Frontiers in Pediatrics

Journal Information
EISSN: 22962360
Total articles ≅ 7,306

Latest articles in this journal

, Shanmuganathan Chandrakasan
Published: 31 March 2023
Frontiers in Pediatrics, Volume 11; https://doi.org/10.3389/fped.2023.1182474

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, Lisandro A. Piaggio, Barroso Jr Ubirajara
Published: 31 March 2023
Frontiers in Pediatrics, Volume 11; https://doi.org/10.3389/fped.2023.1174553

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Qiuping Xu, Xiaoya Wang, Na Li, Ying Wang, Xin Xu,
Published: 31 March 2023
Frontiers in Pediatrics, Volume 11; https://doi.org/10.3389/fped.2023.1124610

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Objectives: To identify craniofacial and upper airway morphological characteristics associated with the presence and severity of obstructive sleep apnea (OSA) in children.Methods: This study consisted of 82 OSA children and 77 controls (age 5–10 years). All subjects underwent cephalograms and were divided into a 5–7 age group and an 8–10 age group. Cephalometric variables were compared between OSA children and controls, and hierarchical regression analysis was performed to examine the relationship between cephalometric variables and OSA severity [expressed by the obstructive apnea–hypopnea index (OAHI)] in different age groups.Results: Increased A/N ratio, narrowed posterior airway space, decreased SNA and SNB angles, and shortened ramus height were observed among OSA children in different age groups. In the 5–7 age group, the A/N ratio and a lower gonial angle explained 40.0% and 14.7% of the variance in the OAHI, respectively. In the 8–10 age group, the BMI z-score and A/N ratio explained 25.2% and 6.6% of the variance in the OAHI, followed by a lower gonial angle and the hyoid-retrognathion distance (19.1% in total).Conclusions: Adenoid hypertrophy was a major factor associated with OSA in preschool children, whereas obesity replaced adenoid hypertrophy as the main contributor to OSA in late childhood. Several craniofacial skeletal variables such as the SNB angle, ramus height, lower gonial angle, and hyoid position are also associated with the presence and/or severity of OSA, which could be used to help recognize children at a higher risk for OSA.
, Ahmad Ayed Al-Shammari, Raed Mohamed Al Nefily, Rawan Abdulrahman AlAnazi, Abdulrahman Hamed Abdulwahab, Ahmed Sabry Ammar
Published: 31 March 2023
Frontiers in Pediatrics, Volume 11; https://doi.org/10.3389/fped.2023.1142950

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Aplasia cutis congenita (ACC) is a heterogeneous disorder with a rarely reported incidence of 0.5–1 in 10,000 births. ACC can be associated with physical defects or syndromes that may help in the diagnosis, prognosis, and further evaluation of the patient. Trisomy 13 is one of the most common fetal life-limiting diagnoses associated with ACC of membranous-type scalp. The patient was born at 35 weeks of gestation via a cesarean section due to fetal distress. Upon admission to our hospital, her pertinent physical examination revealed a newborn girl with dysmorphic facial features, including widely separated eyes, downward slanting of the palpebral fissure, microphthalmia, retrognathia, and low-set ears. She had an area of loss of scalp skin and skull bone with seen brain tissue and an exposed sagittal sinus that was 6 by 5 cm in size. She had a clenched fist, overlapping fingers, and rocker bottom feet. Precordium auscultation revealed medium-pitched high-grade continuous murmur heard best at the pulmonary position with a harsh machinelike quality that often radiated to the left clavicle. Laboratory investigations include basic labs, and the TORCH screen was negative. On the 9th day of life, a chromosomal analysis showed a female karyotype with three copies of chromosome number 13 (trisomy 13) in all 20 metaphase cell counts. The patient was managed with a moist gauze dressing, topical antibiotic ointment, and povidone-iodine. However, a multidisciplinary team agreed on a do-not-resuscitate (DNR) order with no further surgical intervention as the survival rate of trisomy 13 is poor. In this article, we report a case of aplasia cutis congenita of the scalp with dura and bone defect and an exposed sagittal sinus in a newborn diagnosed with trisomy 13. It emphasizes the importance of ACC-associated syndrome, which has high mortality prior to surgical intervention.
Ying Wang, Qingnan He, Xiqiang Dang, Xiaochuan Wu,
Published: 31 March 2023
Frontiers in Pediatrics, Volume 11; https://doi.org/10.3389/fped.2023.1107280

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Background: Alport syndrome (AS) and Wilson's disease (WD) are genetic diseases that could lead to kidney damage. Herein, we report the clinical features and gene variants in a patient with WD and X-linked AS.Case presentation: The proband was a 12-year-old boy diagnosed with AS coexisting with WD at the age of 11 years. The patient underwent a medical check-up when he was 4 years and 8 months. Laboratory tests revealed elevated liver enzymes, decreased serum ceruloplasmin, increased 24-h urinary copper excretion, and one variant in the ATP7B gene. Then, the patient was diagnosed with WD. After 2 months of treatment with D-penicillamine and zinc salt, his liver function had recovered to normal levels, but he presented with microscopic hematuria. The hematuria did not resolve after switching to dimercaptosuccinic acid from D-penicillamine. In addition, he presented with proteinuria 3 years later. A renal biopsy was performed more than 6 years after the patient was diagnosed with WD, and electron microscopy showed that the basement membrane thickness was uneven, layered, and focal torn. Copper staining was negative. A genetic analysis identified a hemizygous variant (c.1718G > A, p. Gly573Asp) in COL4A5 and a homozygous variant (c.2975C > T, p. Pro992leu) in ATP7B. The patient’s urine protein–creatinine ratio was less than 1.0 mg/mg after a 1 year of follow-up, after enalapril was administered for treating AS.Conclusion: This case highlights a lack of improvement in renal function after conventional treatment provides a possible indication for performing renal biopsy or genetic testing to determine the etiology in order to facilitate subsequent clinical management. Clinicians should prevent the occurrence of diagnostic inaccuracies caused by diagnostic anchoring because an accurate diagnosis is essential for achieving precise treatment and improved prognosis.
Shabih Manzar, Katherine Hoops,
Published: 31 March 2023
Frontiers in Pediatrics, Volume 11; https://doi.org/10.3389/fped.2023.1165301

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Baize Zhang, Junhui Wang, Xinxin Han, Ruohao Fang, Zirui Wang, Zeming Hui, Yujiang Chen, Jiajia Liu, Xiaojing Wang
Published: 31 March 2023
Frontiers in Pediatrics, Volume 11; https://doi.org/10.3389/fped.2023.1117935

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Instruction: The purpose of this study was to evaluate the three-year success rate of the treatment for early childhood caries (ECC) under general anesthesia in different periods (2011 and 2018).Methods: Children (<6 years old) who had severe caries and were treated under general anesthesia in 2011 and 2018 were selected and followed up by telephone appointment and clinical examination. Success rate of each treatment was determined and possible factors associated with treatment failure were evaluated.Results: There were 153 patients (with an average age of 48.55 ± 13.37 months) and a total of 2,018 teeth included in the 2011 group. In the 2018 group, there were 273 patients with an average age of 49.01 ± 12.42 months and a total of 3,796 teeth. The success rate in the 2011 group was significantly lower than that in the 2018 group. Teeth with mineral trioxide aggregate (MTA)-capped pulp survived significantly longer than those with calcium hydroxide-capped pulp. The utilization rate of preformed crown restoration was higher than that of resin restoration, and the survival time of dental restorations with preformed crown was prolonged. For posterior teeth, the success rate of indirect pulp capping and pulpotomy was also significantly higher than those without preformed crowns.Discussion: General anesthesia is a safe and effective behavioral management method for uncooperative children's dental treatment. The use of biocompatible pulp capping materials and preformed crowns improved the success rate of treatment and prolonged the survival time of affected teeth.
, Alberto Eugenio Tozzi
Published: 31 March 2023
Frontiers in Pediatrics, Volume 11; https://doi.org/10.3389/fped.2023.1187008

Abstract:
Jing-Ke Cao, Chang-Geng Liu, Dan Wang, Qiu-Ping Li
Published: 30 March 2023
Frontiers in Pediatrics, Volume 11; https://doi.org/10.3389/fped.2023.1144373

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Background: Premature rupture of membranes (PROM) is a common cause of extremely premature infants (EPIs) and also leads to adverse preterm complications. However, the effect of PROM on EPIs remains contradictory. This study used propensity score matching (PSM) to adjust the baseline characteristics to explore the impact of PROM on clinical outcomes of extremely premature infants (EPIs).Methods: Medical data of 470 EPIs at gestational age < 28weeks who received prenatal examination in our hospital between January 1, 2015 and December 31, 2020 were analyzed retrospectively. According to the presence or absence of PROM, they were divided into a PROM group and a non-PROM group. Ten covariates including birth weight, male sex, artificial conception, cesarean delivery, 5-min Apgar score ≤ 7, oligohydramnios, gestational hypertension, preeclampsia, antenatal steroid use, and complete steroid treatment were matched 1:1 by PSM. The major complication occurrence and mortality during hospitalization were compared between the two groups by t-test, nonparametric test or $x2$ test.Results: Among the 470 infants enrolled, 157 (33.4%) were in the PROM group and 313 in the no-PROM group. After matching the ten confounding factors,276 cases were successfully enrolled. The incidence of early pulmonary hypertension (EPH) and severe retinopathy of prematurity (ROP) in the PROM group were higher than those in the no-PROM group [44.2% (61/138) vs. 29.0% (40/138); 34.8% (48/138) vs. 21.7% (30/138), x2 = 6.886 and 5.790, both P < 0.05]. However, there was no significant difference in the in-hospital mortality and the incidence of other major complications between the two groups (all P > 0.05).Conclusions: PROM increased the incidence of EPH and severe ROP in EPI, but had no significant impact on in-hospital mortality, length of hospital stay, and the incidence of other complications.
Schirin Akhbari Ziegler, Rosane Luzia de Souza Morais, Lívia Magalhães, Mijna Hadders-Algra
Published: 30 March 2023
Frontiers in Pediatrics, Volume 11; https://doi.org/10.3389/fped.2023.983680

Abstract:
Infants at high biological risk of or with a neurodevelopmental disorder run a high risk of delayed school readiness. This is especially true for infants in low- and middle-income countries (LMICs). This perspective paper first summarizes evidence on intervention elements that are effective in promoting family well-being and child development in infants at high biological risk in high income countries. Crucial elements are family centeredness, goal orientation, a home setting, focus on activity and participation, and challenging the infant to explore the world and the own body by means of self-produced movements. The studies revealed that coaching as applied in COPCA (COPing and CAring for infants with special needs) is a pivotal element determining the success of intervention.The paper continues by describing COPCA and its coaching. Next, we report on two pilot studies addressing COPCA's implementation in Brazil. Finally, we discuss why COPCA is a promising early intervention program for infants at high biological risk of neurodisability in LMICs: COPCA is adapted to the families' strengths and needs, it empowers families and promotes child development therewith facilitating school readiness. Moreover, it may be delivered by tele-coaching therewith eliminating families' burden to travel to distant intervention clinics.