Current Pediatric Reviews - Volume 19, Issue 3, 2023

Many publications have demonstrated the detrimental effects of school closures on children, families and communities in the past two years of the COVID-19 pandemic. Currently, there is a surge of Omicron cases as children prepare to return to school around the world. While many children are asymptomatic or have mild disease, it is nevertheless an important problem. As we focus on vaccinations in the 5-12-year-old group, we should consider other risk mitigation factors to keep school open, and children safe.

Background: The author and his wife report their unique experience of international travels during the COVID-19 pandemic, and discuss issues encountered in various countries. Methods: Narrated discussion of issues encountered during the COVID-19 pandemic. Discussion: “Zero-COVID” versus “Living with COVID-19” strategies are compared. Children have unique issues with COVID-19 pandemic. Evaluation of efficacy of the approaches in pandemic with time should consider the main types of interventions (e.g., border management/quarantine; physical distancing; mask use; case isolation, testing and contact tracing; vaccination). The key metrics that can be used to compare the impacts of different strategies between the cities (e.g., cumulative case rate, cumulative mortality rate, case fatality risk, stringency index, economic performance) should be identified. Research in these approaches can help manage future pandemics in coronaviruses and emerging infections. The UK started with very loose mitigation ('herd immunity') and then switched to a suppression approach in 2021, followed by "living with the virus" approach. Whereas HK has been targeting towards elimination throughout. In between, countries like Singapore, Australia and New Zealand have shifted from zero-COVID strategy to living with the virus. It is easier to have effective social control measures in Hong Kong because it has clear borders and an authoritarian government, but it did not have a clear exit policy when Omicron spread.

A swallowing disorder or dysphagia is defined as a disorder in the sequence of swallowing, during the oral or pharyngeal phase, which compromises the safety and/or efficiency of transit of the food bolus to the esophagus. The evaluation of neurodevelopment, nutrition, and preventive medicine actions are as important as the clinical evaluation of dysphagia, so they must be included and systematized in all pediatric evaluations; This evaluation can be divided into different parts: bedside swallowing evaluation, instrumental swallowing evaluation, and additional studies. The management of swallowing disorders requires a multidisciplinary team approach, depending on the child's age, cognitive and physical abilities, and the specific swallowing and feeding disorder, ensuring adequate and safe nutrition and improving the patient's quality of life.

Familial hypercholesterolemia (FH) is a genetic disease, the underlying cause of which is represented by mutations capable of influencing the metabolism of low-density lipoproteins (LDL). The distinguishing characteristic of FH has increased LDL cholesterol blood levels since birth, triggering early development of atherosclerosis-related diseases. Diagnosis of FH is frequently either missed or made with a considerable delay. Prompt identification of the disease is pivotal in implementing early prevention measures. Safe and effective drugs have been approved for use in children and adolescents, with statins, with or without ezetimibe, representing first-line therapy. At times, however, these medications may not be sufficient to achieve the therapeutic target, particularly in homozygous FH patients. Lipoprotein apheresis, which has proved safe and efficient, is strongly suggested in such cases. New drugs still at the investigational stage may represent a promising and personalised therapy. Lowering cholesterol levels in childhood hampers the formation of arterial atherosclerotic plaques, thus reducing cardiovascular events later in life. Accordingly, early detection, diagnosis, and therapy in FH subjects are priority aims.

The fifth malaria parasite causing malaria- Plasmodium knowlesi (Pk), is not a novel emergent species but was an undiagnosed species before the availability of molecular methods as a tool from diagnostics and sometimes confused with morphologically similar human malaria parasite P. malariae or P. falciparum. Now it is well-distributed species in Southeast Asia, especially in Malaysia. Since 2004, cases of Pk malaria are continuously being reported in adults. Though adult age, forest-related activities and a recent visit to forested areas are well-known factors, childhood did not remain untouched by this disease. Few pieces of research and reports in the literature indicate that Infection in children is uncomplicated, but this may be attributed to the scarcity of data and research in this field. Pk malaria in pregnant females and infants are being well reported, so this indicates that the problem is not only restricted to known factors related to the disease, but we should think out of the box and take action before the disease takes the form of significant health burden on the human population as P. vivax and P. falciparum species did in the past. With the reports in literature of Pk malaria in pregnancy and early infancy, the possibility of congenital and neonatal malaria also cannot be denied. So more and more research is needed to understand Pk malaria in the pediatric population clearly. So this running review covers the problem status, demographic profile, clinical and haematological features, diagnosis, management and outcome of Pk malaria in paediatric group worldwide. This review also discusses the gaps in our present knowledge of the real problem status, prevention, control, diagnosis and management of Pk malaria, particularly in this age group.

Type 1 diabetes mellitus is a clinical condition characterized by insufficient insulin production due to progressive loss of pancreatic islet β-cells mediated by an autoimmune response. This deregulation of the immune system is caused by the action of genetic, epigenetic, and environmental factors in varying combinations for each individual. Although the inflammation of the islets with immune cell infiltration, known as insulitis, is an important element in pathogenesis, other factors are necessary for disease initiation. Associations with variants of HLA and other genes related to immune system function, mainly haplotypes HLA-DR3-DQ2 and HLA-DR4-DQ8, are more evident. The influence of polymorphisms and epigenetic modifications, as well as the microbiome, is convincing proof of the existence of a complex interaction between genetic, immune, and environmental factors in the etiology and pathogenesis of this metabolic disorder. Loss of selftolerance to autoimmunity is a critical point in the development of the disease, and regulatory T cells play a key role in this process. Thus, any failure of these cells, either due to an insufficient number or altered expression of cytokines and transcription factors, may be the trigger for the onset of the disease. The protective action of regulatory T cells is controlled by gene expression that is modulated by epigenetic modifications, including the dysregulation of noncoding RNAs. This review takes an updated approach to the natural history of type 1 diabetes, focusing on the factors involved in the etiology and pathogenesis.

Despite using antenatal steroids, surfactants and protective ventilation, bronchopulmonary dysplasia (BPD) affects 10-89% of preterm infants. Since lung inflammation is central to the BPD pathogenesis, postnatal systemic corticosteroids could reduce the risk of BPD onset in preterm infants, but short and long-term adverse consequences have been underlined in literature after their use (i.e., hyperglycaemia, hypertension, hypertrophic cardiomyopathy, growth failure, gastrointestinal bleeding, cerebral palsy). Alternative therapeutic strategies such as postponing corticosteroid administration, lowering the cumulative dose, giving pulse rather than continuous doses, or individualizing the dose according to the respiratory condition of the infant have been proposed to avoid their adverse effects. Dexamethasone remains the first-line drug for newborns with severe pulmonary disease beyond the second to the third week of life. Hydrocortisone administration in very preterm infants does not appear to be associated with neurotoxic effects, even if its efficacy in preventing and treating BPD has yet been clearly demonstrated. Alternative methods of corticosteroid administration seem promising. A positive effect on BPD prevention occurs when budesonide is nebulized and intratracheally instilled with a surfactant, but more data are required to establish safety and efficacy in preterm newborns. Additional studies are still needed before the chronic lung disease issue, and its related challenges can be solved.

Necrotizing enterocolitis (NEC) is a devastating disease that primarily affects the gastrointestinal tract of premature neonates. The diagnosis and treatment of NEC remain challenging. New biomarkers and potential treatments for NEC have emerged in recent years, leading to the potential of earlier therapeutic intervention and improved outcomes. This paper aims to provide a review of the most recent diagnostic indicators and therapeutics of NEC along with a brief overview of future directions of research into this disease.

Background: The biomarker procalcitonin (PCT) is good in detecting sepsis in postoperative pediatric trauma patients, especially those with a high suspicion of sepsis, and formulating a quick treatment. Its use is still limited to pediatric surgical patients, particularly those in intensive care units (ICUs), who are more susceptible to sepsis. The purpose of this study was to see if procalcitonin could be used as a reliable and quick biomarker for sepsis in postoperative pediatric trauma patients and were brought to the PICU. Methods: This retrospective longitudinal study was conducted from January 2017 to December 2019. Postoperative pediatric trauma patients aged > 2 weeks old who were hospitalized at the PICU of King Fahd Hospital of the University due to serious trauma or post-acute surgical events were included. Within 24 hours of admission, PCT levels were measured, and again 48-72 hours later. Results: In our study, 31% of severely ill children developed post-surgical sepsis. When compared to the PRISM III score and 24-hour PCT level, PCT levels at 48-72 hours exhibited the largest area under the curve (AUC). With a sensitivity of 71% and a specificity of 65%, the predictive AUC value was estimated to be 0.71. The AUC of PCT levels at 48-72 hours was 0.72 (95% confidence interval (CI): 0.65-0.79; p < 0.001), indicating high predictive validity using a cutoff point > 0.10, with sensitivity, specificity, and positive and negative predictive values of 68.4%, 63.6%, 45.8%, and 81.8%, respectively. Conclusion: PCT is a sensitive biomarker for detecting sepsis in postoperative pediatric trauma patients, especially those with a high pre-test suspicion for sepsis. In addition, PCT can be used alone or in combination with other clinical findings to help formulate a rapid primary diagnosis of sepsis in this subset of patients.

Background: The purpose of this study was to identify the predictors of self-esteem and the relationships between health-promoting behavior, health intentions, and self-esteem among school-aged children and provide basic data for the development of programs that can influence self-esteem among school-aged children in South Korea. Introduction: This study aimed to identify the predictors of self-esteem and the relationships between health intentions and health-promoting behavior and self-esteem among school-aged children. Methods: The study design was a cross-sectional study. The data were collected using a selfreported questionnaire on health intentions, health-promoting behavior, and self-esteem. The data were collected from elementary school students from February 3 to 13, 2020. Data analysis was performed using the SPSS program. Results: Positive correlations were found between self-esteem and both health-promoting behavior (r=.503, p < 0.001) and health intentions (r=.511, p < 0.001). Also, the relationship between health intentions and health-promoting behavior (r = 0.629, p < 0.001) exhibited positive correlation. Selfesteem was identified as a significant predictor of health intentions (β = 0.28, p < 0.001), healthpromoting behavior (β = 0.21, p < 0.001), school records (β = -0.20, p < 0.001), perceived health status (β = 0.18, p < 0.001), and academic grade (β = -0.10, p < 0.05), with an explanatory power of 39.0%. Conclusion: The results indicated that self-esteem positively affects health intentions and healthpromoting behavior.

Background: Although the burden of anemia in pregnant women and its consequences on the pregnancy outcome are well documented, there is limited evidence on the association between maternal hemoglobin concentration and low birth weight (LBW) in the study area. Objectives: This study aimed to determine the association between maternal hemoglobin concentration and neonatal birth weight (BW) in Qazvin, Iran, 2018-2019. Materials and Methods: A case-control study was conducted among 450 neonates with BW < 2500 gm (LBW) and 451 neonates with BW > 2500 gm. In this study, neonates with BW less than 2500 gm were cases, while those who were greater than 2500 gm were considered as control. Multiple logistic regression model was used to calculate OR with 95% Confidence Interval (95 % CI) to determine the association between maternal anemia and other maternal attributes and neonate BW. Results: Maternal hemoglobin (g/dl) was not significantly associated with neonate BW (OR: 1.03 (95 % CI: 0.58 - 1.81), p = 0.93). However, maternal initial weight (Kg) (OR: 0.96 (95 % CI: 0.94 - .098), p < 0.001), mother's age in year (OR: 1.04 (95 % CI: 1.00 - 1.09), p = 0.038), gestational age (OR: 0.49 (95 % CI: 0.43 - 0.57), p < 0.001) were significantly associated with neonatal BW. Conclusion: Maternal hemoglobin concentration was not significantly associated with LBW. However, other maternal attributes such as low initial maternal weight, low gestational age, low education status and old age were significantly associated with LBW. Intervention that targeted mothers with low initial weight, low educational status and older age is required to minimize LBW among neonates in the study area.

Background: Early puberty increases the risk of diverse health outcomes during adolescence and beyond. Several studies have explored the links between short sleep duration and early puberty worldwide. Objective: The current systematic review and meta-analysis aimed to evaluate the association between sleep duration and early pubertal timing based on published evidence systematically. Methods: We searched important electronic databases for articles that reported the association between childhood sleep duration and puberty timing up to October 2020. A total of 848 papers were identified from the databases and manual search. Finally, 10 studies including 23752 participants were included in the meta-analysis. We calculated the pooled effect sizes using a random or fixed effects model as appropriate. Results: There was a significant inverse association between sleep duration and the risk of early puberty, longer duration of sleep was associated with 0.34% decreased odds of early puberty (OR = 0.66, 95% CI = 0.58-0.77, I² = 96.6%). In a subgroup analysis, when pubertal status was assessed by physical examination compared with Pubertal Development Scale (PDS) or Sexual Maturation Scale (SMS), the associations between sleep duration and age of puberty were attenuated. The pooled OR (95% CI) of studies measuring pubertal timing by PDS/SMS and Tanner stage were 0.50(0.37-0.69) and 0.91(0.77-1.09), respectively. When pooling effect sizes was limited to studies that had BMI level adjustment, the association of sleep duration and early puberty was not statistically significant anymore (OR = 0.95, 95% CI = 0.89-1.01). Conclusion: Longer sleep duration is associated with a lower risk of early puberty in children. The association between sleep duration and risk of early puberty may be modified by other factors such as BMI. To clarify the effect of sleep duration on the risk of early puberty in children, further prospective studies are needed.