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Volume 5, September

Children, Volume 5, Issue 10 (October 2018) – 14 articles

Cover Story (view full-size image): Timely diagnosis of Kawasaki disease is crucial to reduce the related risk of coronary artery complications. Nitrogen-terminal B-type natriuretic peptide (NT-proBNP) was shown to be useful in the diagnosis and management of KD. Its utility as an operator-independent biological marker in KD is based on the universal myocardial inflammatory component early in the course of the disease. Patients with resistance to intravenous immunoglobulin treatment and those who develop coronary artery aneurysms also have higher levels of NT-proBNP, which gives it an additional prognostic value. View this paper.
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Review
Molecularly Targeted Therapy for Neuroblastoma
Children 2018, 5(10), 142; https://0-doi-org.brum.beds.ac.uk/10.3390/children5100142 - 15 Oct 2018
Cited by 14 | Viewed by 2537
Abstract
Neuroblastoma is the most common extra-cranial solid tumor encountered in childhood and accounts for 15% of pediatric cancer-related deaths. Although there has been significant improvement in the outcomes for patients with high-risk disease, the therapy needed to achieve a cure is quite toxic [...] Read more.
Neuroblastoma is the most common extra-cranial solid tumor encountered in childhood and accounts for 15% of pediatric cancer-related deaths. Although there has been significant improvement in the outcomes for patients with high-risk disease, the therapy needed to achieve a cure is quite toxic and for those that do experience a disease recurrence, the prognosis is very dismal. Given this, there is a tremendous need for novel therapies for children with high-risk neuroblastoma and the molecular discoveries over recent years provide hope for developing new, less toxic, and potentially more efficacious treatments. Here I discuss many of the molecular aberrations identified thus far in neuroblastoma, as well as the agents in development to target these changes. The progress made in both the preclinical arena and in early phase drug development provide much promise for the future of precision medicine in neuroblastoma. Full article
(This article belongs to the Special Issue Recent Advances in Diagnosis and Treatment of Neuroblastoma)
Review
A Decade of NT-proBNP in Acute Kawasaki Disease, from Physiological Response to Clinical Relevance
Children 2018, 5(10), 141; https://0-doi-org.brum.beds.ac.uk/10.3390/children5100141 - 12 Oct 2018
Cited by 12 | Viewed by 2743
Abstract
Kawasaki disease (KD) is an inflammatory febrile illness of early childhood and the primary cause of acquired heart disease during childhood. Coronary artery aneurysms (CAA) are a serious complication of KD, leading to ischemic heart disease, myocardial infarction, and sudden cardiac death. Timely [...] Read more.
Kawasaki disease (KD) is an inflammatory febrile illness of early childhood and the primary cause of acquired heart disease during childhood. Coronary artery aneurysms (CAA) are a serious complication of KD, leading to ischemic heart disease, myocardial infarction, and sudden cardiac death. Timely diagnosis in the first ten days of fever is crucial to reduce the risk of coronary artery complications. Nitrogen-terminal B-type natriuretic peptide (NT-proBNP), originally used for the management of adults with heart disease, was shown to be useful in the diagnosis and management of patients with KD. NT-proBNP is released by cardiomyocytes in response to mechanical factors such as the dilation of cardiac chambers, and to pro-inflammatory cytokines. The utility of NT-proBNP as a biological marker in KD is based on the universal myocardial inflammatory component early in the course of the disease. Patients with KD have higher NT-proBNP at the time of diagnosis than febrile controls, with a pooled sensitivity of 89% (95% confidence interval 78–95), and a specificity of 72% (95% confidence interval 58–82). The positive likelihood ratio is 3.2:1 (95% confidence interval 2.1–4.8). Moreover, patients with resistance to intravenous immunoglobulin treatment and CAA were found to have higher levels of NT-proBNP, suggesting a prognostic role. Nevertheless, the non-specificity of NT-proBNP to KD limits its use as a stand-alone test. In this light, a tentative associative retrospective diagnostic algorithm was highly reliable for including all cases at risk of CAA, which warrants further prospective studies for a better diagnostic index of suspicion and risk stratification of patients. Full article
(This article belongs to the Special Issue Kawasaki Disease in Children and Adolescents)
Article
Effect of Integrated Physical Activities with Mathematics on Objectively Assessed Physical Activity
Children 2018, 5(10), 140; https://0-doi-org.brum.beds.ac.uk/10.3390/children5100140 - 11 Oct 2018
Cited by 4 | Viewed by 1987
Abstract
Background: One of the promising strategies for increasing physical activity (PA) at school is to integrate it with academic learning. The purposes of this study were: (a) to examine differences in objectively measured PA levels between integrated PA with mathematics and traditional lessons, [...] Read more.
Background: One of the promising strategies for increasing physical activity (PA) at school is to integrate it with academic learning. The purposes of this study were: (a) to examine differences in objectively measured PA levels between integrated PA with mathematics and traditional lessons, and (b) to evaluate the PA levels of different integrated PAs. Methods: Seventy-seven 4th grade students (41 males) were included in an intervention (Move for Thought program: M4T) group (n = 46) that utilized PA integrated with mathematics or a control group (n = 31). Accelerometer data from each student were collected during five complete school days. M4T and control classroom sessions were identified using teachers’ logs. Accelerometer data were extracted, processed separately, and aggregated into a single data set. Minutes and percent time at different PA intensities were obtained using accelerometer minute-by-minute predicted METs. Results: One-way ANOVAs on PA levels showed a significant group effect (F = 5.33, p < 0.05) on moderate-to-vigorous PA (MVPA) in favor of the M4T group, but not on sedentary and light PA. The most active integrated PA provided 10.88 min of MVPA (SD = 11.87; 21.38 ± 24.38%) in a 50 min class period. Conclusion: Integrating PA with mathematics in the classroom can contribute to increasing MVPA levels in children. Full article
(This article belongs to the Special Issue Physical Activity and Sedentary Behaviour in Children and Adolescents)
Article
Hospital-Acquired Hyponatremia in Children Following Hypotonic versus Isotonic Intravenous Fluids Infusion
Children 2018, 5(10), 139; https://0-doi-org.brum.beds.ac.uk/10.3390/children5100139 - 02 Oct 2018
Cited by 3 | Viewed by 2147
Abstract
Hypotonic solutions have been used in pediatrics for maintenance of intravenous (IV) hydration. However, recent randomized control trials and cohort studies have raised significant concerns for association with hospital-acquired hyponatremia (HAH). The study aimed to assess whether the use of hypotonic parenteral solutions [...] Read more.
Hypotonic solutions have been used in pediatrics for maintenance of intravenous (IV) hydration. However, recent randomized control trials and cohort studies have raised significant concerns for association with hospital-acquired hyponatremia (HAH). The study aimed to assess whether the use of hypotonic parenteral solutions (PS) compared with isotonic PS is associated with increased HAH risk in children with common pediatric conditions. Retrospective chart review of 472 patients aged 2 months to 18 years who received either isotonic or hypotonic PS as maintenance fluids. Administration of hypotonic PS was associated with a four-fold increase in risk of developing HAH in the univariate analysis, (unadjusted odds ratio (OR) = 3.99; 95% confidence interval (CI): 1.36–11.69, p = 0.01). Hypotonic PS were associated with HAH (p = 0.04) when adjusted for the level of admission serum CO2. There was a mean decrease of serum sodium of 0.53 mEq/L in the hypotonic group compared to the mean increase of 4.88 mEq/L in the isotonic group. These data suggest that hypotonic PS are associated with HAH in children admitted for common pediatric conditions. Isotonic PS should be considered as a safer choice for maintenance fluid hydration. Full article
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Article
Exploring Gender Differences within Forest Schools as a Physical Activity Intervention
Children 2018, 5(10), 138; https://0-doi-org.brum.beds.ac.uk/10.3390/children5100138 - 26 Sep 2018
Cited by 4 | Viewed by 3025
Abstract
This study investigated whether children engaged in more physical activity (PA) on school days that included Forest School (FS) sessions than a regular school day or a school day with a Physical Education (PE) lesson. How FS sessions influenced children’s general levels of [...] Read more.
This study investigated whether children engaged in more physical activity (PA) on school days that included Forest School (FS) sessions than a regular school day or a school day with a Physical Education (PE) lesson. How FS sessions influenced children’s general levels of PA and wellbeing was also explored across gender. A mixed-methods study followed a sample of 59 child participants aged 7 to 9 years old, from four primary schools, whilst taking part in twelve weekly FS sessions. Measures included the PA Questionnaire for Older Children and accelerometry data together with an individual Write and Draw task to inform focus groups. Children had significantly greater levels of light PA on a FS day and a PE school day compared to a regular school day and children reported feeling both happier and relaxed as a consequence of the intervention. From the qualitative data, boys and girls reported different likes of the FS interventions, whereas their dislikes of FS were comparable. Findings from this research provide evidence for such outdoor, nature-based learning within the school curriculum contributing to daily PA in children. Full article
(This article belongs to the Special Issue Physical Activity and Sedentary Behaviour in Children and Adolescents)
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Article
Wrist-Based Accelerometer Cut-Points to Identify Sedentary Time in 5–11-Year-Old Children
Children 2018, 5(10), 137; https://0-doi-org.brum.beds.ac.uk/10.3390/children5100137 - 26 Sep 2018
Cited by 4 | Viewed by 2366
Abstract
Background: The objective of this paper is to derive a wrist-placed cut-point threshold for distinguishing sedentary behaviors from light-intensity walking using the ActiGraph GT3X+ in children. Methods: This study employed a cross-sectional study design, typically used in measurement-related studies. A sample of 167 [...] Read more.
Background: The objective of this paper is to derive a wrist-placed cut-point threshold for distinguishing sedentary behaviors from light-intensity walking using the ActiGraph GT3X+ in children. Methods: This study employed a cross-sectional study design, typically used in measurement-related studies. A sample of 167 children, ages 5–11 years (mean ± SD: 8.0 ± 1.8 years), performed up to eight seated sedentary activities while wearing accelerometers on both wrists. Activities included: reading books, sorting cards, cutting and pasting, playing board games, eating snacks, playing with tablets, watching TV, and writing. Direct observation verified sedentary behavior from light activity. Receiver operator characteristic (ROC) analyses were used to determine optimal cut-point thresholds. Quantile regression models estimated differences between dominant and non-dominant placement. Results: The optimal cut-point threshold for the non-dominant wrist was 203 counts/5 s with sensitivity, specificity, and area under the curve (AUC) of 71.56, 70.83, and 0.72, respectively. A 10-fold cross-validation revealed an average AUC of 0.70. Statistically significant (p ≤ 0.05) differences in median counts ranging from 7 to 46 counts/5 s were found between dominant and non-dominant placement in five out of eight sedentary activities, with the dominant wrist eliciting higher counts/5 s. Conclusion: Results from this study support the recommendation to place accelerometers on the non-dominant wrist to minimize “noise” during seated sedentary behaviors. Full article
(This article belongs to the Special Issue Physical Activity and Sedentary Behaviour in Children and Adolescents)
Review
Role of the Gut–Liver Axis in Driving Parenteral Nutrition-Associated Injury
Children 2018, 5(10), 136; https://0-doi-org.brum.beds.ac.uk/10.3390/children5100136 - 25 Sep 2018
Cited by 10 | Viewed by 2213
Abstract
For decades, parenteral nutrition (PN) has been a successful method for intravenous delivery of nutrition and remains an essential therapy for individuals with intolerance of enteral feedings or impaired gut function. Although the benefits of PN are evident, its use does not come [...] Read more.
For decades, parenteral nutrition (PN) has been a successful method for intravenous delivery of nutrition and remains an essential therapy for individuals with intolerance of enteral feedings or impaired gut function. Although the benefits of PN are evident, its use does not come without a significant risk of complications. For instance, parenteral nutrition-associated liver disease (PNALD)—a well-described cholestatic liver injury—and atrophic changes in the gut have both been described in patients receiving PN. Although several mechanisms for these changes have been postulated, data have revealed that the introduction of enteral nutrition may mitigate this injury. This observation has led to the hypothesis that gut-derived signals, originating in response to the presence of luminal contents, may contribute to a decrease in damage to the liver and gut. This review seeks to present the current knowledge regarding the modulation of what is known as the “gut–liver axis” and the gut-derived signals which play a role in PN-associated injury. Full article
(This article belongs to the Special Issue 5th Anniversary Issue)
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Article
Evaluation of a Walking-Track Intervention to Increase Children’s Physical Activity during Primary School Break Times
Children 2018, 5(10), 135; https://0-doi-org.brum.beds.ac.uk/10.3390/children5100135 - 25 Sep 2018
Cited by 2 | Viewed by 2410
Abstract
Despite the known benefits of engaging in daily moderate to vigorous physical activity (MVPA), only 22% of children in England are meeting the recommended guidelines. School break times have been advocated as a key part of children’s daily routines in which their MVPA [...] Read more.
Despite the known benefits of engaging in daily moderate to vigorous physical activity (MVPA), only 22% of children in England are meeting the recommended guidelines. School break times have been advocated as a key part of children’s daily routines in which their MVPA can be increased. The main aim of this study was to evaluate the effect of installing a walking-track on children’s MVPA during school break times. A mixed method design was employed which allowed for the quantitative measurement of children’s PA at three time points (baseline, mid-intervention (1–5 weeks) and follow-up (6–9 weeks)), using pedometers (n = 81, 5–9 years) and systematic observation (n = 23, 7–9 years). A semi-structured interview (n = 1) was also conducted at 10 weeks’ follow-up. The installation of the walking-track was grounded in a unique set of theoretical constructs to aid the behaviour change of the teachers. Short term positive increases in girls’ and boys’ MVPA and longer term increases in boys’ vigorous PA (VPA) were found. Qualitative data highlighted that boys dominated the walking-track and the inconsistent behaviour of school staff negatively impacted upon children’s MVPA. A set of principles to guide the installment of walking-tracks in school playgrounds are recommended. Full article
(This article belongs to the Special Issue Physical Activity and Sedentary Behaviour in Children and Adolescents)
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Review
Bilateral Wilms Tumor: A Surgical Perspective
Children 2018, 5(10), 134; https://0-doi-org.brum.beds.ac.uk/10.3390/children5100134 - 24 Sep 2018
Cited by 11 | Viewed by 3071
Abstract
Historically, the management of bilateral Wilms tumor (BWT) was non-standardized and suffered from instances of prolonged chemotherapy and inconsistent surgical management which resulted in suboptimal renal and oncologic outcomes. Because of the risk of end-stage renal disease associated with the management of BWT, [...] Read more.
Historically, the management of bilateral Wilms tumor (BWT) was non-standardized and suffered from instances of prolonged chemotherapy and inconsistent surgical management which resulted in suboptimal renal and oncologic outcomes. Because of the risk of end-stage renal disease associated with the management of BWT, neoadjuvant chemotherapy and nephron-sparing surgery have been adopted as the guiding management principles. This management strategy balances acceptable oncologic outcomes against the risk of end-stage renal disease. A recent multi-institutional Children’s Oncology Group study (AREN0534) has confirmed the benefits of standardized 3-drug neoadjuvant chemotherapy and the utilization of nephron-sparing surgery in BWT patients; however, less than 50% of patients underwent bilateral nephron-sparing surgery. The coordination of neoadjuvant chemotherapy and the timing and implementation of bilateral nephron-sparing surgery are features of BWT management that require collaboration between oncologists and surgeons. This review discusses the surgical management strategy in the context of BWT disease biology, with an emphasis on timepoints during therapy at which surgical decision making can greatly impact this disease and minimize long-term toxicities. Full article
(This article belongs to the Special Issue Pediatric Surgical Oncology)
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Commentary
Developmental Support for Sick Children through Play in Japan’s ECEC System: A Comparison with Hospital Play Specialists
Children 2018, 5(10), 133; https://0-doi-org.brum.beds.ac.uk/10.3390/children5100133 - 21 Sep 2018
Cited by 2 | Viewed by 1968
Abstract
Early childhood education and care (ECEC) workers and hospital play specialists (HPSs) share a role in supporting the development of sick children through play while respecting their autonomy. On the other hand, in supporting children’s play, managing their anxiety, and making environmental arrangements [...] Read more.
Early childhood education and care (ECEC) workers and hospital play specialists (HPSs) share a role in supporting the development of sick children through play while respecting their autonomy. On the other hand, in supporting children’s play, managing their anxiety, and making environmental arrangements for them, ECEC workers and HPSs play different roles. When supporting the development of sick children, the former should respect their autonomy and make the most of the characteristics of ECEC as a measure to comprehensively support their participation in play, including it in their daily lives. ECEC workers are also expected to contribute to the further development of comprehensive support by promoting collaboration and cooperation with various professionals, including HPSs. Full article
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Article
Does the Number of Fingers on the Bag Influence Volume Delivery? A Randomized Model Study of Bag-Valve-Mask Ventilation in Infants
Children 2018, 5(10), 132; https://0-doi-org.brum.beds.ac.uk/10.3390/children5100132 - 21 Sep 2018
Cited by 3 | Viewed by 2384
Abstract
We sought to compare the effectiveness of two versus five fingers used for bag-valve-mask (BVM) ventilation on effective tidal volume (VTeff) delivery in an infant resuscitation model. In a randomised cross-over study, 40 healthcare professionals ventilated a modified leak-free infant resuscitation [...] Read more.
We sought to compare the effectiveness of two versus five fingers used for bag-valve-mask (BVM) ventilation on effective tidal volume (VTeff) delivery in an infant resuscitation model. In a randomised cross-over study, 40 healthcare professionals ventilated a modified leak-free infant resuscitation manikin with both two and five fingers, using a self-inflating bag. The delivered and effective tidal volumes, ventilation rate, and mask leak were measured and recorded using a respiratory function monitor. We found no significant differences in the VTeff (five-finger 61.7 ± 23.9 vs. two-finger 58.8 ± 16.6 mL; p = 0.35) or ventilatory minute volume (2.71 ± 1.59 vs. 2.76 ± 1.24 L/min; p = 0.40) of both BVM ventilation techniques. However, there was an increase in the delivered tidal volume (VTdel) and mask leak when using the five-finger technique compared with the two-finger technique (VTdel 96.1 ± 19.4 vs. 87.7 ± 15.5 mL; p < 0.01; and mask leak 34.6 ± 23.0 vs. 30.0 ± 21.0%; p = 0.02). Although the five-finger technique was associated with an increased mask leak, the number of fingers used during the BVM ventilation had no effect on VTeff in an infant resuscitation model. Full article
(This article belongs to the Special Issue Emerging Concepts in Neonatal Resuscitation)
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Article
The Physical Activity and Sedentary Behaviour Patterns of Children in Kindergarten and Grade 2
Children 2018, 5(10), 131; https://0-doi-org.brum.beds.ac.uk/10.3390/children5100131 - 20 Sep 2018
Cited by 10 | Viewed by 2576
Abstract
Accompanying the transition from early to middle childhood are substantial changes in children’s educational and recreational circumstances. These changes may affect physical activity levels. This study examined levels of physical activity and sedentary behaviours in kindergarten (age range 5–6 years) and grade 2 [...] Read more.
Accompanying the transition from early to middle childhood are substantial changes in children’s educational and recreational circumstances. These changes may affect physical activity levels. This study examined levels of physical activity and sedentary behaviours in kindergarten (age range 5–6 years) and grade 2 (age range 7–8 years). Participants were 96 kindergarten children recruited in the 2010–2011 and 2011–2012 school years and 94 grade 2 children recruited in the 2012–2013 and 2013–2014 school years. A sub-cohort of children was tracked longitudinally from kindergarten to grade 2. Accelerometers were used to measure physical activity and sedentary behaviour. Independent t-tests revealed that children in grade 2 spent significantly less time engaged in physical activity compared to those in kindergarten (292 min/day compared with 354 min/day) and more in sedentary behaviours (443 min/day compared with 368 min/day). For the longitudinal sample, the pattern was similar. Repeated measures ANOVA revealed a significant decrease in physical activity levels (364 min/day to 292 min/day) and a significant increase in sedentary behaviour (368 min/day to 435 min/day) over time. There is a critical need to invest in strategies to maintain higher levels of physical activity across the primary years and reduce sedentary time, since these behaviours affect health outcomes. Full article
(This article belongs to the Special Issue Physical Activity and Sedentary Behaviour in Children and Adolescents)
Review
A Review of Non-Pharmacological Treatments for Pain Management in Newborn Infants
Children 2018, 5(10), 130; https://0-doi-org.brum.beds.ac.uk/10.3390/children5100130 - 20 Sep 2018
Cited by 31 | Viewed by 6840
Abstract
Pain is a major problem in sick newborn infants, especially for those needing intensive care. Pharmacological pain relief is the most commonly used, but might be ineffective and has side effects, including long-term neurodevelopmental sequelae. The effectiveness and safety of alternative analgesic methods [...] Read more.
Pain is a major problem in sick newborn infants, especially for those needing intensive care. Pharmacological pain relief is the most commonly used, but might be ineffective and has side effects, including long-term neurodevelopmental sequelae. The effectiveness and safety of alternative analgesic methods are ambiguous. The objective was to review the effectiveness and safety of non-pharmacological methods of pain relief in newborn infants and to identify those that are the most effective. PubMed and Google Scholar were searched using the terms: “infant”, “premature”, “pain”, “acupuncture”, “skin-to-skin contact”, “sucrose”, “massage”, “musical therapy” and ‘breastfeeding’. We included 24 studies assessing different methods of non-pharmacological analgesic techniques. Most resulted in some degree of analgesia but many were ineffective and some were even detrimental. Sucrose, for example, was often ineffective but was more effective than music therapy, massage, breast milk (for extremely premature infants) or non-invasive electrical stimulation acupuncture. There were also conflicting results for acupuncture, skin-to-skin care and musical therapy. Most non-pharmacological methods of analgesia provide a modicum of relief for preterm infants, but none are completely effective and there is no clearly superior method. Study is also required to assess potential long-term consequences of any of these methods. Full article
(This article belongs to the Special Issue Implementing Pediatric Integrative Medicine in Practice)
Article
School Bag Weight as a Barrier to Active Transport to School among New Zealand Adolescents
Children 2018, 5(10), 129; https://0-doi-org.brum.beds.ac.uk/10.3390/children5100129 - 20 Sep 2018
Cited by 9 | Viewed by 2717
Abstract
Background: Excessive school bag weight is a barrier to active transport to school (ATS). This study examined parents’ and adolescents’ perceptions of school bag weights and actual school bag weights for adolescents in New Zealand. Methods: Parents (n = 331; 76.7% women) completed [...] Read more.
Background: Excessive school bag weight is a barrier to active transport to school (ATS). This study examined parents’ and adolescents’ perceptions of school bag weights and actual school bag weights for adolescents in New Zealand. Methods: Parents (n = 331; 76.7% women) completed a survey. Adolescents (n = 682; age 15.1 ± 1.4 years; 57.3% boys) completed a survey, underwent anthropometry, and had their school bags weighed. Results: Overall, 68.3% of parents perceived that adolescents’ school bags were too heavy to carry to school. This parental perception differed by adolescents’ mode of transport to school (active/motorized/combined: 35.1%/78.4%/68.8%, p < 0.001). Adolescents perceived that their school bags were too heavy to carry to walk (57.8%) or cycle (65.8%) to school. Adolescent perceptions differed by mode of transport to school (for walking (active/motorized/combined): 30.9%/69.2%/55.9% agree, p < 0.001; for cycling: 47.9%/72.8%/67.7%; p < 0.001). Actual school bag weight was, on average, 5.6 ± 2.1 kg. Relative school bag weight (% of body weight) was higher for boys and underweight adolescents compared to their counterparts. Neither absolute nor relative school bag weight differed by mode of transport to school. Conclusions: School bag weight was perceived a barrier to ATS and was a greater perceived barrier among users of motorized versus active transport. Perceptions of school bag weights should be considered in future ATS interventions. Full article
(This article belongs to the Special Issue Physical Activity and Sedentary Behaviour in Children and Adolescents)
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