Diagnostic Criteria For Children Research Articles

Management for children and adolescents with overweight and obesity: a recommendations mapping.

Childhood obesity is a global public health issue, and the status of clinical practice guidelines (CPGs) as instruction manuals for the management of childhood obesity remains unclear. This study aims to identify and apprise the methodological and reporting quality of CPGs focused on childhood obesity and provide an overview of key recommendations. Databases and websites reporting guidelines were searched from January, 2018 to September, 2023. The methodological quality was graded using the AGREE II, and RIGHT was used to assess the reporting completeness. Among the six included CPGs, two were rated as high quality and considered "Recommended" and three were reported no less than 80%. CPGs included 184 recommendations cover diagnosis, assessment and management of complications, interventions and prevention. The diagnostic criteria for children with obesity over 2 years of age are based on normative BMI percentiles, depending on sex and age. CPGs recommended the delivery of multi-component behavior-changed interventions included controlling diet and increasing physical activity. Pharmacological interventions and bariatric surgery are considered as complementary therapies. CPGs for childhood obesity should emphasize the impact of psychological factors and consider the provision of interventions from multiple settings, and could consider the role of complementary alternative therapies. Six guidelines have been published in the past 5 years focusing children obesity. Recommendations covered diagnosis, multiple intervention and prevention. Guidelines should focus on the role of complementary alternative therapies. Guidelines should emphasize the impact of psychological factors. Guidelines should consider the provision of interventions from multiple settings.

Secondary fibromyalgia in children with immune-inflammatory rheumatic diseases

Patients with immune-inflammatory rheumatic diseases (IIRDs) often present with non-inflammatory musculoskeletal pain associated with nociceptive dysfunction, central sensitization, and secondary fibromyalgia (FM). In recent years, an increasing number of publications have appeared dealing with FM in rheumatoid arthritis and systemic connective tissue diseases in adult patients, while this problem is little discussed in pediatric rheumatology, partly due to the differences between the existing diagnostic criteria in children and adults, which complicate the diagnosis of juvenile secondary FM. The consequence of this is often the unfounded prescription or switching of synthetic disease-modifying antirheumatic drugs (DMARDs) or biologic DMARDs in patients who do not require intensified antirheumatic therapy, but rather psychotherapy and psychopharmacotherapy, as well as the wider use of physical and rehabilitation medicine methods. In a brief narrative review, we tried to trace the investigation of FM in a rheumatological clinic, including children with IIRD, from a historical perspective, to summarize current literature data on this problem and to point out possible solutions.

Clinical Presentation, Management, and Diagnostic Performance of 2021 Criteria for Paraneoplastic Neurologic Syndromes in Childhood.

Paraneoplastic neurologic syndromes (PNSs) are remote neurologic immune-related effects of tumors. The clinical characteristics of pediatric PNSs remain unclear. We retrospectively examined the clinical characteristics of cases of pediatric PNSs and assessed the performance of the 2021 diagnostic criteria in children. Patients hospitalized in the Beijing Children's Hospital between June 2015 and June 2023 and fulfilling the description of definite by 2004 diagnostic criteria of PNSs were included. A retrospective analysis of clinical characteristics was conducted, and the 2021 diagnostic criteria were applied to rediagnostic stratification. Among the 42 patients included, the most common neurologic syndrome was opsoclonus-myoclonus syndrome (OMS) (62%), followed by rapidly progressive cerebellar syndrome (26%). Most tumors were neuroblastomas (88%), with few being ovarian teratomas (10%). Approximately 71% (30/42) of patients were classified as definite and 24% (10/42) as probable according to the 2021 criteria. All cases judged as probable exhibited rapidly progressive cerebellar ataxia with neuroblastoma. For OMS, chemotherapy was administered based on the tumor's risk stage, accompanied by regular infusion of IV gamma globulin and oral steroids following tumor diagnosis. Twenty-one patients underwent regular follow-ups over 4.92 (0.58-7.58) years. The initial hospitalization recorded a median score of 12 (7-14) on the Mitchell and Pike OMS rating scale, decreasing to 0 (0-5) at the final follow-up. In cases of rapidly progressive cerebellar syndrome, a similar therapeutic regimen was used. Nine patients underwent regular follow-ups over 4.42 (1.17-7.50) years. The mean modified Rankin scale score at first hospitalization was 4 (3-4), reducing to 1 (0-4) at the final follow-up. Only 17% (5/30) of patients across both groups exhibited poor response to this regimen. Among these 5 patients, 4 belonged to the low-risk group (without chemotherapy). OMS followed by rapidly progressive cerebellar ataxia are the most common forms of PNSs in children and are associated with neuroblastoma. An aggressive approach with multiple immunotherapies may improve the prognosis of neuroblastoma-associated PNSs. The 2021 criteria perform well in pediatric PNSs. However, we propose upgrading the classification of antibody-negative rapidly progressive cerebellar ataxia with neuroblastoma to definite diagnosis. This adjustment aims to further improve the diagnostic efficacy of this diagnostic criterion in childhood.

Applicability of the International League Against Epilepsy (ILAE) 2022 diagnostic criteria for epilepsy syndromes in children: A retrospective review of 1550 children with epilepsy

ObjectiveRecently, the ILAE Nosology and Definitions Task Force defined diagnostic criteria for epilepsy syndromes. There is paucity of data on the use of these new diagnostic criteria in children with epilepsy, and how these criteria may lead to changes from previous practice. MethodsThis was a retrospective chart review of data of children attending the epilepsy clinic in a tertiary care children's hospital from January 2011 to January 2023. The clinical details such as age at onset, types of seizures, co-morbidities, and results of EEG, MRI and genetic testing were reviewed. Epilepsy syndrome diagnosis was made as per the ILAE 2022 criteria, and compared with the previous syndrome diagnosis as per records. ResultsData from 1550 children (63 % boys) with epilepsy were analysed, and 55.4 % children were classified to have epilepsy syndromes as per the new ILAE 2022 diagnostic criteria. Application of the new 2022 ILAE diagnostic criteria was associated with a change in name alone in 676 (77.8 %) children. Hundred (11.5 %) children were newly classified under an epilepsy syndrome who had previously remained unclassified. Eleven (1.3 %) children who were previously classified into an epilepsy syndrome could not be classified using the new diagnostic criteria. Eight (0.9 %) were shifted to a new syndromic category. Overall, change in diagnosis occurred in 13.7 (11.5 + 1.3 + 0.9)%. No change in epilepsy syndrome classification/nomenclature occurred in 74 (8.5 %) children. SignificanceThe new diagnostic criteria led to an overall change in diagnosis in 13.7 % of children with epilepsy. These criteria will hopefully lead to uniformity in diagnosis of epilepsy syndromes across diverse settings.

An Age Study on Adopting Adult Hypertension Standards in Chinese Mature Children and Adolescents

Abstract OBJECTIVE To determine age cutoff values for the use of adult hypertension diagnostic criteria in children and adolescents, and to evaluate the consistency and screening effect of the adult criteria with the sex-, age-, and height-specific blood pressure reference (gold standard). METHODS A literature review and expert consultation were used to determine age cutoff value. In children above the cutoff age, the China Child and Adolescent Cardiovascular Health Survey was used to compare the consistency and screening effect between the adult criteria and the gold standard, and Beijing Blood Pressure Study was used to evaluate the predictive value of childhood hypertension diagnosed by adult criteria and gold criteria for hypertension and subclinical cardiovascular damage in adulthood. RESULTS (i) Adult criteria can be used to evaluate hypertension for children aged 16 and above. (ii) Among adolescents aged 16 and above, the adult standard has lower sensitivity (21.1%) but higher specificity (100.0%) compared with the gold standard, with a consensus rate of over 80.0%. And the predictive ability of the adult standard for subclinical cardiovascular health damage in adulthood is also similar to that of the gold standard. CONCLUSIONS Sixteen years can be used as a cutoff point for the adoption of adult hypertension diagnostic criteria in children, and it has a certain degree of simplicity and accuracy.

Effectiveness of a Sensory Play Activity Program with Parent Engagement for Children with Autism Spectrum Disorder: A Randomized Control Trial

Background: According to DSM-5, sensory processing problems are among diagnostic criteria in children with autism spectrum disorder (ASD). Various studies have shown that play, as the main occupation of children, can be helpful in performing sensory interventions. Solving sensory problems is one of the most common demands of families with children with ASD. Children's families play a key role in the implementation of occupational therapeutic interventions. Objectives: This randomized clinical trial investigated the effectiveness of sensory play activities performed by parents at home on the sensory patterns of children with ASD. Methods: Fifty-one children with ASD, aged 3 to 6 years, were divided into the intervention and control groups. All participants attended 16 sessions of in-person individualized sensory integration therapy (SIT) in a clinic for 8 weeks. In the intervention group, children received 8 sessions of a sensory play activity intervention performed by parents at home. Data collection instruments included the Gilliam Autism Rating Scale-2 and the sensory profile 2. Parametric (independent and paired t-test) and non-parametric (Mann-Whitney and Wilcoxon tests) were used for statistical analysis to compare between-group and within-group mean differences. Results: The results showed that although all four sensory processing patterns improved significantly in both groups (P < 0.05) (i.e., the within-group effect), children in the intervention group showed significant improvements in three sensory patterns, including sensory avoiding, sensory sensitivity, and sensory registration (P< 0.01). There was no significant difference in the mean score of the sensory seeking pattern between the 2 groups (P > 0.05). Conclusions: Sensory integration therapy improved dysfunctional sensory processing patterns in ASD children, an effect that was enhanced by the simultaneous implementation of sensory play interventions.

Skeletal muscle mass, muscle strength, and physical performance in children and adolescents with obesity.

Sarcopenic obesity (SO) is defined as obesity with low skeletal muscle function and mass. This study aimed to evaluate the presence of sarcopenic obesity according to different diagnostic criteria and assess the elements of sarcopenia in children and adolescents with obesity. A total of 95 children and adolescents with obesity (diagnosed with the use of International Obesity Task Force (IOTF) criteria) with a mean age of 12.7( ± 3) years participated in the study. Body composition was assessed with the use of bioelectrical impedance-BIA (Tanita BC480MA) and dual-energy X-ray absorptiometry-DXA (Hologic). Fat mass (FM) and appendicular skeletal muscle mass (SMMa) were expressed as kilograms (kg) and percentage (%). Muscle-to-fat ratio (MFR) was defined as SMMa divided by FM. A dynamometer was used in order to measure grip strength. Six-minute walk test (6MWT) and a timed up-and-go test (TUG) were used to assess physical performance. The presence of SO ranged from 6.32% to 97.89%, depending on the criteria used to define sarcopenia. Children with sarcopenia, defined as a co- occurrence of low skeletal muscle mass % (SMM%) measured by DXA (≤9th centile) according to McCarthy et al. and weak handgrip strength (≤10th centile) according to Dodds et al., had significantly lower SMMa measured by both DXA and BIA, lower maximal handgrip strength, and lower physical performance. Maximal handgrip was positively correlated with SMMa (kg) and SMMa% derived from both DXA and BIA and BIA-MFR. Maximal handgrip was negatively correlated with waist-to-height ratio (WHtR). The distance of 6MWT correlated positively with BIA-measured SMMa% and BIA-MFR. 6MWT distance correlated negatively with BIA-FM% and body mass index (BMI) z-score. TUG was positively correlated with BIA-FM%, BMI z-score, WHtR, and IOTF categories and negatively correlated with BIA-SMMa% and BIA-MFR. The presence of sarcopenia in our study varied depending on the diagnostic criteria used. This is one of the first studies evaluating muscle mass, muscle strength, and physical performance in children and adolescents with obesity. The study highlighted the need for the implementation of a consensus statement regarding SO diagnostic criteria in children and adolescents.

Prevalence of gastroesophageal reflux disease in children with extraesophageal manifestations using combined-video, multichannel intraluminal impedance-pH study

Gastroesophageal reflux disease (GERD) might be either a cause or comorbidity in children with extraesophageal problems especially as refractory respiratory symptoms, without any best methods or criterion for diagnosing it in children.To evaluate the prevalence of extraesophageal GERD using conventional and combined-video, multichannel intraluminal impedance-pH (MII-pH), and to propose novel diagnostic parameters.The study was conducted among children suspected of extraesophageal GERD at King Chulalongkorn Memorial Hospital between 2019 and 2022. The children underwent conventional and/or combined-video MII-pH. The potential parameters were assessed and receiver operating characteristic was used for the significant parameters.Of 51 patients (52.9% males), aged 2.24 years were recruited. The common problems were cough, recurrent pneumonia, and hypersecretion. Using MII-pH, 35.3% of the children were diagnosed with GERD by reflux index (31.4%), total reflux events (3.9%), and symptom indices (9.8%) with higher symptom recorded in the GERD group (94 vs 171, P = 0.033). In the video monitoring group (n = 17), there were more symptoms recorded (120 vs 220, P = 0.062) and more GERD (11.8% vs 29.4%, P = 0.398) by symptom indices. Longest reflux time and mean nocturnal baseline impedance were significant parameters for diagnosis with receiver operating characteristic areas of 0.907 (P = 0.001) and 0.726 (P = 0.014).The prevalence of extraesophageal GERD in children was not high as expected. The diagnostic yield of symptom indices increased using video monitoring. Long reflux time and mean nocturnal baseline impedance are novel parameters that should be integrated into the GERD diagnostic criteria in children.

Serum MOG-IgG in children meeting multiple sclerosis diagnostic criteria

Background: Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is now recognized as distinct from multiple sclerosis (MS). Objective: To evaluate the importance of considering myelin oligodendrocyte glycoprotein (MOG)-immunoglobulin-G (IgG) serology when applying MS diagnostic criteria in children. Methods: Within a prospective cohort of children meeting MS criteria (median follow-up = 6 years, interquartile range (IQR) = 4–9), we measured MOG-IgG in serial archived serum obtained from presentation, and compared imaging and clinical features between seropositive and seronegative participants. Results: Of 65 children meeting MS criteria (median age = 14.0 years, IQR = 10.9–15.1), 12 (18%) had MOG-IgG at disease onset. Seropositive participants were younger, had brain magnetic resonance imaging (MRI) features atypical for MS, rarely had cerebrospinal fluid (CSF) oligoclonal bands (2/8, 25%), and accumulated fewer T2 lesions over time. On serial samples, 5/12 (42%) were persistently seropositive, 5/12 (42%) became seronegative, and 2/12 (17%) had fluctuating results. All 12 children experienced a disease course different from typical MS. Conclusion: While children with MOG-IgG can have clinical, CSF, and MRI features conforming to MS criteria, the presence of MOG-IgG is associated with atypical features and predicts a non-MS disease course. Given MOG-IgG seropositivity can wane over time, testing at first attack is of considerable importance for the diagnosis of MOGAD.

Diagnostic outcomes for molecular genetic testing in children with suspected Ehlers-Danlos syndrome.

Ehlers-Danlos syndrome (EDS) is a heterogeneous group of connective tissue disorders characterized by hyperextensible skin, hypermobile joints, easy bruisability, and fragility of the connective tissues. The diagnosis is based on clinical assessment and phenotype-guided genetic testing. Most EDS subtypes can be confirmed by genetic testing except for hypermobile EDS. This study explored the utility of applying the 2017 EDS classification criteria and molecular genetic testing in establishing an EDS diagnosis in children. In this retrospective study, we reviewed 72 patients referred to a tertiary care center for evaluation of EDS who underwent one or more forms of genetic testing. Eighteen patients (18/72, 25%) met the clinical criteria for one of the EDS subtypes and of these, 15 (15/18, 83%) were confirmed molecularly. Fifty-four patients (54/72, 75%) had features that overlapped EDS and other syndromes associated with joint hypermobility but did not fully meet clinical criteria. Twelve of them (12/54, 22%) were later shown to have a positive molecular genetic diagnosis of EDS. Different molecular genetic tests were performed on the cohort of 72 patients (EDS panel, n=44; microarray, n=25; whole exome sequencing [WES], n=9; single gene sequencing, n=3; familial variant testing, n=10; other genetic panels n=3). EDS panel was completed in 44 patients (61%), and a molecular diagnosis was confirmed in nine of the patients who satisfied criteria for one of the EDS subtypes (9/12, 75%) and in nine of the patients who did not fully meet criteria (9/32, 28%). We observed a correlation between generalized joint hypermobility, poor healing, easy bruising, atrophic scars, skin hyperextensibility, and developmental dysplasia of the hip with a positive molecular result. This study provides guidance for the use of molecular genetic testing in combination with the 2017 clinical diagnostic criteria in children presenting with EDS characteristics.

Acute flaccid myelitis and Guillain-Barré syndrome in children: A comparative study with evaluation of diagnostic criteria.

Background and purposeDifferentiation between acute flaccid myelitis (AFM) and Guillain–Barré syndrome (GBS) can be difficult, particularly in children. Our objective was to improve the diagnostic accuracy by giving recommendations based on a comparison of clinical features and diagnostic criteria in children with AFM or GBS.MethodsA cohort of 26 children with AFM associated with enterovirus D68 was compared to a cohort of 156 children with GBS. The specificity of the Brighton criteria, used for GBS diagnosis, was evaluated in the AFM cohort and the specificity of the Centers for Disease Control and Prevention (CDC) AFM diagnostic criteria in the GBS cohort.ResultsChildren with AFM compared to those with GBS had a shorter interval between onset of weakness and nadir (3 vs. 8 days, p < 0.001), more often had asymmetric limb weakness (58% vs. 0%, p < 0.001), and less frequently had sensory deficits (0% vs. 40%, p < 0.001). In AFM, cerebrospinal fluid leukocyte counts were higher, whereas protein concentrations were lower. Spinal cord lesions on magnetic resonance imaging were only found in AFM patients. No GBS case fulfilled CDC criteria for definite AFM. Of the AFM cases, 8% fulfilled the Brighton criteria for GBS, when omitting the criterion of excluding an alternate diagnosis.ConclusionsDespite the overlap in clinical presentation, we found distinctive early clinical and diagnostic characteristics for differentiating AFM from GBS in children. Diagnostic criteria for AFM and GBS usually perform well, but some AFM cases may fulfill clinical diagnostic criteria for GBS. This underlines the need to perform diagnostic tests early to exclude AFM in children suspected of atypical GBS.

Allergic bronchopulmonary Aspergillosis in children.

Background/aim Allergic bronchopulmonary aspergillus (ABPA) is a lung disease caused by hypersensitivity from Aspergillus fumigatus. Diagnostic criteria, staging systems and treatment methods for ABPA disease have been reported in studies evaluating populations, the majority of which are adult patients. Our study aimed to discuss the use of ABPA diagnostic criteria in children, the success of other alternative regimens to oral corticosteroids in the treatment of ABPA, and the changes that occur during treatment, in the light of the literature.Materials and methods Between January 2017 and 2020, patients diagnosed with ABPA at the Dokuz Eylül University Child Allergy and Immunology clinic were identified; demographic characteristics, clinical and laboratory findings, diagnostic scores and stages, and treatment protocols were analyzed retrospectively. Results The mean age of patients diagnosed with ABPA was 14.33 ± 1.96. At the time of ABPA diagnosis, the median total IgE level was 1033 IU/mL (1004–6129), and the median AF specific IgE was 10.64 (2.59–49.70) kU/L. Bronchiectasis was detected in HRCT of 5 cases. We detected significant improvement in spirometric analysis with omalizumab treatment in our patient with steroid-related complications.Conclusion Today, although risk factors have been investigated for ABPA, it has not been revealed clearly. Both diagnostic criteria and treatment regimens have been described in research studies, mostly adults. In pediatric patients; clarification of diagnosis and treatment algorithms is necessary to prevent irreversible lung tissue damage and possible drug side effects.

Diagnostic criteria in children and adolescents affected by familial hypercholesterolemia in the Italian lipigen paediatric group

Background and Aims: The early identification of familial hypercholesterolemia (FH) in childhood is challenging. We aimed to compare the Dutch Lipid Clinic Network (DLCN) criteria in genetically-confirmed FH adults and children/adolescents.

Serum Bone Alkaline Phosphatase and Growth Hormone Levels May Help as a Diagnostic Criteria for Children with Amelogenesis Imperfecta

Serum Bone Alkaline Phosphatase and Growth Hormone Levels May Help as a Diagnostic Criteria for Children with Amelogenesis Imperfecta

Development and validation of new diagnostic criteria for atopic dermatitis in children of China.

In previous epidemiological study, the prevalence of atopic dermatitis (AD) was 12.94% among children aged 1-7years by clinical diagnosis, whereas that was 4.76% and 3.51% using U.K., and Hanifin and Rajka diagnostic criteria. We aimed to propose new diagnostic criteria for children and evaluate its efficiency in different populations. We screened atopic features and analysed their correlation with AD using data from a previous study. A new set of diagnostic criteria for children in China was proposed and validated in 1031 children in outpatient clinics and 538 children in a birth cohort survey. Clinical diagnosis and atopic feature evaluation were performed face to face by dermatologists specialized in AD. Three criteria were compared for diagnostic efficiency using the clinical diagnosis as the reference. The new diagnostic criteria for children were based on (i) pruritus; (ii) 'typical morphology and distribution' or 'atypical morphology and distribution with xerosis'; and (iii) a chronic or chronically relapsing course. Compared to classical diagnostic criteria, the sensitivity of the new diagnostic criteria was significantly higher in the epidemiological survey and the clinical setting, especially obvious among mild and moderate AD. In the birth cohort, the new criteria showed similar sensitivity and specificity. The new criteria for children yielded higher sensitivity for the diagnosis of AD in the epidemiological survey and clinical setting, particularly for mild and moderate AD. Among the birth cohort with a complete medical history, three criteria showed similar sensitivity and specificity.

Diagnostiquer le trouble de stress post-traumatique chez l’enfant : le passage du DSM-IV-TR au DSM-5

Since the publication of the DSM-IV-TR, the diagnosis of posttraumatic stress disorder (PTSD) in children has been subject to criticism from the scientific community. These criticisms essentially targeted the diagnostic criteria, which were deemed developmentally inappropriate, but also the lack of empirical data from studies of young children and the low prevalence of PTSD in children. Therefore, many alternative diagnostic algorithms were elaborated to address these limitations, in order to revise the diagnosis in the DSM-5. In this article, we start by jointly considering Cook et al.’s (2005) and van der Kolk's (2005) proposals for revision. They refer to complex trauma, which, unlike PTSD, concerns the early experience of multiple traumatic events, and which are, in most cases, of interpersonal nature, often occurring in the child's family circle. We analyze why this proposal is considered more adequate for diagnosing children. Indeed, we find two main reasons for its relevance. Firstly, children would be diagnosed with only one disorder, rather than being diagnosed with multiple comorbid disorders, which would allow a comprehensive understanding of their symptoms. Secondly, as complex trauma leads to adverse consequences on children's future lives, especially on their adult health, such a proposal would enable the development of adequate treatment. We then evaluate the arguments for and against its inclusion in the DSM-5, which indicates a lack of consensus on the proposal of complex trauma. This disagreement contributed to its exclusion from the manual. As it was rejected, we study rigorously the modifications of the revised diagnostic criteria of PTSD in the DSM-5, and compare it to the proposal of complex trauma. On the one hand, we consider the detrimental impact of this decision upon professionals, service users, as well as carers. On the other hand, we highlight its efforts to propose more appropriate diagnostic criteria for children, with the introduction of a preschool subtype. Moreover, we view the new dissociative subtype as contributing to the inclusion of an essential dimension of complex trauma in the diagnosis of PTSD. Finally, we explore another classification, that is, the ICD-11 complex PTSD, which is a non-definitive, yet promising proposal for the acknowledgment of complex trauma in children.

Basal characteristics and first year responses to human growth hormone (GH) vary according to diagnostic criteria in children with non-acquired GH deficiency (naGHD): observations from a single center over a period of five decades.

Background Children with non-acquired (na) growth hormone deficiency (GHD) diagnosed over decades in one center may provide perspective insight. Methods naGHD is divided into idiopathic GHD (IGHD), GHD of known cause (cGHD) and GHD neurosecretory dysfunction (NSD); time periods: <1988 (I); 1988-1997 (II); 1998-2007 (III); 2008-2015 (IV). Descriptive analyses were performed at diagnosis and during first year GH treatment. Results Patients (periods, N): I, 87; II, 141; III, 356; IV, 51. In cGHD (all), age, maximum GH, insulin-like growth factor-I (IGF-I), and insulin-like growth factor-binding protein-3 (IGFBP-3) (5.1 years, 3.6 μg/L, -5.3 standard deviation score [SDS], -3.7 SDS) were lower than in IGHD (all) (6.8 years 5.8 μg/L, -2.5 SDS, -1.0 SDS), but not height (-3.1 vs. -3.2 SDS). Characteristics of NSD were similar to that of IGHD. Patients with IGHD - not cGHD - diagnosed during 2008-2015 (IV) were the youngest with most severe GHD (maxGH, IGF-I, IGFBP-3), and first year height velocity (HV) and ∆ IGF-I (10.5 cm/year, 4.0 SDS) but not ∆ height SDS were the highest on recombinant human growth hormone (rhGH) (27 μg/kg/day). Conclusions Although during 1988-2007 patient characteristics were similar, the recently (>2008) stipulated more stringent diagnostic criteria - HV before testing, sex steroid priming, lower GH cut-off - have restricted diagnoses to more severe cases as they were observed before the rhGH era.

Minor Diagnostic Factors in Ventilator Associated Pneumonia in Children

Background: Ventilator-associated pneumonia (VAP) is nosocomial pneumonia. Minor diagnostic criteria in children are poorly understood. Present study aimed to determine the new diagnostic factors for VAP in children admitted in the intensive care unit according to clinical, laboratory, and radiological assessments. Materials and Methods One hundred thirty pediatric intensive care unit (PICU) admitted patients were selected and classified as VAP (29 patients), and non-VAP (101 patients), prospectively. Clinical parameters, laboratory and radiological findings were followed in patients with and without VAP. Results Among the patients, 60% (78 cases) were male. The median age was one month. All of the VAP patients were neonates with the average age of 10.7±25.29 months. There was no significant difference in age and gender. Duration of mechanical ventilation and ICU admission had significant difference between groups (29.31±20.5 versus 8.45±8.76, and 32.62±21.15 versus 12.88±12.16 days, respectively, p<0.001). Tachycardia was detected in 27 (93.1%), and 51(50.5%) patients in VAP and non-VAP, respectively (p<0.001). Respiratory secretion was detected in 8(27.6%) and 9(8.9%) in VAP, and non-VAP, respectively (p=0.009). Crackles was detected in 9(31%) and 15(14.9%) in VAP and non-VAP, respectively (p=0.04). Blood and bronchoalveolar lavage (BAL) culture, need to change device setting, O2 desaturation, WBC count and chest X- ray showed significant difference between groups (p<0.05). Conclusion According to the results, some clinical and laboratory factors including WBC count, blood culture, crackles and need to change settings should be considered as minor but new diagnostic criteria for VAP.

Definitions and Clinical Guidance on the Enteral Dependence Component of the Avoidant/Restrictive Food Intake Disorder Diagnostic Criteria in Children.

The aim of the current article is to offer definitive guidance on weaning children who are reliant on nasogastric/gastrostomy feeding tubes. To date, no internationally recognized definitions or principles for interventions exist, and clinics have been reliant on creating their own unique intervention criteria. To achieve the aim, 2 goals are set out within the current article. The first goal was to definitively define the process of tube weaning. To achieve this, both tube dependency and oral eating also required definitions. It is necessary for these 2 additional definitions to fully understand the process of tube weaning and the transition that the child is making within these clinical interventions. The second goal of this article was to propose a set of minimum measurement criteria within a tube weaning protocol so that different clinical practices and perspectives may be measured accurately. This would then allow outcomes from different clinical services to be compared for efficacy. The culmination of this article is a set of 5 core principles that should govern clinics that adhere to the auspices of evidence-based practice. These principles, if adopted, will provide the basis of a set of internationally recognized criteria within this field of pediatric gastroenterology.

Functional constipation in children: challenges and solutions.

This review intends to update what is known about and what is still a challenge in functional constipation (FC) in children regarding epidemiology, pathophysiology, diagnosis, and management. Although FC is a common childhood problem, its global burden remains unknown as data from parts of the world are missing. Another problem is that there is a large variation in prevalence due to differences in study methods and defining age groups. The pathophysiology of FC remains unclear to date but is probably multifactorial. Withholding behavior is likely to be the most important factor in toddlers and young children. Genetics may also play a role since many patients have positive family history, but mutations in genes associated with FC have not been found. Over the past years, different diagnostic criteria for FC in infants and children have been proposed. This year, Rome IV criteria have been released. Compared to Rome III, it eliminates two diagnostic criteria in children under the age of 4 who still wear diapers. Physical examination and taking a thorough medical history are recommended, but other investigations such as abdominal radiography, transabdominal recto-ultrasonography, colonic transit time, rectal biopsies, and colon manometry are not routinely recommended. Regarding treatment, guidelines recommend disimpaction and maintenance therapy with polyethylene glycol (PEG) with or without electrolytes. But experience shows that acceptability, adherence, and tolerance to PEG are still a challenge. Counseling of parents and children about causes of FC is often neglected. Recent studies suggest that behavior therapy added to laxative therapy improves the relief of symptoms. Further homogeneous studies, better-defined outcomes, and studies conducted in primary care are needed.