Children

14 pages, 1548 KiB

Open AccessArticle

Introducing the Index of Caries Risk (ICR): A Comparative Study on a Novel Tool for Caries Risk Assessment in Pediatric Patients

by Patrizia Lucchi, Alice Dina Nasuti, Giovanni Franciosi, Carlo Gaeta, Simone Grandini, Francesco Saverio Ludovichetti, Sergio Mazzoleni and Giulia Malvicini

Children 2024, 11(10), 1166; https://doi.org/10.3390/children11101166 - 25 Sep 2024

Abstract

Background: The prevalence of dental caries presents a global public challenge, particularly in children. Traditional caries risk assessment tools like Cariogram are effective but often complex and resource intensive. The aim of the present study was to introduce, for the first time, a [...] Read more.

Background: The prevalence of dental caries presents a global public challenge, particularly in children. Traditional caries risk assessment tools like Cariogram are effective but often complex and resource intensive. The aim of the present study was to introduce, for the first time, a newly designed caries risk assessment (CRA) tool named Index of Caries Risk (ICR) and to evaluate its efficacy for pediatric patients. Methods: This observational study was conducted at the University Hospital of Siena (Italy), involving 55 children aged 6 to 12 years. Participants were assessed using both the newly developed ICR and the well-known Cariogram tool. The data were collected by two calibrated operators. The ICR was compared with the Cariogram tool, and a descriptive analysis and a Pearson correlation coefficient were performed. Results: Results indicated a strong positive correlation (R = 0.88, p < 0.01) between the two methods, with ICR simplifying the assessment process while maintaining efficacy. Conclusions: This study highlights the ICR’s potential to provide a practical, cost-effective alternative for routine caries risk assessment in pediatric dentistry. Despite its limitations, this research marks a preliminary investigation of a promising new CRA tool. Further research should focus on validating the ICR in the larger and more diverse pediatric population, as well as exploring its long-term effectiveness and its application in different clinical settings. Full article

(This article belongs to the Section Pediatric Dentistry & Oral Medicine)

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14 pages, 266 KiB

Open AccessArticle

Which Factors Predict L2 Receptive Vocabulary and Expressive Syntax in Bilingual Children from Low-SES Families?

by Arianna Bello, Paola Ferraresi, Susanna Pallini, Paola Perucchini and Antonia Lonigro

Children 2024, 11(10), 1165; https://doi.org/10.3390/children11101165 - 25 Sep 2024

Abstract

Introduction: The objective of the current study was two-fold. First, it aimed to estimate receptive vocabulary and expressive syntax skills in L2 Italian among early sequential/simultaneous bilingual children of migrant single-mother families with very low socioeconomic status (SES). This objective was achieved by [...] Read more.

Introduction: The objective of the current study was two-fold. First, it aimed to estimate receptive vocabulary and expressive syntax skills in L2 Italian among early sequential/simultaneous bilingual children of migrant single-mother families with very low socioeconomic status (SES). This objective was achieved by matching the participants’ performance with normative data. Secondly, this study aimed to identify which individual and language exposure factors contributed to learning L2 vocabulary and syntax. Methods: Twenty-four early sequential/simultaneous bilingual children (age range = 5.10–12.4 years) and their mothers were enrolled. Mothers answered questions about linguistic biography and demographic information. Children completed Lexical Comprehension, Sentence Repetition, and Non-Word Repetition tasks from the Language Assessment Battery for 4–12-year-olds to, respectively, assess receptive vocabulary, expressive syntax, and phonological processing. Moreover, non-verbal intellectual functioning was evaluated by the Raven’s Test. Results/Discussion: Compared to normative data, 20 children showed lower receptive vocabulary abilities (<−1.5 SD), 24 lower expressive syntax skills (−2DS), and 7 children lower phonological processing (<−1.5 DS). Moreover, L2 phonological processing and the length of L2 exposure in an educational context positively predicted L2 receptive vocabulary as well as L2 expressive syntax skills. To date, performance in L2 among early sequential/simultaneous bilingual children from migrant households and very low SES remains underexplored. Future efforts need to be directed towards the understanding of factors that impact oral competence in L2, considering that these children will also be exposed to written L2 in the school context. Full article

(This article belongs to the Special Issue Language Acquisition and Language Impairment in Children with and without Neurodevelopmental Disorders)

10 pages, 572 KiB

Open AccessArticle

Meningococcal Carriage in Children with Atypical Hemolytic Uremic Syndrome Receiving Eculizumab Therapy

by Asli Kavaz Tufan, Fatma Ozak Batibay, Gulsah Kaya Aksoy, Bora Gulhan, Beltinge Demircioglu Kilic, Ismail Dursun, Bahar Buyukkaragoz, Aysun Caltik Yilmaz, Hulya Nalcacioglu, Tulay Becerir, Nuran Cetin, Kubra Celegen, Meltem Dinleyici, Mucahit Kaya, Omer Kilic and Ener Cagri Dinleyici

Children 2024, 11(10), 1164; https://doi.org/10.3390/children11101164 - 25 Sep 2024

Abstract

Background/Objectives: Eculizumab is a first-line treatment for atypical hemolytic uremic syndrome (aHUS), and patients undergoing eculizumab therapy may become more susceptible to infection caused by Neisseria meningitidis (Nm). While meningococcal vaccination is required for patients undergoing eculizumab therapy, there is limited [...] Read more.

Background/Objectives: Eculizumab is a first-line treatment for atypical hemolytic uremic syndrome (aHUS), and patients undergoing eculizumab therapy may become more susceptible to infection caused by Neisseria meningitidis (Nm). While meningococcal vaccination is required for patients undergoing eculizumab therapy, there is limited knowledge about meningococcal carriage in children with aHUS. We aimed to evaluate (1) the prevalence of Nm carriage, (2) serogroup distribution, and (3) the immunization status of children undergoing eculizumab treatment for aHUS. Methods: The Meningo-aHUS study is a prospective, multi-center study evaluating meningococcal carriage in children and adolescents in Türkiye receiving eculizumab for aHUS. We noted the age, gender, daycare, school, or university attendance, passive smoking status, previous infection and antibiotic use, and previous immunization history, including meningococcal vaccines, from the medical records of those children with aHUS. We collected nasopharyngeal samples, tested them for Nm using real-time polymerase chain reaction, and performed a serogroup analysis on the positive samples. Results: We collected nasopharyngeal samples from 62 children with aHUS. Out of 62 children, 61 (98.4%) had received at least one dose of the meningococcal vaccine. The median time since the last meningococcal vaccine dose was 15 months (1–59 months). We detected meningococcal carriage in three (4.8%, 95% CI 1.0–13.5) children, and all three strains were non-groupable (NG). No other serogroups were detected. Conclusions: Almost all the children received their risk-group meningococcal immunization, including booster doses. A 4.8% of children with aHUS carried NG meningococci and, no vaccine serogroups were detected. Patients treated with eculizumab remain profoundly susceptible to IMD due to these NG meningococcal strains. The occurrence of breakthrough cases and carriage of Nm, especially NG strains, highlights the significance of maintaining a state of constant alertness, promptly seeking medical attention, and swiftly treating any symptoms that align with IMD, regardless of their vaccination status or antibiotic prophylaxis. Full article

(This article belongs to the Section Pediatric Nephrology & Urology)

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3 pages, 159 KiB

Open AccessReply

Reply to Herrmann et al. Comment on “van Gemert et al. Asymptomatic Infant Rib Fractures Are Primarily Non-Abuse-Related and Should Not Be Used to Assess Physical Child Abuse. Children 2023, 10, 1827”

by Martin J. C. van Gemert, Marianne Vlaming, Steven C. Gabaeff, Peter G. J. Nikkels and H. A. Martino Neumann

Children 2024, 11(10), 1163; https://doi.org/10.3390/children11101163 - 25 Sep 2024

Abstract

We thank the authors of [...] Full article

12 pages, 1073 KiB

Open AccessArticle

An Epidemiological Perspective on New Pediatric Cases of Type 1 Diabetes and Vitamin D Deficiency in South-East Romania: A Retrospective Study

by Maria Ursu, Mariana Cretu-Stuparu, Gabriela Gurau, Luciana-Carmen Nitoi, Aurel Nechita and Manuela Arbune

Children 2024, 11(10), 1162; https://doi.org/10.3390/children11101162 - 25 Sep 2024

Abstract

Objectives: The aim of this study is to analyze the epidemiological characteristics and the biological profile of children from the southeast of Romania who have been newly diagnosed with type 1 diabetes (T1DM) and to investigate the potential relationships between vitamin D deficiency [...] Read more.

Objectives: The aim of this study is to analyze the epidemiological characteristics and the biological profile of children from the southeast of Romania who have been newly diagnosed with type 1 diabetes (T1DM) and to investigate the potential relationships between vitamin D deficiency and the onset of this disease, especially in the context of the COVID-19 pandemic. Methods: This is a retrospective study that included 79 children under the age of 18 who were diagnosed with T1DM at the St. Ioan Galati Children’s Emergency Clinical Hospital between 2018 and 2023. Their demographic data (age, sex, and home environment), medical history (family medical history, birth weight, Apgar score, and type of nutrition), and biological parameters, including glycemia, HbA1C, and vitamin D level, were collected. We used advanced statistical methods to compare the levels of vitamin D in the children with T1DM with a control group of nondiabetic children. Results: The demographic characteristics of new T1DM are a median age of 9 and female/male sex ratio of 1:3, with 50.6% living in urban areas, 59.5% with a normal body mass index, and 74.6% presenting with ketoacidosis. Vitamin D deficiency was found in 52% of diabetic cases compared to 2.53% in the nondiabetic controls. Conclusions: There is an increasing incidence of pediatric T1DM. Diabetic ketoacidosis was frequently diagnosed as an initial manifestation and has frequently accompanied lower levels of vitamin D. Children with T1DM showed significant vitamin D deficiencies compared to the control group, highlighting the need for the monitoring and supplementation of this vitamin. Full article

(This article belongs to the Special Issue New Research Progress on Endocrine Disorders in Infants, Children, and Adolescents)

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11 pages, 302 KiB

Open AccessArticle

Association between Academic Performance, Physical Activity, and Academic Stress in Compulsory Secondary Education: An Analysis by Sex

by Dilan Galeano-Rojas, Marina Cuadros-Juárez, Borys Bismark León Reyes, Mónica Alexandra Castelo Reyna, Claudio Farías-Valenzuela and Pedro Valdivia-Moral

Children 2024, 11(10), 1161; https://doi.org/10.3390/children11101161 - 25 Sep 2024

Abstract

Objectives: The main objective of this study is to analyze the relationships between academic performance, physical activity, and academic stress in secondary education students, while the secondary objective is to establish differences by gender in the physical activity and academic stress levels of [...] Read more.

Objectives: The main objective of this study is to analyze the relationships between academic performance, physical activity, and academic stress in secondary education students, while the secondary objective is to establish differences by gender in the physical activity and academic stress levels of secondary students based on academic performance. Methods: The sample was composed of students from both sexes who attended public institutions. Data collection was conducted applying an ad hoc questionnaire for academic performance, the PAQ-C questionnaire for physical activity, and the QASSE questionnaire for academic stress. Data analysis was performed using descriptive statistics: Spearman’s correlation coefficient was used for associations, while comparisons were conducted via the Mann–Whitney U test and Kruskal–Wallis H test. Results: The results show that academic stress is negatively correlated with physical activity and academic performance. Men present significantly higher values in physical activity, while women present higher mean values in general academic stress and the academic overload dimension. Lastly, regarding academic performance, significant differences were observed in the family pressure dimension, with students who perform better academically presenting lower mean values in this dimension of academic stress. Conclusions: In conclusion, the more the general academic stress, the lower the physical activity levels and academic performance. In addition, physical activity appears as a potential coping strategy for academic stress, and its influence on academic performance should be further studied in secondary education. Full article

(This article belongs to the Special Issue The Health Effects of Daily Physical Activity Behaviours in Children: Physical and Psychological Outcomes)

10 pages, 862 KiB

Open AccessArticle

Vitamin D Deficiency and Maternal Diseases as Risk Factors for the Development of Macrosomia in Newborns

by Nazym Ailbayeva, Aliya Alimbayeva, Oxana Yurkovskaya, Raida Faizova, Sayat Tanatarov, Gulnara Taiorazova, Aizhan Abylgazinova, Andrey Orekhov, Ulzhan Jamedinova and Lyudmila Pivina

Children 2024, 11(10), 1160; https://doi.org/10.3390/children11101160 - 25 Sep 2024

Abstract

Background: The aim is to assess the association between the level of vitamin D, maternal diseases, and macrosomia in newborns. Methods: This study included 258 full-term newborns (86 newborns with macrosomia; and 172 newborns with normal weight). Enzyme immunoassays for the determination [...] Read more.

Background: The aim is to assess the association between the level of vitamin D, maternal diseases, and macrosomia in newborns. Methods: This study included 258 full-term newborns (86 newborns with macrosomia; and 172 newborns with normal weight). Enzyme immunoassays for the determination of vitamin D were performed. Results: Newborns with macrosomia were statistically significantly more likely to have severe vitamin D deficiency compared with control (13.5 ± 6.7 ng/mL vs. 21.3 ± 12.1 ng/mL; p < 0.05). In the main group, severe deficiency was found in 40.7% of newborns, in the control group this rate was 5.8% (χ² = 71,788, df = 3, p < 0.001). Multiple regression analysis shows that statistically significant risk factors for the development of macrosomia were vitamin D deficiency in the cord blood (OR = 2.29), maternal age over 36 years old (OR = 19.54), and hypothyroidism (OR = 9.35). Conclusion: the results of our study demonstrate relationship between macrosomia in newborns and vitamin D deficiency in the cord blood, maternal overweight and obesity, maternal age and thyroid disease. Full article

(This article belongs to the Section Pediatric Neonatology)

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10 pages, 722 KiB

Open AccessArticle

Internalizing Symptoms and Their Impact on Patient-Reported Health-Related Quality of Life and Fatigue among Patients with Craniopharyngioma During Proton Radiation Therapy

by Belinda N. Mandrell, Yian Guo, Yimei Li, Donna Hancock, Mary Caples, Jason M. Ashford, Thomas E. Merchant, Heather M. Conklin and Valerie Mc. Crabtree

Children 2024, 11(10), 1159; https://doi.org/10.3390/children11101159 - 25 Sep 2024

Abstract

Objective: The aim of this study was to describe fatigue, health-related quality of life (HRQOL) and brain tumor-associated symptoms after surgical resection and during proton radiotherapy, using latent class analysis (LCA), and to determine if there is class membership change among pediatric patients [...] Read more.

Objective: The aim of this study was to describe fatigue, health-related quality of life (HRQOL) and brain tumor-associated symptoms after surgical resection and during proton radiotherapy, using latent class analysis (LCA), and to determine if there is class membership change among pediatric patients with craniopharyngioma. Methods: For all patients (n = 92), demographic and disease-related/clinical variables were attained, and patient reported outcomes were collected prior to proton therapy, at week three, and at the completion of proton therapy. The mean scores for fatigue, HRQOL, and brain tumor symptoms were compared over time and profiles were identified. Factors that influenced profile status and transition probability were examined. Results: Fatigue, HRQOL, and brain tumor symptoms improved over time during proton therapy; however, a subset remained in the lower profile, profile 1, associated with increased internalizing behaviors, compared to profile 2. Conclusions: Future study should explore the bidirectional relationship of sleep, worry and anxiety in the context of ongoing radiotherapy. Full article

(This article belongs to the Section Pediatric Hematology & Oncology)

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14 pages, 1036 KiB

Open AccessArticle

The Effects of Pediatric Acute Lymphoblastic Leukemia Treatment on Cardiac Repolarization

by Diana R. Lazar, Simona Cainap, Florin Leontin Lazar, Dana Maniu, Cristina Blag, Madalina Bota, Marius C. Colceriu and Mihnea Zdrenghea

Children 2024, 11(10), 1158; https://doi.org/10.3390/children11101158 - 24 Sep 2024

Abstract

Background: In recent years, cardiac dysfunction in childhood cancer survivors has become an important issue. Studies are focusing on identifying means for the early identification of patients at risk. Considering this, our study aims to investigate 24-hour Holter electrocardiogram (ECG) repolarization changes throughout [...] Read more.

Background: In recent years, cardiac dysfunction in childhood cancer survivors has become an important issue. Studies are focusing on identifying means for the early identification of patients at risk. Considering this, our study aims to investigate 24-hour Holter electrocardiogram (ECG) repolarization changes throughout doxorubicin (DOX) and cyclophosphamide (CPM) administration in pediatric patients treated for acute lymphoblastic leukemia (ALL). Methods: This was an investigator-driven, single-center, prospective, observational study. Enrolled children had a baseline bedside ECG examination performed before starting chemotherapy (T0). Serial Holter ECG examinations were conducted at three moments during their treatment protocol: day 8 (T1), day 29 (T2), and day 36 (T3). This study evaluated several ECG repolarization parameters, such as the QT interval, corrected QT interval (QTc), and QTc dispersion, as well as ST segment variations. Results: We evaluated 37 children diagnosed with ALL. The T0 examination revealed that over a third of patients had a resting heart rate (HR) outside the normal range for their age and sex. During chemotherapy, statistically significant increases in both HR as well as QT and QTc dispersion values were noticed, especially during the first DOX administration. What is more, a significant increase in the percentage of patients with ST segment depression from T1 to T2 and T3 was noticed. Rhythm disturbances were rare in the study population, with only a few patients presenting ventricular or supraventricular extrasystoles. Conclusions: This study reveals silent repolarization changes occurring early during anticancer treatment in children treated for ALL. These findings could aid in a better understanding of the cardiac toxicity mechanism, and they could potentially improve cardiac risk stratification for oncologic patients. Because of the small number of patients, our results need to be validated by larger studies Full article

(This article belongs to the Special Issue Children with Leukemia and Lymphoma: Diagnosis and Management)

3 pages, 143 KiB

Open AccessEditorial

Editorial on Asymptomatic Rib Fractures and Their Relationship to Child Abuse

by Oliver J. Muensterer and Eva Möhler

Children 2024, 11(10), 1157; https://doi.org/10.3390/children11101157 - 24 Sep 2024

Abstract

Children recently published a Special Issue that focuses on child abuse and neglect as severe adverse childhood experiences [...] Full article

11 pages, 284 KiB

Open AccessCommunication

Sociodemographic Factors Associated with Video Game Addiction in Schoolchildren from the South-Central Region of Chile

by Alejandra Rodríguez-Fernández, Marcela Ruíz-De la Fuente, Eduard Maury-Sintjago, Sofía Petersen, Valentina Paredes and Bárbara Montero

Children 2024, 11(10), 1156; https://doi.org/10.3390/children11101156 - 24 Sep 2024

Abstract

Video game addiction is a worldwide concern, particularly in schoolchildren where it has impact on academic, social, and emotional spheres. The objective of this study was to determine the sociodemographic factors associated with video game addiction in schoolchildren from the south-central region of [...] Read more.

Video game addiction is a worldwide concern, particularly in schoolchildren where it has impact on academic, social, and emotional spheres. The objective of this study was to determine the sociodemographic factors associated with video game addiction in schoolchildren from the south-central region of Chile. Methods: An analytical cross-sectional study that included a sample of 308 schoolchildren was performed. Sociodemographic factors were analyzed and levels of video game addiction was assessed using the Video Game Addiction Test (VAT) developed by Chóliz and Marco. A general linear regression model (ANCOVA) (α = 0.05) was applied (STATA v16). The prevalence of video game use was 82.7%, while addiction reached 10%. Risk factors associated with the increased risk of addiction were as follows: being male (β = 13.99; p < 0.001); being in the care of another relative (β = 11.1; p < 0.001); a higher number of people in the household (β = 11.2; p < 0.001); the caregiver in employment (β = 12.8; p < 0.001); and not performing extracurricular physical activity (β = 9.9; p < 0.001). Full article

(This article belongs to the Section Global Pediatric Health)

11 pages, 481 KiB

Open AccessArticle

Measuring Food Insecurity in Children under 5 Years of Age with Acute Undernutrition in Valle Del Cauca—Colombia

by Laura Valentina Parra-Pinzon, Elisa Maria Pinzon-Gomez, Sayda Milena Pico-Fonseca, Isabel Cristina Hurtado, Ana Rocio Guzman-Benavides and Olmer Alexander Pantoja-Rodríguez

Children 2024, 11(10), 1155; https://doi.org/10.3390/children11101155 - 24 Sep 2024

Abstract

Malnutrition is a global problem that affects all countries in one or more of its forms, representing one of the greatest challenges worldwide. One of the key contributing factors is food insecurity, which must be evaluated in children with moderate and severe acute [...] Read more.

Malnutrition is a global problem that affects all countries in one or more of its forms, representing one of the greatest challenges worldwide. One of the key contributing factors is food insecurity, which must be evaluated in children with moderate and severe acute malnutrition, as they are at imminent risk of death. Objective: Our objective was to assess food insecurity among children under 5 years old with moderate, and severe malnutrition from Valle del Cauca, a state located in the southwestern region of Colombia. Methods: A descriptive observational study was conducted, including children whose weight-for-height (W/H) indicator was below 2 SD, as recorded on the World Health Organization (WHO) growth charts, or who exhibited severe malnutrition phenotypes such as marasmus or Kwashiorkor. Family and child food security were evaluated using the Latin American and Caribbean Food Security Scale (ELCSA). Results: 58.6% of households with acutely malnourished children experienced food insecurity. A statistically significant relationship was found between food insecurity and children of Afro-Colombian and Indigenous descent. According to caregivers’ perceptions, 30.2% of child malnutrition cases were related to poor feeding and caregiving practices. Conclusions: Not all children with acute malnutrition suffer from food insecurity. Therefore, the findings of this research suggest that governmental efforts should focus not only on ensuring food availability, but also on educating caregivers about the importance of a balanced and nutritious diet tailored to the specific characteristics of each region and promoting appropriate caregiving practices. Full article

(This article belongs to the Topic Children’s Diseases, Family Management, and Quality of Life)

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19 pages, 742 KiB

Open AccessArticle

Retinopathy of Prematurity in Eight Portuguese Neonatal Intensive Care Units: Incidence, Risk Factors, and Progression—A Prospective Multicenter Study

by Mariza Fevereiro-Martins, Ana Carolina Santos, Carlos Marques-Neves, Manuel Bicho and Hercília Guimarães

Children 2024, 11(10), 1154; https://doi.org/10.3390/children11101154 - 24 Sep 2024

Abstract

Background/Objectives: Retinopathy of prematurity (ROP) is a retinal neovascular disease affecting preterm infants. Identifying risk factors for its development and progression is critical for effective screening and prevention. This study aimed to analyze the incidence of ROP and identify key risk factors for [...] Read more.

Background/Objectives: Retinopathy of prematurity (ROP) is a retinal neovascular disease affecting preterm infants. Identifying risk factors for its development and progression is critical for effective screening and prevention. This study aimed to analyze the incidence of ROP and identify key risk factors for its development and progression. Methods: We conducted a prospective, observational cohort study on 455 neonates (gestational age [GA] < 32 weeks or birth weight < 1500 g) across eight Portuguese NICUs. Results: ROP incidence was 37.8%, with 4.6% requiring treatment. Multivariate analysis identified low GA and the number of red blood cell (RBC) transfusions as significant factors for ROP development and progression. After adjusting for these variables, platelet transfusions, high maximum fraction of inspired oxygen (FiO₂) in the second week, and surfactant use remained significantly associated with ROP development, while early and late sepsis, maternal chronic hypertension, and delayed enteral nutrition were associated with progression to ROP requiring treatment. Conclusions: These findings underscore the importance of addressing low GAs and adult RBC transfusions in ROP risk management and suggest that maximum FiO₂, platelet transfusions, and sepsis also play crucial roles. Larger studies are needed to validate these results and explore preventive interventions, particularly regarding the impact of multiple adult RBC transfusions on fetal hemoglobin percentages. Full article

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3 pages, 155 KiB

Open AccessComment

Comment on van Gemert et al. Asymptomatic Infant Rib Fractures Are Primarily Non-abuse-Related and Should Not Be Used to Assess Physical Child Abuse. Children 2023, 10, 1827

by Bernd Herrmann, Tanja Brüning, Sibylle Banaschak and Oliver Berthold

Children 2024, 11(10), 1153; https://doi.org/10.3390/children11101153 - 24 Sep 2024

Abstract

We are deeply concerned about the scientific quality of the article “Asymptomatic Infant Rib Fractures Are Primarily Non-abuse-Related and Should Not Be Used to Assess Physical Child Abuse” published in the journal Children in 2023 by van Gemert et al [...] Full article

11 pages, 909 KiB

Open AccessArticle

The Pulmonary Artery Pulsatility Index Provides No Additional Prognostic Information in Pediatric Pulmonary Arterial Hypertension

by Faye E. Smits, Chantal Lokhorst, Marlies G. Haarman, Mark-Jan Ploegstra, Rolf M. F. Berger and Johannes M. Douwes

Children 2024, 11(10), 1152; https://doi.org/10.3390/children11101152 - 24 Sep 2024

Abstract

Background/Objectives: The pulmonary artery pulsatility index (PAPi, calculated as (SPAP − DPAP)/mRAP) has been suggested as a measure of right ventricular–vascular coupling (RVVC) and as a prognostic parameter in cardiovascular conditions, particularly right ventricular failure. This retrospective study investigated the relationship between the [...] Read more.

Background/Objectives: The pulmonary artery pulsatility index (PAPi, calculated as (SPAP − DPAP)/mRAP) has been suggested as a measure of right ventricular–vascular coupling (RVVC) and as a prognostic parameter in cardiovascular conditions, particularly right ventricular failure. This retrospective study investigated the relationship between the PAPi and its components with disease severity parameters, the RVVC, and clinical outcomes in children with pulmonary arterial hypertension (PAH). Methods: We analyzed data from 111 children from the Dutch National Registry with PAH. The PAPi (median 6.0 [3.9–8.3]) was calculated from heart catheterization data and the RVVC was determined as the TAPSE/sPAP ratio via echocardiography (0.25 ± 0.12 mm/mmHg). Disease severity was characterized by clinical, hemodynamic, and laboratory data. Cox proportional hazard modeling assessed the PAPi’s predictive value for transplant-free survival. Results: There was no correlation between the RVVC and PAPi (R = −0.208, p = 0.111, n = 60). The PAPi correlated negatively with uric acid (R = −0.387, p < 0.001) but not with other disease severity parameters. Mean right atrial pressure correlated with multiple disease severity indicators. Transplant-free survival rates at 1, 3, and 5 years were 87%, 79%, and 73%, respectively. Neither the PAPi nor its components correlated with transplant-free survival. Conclusions: In conclusion, the PAPi does not correlate with the RVVC and this study could not demonstrate any prognostic value of the PAPi regarding disease severity or outcomes in children with PAH, challenging its utility in this population. Full article

(This article belongs to the Special Issue The Management of Pulmonary Hypertension in Infants and Children)

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15 pages, 612 KiB

Open AccessArticle

Experiences in Coping with Stress—A Qualitative Study of Family Caregivers of Children with Medical Complexity

by Mikhaila N. Layshock, Amy S. Porter, Jori F. Bogetz, Lydia McLachlan, Sydney Weill, Abby Rosenberg, Joseph G. Winger, Amy Houtrow, Robert B. Noll, Yael Schenker and Justin A. Yu

Children 2024, 11(9), 1151; https://doi.org/10.3390/children11091151 - 23 Sep 2024

Abstract

Objective: To better understand the strategies family caregivers of children with medical complexity (CMC) utilize to deal with the stress and challenges associated with caregiving. Methods: We conducted a cross-sectional qualitative study among family caregivers of CMC receiving medical care at a children’s [...] Read more.

Objective: To better understand the strategies family caregivers of children with medical complexity (CMC) utilize to deal with the stress and challenges associated with caregiving. Methods: We conducted a cross-sectional qualitative study among family caregivers of CMC receiving medical care at a children’s hospital in Western Pennsylvania. Participants completed in-depth, semi-structured interviews focused on how CMC family caregivers approach and manage caregiving-related challenges and stress. Using constant comparative methodology, we inductively analyzed deidentified transcripts for emergent themes. Results: We interviewed 19 participants (89.4% female) with a mean age of 43 years (range 32–54 years). The mean age of the participants’ children was 10.8 years (range 1–20 years). Twelve participants’ children identified as white and four identified as Black. Three central themes regarding CMC caregivers’ stress-coping strategies emerged: (1) maintaining a positive mindset, (2) developing and relying on interpersonal support networks, and (3) making time for self-preservation. All three themes were universally reported (n = 19/19) by our participants. The most common subthemes for each theme, respectively, focused on staying hopeful and celebrating moments of joy; cultivating supportive relationships with family, friends, and fellow CMC family caregivers; and finding pleasure in “little things” (e.g., everyday activities and hobbies). Conclusion: Family caregivers of CMC utilize a multi-faceted approach to cope with the stress and challenges routinely encountered in caring for CMC. This study’s findings could be used to inform future clinical efforts and research directions aiming to improve clinicians’ ability to support CMC caregivers’ well-being. Full article

(This article belongs to the Special Issue Living beyond Medical Complexity: Factors That Shape Family Health and Wellbeing)

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12 pages, 447 KiB

Open AccessArticle

A New Method to Evaluate Joint Hypermobility in Paediatric Patients with Neurodevelopmental Disorders: A Preliminary Study

by Leonardo Zoccante, Marco Luigi Ciceri, Gianfranco Di Gennaro and Marco Zaffanello

Children 2024, 11(9), 1150; https://doi.org/10.3390/children11091150 - 23 Sep 2024

Abstract

Background/Objectives: Neurodevelopmental disorders (NDDs) include a wide range of conditions that develop during the formation of the central nervous system, such as autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD). Tourette syndrome (TS) is another neurodevelopmental disorder characterised by motor and vocal [...] Read more.

Background/Objectives: Neurodevelopmental disorders (NDDs) include a wide range of conditions that develop during the formation of the central nervous system, such as autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD). Tourette syndrome (TS) is another neurodevelopmental disorder characterised by motor and vocal tics, which often co-occurs with ASD and ADHD. This study explores the feasibility of assessing joint hypermobility in children with specific neurodevelopmental conditions by measuring both ankles’ passive range of motion (pROM). Methods: This study involved children diagnosed with ASD, ADHD, and TS, aged 5 to 15 years, who were compared with a control group of healthy children. The Beighton and Brighton scores and the pROM of the left and right ankles were measured. Data were analysed using SPSS version 22.0 for Windows (IBM SPSS Statistics, Chicago, IL, USA). A total of 102 subjects participated in this study (72.52% male, with a mean age of 10.7 ± 2.2 years). The sample included 24 children with ASD, 27 with ADHD, 26 with TS, and 25 healthy controls. Results: The pROM of the right and left ankles showed a significant positive correlation with the Beighton and Brighton scores in children with NDDs (ASD, ADHD, and TS combined). A trend towards higher Beighton scores (≥6) was observed in the ADHD and TS groups, with significance found in the TS group (p = 0.013). The pROM of the right ankle was significantly higher in the ADHD (p = 0.021) and TS (p = 0.013) groups compared to the controls. Although the left ankle followed a similar trend in the TS group, the difference was not statistically significant (p = 0.066). Controlling for age, the diagnosis of ASD, ADHD, and TS does not appear to impact any of the variables examined. Conclusions: There is a trend towards a higher prevalence of individuals with elevated Beighton scores in the ADHD and TS groups, suggesting greater general flexibility or hypermobility in these patients. However, the pROM of the right ankle is significantly higher in the ADHD and TS groups, with solid evidence in the TS group. These findings were not observed in children with ASD. However, it is necessary to consider the measurements obtained in relation to the patients’ age. Finally, given that the pROM of the ankles correlates with the Beighton and Brighton scores, it could be utilised for the initial screening, monitoring, and follow-up of JH in some children with NDDs. Further investigations are required. Full article

(This article belongs to the Special Issue Children's Public Health and Healthcare: Global Perspective and New Trends)

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14 pages, 531 KiB

Open AccessArticle

Toilet Training Readiness Scale for 0–5-Year-Old Children: A New Measurement Tool Based on a Child-Centred Approach

by Adnan Barutçu, Burak Mete, Hakan Demirhindi, Saliha Barutçu, Aliye Kıdı and Nurdan Evliyaoğlu

Children 2024, 11(9), 1149; https://doi.org/10.3390/children11091149 - 23 Sep 2024

Abstract

Background and Objectives: There is no standardised approach to toilet training in children. This study aimed to determine the factors affecting the duration of toilet training in children aged 0–5 years and to develop a tool to assess the child’s readiness to start [...] Read more.

Background and Objectives: There is no standardised approach to toilet training in children. This study aimed to determine the factors affecting the duration of toilet training in children aged 0–5 years and to develop a tool to assess the child’s readiness to start toilet training. Materials and Methods: This cross-sectional study was conducted on 409 children aged 0–5 years. Social, economic, behavioural, and developmental characteristics that are effective in toilet training in healthy children were evaluated. A scale assessing children’s readiness for toilet training (Toilet Training Readiness Scale-TTRS) was developed and content validated. Results: The mean age of the 409 children included in this study was 44.69 ± 13.07 months (min = 4; max = 60 months). The mean age of initiation of toilet training was 26.8 months. Most frequently, urine and faeces trainings were started together (52.1%). In the logistic regression analysis performed to evaluate the factors affecting the duration of toilet training, it was found that the TTRS score, mother’s employment status, family type, child’s first reaction, toilet type, and continuity of training were important predictors. The duration of toilet training showed a weak negative correlation with the scores obtained from the TTRS and the number of children in the family but a weak positive correlation with the age at the beginning of toilet training. The TTRS scores were inversely proportional to the duration of toilet training. Conclusions: Family characteristics, socioeconomic conditions, and readiness of the child for and no interruption in toilet training are important in completing toilet training in a short time and successfully. If a child-focused approach is adopted, evaluating the child from this point of view and initiating the training at the appropriate time may help to complete a more successful and shorter toilet training. We recommend that the scale we have developed be studied in other studies and different groups. Full article

(This article belongs to the Section Global Pediatric Health)

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12 pages, 263 KiB

Open AccessArticle

The Relationship between Nocturnal Enuresis and Obstructive Sleep Apnea in Children

by María Andreu-Codina, Danica Nikolic-Jovanovic, Eduard Esteller, Núria Clusellas, Montserrat Artés, Javier Moyano and Andreu Puigdollers

Children 2024, 11(9), 1148; https://doi.org/10.3390/children11091148 - 23 Sep 2024

Abstract

Background: The aim of this study is to determine the prevalence of nocturnal enuresis (NE) in children with obstructive sleep apnea (OSA), the effect of adenotonsillectomy (AT) and the width of the arches, and to compare them with control children without respiratory problems. [...] Read more.

Background: The aim of this study is to determine the prevalence of nocturnal enuresis (NE) in children with obstructive sleep apnea (OSA), the effect of adenotonsillectomy (AT) and the width of the arches, and to compare them with control children without respiratory problems. Methods: Children from 2 to 12 years old were divided into three groups: children with OSA and NE (n = 51), children with OSA without NE (n = 79), and the control group (n = 168). NE was defined as at least one bedwetting incident per month. Arch widths were measured at the baseline and one year after. OSA was diagnosed by means of polysomnography, and the apnea-hypopnea index (AHI) was obtained. Parents completed the Pediatric Sleep Questionnaire (PSQ) to classify their children into those with and without NE. Results: NE was present in 39.2% of children with OSA compared to 28% in the control group (p = 0.04). After AT, 49% of the children with OSA and NE significantly improved. Both OSA groups had narrower arch widths than the control group (p = 0.012), with the NE group having the narrowest widths. NE is more prevalent in children with OSA and should be considered one of the first signs of breathing disorders. Adenotonsillectomy reduces NE in about half of the affected children. Both arch widths are narrower in children with OSA, particularly in those with NE. Full article

(This article belongs to the Section Pediatric Dentistry & Oral Medicine)

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