Frontiers in Pediatrics最新文献

{"title":"Paradoxes in pediatric rehabilitation: building an interdisciplinary, total-child framework to promote effective interventions and life course well-being.","authors":"Sharon Landesman Ramey, Michael E Msall, Craig T Ramey","doi":"10.3389/fped.2025.1540479","DOIUrl":"10.3389/fped.2025.1540479","url":null,"abstract":"<p><p>In this paper, we identify major paradoxes that have emerged from randomized controlled trials and longitudinal studies of diverse groups of young children with identified disabilities and risk conditions. We concentrate on the first three years of life because these coincide with a period of rapid changes in brain structure and function as well as dramatic expansion of a child's skills in motor, language, social-emotional, and cognitive domains. The paradoxes support a major revision in hypotheses about how effective interventions can alter a child's functioning and life course. The following conclusions derive from the paradoxes: (1) the intertwined biological and environmental influences on a child's well-being contribute more to functional outcomes than do the primary medical diagnoses and biological risks alone; (2) high-intensity, high-cost interventions that are well-timed, wholistic, and multi-domain can be more powerful and economical (i.e., yield higher \"returns on investment\") than many treatments that initially appear less costly and easier to implement; (3) treatments that are individualized to the child and family, while adhering to evidence-backed treatment protocols, are among the most likely to result in large and long-lasting benefits compared to those that are solely individualized or adherent to a treatment protocol that does not make adjustments for the child; and 4) a clearly presented conceptual theoretical framework about human development can be a remarkably practical and informative tool in maximizing benefits of pediatric rehabilitation. We propose an interdisciplinary \"total-child\" platform - named the <b>I</b>nterdisciplinary <b>M</b>onitoring, <b>P</b>lanning, <b>a</b>nd <b>C</b>aring for the <b>T</b>otal-Child - <b>T</b>ogether (IMPACT2) Developmental Framework - to support forming strong partnerships to facilitate informed clinical and family decision-making as well as the design and conduct of scientific investigations. We encourage others to consider these paradoxes and the IMPACT2 framework to stimulate conversations and promote innovative family and community partnerships to realize greater impact from delivering effective pediatric rehabilitation interventions to all eligible children.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"13 ","pages":"1540479"},"PeriodicalIF":2.1,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931064/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700226","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":"Association of inflammatory biomarkers with new functional morbidity at hospital discharge in children who survive severe sepsis.","authors":"Mallory A Perry-Eaddy, Walter Faig, Martha A Q Curley, Scott L Weiss","doi":"10.3389/fped.2025.1519246","DOIUrl":"10.3389/fped.2025.1519246","url":null,"abstract":"<p><strong>Objective: </strong>New functional morbidity is common in critically ill children who survive sepsis; yet, the underlying biological mechanisms, particularly the impact of inflammation, remain unknown. We sought to test the hypothesis that increased levels of inflammatory biomarkers during the acute phase of pediatric sepsis are associated with new functional morbidity at hospital discharge.</p><p><strong>Methods: </strong>We conducted a <i>post hoc</i> secondary analysis of the <i>MitoPSe</i> clinical study, including <i>N</i> = 119 critically ill children who survived sepsis. Data collected included demographic and clinical variables and 31 inflammatory biomarkers collected at three distinct timepoints (within days 1-2 of PICU admission, days 3-5, and days 8-14). The primary outcome was new functional morbidity, defined as at least a one-point increase in the pediatric overall performance category from baseline to hospital discharge.</p><p><strong>Results: </strong>New functional morbidity occurred in 38 children (32%) and was associated with increased plasma levels of interleukin (IL)-6, IL-18, sIL-2Ra, MCP1, IL-8 (CXCL8), sIL-1RII, IL-10, MIP1a, and IL-2r and decreased RANTES (CCL5) (<i>p</i> < .001) at all three timepoints. However, after adjusting for differences in chronic comorbid conditions, hospital length of stay, number of organ dysfunctions, and severity of illness, absolute biomarker levels, and trajectories were not significantly different between patients with or without new functional morbidity at hospital discharge.</p><p><strong>Conclusions: </strong>In this sample of critically ill children treated for sepsis, increased inflammatory biomarker levels and the trajectory of change during the acute phase of pediatric sepsis were not independently associated with new functional morbidity at hospital discharge. Inflammatory biomarker levels likely reflect illness severity and other clinical variables associated with illness. However, these biomarkers may still be useful in identifying patients at risk of developing functional morbidity, despite the lack of causation within this study.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"13 ","pages":"1519246"},"PeriodicalIF":2.1,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11925794/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691799","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: Duodenal gastrointestinal stromal tumor misdiagnosed as tumor located on the major duodenal papilla leading to fatal gastrointestinal bleeding in a child.","authors":"Chengxian Yang, Kewei Li, Bo Xiang","doi":"10.3389/fped.2025.1546914","DOIUrl":"10.3389/fped.2025.1546914","url":null,"abstract":"<p><strong>Background: </strong>Although gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract, they are rare in children, particularly those located on the duodenum. Here, we present an interesting pediatric case involving a 13-year-old boy who experienced gastrointestinal hemorrhage, he was misdiagnosed with a tumor located on the major duodenal papilla and was ultimately confirmed to be duodenal GISTs.</p><p><strong>Case presentation: </strong>A 13-year-old boy presented to a local hospital with fatigue and melena. Gastroscopy suggested a tumor located at the major duodenal papilla, and the patient was referred to our hospital for surgical evaluation. Upon further investigation and surgical exploration, the diagnosis was revised to a duodenal GIST with surface ulceration and active bleeding. The ulcer's morphology and location mimicked the appearance of the major duodenal papilla, leading to the initial diagnostic error.</p><p><strong>Conclusions: </strong>Duodenal GISTs in pediatric patients often present asymptomatically but can manifest with severe complications such as fatal gastrointestinal bleeding. The tumor's morphology and location can obscure the major papilla, complicating preoperative diagnosis and influencing surgical decision-making. Comprehensive preoperative evaluation and careful intraoperative exploration are critical for accurate diagnosis and optimal management.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"13 ","pages":"1546914"},"PeriodicalIF":2.1,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11925956/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691802","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 novel missense variant of <i>FBN1</i> gene in a Sardinian family with Marfan syndrome: a case report.","authors":"Marina Marsan, Mattia Brutti, F Meloni, M Marica, C Soddu, F Lai, D Martorana, S Savasta","doi":"10.3389/fped.2025.1549504","DOIUrl":"10.3389/fped.2025.1549504","url":null,"abstract":"<p><strong>Background: </strong>Marfan Syndrome (MS) is a connective tissue disorder, an autosomal dominant condition mostly caused by variants in the <i>FBN1</i> gene, which encodes for fibrillin-1 protein. Anomalies in the gene lead to a wide variety of clinical manifestations, including disorders of the cardiac, ocular and musculoskeletal system. We present a case of a child belonging to a Sardinian family of four generations, with a novel variant found in the <i>FBN1</i> gene.</p><p><strong>Objective: </strong>To include this novel missense <i>FBN1</i> variant into genetic counselling for Marfan Syndrome and to discuss its genotypic-phenotypic correlation.</p><p><strong>Methods: </strong>Firstly, the proband was diagnosed with Marfan Syndrome using 2020 Revised Ghent Criteria, and she then underwent genetic testing using Next Generation sequencing.</p><p><strong>Results: </strong>The NGS revealed a novel heterozygous missense variant (c.2348A>G) in the <i>FBN1</i> gene, in exon 20. This genetic variant caused a missense substitution of a serine residue with an arginine residue in the position 783 of Fibrillin-1 protein. The variant was then evaluated in the other family members, and was eventually only found in symptomatic individuals, regardless of the severity of their phenotype, demonstrating the segregation with MS; furthermore, it showed complete penetrance with the disease.</p><p><strong>Conclusions: </strong>Our results suggest that this variant is responsible for MS and it therefore should be included in genetic diagnoses and counselling discussion.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"13 ","pages":"1549504"},"PeriodicalIF":2.1,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11925759/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691781","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: Early diagnosis of LAD-III in newborn with persistent leukocytosis and hemangioma-like lesion of the urinary bladder.","authors":"Riccardo Pagani, Laura Lorioli, Francesca Favini, Eleonora Severi, Marco Salvi, Lidia Pezzani, Maria Iascone, Lucia Migliazza, Claudia Pellegrinelli, Maurizio Cheli, Massimo Provenzi, Giovanna Mangili","doi":"10.3389/fped.2025.1550643","DOIUrl":"10.3389/fped.2025.1550643","url":null,"abstract":"<p><p>Leukocyte Adhesion Defects (LADs) are a group of rare autosomal recessive immune disorders characterized by constitutional defects in the process of leukocyte migration. Among these, LAD-III is the rarest, with only a few cases documented in scientific literature. It is caused by mutations in the FERMT3 gene, impairing integrin function in both white blood cells and platelets. Thus, patients exhibit a variable degree of immunodeficiency along with a severe bleeding tendency referred to as \"Glanzmann-like\", due to dysfunctional platelet GPIIb/IIIa. The diagnosis of LAD-III is typically made in infancy or early childhood, following medical evaluations for recurrent infections and bleeding episodes. Here we report the case of a female newborn admitted to our NICU at day four of life with a history of petechial rash and gross hematuria. Radiological and endoscopic assessments revealed a hemangioma-like lesion of the bladder wall. Blood exams showed persistent leukocytosis without signs of infection, associated with mild thrombocytopenia and normocytic anemia. Notably, platelet function assays demonstrated defective aggregation with all agonists tested. Next generation sequencing analysis identified a homozygous nonsense mutation in the FERMT3 gene, ensuring early access to hematopoietic stem cell transplantation, which is the only curative treatment. To the best of our knowledge, this is the first reported case of LAD-III diagnosed in the neonatal period and the first to associate this rare disorder with bladder angiomatosis. This case highlights the importance of early genetic evaluations in newborns with unexplained hematological abnormalities and bleeding tendencies.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"13 ","pages":"1550643"},"PeriodicalIF":2.1,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11926134/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691805","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: Unmasking a sporadic pediatric tumor emergency: superior vena cava syndrome.","authors":"Gui-Liang Liu, Min Wang, Min Zhang, Yan Dai, Di-Wen Zhang","doi":"10.3389/fped.2025.1517745","DOIUrl":"10.3389/fped.2025.1517745","url":null,"abstract":"<p><strong>Introduction: </strong>Superior Vena Cava Syndrome (SVCS) is a rare but serious oncologic emergency in pediatric patients, most commonly caused by mediastinal masses such as lymphomas or leukemias. This condition results from the obstruction of the superior vena cava (SVC), leading to impaired venous return and respiratory and cardiovascular complications, progressive exacerbation in a short period, and an extremely high fatality rate. We report the case of a 12-year-old boy with SVCS caused by a mediastinal mass.</p><p><strong>Main symptoms/findings: </strong>The patient presented with progressive dyspnea, orthopnea, and swelling of the head and neck. He also exhibited chest tightness, dry cough, and shortness of breath. A chest CT revealed a large anterior mediastinal mass compressing the SVC and main bronchi.</p><p><strong>Diagnosis treatment outcomes: </strong>The patient was diagnosed with SVCS secondary to T-cell lymphoblastic lymphoma. Treatment began immediately with oxygen therapy and intravenous dexamethasone to reduce mediastinal compression. Significant clinical improvement was observed within 48 h, with a reduction in dyspnea and swelling. A biopsy confirmed T-cell lymphoblastic lymphoma and multidisciplinary care was pivotal to successful management.</p><p><strong>Conclusion: </strong>Early recognition and treatment of pediatric SVCS are essential to prevent life-threatening complications. Combined with a multidisciplinary approach, corticosteroid therapy was crucial for the patient's rapid recovery. Further research is needed to optimize treatment protocols and improve outcomes for pediatric SVCS cases.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"13 ","pages":"1517745"},"PeriodicalIF":2.1,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11926146/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691821","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":"Parental satisfaction with care given in neonatal intensive care units, multicentre referral hospitals in eastern Ethiopia.","authors":"Mekdes Workie Dagnew, Aboma Motuma, Arsema Gebreyesus, Kasiye Shiferaw","doi":"10.3389/fped.2025.1417869","DOIUrl":"10.3389/fped.2025.1417869","url":null,"abstract":"<p><strong>Background: </strong>Parental satisfaction is an important dimension of the quality of a child's care and has been shown to improve health outcomes, including adherence to therapeutic regimens and understanding of medical information. Parental satisfaction is low in resource-limited countries like Ethiopia, with the paucity of evidence. This study aimed to determine the magnitude of parental satisfaction with care given in neonatal intensive care and its associated factors among parents of neonates admitted to neonatal intensive care units (NICUs) at referral hospitals in eastern Ethiopia from June to August 2023.</p><p><strong>Method: </strong>A facility-based cross-sectional study was conducted among 418 parents whose new-borns were admitted to the NICU and who were selected using a systematic random sampling technique. A pretested semi structured questionnaire was used to collect the data through face-to-face interviews with participants, and a checklist was used to review the charts/records by trained and experienced bachelor nurse/midwife data collectors. The data were coded, entered into Epi-Data version 4.6, and transferred to SPSS version 25 for analysis. We used binary logistic regression analysis to identify factors associated with the outcome variable. An adjusted odds ratio (AOR) with a 95% confidence interval (CI) was used to report the findings, and a <i>p</i>-value ≤0.05 was considered to indicate statistical significance.</p><p><strong>Results: </strong>The magnitude of parental satisfaction with care given in the NICU was 50.5% (95% CI: 45.6-55.5). Being a rural resident (AOR = 2.13; 95% CI: 1.33-3.43), having a shorter hospital stay (AOR = 4.25, 95% CI: 2.08-8.69), being able to breastfeed (AOR = 2.46; 95% CI: 1.48-4.09), having a single birth (AOR = 4.16; 95% CI: 1.91-9.03), and the availability and quality of the family room (AOR = 2.36; 95% CI:1.40-3.99) were significantly independent associated factors with parental satisfaction with care given in the NICU.</p><p><strong>Conclusion: </strong>Only one in two parents were satisfied with the care given in the NICU. The present study highlights that shortening hospital stays, mothers' ability to breastfeed their newborns, having a single birth, and the availability and quality of the family room contribute to enhancing parental satisfaction with care given in the NICU in eastern Ethiopia.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"13 ","pages":"1417869"},"PeriodicalIF":2.1,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11925713/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691854","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":"Primitive reflexes in infants with cerebral palsy due to Congenital Zika Syndrome and its relationship with other motor features.","authors":"Leticia Serra, Débora Patrícia Rios, Mino Rios, Breno Lima de Almeida, Kelly de Souza Fernandes, Rita Lucena, Isadora Cristina de Siqueira","doi":"10.3389/fped.2025.1483959","DOIUrl":"10.3389/fped.2025.1483959","url":null,"abstract":"<p><strong>Background: </strong>The Zika virus outbreak, which occurred from 2015 to 2016 in Brazil, resulted in the birth of neonates with brain malformations arising from Congenital Zika Syndrome (CZS). The characterization of primitive reflexes and their relationships with other motor characteristics, easily clinically detectable by health professionals, can aid in establishing motor prognosis in affected children.</p><p><strong>Objective: </strong>To describe reflex patterns in children with Cerebral Palsy (CP) due to CZS, and investigate associations with other motor features. Method: Observational cross-sectional study involving infants with CZS aged between 12 and 36 months. Primitive reflexes, protective reaction and markers of motor phenotype were evaluated.</p><p><strong>Results: </strong>48 children, median age: 19 months, were enrolled, most (79.2%) presented very severe CP (GMFCS 5), the persistence of more than 5 primitive reflexes (55%) and motor development age between 3 and 6 months (33.3%) (Bayley-III). A reduced ability to acquire motor skills was associated with the total number of persistent reflexes (rho = -0.45, <i>p</i> < 0.01). Asymmetrical Tonic Neck Reflex (ATNR) correlated with GMFCS level (rho = 0.49, <i>p</i> < 0.001). Lower motor development age was linked to abnormal posturing (<i>p</i> < 0.001) and absence of Parachute Reaction (<i>p</i> < 0.001).</p><p><strong>Conclusion: </strong>Infants with CP due to CZS present severe motor abnormalities. Lower motor development age is associated with the persistence of more than 5 primitive reflexes, abnormal posturing and the absence of Parachute Reaction. Parachute Reaction appears to be a prognostic marker of motor impairment severity in CZS-affected infants.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"13 ","pages":"1483959"},"PeriodicalIF":2.1,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11925945/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691863","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":"Follow-up of transcatheter closure of congenital heart disease complicated with pulmonary arterial hypertension in children.","authors":"Yanyun Huang, Yuting Chen, Danyan Su, Suyuan Qin, Cheng Chen, Dongli Liu, Bingbing Ye, Yuqin Huang, Piaoliu Yuan, Yusheng Pang","doi":"10.3389/fped.2025.1562782","DOIUrl":"10.3389/fped.2025.1562782","url":null,"abstract":"<p><strong>Background: </strong>Transcatheter closure is now the preferred treatment for congenital heart disease complicated with pulmonary arterial hypertension (CHD-PAH), but its long-term effects are not well understood. We aimed to assess the safety, effectiveness, and outcome of this procedure in children with CHD-PAH.</p><p><strong>Methods: </strong>We included 210 children with CHD-PAH at our hospital from 2012 to 2021 and collected their general, laboratory, echocardiographic, and hemodynamic data for analysis. A logistic regression analysis identified risk factors for persistent postclosure PAH (PP-PAH).</p><p><strong>Results: </strong>Among the 210 patients, 84.29% had mild PAH, 8.57% had moderate PAH, and 7.14% had severe PAH. The device was successfully implanted in 98.10% of patients. Early adverse events occurred in 12.14% (<i>n</i> = 25) of patients, with residual shunts and arrhythmia being the most common complications, each affecting 2.91% (<i>n</i> = 6) of patients. Most complications were minor and temporary, except for two cases of residual shunt-one required surgical repair, and one case of complete left bundle branch block led to occluder removal. Postintervention, pulmonary arterial pressure (PAP) decreased significantly, and cardiomegaly resolved. PP-PAH was detected in 13 patients (6.31%). Preoperative pulmonary arterial systolic pressure [odds ratio [OR] = 1.033, 95% confidence interval [CI] = 1.005-1.061, <i>P</i> = 0.019] and right ventricular diameter (OR = 1.111, 95% CI = 1.039-1.187, <i>P</i> = 0.002) were found to be risk factors for PP-PAH.</p><p><strong>Conclusion: </strong>Transcatheter closure is effective and safe for children with correctable CHD-PAH. Preoperative pulmonary arterial systolic pressure and right ventricular diameter are risk factors for PP-PAH.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"13 ","pages":"1562782"},"PeriodicalIF":2.1,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11925882/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691823","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":"Advancing risk factor identification for pediatric lobar pneumonia: the promise of machine learning technologies.","authors":"Li Shen, Jiaqiang Wu, Min Lu, Yiguo Jiang, Xiaolan Zhang, Qiuyan Xu, Shuangqin Ran","doi":"10.3389/fped.2025.1490500","DOIUrl":"10.3389/fped.2025.1490500","url":null,"abstract":"<p><strong>Background: </strong>Community-acquired pneumonia (CAP) is a prevalent pediatric condition, and lobar pneumonia (LP) is considered a severe subtype. Early identification of LP is crucial for appropriate management. This study aimed to develop and compare machine learning models to predict LP in children with CAP.</p><p><strong>Methods: </strong>A total of 25 clinical and laboratory variables were collected. Missing data (<2%) were imputed, and the dataset was split into training (60%) and validation (40%) sets. Univariable logistic regression and Boruta feature selection were used to identify significant predictors. Four machine learning algorithms-Logistic Regression (LR), Support Vector Machine (SVM), Extreme Gradient Boosting (XGBoost), and Decision Tree (DT)-were compared using area under the curve (AUC), balanced accuracy, sensitivity, specificity, and F1 score. SHAP analysis was performed to interpret the best-performing model.</p><p><strong>Results: </strong>A total of 278 patients with CAP were included in this study, of whom 65 were diagnosed with LP. The XGBoost model demonstrated the best performance with an AUC of 0.880 (95% CI: 0.807-0.934) in the training set and 0.746 (95% CI: 0.664-0.843) in the validation set. SHAP analysis identified age, CRP, CD64 index, lymphocyte percentage, and ALB as the top five predictive factors.</p><p><strong>Conclusion: </strong>The XGBoost model showed superior performance in predicting LP in children with CAP. The model enabled early diagnosis and risk assessment of LP, thereby facilitating appropriate clinical decision-making.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"13 ","pages":"1490500"},"PeriodicalIF":2.1,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11925904/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691784","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}