Search Results (72)

Background and Objectives: Childhood acute lymphoblastic leukemia (ALL) carries substantial morbidity, mortality, and economic burden, particularly in middle-income countries. The Pediatric Early Warning System (PEWS) is designed to trigger timely escalation of care, yet its independent impact on survival among critically ill leukemic children has not been well defined in Kazakhstan and Central Asia. Materials and Methods: We conducted a retrospective review all ICU admissions for patients aged 0–18 years with ALL at the National Center of Pediatrics, Almaty, across two periods: pre-implementation (January 2020–December 2022) and post-implementation of 24 h PEWS monitoring (September 2023–December 2024). The primary outcome was ICU mortality. Seven domains of covariates—demographic, clinical history, transfusion, vital signs, symptoms, laboratory, and instrumental data—were extracted. Univariable and multivariable logistic regression models were used to assess associations with mortality. Results: Among 255 admissions (105 during PEWS implementation; 150 prior to PEWS implementation), overall ICU mortality was 21.7%. After adjustment, PEWS implementation was not associated with reduced ICU mortality (AOR 0.89), despite a lower unadjusted mortality (15.9% vs. 26.6%). The most clinically relevant secondary findings included strong associations between mortality and bilateral pneumonia (AOR 7.45), ≥4 episodes of hyperthermia within 24 h of ICU admission (AOR 5.42), and systemic inflammatory response syndrome (AOR 4.61). Conclusions: These findings suggest that, within this high-acuity cohort, inflammatory and cardiorespiratory derangements outweigh any potential survival benefit from ward-based PEWS surveillance. Optimizing outcomes will require integrating early warning systems with timely deterioration management, focused cardiopulmonary support, and resource allocation tailored to the clinical context—rather than relying solely on surveillance scores. Full article

Background and Objectives: Surfactant protein-D (SP-D) enters the circulation when the alveolo-capillary barrier is injured. We synthesised evidence on the diagnostic and prognostic performance of circulating SP-D in children with acute infectious lung disease. Methods: We searched MEDLINE, Embase and Scopus (inception–1 June 2025) for human studies reporting serum/plasma SP-D in patients <18 years with community-acquired pneumonia (CAP), viral pneumonitis or paediatric ARDS (PARDS). Two reviewers independently screened, extracted data and assessed risk of bias (ROBINS-I). Primary outcomes were discrimination of severe versus non-severe disease and prediction of hard outcomes (mechanical ventilation, PARDS and mortality). Heterogeneity in assays and outcome definitions precluded meta-analysis; a narrative synthesis was undertaken. Results: Five studies (n = 723) from emergency and PICU settings met inclusion criteria. Admission SP-D was consistently higher in severe versus mild CAP; reported AUCs ranged 0.699–0.802. Thresholds of 110–180 ng/mL yielded sensitivities of 67–85% and specificities of 45–70%. In influenza-associated respiratory failure, SP-D correlated with ventilator days (r ≈ 0.45) and ICU length of stay (r ≈ 0.44). In multicentre PARDS cohorts, each 10 ng/mL increase in SP-D was associated with higher odds of severe PARDS and death (adjusted OR 1.02 per 10 ng/mL). Overall risk of bias across studies was low-to-moderate, with one study rated serious due to sampling and adjustment limitations. Conclusions: Across pathogens and care settings, elevated circulating SP-D correlates with radiographic consolidation, evolving PARDS and worse short-term outcomes. Although assay standardisation and external validation are needed, current evidence supports incorporating SP-D into multiparametric, age-aware risk-stratification algorithms for childhood pneumonia and viral lung injury. Full article

Background: Chicken pox is a rare but serious condition in neonates—often regarded as a common childhood illness with mild symptoms—yet it can lead to severe complications, especially in the perinatal period. Neonatal varicella may present with fever occurring within the first 5–10 days of life, followed by a generalized vesicular eruption. The syndrome is uncommon, largely due to the widespread immunity in women of childbearing age, acquired through prior chicken pox infection or varicella immunization. However in Indonesia, a developing country without a national mandatory varicella vaccination program, the disease burden remains significant, and cases of neonatal varicella are still encountered. Neonates are at high risk of severe varicella infection, which, if untreated, has a reported mortality rate of up to 30%. Although varicella is rare in neonates, there are limited studies that have reported it. This study highlights the clinical presentations upon admission, diagnostic investigations, therapeutic management strategies, and potential complications of neonatal varicella. Methods: This study presents two cases of neonatal varicella that were managed at Hasan Sadikin General Hospital in West Java, Indonesia. Each patient underwent a clinical assessment and diagnostic evaluation upon arrival, followed by therapeutic management strategies, including the management of any complications that emerged during treatment. Results: The two cases of neonates presented with classic clinical features of neonatal varicella, including a generalized vesicular rash followed by fever within the first 10 to 12 days of life, without dermatological lesions or congenital malformations at birth. In both cases, maternal chicken pox developed within the first few days postpartum, suggesting postnatal transmission as the likely source of infection. Complications observed included respiratory failure and pneumonia, requiring respiratory support. However, both neonates recovered successfully without the administration of IVIG. Conclusions: Early initiation of antiviral therapy, timely administration of antibiotics, comprehensive supportive care, and monitoring for potential complications play a crucial role in managing neonatal varicella, even in the absence of IVIG. Full article

Childhood pneumonia remains a key cause of global morbidity and mortality, highlighting the need for accurate and efficient diagnostic tools. Ensemble methods have proven to be among the most successful approaches for identifying childhood pneumonia from chest X-ray images. However, deploying large, complex convolutional neural network models in resource-constrained environments presents challenges due to their high computational demands. Therefore, we propose a novel ensemble-based knowledge distillation method for identifying childhood pneumonia from X-ray images, which utilizes an ensemble of classification models to distill the knowledge to a more efficient student model. Experiments conducted on a chest X-ray dataset show that the distilled student model achieves comparable (statistically not significantly different) predictive performance to that of the Stochastic Gradient with Warm Restarts ensemble method (F1-score on average 0.95 vs. 0.96, respectively), while significantly reducing inference time and decreasing FLOPs by a factor of 6.5. Based on the obtained results, the proposed method highlights the potential of knowledge distillation to enhance the efficiency of complex methods, making them more suitable for utilization in environments with limited computational resources. Full article

Human metapneumovirus (hMPV), a member of the Pneumoviridae subfamily, has emerged as a significant etiological agent of acute respiratory tract infections across diverse age groups, particularly affecting infants, the elderly, and immunocompromised individuals. Since its initial identification in 2001, hMPV has been recognized globally for its seasonal circulation pattern, predominantly in late winter and spring. hMPV is a leading etiological agent, accounting for approximately 5% to 10% of hospitalizations among pediatric patients with acute respiratory tract infections. hMPV infection can result in severe bronchiolitis and pneumonia, particularly in young children, with clinical manifestations often indistinguishable from those caused by human RSV. Primary hMPV infection typically occurs during early childhood; however, re-infections are frequent and may occur throughout an individual’s lifetime. hMPV is an enveloped, negative-sense RNA virus transmitted through respiratory droplets and aerosols, with a 3–5-day incubation period. The host immune response is marked by elevated pro-inflammatory cytokines, which contribute to disease severity. Advances in molecular diagnostics, particularly reverse transcription–quantitative polymerase chain reaction (RT-qPCR) and metagenomic next-generation sequencing (mNGS), have improved detection accuracy and efficiency. Despite these advancements, treatment remains largely supportive, as no specific antiviral therapy has yet been approved. Promising developments in vaccine research, including mRNA-based candidates, are currently undergoing clinical evaluation. This review synthesizes current knowledge on hMPV, highlighting its virological, epidemiological, and clinical characteristics, along with diagnostic advancements and emerging therapeutic strategies, while underscoring the critical role of continued research and sustained preventive measures—including vaccines, monoclonal antibodies, and non-pharmaceutical interventions—in mitigating the global burden of hMPV-related disease. Full article

Introduction: An effective vaccination strategy requires monitoring serotype changes by geography and age. This study analyzed Streptococcus pneumoniae serotypes in healthy children under 6 years of age vaccinated with PCV10 in Bulgaria from October 2021 to May 2025. Methods: A total of 569 children were screened for the lytA and cpsA genes viareal-time polymerase chain reaction (real-time PCR). Positive samples were typed using relevant kits, and 76 serotypes/serogroups of S. pneumoniae were identified. Results: Nasopharyngeal swabs from 232 children (40.8%) were found to carry S. pneumoniae, and a total of 255 serotypes were detected, with 19B/19C (17.2%), 6C (10.7%), and 15B/15C (9.8%) being the most prevalent. Of these, 91 serotypes (15.9%) were included in at least one vaccine, while the remaining 164 serotypes (25.4%) were not. The carriage rate reduced to 22% in 2023 but increased to 47% in 2024. Overall, younger children had lower carriage rates (p < 0.05), with serotype 6C being more common in children under 12 months of age (25%). Approximately 9.1% of pneumococcal carriage cases involved co-detected serotypes, with significantly higher co-detection rates for 19B/19C, 15B/15C, 10B, 10F/C, 23B, 7C/40, 23A, and 24A compared with mono-detection rates (p < 0.05). Conclusions: 19B/19C, 6C, 15B/15C, and 19A were identified as the main serotypes. Children over 3 years of age were also more likely to carry multiple pneumococci. These findings emphasize the need to reassess childhood vaccination strategies to curb the spread of antibiotic-resistant serotypes. Full article

Klebsiella pneumoniae is a leading cause of nosocomial infections, neonatal sepsis, and childhood mortality worldwide. A drastic rise in antibiotic-resistant isolates poses an urgent threat to humanity, and the World Health Organization (WHO) has classified this as a critical-priority antimicrobial-resistant (AMR) pathogen. Recent advancements in developing vaccines against Klebsiella pneumoniae have highlighted the lack of standardized assays to evaluate immunogenicity, complicating comparison among different vaccines under development and the establishment of a serological threshold of risk reduction (SToRR). Here, we describe the development of a ten-plex multiplex assay to measure IgG against capsular polysaccharides (K2, K25, K102, K149), O antigens (O1v1, O1v2, O2v1, O2v2 and O5), and a conserved protein (MrkA). A standard curve was established by pooling human sera from naturally exposed subjects and then calibrated in terms of Relative Luminex Units/mL. The assay was fully characterized in terms of specificity, precision, linearity, and repeatability. This immunoassay demonstrates performance suitable for future clinical trials, as well as to perform sero-epidemiological studies to gain insights into naturally occurring immunity, potentially contributing to the establishment of a serological threshold of risk reduction against Klebsiella pneumoniae. Full article

Background: Primary lung tumors in pediatric patients are rare, predominantly malignant, and present diagnostic challenges due to symptom overlap with more common conditions such as inflammatory processes or asthma. Evidence-based approaches for managing these rare neoplasms in childhood are scarce. This retrospective study reports the experience of a pediatric referral center in diagnosing and treating these tumors. Methods: Pediatric primary lung tumors treated at Giannina Gaslini Children’s Hospital between January 2016 and January 2024 were included. Data on clinical presentation, histopathology, imaging, treatment approaches, and outcomes were systematically collected and analyzed. Results: Nine patients (six males and three females) were identified, with a mean age (±SD) at diagnosis of 8.81 ± 5 years. The most common clinical manifestation was recurrent pneumonia (four patients), followed by persistent cough and wheezing (three patients). The average duration of symptoms before diagnosis was 12.8 months ± 12.2 months. Histopathological diagnoses were typical carcinoid tumors (n = 2), atypical carcinoid tumors (n = 2), inflammatory myofibroblastic tumors (n = 2), congenital peribronchial myofibroblastic tumor (n = 1), myoepithelial carcinoma (n = 1), and pleuropulmonary blastoma (n = 1). Radical surgery resulted in complete response for seven patients, with a median follow-up of 52 months (IQR 39 months). The myoepithelial carcinoma was treated with multimodal therapy, relapsed after 17 months, and adjuvant chemotherapy is currently ongoing. Neoadjuvant chemotherapy for the pleuropulmonary blastoma is currently ongoing. Conclusions: Primary lung tumors in children, though rare, may have favorable outcomes when appropriately managed. Nonspecific clinical presentations often contribute to diagnostic delays. This study highlights the critical need of thorough evaluation in cases of persistent, therapy-resistant aspecific respiratory symptoms. Early diagnosis, coupled with complete surgical resection, significantly improves prognosis. Full article

Background: Approximately two to three children die from pneumonia every hour, and pneumonia is the leading cause of hospitalization for children under five in Bangladesh. Bangladesh has adopted the Pocket Book guidelines by the World Health Organization (WHO) for hospital management of childhood pneumonia. These guidelines recommend the proper use of injectable antibiotic administration. Objectives: We assessed and compared the prescription drugs for treating childhood pneumonia following WHO guidelines in a secondary and tertiary hospital in Bangladesh. Methods: We conducted a cross-sectional comparative study among children under five years who were admitted to a tertiary hospital, Dhaka Medical College Hospital (DMCH), and a secondary-level hospital, Kushtia District Hospital (KDH), with pneumonia between May 2021 and May 2022. A structured questionnaire was administered to the eligible participants. Additionally, we reviewed the hospital records related to the patient’s treatment. SPSS (Version 28) was used to conduct statistical analysis. Results: 316 children were enrolled during the study period, of whom 66.4% were collected from DMCH. There were 65.8% and 24.6% of patients who were classified with severe pneumonia and very severe pneumonia, respectively. In DMCH, the severity of pneumonia percentage was 57.6%, while in KDH, the percentage was 82%. A significant difference was found between the two facilities in diagnosing complicated pneumonia, prescribing the appropriate antibiotics, and ensuring oxygen availability. Amoxicillin was prescribed to 83.5% of the participants, and ceftriaxone was used at a high rate (64.5–70.9%). Combining injections of ceftriaxone with oral amoxicillin or other combinations of antibiotics, both facilities used high frequencies of non-antibiotic corticosteroids. Conclusions: Antibiotics were overprescribed, and injections were prescribed at higher levels than WHO recommended. This could pose a threat to antibiotic resistance. There is a need to enforce standard prescribing policies and treatment guidelines to reduce morbidity and mortality among hospitalized children with pneumonia. Full article

Indoor heating methods may influence the prevalence of respiratory and allergic diseases among preschool children. However, limited research has explored the relationship between indoor heating methods and childhood illnesses over time or on a large urban scale, and particularly the relationship between heating methods and asthma or allergic rhinitis among preschoolers from 2010 to 2019. This study conducted cross-sectional investigations in two northern cities (Taiyuan and Urumqi) and two southern cities (Chongqing and Changsha) in China during two periods: Period I (2010) and Period II (2019). Using Pearson’s chi-squared tests, we analyzed the associations between four indoor heating methods—convective heating (CH), convective and radiant heating (CH&RH), radiant heating (RH), and polluting heating (PH)—and nine respiratory and allergic diseases. Logistic regression models were employed to explore the relationships between heating methods and disease prevalence. The results revealed substantial differences in heating method choices between northern and southern Chinese cities (p < 0.001). These differences were significantly associated with the prevalence of respiratory and allergic diseases in preschoolers. Heating behaviors may have contributed to a decrease in the lifetime prevalence of asthma, pneumonia, rhinitis, and the 12-month prevalence of eczema in preschool children. In southern households, CH was linked to a lower risk of lifetime asthma (AOR: 0.63) and 12-month wheezing (AOR: 0.53). However, RH in southern households increased disease risks (AOR: 0.53). This study provides insights into the associations between heating methods and the prevalence of diseases among preschoolers across two periods in China. The findings offer new perspectives and guidance for families in selecting appropriate heating methods. Full article

Background: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality globally, and factors such as biomass exposure, demographic characteristics, and comorbidities significantly influence patient outcomes during exacerbations. Aim: This study aims to clarify the impact of patient characteristics on key hospital outcomes, including ICU admissions, hospital length of stay, and in-hospital mortality, focusing on the contextual role of biomass exposure rather than its direct impact. Methods: Using a multicenter, retrospective cohort design, we analyzed the medical records of patients admitted with COPD exacerbations from January 2021 to December 2023. Eligible patients were over 40 years old with confirmed COPD exacerbation, excluding those with other significant lung conditions, severe organ dysfunction, or incomplete data. The collected data included demographics, smoking history, comorbidities, medications, laboratory results, and clinical outcomes, with smoking status categorized into current, former, or never smokers. Results: Our analysis comprised 334 patients with a mean age of 69 ± 8.8 years, including 52 (15.6%) females. Biomass exposure, observed in 22% of patients, was associated with a higher likelihood of being female (p < 0.001), lower smoking rates (p < 0.001), higher prevalence of diabetes mellitus type 2 (p = 0.020), lower peripheral blood eosinophilia (p = 0.001), increased intensive care unit (ICU) admissions (p = 0.034), and higher in-hospital mortality (p = 0.043). Non-survivors tended to be older and had a higher prevalence of hypertension, a history of childhood pneumonia, longer COPD duration, greater need for non-invasive ventilation (NIV) during hospitalization, and more frequent ICU admissions. Univariate Cox regression analysis revealed no significant associations between characteristics and outcomes. Conclusions: Patients with biomass exposure were more likely to be female and had higher rates of ICU admission and in-hospital mortality. Full article

Pneumonia stands as the leading infectious cause of childhood mortality annually, underscoring its significant impact on pediatric health. Although dexamethasone (DXMS) is effective for treating pulmonary inflammation, its therapeutic potential is compromised by systemic side effects and suboptimal carrier systems. To address this issue, the current study introduces solid lipid nanoparticles encapsulating hydrophobic dexamethasone palmitate (DXMS-Pal-SLNs) as an anti-inflammatory nanoplatform to treat pneumonia. The specialized nanoparticle formulation is characterized by high drug loading efficiency, low drug leakage and excellent colloidal stability in particular during nebulization and is proficiently designed to target alveolar macrophages in deep lung regions via local delivery with the nebulization administration. In vitro analyses revealed substantial reductions in the secretions of tumor necrosis factor-α and interleukin-6 from alveolar macrophages, highlighting the potential efficacy of DXMS-Pal-SLNs in alleviating pneumonia-related inflammation. Similarly, in vivo experiments showed a significant reduction in the levels of these cytokines in the lungs of mice experiencing lipopolysaccharide-induced pulmonary inflammation after the administration of DXMS-Pal-SLNs via nebulization. Furthermore, the study demonstrated that DXMS-Pal-SLNs effectively control acute infections without causing pulmonary infiltration or excessive recruitment of immunocytes in lung tissues. These findings highlight the potential of nebulized DXMS-Pal-SLNs as a promising therapeutic strategy for mitigating pneumonia-related inflammations. Full article

In clinical practice, increased “work of breathing” (WOB) is used to rapidly identify the acutely ill child in need of immediate clinical care, and is commonly used to support a clinical diagnosis of pneumonia. However, this key clinical sign is poorly understood and inconsistently defined. This review discusses the physiology, measurement, and clinical assessment of WOB, highlighting its utility in the recognition of pneumonia in under-resourced settings, where access to diagnostic imaging may be limited. Full article

Mycoplasma pneumoniae pneumonia (MPP) is a frequent cause of community-acquired pneumonia (CAP) in children. The incidence of childhood pneumonia caused by M. pneumoniae infection has been rapidly increasing worldwide. M. pneumoniae is naturally resistant to beta-lactam antibiotics due to its lack of a cell wall. Macrolides and related antibiotics are considered the optimal drugs for treating M. pneumoniae infection. However, clinical resistance to macrolides has become a global concern in recent years. Therefore, it is imperative to urgently identify new targets and develop new anti-M. pneumoniae drugs to treat MMP. Previous studies have shown that deficiencies in HPrK/P kinase or phosphorylase activity can seriously affect carbon metabolism, growth, morphology, and other cellular functions of M. pneumoniae. To identify potential drug development targets against M. pneumoniae, this study analyzed the sequence homology and 3D structure alignment of M. pneumoniae HPrK/P. Through sequence and structure analysis, we found that HPrK/P lacks homologous proteins in the human, while its functional motifs are highly conserved in bacteria. This renders it a promising candidate for drug development. Structure-based virtual screening was then used to discover potential inhibitors among 2614 FDA-approved drugs and 948 bioactive small molecules for M. pneumoniae HPrK/P. Finally, we identified three candidate drugs (Folic acid, Protokylol and Gluconolactone) as potential HPrK/P inhibitors through molecular docking, molecular dynamics (MDs) simulations, and ADMET predictions. These drugs offer new strategies for the treatment of MPP. Full article

Molar incisor hypomineralization (MIH) is a congenital disorder of the enamel tissue, characterized by a quantitative deficiency. In childhood, infections such as EBV, HSV-1, HCMV, or H. pylori may occur and cause various diseases. This study aimed to investigate the prevalence of HPV, EBV, HSV-1, HCMV, and H. pylori infections in two groups of children: children with molar incisor hypomineralization (MIH) and a control group, using molecular methods. The study group included 47 children aged between 6–13 years who had been diagnosed with MIH. The control group consisted of 42 children. The study found that, in the MIH group, the prevalence of HPV-16 was 6.38%, HPV-18 was 4.26%, EBV was 31.91%, HSV-1 was 4.26%, HCMV was 4.26%, and H. pylori was 12.77%. There were no significant differences in the prevalence of any of tested pathogens between the study and the control group (p > 0.05). However, the study found a higher prevalence of EBV infection in children who had smallpox/pneumonia by the age of 3 years. Ten children were found to have at least two pathogens present. Moreover, both groups had a high prevalence and activity of EBV. These findings provide new insights into the carriage of pathogens among children with MIH, providing new information for parents, scientists, and healthcare professionals. Full article