Healthy Children Research Articles

Children exposed to salt-dust emission from Urmia Lake have short telomere length: a case-control pilot study

ABSTRACT This study aimed to measure telomere length in healthy children living next to Urmia Lake, Iran, which is exposed to salt dust from a drying lakebed. In this case-control pilot study, we recruited 39 sex- and age-matched healthy children from two different geographic regions to study the relative telomere lengths using qPCR. We categorized the study samples into high-impact and low-impact areas based on wind direction, aerosol particle level, and distance from the lake. Our main results revealed that children living in high-impact areas have shorter telomeres than those living in low-impact areas. Furthermore, according to our statistical model, parental age significantly affected telomere length in children, but inversely. When the father’s age impact was positive, the mother had a negative effect. Based on our results, to prevent Urmia Lake from dying out completely, national and international organizations should implement comprehensive visions and strategies for its restoration.

One-year neurodevelopmental outcome in children with asymptomatic congenital CMV infection

Introduction: Infants with congenital CMV (cCMV) infection may show manifestations at birth and develop symptomatic disease, although the majority have no apparent clinical signs and should be considered asymptomatic (acCMV). Studies about neurodevelopmental and neurological sequelae in acCMV patients during childhood are few and contradictory, thus, the purpose of this study is to evaluate the neurological and neurodevelopmental outcomes in 1-year-old children with acCMV infections. Method: Thirty-five infants with acCMV infections were followed-up for 12 months and were compared to healthy children matched for age and gender. The Bayley Scales of Infant Development III (BSID-III) were administered, and neurological examinations were performed. Results: Children with acCMV infection showed minimal to mild neurological signs and the score obtained from the Motor Scale was significantly lower than that of the control group. No significant differences between the two groups were found regarding the Cognitive and Language Scales. Discussion: Asymptomatic congenital infection of CMV may be associated with a decrease in motor skills that may become evident during the first year of life. Close monitoring is necessary to determine if rehabilitative treatment is required. Longer follow-up is necessary to provide further details about the neurodevelopmental outcome of children with acCMV.

The Role and Importance of Quality of Life among Preschool Children as a Prerequisite for a Positively Oriented Upbringing

The aim of this study was to evaluate the health-related quality of life (QoL) in a sample of healthy preschool children in the Republic of Croatia and comment on whether and how the research results open the preconditions for positive individual scenarios of the future related to positively oriented upbringing. The Pediatric quality of life inventory generic core scales (PedsQLTM) was completed by 230 healthy preschool children (5-6 years old) and their parents as a proxy-report. The data was descriptively analysed first. Reliability was assessed by Cronbach’s alpha. The statistically significant difference between the PedsQLTM scales (physical, emotional, social, kindergarten and psychosocial functioning) for preschool children and their parent’s proxy-report were analysed. The PedsQLTM scale score means for children’s self-report ranged 71.32-76.49, with the total score was 74.53. Score means for their parent’s proxy-report scale ranged 73.59-85.46, with the total score of 80.93. All the self-report and proxy-report scales showed satisfactory reliability with Cronbach’s alpha varying between 0.64 and 0.89. Statistically significant difference between scales in self-report and proxy-report was for physical (t=-7.12, p<0.01), social (t=-6.42, p<0.01) and school functioning (t=-2.62, p<0.01) as well as psychosocial (t=-4.82, p<0.01) and total health (t=-6.85, p<0.01). The Croatian PedsQLTM is valid and reliable generic pediatric health-related QoL measurement that can be recommended for children’s self-reports and their parent’s proxy-reports. The results of the research open a precondition for positive individual scenarios of the future related to positively oriented upbringing.

Normative values of oxygen saturation by pulse oximetry (SpO2) in apparently healthy children from Eastern India - A cross-sectional study.

The primary objective was to determine normative values of oxygen saturation (SpO2) by pulse oximetry in apparently healthy children, aged 1 month to 14 years. The secondary objective was to explore any variation in oxygen saturation levels by age and gender. It was a cross-sectional study conducted at a tertiary care centre and schools in Bhubaneswar, Odisha, India, from January 2021 to December 2022. Apparently healthy children were enrolled. Using a standardized pulse oximeter and appropriately sized probes, SpO2 was recorded after stabilization of plethysmograph waves. Three consecutive readings were taken, and an average was noted. The 2.5th centile SpO2 value was taken as the lower limit of normal. The median (IQR) saturation of the sample population was 99.7% (99-100). The 2.5th, 5th, 25th, and 75th percentiles were 97.7%, 98%, 99%, and 100%, respectively. Median SpO2 and its percentiles were estimated for each age group. The 2.5th centile SpO2 for infantile age group was 96.4%. No significant age and gender-wise variations of SpO2 were noted. The present study established normal reference range oxygen SpO2 levels in apparently healthy children from an eastern India region that is situated at 62 m (204 ft) above the sea level.

Metabolomic biomarkers and altered phenylalanine metabolic pathway in preschool children with atopic dermatitis – A pilot study

Background Atopic dermatitis (AD) has high prevalence in children. Current AD diagnosis and management focuses only on clinical phenotypes, but do not explore the endophenotypes, which are more important because they are a series of biomarkers linking clinical phenotype and genotype Aims Metabolomics can qualitatively and quantitatively capture real-time dynamic changes in a wide range of small molecule metabolites. This pilot study evaluated metabolomics biomarkers and altered metabolic pathways in preschool children with AD, aiming to explore the underlying molecular mechanisms and signalling pathways of the disease. Methods Blood samples of 23 preschool children with AD and 23 healthy children without AD or any other skin disease were collected. The untargeted metabolomic measurements were performed on a SCIEX-AD ultraperformance liquid chromatography system coupled with an AB SCIEX X500B QTOF system. Characteristics of small molecules in AD children were assessed and their associations with AD clinical index were evaluated. Altered metabolic pathways in AD children were also analysed using a comprehensive metabolomics platform. Results A total of 1,969 metabolites were identified, of which AD children exhibited 377 significantly altered metabolites. Multivariate statistical analysis demonstrated that the AD group and the control group could be clearly separated. Volcano plot analysis illustrated that 144 metabolites were up-regulated and 233 metabolites were down-regulated in AD children. The Severity Scoring of Atopic Dermatitis (SCORAD index) showed a moderate-to-strong association with estrogens, carotenes, leukotrienes, flavonols and keto acids in AD children (|r|=0.440–0.557). Several pathways, including the phenylalanine metabolism, were identified as altered in AD children. Limitations A small group of children was included in the study; the results need to be validated in larger sample sizes. Conclusion Results of this study illustrate potential alterations in metabolites and the phenylalanine metabolic pathway in preschool children with AD. Although this is a pilot study with a limited sample size, it may provide a new perspective for exploring the pathogenesis of AD, and for personalised treatment modalities.

The Impact of Disasters on Stress Levels of Caregivers of Children with Special Needs: A Comparative Study

Aim: Caring needs of children with special needs increase the stress levels of caregivers for many reasons. The aim of this study was to examine, compare, and provide recommendations regarding the stress levels, factors influencing stress levels, and coping strategies among caregivers of both healthy and special needs children during disaster periods. Method: This research was planned as a cross-sectional study. The survey, which was created in an electronic environment, disseminated to as many people as possible across the country via e-mail, various communication networks, and social media. After the demographic information of 261 caregivers were recorded, the Depression Anxiety Stress Scale 21, the Caregiver Strain Index, and the Ways of Coping Inventory Questionnaire were administered. Results: While the stress level was high (Mean±SD:7.67±3.98) in the caregivers of children with special needs, this level was within the normal limits (Mean±SD:6.44±3.61) in the caregivers of healthy children. There was a significant difference between the groups (p:0.009). In terms of coping with stress, caregivers of children with special needs were found to prefer emotion-focused/passive approaches, and there was a difference between the groups (p:0.000). Conclusion: The restrictive conditions during disaster period can impact the mental health of caregivers of special needs children, and there are several factors involved in this process. In line with this, we believe that specific policies and strategies need to be developed to support the mental health of caregivers of special needs children during extraordinary situations such as disaster scenarios.

Glycated albumin may have a complementary role to glycated hemoglobin in glucose monitoring in childhood acute leukemia

Purpose: Glycated hemoglobin (HbA1c) as a glycemic index may have limited value in pediatric patients with acute leukemia as they often present with anemia and/or pancytopenia. To address this issue, we evaluated the usefulness of glycated albumin (GA) as a glycemic monitoring index in pediatric patients with acute leukemia.Methods: Medical records of 25 patients with type 2 diabetes mellitus (T2DM), 63 patients with acute leukemia, and 115 healthy children from Seoul St. Mary's Hospital, The Catholic University of Korea, were retrospectively investigated for serum GA, HbA1c, and fasting blood glucose (FBG) levels, along with demographic data.Results: GA, HbA1c, and FBG levels did not differ between the control and acute leukemia groups. In the T2DM group, positive correlations were observed among GA, HbA1c, and FBG (P<0.01). Although GA level was not associated with the HbA1c level in the control group, GA and HbA1c levels showed a positive correlation in the acute leukemia group (P=0.045). Regression analysis revealed GA and HbA1c levels to be positively correlated in the acute leukemia and T2DM groups even after adjusting for age, sex, and body mass index z-score (P=0.007, P<0.01).Conclusion: GA may be a useful complementary parameter to HbA1c for glycemic monitoring in pediatric patients with acute leukemia, similar to its use in patients with T2DM.

Effects of the COVID-19 pandemic on serum vitamin D concentration in Korean children

Purpose: Social distancing policies and school closures in South Korea induced by coronavirus disease 2019 have raised concerns about a lower chance of exposure to sunlight in children and adolescents. This study investigates changes in the vitamin D status of children and adolescents following the pandemic.Methods: This retrospective study includes healthy children aged 3–18 years who visited Hanyang University Hospitals in Seoul or Guri during pre-coronavirus disease 2019 (COVID-19) and post-COVID-19 pandemic periods. August 2017 to July 2019 is defined as the pre-COVID-19 pandemic period, while the period from July 2020 to July 2021 is defined as post-COVID-19 or "during the pandemic." Propensity scores were used to match the prepandemic and pandemic groups 1:1 based on age, sex, season of blood collection, and body mass index z-score to compare vitamin D status among subjects.Results: Among 786 eligible children, 506 were matched using propensity scores. There were no significant differences in mean serum 25-hydroxyvitamin D (25(OH) D) levels (20.1±6.5 ng/mL vs. 19.9±6.3 ng/mL, P>0.05) or vitamin D deficiency rates (53.0% vs. 54.9%, P>0.05) between the prepandemic and pandemic groups. Seasonal analysis revealed lower mean serum 25(OH)D levels during the pandemic in winter/spring seasons in comparison to these levels in subjects in prepandemic winter/spring seasons (19.1±3.8 ng/mL vs. 17.2±3.7 ng/mL, P=0.006).Conclusion: During the COVID-19 pandemic, Korean children and adolescents showed similar serum 25(OH)D levels and vitamin D status to the prepandemic period, with a significant decrease in these measures observed in winter/spring seasons only. Prolonged confinement, such as in pandemic circumstances, underscores the need for vigilant monitoring of vitamin D status and supplementation, particularly in high-risk seasons.

Health in children during schooling

Introduction. The basis of preventive activities in pediatrics is medical examination, based on active dynamic monitoring of sick and healthy children. An important part of medical examination is preventive examinations, which are carried out with the aim of timely detection of deviations in the health status in children and the management of necessary treatment, preventive and health measures. Purpose of the study: based on the results of a dynamic 10-year observation, present the data on the health status of a single cohort of schoolchildren to update the main preventive areas for children’s practice over schooling process. Materials and methods. The study was conducted on the basis of a study of the health status of four hundred thirty seven schoolchildren at different stages of schooling (before entering school, at the end of first grade, during the transition to subject education and at the end of school education), according to a single protocol, on one sample and a single methodology with sequential multiple registration of selected indices of the health status in schoolchildren and annual analysis over a period of 10 years. Results. An analysis of the distribution of those examined cases by membership in health groups clearly demonstrated a decrease in the number of children in health groups I and II and an increase in schoolchildren in health groups III and IV. A dynamic assessment of diagnosed pathological conditions in their compliance with a certain ICD-10 class over a 10-year observation period revealed an increase in the proportion of schoolchildren suffering from diseases of the musculoskeletal system, the organ of vision, cardio- and endocrinopathies. Research limitations.The study has regional (Krasnoyarsk Territory) limitations and concerns 6 to 17 year children. Conclusion. The data obtained established the possibilities of early diagnosis in risk groups, and preventive measures aimed at developing healthy lifestyle skills in schoolchildren and their parents within the framework of priority national projects in Russia.

Children with hemoglobin C or S trait have low serologic responses to a subset of malaria variant surface antigens.

Children with Hb AC or AS have decreased susceptibility to clinical malaria. Parasite variant surface antigen (VSA) presentation on the surface of infected erythrocytes is altered in erythrocytes with hemoglobin C (Hb AC) or sickle trait (Hb AS) mutations in vitro. The protective role of incomplete or altered VSA presentation against clinical malaria in individuals with Hb AC or AS is unclear. Using a high-throughput protein microarray, we sought to use serological responses to VSAs as a measure of host exposure to VSAs among Malian children with Hb AC, Hb AS, or wildtype hemoglobin (Hb AA). In uncomplicated malaria, when compared to Hb AA children, Hb AC children had significantly lower serological responses to extracellular Plasmodium falciparum erythrocyte membrane protein-1 (PfEMP1) domains but did not differ in responses to intracellular PfEMP1 domains and other VSAs, including members of the repetitive interspersed family (RIFIN) and subtelomeric variable open reading frame (STEVOR) family. Healthy children with Hb AC and Hb AS genotypes recognized fewer extracellular PfEMP1s compared to children with Hb AA, especially CD36-binding PfEMP1s. These reduced serologic responses may reflect reduced VSA presentation or lower parasite exposure in children with Hb AC or AS and provide insights into mechanisms of protection.

Unique content of breastmilk: neurotrophic growth factors in breastmilk at 2 years and beyond.

The aim of our study was to show the presence of neurotrophic factors in breast milk that have a significant impact on neurocognitive development of children aged two years and beyond. Mothers expressed at least 5mL of breast milk into sterile containers when their children 18, 24, and ≥ 25months of age, and then specimens were transferred to Eppendorf tubes and stored at -20 °C. One day before the analysis, specimens were kept at +4°C and then thawed at room temperature to prepare them for analysis. Brain-derived neurotrophic factor (BDNF), glial cell line-derived neurotrophic factor (GDNF), and S100B neurotrophic growth factor levels were analyzed using the sandwich enzyme-linked immunosorbent assay (ELISA) principles. Sixty-two mothers with children aged 18months were included in the study. The mean age of the mothers was 33.4 (± 0.71) years. Due to the detection limits of the commercial kits, BDNF and S100B analyses could not be conducted. Therefore, only GDNF was analyzed. The presence of GDNF was found in the breast milk samples taken at 18, 24, and ≥ 25months, and the median (min max) values were 315,505ng/mL (193,067 750,718), 316,721ng/mL (161,278l-752,252), and 564,577ng/mL (238,528-781,104) respectively. There were no significant differences between GDNF levels of breast milk samples collected from the same mother at the three different time points (18, 24, and ≥ 25months) (p = 0.278). Conclusion: Our study was the first to show the presence of neurotrophic factors in the breast milk of mothers with healthy children over one year of age. Our results provide evidence-based data on the importance of breastfeeding until children are at least two years of age. What is Known: • Presence of Brain-derived neurotrophic factor (BDNF), glial cell line-derived neurotrophic factor (GDNF), and S100B neurotrophic growth factor have been shown in the breast milk of mothers whose infants are the first year of life. What is New: • Glial Cell Line-Derived Neurotrophic factors continue to present in breast milk of mothers with children aged 18, 24, and ≥ 25months, without any significant difference in level between months.

Integration and validation of host transcript signatures, including a novel 3-transcript tuberculosis signature, to enable one-step multiclass diagnosis of childhood febrile disease.

Whole blood host transcript signatures show great potential for diagnosis of infectious and inflammatory illness, with most published signatures performing binary classification tasks. Barriers to clinical implementation include validation studies, and development of strategies that enable simultaneous, multiclass diagnosis of febrile illness based on gene expression. We validated five distinct diagnostic signatures for paediatric infectious diseases in parallel using a single NanoString nCounter® experiment. We included a novel 3-transcript signature for childhood tuberculosis, and four published signatures which differentiate bacterial infection, viral infection, or Kawasaki disease from other febrile illnesses. Signature performance was assessed using receiver operating characteristic curve statistics. We also explored conceptual frameworks for multiclass diagnostic signatures, including additional transcripts found to be significantly differentially expressed in previous studies. Relaxed, regularised logistic regression models were used to derive two novel multiclass signatures: a mixed One-vs-All model (MOVA), running multiple binomial models in parallel, and a full-multiclass model. In-sample performance of these models was compared using radar-plots and confusion matrix statistics. Samples from 91 children were included in the study: 23 bacterial infections (DB), 20 viral infections (DV), 14 Kawasaki disease (KD), 18 tuberculosis disease (TB), and 16 healthy controls. The five signatures tested demonstrated cross-platform performance similar to their primary discovery-validation cohorts. The signatures could differentiate: KD from other diseases with area under ROC curve (AUC) of 0.897 [95% confidence interval: 0.822-0.972]; DB from DV with AUC of 0.825 [0.691-0.959] (signature-1) and 0.867 [0.753-0.982] (signature-2); TB from other diseases with AUC of 0.882 [0.787-0.977] (novel signature); TB from healthy children with AUC of 0.910 [0.808-1.000]. Application of signatures outside of their designed context reduced performance. In-sample error rates for the multiclass models were 13.3% for the MOVA model and 0.0% for the full-multiclass model. The MOVA model misclassified DB cases most frequently (18.7%) and TB cases least (2.7%). Our study demonstrates the feasibility of NanoString technology for cross-platform validation of multiple transcriptomic signatures in parallel. This external cohort validated performance of all five signatures, including a novel sparse TB signature. Two exploratory multi-class models showed high potential accuracy across four distinct diagnostic groups.

Children of immigrants' behavioral trajectories and family processes: Using an integrative developmental model.

Using an integrative developmental model, this study revisited the "immigrant paradox" in early behavioral development, differentiating immigrant background from race and examining the role of family processes (family structure, stability, racial/ethnic socialization) in disparities between immigrant and U.S.-origin children. Growth-curve analyses on a sample of children aged 5-7 (N = 12,520) from the Early Childhood Longitudinal Study-Kindergarten class of 2010-2011 data set revealed distinct behavioral trajectories based on parental country of origin. Some groups outperformed the racially matched U.S.-origin peers by improving faster (internalizing behaviors: Salvadoran) or maintaining their advantages (internalizing: Mexican, Dominican; externalizing: Mexican, Salvadoran, Guatemalan, South American, and Dominican), while others faced continued challenges (externalizing behaviors: Japanese, Thai) or exhibited a nuanced pattern such as beginning with an advantage but deteriorating faster (internalizing: Cuban). The time-varying, country-of-origin-specific family processes fully or partly explained some disparities (except for Asian), emphasizing the need for a sociocultural understanding of the distinct strengths and limitations in racial-ethnic minority families. This contextualized knowledge is crucial for promoting healthy child development. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Reference values for reticulocyte haemoglobin equivalent in healthy Chinese children under 5 years and its associations with various blood parameters

BackgroundReticulocyte haemoglobin equivalent (RET-He) is a useful tool for evaluating recent iron usage irrespective of inflammatory status. This study aims to establish a reference for RET-He among Hong Kong healthy...

Psychological Well-Being of Children with Asthma and Their Parents

Background/Objectives: The literature reports that emotional disorders in asthmatic children and their parents may affect asthma control. This research explores the baseline psychological well-being of asthmatic children and their mothers’ and fathers’ psychological functioning, focusing on the influence of the parents’ anxiety and separation anxiety on children’s asthma. Methods: In this cross-sectional study, we enrolled children with non-severe asthma and their parents, and a group of healthy children and their parents. The asthmatic children underwent anamnestic investigation, including asthma control and spirometry. Then, both the asthmatic and control triads filled a survey assessing their psychological functioning. Results: Among the 40 asthmatic children enrolled (8–18 years old), most had good clinical control maintained with GINA (Global Initiative for Asthma) therapy step 1–2 (14 patients, 35%) or step 3–4 (26 patients, 65%); 12 patients (30%) had at least one steroid course in the year before enrollment. They exhibited normal psychological adjustment but elevated levels of general (U = 179,500; p < 0.001) and state anxiety (U = 170,000; p < 0.001) compared to healthy peers. Additionally, the asthmatic children’s mothers displayed higher levels of separation anxiety compared to the fathers (t = −2.865, p = 0.006). Increased separation anxiety in the mothers corresponded to a history of at least one exacerbation in the previous year. Conclusions: The asthmatic children exhibited normal psychological adjustment with higher general and state anxiety. Also, their mothers showed greater levels of separation anxiety compared to their fathers. Lastly, higher mothers’ separation anxiety corresponded to a history of at least one exacerbation in the previous year. The influence of the parents’ psychological well-being on the children’s asthma control was previously unexplored.

Parental and healthcare provider attitudes towards the Healthy Child Programme in England: a qualitative analysis.

The Healthy Child Programme (HCP) in England, delivered by Health Visitors (HV) and Nursery Nurses (NN), aims to assess growth and development in pre-school age children. This qualitative analysis aimed to evaluate the perceptions and experiences of HCP providers and parents located in a London borough. This qualitative analysis is part of a larger study piloting an automated growth screening algorithm in a London borough. We conducted three focus group discussions; two with parents of pre-school children participating in the pilot study, one in English (n = 6) and one in Sylheti (n = 5), and one with HVs and NNs (n = 11). Sampling was purposeful, and written informed consent was obtained. Groups were facilitated by the same bilingual researcher using semi-structured topic guides. Data were analysed using reflexive thematic analysis and assessed for intercoder reliability. Three broad themes were identified in the data: (1) lack of clarity around the role of the HV and NN; (2) a lack of resources; and (3) a desire for a preventative service. Underlying these themes was a sense of disempowerment shown by HVs/NNs and parents, as well as systemic issues in terms of the accessibility and practicality of the service. Nevertheless, parents and HVs/NNs all stressed the importance of the service in providing information, reassurance and advice. Various challenges prevent the HCP from providing equitable and effective care to every child. However, the service was recognised as very valuable by users and providers despite systemic difficulties.

Analysis of ultrasound coronary parameters and blood red cell distribution width and N-terminal pro-brain natriuretic peptide concentrations following coronary lesions in children with Kawasaki disease.

Aims/Background Kawasaki disease is an acute inflammatory condition primarily affecting the young children. It can lead to coronary artery abnormalities, which can worsen the prognosis. Early diagnosis of coronary disease is crucial for the effective treatment and the prognosis evaluation. To explore the clinical significance of ultrasound examination characteristics, peripheral blood red cell distribution width, and changes in N-terminal pro-brain natriuretic peptide levels for the early detect coronary artery abnormality in children with Kawasaki disease. Methods The case-control study was conducted. 85 Kawasaki disease patients diagnosed in our hospital from January 2020 to December 2023 were selected as the Kawasaki disease group. 100 healthy children who received physical examination in the Department of Child Healthcare during the same period were selected as control group. The cardiac ultrasound indicators, erythrocyte sedimentation rate, C-reactive protein, white blood cell, neutrophil percentage, platelet count, D-dimer, red cell distribution width, N-terminal pro-brain natriuretic peptide of two groups were compared. The Kawasaki disease group was further divided into the coronary artery lesion group and the non-coronary artery lesion group based on whether coronary artery lesions occurred in the Kawasaki disease patients. The differences of above indicators were compared. Results The left main coronary artery, left anterior descending branch, and right coronary artery Z-scores of the Kawasaki disease group were all higher than those of the control group (p < 0.05). There was no significant difference in left ventricular ejection fraction between Kawasaki disease group and control group (p > 0.05). The erythrocyte sedimentation rate, C-reactive protein, neutrophil percentage, platelet count, D-dimer, red cell distribution width, and N-terminal pro-brain natriuretic peptide of Kawasaki disease group were all higher than those of control group (p < 0.05). The left main coronary artery, left anterior descending branch, and right coronary artery Z-scores of Kawasaki disease patients with coronary artery lesions were all higher than those of Kawasaki disease patients without coronary artery lesions (p < 0.05). The left ventricular ejection fraction of Kawasaki disease patients with coronary artery lesions was lower than that of Kawasaki disease patients without coronary artery lesions (p < 0.05). The erythrocyte sedimentation rate, C-reactive protein, white blood cell, neutrophil percentage, platelet count, D-dimer, red cell distribution width, and N-terminal pro-brain natriuretic peptide of Kawasaki disease patients with coronary artery lesions were all higher than those of Kawasaki disease patients without coronary artery lesions, and the differences were statistically significant (p < 0.05). After treatment, the left main coronary artery, left anterior descending branch, and right coronary artery Z-scores of Kawasaki disease patients with coronary artery lesions significantly decreased (p < 0.05), and the left ventricular ejection fraction significantly increased (p < 0.05). The erythrocyte sedimentation rate, C-reactive protein, white blood cell, neutrophil percentage, platelet count, D-dimer, red cell distribution width, and N-terminal pro-brain natriuretic peptide of Kawasaki disease patients with or without coronary artery lesions significantly decreased after treatment compared with before treatment in the same group (p < 0.05). Conclusion Kawasaki disease patients with coronary artery lesions exhibit significantly increased coronary artery vessel diameter, as well as elevated red cell distribution width and N-terminal pro-brain natriuretic peptide concentration. The combined use of ultrasound combined with red cell distribution width and N-terminal pro-brain natriuretic peptide examination can assist in determining whether Kawasaki disease patients have coronary artery lesions and assessing the clinical treatment effect.

Optic nerve head morphological variation in craniosynostosis: a cohort study

To evaluate optic nerve head morphology in children with craniosynostosis versus healthy controls. Single-centre, prospective cohort study METHODS: Handheld optical coherence tomography (OCT) was performed in 110 eyes of 58 children (aged 0-13 years) with craniosynostosis. Inclusion criteria were as follows: normal intracranial pressure (ICP) on invasive overnight monitoring, or clinically stable ICP. The latter was defined as stable VA within 1 logMAR line and no papilloedema on fundoscopy for at least four months following OCT, and normal/stable visual evoked potentials. Control data for 218 eyes of 218 children were obtained from a published normative dataset. The main outcome measures were disc width, cup width, rim width and retinal nerve fibre layer (RNFL) thickness (nasal and temporal). Outcome measures were compared using three-way linear mixed model regression analysis (FGFR 1/2-associated craniosynostosis, non-FGFR 1/2-associated craniosynostosis, and controls). Out of 63 eligible children with craniosynostosis, handheld OCT imaging was successful in 110 eyes of 58 children (92%). Of these, 22 (38%) were female. Median subject age at OCT examination was 53 months (range: 2 to 157; IQR: 39 to 73). Twelve children (21%) had FGFR1/2-associated syndromes (Crouzon, n=6; Apert, n=4; Pfeiffer, n=2). Control data were available for 218 eyes of 218 healthy children. 122 controls (56%) were female. Median control age at OCT examination was 20 months (range: 0 to 163; IQR: 6 to 59). When comparing optic nerve head morphology in craniosynostosis (n=58) versus controls (n=218), disc width was 6% greater (p=0.001), temporal cup width was 13% smaller (p=0.027), rim width was 16% greater (p<0.001) and temporal RNFL was 11% smaller (p=0.027). When comparing FGFR1/2-associated syndromes (Crouzon, Apert and Pfeiffer syndromes, n=12) to the rest of the craniosynostosis group (n=46), disc width was 10% smaller (p=0.014) and temporal cup width was 38% smaller (p=0.044). This cohort demonstrated morphological differences of the optic nerve head in craniosynostosis, most markedly in Crouzon, Apert and Pfeiffer syndromes. These findings could help improve ophthalmological monitoring and surgical decision-making in children with craniosynostosis. Further work on longitudinal optic nerve head changes in syndromic and non-syndromic craniosynostosis would be valuable.

Children’s color trails test: Greek normative data and clinical validity in children with traumatic brain injury and attention deficit - Hyperactivity disorder

The Children’s Color Trail Test (CCTT) is considered a culture fair equivalent of the Trail Making Test for the assessment of cognitive flexibility in pediatric populations, while others emphasize its additional validity as a measure of attention, perceptual tracking, processing speed, susceptibility to interference and inhibition. The need for standardized neuropsychological tests in Greece, especially for the pediatric population is significant. In the present study, considering the relatively good psychometric properties of the CCTT and its wide cross-cultural application, we decided that such a tool would be useful to Greek clinicians and researchers, and therefore developed norms for the Greek child and adolescent population. Additionally, we examined the clinical validity of the test, administering it to two groups of patients (children with Traumatic Brain Injury and Attention Deficit - Hyperactivity Disorder). We administered the test to 417 native healthy Greek children 6-15 years, recruited primarily from Southwestern Greece from several public schools. Linear regression analysis revealed a significant influence of age on completion time in both parts of the CCTT, whereas sex did not influence time to completion. Older children consistently completed the test faster than younger children, whereas girls and boys performed similarly on both conditions. In addition, CCTT differentiated the performance of children who have had a TBI and those diagnosed with ADHD from the performances of their typically developing peers. This study provides much needed performance and clinical utility data for the pediatric population in Greece on a promising neuropsychological tool for use in clinical and research settings.

Contrasting presentations of children with ADHD and subthreshold ADHD.

We aimed to explore the differences and relationships in body composition, social function, and comorbidities between children with attention-deficit/hyperactivity disorder (ADHD) and subthreshold ADHD. A case-control study was conducted to analyze the differences between children with ADHD and subthreshold ADHD. Logistic regression models were used to analyze the factors influencing social functional impairments and comorbidities. Children with ADHD and subthreshold ADHD had a higher fat mass index than healthy children (p < 0.05). The scores of all six social functional domains were higher in the subthreshold ADHD and ADHD groups than in the control group (p < 0.05). The prevalence of comorbidity was higher in children with subthreshold ADHD and ADHD compared to the control group (p < 0.05). Inattention and comorbid anxiety/depression increased the risk of functional impairments in children with ADHD (full syndrome/subthreshold), whereas a higher fat-free mass index reduced the risk. The severity of hyperactivity was associated with a higher risk of comorbidity in children with ADHD (full syndrome/subthreshold). Children with subthreshold ADHD and ADHD had more fat mass and higher rates of social functional impairments and comorbidities than healthy children. There were clinical correlations between body composition, social functional impairments, and comorbidities in ADHD. 1. Children with subthreshold ADHD and ADHD had higher fat mass levels than normal children. 2. The social function impairments and comorbidities of children with subthreshold ADHD were similar to those with ADHD. 3. Inattentiveness and anxiety/depression increased the risk of functional impairments in children with ADHD (full syndrome/subthreshold), while a higher fat-free mass index and skeletal muscle-to-body fat ratio reduced the risk.