Healthy Children Research Articles

Changes associated with the COVID-19 pandemic on postpartum screening results in Ontario, Canada: The healthy babies healthy children screening tool.

Research on the impact of the COVID-19 pandemic on mothers/childbearing parents has mainly been cross-sectional and focused on psychological symptoms. This study examined the impact on function using ongoing, systematic screening of a representative Ontario sample. An interrupted time series analysis of repeated cross-sectional data from a province-wide screening program using the Healthy Babies Healthy Children (HBHC) tool assessed changes associated with the pandemic at the time of postpartum discharge from hospital. Postal codes were used to link to neighborhood-level data. The ability to parent or care for the baby/child and other psychosocial and behavioral outcomes were assessed. The co-primary outcomes of inability to parent or care for the baby/child were infrequently observed in the pre-pandemic (March 9, 2019-March 15, 2020) and initial pandemic periods (March 16, 2020-March 23, 2021) (parent 209/63,006 (0.33%)-177/56,117 (0.32%), care 537/62,955 (0.85%)-324/56,086 (0.58%)). Changes after pandemic onset were not observed for either outcome although a significant (p = 0.02) increase in slope was observed for inability to parent (with questionable clinical significance). For secondary outcomes, worsening was only seen for reported complications during labor/delivery. Significant improvements were observed in the likelihood of being unable to identify a support person to assist with care, need of newcomer support, and concerns about money over time. There were no substantive changes in concerns about ability to parent or care for children. Adverse impacts of the pandemic may have been mitigated by accommodations for remote work and social safety net policies.

Associations of Adipocyte-derived Versican and Macrophage-derived Biglycan with Body Adipose Tissue and Hepatosteatosis in Obese Children

In animal models of obesity, adipocyte-derived versican, and macrophage-derived biglycan play a crucial role in mediating adipose tissue inflammation. The aim was to investigate levels of versican and biglycan in obese children and any potential association with body adipose tissue and hepatosteatosis. Serum levels of versican, biglycan, interleukin-6 (IL-6), and high sensitivity C-reactive protein (hsCRP) were measured by ELISA. Fat deposition in the liver, spleen, and subcutaneous adipose tissue was calculated using the IDEAL-IQ sequences in magnetic resonance images. Bioimpedance analysis was performed using the Tanita BC 418 MA device. The study included 36 obese and 30 healthy children. The age of obese children was 13.6 (7.5-17.9) years, while the age of normal weight children was 13.0 (7.2-17.9) years (p=0.693). Serum levels of versican, hsCRP, and IL-6 were higher in the obese group (p=0.044, p=0.039, p=0.024, respectively), while no significant difference was found in biglycan levels between the groups. There was a positive correlation between versican, biglycan, hsCRP, and IL-6 (r=0.381 p=0.002, r=0.281 p=0.036, rho=0.426 p=0.001, r=0.424 p=0.001, rho=0.305 p=0.017, rho=0.748 p<0.001, respectively). Magnetic resonance imaging revealed higher segmental and global hepatic steatosis in obese children. There was no relationship between hepatic fat content and versican, biglycan, IL-6, and hsCRP. Versican, biglycan, hsCRP, and IL-6 were not predictive of hepatosteatosis. Body fat percentage >32% provided a predictive sensitivity of 81.8% and a specificity of 70.5% for hepatosteatosis [area under the curve (AUC): 0.819, p<0.001]. Similarly, a body mass index standard deviation score >1.75 yielded a predictive sensitivity of 81.8% and a specificity of 69.8% for predicting hepatosteatosis (AUC: 0.789, p<0.001). Obese children have higher levels of versican, hsCRP, and IL-6, and more fatty liver than their healthy peers.

Finding Waldo: Sonographic systematic approach to localize the appendix in children.

To describe a systematic scanning approach using anatomical landmarks followed by an assessment of radiology trainees' ability to identify the normal appendix in healthy children. Uncontrolled pre and post study assessing radiology residents' sonographic skills in detecting the normal appendix in healthy children. Initial questionnaire for the trainees' demographics, perceptions and experiences in detecting the appendix with ultrasound in children followed by a precourse test on healthy volunteers. Hands-on training was conducted by describing a systematic sonographic approach to identify the appendix using anatomical landmarks, and then a postcourse test was carried out. The primary outcome was unprompted ability to identify the appendix. Subjective self-scoring of confidence was also recorded. A three-hour hands-on workshop was conducted. Sixteen radiology trainees participated and were randomly distributed to four stations, each with different ultrasound machines and healthy volunteers. Fifteen had a precourse assessment, and 12 completed the postcourse assessment. Before the course, 3/15 (20%) identified the appendix, while 10/12 (83%) identified the appendix afterward. After the course, participants perceived finding the appendix easier than before. There was no statistically significant difference in the participants' perceived confidence in detecting the appendix. With the described scanning technique, most of the participants were able to identify the normal appendix after receiving short hands-on training. This highlights the importance of targeted training of radiology trainees and nonradiologists.

The effect of a visual illusion and self-controlled practice on motor learning in children at risk for developmental coordination disorder

Numerous efforts have been made to test the OPTIMAL theory of motor learning in healthy children and adult populations. However, only a small number of studies have tested this theory in children with cognitive-motor disorders, such as developmental coordination disorder (DCD). The present study aims to examine the individual and additive effects of a visual illusion and self-controlled practice on a golf putting task in children at risk for DCD based on the OPTIMAL theory. Forty children at risk for DCD (mean age = 8.57 ± 1.05 years) were randomly assigned to four experimental groups (1—small visual illusion + self-controlled practice; 2—big visual illusion + self-controlled practice; 3—small visual illusion + yoked; 4—big visual illusion + yoked). Following 12 pretest trials of a golf putting task, the participants completed 5 blocks of 12 trials of practice on the first day. A retention test (12 trials) and a transfer dual-task test (12 trials) were conducted on the second day. The results indicated that in retention test the big visual illusion + self-controlled practice group was significantly better than the small visual illusion + yoked group (p = 0.01), while there was not any other significant difference between groups at retention test as well as between all groups at practice phase and transfer test (p > 0.05 for all comparisons). In other words, an additive effect has been observed just in the retention test but not the practice phase as well as transfer test. In general, the results of this study support the OPTIMAL theory of motor learning in children at risk for DCD and suggests to all educators who work with these children to use the combination of the visual illusion with self-controlled practice to improve the motor learning of children at risk for DCD.

Feasibility, acceptability, and safety of a novel device for self-collecting capillary blood samples in clinical trials in the context of the pandemic and beyond.

Home blood self-collection devices can enable remote monitoring, but their implementation requires validation. Our objectives were to explore (i) the impact of sampling sites and topical analgesia on capillary blood volume and pain perception and (ii) the safety, acceptability, and failure of capillary self-collection among adults and children using the Tasso-SST device. We conducted a two-phase study. The investigational phase consisted of two on-site cross-sectional studies in healthy adult participants (≥ 12 years) and children (1-17 years) with their accompanying parent. Adults received 4 capillary samplings, where puncture sites and topical analgesia were randomized in a factorial design, and a venipuncture; children (and one parent) had one capillary sampling. The two co-primary outcomes were blood volume and pain. The implementation phase was conducted in two multicentre trials in participants choosing remote visits; blood volume, collection failure, adverse events, and satisfaction were documented. In the investigational phase, 90 participants and 9 children with 7 parents were enrolled; 15 adults and 2 preschoolers participated in the implementation phase. In the adult investigational study, the device collected a median (25%, 75%) of 450 (250, 550) μl of blood with no significant difference between the puncture site, topical analgesia, and its interaction. Using topical analgesia reduced pain perception by 0.61 (95% CI: 0.97, 0.24; P <0.01) points on the 11-point scale; the pain reduction varied by puncture site, with the lower back showing the most significant decrease. Overall, combining all studies and phases, the median volume collected was 425 (250, 500) μl, and the device failure rate was 4.4%; minor adverse effects were reported in 8.9% of the participants, all were willing to use the device again. Capillary blood self-collection, yielding slightly less than 500 μl, proves to be a safe and relatively painless method for adults and children, with high satisfaction and low failure rates. The puncture site and topical analgesia do not affect blood volume, but topical analgesia on the lower back could reduce pain.

Automatic urine cultures from catheter-obtained samples—time to implement a practice change to improve value

Abstract Objectives Urine cultures are often automatically obtained after urinary catheterization in young children, even in the absence of pyuria, to test for urinary tract infections (UTIs). Although this practice conflicts with some newer guidelines, it is frequently followed in busy emergency departments (EDs) to minimize the need for a repeat invasive procedure. To assess the implications of this longstanding practice, we aimed to describe the frequency and characteristics of children with normal urinalysis (UA) and positive urine culture obtained via catheterization, and to describe their clinical course. Methods A single center, retrospective cohort study was performed for otherwise healthy children aged 6 to 24 months, presenting to a Pediatric ED between January and June 2019 who underwent UTI testing via a urine catheterization. The point-of-care (POC) UA and urine culture results along with any follow-up phone call documentation were reviewed and analyzed using descriptive statistics. Results Of the 818 urine cultures obtained via catheterization during the 6-month study period, 131 (16%) cultures were reported as positive. Of these positive cultures, 14 (10.7%) of the patients meeting inclusion criteria had a normal POC UA. In follow-up phone calls after the ED visit, the majority of these 14 patients were asymptomatic without any antibiotic treatment and 3 (2.3%) patients were still febrile and classified as a potentially missed UTI. Conclusions The routine practice of sending urine cultures from all catheterized urine samples in children 6 to 24 months, regardless of POC UA results, rarely detect missed UTIs. In alignment with more recent practice guidelines, this practice should be reconsidered in low-risk children seen in EDs to improve overall care quality and resource utilization.

MUC5AC: A potential biomarker of severity in pediatric patients infected with influenza.

Numerous factors can increase the risk of severe influenza; however, a majority of severe cases occur in previously healthy children. Identification of high-risk children is important for targeted preventive interventions and prompt treatment. The aim of this study was to evaluate MUC5AC as a biomarker for influenza disease severity in children. For this, aprospective cohort study was conducted in 2019. Children hospitalized with acute respiratory infection (ARI) with confirmed positive influenza infection were enrolled. Influenza cases were identified by reverse transcriptase-polymerase chain reaction. Life-threatening disease (LTD) was defined by the need for intensive care and ventilatory support. MUC5AC, epidemiologic, and clinical risk factors were assessed. Three hundred and forty-two patients were hospitalized with ARI, of which 49 (14%) had confirmed influenza infection and 6 (12%) of them developed LTD. MUC5AC levels were higher in those patients with mild diseasecompared to cases with poorer outcomes. Our results show that the severity of influenza infection in children is significantly associated with low levels of MUC5AC. These findings suggest its potential as a suitable biomarker for predicting disease severity.

Serum Level of 25-Hydroxyvitamin D in Children with Epilepsy Receiving Long-Term Antiepileptic Treatment

Background: Long-term treatment with antiepileptic drugs (AED) requires monitoring of potential side effects, one of them is the decreasing in serum vitamin D level. Low serum vitamin D level is also a global health problem in healthy children. There are conflicting results regarding the low serum vitamin D level in epileptic children due to treatment with AED. Purpose: This study aimed to compare serum vitamin D level between healthy children and children with epilepsy receiving long-term AED treatment in Soetomo General Hospital. Methods: This was a cross-sectional study conducted in the pediatric neurology clinic of Soetomo general academic hospital from August 2018 to July 2019. Subjects are children ages 2-18 years with epilepsy receiving AED treatment for over 6 months (n=22), with healthy children as control (n=22). Peripheral serum 25-hydroxyvitamin D level were measured using enzyme-linked fluorescence assay (ELFA) method. The differences of those groups were analyzed by comparing the mean of 25-hydroxyvitamin D level of both groups using Anova and T-test (95% CI). Results: Low serum vitamin D level were identified in 27% children with epilepsy and 13% healthy children. The mean of serum 25-hydroxyvitamin D level in children with epilepsy and healthy children was 21.5 ng/ml (SD 8.41) and 34.3 ng/ml (SD 10.09), respectively. There was a significant difference between groups (p&lt;0.05). Conclusion: Children with epilepsy receiving long-term AED treatment have lower level of serum 25-hydroxyvitamin D than healthy children.

Treatment outcomes of pulpotomy versus pulpectomy in vital primary molars diagnosed with symptomatic irreversible pulpitis: protocol for a non-inferiority randomised controlled trial

BackgroundPulpectomy continues to be the standard treatment recommendation for management of vital primary molars diagnosed with symptomatic irreversible pulpitis. The recent decade has seen a paradigm shift in the treatment concepts of how vital mature permanent molars diagnosed with irreversible pulpitis can be more conservatively managed using vital pulp therapy techniques like pulpotomy. However, despite emerging evidence indicating similarities between primary and permanent tooth pulp response to dental caries, there is limited research on whether pulpotomy can be similarly used as a definitive treatment modality for vital primary teeth with irreversible pulpitis. This randomised controlled trial (RCT) aims to compare the treatment effectiveness of pulpotomy versus pulpectomy in management of vital primary molars diagnosed with symptomatic irreversible pulpitis over a two-year period.Methods/designThis clinical study is a parallel, two-armed, open label, non-inferiority RCT with a 1:1 allocation ratio between the experimental intervention arm (pulpotomy) and the active comparator arm (pulpectomy). Healthy cooperative children, between 4–9 years of age, who have painful primary molars with clinical symptoms typical of irreversible pulpitis will be recruited after obtaining informed consent from their parents/legal guardians. 50 vital primary molars clinically diagnosed with symptomatic irreversible pulpitis will be randomly distributed between the two treatment arms. The primary outcomes that will be assessed are clinical and radiographic success after six-months, one-year and two-years of the trial interventions. The influence of baseline pre-operative variables (age; gender; tooth type; site of caries; pre-operative furcal radiolucency; pre-operative pain intensity) and intra-operative factors (time taken to achieve haemostasis) on treatment outcomes will also be assessed. The secondary outcome evaluated will be the immediate (24 h and 7 d) post-operative pain relief afforded by the two treatment interventions.DiscussionThis trial seeks to provide evidence on whether pulpotomy treatment can be no worse than the standard pulpectomy treatment for the management of symptomatic irreversible pulpitis in vital primary molars.Trial registrationClinicalTrials.gov (NCT06183203). Registered on 30 January 2024.

Race-Neutral Equations and Pulmonary Function Test Interpretation in Two Pediatric Cohorts

ObjectivesTo investigate the changes in predicted lung function measurements when using race-neutral equations in children, based upon the new Global Lung Initiative (GLI) reference equations utilizing a race-neutral approach in interpreting spirometry results compared with the 2012 race-specific GLI equations. Study designWe analyzed data from two multicenter prospective cohorts comprised of healthy children and children with history of severe (requiring hospitalization) bronchiolitis. Spirometry testing was done at the 6-year physical exam and 677 tests were analyzed using new GLI Global and 2012 GLI equations. We used multivariable logistic regression, adjusted for age, height, and sex, to examine the association of race with the development of new impairment or increased severity (FEV1 z-score≤-1.645) as per 2022 ATS guidelines. ResultsCompared with the race-specific GLI, the race-neutral equation yielded increases in the median FEV1 and FVC percent predicted in White children but decreases in these two measures in Black children. The prevalence of obstruction increased in White children by 21% and the prevalence of possible restriction increased in Black children by 222%. Compared with White race, Black race was associated with increased prevalence of new impairments (aOR 7.59; 95%CI, 3.00-19.67; p<0.001) and increased severity (aOR 35.40; 95%CI, 4.70-266.40; p=0.001). Results were similar across both cohorts. ConclusionsAs there are no biological justifications for the inclusion of race in spirometry interpretation, use of race-neutral spirometry reference equations led to an increase in both the prevalence and severity of respiratory impairments among Black children.

A 6-week coordinative motor training program improves spatial ability performances in healthy children

A 6-week coordinative motor training program improves spatial ability performances in healthy children

Supporting parents with acutely ill children: Environment scan and user evaluation of mobile applications (the SuPa kids project)

BackgroundChildren are one of the biggest users of emergency departments in the UK, sometimes utilising services when experiencing acute illnesses that can be managed at home. mHealth can be an efficacious way for parents/guardians to manage acute illnesses. It has also become a ubiquitous resource to promote public health interests within a resource constrained health system. However, to be effective, co-design is necessary with concepts such as usefulness, ease of use, trustworthiness and security underpinning the utility of mHealth interventions for acute childhood illness. ObjectiveThe objective of this study was to conduct an environmental scan of mHealth apps for parental assessment and management of acute childhood illnesses in 0- to 5-year-olds, review the content and functionality of each identified app against the list of desired attributes identified in previous research and synthesise publicly available reviews from end users to demonstrate the quality of current apps in the marketplace and identify areas for improvement. MethodApp characteristics were mapped to an a priori defined list of desirable attributes. End user reviews were mapped to a modified Technology Acceptance Model framework that included overarching themes of: Perceived Usefulness (PU), Perceived Ease of Use (PEU), Perceived Trustworthiness (PT) and Perceived Security (PS) using reflexive thematic analysis. ResultsOverall, 15 apps were included in the analysis (Table 2). Fourteen of the 15 apps were available on both the iOS and Android platforms. ‘Baby Illness, Prevention, Cure’ was only available on the Android store. All apps were free to download and did not restrict access to information or features via in-app purchases. Baby and child first aid (British Red Cross) was the earliest app to be released (2014). This app was updated annually, with the most recent update being 2022. The most recent apps to be released (2018) were ‘AskFirst’ (formerly Ask NHS), ‘Essex Child Health’ and ‘The Lullaby Trust Baby Check’, updated in 2022, 2020 and 2019, respectively. No individual app met all the desirable attributes highlighted by parents in previous research. Both ‘Healthier Together’, and ‘The Lullaby Trust Baby Check’ included all but one desirable attributes (video), as did the ‘’CATCH (Common Approach to Children’s Health), which did not utilise a traffic light system. Apps that were locality specific were not rated by users (Berkshire Child Health, Cheshire Child Health, Child Health Guide Newham, Child Health HMR, Oldham Child Illness and Walsall Healthy Child). All other apps were rated from 2/5 to 5/5 stars. When considering localities, the ‘CATCH’ app was only supported in Halton, Cheshire, Knowsley, Liverpool, St Helens and Vale Royal. Further investigation evidenced no correlation between inclusion of the desirable attributes and app rating. ConclusionOverall, this research has highlighted several aspects of best practise when developing mHealth apps for the management of acute childhood illnesses, for increasing PU, PEU, PT and PS; and also, places importance on co-design.

Stages of motor development in children with cyanotic congenital heart defects after surgical treatment

Background. The article deals with the actual problem of pediatric neurology, pediatric cardiology, and pediatric cardiac surgery, in particular, the peculiarities of neurodevelopment in children with congenital heart defects (CHD). The purpose is to conduct a study of stages of stato-motor development (SMD) in patients with cyanotic congenital heart defects after surgical treatment and to determine the influence of pathogenic factors on neurodevelopmental delay. Materials and methods. Thirty-five patients with cyanotic CHD underwent examination and surgical treatment at the Center for Pediatric Cardiology and Cardiac Surgery of the Ministry of Health of Ukraine: 20 children — with transposition of the great vessels (TGV) and 15 children — with tetralogy of Fallot (TOF). The control group consisted of 35 healthy patients whose motor development corresponded to their age. Gestational age, body weight at birth, Apgar score, saturation, and duration of artificial blood circulation during surgical treatment for CHD were considered. Assessment of motor development was carried out with the help of the following scales: Munich Functional Developmental Diagnosis (G.J. Köhler, H.D. Egelkraut) and section 2 of the Hammersmith Infant Neurological Examination. Data were processed using the software Microsoft Excel version 16.0.12527.21236. Results. The gestational age of the studied group of patients with cyanotic CHD was 38 weeks, body weight — 3,500 g, which corresponded to the control group. Patients of the first subgroup with TGV were diagnosed with lower saturation indicators (р = 0.0001), a lower 1-minute Apgar score (p = 0.028) and a longer duration of artificial blood circulation — 146.00 ± 29.03 (р = 0.043) compared to the second subgroup with TOF. SMD delay was diagnosed in 29 % of cases, namely 12 % with TGV and 17 % with TOF. The average period of sitting with delayed SMD was 8.4 ± 2.2 months (p = 0.002), walking — 18.4 ± 6.3 months (p = 0.0001). Subsequently, children with TGV continue to develop without a significant delay compared to the TOF subgroup. Conclusions. 1. Patients with cyanotic CHD are born at 38 weeks of gestation, with sufficient body weight without a significant difference depending on the type of CHD and compared to the control group of healthy children. The predominance of the male gender is typical in cyanotic CHD. However, children with transposition of the great vessels are characterized by a lower 1-minute Apgar score and lower indicators of saturation at birth compared to those with tetralogy of Fallot. 2. Based on the conducted study, a delay of SMD was found in 29 % of patients with cyanotic CHD, namely 17 % with TOF and 12 % with TGV. The average duration of sitting with delay was 8.4 ± 2.2 months and walking was 18.4 ± 6.3 months. 3. Surgical treatment was carried out according to the detected indications, for transposition of the great vessels on the first day and for tetralogy of Fallot at 8 months of life. No pathogenic influence of the duration of artificial blood circulation and aortic clamping during cardiosurgical treatment on SMD in children was found. An increase in the duration of artificial blood circulation was noted during arterial switch operation in children with TGV, but no significant difference was found in children with SMD delay. 4. Timely early surgical treatment of critical CHD — TGV on the first day after birth, a developed route for pregnant women, techniques of performing operations — ensure a better SMD of this subgroup in the future. In patients with TOF, taking into account the long period of hypoxia before the start of surgical correction, neuropsychiatric disorders of varying degrees are more often noted. The development of an individual rehabilitation program is provided for this category of children.

Decreased gray matter volume in the anterior cerebellar of attention deficit/hyperactivity disorder comorbid oppositional defiant disorder children with associated cerebellar-cerebral hyperconnectivity: insights from a combined structural MRI and resting-state fMRI study.

Attention deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) are highly comorbid. Many prior investigations have found that ADHD relates to anatomical abnormalities in gray matter. The abnormal gray matter of ADHD comorbid ODD is still poorly understood. This study aimed to explore the effect of comorbid ODD on gray matter volume (GMV) and functional alterations in ADHD. All data were provided by the ADHD-200 Preprocessed Repository, including 27 ADHD-only children, 27 ADHD + ODD children, and 27 healthy controls aged 9-14 years. Voxel-based morphometry (VBM) and functional connectivity (FC) of resting-state functional magnetic resonance imaging (fMRI) were used to compare the difference in GMV and FC between ADHD + ODD, ADHD-only, and healthy children. The results showed that ADHD children with comorbid ODD had a more significant reduction in cerebellar volume, mainly in the anterior regions of the cerebellum (Cerebellum_4_5). The Cerebellum_4_5 showed increased functional connectivity with multiple cortical regions. These brain regions include numerous executive functioning (EF) and brain default mode network (DMN) nodes. The GMV abnormalities and excessive connectivity between brain regions may further exacerbate the emotional and cognitive deficits associated with ADHD.

Nerve cross-sectional area from childhood to old age: A high-resolution nerve ultrasound study.

Nerve cross-sectional area (CSA) is not constant over the human lifespan. The relationship between an increasing CSA and age has been described as a linear positive correlation, but few studies have found a linear decrease in nerve size with older age. The aim of the present study was to analyze the development of nerve CSA in a healthy population from early childhood to old age using high-resolution ultrasound. The median, ulnar, radial and sural nerves were examined bilaterally at 18 nerve sites in 110 healthy children, adolescents and adults aged between 2 and 98 years. The CSA of every nerve site was evaluated separately and in different age groups. The correlation of CSA with age, height and weight was analyzed in a linear, logarithmic and quadratic model and correlation coefficients were compared in a goodness-of-fit analysis. Models were then adjusted for weight and height. Linear CSA-age correlations showed the lowest correlation coefficients for all nerve sites. An inverted parabolic curve suggesting a quadratic correlation of CSA and age was the best-fitting model. Weight and height had a higher predictive value than age in adjusted models. There is an increase in nerve size during childhood and adolescence and a trend towards a decrease in old age, suggesting an inverted parabolic curve partly explained by age-related changes in weight and height. Enlarged nerves in elderly individuals should not be attributed to age alone.

Mobile ECG devices in pediatric cardiology: efficacy and accuracy of smart watch and hand-held device in healthy children

Abstract Background and Aim Pediatric arrhythmias require accurate electrocardiogram (ECG) assessment for diagnosis and management. Mobile ECG devices, such as smart watch based and hand-held devices, offer potential advantages in terms of portability and accessibility. This study aimed to compare the efficancy and diagnostic accuracy of ECG tracings obtained using a smart watch and a hand-held device with standard 12-lead ECG tracings in healthy children. Methods ECG data were acquired from healthy pediatric subjects (n=30) aged 4 to 18 years using the smart watch, hand-held device, and standard 12-lead ECG. Single leads were acquired sequentially. The time required for ECG acquisition was recorded for each device. Subsequently, ECG leads were analyzed for voltage, duration, and morphology of waves and intervals, as well as ST segments. Qualitative assessment of leads included morphology comparison of waves and complexes to standard 12-lead ECG and using a physician based quality rating scale. Assessment was performed by two blinded pediatric electrophysiologists. Results We found significant differences in the time required to acquire ECG tracings between the smart watch, standard 12-lead ECG, and hand-held device, with the smart watch being notably slower (median 15 min, 4 min, 1 min, respectively). ECG leads obtained with the smart watch and hand-held device demonstrated comparability to standard 12-lead ECG tracings in terms of quantitative key parameters, including voltage (mV) and duration (ms) of waves and intervals. Qualitative assessment revealed good correlation of the hand-held device with standard 12-lead ECG, while the smart watch performed less well. Conclusions This study suggests that mobile ECG devices offer a diagnostic accuracy comparable to that of standard 12-lead ECGs in healthy children. While the smart watch may be slower in ECG acquisition, acquisition of all 12 standard ECG leads is feasible in this population. The potential of both included mobile devices for pediatric usage in specific clinical scenarios, such as remote monitoring or emergencies, is promising.Graphical Abstract

Gut and respiratory tract microbiota in children younger than 12 months hospitalized for bronchiolitis compared with healthy children: can we predict the severity and medium-term respiratory outcome?

Both the intestinal and respiratory microbiota of children with bronchiolitis, especially those with respiratory syncytial virus infection, are altered and differ from that of healthy children. The microbiota pattern in the acute episode could identify those children who will later have other respiratory episodes in the first year of life. Preventive measures could be adopted for this group of infants.

Speed of heart rate changes during postural provocations in children and adolescents

Heart rate is under constant autonomic influence but the development of the influence in children is not fully understood. Continuous electrocardiograms were obtained in 1045 healthy school-age children (550 females) during postural provocations with body position changes between supine, sitting, standing, supine, standing, sitting and supine (in this order), 10 min in each position with position changes within 20 s. Heart rate was measured in each position and speed of heart rate changes between positions were assessed by regressions of rates versus timing of individual cardiac cycles. Supine heart rate was gradually decreasing with age: 82.32 ± 9.92, 74.33 ± 9.79, 67.43 ± 9.45 beats per minute (bpm) in tertile age groups < 11, 11–15, > 15 years, respectively (p < 0.0001), with no significant sex difference. Averaged speed of heart rate changes differed little between sexes and age groups but was significantly faster during rate deceleration than acceleration (e.g., supine ↔ standing: 2.99 ± 1.02 vs. 2.57 ± 0.68 bpm/s, p < 0.0001). The study suggests that in children, vagal heart rate control does not noticeably change between ages of approximately 6–19 years. The gradual resting heart rate decrease during childhood and adolescence is likely caused by lowering of cardiac sympathetic influence from sympathetic overdrive in small children to adult-like sympatho-vagal balance in older adolescents.

Safety and Immunogenicity of the Live Attenuated Varicella Vaccine in Vietnamese Children Aged 12 Months to 12 Years: An Open-Label, Single-Arm Bridging Study.

This study aims to evaluate the safety and immunogenicity of the SKYVaricella vaccine in healthy Vietnamese children aged 12 months to 12 years. This open-label, single-arm study involved 201 children divided into two groups: 60 children aged 12 months to 5 years and 141 children aged 6 to 12 years. Safety was assessed through immediate reactions, solicited adverse events within 7 days, and unsolicited events up to Day 42. Immunogenicity was evaluated by seroconversion rates (SCR) and geometric mean titer (GMT) increments using fluorescent antibody-to-membrane antigen (FAMA) on the day of vaccination (D0) and 42 days after vaccination (D42). All participants completed the follow-up. Immediate adverse events included pain (8.0%), redness (8.0%), and swelling (20.9%) at the injection site. Within 7 days, pain (17.9%) and swelling (12.4%) were mild and self-resolving. Unsolicited adverse events were infrequent and mild. Both age groups achieved 100% SCR. GMT of varicella-zoster virus antibodies increased from 1.37 (SD 1.97) at D0 to 18.02 (SD 2.22) at D42, a 13.12-fold rise. No Grade 3 adverse events were observed. The SKYVaricella vaccine shows a robust immunogenic response and favorable safety profile in Vietnamese children aged 12 months to 12 years. These findings endorse its potential inclusion in pediatric vaccination programs as a reliable preventive option against varicella.

Computer-based facial recognition as an assisting diagnostic tool to identify children with Noonan syndrome

BackgroundNoonan syndrome (NS) is a rare genetic disease, and patients who suffer from it exhibit a facial morphology that is characterized by a high forehead, hypertelorism, ptosis, inner epicanthal folds, down-slanting palpebral fissures, a highly arched palate, a round nasal tip, and posteriorly rotated ears. Facial analysis technology has recently been applied to identify many genetic syndromes (GSs). However, few studies have investigated the identification of NS based on the facial features of the subjects.ObjectivesThis study develops advanced models to enhance the accuracy of diagnosis of NS.MethodsA total of 1,892 people were enrolled in this study, including 233 patients with NS, 863 patients with other GSs, and 796 healthy children. We took one to 10 frontal photos of each subject to build a dataset, and then applied the multi-task convolutional neural network (MTCNN) for data pre-processing to generate standardized outputs with five crucial facial landmarks. The ImageNet dataset was used to pre-train the network so that it could capture generalizable features and minimize data wastage. We subsequently constructed seven models for facial identification based on the VGG16, VGG19, VGG16-BN, VGG19-BN, ResNet50, MobileNet-V2, and squeeze-and-excitation network (SENet) architectures. The identification performance of seven models was evaluated and compared with that of six physicians.ResultsAll models exhibited a high accuracy, precision, and specificity in recognizing NS patients. The VGG19-BN model delivered the best overall performance, with an accuracy of 93.76%, precision of 91.40%, specificity of 98.73%, and F1 score of 78.34%. The VGG16-BN model achieved the highest AUC value of 0.9787, while all models based on VGG architectures were superior to the others on the whole. The highest scores of six physicians in terms of accuracy, precision, specificity, and the F1 score were 74.00%, 75.00%, 88.33%, and 61.76%, respectively. The performance of each model of facial recognition was superior to that of the best physician on all metrics.ConclusionModels of computer-assisted facial recognition can improve the rate of diagnosis of NS. The models based on VGG19-BN and VGG16-BN can play an important role in diagnosing NS in clinical practice.