Objective Methicillin-resistant Staphylococcus aureus (MRSA) infection in children has been on the rise, which poses a serious threat to their health and life in China. The purpose of this study was to determine the molecular characteristics, risk factors, and clinical outcomes of MRSA infections among critically ill pediatric patients. Methods A retrospective case-control study was performed in the pediatric intensive care unit (PICU) of a tertiary university teaching hospital. All children infected with culture-positive S. aureus in the PICU between January 2016 and December 2021 were included. Univariate and multivariable logistic regression analyses were used to identify potential risk factors for MRSA infection and clinical outcomes of S. aureus infection. All S. aureus isolates were characterized based on antimicrobial resistance, multilocus sequence typing (MLST) and Staphylococcal protein A ( spa ) typing. Results Of 3,974 patients admitted to the PICU, 280 were diagnosed with a S. aureus infection during the 6-year study period. Among them, 43.2% (121/280) were MRSA. All MRSA isolates showed significantly higher rates of resistance to penicillin, erythromycin, clindamycin and tetracycline than MSSA strains. The MRSA strains consisted of 45 spa types and 20 sequence types (STs) (20 clonal complexes), among which the most frequently represented were ST59-t437and ST398-t034. Multivariable logistic regression revealed vaginal delivery, respiratory failure, co-infection with a virus, C-reactive protein (CRP) &amp;gt; 8 mg/L as significant risk factors for MRSA infection. There was no significant difference in all-cause mortality during hospitalization between the MRSA group and the MSSA group. Furthermore, independent predictors for mortality in patients with S. aureus infections were the presence of hypoproteinemia, hematopathy, septic shock, respiratory failure, fever, and white blood cell (WBC) &amp;gt; 15.0 × 10 9 /L. Conclusions The study revealed a high proportion of MRSA infections among critically ill pediatric patients, and found significant risk factors for MRSA infection and poor prognosis of S. aureus infection. Methicillin resistance did not contribute to the mortality in the current study. These findings will provide evidence-based practices to make the strategies of prevention and rational use of antibiotics for pediatric patients with S. aureus infection in the ICU.

Congyi Dai

Wenting Ji

Yufei Zhang

Weichun Huang

Haiying Wang

Xing Wang

Frontiers in Pediatrics

Molecular characteristics, risk factors, and clinical outcomes of methicillin-resistant Staphylococcus aureus infections among critically ill pediatric patients in Shanghai, 2016–2021

2016-2021年上海危重儿科患者耐甲氧西林金黄色葡萄球菌感染的分子特征、危险因素及临床结局

Background Failure of successful transition to adult care for adolescents and young adults with chronic rheumatic diseases negatively impacts their health and wellbeing. Transition of care is a vital and complex process within pediatric rheumatology that can be difficult to execute. Use of quality improvement (QI) and clinical informatics (CI) can help implement transition programs. Local problem Despite efforts to improve transition of care within our pediatric rheumatology clinic, it has been difficult to implement and sustain good transition practices including assessment of transition readiness. Using QI methodology and CI, this study aimed to improve transition readiness assessment from 12 to 30% and sustain for one year by surveying transitioning patients yearly. Methods A transition-focused QI team utilized methods endorsed by the Institute for Healthcare Improvement and leveraged CI to improve survey completion. Control charts of survey completion rates were tracked monthly. Descriptive statistics were used to analyze survey responses. Interventions Interventions focused on automation of patient surveys at regularly scheduled clinic visits. Results 1,265 questionnaires were administered to 1,158 distinct patients. Survey completion rose from a baseline of 12% to greater than 90% and was sustained over 18 months. Identified educational needs included health insurance, scheduling appointments, obtaining care outside of rheumatology clinic business hours, Electronic Health Record messaging, and refilling medications. Conclusions By leveraging CI and QI methodology, we were able to assess transition readiness in more than 90% of our patients and identify gaps in self-management. Process automation can create sustainable transition practices.

Melissa Argraves

Elizabeth Murray

Alysha Taxter

Kelly Wise

Paul T. Jensen

Alana Goldstein-Leever

Bethanne Thomas

Alexa Scott

James Gallup

Ashlee Leone

Stacy P. Ardoin

Vidya Sivaraman

Implementation of an automated transition readiness assessment in a pediatric rheumatology clinic

儿科风湿病诊所中自动化过渡准备评估的实施

Carla Gaggiano

Mohamed Tharwat Hegazy

Luca Cantarini

Gaafar Ragab

Editorial: Recurrent fever in pediatrics

编者按：儿科中的复发性发热

Introduction Sepsis is the leading cause of child death worldwide, with the majority of these deaths occurring in low- and middle-income countries (LMICs). The aim of this systematic review and meta-analysis was to describe clinical prognostic scores and models for pediatric sepsis outcomes and assess the performance of these scores for predicting mortality in LMICs. Methods Ovid Medline, CINAHL, Cochrane Library, EBSCO Global Health, and Web of Science, were searched through September 2022 for citations related to the development or validation of a clinical prognostic score or model among children with sepsis, conducted in LMIC. Titles, abstracts, and full texts were screened by two independent reviewers and data extracted included population characteristics, variables included, outcomes, and model performance. Risk of bias was assessed with the Prediction Model Risk of Bias Assessment Tool (PROBAST). Results 4,251 titles/abstracts and 315 full-text studies were screened, with 12 studies meeting inclusion criteria. Study countries included India, China, Egypt, Indonesia, Tanzania, and a multi-site study in Latin America. Prognostic scores/models included existing scores such as PELOD-2, pSOFA, PRISM, P-MODS, refractory shock criteria. There was high risk of bias in all studies. Meta-analysis was possible for pSOFA, PELOD-2, PRISM, and P-MODS, with pooled area under the receiver-operator characteristic curve of 0.86 (95%CI 0.78–0.94), 0.83 (95% CI 0.76–0.91), respectively. Conclusion Relatively few clinical scores and models have been externally validated for prognostication and risk-stratification among children with sepsis in diverse LMIC settings. Notably there were no studies from low-income countries. Some potentially relevant studies were excluded due to lack of clarity regarding the presence of sepsis in the study populations. More widespread and standardized use of sepsis criteria may aid in better understanding the burden of sepsis and prognostic model performance at the bedside among children in LMICs. Further research to externally validate, implement and adapt these models is needed to account for challenges in use of these scores in resource-limited settings. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022340126 , PROSPERO [CRD42022340126].

Jessica Jordan

Celinie M. Nguyen

Lauren M. Fletcher

Stephanie C. Garbern

Clinical prognostic models in children with sepsis in low- and middle-income countries: a systematic review and meta-analysis

低收入和中等收入国家儿童脓毒症的临床预后模型：系统综述和荟萃分析

Hypoketotic hypoglycemia due to dysregulated insulin secretion is the most common cause of persistent hypoglycemia in children. However, this type of hypoglycemia can also result from defects in the insulin signaling pathway. Distinguishing between the two is important for informing treatment decisions. Here we describe the case of a 10-year-old female with fasting and postprandial hypoglycemia who was found to have a missense variant in the INSR gene, which we functionally characterized. The proband presented with fasting and postprandial hypoglycemia at age six. Diagnostic evaluation was consistent with hypoketotic hypoglycemia suspected to be due to hyperinsulinism, and she was treated with diazoxide. Whole exome sequencing identified a maternally inherited heterozygous missense variant in INSR . Phenotypic studies on the mother were consistent with postprandial hypoglycemia. Phosphorylated Akt and ERK1/2 levels were higher at baseline and in response to stimulation with insulin in 3T3-L1 cells expressing mutant INSR compared to cells expressing wild type INSR . Thus, herein we present a heterozygous missense variant in INSR (c.1151A&amp;gt;G, p.Asn384Ser) that results in constitutive and increased activation of the human insulin receptor, leading to both fasting and postprandial hypoglycemia.

Herodes Guzman

Lauren M. Mitteer

Pan Chen

Christine A. Juliana

Kara Boodhansingh

Katherine Lord

Arupa Ganguly

Diva D. De Leon

Case Report: Functional characterization of a missense variant in INSR associated with hypoketotic hypoglycemia

病例报告：INSR基因错义变异的功能表征与低酮性低血糖症的关联

Objective By analyzing high readership articles from the Chinese Journal of Contemporary Pediatrics ( CJCP ) in the PubMed Central (PMC) database, this study aims to identify research hotspots and trends in the field of pediatrics. Methods Articles from the CJCP ranked by annual readership in PMC from 2021 to 2023 were collected. Using word frequency analysis and co-word analysis, the thematic characteristics of these articles were explored. Results The word frequency analysis and co-word analysis revealed four thematic directions that were of significant interest to researchers: (1) current public health or medical events such as COVID-19 and influenza; (2) mental health issues in children and adolescents; (3) pediatric neurological diseases and neurodevelopment; (4) diseases in preterm infants and newborns. Conclusions This study provides pediatric researchers with a valuable perspective to understand and grasp the development dynamics and future directions in the field of pediatrics.

Fangming Deng

Wen Sun

Jiangwei Guo

Yujia Yang

Research hotspots in pediatrics: co-word clustering analysis based on readership in PubMed Central

儿科研究热点：基于PubMed Central读者群的共词聚类分析

Ana Concheiro Guisán

Sonia Caserío Carbonero

Editorial: Bioethics in neonatology

社论：新生儿学中的生物伦理学

Background Emergence delirium (ED) is a widely recognized issue that prolongs mechanical ventilation and post-anesthesia care unit (PACU) resuscitation time, consequently increasing hospital costs and mortality. Postoperative disturbance in circadian rhythms, commonly leading to sleep disorders, has been identified as a significant risk factor for ED. However, the influence of surgery timing (morning vs. afternoon) on the incidence of ED in pediatric patients undergoing general anesthesia remains unknown. Methods Patients aged 2–6 years who were operated on under general anesthesia with a bispectral index value between 50 and 60 were categorized based on anesthesia start time into either the morning surgery group (Group M, 8:00–12:00) or the afternoon surgery group (Group A, 13:00–17:00). The primary outcome was the post-extubation incidence of ED assessed by the Cornell Assessment of Pediatric Delirium (CAPD) score. Secondary outcomes included extubation time, duration of PACU stay, and adverse postoperative events and complications. Results We recruited a total of 560 patients, 280 in group M and 280 in group A. Compared to Group M, Group A exhibited a significantly higher incidence of ED ( p &amp;lt; 0.001), elevated CAPD scores ( p &amp;lt; 0.001), and prolonged PACU stays ( p &amp;lt; 0.001). Notably, there was no significant difference in extubation time and anesthesia-related adverse events or other postoperative complications between the groups. Conclusion Our study highlights that the time of surgery significantly affects the incidence of ED, CAPD scores, and PACU stay duration in children. Further validation of these findings may guide future strategies to reduce ED.

Wei Wei

Haihang Xie

Yingyi Xu

Jingwen Qin

Xinying Guo

Xingrong Song

Gaofeng Yu

Na Zhang

Daqing Ma

Yonghong Tan

Tianyun Zhao

The impact of diurnal variations on emergence delirium following general anesthesia and surgery in children

儿童全身麻醉和手术后谵妄的昼夜变化影响

Mixed gonadal dysgenesis is caused by a variety of chromosome abnormalities, most commonly Y chromosome mosaicism. An 8-year-old boy presented with short stature for possible treatment with recombinant growth hormone. He had a history of mixed gonadal dysgenesis (hypospadias, bilateral cryptorchidism, processus vaginalis, and dysplastic immature uterus) and a series of corrective surgeries. At 14 months of age, chromosomal karyotyping revealed 46,X,+mar. Upon presentation, lab testing was consistent with the male phenotype at prepuberty. Fluorescence in situ hybridization revealed 45,X[2]/46,X,der(Y).ish psu idic(Y)(q11.2)(SRY++,DYZ3++)[38] karyotype. A literature review identified eight case reports of mixed gonadal dysgenesis associated with 45,X/46,X,idic(Y)(q11.2). Neither sex phenotype nor short stature correlated with the 46,X,idic(Y)(q11.2) mosaic ratio.

Qiang Zhang

Xiaoxiao Chen

Yanyan Cao

Yun Zhou

Yingye Liu

Lijun Liu

Lei Liu

Xiaowei Cui

45,X[2]/46,X,der(Y).ish Psu idic(Y)(q11.2)[38] mosaic karyotype in mixed gonadal dysgenesis: a case report and literature review

45,X[2]/46,X,der(Y).ish Psu idic(Y)(q11.2)[38] 嵌合核型在混合性腺发育不良中的表现：一例报告及文献综述

Nemaline myopathy (NM) is a rare congenital muscle disease that leads to muscle damage, resulting in muscle weakness and atrophy. Cases of scoliosis induced by muscle weakness and atrophy are exceedingly uncommon. The author clinically treated one patient with NM complicated by scoliosis and analyzed its clinical characteristics through a literature review. The pathogenic genes of this patient originated from compound heterozygous mutations c.12471 + 3A&amp;gt;G from the mother and c.7727G&amp;gt;A from the father, leading to the diagnosis of NM accompanied by scoliosis, which represents a relatively rare clinical phenotype.

Jin Huang

Chen Zhang

Jing Li

Huaming Wang

Xiaojuan Cui

Juan Wang

Borong Zhang

Xiaoqiang Wang

Deming Lin

Jun Zhao

Jiantao Wen

Nemaline myopathy with scoliosis: a case report

杆状肌病伴脊柱侧弯：病例报告

FRONTIERS IN PEDIATRICS（影响因子 2.33）在该领域广泛发表经过严格同行评审的研究，从基础研究到临床研究，应对儿科患者护理和儿童健康方面的持续挑战。莱顿大学的现场主编 ARJAN TE PAS 和匹兹堡儿童医院的 MICHAEL L. MORITZ 得到了杰出的国际专家编辑委员会的支持。这本多学科的开放获取期刊处于传播和交流科学知识和对全球研究人员、学者、临床医生和公众产生影响的发现。《儿科学前沿》还设有研究主题、由客座副主编管理的以前沿为主题的特殊问题，解决儿科学的重要领域。以这种方式，前沿作为出版的渠道儿科在基础和临床研究中最广泛的方面，包括与儿科各个方面相关的高质量评论、病例报告、社论和评论。

Frontiers in Pediatrics (Impact Factor 2.33) is a journal that publishes rigorously peer-reviewed research across a wide range of topics, from basic science to clinical studies, addressing ongoing challenges in pediatric patient care and child health. The journal is led by Editor-in-Chief ARJAN TE PAS from Leiden University and MICHAEL L. MORITZ from the Children's Hospital of Pittsburgh, supported by an outstanding international editorial board. As a multidisciplinary open-access journal, Frontiers in Pediatrics aims to disseminate and communicate scientific knowledge, impacting researchers, scholars, clinicians, and the public worldwide. The journal also features research themes and special issues managed by guest associate editors, focusing on significant areas in pediatrics. In this way, Frontiers in Pediatrics serves as a publication channel for the broadest aspects of pediatric research, including high-quality reviews, case reports, editorials, and commentaries related to various aspects of pediatrics.

《Frontiers in Pediatrics》（影响因子 2.33）是一份广泛发表经过严格同行评审研究的期刊，涵盖从基础研究到临床研究，旨在应对儿科患者护理和儿童健康方面的持续挑战。该期刊由莱顿大学的主编 ARJAN TE PAS 和匹兹堡儿童医院的 MICHAEL L. MORITZ 领导，并得到杰出的国际专家编辑委员会的支持。作为一本多学科的开放获取期刊，《Frontiers in Pediatrics》致力于传播和交流科学知识，影响全球研究人员、学者、临床医生和公众。期刊还设有研究主题，由客座副主编管理的以前沿为主题的特殊问题，聚焦于儿科学的重要领域。通过这种方式，《Frontiers in Pediatrics》作为出版渠道，涵盖儿科基础和临床研究的广泛领域，包括与儿科各个方面相关的高质量评论、病例报告、社论和评论。

期刊	Frontiers in Pediatrics
ISSN	2296-2360
h-index	74
Journal Impact	2.12
国际分区	PEDIATRICS(Q2)
国内分区	医学(3区)医学儿科(3区)