Том 20, № 1 (2024)
- Год: 2024
- Статей: 9
- URL: https://rjeid.com/1573-3963/issue/view/10122
Medicine
Old and New Challenges in Pediatrics



Childhood Obesity: An Updated Review
Аннотация
Background:Childhood obesity is an important and serious public health problem worldwide.
Objective:This article aims to familiarize physicians with the evaluation, management, and prevention of childhood.
Methods:A PubMed search was conducted in May 2021 in Clinical Queries using the key terms \"obesity\" OR "obese". The search included clinical trials, randomized controlled trials, case control studies, cohort studies, meta-analyses, observational studies, clinical guidelines, case reports, case series, and reviews. The search was restricted to English literature and children. The information retrieved from the above search was used in the compilation of the present article.
Results:Most obese children have exogenous obesity characterized by a growth rate for height above the 50th percentile, normal intelligence, normal genitalia, and lack of historical or physical evidence of an endocrine abnormality or a congenital syndrome. Obese children are at risk for dyslipidemia, hypertension, diabetes mellitus, non-alcoholic fatty liver disease, obstructive sleep apnea, psychosocial disturbances, impaired quality of life, and shorter life expectancy. The multitude of serious comorbidities necessitates effective treatment modalities. Dietary modification, therapeutic exercise, and behavioral modification are the fundamentals of treatment. Pharmacotherapy and/or bariatric surgery should be considered for obese individuals who do not respond to the above measures and suffer from a serious comorbid condition.
Conclusion:Childhood obesity, once established, is often refractory to treatment. Most treatment programs lead to a brief period of weight loss followed by rapid re-accumulation of the lost weight after termination of therapy. As such, preventive activity is the key to solve the problem of childhood obesity. Childhood obesity can be prevented by promoting healthy diet, regular physical activity, and lifestyle modification. Parents should be encouraged to become involved in school and community programs that improve nutritional status and physical activity in their children.



Common Childhood Sleep Problems and Disorders
Аннотация
Background:Sleep insufficiency and disturbances affect the physical, cognitive, and emotional well-being of children.
Objective:To perform a narrative review on common sleep problems and disorders encountered in primary care for children and adolescents.
Methods:A search of English literature in the Pubmed and Google Scholar databases published from 1 January 2000 till 31 October 2021 was conducted with the keywords "sleep problem" or "sleep disorder" and "child" or "adolescent". Findings in the relevant articles and cross-references were compiled.
Results:Sleep duration and habits of children vary widely across countries with different cultural backgrounds. There is robust evidence to support the promotion of positive bedtime routines and sleep hygiene as prevention and management of sleep problems. 15-70% of parents reported their children having sleep problems or disturbances. Common sleep complaints include difficulty in ini-tiation or maintenance of sleep, abnormal behaviors or movements, snoring or abnormal breathing, and excessive daytime sleepiness. Comprehensive sleep history and a sleep diary are the first steps for evaluation. Home video and actigraphy may be used as preliminary tools to confirm the history. Referrals to a sleep specialist for polysomnography and other tests are needed, if suspecting specific sleep disorders, such as obstructive sleep apnea and narcolepsy, needs timely intervention. Common sleep disorders in different age groups encountered in primary care are reviewed with clinical fea-tures, indications for evaluation, and treatment options summarized.
Conclusion:Screening for sleep problems shall be an integral part of each child's health care visit. It is important to evaluate the impact of common sleep problems and identify specific sleep disor-ders for early intervention to prevent long-term adverse outcomes.



Febrile Seizures: An Updated Narrative Review for Pediatric Ambulatory Care Providers
Аннотация
Background:While generally self-limited, febrile seizures result in significant familial distress. Ambulatory pediatric care providers must be prepared to counsel families on the causes, risk factors, management principles, and prognosis of children with febrile seizures.
Objective:To provide an updated, evidence-based review of febrile seizures focused on the needs of an ambulatory pediatric care provider.
Methods:A narrative review of the literature prioritizing landmark articles, metanalyses, longitudinal population longitudinal cohort studies and national level guidelines.
Results:Febrile seizures are aberrant physiological responses to fever in children caused by complex interactions of cytokine mediated neuroinflammation, environmental triggers, and genetic predisposition. Other than investigations to determine fever etiology, routine bloodwork, lumbar punctures, neuroimaging and electroencephalograms are low yield. The general prognosis is excellent, however, clinicians should be aware of long-term outcomes including: cognitive impairment with non-simple febrile seizures; neuropsychiatric associations; recurrent febrile seizure and epilepsy risk factors; and association between complex febrile seizures and sudden unexpected death. Children with high risk of recurrence, complex febrile seizures, limited access to care, or extreme parental anxiety may benefit from intermittent oral diazepam prophylaxis.
Conclusion:Clinicians should consider four management priorities: 1) terminating the seizure; 2) excluding critical differential diagnoses; 3) investigating fever etiology; and 4) providing adequate counselling to families. The clinical approach and prognosis of febrile seizure can be based on subtype. Children with non-simple (i.e. complex or febrile status epilepticus) febrile seizures require closer care than the vast majority of children with simple febrile seizures, who have excellent outcomes.



Impact of "Long Covid" on Children: Global and Hong Kong Perspectives
Аннотация
Background:The coronavirus disease (COVID-19) pandemic spares no nation or city, and the virus is responsible for the escalating incidence and mortality all around the world.
Objective:This article reviews the impact of "Long Covid" on Children.
Methods:A PubMed search was conducted in December 2021 in Clinical Queries using the key terms \"COVID-19\" OR "long COVID". The search was restricted to children and adolescent agep < 08 years, and English literature.
Results:Many large-scale studies have provided strong scientific evidence as to the detrimental and irreversible sequelae of COVID-19 on the health, psychology, and development of affected children. Many insights to the management of this disease can be obtained from comparing the management of influenza disease. COVID-19 is generally a mild respiratory disease in children. Several syndromes such as multisystem inflammatory syndrome in children (MIS-C) and COVID toe are coined but are probably not specific to SARS-CoV-2. "Long COVID" or the long-term effects of SARS-CoV-2 infection, or the prolonged isolation and containment strategies on education and psychosocial influences on children associated with the pandemic, are significant.
Conclusions:Healthcare providers must be aware of the potential effects of quarantine on children's mental health. More importantly, health care provides must appreciate the importance of the decisions and actions made by governments, non-governmental organizations, the community, schools, and parents in reducing the possible effects of this situation. Multifaceted age-specific and developmentally appropriate strategies must be adopted by health care authorities to lessen the negative impact of quarantine on the psychological wellbeing of children.



The Role of Nutraceutical Supplements in the Treatment of Irritable Bowel Syndrome: A Mini Review
Аннотация
Background:Irritable bowel syndrome (IBS) is a prolonged bowel illness that is general-ly stress-related and is characterized by a variety of gastrointestinal problems, the most prominent of which is chronic visceral abdominal discomfort. As a result, IBS typically impacts sufferers' standard of living, and it is typically associated with depression and anxiety symptoms. IBS medica-tion is based mostly on symptom alleviation. However, no effective medicines have been discov-ered too far. As a result, it is essential to discover novel anti-IBS medications.
Objective:The purpose of this brief review is to describe the existing research on nutraceutical sup-plements in irritable bowel syndrome management, including probiotics, prebiotics, symbiotics, herbal products, and dietary fibers.
Methods:This review covered the relevant papers from the previous twenty years that were availa-ble in different journals such as Science Direct, Elsevier, NCBI, and Web of Science that were re-lated to the role and function of Nutraceuticals in Irritable Bowel Syndrome.
Results:Neutraceutical substances have a variety of modes of action, including restoring the healthy microbiome, improving the function of the gastrointestinal barrier, immunomodulatory, an-ti-inflammatory, and antinociceptive properties. According to the literature, these substances not on-ly can improve irritable bowel syndrome symptomatology but also have an excellent long-term safety profile.
Conclusion:Irritable bowel syndrome is a prolonged bowel illness with a lot of gastrointestinal problems. The nutraceuticals treatment works as an anti-IBS intervention and enhances patient compliance with minimum side effects since patients take it better than pharmaceutical treatments.



Interventions for Enuresis in Children and Adolescents: An Overview of Systematic Reviews
Аннотация
Background:enuresis is an involuntary and intermittent loss of urine during sleep and its treatment can be done by pharmacological and non-pharmacological strategies.
Objective:to conduct an overview to carry out a survey of the systematic reviews about treatment options for children/adolescents with enuresis.
Methods:Databases used were Cochrane Library, PROSPERO, MEDLINE/PubMed, EMBASE, LILACS/BVS, PEDro, SciELO and Google Scholar. Any type of intervention for the treatment of enuresis in children/adolescents were selected by two independent researchers. Data extraction was done by two independent researchers. The risk of bias was assessed using Risk of Bias in Systematic Reviews (ROBIS) and A MeaSurement Tool to Assess Systematic Reviews (AMSTAR-2).
Results:seven systematic reviews were included. According to ROBIS, three reviews had a low risk of bias, while the others had a high risk of bias. Based on AMSTAR-2, four systematic reviews were of moderate quality, two were low quality and one was critically low quality.
Conclusion:there is moderate confidence that the use of desmopressin plus an anticholinergic agent increases the chance of complete response compared to desmopressin alone. Neurostimulation may increase the risk of responses ≥50% and ≥90% compared to the control group. Likewise, it appears that electrical stimulation is superior to placebo about the chance of response ≥50%. In addition, there is the clinical relevance in reducing enuresis episodes per week when neurostimulation is used compared to control groups.



Short Term Effects of Inhalation Sedation on Child Dental Fear and Anxiety
Аннотация
Background:Dental procedures profoundly affect a child's dental fear and anxiety, ren-dering dental treatment difficult. Inhalation sedation with a mixture of nitrous oxide and oxygen (NO2/02) breathed through a nosepiece is a form of light conscious sedation widely used in appre-hensive children to help them relax and accept dental treatment. This, however, can have both short-and long-term effects on child dental fear and anxiety. This study aimed to assess the short-term immediate effect of inhalation sedation on child dental fear and anxiety scores.
Methods:This analytical cross-sectional study was conducted at the Department of Paediatric Den-tistry at Rehman College of Dentistry, Peshawar, Pakistan, over a period of 1.9 years (January 2019- October 2020). A total of 171 children aged 6-11 years were selected with moderate to severe dental anxiety using the Child Fear Survey Schedule-Dental Subscale (CFSS-DS), requiring pulp therapy in at least one of their deciduous molars. Baseline anxiety scores were calculated using Venham Clinical Anxiety Score (VCAS) and Venham Picture test (VPT) with a dental check-up and fluoride application. VCAS and VPT scores were then assessed at the end of their scheduled second dental visit involving dental anaesthesia and inhalation sedation. VCAS and VPT scores at the end of treatment were compared with the baseline scores.
Results:Out of 171 children, 86 were male and 85 were female, with a mean age of 7.77. Females showed a higher range of VCAS and VPT scores (p ≤0.001) compared to males. The VCAS and VPT scores declined just at the end of the second dental visit following dental anaesthesia with in-halation sedation (mean difference = 1.96 and 3.39, respectively), which was statistically significant (p ≤0.001).
Conclusion:Inhalation sedation has a significant role in reducing child dental fear and anxiety in the short term.



Neurodevelopmental Outcome at 3 Years of Age in Very Low Birth Weight Infants According to Brain Development and Lesions
Аннотация
Background:During the last decades, severe brain lesions affecting very low birth weight (<1500 gr, VLBW) infants were gradually substituted by milder lesions with debatable prognoses.
Objective:The objective of this study is to define type, frequency and 3 years of neurodevelopmental outcome of prematurity-related brain lesions in a modern cohort of VLBW infants.
Methods:VLBW infants admitted to our NICU in 5 years period with brain MRI at term-equivalent age were included. MRI scans were reviewed to identify and grade white matter lesions (WML), intraventricular hemorrhage (IVH), and cerebellar hemorrhage (CBH). Linear measurements of brain size, biparietal width (BPW) and trans-cerebellar diameter (TCD) were carried out. Total maturation score (TMS) was calculated. Developmental Coefficients (DQ) on Griffiths Scale at 3 years of age were compared between patients with different types and grades of lesions and patients without lesions; possible correlations between linear brain measurements, brain maturation and outcome were explored.
Results:Study included 407 patients. Of them, 187 (46%) had at least one brain lesion on MRI, while 37 (9%) had severe lesions. The most frequent lesion was IVH (28%), followed by WML (21%) and CBH (17%). Mild and severe IVH, moderate and severe WML and all grades of CBH were related to worst outcome at 3 years. In patients without lesions, small BPW and small TCD were associated with worse outcomes. No correlations were observed between TMS and outcome.
Conclusion:We have observed that even mild brain lesions have a negative influence on neurological outcome at 3 years of age.


