Changes In Children Research Articles

Agomelatine in pediatric patients with moderate to severe major depressive disorder: an open-label extension study.

Major depressive disorder (MDD) in young people is a common psychiatric disorder, but treatment options are limited. Agomelatine has demonstrated short-term efficacy and safety in pediatric patients. We report here the results of a 92-week open-label extension (OLE). The international, multicenter, double-blind, study randomized 400 patients (80 children, 320 adolescents) with moderate-to-severe MDD to one of four treatment groups: agomelatine 10mg (n = 102), agomelatine 25mg (n = 95), placebo (n = 103), and fluoxetine 10-20mg (n = 100). After 12weeks, patients who could benefit from treatment continuation were offered entry into an optional OLE during which they received agomelatine 10 or 25mg for a further 92weeks. A total of 339 patients (271 adolescents) entered the OLE. Treatment groups considered for the OLE analysis reflected those received in the double-blind and OLE periods: agomelatine (10 or 25mg) in both (ago/ago, n = 170); placebo then agomelatine 10-25mg (pcb/ago, n = 85); or fluoxetine then agomelatine 10-25mg (fluox/ago, n = 84). Mean age (± SD) at entry into the double-blind phase (Week 0) was 13.6 ± 2.7years and 61.9% were female. Mean changes in Children's Depression Rating Scale revised (CDRS-R) raw total score from Week 12 to last post-Week 12 value in the three groups were - 16.3 ± 12.2 (ago/ago), - 18.9 ± 16.1 (pcb/ago), and - 16.1 ± 15.5 (fluox/ago), reflecting the difference in efficacy between treatments during the double-blind period, and heterogeneity at W12 between the treatment groups. Adverse events considered related to treatment occurred in 14.5% of patients: 15.3% ago/ago, 16.5% pcb/ago, and 10.7% fluox/ago. Three patients (all adolescents) experienced treatment-related severe adverse events: two treated with ago/ago and one treated with pcb/ago. Among the adolescents, one treatment-related severe adverse event in a patient in the pcb/ago group led to study withdrawal. Agomelatine was associated with continuous improvement in depressive symptoms without unexpected safety signals. These findings support the safe use of agomelatine in a pediatric population with moderate-to-severe MDD for up to 104weeks.Trial registration No: EUDRACT No. 2015-002181-23.

Longitudinal Microbiome Changes in Children Exposed to Proton Pump Inhibitors.

Proton pump inhibitor (PPI) use has been associated with an increased risk of gastrointestinal and upper respiratory infections in children. There are limited longitudinal data on the effect of PPI in children. The goal of this prospective observational study was to compare the stool and oropharyngeal microbiome of children before and after starting PPIs. We prospectively recruited participants from a gastroenterology clinic. Consented participants provided stool samples and oropharyngeal swabs at baseline and after 8 weeks of PPI therapy. Microbiome changes were measured by analyzing 16S sequencing from both body sites at both time points. Thirty-four participants completed the study and provided samples both at baseline and after 8 weeks on PPI therapy. Of those, 24 participants had sufficient sequencing from both stool and oropharyngeal samples at both time points. There were no differences between the pre-PPI and post-PPI samples using beta-diversity metrics in either the oropharynx or stool. There were, however, significant changes in specific taxa. There was an enrichment of Streptococcus in the stool after PPI use and a reduction in the relative abundance of Bifidobacterium , Peptostreptococcus , and Turicibacter ( P -values < 0.01). Furthermore, there was an increase in the relative abundance of oropharyngeal bacteria in the stool after PPI therapy. This enrichment of oropharyngeal bacteria in the stool was most prominent in younger participants. Further investigation is needed to determine the clinical and microbial factors that predispose or protect against microbiome changes due to PPI use and why young children are more susceptible to this PPI effect.

A Study on Changes in Children's Language Development Through Reading Picture Books

A Study on Changes in Children's Language Development Through Reading Picture Books

Intraoperative Intracranial Pressure Changes in Children With Craniosynostosis Undergoing Endoscopic-Assisted Strip Craniectomy.

Craniosynostosis can lead to progressive cranial and skull base deformities and can be associated with increased intracranial pressure (ICP), ophthalmological manifestations, behavioral changes, and developmental delay. Most published data on the incidence of elevated ICP include older children undergoing open surgical correction. Endoscopic-assisted release of fused sutures with postoperative helmet therapy is an established method for managing craniosynostosis presenting at an early age; however, the immediate effect of this approach on ICP in a young cohort has not been previously reported. Prospective data on 52 children undergoing endoscopic-assisted release of stenosed cranial sutures were included. Individuals were excluded if they underwent open correction or had previous cranial surgery. Individuals underwent a standardized endoscopic approach for each suture type. ICP was measured using an intraparenchymal sensor both before creation of the neosuture and after complete release of the stenosed suture. An ICP reading of >10 mm Hg was considered elevated. The mean age was 5.3 months, range 1 to 32 months, and 94% was younger than 12 months. The mean opening pressure was 12.7 mm Hg, and the mean closing pressure was 2.9 mm Hg. Opening ICP ≥10 mm Hg was present in 58%, ≥15 mm Hg was present in 31%, and ≥20 mm Hg was present in 23%. No patient had an ICP above 10 mm Hg at closing. The mean percentage change in ICP among all craniosynostosis cases was a 64% decrease. Optic disk swelling was identified in 28 children preoperatively and improved in 22 children at follow-up. Elevated ICP may occur in infants with craniosynostosis at higher rates than previously reported. Endoscopic-assisted craniectomy has an immediate effect on lowering ICP and improving postoperative ophthalmological findings.

Respiratory Changes in Children Exposed to Mining Waste Dust in Brumadinho, Minas Gerais, Brazil. Bruminha Project

Respiratory Changes in Children Exposed to Mining Waste Dust in Brumadinho, Minas Gerais, Brazil. Bruminha Project

The effect of volatility in linguistic input on prediction behavior in autistic toddlers.

Domain-general prediction differences have been posited as underlying many aspects of the cognitive-behavioral profile in autism. An interesting potential implication of such differences is hyperplasticity of learning-the idea that autistic individuals may privilege more recent input over the accumulation of prior learning. Because real world language input is highly variable, hyperplasticity could have serious ramifications for language learning. To investigate potential hyperplasticity during a language processing task, we administered an experimental anticipatory eye movement (AEM) task to 2- to 3-year-old autistic children and neurotypical (NT) peers. Autistic children's change in anticipation from before to after a switch in contingencies did not significantly differ from NT counterparts, failing to support claims of hyperplasticity in the linguistic domain. Analysis of individual differences among autistic children revealed that cognitive ability was associated with prediction of the initial, stable contingencies, but neither age nor receptive language related to task performance. Results are discussed in terms of clinical implications and the broader context of research investigating prediction differences in autism.

The Normal Weight Obesity (NWO) Problem-Prevalence and Time Changes in Children and Adolescents From Kraków (Poland).

Normal weight obesity can be associated with an increased risk of metabolic abnormalities, systemic inflammation and mortality. The main aim of the study was to analyze the changes in the prevalence of normal weight obesity in 8-18-year-olds from Kraków (Poland) between 2010 and 2020. The study was based on two sets of cross-sectional, school-based data obtained in 2010 and 2020. Body height, weight, and fat percentage were obtained. Body mass index was calculated, and only normal-weight individuals were included. Normal weight obesity was defined as normal BMI with adiposity >85 percentile for age and sex. The prevalence of normal weight obesity among Polish children and adolescents has been alarming for at least the last 10 years. Depending on the sex and age, normal weight obesity was present in more than 10% up to even more than 20% of the examined population. Alarming numbers of Polish children and adolescents suffer from NWO and this problem seems to be present for at least the last decade. A need for a maximally universal definition and cut-offs to diagnose normal weight obesity should also be stressed, as it will be helpful in providing the best prophylaxis and help to persons already suffering from normal weight obesity.

Lung Volume and Pneumatization Changes in Children in Early Post-Surgical Period After Correction of Severe Neuromuscular Scoliosis Complicated with Respiratory Failure: Cohort Study

Background. The effect of spinal deformity surgical correction in children with severe neuromuscular scoliosis (NMS) on lung function remains unexplored. Objective. The aim of the study is to — to survey the dynamics of volume and structure of lungs pneumatization in children after surgical correction of severe neuromuscular deformities of the spine complicated by respiratory disorders. Methods. CT scans of lungs from 5 children with right-sided NMS, grade IV (Cobb angle &gt; 50°) and functional respiratory disorders (lung capacity &lt; 30% of normal value according to spirometry data and/or clinical signs of respiratory failure) were retrospectively studied. Right and left lungs volumes, their ratio (asymmetry index), indicators of distribution of tissue density of each lung (as a percentage of total volume) before (not earlier than 2 months) and after (not later than 3 months) surgical correction of scoliosis were determined via the data processing from CT scans of the thoracic spine. Results. All children had both lung volumes below reference values (healthy peers) before surgery. The right lung volume increased by 11% (6.4–40.6%), the left lung — by 41% (22.5–90%) with the asymmetry index approaching the reference values for the corresponding age after correction of spinal deformity (the value of scoliotic deformity decreased (median) from 94 to 68°). The volume of normal ventilation zones increased from 30 to 50% on the right side, and from 41 to 55% on the left side, primarily due to decrease in the volume of hypoventilation zones, but not atelectasis and emphysema. Conclusion. Surgical correction of spinal deformity in children with NMS, grade IV, complicated with respiratory failure led to normalization of lungs volume and tissue density characteristics already in the early postoperative period.

Learning to Listen: Changes in Children's Brain Activity Following a Listening Comprehension Intervention.

"Are you LISTENING?" may be one of the most frequent questions preschoolers hear from their parents and teachers, but can children be taught to listen carefully-and thus better comprehend language-and if so, what changes occur in their brains? Twenty-seven four- and five-year-old children were taught a language simulation strategy to use while listening to stories: first, they practiced moving graphics on an iPad to correspond to the story actions, and then they practiced imagining the movements. Compared to a control condition, children in the intervention answered comprehension questions more accurately when imagining moving the graphics and on a measure of transfer using a new story without any instruction and with only immovable graphics. Importantly, for children in the intervention, the change in comprehension from the first to the sixth day was strongly correlated with changes in EEG mu and alpha desynchronization, suggesting changes in motor and visual processing following the intervention. Thus, the data are consistent with our hypothesis that a language simulation listening comprehension intervention can improve children's listening comprehension by teaching children to align visual and motor processing with language comprehension.

Renal Histopathological Changes in Children With Congenital Ureteropelvic Junction Obstruction

Renal histologic changes in congenital ureteropelvic junction obstruction (UPJO), although well documented, are sparsely studied in children. This study aims to establish a histological grading depending on the glomerular and tubulo-interstitial changes in hydronephrotic kidneys and determine correlation with age at surgery and impact on function post-pyeloplasty. A renal cortical wedge biopsy was obtained after pyeloplasty and histological changes were graded from 1 to 4. A total of 47 viable biopsies from 57 children showed grade 1 changes in 10, grade 2 in 7, grade 3 in 27, and grade 4 in 3. Age at surgery, histological grade, and changes in differential renal function (DRF) were statistically analyzed. Younger age, near normal histology, and those with changes in 1 domain had preserved DRF pre-operatively. Renal histology and overall grade showed positive correlation with pre-operative DRF. However, no statistically significant association was noted with age at surgery or change in post-operative DRF.

놀이정책에 나타난 아동담론의 변화*

놀이정책에 나타난 아동담론의 변화*

The Effect of Listening to Music, Performing Mathematic Operations and Ball Squeezing in Reducing Pain During Dressing Change in Children

Objective: The aim of this study was to determine the effect of listening to music (LM), ball squeezing (BS), and performing mathematical operations (MO) on the pain and physiological parameters during the first dressing in children aged 8-18 with appendectomy. Methods: This study was a randomized controlled trial. The sample of the study consisted of 120 children (LM:30, BS:30, MO:30, control:30). Research data were collected using Information Form, Visual Analogue Scale (VAS), mathematical operations form, a softball, a pulse oximeter, and a thermometer. A minute before dressing and during dressing, the children in the LM group listened to music, the children in the SB group squeezed the ball, and the children in the MO group performed mathematical operations. Results: According to the assessment of the child, parent, and nurse, it was determined that the pain score of the children in the LM and MO groups was lower than that of BS group and control groups (p&lt; .05). The mean pulse of the children in the control group was found to be higher during and after dressing than that of LM and MO groups (p&lt; .05). In addition, the mean pulse of the children in the BS group during dressing was found to be higher than that of MO group (p&lt; .05). Conclusion: It was determined that listening to music and performing mathematical operations were effective in reducing the pain of children during dressing. It is recommended that nurses use these non-pharmacological methods, which are easy to apply, in reducing children’s pain.

Safety and Efficacy of Levomilnacipran Extended Release in Pediatric Patients Aged 7-17 Years with Major Depressive Disorder: Results of Two Phase 3, Randomized, Double-Blind Studies.

Objective: Major depressive disorder (MDD) presents a significant psychosocial burden, and there is an unmet need for additional treatment options in pediatric patients. Here, we report the results of two phase 3 multicenter, randomized, double-blind, placebo- and active-controlled, parallel-group studies evaluating the efficacy and safety of levomilnacipran extended release in children and adolescents with MDD. Methods: In the first study, LVM-MD-11, patients aged 12-17 years received daily doses of levomilnacipran 40 mg (n = 134), levomilnacipran 80 mg (n = 138), fluoxetine 20 mg (n = 134), or placebo (n = 141). In the second study, LVM-MD-14, patients aged 7-17 years received levomilnacipran 40 to 80 mg (n = 166), fluoxetine 20 mg (n = 166), or placebo (n = 160) daily. Primary and secondary efficacy endpoints were changes in Children's Depression Rating Scale-Revised (CDRS-R) total score and Clinical Global Impressions-Severity (CGI-S) score, respectively. Results: In LVM-MD-11, there were no significant differences in change in CDRS-R total score between patients treated daily with placebo (least squares mean [LSM] change in CDRS-R total score -22.9) versus levomilnacipran 40 mg (-23.3; p = 0.8035) or 80 mg (-22.6; p = 0.8681). Similarly, in LVM-MD-14, there were no significant differences in LSM change in CDRS-R total score with placebo (-21.3) versus levomilnacipran 40 to 80 mg daily (-23.0; p = 0.2215). There were also no significant differences between the fluoxetine and placebo groups in either study for changes in CDRS-R total score. Changes in CGI-S score were not significant between placebo and levomilnacipran 40 to 80 mg daily or between placebo and fluoxetine. Levomilnacipran was generally well tolerated. Conclusions: The high placebo response in this study prevented the detection of an effect of levomilnacipran in children and adolescents. Clinical Trial Registration numbers: NCT02431806 and NCT03569475.

Evaluation of Structural and Functional Retinal Changes in Children With Intermittent Exotropia Versus Healthy Children.

To detect structural and functional changes in children with intermittent exotropia using optical coherence tomography, pattern electroretinography (ERG), and multifocal ERG. The study included 26 patients with intermittent exotropia and 26 healthy individuals matched for age and sex with a mean age of 9.23 and 11.20 years in the intermittent exotropia and control groups, respectively (P = .310). All patients underwent full ophthalmic examination including measurement of the angle of strabismus at near and far, and assessment of the macula and optic nerve using optical coherence tomography, pattern ERG, and multifocal ERG. All patients had 6/6 best corrected visual acuity with no fixation preference. A significantly prolonged P and N wave latency was found in all measured rings of multifocal ERG of patients with intermittent exotropia, P wave amplitude was lower in rings 1 and 5, and N wave amplitude was lower in rings 1 and 2. Regarding pattern ERG, the amplitude of P50 wave was lower and N95 latency was prolonged in the intermittent exotropia group. The upper and lower ganglion cell complex and the superior retinal nerve fiber layer were significantly thinner in the intermittent exotropia group compared to controls. Children with intermittent exotropia without any associated amblyopia or refractive error showed a subnormal pattern and multifocal ERG response in addition to a thinner ganglion cell layer and retinal nerve fiber layer compared to normal controls. This signifies that subtle structural and functional retinal changes are found in patients with intermittent exotropia. [J Pediatr Ophthalmol Strabismus. 20XX;X(X):XXX-XXX.].

Choroidal Vascularity Index and Choroidal Structural Changes in Children With Nephrotic Syndrome.

To investigate the choroidal vascularity index (CVI) and choroidal structural changes in children with nephrotic syndrome. This was a cross-sectional study involving 45 children with primary nephrotic syndrome and 40 normal controls. All participants underwent enhanced depth imaging-optical coherence tomography examinations. An automatic segmentation method based on deep learning was used to segment the choroidal vessels and stroma, and the choroidal volume (CV), vascular volume (VV), and CVI within a 4.5mm diameter circular area centered around the macular fovea were obtained. Clinical data, including blood lipids, serum proteins, renal function, and renal injury indicators, were collected from the patients. Compared with normal controls, children with nephrotic syndrome had a significant increase in CV (nephrotic syndrome: 4.132 ± 0.464 vs. normal controls: 3.873 ± 0.574; P = 0.024); no significant change in VV (nephrotic syndrome: 1.276 ± 0.173 vs. normal controls: 1.277 ± 0.165; P = 0.971); and a significant decrease in the CVI (nephrotic syndrome: 0.308 [range, 0.270-0.386] vs. normal controls: 0.330 [range, 0.288-0.387]; P < 0.001). In the correlation analysis, the CVI was positively correlated with serum total protein, serum albumin, serum prealbumin, ratio of serum albumin to globulin, and 24-hour urine volume and was negatively correlated with total cholesterol, low-density lipoprotein cholesterol, urinary protein concentration, and ratio of urinary transferrin to creatinine (all P < 0.05). The CVI is significantly reduced in children with nephrotic syndrome, and the decrease in the CVI parallels the severity of kidney disease, indicating choroidal involvement in the process of nephrotic syndrome. Our findings contribute to a deeper understanding of how nephrotic syndrome affects the choroid.

Developmental and Nutritional Changes in Children with Severe Acute Malnutrition Provided with n-3 Fatty Acids Improved Ready-to-Use Therapeutic Food and Psychosocial Support: A Pilot Study in Tanzania.

Children with severe acute malnutrition (SAM) are at high risk of impaired development. Contributing causes include the inadequate intake of specific nutrients such as polyunsaturated fatty acids (PUFAs) and a lack of adequate stimulation. We conducted a pilot study assessing developmental and nutritional changes in children with SAM provided with a modified ready-to-use therapeutic food and context-specific psychosocial intervention in Mwanza, Tanzania. We recruited 82 children with SAM (6-36 months) and 88 sex- and age-matched non-malnourished children. We measured child development, using the Malawi Development Assessment Tool (MDAT), measures of family and maternal care for children, and whole-blood PUFA levels. At baseline, the mean total MDAT z-score of children with SAM was lower than non-malnourished children; -2.37 (95% confidence interval: -2.92; -1.82), as were their total n-3 fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) levels. After 8 weeks of intervention, MDAT z-scores improved in all domains, especially fine motor, among children with SAM. Total n-3 and EPA levels increased, total n-6 fatty acids decreased, and DHA remained unchanged. Family and maternal care also improved. The suggested benefits of the combined interventions on the developmental and nutritional status of children with SAM will be tested in a future trial.

Behavioral and Cortical Activation Changes in Children Following Auditory Training for Dichotic Deficits.

We report changes following auditory rehabilitation for interaural asymmetry (ARIA) training in behavioral test performance and cortical activation in children identified with dichotic listening deficits. In a one group pretest-posttest design, measures of dichotic listening, speech perception in noise, and frequency pattern identification were assessed before and 3 to 4.5 months after completing an auditory training protocol designed to improve binaural processing of verbal material. Functional MRI scans were also acquired before and after treatment while participants passively listened in silence or to diotic or dichotic digits. Significant improvements occurred after ARIA training for dichotic listening and speech-in-noise tests. Post-ARIA, fMRI activation increased during diotic tasks in anterior cingulate and medial prefrontal regions and during dichotic tasks, decreased in the left precentral gyrus, right-hemisphere pars triangularis, and right dorsolateral and ventral prefrontal cortices, regions known to be engaged in phonologic processing and working memory. The results suggest that children with dichotic deficits may benefit from the ARIA program because of reorganization of cortical capacity required for listening and a reduced need for higher-order, top-down processing skills when listening to dichotic presentations.

Evaluation of Jaw Bone Change in Children and Adolescents with Rheumatic Heart Disease by Fractal Analysis.

Recognizing the oral needs of people living with rheumatic heart disease (RHD), particularly in relation to their jaws, is of paramount importance. This study aimed to evaluate potential jaw bone changes in children and adolescents diagnosed with RHD and compare them with a group of healthy children and adolescents. The dental panoramic radiographs (DPRs) of 32 children and adolescents diagnosed with RHD comprised the case group. In contrast, the control group consisted of DPRs from 32 children and adolescents without any known diseases. Two regions of interest (ROI1 and ROI2) of trabecular bone and a separate region of interest (ROI3) of cortical bone were selected for fractal analysis. The mandibular cortical index (MCI) was evaluated. The ROI1 fractal dimension (FD) value of the individuals in the case group was statistically higher in the right jaw than in the left jaw (P < 0.01). Significant differences were determined between the case and control groups regarding the left ROI1, and the left and the right ROI2 (P < 0.05). No significant difference was found between the patient and control groups regarding the MCI value (P > 0.05). The results of this study showed that bone metabolism was affected unilaterally in the condyle region and bilaterally in the gonial region of patients with RHD. It also revealed that the cortical layer was not affected.

Body Mass Index Changes in Children and Adolescents Treated with Methylphenidate for Attention Deficit Hyperactivity Disorder.

Attention Deficit Hyperactivity Disorder (ADHD) and obesity are major pediatric public health problems. The present study aimed to examine the association between these two health parties in our pediatric populations. This study is a single group retrospective cohort study about Body Mass Index (BMI) changes in 149 children and adolescents between 3-18 years old with a diagnosis of ADHD based on one child and adolescent psychiatrist interview according to the Diagnostic and Statistical Manual of Mental Disorders 4th edition criteria (DSM-IV-TR). All participants were treated with methylphenidate. Besides, they were reassessed by the Kiddie Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Persian version (K-SADS-PL-P). Furthermore, the height, weight, and BMI of participants were calculated. The data were analyzed by descriptive statistics, repeated measures, and Wilks' lambda analysis using IBMSPSSStatisticsversion 23. The mean age of patients was 8.2±2.6 years, and 71.8% were boys. The obtained results showed that those treated with methylphenidate for more extended periods had higher BMI increases (p <0.001). The change in BMI was not related to the age at the start of treatment (p = 0.125), but this index was significantly different based on the years under treatment (p = 0.002). Moreover, changes in BMI were not significant based on gender (p = 0.850), the type of ADHD specifiers (p= 0.686), and concomitant drugs (p = 0.783). This study's findings suggest that long-term use of ADHD medications could raise the risk of obesity in children.

ECG Changes in Children with Convulsions at Sohag University Hospital

ECG Changes in Children with Convulsions at Sohag University Hospital