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Vol 17, No 2
Vol 17, No 2 April 2021 ISSN 1708-8569
Review articles
Original articles
Brief report
Letters to the editor
Pediatric food allergy clinic: a way to improve the quality of service
  Zakaria Barsoum
  [Abstract] [Full Text] [PDF]  
Sleep in children with eosinophilic esophagitis
  Isabela A. Ishikura, Gustavo Moreira, Sergio Tufik, Monica L. Andersen
  [Abstract] [Full Text] [PDF]  
Review articles:
Immunopathogenesis of idiopathic nephrotic syndrome in children: two sides of the coin
  Jing Chen, Xiao‑Hui Qiao, Jian‑Hua Mao
Background: Idiopathic nephrotic syndrome is a common form of glomerular nephropathy in children, with an incidence rate of 1.15-16.9/100,000 depending on different nationalities and ethnicities. The etiological factors and mechanisms of childhood idiopathic nephrotic syndrome have not yet been fully elucidated. This review summarizes the progress of the immunopathogenesis of idiopathic nephrotic syndrome in children.
Data sources: We review the literature on the immunopathogenesis of idiopathic nephrotic syndrome in children. Databases including Medline, Scopus, and Web of Science were searched for studies published in any language with the terms “children”, “idiopathic nephrotic syndrome”, “immunopathogenesis”, “T cells”, “circulating permeability factors”, and “B cells”.
Results: Dysfunction in T lymphocytes and pathogenic circulatory factors were indicated to play key roles in the pathogenesis of idiopathic nephrotic syndrome. Recently, some studies have shown that cellular immune dysfunction may also be involved in the pathogenesis of idiopathic nephrotic syndrome.
Conclusions: Both T- and B-cell dysfunction may play significant roles in the pathogenesis of idiopathic nephrotic syndrome, like two sides of one coin, but the role of B cell seems more important than T cells.
  [Abstract] [Full Text] [PDF]  
Standards of care for Kasabach−Merritt phenomenon in China
  Wei Yao, Ke‑Lei Li, Zhong‑Ping Qin, Kai Li, Jia‑Wei Zheng, Xin‑Dong Fan, Lin Ma, De‑Kai Zhou, Xue‑Jian Liu, Li Wei, Li Li, Mao‑Zhong Tai, Jin‑Hu Wang, Yi Ji, Lin Zhou, Hai‑Jin Huang, Xiao‑Yun Gao, Zhi‑Jian Huang, Song Gu, He‑Ying Yang
  KasabachMerritt phenomenon (KMP) is a rare disease that is characterized by severe thrombocytopenia and consumptive coagulation dysfunction caused by kaposiform hemangioendothelioma or tufted hemangioma. This condition primarily occurs in infants and young children, usually with acute onset and rapid progression. This review article introduced standardized recommendations for the pathogenesis, clinical manifestation, diagnostic methods and treatment process of KMP in China, which can be used as a reference for clinical practice.
  [Abstract] [Full Text] [PDF]  
Reducing neonatal mortality and respiratory distress syndrome associated with preterm birth: a scoping review on the impact of antenatal corticosteroids in low‑ and middle‑income countries
  Stanley Mwita, Mary Jande, Deogratias Katabalo, Benjamin Kamala, Deborah Dewey
Background: The most common cause of death among preterm infants in low- and middle-income countries is respiratory distress syndrome. The purpose of this review was to assess whether antenatal corticosteroids given to women at risk of preterm birth at ≤ 34 weeks of gestation reduce rates of neonatal mortality and respiratory distress syndrome in low- and middle-income countries.
Methods: Two reviewers independently searched four databases including MEDLINE (through PubMed), CINAHL, Embase, and Cochrane Libraries. We did not apply any language or date restrictions. All publications up to April 2020 were included in this search.
Results: The search yielded 71 articles, 10 of which were included in this review (3 randomized controlled trials, 7 observational studies, 36,773 neonates). The majority of studies reported associations between exposure to antenatal corticosteroids and lower rates of neonatal mortality and respiratory distress syndrome. However, a few studies reported that antenatal corticosteroids were not associated with improved preterm birth outcomes.
Conclusions: Most of the studies in low- and middle-income countries showed that use of antenatal corticosteroids in hospitals with high levels of neonatal care was associated with lower rates of neonatal mortality and respiratory distress syndrome. However, the findings are inconclusive because some studies in low-resource settings reported that antenatal corticosteroids had no benefit in reducing rates of neonatal mortality or respiratory distress syndrome. Further research on the impact of antenatal corticosteroids in resource-limited settings in low-income countries is a priority.
  [Abstract] [Full Text] [PDF]  
Multisystem inflammatory syndrome in pediatric COVID‑19 patients: a meta‑analysis
  Eman A. Toraih, Mohammad H. Hussein, Rami M. Elshazli, Adam Kline, Ruhul Munshi, Nasrin Sultana, Sharven Taghavi, Mary Killackey, Juan Duchesne, Manal S. Fawzy, Emad Kandil
Background: We aimed to systematically review the clinical and laboratory features of patients with the multisystem inflammatory syndrome in pediatrics diagnosed during the COVID-19 pandemic.
Methods: A literature search in Web of Science, PubMed, Scopus, and Science Direct was made up to June 29, 2020.
Results: Analysis of 15 articles (318 COVID-19 patients) revealed that although many patients presented with the typical multisystem inflammatory syndrome in pediatrics, Kawasaki-like features as fever (82.4%), polymorphous maculopapular exanthema (63.7%), oral mucosal changes (58.1%), conjunctival injections (56.0%), edematous extremities (40.7%), and cervical lymphadenopathy (28.5%), atypical gastrointestinal (79.4%) and neurocognitive symptoms (31.8%) were also common. They had elevated serum lactic acid dehydrogenase, D-dimer, C-reactive protein, procalcitonin, interleukin-6, troponin I levels, and lymphopenia. Nearly 77.0% developed hypotension, and 68.1% went into shock, while 41.1% had acute kidney injury. Intensive care was needed in 73.7% of cases; 13.2% were intubated, and 37.9% required mechanical ventilation. Intravenous immunoglobulins and steroids were given in 87.7% and 56.9% of the patients, respectively, and anticoagulants were utilized in 67.0%. Pediatric patients were discharged after a hospital stay of 6.77 days on average (95% CI 4.93–8.6).
Conclusions: Recognizing the typical and atypical presentation of the multisystem inflammatory syndrome in pediatric COVID-19 patients has important implications in identifying children at risk. Monitoring cardiac and renal decompensation and early interventions in patients with multisystem inflammatory syndrome is critical to prevent further morbidity.
  [Abstract] [Full Text] [PDF]  
Effect of budesonide on hospitalization rates among children with acute asthma attending paediatric emergency department: a systematic review and meta‑analysis
  Cheng‑Yao Li, Zhang Liu
Background: The efficacy of inhaled budesonide for managing moderate-to-severe acute exacerbations in children is not clear. Therefore, this study aimed to evaluate hospital admission rates, need for use of systemic corticosteroids, length of hospital stay and adverse events when inhaled budesonide is added to standard pediatric emergency department management of moderate-to-severe acute exacerbations of asthma.
Methods: A systematic search was conducted in PubMed, Scopus, CENTRAL (Cochrane Central Register of Controlled Trials) and Google scholar databases. Randomized controlled trials that evaluated the effect of nebulized budesonide in moderate-to-severe acute exacerbations of asthma in pediatric patients were included for this meta-analysis. Statistical analysis was done using STATA version 13.0.
Results: A total of 16 RCTs were included. Children receiving nebulized budesonide had 43% lower risk of being hospitalized (RR 0.57; 95% CI, 0.39; 0.85) and 66% lower risk of requiring systemic corticosteroids (RR 0.34; 95% CI, 0.21; 0.55) compared with those receiving placebo. There were no differences in the length of hospital stay (Hedges’s g standardized mean difference − 1.53; 95% CI, − 3.64; 0.58) and risk of adverse events (RR 0.87, 95% CI; 0.65; 1.17) between the two groups. There was no evidence of publication bias for any of the outcomes considered.
Conclusions: The findings of this meta-analysis support the use of inhaled budesonide in reducing risk of hospitalization and the need for systemic corticosteroids among children with acute moderate-to-severe asthma exacerbation.
  [Abstract] [Full Text] [PDF]  
Association of neonatal blood levels of brain‑derived neurotrophic factor with development of autism spectrum disorder: a systematic review and meta‑analysis
  Ya‑Kun Liu, Hua Gao, Shao‑Bin Jin, Wen‑Jun Tu, Ya‑Jun Chen
Background: Our goal was to evaluate the association between neonatal blood brain-derived neurotrophic factor (BDNF) level and autism spectrum disorder (ASD) diagnosis later in life.
Methods: MEDLINE and Web of Science databases were searched from inception until September 16, 2020. Reference lists of all relevant articles also were reviewed. Mean blood BDNF concentrations, standard deviations, sample sizes, and other data needed for calculation of effect sizes were extracted by two independent investigators. The quality of the included studies was appraised using the Newcastle-Ottawa Scale for case-control studies. Data were pooled using the random-effects model.
Results: Five case-control studies involving 1341 cases and 3395 controls were included in the meta-analysis. The meta-analysis of all included studies showed no significant difference in blood BDNF levels between neonates diagnosed with ASD later in life and healthy controls [standardized mean difference (SMD) = 0.261; 95% confidence interval (CI) − 0.052 to 0.573; P = 0.102], with high level of heterogeneity (Q = 64.346; I2 = 93.784; P < 0.001). A subgroup analysis by assay type showed decreased blood BDNF levels in ASDs compared to controls (SMD = − 0.070; 95% CI − 0.114 to − 0.026; P = 0.002), with high level of homogeneity (Q = 0.894; I2 = 0.000; P = 0.827). No evidence of publication bias was observed.
Conclusions: Neonates diagnosed with ASD later in life have decreased blood levels of BDNF measured by double-antibody immunoassay. More studies are warranted to facilitate a more robust conclusion.
  [Abstract] [Full Text] [PDF]  
Original articles:
Effects of SARS‑CoV‑2 infection on neuroimaging and neurobehavior in neonates
  Kai Yan, Fei‑Fan Xiao, Yu‑Wei Jiang, Tian‑Tian Xiao, Da‑Jiang Zhang, Wen‑Hao Yuan, Jian‑Bo Shao, Guo‑Qiang Cheng, Ling‑Kong Zeng
Background: We collected neonatal neurological, clinical, and imaging data to study the neurological manifestations and imaging characteristics of neonates with coronavirus disease 2019 (COVID-19).
Methods: This case-control study included newborns diagnosed with COVID-19 in Wuhan, China from January 2020 to July 2020. All included newborns had complete neurological evaluations and head magnetic resonance imaging. We normalized the extracted T2-weighted imaging data to a standard neonate template space, and segmented them into gray matter, white matter, and cerebrospinal fluid. The comparison of gray matter volume was conducted between the two groups.
Results: A total of five neonates with COVID-19 were included in this study. The median reflex scores were 2 points lower in the infected group than in the control group (P = 0.0094), and the median orientation and behavior scores were 2.5 points lower in the infected group than in the control group (P = 0.0008). There were also significant differences between the two groups in the total scale score (P = 0.0426). The caudate nucleus, parahippocampal gyrus, and thalamus had the strongest correlations with the Hammersmith neonatal neurologic examination (HNNE) score, and the absolute correlation coefficients between the gray matter volumes and each part of the HNNE score were all almost greater than 0.5.
Conclusions: We first compared the neurological performance of neonates with and without COVID-19 by quantitative neuroimaging and neurological examination methods. Considering the limited numbers of patients, more studies focusing on the structural or functional aspects of the virus in the central nervous system in different age groups will be carried out in the future.
  [Abstract] [Full Text] [PDF]  
Clinical and molecular characteristics of Staphylococcus aureus isolated from Chinese children: association among the agr groups and genotypes, virulence genes and disease types
  Yan Xu, Su‑Yun Qian, Kai‑Hu Yao, Fang Dong, Wen‑Qi Song, Chen Sun, Xin Yang, Jing‑ Hui Zhen, Xi‑Qing Liu, Zhi‑Yong Lv, Xi Yang
Background: This study was aimed to investigate the clinical and molecular epidemiology of Staphylococcus aureus (S. aureus) isolated from Chinese children and determine the possible relationship among the accessory gene regulator (agr) groups and genotypes, as well as among the virulence genes and disease types.
Methods: S. aureus strains were isolated from Beijing Children’s Hospital between October 2017 and October 2019. The isolates and 19 virulence genes were characterized using multi-locus sequence typing, staphylococcal protein A (spa), staphylococcal cassette chromosome mec, and agr typing.
Results: A total of 191 non-repetitive S. aureus clinical isolates were divided into 33 sequence types (STs), 18 clonal complexes (CCs), and 59 spa types. ST59 (39.8%), t437 (37.7%), and agr I (84.8%) were the predominant types. CC59, CC25, CC22, CC951, CC8, and CC398 belonged to agr I. CC5 and CC15 were assigned to agr II, and CC30 was characterized as agr III. CC121 was classified under agr IV. The eta, etb, and bbp genes were more prevalent in agr IV (P < 0.001 for each), while tst was more prevalent in agr group III compared to the other groups (P < 0.001). Nearly all isolates that harbored lukS/F-PV belonged to agr I (P = 0.005). However, the correlation between disease types and agr groups was not significant (P > 0.05).
Conclusions: An association among the agr groups and genotypes, as well as specific toxin genes, was observed among the S. aureus strains isolated from Chinese children. However, a statistical correlation was not found among the agr groups and disease types.
  [Abstract] [Full Text] [PDF]  
Continuous positive airway pressure acutely increases exercise duration in children with severe therapy‑resistant asthma: a randomized crossover trial
  Cláudia Silva Schindel, Daniele Schiwe, João Paulo Heinzmann‑Filho, Natália Evangelista Campos, Paulo Márcio Pitrez, Márcio Vinícius Fagundes Donadio
Background: Lower exercise tolerance is an important component of asthma and the possible effects of non-invasive ventilation on exercise capacity in individuals with severe therapy-resistant asthma (STRA) are unknown. This study aimed to evaluate the immediate effect of continuous positive airway pressure (CPAP) on exercise tolerance in children with STRA.
Methods: We performed a controlled, randomized, crossover clinical trial including subjects aged 6 to 18 years old diagnosed with STRA. Clinical, anthropometric and lung function data were collected. The participants in the intervention group (IG) used CPAP (PEEP 10cmH2O and FiO2 0.21) for a period of 40 min. Subjects in the control group (CG) used CPAP with minimum PEEP at 1 cmH2O also for 40 min. Afterwards, subjects from both groups underwent cardiopulmonary exercise testing (CPET). After a 15-day washout period, on a subsequent visit, subjects participated in the opposite group to the initial one.
Results: Thirteen subjects with a mean age of 12.30 ± 1.7 years were included. The variables of peak expiratory flow (PEF) and forced expiratory volume in the first second (FEV1) before using CPAP and after performing CPET did not show significant differences. Regarding CPET results, there was no significant difference (P = 0.59) between groups at peak exercise for oxygen consumption—VO2 (CG: 33.4 ± 6.3 and IG: 34.5 ± 5.9, mL kg1 min1). However, the IG (12.4 ± 2.1) presented a total test time (min) significantly (P = 0.01) longer than the CG (11.5 ± 1.3).
Conclusion: The results suggest that the use of CPAP before physical exercise increases exercise duration in children and adolescents with STRA.
  [Abstract] [Full Text] [PDF]  
Association between gestational anemia in different trimesters and neonatal outcomes: a retrospective longitudinal cohort study
  Chang‑Fa Sun, Han Liu, Yan‑Hui Hao, Hong‑Tao Hu, Zhi‑Yang Zhou, Ke‑Xin Zou, Xin‑Mei Liu, Jian‑Zhong Sheng, Guo‑Lian Ding, He‑Feng Huang
Background: Previous studies investigated the association between gestational anemia and neonatal outcomes. However, few studies explored whether the effects of gestational anemia could be eliminated by subsequent correction of anemia in the later stages of pregnancy. This study aimed to investigate the relationship between anemia in different trimesters and neonatal outcomes.
Methods: The study was conducted in Shanghai, China, with a sample of 46,578 pregnant women who delivered between January 1, 2016 and July 1, 2019. A multivariable logistic regression model was adopted to analyse the associations between maternal anemia and neonatal outcomes.
Results: The incidence of gestational anemia was 30.2%, including 4.4% in the first trimester, 9.6% in the second trimester, and 16.2% in the third trimester. Only 24.5% (507/2066) of anemia that occurred in the first trimester and 29.6% (1320/4457) that occurred in the second trimester could be corrected in the later stages of pregnancy. Anemia occurring in the first trimester was associated with small for gestational age [odds ratio (OR) 1.46; 95% confidence interval (CI) 1.20-1.78] and with fetal distress (OR 1.23; 95% CI 1.08-1.40). Anemia corrected in the first trimester also was associated with a higher risk of small for gestational age.
Conclusions: Gestational anemia is a public health problem in China impacting neonatal health. Anemia in pregnancy could be corrected in only about a quarter of the women. Anemia in the first trimester, whether corrected or not, still led to lower birth weight; therefore, the prevention of anemia prior to pregnancy is important.
  [Abstract] [Full Text] [PDF]  
Prevalence of Epstein–Barr virus infection and characteristics of lymphocyte subsets in newly onset juvenile dermatomyositis
  Qi Zheng, Kun Zhu, Cai‑Na Gao, Yi‑Ping Xu, Mei‑Ping Lu
Background: The underlying etiology of juvenile dermatomyositis (JDM) is unknown. T cell deficiency as well as Epstein-Barr virus (EBV) infection had been suspected to be involved in the pathogenesis, but it has been poorly evaluated in JDM patients.
Methods: This study described the traits of T and B lymphocyte subsets in newly onset JDM patients and the incidence of EBV infection in JDM patients compared with match controls. Newly developed JDM patients from 2014 to 2018 were included in the study. Lymphocytes with different markers (CD3+, CD3+CD4+, CD3+CD8+, CD3CD19+ and CD3CD16+CD56+) were tested with flow cytometry in the first admission or after 6 months of treatment. Statistical analysis was conducted to compare the EBV infection in the group of JDM patients and controls.
Results: We observed that JDM patients had higher positive rate of Epstein-Barr nuclear antigen-immunoglobulin G (IgG) (P < 0.0001) as well as EBV capsid antigen-IgG (P < 0.05) than normal controls. CD3CD16+CD56+ lymphocyte was found to be extremely low in early stage of JDM patients, but increased after 6 months of treatment (P = 0.0091).
Conclusions: The level of CD3CD16+CD56+ cells may associate with the clinical course of JDM. EBV may act as an environmental factor predisposing patients to the development of JDM.
  [Abstract] [Full Text] [PDF]  
Brief report:
Relationship between parent perception of child anthropometric phenotype and body mass index change among children with developmental disabilities
  Lu‑Yu Xie, Folefac D. Atem, Sari Bar, Matthew Sunil Mathew, Cynthia Lebron, Catherina Chang, Ruby Natale, Sarah E. Messiah
Background: Preschool-age children with developmental disabilities (DD) have higher prevalence of obesity than children without DD. This study aimed to explore the relationship between parent perception of their children’s anthropometric phenotype and child body mass index (BMI) z score change over one school year among preschoolers with DD.
Methods: The analysis consisted of a subsample (N = 64) of children with DD from a larger randomized controlled trial to test an obesity prevention program in the childcare center setting. Parents ranks their child’s anthropometric phenotype on a visual silhouette chart on a scale from 1 (underweight) to 7 (obese) and that rank score is compared to their BMI z score change over one school year.
Results: The majority (75%) of parents with an obese child underestimated their child’s anthropometric phenotype while 7% parents with a non-obese child overestimated. Parent overestimation of child anthropometric phenotype status is associated with increased BMI z score change over 1 school year among preschool-age children with disabilities.
Conclusion: Parental overestimation of child anthropometric phenotype status was associated with weight gain in preschool children with DD after one school year.
  [Abstract] [Full Text] [PDF]  
Letters to the editor:
Prevalence and characteristics of Kawasaki disease before and during the COVID‑19 pandemic
  Rintaro Ono, Daisuke Hasegawa
  [Abstract] [Full Text] [PDF]  
Imipramine‑precipitated status epilepticus
  Ahmed Naguy
  [Abstract] [Full Text] [PDF]  
World Journal of Pediatric Surgery
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