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Children, Volume 9, Issue 7 (July 2022) – 174 articles

Cover Story (view full-size image): It is essential for the resilience of a society to provide timely multisystemic support to young people and children living with adversity. Access to support systems such as mental health services for children and youth, pedagogical psychology services or child welfare services is crucial for providing immediate assistance and treatment to children living with violence and mental health issues. However, even in a highly developed country with welfare provisions such as Norway, not all children and young people living with adversity have access to existing support systems. In order to build social resilience, greater openness, transparent practices and close collaboration are necessary in policy, education and practice across all levels, from the government, support system operators, schools and families to individual children and young people. View this paper
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Editorial
Special Issue: Psychosocial Considerations for Children and Adolescents Living with a Rare Disease
Children 2022, 9(7), 1099; https://doi.org/10.3390/children9071099 - 21 Jul 2022
Viewed by 313
Abstract
This Special Issue of the journal Children constitutes an opportune moment to reflect on the psychosocial needs of children living with rare diseases and of their families [...] Full article
Article
Oral-Health-Related Quality of Life among Non-Syndromic School-Age Children with Orofacial Clefts: Results from a Cross-Sectional Study in Northern Italy
Children 2022, 9(7), 1098; https://doi.org/10.3390/children9071098 - 21 Jul 2022
Viewed by 252
Abstract
The aim of this cross-sectional study was to determine the influence of orofacial clefts on the oral-health-related quality of life (OHRQoL) in a group of Italian children and adolescents and to examine whether gender, age, cleft type, and surgical protocol were associated with [...] Read more.
The aim of this cross-sectional study was to determine the influence of orofacial clefts on the oral-health-related quality of life (OHRQoL) in a group of Italian children and adolescents and to examine whether gender, age, cleft type, and surgical protocol were associated with patients’ OHRQoL. A total of 71 patients with cleft lip and/or cleft palate (CLP) and 71 age- and gender-matched controls (aged 8 to 18 years) were asked to complete the Child Oral Health Impact Profile (COHIP), a validated and reliable questionnaire to assess self-reported OHRQoL in children and teenagers. Children with orofacial clefts showed statistically significant lower quality of life scores than controls for total OHRQoL and for each of the subscales. Gender, the type of cleft, and the type of surgical protocol had no significant influence on OHRQoL. The negative impact of CLP on the area of self-image was greater in 12–18-year-olds, indicating a higher need for psychosocial counselling. These findings suggest that Italian CLP children and adolescents experience a poorer OHRQoL in comparison to their non-cleft peers. Full article
(This article belongs to the Special Issue Current Research on Cleft Lip in Children)
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Article
Can Infant Dyschezia Be a Suspect of Rectosigmoid Redundancy?
Children 2022, 9(7), 1097; https://doi.org/10.3390/children9071097 - 21 Jul 2022
Viewed by 337
Abstract
Infant dyschezia is a functional gastrointestinal disorder that occurs in children less than nine months of age. This disorder causes much anxiety among parents who consult different physicians when suspecting major intestinal problems. The aim of this study is to verify whether infant [...] Read more.
Infant dyschezia is a functional gastrointestinal disorder that occurs in children less than nine months of age. This disorder causes much anxiety among parents who consult different physicians when suspecting major intestinal problems. The aim of this study is to verify whether infant dyschezia involves an anatomic abnormality (redundancy) of the colon. In this retrospective study (48 months) we analyzed all the children younger than 9 months who came to our attention through the suspicion of gastrointestinal abnormality (Hirschsprung’s disease, anorectal malformations, colonic disorders or constipation). They all had a complete medical history, clinical examination and diagnostic tests, such as blood samples, suction rectal biopsy, a study of stool characteristics and, finally, a contrast enema. In cases with infant dyschezia, different colonic sizes and rectosigmoid length were measured, which created a ratio with the diameter of the second lumbar vertebra. These values were compared with those reported in the literature as normal for the age of one year. Of the 24 patients evaluated (mean age 4 months), 9 were excluded for different diagnoses (aganglionic megacolon, hypothyroidism, constipation). The comparison of the ratios obtained in the remaining 15 cases showed a significantly higher rectosigmoid length (redundancy) in children with dyschezia, 18.47 vs. 9.75 (p < 0.001). The rectosigmoid redundancy, a congenital anomaly already reported as a cause of refractory constipation, may be present in children with infant dyschezia. Full article
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Article
Comparison of Different Nutritional Screening Approaches and the Determinants of Malnutrition in Under-Five Children in a Marginalized District of Punjab Province, Pakistan
Children 2022, 9(7), 1096; https://doi.org/10.3390/children9071096 - 21 Jul 2022
Viewed by 337
Abstract
Objectives: This research measures the occurrence of malnutrition amongst under-five children in the Rahimyar Khan district of Southern Punjab in Pakistan. Employing different anthropometric measurement approaches such as (1) conventional indices (HAZ, WAZ, and WHZ), (2) CIAF, (3) BMI-for-age, and (4) MUAC, we [...] Read more.
Objectives: This research measures the occurrence of malnutrition amongst under-five children in the Rahimyar Khan district of Southern Punjab in Pakistan. Employing different anthropometric measurement approaches such as (1) conventional indices (HAZ, WAZ, and WHZ), (2) CIAF, (3) BMI-for-age, and (4) MUAC, we compare their estimated results and examine the relationship between socioeconomic determinants and different anthropometric indicators. Methods: The study employs a proportional purposive random sampling method to collect data from 384 rural households in the community-based study using a self-administered survey and following the Lady Health Workers (LHWs) registered records. The nutritional status of 517 under-five children is measured with references to WHO (2009) child growth standards. Furthermore, the investigation used the model of binary logistic regression to measure the impact of socioeconomic factors on child malnutrition. Results: Compared with other approaches, the CIAF identifies more malnourished children (63%). The results of binary logistic regression illustrate that all the explanatory variables indicate a more significant empirical association with CIAF than conventional indices, BMI-for-age, and MUAC. Conclusion: CIAF is a more reliable tool for assessing child nutrition because it not only demonstrates more accurate estimates of malnutrition but also recognizes children with multiple anthropometric failures. Full article
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Review
Developmental Coordination Disorder and Most Prevalent Comorbidities: A Narrative Review
Children 2022, 9(7), 1095; https://doi.org/10.3390/children9071095 - 21 Jul 2022
Viewed by 285
Abstract
This narrative review describes, in detail, the relationships between Developmental Coordination Disorder (DCD) and most prevalent associated comorbidities in their complexity, heterogeneity and multifactoriality. The research has been conducted on the main scientific databases, excluding single case papers. Blurred borders between the different [...] Read more.
This narrative review describes, in detail, the relationships between Developmental Coordination Disorder (DCD) and most prevalent associated comorbidities in their complexity, heterogeneity and multifactoriality. The research has been conducted on the main scientific databases, excluding single case papers. Blurred borders between the different nosographic entities have been described and advances in this field have been highlighted. In this multifaceted framework a specific profiling for co-occurring DCD, ADHD and ASD signs and symptoms is proposed, confirming the need for a multidisciplinary approach to define new diagnostic paradigms in early childhood. Full article
(This article belongs to the Special Issue Impact of Developmental Coordination Disorder on Children)
Article
Access to Care for US Children with Co-Occurrence of Autism Spectrum Disorder and Epilepsy
Children 2022, 9(7), 1094; https://doi.org/10.3390/children9071094 - 21 Jul 2022
Viewed by 254
Abstract
Epilepsy is a common comorbidity among children with autism spectrum disorder (ASD). There is a lack of understanding of the inequality in access to care for children with co-occurring ASD and epilepsy (ASD-EP). The purpose of this study is to examine key indicators [...] Read more.
Epilepsy is a common comorbidity among children with autism spectrum disorder (ASD). There is a lack of understanding of the inequality in access to care for children with co-occurring ASD and epilepsy (ASD-EP). The purpose of this study is to examine key indicators for access to care and care coordination for children with ASD-EP in the US National Survey of Children’s Health (NSCH). Data were collected from the 2017–2019 NSCH. Our analytic sample included children with ASD without epilepsy (N = 2150), children with both ASD and epilepsy (N = 143), and children with epilepsy without ASD (N = 711). The dependent variables included important access to care indicators such as having usual sources of care, having adequate coverage, being frustrated in efforts to get service, and receiving care coordination. The independent variables included ASD-EP status, child demographics, and an intellectual disability (ID) diagnosis. Our results show that demographic characteristics such as sex, race, income level, and insurance type affect access to care. Inadequate access to healthcare was significantly higher among female children, children from low-income families, and children with ID. The access barriers among children with ASD-EP were more likely due to the interplay of multiple clinical and individual factors. Full article
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Review
Current Antithrombotic Therapy Strategies in Children with a Focus on Off-Label Direct Oral Anticoagulants—A Narrative Review
Children 2022, 9(7), 1093; https://doi.org/10.3390/children9071093 - 21 Jul 2022
Viewed by 374
Abstract
(1) Background: The incidence of thromboembolic events is relatively low in the general population, but it increases in hospitalized children and those who underwent thrombogenic procedures. Although the evidence regarding direct oral anticoagulants (DOACs) in children with venous thromboembolism (VTE) is growing, DOACs [...] Read more.
(1) Background: The incidence of thromboembolic events is relatively low in the general population, but it increases in hospitalized children and those who underwent thrombogenic procedures. Although the evidence regarding direct oral anticoagulants (DOACs) in children with venous thromboembolism (VTE) is growing, DOACs were excluded from existing guidelines due to the lack of reliable data at that moment. Therefore, current evidence on VTE management in children needs to be critically reviewed. (2) Methods: We have conducted a literature search in the Scopus, EMBASE, and MEDLINE databases using prespecified keywords to retrieve studies published between 2010 and 2022. (3) Results: Clinical trials highlighted that rivaroxaban and dabigatran had predictable pharmacokinetic and pharmacodynamic profiles in children, similar to those observed in adults. Dabigatran and rivaroxaban had a similar safety profile to standard therapy but improved thrombotic burden and resolution during follow-up. Most studies involving apixaban and edoxaban are ongoing, and results are awaited. (4) Conclusions: Dabigatran and rivaroxaban could be valid therapeutic options for VTE management in children. In the case of apixaban and edoxaban, results from ongoing clinical studies are required before using them in pediatric VTE. Full article
Article
Magnetic Resonance Imaging Findings in Infants with Severe Traumatic Brain Injury and Associations with Abusive Head Trauma
Children 2022, 9(7), 1092; https://doi.org/10.3390/children9071092 - 21 Jul 2022
Viewed by 274
Abstract
Young children with severe traumatic brain injury (TBI) have frequently been excluded from studies due to age and/or mechanism of injury. Magnetic resonance imaging (MRI) is now frequently being utilized to detect parenchymal injuries and early cerebral edema. We sought to assess MRI [...] Read more.
Young children with severe traumatic brain injury (TBI) have frequently been excluded from studies due to age and/or mechanism of injury. Magnetic resonance imaging (MRI) is now frequently being utilized to detect parenchymal injuries and early cerebral edema. We sought to assess MRI findings in infants with severe TBI, and to determine the association between specific MRI findings and mechanisms of injury, including abusive head trauma (AHT). MRI scans performed within the first 30 days after injury were collected and coded according to NIH/NINDS Common Data Elements (CDEs) for Neuroimaging in subjects age < 2 years old with severe TBI enrolled in the Approaches and Decisions in Acute Pediatric Traumatic Brain Injury Trial. Demographics and injury characteristics were analyzed. A total of 81 children were included from ADAPT sites with MRI scans. Median age was 0.77 years and 57% were male. Most common MRI finding was ischemia, present in 57/81 subjects (70%), in a median of 7 brain regions per subject. Contusion 46/81 (57%) and diffuse axonal injury (DAI) 36/81 (44.4%) subjects followed. Children were dichotomized based on likelihood of AHT with 43/81 subjects classified as AHT. Ischemia was found to be significantly associated with AHT (p = 0.001) and “inflicted” injury mechanism (p = 0.0003). In conclusion, the most common intracerebral injury seen on MRI of infants with severe TBI was ischemia, followed by contusion and DAI. Ischemia was associated with AHT, and ischemia affecting > 4 brain regions was predictive of AHT. Full article
(This article belongs to the Special Issue Pediatric Neurocritical Care and Neurotrauma Recovery)
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Article
Being Deaf in Mainstream Schools: The Effect of a Hearing Loss in Children’s Playground Behaviors
Children 2022, 9(7), 1091; https://doi.org/10.3390/children9071091 - 21 Jul 2022
Viewed by 289
Abstract
Naturalistic playground observations are a rich source of information when studying the social interactions of preschool children. On the playground, children can interact with their peers, explore different places and activities, and engage in different types of play. For deaf and hard of [...] Read more.
Naturalistic playground observations are a rich source of information when studying the social interactions of preschool children. On the playground, children can interact with their peers, explore different places and activities, and engage in different types of play. For deaf and hard of hearing (DHH) children, interactions at a playground can be more difficult because of the large number of auditory stimuli surrounding them. Constraints in the access to the social world on the playground might hamper DHH children’s interactions with their typically hearing (TH) peers, activities, and play. This pilot study aimed to examine the playground behaviors of preschool DHH children across three aspects: social levels, type of activities, and play choices. For this purpose, 12 preschool DHH children were observed during recess time, and their behaviors were coded and compared to their 85 TH peers. The preliminary findings indicate that DHH children spend less time in social interactions compared to their TH peers and that they still face difficulties when socially engaging with their TH peers. These findings suggest that interventions should focus on three aspects: the physical environment awareness of TH peers about communicating with DHH children, and the use of exercise play to facilitate social interactions between DHH children and their TH peers. Full article
(This article belongs to the Special Issue Child Psychomotricity: Development, Assessment, and Intervention)
Article
Survey on Untethering of the Spinal Cord and Urological Manifestations among Spina Bifida Patients in Malaysia
Children 2022, 9(7), 1090; https://doi.org/10.3390/children9071090 - 21 Jul 2022
Viewed by 405
Abstract
The incidence and severity of urinary tract infections (UTIs) due to spina bifida is poorly understood in Malaysia. Tethering of the spinal cord is a pathological fixation of the cord in the vertebral column that can result in neurogenic bladder dysfunction and other [...] Read more.
The incidence and severity of urinary tract infections (UTIs) due to spina bifida is poorly understood in Malaysia. Tethering of the spinal cord is a pathological fixation of the cord in the vertebral column that can result in neurogenic bladder dysfunction and other neurological problems. It occurs in patients with spina bifida, and the authors of this study sought to investigate the impact of untethering on the urological manifestations of children with a tethered cord, thereby consolidating a previously known understanding that untethering improves bladder and bowel function. Demographic and clinical data were collected via an online questionnaire and convenient sampling techniques were used. A total of 49 individuals affected by spina bifida participated in this study. UTIs were reported based on patients’ observation of cloudy and smelly urine (67%) as well as urine validation (60%). UTI is defined as the combination of symptoms and factoring in urine culture results that eventually affects the UTI diagnosis in spina bifida individuals irrespective of CISC status. Furthermore, 18% of the respondents reported being prescribed antibiotics even though they had no history of UTI. Therefore, indiscriminate prescription of antibiotics by healthcare workers further compounds the severity of future UTIs. Employing CISC (73%) including stringent usage of sterile catheters (71%) did not prevent patients from getting UTI. Overall, 33% of our respondents reported manageable control of UTI (0–35 years of age). All individuals below the age of 5 (100%, n = 14) were seen to have improved urologically after the untethering surgery under the guidance of the Malaysia NTD support group. Improvement was scored and observed using KUB (Kidneys, Ureters and Bladder) ultrasound surveillance before untethering and continued thereafter. Spina bifida individuals may procure healthy bladder and bowel continence for the rest of their lives provided that neurosurgical and urological treatments were sought soon after birth and continues into adulthood. Full article
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Article
Structural Equation Modeling of Common Cognitive Abilities in Preschool-Aged Children Using WPPSI-IV and BRIEF-P
Children 2022, 9(7), 1089; https://doi.org/10.3390/children9071089 - 21 Jul 2022
Viewed by 199
Abstract
Various studies have addressed the relationship between intelligence and executive functions (EF). There is widespread agreement that EF in preschool children is a unitary construct in which the subordinate factors of Updating, Inhibition, and Shifting are still undifferentiated and correlate moderately with a [...] Read more.
Various studies have addressed the relationship between intelligence and executive functions (EF). There is widespread agreement that EF in preschool children is a unitary construct in which the subordinate factors of Updating, Inhibition, and Shifting are still undifferentiated and correlate moderately with a general factor of intelligence (g). The aim of this study is to investigate the common structural relationship between these two constructs using confirmatory factor analysis. Furthermore, we intend to close the gap of more daily life-associated executive functions and replicate findings in preschool-aged children. Data from a sample of N = 124 average developed children without severe impairments (aged 4 years 0 months–6 years 11 months) were analyzed using the data pool of the standardization and validation studies on the German Wechsler Preschool and Primary Scale of Intelligence—Fourth Edition. Additionally, Executive functions were assessed using a standardized parent-completed questionnaire (BRIEF-P) on their children’s everyday behavior. A second-order factor solution revealed that a model with a loading of the common factor of general intelligence (g-factor) onto the EF factor fits the data best. To specify possible method effects due to different sources of measurements, a latent method factor was generated. The results indicate a heterogeneous method effect and a decreasing factor loading from g on to EF while controlling for the method factor. Full article
Article
The Association of Sugar-Sweetened Beverages to Children’s Weights Status Is Moderated by Frequency of Adding Sugars and Sleep Hours
Children 2022, 9(7), 1088; https://doi.org/10.3390/children9071088 - 20 Jul 2022
Viewed by 308
Abstract
Adding extra sugars in milk and the moderating effect of sleep has yet to be investigated, setting the aim of this study. A total of 1361 school-aged children were included, aged 10–12 years old, by randomly sampling schools. Data were interview-obtained by trained [...] Read more.
Adding extra sugars in milk and the moderating effect of sleep has yet to be investigated, setting the aim of this study. A total of 1361 school-aged children were included, aged 10–12 years old, by randomly sampling schools. Data were interview-obtained by trained personnel using a validated 17-item food frequency questionnaire, with specifics on type of milk and extra sugar additions. Analyses were stratified by average recommended hours of sleep. Predictive probability margins were obtained following necessary adjustments. Mean BMI was significantly lower, the level of SSB intake was higher, and the prevalence of adding sugars to milk four or more times per week was higher in children that slept ≥10 h. Most children (64%) consumed full fat milk, 21% had low fat, and 19.7% chocolate milk, with a significantly larger proportion of overweight or obese children consuming full fat or chocolate milk, also adding extra sugars four or more times per week (4.1% compared to 9.6%, and 12.2% compared to 39.5%, respectively). The predictive probability of being overweight or obese exponentially increased for children consuming >0.5 SSB/day while also adding sugars to their milk frequently, although this effect remained significant only for children sleeping <10 h/day. In conclusion, to accurately address the effect of SSBs on children’s body weight, frequency of any type of sugar addition in milk should be accounted for, as well as average sleep hours that may further moderate the effect. Full article
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Article
The Impact of Insulin-Induced Lipodystrophy on Glycemic Variability in Pediatric Patients with Type 1 Diabetes
Children 2022, 9(7), 1087; https://doi.org/10.3390/children9071087 - 20 Jul 2022
Viewed by 277
Abstract
Lipodystrophy is the most common dermatological complication in patients with diabetes on insulin therapy. Despite the high frequency of lipodystrophy, there are still several difficulties in giving advice about avoidance into practice among children and adolescents with type 1 diabetes and their caregivers. [...] Read more.
Lipodystrophy is the most common dermatological complication in patients with diabetes on insulin therapy. Despite the high frequency of lipodystrophy, there are still several difficulties in giving advice about avoidance into practice among children and adolescents with type 1 diabetes and their caregivers. This cross-sectional study aims to evaluate the prevalence of insulin-induced lipodystrophy in a cohort of pediatric patients with type 1 diabetes, to identify associated clinical factors and to assess its influence on glycemic control. Two hundred and twelve patients attending our Diabetes Center during a three-month period were enrolled. The presence of lipodystrophy was assessed by inspection and palpation procedures. Demographic and clinical data including type of treatment, frequency of rotation of insulin administration sites, and glucose metrics of the previous 30 days were assessed and statistically analyzed. Prevalence of lipohypertrophy was 44.3%. Two patients were affected by lipoatrophy (0.9%). Improper rotation of insulin administration sites and low awareness on lipodystrophy were associated to the occurrence of this skin condition (p = 0.050 and p = 0.005, respectively). When comparing patients with and without lipodystrophy, a significant difference in glycemic variability parameters was detected (p = 0.036 for coefficient of variation, p = 0.029 for standard deviation score of glucose levels). Lipodystrophy still represents a common complication in patients on insulin therapy. The present study reveals its negative impact on glycemic variability. This finding emphasizes the importance of prevention strategies to minimize the occurrence of this dermatological complication that may interfere with clinical history of the disease. Full article
(This article belongs to the Special Issue Type 1 Diabetes in Children: Clinical Advances and Future Challenges)
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Article
A Virtual Community of Practice: An International Educational Series in Pediatric Neurocritical Care
Children 2022, 9(7), 1086; https://doi.org/10.3390/children9071086 - 20 Jul 2022
Viewed by 386
Abstract
Pediatric neurocritical care (PNCC) is a rapidly growing field. Challenges posed by the COVID-19 pandemic on trainee exposure to educational opportunities involving direct patient care led to the creative solutions for virtual education supported by guiding organizations such as the Pediatric Neurocritical Care [...] Read more.
Pediatric neurocritical care (PNCC) is a rapidly growing field. Challenges posed by the COVID-19 pandemic on trainee exposure to educational opportunities involving direct patient care led to the creative solutions for virtual education supported by guiding organizations such as the Pediatric Neurocritical Care Research Group (PNCRG). Our objective is to describe the creation of an international, peer-reviewed, online PNCC educational series targeting medical trainees and faculty. More than 1600 members of departments such as pediatrics, pediatric critical care, and child neurology hailing from 75 countries across six continents have participated in this series over a 10-month period. We created an online educational channel in PNCC with over 2500 views to date and over 130 followers. This framework could serve as a roadmap for other institutions and specialties seeking to address the ongoing problems of textbook obsolescence relating to the rapid acceleration in knowledge acquisition, as well as those seeking to create new educational content that offers opportunities for an interactive, global audience. Through the creation of a virtual community of practice, we have created an international forum for pediatric healthcare providers to share and learn specialized expertise and best practices to advance global pediatric health. Full article
(This article belongs to the Special Issue Pediatric Neurocritical Care and Neurotrauma Recovery)
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Case Report
An Unusual Case of Torticollis: Split Cord Malformation with Vertebral Fusion Anomaly: A Case Report and a Review of the Literature
Children 2022, 9(7), 1085; https://doi.org/10.3390/children9071085 - 20 Jul 2022
Viewed by 292
Abstract
We describe the exceptional case of spinal cord malformation, associating neurenteric cyst, and cervical vertebral malformation, initially presenting as torticollis. A 4-month-old child presented with torticollis to the right since birth. A cervical spine X-ray revealed suspicious findings of fusion anomaly, and a [...] Read more.
We describe the exceptional case of spinal cord malformation, associating neurenteric cyst, and cervical vertebral malformation, initially presenting as torticollis. A 4-month-old child presented with torticollis to the right since birth. A cervical spine X-ray revealed suspicious findings of fusion anomaly, and a cervical spine CT showed extensive segmentation-fusion anomaly with an anterior and posterior bony defect in the C1–6 vertebrae. A cervical spine MRI revealed extensive segmentation-fusion anomaly with an anterior bony defect, and the spinal cord split forward and backward at the C3 level, showing two hemicords. The anterior half of the hemicord and dural sac extended to the right inferior side, towards the upper blind end of esophageal duplication, and the posterior half joined the hemicord at the back and C6 level. After multidisciplinary collaboration, follow-up and conservative treatment were planned. At 12 months, he had developmental delay, and torticollis showed little improvement. No neurological abnormalities have been observed. The patient plans to undergo surgery for the cervical spine fusion anomaly. Cervical spine X-rays should always be performed when assessing a patient with torticollis to rule out cervical vertebral segmentation anomalies, despite the rarity of the condition. Full article
(This article belongs to the Section Child Neurology)
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Article
Analysis of Minor Proteins Present in Breast Milk by Using WGA Lectin
Children 2022, 9(7), 1084; https://doi.org/10.3390/children9071084 - 20 Jul 2022
Viewed by 279
Abstract
Breast milk is a complex and dynamic biological fluid and considered an essential source of nutrition in early life. In its composition, the proteins have a relevant biological activity and are related to the multiple benefits demonstrated when compared with artificial milks derived [...] Read more.
Breast milk is a complex and dynamic biological fluid and considered an essential source of nutrition in early life. In its composition, the proteins have a relevant biological activity and are related to the multiple benefits demonstrated when compared with artificial milks derived from cow’s milk. Understanding human milk composition provides an important tool for health care providers toward the management of infant feeding and the establishment of breastfeeding. In this work, a new technique was developed to increase the knowledge of human milk, because many of the components remain unknown. To isolate minor proteins present in breast milk by using WGA lectin, breast milk was centrifuged to remove cells and separate the fat phase from the serum phase. The serum obtained was separated into two groups: control (n = 3; whole serum sample from mature milk) and WGA lectin (n = 3; sample processed with WGA lectin to isolate glycosylated proteins). The samples were analyzed by high-performance liquid chromatography coupled to mass spectrometry (HPLC/MS). A total of 84 different proteins were identified from all of the samples. In the WGA lectin group, 55 different proteins were isolated, 77% of which had biological functions related to the immune response. Of these proteins, there were eight WGA lectin group exclusives, and two had not previously been described in breast milk (polyubiquitin-B and POTE ankyrin domain family member F). Isolation by WGA lectin is a useful technique to detect minor proteins in breast milk and to identify proteins that could not be observed in whole serum. Full article
(This article belongs to the Special Issue Complementary Feeding in Newborns)
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Review
Old and New Aspects of H. pylori-Associated Inflammation and Gastric Cancer
Children 2022, 9(7), 1083; https://doi.org/10.3390/children9071083 - 20 Jul 2022
Viewed by 380
Abstract
H. pylori is involved in the development of 80% of gastric cancers and 5.5% of all malignant conditions worldwide. Its persistence within the host’s stomach causes chronic inflammation, which is a well-known hallmark of carcinogenesis. A wide range of cytokines was reported to [...] Read more.
H. pylori is involved in the development of 80% of gastric cancers and 5.5% of all malignant conditions worldwide. Its persistence within the host’s stomach causes chronic inflammation, which is a well-known hallmark of carcinogenesis. A wide range of cytokines was reported to be involved in the initiation and long-term persistence of this local and systemic inflammation. IL-8 was among the first cytokines described to be increased in patients with H. pylori infection. Although, this cytokine was initially identified to exert a chemoattracting effect that represents a trigger for the activation of inflammatory cells within H.-pylori-infected mucosa, more recent studies failed in encountering any association between IL-8 and H. pylori infection. IL-6 is a multifunctional, pleiotropic and multipotent cytokine involved in mediating the interaction between innate and adaptive immunity with a dichotomous role acting as both a proinflammatory and an anti-inflammatory cytokine depending on the signaling pathway. IL-1α functions as a promoter of angiogenesis and vascular endothelial cell proliferation in gastric carcinoma since it is closely related to H.-pylori-induced inflammation in children. IL-1β is an essential trigger and enhancer of inflammation. The association between a low IL-1β level and an increased TNF-α level might be considered a risk factor for peptic ulcer disease in the setting of H. pylori infection. IL-10 downregulates both cytotoxic inflammatory responses and cell-mediated immune responses. H. pylori uses the immunosuppressive role of IL-10 to favor its escape from the host’s immune system. TGFβ is a continuous inflammatory mediator that promotes the adherence of H. pylori to the host’s cells and their subsequent colonization. The role of H.-pylori-induced inflammatory responses in the onset of gastric carcinogenesis seems to represent the missing puzzle piece for designing effective preventive and therapeutic strategies in patients with H.-pylori-associated gastric cancer. Full article
(This article belongs to the Special Issue Childhood Helicobacter pylori Infection: Treatment and Prevention)
Article
Performance of Machine Learning Classifiers in Classifying Stunting among Under-Five Children in Zambia
Children 2022, 9(7), 1082; https://doi.org/10.3390/children9071082 - 20 Jul 2022
Viewed by 386
Abstract
Stunting is a global public health issue. We sought to train and evaluate machine learning (ML) classification algorithms on the Zambia Demographic Health Survey (ZDHS) dataset to predict stunting among children under the age of five in Zambia. We applied Logistic regression (LR), [...] Read more.
Stunting is a global public health issue. We sought to train and evaluate machine learning (ML) classification algorithms on the Zambia Demographic Health Survey (ZDHS) dataset to predict stunting among children under the age of five in Zambia. We applied Logistic regression (LR), Random Forest (RF), SV classification (SVC), XG Boost (XgB) and Naïve Bayes (NB) algorithms to predict the probability of stunting among children under five years of age, on the 2018 ZDHS dataset. We calibrated predicted probabilities and plotted the calibration curves to compare model performance. We computed accuracy, recall, precision and F1 for each machine learning algorithm. About 2327 (34.2%) children were stunted. Thirteen of fifty-eight features were selected for inclusion in the model using random forest. Calibrating the predicted probabilities improved the performance of machine learning algorithms when evaluated using calibration curves. RF was the most accurate algorithm, with an accuracy score of 79% in the testing and 61.6% in the training data while Naïve Bayesian was the worst performing algorithm for predicting stunting among children under five in Zambia using the 2018 ZDHS dataset. ML models aids quick diagnosis of stunting and the timely development of interventions aimed at preventing stunting. Full article
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Article
Differences between Creativity and Gender in Students with High Abilities Attending a School with Total Grouping
Children 2022, 9(7), 1081; https://doi.org/10.3390/children9071081 - 20 Jul 2022
Viewed by 297
Abstract
Background: Creativity is one of the most relevant aspects in students’ training. One of the purposes of the present work is to show the lack of differences between boys and girls in creativity; the other is the possibility of improving creativity among high-ability [...] Read more.
Background: Creativity is one of the most relevant aspects in students’ training. One of the purposes of the present work is to show the lack of differences between boys and girls in creativity; the other is the possibility of improving creativity among high-ability students who received specific training as part of their intra-curricular content in a total grouping program for gifted students. Method: The sample consisted of 42 students from first to third grade (13 females and 29 males) and 58 students from fourth to sixth grade (21 females and 37 males). Creativity was measured with the CREA test for younger students and with the PIC-N for older students. Training was carried out through an Integral Innovation and Creativity Program (PIIC). Results: The results showed no differences between genders, except in one of the graphic creativity scales (Details). There were improvements due to the training in all measures of narrative creativity and in the scale of elaboration of graphic creativity. Conclusions: The main conclusions are the importance of increasing creativity with specific programs and the need to improve interventions in graphic creativity. Full article
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Review
Going the Extra Mile: Why Clinical Research in Cystic Fibrosis Must Include Children
Children 2022, 9(7), 1080; https://doi.org/10.3390/children9071080 - 20 Jul 2022
Viewed by 347
Abstract
This is an exciting time for research and novel drug development in cystic fibrosis. However, rarely has the adage, “Children are not just little adults” been more relevant. This article is divided into two main sections. In the first, we explore why it [...] Read more.
This is an exciting time for research and novel drug development in cystic fibrosis. However, rarely has the adage, “Children are not just little adults” been more relevant. This article is divided into two main sections. In the first, we explore why it is important to involve children in research. We discuss the potential benefits of understanding a disease and its treatment in children, and we highlight that children have the same legal and ethical right to evidence-based therapy as adults. Additionally, we discuss why extrapolation from adults may be inappropriate, for example, medication pharmacokinetics may be different in children, and there may be unpredictable adverse effects. In the second part, we discuss how to involve children and their families in research. We outline the importance and the complexities of selecting appropriate outcome measures, and we discuss the role co-design may have in improving the involvement of children. We highlight the importance of appropriate staffing and resourcing, and we outline some of the common challenges and possible solutions, including practical tips on obtaining consent/assent in children and adolescents. We conclude that it is unethical to simply rely on extrapolation from adult studies because research in young children is challenging and that research should be seen as a normal part of the paediatric therapeutic journey. Full article
(This article belongs to the Special Issue Cystic Fibrosis in Children)
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Editorial
Key Concepts to Identify the Role of Orthopedics in Child Development
Children 2022, 9(7), 1079; https://doi.org/10.3390/children9071079 - 20 Jul 2022
Viewed by 266
Abstract
In order to examine the role of orthopedics in child development, longitudinal study designs are necessary [...] Full article
(This article belongs to the Special Issue The Role of Orthopedics in Child Development)
Article
Effect of COVID-19 Lockdown on Children’s Eating Behaviours: A Longitudinal Study
Children 2022, 9(7), 1078; https://doi.org/10.3390/children9071078 - 20 Jul 2022
Viewed by 340
Abstract
The COVID-19 pandemic has had a huge impact on children’s lifestyle and eating behaviour, resulting in an increase of obesity prevalence. The CEBQ (Children’s Eating Behaviour Questionnaire) is a validate questionnaire that investigates children’s eating behaviour. Knowing the psychological consequences of daily routine [...] Read more.
The COVID-19 pandemic has had a huge impact on children’s lifestyle and eating behaviour, resulting in an increase of obesity prevalence. The CEBQ (Children’s Eating Behaviour Questionnaire) is a validate questionnaire that investigates children’s eating behaviour. Knowing the psychological consequences of daily routine disruption during lockdown, we evaluated the changes in eating behaviours in a paediatric cohort before and during the lockdown period through the evaluation of the Italian version of the CEBQ. We prospectively enrolled children attending the pediatric clinic of the University of Campania ‘Luigi Vanvitelli’. All parents answered the parent-report version of the CEBQ before lockdown containment. During lockdown, the second survey was carried out by telephone call. The study sample included 69 children. Food responsiveness and emotional overeating subscales showed higher scores during lockdown compared to data before lockdown (p = 0.009 and p = 0.001, respectively). Conversely, desire to drink and satiety responsiveness showed lower scores at follow-up (p = 0.04 and p = 0.0001, respectively). No differences were observed for slowness in eating and enjoyment of food. Delta changes were higher in normal-weight children compared to children with obesity (p = 0.02). Our results confirm that containment measures during the COVID-19 pandemic have acted as triggers on certain eating behaviors that mostly predispose to an obesogenic manner. Full article
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Article
Inequities in Availability of Evidence-Based Birth Supports to Improve Perinatal Health for Socially Vulnerable Rural Residents
Children 2022, 9(7), 1077; https://doi.org/10.3390/children9071077 - 19 Jul 2022
Viewed by 355
Abstract
Rural residents in the United States (US) have disproportionately high rates of maternal and infant mortality. Rural residents who are Black, Indigenous, and People of Color (BIPOC) face multiple social risk factors and have some of the worst maternal and infant health outcomes [...] Read more.
Rural residents in the United States (US) have disproportionately high rates of maternal and infant mortality. Rural residents who are Black, Indigenous, and People of Color (BIPOC) face multiple social risk factors and have some of the worst maternal and infant health outcomes in the U.S. The purpose of this study was to determine the rural availability of evidence-based supports and services that promote maternal and infant health. We developed and conducted a national survey of a sample of rural hospitals. We determined for each responding hospital the county-level scores on the 2018 CDC Social Vulnerability Index (SVI). The sample’s (n = 93) median SVI score [IQR] was 0.55 [0.25–0.88]; for majority-BIPOC counties (n = 29) the median SVI score was 0.93 [0.88–0.98] compared with 0.38 [0.19–0.64] for majority-White counties (n = 64). Among counties where responding hospitals were located, 86.2% located in majority-BIPOC counties ranked in the most socially vulnerable quartile of counties nationally (SVI ≥ 0.75), compared with 14.1% of majority-White counties. In analyses adjusted for geography and hospital size, certified lactation support (aOR 0.36, 95% CI 0.13–0.97), midwifery care (aOR 0.35, 95% CI 0.12–0.99), doula support (aOR 0.30, 95% CI 0.11–0.84), postpartum support groups (aOR 0.25, 95% CI 0.09–0.68), and childbirth education classes (aOR 0.08, 95% CI 0.01–0.69) were significantly less available in the most vulnerable counties compared with less vulnerable counties. Residents in the most socially vulnerable rural counties, many of whom are BIPOC and thus at higher risk for poor birth outcomes, are significantly less likely to have access to evidence-based supports for maternal and infant health. Full article
Review
Acupuncture for Pain Management in Pediatric Patients with Sickle Cell Disease
Children 2022, 9(7), 1076; https://doi.org/10.3390/children9071076 - 19 Jul 2022
Viewed by 267
Abstract
Pain management in an acute vaso-occlusive episode for pediatric patients with sickle cell disease (SCD) is challenging and often is focused on opioids, IV fluids, regional anesthesia, ketamine infusions, and non-steroidal anti-inflammatory drugs (NSAIDs). Acupuncture has long been studied as an effective method [...] Read more.
Pain management in an acute vaso-occlusive episode for pediatric patients with sickle cell disease (SCD) is challenging and often is focused on opioids, IV fluids, regional anesthesia, ketamine infusions, and non-steroidal anti-inflammatory drugs (NSAIDs). Acupuncture has long been studied as an effective method of pain relief, although the use of acupuncture in pediatric patients with SCD during an acute vaso-occlusive pain episode is vastly understudied. This article provides a review of current research regarding the use of acupuncture as a pain treatment strategy for pediatric patients with SCD experiencing acute pain. A literature review of scientific papers published within the last ten years was conducted on the topic. Five primary literature articles on acupuncture for pain management in pediatric patients with SCD were reviewed. Acupuncture is feasible and acceptable, with statistically significant findings for effectiveness as an adjunct treatment for pain in this setting. It is concluded that acupuncture is a promising and understudied therapy for the treatment of pain during an acute pain episode in pediatric patients with SCD. Hopefully, this paper stimulates interest in this specific area of medicine and prompts future research studies to be conducted to reveal conclusive outcomes. Full article
Article
Caregivers’ Responses to Children’s Negative Emotions: Associations with Preschoolers’ Executive Functioning
Children 2022, 9(7), 1075; https://doi.org/10.3390/children9071075 - 19 Jul 2022
Viewed by 263
Abstract
There is a lack of knowledge regarding the connection between parental emotional responsiveness and children’s executive functioning (EF). This study aimed to explore the relations between caregivers’ reactions to their children’s distress and children’s EF. Mothers of 136 preschoolers reported their reactions to [...] Read more.
There is a lack of knowledge regarding the connection between parental emotional responsiveness and children’s executive functioning (EF). This study aimed to explore the relations between caregivers’ reactions to their children’s distress and children’s EF. Mothers of 136 preschoolers reported their reactions to their children’s negative emotions using the Coping with Children’s Negative Emotions Scale. Children’s EF was assessed through the mothers and teachers’ reports using the Behavioral Inventory of Executive Functioning for Preschool Children. Results showed that the mothers’ perceived use of negative emotional regulation responses (i.e., punitive and minimizing reactions) was associated with lower levels of EF in children, as reported by both mothers and teachers. The association between the mothers’ use of positive emotional regulation responses (i.e., problem-focused, emotion-focused, and expressive encouragement reactions) and children’s EF was not significant. Multiple regression analyses revealed that the mothers’ use of negative emotional regulation responses accounted for significant proportions of variance in EF indexes. These findings suggest that parental socialization of emotion could be important for children’s EF. Specifically, caregivers’ negative emotional regulation responses to children’s distress may serve as a risk factor for poorer EF in children. Efforts to improve children’s EF may be more effective when parental emotional responsiveness to their distress is considered. Full article
(This article belongs to the Section Child and Adolescent Psychiatry)
Article
Analysis of Supporting Factors Associated with Exclusive Breastfeeding Practice in the Urban Setting during the COVID-19 Pandemic
Children 2022, 9(7), 1074; https://doi.org/10.3390/children9071074 - 19 Jul 2022
Viewed by 305
Abstract
Breastfeeding mothers have had limited access to breastfeeding support throughout the COVID-19 pandemic. This study aims to investigate breastfeeding practices during the COVID-19 period and to determine the factors associated with supporting exclusive breastfeeding. A sequential explanatory mixed methods approach was adopted, including [...] Read more.
Breastfeeding mothers have had limited access to breastfeeding support throughout the COVID-19 pandemic. This study aims to investigate breastfeeding practices during the COVID-19 period and to determine the factors associated with supporting exclusive breastfeeding. A sequential explanatory mixed methods approach was adopted, including a quantitative method in the first phase and qualitative method in the second phase. Mothers whose babies were aged over 6 months to 24 months old from July to September 2021 in Pekanbaru City were selected as research subjects. Data analysis was performed with multivariate and deductive content analysis. Of 156 participants, 97 mothers (62.2%) exclusively breastfed their babies. Of those, mothers who delivered exclusive breastfeeding worked less than eight hours per day, were aged 17–25 and had low education. Though by using exclusive breastfeeding practice as a reference, associated supports, including emotional, instrumental, appraisal and information regarding exclusive breastfeeding practice were insignificant; however, mothers who practice exclusive breastfeeding had higher information support. During the COVID-19 pandemic period, the informational support factor was found to be important to achieve the successful exclusive breastfeeding practice. Full article
Article
Craniofacial Morphologic Predictors for Passive Myofunctional Therapy of Pediatric Obstructive Sleep Apnea Using an Oral Appliance with a Tongue Bead
Children 2022, 9(7), 1073; https://doi.org/10.3390/children9071073 - 18 Jul 2022
Viewed by 431
Abstract
We conducted this retrospective study to identify potential clinical, polysomnographic, and cephalometric predictors for the treatment outcomes of a tongue-beaded oral appliance (OA) in children with obstructive sleep apnea syndrome (OSAS). In total, 63 patients—50 boys and 13 girls ranging in age from [...] Read more.
We conducted this retrospective study to identify potential clinical, polysomnographic, and cephalometric predictors for the treatment outcomes of a tongue-beaded oral appliance (OA) in children with obstructive sleep apnea syndrome (OSAS). In total, 63 patients—50 boys and 13 girls ranging in age from 4 to 16 years—underwent OA treatment nightly for at least 6 months. A baseline digital lateral cephalometric radiograph was obtained for each patient. Multivariate logistic regression analysis was performed to examine predictors for the treatment outcome based on the clinical and cephalometric measurements. Overall, 28 patients responded to the treatment (post-treatment improvement > 50% or apnea–hypopnea index (AHI) < 1/h), and 35 did not (post-treatment improvement < 50% and AHI ≥ 1/h). Significantly larger cranial base angle (SNBa), smaller lower gonial angle (LGo Angle), and shorter length of anterior cranial base (SN) were found in responders. Smaller lower gonial angle (LGo Angle) and smaller anterior cranial base (SN) predict a favorable outcome for pediatric OSAS using a tongue-beaded OA. This finding will equip practitioners with additional insights when selecting suitable candidates for OA therapy in pediatric patients. Full article
(This article belongs to the Special Issue Advances in Pediatric Dentistry and Juvenile Orthodontics)
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Review
Infancy Dietary Patterns, Development, and Health: An Extensive Narrative Review
Children 2022, 9(7), 1072; https://doi.org/10.3390/children9071072 - 18 Jul 2022
Viewed by 488
Abstract
Correct dietary patterns are important for a child’s health from birth to adulthood. Understanding a child’s health as a state of entire physical, mental, and social well-being is essential. However, reaching adulthood in a complete health proper state is determined by feeding and [...] Read more.
Correct dietary patterns are important for a child’s health from birth to adulthood. Understanding a child’s health as a state of entire physical, mental, and social well-being is essential. However, reaching adulthood in a complete health proper state is determined by feeding and dietary habits during preconception, pregnancy, or children infancy. Different factors, such as the mother’s lifestyle, culture, or socioeconomic status, are crucial during all these phases. In this review, we aimed to assess the long-term associations between infancy dietary patterns and health and their influence on development and growth. To reach this objective, a consensus critical review was carried out using primary sources such as scientific articles, and secondary bibliographic indexes, databases, and web pages. PubMed, SciELO, and Google Scholar were the tools used to complete this research. We found that high-income countries promote high-calorie foods and, consequently, obesity problems among children are rising. However, undernutrition is a global health issue concerning children in low- and middle-income countries; thus, parental socioeconomic status in early life is essential to children’s health and development, showing that biological, social, and environmental influences are increased risk factors for chronic diseases. This narrative review is aimed to collect evidence for early nutritional intervention and future disease prevention. Full article
Article
Assessing Individual- and Community-Level Variability in Predictors of Neonatal, Infant, and Under-Five Child Mortality in Ethiopia Using a Multilevel Modeling Approach
Children 2022, 9(7), 1071; https://doi.org/10.3390/children9071071 - 18 Jul 2022
Viewed by 290
Abstract
Background: In low-and middle-income countries, child mortality rates are basic indicators of a country’s socio-economic situation and quality of life. The Ethiopian government is currently working to reduce child mortality to accomplish its long-term development goals. Using data from the Ethiopian Mini Demographic [...] Read more.
Background: In low-and middle-income countries, child mortality rates are basic indicators of a country’s socio-economic situation and quality of life. The Ethiopian government is currently working to reduce child mortality to accomplish its long-term development goals. Using data from the Ethiopian Mini Demographic and Health Survey, 2019, this study analyzed the determinants of child mortality in Ethiopia. Methods: A total of 4806 children were considered in the final analyses. Multivariate analysis was used to estimate the effects of the predictors simultaneously on each child mortality outcome. Results: The findings revealed that 31.6% of children died during the neonatal stage, 39.1% during the infant stage, and 48.5% during the under-five stage. Variation in child mortality was discovered between Ethiopian community clusters, with the result of heterogeneity between clusters on newborn mortality (χ2 = 202.4, p-value < 0.0001), (χ2 = 777.35, p-value < 0.0001), and (χ2 = 112.92, p-value < 0.0001). Children’s neonatal, infant, and under-five mortality intracluster correlation coefficient (ICC) were 0.35, 0.33, and 0.36, respectively, across communities. Conclusions: In Ethiopia, under-five mortality remains a serious public health issue, with wide variations and high rates among community clusters. Intervention measures focusing on lowering rates of household poverty, increasing education opportunities, and improving access to health care could assist in reducing child mortality in Ethiopia. Full article
(This article belongs to the Section Pediatric Nursing)
Systematic Review
Hyponatremia—A New Diagnostic Marker for Complicated Acute Appendicitis in Children: A Systematic Review and Meta-Analysis
Children 2022, 9(7), 1070; https://doi.org/10.3390/children9071070 - 18 Jul 2022
Viewed by 431
Abstract
Background: Acute appendicitis in the pediatric population remains a diagnostic challenge for clinicians. Despite many biochemical markers, imaging modalities and scoring systems, initial misdiagnosis and complication rates are high in children. This suggests the need for investigations directed towards new diagnostic tools to [...] Read more.
Background: Acute appendicitis in the pediatric population remains a diagnostic challenge for clinicians. Despite many biochemical markers, imaging modalities and scoring systems, initial misdiagnosis and complication rates are high in children. This suggests the need for investigations directed towards new diagnostic tools to aid in the diagnosis. Recent studies have shown a correlation between serum sodium levels and complicated appendicitis. Although the exact reasons for hyponatremia in patients with complicated appendicitis are not known, there is persuasive data to support the role of pro-inflammatory cytokines such as IL-6 in the non-osmotic release of antidiuretic hormone. This meta-analysis aims to investigate all available data on hyponatremia as a diagnostic marker of complicated appendicitis in the pediatric population. Methods: The literature search was conducted by two independent investigators according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The scientific databases (PubMed, EMBASE, Web of Science, and Scopus) were systematically searched for relevant studies using the keywords (hyponatremia) AND (appendicitis) AND (children). The methodological quality was assessed using a validated scale, and RevMan 5.4 software was utilized for pooled analysis. Results: Seven studies were included in the final meta-analysis, five of which were retrospective. A total of 1615 and 2808 cases were distributed into two groups: group A with complicated appendicitis and group B with uncomplicated acute appendicitis, respectively. The studies compared serum sodium levels of patients among the groups. Pooling the data demonstrated significantly lower serum sodium levels in children with complicated appendicitis vs. the non-complicated appendicitis (WMD: −3.29, 95% CI = −4.52 to −2.07, p < 0.00001). The estimated heterogeneity among the included studies was substantial and statistically significant (I2 = 98%, p < 0.00001). Conclusion: The results of the present meta-analysis indicate that hyponatremia has potential to be utilized as a biochemical marker in the diagnosis of complicated appendicitis in the pediatric population. However, well designed prospective diagnostic efficiency studies are essential to consolidate the association between hyponatremia and complicated acute appendicitis. Full article
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