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  • Reciprocal links between anxiety sensitivity and obsessive–compulsive symptoms in youth: a longitudinal twin study
    J. Child Psychol. Psyc. (IF 6.129) Pub Date : 2020-01-16
    G. Krebs; L.J. Hannigan; A.M. Gregory; F.V. Rijsdijk; T.C. Eley

    Anxiety sensitivity, the tendency to fear the symptoms of anxiety, is a key risk factor for the development anxiety disorders. Although obsessive–compulsive disorder was previously classified as an anxiety disorder, the prospective relationship between anxiety sensitivity and obsessive–compulsive symptoms (OCS) has been largely overlooked. Furthermore, a lack of genetically informative studies means the aetiology of the link between anxiety sensitivity and OCS remains unclear.

    更新日期:2020-01-17
  • Harmonizing behavioral outcomes across studies, raters, and countries: application to the genetic analysis of aggression in the ACTION Consortium
    J. Child Psychol. Psyc. (IF 6.129) Pub Date : 2020-01-16
    Justin M. Luningham; Anne M. Hendriks; Eva Krapohl; Hill Fung Ip; Catharina E.M. van Beijsterveldt; Sebastian Lundström; Eero Vuoksimaa; Tellervo Korhonen; Paul Lichtenstein; Robert Plomin; Lea Pulkkinen; Richard J. Rose; Jaakko Kaprio; Meike Bartels; Dorret I. Boomsma; Gitta H. Lubke

    Aggression in children has genetic and environmental causes. Studies of aggression can pool existing datasets to include more complex models of social effects. Such analyses require large datasets with harmonized outcome measures. Here, we made use of a reference panel for phenotype data to harmonize multiple aggression measures in school‐aged children to jointly analyze data from five large twin cohorts.

    更新日期:2020-01-17
  • Cleidocranial dysplasia with growth hormone deficiency: a case report
    BMC Pediatr. (IF 1.983) Pub Date : 2020-01-16
    Nozomi Takaki; Jun Mori; Satoshi Matsuo; Toshio Osamura; Toshimi Michigami

    Cleidocranial dysplasia (CCD) is a rare skeletal disorder with autosomal dominant inheritance that is characterized by hypoplastic clavicles, delayed closure of the cranial sutures, dental abnormalities, and short stature, among other features. The responsible gene for CCD is RUNX2 located on the short arm of chromosome 6p21. In general, there are intrafamilial variations in height among CCD patients. Few studies have reported data on recombinant human growth hormone (rhGH) treatment for patients with CCD; thus, it remains to be elucidated whether rhGH treatment can improve short stature. Here, we report a case of a 6-year-old girl with CCD who has growth hormone deficiency (GHD) and a novel mutation of RUNX2. At 5 years of age, this patient was diagnosed with GHD and rhGH treatment was initiated. Thereafter, she was diagnosed with CCD due to the presence of hypoplastic clavicles and an open fontanelle, which was also observed in her mother and brother. She responded well to rhGH treatment; her height improved from − 3.2 SD to − 2.4 SD after 13 months. A detailed patient history and physical examination are necessary for the early diagnosis of CCD. Similarly, to ascertain the effect of rhGH treatment, careful evaluation of the patient’s final height post-therapy is needed.

    更新日期:2020-01-17
  • Determinants of healthcare seeking for childhood illnesses among caregivers of under-five children in urban slums in Malawi: a population-based cross-sectional study
    BMC Pediatr. (IF 1.983) Pub Date : 2020-01-17
    Edgar Arnold Lungu; Catherine Darker; Regien Biesma

    There is considerable evidence that health systems, in so far as they ensure access to healthcare, promote population health even independent of other determinants. Access to child health services remains integral to improving child health outcomes. Cognisant that improvements in child health have been unevenly distributed, it is imperative that health services and research focus on the disadvantaged groups. Children residing in urban slums are known to face a health disadvantage that is masked by the common view of an urban health advantage. Granted increasing urbanisation rates and proliferation of urban slums resulting from urban poverty, the health of under-five children in slums remains a public health imperative in Malawi. We explored determinants of healthcare-seeking from a biomedical health provider for childhood symptoms of fever, cough with fast breathing and diarrhoea in three urban slums of Lilongwe, Malawi. This was a population-based cross-sectional study involving 543 caregivers of under-five children. Data on childhood morbidity and healthcare seeking in three months period were collected using face-to-face interviews guided by a validated questionnaire. Data were entered in CS-Pro 5.0 and analysed in SPSS version 20 using descriptive statistics and logistic regression analyses. 61% of caregivers sought healthcare albeit 53% of them sought healthcare late. Public health facilities constituted the most frequently used health providers. Healthcare was more likely to be sought: for younger than older under-five children (AOR = 0.54; 95% CI: 0.30–0.99); when illness was perceived to be severe (AOR = 2.40; 95% CI: 1.34–4.30); when the presenting symptom was fever (AOR = 1.77; 95% CI: 1.10–2.86). Home management of childhood illness was negatively associated with care-seeking (AOR = 0.54; 95% CI: 0.36–0.81) and timely care-seeking (AOR = 0.44; 95% CI: 0.2–0.74). Caregivers with good knowledge of child danger signs were less likely to seek care timely (AOR = 0.57; 95% CI: 0.33–0.99). Even in the context of geographical proximity to healthcare services, caregivers in urban slums may not seek healthcare or when they do so the majority may not undertake timely healthcare care seeking. Factors related to the child, the type of illness, and the caregiver are central to the healthcare decision making dynamics. Improving access to under-five child health services therefore requires considering multiple factors.

    更新日期:2020-01-17
  • The role of pediatric radiologists and radiographers: a different future from the past
    Pediatr. Radiol. (IF 2.022) Pub Date : 2020-01-02
    Graciano Paulo

    The author of this paper reflects on the reality of pediatric radiology practice and pinpoints several constraints identified in the literature, constraints that limit the development of the role of pediatric radiologists and radiographers and therefore compromise the quality of medical imaging care delivered to the children. There is a need to build a pediatric imaging family of dedicated radiographers and radiologists at every hospital that has a radiology department. This strategy could improve the quality of the 350 million pediatric imaging procedures performed every year.

    更新日期:2020-01-17
  • Educational review: role of the pediatric nephrologists in the work-up and management of kidney stones.
    Pediatr. Nephrol. (IF 2.816) Pub Date : null
    Carmen Inés Rodriguez Cuellar,Peter Zhan Tao Wang,Michael Freundlich,Guido Filler

    BACKGROUND The incidence of nephrolithiasis in children and adolescents is increasing and appears to double every 10 years. The most important role of the pediatric nephrologist is to diagnose and modify various metabolic and non-metabolic risk factors, as well as prevent long-term complications especially in the case of recurrent nephrolithiasis. OBJECTIVE The purpose of this review is to summarize the existing literature on the etiology and management of pediatric nephrolithiasis. RESULTS The incidence of kidney stones is increasing; dietary and environmental factors are probably the main causes for this increased incidence. In most pediatric patients, the etiology for the kidney stones can be identified. Metabolic factors, such as hypercalciuria and hypocitraturia, urinary tract infection, and urinary stasis, constitute leading causes. Herein, we review the etiologies, diagnostic work-up, and treatment options for the most prevalent causes of kidney stones. The detrimental effects of excessive dietary sodium, reduced fluid intake, and the benefits of plant-based over animal-based protein consumption on urinary crystal formation are discussed. We also review the long-term complications. CONCLUSIONS Pediatric nephrologists have an important role in the diagnostic work-up and prevention of recurring nephrolithiasis.

    更新日期:2020-01-17
  • Treatment of hyperphosphatemia: the dangers of aiming for normal PTH levels
    Pediatr. Nephrol. (IF 2.816) Pub Date : 2019-12-10
    Dieter Haffner, Maren Leifheit-Nestler

    Abstract Secondary hyperparathyroidism is part of the complex of chronic kidney disease-associated mineral and bone disorders (CKD-MBD) and is linked with high bone turnover, ectopic calcification, and increased cardiovascular mortality. Therefore, measures for CKD-MBD aim at lowering PTH levels, but there is no general consensus on optimal PTH target values. This manuscript is part of a pros and cons debate for keeping PTH levels within the normal range in children with CKD, focusing on the cons. We conclude that a modest increase in PTH most likely represents an appropriate adaptive response to declining kidney function in patients with CKD stages 2–5D, due to phosphaturic effects and increasing bone resistance. There is no evidence for strictly keeping PTH levels within the normal range in CKD patients with respect to bone health and cardiovascular outcome. In addition, the potentially adverse effects of PTH-lowering measures, such as active vitamin D and calcimimetics, must be taken into account. We suggest that PTH values of 1–2 times the upper normal limit (ULN) may be acceptable in children with CKD stage 2–3, and that PTH levels of 1.7–5 times UNL may be optimal in patients with CKD stage 4–5D. However, standard care of CKD-MBD in children relies on a combination of different measures in which the observation of PTH levels is only a small part of, and trends in PTH levels rather than absolute target values should determine treatment decisions in patients with CKD as recommended by the 2017 KDIGO guidelines.

    更新日期:2020-01-17
  • The dietary management of calcium and phosphate in children with CKD stages 2-5 and on dialysis-clinical practice recommendation from the Pediatric Renal Nutrition Taskforce.
    Pediatr. Nephrol. (IF 2.816) Pub Date : null
    Louise McAlister,Pearl Pugh,Laurence Greenbaum,Dieter Haffner,Lesley Rees,Caroline Anderson,An Desloovere,Christina Nelms,Michiel Oosterveld,Fabio Paglialonga,Nonnie Polderman,Leila Qizalbash,José Renken-Terhaerdt,Jetta Tuokkola,Bradley Warady,Johan Vande Walle,Vanessa Shaw,Rukshana Shroff

    In children with chronic kidney disease (CKD), optimal control of bone and mineral homeostasis is essential, not only for the prevention of debilitating skeletal complications and achieving adequate growth but also for preventing vascular calcification and cardiovascular disease. Complications of mineral bone disease (MBD) are common and contribute to the high morbidity and mortality seen in children with CKD. Although several studies describe the prevalence of abnormal calcium, phosphate, parathyroid hormone, and vitamin D levels as well as associated clinical and radiological complications and their medical management, little is known about the dietary requirements and management of calcium (Ca) and phosphate (P) in children with CKD. The Pediatric Renal Nutrition Taskforce (PRNT) is an international team of pediatric renal dietitians and pediatric nephrologists, who develop clinical practice recommendations (CPRs) for the nutritional management of various aspects of renal disease management in children. We present CPRs for the dietary intake of Ca and P in children with CKD stages 2-5 and on dialysis (CKD2-5D), describing the common Ca- and P-containing foods, the assessment of dietary Ca and P intake, requirements for Ca and P in healthy children and necessary modifications for children with CKD2-5D, and dietary management of hypo- and hypercalcemia and hyperphosphatemia. The statements have been graded, and statements with a low grade or those that are opinion-based must be carefully considered and adapted to individual patient needs based on the clinical judgment of the treating physician and dietitian. These CPRs will be regularly audited and updated by the PRNT.

    更新日期:2020-01-17
  • Diagnostics, treatment, and immune response in BK polyomavirus infection after pediatric kidney transplantation.
    Pediatr. Nephrol. (IF 2.816) Pub Date : null
    Thurid Ahlenstiel-Grunow,Lars Pape

    After pediatric kidney transplantation BK polyomavirus (BKPyV) infections are associated with an increased risk of graft loss by BKPyV-associated nephropathy (BkPyVAN). However, suitable prognostic markers for the individual outcome of BKPyV infections are missing and the management of therapeutic interventions remains a challenge to the success of pediatric kidney transplantation. This review gives an overview on current diagnostic and therapeutic strategies in the field of BKPyV infections after pediatric kidney transplantation. Methods determining the individual immune response to BKPyV are described and their usability is discussed. There is growing evidence that BKPyV-specific T cells (BKPyV-Tvis) may serve as prognostic markers in order to steer immunosuppressive therapy in pediatric kidney recipients with BKPyV viremia in future. Prospective randomized trials in viremic kidney recipients comparing Tvis-steered therapeutic intervention with standard reduction of immunosuppression are needed before implementation of BKPyV-Tvis monitoring in routine care of BKPyV infections.

    更新日期:2020-01-17
  • Prognostic role of acute kidney injury on long-term outcome in infants with hypoxic-ischemic encephalopathy
    Pediatr. Nephrol. (IF 2.816) Pub Date : 2019-12-11
    Francesco Cavallin, Giulia Rubin, Enrico Vidal, Elisa Cainelli, Luca Bonadies, Agnese Suppiej, Daniele Trevisanuto

    Abstract Background The objective of this study was to evaluate the prognostic role of postnatal acute kidney injury (AKI) on neurodevelopmental outcome in infants with hypoxic-ischemic encephalopathy (HIE) receiving therapeutic hypothermia (TH). Methods This is a prospective observational study including all neonates with HIE receiving TH between 2009 and 2016 at a single center. AKI was classified according to the Kidney Disease: Improving Global Outcomes definition modified for neonatal age. Child development was assessed using the Griffiths Mental Development Scales (GMDS). Study outcome was defined as unfavorable outcome (including death or disability according to GMDS) or favorable otherwise, at 12 and 24 months. Results One-hundred and one neonates (median gestational age 39 weeks) were included. AKI was diagnosed in 10 neonates (10%). Seven patients died within the first year, 35 patients had disability at 12 months, and 45 patients at 24 months. AKI was associated with increased likelihood of unfavorable outcome at 24 months (100% vs. 59% in neonates without AKI; p = 0.01). AKI showed good positive predictive value (1.00, 95% CI 0.71–1.00) and specificity (1.00, 95% CI 0.88–1.00), but poor negative predictive value (0.41, 95% CI 0.30–0.52) and sensitivity (0.19, 95% CI 0.11–0.32) at 24 months. Conclusions AKI might be a reliable indicator of death or long-term disability in infants with HIE receiving TH, but the absence of AKI does not guarantee a favorable long-term outcome.

    更新日期:2020-01-17
  • Steroid therapy in children with IgA nephropathy.
    Pediatr. Nephrol. (IF 2.816) Pub Date : 2019-02-20
    Alexandra Cambier,Olivia Boyer,Georges Deschenes,James Gleeson,Anne Couderc,Julien Hogan,Thomas Robert

    IgA nephropathy (IgAN) is one the most common primary glomerulonephritis in children and adolescents worldwide, with 20% of children developing end-stage kidney disease (ESKD) within 20 years of diagnosis. There is a need for treatment guidelines, especially for steroids in children with primary IgAN, since the STOP-IgA trial casts doubts on the use of steroids in adults with intermediate risk. Pediatricians are prone to prescribe steroids in addition to renin-angiotensin system blockade (RASB) when proteinuria is > 0.5 g/l, eGFR deteriorates < 70 ml/min/1.73 m2, or when a biopsy sample shows glomerular inflammation. Lack of randomized controlled trials (RCTs) in children with IgAN has led to an absence of consensus on the use of immunosuppressive agents in the treatment of progressive IgAN. This literature review evaluates the available evidence on steroid treatment in children with IgAN.

    更新日期:2020-01-17
  • Long-lasting chronic high load carriage of Epstein-Barr virus is more common in young pediatric renal transplant recipients
    Pediatr. Nephrol. (IF 2.816) Pub Date : 2019-12-04
    Susanne Westphal Ladfors, Jenny K. Lindahl, Sverker Hansson, Per Brandström, Rune Andersson, Marianne Jertborn, Magnus Lindh, Susanne Woxenius, Vanda Friman

    Abstract Background Epstein-Barr virus (EBV) infections can induce post-transplant lymphoproliferative disorder (PTLD). A chronic high load (CHL), as indicated by long-term high EBV DNA levels after transplantation, has been associated with an enhanced risk of PTLD. We aimed to evaluate incidence, time of occurrence, risk factors, and outcome of EBV CHL carrier state after pediatric renal transplantation. Methods A retrospective study of 58 children aged 1–17 years (median 10), who underwent renal transplantation between January 2004 and June 2017 at a single medical center. EBV IgG antibodies in serum were analyzed before and yearly after transplantation. EBV DNA in whole blood were analyzed weekly for the first 3 months post-transplant, monthly up to 1 year and then at least once yearly. CHL was defined as EBV DNA ≥ 4.2 log10 Geq/ml in > 50% of the samples during ≥ 6 months. Results At transplantation, 31 (53%) patients lacked EBV IgG and 25 (81%) of them developed primary EBV infection post-transplant. Of the 27 seropositive patients, 20 (74%) experienced reactivation of EBV. Altogether, 14 (24%) children developed CHL, starting at a median of 69 days post-transplant and lasting for a median time of 2.3 years (range 0.5–6.5), despite reduction of immunosuppression. Patients with CHL were younger and 11/14 were EBV seronegative at transplantation. No child developed PTLD during median clinical follow-up of 7.8 years (range 0.7–13). Conclusions CHL was frequent, long lasting, and occurred mainly in young transplant recipients. The absence of PTLD suggests that monitoring of EBV DNA to guide immunosuppression was effective.

    更新日期:2020-01-17
  • A cross-sectional study on uric acid levels among Chinese adolescents
    Pediatr. Nephrol. (IF 2.816) Pub Date : 2019-12-06
    Jie Lu, Wenyan Sun, Lingling Cui, Xinde Li, Yuwei He, Zhen Liu, Hailong Li, Lin Han, Aichang Ji, Can Wang, Hui Zhang, Xiaopeng Ji, Wei Ren, Xuefeng Wang, Changgui Li

    Abstract Background The prevalence of hyperuricemia is increasing in adults, while the prevalence among adolescents is seldom reported. Methods A cross-sectional survey by multistage, stratified sampling method was carried out in Shandong Province during 2017–2018. A total of 9371 adolescents aged from 13 to 19 years were randomly sampled and analyzed in this survey. Results The overall mean serum uric acid (sUA) concentration was 6.08 ± 1.57 mg/dL and overall hyperuricemia prevalence was 25.4% and 60.5% (when hyperuricemia was defined as sUA ≥ 7 mg/dL or ≥ 5.5 mg/dL). Prevalence were 42.3% (male) and 8.0% (female) when limit was 7 mg/dL and prevalence were 82.1% (male) and 38.4% (female) when limit was 5.5 mg/dL. Male gender, increased body mass index, increased waist circumstance, increased triglycerides, increased fasting blood glucose, increased systolic blood pressure, decreased estimated glomerular filtration rate, and positive family gout history were associated with the enhanced risk of hyperuricemia according to univariate and/or multivariate logistic regression analysis. Food intake frequency of carbonate beverage, mutton, and other kinds varied between hyperuricemia adolescents and normal sUA ones. Conclusions The studied adolescent population showed sUA level and hyperuricemia prevalence which are even higher than those of adults in China. The epidemic of youth hyperuricemia may pose a future threat of gout attacks and other hyperuricemia-related diseases, which alarms the public, health professionals and health policy makers to prepare the future health challenges.

    更新日期:2020-01-17
  • The pathogenesis and management of renal scarring in children with vesicoureteric reflux and pyelonephritis.
    Pediatr. Nephrol. (IF 2.816) Pub Date : null
    Vasikar Murugapoopathy,Christine McCusker,Indra R Gupta

    Bacterial urinary tract infections (UTIs) are one of the most common reasons for children to be admitted to hospital. Bacteria infect and invade the bladder (the lower urinary tract) and if the infection disseminates to the upper urinary tract, significant inflammation in the kidneys may arise. Inflammation is a double-edged sword: it is needed to clear bacteria, but if excessive, kidney tissue is injured. During injury, nephrons are destroyed and replaced with deposition of extracellular matrix and a renal scar. In this review, we explore the pathogenesis of UTIs and discuss the risk factors that result in dissemination of bladder infection to the kidneys. Three major risk factors predispose to kidney infections: the presence of vesicoureteric reflux, the presence of bladder and bowel dysfunction, and defects in the ability of the host immune response to clear bacteria. In this review, we will discuss these factors, their relationship to renal scarring, and potential treatments that might be beneficial to prevent renal scar formation in children.

    更新日期:2020-01-17
  • Sex and age as determinants for high blood pressure in pediatric renal transplant recipients: a longitudinal analysis of the CERTAIN Registry
    Pediatr. Nephrol. (IF 2.816) Pub Date : 2019-12-07
    Rizky I. Sugianto, Bernhard M. W. Schmidt, Nima Memaran, Ali Duzova, Rezan Topaloglu, Tomas Seeman, Sabine König, Luca Dello Strologo, Luisa Murer, Zeynep Birsin Özçakar, Martin Bald, Mohan Shenoy, Anja Buescher, Peter F. Hoyer, Michael Pohl, Heiko Billing, Jun Oh, Hagen Staude, Martin Pohl, Gurkan Genc, Günter Klaus, Caner Alparslan, Ryszard Grenda, Jacek Rubik, Kai Krupka, Burkhard Tönshoff, Elke Wühl, Anette Melk

    High prevalence of arterial hypertension is known in pediatric renal transplant patients, but how blood pressure (BP) distribution and control differ between age groups and whether sex and age interact and potentially impact BP after transplantation have not been investigated.

    更新日期:2020-01-17
  • Energy and protein requirements for children with CKD stages 2-5 and on dialysis–clinical practice recommendations from the Pediatric Renal Nutrition Taskforce
    Pediatr. Nephrol. (IF 2.816) Pub Date : 2019-12-16
    Vanessa Shaw, Nonnie Polderman, José Renken-Terhaerdt, Fabio Paglialonga, Michiel Oosterveld, Jetta Tuokkola, Caroline Anderson, An Desloovere, Laurence Greenbaum, Dieter Haffner, Christina Nelms, Leila Qizalbash, Johan Vande Walle, Bradley Warady, Rukshana Shroff, Lesley Rees

    Abstract Dietary management in pediatric chronic kidney disease (CKD) is an area fraught with uncertainties and wide variations in practice. Even in tertiary pediatric nephrology centers, expert dietetic input is often lacking. The Pediatric Renal Nutrition Taskforce (PRNT), an international team of pediatric renal dietitians and pediatric nephrologists, was established to develop clinical practice recommendations (CPRs) to address these challenges and to serve as a resource for nutritional care. We present CPRs for energy and protein requirements for children with CKD stages 2–5 and those on dialysis (CKD2–5D). We address energy requirements in the context of poor growth, obesity, and different levels of physical activity, together with the additional protein needs to compensate for dialysate losses. We describe how to achieve the dietary prescription for energy and protein using breastmilk, formulas, food, and dietary supplements, which can be incorporated into everyday practice. Statements with a low grade of evidence, or based on opinion, must be considered and adapted for the individual patient by the treating physician and dietitian according to their clinical judgment. Research recommendations have been suggested. The CPRs will be regularly audited and updated by the PRNT.

    更新日期:2020-01-17
  • A single-center study to evaluate the efficacy of a fetal urine peptide signature predicting postnatal renal outcome in fetuses with posterior urethral valves.
    Pediatr. Nephrol. (IF 2.816) Pub Date : null
    Bénédicte Buffin-Meyer,Marcin Tkaczyk,Małgorzata Stańczyk,Benjamin Breuil,Justyna Siwy,Krzysztof Szaflik,Tomasz Talar,Justyna Wojtera,Waldemar Krzeszowski,Stéphane Decramer,Julie Klein,Joost P Schanstra

    BACKGROUND Posterior urethral valves (PUVs) account for 17% of pediatric renal failure. The management of pregnancies involving fetuses with PUV is hampered by the fact that current clinical parameters obtained from fetal ultrasound and/or fetal urine biochemistry are insufficient to predict postnatal renal function. We previously have developed a fetal urine peptide signature (12PUV) that predicted with high precision postnatal renal failure at 2 years of age in fetuses with PUV. Here, we evaluated the accuracy of this signature to predict postnatal renal outcome in fetuses with PUV in an independent single-center study. METHODS Thirty-three women carrying fetuses with suspected PUV were included. Twenty-five fetuses received vesicoamniotic shunts during pregnancy. PUV was confirmed postnatally in 23 patients. Of those 23 fetuses, 2 were lost in follow-up. Four and 3 patients died in the pre- and perinatal periods, respectively. Follow-up renal function at 6 months of age was obtained for the remaining 14 patients. The primary outcome was early renal failure, defined by an eGFR < 60 mL/min/1.73 m2 before 6 months of age or pre- or perinatal death. RESULTS The peptide signature predicted postnatal renal outcome in postnatally confirmed PUV fetuses with an AUC of 0.94 (95%CI 0.74-1.0) and an accuracy of 90% (95%CI 78-100). The signature predicted postnatal renal outcome for the suspected PUV cases with an AUC of 0.89 (95%CI 0.72-0.97) and an accuracy of 84% (95%CI 71-97). CONCLUSIONS This single-center study confirms the predictive power of the previously identified 12PUV fetal urinary peptide signature.

    更新日期:2020-01-17
  • Immunoglobulin serum levels in rituximab-treated patients with steroid-dependent nephrotic syndrome.
    Pediatr. Nephrol. (IF 2.816) Pub Date : null
    Cyrielle Parmentier,Jean-Daniel Delbet,Stéphane Decramer,Olivia Boyer,Julien Hogan,Tim Ulinski

    BACKGROUND Rituximab (RTX) is efficient in steroid-dependent nephrotic syndrome (SDNS) in pediatric and adult patients. The aim of this study is to describe hypogammaglobulinemia as a side effect of RTX treatment. METHODS All pediatric patients (< 18 years old) of four French pediatric nephrology centers who received RTX for SDNS between 2010 and 2015 have been included. Clinical and biological data have been analyzed retrospectively before, during, and after RTX treatment. Hypogammaglobulinemia was defined as an IgG level < - 2 standard deviations for patient age. RESULTS A total of 107 pediatric patients have been included, 65.9% were boys, median age at nephrotic syndrome diagnosis was 3.1 interquartile range [IQ 2.24-5.45] years and age at RTX introduction was 11.7 [IQ 8.6-14.2] years. Twenty-one patients had hypogammaglobulinemia before the initiation of RTX. Of the patients, 25/86 had at least one hypogammaglobulinemia during B cell depletion or after B cell recovery while IgG levels at initiation were normal with a persisting hypogammaglobulinemia for 13 patients 1 year after B cell recovery. Patients who developed hypogammaglobulinemia were younger at RTX initiation with a median age of 8.2 years [IQ 6.3-12.4]. Among all the 46 patients with hypogammaglobulinemia during follow-up, 13 had a concomitant infection. CONCLUSIONS Hypogammaglobulinemia is a frequent complication of RTX treatment in younger children treated for SDNS. The use of RTX in children has to be carefully evaluated and their clinical and biological follow-up should be adapted to the age-dependent risk profile for hypogammaglobulinemia.

    更新日期:2020-01-17
  • Growth plate alterations in chronic kidney disease.
    Pediatr. Nephrol. (IF 2.816) Pub Date : null
    Ángela Fernández-Iglesias,José Manuel López,Fernando Santos

    Growth retardation is a major feature of chronic kidney disease (CKD) of onset in infants or children and is associated with increased morbidity and mortality. Several factors have been shown to play a causal role in the growth impairment of CKD. All these factors interfere with growth by disturbing the normal physiology of the growth plate of long bones. To facilitate the understanding of the pathogenesis of growth impairment in CKD, this review discusses cellular and molecular alterations of the growth plate during uremia, including structural and dynamic changes of chondrocytes, alterations in their process of maturation and hypertrophy, and disturbances in the growth hormone signaling pathway.

    更新日期:2020-01-17
  • Enquiring beneath the surface: can a gene expression assay shed light into the heterogeneity among newborns with neonatal encephalopathy?
    Pediatr. Res. (IF 2.880) Pub Date : 2020-01-17
    Rafael Balada; Cristian Tebé; Marisol León; Gemma Arca; Miguel Alsina; Alba-Aina Castells; Soledad Alcántara; Alfredo Garcia-Alix

    Background We aimed to assess whether a gene expression assay provided insights for understanding the heterogeneity among newborns affected by neonatal encephalopathy (NE). Methods Analysis by RT-qPCR of the mRNA expression of candidate genes in whole blood from controls (n = 34) and NE (n = 24) patients at <6, 12, 24, 48, 72 and 96 h of life, followed by determination of differences in gene expression between conditions and correlation with clinical variables. Results During the first 4 days of life, MMP9, PPARG, IL8, HSPA1A and TLR8 were more expressed and CCR5 less expressed in NE patients compared to controls. MMP9 and PPARG increased and CCR5 decreased in moderate/severe NE patients compared to mild. At 6–12 h of life, increased IL8 correlated with severe NE and death, decreased CCR5 correlated with chorioamnionitis and increased HSPA1A correlated with expanded multiorgan dysfunction, severe NE and female sex. Conclusions MMP9, PPARG and CCR5 mRNA expression within first days of life correlates with the severity of NE. At 6–12 h, IL8 and HSPA1A are good reporters of clinical variables in NE patients. HSPA1A may have a role in the sexual dimorphism observed in NE. CCR5 is potentially involved in the link between severe NE and chorioamnionitis.

    更新日期:2020-01-17
  • Sex differences in infant blood metabolite profile in association with weight and adiposity measures
    Pediatr. Res. (IF 2.880) Pub Date : 2020-01-17
    Susan Ellul; Anne-Louise Ponsonby; John B. Carlin; Fiona Collier; Toby Mansell; Peter Vuillermin; David Burgner; Richard Saffery

    BACKGROUND Nuclear magnetic resonance (NMR) metabolic profiling quantifies a large number of metabolites. From adolescence, specific metabolites are influenced by age, sex and body mass index; data on early-life metabolic profiles are limited. We investigated associations between sex, birth weight, weight and adiposity with NMR metabolic profile at age 12 months. METHODS The plasma NMR metabolic profile was quantified in infants (n = 485) from the Barwon Infant Study. Associations between 74 metabolites and sex, birth weight z-score and 12-month measures (weight z-score, skinfold thickness, weight-for-length z-score) were examined using linear regression models. RESULTS Several cholesterol and fatty acid measures were higher (0.2–0.3 SD) in girls than in boys; we observed modest sex-specific associations of birth weight z-scores and 12-month sum of skinfold thicknesses with metabolites. The pattern of associations between weight z-score and weight-for-length z-score with metabolites at 12 months was more pronounced in girls, particularly for fatty acid ratios. CONCLUSIONS We identified sex differences in the infant metabolic profile. Sex-specific patterns observed differ from those reported in older children and adults. We also identified modest cross-sectional associations between anthropometric and adiposity measures and metabolites, some of which were sex specific.

    更新日期:2020-01-17
  • Dysregulation of Notch signaling in cardiac mesenchymal cells of patients with tetralogy of Fallot
    Pediatr. Res. (IF 2.880) Pub Date : 2020-01-17
    Ivan Kozyrev; Pavel Dokshin; Aleksandra Kostina; Artem Kiselev; Elena Ignatieva; Alexey Golovkin; Tatiana Pervunina; Evgeny Grekhov; Mikhail Gordeev; Anna Kostareva; Anna Malashicheva

    BACKGROUND Tetralogy of Fallot (TF) is a severe congenital defect of heart development. Fine-tuned sequential activation of Notch signaling genes is responsible for proper heart chamber development. Mutations in Notch genes have been associated with TF. The aim of this study was to analyze the activity of the Notch pathway in cardiac mesenchymal cells derived from ventricular tissue of TF patients. METHODS Cardiac mesenchymal cells were isolated from 42 TF patients and from 14 patients with ventricular septal defects (VSDs), used as a comparison group. The Notch pathway was analyzed by estimating the expression of Notch-related genes by qPCR. Differentiation and proliferation capacity of the cells was estimated. RESULTS The TF-derived cells demonstrated a dysregulated pattern of Notch-related gene expression comparing to VSD-derived cells. Correlation of Notch signaling activation level by HEY1/HES1 expression level with proliferation and cardiogenic-like differentiation of cardiac mesenchymal cells was observed but not with clinical parameters nor with the age of the patients. CONCLUSIONS The data suggest a contribution of dysregulated Notch signaling to the pathogenesis of tetralogy of Fallot and importance of Notch signaling level for the functional state of cardiac mesenchymal cells, which could be critical considering these cells for potential cell therapy approaches.

    更新日期:2020-01-17
  • An experience with a bubble CPAP bundle: is chronic lung disease preventable?
    Pediatr. Res. (IF 2.880) Pub Date : 2020-01-17
    Hany Aly; Mohamed A. Mohamed

    Background Continuous positive airway pressure (CPAP) is associated with marginal decrease in chronic lung disease (CLD). This study aims to report outcomes, with focus on CLD, of preterm infants managed with a bubble CPAP (b-CPAP) bundle of care. Methods Infants <1500 g were stratified into four groups depending on intubation status through first 3 days of life. The incidence of mortality, CLD and other morbidities were compared over four chronological epochs. Outcomes of the most recent epoch were compared to contemporaneous benchmarks from Vermont Oxford Network (VON). Results Of 773 infants (median GA = 28 weeks, average BW = 995 g), 24.5% were intubated in DR and 11.7% in the first day of life. Mechanical ventilation, bCPAP and oxygen days in survivors were 1.5, 29 and 14, respectively. Overall incidence of CLD was 6.4% that remained consistent in the four epochs (7.6%, 7.5%, 5.8% and 5%), respectively. In comparison to VON, CLD was significantly less (p < 0.001). Initial DR intubation was not associated with increased CLD compared to initial management with CPAP that required subsequent intubation. Conclusion It is feasible and sustainable to administer a b-CPAP bundle of care to decrease CLD. Cluster randomized trials are needed to validate the reproducibility of this approach.

    更新日期:2020-01-17
  • Who benefits from the intervention? Correlates of successful BMI reduction in the Texas Childhood Obesity Demonstration Project (TX‐CORD)
    Pediatr. Obes. (IF 3.713) Pub Date : 2020-01-15
    Sarah E. Barlow; Casey Durand; Meliha Salahuddin; Stephen J. Pont; Nancy F. Butte; Deanna M. Hoelscher

    Many childhood obesity intervention studies report mean outcomes but do not explore the variation in responses and the characteristics of those who respond well.

    更新日期:2020-01-16
  • Commentary: Microbial panaceas. Does development have the answer? Reflections on Cowan, Dinan, & Cryan (2019)
    J. Child Psychol. Psyc. (IF 6.129) Pub Date : 2020-01-15
    Bridget Callaghan

    Is the microbiome a promising adjunct, a potential panacea, or a distraction from feasible treatments for neurodevelopmental disorders? Taking a developmental approach may get us closer to understanding the data and give us pause in trying to translate this nascent field to the clinic right now.

    更新日期:2020-01-16
  • Analysis of salivary level Lactobacillus spp. and associated factors as determinants of dental caries amongst primary school children in Harar town, eastern Ethiopia
    BMC Pediatr. (IF 1.983) Pub Date : 2020-01-16
    Dawit Ademe; Desalegn Admassu; Senthilkumar Balakrishnan

    Lactobacillus spp. play a major role in the development of dental caries. Although effective methods are known for the prevention and management of dental caries, its prevalence of dental caries is increasing amongst school-age children in Ethiopia. Hence, this study is aimed to determine the association of salivary Lactobacillus spp. level and oral health factors as determinants of dental caries amongst primary school children in Harar town, Eastern Ethiopia. A cross-sectional study was conducted amongst primary school children (n = 407) using a questionnaire survey, clinical DMFT (decayed, missing, filled tooth number) examination and enumeration of salivary level Lactobacillus spp. Data were analyzed by SPSS (Statistical Package for Social Science software- version 25.0). The odds ratio was used to determine the predictors of the outcome. The data were expressed as mean ± SD. Statistical significance was defined as a p-value of less than 0.05. The prevalence of dental caries was found to be 36.9% amongst primary school children. The mean DMFT value of the participants was 0.95 ± 1.57. The dental decay component was the primary observation that accounted for 84.6% of the DMFT. Almost, 67% of the saliva culture revealed a significant amount of Lactobacillus spp. count. The mean bacterial count was found to be 14.92 × 105 ± 22.92 × 105. Among various parameters analysed for association with dental caries, a number of them show positive associtation, incluing reduction in academic scores in the prevous academic year (p = 0.034), grade levels of school children 1–4 (p = 0.041), sweet food consumption habit (p = 0.003), absence of daily teeth cleaning habit (p = 0.002), absence of toothpaste use (p = 0.001), dental ache history (p = < 0.001), significant microbial load of salivary Lactobacillus spp. (p = < 0.001), acidic (p = 0.028) and basic salivary pH (p = 0.025). A significant salivary Lactobacillus count associated with lower grade level, sweet diet, and poor oral hygiene were found to be the determinant factors for dental caries. Thus, dissemination of oral health information is obligatory to prevent dental caries amongst primary school children in the study area.

    更新日期:2020-01-16
  • Indole-3-lactic acid, a metabolite of tryptophan, secreted by Bifidobacterium longum subspecies infantis is anti-inflammatory in the immature intestine
    Pediatr. Res. (IF 2.880) Pub Date : 2020-01-16
    Di Meng; Eduardo Sommella; Emanuela Salviati; Pietro Campiglia; Kriston Ganguli; Karim Djebali; Weishu Zhu; W. Allan Walker

    Background Necrotizing enterocolitis (NEC), a necrotic inflammation of the intestine, represents a major health problem in the very premature infant. Although prevention is difficult, the combination of ingestion of maternal-expressed breastmilk in conjunction with a probiotic provides the best protection. In this study, we establish a mechanism for breastmilk/probiotic protection. Methods Ultra-high-performance liquid chromatography-tandem mass spectrometry of Bifidobacterium longum subsp. infantis (B. infantis) secretions was used to identify an anti-inflammatory molecule. Indole-3-lactic acid (ILA) was then tested in an established human immature small intestinal cell line, necrotizing colitis enterocytes, and other immature human enteroids for anti-inflammatory effects and to establish developmental function. ILA was also examined in immature and mature enterocytes. Results We have identified ILA, a metabolite of breastmilk tryptophan, as the anti-inflammatory molecule. This molecule is developmentally functional in immature but not mature intestinal enterocytes; ILA reduces the interleukin-8 (IL-8) response after IL-1β stimulus. It interacts with the transcription factor aryl hydrocarbon receptor (AHR) and prevents transcription of the inflammatory cytokine IL-8. Conclusions This molecule produced by B. infantis (ATCC No. 15697) interaction with ingested breastmilk functions in a complementary manner and could become useful in the treatment of all at-risk premature infants for NEC if safety and clinical studies are performed.

    更新日期:2020-01-16
  • Editor's Focus
    Pediatr. Res. (IF 2.880) Pub Date : 2020-01-14
    更新日期:2020-01-15
  • Infant domestic adoption: outcomes at mid‐life
    J. Child Psychol. Psyc. (IF 6.129) Pub Date : 2020-01-14
    Rukmen Sehmi; Alan Rushton; Andrew Pickles; Margaret Grant; Barbara Maughan

    Adoption studies can cast light on environmental influences on development, but heterogeneity in preplacement experiences often complicates interpretation of findings.

    更新日期:2020-01-14
  • Non-invasive forced oscillometry to quantify respiratory mechanics in term neonates
    Pediatr. Res. (IF 2.880) Pub Date : 2020-01-14
    Andrew P. Klinger; Colm P. Travers; Abigail Martin; Hui-Chien Kuo; Ammar Saadoon Alishlash; William T. Harris; Waldemar A. Carlo; Namasivayam Ambalavanan

    Background To determine normative data by forced oscillation technique (FOT) in non-sedated normal term neonates and test the hypothesis that infants with transient tachypnea of the newborn (TTN) have higher resistance (R) and lower reactance (X) on day 1. Methods Healthy term infants (n = 138) and infants with TTN (n = 17) were evaluated on postnatal days 1 through 3 (NCT03346343). FOT was measured with a mask using a TremoFlo C-100 Airwave System™. R, X, and area under the reactance curve (AX) were measured at prime frequencies 7–41 Hz for 8 s. Results In all, 86% of control infants had adequate measurements (coherence >0.8, CV < 0.25) on day 1. Infants with TTN had higher resistance at 13 Hz (TTN 32.5 cm H2O·s/L [95% CI 25.5–39.4]; controls 23.8 cm H2O·s/L [95% CI 22.2 to 25.3], P = 0.007) and lower reactance from 17 to 37 Hz (TTN −35.1 to −10.5; controls −26.3 to −6.1, P < 0.05). In healthy controls, lung mechanics were unchanged from days 1 to 3. In TTN, lung mechanics normalized on days 2 and 3. Conclusions FOT is feasible in neonates and distinguishes normal control infants from those with TTN on postnatal day 1. Oscillometry offers a non-invasive, longitudinal technique to assess lung mechanics in newborns.

    更新日期:2020-01-14
  • N -acetylcysteine mitigates acute opioid withdrawal behaviors and CNS oxidative stress in neonatal rats
    Pediatr. Res. (IF 2.880) Pub Date : 2020-01-14
    Price Ward; Hunter G. Moss; Truman R. Brown; Peter Kalivas; Dorothea D. Jenkins

    Background Neonatal abstinence syndrome (NAS) is a significant problem. Opioid withdrawal induces oxidative stress and disrupts glutamate and glutathione homeostasis. We hypothesized that N-acetylcysteine (NAC) administered during acute opioid withdrawal in neonatal rats would decrease withdrawal behaviors and normalize CNS glutathione and glutamate. Methods Osmotic minipumps with methadone (opioid dependent, OD) and saline (Sham) were implanted into Sprague Dawley dams 7 days prior to delivery. Pups were randomized to receive either naloxone plus saline or NAC (50–100 mg/kg), administered on postnatal day (PND) 7. We performed MR spectroscopy on PND6–7 before, 30 min, and 120 min after withdrawal. On PND7, we assessed withdrawal behaviors for 90 min after naloxone administration and summed scores during peak withdrawal period. Results Mean summed behavioral scores were significantly different between groups (χ2 (2) = 10.49, p = 0.005) but not different between NAC/NAL/OD and Sham (p = 0.14): SAL/NAL/OD = 17.2 ± 4.2 (n = 10); NAC/NAL/OD = 11.3 ± 5.6 (n = 9); Sham = 6.5 ± 0.6 (n = 4). SAL/NAL/OD pups had decreased glutathione at 120 min (p = 0.01), while NAC/NAL/OD pups maintained pre-withdrawal glutathione (p = 0.26). Conclusion In antenatal OD, NAC maintains CNS glutathione and mitigates acute opioid withdrawal in neonatal rats. This is the first study to demonstrate acute opioid withdrawal neurochemical changes in vivo in neonatal OD. NAC is a potential novel treatment for NAS.

    更新日期:2020-01-14
  • Enhanced formation of neutrophil extracellular traps in Kawasaki disease
    Pediatr. Res. (IF 2.880) Pub Date : 2020-01-14
    Yusuke Yoshida; Seiichiro Takeshita; Yoichi Kawamura; Takashi Kanai; Yuki Tsujita; Shigeaki Nonoyama

    BACKGROUND Neutrophils contribute to the clearance of pathogens through the formation of neutrophil extracellular traps (NETs) in a process known as NETosis, but the excessive release of NETs has been reported to be involved in the pathogenesis of various diseases, including vasculitis, by inducing tissue injury. The aim of the present study was to investigate whether or not NETosis is enhanced in the acute phase of Kawasaki disease (KD). METHODS After neutrophils isolated from the peripheral blood of patients with KD and healthy children (HC) were cultured in vitro, the degree of spontaneous NETosis was evaluated by measuring the number of NETs formed and the titers of cell-free DNA (cfDNA) and neutrophil elastase (NE)-DNA complex. RESULTS Spontaneous NET formation in vitro was observed in neutrophils isolated from KD patients, and the number of NET formations was significantly higher in acute KD than in convalescent KD and HC. The increased levels of cfDNA and NE-DNA complexes in the acute phase of KD tended to decrease in the convalescent phase. CONCLUSIONs Spontaneous NET formation was enhanced in neutrophils from patients with acute KD, suggesting that circulating neutrophils may be primed to undergo NETosis in KD vasculitis.

    更新日期:2020-01-14
  • Comparison of INVOS 5100C and Nonin SenSmart X-100 oximeter performance in preterm infants with spontaneous apnea
    Pediatr. Res. (IF 2.880) Pub Date : 2020-01-14
    Bjørn Andresen; Gorm Greisen; Simon Hyttel-Sorensen

    Background Tissue oximeters are not interchangeable. Two instruments with sensors dedicated to preterm infants—INVOS 5100C and Nonin SenSmart X-100—have not yet been compared. Methods By measuring cerebral oxygenation in ten preterm infants with spontaneous apneic episodes defined by pulse oximeter readings (SpO2) below 80%, as well as tissue oxygenation during vascular occlusion on the forearm of ten adults, simultaneously we compared performance in the hypoxic range. Results We found the mean conversion equations to be StO2,SenSmart X-100 = 0.34 × StO2,INVOS 5100C + 44.8% during apnea in infants and StO2,SenSmart X-100 = 0.59 × StO2,INVOS 5100C + 34.4% during vascular occlusion. The individual regressions displayed large and statistically significant variations in both infants and adults. In three infants the INVOS sensor showed very little reaction to decreases in SpO2. Conclusion These findings confirm that different NIRS devices give very different estimates when the oxygenation is low. The large variation when compared to SpO2 suggest that the sensor placement is very important in preterm infants.

    更新日期:2020-01-14
  • Assessing childhood health outcome inequalities with area-based socioeconomic measures: a retrospective cross-sectional study using Manitoba population data
    Pediatr. Res. (IF 2.880) Pub Date : 2020-01-14
    Atul K. Sharma; Kristine Kroeker; Dan Chateau; Marni Brownell; Celia J. Rodd

    Background Socioeconomic gradients in health exist in Canada. Although multiple Canadian area-based socioeconomic measures (ABSM) have been developed, none have been specifically validated against pediatric outcomes. Our objective was to compare the strength of association between key pediatric health outcomes and a number of ABSM, including income quintile. Methods This was a retrospective cross-sectional assessment of the association between socioeconomic status (SES) measured by ABSM and 20 specific pediatric health outcomes. Data from the Manitoba Population Research Data Repository were used for residents aged 0–19 years from 2010 to 2015. Outcomes included birth-related events (e.g. mortality), vaccination uptake, hospitalizations, and teen pregnancy. Regression goodness of fit was used to assess the strength of individual associations. Inequality was measured by slope index of inequality (SII) and relative index of inequality (RII). Results Overall, 19 of 20 outcomes had socioeconomic gradients identified by SII and RII. The multidimensional CAN-Marg indices had the best explanatory power in standard regression models. The simplest ABSM—income quintile—detected 16 of 19 confirmed inequalities, more than any other single measure. Conclusions At all ages, many pediatric health outcomes in Manitoba were associated with significant socioeconomic inequalities; while income quintile detected most, CAN-Marg composite indices had the best explanatory power.

    更新日期:2020-01-14
  • Sex differences in the associations of physical activity and macronutrient intake with child body composition: A cross‐sectional study of 3‐ to 7‐year‐olds in Samoa
    Pediatr. Obes. (IF 3.713) Pub Date : 2020-01-10
    Avery A. Thompson; Rachel L. Duckham; Mayur M. Desai; Courtney C. Choy; Lauren B. Sherar; Take Naseri; Christina Soti‐Ulberg; Muagatutia S. Reupena; Abigail I. Wetzel; Nicola L. Hawley

    Overweight/obesity is prevalent among children in the Pacific Islands, but its aetiology is poorly understood. Few studies have considered body composition in addition to body mass index–based measures.

    更新日期:2020-01-13
  • Toward precision therapeutics: general and specific factors differentiate symptom change in depressed adolescents
    J. Child Psychol. Psyc. (IF 6.129) Pub Date : 2020-01-12
    Madison Aitken; John D. Haltigan; Peter Szatmari; Bernadka Dubicka; Peter Fonagy; Raphael Kelvin; Nick Midgley; Shirley Reynolds; Paul O. Wilkinson; Ian M. Goodyer

    The longitudinal course of multiple symptom domains in adolescents treated for major depression is not known. Revealing the temporal course of general and specific psychopathology factors, including potential differences between psychotherapies, may aid therapeutic decision‐making.

    更新日期:2020-01-13
  • Commentary: Enabling efficient and full application of prevention strategies for population mental health — reflections on Dodge 2020
    J. Child Psychol. Psyc. (IF 6.129) Pub Date : 2020-01-12
    Patrick Tolan

    Dodge (2020) provides a challenging and compelling formulation for more systematic determination of prevention component selection. The essay reminds us that population impact should be front and center in prevention specifically and public health organization in general. Dodge brings forth numerous issues in the science and the application of knowledge about prevention that warrant more research support and study. These issues include the need to recognize the existence of and increase the number of proven programs, the need for better and more extensive knowledge about impact variation across populations, and more attention to strengths and capabilities as guides for prevention. His essay also reminds us of the nuance and complexities in attempting to compare effect sizes and cost–benefit ratios of universal versus selective efforts. In addition, he provides compelling rationale for formalization of how prevention is organized and implemented in local community efforts. Further, in refocusing on the centrality of population effects in intervention application, Dodge also reminds us of the attendant principles of health equity and social justice in how we implement and judge the benefits of interventions. This essay provides a compelling argument for a strategy to realize the potential of the accumulating evidence of prevention as vital for addressing mental health and development.

    更新日期:2020-01-13
  • Are parental dietary patterns associated with children’s overweight and obesity in China?
    BMC Pediatr. (IF 1.983) Pub Date : 2020-01-11
    Daisheng Tang; Tao Bu; Xuefan Dong

    It is believed that parents have a great influence on their children’s dietary behaviours. However, it is not clear whether parental food patterns are associated with children’s nutritional status in China, which includes a vast territory with rich, diverse cultures. The goal of this project is to systematically study the associations between parental food intake and children’s overweight and obesity in China, according to children’s ages and regional differences. Based on individual food consumption data from the China Health and Nutrition Survey (CHNS) package in 2011, cross-sectional studies have previously been conducted to analyse the association between different categories of food intake of parents and children. The current study extends this research by directly. Our analysis results show that parental food intake is highly correlated with children’s food intake, with the estimated coefficients of most food intake categories being greater than 0.5. Furthermore, this association between parental food intake and children’s overweight and obesity is most significant in young children, but it begins to weaken in relation to children aged between 13 and 18. Additionally, the associations between parental food intake and children’s overnutrition are more significant in rural areas than they are in urban areas. The association between parental food intake and childhood overweight and obesity is significant, although it varies considerably according to food categories, children’s ages and area differences. These results show promise for intervening in the overnutrition of children by controlling household dietary patterns according to children’s developmental stages and regional differences.

    更新日期:2020-01-13
  • Developmental risk among Aboriginal children living in urban areas in Australia: the Study of Environment on Aboriginal Resilience and Child Health (SEARCH)
    BMC Pediatr. (IF 1.983) Pub Date : 2020-01-13
    Shingisai Chando; Jonathan C. Craig; Leonie Burgess; Simone Sherriff; Alison Purcell; Hasantha Gunasekera; Sandra Banks; Natalie Smith; Emily Banks; Sue Woolfenden

    Most Australian Aboriginal children are on track with their development, however, the prevalence of children at risk of or with a developmental or behavioural problem is higher than in other children. Aboriginal child development data mostly comes from remote communities, whereas most Aboriginal children live in urban settings. We quantified the proportion of participating children at moderate and high developmental risk as identified by caregivers’ concerns, and determined the factors associated with developmental risk among urban Aboriginal communities. Study methods were co-designed and implemented with four participating urban Aboriginal Community Controlled Health Services in New South Wales, Australia, between 2008 and 2012. Caregiver-reported data on children < 8 years old enrolled in a longitudinal cohort study (Study of Environment on Aboriginal Resilience and Child Health: SEARCH) were collected by interview. The Parents’ Evaluation of Developmental Status (PEDS) was used to assess developmental risk through report of caregiver concerns. Odds ratios (OR) were calculated using multinomial logistic regression to investigate risk factors and develop a risk prediction model. Of 725 children in SEARCH with PEDS data (69% of eligible), 405 (56%) were male, and 336 (46%) were aged between 4.5 and 8 years. Using PEDS, 32% were at high, 28% moderate, and 40% low/no developmental risk. Compared with low/no risk, factors associated with high developmental risk in a mutually-adjusted model, with additional adjustment for study site, were male sex (OR 2.42, 95% confidence intervals 1.62–3.61), being older (4.5 to < 8 years versus < 3 years old, 3.80, 2.21–6.54), prior history of ear infection (1.95, 1.21–3.15), having lived in 4 or more houses versus one house (4.13, 2.04–8.35), foster care versus living with a parent (5.45, 2.32–12.78), and having a caregiver with psychological distress (2.40, 1.37–4.20). In SEARCH, 40% of urban Aboriginal children younger than 8 years were at no or low developmental risk. Several factors associated with higher developmental risk were modifiable. Aboriginal community-driven programs to improve detection of developmental problems and facilitate early intervention are needed.

    更新日期:2020-01-13
  • Rapid brain MRI protocols reduce head computerized tomography use in the pediatric emergency department
    BMC Pediatr. (IF 1.983) Pub Date : 2020-01-13
    Sriram Ramgopal; Sabrina A. Karim; Subramanian Subramanian; Andre D. Furtado; Jennifer R. Marin

    Rapid magnetic resonance imaging (MRI) protocols may be effective in the emergency department (ED) to evaluate nontraumatic neurologic complaints. We evaluate neuroimaging (rapid MRI [rMRI]), head computerized tomography [HCT], and full MRI) use following widespread implementation of rMRI protocols in a pediatric emergency department (ED). We conducted a retrospective study in a tertiary care pediatric ED of encounters with neuroimaging during two 9-month periods: one prior to (control period) and one after generalized availability of 4 rMRI protocols (rMRI period). The primary outcome was differences in neuroimaging rates between the two periods. Secondary outcomes included ED process measures, unsuccessful imaging, and undetected pathology, with full MRI within 14 days as the reference standard. There were 1052 encounters with neuroimaging during the control and 1308 during the rMRI periods. Differences in neuroimaging between periods were 27.7% for rMRI (95% CI, 24.4, 31.0), − 21.5% for HCT (95% CI, − 25.5, − 17.5), and − 6.2% for full MRI (95% CI, − 9.3, − 3.1%.) Time to imaging (182 [IQR 138–255] versus 86 [IQR 52–137] minutes) as well as ED length of stay (396 [IQR 304–484] versus 257 [IQR 196–334] minutes) was longer for rMRI versus HCT (p < 0.01). Between the control and rMRI periods, there were differences in types of neuroimaging performed for patients with altered mental status, headache, seizure, shunt dysfunction, stroke, syncope, trauma, vomiting, infection, and other neurologic complaints (p < 0.05). rMRI studies were unsuccessful in 3.6% of studies versus 0.0% of HCTs (p < 0.01). The 22 unsuccessful rMRI studies were unsuccessful due to artifacts from dental hardware (n = 2) and patient motion (n = 20). None of the rMRI studies with full MRI follow-up imaging had undetected pathology; the false negative rate for the HCT exams was as high as 25%. After routine ED use of 4 rMRI protocols, there was a more than 20% decrease in HCT use without missed diagnoses. Time to neuroimaging and length of stay were longer for rMRI than HCT, with higher rates of unsuccessful imaging. Despite these limitations, rMRI may be an alternative to HCT for nontraumatic complaints in the ED.

    更新日期:2020-01-13
  • Hemophagocytic lymphohistiocytosis complicating invasive pneumococcal disease: a pediatric case report
    BMC Pediatr. (IF 1.983) Pub Date : 2020-01-13
    Mitsuru Tsuge; Machiko Miyamoto; Reiji Miyawaki; Yoichi Kondo; Hirokazu Tsukahara

    Hemophagocytic lymphohistiocytosis (HLH) is an infrequent but life-threatening disease due to excessive immune activation. Secondary HLH can be triggered by infections, autoimmune diseases, and malignant diseases. Streptococcus pneumoniae is a pathogenic bacterium responsible for invasive pneumococcal disease (IPD) such as meningitis and bacteremia. Although the pneumococcal conjugate vaccine (PCV) has led to reductions in IPD incidence, cases of IPD caused by serotypes not included in PCV are increasing. There are few reports of secondary HLH caused by IPD in previously healthy children. We herein report a rare case of a previously healthy boy with secondary HLH complicating IPD of serotype 23A, which is not included in the pneumococcal 13-valent conjugate vaccine (PCV-13). An 11-month-old boy who had received three doses of PCV-13 was hospitalized with prolonged fever, bilateral otitis media, neutropenia and elevated C-reactive protein (CRP) levels. Blood culture on admission revealed S. pneumoniae, leading to a diagnosis of IPD. HLH was diagnosed based on a prolonged fever, neutropenia, anemia, hepatosplenomegaly, hemophagocytosis in the bone marrow, and elevated serum levels of triglycerides, ferritin, and soluble interleukin-2 receptor. He received broad-spectrum antibiotics and intravenous immunoglobulins for IPD and high-dose steroid pulse therapy and cyclosporine A for HLH; thereafter, his fever resolved, and laboratory findings improved. The serotype of the isolated S. pneumoniae was 23A, which is not included in PCV-13. It is important to consider secondary HLH as a complication of IPD cases with febrile cytopenia or hepatosplenomegaly, and appropriate treatment for HLH should be started without delay.

    更新日期:2020-01-13
  • Management of fever in Australian children: a population-based sample survey
    BMC Pediatr. (IF 1.983) Pub Date : 2020-01-13
    Joanna Holt; Leslie White; Gavin R. Wheaton; Helena Williams; Shefali Jani; Gaston Arnolda; Hsuen P. Ting; Peter D. Hibbert; Jeffrey Braithwaite

    Fever in childhood is a common acute presentation requiring clinical triage to identify the few children who have serious underlying infection. Clinical practice guidelines (CPGs) have been developed to assist clinicians with this task. This study aimed to assess the proportion of care provided in accordance with CPG recommendations for the management of fever in Australian children. Clinical recommendations were extracted from five CPGs and formulated into 47 clinical indicators for use in auditing adherence. Indicators were categorised by phase of care: assessment, diagnosis and treatment. Patient records from children aged 0 to 15 years were sampled from general practices (GP), emergency departments (ED) and hospital admissions in randomly-selected health districts in Queensland, New South Wales and South Australia during 2012 and 2013. Paediatric nurses, trained to assess eligibility for indicator assessment and adherence, reviewed eligible medical records. Adherence was estimated by individual indicator, phase of care, age-group and setting. The field team conducted 14,879 eligible indicator assessments for 708 visits by 550 children with fever in 58 GP, 34 ED and 28 hospital inpatient settings. For the 33 indicators with sufficient data, adherence ranged from 14.7 to 98.1%. Estimated adherence with assessment-related indicators was 51.3% (95% CI: 48.1–54.6), 77.5% (95% CI: 65.3–87.1) for diagnostic-related indicators and 72.7% (95% CI: 65.3–79.3) for treatment-related indicators. Adherence for children < 3 months of age was 73.4% (95% CI: 58.0–85.8) and 64.7% (95% CI: 57.0–71.9) for children 3–11 months of age, both significantly higher than for children aged 4–15 years (53.5%; 95% CI: 50.0–56.9). The proportion of adherent care for children attending an ED was 77.5% (95% CI: 74.2–80.6) and 76.7% (95% CI: 71.7–81.3) for children admitted to hospital, both significantly higher than for children attending a GP (40.3%; 95% CI: 34.6–46.1). This study reports a wide range of adherence by clinicians to 47 indicators of best practice for the management of febrile children, sampled from urban and rural regions containing 60% of the Australian paediatric population. Documented adherence was lowest for indicators related to patient assessment, for care provided in GP settings, and for children aged 4–15 years.

    更新日期:2020-01-13
  • What should we consider in the case of combined Down- and 47,XY,+i(X)(q10) Klinefelter syndromes? The unique case of a male newborn and review of the literature
    BMC Pediatr. (IF 1.983) Pub Date : 2020-01-13
    Eva Pinti; Anna Lengyel; Gyorgy Fekete; Iren Haltrich

    Double aneuploidies - especially in combination with structural aberrations - are extremely rare among liveborns. The most frequent association is that of Down (DS) and Klinefelter syndromes (KS). We present the case of a male newborn with a unique 47,XY,+ 21[80%]/48,XY,+i(X)(q10),+ 21[20%] karyotype, hypothesize about his future phenotype, discuss the aspects of management and review the literature. The additional association of isochromosome Xq (i(X)(q10)) could be the result of a threefold non-disjunction event. 47,XY,+i(X)(q10) KS is not common and its symptoms differ from the classical KS phenotype. In combined DS and i(X)(q10) KS, the anticipatory phenotype is not simply the sum of the individual syndromic characteristics. This genotype is associated with higher risk for several diseases and certain conditions with more pronounced appearance: emotional and behavioral disorders; poorer mental and physical quality of life; lower muscle mass/tone/strength; connective tissue weakness; muscle hypotonia and feeding difficulties; osteopenia/−porosis with earlier beginning and faster progression; different types of congenital heart diseases; more common occurrence of hypertension; increased susceptibility to infections and female predominant autoimmune diseases; higher risk for hematological malignancies and testicular tumors. In multiple aneuploidies, the alterations have the potential to weaken or enhance each other, or they may not have modifying effects at all. Prenatal ultrasound signs are not obligatory symptoms of numerous chromosomal anomalies (specifically those involving supernumerary sex chromosomes), therefore combined prenatal screening has pertinence in uncomplicated pregnancies as well.

    更新日期:2020-01-13
  • Extrapolation Pitfalls and Methodology Flaws in Curing Anemia via Parental Education and Counseling—Reply
    JAMA Pediatr. (IF 12.004) Pub Date : 2020-01-13
    Arun S. Shet; Merrick Zwarenstein; Maria Rosaria Galanti

    In Reply We thank Zhou and Niu for their comments regarding our pragmatic cluster randomized trial. The authors raise 2 specific issues that they believe are legitimate. First, Zhou and Niu question the generalizability of the trial conducted in Chamarajnagar district, South India, to rural children from the rest of India. In support of their concern is cited evidence for genetic diversity among Indian individuals and documentation of rare germline mutations in TMPRSS6, which encodes a type II transmembrane serine protease produced by the liver that regulates the expression of the systemic iron regulatory hormone hepcidin that can cause iron-refractory iron-deficiency anemia.1 This concern is unfounded for the following reasons. In spite of genetic diversity, anemia prevalence in children younger than 5 years between rural Indian provinces is remarkably similar.2 Moreover, genetic mutations causally associated with iron deficiency anemia in the general population are likely to be randomly distributed. Besides, regardless of heterogeneity in anemia prevalence among genetically diverse individuals, there is no logical reason to think that the relative effect of our intervention would be different because the effect is obtained via education and counselling, mechanisms that are social and cultural rather than genetic.

    更新日期:2020-01-13
  • Extrapolation Pitfalls and Methodology Flaws in Curing Anemia via Parental Education and Counseling
    JAMA Pediatr. (IF 12.004) Pub Date : 2020-01-13
    Bo Zhou; Wenquan Niu

    To the Editor In their pragmatic cluster randomized clinical trial, Shet et al1 reported a perceivable effect of community-based parental education and counseling annexed with usual treatment on children’s anemia cure rate in India. Globally, anemia has escalated to epidemic proportions, with an estimated prevalence of 32.9% in 2010, causing 68.36 million years lived with disability.2 Hence, strategies to prevent anemia and mitigate its adverse effects are of major public importance. To fill this gap in knowledge, Shet et al1 have proposed an effective strategy that might guide policy makers and practitioners to enhance anemia control at a population level. However, we are concerned about result extrapolation and data management.

    更新日期:2020-01-13
  • Extended Follow-up From a Randomized Clinical Trial of Routine Amoxicillin in the Treatment of Uncomplicated Severe Acute Malnutrition in Niger
    JAMA Pediatr. (IF 12.004) Pub Date : 2020-01-13
    Sheila Isanaka; Kyra H Grantz; Fatou Berthé; Myrto Schaefer; Eric Adehossi; Rebecca F. Grais
    更新日期:2020-01-13
  • Association of Maternal Psychological Distress With In Utero Brain Development in Fetuses With Congenital Heart Disease
    JAMA Pediatr. (IF 12.004) Pub Date : 2020-01-13
    Yao Wu; Kushal Kapse; Marni Jacobs; Nickie Niforatos-Andescavage; Mary T. Donofrio; Anita Krishnan; Gilbert Vezina; David Wessel; Adré du Plessis; Catherine Limperopoulos
    更新日期:2020-01-13
  • An Athletic Coach–Delivered Middle School Gender Violence Prevention Program: A Cluster Randomized Clinical Trial
    JAMA Pediatr. (IF 12.004) Pub Date : 2020-01-13
    Elizabeth Miller; Kelley A. Jones; Lisa Ripper; Taylor Paglisotti; Paul Mulbah; Kaleab Z. Abebe
    更新日期:2020-01-13
  • Gender Violence Prevention in Middle School Male Athletics Programs
    JAMA Pediatr. (IF 12.004) Pub Date : 2020-01-13
    Angela Amar; Kathryn Laughon

    Relationship abuse and sexual violence are important societal and public health concerns that begin in adolescence, with behaviors and consequences continuing across the life span. They include physical, sexual, and psychological abuse by a current or former partner in same-sex and opposite-sex couples and occurs across all racial/ethnic groups and socioeconomic statuses. All sexes are identified as survivors and perpetrators of relationship abuse and sexual violence.1 However, women and girls are more likely to be survivors and men and boys more likely to be perpetrators.2,3 While not as well studied, gender-nonconforming youths of all identities are more likely than their gender-conforming peers to be targets of physical and sexual violence.4 Overall, female-identified individuals endure the most injury. Intimate partner violence (IPV) is the leading cause of injury in women aged 16 to 24 years. Femicide is the third leading cause of death in that age group, of which IPV accounts for at least half.5 Relationship abuse and sexual violence can result in a range of physical and psychological health needs that increase health care utilization and costs. The combined medical, mental health, and lost productivity costs of IPV against women are estimated to exceed $8.3 billion per year.6

    更新日期:2020-01-13
  • The Case for Removing Race From the American Academy of Pediatrics Clinical Practice Guideline for Urinary Tract Infection in Infants and Young Children With Fever
    JAMA Pediatr. (IF 12.004) Pub Date : 2020-01-13
    Rachel H. Kowalsky; Ashley C. Rondini; Shari L. Platt

    In August 2019, the American Academy of Pediatrics (AAP) published a critically important policy statement2 on the effects of racism on child and adolescent health. This statement (referred to here as the AAP policy statement) powerfully underscores the work undertaken by scholars and scientists regarding racial inequities in health care, and it comes at a critical sociohistorical moment in which public discourse on racism is squarely at the forefront. The AAP policy statement proposes an integrated approach to combating racism by addressing “implicit and explicit biases, institutional structures, and interpersonal relationships,”2(p1) and advocates “untangling the thread of racism sewn through the fabric of society and affecting the health of pediatric populations.”2(p7)

    更新日期:2020-01-13
  • Computer-aided diagnosis for World Health Organization-defined chest radiograph primary-endpoint pneumonia in children
    Pediatr. Radiol. (IF 2.022) Pub Date : 2020-01-13
    Nasreen Mahomed, Bram van Ginneken, Rick H. H. M. Philipsen, Jaime Melendez, David P. Moore, Halvani Moodley, Tanusha Sewchuran, Denny Mathew, Shabir A. Madhi

    The chest radiograph is the most common imaging modality to assess childhood pneumonia. It has been used in epidemiological and vaccine efficacy/effectiveness studies on childhood pneumonia.

    更新日期:2020-01-13
  • Confounding biases in studies on early- versus late-caffeine in preterm infants: a systematic review
    Pediatr. Res. (IF 2.880) Pub Date : 2020-01-13
    Sandra Nylander Vujovic; Chiara Nava; Minna Johansson; Matteo Bruschettini

    Background Caffeine is indicated for the management of apnoea of prematurity and extubation in preterm infants. Early initiation of caffeine administration has increased in the past decades with the purpose of reducing respiratory morbidity. However, there might be harms associated with this approach. This systematic review aims to assess whether early administration of caffeine reduces morbidity and mortality in preterm infants. Methods The methods were published in a preregistered protocol. The literature search was performed in February 2019 with no restrictions for language or publication date. Randomised controlled trials (RCTs) and cohort studies comparing early versus late caffeine administration to infants born before week 34 were included. Results Two RCTs and 14 cohort studies were included. All studies but one had a serious/critical overall risk of bias. Few studies reported on long-term or patient-relevant outcomes. No meta-analysis could be performed. Conclusion Based on the available evidence, no conclusions about the optimal timing of caffeine administration can be drawn. There are inherent methodological problems in the cohort studies. RCTs are needed to answer the question of optimal timing for caffeine administration in neonatal care. Future trials should focus on outcomes relevant to patients and their families and include long-term outcomes.

    更新日期:2020-01-13
  • How to introduce MSC-based therapy for the developing lung safely into clinical care?
    Pediatr. Res. (IF 2.880) Pub Date : 2020-01-13
    Mario Rüdiger; Haresh Kirpalani; Robin Steinhorn; Jonathan M. Davis; Bernard Thebaud

    Extreme prematurity is associated with an increased risk to develop bronchopulmonary dysplasia (BPD). Severe BPD is associated with a significant long-term burden for the affected infant, families and society. Currently there are limited prevention and treatment options. Regenerative approaches using mesenchymal stromal cells (MSC) are associated with promising benefits in animal experiments. First clinical studies, using MSC in humans, suggest safety. To accelerate the process of bench to bed-side development of MSC-based therapies, a global and collaborative approach is needed that includes all key stakeholders. Results of a workshop that was held during the Pediatric Academic Societies meeting in 2019 are summarized. A roadmap is provided discussing next steps of bringing MSC-based interventions into clinical practice.

    更新日期:2020-01-13
  • Modification of the effects of prenatal manganese exposure on child neurodevelopment by maternal anemia and iron deficiency
    Pediatr. Res. (IF 2.880) Pub Date : 2020-01-11
    Allison Kupsco; Guadalupe Estrada-Gutierrez; Alejandra Cantoral; Lourdes Schnaas; Ivan Pantic; Chitra Amarasiriwardena; Katherine Svensson; David C. Bellinger; Martha María Téllez-Rojo; Andrea A. Baccarelli; Robert O. Wright

    Background We evaluated: (1) associations of prenatal manganese (Mn) levels with child neurodevelopment at 4–6 years; (2) effect modification by maternal anemia and iron deficiency; and (3) sex-specific effects. Methods We measured blood Mn, hemoglobin, and serum ferritin in mothers at the second trimester, third trimester, and at birth, and in cord blood from a prospective birth cohort in Mexico City (n = 571). McCarthy Scales of Children’s Abilities were measured at 4–6 years. Using linear regression, we estimated associations between prenatal Mn and neurodevelopment, examined anemia and iron deficiency as effect modifiers, and analyzed associations by child sex. Results No direct associations were observed between Mn, anemia, or iron deficiency and McCarthy Scales. Second trimester iron deficiency and third trimester anemia modified the effect of Mn on child neurodevelopment. For instance, second trimester Mn was positively associated child memory scores in mother’s with normal ferritin (1.85 (0.02, 3.45)), but negatively associated in mother’s with low ferritin (−2.41 (−5.28, 0.47), interaction P value = 0.01), a pattern observed across scales. No effect modification at birth or in cord blood was observed. Conclusions Anemia/iron deficiency during pregnancy may modify Mn impacts on child neurodevelopment, particularly in boys.

    更新日期:2020-01-13
  • Surfactant replacement therapy: from biological basis to current clinical practice
    Pediatr. Res. (IF 2.880) Pub Date : 2020-01-11
    Roland Hentschel; Kajsa Bohlin; Anton van Kaam; Hans Fuchs; Olivier Danhaive

    This review summarizes the current knowledge on the physiological action of endogenous and exogenous pulmonary surfactant, the role of different types of animal-derived and synthetic surfactants for RDS therapy, different modes of administration, potential risks and strategies of ventilation, and highlights the most promising aims for future development. Scientists have clarified the physicochemical properties and functions of the different components of surfactant, and part of this successful research is derived from the characterization of genetic diseases affecting surfactant composition or function. Knowledge from functional tests of surfactant action, its immunochemistry, kinetics and homeostasis are important also for improving therapy with animal-derived surfactant preparations and for the development of modified surfactants. In the past decade newly designed artificial surfactants and additives have gained much attention and have proven different advantages, but their particular role still has to be defined. For clinical practice, alternative administration techniques as well as postsurfactant ventilation modes, taking into account alterations in lung mechanics after surfactant placement, may be important in optimizing the potential of this most important drug in neonatology.

    更新日期:2020-01-13
  • Body composition and neuromotor development in the year after NICU discharge in premature infants
    Pediatr. Res. (IF 2.880) Pub Date : 2020-01-11
    Dan M. Cooper; Gay L. Girolami; Brenda Kepes; Annamarie Stehli; Candice Taylor Lucas; Fadia Haddad; Frank Zalidvar; Nitzan Dror; Irfan Ahmad; Antoine Soliman; Shlomit Radom-Aizik

    Background Hypothesis: neuromotor development correlates to body composition over the first year of life in prematurely born infants and can be influenced by enhancing motor activity. Methods Forty-six female and 53 male infants [27 ± 1.8 (sd) weeks] randomized to comparison or exercise group (caregiver provided 15–20 min daily of developmentally appropriate motor activities) completed the year-long study. Body composition [lean body and fat mass (LBM, FM)], growth/inflammation predictive biomarkers, and Alberta Infant Motor Scale (AIMS) were assessed. Results AIMS at 1 year correlated with LBM (r = 0.32, p < 0.001) in the whole cohort. However, there was no effect of the intervention. LBM increased by ~3685 g (p < 0.001)); insulin-like growth factor-1 (IGF-1) was correlated with LBM (r = 0.36, p = 0.002). IL-1RA (an inflammatory biomarker) decreased (−75%, p < 0.0125). LBM and bone mineral density were significantly lower and IGF-1 higher in the females at 1 year. Conclusions We found an association between neuromotor development and LBM suggesting that motor activity may influence LBM. Our particular intervention was ineffective. Whether activities provided largely by caregivers to enhance motor activity in prematurely born infants can affect the interrelated (1) balance of growth and inflammation mediators, (2) neuromotor development, (3) sexual dimorphism, and/or (4) body composition early in life remains unknown.

    更新日期:2020-01-13
  • Lean mass index is positively associated with white matter volumes in several brain regions in children with overweight/obesity
    Pediatr. Obes. (IF 3.713) Pub Date : 2020-01-09
    Luis Gracia‐Marco; Irene Esteban‐Cornejo; Esther Ubago‐Guisado; Maria Rodriguez‐Ayllon; Jose Mora‐Gonzalez; Patricio Solis‐Urra; Cristina Cadenas‐Sanchez; Juan Verdejo‐Roman; Andres Catena; Kirk I. Erickson; Francisco B. Ortega

    The relationship of obesity with grey and white matter volumes has been examined in several studies, and the results are decidedly mixed.

    更新日期:2020-01-11
  • In utero exposure to gestational diabetes mellitus and cardiovascular risk factors in youth: A longitudinal analysis in the EPOCH cohort
    Pediatr. Obes. (IF 3.713) Pub Date : 2020-01-09
    Wei Perng; Christine W. Hockett; Katherine A. Sauder; Dana Dabelea

    To examine associations of maternal gestational diabetes mellitus (GDM) with offspring cardiovascular biomarkers from late childhood through adolescence.

    更新日期:2020-01-11
  • Commentary: A challenge for a higher bar in research on childhood trauma: reflections on Danese 2019
    J. Child Psychol. Psyc. (IF 6.129) Pub Date : 2020-01-09
    Cathy S. Widom

    While there have been major advances in documenting the consequences of childhood adversities for psychopathology, Professor Danese's excellent paper challenges existing theory and research methods, urging the field to move ahead with future research that overcomes existing limitations. Importantly, he reminds us of the methodological caveats necessary to consider when assessing the body of evidence for causal effects of childhood trauma and urges caution in interpreting the ACEs literature. This editorial calls attention to and elaborates on a number of issues, including (a) why prospective and retrospective data cannot be used interchangeably; (b) the need for researchers to distinguish among childhood adversities, childhood traumas, and childhood maltreatment; (c) the sparse attention at present to the role of pre‐existing vulnerabilities in influencing assessments of the risk of psychopathology; and (d) the critical importance of contextual factors (e.g., age, sex, race, ethnicity, and social class) that are likely to influence the risk of psychopathology. Professor Danese argues for the use of new analytic strategies to advance the field. This editorial elaborates on this recommendation and calls attention to the use of machine learning techniques that may be particularly worthwhile for the child maltreatment field, where there is little psychometric research on measures.

    更新日期:2020-01-11
  • Pediatric multiple sclerosis: from clinical basis to imaging spectrum and differential diagnosis
    Pediatr. Radiol. (IF 2.022) Pub Date : 2020-01-10
    Igor G. Padilha, Ana P. A. Fonseca, Ana L. M. Pettengill, Diego C. Fragoso, Felipe T. Pacheco, Renato H. Nunes, Antonio C. M. Maia, Antônio J. da Rocha

    Abstract Pediatric multiple sclerosis (MS) deserves special attention because of its impact on cognitive function and development. Although knowledge regarding pediatric MS has rapidly increased, understanding the peculiarities of this population remains crucial for disease management. There is limited expertise about the efficacy and safety of current disease-modifying agents. Although pathophysiology is not entirely understood, some risk factors and immunological features have been described and are discussed herein. While the revised International Pediatric MS Study Group diagnostic criteria have improved the accuracy of diagnosis, the recently revised McDonald criteria also offer some new insights into the pediatric population. It is fundamental that radiologists have strong knowledge about the vast spectrum of demyelinating disorders that can occur in childhood to ensure appropriate diagnosis and provide early treatment.

    更新日期:2020-01-11
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