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Children, Volume 5, Issue 11 (November 2018)

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Cover Story (view full-size image) Although the most common forms of brain injury in preterm infants have been associated with adverse [...] Read more.
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Open AccessCase Report Recurrent Kawasaki Disease: A Case Report of Three Separate Episodes at >4-Year Intervals
Children 2018, 5(11), 155; https://doi.org/10.3390/children5110155
Received: 9 October 2018 / Revised: 9 November 2018 / Accepted: 11 November 2018 / Published: 21 November 2018
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Abstract
Kawasaki disease (KD) is a self-limited systemic vasculitis, most often occurring in children 1–5 years old. It has a 2% recurrence rate and is associated with coronary aneurysms (CA), which can develop within two weeks of onset. A 25% increased risk is noted
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Kawasaki disease (KD) is a self-limited systemic vasculitis, most often occurring in children 1–5 years old. It has a 2% recurrence rate and is associated with coronary aneurysms (CA), which can develop within two weeks of onset. A 25% increased risk is noted in patients who are recalcitrant to treatment. We describe a patient with recurrence of KD three times, approximately four years apart. A 10-year-old female with two previous episodes of KD, at 11 months and five years of age), in which she met five out of five criteria for KD and had no coronary involvement, presented with 15 days of fever, conjunctivitis and mucocutaneous changes. Infectious work-up was negative, and she was diagnosed with incomplete KD meeting three out of five criteria. An echocardiogram (ECHO) on day 12 revealed dilation of the right coronary artery (RCA) and left coronary artery (LCA). Treatment with intravenous immunoglobulin (IVIG) and high-dose aspirin was started at an outside hospital. After transfer, serial ECHOs showed evolving coronary aneurysms, left anterior descending (LAD) z-score + 8.2 and RCA z-score + 4.0. She received 10 mg/kg infliximab (day 18) and began clopidogrel. A cardiac MRI (day 20) demonstrated progression of the LAD aneurysm, with a z-score + 13, and warfarin was started. To our knowledge, this is the first report of recurrent KD occurring three times at ~5 year intervals. Full article
(This article belongs to the Special Issue Kawasaki Disease in Children and Adolescents)
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Open AccessOpinion The Elephant in the Room: The Need for Increased Integrative Therapies in Conventional Medical Settings
Children 2018, 5(11), 154; https://doi.org/10.3390/children5110154
Received: 15 October 2018 / Revised: 10 November 2018 / Accepted: 10 November 2018 / Published: 16 November 2018
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Abstract
Pediatric integrative therapy programs are essential to the treatment and well-being of patients. Identifying an effective integrative therapy model within conventional pediatric medical settings, however, often proves difficult. Our goal in this article is to explore varied solutions to increase access and inclusion
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Pediatric integrative therapy programs are essential to the treatment and well-being of patients. Identifying an effective integrative therapy model within conventional pediatric medical settings, however, often proves difficult. Our goal in this article is to explore varied solutions to increase access and inclusion of integrative therapies in an effort to promote best practice and holistic care. The main methods applied in this article are vignettes that illustrate how the integrative therapies in a metropolitan academic hospital successfully treat the patient by complementing conventional medicine. This leads to comprehensive care. The central finding of the article proposes viable solutions to increase interdisciplinary collaboration both internally within the institution and externally. Integrative therapists detail how they were able to increase visibility and yield best practice through increased educational initiatives and interdisciplinary collaboration. Full article
(This article belongs to the Special Issue Implementing Pediatric Integrative Medicine in Practice)
Open AccessArticle The Relationship between Sleep and Cognitive Performance in Autism Spectrum Disorder (ASD): A Pilot Study
Children 2018, 5(11), 153; https://doi.org/10.3390/children5110153
Received: 9 October 2018 / Revised: 11 November 2018 / Accepted: 13 November 2018 / Published: 16 November 2018
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Abstract
Background: Sleep concerns are common in children with autism spectrum disorders (ASD). The impact of poor sleep on cognitive performance in ASD children is not well-established. We investigated the possible correlation between sleep quality in ASD children and cognitive performance. The Cambridge Neuropsychological
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Background: Sleep concerns are common in children with autism spectrum disorders (ASD). The impact of poor sleep on cognitive performance in ASD children is not well-established. We investigated the possible correlation between sleep quality in ASD children and cognitive performance. The Cambridge Neuropsychological Test Automated Battery (CANTAB) was administered to examine specific components of non-verbal cognition. Methods: The Children’s Sleep Habits Questionnaire (CSHQ) and actigraphy-measured data from 18 children with diagnosis of ASD were evaluated. Motor planning task (MOT), simple reaction time task (SRT) and the intradimensional/extradimensional shift (IED) of CANTAB were administered. Results: ASD good sleeper (ASD-GS) showed significant better response time for SRT task as compared to ASD poor sleeper (ASD-PS) based on CSHQ score. Parameters of bedtime resistance (r = 0.531, p = 0.023), sleep anxiety (r = 0.474, p = 0.047) from CSHQ and actigrapgy dependent (wake after sleep onset (WASO) (r = 0.430, p = 0.024) were significantly correlate with response time of SRT task. Conclusion: We conclude that some signs reflecting the presence of poor sleep in ASD correlate with various aspects of motor output on non-verbal performance tasks. The question is raised whether poor sleep in non-complaining persons with autism should be treated. Full article
(This article belongs to the Section Global and Public Health)
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Open AccessReview Extracellular Vesicles: A Potential Novel Regulator of Obesity and Its Associated Complications
Children 2018, 5(11), 152; https://doi.org/10.3390/children5110152
Received: 14 September 2018 / Revised: 9 November 2018 / Accepted: 9 November 2018 / Published: 15 November 2018
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Abstract
Childhood obesity continues to be a major public health concern. Obesity causes various metabolic complications, including insulin resistance, type 2 diabetes mellitus (T2DM), non-alcoholic fatty liver disease (NAFLD), dyslipidemia, and cardiovascular disease. However, currently, we have a limited understanding of the pathophysiology in
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Childhood obesity continues to be a major public health concern. Obesity causes various metabolic complications, including insulin resistance, type 2 diabetes mellitus (T2DM), non-alcoholic fatty liver disease (NAFLD), dyslipidemia, and cardiovascular disease. However, currently, we have a limited understanding of the pathophysiology in the development of these processes. Extracellular vesicles (EVs) are nano-sized vesicles secreted by different cell types that travel to various organ systems carrying molecular and genetic information. These vesicles have been proposed as a novel intercellular communication mode in systemic metabolic regulation and in several pathophysiologic processes. In particular, recent studies indicate that EVs play a critical role in the pathogenesis of obesity and its metabolic complications. In this study, we reviewed the current literature that supports the role of EVs in the regulation of metabolic homeostasis and pathogenesis of obesity and its associated metabolic complications, with a short discussion about future directions in the EV research field. Full article
(This article belongs to the Special Issue Obesity and Metabolic Dysregulation in Childhood)
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Open AccessArticle A Web-Based Calculator for the Prediction of Severe Neurodevelopmental Impairment in Preterm Infants Using Clinical and Imaging Characteristics
Children 2018, 5(11), 151; https://doi.org/10.3390/children5110151
Received: 10 October 2018 / Revised: 2 November 2018 / Accepted: 8 November 2018 / Published: 14 November 2018
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Abstract
Although the most common forms of brain injury in preterm infants have been associated with adverse neurodevelopmental outcomes, existing MRI scoring systems lack specificity, do not incorporate clinical factors, and are technically challenging to perform. The objective of this study was to develop
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Although the most common forms of brain injury in preterm infants have been associated with adverse neurodevelopmental outcomes, existing MRI scoring systems lack specificity, do not incorporate clinical factors, and are technically challenging to perform. The objective of this study was to develop a web-based, clinically-focused prediction system which differentiates severe neurodevelopmental outcomes from normal-moderate outcomes at two years. Infants were retrospectively identified as those who were born ≤30 weeks gestation and who had MRI imaging at term-equivalent age and neurodevelopmental testing at 18–24 months. Each MRI was scored on injury in three domains (intraventricular hemorrhage, white matter injury, and cerebellar hemorrhage) and clinical factors that were strongly predictive of an outcome were investigated. A binary logistic regression model was then generated from the composite of clinical and imaging components. A total of 154 infants were included (mean gestational age = 26.1 ± 1.8 weeks, birth weight = 889.1 ± 226.2 g). The final model (imaging score + ventilator days + delivery mode + antenatal steroids + retinopathy of prematurity requiring surgery) had strong discriminatory power for severe disability (AUC = 0.850), with a PPV (positive predictive value) of 76% and an NPV (negative predictive value) of 90%. Available as a web-based tool, it can be useful for prognostication and targeting early intervention services to infants who may benefit the most from such services. Full article
(This article belongs to the Special Issue Neurodevelopment of Survivors Born Very Preterm)
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Open AccessArticle Childhood Obesity and Academic Outcomes in Young Adulthood
Children 2018, 5(11), 150; https://doi.org/10.3390/children5110150
Received: 10 October 2018 / Revised: 8 November 2018 / Accepted: 9 November 2018 / Published: 13 November 2018
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Abstract
The present study used nationally representative data from the National Longitudinal Study of Adolescent Health (a.k.a., Add Health) to examine the impact of childhood obesity on young adult educational attainment. In addition to weight status, independent variables included race–ethnicity, immigrant generational status, family
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The present study used nationally representative data from the National Longitudinal Study of Adolescent Health (a.k.a., Add Health) to examine the impact of childhood obesity on young adult educational attainment. In addition to weight status, independent variables included race–ethnicity, immigrant generational status, family socio-economic status (SES), preference for overweight and obese friends in school, school socio-economic and race–ethnic composition, and other important predictors. Educational attainment was measured as a categorical variable with the categories reflecting key educational benchmarks: (1) being a high school graduate; (2) having some college education; and (3) having completed a bachelor’s or higher degree. The results indicate that in general, individuals who were obese as children are less likely to transition from high school to college, and even less likely to obtain a baccalaureate or more advanced degree. In line with the social network hypothesis of the obesity epidemic, we also found that having overweight and obese friends drives down the odds of educational success. Attendance at a higher SES school or a school with a lower percentage of minority students was positively associated with the odds of college attendance and obtaining a baccalaureate. Other important effects included race–ethnicity and immigrant generational status. Full article
Open AccessCase Report A Rare Pediatric Case of Severe Bird Fancier’s Lung Presented with Viral Pneumonitis-Like Picture
Children 2018, 5(11), 149; https://doi.org/10.3390/children5110149
Received: 7 October 2018 / Revised: 6 November 2018 / Accepted: 6 November 2018 / Published: 12 November 2018
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Abstract
Bird Fancier’s Lung (BFL) is a rare, nonatopic immunologic response to repeated or intense inhalation of avian (bird) proteins/antigens found in the feathers or droppings of many species of birds, which leads to an immune-mediated inflammatory reaction in the respiratory system. Although this
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Bird Fancier’s Lung (BFL) is a rare, nonatopic immunologic response to repeated or intense inhalation of avian (bird) proteins/antigens found in the feathers or droppings of many species of birds, which leads to an immune-mediated inflammatory reaction in the respiratory system. Although this is the most common type of hypersensitivity pneumonitis (HP) reported in adults, it is one of the classifications of a rare subtype of interstitial lung disease that occurs in the pediatric age group of which few case reports are available in the literature. The pathophysiology of HP is complex; numerous organic and inorganic antigens can cause immune dysregulation, leading to an immune-related antigen–antibody response (immunoglobulin G—IgG- against the offending antigen). Diagnosing BFL in the pediatric age group is challenging due to the history of exposure usually being missed by health care providers, symptoms and clinical findings in such cases being nonspecific and often misdiagnosed during the acute illness with other common diseases such asthma or acute viral lower respiratory tract infection, and the lack of standardization of criteria for diagnosing such a condition or sensitive radiological or laboratory tests. Treatment, on the other hand, is also controversial. Avoidance of the offending antigen could be the sole or most important part of treatment, particularly in acute mild and moderate cases. Untreated cases can result in irreversible lung fibrosis. In this case report, we highlight how children presenting with an acute viral lower respiratory tract infection can overlap with the acute/subacute phase of HP. Early intervention with pulse steroids markedly improves the patient’s clinical course. Full article
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Open AccessReview Novel Therapies for Relapsed and Refractory Neuroblastoma
Children 2018, 5(11), 148; https://doi.org/10.3390/children5110148
Received: 11 September 2018 / Revised: 23 October 2018 / Accepted: 23 October 2018 / Published: 31 October 2018
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Abstract
While recent increases in our understanding of the biology of neuroblastoma have allowed for more precise risk stratification and improved outcomes for many patients, children with high-risk neuroblastoma continue to suffer from frequent disease relapse, and despite recent advances in our understanding of
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While recent increases in our understanding of the biology of neuroblastoma have allowed for more precise risk stratification and improved outcomes for many patients, children with high-risk neuroblastoma continue to suffer from frequent disease relapse, and despite recent advances in our understanding of neuroblastoma pathogenesis, the outcomes for children with relapsed neuroblastoma remain poor. These children with relapsed neuroblastoma, therefore, continue to need novel treatment strategies based on a better understanding of neuroblastoma biology to improve outcomes. The discovery of new tumor targets and the development of novel antibody- and cell-mediated immunotherapy agents have led to a large number of clinical trials for children with relapsed neuroblastoma, and additional clinical trials using molecular and genetic tumor profiling to target tumor-specific aberrations are ongoing. Combinations of these new therapeutic modalities with current treatment regimens will likely be needed to improve the outcomes of children with relapsed and refractory neuroblastoma. Full article
(This article belongs to the Special Issue Recent Advances in Diagnosis and Treatment of Neuroblastoma)
Open AccessArticle Gamma Glutamyl Transferase and Uric Acid Levels Can Be Associated with the Prognosis of Patients in the Pediatric Intensive Care Unit
Children 2018, 5(11), 147; https://doi.org/10.3390/children5110147
Received: 11 October 2018 / Revised: 24 October 2018 / Accepted: 24 October 2018 / Published: 30 October 2018
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Abstract
Introduction: Gamma glutamyl transferase (GGT) and uric acid (UA) are reported to be predictive markers in various disorders. It has been reported that these biomarkers can be used to indicate increased risk of mortality in critically ill patients. Herein, we aimed to
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Introduction: Gamma glutamyl transferase (GGT) and uric acid (UA) are reported to be predictive markers in various disorders. It has been reported that these biomarkers can be used to indicate increased risk of mortality in critically ill patients. Herein, we aimed to evaluate the effects of the initial serum GGT and UA levels on the outcomes of patients in the pediatric intensive care unit (PICU) and to investigate if these biomarkers can be used to predict pediatric mortality. Materials and Methods: The relationship between the initial GGT and UA levels and invasive mechanical ventilation (IMV) and noninvasive mechanical ventilation (NIV) support, inotropic drug need, acute renal kidney injury (AKI), continuous renal replacement therapy (CRRT), presence of sepsis, mortality, and hospitalization period were investigated retrospectively. Results: In all, 236 patients (117 males and 119 females) were included in the study. The age distribution of the patients was 1–12 years. There was a statistically significant relationship between GGT levels in the first biochemical analysis performed during admission and inotropic drug use, AKI, duration of hospitalization in intensive care unit, and sepsis. There was a statistically significant relationship between initial UA levels and inotropic drug use, AKI, CCRT, and sepsis. Conclusion: We suggest that initial GGT and UA levels during admission could be used to predict the outcomes of patients in PICU. Full article
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Open AccessReview A Scoping Review of Modifiable Risk Factors in Pediatric Onset Multiple Sclerosis: Building for the Future
Children 2018, 5(11), 146; https://doi.org/10.3390/children5110146
Received: 12 September 2018 / Revised: 20 October 2018 / Accepted: 22 October 2018 / Published: 26 October 2018
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Abstract
Knowledge of the effect of modifiable lifestyle factors in the pediatric multiple sclerosis (MS) population is limited. We therefore conducted a scoping review, following the framework provided by Arksey and O’Malley. Four databases were searched for pediatric MS and modifiable lifestyle factors using
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Knowledge of the effect of modifiable lifestyle factors in the pediatric multiple sclerosis (MS) population is limited. We therefore conducted a scoping review, following the framework provided by Arksey and O’Malley. Four databases were searched for pediatric MS and modifiable lifestyle factors using index terms and keywords, from inception to May 2018. All quantitative and qualitative primary articles were included and limited to English and full text. Of the 7202 articles identified and screened, 25 full-text articles were relevant to our objective and were included. These articles focused on diet obesity, physical activity, and sleep. In cross-sectional analyses, these lifestyle factors were associated with increased risk of pediatric onset MS (POMS), and increased disease activity. Diet, particularly vitamin D and vegetable intake, was associated with reduced relapse rate. Obesity was linked to increased risk of POMS, and physical activity was associated with reduced relapse rate and sleep/rest fatigue. Thus, available studies of lifestyle related outcomes in pediatric MS suggest specific lifestyle related factors, including obesity, higher vitamin D levels, and higher physical activity may associate with lower disease burden in POMS. Studies reviewed are limited by their observational designs. Future studies with longitudinal and experimental designs may further clarify the role of modifiable lifestyle factors in this population. Full article
(This article belongs to the Special Issue Multiple Sclerosis and Demyelinating Disorders in Children)
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Open AccessReview Biological Drivers of Wilms Tumor Prognosis and Treatment
Children 2018, 5(11), 145; https://doi.org/10.3390/children5110145
Received: 29 September 2018 / Revised: 16 October 2018 / Accepted: 18 October 2018 / Published: 26 October 2018
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Abstract
Prior to the 1950s, survival from Wilms tumor (WT) was less than 10%. Today, a child diagnosed with WT has a greater than 90% chance of survival. These gains in survival rates from WT are attributed largely to improvements in multimodal therapy: Enhanced
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Prior to the 1950s, survival from Wilms tumor (WT) was less than 10%. Today, a child diagnosed with WT has a greater than 90% chance of survival. These gains in survival rates from WT are attributed largely to improvements in multimodal therapy: Enhanced surgical techniques leading to decreased operative mortality, optimization of more effective chemotherapy regimens (specifically, dactinomycin and vincristine), and inclusion of radiation therapy in treatment protocols. More recent improvements in survival, however, can be attributed to a growing understanding of the molecular landscape of Wilms tumor. Particularly, identification of biologic markers portending poor prognosis has facilitated risk stratification to tailor therapy that achieves the best possible outcome with the least possible toxicity. The aim of this review is to (1) outline the specific biologic markers that have been associated with prognosis in WT and (2) provide an overview of the current use of biologic and other factors to stratify risk and assign treatment accordingly. Full article
(This article belongs to the Special Issue Pediatric Surgical Oncology)
Open AccessArticle Reproducibility of Preschool Personnel and Guardian Reports on Energy Balance-Related Behaviors and Their Correlates in Finnish Preschool Children
Children 2018, 5(11), 144; https://doi.org/10.3390/children5110144
Received: 19 September 2018 / Revised: 16 October 2018 / Accepted: 19 October 2018 / Published: 23 October 2018
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Abstract
Valid and reliable non-objective assessments of guardian and preschool personnel reports are necessary when estimating young children’s health behaviors. This study examines the test-retest reproducibility of (a) guardian and preschool personnel questionnaires about correlates of preschool-aged children’s energy balance-related behaviors (EBRBs), (b) a
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Valid and reliable non-objective assessments of guardian and preschool personnel reports are necessary when estimating young children’s health behaviors. This study examines the test-retest reproducibility of (a) guardian and preschool personnel questionnaires about correlates of preschool-aged children’s energy balance-related behaviors (EBRBs), (b) a screen time diary, and (c) a food frequency questionnaire (FFQ) reported by a guardian. A sample of guardians having preschool-aged children (N = 69) and preschool personnel (N = 61) completed questionnaires twice within a five-week time interval during April–May 2018 in Finland. Intra-class correlations (ICC), kappas, and percentage agreement were calculated to test the test-retest-reproducibility. The guardian questionnaire for correlates of the children’s EBRBs demonstrated mainly moderate to good reproducibility whereas the preschool personnel questionnaire of preschool correlates for children’s EBRBs was mostly good. The reproducibility of the screen time diary was good and FFQ food items showed mostly moderate reproducibility. The reproducibility of the FFQ foods items for vegetables, fruit, and berries was slightly better for the amount consumed than for the frequency of consumption. To conclude, all the instruments are acceptable for use in future studies. Full article
(This article belongs to the Special Issue Physical Activity and Sedentary Behaviour in Children and Adolescents)
Open AccessReview Pediatric Solid Tumors in Resource-Constrained Settings: A Review of Available Evidence on Management, Outcomes, and Barriers to Care
Children 2018, 5(11), 143; https://doi.org/10.3390/children5110143
Received: 30 September 2018 / Revised: 17 October 2018 / Accepted: 18 October 2018 / Published: 23 October 2018
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Abstract
International disparities in outcomes from pediatric solid tumors remain striking. Herein, we review the current literature regarding management, outcomes, and barriers to care for pediatric solid tumors in low- and middle-income countries (LMICs). In sub-Saharan Africa, Wilms Tumor represents the most commonly encountered
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International disparities in outcomes from pediatric solid tumors remain striking. Herein, we review the current literature regarding management, outcomes, and barriers to care for pediatric solid tumors in low- and middle-income countries (LMICs). In sub-Saharan Africa, Wilms Tumor represents the most commonly encountered solid tumor of childhood and has been the primary target of recent efforts to improve outcomes in low-resource settings. Aggressive and treatment-resistant tumor biology may play a role in poor outcomes within certain populations, but socioeconomic barriers remain the principal drivers of preventable mortality. Management protocols that include measures to address socioeconomic barriers have demonstrated early success in reducing abandonment of therapy. Further work is required to improve infrastructure and general pediatric care to address disparities. Full article
(This article belongs to the Special Issue Pediatric Surgical Oncology)
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