Long-term Outcome Of Children Research Articles

The long-term outcome of children with VP shunt and hydrocephalus: motor developmental outcome and QOL of patients with hydrocephalus is associated with the number of revisional procedures but is not impacted by the type of the valve

PurposeDespite constant advances in ventriculo-peritoneal shunt systems, pediatric patients with hydrocephalus may present with neurodevelopmental delay. Therefore, we performed a study including a questionnaire, which aimed to analyze parameters that may have an impact on the cognitive function and quality of life of the pediatric patient with hydrocephalus.MethodsIn this retrospective study, we included 81 patients aged 0–17 with hydrocephalus who were treated with a ventriculo-peritoneal shunt at a single institution. Demographic data, etiology of the hydrocephalus, type of valve implanted, any revision procedures and any complications were analyzed and the neurodevelopmental outcome, epilepsy and quality of life were assessed using a questionnaire sent to these patients. Statistical analysis was performed using SPSS. The significance level was set at p ≤ 0.05.ResultsQuestionnaires were sent to 81 patients who were treated at our institution over a mean retrospective study period of 18 years. Of these, 30 questionnaires were completed by the patients themselves or with the support of their families and included in the study. The etiology of the hydrocephalus as a non-controllable parameter did not affect the cognitive and motor development as well as the occurrence of epilepsy, cephalalgia and the quality of life. However, the number of revisions had a significant (p = 0.041) impact on the motor development of the child. The mean Wellbeing Five score was better with 19.63 in the group with no revisions whereas the score was 12.2 in the group with more than two revisional procedures. The type of the valve (adjustable or not adjustable) as a controllable parameter did not change any of the tested parameters (p > 0.05).ConclusionThe number of revisional procedures significantly affected the motor development of pediatric patients with a ventriculo-peritoneal (VP) shunt calling for further research to improve VP shunt systems as well as surgical procedures like endoscopic third ventriculo-cisternostomy (ETV) in the future.

Chronic hand ischemia in pediatric patients due to brachial artery injury after supracondylar humerus fracture.

Brachial artery injury due to displaced supracondylar fracture (SC) of the humerus in children may present with pink pulseless hand (PPH), denoting a well perfused hand without radial pulse, or acute hand ischemia. Some reports state that brachial artery reconstruction is not necessary in children with persisting PPH, but the reports on long-term consequences such as intermittent claudications, growth retardation and ischemic contracture in children with pulseless hand are scarce and often misinterpreted. The objective of our analysis was to assess the long-term outcomes of children with brachial artery injury associated with SC fracture. A retrospective review was performed and data on all children treated for SC fracture with brachial artery injury from 2010 to 2022 were collected. Functional outcomes, brachial artery patency and complications were analyzed. Overall, 10 patients with acute ischemia or PPH persisting after fracture reduction/fixation were identified, and all underwent brachial artery exploration (age range 3-10 years). Six patients underwent immediate exploration after fracture reduction and fixation: three due to signs of acute ischemia, and three for persisting PPH. Two patients underwent vascular surgery for PPH that persisted for more than 48 hours following fracture reduction. Two patients were discharged and later developed intermittent claudications/critical ishemia requiring revascularization. Mean follow up was 3.5 years (ranged 2-6 years). There were no postoperative complications. All patients had a palpable radial pulse, patent brachial artery on the last follow-up examination and no signs of ischemic contracture. Brachial artery reconstruction after SC fracture with brachial artery injury is a safe procedure that offers excellent long-term patency. Revascularization should be done in all patients with persistently absent radial pulse to avoid chronic hand and forearm ischemia.

P0504 The Impact of Disease Activity and Medications on Pregnancy and Fetal Outcomes in Women With Inflammatory Bowel Disease: A Cohort Study From the IBD-ME Group

Abstract Background Women with Inflammatory bowel disease (IBD) and their children may face a higher risk of adverse outcomes during and after pregnancy. The primary aim was to examine the association between IBD and adverse pregnancy outcomes: preterm birth, small for gestational age, birth weight, congenital anomalies, and stillbirth. The secondary aim was to assess the impact of maternal IBD and medications used on children’s outcomes: adverse reactions to vaccinations and development of IBD in the offspring up until seven years of age. Methods We performed a multicenter retrospective study in Saudi Arabia and Kuwait. Three participating hospitals enrolled women with IBD who gave birth between 2016 and 2023. Information regarding disease characteristics, medication use, pregnancy outcomes, and long-term health outcomes of children until age fourteen was collected. Results This study analyzed data from 167 patients with a median age of 37.0 years (IQR: 33.0 to 44.0). Crohn’s disease was the most common type of IBD (51.2%), followed by ulcerative colitis (46.3%). Of note, 42.7% of the women were on mesalamine, while 25.1% of the study population were on both anti-TNF agents and Azathioprine. The most frequent pregnancy outcome was low birth weight (22.5%), and 8.2% of the offsprings were diagnosed with IBD. A history of having six or more pregnancies significantly predicted IBD in an offspring (OR = 4.02, 95% CI, 1.19 to 14.8, p < 0.01). In contrast, disease control before pregnancy significantly reduced the risk of adverse infant outcomes (OR = 0.10, 95% CI, 0.01 to 0.61, p < 0.01). None of the IBD medications predicted poor pregnancy outcomes. Conclusion Infants of women with active IBD have an increased risk of prematurity and being small for gestational age. Number of pregnancies was a significant predictor for IBD in an offspring. Controlling disease activity at conception is essential to improve both pregnancy and fetal outcomes.

P0285 Long-term outcome of children with very early-onset non-monogenic colitis: a single center retrospective study

Abstract Background Very early-onset inflammatory bowel disease (VEOIBD), defined by IBD diagnosed before the age of 6 years, is a challenging condition with complex clinical features and limited long-term data. Our study describes the long-term outcome of patients diagnosed with VEOIBD without any identified genetic mutation. Methods Data on all consecutive patients aged 0–6 years diagnosed with colitis (CD, UC, or IBD-U) at Necker-Enfants Malades Hospital (Paris, France) between 2013 and 2023 were retrospectively reviewed. Patients with monogenic forms of VEOIBD and perianal disease were excluded. Clinical, biological, and endoscopic data were collected at diagnosis and during follow-up (1, 3 and 5 years). Comparisons were made between patients in remission and those with active disease at 3 years of follow up and between age groups (diagnosis before 2 and after2 years). A standardised questionnaire regarding environmental factors during pregnancy and infancy was sent to parents. Results Sixty-five patients (49% male, mean follow-up 4.8 ± 2.9 years, including 28 [41%]) with infantile IBD (diagnosed before the age of 2 years) were included. There were 8 (12%) patients with Crohn’s disease (CD), 21 (34%) with ulcerative colitis (UC) and 35 (54%) with IBD unclassified (IBDU). Most of the patients had pancolitis. Only 3 patients underwent colectomy and diversion during follow-up. Corticosteroid-free remission rates were 48% at 1 year, 71% at 3 years, and 76% at 5 years. 64% of patients were treated with an immunosuppressant during follow-up, mainly azathioprine. Earlier initiation of corticosteroids was associated with better 1-year remission rates. Patients with infantile-onset IBD (IO-IBD) had more severe disease at diagnosis (higher disease activity and endoscopic scores, greater need for steroids; p=0.04). However, IO-IBD patients had better long-term outcomes, with lower anti-TNF-alpha use and fewer therapy escalations at 3 and 5 years (p<0.05). Finally, poorer outcomes were associated with maternal consumption of processed foods, paternal smoking and western lifestyle. Conclusion Patients with VEOIBD without genetic mutation exhibit low rate of complications and surgical interventions at the long term. Environmental factors seem to impact the disease burden even in VEOIBD.

Characterisation of pregnancy-induced alterations in apolipoproteins and their associations with maternal metabolic risk factors and offspring birth outcomes: apreconception and longitudinal cohort study.

Apolipoproteins as an integral part of lipoproteins are crucial for the transport and metabolism of lipids. However, there is a lack of longitudinal studies to quantify the concentrations of maternal apolipoproteins from preconception to postpartum and their associations with maternal metabolic health and offspring birth outcomes. Quantification of apolipoproteins was performed on maternal plasma samples (N=243 trios) collected at preconception, 26-28 weeks' pregnancy, and three months postpartum in the Singapore PREconception Study of long-Term maternal and child Outcomes (S-PRESTO) cohort study. Linear regression models and network analysis were implemented to investigate the association of apolipoproteins with maternal genetic variants, biochemical measures, metabolic risk factors, and offspring birth outcomes. The concentrations of ApoC-III, ApoB and ApoL1 substantially increased in pregnancy compared to preconception and postpartum. Genome-wide association studies (GWAS) identified multiple single-nucleotide polymorphisms (SNPs) associated with plasma apolipoproteins (P<5.00E-08), including APOE-rs7412 for ApoE, LPA-rs56393506 for Apo(a), APOM-rs707921 for ApoM, ABCC4-rs117797426 for ApoJ, THSD7B-rs575613 for ApoA-II, and LOC102724443-rs140433245 for ApoA-IV. Plasma apolipoproteins were strongly associated with biochemical measures including lipidomic profiles, lipoprotein features and fat-soluble vitamins, as well as metabolic risk factors including glycaemic traits, liver enzymes, inflammatory markers, albumin, and blood pressure. Integrative network analysis of apolipoproteins and their correlates/determinants revealed both shared and specific associations, with the strongest relationships observed among apolipoproteins, cholesterol, triglycerides, alpha tocopherol, and GlycA (Padj<0.05). Higher maternal ApoC-I and ApoC-III concentrations at preconception were significantly associated with shorter gestational age of the offspring. We describe the longitudinal landscape of maternal circulating apolipoproteins from preconception to postpartum and their associations with maternal metabolic risk factors and offspring birth outcomes. This multi-omics characterisation of biochemical correlates and genetic determinants of maternal apolipoproteins will deepen our understanding of the molecular basis of metabolic flexibility in expectant mothers, leading to better assessment of pregnancy-related outcomes. This research was supported by the Singapore National Research Foundation under its Translational and Clinical Research (TCR) Flagship Programme and administered by the Singapore Ministry of Health's National Medical Research Council (NMRC), Singapore- NMRC/TCR/004-NUS/2008; NMRC/TCR/012-NUHS/2014. The Singapore Lipidomics Incubator (SLING) is supported by grants from the National University of Singapore via the Life Sciences Institute, the National Research Foundation (NRF, NRFI2015-05 and NRFSBP-P4) and A∗STAR IAF-ICP I1901E0040. Additional funding is provided by Institute for Human Development and Potential (IHDP)-Agency for Science, Technology and Research (A∗STAR), Singapore.

The long-term development outcomes of the offspring born to patients with systemic lupus erythematosus: a cross-sectional study.

This study aims to explore the long-term physical, neurological, social and emotional development outcomes of the offspring born to patients with systemic lupus erythematosus (SLE), and to provide insights that can assist pediatricians in enhancing the long-term prognosis of these children. We conducted a cross-sectional study on the offspring of SLE patients who had undergone pregnancy and were admitted to our obstetrics department between January 1, 2016 and September 30, 2021. The control group consisted of offspring born to mothers without connective tissue disease, and was matched 1:1 based on age (birth date ± 1 month) with the offspring of SLE patients. Physical development, including measurements of weight and height (length), was assessed. The Ages and Stages Questionnaires, Third Edition (ASQ-3) was utilized to evaluate development in five domains: communication, gross motor, fine motor, problem solving, and personal-social. The Ages and Stages Questionnaires: Social-Emotional (ASQ: SE) was used to assess social-emotional development. Weight, height (length), BMI (body mass index), and ASQ-3 domain scores at different ages and for both genders were standardized into Z-scores for comparison. In the SLE group, the offspring demonstrated higher BMI Z-scores, higher rates of obesity, and increased probabilities of abnormal social-emotional development screening. In addition, their problem solving domain Z-scores were lower as compared to the control group. All of these differences were statistically significant. It is recommended that SLE patients should pay close attention to sensible feeding practices after the birth of their offspring to prevent the occurrence of obesity. Furthermore, there should be an emphasis on strengthening monitoring and intervention efforts to enhance the problem solving abilities and social-emotional development of the offspring. By implementing these measures, the overall long-term developmental outcomes of children born to SLE patients can be improved.

A protocol to study the effect of targeted parental education intervention to identify early childhood development disorder – multisite interventional study

BackgroundIn India, approximately 3.5 million children are affected by Developmental Delay (DD), often stemming from preterm births. These delays contribute to neurological and motor development delays, placing a significant financial burden on families. Maternal unemployment rates are also elevated in such cases. Delayed Developmental Milestones identification, often due to a lack of parental awareness, further compounds these challenges. This study introduces a multiphasic approach aimed at educating antenatal women on monitoring neurological maturation, with the overarching objective of assessing the effectiveness of a targeted multi-method parental education intervention in improving parents’ knowledge and early detection of developmental disorders in early childhood.MethodsAntenatal women will be assigned to intervention or control groups. The intervention group will undergo specialized training in a multiphasic study, while the control group will receive routine care. A meticulously developed intervention module for early detection of neurodevelopmental disorders will empower mothers to monitor their newborns for potential deficits. Outcomes will be assessed through questionnaires, analyzing knowledge improvement and early identification of DD using statistical methods such as chi-square tests. The study involves three phases: preparatory, implementation, and evaluation, aiming to empower mothers to detect developmental concerns early and improve maternal awareness of child development. The study was approved by the SRM Institutional Ethical Committee with the reference number 8688/IEC/2023.DiscussionThis study will identify DD and improve parental awareness by providing tools for early detection thereby empowers parents to identify developmental concerns early. The study supports policy goals to reduce the burden of DD, enhance early intervention, and improve long-term outcomes for children. It is anticipated that this intervention will complement existing health policies, contributing to better child health and developmental outcomes in India.Trial registrationTrail is registered under Clinical Trails Registry - India (CTRI/2024/04/065008) registered on 01 April 2024.

A Cross-Sectional Study of the Prevalence of Short Stature Among Children Visiting the Outpatient Department of a Tertiary Care Center

Background: Short stature in children is a significant global health concern, often indicating underlying nutritional, endocrine, or genetic disorders. Identifying the prevalence and associated risk factors in specific populations in regions with limited access to healthcare, poor nutrition, or inadequate prenatal care eg in rural or low-income communities, is essential for early diagnosis and timely intervention. Objective: This study aimed to assess the prevalence of short stature among children visiting the outpatient department of a tertiary care center and to explore the sociodemographic (lower SES, nuclear families) and clinical factors {chronic illness like hypothyroidism, diabetes, and bone age} associated with short stature. Methods: A cross-sectional observational study was conducted at the Department of Pediatrics, LN Medical College, and JK Hospital, Bhopal. A total of 210 children aged 2-12 years attending the outpatient department were systematically selected (systematic sampling) and approved by the IEC. Inclusion criteria involved children whose parents or guardians provided informed consent, while exclusion criteria included children with hypotension or those whose guardians did not consent. Anthropometric measurements, clinical assessments, and family histories were recorded. Short stature was defined as height-for-age below -2 standard deviations from the WHO growth standards. Results: The prevalence of short stature was 4.29%. It was more common among children from lower socioeconomic backgrounds (55.6%) and nuclear families (66.7%). The highest prevalence was observed in children aged 5-8 years (77.8%), with no significant gender difference. Additionally, 77.8% of children with short stature had a chronic illness, such as hypothyroidism or diabetes. And 88.9% showed delayed bone age. The influence of maternal education was also significant, with 55.6% of affected children having illiterate mothers. Conclusion: The study found a relatively lower prevalence of short stature compared to other studies, but it was significantly associated with lower socioeconomic status, chronic illness, delayed bone age, and maternal education. Early detection, nutritional interventions, and addressing socioeconomic disparities, enhancing maternal education are essential to improve growth outcomes in children. Further research is needed to investigate the long-term outcomes of children with short stature and the effectiveness of targeted interventions.

Factors associated with accelerated parenteral weaning in children with intestinal failure: A descriptive cohort study.

The goal of intestinal rehabilitation in children is to wean from parenteral nutrition (PN). The aim of this study was to identify factors associated with accelerated weaning and to evaluate long-term outcomes of children receiving long-term PN. This was a retrospective study of children managed by the Intestinal Rehabilitation Center at Cincinnati Children's Hospital. Medical history data were retrieved. The outcomes of children receiving long-term chronic PN (>2 years) were compared with those of children receiving short-term chronic PN regimen (<2 years). The cohort consisted of 112 children (58% boys, median [IQR] age of 6.0 [3.7-9.5] years). The group treated with a long-term PN regimen had significantly shorter residual small bowel and large bowel compared with the group treated with a short-term PN regimen (20% vs 60% and 75% vs 100%, respectively; P < 0.05). The lapse of time between PN and enteral feed initiation was longer in the group undergoing long-term PN regimen than in the short-term group (71 vs 32.5 days; P = 0.012). More episodes of central line-associated bloodstream infection (CLABSI) and a higher percentage of feeding aversion was demonstrated in the long-term PN group (2 [1-3] vs 1 [0-2] episodes and 36% vs 0%, respectively). Small bowel, colon length, enteral feed initiation, and frequency of CLABSI are factors associated with duration of PN regimen. A long-term chronic PN regimen is associated with a higher risk of food aversion.

Molecular profiles and long-term outcomes of Thai children with hepatic glycogen storage disease in Thailand.

Thus far, genetic analysis of patients clinically diagnosed with glycogen storage diseases (GSDs) in Thailand has not been reported. To evaluate the clinical and biochemical profiles, molecular analysis and long-term outcomes of Thai children diagnosed with hepatic GSD. Children aged < 18 years diagnosed with hepatic GSD and followed up at King Chulalongkorn Memorial Hospital were recruited. Whole-exome sequencing (WES) was performed to identify the causative gene variants. Medical records were assessed. All eight children with histopathologically confirmed diagnosis were classified by WES into subtypes Ia (n = 1), III (n = 3), VI (n = 3), and IX (n = 1). A total number of 10 variants were identified including G6PC (n = 1), AGL (n = 4), PYGL (n = 5), and PHKA2 (n = 1). AGL had two novel variants. The clinical manifestations were hepatomegaly (n = 8), doll-like facies (n = 3), wasting (n = 2), and stunting (n = 5). All patients showed hypoglycemia, transaminitis, and dyslipidemia. The mainstay of treatment was cornstarch supplementation and high-protein and low-lactose-fructose diet. After a median follow-up time of 9.59 years, height turned to normal for age in 3/5 patients and none had malnutrition. Liver enzymes, blood sugar, and lipid profiles improved in all. Hepatomegaly, transaminitis, and hypoglycemia are the hallmarks of GSD confirmed by liver histopathology. Molecular analysis can confirm the diagnosis or classify the subtype that might benefit from personalized treatment, prognosis, and long-term care.

Outcomes of HIV-infected children on antiretroviral therapy for at least 10 years at the Essos Hospital Centre, Cameroon: contributing to the elimination of paediatric AIDS in tropical settings.

Evidence on long-term outcomes of children receiving antiretroviral therapy (ART) in low- and middle-income countries (LMICs) is of utmost importance to optimize current and future therapeutic strategies for HIV. We sought to ascertain the long-term responses among ART-experienced children and their potential implications. A retrospective, observational, facility-based cohort study was conducted among 136 ART-experienced children monitored for 10 years (2007-2017) at the Essos Hospital Centre in Yaoundé, Cameroon. Primary outcomes were good clinical response defined as the World Health Organization (WHO) clinical stage 1/2, immune restoration as CD4 >500 cells/mm3, viral suppression (VS) as viral load (VL) <1000, or viral undetectability as VL <40 copies/ml at the last follow-up and their predictors (P < .05). At ART initiation among the 90 eligible children, median (interquartile range) age was 29.5 (11-60) months, 53.3% were males, 34.5% were at WHO clinical stage 1/2, median-CD4 was 497 cells/mm3, and initial ART-regimens were mainly zidovudine-lamivudine-nevirapine (85.5%) and zidovudine-lamivudine-efavirenz (12.2%). After 10 years of follow-up, 36.7% were switched to protease-based ART regimens, those at WHO clinical stage 1/2 improved to 75.5%; median-CD4 increased to 854 cells/mm3; 83.3% achieved VS, while only 10% achieved viral undetectability. Following multivariate analysis, no predictor of VS or immune recovery was identified (P > .05). In this LMIC, long-term outcomes of children on ART appear encouraging, characterized by moderate VS rate and immune recovery. However, challenges in achieving viral undetectability indicate continuous viral replication and risks of drug resistance emergence that may jeopardize effectiveness of future paediatric ART strategies.

Longitudinal Success of Tonsillectomy for Obstructive Sleep Apnea in Children with Down Syndrome.

Obstructive sleep apnea is common in children with Down syndrome (DS). Tonsillectomy is recommended as the first-line approach in treating children with obstructive sleep apnea (OSA), however, there is limited data on the long-term outcomes in children with DS who undergo tonsillectomy. In this retrospective study, we examined the long-term polysomnographic and symptomatic outcomes in children with DS who underwent tonsillectomy with or without an adenoidectomy (T&A). We hypothesize that the success of T&A to treat OSA in children with DS will diminish with time. A retrospective chart review of children with DS who underwent T&A between 2009 and 2015 was conducted. Inclusion criteria were children with at least 1 postoperative polysomnogram (PSG) within 6 months of T&A with an obstructive apnea/hypopnea index (OAHI) < 5. Outcomes were determined by subsequent clinic visits and postoperative polysomnograms: OAHI ≥ 5, snoring reported during clinic visit and time to reoccurrence. Childrens Hospital Colorado. Of the 57 children with mild OSA at 1st (initial) PSG, 13/40 (33%) children had OAHI ≥ 5 at the 2nd postoperative PSG. Of the 18 patients who underwent a 3rd PSG, 4 (22%) progressed to moderate/severe OSA. A total of 17 patients out of the original 57 (30%) progressed to moderate/severe OSA with the median time for the additional post-op PSG's being 2.3 years. Children with DS who have at most mild OSA (OAHI < 5) following a T&A are at risk for progressing to at least moderate OSA within 2 years after their T&A. A surveillance PSG 2 years following surgery will identify these children.

Oncology

The December 2024 Oncology Roundup360 looks at: Non-reversed great saphenous vein grafts for vascular reconstruction after resection of lower limb sarcoma; Detrimental effects of COVID-19 pandemic on patients with limb bone sarcoma: reference centre experience; Whole-body staging guidelines in sarcoma; Intraoperative marrow margin frozen section in limb bone sarcoma resection; Vacuum-assisted closure and paediatric oncological limb salvage; Treatment differences and long-term outcomes in adults and children with Ewing’s sarcoma; Survival, complications, and functional outcomes of uncemented distal femoral endoprosthesis with short, curved stem for patients with bone tumours; Survival, complications, and functional outcomes of uncemented distal femoral endoprosthesis with short, curved stem for patients with bone tumours.

Maternal symptoms of prenatal depression predict context-incongruent negative emotion in infants.

Prenatal symptoms of depression in mothers are associated with infants' emotional reactivity. Context-incongruent reactivity, comprising mismatches between the eliciting context and emotional reactions, predicts negative long-term socioemotional outcomes in children. However, the etiology of context-incongruent reactivity is largely unknown, obscuring a full understanding of its potential role as a vulnerability in models outlining the transmission of risk for emotion difficulties from mothers to offspring. We tested mothers' (N = 92) prenatal depressive symptoms as prospective predictors of infants' context-incongruent emotion. Greater prenatal symptoms predicted more context-incongruent negativity in infants even when controlling for context-congruent affect. Findings demonstrate a novel utility of context-incongruent emotion as one possible vulnerability linking mothers' prenatal depression to socioemotional difficulties in offspring. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Vaccination in hemophilic children: Challenges, innovations, and future directions

Introduction: Hemophilia, an inherited disorder primarily affecting blood clotting due to deficiencies in clotting factors VIII or IX, presents complex challenges for vaccination. Children with hemophilia require vaccinations to prevent infections that may exacerbate their bleeding disorder. However, traditional intramuscular vaccination poses bleeding risks, necessitating specialized administration methods and careful post-vaccination care. Purpose: This study examines the efficacy and safety of vaccination in pediatric hemophilia patients, emphasizing the importance of individualized protocols to manage bleeding risks effectively. It explores recent advancements, including needle-free technologies, the potential of gene therapy, and mRNA vaccines. Materials and Methods: The study synthesizes current guidelines from global health organizations, hemophilia management protocols, and clinical studies on vaccine safety in hemophilia. It highlights techniques such as subcutaneous administration, clotting factor prophylaxis, and the use of fine-gauge needles to minimize bleeding complications. Results: Findings indicate that with appropriate management, hemophilic children achieve adequate immune responses to vaccines, with reduced bleeding risks. Emerging technologies, such as microneedle patches, jet injectors, and gene therapy, offer promising safer vaccination alternatives. Additionally, mRNA vaccines demonstrate strong immunogenicity without the need for live-virus vectors, reducing complication risks. Conclusions: Vaccination, when adapted to hemophilia-specific needs, remains essential for infection prevention in this vulnerable population. Newer vaccine technologies and individualized care protocols enhance safety and efficacy, contributing to improved quality of life and long-term health outcomes for hemophilic children.

Timing of single-event multilevel surgical interventions on long-term motor outcomes in children and adolescents with cerebral palsy: A systematic review and meta-analysis

BackgroundThe aim of this meta-analysis was to evaluate the impact of the timing of single-event multilevel surgery (SEMLS) on long-term motor outcomes in children and adolescents with cerebral palsy (CP). MethodsA systematic review and meta-analysis were conducted by searching PubMed, Cochrane Library, Embase, and Web of Science databases for studies up to April 2024. Twelve eligible studies were included, from which we examined patients’ gait, stride length, walking speed, and the gross motor function measure (GMFM66). ResultsGait analysis showed significant improvements in CP patients after SEMLS, which included an increased gait deviation index (p < 0.001), reduced Gillette gait index (p < 0.001), and reduced gait profile score (p < 0.001). Subgroup analysis showed that age at surgery (<12 years old vs. 12−18 years old) was not a factor affecting patients’ gait. Spatial and temporal parameters such as stride length (p < 0.001) and walking velocity (p = 0.02) also improved significantly after surgery. However, there were only trends towards broader motor function gains measured by the GMFM66 (p = 0.39). ConclusionsSEMLS effectively improved key gait and mobility parameters in children and adolescents with CP, and was not affected by younger or older surgical ages (<12 years old or 12−18 years old). However, these gait improvements do not uniformly translate into broader motor function gains.

Understanding and Exploring the Food Preferences of Filipino School-Aged Children Through Free Drawing as a Projective Technique.

Numerous traditional and innovative approaches have been employed to understand and evaluate children's food preferences and food and nutrition knowledge, recognizing their essential role in shaping good nutrition. Drawing as a projective technique allows children to express their unconscious thoughts and preferences through visual representation, distinguishing it from other methods by providing an insight into their inner feelings and perceptions that may not be easily articulated through verbal techniques. The main goals of the study are to use drawing as a projective technique to gain insights into children's food preferences, and to examine the children's current nutrition knowledge and dietary perceptions. This study involved school-aged children from four public schools in San Jose City, Nueva Ecija, Philippines, who met the inclusion criteria and provided parental consent and the children's permission. Data collection included (a) questionnaires to measure food group and food frequency knowledge, the children's opinions on food healthiness and likability, and (b) a drawing activity as a projective technique. The questionnaire scores and the specific foods on the children's drawings were entered into an electronic worksheet and analyzed quantitatively. The majority of Filipino school-aged children have a low (50%) to average (43%) level of food group knowledge and an average (62%) to low (32%) level of food frequency knowledge. The children can identify the healthiness of the food, but they express a liking for both healthy and unhealthy options. The children's drawings showed a low preference for Glow food groups, including fruits and vegetables (47%), as compared to Grow foods (94%), Beverages (89%), and Go foods (85%) groups. "Rice and Egg", the most paired items, indicated a preference among Filipino children. Gender-based analysis showed girls favored "Ice Cream", "Bread", "Apple", and "Oranges" more than boys, but there were no significant gender differences found in Grow food group preferences. Children's drawings are an effective, valuable complementary tool for understanding children's food preferences, displaying the value of creative methods in gaining unique insights. The results highlight specific gaps in knowledge, such as the need for a better understanding of food groups and the importance of fruits and vegetables among children. Addressing these gaps in educational programs could enhance children's food knowledge and encourage healthier dietary choices. Nutrition education programs might use interactive activities focused on food groups and emphasize the benefits of fruits and vegetables to promote better dietary habits for the improvement of children's long-term health outcomes.

Examining Infant and Child Neurodevelopmental Outcomes After Lyme Disease During Pregnancy.

Lyme disease is the most common vector-borne disease in the United States. Recent environmental and socioecological changes have led to an increased incidence of Lyme and other tick-borne diseases, which enhances the urgency of identifying and mitigating adverse outcomes of Lyme disease exposure. Lyme disease during pregnancy, especially when untreated, may lead to adverse pregnancy and neonatal outcomes; however, long-term child outcomes following utero exposure to Lyme disease have not yet been systematically assessed. This concise review describes the current state of knowledge of Lyme disease as a congenital infection and the potential effects of in utero exposure to Lyme disease infection on the neurodevelopment of infants and children. We highlight the importance of distinguishing between acute Lyme disease and a chronic condition termed Post-Treatment Lyme Disease Syndrome, as the impacts of both conditions on the developing fetus and subsequent child development may differ. The importance of placental pathology for patients with acute or chronic symptoms of Lyme disease in pregnancy is explored. Future research aiming to understand and protect neurodevelopment after antenatal Lyme disease must carefully collect potentially confounding variables such as symptomatology and treatment, use clear and standard case definitions, and follow children into school-age and beyond.

Long-Term Outcome of Children With Steroid-Resistant Nephrotic Syndrome: A Single Center Experience From Pakistan

Objective: To determine the long-term outcome of children with steroid-resistant nephrotic syndrome at a single center in Pakistan. Study Design: Retrospective, observational study. Place and Duration of Study: Pediatric Nephrology Department, Sindh Institute of Urology and Transplantation, Karachi, Pakistan from July 2008 to June 2014. Methodology: The study included 153 children aged 4 months-12 years with steroid-resistant nephrotic syndrome. We collected data at the time of diagnosis and the last follow-up. The data was entered and analyzed by SPSS version 20. Results: Among 153 children, 84(55%) were males and 69(45%) females. At the time of diagnosis, 118(77%) were hypertensive and 65 (42.5%) had microscopic hematuria. Histopathological spectrum included focal segmental glomerulosclerosis, 63(41%); minimal change disease, 33(22%); IgM nephropathy, 9 (6%); mesangioproliferative glomerulonephritis, 26(17%), membranous glomerulonephritis, 13(8%) and membranoproliferative glomerulonephritis, 9(6%). Complete remission with cyclosporine was seen in 53(34.6%), partial remission in 36(23.5%), while 53(35%) developed chronic kidney disease, of which 26(78.8%) needed renal replacement therapy. Mortality was 21(13.7 %) and 11(7.2%) were lost to follow-up. Calcineurin inhibitors’ toxicity was seen in 52(34%). One patient received renal transplant but lost the graft 6 years post-transplant due to disease recurrence. Conclusion: Steroid-resistant nephrotic syndrome has significant long-term morbidity and mortality. Recurrence of disease in transplanted kidney is common and can result in graft loss.

In vitro fertilization and long-term child health and development: nationwide birth cohort study in Japan

The aim of this study is to compare long-term health outcomes between IVF-conceived children and non-IVF-conceived children in Japan, in the context of strong recommendation for single embryo transfer. Using data from a nationwide birth cohort linked with perinatal database, this study analyzed 2140 children born in Japan in May 2010. It compared child health and development outcomes up to 9 years of age between IVF-conceived and non-IVF-conceived children (binary exposure). A Poisson regression with robust variance to estimate the risk ratios for the association between IVF and various long-term child health and developmental outcomes. After adjusting for confounding factors, no significant differences were observed between IVF-conceived and naturally conceived children for most outcomes, including hospitalization, obesity, and developmental milestones. IVF-conceived children showed a slightly lower risk of attention problems at 8 years (adjusted Risk Ratio [aRR]: 0.73, 95% CI: 0.53–1.00). In subgroup analyses, IVF-conceived term children and singletons demonstrated reduced risk of cognitive delays at 5.5 years (aRR: 0.31, 95% CI: 0.10–0.96 and aRR: 0.37, 95% CI: 0.14–0.98, respectively).Conclusion: In this Japanese cohort, IVF conception was not associated with adverse long-term health or developmental outcomes. These findings provide reassurance about the safety of IVF, particularly in the context of single embryo transfer policies. Further research is needed to explore specific IVF protocols and subgroups.What is known:• Long-term health and developmental outcomes of IVF-conceived children remain inconsistent across studies and populations, despite the widespread use of this technology.What is new:• A nationwide population-based cohort study in Japan did not show adverse effects of IVF on long-term child health and development through age 9.• These findings provide reassurance about the safety of IVF, while indicating the need for careful monitoring in specific subgroups such as preterm and multiple births.