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Vol 16, No 4
Vol 16, No 4 August 2020 ISSN 1708-8569
Review articles
Original articles
Brief reports
Letters to the editor
Pediatric COVID-19: what disease is this?
  Kam Lun Ellis Hon, Karen Ka Yan Leung
  [Abstract] [Full Text] [PDF]  
Review articles:
Best practice for infection prevention in pediatric respiratory clinics during the COVID-19 epidemic
  Jing Zhang, Lei Zhang, Yong Yin, Quan Lu, Jian-Guo Hong, Xiao-Bo Zhang, Xiao-Jian Zhou, Li-Bo Wang, Jian-Hua Zhang, Min Lu, Xiao-Yan Dong, Jie Shao, Yan-Ming Lu, Jun Yu, Li Gu, Respiratory Disease Group, Pediatric Committee of Shanghai Medical Association, Shanghai, China
  During the COVID-19 epidemic, it is important for ensuring infection prevention and control in the pediatric respiratory clinics. Herein, we introduced the practice of infection prevention and control in pediatric respiratory clinics in China. Triage measures for patients who visit respiratory clinics, quality control for pediatric respiratory clinics and other preventive measures for related examinations and treatment have been introduced in this review article.
  [Abstract] [Full Text] [PDF]  
Dilemmas in diagnosis and management of hemophagocytic
  Xiao-Jun Xu, Yong-Min Tang
Background: Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening entity which is characterized by severe hyperinflammation. Now the HLH-2004 protocol has been widely accepted and clinically used; however, many questions still remain in clinical practice. In this review, we discuss the dilemmas in the diagnosis and treatment of HLH in children.
Data sources: Original research for articles and literature reviews published in PubMed was carried out using the key term ¡°hemophagocytic lymphohistiocytosis¡±.
Results: As the gene sequencing technology progresses, the range of causal mutations and primary HLH has been redefined. The monoallelic variants may contribute to the pathogenesis of the disease. Many conditions without defective cytotoxicity of T or NK cells may lead to HLH, such as primary immunodeficiency (PID) and dysregulated immune activation or proliferation (DIAP). HLH shares overlapping clinical and laboratory characteristics with severe sepsis, but usually the single values are more pronounced in HLH than sepsis. H score is another approach to help the diagnosis of secondary HLH. Specific Th1/Th2 cytokine patterns are very helpful tools to differentiate HLH (reactivation of HLH) from sepsis. Moreover, it also has been used successfully to stratify the therapy intensity. The treatment of HLH should consider underlying diseases, triggers and severity. HLH-94 is recommended for patients who need etoposide-based therapy.
Conclusions: Dramatic progress has been made during the past decades in understanding the pathophysiology of HLH. However, diagnosis and treatment of HLH remain with many dilemmas because of the heterogeneous nature of the disease. Better understanding new gene defects and more effective diagnostic approaches and salvage regimens are goals for the future.
  [Abstract] [Full Text] [PDF]  
Prenatal risk factors for internalizing and externalizing problems in childhood
  Joyce Tien, Gary D. Lewis, Jianghong Liu
Background: A growing body of research has documented the effects of prenatal risk factors on a wide spectrum of adverse off spring health outcomes. Childhood behavior problems, such as externalizing and internalizing problems, are no exception. This comprehensive literature review aims to summarize and synthesize current research about commonly experienced prenatal risk factors associated with internalizing and externalizing problems, with a focus on their impact during childhood and adolescence. Potential mechanisms as well as implications are also outlined.
Data sources: The EBSCO, Web of Science, PubMed, Google Scholar, and Scopus databases were searched for studies examining the association between prenatal risk factors and off spring internalizing/externalizing problems, using keywords ¡°prenatal¡± or ¡°perinatal¡± or ¡°birth complications¡± in combination with ¡°internalizing¡± or ¡°externalizing¡±. Relevant articles, including experimental research, systematic reviews, meta-analyses, cross-sectional and longitudinal cohort studies, and theoretical literature, were reviewed and synthesized to form the basis of this integrative review.
Results: Prenatal risk factors that have been widely investigated with regards to off spring internalizing and externalizing problems encompass health-related risk factors, including maternal overweight/obesity, substance use/abuse, environmental toxicant exposure, maternal infection/inflammation, as well as psychosocial risk factors, including intimate partner violence, and anxiety/depression. Collectively, both epidemiological and experimental studies support the adverse associations between these prenatal factors and increased risk of emotional/behavioral problem development during childhood and beyond. Potential mechanisms of action underlying these associations include hormonal and immune system alterations. Implications include prenatal education, screening, and intervention strategies.
Conclusions: Prenatal risk factors are associated with a constellation of off spring internalizing and externalizing problems. Identifying these risk factors and understanding potential mechanisms will help to develop effective, evidence-based prevention, and intervention strategies.
  [Abstract] [Full Text] [PDF]  
Combined effects of physical activity and calcium on bone health in children and adolescents: a systematic review of randomized controlled trials
  Xi Yang, Yi Zhai, Jian Zhang, Jing-Yi Chen, Dan Liu, Wen-Hua Zhao
Background: A better understanding of the role of exercise and nutrition in bone health is significant for preventing osteoporosis. The aim of this review was to assess the combined effects of physical activity and calcium intake on improving bone mineral density in children and adolescents.
Methods: A search of electronic databases (MedLine, ISI Web of Science, Science Direct) and the literature references were performed. Randomized controlled trials published between 1997 and 2017, evaluating the effect of both physical activity and calcium intake intervention on bone mineral density or bone mineral content among children aged 3-18 years were selected. The Improved Jadad Rating Scale was used to assess the methodological quality of the included studies. Study characteristics were summarized in accordance with the review¡¯s PICO criteria. Changes in bone mineral content were detected at several different bone sites.
Results: A total of nine studies involving 908 participants were included in this review. The combined intervention of physical activity and calcium increased bone mineral in children and adolescents, especially when baseline calcium intake level was low and among participants on the stage of early puberty.
Conclusions: Regular physical activity combined with high level of calcium intake is beneficial for bone health in young population. Further research is needed to evaluate the dose-response associations and long-term effects of the interaction between physical activity and calcium intake.
  [Abstract] [Full Text] [PDF]  
Cord blood zinc status effects on pregnancy outcomes and its relation with maternal serum zinc levels: a systematic review and meta-analysis
  Sevginur Akdas, Nuray Yazihan
Background: The association between maternal and cord blood zinc level and pregnancy outcomes remains uncertain. The present study aims to assess whether maternal blood zinc level represents cord blood zinc level correctly.
Methods: In this meta-analysis, systematic search was performed in PubMed, Web of Science, and Scopus databases for relevant available English articles which included mean and standard deviation values of cord blood zinc level up to April 2019. For the assessment of the relation between cord blood zinc level and pregnancy outcomes, the pooled standard mean difference with 95% confidence interval (CI) was used and 23 studies were analyzed.
Results: Cumulative analysis showed that cord blood zinc level was found significantly decreased in pregnancies with complications compared with healthy pregnancy controls [REM: P = 0.0007, mean difference -7.9 (-12.48, -3.31)]. For further analysis, maternal serum zinc level status was determined from same studies to compare with cord blood levels and subgroups were detected as ¡°Preterm¡±, ¡°Preeclampsia¡±, ¡°Small for gestational age/Intrauterine growth restriction and Low birth weight¡±. It was observed that cord blood zinc levels in subgroup analysis were also decreased and/or tend to be decreased compared to healthy pregnancies, except for preeclampsia subgroup. Also, a correlation was seen between cord blood and maternal blood zinc level status (R = 0.4365, 95% CI -0.530, 0.756; P = 0.0351).
Conclusion: It was thought that cord blood zinc level might tend to decrease more than maternal serum zinc level in the pathological conditions during pregnancies.
  [Abstract] [Full Text] [PDF]  
Risk factors for infantile hemangioma: a meta-analysis
  Yuan Ding, Jing-Zhan Zhang, Shi-Rong Yu, Fang Xiang, Xiao-Jing Kang
Background: Infantile hemangioma (IH) is one of the most common tumors in infants. Its pathogenesis is complex and poorly understood. The risk factors of IH have been extensively studied from clinical and epidemiological perspectives in recent years, but the conclusions in the literature reports are inconsistent. To provide a reference for the prevention of hemangioma, we conducted a meta-analysis of the published studies of potential risk factors for IH.
Methods: The Cochrane Library, Ovid, PubMed, and Web of Science databases were searched systematically. Log odds ratios (log ORs), logistic regression standard errors and 95% confidence intervals (CIs) were used to compare the correlation between IH and potential risk factors. Review Manager 5.3.3 was used for the statistical analysis.
Results: Six studies were included and 17 potential risk factors were eventually evaluated. P values < 0.05 were found for female gender (P < 0.01, OR 2.04, 95% CI 1.65-2.51), low birth weight (P < 0.01, OR 4.39, 95% CI 3.05-6.31), multiple gestation (P = 0.01, OR 2.39, 95% CI 1.21-4.71), preterm birth (P = 0.03, OR 2.37, 95% CI 1.07-5.23), progesterone therapy (P < 0.01, OR 2.73, 95% CI 2.12-3.51), and family history (P = 0.01, OR 1.98, 95% CI 1.16-3.38).
Conclusions: This meta-analysis revealed that risk factors, including female gender, low birth weight, multiple gestation, preterm birth, progesterone therapy, and family history may affect the occurrence of IH.
  [Abstract] [Full Text] [PDF]  
Original articles:
High birth weight and its interaction with physical activity influence the risk of obesity in early school-aged children
  Jia-Ru Deng, Wei-Qing Tan, Shu-Yi Yang, Li-Ping Ao, Jian-Ping Liang, Li-Xia Li, Yan-Hui Gao, Yi Yang, Li Liu
Background: High birth weight (HBW) is associated with childhood obesity, but with inconsistent results. This study investigated the relationship between HBW and childhood obesity, and further explored the interaction of HBW with behavioral and socio-economic determinants of obesity.
Methods: This cross-sectional study enrolled 1906 grade-two children of Guangzhou, China, from June to November, 2016. Overweight/obesity corresponded to a body mass index higher than the sex-age-specific criteria. Abdominal obesity was assessed using the sex-specific waist-height ratio cutoffs. The association of HBW with obesity was evaluated in multivariable logistic regression model. The relative excess risk due to interaction (RERI) and the attributable proportion of interaction (AP) indices were used to measure additive interaction, while applying the interaction of OR index for multiplicative interaction assessment.
Results: Children with HBW had an increased risk of overweight/obesity [odds ratio (OR) = 2.42, 95% confidence interval (CI) = 1.56-3.76] compared with those without HBW. Significant additive interaction of HBW with physical activity was found for overweight/obesity [relative excess risk due to interaction (RERI) = 2.69, 95% CI = 0.62-4.75; attributable proportion of interaction (AP) = 0.72, 95% CI = 0.42-1.02]. The HBW children with insufficient activity had higher odds of overweight/obesity compared to the non-HBW children with sufficient activity (OR = 3.75, 95% CI = 2.06-6.83). In addition, we identified a significant interaction of HBW with household income for abdominal obesity (RERI = 1.20, 95% CI = 0.02-2.37; AP = 0.76, 95% CI = 0.16-1.36).
Conclusions: HBW confers an increased risk for childhood overweight/obesity. Physical activity attenuates the effect of HBW on overweight/obesity, and HBW possibly synergistically interacts with high household income to promote abdominal obesity in childhood.
  [Abstract] [Full Text] [PDF]  
Impact of National Egyptian school feeding program on growth, development, and school achievement of school children
  A. M. Metwally, Marwa M. El-Sonbaty, L. A. El Etreby, E. M. Salah El-Din, N. Abdel Hamid, H. A. Hussien, A. M. Hassanin, Z. M. Monir
Background: School feeding program (SFP) increases access to education and to better health. This study aims to evaluate the effects of SFP on physical growth, cognitive development, psychosocial behavior, and learning achievement of school children.
Methods: A quasi-experimental study was conducted. The intervention group included 903 pupils in the fifth grade receiving the school meal, while the control group included 886 pupils, matched for age and sex, without meal. The meal consisted of a pie made of flour fortified with vitamins A, B6, B12, C, thiamin, riboflavin, niacin, folate, calcium, iron, zinc, and phosphorus. Socioeconomic position, nutritional status, and dietary behavior were evaluated. Neuropsychological tests were done. Psychosocial behavior was rated and educational achievement was recorded. Post hoc and independent sample t tests were used to detect the association of the studied parameters with the intake of school snack.
Results: Children who took the meal had better scores on visual memory, auditory vigilance tests (9.71 ¡À 2.80 vs. 7.45 ¡À 3.25; 25.02 ¡À 3.36 vs. 10.82 ¡À 8.92, respectively, P < 0.001), the afternoon attention and working memory test (8.20 ¡À 2.21vs. 7.75 ¡À 3.05) (P < 0.001), but less score of externalizing behavior (P < 0.001) than the control group. No significant changes of children¡¯s nutritional status were detected between the two groups. School meal was the main predictor of visual memory and auditory vigilance (P < 0.001), and was the strongest predictor of academic achievements when combined with family size and meals¡¯ frequency (P < 0.001).
Conclusion: School meal improves academic achievements of school children.
  [Abstract] [Full Text] [PDF]  
Identification of eight novel mutations in 11 Chinese patients with maple syrup urine disease
  Wei-Hua Sun, Bing-Bing Wu, Ya-Qiong Wang, Meng-Yuan Wu, Xin-Ran Dong, Yue-Ping Zhang, Wei Lu, Ping Zhang, Bin Yang, Min Zhang, Hong-Jiang Wu, Wen-Hao Zhou
Background: Maple syrup urine disease (MSUD) is an autosomal recessive inherited disorder that affects the degradation of branched-chain amino acids and is associated with acute and chronic brain dysfunction. This study presents 11 new patients with MSUD and describes the clinical characteristics and gene mutations reported in Chinese individuals.
Methods: During 2011-2018, 11 pedaitric patients with MSUD from 11 Chinese families were analyzed based on clinical characteristics and mass spectrometry, with confirmation via gene sequencing. Novel mutations affecting protein function were predicted with Mutation-Taster, PolyPhen-2, CADD and SIFT software. 3D models of the mutated proteins were generated by using the SWISS-MODEL online server, and the models were visualized in PyMOL. The characteristics and gene mutations in patients with MSUD were analyzed retrospectively.
Results: Seventeen mutations in the BCKDHA, BCKDHB and DBT genes were found, 8 of which are novel: c.55C>/T, c.349C>T, c.565C>T, c.808G>A, c.859C>G, and c.1270dupC in BCKDHA; c.275-2A>G in BCKDHB; and c.1291C>T in DBT. Eight patients died. Two patients had severe mental retardation and were physically handicapped. One patient with the intermediate type had relatively good prognosis, with mild psychomotor retardation and adiposity. Four mothers underwent amniocentesis for prenatal diagnosis during their second pregnancy; two fetuses were wild type, and two were carriers of one heterozygous mutation.
Conclusions: Eight novel mutations were associated with MSUD in Chinese patients. Prenatal diagnosis was successfully performed by genetic analysis. Mutations in the BCKDHB gene were found in the majority of Chinese patients with MSUD.
  [Abstract] [Full Text] [PDF]  
Brief reports:
Incidence of congenital heart diseases in Chinese children with non-syndromic congenital blepharoptosis: a prospective observational study of 1053 patients
  Le-Feng Zeng, Zheng-De Tang, Jun Gu, Chang-Qian Wang, Hui-Li Zhang
Background: Congenital blepharoptosis (CBP) may be part of a large spectrum of birth defects presenting with other ocular or systemic conditions. Therefore, the aim of the study was to investigate the incidence of congenital heart diseases (CHD) in CBP children not associated with specific syndromes.
Methods: A total of 1053 Chinese children diagnosed with non-syndromic CBP were consecutively enrolled and their cardiac structure was evaluated by echocardiography.
Results: Forty children were identified with CHD. Twenty-four children had one type of structural malformation (simple CHD). Sixteen children had two or more types of structural malformation (complex CHD). CHD and complex CHD were more prevalent in patients with severe or bilateral ptosis. Multivariate analysis revealed that presence of severe ptosis and bilateral ptosis was independently associated with CHD occurrence.
Conclusion: We found an increased frequency of CHD in CBP children, suggesting a clinical need for routine echocardiography evaluation in CBP, especially in children with severe or bilateral ptosis.
  [Abstract] [Full Text] [PDF]  
Effect of hand hygiene intervention on the absenteeism of pre-school children in Klang Valley, Malaysia: a quasi-experimental study
  Nurul Azmawati Mohamed, Mohd Dzulkhairi Mohd Rani, Tengku Zetty Maztura Tengku Jamaluddin, Zarini Ismail, Shalinawati Ramli, Habibah Faroque, Farisha Nur Abd Samad, Abdul Rashid Ariffien, Aisyah Ar Redha Che Amir Farid, Ilina Isahak
Background: Absenteeism amongst pre-school children is often due to illnesses such as hand, foot, and mouth disease, acute gastroenteritis, cold and flu, which are easily spread amongst them. This is because of weak immunity and lack of knowledge on proper hand hygiene. This quasi-experimental study assessed the efficacy of an intervention consisting of a hand hygiene education programme, along with digital tools in bringing about a change in behaviour and health conditions amongst preschool children in Klang Valley, Malaysia.
Methods: A total of 377 school children, male and female, aged 5-6 years old, participated and were assigned to either the intervention or a control group. During the 2 months intervention period, children in the test group were trained on proper hand hygiene practices and techniques with the aid of the interactive android-based tablets. The numbers of absent days of all the children were recorded for 2 months before the intervention and during the intervention.
Results: In the test group, there was a 25% increase in the total number of absent days from the pre-intervention period to the intervention period, a much lesser increment observed as compared to that of control group in which the increase was much higher at 89%. Results showed a significant difference (P < 0.05) between the absenteeism rates for the test and control group during the intervention period.
Conclusion: These results suggest that proper education and intervention increase hand hygiene compliance, which may help decrease school absenteeism due to illness; however, a longer study duration may be necessary to evaluate the benefit further.
  [Abstract] [Full Text] [PDF]  
Noninvasive ventilation for pediatric interfacility transports: a retrospective study
  Samantha Holbird, Tanya Holt, Adam Shaw, Gregory Hansen
Background: To characterize pediatric patients supported with continuous positive airway pressure and bilevel positive airway pressure (CPAP/BiPAP) or high-flow nasal cannula (HFNC) during interfacility transport (IFT).
Methods: A retrospective study with a provincial pediatric transport team from a tertiary hospital pediatric intensive care unit. Pediatric patients aged 28 days to < 17 years, who required IFT between January 2017 and December 2018, were identified through a transport registry and were included in the study.
Results: A total of 118 (26.7%) patients received CPAP/BIPAP or HFNC support for IFT. The most common respiratory diagnosis was bronchiolitis (46%). These patients were placed on respiratory support, 31.4 minutes after the transport team¡¯s arrival. None required intubation during their IFT, despite mean transport times of 163 minutes.
Conclusion: This study may provide important information for programs with large catchment areas, in which large distances and transport times should not be barriers to NIV implementation.
  [Abstract] [Full Text] [PDF]  
Letters to the editor:
COVID-19 disease in children: not as mild as we have been led to believe
  Laura Moreno-Galarraga, Elsie M. Taveras
  [Abstract] [Full Text] [PDF]  
COVID-19 pandemic: personal view to a new model of pediatric practice
  Zakaria Barsoum
  [Abstract] [Full Text] [PDF]  
Novel mitochondrial tRNAArg 10461A>G mutation in a pedigree with obesity
  Jin-Ling Wang, Yan-Chun Ji, Jun-Fen Fu
  [Abstract] [Full Text] [PDF]  
World Journal of Pediatric Surgery
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