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Diagnostics
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Advances in Diagnosis and Management of Pediatric Diseases
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Advances in Diagnosis and Management of Pediatric Diseases

A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Pathology and Molecular Diagnostics".

Deadline for manuscript submissions: closed (31 March 2024) | Viewed by 15421

Special Issue Editor

Dr. Ivan Pavić

E-Mail Website
Guest Editor
Department of Pulmonology, Immunology, Rheumatology and Allergology, Children's Hospital Zagreb, Zagreb, Croatia
Interests: pediatric pulmonology; bronchoscopy and bronchoalveolar lavage; noninvasive ventilation; respiratory manifestations of gastro-oesophageal reflux in children; chronic lung disease

Special Issue Information

Dear Colleagues,

Over the past 20 years, diagnostic tests for all areas of pediatrics have revolutionized the treatment of children suffering from various disorders. These tests help not only in the diagnosis, but also in the care and treatment of affected children. In addition, it is important to keep pediatricians and other professionals up to date on advances in the diagnosis and treatment of pediatric disorders.

This Special Issue, entitled "Advances in Diagnosis and Management of Pediatric Diseases", is designed to address high-quality research studies from all areas of pediatrics in both scientific and clinical contexts. This Special Issue is intended to disseminate information on all scientific principles and clinical aspects related to pediatric topics, especially the diagnosis and management of specific diseases according to the most important problems.

Potential areas of interest may include new and substantive developments that focus on the assessment and stabilization of the most commonly encountered conditions in pediatric practice.

This Special Issue focuses on the major diagnostic and therapeutic modalities used in the evaluation of pediatric patients with various conditions and is intended to present current information on the benefits and limitations of each diagnostic and therapeutic approach for a variety of conditions encountered in pediatric practice.

Submissions addressing innovative diagnostic and therapeutic applications with scientific and/or clinical utility will be considered for publication. Research articles and review articles related to diagnostic and therapeutic approaches are welcome.

Overall, basic research and clinical studies with in vitro, in situ, or in vivo designs that address various pediatric conditions that are clinically relevant to the topic will be considered.

Dr. Ivan Pavić
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Diagnostics is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

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Further information on MDPI's Special Issue policies can be found here.

Published Papers (7 papers)

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12 pages, 249 KiB  
Article
Assessment of Medical Test Overuse and Its Impact on Pediatric Emergency Department Outcomes in Upper Respiratory Tract Infections in a University Hospital in Lithuania
by Melita Nedzinskaite, Dagna Karakaite, Erika Zubrickyte and Lina Jankauskaite
Diagnostics 2024, 14(10), 970; https://doi.org/10.3390/diagnostics14100970 - 7 May 2024
Cited by 1 | Viewed by 2303
Abstract
Medical overuse poses potential risks to patients and contributes to increasing healthcare costs, pediatric emergency departments (PED) in particular. Often, upper respiratory tract infection (URTI) cases are viral-induced and self-limiting, and they do not require specific investigations or treatment. We conducted a retrospective [...] Read more.
Medical overuse poses potential risks to patients and contributes to increasing healthcare costs, pediatric emergency departments (PED) in particular. Often, upper respiratory tract infection (URTI) cases are viral-induced and self-limiting, and they do not require specific investigations or treatment. We conducted a retrospective study from 1 December 2021 to 31 January 2022, thereby aiming to identify the common tests and factors influencing specific diagnostic and treatment decisions for URTI in PED. In total, 307 (74.9%) URTI cases underwent complete blood count (CBC) tests, 312 (76.1%) were subjected to C-reactive protein (CRP) tests, and 110 (26.8%) received urinalysis tests. Patients with a longer duration of fever and a physician‘s suspicion of bacterial infection were more likely to receive CBC, CRP, and/or urinalysis tests (p < 0.05). Moreover, 75.1% of the cases were classified as viral URTIs, 9.8% were bacterial URTIs, and 15.1% were unspecified. Notably, 86 (20.1%) children received antibiotics and antibiotic prescription correlated with age, tonsillitis diagnosis, CRP values higher than 30 mg/L, and a CBC of p < 0.05. Patients triaged in the second or third categories were three times more likely to be observed for 24 h compared to patients with URTI and the fourth triage category (p < 0.05). This study highlights the need for interventions to improve the appropriateness of emergency service utilization, thereby emphasizing the importance of judicious decision making in managing pediatric URTIs. Full article
(This article belongs to the Special Issue Advances in Diagnosis and Management of Pediatric Diseases)
14 pages, 1530 KiB  
Article
Determination of l-Asparaginase Activity and Its Therapeutic Monitoring in Children with Hematological Malignancies in a Single Croatian Center
by Jasna Lenicek Krleza, Ana Katusic Bojanac and Gordana Jakovljevic
Diagnostics 2024, 14(6), 623; https://doi.org/10.3390/diagnostics14060623 - 15 Mar 2024
Cited by 7 | Viewed by 2416
Abstract
Background: Among malignant diseases which develop during childhood, hematological cancers, such as leukemias and lymphomas, are the most common. Outcomes have greatly improved due to the refinement of multiagent chemotherapy regimens that include enhanced asparaginase therapy. In this study, we aimed to evaluate [...] Read more.
Background: Among malignant diseases which develop during childhood, hematological cancers, such as leukemias and lymphomas, are the most common. Outcomes have greatly improved due to the refinement of multiagent chemotherapy regimens that include enhanced asparaginase therapy. In this study, we aimed to evaluate our experiences related to the analytical and clinical significance of determining l-Asparaginase activity. Methods: Since 2016, the Laboratory of the Children’s Hospital Zagreb has routinely measured l-Asparaginase activity and to date, has measured more than 280 examples of activity in a total of 57 children with hematological malignancy treated at the Pediatric Oncology Department of the Children’s Hospital Zagreb. Three asparaginase products were available: native E. colil-Asparaginase; a pegylated form of this enzyme; and a native product from Erwinia chrysanthemi. A retrospective data analysis was performed. Results: Out of the fifty-seven children, seven had an allergic reaction (12.3%), five (8.8%) had silent inactivation, and seven (12.3%) developed acute pancreatitis. Allergic reactions and silent inactivation were more common in children treated with native E. colil-Asparaginase, while pancreatitis was more common in children treated with the pegylated form. Conclusions: The monitoring of l-Asparaginase activity may help to optimize therapy by identifying patients with ‘silent inactivation’, and/or by dose correction when l-Asparaginase activity is too high (slow elimination). Full article
(This article belongs to the Special Issue Advances in Diagnosis and Management of Pediatric Diseases)
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11 pages, 1559 KiB  
Article
Safety beyond Sight: Handheld Metal Detectors as Diagnostic Allies in the Management of Children Suspected to have Ingested Foreign Bodies
by Tomaz Krencnik, Tadej Jalsovec, Martina Klemenak, Petra Riznik and Jernej Dolinsek
Diagnostics 2024, 14(4), 356; https://doi.org/10.3390/diagnostics14040356 - 6 Feb 2024
Viewed by 1987
Abstract
Background. Foreign body (FB) ingestion remains a common cause of pediatric emergency department referrals, and the gold standard for detection is whole-digestive-tract radiographic examination. Our study explores whether handheld metal detectors (HHMD) can effectively identify the presence and location of ingested metal objects, [...] Read more.
Background. Foreign body (FB) ingestion remains a common cause of pediatric emergency department referrals, and the gold standard for detection is whole-digestive-tract radiographic examination. Our study explores whether handheld metal detectors (HHMD) can effectively identify the presence and location of ingested metal objects, potentially reducing the need for additional radiographic examination. Methods. We collected medical data from children with suspected metal FB ingestion who were referred to our emergency department (October 2017–March 2023), focusing on object type and correlating metal detector findings with radiographic images. Results. Data from 43 children (39.5% female; mean age: 4 y) referred to our emergency department were analyzed. Coins (32.6%), button batteries (18.6%), and hairpins (11.6%) were the most common ingested objects. Metal detectors detected the presence of FBs in 81.4% of cases (sensitivity: 89.7%; specificity: 100%). Radiographs, taken for 40 children, showed that the most common locations were the stomach (37%) and intestine (33%). The metal detector signals matched the radiography results in 69.8% of cases. According to HHMD, 34.9% of objects were accessible via endoscopy, contrasting with 51.2% via radiography (p < 0.05). Conclusion. While the findings obtained using handheld metal detectors often correlate well with radiograph findings in detecting metal FBs, for an important number of children, this confirmation is lacking, especially when determining the exact location of an object. Full article
(This article belongs to the Special Issue Advances in Diagnosis and Management of Pediatric Diseases)
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12 pages, 910 KiB  
Article
Evolving Landscape of Paediatric Inflammatory Bowel Disease: Insights from a Decade-Long Study in North-East Slovenia on Incidence, Management, Diagnostic Delays, and Early Biologic Intervention
by Martina Klemenak, Manca Zupan, Petra Riznik, Tomaz Krencnik and Jernej Dolinsek
Diagnostics 2024, 14(2), 188; https://doi.org/10.3390/diagnostics14020188 - 15 Jan 2024
Viewed by 1905
Abstract
Background: In the past decade, significant progress has been achieved in the care of children with inflammatory bowel disease (IBD). Our study concentrated on assessing the incidence and management of IBD in children in North-Eastern Slovenia over a 10-year period. Methods: Medical data [...] Read more.
Background: In the past decade, significant progress has been achieved in the care of children with inflammatory bowel disease (IBD). Our study concentrated on assessing the incidence and management of IBD in children in North-Eastern Slovenia over a 10-year period. Methods: Medical data from children and adolescents diagnosed with IBD in North-Eastern Slovenia (2014–2023) was analysed. Disease incidence and management of children were assessed. Findings were compared between two periods (2014–2019 and 2020–2023, coinciding with the COVID-19 pandemic). Results: 87 patients (median age 15.5 year; 50.6% male) with IBD (43.7% Crohn’s disease (CD)), diagnosed between 2014 and 2023 were included. Extraintestinal manifestations were more common in CD than ulcerative colitis (UC) (15.8% vs. 2.4%, p < 0.05). Median delay from symptom onset to diagnosis was 2 months, lower in UC than CD (NS). Mean annual IBD incidence per 100,000 children aged 0 to 19 years was 6.4 (95% CI 4.4–8.3), slightly lower for CD than UC (2.8/100,000 vs. 3.1/100,000). In the second period, IBD incidence significantly rose (9.1 vs. 4.6, p < 0.05). During this period, 53% of CD patients transitioned to biological treatment within three months of diagnosis. Conclusion: IBD incidence rose among children in North-Eastern Slovenia over the past decade. Additionally, more children with CD underwent biological therapy in the second period. Full article
(This article belongs to the Special Issue Advances in Diagnosis and Management of Pediatric Diseases)
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16 pages, 1129 KiB  
Article
Management of Childhood Iron Deficiency Anemia in a Developed Country—A Multi-Center Experience from Croatia
by Izabela Kranjčec, Nuša Matijašić Stjepović, Domagoj Buljan, Lucija Ružman, Karolina Malić Tudor, Marijana Jović Arambašić, Maja Pavlović, Nada Rajačić, Kristina Lovrinović Grozdanić, Tomislava Brković, Krešimir Šantić and Jelena Roganović
Diagnostics 2023, 13(24), 3607; https://doi.org/10.3390/diagnostics13243607 - 5 Dec 2023
Cited by 4 | Viewed by 2620
Abstract
Iron deficiency anemia (IDA) continues to be a global public health concern, mostly in the developing countries. However, precise epidemiological data on childhood IDA in Croatia are lacking. In order to establish its frequency, underlying etiologies, the rationale for tertiary care visits, diagnostic [...] Read more.
Iron deficiency anemia (IDA) continues to be a global public health concern, mostly in the developing countries. However, precise epidemiological data on childhood IDA in Croatia are lacking. In order to establish its frequency, underlying etiologies, the rationale for tertiary care visits, diagnostic practices, and current treatment regimens of IDA, medical records of children referred to pediatric hematologists for iron deficiency in a five-year period at tertiary institutions (Zagreb, Rijeka, Split, Osijek) throughout Croatia were retrospectively analyzed. Eight hundred and sixty-four children, predominately of preschool age, were referred mainly by the primary care pediatricians, who, in general, performed basic diagnostics but failed to initiate oral iron therapy in half of the patients. Approximately one-third of patients were symptomatic, with inadequate nutrition prevailing as underlying etiology. Dextriferron was the preferred iron formulation among hematologists, with a median dose of 5 mg/kg, with acceptable compliance rates (63.5–93.2%). Hospital admission rates varied among the centers (9.4–35%), and so did transfusion policies (6.4–22.9%). The greatest difference was observed in the frequency of parenteral iron administration (0.3–21.5%). In conclusion, the burden of childhood IDA, even in a high-income country, remains substantial, necessitating consistent implementation of national guidelines and additional education of primary health care providers. Full article
(This article belongs to the Special Issue Advances in Diagnosis and Management of Pediatric Diseases)
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11 pages, 464 KiB  
Article
Diagnostic Utility of pH-MII Monitoring in Preschool Children with Recurrent Wheeze and Suspected Gastroesophageal Reflux Disease: A Prospective Study
by Ivan Pavić, Roberta Šarkanji-Golub and Iva Hojsak
Diagnostics 2023, 13(23), 3567; https://doi.org/10.3390/diagnostics13233567 - 29 Nov 2023
Cited by 4 | Viewed by 1357
Abstract
Background: Recurrent wheezing and gastroesophageal reflux disease (GERD) are common in young children, with a suggested but challenging link between them. This study aimed to investigate the diagnostic value of pH-MII monitoring in preschool children with recurrent wheezing and evaluate GERD-related therapy effects. [...] Read more.
Background: Recurrent wheezing and gastroesophageal reflux disease (GERD) are common in young children, with a suggested but challenging link between them. This study aimed to investigate the diagnostic value of pH-MII monitoring in preschool children with recurrent wheezing and evaluate GERD-related therapy effects. Methods: Children under 6 years with recurrent wheeze were eligible. The pH-MII monitoring was conducted in those clinically suspected of GERD’s involvement. Flexible bronchoscopy with bronchoalveolar lavage (BAL) was performed in severe cases. The primary outcome was the difference in wheezing episodes between proven GERD and non-GERD groups. Secondary outcomes included GERD therapy impact and predictive factors for wheezing reduction. Results: Of 66 children (mean age 3.9 years), 71% had proven GERD on pH-MII. Compared to the non-GERD group, the GERD group had higher total, liquid, mixed, and gas reflux episodes, as well as more acidic and weakly acidic episodes. GERD treatment significantly reduced wheezing episodes. PPI (proton pump inhibitor) introduction was associated with ≥50% wheezing reduction. Children with GERD showed ≥50% wheezing reduction more frequently than those without GERD. PPI usage, higher total GER episodes, acidic episodes, and liquid and proximal episodes on MII predicted ≥50% wheezing reduction. No significant BAL differences were observed between GERD and non-GERD groups. Conclusions: The pH-MII monitoring is valuable in diagnosing GERD-related wheezing in preschool children. GERD therapy, particularly PPI usage, was associated with reduced wheezing episodes. The pH-MII parameters correlated with wheezing reduction, suggesting their potential predictive role. BAL did not differentiate between GERD and non-GERD cases. Full article
(This article belongs to the Special Issue Advances in Diagnosis and Management of Pediatric Diseases)
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14 pages, 3443 KiB  
Case Report
From Severe Anemia to Intestinal Hemangiomatosis, a Bumpy Road—A Case Report and Literature Review
by Raluca Maria Vlad, Ruxandra Dobritoiu, Carmen Niculescu, Andreea Moga, Laura Balanescu and Daniela Pacurar
Diagnostics 2024, 14(3), 310; https://doi.org/10.3390/diagnostics14030310 - 31 Jan 2024
Cited by 1 | Viewed by 1793
Abstract
Gastrointestinal hemangiomas (GIH) are unusual vascular tumors found anywhere alongside the GI tract, the small bowel being the most common site. Diagnosis requires good clinical insight and modern imaging. This is a comprehensive review of the literature, starting from a new pediatric case [...] Read more.
Gastrointestinal hemangiomas (GIH) are unusual vascular tumors found anywhere alongside the GI tract, the small bowel being the most common site. Diagnosis requires good clinical insight and modern imaging. This is a comprehensive review of the literature, starting from a new pediatric case diagnosed through exploratory laparotomy after complex imaging techniques failed. This research was conducted on published articles from the past 25 years. We identified seventeen original papers (two series of cases with three and two patients, respectively, and fifteen case reports). The female/male ratio was 1.5. The youngest patient was a 3-week-old boy, and the was oldest a 17-year-old girl. The most common localization was the jejunum (eight cases), followed by the ileum (four), colon (three), stomach (two), and rectum (one). Seven children had cavernous and four had capillary hemangiomas. Eight patients presented gastrointestinal bleeding, seven had refractory anemia, such as our index patient, three had recurrent abdominal pain, and two had bowel obstruction. Surgical assessment was successful in fifteen cases; three cases experienced great outcomes with oral propranolol, one child was treated successfully with sirolimus, and for one patient, endoscopic treatment was the best choice. The authors present the case of a female patient admitted to the Pediatrics Department of “Grigore Alexandrescu” Emergency Children’s Hospital from 25 February to 28 March 2019 for severe anemia, refractory to oral iron treatment, and recurrent blood infusions. No clear bleeding cause had been found. Although very uncommon, intestinal hemangiomas can express puzzling, life-threatening symptoms. We should keep in mind this disorder in cases of unresponsive chronic anemia. Full article
(This article belongs to the Special Issue Advances in Diagnosis and Management of Pediatric Diseases)
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