Injuries In Children Research Articles

Meta-analysis of effectiveness evaluation of preventive measures for acute kidney injury in children

Objective: To comprehensively evaluate the effectiveness of preventive measures for acute kidney injury (AKI) in children and identify the effective strategies. Methods: Databases were systematically searched including CNKI, Wanfang, VIP, China Biology Medicine National Knowledge Infrastructure, PubMed, Embase, Cochrane Library databases, and the reference lists of relevant papers for randomized controlled trials on preventing pediatric AKI up to December 2023. Literature screening was conducted based on the inclusion and exclusion criteria, followed by data extraction and quality assessment of included studies. Traditional and network meta-analyses were performed, along with trial sequential analysis (TSA). Results: A total of 21 studies involving 3 483 children were included. Traditional and network meta-analysis showed that dexmedetomidine was effective in preventing AKI in children undergoing cardiac surgery or cardiac angiography (OR=0.26, 0.27; 95%CI 0.11-0.64, 0.13-0.58). Remote ischemic preconditioning (RIPC) was effective in preventing AKI in children after cardiac surgery (OR=0.43, 0.44; 95%CI 0.24-0.79, 0.23-0.83). Traditional and network meta-analysis specific to children with sepsis or septic shock showed that balanced solution was effective in preventing pediatric AKI (OR=0.58, 0.52; 95%CI 0.42-0.79, 0.37-0.73). TSA indicated that the total sample sizes of dexmedetomidine (348 cases) and RIPC (666 cases) both reached the required information size (320 and 534 cases); additionally, the Z-curve for balanced solution (cumulative Z=3.38) crossed the TSA monitoring boundary (Z=3.29). Conclusion: Dexmedetomidine reduces the risk of AKI in children undergoing cardiac surgery or cardiac angiography, RIPC decreases the risk of AKI in children after cardiac surgery, and balanced solution lowers the risk of AKI in children with sepsis or septic shock.

Significance of detecting cardiac troponin I and creatine kinase MB in critically Ill children without primary cardiac illness.

To investigate the incidence of myocardial injury in children with critically ill children without primary cardiac disease and the association between elevated cardiac troponin I (cTnl) and creatine kinase MB (CK-MB) concentrations and disease progression and prognosis to guide early treatment. The serum cTnI and CK-MB concentrations of 292 children with critically ill children without primary cardiac disease in Yantai Yuhuangding Hospital between January 2021 and January 2024 were retrospectively analyzed within 24 h after entering the Pediatric Intensive Care Unit (PICU). The children were divided into normal and abnormal groups according to the myocardial marker results. The abnormal group was further divided into the cTnI-elevated, CK-MB-elevated, single-elevated (cTnI- or CK-MB-elevated) and double-elevated (cTnI- and CK-MB-elevated) groups. The differences in the clinical indicators and their relationships with prognosis for the groups were compared. The incidence of myocardial injury among the critically ill children without primary cardiac disease was 55.1%. The incidence of myocardial injury in children with infectious diarrhea combined with moderate and severe dehydration reached 85.19%. The pediatric critical illness score; frequency of use of vasoactive drugs; hypotension, shock, heart failure, respiratory failure, and multiple organ dysfunction syndrome; and mortality indexes differed significantly for the normal and abnormal myocardial marker groups (P < 0.05). The single-elevated and normal groups only showed a difference in mortality (P < 0.017). The cTnI and CK-MB concentrations were negatively correlated with prognosis (P < 0.01). Myocardial injury, as evidenced by elevated cardiac biomarkers, is common in critically ill children without primary cardiac illness. cTnI and CK-MB are associated with outcomes. Shock, heart failure, and multiple organ dysfunction syndromes are independently associated with simultaneous elevations of CK-MB and cTnI concentrations. Further prospective studies are needed to elucidate the clinical utility of these biomarkers.

Epidemiology of injuries among children and adolescents from the Xinglin District in Xiamen, 2016-2019.

To investigate the epidemiology of injuries among children and adolescents in the Xinglin District of Xiamen from 2016 to 2019. This study collected data from patients who attended the outpatient and emergency departments of the Xinglin District at the First Affiliated Hospital of Xiamen University between January 2016 and December 2019, diagnosed with injuries. A total of 13,123 patients were included, categorized into age groups 0-4 (n = 4,834), 5-9 (n = 3,924), 10-14 (n = 2,671), and 15-18 (n = 1,694). The rates of unintentional injuries were 97.00%, 96.94%, 94.50%, and 90.08% in the 0-4, 5-9, 10-14, and 15-18 age groups, respectively (P < 0.001). The proportion of head injuries decreased with age (from 41.13% in the 0-4 age group to 18.00% in the 15-18 age group), compensated by an increase in rates of injuries to upper and lower extremities and multisite injuries (P < 0.001). The most common causes of injuries were fall-related injuries (30.46%-52.05%), followed by mechanical injuries (18.35%-36.42%), with the rates of fall-related injuries decreasing with age and rates of mechanical injuries increasing with age (P < 0.001). Age-period-cohort models revealed that the time factor was not significant for fall-related injuries and mechanical injuries (all P > 0.05) despite apparent increases in incidence over time. Injuries in children and adolescents continue to be a significant public health concern in the Xinglin District (China), predominantly driven by fall-related injuries and mechanical injuries.

Neural response to monetary incentives in acquired adolescent depression after mild traumatic brain injury: Stage 2 Registered Report.

Depression is a common consequence of traumatic brain injury. Separately, spontaneous depression-arising without brain injury-has been linked to abnormal responses in motivational neural circuitry to the anticipation or receipt of rewards. It is unknown if post-injury and spontaneously occurring depression share similar phenotypic profiles. This issue is compounded by the fact that nearly all examinations of these psychiatric sequelae are post hoc: there are rarely any prospective assessments of mood and neural functioning before and after a brain injury. In this Stage 2 Registered Report, we used the Adolescent Brain Cognitive Development Consortium dataset to examine if a disruption in functional neural responses to rewards is present in patients with depression after a mild traumatic brain injury. Notably, this study provides an unparalleled opportunity to examine the trajectory of neuropsychiatric symptoms longitudinally within-subjects. This allowed us to isolate mild traumatic brain injury-specific variance independent from pre-existing functioning. Here, we focus on a case-control comparison between 43 youth who experienced a mild traumatic brain injury between MRI visits, and 43 well-matched controls. Contrary to pre-registered predictions (https://osf.io/h5uba/), there was no statistically credible increase in depression in mild traumatic brain injury cases relative to controls. Mild traumatic brain injury was associated with subtle changes in motivational neural circuit recruitment during the anticipation of incentives on the Monetary Incentive Delay paradigm. Specifically, changes in neural recruitment appeared to reflect a failure to deactivate 'task-negative' brain regions (ventromedial prefrontal cortex), alongside blunted recruitment of 'task-positive' regions (anterior cingulate, anterior insula and caudate), during the anticipation of reward and loss in adolescents following mild brain injuries. Critically, these changes in brain activity were not correlated with depressive symptoms at either visit or depression change scores before and after the brain injury. Increased time since injury was associated with a recovery of cognitive functioning-driven primarily by processing speed differences-but depression did not scale with time since injury. These cognitive changes were also uncorrelated with neural changes after mild traumatic brain injury. This report provides evidence that acquired depression may not be observed as commonly after a mild traumatic brain injury in late childhood and early adolescence, relative to findings in adult cases. Several reasons for these differing findings are considered, including sampling enrichment in retrospective cohort studies, under-reporting of depressive symptoms in parent-report data, and neuroprotective factors in childhood and adolescence.

Dynamic point of care ultrasound is effective in the early diagnosis of anterior cruciate ligament injuries in children and adolescents

IntroductionSeveral studies have proven that ultrasound (US) can improve the efficiency of early diagnostics of anterior cruciate ligament (ACL) injuries. ACL US is mainly performed by sonologists or radiologists. We have very little data on how effective these tests are if they are performed by an orthopaedic surgeon. We also have no information on the applicability of ACL US in children and adolescents. In this retrospective study, we analysed the results of point of care ultrasound (POCUS), which were performed by orthopaedic surgeons on children with suspected ACL injury. Materials and methodsWe reviewed the data of children and adolescents who were examined with ultrasound between 2018 and 2021 for suspected ACL injury. ACL POCUS was done immediately after the physical examination, according to a standard technique. The tests were performed by an orthopaedic resident and young and a senior orthopaedic surgeon. The inclusion criteria were as follows: the child's age is between 0–15 years, the growth zones are open, the child later underwent MRI and/or arthroscopy, which confirmed or excluded the fact of an ACL injury. We excluded patients with incomplete recordings and documentation. Results119 children met the above criteria. The children were between 8 and 15 years old (mean = 13.29). Positive findings were found in 47, negative findings in 72 children with ACL POCUS. During the subsequent treatment, 57 children underwent only MRI examination, 11 children only arthroscopy, and 51 children both MRI and arthroscopy. The specificity of the test was measured as 0.958 and the sensitivity as 0.917 for complete ACL rupture. Regarding all ACL injuries (complete + partial), we found the sensitivity to be 83.019 and the specificity to be 95.45. The interrater agreement between radiologist and clinicians was 94.957 %. (Cohen's k: 0.8945). ConclusionsPOCUS can indicate functional insufficiency caused by ACL injury in children and adolescents. The biggest advantage of the test is that it is quick and simple, non-invasive. Further prospective diagnostic tests and standardized examination protocols can confirm our favourable experiences.

Open Reduction and Fixation of Late-Presenting Pediatric Supracondylar Humeral Fractures: A Prospective Study.

Supracondylar humeral fracture (SCHF) is a common injury in children, and early treatment provides excellent results and prevents disabilities. Delayed presentation is still prevalent, mainly in developing countries, because many factors hinder the opportunity to receive appropriate treatment. Currently, there are no standard treatment protocols, and there is insufficient published literature on this topic. This study aimed to evaluate the effectiveness and outcomes of open reduction and Kirschner wire fixation using a triceps-sparing posterior approach in neglected cases with complicated fractures. This was a prospective multicenter clinical study conducted between July 2016 and June 2021, which included 28 pediatric patients with neglected SCHF who presented to the hospital for definitive treatment five days or more after initial trauma without previous surgical intervention. All the patients underwent open reduction and K-wire fixation using a posterior triceps-sparing approach. The final functional outcome was assessed using the Mayo Elbow Performance Index (MEPI) and Flynn criteria. All fractures (100%) united within 3-5.5weeks (mean 4 ± 0.7 weeks). Excellent scores observed in 67.9% (n = 19), good in 21.4% (n = 6), fair in 7.1% (n=2), and poor in 3.6% (n = 1) patients according to MEPI. Correspondingly, Flynn's criteria showed 96.4% (n = 27) satisfactory and 3.6% (n = 1) unsatisfactory outcome. Open reduction and fixation using Kirschner wires through the posterior triceps-sparing approach is an effective treatment method for late-presenting SCHF in children with consequent satisfactory results.

Reducing Blood Draws in Pediatric Patients With Solid Organ Injury Through Protocolized Transcutaneous Hemoglobin Monitoring

BackgroundManagement of pediatric solid organ injuries continues to evolve, decreasing the need for serial hemoglobin measurements, repeat imaging, and operative intervention. Transcutaneous continuous hemoglobin monitoring (TCHM) has been shown to effectively monitor hemoglobin levels in children with solid organ trauma. MethodsA 6-year, single-center, retrospective chart review was conducted of pediatric solid organ injury patients aged 30 days to <18 years admitted to a quaternary children's hospital following implementation of a highly protocolized TCHM system. A laboratory hemoglobin measurement was obtained at the time of diagnosis and additional measurements were determined based on injury grading. Adverse events were tracked and included: central or arterial line placement, blood product(s) administration, percutaneous embolization procedures, transfer to the pediatric ICU and operative intervention. ResultsA total of 97 patients met the inclusion criteria. Blood draws were significantly reduced following TCHM protocol implementation (3.0 [IQR 2.0–5.5] vs 2.0 [IQR 1.0–4.5], p 0.01) without a significant increase in blood product administration (p = 0.30), central or arterial line placement (p = 1), or operative intervention (p = 0.29). Length of stay was not impacted (p = 0.36). The rate of unplanned ICU transfers and percutaneous embolization procedures were too low for statistical evaluation. ConclusionTCHM safely reduces the need for serial blood draws in pediatric trauma patients when utilized within a well-defined protocol for solid organ injury. Further studies are needed to evaluate the role of TCHM in shortening or eliminating hospital admission for low-grade solid organ injuries in children. Level of EvidenceLevel III. Type of StudySingle-center, retrospective chart review cohort study.

Contemporary management and outcomes of blunt traumatic American Association for the Surgery of Trauma Organ Injury Scale grades III and IV pancreatic injuries in children: A Trauma Quality Improvement Program analysis.

The Trauma Quality Improvement Program (TQIP) database has delineated management strategies and outcomes for adults with American Association for the Surgery of Trauma Organ Injury Scale grades III and IV pancreatic injuries and suggests that nonoperative management (NOM) is a viable option for these injuries. However, management strategies vary for children following significant pancreatic injuries and outcomes for these intermediate/high-grade injuries have not been sufficiently studied. Our aim was to describe the management and outcomes for grades III and IV pancreatic injuries using TQIP. We hypothesize that pediatric patients with intermediate/high-grade injuries can be safely managed with NOM. All pediatric patients (younger than 18 years) registered in TQIP between 2013 and 2021 who suffered a grade III or IV pancreatic injury due to blunt trauma were included in the current study. Patient demographics, clinical characteristics, complications, and in-hospital mortality were compared between the different treatment strategies for pancreatic injury: NOM versus drainage and/or pancreatic resection. A total of 580 patients meeting the inclusion criteria were identified. A total of 416 pediatric patients suffered a grade III pancreatic injury; 79% (n = 332) were NOM, 7% (n = 27) received a drain, and 14% (n = 57) underwent a pancreatic resection. A further 164 patients suffered a grade IV pancreatic injury; 77% (n = 126) were NOM, 11% (n = 18) received a drain, and 12% (n = 20) underwent a pancreatic resection. No differences in overall injury severity or demographical data were observed between the treatment groups. No difference in in-hospital mortality was detected between the different management strategies. Patients who received a drain had a longer hospital length of stay. The majority of children with American Association for the Surgery of Trauma Organ Injury Scale grades III and IV pancreatic injuries are managed nonoperatively. Nonoperative management is a reasonable strategy for these injuries and results in equivalent in-hospital adverse outcome profiles as pancreatic drainage or resection with a shorter hospital length of stay. Therapeutic/Care Management; Level IV.

A short scale to measure health-related quality of life after traumatic brain injury in children and adolescents (QOLIBRI-OS-KID/ADO): psychometric properties and German reference values

PurposeThe impact of pediatric traumatic brain injury (pTBI) on health-related quality of life (HRQoL) in children and adolescents remains understudied. Short scales have some advantages in terms of economy and administration over longer scales, especially in younger children. The aim of the present study is to psychometrically evaluate the six-item German version of the QOLIBRI-OS-KID/ADO scale for children and adolescents. In addition, reference values from a general German pediatric population are obtained to assist clinicians and researchers in the interpretation of HRQoL after pTBI.MethodsA total of 297 individuals after TBI and 1997 from a general population sample completed the questionnaire. Reliability, validity, and comparability of the assessed construct were examined.ResultsThe questionnaire showed satisfactory reliability (α = 0.75 and ω = 0.81 and α = 0.85 and ω = 0.86 for the TBI and general population samples, respectively). The QOLIBRI-OS-KID/ADO was highly correlated with its long version (R2 = 67%) and showed an overlap with disease-specific HRQoL (R2 = 55%) in the TBI sample. The one-dimensional factorial structure could be replicated and tested for measurement invariance between samples, indicating a comparable HRQoL construct assessment. Therefore, reference values and cut-offs indicating clinically relevant impairment could be provided using percentiles stratified by factors significantly associated with the total score in the regression analyses (i.e., age group and gender).ConclusionIn combination with the cut-offs, the QOLIBRI-OS-KID/ADO provides a cost-effective screening tool, complemented by interpretation guidelines, which may help to draw clinical conclusions and indications such as further administration of a longer version of the instrument to gain more detailed insight into impaired HRQoL domains or omission of further steps in the absence of an indication.

Injury prevention in the US Maternal, Infant and Early Childhood Home Visiting programme

BackgroundMany home-based interventions have been demonstrated to reduce unintentional and intentional injuries in young children aged 0–4 years, but an understanding of their inclusion in federally-funded home visiting programmes in...

Association between the guardians’ educational levels and unintentional injuries in children aged 6–18 in Shenzhen, China

BackgroundUnintentional injuries is the leading cause of death in children aged 6–18 in China. Previous studies on the association between the guardians’ educational levels and unintentional injuries in children have been inconclusive, and it remains unclear among the Chinese population. Therefore, this study aimed to identify the association between guardians’ educational levels and unintentional injuries in children aged 6–18 in Shenzhen, China.MethodsThis cross-sectional study enrolled 9,903 children aged 6–18 in Shenzhen in 2020 using a multistage cluster sampling method. Information on the children and guardians were collected, and unintentional injuries in the past year was examined by using two nested questions. Logistic regression analyses were used to test the association between the guardians’ educational levels and unintentional injuries in children aged 6–18, and the crude odds ratios (ORs) and adjusted ORs with 95% confidence intervals (95% CI) were calculated.Results275 of the 9,903 children reported experiencing at least one unintentional injuries in the past year, and the weighted incidence of unintentional injuries was 6.3% (95% CI: 5.8–6.8%) in children aged 6–18 in Shenzhen, China. The incidence of unintentional injuries differed significantly in the guardians’ education levels (P < 0.05). After adjustment for the children’s variables, multiple binary logistic regression analysis showed that compared to children whose guardians’ educational levels were low, children whose guardians’ educational levels were high (adjusted OR = 0.57, 95% CI: 0.37–0.87) and medium (adjusted OR = 0.56, 95% CI: 0.39–0.81) had a lower odds of unintentional injuries. Similar results were also observed when further adjustment for both the children’s and guardians’ variables.ConclusionThe overall incidence of unintentional injuries in children aged 6–18 in Shenzhen was low, and it was associated with the guardians’ educational levels. Children whose guardians’ educational levels were low should be given special concern to prevent unintentional injuries, and it is suggested to reduce the incidence of unintentional injuries in children by improving the guardians’ educational levels.

Diagnostic criteria for optimizing treatment tactics for children with traumatic splenic ruptures

BACKGROUND: Damage to the spleen is the leading cause of abdominal trauma in children. This often becomes the main indication for splenectomy. This article addresses concerns on the safety of conservative treatment of these injuries in children. Most studies have found that asplenization results in the complete loss of the immunological and hematological functions of the spleen. Thus, spleen-preserving surgeries are crucial to prevent post-splenectomy hyposplenism and associated life-threatening complications. AIM: This study aimed to develop a mathematical model using logistic regression to determine aggregate variables associated with the possibility of surgical treatment and identify safe shock index parameters for the conservative treatment of traumatic splenic ruptures in children. MATERIALS AND METHODS: This prospective study included 91 patients with traumatic splenic rupture: 80 (87.9%) children received conservative treatment and 11 (12.1%) underwent surgical treatment. The age of the children was 11 (8; 13) years; there were 3.3 times more boys (70 versus 21). To assess the need for surgical treatment, an analysis of categorical variables was conducted using a mathematical model using logistic regression. RESULTS: Increased shock index (β = −0.264 ± 0.083; t(86) = −3.191; p = 0.002) and the need for blood transfusion (β = 0.464 ± 0.089; t(86) = 5.218; p = 0.001) were cumulative factors associated with a high possibility of surgical treatment of splenic ruptures in children. With the combination of parameters of increased shock index and blood transfusion for surgical treatment, moderate sensitivity was determined at 85.7% (95% CI: 52.1–99.6; p = 0.001) and a positive predictive value at 75% (95% CI: 34.9–96.8). In the absence of these factors, the probability of conservative treatment of children with splenic ruptures reached 100% (specificity: 97.5%; 95% CI: 91.1–99.7; p = 0.001). When summarizing the identified parameters, the area under the curve was 0.941 ± 0.026 (95% CI: 0.872–0.980), and the assessment of the model’s suitability showed a positive test (χ2 = 32.7; p = 0.264). In nonoperative treatment, the frequency of identified cumulative factors was 2.5% (n = 2). Safe shock index parameters for successful conservative treatment of splenic ruptures in children have been determined: SIPA 1.1 (age up to 6 years), 0.85 (7–12 years), and 0.83 (over 13 years). CONCLUSIONS: An increased shock index and the need for blood transfusion are combined factors that determine the high probability of surgical treatment for traumatic ruptures of the spleen in children. In nonoperative treatment, the frequency of identified cumulative factors was 2.5%, which indicates a strong argument for justifying the safety of conservative therapy.

Preclinical Detection of Early Glomerular Injury in Children with Kidney Diseases-Independently of Usual Markers of Kidney Impairment and Inflammation.

Glomerular kidney diseases typically begin insidiously and can progress to end stage kidney failure. Early onset of therapy can slow down disease progression. Early diagnosis is required to ensure such timely therapy. The goal of our study was to evaluate protein biomarkers (BMs) for common nephropathies that have been described for children with Alport syndrome. Nineteen candidate BMs were determined by commercial ELISA in children with congenital anomalies of the kidneys and urogenital tract, inflammatory kidney injury, or diabetes mellitus. It is particularly essential to search for kidney disease BMs in children because they are a crucial target group that likely exhibits early disease stages and in which misleading diseases unrelated to the kidney are rare. Only minor differences in blood between affected individuals and controls were found. However, in urine, several biomarker candidates alone or in combination seemed to be promising indicators of renal injury in early disease stages. The BMs of highest sensitivity and specificity were collagen type XIII, hyaluronan-binding protein 2, and complement C4-binding protein. These proteins are unrelated to inflammation markers or to risk factors for and signs of renal failure. In conclusion, our study evaluated several strong candidates for screening for early stages of kidney diseases and can help to establish early nephroprotective regimens.

Transphyseal arthroscopic anterior cruciate ligament reconstruction in children under 12 years.

The incidence of anterior cruciate ligament (ACL) injuries in children is on the rise. Despite this trend, the optimal management of these injuries remains a matter of ongoing debate. In this light, our study seeks to assess the clinical, radiological, and functional outcomes of transphyseal ACL reconstruction in preadolescent patients in the medium-term. This prospective study included preadolescent patients aged up to 12 years who underwent ACL transphyseal reconstruction between 2010 and 2020 and had a minimum follow-up of 2 years. Clinical assessments encompassed joint stability and range of motion. Furthermore, leg length discrepancy (LLD) and femorotibial alignment were evaluated both clinically and radiologically using full-length lower limb standing radiographs. Pre- and postoperative functional outcomes were assessed using the International Knee Documentation Committee (IKDC) and Lysholm scales, and the return to normal sports activity was evaluated using the ACL-Return to Sport after Injury (ACL-RSI) scale. Complications and relevant follow-up data were also recorded. Statistical analyses were conducted to evaluate these outcomes. A total of 35 preadolescent patients, consisting of 24 males and 11 females, with a mean age at surgery of 11.2 ± 0.7 years (8.7-12), were included in the study. The mean follow-up was 52.3 ± 20.7 months (24.1-95.9). No significant growth disturbances or clinically relevant LLD were evidenced. All patients demonstrated clinically stable knees with full range of motion at the 2-year follow-up. There were statistically significant improvements in pre- and postoperative IKDC (39.3 ± 13.5 vs. 99.7 ± 0.8, p < 0.005) and Lysholm scores (48.2 ± 15.1 vs. 99.6 ± 1.4, p < 0.005). All but two patients were able to return to their pre-injury level of sports activity, with a mean ACL-RSI score of 93.5 ± 1.3. The analysis revealed an 8.6% rerupture rate and an11.4% rate of contralateral ACL injuries, with 5-year survival rates of 92.3% and 88.8%, respectively. Subgroup analyses based on age, gender, surgical delay, or associated meniscal lesions did not reveal any significant differences in functional outcomes. Additionally, there was no discernible relationship between age or timing of ACL reconstruction and the risk of meniscal injuries. Our study reinforces the value of ACL reconstruction in skeletally immature preadolescent patients, with transphyseal technique proven to be a safe, effective, and technically simpler option, even for children under the age of 12. The findings indicate excellent functional outcomes, a high rate of successful return to sporting activities, and minimal to no incidence of growth-related complications in the medium-term. Level II, prospective comparative cohort study, before and after intervention.

Development of an Internet-based Product-related Child Injury Textual Data Platform (IPCITDP) in China.

Internet-based media stories provide valuable information for emerging risks of product-related child injury prevention and control, but critical methodological challenges and high costs of data acquisition and processing restrict practical use by stakeholders. We constructed a data platform through literature reviews and multi-round research group discussions. Developed components included standard search strategies, filtering criteria, textual document classification, information extraction standards and a keyword dictionary. We used ten thousand manually labelled media stories to validate the textual document classification model, which was established using the Bidirectional Encoder Representation from Transformers (BERT). Multiple information extraction methods based on natural language processing algorithms were adopted to extract data for 29 structured variables from media stories. They were evaluated through manual validation of 1000 media stories about product-related child injury. We mapped the geographic distribution of media sources and media-reported product-related child injury events. We developed an internet-based product-related child injury textual data platform, IPCITDP, consisting of four layers - automatic data search and acquisition, data processing, data storage, and data application - concerning product-related child injury online media stories in China. Each layer occurred daily. External validation demonstrated high performance for the BERT classification model we established (accuracy = 0.9703) and the combined information extraction strategies (accuracy >0.70 for 25 variables). As of 31 December 2023, IPCITDP collected 35 275 eligible product-related child injury reports from 13 261 news media websites or social media platform accounts which were geographically located across all 31 mainland Chinese provinces and covered over 97% of prefecture-level cities. The injury cases in IPCITDP were typically reported several months or years earlier than official announcements about the product-related child injury risks. Our data platform added data concerning 15 supplementary variables that the national product-related injury surveillance system lacks. Two examples demonstrate the value of IPCITDP in supplementing existing data and providing early epidemiological detection of emerging signals concerning product-related child injury: magnetic beads and electric self-balancing scooters. Our data platform provides injury data that can support early detection of new product-related child injury characteristics and supplement existing data sources to reduce the burden of product-related injury among Chinese children.

Prevalence, Characteristics, and Management of Pediatric Ocular Trauma in Riyadh, Saudi Arabia: A Retrospective Analysis.

Ocular trauma is a major cause of visual impairment; however, little is known about its burden in Saudi Arabia. Therefore, this study aimed to determine the epidemiological characteristics of ocular trauma in pediatric patients in Riyadh, Saudi Arabia. Medical records of pediatric patients diagnosed with eye injuries between January 2016 and December 2020 were retrospectively reviewed. Demographic and injury characteristics were collected, and ocular trauma injuries were classified according to the Birmingham Eye Trauma Terminology. A total of 855 injured patients were included in the study, of whom 525 (61.4%) were boys. Patient age ranged from one month to 18 years. Most ocular injuries occurred in children aged 5-9 years. The injuries were more prevalent in boys than in girls. Closed globe injuries accounted for 70% of cases, open globe injuries for 21%, and other injuries for 9%. Most ocular injuries occurred at home (n = 87, 42%), followed by school (n = 61, 30%). These results may inform the implementation and targeting of interventions to reduce or prevent eye injuries in children. Further, they highlight the importance of well-planned prevention programs to prevent eye injuries from occurring in children's daily lives.

Analysis of the occurrence and liver function characteristics of arsenic-associated liver injury during the treatment of pediatric patients with acute promyelocytic leukemia.

Liver injury during arsenic treatment for acute promyelocytic leukemia was previously reported in adults, but not comprehensively in children until now. This study aims to investigate liver injury in pediatric patients with APL, changes in liver function during treatment, and compare the effects of Arsenic trioxide (ATO) and Realgar-Indigo naturalis formula (RIF) on liver function. One hundred and eighty-six patients with 3076 patient tests were analyzed, who were enrolled in the Chinese Children's Leukemia Group (CCLG)-APL2016 Protocol database between November 2016 and November 2018 in 38 hospitals across China(ChiCTR-OIN-17011227). Twenty of 164 patients (12.2%) suffered from liver injury after treatment with arsenic. In addition, sixteen (80%) cases of liver injury occurred during the induction period of treatment. What's not disheartening was that 18 (90%) cases of liver injury were transient, occurring at a median time of 17 days after exposure to arsenic. More importantly, the risk of liver injury associated with RIF was not higher than that associated with ATO (RR = 0.854, 95% CI: 0.292-2.495). Otherwise, the ALP of 18 cases of liver injury was not higher than the ULN of ALP. Thus, the incidence of liver injury associated with arsenic in pediatric patients with APL was similar to that in adult patients and the risk of liver injury associated with RIF was not higher than that associated with ATO. Since ALP was not higher in pediatric APL patients with liver injury, further research is needed to explore whether ALP is an index of liver injury in children.

Characteristics and outcomes of children ≤ 10 kg receiving continuous kidney replacement therapy: a WE-ROCK study.

Continuous kidney replacement therapy (CKRT) is often used for acute kidney injury (AKI) or fluid overload (FO) in children ≤ 10kg. Intensive care unit (ICU) mortality in children ≤ 10kg reported by the prospective pediatric CRRT (ppCRRT, 2001-2003) registry was 57%. We aimed to evaluate characteristics associated with ICU mortality using a contemporary registry. The Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Disease (WE-ROCK) registry is a retrospective, multinational, observational study of children and young adults aged 0-25years receiving CKRT (2015-2021) for AKI or FO. This analysis included patients ≤ 10kg at hospital admission. ICU mortality and major adverse kidney events at 90days (MAKE-90) defined as death, persistent kidney dysfunction, or dialysis within 90days, respectively. A total of 210 patients were included (median age 0.53years (IQR, 0.1, 0.9)). ICU mortality was 46.5%. MAKE-90 occurred in 150/207 (72%). CKRT was initiated at a median 3days (IQR 1, 9) after ICU admission and lasted a median 6days (IQR 3, 16). On multivariable analysis, pediatric logistic organ dysfunction score (PELOD-2) at CKRT initiation was associated with increased odds of ICU mortality (aOR 2.64, 95% CI 1.68-4.16), and increased odds of MAKE-90 (aOR 2.2, 95% CI 1.31-3.69). Absence of comorbidity was associated with lower MAKE-90 (aOR 0.29, 95%CI 0.13-0.65). We report on a contemporary cohort of children ≤ 10kg treated with CKRT for acute kidney injury and/or fluid overload. ICU mortality is decreased compared to ppCRRT. The extended risk of death and morbidity at 90days highlights the importance of close follow-up.

A Single-center Clinical Analysis of Drug-Induced Liver Injury in Children with Acute Leukemia

A Single-center Clinical Analysis of Drug-Induced Liver Injury in Children with Acute Leukemia

Acute Kidney Injury in Children: A Focus for the General Pediatrician.

Acute kidney injury (AKI) presents significant challenges in pediatric care, often remaining underrecognized. This paper provides an overview of pediatric AKI, highlighting its epidemiology, pathophysiology, diagnosis, predisposing conditions, and treatment. AKI in children stems from diverse causes, including renal tubular damage, vasoconstriction, and inflammation. Diagnosis relies on traditional markers such as serum creatinine and urine output, alongside emerging biomarkers such as Cystatin C, NGAL, KIM-1, IL-18, TIMP-2 and IGFBP7, urinary calprotectin, URBP4, L-FABP, and clusterin. Various pediatric conditions predispose to AKI, including type 1 diabetes, pneumonia, bronchiolitis, appendicitis, gastroenteritis, COVID-19, multisystem inflammatory syndrome, sickle cell disease, and malignancies. Treatment entails supportive care with fluid management and, in severe cases, renal replacement therapy. Timely recognition and management are essential to mitigating adverse outcomes. Enhanced awareness and integration of novel biomarkers could improve pediatric AKI care, warranting further research for better diagnosis and management.