Pineal gland volume in children with intellectual disability

OBJECTIVE

Pineal gland volume (PGV), which is associated with sleep and circadian rhythm, is known to be changed in some psychiatric disorders such as major depression, mood disorders and schizophrenia. This study aimed to compare the PGV of children with mild and moderate intellectual disability (ID) and healthy children.

METHODS

This multicentre retrospective study included 40 children with ID (patient group), aged 6-12 years and 40 age- and sex-matched healthy children (control group). The children were examined for their sociodemographic characteristics and for PGV using magnetic resonance imaging.

RESULTS

The PGV of the patient group was significantly larger than that of the controls (p = 0.023). There was no statistically significant difference in PGV between mild and moderate ID. A moderate and positive correlation was found between Weschler Intelligence Scale for Children-revised (WISC-R) performance score and PGV (p = 0.049, r = 0.313) only in the patient group. In the receiver operating characteristic analysis, the area under the curve was 0.648, and the sensitivity was 70.0%, and the specificity was 60.0%.

CONCLUSIONS

In conclusion, this study demonstrated that the increased PGV levels were associated with autism spectrum disorder (ASD) and PGV could be a risk factor in the aetiology of ID. Further research with larger sample sizes is needed to clarify this issue.

Prevalence and risk factors associated with psychological distress among children in Penang, Malaysia: A stratified multistage cluster study

Mental health is a state of mind influences one thinking, feeling and acting from inside and outside that are vital for children's normal growth and development. Psychological distress may results in serious mental health problem if left untreated. Hence, early diagnosis can largely improve the condition from being deteriorating. This study determined the prevalence of psychological distress and its associated risk factors among children in Penang, Malaysia. The study applied stratified multistage cluster sampling for the recruitment of children, and their socio-demographics background, health and lifestyle practices, and the prevalence and risk factors of psychological distress were succinctly studied. The study provides a fundamental platform for informing parents and policy makers about psychological distress, and the need to strategize potential health intervention for achieving optimum human well-being.•Stratified multistage cluster sampling was useful to study the prevalence and risk factors of psychological distress in a children population.•DASS-Y is robust for brief dimensional measure of depression, anxiety and stress among children.

Attachment & biobehavioral catch-up participation & reunification in a family treatment court

BACKGROUND

Children impacted by substances are at increased risk for child welfare involvement, which often leads to out-of-home care. Substance use disorder (SUD) impacts the family unit, and thus, prevention and intervention efforts need to target the family, not just the individual with a SUD. There are efficacious interventions for families impacted by SUD, but limited information exists on family reunification outcomes following services.

OBJECTIVE

This study examined whether participation in the Attachment and Biobehavioral Catch-Up (ABC) model was associated with a higher likelihood of reunification among families involved with a family treatment court (FTC) per conditions of an open child welfare case.

METHODS

The study sample includes a total of 215 children from 112 families, ages six months to forty-seven months, and their caregivers, all enrolled in an FTC due to SUD. Children were considered exposed to the intervention (N = 39; 18.1 %) if either they or a sibling participated with either a biological or foster parent. The ABC treatment was delivered by a trained therapist either in the home or via telehealth.

RESULTS

74 % of children exposed to the ABC model reunified by study end compared to 57 % of children who were not exposed to the intervention. In a multivariable Cox regression model controlling for covariates, reunification was driven by cases with biological parent participation. Compared to no exposure, cases with biological parent exposure were 2.3 times more likely to reunify. Reunification was not impacted by foster parent exposure.

CONCLUSIONS

Families impacted by substances need interventions that target the caregiver-child dyad. Facilitating family bonding and attachment with direct caregiver involvement is critical to serving caregivers and their children. This study shows the ABC model, particularly when delivered to biological parent-child dyads, is associated with a higher likelihood of reunification for children in child welfare, an outcome that, when safe, secure, and stable, critically improves long-term, healthy development.

Measles-specific antibodies loss after a single dose of MMR vaccine in children with oligo-articular JIA on methotrexate treatment: a single-center case-controlled study

Novel treatments have revolutionized the care and outcome of patients with juvenile idiopathic arthritis (JIA). Patients with rheumatic diseases are susceptible to infections, including vaccine preventable ones, due to waning immunity, failing immune system and immunosuppressive treatment received. However, data regarding long-term immunological memory and response to specific vaccines are limited. Assessment of the impact of methotrexate (MTX) treatment on measles-specific-IgG titers, in children with oligo-JIA previously vaccinated with Measles Mumps Rubella (MMR) vaccine (1 dose); by evaluating the persistence of antibodies produced after measles vaccination while on immunomodulating treatment at 0, 12 and 24 months. Single-center controlled study including 54 oligo-JIA patients and 26 healthy controls. Seroprotection rates and measles-specific-IgG titers were measured by ELISA and were expressed as GMCs (Geometric Mean Concentrations).The two groups had similar demographic characteristics, vaccination history and immunization status. Seroprotection rates were adequate for both groups. Nonetheless, measles GMCs were significantly lower in the oligo-JIA compared to the control group at one (p = 0.039) and two years' follow-up (p = 0.021). Children with oligo-JIA on MTX treatment appeared to have lower measles-specific-IgG titers. Further studies are required to assess the long-term immunity conveyed by immunizations given at an early stage in children with rheumatic diseases on synthetic Disease Modifying Antirheumatic Drugs (sDMARDs) and to assess the need for booster doses to subjects at risk.

Management of neonates at risk of early onset sepsis: a probability-based approach and recent literature appraisal : Update of the Swiss national guideline of the Swiss Society of Neonatology and the Pediatric Infectious Disease Group Switzerland

In Switzerland and other high-income countries, one out of 3000 to 5000 term and late preterm neonates develops early onset sepsis (EOS) associated with a mortality of around 3%, while incidence and mortality of EOS in very preterm infants are substantially higher. Exposure to antibiotics for suspected EOS is disproportionally high compared to the incidence of EOS with consequences for future health and antimicrobial resistance (AMR). A safe reduction of unnecessary antibiotic treatment has to be a major goal of new management strategies and guidelines. Antibiotics should be administered immediately in situations with clinical signs of septic shock. Group B streptococcus (GBS) and Escherichia coli (E. coli) are the leading pathogens of EOS. Amoxicillin combined with an aminoglycoside remains the first choice for empirical treatment. Serial physical examinations are recommended for all neonates with risk factors for EOS. Neonates without any clinical signs suggestive of EOS should not be treated with antibiotics. In Switzerland, we do not recommend the use of the EOS calculator, a risk stratification tool, due to its unclear impact in a population with an observed antibiotic exposure below 3%. Not all neonates with respiratory distress should be empirically treated with antibiotics. Isolated tachypnea or respiratory distress starting immediately after delivery by elective caesarean section or a clearly assessed alternative explanation than EOS for clinical signs may point towards a low probability of sepsis. On the other hand, unexplained prematurity with risk factors has an inherent higher risk of EOS. Before the start of antibiotic therapy, blood cultures should be drawn with a minimum volume of 1 ml in a single aerobic blood culture bottle. This standard procedure allows antibiotics to be stopped after 24 to 36 h if no pathogen is detected in blood cultures. Current data do not support the use of PCR-based pathogen detection in blood as a standard method. Lumbar puncture is recommended in blood culture-proven EOS, critical illness, or in the presence of neurological symptoms such as seizures or altered consciousness. The accuracy of a single biomarker measurement to distinguish inflammation from infection is low in neonates. Therefore, biomarker guidance is not a standard part of decision-making regarding the start or stop of antibiotic therapy but may be used as part of an algorithm and after appropriate education of health care teams. Every newborn started on antibiotics should be assessed for organ dysfunction with prompt initiation of respiratory and hemodynamic support if needed. An elevated lactate may be a sign of poor perfusion and requires a comprehensive assessment of the clinical condition. Interventions to restore perfusion include fluid boli with crystalloids and catecholamines. Neonates in critical condition should be cared for in a specialized unit. In situations with a low probability of EOS, antibiotics should be stopped as early as possible within the first 24 h after the start of therapy. In cases with microbiologically proven EOS, reassessment and streamlining of antibiotic therapy in neonates is an important step to minimize AMR.

CONCLUSION

 This guideline, developed through a critical review of the literature, facilitates a probability-based approach to the management of neonates at risk of early onset sepsis.

WHAT IS KNOWN

• Neonatal exposure to antibiotics is disproportionally high compared with the incidence of early onset sepsis with implications for future health and antimicrobial resistance.

WHAT IS NEW

• A probability-based approach may facilitate a more balanced management of neonatal sepsis and antibiotic stewardship.

Significant correlation between serum biomarkers and outcome in neonatal hypoxic-ischaemic encephalopathy

AIM

Associations between serum biomarkers S100 calcium-binding protein B (S100B) and neuron-specific enolase (NSE) in neonates with hypoxic-ischaemic encephalopathy (HIE) offer contradicting data in regard to neurocognitive outcome. The aim of our study was to provide another dataset to answer this question if S100B or NSE correlates to outcome in neonatal HIE. In addition, we investigate whether amplitude-integrated EEG (aEEG) or magnetic resonance imaging (MRI) also has predictive value.

METHODS

In neonates with HIE born in Vorarlberg, Austria, (n = 34) from 2012to 2020, NSE and S100B serum levels were measured on day one. aEEG was installed at admission and MRI performed within 7 days. Surviving children (n = 27) were categorised as good or poor outcome by using an age-appropriate neurocognitive test and a standardised neurological follow-up. Positive and negative predictive values and receiver operating characteristic curves were calculated to evaluate the prognostic value.

RESULTS

S100B showed best positive and negative predictive value, 72.7% and 90.5%, respectively, and a significant area under the curve of 0.820. NSE showed a positive and a negative predictive value of 43.8% and 81.3% and an area under the curve of 0.757. Severely abnormal aEEG and abnormal MRI significantly correlated with outcome (p = 0.024 and 0.001 respectively).

CONCLUSION

S100B and NSE on day one, severely abnormal aEEG and abnormal MRI show a significant correlation and good predictive value for neurocognitive outcome.

Karate Kata training: A promising intervention for behavioral problems in elementary school children

Behavioral issues frequently arise in primary school children, affecting their academic performance, social interactions, and general welfare. These concerns encompass challenges related to attention, concentration, aggression, oppositional behavior, and social maladaptation. The purpose of the current study was to examine the impacts of karate Kata training on extrinsic behavioral problems of elementary school students. The Achenbach Child Behavior Checklist (CBCL) questionnaire was given to all fourth- to sixth-grade students from a male elementary school, totaling 241 students, in Mashhad, Iran. A total of 76 eligible school-aged children with a total score of 65 and above in attention, aggression, oppositional defiance, and social maladaptation issues were selected and randomly assigned to an exercise group (n = 38) or a no-exercise control group (n = 38). Participants in the exercise group were instructed to engage in Kata training, which consists of a series of choreographed movements designed to enhance physical and mental discipline, for a duration of 12 60-min sessions, whereas the participants in the control group followed their daily activities. The CBCL from the Achenbach System of Empirically Based Assessment was used to assess dependent variables such as attention and concentration, aggression, oppositional defiance, and social maladaptation at baseline and post-intervention. The repeated-measures analysis of variance indicated that Kata training results in significant improvements in attention and concentration and significant reductions in aggression, oppositional defiance, and social maladaptation among elementary school students (all ps < .001). These results highlight the potential benefits of incorporating Kata training into interventions aimed at improving the behavioral outcomes of children.

Chilaiditi Sign and Syndrome as a Finding in the Emergency Room: A Case Report

The Chilaiditi sign is the presence of a loop of bowel interposed between the liver and the diaphragm. In most cases, the Chilaiditi sign is diagnosed as a rare incidental radiological finding on chest X-rays or the abdomen of asymptomatic patients. When associated with symptoms, it is named Chilaiditi syndrome. However, the symptoms are nonspecific, encompassing some of the most common causes of resorting to the emergency room (ER), such as abdominal pain, dyspnea, vomiting, or constipation, which hinders the differential diagnosis, so it's necessary to resort to imaging tests. We report a case of a 56-year-old male who presented to the ER due to dyspnea, constipation, and generalized abdominal pain/discomfort, with no other complaints. The chest X-ray revealed the presence of the Chilaiditi sign, and the diagnosis of Chilaiditi syndrome was considered as a diagnostic hypothesis and later confirmed with the computerized tomography (CT) scan and correlation of the patient's symptoms. We conclude that although Chilaiditi's syndrome is a rare condition, it should be considered as a possible differential diagnosis so that the patient receives adequate treatment with minimal harm since most cases are resolved with conservative treatment.

Rotavirus Infections: A 2-Year Comprehensive Review in Admitted Pediastric Patients Amid Conflicting National Policies

Highlighting rotavirus (RV) as a significant food and waterborne pathogen, particularly affecting infants and children, causing serious gastrointestinal infections and dehydration, is important. It should be noted that there are significant debates regarding the effectiveness and outcomes of RV vaccination. In contrast to Turkey's nonmandatory vaccination policy, many developed countries implement mandatory vaccination policies, raising questions about their impact on disease prevalence and healthcare expenditures. Our study aims to comprehensively understand RV infections in Turkey and compare them with countries that have mandatory vaccination policies. We found similar, and even better, hospitalization rates, length of hospital stays, and laboratory parameters demonstrating the effectiveness of Turkey's independent vaccination approach. These findings contribute valuable insights to global vaccination strategies and disease control.

Ultrasound Imaging of Various Ingested Foreign Bodies in an Ex Vivo Intestinal Model

OBJECTIVE

Foreign body ingestion is an increasingly prevalent issue for children who are in the preverbal to early verbal stages of life. Foreign bodies lodged in the gastrointestinal tract can cause issues such as obstruction, perforation, and fistulae. Radiographic imaging can often locate most foreign bodies; however, radiolucent objects may be missed. Ultrasound is an alternative imaging modality that can be used to locate and track foreign objects as they pass through the bowel. The objective of this study was to characterize the sonographic appearance of various ingested foreign bodies of varying characteristics in an ex vivo gastrointestinal tract segment.

METHODS

A GE Logiq 9 ultrasound machine with a linear transducer at a frequency of 15 MHz was used to examine various ingested foreign bodies placed in a segment of pig intestinal tract.

RESULTS

Imaged objects varied in visual appearance from echogenicity, texture, size, and shape; acoustic shadows and reverberation artifacts cast were particularly distinguishing characteristics.

CONCLUSIONS

Ultrasound evaluation to assess foreign body ingestion in the pediatric population may provide a useful alternative or supportive imaging modality in confirming the location and real-time tracking of the ingested item. This may be especially useful for objects of varying radiodensities that cannot always be reliably seen in traditional radiographs.

The use of immersive virtual reality for managing physical and psychological distress in children and adolescents with cancer undergoing chemotherapy via implanted vascular access device needle insertion: A systematic review

PURPOSE

Children and adolescents undergoing cancer treatment often endure distressing procedures, leading to pain and anxiety. Immersive virtual reality (VR) is a novel distraction technique for distress management, but research in pediatric oncology remains limited. This systematic review aims to assess the effectiveness of IVR intervention utilizing advanced head-mounted displays, in alleviating physical and psychological distress among Children and Adolescents diagnosed with malignancies undergoing chemotherapy treatment via Implantable Venous Access Device/Port (IVAD/P) (P) needle insertion. Additionally, the study evaluates the usability and acceptability of the IVR intervention among healthcare professionals, patients, and their parents.

METHOD

A thorough database search (PubMed, Medline, Embase, CINHAL, and APA Psycinfo) identified seven relevant quantitative studies published until April 2024.

RESULTS

In five studies, VR significantly reduced physical distress, especially pain, though the other two showed positive trends without statistical significance. For psychological distress, two studies reported significantly lower levels in the VR group, while three showed promising but statistically insignificant results. Children and adolescents, as well as healthcare professionals, found VR user-friendly and expressed willingness to use it again.

CONCLUSIONS

The review suggests that immersive VR has significant potential as a distraction method for children and adolescents undergoing CMT via IVAD/P. It shows promise in reducing physical and psychological distress and is well-received by patients and healthcare professionals.

An update on multiple breath washout in children with cystic fibrosis

INTRODUCTION

Cystic fibrosis (CF) is an autosomal recessive disorder caused by mutations in the CF transmembrane regulator (CFTR) gene, leading to progressive lung disease and systemic complications. Lung disease remains the primary cause of morbidity and mortality, making early detection of lung function decline crucial. The Lung Clearance Index (LCI), derived from the multiple breath washout (MBW) test, has emerged as a sensitive measure for identifying early airway disease.

AREAS COVERED

This review examines the technical aspects and clinical relevance of LCI, its advantages over traditional lung function tests, and its application in CF clinical trials. A focused literature review highlights LCI's utility in evaluating treatment efficacy and its potential integration into routine CF care.

EXPERT OPINION

LCI is more sensitive than spirometry for detecting early lung function decline and is predominantly used in pediatric settings. Its use is expanding in adult CF populations as advances in treatment allow adults to maintain stable lung function. In clinical trials, LCI is widely recognized as an outcome measure. While implemented into clinical care in many centers in Europe, this is not yet the case in North America. Faster testing protocols and point-of-care interpretation tools will support LCI's integration into routine CF monitoring.

Copper supplementation alleviates hypoxia‑induced ferroptosis and oxidative stress in neuronal cells

Hypoxic ischemia is the primary cause of brain damage in newborns. Notably, copper supplementation has potential benefits in ischemic brain damage; however, the precise mechanisms underlying this protective effect remain unclear. In the present study, a hypoxic HT22 cell model was developed to examine the mechanism by which copper mitigates hypoxia‑induced oxidative stress. Cell viability was assessed using the Cell Counting Kit‑8 assay, mitochondrial structure was examined with a transmission electron microscope, intracellular ferrous ions and lipid reactive oxygen species levels in HT22 cells were measured using FerroOrange and BODIPY 581/591 C11 staining, copper content was determined using graphite furnace atomic absorption spectroscopy, and gene and protein expression were analyzed by reverse transcription‑quantitative PCR and western blotting. The present findings indicated that hypoxic exposure may lead to reduced cell viability, along with the upregulation of various markers associated with ferroptosis. Furthermore, hypoxia elevated the levels of reactive oxygen species, hydrogen peroxide and malondialdehyde, and decreased the activity of superoxide dismutase 1 (SOD1) in HT22 cells. In addition, the intracellular copper concentration exhibited a notable decrease, while supplementation with an appropriate dose of copper effectively shielded neurons from hypoxia‑induced oxidative stress and ferroptosis, and elevated cell viability in hypoxia‑exposed HT22 cells through the copper chaperone for superoxide dismutase/SOD1/glutathione peroxidase 4 axis. In conclusion, the present study identified a novel function of copper in protecting neurons from oxidative stress and ferroptosis under hypoxic conditions, providing fresh insights into the therapeutic potential of copper in mitigating hypoxia‑induced neuronal injury.

Parent-reported offering of allergen foods to infants during complementary feeding: An observational study of New Zealand infants

The prevalence of food allergies in New Zealand infants is uncertain but is believed to be similar to Australia, exceeding 10%. Current recommendations for reducing food allergy risk are to offer all major food allergens to infants from as early as six months of age (start of complementary feeding), and before 12 months of age. However, little is known regarding parental practices around introducing major food allergens. This study aimed to explore parental offering of major food allergens to infants during complementary feeding, and parent-reported food allergies. The cross-sectional study is a secondary analysis of the multi-centre (Auckland and Dunedin) First Foods New Zealand study of 625 parent-infant dyads. Participants were recruited in 2020-2022 when infants were 7-10 months of age. Questionnaires assessed sociodemographic characteristics, complementary feeding approach, infant pouch use and parental responses to five food allergy questions. All major food allergens had been offered to only 17% of infants by 9-10 months of age. Having offered egg, peanut, tree nuts, sesame, soy and seafood was more commonly associated with using a baby-led complementary feeding approach than a parent-led approach (p < 0.001). Frequent baby food pouch use was associated with a lower likelihood of offering egg and peanut (both p < 0.001). Overall, 12.6% of infants had a reported food allergy, with symptomatic response after exposure being the most common diagnostic tool. Most infants are not offered all major food allergens during early complementary feeding, with some parents actively avoiding major food allergens in the first year of life. These results provide up-to-date knowledge of parental practices, highlighting the need for more targeted advice and strategies to improve parental engagement with allergy prevention and diagnosis.

Yoga in Pediatric Gastroenterology

PURPOSE OF REVIEW

Pediatric use of yoga as an integrative medicine modality has increased in prevalence over the last several decades. In this article, we review the available evidence for yoga in pediatric gastrointestinal disorders.

RECENT FINDINGS

Evidence supports that in many pediatric disorders of gut brain interaction (DGBI), including irritable bowel syndrome, functional abdominal pain and functional dyspepsia, yoga decreases pain intensity and frequency and increases school attendance. Yoga has been shown to improve health-related quality of life and improve stress management as an effective adjunct to standard medical therapy in pediatric inflammatory bowel disease (IBD). Further studies are needed regarding optimal frequency, duration of practice and evaluation of the impact on IBD disease activity measures. Yoga may benefit pediatric gastroenterology patients with DGBIs and IBD through improving quality of life and reducing pain. Future yoga studies could investigate biomarkers and continued research will help integrate this modality into routine pediatric gastroenterology care.

An Overview of Pharmacotherapy in the Management of Children with Autism Spectrum Disorder at a Public Hospital in KwaZulu-Natal

This study presents an overview of prescribing patterns and provides insight into the current management practice for the core symptoms and comorbidities of ASD in children. A quantitative retrospective study was conducted at a public hospital in KwaZulu-Natal, South Africa by reviewing patient files of children diagnosed with ASD and meeting the inclusion criteria for the study. A descriptive analysis of data was done to identify treatment trends and patient therapeutic outcomes. A total of 181 children met the inclusion criteria of the study. Risperidone was the most frequently prescribed drug (88%) for the management of comorbidities and/or core symptoms of ASD. Drugs prescribed to manage ASD comorbidities included methylphenidate, melatonin, sodium valproate, risperidone, oxybutynin, carbamazepine, and others. Except for risperidone, there were no additional drugs that targeted the core symptoms of ASD. Non-pharmacological therapies were often used collaboratively with medication to manage ASD symptoms. In 41% of patients, there were improvements in their symptoms.

Does Postanesthesia Forced-Air Warming Affect Emergence Delirium in Pediatric Patients Receiving Daily Anesthesia?

PURPOSE

To determine if postanesthesia forced-air warming as a nonpharmacologic intervention for emergence delirium (ED)/emergence agitation (EA) decreased the incidence and severity of ED in children aged 18 months to 6 years old.

DESIGN

Prospective nonrandomized controlled trial.

METHODS

Participants included children aged 18 months to 6 years old receiving general anesthesia within a radiation oncology setting. Status of ED/EA was based on the participants' Pediatric Anesthesia Emergence Delirium (PAED) scale score (two consecutive scores greater than 10 out of 20) or inconsolable agitation behaviors post computed tomography simulation (day 0). Interrater reliability was conducted among the center's perianesthesia care nurses. Participants who scored positive for ED/EA received a forced-air warming blanket for the remainder of treatment with data collection 1 to 14 days postanesthesia. Non-ED/EA participants were followed for 14 days and provided forced-air warming if ED/EA occurred. Data consisted of daily PAED scores and self- or parent-report on the anxiety scale. If the participants received forced-air warming, nurses' clinical observations and parent satisfaction surveys were collected 3 times during the 14-day study period.

FINDINGS

A total of 59 participants completed the study (mean age 3.43 years; 60% male; 63% non-Hispanic White); 16 were identified with ED or EA (mean age 3.56 years; 50% male; 69% non-Hispanic White) with an incidence rate of 28%. For the 16 participants with ED/EA, the primary diagnosis consisted of solid tumors and an American Society of Anesthesia Classification III to IV. Prior to the forced-air warming intervention, all 16 participants exhibited inconsolable ED/EA behaviors, including 8 who had PAED scores greater than 10. ED/EA behaviors expressed included inconsolability, confusion, thrashing, and combativeness. Within the 14-day period, 3 participants received forced-air warming on day 1, while the other 13 received an average of 4.23 days of treatment (range 1 to 11 days; mode 1 day; median 4 days). Comparison of PAED scores pre (mean 4.4) and post (mean 1.8) indicated that the use of forced-air warming was statistically significant (P = .001). ED/EA behaviors and PAED scores after the forced-air warming period decreased in all but one participant. Some agitation behaviors were not captured within the PAED score.

CONCLUSIONS

Forced-air warming impacted PAED scores and agitation behaviors for studied participants, offering a safe, nonpharmacological nursing intervention that may be an effective tool for helping to manage this baffling condition.

A feasibility study on the virtual adaptation of Child Adult Relationship Enhancement in Primary Care

Childhood behavioral problems are common; despite evidence that parenting interventions improve outcomes, the use of these programs is limited. Virtual delivery may ameliorate attendance barriers, but little is known on the acceptability and feasibility of virtual group parenting interventions. This mixed-methods study explored the feasibility, acceptability, and appropriateness of the virtual delivery of a parenting intervention, Child Adult Relationship Enhancement in Primary Care (PriCARE) among 18 caregivers and 8 facilitators. Subjects completed survey instruments assessing acceptability, appropriateness, feasibility, and telehealth usability and participated in semi-structured interviews exploring these constructs. Directed content analysis of interview transcripts identified themes. Most participants were female with a mean age of 35 years among caregivers and 37 years among facilitators. Slightly less than half of caregivers were Black (44%), with the remaining White. The majority of facilitators were White (88%). Over half (56%) of families received government assistance. Surveys indicated high acceptability, appropriateness, feasibility, and telehealth usability. We identified five overarching themes from qualitative analysis: nuances of feasibility, high acceptability, balancing skills and group dynamics, flexibility within fidelity, and multiple perspectives of disparities. Within these themes, reduced logistical barriers and the normalization of virtual meetings were contrasted with virtual burnout and distractions in the home. The majority of participants expressed that they learned helpful parenting skills, even in the setting of the suboptimal group dynamic of the virtual format. While disparities in technology and support systems were identified, the participation of caregivers who would not have attended in person was highlighted.

Assessment of Psychological Impact among Hospitalized Children; Single Centre Study

Background: The goal of the contemporary hospital setting is to give patients suffering from a range of diseases a secure and therapeutic space. Aim: Psychosocial and mental health assessment among hospitalized children between 7 to 12 years of age. Methods: This Cross-Sectional Study was carried out at the Children's Hospital Faculty of Medicine for 1-year duration. Results: Higher statistically significant positive results were found in cases than in control regarding all Vanderbilt subscales except in the conduct subscale. Higher results were found in chronic cases than control in all subscales except for oppositional defiant disorder results. Conclusion: Hospitalized Children, due to chronic or acute conditions, are at a higher risk for Psychosocial and mental health disorders such as depression, anxiety, ADHD, PTSD, and pain in comparison with healthy children.

Assessment of Physical Performance in Children After Surgery for Congenital Diaphragmatic Hernia

Objective: This study aims to evaluate long-term physical and motor performance in children aged 3-6 years following congenital diaphragmatic hernia (CDH) surgery, in comparison with healthy peers. While existing research emphasizes prognostic factors such as the lung to heart ratio (LHR) and liver position, few studies address physical outcomes in early childhood post-surgery. Methods: A total of 31 children who underwent neonatal CDH surgery (study group) and 41 age-matched healthy children (reference group) were assessed. The Wrocław Test and the Ozierecki Metric Scale (modified by Barański) were used to evaluate strength, endurance, motor coordination, and agility. Results: Findings indicated that children in the CDH group had significantly lower scores in physical performance, particularly in endurance and motor coordination, compared to their healthy peers. Strength differences were present but less pronounced. Conclusions: Children post-CDH surgery exhibit slightly delayed physical and motor development, suggesting a potential need for targeted physical activity programs in early childhood to support improved outcomes.

Selected Markers of Inflammation in the Saliva of Children Infected with Helicobacter pylori

Helicobacter pylori has been of interest to scientists and clinicians for many years, often causing diagnostic difficulties, especially in the youngest age group, in children. The presence of this bacterium in the population depends on the geographic region. However, it is assumed that even half of the world's population may be infected with H. pylori. Children infected with H. pylori-the study group (Hp(+)) and control group (Hp(-)), were chosen for further examination. The aim of the study was to analyze the concentrations of selected inflammatory markers in saliva (TNF-α, IL-8) and other markers (neutrophil defensin-1, sICAM-1, calprotectin, metalloproteinase-9, metalloproteinase-2, lactotransferrin, TLR-2) using ELISA technique. We confirmed the increased concentrations of IL-8, ND-1, and TLR-2 in the group of children infected with Helicobacter pylori. Moreover, there was also a positive, significant correlation between the concentration of ND-1 and MMP-2, sICAM-1, and calprotectin as well as MMP-9 and MMP-2 in the group of infected children. The study created new possibilities of insight into the pathogenetic mechanisms of developing inflammation in the mouth. This type of comprehensive research is also used to monitor the current disease process and create new opportunities for better in-depth diagnostics of children infected with H. pylori.

Down syndrome frontal cortex layer III and layer V pyramidal neurons exhibit lamina specific degeneration in aged individuals

Selective vulnerability of neuronal populations occurs in both Down syndrome (DS) and Alzheimer's disease (AD), resulting in disproportional degeneration of pyramidal neurons (PNs) affecting memory and executive function. Elucidating the cellular mechanisms underlying the selective vulnerability of these populations will provide pivotal insights for disease progression in DS and AD. Single population RNA-sequencing analysis was performed on neurons critical for executive function, prefrontal cortex Brodmann area 9 (BA9) layer III (L3) and layer V (L5) excitatory PNs in postmortem human DS and age- and sex-matched control (CTR) brains. Data mining was performed on differentially expressed genes (DEGs) from PNs in each lamina with DEGs divergent between lamina identified and interrogated. Bioinformatic inquiry of L3 PNs revealed more unique/differentially expressed DEGs (uDEGs) than in L5 PNs in DS compared to CTR subjects, indicating gene dysregulation shows both spatial and cortical laminar projection neuron dependent dysregulation. DS triplicated human chromosome 21 (HSA21) comprised a subset of DEGs only dysregulated in L3 or L5 neurons, demonstrating partial cellular specificity in HSA21 expression. These HSA21 uDEGs had a disproportionally high number of noncoding RNAs, suggesting lamina specific dysfunctional gene regulation. L3 uDEGs revealed overall more dysregulation of cellular pathways and processes, many relevant to early AD pathogenesis, while L5 revealed processes suggestive of frank AD pathology. These findings indicate that trisomy differentially affects a subpopulation of uDEGs in L3 and L5 BA9 projection neurons in aged individuals with DS, which may inform circuit specific pathogenesis underlying DS and AD.

Dietary Intake and Quality in Irritable Bowel Syndrome: A Comparative Study With Controls and the Association With Symptom Severity

INTRODUCTION

Patients with irritable bowel syndrome (IBS) often attribute the onset or worsening of gastrointestinal symptoms to intake of food. Hence, to alleviate symptoms, patients with IBS may avoid triggering foods, potentially impacting their dietary intake and diet quality. This study aimed to compare the habitual diet intake and quality of patients with IBS with controls and to explore the association between dietary habits and symptoms in patients with IBS.

METHODS

Patients with IBS were included in 4 clinical studies reporting habitual dietary intakes at baseline. Age- and sex-matched controls representing the general population were derived from the Swedish population-based Riksmaten study. Dietary intakes were assessed using 4-day food diaries. Diet quality was measured using the diet quality index-Swedish national dietary guidelines (DQI-SNR), and diet diversity was scored based on the variety of food groups consumed.

RESULTS

The study included 646 patients with IBS and 646 controls (38 ± 14 years, 77% female). Both groups adhered to Nordic nutrition recommendations for macronutrients, except patients consumed fewer carbohydrates. Patients reported eating less carbohydrates, coffee, and dairy products and more fats, lactose-free dairy products, and nuts and seeds compared with controls. Fewer patients had a good diet quality according to the DQI-SNR. In patients, symptom severity and gastrointestinal-specific anxiety were associated with reduced energy and carbohydrate intake, lower diet diversity, and worse diet quality. Poor diet quality was associated with younger age, more severe IBS symptoms, anxiety, and depression.

DISCUSSION

Patients with IBS exhibit different dietary patterns compared with controls, with poorer dietary habits linked to more severe symptoms. Understanding food-symptom associations may enhance the optimization and personalization of dietary management for patients with IBS.

Protective Effects of Food-Derived Kaempferol on Pancreatic β-Cells in Type 1 Diabetes Mellitus

BACKGROUND

Kaempferol (KPF), a flavonoid abundant in edible plants, possesses potent anti-inflammatory and antioxidant properties beneficial with notable health benefits.

OBJECTIVE

To evaluate the protective effects of KPF on metabolic disturbances and pancreatic damage in a Type 1 diabetes mellitus (T1DM) mouse model.

METHODS

Male C57BL/6 mice were divided into normal, T1DM, T1DM + KPF 25 mg/kg, and T1DM + KPF 50 mg/kg groups. T1DM was induced by streptozotocin (STZ). KPF was administered via intraperitoneal injection for 2 weeks. After 4 weeks from the start, metabolic parameters, pancreatic histology, and plasma metabolites were analyzed. Network pharmacology and molecular docking identified key targets and pathways. In vitro, INS-1 cells were used to assess reactive oxygen species (ROS) production and apoptosis.

RESULTS

KPF significantly reduced blood glucose (GLU) and triglyceride (TG) levels, increased high-density lipoprotein (HDL) levels, and preserved pancreatic β-cell structure. Metabolomics revealed changes in energy metabolism and oxidative stress-related metabolites. Network analysis highlighted the PI3K/AKT/mTOR pathway, with strong binding affinities to targets such as AKT1. In vitro, KPF decreased ROS production in INS-1 cells; this effect was reversed by a PI3K/AKT inhibitor. KPF also reduced apoptosis in INS-1 cells.

CONCLUSIONS

KPF ameliorates metabolic disturbances and pancreatic damage in T1DM mice, suggesting potential as a functional food ingredient for diabetes management.

Global Prevalence and Clinical Manifestations of Celiac Disease Among First-Degree Relatives: A Systematic Review and Meta-Analysis

INTRODUCTION

First-degree relatives (FDRs) of patients with celiac disease (CeD) are at high risk for developing CeD. We conducted a systematic review and meta-analysis to estimate CeD prevalence and clinical manifestations by analyzing studies that used the anti-tissue transglutaminase antibody test for screening.

METHODS

In this systematic review with meta-analysis, studies published in PubMed, Web of Science, Embase, and Scopus were searched up to January 11, 2024, using keywords related to CeD and FDRs. Random-effects models were used, with heterogeneity assessed using the Cochran Q test and the I2 statistic performed in STATA 18.

RESULTS

Of 8,764 studies screened, 34 studies involving 10,016 FDRs of patients with CeD were included. The pooled estimates for seroprevalence and the biopsy-confirmed CeD prevalence in FDRs were 11% (95% CI: 9%-13%) and 7% (95% CI: 6%-9%), respectively. Daughters and sisters had the highest prevalence rates at 23% and 14%, compared with sons and brothers at 6% and 9%, respectively. Regional analysis revealed the highest seroprevalence estimates in Hungary (24%) and Cuba (19%), while the highest prevalence of biopsy-confirmed CeD was reported in Serbia (16%) and the United States (15%). Abdominal pain (42%), bloating (39%), and flatulence (38%) were the most common gastrointestinal symptoms, while 34% of FDRs with CeD were asymptomatic. In addition, pallor was the most frequent nongastrointestinal symptom (54%).

DISCUSSION

Approximately 1 in 14 FDRs of patients with CeD is estimated to have CeD, with 1 in 4 daughters, 1 in 7 sisters, 1 in 11 brothers, 1 in 16 sons, and 1 in 20 fathers and mothers could be affected. Routine screening for FDRs could support early detection and management of CeD.

Shared genetic architecture and causality between autism spectrum disorder and irritable bowel syndrome, multisite pain, and fatigue

Autism spectrum disorder (ASD) often co-occurs with functional somatic syndromes (FSS), such as irritable bowel syndrome (IBS), multisite pain, and fatigue. However, the underlying genetic mechanisms and causality have not been well studied. Using large-scale genome-wide association study (GWAS) data, we investigated the shared genetic architecture and causality between ASD and FSS. Specifically, we first estimated genetic correlations and then conducted a multi-trait analysis of GWAS (MTAG) to detect potential novel genetic variants for single traits. Afterwards, polygenic risk scores (PRS) of ASD were derived from GWAS and MTAG to examine the associations with phenotypes in the large Dutch Lifelines cohort. Finally, we performed Mendelian randomization (MR) to evaluate the causality. We observed positive genetic correlations between ASD and FSS (IBS: rg = 0.27, adjusted p = 2.04 × 10-7; multisite pain: rg = 0.13, adjusted p = 1.10 × 10-3; fatigue: rg = 0.33, adjusted p = 5.21 × 10-9). Leveraging these genetic correlations, we identified 3 novel genome-wide significant independent loci for ASD by conducting MTAG, mapped to NEDD4L, MFHAS1, and RP11-10A14.4. PRS of ASD derived from both GWAS and MTAG were associated with ASD and FSS in Lifelines, and MTAG-derived PRS showed a bigger effect size, larger explained variance, and smaller p-values. We did not observe significant causality using MR. Our study found genetic associations between ASD and FSS, specifically with IBS, multisite pain, and fatigue. These findings suggest that a shared genetic architecture may partly explain the co-occurrence between ASD and FSS. Further research is needed to investigate the causality between ASD and FSS due to current limited statistical power of the GWASs.

The Association of Short-Chain Fatty Acids with the Occurrence of Gastrointestinal Symptoms in Infants

Short-chain fatty acids (SCFAs) are produced by the fermentation of undigested polysaccharides; they are a group of metabolites resulting from the activity of intestinal bacteria. The main SCFAs are acetic, butyric, propionic, valeric, and caproic acid, and their levels and proportions depend on various factors. The aim of this study was to investigate the relationship between the concentration of SCFAs and the occurrence of specific gastrointestinal symptoms in infants. This study was conducted using faecal samples obtained at 1, 3, 6, and 12 months of age. The SCFA content was measured using gas chromatography. At 1 month, an association was found between butyric acid and flatulence. At 3 months, an association was found between butyric acid and flatulence/gas and between 3,4-methylovaleric acid and mucus in the stool. At 6 months, an association was found between butyric and valeric acids and flatulence. By 12 months, the gastrointestinal symptoms had decreased significantly. This study confirms that there is an association between SCFA levels and the presence of bloating, gas, mucus in the stool, and constipation in the gastrointestinal tract. Higher levels of butyric and valeric acids may lead to an increase in troublesome symptoms, such as flatulence and gas, in the first few months of life but are not associated with the occurrence of intestinal colic. The level of 3,4-methylovaleric acid is associated with the presence of allergies, whereas a decrease in acetic acid and an increase in isovaleric acid may exacerbate defecation problems in infants.

Predictive model for congenital heart disease in children of Pakistan by using structural equation modeling

BACKGROUND

The structural abnormality of the heart and its blood vessels at the time of birth is known as congenital heart disease. Every year in Pakistan, sixty thousand children are born with CHD, and 44 in 1000 die before they are a month old. Various studies used different techniques to estimate the risk factors of congenital heart disease, but these techniques suffer from a deficiency of capacity to present human understanding and a deficiency of adequate data. The current study provided an innovative approach by defining the latent variables to handle this issue and building a reasonable model.

METHOD

Data used in this study has been collected from mothers and hospital records of the children. The dataset contains information on 3900 children who visited the OPD of the Chaudry Pervaiz Elahi Institute of Cardiology (CPEIC) Multan, Pakistan from October 2021 to September 2022. The latent variables were defined from the data and structural equation modeling was used to model them.

RESULT

The results show that there are 53.6% of males have acyanotic CHD and 54.5% have cyanotic CHD. There are 46.4% of females have acyanotic CHD and 45.5% have cyanotic CHD. The children who have no diabetes in the family are 64.0% and children who have diabetes in the family are 36.0% in acyanotic CHD, the children who have no diabetes in the family are 59.7% and children have diabetes in the family are 40.3% in cyanotic CHD. The value of standardized root mean residual is 0.087 is less than 0.089 which shows that the model is a good fit. The value of root mean square error of approximation is 0.113 is less than 0.20 which also shows the good fit of the model.

CONCLUSION

It was concluded that the model is a good fit. Also, the latent variables, socioeconomic factors, and environmental factors of mothers during pregnancy have a significant effect in causing cyanotic while poor general health factor increases the risk of Acyanotic congenital heart disease.

Kidney Damage in Pediatric Obesity: Insights from an Emerging Perspective

The role of obesity as a risk factor for chronic kidney disease (CKD) in adulthood has been well established. Over the last years, kidney damage (KD) has emerged as a significant consequence of obesity since childhood. Indeed, a complex interplay of metabolic factors, including insulin resistance (IR), hypertension, oxidative stress, adipose tissue dysfunction, and systemic inflammation, might affect renal hemodynamics, contributing to CKD development over time in at-risk young patients. As the prevalence of pediatric obesity continues to rise globally, understanding the implications for kidney health in terms of early intervention is of paramount importance. Careful monitoring of kidney function within a multidisciplinary approach in children with obesity is crucial for detecting early KD, allowing for timely lifestyle modifications and treatment. In this framework, continued research is essential to further elucidate mechanisms linking obesity and KD and to explore not only effective preventive strategies but also the long-term impact of obesity on kidney health in children with obesity. Given the intimate link of KD with the metabolic milieu in children with obesity, we aimed to provide a comprehensive and insightful overview on KD and its implications in pediatric obesity by reviewing the most recent literature in the field.

How to Utilize University Nursing Clinic Resources Successfully to Transition Autistic Adolescents into Higher Education

Autism Spectrum Disorder (ASD) is complex neurodevelopmental disorder that is exhibited through a wide‐range of symptoms including social interactions, communication deficits, limited interests, and repetitive behaviors (e.g., stimming). The prevalence of autism amongst children and adolescents continues to grow with 1 in 36 diagnosed annually (CDC, 2024). Because autism often comes with a myriad of comorbidities (e.g., sleep disorders, seizure activity, nutritional imbalances, gastrointestinal issues, and mental health disorders), children and adolescents are often prescribed medications and/or treatments to help with the management of these chronic diseases. Croen et al., (2006) found that adolescents are six times more likely to be hospitalized than their neuro‐typical peers. Managing autism takes a multi‐disciplinary approach. Navigating a large university system, academics, and being away from home can be challenging for any teenager. But, adding the complexity of managing a chronic neurodevelopmental disorder on top of the new environment could potentially be overwhelming for the autistic adolescent. It makes sense to use all available resources when transitioning into a college setting. Registered nurses (RN) and advanced practice nurses (APN) are employed at university clinics to help manage student healthcare issues including acute healthcare problems (e.g., viruses), traumatic issues, and chronic healthcare issues. This paper will examine how nursing professionals can assist autistic adolescents when they are entering into a college environment by managing medications and other treatment modalities while being a student advocate within a multi‐disciplinary team.

The Role of Emotionality Stigma in Adolescent Mental Health: Measure Development and Call for Systems-Level Change

Youth mental health concerns, including substance abuse, continue to rise. With high co-morbidity rates and a marked lack of representation from diverse groups in study conceptualization, measurement, and implementation, efforts to understand factors impacting youth mental health from a cultural lens are needed. The theory of emotionality stigma posits that many mental health concerns can be understood based on one's endorsement of emotionality stigma-the experience of stigma around emotions-which manifests within one's context. Informed by this theory, the current study aimed to adapt and test a measure of emotionality stigma for diverse youth in combined mental health and substance use treatment. Targeted youth focus groups informed the adaptation of the pre-existing Emotionality Stigma Scale for implementation with diverse youth. Using a mixed methods approach, this measure was then tested for relevance, reliability, and validity in an outpatient youth clinic. Patients (N = 58, aged 13 to 21) reported their emotionality stigma, values, and attachment as part of routine monitoring. Based on qualitative feedback and quantitative analysis, our results illustrate the reliability and validity of the adapted Emotionality Stigma Scale and the relevance of this new measure for assessing youth mental health concerns and treatment outcomes. Areas for continued research are identified, and recommendations for implementation in conceptualization and treatment are provided.

Is exposure to Bisphenol A associated with Attention-deficit hyperactivity disorder (ADHD) and associated executive or behavioral problems in children? A comprehensive systematic review

Numerous studies have investigated environmental risk factors in ADHD, and Bisphenol A (BPA), an endocrine disruptor, is suspected by several reviews. However, the quality of the studies has never been carefully assessed, leading us to rigorously examine associations between BPA exposure and ADHD and associated symptoms in children. Using PRISMA criteria, we conducted a systematic review on the MEDLINE/PubMed, Web of Science, EBSCOhost, PsycINFO, PsycARTICLES and Cochrane databases. We used the ROBINS-E tool to assess the quality, and the GRADE Approach. This study was registered with PROSPERO, CRD42023377150. Out of 10446 screened articles, 46 were included. Unlike pre-existing reviews, most studies failed to find clear links with ADHD or associated symptoms, with a high risk of bias and a very low level of certainty. Our systematic review reveals insufficient evidence regarding the impact of BPA on ADHD, despite some behavioral results that cannot be generalized. Future studies will require improved consideration of confounding factors and more precise sampling methods. This study did not receive specific funding.

Common complications in spinal muscular atrophy (SMA) type 1 after nusinersen treatment

BACKGROUND

Spinal muscular atrophy (SMA) is an inherited disease with progressive muscle weakness and atrophy. Despite the new treatments developed recently, primary and secondary effects of muscle weakness in patients with SMA cause mortality and morbidity. The aim of this study is to identify common problems in the follow-up of patients after new treatment modalities and to examine the difficulties in management of these problems.

METHODS

The study included 16 patients diagnosed with SMA type 1 according to clinical findings and genetic results between 2017 and 2022. The patients were divided into two groups as living and deceased, and complications were examined and compared between the groups.

RESULTS

The patients comprised 8 (50%) females and 8 (50%) males with a median age at diagnosis of 3 months. The patients had a history of gastrointestinal problems, orthopedic problems, infection and sepsis, and especially respiratory distress. Death occurred in 8 (50%) patients during follow-up (median age 38 months). Mortality was higher in patients who needed tracheostomy and had gastroesophageal reflux. The survival rate was better in patients who received more nusinersen treatment and had a higher CHOP-INTEND score.

CONCLUSIONS

Despite new-generation treatments for SMA type 1, morbidity and mortality rates remain very high. As the survival rate in SMA type 1 increases, the incidence of complications similar to those frequently seen in SMA type 2 and type 3 patients also increases. The follow-up and treatment of patients with SMA should be undertaken by a multidisciplinary team.

The path of depression in rural children: A fuzzy-set qualitative comparative analysis across multiple provinces in China

OBJECTIVES

This study explores the combinations of conditional variables contributing to depressive symptoms in rural children.

METHODS

We analyzed data from 715 children from a rural mental health database, conducting detailed follow-up investigations on 129 children in Zhejiang and Henan provinces. We used fuzzy set Qualitative Comparative Analysis (fsQCA) and regression analysis to identify causal pathways leading to depression.

RESULTS

The results indicate that depression in rural children does not stem from a single, necessary condition but arises from multiple factors. Our findings highlight significant contributions from both maternal and paternal involvement. Specifically, maternal involvement, combined synergistically with peer support and problematic behaviors, as well as paternal involvement, together with peer support and anxiety, significantly affects depressive outcomes. Additionally, anxiety and strong peer relationships independently have a substantial impact on these outcomes. Effective mitigation strategies involve active parental engagement and robust peer support, reducing the influence of risk factors such as problematic behaviors and anxiety.

LIMITATIONS

The generalizability of the results is limited by cultural and geographical variations. The study also does not account for all potential factors influencing depression in rural children.

CONCLUSION

Depression in rural children results from multiple interacting factors. Tailored interventions addressing these specific combinations are recommended.

Mitochondrial related Mendelian randomization identifies causal associations between metabolic disorders and childhood neurodevelopmental disorders

Childhood neurodevelopmental disorders (NDDs), including autism spectrum disorder (ASD), attention-deficit hyperactivity disorder, and Tourette syndrome, are a predominant cause of health-related disabilities in children and adolescents. Nevertheless, disease biomarkers are still limited. The aim of this study was to evaluate the potential, causal relationship between mitochondrial DNA copy number (mtDNA-CN), metabolic disorders, and childhood NDDs using the two-sample Mendelian randomization (MR) method. Genetic associations with mtDNA-CN, disorders of lipoprotein metabolism, and disorders of iron metabolism were selected as exposures, and genome-wide association data from ASD, attention-deficit hyperactivity disorder, and Tourette syndrome were utilized as outcomes. Results of the study suggested that a high degree of disordered lipoprotein metabolism related increases in ASD risk result from a decrease in mtDNA-CN (disordered lipoprotein metabolism-mtDNA: inverse variance weighting β: -0.03, 95% confidence interval: -0.05 to -0.02, P = 2.08 × 10-5; mtDNA-CN-ASD: inverse variance weighting odds ratio: 0.83, 95% confidence interval: 0.69-0.99, P = .034). The research findings implied that mtDNA-CN can mediate disorders of lipoprotein metabolism, potentially influencing the development of ASD. The potential impact of the results of this study for the prevention and treatment of childhood NDDs warrants validation in robust randomized clinical trials.

Prenatal PM2.5 Exposure Associated with Neonatal Gut Bacterial Colonization and Early Children's Cognitive Development

Previous research indicated that fine particulate matter (PM2.5) exposure affected both offspring neurodevelopment and the colonization of gut microbiota (GM), while the underlying mechanism remained unclear. Our study aimed to evaluate the impacts of prenatal PM2.5 exposure on child cognitive development and investigate the role of neonatal GM colonization in the association. Based on the Shanghai Maternal-Child Pairs Cohort, 361 maternal-child pairs were recruited. Prenatal PM2.5 exposure concentrations were estimated using a high-spatial-resolution prediction model, and child neurodevelopment was assessed by the Ages and Stages Questionnaire. Multivariable linear regression models, logistic regression models, linear discriminant analysis effect size, and random forest model were applied to explore the associations among PM2.5 exposure, GM colonization, and children's neurodevelopment. The present study revealed a negative correlation between PM2.5 exposure throughout pregnancy and child neurodevelopment. Prenatal PM2.5 exposure was associated with an increased risk of suspected developmental delay (SDD) (OR = 1.683, 95% CI: 1.138, 2.489) in infants aged 2 months. Additionally, potential operational taxonomic unit markers were identified for PM2.5-related neurotoxicity, demonstrating promising classification potential for early SDD screening (AUC = 71.27%). Prenatal PM2.5 exposure might disrupt the composition, richness, and evenness of meconium GM, thereby influencing cognitive development and the occurrence of SDD in offspring. Seven PM2.5-related genera, Ruminococcus gnavus group, Romboutsia, Burkholderiaceae Caballeronia Paraburkholderia, Blautia, Alistipes, Parabacteroides, and Bacteroides, were validated as correlated with prenatal PM2.5 exposure and the occurrence of SDD. Moreover, alterations of GM related to PM2.5 exposure and SDD might be accompanied by changes in functional pathways of amino acid, lipid, and vitamin metabolism as indicated by differentially enriched species in the Kyoto Encyclopedia of Genes and Genomes.

Certified Child Life Specialists in Hospice and Palliative Care Organizations: A State of the Profession

BACKGROUND

Certified Child Life Specialists (CCLSs) provide developmentally appropriate psychosocial care to children to promote positive coping. However, little is known about the current professional landscape and opportunities for professional growth, especially in hospice and palliative care.

OBJECTIVES

To conduct a needs assessment among CCLS and examine the role in hospice and palliative care.

METHODS

CCLSs were surveyed on their experience and needs in providing care in hospice and palliative care organizations. The online survey contained questions about demographics and work environment. The survey included multiple choice, yes/no, and open-ended questions. Descriptive statistics were generated from the survey items and comments/open-ended questions were coded and assessed for themes.

RESULTS

Among the 191 respondents, most were females (96.3%), under 40 years of age (63.8%), Caucasian (87.4%), and non-Hispanic (95.3%) with under 12 years of full-time work experience (57.0%). CCLSs commonly worked in urban/suburban (67.5%) pediatric programs (62.3%) with clients ranging from perinatal (33.5%) to adult caregivers of children (60.2%). Themes from the open-ended questions were: (a) role clarification, (b) staffing, (c) funding, (d) training/education, (e) professionality, and (f) self-care.

CONCLUSIONS

Key insights into the profession, along with challenges and opportunities of working within the hospice and palliative care setting were identified. The findings highlighted the unique need for professional development among CCLSs.

Raloxifene Protects Oxygen-Glucose-Deprived Astrocyte Cells Used to Mimic Hypoxic-Ischemic Brain Injury

Perinatal asphyxia (PA) is a clinical condition characterized by oxygen supply suspension before, during, or immediately after birth, and it is an important risk factor for neurodevelopmental damage. Its estimated 1/1000 live births incidence in developed countries rises to 5-10-fold in developing countries. Schizophrenia, cerebral palsy, mental retardation, epilepsy, blindness, and others are among the highly disabling chronic pathologies associated with PA. However, so far, there is no effective therapy to neutralize or reduce PA-induced harm. Selective regulators of estrogen activity in tissues and selective estrogen receptor modulators like raloxifene have shown neuroprotective activity in different pathological scenarios. Their effect on PA is yet unknown. The purpose of this paper is to examine whether raloxifene showed neuroprotection in an oxygen-glucose deprivation/reoxygenation astrocyte cell model. To study this issue, T98G cells in culture were treated with a glucose-free DMEM medium and incubated at 37 °C in a hypoxia chamber with 1% O2 for 3, 6, 12, and 24 h. Cultures were supplemented with raloxifene 10, and 100 nM during both glucose and oxygen deprivation and reoxygenation periods. Raloxifene 100 nM and 10 nM improved cell survival-65.34% and 70.56%, respectively, compared with the control cell groups. Mitochondrial membrane potential was preserved by 58.9% 10 nM raloxifene and 81.57% 100 nM raloxifene cotreatment. Raloxifene co-treatment reduced superoxide production by 72.72% and peroxide production by 57%. Mitochondrial mass was preserved by 47.4%, 75.5%, and 89% in T98G cells exposed to 6-h oxygen-glucose deprivation followed by 3, 6, and 9 h of reoxygenation, respectively. Therefore, raloxifene improved cell survival and mitochondrial membrane potential and reduced lipid peroxidation and reactive oxygen species (ROS) production, suggesting a direct effect on mitochondria. In this study, raloxifene protected oxygen-glucose-deprived astrocyte cells, used to mimic hypoxic-ischemic brain injury. Two examiners performed the qualitative assessment in a double-blind fashion.

Trends in Childhood Behavioral, Mental, and Developmental Problems (2019-2022) Using the National Survey of Children's Health

BACKGROUND

This study examines nationwide prevalence of US childhood behavioral, mental, and developmental problems in the 6-11 age group category between 2019 and 2022, and several key metrics related to caregiver social determinants of health.

METHODS

We used NSCH data for 6-11-year-old children for the years 2019-2022. Summary statistics for the selected sample were generated and binary logistic regressions were conducted for each severity level binary variable for each study year with caregiver mental or emotional health as a covariate.

RESULTS

Our study found significant associations between severe childhood anxiety and "fair" or "poor" caregiver rankings of mental and emotional health for both the 2020 and 2022 survey years. Our study also found that caregiver mental and emotional health may play a role in childhood ADD and ADHD prevalence rates as caregivers who ranked their mental health as "fair" or "good" had significantly higher odds of having a child with severe ADD or ADHD than caregivers who reported "excellent" mental and emotional health.

CONCLUSION

These findings support prospects of an increase in the need for developmental health services, thus necessitating efforts towards effective allocation and focus of developmental treatment programs tailored to children and pediatric population groups.

Efficacy and safety of three antiseptics for neonatal skin disinfection: a cohort study

BACKGROUND

The choice of the ideal antiseptic is not only based on its efficacy but also on safety and skin-friendliness. There are no standard recommendations regarding ideal skin preparation in neonates.

METHODS

This was a prospective cohort study to evaluate the efficacy of 3 antiseptics[10% Povidone Iodine(PI), 70% isopropyl alcohol(AL), 2% chlorhexidine in 70% alcohol(CHG-IPA)] in disinfecting the skin before venipuncture in term neonates as assessed by logarithmic reduction in skin bacterial colony counts post-application. Secondary objectives were to assess the changes in skin condition. Measurements were done pre-, post-antiseptic and 6-24 h (for residual effect) later. Fifty neonates were enrolled in each group.

RESULTS

All three antiseptics caused a significant reduction in bacterial load post-application, but maximal efficacy [2.6(2.2-2.8)log reduction] and, maximal residual effect at 6-24 h was seen with CHG-IPA [2.4(2.2-2.6)log reduction]. The logarithmic reduction in colony counts from pre-intervention to 6-24 h later remained significant for all three groups [(PI, p-0.039; CHG-IPA, p-0.00; AL, p - 0.01)]. After an initial alteration in hydration, and skin condition score, there was a return to baseline after 6-24 h.

CONCLUSION(S)

2% CHG-IPA had better efficacy than AL or PI for skin antisepsis in term neonates. There was no significant change in skin integrity in all three groups.

IMPACT

All three antiseptics [2% chlorhexidine gluconate in 70% isopropyl alcohol(CHG + IPA), 10% Povidone Iodine(PI), and 70% isopropyl alcohol(AL)] cause significant reduction in bacterial colony counts. CHG + IPA has the maximum efficacy as assessed by log reduction of bacterial colony counts with optimal residual effect favouring its usage in term neonates. The least efficacy is seen with 70% isopropyl alcohol. All three antiseptics are skin-friendly and do not affect the skin integrity. Future studies addressing the clinical outcomes and safety in preterm populations with these commonly used antiseptics should be done.

Health Disparities in Hospitalized Pediatric Patients with Autism Spectrum Disorder and COVID-19

BACKGROUND/OBJECTIVES

Pediatric patients with autism spectrum disorder (ASD) face unique challenges, especially amongst individuals from historically minoritized racial groups. ASD has also been associated with an increased mortality from COVID-19. This study aims to explore the differences in sociodemographic factors and health outcomes (as measured by length of stay) amongst hospitalized pediatric patients with COVID-19 infections and a diagnosis of ASD compared to individuals with a COVID-19 infection alone; Methods: We performed a retrospective cohort study examining pediatric patients (ages birth to 21) who were hospitalized with a diagnosis of ASD and COVID-19 compared to patients with a diagnosis of COVID-19 alone between January 2019 and June 2023 using Epic Systems Corporation's Cosmos, a de-identified dataset aggregated from electronic health record data. We examined differences in demographic factors and length of stay (LOS) between groups by utilizing chi-square and Wilcoxon rank sum tests. Multiple logistic regression models were utilized to assess the association between length of stay and diagnosis; Results: A total of 21,708 distinct pediatric patients with a diagnosis of ASD and COVID-19 or COVID-19 alone were included in the analytical dataset. Patients with ASD and COVID-19, compared to patients with COVID-19 alone, had a higher proportion of individuals identifying as male and White. Patients with COVID-19 alone, compared to individuals with ASD and COVID-19, had higher proportions of individuals identifying as Black or African American. Higher proportions of individuals with ASD and COVID-19 had public insurance, compared to individuals with COVID-19 alone. Having a diagnosis of ASD and COVID, after controlling for covariates, was associated with higher odds of having a length of stay greater than the three days (cutoff value determined by the median LOS of three days) compared to having a diagnosis of COVID alone (aOR 1.19, 95% CI 1.04-1.35); Conclusions: Our study highlights the health disparities experienced during hospitalizations by pediatric patients with ASD and COVID-19. Further studies should address barriers and support health outcomes for pediatric patients with ASD.

Respiratory viruses associated with severe acute respiratory infection in children aged <5 years at a tertiary care hospital in Delhi, India during 2013-15

Background

With the increased availability of licensed vaccines for respiratory viruses such as severe acute respiratory syndrome coronavirus 2, respiratory syncytial virus (RSV), and influenza virus, a better understanding of the viral aetiology of severe acute respiratory infections (SARI) among children could help in optimising the use of these vaccines. We conducted a study among children aged <5 years hospitalised with SARI at a tertiary care children's hospital in north India and tested for common respiratory pathogens.

Methods

We randomly enrolled eligible SARI cases aged <5 years from August 2013 to July 2015. SARI cases were defined as either <7-day history of fever with cough or in children aged eight days to three months, a physician diagnosis of acute lower respiratory infection requiring hospitalisation. We also enrolled an age-group matched control without any acute illness in a 2:1 ratio from the outpatient clinic within 24 hours of case enrolment. Nasopharyngeal and/or oropharyngeal swabs were collected and tested using TaqMan Array Cards, a real-time reverse transcription polymerase chain reaction-based multi-pathogen testing platform for selected respiratory viruses among the enrolled cases and controls. We compared the prevalence of each pathogen among cases and controls using the χ2 (χ2) or Fisher exact test (P < 0.05). We used logistic regression to estimate adjusted odds ratios (aORs) which were then used to calculate aetiologic fractions (EFs).

Results

We enrolled 840 cases and 419 outpatient controls. Almost half of the individuals in the whole sample were aged <6 months (n = 521, 41.4%). Females made up 33.7% of cases and 37.2% of controls. Viral detections were more common among cases (69%, 95% confidence interval (CI) = 66, 73) compared to controls (33%; 95% CI = 29, 38) (P < 0.01). RSV (n = 257, 31%; 95% CI = 28, 34%) was the most common virus detected among cases. Influenza A was detected among 24 (3%; 95% CI = 2, 4%), and influenza B among 5 (1%; 95% CI = 0, 1%) cases. The association between the virus and SARI was strongest for RSV (aOR = 23; 95% CI = 12, 47; EF = 96%). Antivirals were administered to 1% of SARI cases while 78% received antibiotics.

Conclusions

Using a multi-pathogen molecular detection method, we detected respiratory viruses among more than two-thirds of children aged <5 years admitted with SARI in the Delhi tertiary care children's hospital. The guidelines for preventing and managing SARI cases among children could be optimised further with the improved availability of antivirals and vaccines.

Evaluation of criterion-based audit in improving quality of neonatal birth asphyxia care at Balaka district hospital in Malawi

BACKGROUND

Birth asphyxia remains one of the leading causes of neonatal deaths worldwide with a higher incidence in resource limited countries such as Malawi. At Balaka district hospital, Birth asphyxia is the primary cause of neonatal mortality accounting for 37.3% of the district's neonatal deaths. Although various quality improvement initiatives on birth asphyxia such as Helping Babies Breathe have been documented in Malawi, there is limited information on use of criterion-based audit (CBA) to enhance the care of neonates with birth asphyxia. Criterion-based audit is a systematic and critical analysis that seeks to improve quality of care by reviewing cases against an explicit criterion and using findings to modify practice as necessary. This study aimed to evaluate the effectiveness of CBA in improving the quality of neonatal birth asphyxia care at Balaka district hospital in Malawi.

METHODS

A CBA on the care of asphyxiated neonates was conducted at Balaka district hospital in Malawi. The care practices were assessed through a retrospective review of 110 cases notes which were selected by systematic random sampling technique. The care practices were compared with locally established standards, by a multidisciplinary team, based on the Malawi guidelines on care of the infant and newborn and World Health Organization documents. The gaps in the current practice were identified, reasons discussed, and recommendations were made and implemented. A re-audit was conducted on 110 case notes, six months after the initial audit.

RESULTS

The re-audit showed significant improvements in most of the set criteria for quality care: Checking of vital signs (80% vs. 98.2%; p = 0.000), laboratory investigations done (0.9% vs. 74%; p = 0.000), thermal support (82.7% vs. 91.8%; p = 0.041), correct diagnosis (60% vs. 81%; p = 0.001), correct treatment (18.7% vs. 81%; p = 0.000), correct feeding (12.7% vs. 56.4%; p = 0.000), Clinical officers conducting ward rounds (0% vs. 72%; p = 0.000), and daily weight check (49.1% vs. 93%; p = 0.000). Additionally, neonatal death decreased from 11% in the initial audit to 5% in the re-audit.

CONCLUSION

Criterion-based audit is a low-cost tool that can significantly improve the care of neonates with birth asphyxia in resource-limited countries.

Incontinentia pigmenti underlies thymic dysplasia, autoantibodies to type I IFNs, and viral diseases

Human inborn errors of thymic T cell tolerance underlie the production of autoantibodies (auto-Abs) neutralizing type I IFNs, which predispose to severe viral diseases. We analyze 131 female patients with X-linked dominant incontinentia pigmenti (IP), heterozygous for loss-of-function (LOF) NEMO variants, from 99 kindreds in 10 countries. Forty-seven of these patients (36%) have auto-Abs neutralizing IFN-α and/or IFN-ω, a proportion 23 times higher than that for age-matched female controls. This proportion remains stable from the age of 6 years onward. On imaging, female patients with IP have a small, abnormally structured thymus. Auto-Abs against type I IFNs confer a predisposition to life-threatening viral diseases. By contrast, patients with IP lacking auto-Abs against type I IFNs are at no particular risk of viral disease. These results suggest that IP accelerates thymic involution, thereby underlying the production of auto-Abs neutralizing type I IFNs in at least a third of female patients with IP, predisposing them to life-threatening viral diseases.

Adverse food reactions and alterations in nutritional status in children with autism spectrum disorders: results of the NAFRA project

BACKGROUND

To assess the adverse food reactions (AFR) prevalence in children with autism spectrum disorder (ASD) and in non-ASD healthy controls (NASD). Nutritional status alterations, food selectivity and adherence to Mediterranean Diet (MD) were also evaluated.

METHODS

The NAFRA (Nutritional status and Adverse Food Reactions in children with Autism Spectrum Disorder) project was an observational, case-control, comparative study conducted at a tertriary center for pediatrics involving Caucasian patients of both sexes, aged 18 months-7 years, with a diagnosis of ASD, and matched NASD controls.

RESULTS

From October 2017 to December 2023, 100 ASD patients [79 male, mean (± SD) age 49.9 months (± 15.4)] and 100 NASD controls [75 male, mean (± SD) age 49.8 months (± 17.7)] were enrolled at the Pediatric Section of the Department of Translational Medical Science of the University of Naples Federico II. A significantly higher prevalence of AFR was observed in ASD patients if compared with NASD (16% vs. 2%, p = 0.001), mainly due to a higher prevalence of food allergy (7% vs. 1%, p = 0.03). A significantly higher prevalence of food intolerance and celiac disease was also observed in ASD children. The rate of obesity was significantly higher in ASD patients compared to NASD. Food selectivity and low MD-adherence were more frequent in ASD children (26% vs. 2%, p < 0.0001 and 28% vs. 16%, p = 0.041, respectively).

CONCLUSIONS

The high rate of AFR, obesity and unhealthy dietary habits observed in ASD children strongly suggest the importance of a multidisciplinary approach, providing early diagnosis of AFR and appropriate nutritional management to improve core and associated ASD-related conditions.

TRIAL REGISTRATION

The NAFRA Project was registered on https://clinicaltrials.gov/ with the identifier NCT04719923. Registered 18 January 2021. https://clinicaltrials.gov/study/NCT04719923 .

Daily intake of household-produced milk kefir on Salmonella Typhimurium infection in C57BL/6 mice: mortality, microbiota modulation, and immunological implications

AIMS

Salmonellosis, a major global cause of diarrheal diseases, significantly impacts the intestinal microbiome. Probiotic-rich beverages, such as kefir, are increasingly utilized as alternative health-promoting beverages associated with various microbiota benefits. This study investigated the repercussions of daily consumption of household-produced milk kefir on Salmonella enterica serovar Typhimurium infection in C57BL-6 mice.

METHODS AND RESULTS

Kefir consumption pre-infection reduced the presence of inflammatory cells in the colon and altered the cytokine profile by reducing IL-10 and increasing IFN-γ. Despite reducing intestinal inflammation, kefir intake did not yield a prompt response to an acute infection caused by the aggressive pathogen Salmonella. This contributed to increased mortality in the mice, evidenced by higher fecal Salmonella counts post-infection. Metabarcoding analysis demonstrated that the use of kefir before infection increases butyric acid by the higher abundance of Lachnospiraceae and Prevotellaceae families and genus in feces, coupled with an increase in Muribaculaceae family and Bacteroides genus among infected kefir-treated mice. While kefir hinted at microbiota alterations reducing enterobacteria (Helicobacter), decrease IL-10, and increased IFN-γ, butyric acid on pre-infection, the beverage potentially facilitated the systemic translocation of pathogens, intensifying the infection's severity by altering the immune response.

CONCLUSIONS

The use of kefir in the dosage of 10% w/v (109 CFU), for acute infections with Salmonella Typhimurium, may not be enough to combat the infection and worsen the prognosis, leaving the intestine less inflamed, favoring the replication and translocation of the pathogen. These findings underscore the importance of prudently evaluating the widespread use of probiotics and probiotic-rich beverages, especially during acute infections, given their potential association with adverse effects during these diseases.

Using Comfort Theory for Addressing the Psychosocial Needs of an Afghan Refugee Child with Thalassemia: A Case Report

Psychological and social support is one of the factors that promote resilience in refugee children. Immigrant children with thalassemia have special psychosocial needs in the host country. The comfort model can help identify psychosocial needs. We applied Kolcaba's comfort theory to an 8-year-old Afghan boy with a history of thalassemia in Iran. According to Kolcaba's model, the taxonomy of psychological and social comfort needs were separation from mother, anxiety due to unfamiliarity with the hospital, fear of interaction and preference for silence, different culture and place of living, language barrier. To address his psychospiritual and sociocultural comfort care, we used coaching and comfort food interventions recommended by Kolcaba. The use of Kolcaba's Comfort Theory was helpful in promoting the child's emotional and social comfort in the case of an Afghan refugee child with thalassemia in Iran.