"Most downloaded" Articles are from the articles published in 2022 during the last six months.
· Most commonly confirmed causes of community-acquired pneumonia (CAP) in children are Mycoplasma pneumoniae (8%–40%) and respiratory syncytial virus (15%–20%). · Pyogenic bacteria, most commonly Streptococcus pneumoniae (40%–50%) and Streptococcus pyogenes (10%–25%), are detected in 2%–5% of children hospitalized with CAP. · CAP should be diagnosed conservatively according to clinical and radiological criteria. · The etiology should be identified via appropriate test result interpretation. |
· Inflammatory responses accompanying fever increase neuronal excitability in the central nervous system, which in turn provokes seizures. · Fever in children with febrile seizures is usually caused by common respiratory viruses, the distributions of which match those of seasonal community-acquired respiratory tract infections. · Several genetic variations in ion channels seem associated with neuronal hyperexcitability in children with febrile seizures. |
Question: Does zinc supplementation along with probiotics affect disease severity or clinical outcomes of children with acute diarrhea? Findings: This study indicated that zinc supplementation and probiotics had no effect on clinical improvement or disease severity among pediatric patients with acute diarrhea. Meaning: Children who received probiotics plus zinc recovered faster than those who received probiotics only. |
· Neonatal seizures are often electrographic-only seizures without clinical signs; therefore, the identification of electrical seizure activity on electroencephalography is the gold standard for diagnosis. · Clinical signs of neonatal seizures are divided into motor or nonmotor seizures, and motor seizures are mostly focal or multifocal. · Most neonatal seizures are caused by acute symptomatic etiologies, but in cases of intractable seizures, structural, genetic, or metabolic etiologies should be investigated. |
· Pediatric heart failure (PHF) is a clinical syndrome featuring various symptoms (shortness of breath, ankle swelling, fatigue) and signs (pulmonary crackles, peripheral edema). · Congenital heart diseases are the most common underlying etiology of PHF, whereas myocarditis and primary cardio-myopathies are common in children without structural ab-normalities. · PHF pathophysiology is complex and multifactorial and varies by etiology and age. · PHF management includes decongestive therapy, treatment of underlying causes, preventing progression, and managing pulmonary or systemic obstructions. · Drugs should be chosen based on pharmacodynamics, clinical manifestations, hemodynamic state, and renal function. |
· Congenital cytomegalovirus (CMV) infection is among the most common causes of nongenetic sensorineural hearing loss. · Congenital CMV is initially treated with intravenous ganciclovir for 2–6 weeks and switched to oral valganciclovir, or with oral valganciclovir for the entire 6-month period. · Infants with congenital CMV require periodic monitoring of absolute neutrophil count, platelet count, and blood urea nitrogen, creatinine, liver function tests, audiological, ophthalmological, and developmental tests during antiviral medication. |
· Concrete evidence exists of early parent-infant attachment supported by family-centered care (FCC) in the neonatal intensive care unit. · FCC involves the parents’ presence and participation in the infant’s care and decision-making. · A private and comfortable space should be provided. A single-family room is ideal; however, a quiet space with a recliner can be a good alternative. · Care culture changes and staff training are required. |
Despite worldwide acceptance of acetaminophen (paracetamol) in pediatric medicine, careful examination reveals no valid objections to the conclusion that early exposure to acetaminophen causes neurodevelopmental injury in susceptible babies and children. Nevertheless, debate that early exposure to acetaminophen causes neurodevelopmental injury has centered around the prenatal period, evidence of which is relatively limited compared to that in the postnatal period, which is the time of greatest absolute and relative risk. |
In neonatal resuscitation: · Laryngeal masks are recommended when endotracheal intubation or positive-pressure ventilation fails. · Laryngeal masks are useful even during chest compressions. · Laryngeal masks aid neonates >34 weeks’ gestation and/or with a birth weight >2 kg. · Main usage barriers include limited experience (81%), preference for endotracheal tubes (57%), and lack of awareness (56%). · Second-generation laryngeal masks have a built-in esophageal drainage tube that prevents regurgitation into the glottis, and an orogastric tube can be inserted within the esophageal drainage tube to protect against gastric inflation. |
· Orphan disease is a rare disease, primarily affecting newborn and children. Vast majority of orphan diseases has genetic background. · Orphan disease is individually rare. But as a whole, it is not rare, becoming a great socioeconomic burden. · The diagnosis of rare genetic disease has been problematic, but recent progress of genome analysis technologies makes it faster and more precise. · There are many unmet needs as to the curative treatment. However, the number of treatable rare diseases is growingly increasing owing to the development of biotechnology. · Most orphan drugs are extremely expensive because of numer ous hurdles during the process of drug development as well as small number of patients. |
· Congenital hearing loss is common, with an approximate incidence of 1.5 per 1,000 newborns and affecting 1.2%–11% of preterm and 1.6%–13.7% of neonatal intensive care unit neonates. · Etiologies vary, and up to 80% of cases are genetic. · Newborn hearing screenings follow the 1-3-6 rule, and babies at high risk of hearing loss should be referred to otolaryngology for early detection and timely intervention. |
· Pediatric obesity increases the risk of metabolic complications (insulin resistance, dyslipidemia, nonalcoholic fatty liver disease) and long-term cardiovascular diseases. · A new obesity definition and various indicators (continuous metabolic syndrome score, pediatric simple metabolic syndrome score, fatty liver index) have been proposed to evaluate children’s susceptibility to metabolic disorders. · Laboratory and body composition tests in pediatric screenings can identify groups at high risk of metabolic complications of obesity. |
· Primary pediatricians should play a key role in the diagnosis and treatment of attention-deficit/hyperactivity disorder (ADHD). · The Diagnostic and Statistical Manual of Mental Disorders, fifth edition, has lowered the diagnostic threshold for older teens and adults and a comorbid diagnosis with autism is now allowed. · The American Academy of Pediatrics had added recommendation-related comorbid conditions in its guideline and the Society of Developmental and Behavioral Pediatrics recently developed a complex ADHD guideline. · The European ADHD Guideline Group recently developed a guideline for managing ADHD during the coronavirus disease 2019 pandemic. |
· Oral immunotherapy should be supervised by pediatricians with experience administering oral food challenge tests and managing allergic reactions. · Food allergen intake is gradually increased and maintained for years. · Patients may experience allergic reactions and psychological problems. · Adjunctive therapies (biologics, antihistamines, and leukotriene receptor antagonists) may improve efficacy and safety. · Contraindications include uncontrolled asthma, malignancy, active autoimmune disorders, and beta-blocker usage. |
· Sensitivity to endocrine-disrupting chemical (EDC) exposure increases during critical developmental periods (in embryos, fetuses, and neonates). · Pre- and postnatal exposure to EDCs is associated with fetal growth restriction, preterm birth, and low birth weight. · Exposure to EDCs during fetal and early postnatal life can have lasting and lifelong neurodevelopmental outcomes, including autism spectrum, attention deficit hyperactivity, and other cognitive and behavioral disorders. |
· Pediatric small intestinal bacterial overgrowth (SIBO) manifestations range from nonspecific abdominal symptoms to malabsorption or malnutrition. · SIBO is prevalent in children and adolescents with functional abdominal pain disorders. · Predisposing factors include disturbed intestinal motility, altered anatomy, and/or abnormal body defense systems against intestinal bacteria. · Breath tests are safe and noninvasive. · Treatment principles include managing predisposing conditions, nutritional support, symptom control, and antibiotics. |
Question: What are the risk factors for prolonged diarrhea in children under 2 years old? Finding: History of antibiotic use, zinc deficiency, and elevated fecal alpha-1 antitrypsin levels were the main risk factors of prolonged diarrhea in children under 2 years old with acute diarrhea. Meaning: Rational antibiotic usage is necessary as well as thorough testing of serum zinc level and fecal alpha-1 antitrypsin levels. |
Question: What emotions do parents experience when their newborns are admitted to the neonatal intensive care unit (NICU)? Finding: Mothers experienced more anxiety (51%), depression (31%), and stress (41%) symptoms than fathers (26%, 12%, and 22%, respectively). Meaning: Parents often experience anxiety, stress, and depression following NICU admission. Healthcare workers are responsible for providing regular parental counseling. |
· Dendritic, regulatory T, and regulatory B cells significantly contribute to the natural course of food allergy. · Cow’s milk and hen’s egg allergies tend to resolve in earlier childhood but recent studies show that 50% of patients still persist into school age. · The potential factors affecting the natural course of food allergy are age at diagnosis, symptom severity, sensitization status and its change rate, and external factors such as diet and interventions. · There is a considerable possibility of food allergy outgrow if specific IgE levels are 2–5 kUA/L or less, but other factors such as age and recent symptoms should be considered together. · With a clear understanding of the natural course of food allergy, pediatricians can provide appropriate assessment and interventions to our patients, and consequently can help patients overcome their food allergy and improve the social safety net. |
Question: Is vitamin E a viable therapeutic option for managing neonatal hyperbilirubinemia? Finding: This randomized clinical trial examined the effects of oral vitamin E supplementation on bilirubin reduction (primary outcome), phototherapy duration, and length of hospital stay (secondary outcome) in 138 infants. Meaning: Infants administered vitamin E versus placebo demonstrated similar reductions in bilirubin levels and length of hospital stay. |
· The infant gut microbiome is highly dynamic and individualized. · Microbes are vertically transmitted from mother to infant during delivery and throughout infancy. · Delivery mode, gestational age, diet, and antibiotic use influence infant microbiome composition and function. · In animal studies, the microbiome played critical roles in the structural and functional development of the infant gastrointestinal and immune systems. · Microbiome-targeted therapies have great potential to reduce infant morbidity and mortality. |
Question: What are the primary motor and balance dysfunctions in children with Down syndrome? Finding: These individuals have gross delays, altered balance, and inefficient compensatory mechanisms. Meaning: Neuromuscular and musculoskeletal impairments due to the chromosomal abnormality lead to developmental delay. These children also exhibit poor balance with greater instability and inefficient compensatory mechanisms including altered center of pressure displacement and trunk stiffening that predisposes them to falls. |
· Review of articles that investigated the applications of virtual, augmented, or mixed reality in pediatric clinical settings and in the training of pediatric medical professionals was conducted. · A total of 89 studies were retrieved, with 36 randomized controlled trials. · In most studies, intervention using the novel technology was at least as effective or more effective than the traditional method. · Use of virtual, augmented, and mixed reality has potential in pediatrics. |
· Eosinophilic gastrointestinal disease (EGID) is uncommon, with a prevalence of 1–30/100,000 in the general population; however, it is increasing worldwide. · The diagnosis of EGID is based on histopathological findings of endoscopic mucosal biopsy in which tissue eosinophils are counted in each gastrointestinal tract segment of patients with chronic or recurrent gastrointestinal symptoms. · Individualized treatment strategies, including adequate dietary and pharmacological therapy, may help improve outcomes of children with EGID. |
Question: What is the ideal initiation timing of parenteral nutrition for critically ill children? Finding: This randomized clinical trial of 140 children examined the effects of an early or late start of parenteral nutrition on mechanical ventilation need (primary outcome) and length of stay and mortality (secondary outcomes). Meaning: Children who received early versus late parenteral nutrition had lower mechanical ventilation need and duration. |
· Anorectal manometry is safe in children. · Defecation Dyssynergia is one of the commonest cause of chronic constipation. · Positive Rectoanal inhibiory reflex rules out Hirschsprung's Disease |
· Systemic autoinflammatory disorders (SAID) are disorders caused by dysregulation of the innate immunity with genetic background, leading to recurrent episodes of systemic inflammation. · SAID is characterized by recurrent acute inflammatory responses including fever or skin manifestations, unrelated with infection or malignancy. · Diagnosis is based on family and long-term history with detailed clinical and laboratory manifestations during febrile periods. |
There have been global tri-phasic epidemic periods of retinopathy of prematurity (ROP). In recent years, its incidence has reportedly been 10%–40% depending on country and study population. Current treatment strategies for ROP include laser photocoagulation, surgical treatment, and anti-vascular endothelial growth factor treatment, the role of which has drawn attention in recent years. |
SpO2/FiO2 ratio ≤166, pediatric respiratory rate-oxygenation index <132, and clinical respiratory score ≥6 at 12 hours after high-flow nasal cannula (HFNC) initiation were useful bedside predictors for HFNC failure in pediatric patients. |
Question: What is the optimal dose of bone marrow-derived mesenchymal stem cells (BM-MSCs) for treating necrotizing enterocolitis (NEC), and is orally administered BM-MSC effective? Findings: High (1×106 cells) or multiple BM-MSC doses showed similar effects as low (1×105 cells) doses of intraperitoneally administered BM-MSCs. Furthermore, orally administered BM-MSCs were as effective as intraperitoneally administered BM-MSCs. Meaning: Orally administered low-dose BM-MSCs are a potential treatment for NEC. |