World Journal of Pediatrics

Publisher: Zhejiang da xue. Institute of Pediatrics, Springer Verlag


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Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND: Children are in a continuous and dynamically changing state of growth and development. A thorough understanding of developmental pharmacokinetics (PK) and pharmacodynamics (PD) is required to optimize drug therapy in children. DATA SOURCES: Based on recent publications and the experience of our group, we present an outline on integrating pharmacometrics in pediatric clinical practice to develop evidence-based personalized pharmacotherapy. RESULTS: Antibiotics in septic neonates and immunosuppressants in pediatric transplant recipients are provided as proof-of-concept to demonstrate the utility of pharmacometrics in clinical practice. Dosage individualization based on developmental PK-PD model has potential benefits of improving the efficacy and safety of drug therapy in children. CONCLUSION: The pharmacometric technique should be better developed and used in clinical practice to personalize drug therapy in children in order to decrease variability of drug exposure and associated risks of overdose or underdose.
    World Journal of Pediatrics 08/2014; 10(3):197-203.
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    ABSTRACT: Background. Most studies on physical fitness and detraining have been conducted on normal-weight children. Their results indicate that any gains regress to the untrained control values during the detraining period. It therefore seems necessary to determine how detraining affects the different fitness parameters in obese children. The aim of the present study was to evaluate the effects of detraining (6 months) on kinanthropometry and the components of physical fitness after an intervention (31 months) consisting of a program of exercise and/or diet for obese boys. Methods. The participants were 18 boys, ages between 8 and 11, divided into two groups according to the program they followed. The E group followed a physical exercise program (three 90-minute sessions/week), and the E+D group this physical exercise program plus a low calorie diet. Physical fitness was assessed by the European physical fitness test battery including flamingo balance, plate tapping, sit-and-reach, standing broad jump, hand-grip strength, sit-ups, bent-arm hang, 10×5-metre shuttle run, and 20-metre endurance shuttle run. The Kruskal-Wallis test was applied to reveal overall intergroup differences (E and E+D group), and measurements showing significant differences were further analysed for differences between individual groups by the Mann-Whitney U-test. Results. In both groups, changes were observed in various physical fitness parameters, especially limb speed (E group, p=0.001; E+D group, p=0.002), agility (E group, p<0.001; E+D group, p<0.001), and aerobic fitness (E group, p=0.009; E+D group, p=0.002). Conclusions. Detraining after a long-term intervention based on the combination of exercise program and exercise program plus diet in obese boys does not affect the changes attained during the intervention.
    World Journal of Pediatrics 01/2014; 10(1):38-45.
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    ABSTRACT: The problem of obesity in children has grown considerably in recent years in the United States as well as the rest of the world. This has resulted in a marked increase in the prevalence of nonalcoholic liver disease in the pediatric age group. Nonalcoholic fatty liver disease (NAFLD) is currently the most common hepatic disorder seen in pediatric hepatology practice. We have reviewed the most recent literature regarding the prevalence, pathogenesis as well as the most recent advances in the diagnostic and therapeutic modalities of NAFLD in children. NAFLD affects a substantial portion of the population including children. The rising incidence of NAFLD, nonalcoholic steatohepatitis (NASH) and cirrhosis emphasizes the need for effective treatment options. The lack of complete understanding of the pathogenesis of NAFLD still limits our ability to develop novel therapeutic modalities that can target the metabolic derangements implicated in the development of the disorder.
    World Journal of Pediatrics 11/2009; 5(4):245-54.
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    ABSTRACT: Gastrointestinal duplications are rare congenital abnormalities known to occur at any level of the alimentary tract from the mouth to the anus. The cause of intestinal duplication has not been established. Several theories have been put forward to explain different types of duplications. Some of these duplications are large sized and giant, and only 4 cases have been reported. A 4-year-old girl was referred to our hospital with a history of abdominal pain, abdominal distension, and diarrhea mixed with black blood for 20 days. Technetium-99m scintigraphy identified heterotopic gastric mucosa at the middle and lower abdominal region. Enteric duplication was suspected. Operatively, duplication was found to be located at the ileum with abnormal hypertrophy in shape, 50 cm of the ileum was resected, and an ileoileal end-to-end anastomosis was made. Stomach-like mucosa and some ring structures were identified instead of the normal intestinal mucosa when opening this ileal duplication. Microscopically, most of mucosa showed gastric corpusfundic glands. This is an unusual case of enteric duplication. Ultrasonography, computed tomography and technetium-99m scintigraphy are helpful in the diagnosis of duplication.
    World Journal of Pediatrics 11/2009; 5(4):322-4.
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    ABSTRACT: Anemia is a widespread public health problem, which is due to many factors, nutritional or non-nutritional. Iron, vitamin A and growth status were assessed to investigate anemia of preschool children in suburb Chongqing, China. A descriptive, cross-sectional survey was performed on 459 preschool children aged 2 to 7 years randomly chosen from the kindergartens in 6 suburban districts of Chongqing. Weight and height levels, hemoglobin, erythrocyte protoporphyrin, serum retinol, and ferritin concentrations were measured to evaluate the anthropometric and nutritional status. The rates of stunt, underweight, overweight, wasting, obesity, anemia, iron deficiency, vitamin A deficiency (VAD), and marginal VAD were 6.3%, 3.9%, 3.7%, 1.5%, 3.1%, 23.5%, 15.0%, 6.3% and 25.9%, respectively. Serum retinol concentration was significantly lower in children with anemia than in those without anemia (P=0.003), and the retinol concentration was associated with hemoglobin (Pearson's correlation coefficient, r=0.22, P<0.01). Children with VAD had a significantly increased risk for anemia (odds ratio, 2.56; 95% confident interval, 1.15-5.70). In all 108 children with anemia, only 42 were related to VAD and 12 related to iron deficiency, suggesting that almost half of the anemia children cannot be explained solely by iron deficiency or VAD. Vitamin A and iron deficiency are still public health problems in some localities of China. Public health interventions in anemia control should be used to eliminate deficiencies of vitamin A, iron, and other micronutrients by deliberate supplementation. Attention must be paid to such deficiencies in high-risk groups, especially in preschool children.
    World Journal of Pediatrics 11/2009; 5(4):275-81.
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    ABSTRACT: Proteinuria is one of the risk factors for the progression of renal diseases including Alport syndrome (AS), a hereditary glomerular renal disease. This study aimed to evaluate the efficacy of angiotensin converting enzyme inhibitors (ACEIs) and/or tripterygium, a Chinese herbal medicine widely used in Chinese patients with hematuria and proteinuria, on proteinuria in patients with AS. Twenty-nine children were enrolled into this retrospective study. Patients were divided into 3 therapy groups: ACEI group, tripterygium group, and ACEI plus tripterygium group. In the 29 children, 23 were male and 6 female. In the ACEI group and the tripterygium group, the effective rate was 87.5% and 25.0%, respectively and in the ACEI plus tripterygium group was 42.9%. ACEI is effective in controlling proteinuria of AS patients. Tripterygium should be carefully administered in controlling proteinuria of AS patients.
    World Journal of Pediatrics 11/2009; 5(4):308-11.
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    ABSTRACT: Vitiligo is an acquired depigmentary disorder affecting around 1% of the world's population. In 25% of cases it has its onset prior to the age of 14 years. Articles on vitiligo in children published after 1995 were retrieved from PubMed. The prevalence, etiology, clinical presentation, differential diagnosis, treatment and management of vitiligo in children were summarized. Vitiligo is characterized by acquired, sharply demarcated depigmented macules or patches on the skin, the mucous membranes and/or white hair and it is mainly differentiated from congenital achromic skin lesions. It is frequently associated with various autoimmune diseases. Hashimoto's thyroiditis is the most common association in children. Information on the nature, possible causes and course of the disease leads to acceptance of the disorder and higher compliance with the treatment. The choice of medical treatment depends on the type, location and duration of lesions as well as the eagerness of the child and his/her parents to pursue therapy. The management of childhood vitiligo includes information and reassurance of young patients and their parents on the disease, thyroid investigation, avoidance of trigger factors, topical treatment and proper follow-up.
    World Journal of Pediatrics 11/2009; 5(4):265-8.
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    ABSTRACT: Congenital rubella syndrome (CRS) resulting from maternal rubella infection can result in miscarriages, still birth and rubella infection of the infant. The aim of this study was to evaluate the pattern and presentation of CRS over an 8-year period as seen in the University of Port-Harcourt Teaching Hospital (UPTH), Nigeria. The medical records of all cases of CRS presenting to the Pediatric Department of UPTH from January 2000 to December 2007 were reviewed. There were 16 394 babies delivered in UPTH from January 2000 to December 2007. Of these babies, 19 were clinically diagnosed as having CRS, but none had laboratory confirmation. They had a mean age of 5.1 +/-3.2 months (range: 1-11 months). Seventy-five percent of their mothers had presumed rubella infection during the first trimester of pregnancy. Cataract was noticed to be the most prominent systemic manifestation in 18 of the 19 babies. Other common manifestations included hearing impairment (n=14), microcephaly (n=13), patent ductus arteriosus (n=11), and low birth weight (n=10). A surge was observed in the number of babies with CRS from 2004 to 2007; however, this was not statistically significant (chi (2)=8.68, P=0.28). Unfortunately, long-term outcome of the 19 babies was not available. CRS is commonly diagnosed at our center. Thus, mounting effective surveillance for CRS and considering the inclusion of rubella vaccine in Nigeria are of extreme importance.
    World Journal of Pediatrics 11/2009; 5(4):287-91.
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    ABSTRACT: Obesity has made obesity-related diseases a worldwide problem. This study was undertaken to evaluate the effects of diet-oriented intervention on obese children with hypertension in China and to determine the relationship between anthropometric indexes and hypertension. A total of 469 obese children, aged 6 to 18 years, were evaluated between January 2001 and December 2005; 184 of them were diagnosed with hypertension. Hypertensive children were provided with individual diet-oriented intervention for more than 6 months. Physical exercises were recommended for obese children at least 30 minutes per day. Height, body weight, waist circumference, systolic blood pressure, and diastolic blood pressure were taken for each subject before and after intervention. Of the 184 children enrolled, 139 (75.5%; 86 boys) completed the study. Weight, body mass index (BMI), waist circumference, and hip circumference all decreased after a 6-month intervention, despite a 2.1 cm increase in height. Systolic and diastolic pressures decreased by 16.6 and 13.3 mmHg compared with baseline levels. Of the 139 children, 103 (74.1%) who had blood pressure in the normal range (<90th percentile for age and sex) were taken as a response group. The other 36 children who remained hypertensive showed no obvious differences in anthropometric measurements and were taken as a non-response group. Weight, BMI, BMI%, waist circumference, hip circumference and blood pressure in the 139 children showed significant differences after the intervention compared with baseline values. Weight, BMI, BMI%, waist circumference, and hip circumference were positively correlated with both systolic and diastolic blood pressures; they were correlated more strongly with systolic pressure than with diastolic pressure. Diet-oriented intervention can decrease blood pressure in most obese children with hypertension. Weight, height, BMI, BMI%, waist circumference, and hip circumference are closely associated with blood pressure.
    World Journal of Pediatrics 11/2009; 5(4):269-74.
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    ABSTRACT: Few studies on foreskin development and the practice of circumcision have been done in Chinese boys. This study aimed to determine the natural development process of foreskin in children. A total of 10 421 boys aged 0 to 18 years were studied. The condition of foreskin was classified into type I (phimosis), type II (partial phimosis), type III (adhesion of prepuce), type IV (normal), and type V (circumcised). Other abnormalities of the genitalia were also determined. The incidence of a completely retractile foreskin increased from 0% at birth to 42.26% in adolescence; however, the phimosis rate decreased with age from 99.7% to 6.81%. Other abnormalities included web penis, concealed penis, cryptorchidism, hydrocele, micropenis, inguinal hernia, and hypospadias. Incomplete separation of foreskin is common in children. Since it is a natural phenomenon to approach the adult condition until puberty, circumcision should be performed with cautions in children.
    World Journal of Pediatrics 11/2009; 5(4):312-5.
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    ABSTRACT: Celiac disease presents with a spectrum of clinical disorders. The variety of clinical presentations largely depends on age and extraintestinal findings. This study aimed to determine typical and atypical cases according to presenting symptoms and to evaluate their biochemical and pathological parameters. Eighty-seven patients with celiac disease in our unit between 2000 and 2007 were reviewed. Their diagnosis was made by serological and histological examination. The patients were divided into two groups according to their typical or atypical symptoms. The mean age of the patients at diagnosis was 8.2 years (range, 1-18 years), but patients presenting with typical symptoms were younger than those presenting with atypical symptoms. The patients in the two groups did not differ significantly in sex, weight and height Z scores except age. Diarrhea (96.3%), abdominal distention (65.4%) and failure to thrive (60%) were the most common clinical presentations in the typical group, and short stature (62.5%) and anemia (31.2%) were the most common in the atypical group. Total/subtotal villous atrophy was significantly higher in the typical group than in the atypical group. Many children with celiac disease show an atypical form. The understanding of presentations of celiac disease may prevent delayed diagnosis. Celiac disease should be specially investigated in patients with recurrent iron deficiency anemia, short stature and autoimmune disorders.
    World Journal of Pediatrics 11/2009; 5(4):282-6.
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    World Journal of Pediatrics 09/2009; 5(3):232-3.
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    ABSTRACT: Foreign body aspiration (FBA) into the tracheobronchial tree is a common problem in children necessitating prompt recognition and management. This study aimed to report our experience in airway foreign body removal by flexible bronchoscopy in children. A total of 1027 patients with FBA were reviewed retrospectively. They were 626 boys and 401 girls aged from 5 months to 14 years with a median age of 17 months. The clinical manifestations, radiological findings, bronchoscopic findings and complications of the procedure were analyzed. Among the patients, only 53.4% had a definite history of FBA. The most frequent symptom was paroxysmal cough (84.3%), followed by stridor or wheezing, fever and dyspnea. Chest X-ray showed emphysema in 68.8% of the patients, atelectasis in 13.3% and bronchopneumonia in 56.3%. A bronchoscope was inserted intranasally in most children, but through mouth and endotracheal tube in 17 and 3 children, respectively. Foreign bodies were removed successfully by flexible bronchoscopy with disposable grasping forceps or biopsy forceps in 938 (91.3%) of the patients. The other 89 patients turned to rigid bronchoscopy. During the procedures, 132 (12.9%) of the patients showed transient hypoxia, which was alleviated by oxygen supplement and/or temporary cessation of the procedure. A small amount of bleeding was found in 17 patients and bradycardia in 3. Air leak and laryngeal edema were noted in 2 patients and relieved within 24 hours. Flexible bronchoscopy is useful and safe in retrieving airway foreign bodies in children. With skilled personnel and perfect equipments, flexible bronchoscopy could be considered as the first choice for the removal of airway foreign body.
    World Journal of Pediatrics 09/2009; 5(3):191-5.