Children, neonates, and pregnant women are particularly vulnerable during disasters. Fragmentation between specialized pediatric-perinatal systems and general disaster response frameworks can hinder coordinated care. Following lessons from the 2011 Great East Japan Earthquake, Japan established the Disaster Liaison for Pediatric and Perinatal Medicine (DLPPM) to embed specialists within disaster command structures. However, large-scale activation under prolonged infrastructure disruption has not been systematically evaluated. We conducted a structured retrospective descriptive analysis of DLPPM operational records during the first month after the 2024 Noto Peninsula Earthquake. Activities were reviewed across five pre-specified domains to examine how the liaison framework functioned during the acute and subacute phases. DLPPM was integrated into the prefectural disaster headquarters and consolidated maternal-child health information, enabling centralized identification of 83 pregnant women, estimated to represent most pregnant women in the severely affected region. Twenty-one obstetric transfers were coordinated. Pediatric transfers and evacuation of medically dependent children were facilitated through established networks. During the subacute phase, DLPPM initiated maternal-child support measures, including a "Children's Conference" and a support website. These findings suggest that DLPPM functioned as a centralized coordination hub linking specialized clinical networks with disaster governance, although real-time identification of vulnerable families in shelters remained limited. Embedding pediatric and perinatal specialists within disaster headquarters can support structured medical coordination for vulnerable populations. Earlier and more systematic integration with public health and welfare systems is essential to extend this hub function beyond hospital-centered care.
In the previous study, persistent inflammation, immunosuppression, and catabolism syndrome in pediatrics (PIICS-p) criteria identified a subgroup with poor long-term prognosis. Pediatric sequential organ failure assessment (pSOFA) score is a well-known predictor of short-term mortality. We hypothesized that combining the pSOFA score and PIICS-p criteria could provide more comprehensive risk stratification. We conducted a retrospective cohort study in a PICU. Included were 285 eligible patients aged zero to 19 years with 15 days or longer of PICU stay between January 2019 and December 2023. The primary outcomes were death during the observation period and time from PICU day 14 to death. Patients were classified on PICU day 14: high pSOFA (> 8) or low, subsequently stratified by PIICS-p or not. The overall mortality rate was 47% (35/75) in high pSOFA, 32% (8/25) in low pSOFA/PIICS-p, and 10% (18/185) in low pSOFA/non-PIICS-p group (p < 0.001). In a multivariable Cox proportional hazards model, high pSOFA (HR 6.33, 95% CI 3.43-11.7, p < 0.001) and low pSOFA/PIICS-p (HR 3.14, 95% CI 1.28-7.69, p = 0.012) were identified as significant risk factors for mortality. The Kaplan-Meier curves showed significant differences among the three groups (p < 0.001). The high pSOFA group showed an early decline in survival. Survival in the low pSOFA/PIICS-p group was lower than that in the low pSOFA/non-PIICS-p group, and the difference widened over time. Integration of pSOFA and PIICS-p enables three-group mortality stratification in critically ill children and early recognition of late-mortality risk among those who appear low risk acutely.
Identifying factors related to physicians' specialty choice is crucial to ensure a sustainable healthcare workforce. However, knowledge regarding the factors influencing the choice of pediatrics remains inadequate. This study aimed to clarify physicians' background characteristics associated with choosing pediatrics and factors associated with hospital-based practice among pediatricians in Japan. This cross-sectional study, comprising an online survey of eligible physicians (N = 6415), was conducted in June 2022 via the Nikkei Medical Online website. The primary outcome was the choice of pediatrics, whereas factors associated with hospital-based pediatricians were examined in a secondary analysis. Multivariate logistic regression analyses were used to assess the association between physician background characteristics and outcomes. Among 6415 physicians, 340 (5.3%) were pediatricians. Factors associated with choosing pediatrics included being female (adjusted odds ratio [aOR] 1.84, 95% CI 1.39-2.44), having children (aOR 1.71, 95% CI 1.27-2.29), and graduating from a public university (aOR 1.67, 95% CI 1.24-2.26). Analyses restricted to pediatricians demonstrated that willingness to work in rural areas (aOR 3.24, 95% CI 1.05-10.04) was positively associated with hospital-based practice, whereas age (per 1-year increase; aOR 0.93, 95% CI 0.90-0.95), an urban hometown (aOR 0.54, 95% CI 0.29-0.98), and having a physician father (aOR 0.40, 95% CI 0.19-0.83) were negatively associated. These findings indicate that pediatric healthcare workforces may be shaped by structural factors, such as educational environment, regional background, and family background, in addition to individual preferences.
The prenatal detection rate (PDR) of congenital heart disease (CHD) has been scarcely reported in Japan. This study aimed to investigate PDR of critical CHD in a region of Japan and to evaluate the impact of prenatal diagnosis on postnatal mortality and severe morbidity. We included patients diagnosed with CHD either prenatally and postnatally between January 1st 2018 and December 31st 2020, based on the institutional database. The Kyu-Yama region comprises the seven prefectures of Kyushu island, Yamaguchi prefecture, and Okinawa prefecture. Clinical outcome was compared with prenatal versus postnatal diagnosis. The overall PDR of critical CHD in the region was 64% (400 of 626 cases). Fifty-four (14%) fetuses were diagnosed within 22 weeks of gestational age. Among these cases, termination of pregnancy was selected in 5 (1%) cases. In subgroup analyses by CHD type, heterotaxy had the highest detection rate (91%), followed by hypoplastic left heart syndrome (86%). In contrast, lower detection rates were observed in transposition of the great arteries (43%) and total anomalous pulmonary venous connection (15%). Detection rates varied by prefectures, ranging from 41% to 75%. Among actively managed cases, overall, there was a significant difference in mortality and severe morbidity between prenatal and postnatal groups [66 (18%) vs. 20 (9%), p = 0.0031]. The overall PDR in this regional cohort was favorable; however, substantial differences remained across prefectures and CHD types. Reducing these disparities may require guideline-based education. Further research is warranted to clarify the prognostic impact of prenatal diagnosis.
This study aimed to validate our therapeutic strategy for the nonselective conservative treatment of pediatric acute appendicitis. This single-center retrospective comparative study was conducted using the data of 368 patients with acute appendicitis. Two therapeutic strategies were compared: emergent open appendectomy (early group, n = 138 patients; 2007-2011) and conservative antibiotic treatment (late group, n = 230; 2012-2023). Both strategies were nonselectively applied, regardless of the degree of disease progression. None of the patients in the late group required admission to the intensive care unit or experienced mortality. Compared with the early group, the late group had a significantly longer duration of hospitalization (5 vs. 7 days; p = 0.0017) and a higher rate of non-planned readmission after initial admission (2% vs. 13%; p = 0.0004). Surgery was performed on a nonworking day for 26% of patients and at night for 59% of patients in the early group. However, subsequent interval appendectomy for patients in the late group was not performed on a nonworking day or at night. Nonselective conservative treatment with antibiotics was safe for managing acute appendicitis in children and eliminated the need for surgery at night and during nonworking days, despite longer duration of the initial hospitalization and the higher rate of readmission.
Duodenogastric reflux (DGR), the backward flow of duodenal contents into the stomach, is often overlooked in children. This study aimed to evaluate the endoscopic and histopathological changes in the esophagus associated with DGR in children. This retrospective study included 537 children aged 0-18 years who underwent esophagogastroduodenoscopy (EGD). DGR was defined by the presence of bile in the stomach upon initial endoscope entry together with concurrent endoscopic or histopathological evidence of gastritis. Conditions that could potentially confound the findings were excluded using defined exclusion criteria. Endoscopic and histopathological findings of the esophagus, stomach, and duodenum were evaluated for each patient. DGR was detected in 22% of the patients. Endoscopic findings such as esophageal hyperemia, erosion, and ulceration were significantly more frequent in the DGR group (p < 0.001). Histopathologically, the frequency and severity of esophagitis were also higher in patients with DGR (p = 0.002 and p = 0.019, respectively). DGR was independently associated with higher odds of both endoscopic (Odds ratio (OR): 2.18, p = 0.004) and histopathological esophagitis (OR: 1.80, p = 0.008). Endoscopic signs of gastric mucosal injury, including erythema, friability, edema, and ulcers, were more common in the DGR group (p < 0.001); however, these findings were interpreted descriptively because gastritis was part of the DGR definition, and no significant difference was observed in gastric histopathology. In pediatric patients, DGR is associated with significant esophageal mucosal injury at both endoscopic and histopathological levels. These findings indicate an increased risk of esophagitis in children with DGR and support the clinical value of esophageal biopsy during pediatric EGD.
Subacute sclerosing panencephalitis (SSPE) is a rare, fatal, late complication of measles that develops years after infection, particularly following measles in early childhood. In Japan, measles incidence has declined markedly after improved vaccination coverage and verification elimination; however, recent SSPE epidemiology remains poorly characterized. SSPE cases were identified from the Intractable Disease Treatment Research Project, the Research Project on the Treatment of Children with Specified Chronic Diseases, and Okinawa-specific publications. Measles-related outpatient visits (1986-2007) were estimated by public health center jurisdiction using annual pediatric sentinel surveillance reports and outpatient visit volumes from the Static Survey of Medical Institutions. Ratio estimation with finite population correction was applied. Seventeen SSPE cases were identified, 71% in males. SSPE onset occurred during 1994-2009, at a mean age of 8.1 years. The year of measles infection was known for 14 cases, most frequently 1990. For risk estimation, 16 infections occurring during 1986-2007 were included. SSPE risk was estimated as one per 3944 estimated measles-related outpatient visits (95% CI: 1054-6995). In 1990, SSPE risk was one per 1828 outpatient visits (95% CI: 836-2820). Among infants aged < 1 year, SSPE risk was one per 910 outpatient visits (95% CI: 416-1403). Estimating denominators for medically attended measles cases from sentinel surveillance enabled quantification of SSPE risk during historical outbreaks in Okinawa. The higher risk during infancy emphasizes the long-term consequences of measles transmission and the need to maintain high measles vaccination coverage.
Aerococcus urinae is a potential causative pathogen of urinary tract infections in pediatric patients with underlying nephrological or urinary tract disorders. However, the need for targeted antimicrobial therapy remains controversial. Herein, we evaluated pediatric patients in whom A. urinae was identified in urine cultures and compared the clinical outcomes between those who received antimicrobial therapy and those managed with observation alone. Urine cultures submitted from 2018 to 2023 were retrospectively reviewed. Cases were included if A. urinae was cultured at ≥ 104 colony-forming units (CFU)/mL in the presence of pyuria. Twenty-six patients met the inclusion criteria; all had preexisting nephrological or urinary tract disorders. A. urinae was isolated as a monoclonal species in only two cases. Thirteen patients (50%) received antimicrobial therapy, most commonly for cystitis, while 13 (50%) were managed conservatively without antimicrobials, achieving spontaneous resolution without relapse. Comparative analysis revealed that myelomeningocele and nitrite positivity were significantly more frequent in the observation group (p = 0.021 and p = 0.009, respectively). Co-infection with other bacterial species was frequently observed in cases where A. urinae was isolated; however, whether these co-isolated organisms were the primary pathogens remains unclear, along with guidance on treatment decisions. Given that approximately half of the cases involving multiple organisms, including A. urinae, were resolved without antimicrobial intervention, it is crucial to reassess the clinical significance of A. urinae and its potential for contaminating such cultures. Treatment decisions should be individualized by considering anatomical risk factors and the overall clinical context.
Although adrenaline auto-injector (AAI) prescribing has increased in Japan following insurance coverage expansion, real-world utilization during pediatric anaphylaxis remains insufficiently characterized. This study aimed to describe current AAI prescription patterns, actual utilization rates, and factors potentially associated with appropriate use. This retrospective descriptive study analyzed AAI prescriptions and anaphylaxis hospitalizations at a tertiary care hospital in Shizuoka, Japan (2023-2024). We reviewed 124 AAI-prescribed children and 34 hospitalized anaphylaxis cases. For hospitalized patients possessing AAI (n = 8), we conducted detailed interviews assessing prior education quality, including hands-on training with expired AAI and smartphone application utilization. Among 124 AAI-prescribed patients, only 5 (4.0%) used AAI during follow-up. Among 34 hospitalized anaphylaxis cases, more than half (55.9%) occurred on first known allergen exposure, particularly for seafood (92.9%). Only 8 patients (23.5%) possessed an AAI prior to the event; among them, 4 (50%) used their AAI. Notably, AAI use appeared to differ by concordance between the triggering allergen and the allergen for which AAI was prescribed: 4/5 (80%) used AAI when allergens matched versus 0/3 (0%) when they differed. This study characterized current AAI prescription patterns and real-world utilization during pediatric anaphylaxis in Japan. Only 23.5% of hospitalized anaphylaxis cases possessed AAI, and utilization among possessors differed markedly depending on whether the triggering allergen matched the prescription indication. These findings suggest that AAI education should emphasize use for any anaphylaxis symptoms regardless of trigger.
Phenylketonuria (PKU) is an inherited metabolic disease associated with pathogenic variants in the phenylalanine hydroxylase (PAH) gene. We aimed to investigate the effect of allelic variants in the PAH gene on the chemical phenotype in patients with PKU and hyperphenylalaninemia (HPA) in our center. We reviewed the medical files of patients diagnosed with PKU and HPA between 2013 and 2022 who had PAH gene analysis. Based on their Phe concentrations at the time of diagnosis, the metabolic phenotypes were classified as follows: classic PKU (cPKU; Phe = 1200 μmol/L), mild PKU (mPKU; Phe = 600-1200 μmol/L), and HPA (Phe = 120-600 μmol/L). We used the allelic phenotype values in the BIOPKUdb to examine the effect of the genotypic findings on the phenotype (0 = cPKU; 5 = mPKU; 10 = HPA). According to their genotypic phenotype values (GPVs), patients were further divided into cPKU, mPKU, and HPA groups. Patients with known BH4 responsiveness were analyzed within groups. We identified 59 types of variants. A fair but statistically significant compatibility was observed between phenotype classification and the GPV classification (kappa statistic = 0.38, p < 0.001, accuracy rate = 0.594). BH4 unresponsiveness was higher in cPKU groups. Our findings demonstrate that genotype-phenotype correlation in PKU and HPA is complex and influenced by both genetic variability and metabolic response. The significant association between BH4 responsiveness and genotype highlights the value of molecular testing in guiding individualized treatment. Identification of novel PAH variants further broadens the genetic spectrum and supports the need for continuous genetic characterization in clinical practice.
Sn-2 palmitate is a unique lipid found in breast milk that enhances the absorption of palmitic acid (PA) and prevents the soaping of PA in the gut. Feeding formulas with high sn-2 palmitate levels influences infant growth and neurodevelopment; however, few studies have evaluated the long-term effects on these outcomes. In this study, we evaluated the association between feeding formula and exposure to different levels of sn-2 palmitate in infancy and growth or neurodevelopment in infants after 6 months. This study was conducted as a follow-up of 1-month-old infants included in a previous study. Infant formulas commercially available in Japan were classified as either high sn-2 formula (PA sn-2 ratio ≥ 50%) or low sn-2 formula (< 50%). The associations between the feeding volume of high/low sn-2 formula at 1 and 6 months of age and anthropometric z-scores or neurodevelopment (Ages & Stages Questionnaires, third edition; ASQ-3) scores at 9 and 18 months were evaluated. Multiple regression analysis of anthropometric z-scores showed no significant association with feeding with either the low or high sn-2 formulas. Multiple regression analysis of the ASQ-3 scores showed that the communication score at 18 months was negatively associated with feeding with the low sn-2 formula at 1 month, with no association observed for the high sn-2 formula. Compared with the formula with low sn-2 palmitate, feeding formulas with high sn-2 palmitate at 1 month had a lower association with reduced neurodevelopment at 18 months.
Unbound bilirubin (UB) is the most direct indicator of bilirubin-induced neurotoxicity in neonates; however, its measurement may be unreliable under certain conditions. Although the total bilirubin-to-albumin ratio (TB/Alb) reflects bilirubin-binding capacity, frequent albumin measurement is limited by blood volume requirements and cost. Plasma total protein (pTP) measured by refractometry can be rapidly obtained using minimal blood volume and may serve as a practical surrogate. This study aimed to evaluate the relationship between pTP and albumin and examine whether the TB/pTP ratio correlates with UB levels. We retrospectively analyzed neonates born at ≥ 35 weeks' gestation who were admitted to a neonatal intensive care unit between January 2023 and August 2025. Total protein and albumin were measured in the central laboratory, while TB, pTP, and UB were measured at the point of care. Agreement between TP and pTP was assessed using Bland-Altman analysis. Correlations among biochemical markers and the relationship between UB and the TB/pTP ratio were evaluated. In total, 192 infants (694 measurements) were included. TP and pTP showed good agreement (mean difference, 0.04 g/dL). Both correlated significantly with albumin (r2 = 0.73 and 0.57, respectively; p < 0.05). In non-acetaminophen-treated samples, UB was strongly correlated with the TB/pTP ratio (r2 = 0.72, p < 0.05). In contrast, acetaminophen-treated samples showed higher UB values that deviated from those predicted by TB/pTP. The TB/pTP ratio may serve as a simple and practical alternative to TB/Alb for managing neonatal hyperbilirubinemia, particularly when UB measurements are unreliable or unavailable.
To explore the risk factors affecting Epstein-Barr virus (EBV) infection after pediatric liver transplantation (PLT) and analyze the survival outcomes of EBV infection in PLT. A retrospective analysis was conducted on clinical data from 251 pediatric patients (≤ 14 years) who underwent liver transplantation at West China Hospital of Sichuan University between January 1, 2008, and February 1, 2025. The cohort included 129 males and 122 females, with a median transplant age of 15 (10, 48) months. Patients were categorized into noninfection (n = 110), asymptomatic infection (n = 85), and symptomatic infection (n = 56) groups based on EBV infection status and severity. Clinical data were collected for univariate analysis, multivariate analysis, and Kaplan-Meier survival analysis. Multivariate logistic regression analysis identified tacrolimus trough concentration, preoperative EBV infection in the recipient, and transplant age as independent risk factors for post-transplant EBV infection. The 1-, 3-, and 5-year survival rates were 94.7%, 92.2%, and 89.4% in the EBV-infected group, compared to 95.3%, 94.3%, and 93.1% in the noninfected group, with no significant difference in 5-year survival between the two groups (p = 0.376). EBV infection is common after PLT, with a high incidence and potential for severe complications. Tacrolimus trough concentration, preoperative EBV infection, and age are independent risk factors for post-transplant EBV infection. EBV infection does not significantly impact long-term survival.
Inborn errors of immunity (IEIs) affecting the NF-κB pathway impair innate and/or adaptive immune responses and may present with or without developmental abnormalities. In this review, we summarize our recent findings from two studies. Monoallelic variants in the RELA gene that result in haploinsufficiency have been linked to tumor necrosis factor-dependent chronic mucosal ulcers and autoimmune cytopenias. However, we have identified a novel form of IEIs caused by dominant-negative RELA mutations, which lead to chronic mucocutaneous ulcerations accompanied by additional autoinflammatory and autoimmune features. Notably, patients exhibit increased expression of Toll-like receptor 7 (TLR7) and MYD88 mRNA in both plasmacytoid dendritic cells and non-plasmacytoid myeloid dendritic cells, resulting in heightened TLR7-mediated production of type I interferons (IFNs). This study provides a mechanistic link between previously distinct groups of IEIs: those involving the NF-κB pathway and those classified as type I interferonopathies. RelB is a critical molecule involved in immune regulation through the non-canonical NF-κB pathway. We describe two families with RelB deficiency caused by novel variants, and we performed detailed functional analyses. As a result, inherited human RelB deficiency disrupts the non-canonical NF-κB pathway, underlying a T- and B cell immunodeficiency, which, together with neutralizing autoantibodies against type I IFNs, confers a predisposition to viral, bacterial, and fungal infections.
Quantitative brain magnetic resonance imaging has revolutionized pediatric neurodevelopment research by enabling noninvasive, reproducible, and high-resolution assessments of brain morphology across the entire brain. Advances in anatomical structure analysis and diffusion-weighted tractography now permit detailed characterization of gray and white matter, cortical thickness, surface area, gyrification, and fiber integrity throughout development. Automated processing pipelines, including FreeSurfer, FSL, and CIVET, have supported large-scale analyses, while harmonization frameworks and normative growth curves have facilitated clinical translation. Diffusion tensor imaging (DTI) provides complementary insights into white matter microstructure, revealing neurodevelopmental trajectories and disorder-specific connectivity alterations. These approaches have identified structural biomarkers in multiple conditions, including reduced nucleus accumbens volume and ventricular enlargement in autism spectrum disorder (ASD), as well as early amygdala overgrowth and glymphatic dysfunction that may predict ASD onset. Despite these advances, several challenges remain, such as inter-scanner variability, age-dependent processing limitations, and the lack of validated individual-level biomarkers. Standardization of imaging protocols and robust statistical harmonization will be essential to overcome these obstacles and enable longitudinal, patient-specific assessments. The incorporation of quantitative magnetic resonance imaging into clinical workflows holds promise for early diagnosis, individualized monitoring, and therapeutic stratification of neurodevelopmental and genetic disorders. Ultimately, comprehensive morphometric and diffusion-based profiling will advance understanding of brain morphogenesis and drive precision medicine in pediatric neurology.
There is a dearth of studies conducted on the mental health of the Malaysian aboriginal people who are known locally as the 'Orang Asli' (OA). The purpose of this study was to describe the behavioral and emotional problems in OA and non-aboriginal (NA) children in Kampung Sungai Buah and its association with parenting stress in both communities. This was a cross-sectional comparative community study. A total of 27 OA and 39 NA parents answered the Strengths and Difficulties Questionnaire (SDQ) and Parenting Stress Index-Short Form (PSI-SF) regarding 64 OA children and 80 NA children. OA children had higher total SDQ scores than NA children (p = 0.010). This difference disappeared after controlling for parental education. OA children had less conduct problems than NA children (p = 0.005). OA showed overall lower parental distress (p = 0.032) compared to NA. OA mothers had more parental distress than OA fathers (p = 0.02). There was a negatively moderate correlation between total SDQ and total PSI-SF scores within both OA (r = -0.27) and NA (r = -0.50) communities. With the OA community being at a significant disadvantage in terms of education and income, it is worrying that the Orang Asli children experience as many behavioral and emotional problems as a conventional community. However, the parents may not clearly express their difficulties to others. These are important issues to keep in mind when designing services for the OA in this community.
Delays in end-of-life (EOL) decisions and prolonged life-sustaining treatments (LST) are common in pediatric intensive care units (PICUs), but the influence of underlying disease on EOL decision-making remains unclear. We compared EOL decision patterns and LST practices between oncology and non-oncology patients in PICUs. This retrospective study was conducted at two tertiary PICUs in Seoul, Korea (March 2023-February 2025 at one center; March 2024-February 2025 at the other). Inclusion criteria were patients (0-25 years) admitted to the PICU with a documented EOL decision. Among 55 patients, 23 were oncology and 32 were non-oncology. Non-oncology patients were younger (median 4.8 vs. 10.8 years, p = 0.040), had more pre-PICU CPR (p = 0.004), and higher Pediatric Logistic Organ Dysfunction-2 (PELOD-2) scores (p = 0.001). Time from PICU admission to EOL decision (15.5 vs. 5.0 days, p = 0.034) was longer in non-oncology patients. Palliative care consultation at EOL decision was more frequent among non-oncology patients (78.1% vs. 47.8%, p = 0.025). In exploratory multivariable negative binomial regression adjusting for age and PELOD-2, non-oncology status was associated with a longer time from PICU admission to documented EOL decision (IRR 2.13, 95% CI 1.05-4.35). Withdrawal of LST was more common in non-oncology patients (65.6% vs. 26.1%), while no escalation of support was more common in oncology patients (60.9% vs. 31.3%, p = 0.011). EOL decision timing and care patterns differed between oncology and non-oncology patients, suggesting disease trajectory may influence EOL decision-making in PICUs.
Many countries lack comprehensive systems or standardized use of diagnostic codes to track child abuse. This study evaluated the validity of the International Classification of Diseases, 10th Revision (ICD-10) diagnostic codes and developed algorithms to identify physical abuse using administrative data. We analyzed children under 10 years hospitalized for injuries between April 2013 and March 2023 at a children's hospital in Japan. Child protection team records notifying local services were used as the reference standard. We assessed diagnostic, procedure, and medication codes using machine learning. Among 1375 injury cases, 53 involved physical abuse, but only one used an abuse-specific ICD-10 code, indicating limited reliability. Combining X-ray and fundus examinations achieved 73.6% sensitivity (95% CI, 59.7-84.7) and 85.7% specificity (95% CI, 83.7-87.5) among children aged < 10 years and 80.9% sensitivity (95% CI, 66.7-90.9) and 79.1% specificity (95% CI, 76.2-81.7) among children aged < 6 years. Several machine learning approaches, including Lasso regression, random forest, and bootstrap classification-and-regression-tree models, yielded broadly consistent findings. ICD-10 codes alone are insufficient for identifying physical abuse combining specific procedures may improve case identification for future epidemiological surveillance.
Diagnosis of urinary tract infection (UTI) in children with neurogenic bladder is challenging due to frequent bacterial colonization and unreliable symptom assessment. This study aimed to evaluate the diagnostic performance of urinalysis parameters in predicting urine culture positivity in children undergoing clean intermittent catheterization (CIC). We retrospectively analyzed urine samples from children with neurogenic bladder who underwent CIC between 2015 and 2024. All samples were included regardless of symptom status. Urinalysis parameters, including leukocyte esterase (LE), nitrite, pyuria, and bacteriuria, were evaluated. Culture positivity was defined as growth of a single organism ≥ 105 CFU/mL. Generalized estimating equations were used to account for repeated measurements. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and likelihood ratios were calculated for individual and combined parameters. A total of 1362 urine samples from 107 patients were analyzed. The combination "Nitrite OR Bacteriuria" achieved the highest AUC (0.84), with sensitivity 0.85, specificity 0.84, PPV 0.84, NPV 0.85, and NLR 0.18. The three-parameter combination "LE OR Nitrite OR Bacteriuria" showed the highest sensitivity (0.94) and NPV (0.92), with an NLR of 0.10 indicating strong rule-out potential. Among AND-rule combinations, "LE AND Nitrite" showed the highest specificity (0.98) and PPV (0.93; PLR 14.27), but low sensitivity (0.36). Urinalysis parameter combinations may help predict urine culture positivity (≥ 105 CFU/mL) in children undergoing CIC, though these findings cannot distinguish between asymptomatic bacteriuria and clinically significant UTI requiring treatment.
Pain assessment is essential for effectively managing pain in pediatric oncology. Despite various tools being used globally, few comprehensive studies summarize their features; this complicates the selection of appropriate tools. This scoping review aimed to map the existing literature on pain assessment tools for children with cancer. On November 20, 2023, we followed the guidelines of the Joanna Briggs Institute Manual for Evidence Synthesis and conducted a comprehensive search of PubMed, Cumulative Index to Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials, Embase, and Ichushi-Web. Studies describing pain assessment tools for children aged 0-18 years were included. The tools were categorized as self-reporting and proxy reporting. As this study aimed to map, a critical appraisal of study quality was not performed. We identified 33 pain assessment tools across 48 studies: 18 self-report measures, 10 proxy-rated measures, and five hybrid tools. Commonly identified tools included the visual analog scale (VAS), Numeric Rating Scale (NRS), Wong-Baker FACES Pain Rating Scale, and Face, Legs, Activity, Cry, Consolability (FLACC) Scale. Formats varied from visual scales to digital applications. Several tools used illustrations, making them accessible to children as young as 3-4 years. Most tools were originally developed in English for non-cancer populations, with few validated translations or cultural adaptations. This review maps available tools for assessing pediatric cancer pain and highlights the need for age-appropriate multidimensional approaches that prioritize self-reporting. Further research should focus on validation and cultural adaptation across diverse groups of children with cancer.