of children with primary BMFS who received regular follow-up visits exceeding one year at the First Affiliated Hospital of Shandong First Medical University from January 2020 to September 2024. Based on long-term follow-up results, the children were reclassified into subgroups, and early clinical features, blood counts, and bone marrow examination results were compared across groups. Univariate and multivariate analyses were performed.</p><p><strong>Results: </strong>A total of 167 pediatric patients with primary BMFS were included in this study, of whom 112 (67.1%) were diagnosed with aplastic anemia (AA), 34 (20.3%) with refractory cytopenia (RCC), and 21 (12.6%) with idoipathic cytopenia of undetermined significance (ICUS). Significant statistical differences were observed among the three groups in terms of gender, red blood cell and platelet transfusion volumes within the first three months of disease onset, infection incidence, initial platelet and neutrophil counts, the lowest platelet and neutrophil values during the early stage of the disease, initial reticulocyte (RET) count and percentage, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), red cell distribution width (RDW), bone marrow cellularity, number of megakaryocytes, enzyme-linked tissue staining for megakaryocytes, and dysplasia in bone marrow smears (<i>p</i> < 0.05). Among these, gender, initial RET count, and bone marrow cellularity were identified as independent predictors for AA (<i>p</i> < 0.01).</p><p><strong>Conclusion: </strong>Early manifestations of pediatric BMFS are characterized by pancytopenia and bone marrow hematopoietic failure; however, different subtypes exhibit variations in early clinical features and laboratory findings. Early identification of these characteristics may improve diagnostic accuracy and facilitate more effective clinical management.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"13 ","pages":"1557212"},"PeriodicalIF":2.1,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12176817/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144332934","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":"Exercise training improves circulatory dynamics in adolescents with postural orthostatic tachycardia syndrome.","authors":"Yoshitoki Yanagimoto, Yuko Ishizaki, Toshiki Terashima, Ryuhei Yoshida, Kento Ishitani, Kohei Haraguchi, Mana Yamamoto, Mayumi Kubota, Yuto Adomi, Shinobu Yamasaki, Toshimitsu Suga, Kazunari Kaneko","doi":"10.3389/fped.2025.1573842","DOIUrl":"10.3389/fped.2025.1573842","url":null,"abstract":"<p><strong>Introduction: </strong>Exercise training is recommended for PoTS; however, very few studies have examined the effectiveness of exercise training in young adolescents with PoTS. We evaluated the effects of ergometer endurance exercise on the circulatory dynamics of children with PoTS using cardiopulmonary exercise (CPX) testing, standing tests, and cardiac output monitoring.</p><p><strong>Methods: </strong>Overall, 28 participants with PoTS (19 males) aged 12-15 years were admitted to the Department of Pediatrics, Kansai Medical University General Medical Center, for 1 month between August 2020 and November 2023. Of the participants, 17 were assigned to the exercise group (13 boys) and 11 were assigned to the control group (6 boys). All participants underwent the standing test and CPX testing upon admission. The exercise group performed ergometer exercise for 30 min once per day, five times per week for 4 weeks. After 4 weeks, both groups completed the standing and CPX tests again. During the standing test, the patients underwent non-invasive hemodynamic monitoring using the AESCULON Mini®.</p><p><strong>Results: </strong>There were no significant differences between the two groups in demographic characteristics at admission (before the start of exercise training). Stroke volume, cardiac output, cardiac index, and thoracic fluid content increased after exercise training in the exercise group [pre- vs. post-exercise: cardiac output (ml) 61.7 vs. 73.1 (<i>P</i> = 0.009); cardiac output (L/min): 6.6 vs. 7.7 (<i>P</i> = 0.001); cardiac index (L/min/m²): 4.3 vs. 5.0 (<i>P</i> = 0.029); thoracic fluid content: 28.7 vs. 33.8 (<i>P</i> = 0.001)]. Exercise duration and maximal oxygen uptake (VO₂) increased after exercise training in the exercise group on CPX testing [pre- vs. post-exercise: load time (min): 1.8 vs. 9.6 (<i>P</i> = 0.002), peak VO₂ (ml/min/kg): 30.3 vs. 33.2 (<i>P</i> = 0.005)]. The hemodynamic and CPX test results were unchanged in the control group. No significant changes were observed in orthostatic test results in either group.</p><p><strong>Discussion: </strong>Endurance exercise training for 4 weeks increased cardiac output during orthostasis in children with PoTS and inhibited the downward migration of blood. We conclude that ergometer exercise training for 4 weeks in young adolescents with PoTS may improve circulatory dynamics during orthostasis.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"13 ","pages":"1573842"},"PeriodicalIF":2.1,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12176885/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144332935","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":"Low- and negative-pressure hydrocephalus in children, clinical features, treatment, prognosis and proposed mechanisms.","authors":"Binghong Chen, Yongxiang Zhang, Yajun Jiang, Wenzhong Mei, Yuanlong Zhang","doi":"10.3389/fped.2025.1602767","DOIUrl":"10.3389/fped.2025.1602767","url":null,"abstract":"<p><strong>Introduction: </strong>Low- and negative-pressure hydrocephalus (L&NPH) is not a rare clinical syndrome, often seen as a consequence of multiple cranial surgery, characterized by enlarged ventricles and paradoxically low intracranial pressure. L&NPH has also been reported in children, but only a few cases have been reported in the literature and understanding of the characteristics of L.NPH, treatment and prognosis in children is lacking.</p><p><strong>Methods: </strong>We performed a systematic analysis of 44 pediatric patients with L&NPH described in the literature and 4 patients treated at our institution.</p><p><strong>Results: </strong>The results indicated that the most common cause of L&NPH in children was craniotomy. More than half of children with L&NPH had surgery prior to onset of the disease, including cerebrospinal fluid (CSF) shunt surgery or CSF drainage. Conservative treatments include postural therapy, intermittent compression of the shunt pump to drain CSF, and in a small number of patients, the adjustment of the shunt pressure is effective, but the vast majority of patients (90.91%) ultimately require a shunt device repositioning and often require more than 2 days of external CSF drainage prior to surgery. After comprehensive treatment, 77.5% of pediatric patients with L&NPH recover to pre-existing hydrocephalus, while 22.5% have severe symptoms such as coma or vegetative state or even death, which are clearly associated with the progression of the underlying disease.</p><p><strong>Discussion: </strong>The pathophysiological mechanism may be the result of self-regulatory decompensation of CSF circulatory dynamics, brain relaxation due to excessive loss of interstitial fluid in brain tissue, and gradual increase in compliance.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"13 ","pages":"1602767"},"PeriodicalIF":2.1,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12176887/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144332939","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}