Subset Of Children Research Articles

Generational Trends in Children's Shyness: Does COVID-19 Matter?

Although early childhood shyness is known to portend later internalizing-related problems, we know relatively little about how broad socio-cultural and socio-historical factors shape children's shyness. In this study, we leveraged the COVID-19 pandemic as a quasi-experiment to examine generational and period differences in parent-reported children's shyness at the same age in three separate cohorts (N = 648): Generation Z (tested: 1999-2000, n = 217, M = 4.43years), Generation Alpha: pre-pandemic (tested: 2018-2019, n = 217, M = 4.76years) and mid-pandemic (tested: 2021, n = 214, M = 4.47years). The two Generation Alpha groups did not differ on shyness levels despite the pandemic-related social restrictions, and both Generation Alpha cohorts had unexpectedly relatively lower parent-reported shyness levels today compared with Generation Z assessed approximately twenty years ago. Observed behavioral measures of shyness collected prior to the pandemic on a subset of children also revealed lower levels of shyness in Generation Alpha pre-pandemic compared with Generation Z, converging with parent-reported findings of shyness. Findings suggest that generational differences in children's shyness may result from more protracted socio-cultural influences than from acute period effects such as COVID-19 lockdowns.

A severe course in paediatric acute haematogenous osteomyelitis: Predictor variables present on admission.

A subset of children with acute haematogenous osteomyelitis become severely ill. This study aimed to define a severe and standard course and identify potential risk factors on admission for a severe course as well as the cumulative incidence. This retrospective cohort study included all children under 16 years with acute haematogenous osteomyelitis between January 2018 and September 2021. The outcome parameters included >2 surgical debridements, C-reactive protein level not halving in 48 h, extraosseous involvement and hospital stay >14 days. Predictor variables (delayed presentation (>5 days), C-reactive protein >250 mg/L on admission, >1 bone segment and need for intensive care unit on admission) were tested against the outcome of a severe clinical course using univariate logistic regression analysis (using p < 0.2). One hundred and twenty-one patients were included. Thirty-nine patients (32.2%) had a complicated course. Patients admitted to intensive care unit had a 2.8-times higher risk of a severe course compared to those not requiring intensive care unit (risk ratio 2.8; 95% confidence interval 1.6-4.8); having a C-reactive protein >250 mg/L on admission increased the risk of a severe course 1.7 times (risk ratio 1.71, 95% confidence interval 1.3-2.3). Having more than one bone segment involved and a delayed presentation of >5 days increased risk of a severe course by 2.4 (risk ratio 2.4, 95% confidence interval 1.6-3.6) and 1.3 times (risk ratio 1.3, 95% confidence interval 1.3-1.3), respectively, compared to the alternative. The cumulative incidence of acute haematogenous osteomyelitis ranged between 4.0% and 5.0% per year. Four risk factors present on admission were identified and are suggested to modify the risk of a severe disease as well as change treatment protocols.

Biologic Mechanisms Underlying the Heterogeneous Response to Tight Glycemic Control among Differentially Inflamed Patients in the HALF-PINT Trial.

Tight glycemic control with insulin (TGC) has not consistently shown benefit in critically ill patients. We previously reported that the subset of children with a hyperinflammatory subphenotype benefitted from TGC in the HALF-PINT study of hyperglycemic children with heart and lung failure and the IIT-SBPP study in severely burned pediatric patients. However, whether this effect was mediated through a reduction in inflammation or some other biological process is not fully understood. To deepen the understanding of inflammatory subphenotypes and explore the biological mechanisms underlying heterogeneous response to TGC. Plasma cytokine measurements and whole blood transcriptomics from 740 blood samples collected on pre- and post- treatment study days 0, 2, and 4 from 293 HALF-PINT participants (n=250 hypoinflammatory and n=43 hyperinflammatory) were used to identify cytokine and gene expression signatures of differential responses to TGC. Patients with hyperinflammatory subphenotype had greater baseline expression of genes relating to inflammation, cell cycle activity, and immunometabolism. Hyperinflammatory patients treated to a target glucose range of 80-110 mg/dL experienced greater reduction in inflammatory cytokines, innate immune gene expression, and heme metabolism gene expression, as well as an increase in lymphocyte gene expression, compared to those treated to a target range of 150-180 mg/dL. Causal mediation testing indicated that these changes partly explained the observed mortality benefit of TGC in the hyperinflammatory subgroup of patients. These findings expand our understanding of the biology underlying inflammatory subphenotypes, and provide biological insight into the mortality benefit of TGC in hyperinflammatory children.

Study of WNT and NOTCH Signaling Pathways in Hepatoblastoma: Role in Diagnosis and Prognosis.

Background. Hepatoblastoma has an aggressive course in a subset of children. Studying various markers related to the signaling pathways can aid in understanding its pathogenesis at the molecular level and may pave the way for targeted therapy. We conducted this study to evaluate the immunohistochemical expression of markers related to WNT and NOTCH signaling pathways in hepatoblastoma and to compare them among its histological subtypes. Methods. The specimens of hepatoblastoma diagnosed over a period of 8 years were retrieved. Clinicoradiological data was obtained. Slides were reviewed and detailed histopathological parameters, diagnosis, and subtypes were reevaluated. Immunohistochemistry for β-catenin, CCND1, glutamine synthetase, MYC, AXIN2, NOTCH2, DLK1, and HES1 was performed. Statistical analysis was done. Results. A total of 51 samples of hepatoblastoma were included in the study. Mixed epithelial-mesenchymal hepatoblastoma was the most common histologic subtype. PRETEXT IV, high-risk group, high mitotic index, and less differentiated histologic subtype were associated with worse outcomes. β-catenin, AXIN2, CCND1, expression was more in less differentiated subtypes. MYC, HES1, and glutamine synthetase expression was more common in the fetal component. NOTCH2 and DLK1 expression was seen across all types. A statistically significant association was observed among AXIN2 expression with β-catenin, CCND1, and MYC nuclear expression. Mean overall survival was 66.6 months and mean event-free survival was 54.7 months. Conclusions. The NOTCH pathway converges with the WNT pathway. Differential expression of the immunohistochemical markers of these pathways helps in the semiquantitation of various epithelial components, guides adjuvant treatment, and patient prognostication.

Gender and racial/ethnic disparities in children presenting for short stature evaluation: in-depth analysis at a single center.

To assess disparities in children referred for short stature evaluation and to evaluate the effectiveness of interventions on referral rates. Retrospective chart review was conducted on children referred to a pediatric endocrinology center for short stature evaluation between 1/1/2022-12/31/2023. Interventions included an educational lecture and electronic medical record alert. Six month pre- and post-intervention referral rates for short stature from a general pediatrics practice were assessed. There were 747 children (68% males) with a predominance of non-Hispanic White (NHW) children (64%). Females presented at a younger age (P<0.001), with a lower height (P<0.001), and a greater height deficit (P=0.002) than males. Hispanic children presented with greater height deficits than NHW and non-Hispanic Black (NHB) children (all P<0.05). In those with heights <-2 standard deviations (SD) (n=192), there were no significant gender differences however Hispanic children continued to have greater height deficit than NHW and NHB children (all P<0.02). There was no gender difference in those who underwent growth hormone stimulation testing (GHST); however NHW children comprised the largest racial group. After implementing the interventions in the general pediatrics practice, short stature referral rates improved (15 of 118 referrals [13%] to 25 of 81 referrals [31%]; P=0.002). Disparities in overall short stature referrals were less evident in the subset of children with heights <-2 SD. There was no significant gender bias in GHST but racial/ethnic disparities remained. Improvement in referring and evaluating females and children from minoritized groups is still crucial as they remain under referred.

Communication and Psychosocial Functioning in Children With Tourette Syndrome: Parent-Reported Measures.

Previous studies indicate that a subset of children with Tourette syndrome (TS) experiences communication difficulties; however, the specific characteristics of these challenges remain underexplored. This study aimed to (1) quantify the proportion of children with TS within a North American cohort exhibiting communication challenges as assessed by a standardized parent questionnaire, (2) determine how many children with parent-reported communication challenges had been diagnosed with a communication disorder, (3) examine the relationship between parent-reported co-occurring conditions and parent-reported communication skills, and (4) evaluate the association between parent-reported communication skills and parent-reported psychosocial functioning. Questionnaires were distributed to parents in North America through TS-focused social media groups and organizations (United States and Canada) and Canadian medical clinics specializing in TS care. Data collected included demographic information, information on tic severity and co-occurring conditions, parent-reported communication function using the Children's Communication Checklist, Second Edition (CCC-2), and psychosocial function using the Strengths and Difficulties Questionnaire (SDQ). The questionnaire was completed by 61 parents of children with TS. On the CCC-2, 62% of children obtained scores consistent with age-appropriate communication skills, while 38% obtained scores suggestive of communication challenges (> 1SD below the mean on general communication and/or social-pragmatic communication). Ten percent of children were reported to have a formal language disorder diagnosis. A significant correlation was observed between communication proficiency and psychosocial functioning: lower scores for general and social-pragmatic communication skills were associated with increased psychosocial difficulties (r=-0.44, p<0.001). Notably, the presence of specific co-occurring conditions did not predict general communication or social-pragmatic communication challenges. Speech-language pathologists (S-LPs) should anticipate that most children with TS will exhibit age-appropriate communication development; however, a substantial proportion will present with communication challenges in formal language and/or social communication. Medical practitioners are advised to promptly refer children for speech-language evaluation upon identifying potential communication challenges, particularly among those demonstrating heightened psychosocial difficulties. Comprehensive assessment by S-LPs should encompass both core language and social-communication dimensions. What is already known on this subject There is evidence that communication challenges are relatively common in children with TS; however, we have little information about what these challenges look like and what other factors relate to them. What this study adds This study demonstrated underdiagnosis of language and communication difficulties in TS, given the discrepancy between communication challenges suggested by CCC-2 results and the number of children who had previously received a communication diagnosis. Moreover, parent-reported challenges were observed for both social communication and general communication. This is the first study to report a correlation between psychosocial functioning and communication skills in children with TS. What are the clinical implications of this study? Children with TS should be referred for speech-language pathology services if challenges are indicated and attention should be placed on evaluating aspects of social-pragmatic language while promoting acceptance of social differences that are not interfering with functional communication.

Moving to lower-poverty neighborhoods offers broad benefits for children with asthma, regardless of sex or other baseline characteristics.

Moving to lower-poverty neighborhoods offers broad benefits for children with asthma, regardless of sex or other baseline characteristics.

Factors Associated With Hearing-Related Quality of Life in Children With Hearing Loss.

Our objective was to determine how hearing-related quality of life (HEAR-QL) varies with time and explore its association with hearing loss (HL) characteristics in children aged 7-18 years old. Retrospective chart review. Medical records of 7-18 year-olds with HL who completed ≥ 1 HEAR-QL questionnaire were reviewed. Longitudinal HEAR-QL changes were explored using mixed linear models. Data from 109 children with HL were analyzed. Most recent total HEAR-QL score was not associated with HL severity. Median score differences were estimated at 7.6 (slight/mild-moderate/moderately severe; 95% CI -2.3 to 15.7), 2.16 (slight/mild-severe/profound; 95% CI -9.0 to 11.2), and -3.9 (moderate/moderately severe-severe/profound; 95% CI -11.6 to 2.7). In children without changes in device use, there were no changes over time in HEAR-QL Environments/Situations, Activities/Social, or School scores. Feelings score increased by 2.9 points (95% CI 1.5-4.3) with each additional year of age. In six children who initiated device use between surveys, total HEAR-QL scores increased by a median of 15.2 points (95% CI 3.0-41.7) after device initiation. In children with HL, overall HEAR-QL scores remained similar over time and between HL severity categories. Feelings scores appeared to increase with age as children adjusted to their diagnosis. In a subset of children, HEAR-QL scores increased after device initiation. Clinicians may consider recommending hearing devices for children whose QOL is significantly impacted by HL, regardless of severity. Additional investigation is necessary to further characterize how QOL changes after device initiation.

Screening for Caregiver Stress in an Urban Medical Home for Children with Medical Complexity: Results of a Pilot Study.

Children with medical complexity (CMC), a subset of children with special healthcare needs, have chronic conditions affecting multiple organ systems, require medical technology, and account for a significant share of pediatric healthcare spending despite comprising only 1% of the population. Their families experience unique stressors, including financial strain and high rates of workforce attrition, suggesting medical inequity is an independent risk factor for health inequity. The role of universal caregiver stress screening using a validated tool within the outpatient primary care medical home for CMC youth has not been explored in the literature. Caregivers of all patients in the Complex Care Program (CCP) within a large academic pediatric primary care Medical Home-certified practice at the Children's National Hospital were screened for caregiver stress during routine primary care appointments using the University of Washington Caregiver Stress Scale 8-Item Short Form V. 2.0 (UW-CSS). Elevated scores prompted referrals to the CCP psychosocial team, and composite scores were recorded in the electronic medical record. Demographics, medical diagnoses, and technology support status were extracted from the medical chart. The childhood opportunity index (COI) was calculated as a proxy for socioeconomic position. Screening for caregiver stress in our medical home for CMC was feasible and yielded unexpected results. We found no difference in levels of stress among caregivers based on the COI. This finding highlights the importance of universal rather than targeted screening. Future directions include measuring the impact of targeted interventions for families who initially screen positive via longitudinal follow-up. Screening for caregiver stress in a primary care medical home for CMC is feasible. As no single variable alone was a predictor of high caregiver stress, universal screening seems to be the most appropriate strategy to capture all families at the highest risk.

Machine learning in lymphocyte and immune biomarker analysis for childhood thyroid diseases in China

ObjectiveThis study aims to characterize and analyze the expression of representative biomarkers like lymphocytes and immune subsets in children with thyroid disorders. It also intends to develop and evaluate a machine learning model to predict if patients have thyroid disorders based on their clinical characteristics, ultimately providing insights to enhance the clinical guidelines for the pathogenesis of childhood thyroid disorders.MethodThis cross-sectional study conducted in China examined diagnosed cases to describe the characteristics and expression of lymphocyte and immune subsets as predicted by the model. The study included two groups of children: 139 who were hospitalized in the Department of Endocrinology and a control group consisting of 283 children who underwent routine health checks at the Department of Children Healthcare. Cases were classified into three groups based on diagnoses: Graves’ disease (GD), Hashimoto’s thyroiditis (HT), and hypothyroidism. By employing 11 readily obtainable serum biochemical indicators within three days of admission, the median concentrations and percentages of subset measurements were analyzed. Additionally, nine machine learning (ML) algorithms were utilized to construct prediction models. Various evaluation metrics, including the area under the receiver operating characteristic curve (AUC), were employed to compare predictive performance.ResultsGD cases had increased levels of CD3-CD19 + and CD3 + CD4 + T lymphocytes, and a higher CD4+/CD8 + ratio. In both GD and HT, the levels of complement C3c, IgA, and IgG were higher than those in the control group. HT cases also had an increasing percentage of CD3-CD16 + 56 + T lymphocytes. Most immune markers increased in hypothyroidism, except for some T lymphocyte percentages and the CD4+/CD8 + ratio. To reduce age-related bias, propensity score matching was used, yielding consistent results. Among the nine machine learning models evaluated, logistic regression showed the best performance, being useful in clinical practice.ConclusionsSpecific lymphocytes with different biomarkers are positively correlated with autoimmune thyroid disease (AITD) in children. Complement proteins C3c and C4, along with IgG, IgA, IgM, and T/B cells, are significant in childhood thyroid diseases. Our best model can effectively distinguish these conditions, but to enhance accuracy, more detailed information such as clinical images might be needed.

Autistic traits in childhood and post-traumatic stress disorder as young adults: a cohort study.

Despite the higher prevalence of childhood traumatic experiences and post-traumatic stress disorder (PTSD) in autistic adults, research on trauma-related psychopathology and autistic traits in young people is lacking. This study examined if high autistic traits in childhood predispose individuals to traumatic experiences, the development of PTSD and general psychopathology, and greater functional impairment by age 18, in both the general population and a subsample of trauma-exposed young people. Data were utilised from the Environmental Risk (E-Risk) Longitudinal Twin Study, a nationally representative cohort of 2,232 same-sex twins born in 1994-1995 across England and Wales. Participants were a subset of children whose parents completed the Childhood Autism Spectrum Test (CAST), during assessments at ages 8, 9 and/or 12 years (N = 1,504). We tested associations between autistic traits in childhood and age-18 reports of lifetime trauma exposure, lifetime PTSD diagnosis, general psychopathology ('p-factor') and NEET status ('not in employment, education or training'). Analyses were conducted controlling for sex, family socioeconomic status (SES), intelligence quotient (IQ) and accounting for family clustering. Higher autistic traits in childhood were significantly associated with greater reports of lifetime trauma exposure (Odd Ratio [OR] = 1.26, 95% Confidence Intervals [CI] = 1.03; 1.54), lifetime PTSD diagnosis (OR = 1.91, 95% CI = 1.29; 2.82), general psychopathology (beta = 3.22, 95% CI = 1.84; 4.60) and NEET status (OR = 1.48, 95% CI = 1.05; 2.09) at age 18. Only the associations of autistic traits with PTSD and general psychopathology were robust to adjustment for potential confounders. Among trauma-exposed children, autistic traits were also significantly associated with lifetime PTSD diagnosis (OR = 1.75, 95% CI = 1.15; 2.68) and psychopathology (beta = 3.36, 95% CI = 0.68; 6.04) at age 18, but only the association with PTSD held when adjusted for confounders. Our findings suggest a need to develop targeted assessments and evidence-based treatments for PTSD to meet the needs of children with high autistic traits. However, whether our findings extend to diagnosed autistic children requires further investigation.

Reduced Cerebellar Volumes Associate with P300 Amplitude Attenuation in Children with Clinical High Risk for Psychosis and Early Onset Psychosis.

Patients with psychotic illnesses, including early onset psychosis (EOP), often experience cognitive impairment. The cerebellum is critically involved in neurocognitive processes, yet possible regional alterations in the cerebellum and their associations with behavioral parameters remain largely unexplored in EOP. In this preliminary study, we aimed to investigate structural morphological properties of the cerebellum as well as the supratentorial brain, and how morphological changes in the central nervous system relate to neurocognitive performance in children with EOP and clinical high-risk for psychosis (CHR). We performed whole-brain structural magnetic resonance imaging (MRI) and voxel-based morphological analyses in children with EOP (N = 15), children with CHR (N = 11), and healthy controls (Con, N = 13). An auditory event-related potential (ERP) task to elicit a P300 response was also completed by a subset of children (N = 29) as a measure of neurocognitive functioning. Linear regression analyses were performed to explore relationships between cerebellar volume, cortical thickness, and P300 amplitudes. Volumetric reductions (Con > CHR > EOP) in bilateral Crus I, Crus II, lobule VI and VIIIa, left VIIIb, and right lobules V and IX of the cerebellum were observed (p < 0.05). This downward trend across study cohorts was also evident for rostral middle frontal cortical (RMFC) thickness, and for centroparietal P300 amplitudes. Significant positive correlations among P300 amplitudes and cerebellar volumes were observed (p < 0.05). Significant correlations between P300 amplitudes and RMFC thickness were not present. Robust morphological disruptions in cerebellar subdivisions and frontal subdivisions were quantified in children with EOP. Structural abnormalities in these regions, particularly in the cerebellum, may signify broader brain network disruptions, potentially contributing to neurocognitive dysfunction in EOP.

TGFβ links EBV to multisystem inflammatory syndrome in children

In a subset of children and adolescents, SARS-CoV-2 infection induces a severe acute hyperinflammatory shock1 termed multisystem inflammatory syndrome in children (MIS-C) at four to eight weeks after infection. MIS-C is characterized by a specific T cell expansion2 and systemic hyperinflammation3. The pathogenesis of MIS-C remains largely unknown. Here we show that acute MIS-C is characterized by impaired reactivation of virus-reactive memory T cells, which depends on increased serum levels of the cytokine TGFβ resembling those that occur during severe COVID-19 (refs. 4,5). This functional impairment in T cell reactivity is accompanied by the presence of TGFβ-response signatures in T cells, B cells and monocytes along with reduced antigen-presentation capabilities of monocytes, and can be reversed by blocking TGFβ. Furthermore, T cell receptor repertoires of patients with MIS-C exhibit expansion of T cells expressing TCRVβ21.3, resembling Epstein–Barr virus (EBV)-reactive T cell clones capable of eliminating EBV-infected B cells. Additionally, serum TGFβ in patients with MIS-C can trigger EBV reactivation, which is reversible with TGFβ blockade. Clinically, the TGFβ-induced defect in T cell reactivity correlates with a higher EBV seroprevalence in patients with MIS-C compared with age-matched controls, along with the occurrence of EBV reactivation. Our findings establish a connection between SARS-CoV-2 infection and COVID-19 sequelae in children, in which impaired T cell cytotoxicity triggered by TGFβ overproduction leads to EBV reactivation and subsequent hyperinflammation.

Characteristics of peripheral blood lymphocyte subsets in children with mycoplasma pneumoniae pneumonia under different infection states

The research investigated the characteristics of lymphocyte subsets in peripheral blood of children with mycoplasma pneumoniae pneumonia in different infection states. The retrospective cross-sectional study selected 194 children with pneumonia from October 2023 to January 2024 in Zhongnan Hospital of Wuhan University as the study objects, patients aged 7 months to 13 years old, including 91 female children and 103 male children. According to the types of pathogens, the children with pneumonia were divided into single MP infection group (80 cases), non-MP infection group (29 cases) and mixed pathogen infection group (85 cases). According to the mutation of MP23S rRNA gene, the MPP children were divided into drug-resistance group (112 cases) and non-drug-resistance group (53 cases). According to the results of bronchoscopy and imaging, the MPP children were divided into severe group (35 cases) and mild group (130 cases). Pathogen infection, the percentage and absolute count of lymphocyte subsets in peripheral blood, hypersensitive CRP, interferon-γ, tumor necrosis factor-α, interleukin-10, interleukin-4, interleukin-6 and interleukin-2 in each group were analyzed retrospectively. The levels of the test items in each group were compared. The value of peripheral blood lymphocyte subsets in the diagnosis of MPP in children was evaluated by ROC curve. The results showed that the co-infection rate of MPP children was 51.51% (85/165). Streptococcus pneumoniae was the most common co-infection (39/85, 45.88%), followed by Haemophilus influenzae (26/85, 30.89%). The mutation rate of MP resistance gene was 67.88% (112/165) in MPP children tested for tNGS in bronchoalveolar lavage fluid. The absolute counts (cells/μl) of CD3+, CD3+CD4+, CD3+CD8+, CD3-CD19+, CD3-CD16+CD56+and CD3+CD16+CD56+ in the simple MP group (1 164, 612, 415, 242, 168, 50) and the mixed pathogen group (1 285, 694, 457, 313, 176, 52) were significantly lower than those in the non-MP group (2 092, 1 037, 660, 541, 295, 86) (P<0.05). There was no significant difference between drug-resistant group and non-drug-resistant group (P>0.05). The CD3+CD4+% (34.91) and the absolute counts of CD3-CD16+CD56+ (148 cells/μl) in severe group was significantly lower than that in mild group (37.91, 187 cells/μl), and CD3-CD19+% (19.48) was significantly higher than that in mild group (16.33) (P<0.05). The median values (cells/μl) of CD3+ (1 093, 925), CD3+CD4+ (576, 543), CD3+CD8+ (401, 356), CD3-CD19+ (238, 234) and CD3-CD16+CD56+ (181, 153) in MPP children aged 4 to 8 years and 9 to 12 years were lower than the reference range in corresponding age. ROC curve analysis showed that the AUC of peripheral blood lymphocyte subsets for MPP diagnosis was 0.813, and the sensitivity was 79.3%, the specificity was 75%. In conclusion, the co-infection rate of MPP children was higher than single MP infection. The characteristics of peripheral blood lymphocyte subsets in children with pneumonia were that the absolute count test value of MPP children was significantly lower than that of non-MP infection, and there are differences between MPP children clinical types.

Outcomes Following Fecal Diversion for Intractable Hirschsprung Associated Enterocolitis: A Study from the Pediatric Colorectal and Pelvic Learning Consortium.

Outcomes Following Fecal Diversion for Intractable Hirschsprung Associated Enterocolitis: A Study from the Pediatric Colorectal and Pelvic Learning Consortium.

Prognostic Value of Peripheral Blood Lymphocyte Subsets in Children and Adolescents With High-Grade Mature B-Cell Non-Hodgkin Lymphoma: A Real-World Outcomes Study.

Little progress has been made in determining prognostic factors for patients with high-grade mature B-cell non-Hodgkin lymphoma (HG B-NHL). Based on the important role of lymphocytes in cancer progression, this study aimed to explore the effect of peripheral blood lymphocytes on the prognosis of pediatric HG B-NHL. Patients aged less than 18years with newly diagnosed HG B-NHL were enrolled. Peripheral blood lymphocyte subset levels were detected at diagnosis, and their optimal cutoff values were determined according to event-free survival (EFS). In total, 206 patients were enrolled. The 5-year EFS and overall survival (OS) rates of the whole group were 92.1% ± 1.9% and 96.6% ± 1.3%, respectively. The 5-year EFS rate was worse in patients with a low relative CD4+ T-cell count (87.2% vs. 97.0%, p = 0.008), high relative CD8+ T-cell count (79.1% vs. 93.4%, p = 0.03), low CD4/CD8 ratio (80.5% vs. 94.2%, p = 0.01), and low B-cell count (80.0% vs. 93.4%, p = 0.02) at diagnosis than their counterparts. Cox multivariate analysis identified low relative CD4+ T-cell (HR = 4.91) and B-cell (HR = 3.87) counts at diagnosis as independent adverse prognostic factors. Patients with simultaneously low levels of CD4+ T and B cells had the worst outcomes in the entire cohort, with a 5-year EFS rate of 60.0%. Low relative CD4+ T-cell and B-cell counts at diagnosis are associated with poor prognosis in children and adolescents with HG B-NHL in the real world.

Human-Centered Design to Create anEmergency Care Action Plan for Children With Medical Complexity.

Human-centered design (HCD) is rooted in building trust with end users by developing empathetic understanding of key partners' needs, continuous engagement, and iterative solution creation and refinement. One of the core tenets of HCD in health care is that consistent end-user engagement will result in better health outcomes. Children with medical complexity (CMC), a subset of children and youth with special health care needs, are characterized by multiple chronic health care conditions and high health care use, including emergency department visits. To address the known challenges with providing high-quality care for CMC in emergency settings, emergency information forms are currently recommended to provide insights into existing health complexities at the point of care. However, these forms have faced significant implementation challenges that lead to limited stakeholder buy-in and lack of incorporation into current emergency care workflows. We present HCD as a strategy to aid in the creation and optimization of an emergency care action plan (ECAP) for CMC. The objectives of this communication are, therefore, as follows: (1) to demonstrate HCD as an accessible approach to delineate and address pediatric care challenges within a complex health care system and (2) to illustrate a commonly used HCD methodological approach to address implementation challenges of an emergency care planning tool through the creation of an ECAP for CMC.

A distinct immunophenotype in children carrying the Blautia enterotype: The Generation R study.

A distinct immunophenotype in children carrying the Blautia enterotype: The Generation R study.

Evidence Suggesting Prolonged Neuroinflammation in a Subset of Children after Moderate/Severe TBI: A UCLA RAPBI Study

Traumatic brain injury (TBI) presents a public health concern as a leading cause of death and disability in children. Pediatric populations are particularly vulnerable to adverse outcomes following TBI due to periods of rapid growth, synaptic pruning, and myelination. Pediatric patients with moderate-severe TBI (msTBI) and healthy controls were evaluated from the post-acute (2–5 months) to chronic phase (13–19 months) of recovery using diffusion magnetic resonance imaging (dMRI) and interhemispheric transfer time (IHTT), which is an event-related potential measure the speed of information transfer across the corpus callosum. We previously identified two subgroups of patients based on IHTT, with one group showing a significantly slower IHTT (TBI-slow), poorer cognitive performance, and progressive structural damage. In contrast, the other group (TBI-normal) did not differ from controls on IHTT or cognitive performance and showed relative structural recovery over time. Here, we examined group differences in restricted diffusion imaging (RDI), which is a dMRI metric sensitive to inflammation. Comparing TBI-slow, TBI-normal, and controls on RDI cross-sectionally, dMRI connectometry analysis revealed higher RDI across the white matter in the TBI-slow group compared to both the control and TBI-normal groups. Longitudinal analyses indicated that while both TBI groups exhibited a decrease in RDI over time, suggesting resolution of neuroinflammation and recovery, the decreases in the TBI-slow group were smaller. The differences in RDI between TBI-slow and TBI-normal suggest that inflammation may play a key role in the prolonged recovery, including brain structure, cognitive performance, and symptom reports, of pediatric patients with msTBI.

Characterization of children with early onset pediatric multiple sclerosis.

Characterization of children with early onset pediatric multiple sclerosis.