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Children, Volume 9, Issue 4 (April 2022) – 135 articles

Cover Story (view full-size image):

Is the Demirjian Method Useful for Dental Age Assessment in Romanian Children?

Developed on a French-Canadian population sample, the Demirjian method quickly became one of the most popular techniques for determining dental age. However, most of the time, the original values of the method are not suitable in other populations, with many authors reporting overestimations of dental age.

We wanted to see if this is consistent for the Romanian population as well, so we applied the Demirjian method for dental age estimation in a group of Romanian children. We obtained overestimation of age in all age categories. View this paper

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Article
Implementing Rounding Checklists in a Pediatric Oncologic Intensive Care Unit
Children 2022, 9(4), 580; https://0-doi-org.brum.beds.ac.uk/10.3390/children9040580 - 18 Apr 2022
Viewed by 661
Abstract
Standardized rounding checklists during multidisciplinary rounds (MDR) can reduce medical errors and decrease length of pediatric intensive care unit (PICU) and hospital stay. We added a standardized process for MDR in our oncologic PICU. Our study was a quality improvement initiative, utilizing a [...] Read more.
Standardized rounding checklists during multidisciplinary rounds (MDR) can reduce medical errors and decrease length of pediatric intensive care unit (PICU) and hospital stay. We added a standardized process for MDR in our oncologic PICU. Our study was a quality improvement initiative, utilizing a four-stage Plan–Do–Study–Act (PDSA) model to standardize MDR in our PICU over 3 months, from January 2020 to March 2020. We distributed surveys to PICU RNs to assess their understanding regarding communication during MDR. We created a standardized rounding checklist that addressed key elements during MDR. Safety event reports before and after implementation of our initiative were retrospectively reviewed to assess our initiative’s impact on safety events. Our intervention increased standardization of PICU MDR from 0% to 70% over three months, from January 2020 to March 2020. We sustained a rate of zero for CLABSI, CAUTI, and VAP during the 12-month period prior to, during, and post-intervention. Implementation of a standardized rounding checklist may improve closed-loop communication amongst the healthcare team, facilitate dialogue between patients’ families and the healthcare team, and reduce safety events. Additional staffing for resource RNs, who assist with high acuity patients, has also facilitated bedside RN participation in MDR, without interruptions in clinical care. Full article
(This article belongs to the Special Issue Advances in Pediatric Critical Care)
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Technical Note
Double Pre-Bending of an Intramedullary Nail Is the Minimal Invasive Osteosynthesis Solution for Dia-Metaphyseal Fractures of the Radius in Children: Technical Note and Case Series
Children 2022, 9(4), 579; https://0-doi-org.brum.beds.ac.uk/10.3390/children9040579 - 18 Apr 2022
Viewed by 442
Abstract
Whereas in paediatric traumatology for diaphyseal fractures of the radius (intramedullary nail), as well as metaphyseal fractures (K-wire), minimal invasive methods for osteosynthesis were established as gold standard, the ideal osteosynthesis of fractures of the dia-metaphyseal area remains controversial. In this article, the [...] Read more.
Whereas in paediatric traumatology for diaphyseal fractures of the radius (intramedullary nail), as well as metaphyseal fractures (K-wire), minimal invasive methods for osteosynthesis were established as gold standard, the ideal osteosynthesis of fractures of the dia-metaphyseal area remains controversial. In this article, the author describes his own minimal invasive technique, using an intramedullary nail that must be pre-bent twice to achieve a stable reduction, with three-point support. The material used for this new surgical technique is an ordinary intramedullary nail. If not available, the operation can also be performed with a sufficiently lengthy K-wire. The intramedullary nail needs to be pre-bent twice, which follows a standardised procedure. A small case series is included to visualise the scope of this minimal-invasive method. Full article
(This article belongs to the Special Issue Current Development of Pediatric Minimally Invasive Surgery)
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Article
Factors Affecting Psychological and Health-Related Quality-of-Life Status in Children and Adolescents with Congenital Heart Diseases
Children 2022, 9(4), 578; https://0-doi-org.brum.beds.ac.uk/10.3390/children9040578 - 18 Apr 2022
Viewed by 522
Abstract
Congenital heart disease (CHD), a severe cardiac defect in children, has unclear influences on young patients. We aimed to find the impacts of differently structure heart defects and various treatments on psychology and health-related quality of life (HRQoL) in CHD children and adolescents. [...] Read more.
Congenital heart disease (CHD), a severe cardiac defect in children, has unclear influences on young patients. We aimed to find the impacts of differently structure heart defects and various treatments on psychology and health-related quality of life (HRQoL) in CHD children and adolescents. CHD patients aged between 6 and 18 years old visited our hospital from 1 May 2018 to 31 September 2018, and their principal caregivers were asked to participate. We used two validated questionnaires, Children Depression Inventory-TW (CDI-TW) and Child Health Questionnaire—Parent Form 50 (CHQ-PF 50), to evaluate CHD patients’ psychological and HRQoL conditions. Participants were grouped based on their cardiac defects and previous treatments. We analyzed the results via summary independent-samples t-test with post hoc Bonferroni correction and multivariant analysis. Two hundred and seventy-seven children and their principal caregivers were involved. There was no apparent depressive condition in any group. Single cardiac defect patients exhibited similar HRQoL to controls; simultaneously, those with cyanotic heart disease (CyHD), most multiple/complex CHDs children and adolescents, and those who received invasive treatments had poorer HRQoL. CyHD impacted the most on patients’ psychological and HRQoL status. Patients with sole cardiac defect could live near-normal lifes; on the other hand, CyHD had the worst effects on patients’ psychology and HRQoL. Full article
(This article belongs to the Special Issue Recent Advances in Child and Adolescent Psychiatry)
Article
Coughing Can Be Modulated by the Hydration Status in Adolescents with Asthma
Children 2022, 9(4), 577; https://0-doi-org.brum.beds.ac.uk/10.3390/children9040577 - 18 Apr 2022
Viewed by 467
Abstract
A lower thirst sensitivity frequently characterizes children and adolescents. The daily water intake can be frequently insufficient for the homeostasis and the integrity of their airway epithelium. Little is known about the real-life relationship between dehydration and coughing in young students with asthma. [...] Read more.
A lower thirst sensitivity frequently characterizes children and adolescents. The daily water intake can be frequently insufficient for the homeostasis and the integrity of their airway epithelium. Little is known about the real-life relationship between dehydration and coughing in young students with asthma. The aim was to investigate the effect of dehydration on coughing in asthmatic students aged ≤16 years. A validated questionnaire aimed to investigate their respiratory history and cough incidence was used. Urine samples were also collected for assessing osmolality. Wilcoxon test, the Pearson Chi Square and the Fisher Exact Test were used; p < 0.05 was assumed as significant. Valid data were obtained from 305 healthy and 56 asthmatic students. Mean urine osmolality was significantly higher in asthmatic than in healthy students (1012 ± 197.7 vs. 863.0 ± 223.0 mOsm/kg, respectively; p < 0.001), particularly in symptomatic asthmatic students (1025 ± 191.6 mOsm/kg, p < 0.01). Both the incidence and duration of coughing episodes were directly related to the degree of urine osmolality (both p < 0.001). Dehydration affects the prevalence and the duration of a cough in asthmatic students aged ≤16 years. Adequate daily water intake should be stimulated in these subjects in order to contain their basic cough attitude. Full article
(This article belongs to the Special Issue Asthma and Its Impact in Adolescents)
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Editorial
Pediatric Asthma: A Daily Challenge
Children 2022, 9(4), 576; https://0-doi-org.brum.beds.ac.uk/10.3390/children9040576 - 18 Apr 2022
Cited by 1 | Viewed by 420
Abstract
Asthma is a prevalent disease in children and adolescents, as the prevalence concerns about 10% of the general pediatric population [...] Full article
(This article belongs to the Special Issue Pediatric Asthma)
Article
Liver and Pancreatic Involvement in Children with Multisystem Inflammatory Syndrome Related to SARS-CoV-2: A Monocentric Study
Children 2022, 9(4), 575; https://0-doi-org.brum.beds.ac.uk/10.3390/children9040575 - 18 Apr 2022
Viewed by 640
Abstract
Liver and pancreatic involvement in children with Multisystem Inflammatory Syndrome related to SARS-CoV-2 (MIS-C) has been poorly investigated so far. We reviewed a cohort of MIS-C patients to analyze the prevalence of acute liver injury (ALI) and pancreatic injury and their correlation with [...] Read more.
Liver and pancreatic involvement in children with Multisystem Inflammatory Syndrome related to SARS-CoV-2 (MIS-C) has been poorly investigated so far. We reviewed a cohort of MIS-C patients to analyze the prevalence of acute liver injury (ALI) and pancreatic injury and their correlation with clinical outcomes. Demographic, clinical, laboratory and imaging features of children with MIS-C at admission and during hospital stay were prospectively collected. Fifty-five patients (mean age 6.5 ± 3.7 years) were included. At admission, 16 patients showed ALI and 5 had increased total serum lipase. During observation, 10 more patients developed ALI and 19 more subjects presented raised pancreatic enzymes. In comparison to those with normal ALT, subjects with ALI were significantly older (p = 0.0004), whereas pancreatic involvement was associated to a longer duration of hospital stay compared with patients with normal pancreatic enzymes (p = 0.004). Time between hospital admission and onset of ALI was shorter compared to the onset of raised pancreatic enzymes (3.2 ± 3.9 versus 5.3 ± 2.7 days, respectively; p = 0.035). Abdominal ultrasound showed liver steatosis in 3/26 (12%) and hepatomegaly in 6/26 (16%) patients with ALI; 2 patients presented enlarged pancreas. Although liver and pancreatic involvement is commonly observed in MIS-C patients, it is mild in most cases with a complete recovery. Full article
(This article belongs to the Special Issue Progress on Pediatric Inflammatory Multisystem Syndrome)
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Article
Influence of an Educational Intervention on Eating Habits in School-Aged Children
Children 2022, 9(4), 574; https://0-doi-org.brum.beds.ac.uk/10.3390/children9040574 - 17 Apr 2022
Viewed by 633
Abstract
A health promotion intervention directed at preventing unhealthy habits in relation to physical exercise, hygiene habits, diet and personal relationships can lead to a decrease in diseases during adulthood and obtaining a better quality of life. The intervention had a participative and multidisciplinary [...] Read more.
A health promotion intervention directed at preventing unhealthy habits in relation to physical exercise, hygiene habits, diet and personal relationships can lead to a decrease in diseases during adulthood and obtaining a better quality of life. The intervention had a participative and multidisciplinary nature, and it was developed by health professionals, teachers and parents for school children. It promoted healthy lifestyle habits around food by working on four areas through video lessons, interactive talks, practical and theoretical–practical classes and an individual project on behalf of the student where they had to design healthy menus. We randomly selected, by stratified multistage sampling, three public primary education schools. A sample of 479 students registered during the 2014/2015 academic year aged between 6–12 years were included in the study. After the educational intervention, we found a significant reduction in the BMI of the students (p < 0.001). For breakfast, the overweight or obese children modified their usual food consumption after the intervention for a healthier breakfast based on fruit juice and bread instead of sugary snacks (p < 0.001). Regarding eating habits during the mid-morning break, there was a decrease in the consumption of sugary snacks (p < 0.001) and an increase in the consumption of fruits and sandwiches. We found that, after the intervention, the excessive consumption of pasta for the main meal reduced in favor of an increase in the consumption of proteins and different beans and pulses (p > 0.001). Educational interventions on healthy lifestyle habits carried out in children during their early years improve and correct unhealthy habits. Full article
(This article belongs to the Special Issue Childhood and Adolescent Obesity and Weight Management Update)
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Case Report
Congenital Hypertrophic Pyloric Stenosis in a Preterm Dizygotic Female Twin Infant: Case Report
Children 2022, 9(4), 573; https://0-doi-org.brum.beds.ac.uk/10.3390/children9040573 - 17 Apr 2022
Viewed by 456
Abstract
Infants with hypertrophic pyloric stenosis are usually diagnosed at about 3 to 8 weeks of age. The clinical onset of symptoms in preterm babies is observed normally at a later age than in term or post-term newborns. This report describes a rare case [...] Read more.
Infants with hypertrophic pyloric stenosis are usually diagnosed at about 3 to 8 weeks of age. The clinical onset of symptoms in preterm babies is observed normally at a later age than in term or post-term newborns. This report describes a rare case of a 2-day old preterm twin girl presenting with drinking laziness and recurrent vomiting. Five days after the beginning of symptoms and after several studies, including an upper gastrointestinal contrast study, the diagnosis of hypertrophic pyloric stenosis was made and confirmed at surgery. The postoperative course was uneventful. Interestingly, the mother of the child herself had a history of postnatal surgery on her fifth day of life due to congenital hypertrophic pyloric stenosis. To our best knowledge, this is the first report in the literature describing congenital hypertrophic pyloric stenosis in a mother and her child. Full article
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Review
Motivators and Barriers to Physical Activity among Youth with Sickle Cell Disease: Brief Review
Children 2022, 9(4), 572; https://0-doi-org.brum.beds.ac.uk/10.3390/children9040572 - 17 Apr 2022
Viewed by 598
Abstract
Purpose: Health disparities for minority groups include a low rate of physical activity and underserved urban minority youth with chronic disease are among the least active population segments, as exemplified by sickle cell disease (SCD). “Exercise prescriptions” for youth with chronic diseases need [...] Read more.
Purpose: Health disparities for minority groups include a low rate of physical activity and underserved urban minority youth with chronic disease are among the least active population segments, as exemplified by sickle cell disease (SCD). “Exercise prescriptions” for youth with chronic diseases need to be evidence based and align with psychologic motivators and barriers. This scoping review sought evidence for psychosocial motivators or barriers to physical activity (PA) in youth with SCD and other chronic disease that could be relevant to SCD. Methods: Five databases were searched for studies on urban minority youth published between 2009 and 2022. Results: Keyword searching yielded no papers on SCD and PA motivation and barriers. Adding health-related quality of life (HRQL) in SCD found eleven relevant papers. Widening the search to chronic disease in minority youth resulted in a total of 49 papers. Three thematic categories and seven sub-themes emerged. PA barriers added by chronic disease include fear of triggering disease complications, negative relationships due to disease limitations on performance in sports, and lack of suitable environment for PA that accommodates the chronic disease. PA motivators are similar for youth without chronic disease: self-efficacy, autonomy, positive relationships with peers and parents and coach/teacher. Conclusion: Direct descriptions of PA motivations and barriers to PA in SCD are limited to fatigue and fear of sickle vaso-occlusive pain. The PA barriers and motivators found for urban youth with chronic disease overlap with themes in healthy adolescents from underserved minorities. Community-based interventions could strengthen PA motivators (self-efficacy, autonomy, positive relationships with peers and parents and coach/teacher) but need disease accommodations to overcome the barriers (fear of triggering disease complications, environmental limitations, and negative relationships). Evidence-based exercise prescriptions might incorporate educational modules to overcome disease stigma and misconceptions. Prospective studies of PA motivators and barriers could improve HRQL in SCD. Full article
(This article belongs to the Section Oncology and Hematology)
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Article
Reliability of Educational Content Videos in YouTubeTM about Stainless Steel Crowns
Children 2022, 9(4), 571; https://0-doi-org.brum.beds.ac.uk/10.3390/children9040571 - 17 Apr 2022
Viewed by 513
Abstract
The purpose of the present study is to evaluate the quality and educational information provided on YouTubeTM about stainless steel crowns (SSC). Videos were searched for on YouTube TM using keywords related to stainless steel crowns in pediatric dentistry in the Google [...] Read more.
The purpose of the present study is to evaluate the quality and educational information provided on YouTubeTM about stainless steel crowns (SSC). Videos were searched for on YouTube TM using keywords related to stainless steel crowns in pediatric dentistry in the Google Trends application. A total of 52 videos were available. After exclusion criteria application, 22 videos were selected for the study for analysis. To classify the video content as high or low quality, a scoring system formed of seven parameters was used. For a global evaluation of the video quality, the video information and quality index were applied. Data obtained were analyzed statistically. Only a few videos explained the importance of SSCs. Most of the videos uploaded with a high number of likes were of low quality. Very few videos were of high quality. The content quality and educational quality of videos is poor and incomplete. None of the videos explained the need for the SSC and its benefits in pediatric dentistry. Full article
(This article belongs to the Special Issue Advances in Pediatric Dentistry and Juvenile Orthodontics)
Article
Longitudinal Motor-Developmental Outcomes in Infants with a Critical Congenital Heart Defect
Children 2022, 9(4), 570; https://0-doi-org.brum.beds.ac.uk/10.3390/children9040570 - 16 Apr 2022
Viewed by 626
Abstract
Infants with critical congenital heart defects (CCHDs) are at increased risk for neurodevelopmental delays. The early identification of motor delays is clinically relevant to prevent or reduce long-term consequences. The current study aims to describe the motor-developmental pathways of infants with a CCHD. [...] Read more.
Infants with critical congenital heart defects (CCHDs) are at increased risk for neurodevelopmental delays. The early identification of motor delays is clinically relevant to prevent or reduce long-term consequences. The current study aims to describe the motor-developmental pathways of infants with a CCHD. Motor development was assessed in 215 infants and toddlers using the Dutch version of the Bayley-III. At 3 months (n = 165), 9 months (n = 188), and 18 months (n = 171) the motor composite scores were 97, 98, and 104, respectively. A motor composite score of ≤−2 SD was only seen in 2.4%, 0%, and 2.3%, respectively, with gross motor deficits being observed more often than fine motor deficits (12% vs. 0% at 18 months). Over 90% of infants who scored average at 9 months still did so at 18 months. The majority of infants with below-average gross motor scores (≤−1) at 9 months still had a below-average or delayed motor score (≤−2 SD) at 18 months. Abnormal gross motor scores (≤−2 SD) increased with age. Infants with single-ventricle physiology performed significantly (p ≤ 0.05) worse on both fine and gross motor skills at 9 and 18 months compared to infants with other CCHDs. Full article
(This article belongs to the Section Integrative Pediatrics)
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Article
Impact of HLA-B27 and Disease Status on the Gut Microbiome of the Offspring of Ankylosing Spondylitis Patients
Children 2022, 9(4), 569; https://0-doi-org.brum.beds.ac.uk/10.3390/children9040569 - 16 Apr 2022
Viewed by 752
Abstract
Multiple studies have shown the microbiota to be abnormal in patients with spondyloarthritis (SpA). The purpose of this study was to explore the genetic contributions of these microbiota abnormalities. We analyzed the impact of HLA-B27 on the microbiota of children at risk for [...] Read more.
Multiple studies have shown the microbiota to be abnormal in patients with spondyloarthritis (SpA). The purpose of this study was to explore the genetic contributions of these microbiota abnormalities. We analyzed the impact of HLA-B27 on the microbiota of children at risk for SpA and compared the microbiota of HLA-B27+ pediatric offspring of ankylosing spondylitis (AS) patients with that of HLA-B27+ children with SpA. Human DNA was obtained from the offspring for determination of HLA-B27 status and polygenic risk score (PRS). Fecal specimens were collected from both groups for sequencing of the V4 region of the 16S ribosomal RNA gene. Among the offspring of AS patients, there was slight clustering by HLA-B27 status. After adjusting for multiple comparisons, five operational taxonomic units (OTUs) representing three unique taxa distinguished the HLA-B27+ from negative children: Blautia and Coprococcus were lower in the HLA-B27+ offspring, while Faecalibacterium prausnitzii was higher. HLA-B27+ offspring without arthritis were compared to children with treatment-naïve HLA-B27+ SpA. After adjustments, clustering by diagnosis was present. A total of 21 OTUs were significantly associated with diagnosis state, including Bacteroides (higher in SpA patients) and F. prausnitzii (higher in controls). Thus, our data confirmed associations with B. fragilis and F. prausnitzii with juvenile SpA, and also suggest that the mechanism by which HLA-B27 is associated with SpA may not involve alterations of the microbiota. Full article
(This article belongs to the Special Issue Advances in Juvenile Idiopathic Arthritis)
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Editorial
Does Neonatal Sepsis Independently Increase Neurodevelopmental Impairment?
Children 2022, 9(4), 568; https://0-doi-org.brum.beds.ac.uk/10.3390/children9040568 - 16 Apr 2022
Viewed by 524
Abstract
Editorial Comment on: Short- and long- term neurodevelopmental outcomes of very preterm infants with neonatal sepsis: a systematic review and meta-analysis [...] Full article
(This article belongs to the Section Pediatric Neonatology)
Article
Validity of the Demirjian Method for Dental Age Estimation in Romanian Children
Children 2022, 9(4), 567; https://0-doi-org.brum.beds.ac.uk/10.3390/children9040567 - 16 Apr 2022
Viewed by 1200
Abstract
Dental age assessment is useful in various medical fields. The Demirjian method for dental age estimation is one of the most widely used in the field of pediatric dentistry. The aim of this study was to verify the accuracy of the Demirjian method [...] Read more.
Dental age assessment is useful in various medical fields. The Demirjian method for dental age estimation is one of the most widely used in the field of pediatric dentistry. The aim of this study was to verify the accuracy of the Demirjian method in determining age in a sample of girls and boys from Oradea, Romania. This retrospective and radiographic study was based on the evaluation of 1006 panoramic radiographs, belonging to 1006 patients (431 boys and 575 girls) with ages between 3 and 13.9 years from the city of Oradea, Romania. They were collected from three private dental practices from Oradea and were analyzed between 1 September 2021, and 10 November 2021. The patients were distributed into 11 age groups, each group spanning over one year (e.g., 3–3.9, 4–4.9). For the assessment of dental age, the Demirjian method was used, which is based on the evaluation of the developmental stages of the lower left permanent teeth. The mean chronological age of the patients was 9.496 ± 2.218 years, and the mean dental age was 10.934 ± 2.585 years. The overestimation of dental age was obtained in all age groups for the entire sample. As such, dental age was higher than chronological age, with values varying from 0.34 years in the 3–3.9 years age group to 1.7 years in the 10–10.9 years age group. In girls, dental age was higher than chronological age, with values varying from 0.46 years in the 3–3.9 years age group to 1.73 years in the 11–11.9 years age group, while in boys, the values varied from 0.15 years in the first age group to 2.02 years in the 10–10.9 years age group. The comparison of the differences between chronological age and dental age according to the gender of the patients revealed that the distribution of the differences was nonparametric in both groups according to the Shapiro–Wilk test (p < 0.05). The differences between the groups were not significant according to the Mann–Whitney U test. However, larger differences were identified for boys (1.46 years) than girls (1.417 years), with an overestimation of the dental age. The Demirjian method overestimated the age of the children included in the investigated sample, with different values for the different age groups investigated, and requires adaptations. Full article
(This article belongs to the Collection Advance in Pediatric Dentistry)
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Review
Prevention and Treatment of Oral Complications in Hematologic Childhood Cancer Patients: An Update
Children 2022, 9(4), 566; https://0-doi-org.brum.beds.ac.uk/10.3390/children9040566 - 15 Apr 2022
Viewed by 649
Abstract
Cancers have a highly negative impact on the quality of life of paediatric patients and require an individualised oral treatment program for the phases of the disease. The aim of this study was to update existing research on oral care in children diagnosed [...] Read more.
Cancers have a highly negative impact on the quality of life of paediatric patients and require an individualised oral treatment program for the phases of the disease. The aim of this study was to update existing research on oral care in children diagnosed with cancer. We carried out a literature search (in English, Spanish and Portuguese) in the Pubmed, Cochrane Library, EBSCO, WOS, SciELO, Lilacs, ProQuest, and SCOPUS databases and the websites of hospitals that treat childhood cancers. We found 114 articles and two hospital protocols. After review, we describe the interventions necessary to maintain oral health in children with cancer, divided into: phase I, before initiation of cancer treatment (review of medical record and oral history, planning of preventive strategies and dental treatments); phase II, from initiation of chemo-radiotherapy to 30–45 days post-therapy (maintenance of oral hygiene, reinforcement of parent/patient education in oral care, prevention and treatment of complications derived from cancer treatment); phase III, from 1 year to lifetime (periodic check-ups, maintenance, and reinforcement of oral hygiene, dental treatments, symptomatic care of the effects of long-term cancer treatment). The use of standardised protocols can avoid or minimise oral cancer complications and the side effects of cancer therapies. Full article
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Review
‘Teratoid’ Hepatoblastoma: An Intriguing Variant of Mixed Epithelial-Mesenchymal Hepatoblastoma
Children 2022, 9(4), 565; https://0-doi-org.brum.beds.ac.uk/10.3390/children9040565 - 15 Apr 2022
Viewed by 511
Abstract
Liver neoplasms are quite rare in childhood. They often involve 6.7 cases per 10 million children aged 18 years or younger. Hepatoblastoma (HB) is the most frequent tumor, but this neoplasm’s rarity points essentially to the difficulty of performing biologic studies and large-scale [...] Read more.
Liver neoplasms are quite rare in childhood. They often involve 6.7 cases per 10 million children aged 18 years or younger. Hepatoblastoma (HB) is the most frequent tumor, but this neoplasm’s rarity points essentially to the difficulty of performing biologic studies and large-scale therapeutic trials. On the pathological ground, HB is separated into an entirely epithelial neoplasm or a mixed neoplasm with epithelial and mesenchymal components. This last category has been further subdivided into harboring teratoid features or not. The ‘teratoid’ HB includes a mixture of components with heterologous origin. The heterologous components include neuroectoderm, endoderm, or melanin-holding cells with or without mesenchymal components. The most important criterium for the teratoid component is neuroepithelium, melanin, and, more recently, a yolk-sac-like component and neuroendocrine components. The mesenchymal components include muscle, osteoid, and cartilage, which are most often observed mainly in ‘teratoid’ neoplasms. The teratoid component or mesenchymal components are diagnosed with biopsies. They appear more prominent after chemotherapy due to the response and shrinkage of epithelial elements and non- or low-responsive components of mixed HB. This review focuses on the clinical, radiological, and pathological findings of HB with teratoid features. Full article
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Case Report
Infection-Triggered Hyperinflammatory Syndromes in Children
Children 2022, 9(4), 564; https://0-doi-org.brum.beds.ac.uk/10.3390/children9040564 - 15 Apr 2022
Viewed by 448
Abstract
An association between infectious diseases and macrophage activation syndrome (MAS) has been reported, yet the exact role of infection in MAS development is still unclear. Here, a retrospective analysis of the clinical records of patients with rheumatic diseases complicated with MAS who were [...] Read more.
An association between infectious diseases and macrophage activation syndrome (MAS) has been reported, yet the exact role of infection in MAS development is still unclear. Here, a retrospective analysis of the clinical records of patients with rheumatic diseases complicated with MAS who were treated in a pediatric tertiary care center between 2011 and 2020 was performed. Any infection documented within the 30 days preceding the onset of MAS was reported. Out of 125 children in follow-up for systemic rheumatic diseases, 12 developed MAS, with a total of 14 episodes. One patient experienced three episodes of MAS. Clinical and/or laboratory evidence of infection preceded the onset of MAS in 12 events. Clinical features, therapeutic strategies, and patient outcomes were described. The aim of this study was to evaluate the possible role of infection as a relevant trigger for MAS development in children with rheumatic conditions. The pathogenetic pathways involved in the cross-talk between uncontrolled inflammatory activity and the immune response to infection deserve further investigation. Full article
(This article belongs to the Special Issue Advances in Juvenile Idiopathic Arthritis)
Article
Educating Parents Improves Their Ability to Recognize Adolescent Idiopathic Scoliosis: A Diagnostic Accuracy Study
Children 2022, 9(4), 563; https://0-doi-org.brum.beds.ac.uk/10.3390/children9040563 - 15 Apr 2022
Viewed by 470
Abstract
(1) In countries where scoliosis screening programs ended, the responsibility for detection shifted from healthcare professionals to parents. Since recognizing scoliosis is difficult for parents, more patients are presenting late. Increased awareness of scoliosis may favor earlier detection. This study examines the effect [...] Read more.
(1) In countries where scoliosis screening programs ended, the responsibility for detection shifted from healthcare professionals to parents. Since recognizing scoliosis is difficult for parents, more patients are presenting late. Increased awareness of scoliosis may favor earlier detection. This study examines the effect of educating parents to recognize scoliosis. (2) In this cross-sectional study a consecutive group of parents completed a digital assessment. They had to complete two identical series of fourteen cases (eight with scoliosis and six without). Each case displayed two photographs of the child’s back; one in standing position and one during forward-bending. Based on visual inspection, parents had to indicate if the child had to be referred to a physician. After assessing the first series, information was given on how to detect scoliosis. Subsequently, parents assessed the second series of cases. Sensitivity and specificity were calculated before and after education. (3) A total of 100 parents completed the assessment. The sensitivity to detect scoliosis was slightly but significantly higher after education (68.8% versus 74.0%; p = 0.002), while specificity was not (74.0% versus 74.8%; p = 0.457). (4) This study showed that educating parents improved their ability to recognize scoliosis without increasing the false positive referral rate. Although written instructions can bridge the gap with professional screening programs, the overall sensitivity in this study remained low. Therefore, education can improve the awareness and ability to detect scoliosis, but will not replace screening by professionals. Full article
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Editorial
Interdisciplinary Collaborative Care to Manage Total Pain in Children with Cancer
Children 2022, 9(4), 562; https://0-doi-org.brum.beds.ac.uk/10.3390/children9040562 - 14 Apr 2022
Viewed by 423
Abstract
The pain and suffering of children with cancer became national news in the winter of 2000 with the publication of Wolfe’s landmark paper in the New England Journal of Medicine, “Symptoms and Suffering Children with Cancer” [...] Full article
(This article belongs to the Special Issue Total Pain Management in Children with Cancer)
Article
An Updated Overview of MRI Injuries in Neonatal Encephalopathy: LyTONEPAL Cohort
Children 2022, 9(4), 561; https://0-doi-org.brum.beds.ac.uk/10.3390/children9040561 - 14 Apr 2022
Viewed by 442
Abstract
Background: Brain magnetic resonance imaging (MRI) is a key tool for the prognostication of encephalic newborns in the context of hypoxic−ischemic events. The purpose of this study was to finely characterize brain injuries in this context. Methods: We provided a complete, descriptive analysis [...] Read more.
Background: Brain magnetic resonance imaging (MRI) is a key tool for the prognostication of encephalic newborns in the context of hypoxic−ischemic events. The purpose of this study was to finely characterize brain injuries in this context. Methods: We provided a complete, descriptive analysis of the brain MRIs of infants included in the French national, multicentric cohort LyTONEPAL. Results: Among 794 eligible infants, 520 (65.5%) with MRI before 12 days of life, grade II or III encephalopathy and gestational age ≥36 weeks were included. Half of the population had a brain injury (52.4%); MRIs were acquired before 6 days of life among 247 (47.5%) newborns. The basal ganglia (BGT), white matter (WM) and cortex were the three predominant sites of injuries, affecting 33.8% (n = 171), 33.5% (n = 166) and 25.6% (n = 128) of participants, respectively. The thalamus and the periventricular WM were the predominant sublocations. The BGT, posterior limb internal capsule, brainstem and cortical injuries appeared more frequently in the early MRI group than in the late MRI group. Conclusion: This study described an overview of brain injuries in hypoxic−ischemic neonatal encephalopathy. The basal ganglia with the thalamus and the WM with periventricular sublocation injuries were predominant. Comprehensive identification of brain injuries in the context of HIE may provide insight into the mechanism and time of occurrence. Full article
(This article belongs to the Special Issue Neurodevelopmental Disabilities in Neonates)
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Article
Qualitative and Quantitative Micro-CT Analysis of Natal and Neonatal Teeth
Children 2022, 9(4), 560; https://0-doi-org.brum.beds.ac.uk/10.3390/children9040560 - 14 Apr 2022
Viewed by 410
Abstract
The objective of this study was to characterize natal and neonatal teeth using micro-computed tomography. A total of 4 natal and 11 neonatal teeth were used for the analysis. The reconstructed scans were assessed for the maximum enamel/dentin thickness and mineral density (MD). [...] Read more.
The objective of this study was to characterize natal and neonatal teeth using micro-computed tomography. A total of 4 natal and 11 neonatal teeth were used for the analysis. The reconstructed scans were assessed for the maximum enamel/dentin thickness and mineral density (MD). The scanned specimens were 3D reconstructed to qualitatively determine the surface topography. The dentin thickness was two-fold greater than enamel thickness for both natal and neonatal teeth (p < 0.05). The cervical third enamel MD remained undetermined in natal and neonatal teeth. The dentin MD at the cervical third for neonatal teeth was significantly lower than the incisal and middle third dentin (p < 0.05). Similarly, the dentin MD at the cervical third of neonatal teeth was significantly lower than the cervical third dentin MD of natal teeth (p < 0.05). Our qualitative analysis suggests that the cervical thirds of both natal and neonatal teeth are peculiar of an anomalous structure, with neonatal teeth showing an irregular outline. Under the conditions of the present study, it can be concluded that the neonatal teeth studied exhibited a distinguishable aberrant structure compared to the natal teeth. Therefore, the natal teeth unfold as a more organized, three-dimensional structure compared to the neonatal teeth. Full article
(This article belongs to the Special Issue Pediatric Oral Health)
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Article
Clinical Assessment of Neuroinflammatory Markers and Antioxidants in Neonates with Hyperbilirubinemia and Their Association with Acute Bilirubin Encephalopathy
Children 2022, 9(4), 559; https://0-doi-org.brum.beds.ac.uk/10.3390/children9040559 - 14 Apr 2022
Viewed by 416
Abstract
Objective: To assess the oxidant and antioxidant status in neonates with and without hyperbilirubinemia and their association with early manifestations of acute bilirubin encephalopathy (ABE), in addition to eliciting the possible oxidative effects of phototherapy. Methods: This prospective observational study was conducted with [...] Read more.
Objective: To assess the oxidant and antioxidant status in neonates with and without hyperbilirubinemia and their association with early manifestations of acute bilirubin encephalopathy (ABE), in addition to eliciting the possible oxidative effects of phototherapy. Methods: This prospective observational study was conducted with 104 full-term newborns at Menoufia University Hospitals from January 2020 to January 2021 to help resolve the debate regarding whether bilirubin is an antioxidant. The cases group (Group I) included 52 full-term newborns (37–40 weeks) with hyperbilirubinemia during the neonatal period, while the control group (Group II) included 52 healthy, full-term age and sex-matched newborns who did not have hyperbilirubinemia. The cases group was further subdivided into Group Ia (n = 12), which included newborns who presented with neurological manifestations suggesting early ABE, and Group Ib (n = 40), which included newborns with no signs suggestive of ABE. All newborns were subjected to clinical and neurological examinations, as well as laboratory investigations. Results: Comparing the specific biological markers between the Group 1 subgroups before phototherapy, the mean plasma levels of prostaglandin-Em, prostaglandin E2, and TSB were significantly higher in Subgroup I(a) (all p < 0.05). After phototherapy, Subgroup I(a) patients had significantly higher levels of prostaglandin-Em, DSB, and TSB (p < 0.05). The biological marker levels improved after phototherapy in terms of TAC (0.811 vs. 0.903), MDA (8.18 vs. 5.13), prostaglandin-Em (37.47 vs. 27.23), prostaglandin E2 (81.09 vs. 31.49), DSB (1.21 vs. 0.55), and TSB (16.63 vs. 8.26; p-value < 0.05). Conclusion: Our study showed that an elevated level of serum bilirubin increases oxidative stress and decreases antioxidant capacity. The reduction in bilirubin levels by phototherapy is associated with a decrease in oxidative stress markers (MDA, PGEm, and PGE2) and an upsurge in TAC, highlighting the absence of oxidative stress effects arising from phototherapy. Neonates with neurological manifestations suggesting ABE had higher levels of oxidative stress markers and lower levels of total antioxidant capacity than those without. Full article
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Editorial
Special Issue “Neuromuscular Disorders in Children and Adolescents”
Children 2022, 9(4), 558; https://0-doi-org.brum.beds.ac.uk/10.3390/children9040558 - 14 Apr 2022
Viewed by 393
Abstract
Our call for contributions in early 2021 resulted in 10 peer-reviewed publications by the end of the year covering a wide range of topics in the field of neuromuscular diseases in children and adolescents [...] Full article
(This article belongs to the Special Issue Neuromuscular Disorders in Children and Adolescents)
Article
Comparison of the Standard vs. Thoracoscopic Extrapleural Modification of the Nuss Procedure—Two Centers’ Experiences
Children 2022, 9(4), 557; https://0-doi-org.brum.beds.ac.uk/10.3390/children9040557 - 14 Apr 2022
Viewed by 502
Abstract
Pectus excavatum is the most common congenital anterior chest wall deformity, with an incidence of 1:400 to 1:1000. Surgical strategy has evolved with the revolutionary idea of Donald Nuss, who was a pioneer in the operative correction of this deformity using minimally invasive [...] Read more.
Pectus excavatum is the most common congenital anterior chest wall deformity, with an incidence of 1:400 to 1:1000. Surgical strategy has evolved with the revolutionary idea of Donald Nuss, who was a pioneer in the operative correction of this deformity using minimally invasive surgery. The aim of this paper is to compare the preliminary results of pectus excavatum repair in two University Centers with a moderate number of patients using the standard Nuss procedure and its modification, the extrapleural thoracoscopic approach. The statistical analysis showed no significant difference for the patient’s age (14.52 ± 3.70 vs. 14.57 ± 1.86; p = 0.95) and the CT Haller index (4.17 ± 1.58 vs. 3.78 ± 0.95; p = 0.32). A statistically significant difference was noted for the duration of a pectus bar implant (2.16 ± 0.24 vs. 2.48 ± 0.68; p = 0.03) between the Maribor and Novi Sad Center. We report 14 complications (28%), including dislocation of the pectus bar (10%), pleural effusion (8%), wound inflammation (6%), pericarditis (2%) and an allergic reaction to the pectus bar (2%). Standard and thoracoscopic extrapleural Nuss procedures are both safe and effective procedures used to correct a pectus excavatum deformity. The choice of surgical procedure should be made according to a surgeon’s reliability in performing a particular procedure. Our study found no advantages of one procedure over the other. Full article
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Article
Joint Attention and Its Relationship with Autism Risk Markers at 18 Months of Age
Children 2022, 9(4), 556; https://0-doi-org.brum.beds.ac.uk/10.3390/children9040556 - 13 Apr 2022
Viewed by 553
Abstract
(1) Joint attention is the ability to coordinate attention to share a point of reference with another person. It has an early onset and is a clear indicator of understanding the representations of others, and it is essential in the development of symbolic [...] Read more.
(1) Joint attention is the ability to coordinate attention to share a point of reference with another person. It has an early onset and is a clear indicator of understanding the representations of others, and it is essential in the development of symbolic thought and the acquisition of language. Deficiencies in this prelinguistic early communication skill are strong markers of the risk of autism spectrum disorder (ASD); (2) this longitudinal study aimed to evaluate joint attention skills in a group of 32 infants at two developmental moments (8 and 12 months) in order to explore whether their performance on this skill was related to the presence of early signs of ASD at 18 months. Logistic multiple regressions were carried out for the data analysis; (3) results of the analysis showed that the variables of initiating joint attention at 8 months and responding to joint attention at 12 months were linked to the risk of ASD at 18 months of age; (4) in conclusion, early joint attention skills had a pivotal role in defining early manifestations of ASD. Full article
(This article belongs to the Special Issue Autism and Children)
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Case Report
The Key Role of Lung Ultrasound in the Diagnosis of a Mature Cystic Teratoma in a Child with Suspected Difficult to Treat Pneumonia: A Case Report
Children 2022, 9(4), 555; https://0-doi-org.brum.beds.ac.uk/10.3390/children9040555 - 13 Apr 2022
Viewed by 395
Abstract
To date, the diagnosis of mediastinal teratoma and mediastinal masses relies on the use of chest X-ray and CT. Lung and thoracic ultrasound is becoming increasingly used in the diagnosis and follow-up of many lung and thoracic diseases. Here, we report the case [...] Read more.
To date, the diagnosis of mediastinal teratoma and mediastinal masses relies on the use of chest X-ray and CT. Lung and thoracic ultrasound is becoming increasingly used in the diagnosis and follow-up of many lung and thoracic diseases. Here, we report the case of a mature cystic teratoma in which the performance of lung ultrasound allowed to speed up the diagnostic workup and to provide the indication for the execution of CT of the thorax allowing the diagnosis. Full article
(This article belongs to the Special Issue Application of Pulmonary Ultrasonography in Children)
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Article
Managing Care during the COVID-19 Pandemic: The Point of View and Fears of Pediatric Cancer Patients’ Families
Children 2022, 9(4), 554; https://0-doi-org.brum.beds.ac.uk/10.3390/children9040554 - 13 Apr 2022
Viewed by 380
Abstract
(1) Background: When the COVID-19 pandemic arrived, changes had to be made to several management aspects at our Pediatric Oncology Unit. We investigated how the families perceived these changes. (2) Methods: Two questionnaires were developed at the Pediatric Oncology Unit of the Istituto [...] Read more.
(1) Background: When the COVID-19 pandemic arrived, changes had to be made to several management aspects at our Pediatric Oncology Unit. We investigated how the families perceived these changes. (2) Methods: Two questionnaires were developed at the Pediatric Oncology Unit of the Istituto Nazionale dei Tumori in Milan in order to explore how the pandemic had affected the experience of patients who had been or were being treated at our hospital, as well as their families. These questionnaires were administered to three groups of individuals. (3) Results: Between July and October 2020, 120 questionnaires were administered to parents of patients. The impact of school closures and the impossibility of attending sports and social activities outside the hospital were regarded as important, and it was reported that 77.5% of parents judged social distancing to have affected their children. Regarding the changes introduced in the management of the ward and outpatient clinic, most parents’ opinions were positive. Differences in the opinions expressed by Groups 2 and 3 were statistically significant on the topics of relationships in the ward and staff workload. The aspect most negatively affected by the pandemic was the support that patients’ parents were able to give each other. Regardless of whether patients were treated before the pandemic or after the first lockdown, all parents indicated strong degrees of satisfaction with the care received and the organizational arrangements. (4) Conclusions: The results of our study point us in the right direction to further improve our daily work and better respond to the needs of our patients and their families. Full article
(This article belongs to the Section Oncology and Hematology)
Article
Thriving despite Parental Physical Abuse in Adolescence: A Two-Wave Latent Transition Analysis on Hedonic and Eudaimonic Violence-Resilience Outcome Indicators
Children 2022, 9(4), 553; https://0-doi-org.brum.beds.ac.uk/10.3390/children9040553 - 13 Apr 2022
Viewed by 436
Abstract
Internationally, about 25% of all children experience physical abuse by their parents. Despite the numerous odds against them, about 30% of adolescents who have experienced even the most serious forms of physical abuse by their parents escape the vicious family violence cycle. In [...] Read more.
Internationally, about 25% of all children experience physical abuse by their parents. Despite the numerous odds against them, about 30% of adolescents who have experienced even the most serious forms of physical abuse by their parents escape the vicious family violence cycle. In this study, we analyzed longitudinally the data from a sample of N = 1767 seventh-grade high school students in Switzerland on physical abuse by their parents. We did this by conducting an online questionnaire twice within the school year. We found that in our sample, about 30% of the participating adolescents’ parents had physically abused them. We considered violence resilience a multi-systemic construct that included the absence of psychopathology on one hand and both forms of well-being (psychological and subjective) on the other. Our latent construct included both feeling good (hedonic indicators, such as high levels of self-esteem and low levels of depression/anxiety and dissociation) and doing well (eudaimonic indicators, such as high levels of self-determination and self-efficacy as well as low levels of aggression toward peers). By applying a person-oriented analytical approach via latent transition analysis with a sub-sample of students who experienced physical abuse (nw2 = 523), we identified and compared longitudinally four distinct violence-resilience patterns and their respective trajectories. By applying to the field of resilience, one of the most compelling insights of well-being research (Deci & Ryan, 2001), we identified violence resilience as a complex, multidimensional latent construct that concerns hedonic and eudaimonic well-being and is not solely based on terms of psychopathology. Full article
(This article belongs to the Special Issue Family Risk and Protective Factors and Child Development)
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Article
Systems Challenges in Accessing Medicines among Children under Thailand’s Universal Health Coverage: A Qualitative Study of a Provincial Public Hospital Network
Children 2022, 9(4), 552; https://0-doi-org.brum.beds.ac.uk/10.3390/children9040552 - 13 Apr 2022
Viewed by 455
Abstract
Lack of access to child-appropriate medicines results in off-label use. This study aimed to explore medicine management for paediatric patients and to highlight the challenges of the healthcare system under the universal health coverage of Thailand. Semi-structured interviews were conducted with 35 healthcare [...] Read more.
Lack of access to child-appropriate medicines results in off-label use. This study aimed to explore medicine management for paediatric patients and to highlight the challenges of the healthcare system under the universal health coverage of Thailand. Semi-structured interviews were conducted with 35 healthcare practitioners working in the public hospital network of Chiang Mai province from February to September 2020. Participants were asked about their experiences in managing the medicine supply for children. Findings revealed that paediatric patients had limited access to age-appropriate medicines. Children’s medicines are rarely selected for inclusion into hospital formularies because of constraining regulations and limited budgets. Additionally, child-appropriate formulations are unavailable on the market. Pharmaceutical compounding is unavoidable. Prepared products are provided weekly or monthly because of product stability concerns. Often, tablets are dispensed, and caregivers are instructed to cut up a tablet and disperse it in syrup in order to obtain a smaller dose in a dosage form appropriate for children to use at home. Without systematic support, access to safe and quality medicines for children is limited. Full article
Article
Psychosocial Difficulties in Preschool-Age Children with Beckwith–Wiedemann Syndrome: An Exploratory Study
Children 2022, 9(4), 551; https://0-doi-org.brum.beds.ac.uk/10.3390/children9040551 - 13 Apr 2022
Viewed by 418
Abstract
Beckwith–Wiedemann syndrome (BWS) is a rare overgrowth disease and is not usually associated with intellectual delay. Living with a chronic illness condition such as BWS, however, might affect emotional-behavioral functioning and psychosocial development. To investigate this issue, parents of 30 children with BWS [...] Read more.
Beckwith–Wiedemann syndrome (BWS) is a rare overgrowth disease and is not usually associated with intellectual delay. Living with a chronic illness condition such as BWS, however, might affect emotional-behavioral functioning and psychosocial development. To investigate this issue, parents of 30 children with BWS between 1.5 and 6 years old compiled standardized questionnaires assessing the presence of emotional-behavioral and developmental problems. The group mean scores in each scale of behavioral problems fell within the average range. Nevertheless, 23% of the sample presented scores beyond the risk threshold for social withdrawal. As regards psychomotor development, a lower mean score was reliable in the social domain compared to other developmental scales, and in the gross-motor compared to fine-motor functions. Moreover, scores in the at-risk band were reliable in almost half of the children for social development. Notably, older age was overall associated with higher emotional-behavioral and developmental difficulties, while no other socio-demographic or clinical variables accounted for the scores obtained in the questionnaires. These findings ask for a wider consideration by health and educational professionals of the psychosocial functioning of children with BWS, so as to early detect at-risk conditions and eventually promote adequate interventions. Full article
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