Frontiers in Pediatrics最新文献

{"title":"Magnitude and factors associated with low birth weight among newborns in public health facilities of Mekelle City, northern Ethiopia: a multi-center study.","authors":"Gebremichael Aregawi Teklehaimanot, Kahsay Zenebe Gebreslasie, Woldu Mammo Werid, Berhanu Gebresilassie, Gebregziabher Kidanemariam, Etsay Weldekidan Tsegay, Zenawi Hagos Gufue, Meresa Berwo Mengesha","doi":"10.3389/fped.2024.1455248","DOIUrl":"https://doi.org/10.3389/fped.2024.1455248","url":null,"abstract":"<p><strong>Background: </strong>Low birth weight is a key determinant of child survival, significantly influencing rates of infant and childhood mortality, morbidity, and disability. While some studies have been conducted in our region, there is still a gap in evidence regarding the maternal characteristics associated with low birth weight. Hence, this study aimed to determine the proportion of newborns with low birth weight and determinant factors, particularly focusing on maternal characteristics.</p><p><strong>Method: </strong>A facility-based cross-sectional study was conducted from 21 March to 20 April 2020 involving mothers and their newborns at selected public health facilities in Mekelle City. The sample included 447 participants, with two public hospitals and three health centers chosen by a lottery method. Systematic random sampling was applied to select mother-newborn pairs. Data were collected using a structured, interviewer-administered questionnaire and analyzed using the Statistical Package for Social Sciences version 21. Bivariate and multivariate logistic regression analyses, with a 95% confidence interval (CI), were used to identify factors associated with low birth weight.</p><p><strong>Results: </strong>The study included 447 mothers of newborns, achieving a 100% response rate. The proportion of low birth weight was 14.3%. Significant factors associated with low birth weight included attending the first antenatal care (ANC) visit in the third trimester [adjusted odds ratio (AOR) = 3.66, 95% CI: 1.28-10.44], not receiving additional nutrition during pregnancy (AOR = 4.16, 95% CI: 1.38-12.58), experiencing obstetric complications during the current pregnancy (AOR = 7.72, 95% CI: 2.76-21.59), and a gestational age at birth of less than 37 weeks (AOR = 5.36, 95% CI: 1.96-14.67).</p><p><strong>Conclusion and recommendation: </strong>This study revealed a substantial incidence of low birth weight. The initiation of the first antenatal care visit in the third trimester, failure to supplement nutrition during pregnancy, the occurrence of obstetric complications during pregnancy, and a gestational age at birth less than 37 weeks were all found to be significantly correlated with this condition. It is recommended that policymakers strengthen maternal and child health services, especially through the focused ANC program, to improve outcomes. Health facilities should promote awareness of the importance of initiating ANC visits early, with an emphasis on nutritional counseling throughout pregnancy.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"12 ","pages":"1455248"},"PeriodicalIF":2.1,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11703961/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142947612","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":"Reforming early intervention for premature infants: insights into integrated nursing and medical care in Western China.","authors":"Meicen Zhou, Xin Lin, Huan Luo, Haiting Liu, Shaopu Wang, Hua Wang, Dezhi Mu","doi":"10.3389/fped.2024.1469757","DOIUrl":"https://doi.org/10.3389/fped.2024.1469757","url":null,"abstract":"<p><strong>Background: </strong>Premature births has imposed substantial burdens on medical resources. Consequently, a specialized team was established and a model focused on early intervention, namely the Delivery Room Intensive Care Unit (DICU) emphasizing \"care, support, and treatment\" was introduced and its impact on the morbidity and mortality outcomes of newborns was assessed. Additionally, we aimed to develop a nomogram model for predicting the risk of intraventricular hemorrhage (IVH) in preterm infants.</p><p><strong>Methods: </strong>A retrospective study involving 2,788 infants was conducted to compare the characteristics and outcomes of infants admitted following the transition from the previous \"neonatal intensive care unit (NICU)-centered\" approach to the current early \"care, support, and treatment\" model. Clinical and laboratory data were recorded from birth until their discharge. The primary outcome was IVH, with additional evaluation of mortality and morbidities related to the neurological, respiratory, circulatory, and digestive systems.</p><p><strong>Results: </strong>The DICU approach significantly declined the incidence of IVH [OR: 0.16, 95% CrI (0.11,0.23)], hypothermia [OR: 0.33, 95% CrI (0.21,0.50)], apnea [OR: 0.60, 95% CrI (0.47,0.75)], perinatal respiratory diseases [OR: 0.63, 95% CrI (0.52,0.75)] and metabolic acidosis [OR: 0.24, 95% CrI (0.16,0.34)]. Five predictors were selected: DICU exposure, gestational age, birth weight, ventilation mode within seven days, and ibuprofen use (d). The model built by these predictors displayed good prediction ability with the area under the ROC curve of 0.793 in the training set and 0.803 in the validation set.</p><p><strong>Conclusions: </strong>The standardized DICU model had significantly reduced the incidences of morbidities. The risk nomogram is useful for prediction of IVH risk in eligible infants, with a high accuracy, sensitivity, consistency, and practicability. This study emphasizes the shift in early intervention concepts and team collaboration sets \"neonatologists, neonatal nurse practitioners, and respiratory therapists\", which advocates for standardized decision-making for treatment from the delivery room to improve the success rate of resuscitation and enhance the prognosis of these infants.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"12 ","pages":"1469757"},"PeriodicalIF":2.1,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11703874/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142947615","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: Prenatal ultrasound presentation of congenital melanocytic nevus syndrome.","authors":"ZhiH Shi, TingT Sun, Juan Yin, Shuo Qiu, YueM Wang, JunH Leng","doi":"10.3389/fped.2024.1466999","DOIUrl":"https://doi.org/10.3389/fped.2024.1466999","url":null,"abstract":"<p><p>Congenital melanocytic nevus (CMN) syndrome is a rare, non-familial neural ectodermal dysplasia characterized by CMN combined with extracutaneous abnormalities, predominantly involving the central nervous system (CNS). The pathogenesis of CMN syndrome is thought to result from early post-zygotic somatic mutations. CNS melanosis frequently affects the anterior temporal lobes, brainstem, cerebellum, and cerebral cortex. Magnetic resonance imaging typically demonstrates T1 hyperintensity associated with CNS melanosis, while ultrasound often reveals abnormal echogenicity. We report a case of a fetus diagnosed with CMN syndrome, presenting with abnormal echogenicity in the cerebellar and amygdaloid complexes and a posterior fossa cyst. Autopsy identified two melanocytic nevi on the lumbosacral region of the fetus. Reports linking CMN syndrome to fetal intracranial abnormalities remain exceedingly rare.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"12 ","pages":"1466999"},"PeriodicalIF":2.1,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11703949/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142947560","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":"Baricitinib in pediatric chronic immune thrombocytopenia and associated autoimmune conditions: a case report.","authors":"G López de Hontanar Torres, J Zubicaray, E Sebastián, A Hernández-Martín, J Iriondo, J Sevilla","doi":"10.3389/fped.2024.1516039","DOIUrl":"https://doi.org/10.3389/fped.2024.1516039","url":null,"abstract":"<p><p>Immune thrombocytopenia (ITP) is a disease characterized by platelet destruction, presenting substantial challenges in clinical practice. The classic first line therapeutic management includes corticosteroids and intravenous immunoglobulins. Although it is less frequent in children than in adults, there is a significant percentage of patients, up to 47% according to the Pediatric and Adult Registry on Chronic ITP, who require second-line or further treatment, due to non-response to the first line treatment or persistence of disease, among other reasons. Several second line approaches for its treatment are currently in use, including increasing platelet production with thrombopoietin receptor agonists. We report the case of a 16-year-old patient with ITP and alopecia areata successfully treated with baricitinib, a reversible and selective JAK 1/2 inhibitor. Baricitinib is currently in use for the treatment of several autoimmune conditions and has been shown to increase platelet counts in these patients. This phenomenon has been linked to increased TPO signaling and reduced platelet destruction. There are promising preliminary results of adult ITP patients treated with baricitinib. This case report is the first reported use of baricitinib in ITP in the pediatric and adolescent setting, potentially leading to its use in this condition.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"12 ","pages":"1516039"},"PeriodicalIF":2.1,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11703952/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142947557","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":"Improving the quality of life of children and parents with nocturnal enuresis: the role of health education.","authors":"Jianrong Liao, Lin Zhu, Danfeng Xie, Xiaomeng Wang, Ping Zhou","doi":"10.3389/fped.2024.1464465","DOIUrl":"https://doi.org/10.3389/fped.2024.1464465","url":null,"abstract":"<p><p>The sleep disorder nocturnal enuresis (NE) affects children's health and quality of life, as well as places a heavy burden on their families. Treatment improves the child's quality of life. Unfortunately, some parents do not seek treatment for their children because they are unaware or misinformed about NE. The goal of health education is to enhance or maintain the patient's health status, thereby enhancing the patient's quality of life through positive coping strategies. Educating children and parents about NE is an effective way for nurses to raise their awareness. Furthermore, they can improve the quality of life of children by promoting their active participation in treatment. The purpose of this paper is to review information about NE and explore the role of health education in improving children's and parents' quality of life.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"12 ","pages":"1464465"},"PeriodicalIF":2.1,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11703977/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142947605","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":"Impact of metabolic-associated fatty liver disease on the cholesterol efflux capacity of high-density lipoproteins in adolescents with type 2 diabetes.","authors":"José Antonio Orozco Morales, Aída Xochitl Medina Urrutia, Margarita Torres Tamayo, Juan Reyes Barrera, Esteban Jorge Galarza, Juan Gabriel Juárez Rojas, Pilar Dies Suarez, Nahum Méndez Sánchez, Luis Enrique Díaz Orozco, Lubia Velázquez-López, Patricia Medina Bravo","doi":"10.3389/fped.2024.1462406","DOIUrl":"https://doi.org/10.3389/fped.2024.1462406","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Context: &lt;/strong&gt;Type 2 diabetes (DM2) is an emerging disease in the pediatric population. DM2 is associated with metabolic-associated fatty liver disease (MAFLD). High-density lipoproteins (HDLs) are lipoproteins that are believed to have atheroprotective properties that reduce the risk of cardiovascular disease (CVD). Current evidence suggests that the physicochemical and functional features of HDLs may play a key role in the pathogenesis of atherosclerosis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;We aimed to assess the impact of MAFLD on cholesterol efflux capacity (CEC) in adolescents with DM2.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;A cross-sectional study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;Attention clinic for Children with Diabetes of the Hospital Infantil de México Federico Gómez.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patients or other participants: &lt;/strong&gt;This study included a total of 70 adolescents, 47 of which had DM2 and 23 were healthy individuals.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interventions: &lt;/strong&gt;The presence of MAFLD was determined by MR spectroscopy with proton density fat fraction. We compared the distribution of HDL subtypes (HDL2b, HDL2a, HDL3a, HDL3b, and HDL3c) and the chemical composition of HDLs (total protein, triglycerides, phospholipids, cholesteryl esters, and free cholesterol). HDL functionality was determined by the CEC, measuring the fluorescent cholesterol efflux from J774 macrophage cells.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcome measures: &lt;/strong&gt;We were expecting to observe a decrease in HDL efflux capacity in adolescents with type 2 diabetes and MAFLD.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In our study, we observed a prevalence of MAFLD in 66% of adolescents with DM2, similar to that reported in other international studies (60%-80%). In the population with DM2 and MAFLD, we did not observe a decrease in CEC. Initially we found a slight elevation of CEC in adolescents with DM2, however, with the increase in liver fat, a little decrease is observed, which could explain a probable metabolic phenomenon, since the physicochemical composition and distribution of the particles is associated with the percentage of liver fat. A positive correlation between the percentage of liver fat and the concentration of HDL2b (&lt;i&gt;p&lt;/i&gt; = 0.011), HDL2a (&lt;i&gt;p&lt;/i&gt; = 0.014) and average particle size (&lt;i&gt;p&lt;/i&gt; = 0.011) and the proportion of triglycerides inside the particles (&lt;i&gt;p&lt;/i&gt; = 0.007). Likewise, negative correlation were found with the percentage of liver fat, cholesterol esters (&lt;i&gt;p&lt;/i&gt; = 0.010) and free cholesterol of the particles (&lt;i&gt;p&lt;/i&gt; &lt; 0.001). We observed a positive correlation between CEC and the percentage of triglycerides (&lt;i&gt;p&lt;/i&gt; = 0.007), and a negative correlation with the percentage of cholesterol esters (&lt;i&gt;p&lt;/i&gt; = 0.05) inside the HDL's particles.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In this group of adolescents with DM2, the presence of MAFLD was not associated with CEC; however, it is associated with abnormalities in the distribution and lipid composition of HDL ","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"12 ","pages":"1462406"},"PeriodicalIF":2.1,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11703661/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142947601","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":"Cleft palate, congenital heart disease, and developmental delay involving <i>MEIS2</i> heterozygous mutations found in the patient with attention deficit hyperactivity disorder: a case report.","authors":"Fang Shen, Junyan Li, Dandan Li, Hui Zhou","doi":"10.3389/fped.2024.1500152","DOIUrl":"https://doi.org/10.3389/fped.2024.1500152","url":null,"abstract":"<p><p>This case is the first reported patient with a <i>MEIS2</i> gene mutation who primarily exhibits pronounced inattention as the main manifestation and is diagnosed with ADHD, requiring methylphenidate treatment. It is characterized by unique clinical features that set it apart from previously reported cases with mutations in the <i>MEIS2</i> gene. Here, we report a female child with a diagnosis of ADHD and comorbidities. She received treatment with methylphenidate, starting at a dose of 18 milligrams per day, which was gradually increased to 45 milligrams per day based on her attention performance, while also undergoing physical and language rehabilitation training. In addition, the parents involved the child in reading and retelling stories at home every day. After 2 years of treatment, the scale results indicated that the child still had a moderate degree of attention deficit. Therefore, she underwent whole exome sequencing (WES) showing that her <i>MEIS2</i> gene carries a <i>de novo</i> frameshift mutation (c.934_937del, p. Leu312Argfs*11). After comparing the patient's features with those of other patients who also had the <i>MEIS2</i> mutation, we discovered that the patient's cleft palate, heart abnormalities, and minor facial dysmorphism were all extremely comparable. A broad forehead, elongated and arched eyebrows, and a tent-shaped upper lip were examples of mild facial dysmorphic traits. Subtypes with phenotypes such as cleft palate, cardiac anomalies, or facial malformations were presented in all previously reported cases of <i>MEIS2</i> mutations. Furthermore, less common characteristics include ADHD, learning difficulties, hearing loss, recurring respiratory infections, asthma, rhinitis, enuresis, and dental cavities. This case further supports the critical role of genetic testing in patients with ADHD who exhibit a suboptimal response to methylphenidate and present with multiple comorbidities. Furthermore, this case report expands the clinical symptom spectrum associated with <i>MEIS2</i> gene mutations, providing a broader understanding of the condition.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"12 ","pages":"1500152"},"PeriodicalIF":2.1,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11703840/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142947588","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":"Diagnostic challenges of long COVID in children: a survey of pediatric health care providers' preferences and practices.","authors":"Vivian Y Liu, Madeleine Godfrey, Matthew Dunn, Robert Fowler, Lauren Guthrie, David Dredge, Scott Holmes, Alicia M Johnston, Tregony Simoneau, Alessio Fasano, Dawn Ericson, Lael M Yonker","doi":"10.3389/fped.2024.1484941","DOIUrl":"https://doi.org/10.3389/fped.2024.1484941","url":null,"abstract":"<p><strong>Introduction: </strong>Given the challenges in diagnosing children with long COVID, we sought to explore diagnostic practices and preferences among clinicians.</p><p><strong>Methods: </strong>A ten-question survey assessed pediatric providers' clinical decision making for identifying and evaluating long COVID in children. Of the 120 survey respondents, 84 (70%) were physicians, 31 (26%) nurse practitioners, and 5 (4%) physician assistants.</p><p><strong>Results: </strong>The most common categories of symptoms identified as raising suspicion for long COVID in children included cardiopulmonary symptoms, selected by 119 (99%) of pediatric providers, and neurocognitive symptoms, selected by 118 (98%) of providers. However, there was more ambiguity on the primary feature of long COVID, with providers selecting a range of key symptoms. Of all physical exam findings, postural orthostatic tachycardia, was most suggestive of long COVID [identified by 49 (41%) of pediatric providers], whereas one-third of providers reported no specific identifiable exam finding.</p><p><strong>Discussion: </strong>Pediatric providers report variable decision making in the clinical evaluation of long COVID, with patient demographics and clinical factors impacting whether a diagnosis of long COVID is considered. This variation in diagnosing pediatric long COVID reflects ambiguity in the definition of long COVID in children and the absence of clinical guidelines to support providers in the identification of disease and treatment. This study highlights an area of need for future clinical advances in pediatric long COVID.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"12 ","pages":"1484941"},"PeriodicalIF":2.1,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11700732/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142970400","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":"Achievements, priorities and strategies in pediatric nephrology in Europe: need for unifying approaches or acceptance of differences?","authors":"Jochen Ehrich, Velibor Tasic, Vidar O Edvardsson, Evgenia Preka, Larisa Prikhodina, Constantinos J Stefanidis, Rezan Topaloglu, Diamant Shtiza, Ashot Sarkissian, Thomas Mueller-Sacherer, Rena Fataliyeva, Ina Kazyra, Elena Levtchenko, Danka Pokrajac, Dimitar Roussinov, Danko Milošević, Avraam Elia, Tomas Seeman, Mia Faerch, Inga Vainumae, Janne Kataja, Michel Tsimaratos, Irakli Rtskhiladze, Peter F Hoyer, George Reusz, Atif Awan, Danny Lotan, Licia Peruzzi, Nazym Nigmatullina, Nasira Beishebaeva, Edite Jeruma, Augustina Jankauskiene, Olivier Niel, Valerie Said-Conti, Angela Ciuntu, Snežana Pavićević, Michiel Oosterveld, Anna Bjerre, Marcin Tkaczyk, Ana Teixeira, Adrian C Lungu, Alexey Tsygin, Vesna Stojanović, Ludmila Podracka, Tanja Kersnik Levart, Mar Espino-Hernández, Per Brandström, Giuseppina Sparta, Harika Alpay, Dmytro Ivanov, Jan Dudley, Komiljon Khamzaev, Dieter Haffner","doi":"10.3389/fped.2024.1458003","DOIUrl":"https://doi.org/10.3389/fped.2024.1458003","url":null,"abstract":"<p><strong>Background: </strong>There is a lack of information on the current healthcare systems for children with kidney diseases across Europe. The aim of this study was to explore the different national approaches to the organization and delivery of pediatric nephrology services within Europe.</p><p><strong>Methods: </strong>In 2020, the European society for Paediatric Nephrology (ESPN) conducted a cross-sectional survey to identify the existing pediatric nephrology healthcare systems in 48 European countries covering a population of more than 200 million children.</p><p><strong>Results: </strong>The reported three most important priorities in the care of children with kidney diseases were better training of staff, more incentives for physicians to reduce staff shortages, and more hospital beds. Positive achievements in the field of pediatric nephrology included the establishment of new specialized pediatric nephrology centers, facilities for pediatric dialysis and transplant units in 18, 16, and 12 countries, respectively. The most common problems included no access to any type of dialysis (12), inadequate transplant programs for all ages of children (12), lack of well-trained physicians and dialysis nurses (12), inadequate reimbursement of hospitals for expensive therapies (10), and lack of multidisciplinary care by psychologists, dieticians, physiotherapists, social workers and vocational counsellors (6). Twenty-five of 48 countries (52%) expected to have a shortage of pediatric nephrologists in the year 2025, 63% of clinical nurses and 56% of dialysis nurses. All three groups of health care professionals were expected to be lacking in 38% of countries. Prenatal assessment and postnatal management of renal malformations by a multidisciplinary team including obstetricians, geneticists, pediatricians, and pediatric surgeons was available in one third of countries.</p><p><strong>Conclusions: </strong>Our study shows that there are still very marked differences in pediatric health care systems across the European countries and highlights the need need for appropriate services for children with kidney disease in all European countries.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"12 ","pages":"1458003"},"PeriodicalIF":2.1,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11695125/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142931341","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":"Incidence and risk factors for acute kidney injury in children with nephrotic syndrome: a meta-analysis.","authors":"Changdi Chen, Bingbing Qiu, Jianxin Wang, Liuqing Yang, Yanru Huang","doi":"10.3389/fped.2024.1452568","DOIUrl":"https://doi.org/10.3389/fped.2024.1452568","url":null,"abstract":"<p><strong>Background: </strong>Nephrotic syndrome (NS) is a prevalent kidney disease in children. Acute kidney injury (AKI) is a severe complication of NS and has the potential to be life-threatening.</p><p><strong>Objective: </strong>The aim of this study was to analyze the prevalence and risk factors of AKI in children with NS, and to provide an evidence-based medical basis for the early identification of high-risk children in the clinic.</p><p><strong>Methods: </strong>A comprehensive search was conducted in publicly available databases, namely PubMed, Embase, Web of Science, Scopus, and the Cochrane Library, covering the period from the inception of each database until May 2024. The analysis involved examining basic characteristics (age, sex), the concomitant diseases (hypertension, infections), NS disease characteristics (steroid susceptibility classification, pathologic classification), laboratory test (e.g., serum albumin), and the use of nephrotoxic drugs. Traditional and network meta-analyses were performed for analysis.</p><p><strong>Results: </strong>A total of 11 studies were included in the analysis, revealing an incidence of AKI of 29% (95% CI: 23%-37%). The analysis of factors indicated that the age of NS onset [standardized mean difference (SMD): 0.31; 95% confidence interval (CI): 0.08, 0.54; <i>p</i> = 0.009], sex [odds ratio (OR): 1.49; 95% CI: 1.03, 2.16; <i>p</i> = 0.035], serum albumin level (SMD: -0.43; 95% CI: -0.85, -0.02; <i>p</i> = 0.041), response to steroid treatment (OR: 0.52; 95% CI: 0.33, 0.80; <i>p</i> = 0.003), infection (OR: 3.60; 95% CI: 1.91, 6.78; <i>p</i> < 0.001), hypertension (OR: 4.02; 95% CI: 2.94, 5.51; <i>p</i> < 0.001), and nephrotoxic drug application (OR: 4.43; 95% CI: 1.86, 10.53; <i>p</i> = 0.001), were all significantly associated with the incidence of AKI. Furthermore, the results of the network meta-analysis suggested that the pathologic type of minor glomerular abnormalities (MGA)/diffuse mesangial proliferation (DMP), the type of infrequent relapses (IFRNS)/steroid-sensitive NS (SSNS), and the use of diuretic medications were associated with a relatively low risk of AKI occurrence.</p><p><strong>Conclusion: </strong>Factors upon admission of children with NS are associated with the onset of AKI. Emphasis should be placed on populations with a heightened risk of AKI in clinical practice. Further research is warranted to confirm the findings due to the limitations of this study.</p><p><strong>Systematic review registration: </strong>https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024571170, PROSPERO (CRD42024571170).</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"12 ","pages":"1452568"},"PeriodicalIF":2.1,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11695129/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142931356","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}