搜索结果：Advances in pediatrics

Timely and comprehensive analyses of causes of death stratified by age, sex, and location are essential for shaping effective health policies aimed at reducing global mortality. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 provides cause-specific mortality estimates measured in counts, rates, and years of life lost (YLLs). GBD 2023 aimed to enhance our understanding of the relationship between age and cause of death by quantifying the probability of dying before age 70 years (70q0) and the mean age at death by cause and sex. This study enables comparisons of the impact of causes of death over time, offering a deeper understanding of how these causes affect global populations. GBD 2023 produced estimates for 292 causes of death disaggregated by age-sex-location-year in 204 countries and territories and 660 subnational locations for each year from 1990 until 2023. We used a modelling tool developed for GBD, the Cause of Death Ensemble model (CODEm), to estimate cause-specific death rates for most causes. We computed YLLs as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. Probability of death was calculated as the chance of dying from a given cause in a specific age period, for a specific population. Mean age at death was calculated by first assigning the midpoint age of each age group for every death, followed by computing the mean of all midpoint ages across all deaths attributed to a given cause. We used GBD death estimates to calculate the observed mean age at death and to model the expected mean age across causes, sexes, years, and locations. The expected mean age reflects the expected mean age at death for individuals within a population, based on global mortality rates and the population's age structure. Comparatively, the observed mean age represents the actual mean age at death, influenced by all factors unique to a location-specific population, including its age structure. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 250-draw distribution for each metric. Findings are reported as counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2023 include a correction for the misclassification of deaths due to COVID-19, updates to the method used to estimate COVID-19, and updates to the CODEm modelling framework. This analysis used 55 761 data sources, including vital registration and verbal autopsy data as well as data from surveys, censuses, surveillance systems, and cancer registries, among others. For GBD 2023, there were 312 new country-years of vital registration cause-of-death data, 3 country-years of surveillance data, 51 country-years of verbal autopsy data, and 144 country-years of other data types that were added to those used in previous GBD rounds. The initial years of the COVID-19 pandemic caused shifts in long-standing rankings of the leading causes of global deaths: it ranked as the number one age-standardised cause of death at Level 3 of the GBD cause classification hierarchy in 2021. By 2023, COVID-19 dropped to the 20th place among the leading global causes, returning the rankings of the leading two causes to those typical across the time series (ie, ischaemic heart disease and stroke). While ischaemic heart disease and stroke persist as leading causes of death, there has been progress in reducing their age-standardised mortality rates globally. Four other leading causes have also shown large declines in global age-standardised mortality rates across the study period: diarrhoeal diseases, tuberculosis, stomach cancer, and measles. Other causes of death showed disparate patterns between sexes, notably for deaths from conflict and terrorism in some locations. A large reduction in age-standardised rates of YLLs occurred for neonatal disorders. Despite this, neonatal disorders remained the leading cause of global YLLs over the period studied, except in 2021, when COVID-19 was temporarily the leading cause. Compared to 1990, there has been a considerable reduction in total YLLs in many vaccine-preventable diseases, most notably diphtheria, pertussis, tetanus, and measles. In addition, this study quantified the mean age at death for all-cause mortality and cause-specific mortality and found noticeable variation by sex and location. The global all-cause mean age at death increased from 46·8 years (95% UI 46·6-47·0) in 1990 to 63·4 years (63·1-63·7) in 2023. For males, mean age increased from 45·4 years (45·1-45·7) to 61·2 years (60·7-61·6), and for females it increased from 48·5 years (48·1-48·8) to 65·9 years (65·5-66·3), from 1990 to 2023. The highest all-cause mean age at death in 2023 was found in the high-income super-region, where the mean age for females reached 80·9 years (80·9-81·0) and for males 74·8 years (74·8-74·9). By comparison, the lowest all-cause mean age at death occurred in sub-Saharan Africa, where it was 38·0 years (37·5-38·4) for females and 35·6 years (35·2-35·9) for males in 2023. Lastly, our study found that all-cause 70q0 decreased across each GBD super-region and region from 2000 to 2023, although with large variability between them. For females, we found that 70q0 notably increased from drug use disorders and conflict and terrorism. Leading causes that increased 70q0 for males also included drug use disorders, as well as diabetes. In sub-Saharan Africa, there was an increase in 70q0 for many non-communicable diseases (NCDs). Additionally, the mean age at death from NCDs was lower than the expected mean age at death for this super-region. By comparison, there was an increase in 70q0 for drug use disorders in the high-income super-region, which also had an observed mean age at death lower than the expected value. We examined global mortality patterns over the past three decades, highlighting-with enhanced estimation methods-the impacts of major events such as the COVID-19 pandemic, in addition to broader trends such as increasing NCDs in low-income regions that reflect ongoing shifts in the global epidemiological transition. This study also delves into premature mortality patterns, exploring the interplay between age and causes of death and deepening our understanding of where targeted resources could be applied to further reduce preventable sources of mortality. We provide essential insights into global and regional health disparities, identifying locations in need of targeted interventions to address both communicable and non-communicable diseases. There is an ever-present need for strengthened health-care systems that are resilient to future pandemics and the shifting burden of disease, particularly among ageing populations in regions with high mortality rates. Robust estimates of causes of death are increasingly essential to inform health priorities and guide efforts toward achieving global health equity. The need for global collaboration to reduce preventable mortality is more important than ever, as shifting burdens of disease are affecting all nations, albeit at different paces and scales. Gates Foundation.

Enteric infectious diseases claim more than 1 million lives annually and are among the top ten causes of death in children younger than 5 years. Remarkable global investment has been dedicated to enteric infectious disease prevention and control; however, the shifting global health landscape is testing the continuance of progress. To evaluate the current status and guide future interventions, we present the latest epidemiological estimates of enteric infectious diseases from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 and assess progress towards the Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea (GAPPD) mortality target of fewer than 20 deaths per 100 000 children younger than 5 years by 2025. We quantified the incidence, mortality, and disability-adjusted life-years (DALYs) of enteric infectious diseases by age, sex, and year across 204 countries and territories from 1990 to 2023. In GBD 2023, the following were considered under the category of enteric infectious diseases: diarrhoeal diseases, enteric fever (typhoid and paratyphoid), invasive non-typhoidal Salmonella spp (iNTS) infections, and other intestinal infectious diseases. We also examined 15 aetiologies contributing to diarrhoeal diseases. Incidence and prevalence were estimated with DisMod-MR (version 2.1), a Bayesian meta-regression tool, drawing on data from systematic reviews, population-based surveys, claims data, and hospital sources. Cause-specific mortality was modelled with Cause of Death Ensemble Modelling based on data from sources including vital registration, mortality surveillance, verbal autopsy, and minimally invasive tissue sampling. Years of life lost and years lived with disability were computed and combined to derive DALYs. For aetiology-specific estimation, population-attributable fractions (PAFs) for 15 pathogens were derived with a counterfactual framework. Point estimates and 95% uncertainty intervals (UIs) were generated from 250 draws from the posterior distribution. In 2023, enteric infectious diseases resulted in an estimated 1·27 million (95% UI 0·963-1·68) deaths globally, declining from 3·69 million (3·04-4·56) in 1990. The global age-standardised mortality rate (ASMR) decreased from 74·1 (62·0-92·9) per 100 000 population to 16·4 (12·6-21·3) per 100 000 population during the same period. Diarrhoeal diseases accounted for most deaths in 2023 (1·11 million [0·811-1·54]), followed by enteric fever and iNTS. South Asia and sub-Saharan Africa remained the most affected regions in 2023, with 599 000 (441 000-882 000) and 501 000 (373 000-648 000) deaths due to enteric infectious diseases, respectively, predominantly from diarrhoeal disease. Rotavirus was the leading cause of all-age diarrhoeal disease deaths (PAF 16·3% [12·0-21·5]), followed by norovirus (10·2% [2·4-17·0]) and Shigella spp (9·3% [5·4-15·2]). Among children younger than 5 years, PAFs of deaths due to diarrhoeal diseases were 40·2% (32·5-48·5) for rotavirus, 24·0% (15·1-36·7) for Shigella spp, and 23·4% (13·7-34·3) for adenovirus. Across 204 countries and territories, 141 met the GAPPD mortality target in 2023. The driving aetiologies among countries that did not meet the target in 2023 varied slightly by GBD super-region, but the highest or second-highest number of deaths in children younger than 5 years were consistently attributed to rotavirus. Astrovirus and sapovirus, newly included in GBD 2023, were responsible for 24 600 (6290-49 000) and 18 800 (4650-44 400) deaths, respectively, in 2023, mainly in children younger than 5 years. Our findings show that mortality and ASMRs of enteric infectious diseases declined substantially between 1990 and 2023. This decline is consistent with the expansion of public health measures and broader socioeconomic development. However, the burden in 2023 remains considerably high, with the highest mortality concentrated in sub-Saharan Africa and south Asia. Considering that more than a quarter of all countries had yet to meet the GAPPD mortality target in 2023, sustained efforts are needed to address the persistent burden in affected countries and to adapt to the changing global health landscape. Gates Foundation.

Hyperglycemia in pregnancy is associated with increased maternal and fetal morbidity and long-term health risks for both mother and child. For the first time our current guidelines integrate gestational diabetes mellitus (GDM) and preconception diabetes into joint guidelines. While the characteristics of individual diabetes subtypes are addressed separately, recommendations regarding lifestyle, glucose monitoring and pharmacotherapy apply to all forms of hyperglycemia during pregnancy. Women with diabetes diagnosed early in pregnancy are classified as pregnant women with overt diabetes, whereas GDM is usually identified by oral glucose tolerance testing (oGTT) between 24 and 28 weeks gestation, or earlier in high-risk patients. A novel aspect is the consideration of specific diagnostic criteria for early GDM. Key management strategies include nutritional counselling, regular self-monitoring of blood glucose and physical activity, with insulin as the treatment of choice if glycemic targets are not achieved. In women with preconception diabetes, pregnancy planning, preconception metabolic optimization and close interdisciplinary care are essential. Technical advances in continuous glucose monitoring, insulin pump therapy and automated insulin delivery (AID) systems are becoming increasingly more relevant in pregnancy. Postpartum, women with GDM should undergo an oGTT 4-12 weeks after delivery, with follow-up screening every 1-3 years if results are normal. All affected women should be informed about their elevated risk of type 2 diabetes and cardiovascular diseases. Breastfeeding is strongly recommended. Children of mothers with GDM or diabetes require long-term follow-up due to an increased risk of obesity and developmental disorders. Hyperglykämie in der Schwangerschaft ist mit erhöhter mütterlicher und fetaler Morbidität sowie langfristigen Risiken für Mutter und Kind assoziiert. Unsere aktuelle Leitlinie fasst erstmals Gestationsdiabetes (GDM) und präkonzeptionellen Diabetes in einer gemeinsamen Leitlinie zusammen. Während die Besonderheiten der einzelnen Diabetesformen getrennt dargestellt werden, gelten Empfehlungen zu Lebensstil, Glukosemonitoring und Pharmakotherapie für alle Formen der Hyperglykämie in der Schwangerschaft. Frauen mit in der Frühschwangerschaft diagnostiziertem Diabetes gelten als Schwangere mit manifestem Diabetes, während GDM üblicherweise zwischen der 24. und 28. Schwangerschaftswoche mittels oGTT diagnostiziert wird, bei Hochrisikopatientinnen auch früher. Eine Neuerung ist die Diskussion eigener Diagnosekriterien für einen frühen GDM. Zentrale Therapieelemente sind Ernährungsberatung, regelmäßige Blutzuckerselbstkontrollen und körperliche Aktivität; bei unzureichender Stoffwechselkontrolle ist Insulin die Therapie der Wahl. Bei präkonzeptionellem Diabetes sind Schwangerschaftsplanung, präkonzeptionelle Stoffwechseloptimierung sowie eine engmaschige Betreuung essenziell. Technische Fortschritte im kontinuierlichen Glukosemonitoring, in der Pumpentherapie und bei AID-Systemen gewinnen auch in der Schwangerschaft zunehmend an Bedeutung. Postpartal wird bei Frauen mit GDM ein oGTT nach 4 bis 12 Wochen empfohlen, bei Normalbefund mit Nachsorgeuntersuchungen alle 1 bis 3 Jahre. Alle Betroffenen sollen über ihr erhöhtes Risiko für Typ-2-Diabetes und kardiovaskuläre Erkrankungen aufgeklärt werden. Stillen wird ausdrücklich empfohlen. Kinder von Müttern mit GDM oder Diabetes sollten aufgrund eines erhöhten Risikos für Adipositas und Entwicklungsauffälligkeiten langfristig nachbetreut werden.

The 22q11.2 deletion syndrome (22q11DS) is an autosomal dominant genetic syndrome, frequently due to a microdeletion located on chromosome 22, presenting a wide variety of clinical manifestations. Cytogenetic methods, such as fluorescence in situ hybridization (FISH), and molecular biology techniques, such as multiplex ligation-dependent probe amplification (MLPA), are used to identify chromosomal deletions specific to the 22q11.2 region. This study aimed to describe the first series of pediatric patients in Morocco, selected for their strong suspicion of DiGeorge syndrome. As part of a collaboration between the University Hospital Center Hassan II in Fez and the University Hospital Center Abderrahim El Harouchi Ibn Rochd in Casablanca, Morocco, a prospective study was carried out from January 2021 to January 2024 on 30 patients screened for DiGeorge syndrome (DGS). The children included had at least two major signs of DGS. Diagnostic confirmation of 22q11DS was obtained by FISH analysis for all patients. In addition, MLPA analysis was performed on five patients among those confirmed by FISH. The MLPA process included DNA extraction, PCR amplification and capillary electrophoresis, with results analyzed using GeneMapper and Coffalyser software. Of the 30 patients selected, 22 were confirmed as having a 22q11DS. Among these, 19 had congenital heart disease and 17 had hypocalcemia, which was often associated with hypoparathyroidism. Facial dysmorphia was almost constant, and thymic abnormalities were observed in half the patients. Recurrent infections, hematological disorders and immune abnormalities were also common, underlining the clinical complexity of the syndrome. Advances in molecular cytogenetics have enabled precise detection of microdeletions associated with 22q11DS, highlighting its global importance, but also revealing regional diagnostic challenges. Larger cohort studies are needed to strengthen the validity of results and improve clinical management approaches. Introduction: The 22q11.2 deletion syndrome (22q11DS) is an autosomal dominant genetic syndrome, frequently due to a microdeletion located on chromosome 22, presenting a wide variety of clinical manifestations. Cytogenetic methods, such as fluorescence in situ hybridization (FISH), and molecular biology techniques, such as multiplex ligation-dependent probe amplification (MLPA), are used to identify chromosomal deletions specific to the 22q11.2 region. Aim: This study aimed to describe the first series of pediatric patients in Morocco, selected for their strong suspicion of DiGeorge syndrome. Methods: As part of a collaboration between the University Hospital Center Hassan II in Fez and the University Hospital Center Abderrahim El Harouchi Ibn Rochd in Casablanca, Morocco, a prospective study was carried out from January 2021 to January 2024 on 30 patients screened for DiGeorge syndrome (DGS). The children included had at least two major signs of DGS. Diagnostic confirmation of 22q11DS was obtained by FISH analysis for all patients. In addition, MLPA analysis was performed on five patients among those confirmed by FISH. The MLPA process included DNA extraction, PCR amplification and capillary electrophoresis, with results analyzed using GeneMapper and Coffalyser software. Results: Of the 30 patients selected, 22 were confirmed as having a 22q11DS. Among these, 19 had congenital heart disease and 17 had hypocalcemia, which was often associated with hypoparathyroidism. Facial dysmorphia was almost constant, and thymic abnormalities were observed in half the patients. Recurrent infections, hematological disorders and immune abnormalities were also common, underlining the clinical complexity of the syndrome. Conclusion: Advances in molecular cytogenetics have enabled precise detection of microdeletions associated with 22q11DS, highlighting its global importance, but also revealing regional diagnostic challenges. Larger cohort studies are needed to strengthen the validity of results and improve clinical management approaches.

The human body has abundant mechanisms to counteract hypoglycemia and prevent neuroglycopenia primarily involving the secretion of glucagon and adrenalin. Within several years from the onset of diabetes, people with type 1 diabetes lose their ability to mount a counterregulatory response to hypoglycemia and develop hypoglycemia unawareness, thus being at risk for deteriorating to a state of severe hypoglycemia and neuroglycopenia. Pregnant individuals with type 1 diabetes are particularly prone to experience severe hypoglycemia during the first half of pregnancy. This may be not only due to the institution of strict glycemic control and the nausea and vomiting prevalent during the early months of pregnancy, but also because the counterregulatory responses are further diminished during pregnancy. Severe hypoglycemia during early pregnancy does not appear to increase the risks of spontaneous abortion or congenital fetal malformations, but the potential long-term effects on the fetus are unknown. Recent technological advances have contributed to improved glycemic control and time in range as well as decreased risk of hypoglycemia in people with diabetes. These advances include treatment with insulin analogs, use of continuous glucose monitors, and closed-loop systems for administration of insulin. Limited studies have demonstrated that pregnant individuals with type 1 diabetes may also benefit from these modalities. While ongoing research continues to explore the adjustment of closed-loop systems for optimal use during pregnancy, more effort is needed to explore the optimal use of these modalities in pregnancy. · People with type 1 diabetes have diminished counterregulatory responses to hypoglycemia and frequently develop hypoglycemia unawareness.. · Pregnant individuals with type 1 diabetes are at increased risk for severe hypoglycemia particularly during the first half of pregnancy.. · Use of insulin analogs and newer technologies for insulin administration may lower the risk of hypoglycemia in pregnant individuals with type 1 diabetes..

Adamantinomatous craniopharyngioma (ACP) is a benign but histologically complex brain tumor that arises in the sellar or suprasellar region. Contrast-enhanced MRI of the brain is the standard of care for radiologic follow-up. Numerous studies have demonstrated gadolinium retention in the brain and body as a result of gadolinium-based contrast agent (GBCA) usage in MRI. While the clinical consequences of GBCA retention remain unknown, the concern for potential injury combined with advances in noncontrast imaging has promoted efforts to determine the necessity for contrast enhancement in the care of pediatric patients, particularly those with brain tumors. This study aims to evaluate the agreement and interrater reliability between noncontrast and contrast-enhanced MRI in the routine surveillance of children with ACP. We conducted a retrospective review of MR imaging for 25 patients with ACP undergoing routine imaging follow-up assessment. Pre- and postcontrast-enhanced MRI sequences were evaluated by 2 pediatric neuroradiologists. Three consecutive 1-year follow-up scans were graded based on the characteristics of the solid and cystic components of the residual lesion. Percent agreement and interrater reliability were determined for grading between contrasted and unenhanced MRI scans. The mean age of patients was 8.72 ± 4.59 years, and the mean time between scans was 12.60 ± 4.08 months and 14.48 ± 7.77 months from the first to second and second to third scans, respectively. Interrater reliability between grading by using contrast-enhanced and unenhanced MRIs was high. We observed a Cohen κ of 0.961 (95% CI, 0.92-1.0) when evaluating the cystic tumor and a Cohen κ of 0.80 (95% CI, 0.68-0.92) when assessing the solid tumor. The percent agreement between grading by using contrast-enhanced and unenhanced MRI for the cystic tumor component was 98.7% (74/75) for radiologist 1, and 97.3% (73/75) for radiologist 2. The percent agreement between grading by using contrast-enhanced and unenhanced MRI for the solid tumor component was 93.3% (70/75) for both radiologists. For children with ACP and known residual disease, noncontrast MRI may be sufficient for the assessment of solid tumor or cyst growth.

Advances in cancer detection and treatment have resulted in a growing population of survivors. Many face long-term physical, psychological, and financial challenges that are unevenly distributed across socioeconomic, racial, and demographic groups. Clinical guidelines should provide recommendations to guide survivorship care and ensure equity. To provide an overview of recommendations from existing guidelines addressing follow-up care after cancer. International and German clinical guidelines were identified through a systematic search of MEDLINE, TRIP, GuidelineCentral, NICE, G-I-N and SIGN, complemented by manual searches of relevant registries (AWMF, Onkopedia, ESMO, IGHG). Guidelines were included if they contained at least one recommendation on follow-up or survivorship care. Screening was performed independently by two reviewers. Recommendations were coded using a predefined framework and synthesized using tables and interactive evidence-maps. 198 guidelines comprising 2270 recommendations were included. The most frequently represented categories were cross-sectional guidelines (i.e., not limited to a specific cancer type) (n = 36), followed by gastrointestinal tumors (n = 15) and myeloid proliferations (n = 14); most targeted adults (n = 150). Of all recommendations, 39% were evidence-based. Frequently addressed topics included previous treatment (n = 342), long-term survivorship (>5 years) (n = 705), screening for adverse events (n = 263), timing of follow-up (n = 338), and counselling and education (n = 234). The extent to which recommendations explicitly addressed equity-related factors varied considerably: age was frequently considered (n = 160), whereas socioeconomic status (n = 18), race/ethnicity (n = 5), and religion/culture (n = 6) were rarely addressed. Survivorship care was addressed heterogeneously across guidelines, with long-term and equity aspects underrepresented. More consistent, evidence-based and equity-oriented guideline development is needed.

Maternal obesity is increasingly recognized as an important modulator of early-life microbial and metabolic environments. This study investigates the association between maternal body mass index (BMI) and the microbiota and metabolite profiles of colostrum and neonatal feces in a Mexican mother–infant cohort. Milk and fecal samples were collected from dyads of obese and normal-weight mothers. Bacterial microbiota composition was characterized by sequencing the 16 S rRNA gene (V3 region) using Ion Torrent technology, and metabolomic profiling was performed using Fourier transform ion cyclotron resonance (FT-ICR) mass spectrometry. The results provide evidence consistent with vertical microbial and metabolic transmission, with Firmicutes and Patescibacteria predominating in Colostrum. Neonates born to obese mothers exhibited reduced relative abundances of Lactobacillus in neonatal fecal samples, alongside increased levels of Lactobacillus and Staphylococcus in both colostrum and mother´s feces. Overall microbial diversity across maternal stool, colostrum, and neonatal stool samples was not significantly associated with maternal BMI; however, distinct metabolite signatures linked to maternal obesity, like oligopeptides, glycoside-related compounds, Phosphatidic Acid (PA) Derivatives, bioactive molecules such as enkephalinamide derivatives, were observed. These findings highlight the role of breastfeeding as a key interface in shaping the neonatal gut microbiota and metabolome and suggest potential pathways linking maternal metabolic status with early-life microbial and metabolic programming. This study advances understanding of maternal–infant microbial ecology and supports further investigation into the long-term health implications of maternal obesity.

Acute kidney injury (AKI) is a common condition globally associated with substantial morbidity, mortality and costs to health-care systems. The epidemiology and outcomes of AKI differ within and between countries, and depend on multiple factors. Social determinants of health (SDoHs) are the circumstances in which people are born, grow, work, live and age, including the broader set of forces and systems that influence the conditions of everyday life. Despite advances in medical care, many inequities, including those associated with socioeconomic status, race, ethnicity, gender and environment, persist and are increasingly recognized to influence health outcomes. Superimposed on these inequities are differences in access to health care and health resources, including public health prevention, access to screening, early diagnosis and treatment (including kidney replacement therapy), and quality of care, which vary within and between high- and low-resource settings. Over the past few years, these disparities have intensified as societies have emerged from a global pandemic and are challenged with accelerating climate change and escalating levels of global conflict. However, the role of SDoHs remains poorly defined for people with or at risk of AKI. Targeted policies addressing SDoHs are essential to reduce AKI burden globally. Here, we examine the effects of SDoHs on the incidence, recognition, management, follow-up and outcomes of adult and paediatric populations at risk of or with AKI.

Among the various etiologies related to the presence of abdominal masses in newborns, the diagnosis of fetus in fetu (FIF), a term used to describe a congenital condition in which one fetus parasitizes the body, should be considered. We present the case of a male newborn who was found to have an abdominal mass during perinatal evaluation, leading to termination of pregnancy by cesarean section. After a thorough evaluation, a protocol was established that resulted in surgical intervention and the diagnosis of FIF. FIF is an exceptionally rare entity characterized by the presence of a "parasitic twin." Its pathophysiology and risk factors remain poorly understood, but it must be considered in the differential diagnosis of neonatal abdominal masses. Owing to its rarity, standardized follow-up protocols have not been established. Nevertheless, with current advances in pediatric surgery, the prognosis after complete excision is favorable. Dentro de las múltiples causas asociadas a la presencia de masas abdominales en el neonato debe considerarse entre las posibilidades diagnósticas el fetus-in-fetu (FIF), término utilizado para describir una condición congénita caracterizada por la presencia de un feto parasitado dentro del cuerpo de su gemelo. Corresponde reportar el caso de un recién nacido de sexo masculino, en quien se detectó la presencia de una masa abdominal durante la evaluación perinatal, por lo que se decidió el nacimiento de dicho producto por vía abdominal. Se le evaluó y protocolizó de manera integral, realizando abordaje quirúrgico y obteniendo como diagnóstico FIF. El FIF es una condición poco común, caracterizada por la presencia de un «gemelo fantasma», cuya explicación fisiopatología y/o factores de riesgo aún no se encuentran del todo dilucidados, pero que tiene que considerarse como una posibilidad diagnóstica dentro del espectro de las masas abdominales del recién nacido. Por esta infrecuencia, aún no existen protocolos descritos para el seguimiento de estos pacientes. Afortunadamente, gracias al desarrollo de las técnicas quirúrgicas en pediatría, el pronóstico y sobrevida de estos pacientes una vez resuelto el condicionante inicial es bastante favorable.

Advances in pediatric and adolescent young adult Hodgkin lymphoma (HL), including the incorporation of targeted therapy and immunotherapy have resulted in excellent cure rates with survival greater than 90%, including patients with advanced stage disease. Current trials seek to maintain excellent survival while reducing acute and long-term toxicities. Despite these successes, vulnerable patient populations, including Black, Hispanic, and adolescent young adult patients, continue to have inferior outcomes. This article reviews recent therapeutic advances in HL, summarizes therapeutic gaps, and highlights opportunities to improve outcomes in patients with social and economic disparities.

Trisomy 21 (T21) is the most common chromosomal disorder worldwide and the leading cause of intellectual disability. Individuals with T21 present with unique facial features, developmental challenges, and multiorgan system defects including cardiovascular, pulmonary, gastrointestinal, endocrine, neurologic, hematological, immunologic diseases, and other systems. We reviewed the latest changes and advances in T21 management over the last 10 years, focusing on new findings and improvements in diagnosing, preventing, and treating complications across different organ systems, which have led to a longer lifespan and better quality of life for children with T21.

Procalcitonin (PCT) has been increasingly evaluated as a biomarker in clinical situations where it is important to distinguish bacterial infection from viral and other inflammatory conditions. When added to other clinical and laboratory markers, PCT has comparably high sensitivity but markedly better specificity for detecting invasive bacterial infections in febrile young infants than decision algorithms not including PCT. For febrile infants, evidence shows PCT reduces unnecesary lumbar punctures (LPs), hospitalizations, and antibiotic use. PCT has also been documented to accurately distinguish between acute pyelonephritis and cystitis. Implementation strategies have succeeded in incorporating PCT into clinical care.

Biliary atresia is a leading cause of neonatal cholestasis and the most common indication for pediatric liver transplantation. Early recognition is critical, as outcomes depend on timely surgical intervention with the Kasai portoenterostomy. Advances in the diagnostic work-up of infant jaundice now emphasize earlier differentiation of cholestatic from physiologic causes using fractionated bilirubin screening, direct bilirubin measurement in newborn panels, and noninvasive imaging techniques such as ultrasound. Emerging biomarkers and genetic testing show promise in supporting earlier detection, reducing delays in referral, and improving long-term outcomes for infants with biliary atresia.

Chronic respiratory diseases, including chronic obstructive pulmonary disease (COPD), asthma, pneumoconiosis, interstitial lung disease (ILD) and pulmonary sarcoidosis, are major global causes of mortality and morbidity. Although the COVID-19 pandemic has influenced acute respiratory health, its impact on chronic respiratory conditions remains unclear. We estimated the global, regional and national burden of chronic respiratory diseases from 1990 to 2023, including risk factors, and evaluated how these burdens have shifted during the COVID-19 pandemic using the Global Burden of Disease Study 2023. In 2023, chronic respiratory diseases accounted for 569.2 million (95% uncertainty interval (UI), 508.8-639.8) cases and 4.2 million (3.6-5.1) deaths. The age-standardized death rate declined by 25.7% globally from 1990 to 2023 despite an increase in ILD and pulmonary sarcoidosis. Mortality declined in younger males, especially for asthma, whereas older adults experienced a rise in ILD and pulmonary sarcoidosis. Smoking was the primary risk factor for COPD, whereas high body mass index and silica exposure were key risk factors for asthma and pneumoconiosis. During the pandemic, the incidence of chronic respiratory diseases increased modestly, but the decline in mortality rates became more pronounced, highlighting the need for sustained global attention and action to address their long-term burden.

Maternal-fetal surgery has advanced rapidly, offering targeted prenatal interventions that can improve outcomes for conditions such as myelomeningocele, sacrococcygeal teratoma, congenital diaphragmatic hernia, lung lesions, lower urinary tract obstruction, and twin-twin transfusion syndrome. This review summarizes current fetal therapies, patient selection, contraindications, and maternal risks, emphasizing the need for multidisciplinary evaluation. Emerging innovations, including fetoscopic repair techniques, stem cell and gene-based therapies, and tissue engineering, highlight the expanding potential of fetal intervention. Ethical frameworks remain essential to ensure that maternal autonomy and safety are prioritized while pursuing fetal benefit.

This review synthesizes emerging evidence on gastrointestinal (GI) disorders, specifically luminal and pancreatic function in the era of triple cystic fibrosis transmembrane conductance regulator (CFTR) modulator therapy. Elexacaftor-tezacaftor-ivacaftor has been associated with mild improvements in GI symptoms and disease burden in patients' reported outcomes and has shown a significant increase in growth and body mass index reflecting improved nutritional status, even among individuals who remain pancreatic insufficient. Long-term data on triple CFTR modulators remain limited, highlighting the need to understand their long-term impact on GI manifestations, as survival improves and chronic intestinal inflammation persists.

Advances in cancer treatment have led to an increased number of survivors who may subsequently have children. We aim to describe the prevalence of a parental cancer history with and without the utilization of in vitro fertilization (IVF) in several states in the United States. This study used data from IVF cycles resulting in live births reported to the Society for Assisted Reproductive Technology Clinic Outcome Reporting System from 2004 to 2018. These were linked to birth certificates and cancer registries in 3 states (New York, Massachusetts, and North Carolina). For each IVF-conceived delivery, the subsequent 10 deliveries were used as the naturally conceived comparison group. A parent's cancer history was included if the diagnosis preceded the birth of the first child. There were 814&#x200a;658 births (82&#x200a;544 IVF-conceived and 732&#x200a;114 naturally conceived births) in our analysis. Among births conceived naturally, 0.5% of mothers and 0.4% of fathers had a cancer history compared with 1.2% of mothers and 1.8% of fathers among IVF-conceived births. The prevalence of cancer history increased over the study period (P&#xa0;&#x2264;.004). The most common cancers among mothers were thyroid or endocrine (28.7%) and breast (12.2%) vs male genital (26.3%) and thyroid or endocrine (9.1%) among fathers. There were higher rates of male and female genital malignancies, female breast, and female lymphoid or hematopoietic cancers among parents who conceived with IVF (P&#x2009;<&#x2009;.001). Overall, 1.1% of all births and 3.0% of IVF-conceived births had at least 1 parent with a cancer history with an increasing prevalence over the study period, highlighting the importance of oncofertility programs.

Pediatric hidradenitis suppurativa is a chronic relapsing skin disease that peaks in adolescence and is often misdiagnosed. Clinical diagnosis is made by identifying recurrent, painful nodules in flexural sites that have risk of tunneling and scarring. Initiate education, gentle skin care, and topical therapy while adding age-appropriate oral antibiotics when indicated. Screen for comorbidities and refer early to dermatology for medical management as well as procedural and biological treatments.