Children

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Open AccessReview

Insulin Resistance and NAFLD: A Dangerous Liaison beyond the Genetics

by Melania Manco

Children 2017, 4(8), 74; https://doi.org/10.3390/children4080074 - 14 Aug 2017

Cited by 47 | Viewed by 6746

Over the last decade, the understanding of the association between insulin resistance (IR) and non-alcoholic fatty liver disease (NAFLD) has dramatically evolved. There is clear understanding that carriers of some common genetic variants, i.e., the patatin-like phospholipase domain-containing 3 (PNPLA3) or the transmembrane [...] Read more.

Over the last decade, the understanding of the association between insulin resistance (IR) and non-alcoholic fatty liver disease (NAFLD) has dramatically evolved. There is clear understanding that carriers of some common genetic variants, i.e., the patatin-like phospholipase domain-containing 3 (PNPLA3) or the transmembrane 6 superfamily member 2 (TM6SF2) are at risk of developing severe forms of NAFLD even in the presence of reduced or absent IR. In contrast, there are obese patients with “metabolic” (non-genetically driven) NAFLD who present severe IR. Owing to the epidemic obesity and the high prevalence of these genetic variants in the general population, the number of pediatric cases with combination of genetic and metabolic NAFLD is expected to be very high. Gut dysbiosis, excessive dietary intake of saturated fats/fructose-enriched foods and exposure to some chemicals contribute all to both IR and NAFLD, adding further complexity to the understanding of their relationship. Once NAFLD is established, IR can accelerate the progression to the more severe form of liver derangement that is the non-alcoholic steatohepatitis. Full article

(This article belongs to the Special Issue Pediatric Nonalcoholic Fatty Liver Disease)

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Open AccessReview

Imaging Features of Non-Alcoholic Fatty Liver Disease in Children and Adolescents

by Michele Di Martino, Kameliya Koryukova, Mario Bezzi and Carlo Catalano

Children 2017, 4(8), 73; https://doi.org/10.3390/children4080073 - 11 Aug 2017

Cited by 18 | Viewed by 19384

Abstract

Non-invasive diagnosis and quantification of liver steatosis is important to overcome limits of liver biopsy, in order to follow up patients during their therapy and to establish a reference standard that can be used in clinical trials and longitudinal studies. Imaging offers several [...] Read more.

Non-invasive diagnosis and quantification of liver steatosis is important to overcome limits of liver biopsy, in order to follow up patients during their therapy and to establish a reference standard that can be used in clinical trials and longitudinal studies. Imaging offers several methods in this setting: ultrasound, which is the cheapest technique and easy to perform; magnetic resonance spectroscopy (MRS), which reflects the real content of triglycerides in a specific volume; and proton density fat fraction (PDFF) magnetic resonance, which is a simple method that reflects the distribution of the fat in the whole liver. Other techniques include ultrasound elastography (EUS) and magnetic resonance elastrography (MRE), which can evaluate the progression of non-alcoholic fatty liver disease (NAFLD) into non-alcoholic steato-hepatitis (NASH) and cirrhosis, by quantifying liver fibrosis. Full article

(This article belongs to the Special Issue Pediatric Nonalcoholic Fatty Liver Disease)

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Open AccessReview

Assessment of Sleep in Children with Autism Spectrum Disorder

by Makeda Moore, Victoria Evans, Grace Hanvey and Cynthia Johnson

Children 2017, 4(8), 72; https://doi.org/10.3390/children4080072 - 8 Aug 2017

Cited by 59 | Viewed by 14057

Abstract

Sleep disturbances in children with autism spectrum disorder (ASD) are significantly more prevalent than found in typically developing (TD) children. Given the detrimental impact of poor sleep on cognitive, emotional, and behavioral functioning, it is imperative to screen and assess for sleep disturbances [...] Read more.

Sleep disturbances in children with autism spectrum disorder (ASD) are significantly more prevalent than found in typically developing (TD) children. Given the detrimental impact of poor sleep on cognitive, emotional, and behavioral functioning, it is imperative to screen and assess for sleep disturbances in this population. In this paper, we describe the screening and assessment process, as well as specific measures commonly used for assessing sleep in children with ASD. Advantages and limitations for use in children with ASD are discussed. While subjective measures, such as parent-report questionnaires and sleep diaries, are the most widely used, more objective measures such as actigraphy, polysomnography, and videosomnography provide additional valuable information for both diagnostic purposes and treatment planning. These objective measures, nonetheless, are limited by cost, availability, and feasibility of use with children with ASD. The current review provides an argument for the complementary uses of both subjective and objective measures of sleep specifically for use in children with ASD. Full article

(This article belongs to the Special Issue Sleep Medicine in Children and Adolescents)

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Open AccessReview

The Pulmonary Circulation in the Single Ventricle Patient

by Amanda Hauck, Nicolas Porta, Steven Lestrud and Stuart Berger

Children 2017, 4(8), 71; https://doi.org/10.3390/children4080071 - 7 Aug 2017

Cited by 26 | Viewed by 7413

Abstract

In recent decades, survival of children with complex congenital heart disease has improved considerably. Specifically, children with a variety of congenital heart defects resulting in ‘single ventricle’ physiology can now undergo palliative surgery that allows survival beyond the neonatal period, and in many [...] Read more.

In recent decades, survival of children with complex congenital heart disease has improved considerably. Specifically, children with a variety of congenital heart defects resulting in ‘single ventricle’ physiology can now undergo palliative surgery that allows survival beyond the neonatal period, and in many cases into adulthood, despite having a single functional ventricular pumping chamber supplying both the pulmonary and systemic circulation. Our growing understanding of the functionally univentricular heart has resulted in freedom from Fontan failure of >50% at 25 years post-Fontan. Yet there is still a fair amount of knowledge to be gained, specifically as it relates to the pulmonary circulation in this group of patients. Knowledge gaps relate not only to the pulmonary circulation after Fontan operation, but also at each stage of the single ventricle surgical palliation, including the native physiology prior to any intervention. The pulmonary circulation is affected by multiple issues related to the single ventricle, including specific details of the anatomy unique to each patient, any intervention(s) undertaken, and potential complications such as aortopulmonary collaterals, protein losing enteropathy, plastic bronchitis, venovenous collaterals, pulmonary arteriovenous fistulae, ventricular dysfunction, pulmonary venous stenosis, and more. This chapter will review the current knowledge with regard to the pulmonary circulation in the single ventricle patient, primarily after the Fontan operation. Additionally, it is our hope to help the practitioner assess the pulmonary circulation in the single ventricle patient; we will also discuss the evidence behind and approach to treatment strategies in order to optimize the pulmonary circulation in this complex group of patients. Full article

(This article belongs to the Special Issue New Trend in Pediatric Cardiology: Pulmonary Hypertension)

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Open AccessArticle

Health and Self-Regulation among School-Age Children Experiencing Family Homelessness

by Andrew J. Barnes, Theresa L. Lafavor, J. J. Cutuli, Lei Zhang, Charles N. Oberg and Ann S. Masten

Children 2017, 4(8), 70; https://doi.org/10.3390/children4080070 - 4 Aug 2017

Cited by 17 | Viewed by 9184

Abstract

Children in homeless families have high levels of adversity and are at risk for behavior problems and chronic health conditions, however little is known about the relationship between cognitive-emotional self-regulation and health among school-aged homeless children. Children (n = 86; mean age 10.5) [...] Read more.

Children in homeless families have high levels of adversity and are at risk for behavior problems and chronic health conditions, however little is known about the relationship between cognitive-emotional self-regulation and health among school-aged homeless children. Children (n = 86; mean age 10.5) living in shelters were assessed for health, family stress/adversity, emotional-behavioral regulation, nonverbal intellectual abilities, and executive function. Vision problems were the most prevalent health condition, followed by chronic respiratory conditions. Cumulative risk, child executive function, and self-regulation problems in children were uniquely related to child physical health. Homeless children experience problems with cognitive, emotional, and behavioral regulation as well as physical health, occurring in a context of high psychosocial risk. Several aspects of children’s self-regulation predict physical health in 9- to 11-year-old homeless children. Health promotion efforts in homeless families should address individual differences in children’s self-regulation as a resilience factor. Full article

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Open AccessArticle

Trends in Food and Beverage Portion Sizes in Australian Children; a Time-Series Analysis Comparing 2007 and 2011–2012 National Data

by Daphne Van der Bend, Tamara Bucher, Tracy L. Schumacher, Kate Collins, Nienke De Vlieger, Megan Rollo, Tracy L. Burrows, Jane F. Watson and Clare E. Collins

Children 2017, 4(8), 69; https://doi.org/10.3390/children4080069 - 4 Aug 2017

Cited by 14 | Viewed by 9345

Abstract

In 2011–2012 approximately 26% of Australian children aged between 5–17 years were reported to be overweight or obese. Furthermore, the increase in prevalence of overweight and obesity among US children parallels reported increases in energy intake and portion sizes of common foods, leading [...] Read more.

In 2011–2012 approximately 26% of Australian children aged between 5–17 years were reported to be overweight or obese. Furthermore, the increase in prevalence of overweight and obesity among US children parallels reported increases in energy intake and portion sizes of common foods, leading to the recognition that availability of larger portion sizes contributes to the rise in overweight and obesity prevalence. Thus, the aim of this time-series analysis was to investigate whether selected food portion sizes in Australian children aged 2–16 years changed between 2007 and 2011–2012. Portion size data from 24-h recalls collected in Australian nutrition surveys were compared between 2007 and 2011–2012. Portion sizes changed significantly in 23% of items with increases in 15% and decreases in 8%. Changes in portion sizes varied by age, sex, and food group. Changes occurred for many meat-based items, energy-dense, nutrient-poor food items, breads, cereals, and some fruits and vegetables. Vegetable and fruit portion sizes were below the respective serving sizes of 75 g and 150 g in the Australian Guide to Healthy Eating, while portion sizes of some energy-dense, nutrient-poor foods have increased. These findings suggest approaches to increasing consumption of nutrient-dense core foods and reducing energy-dense, nutrient-poor food items in children are warranted. Full article

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Open AccessCommentary

Key Challenges in the Search for Innovative Drug Treatments for Special Populations. Converging Needs in Neonatology, Pediatrics, and Medical Genetics

by Stuart MacLeod

Children 2017, 4(8), 68; https://doi.org/10.3390/children4080068 - 4 Aug 2017

Cited by 1 | Viewed by 4555

Abstract

The explosion of knowledge concerning the interplay of genetic and environmental factors determining pathophysiology and guiding therapeutic choice has altered the landscape in pediatric clinical pharmacology and pharmacy. The need for innovative research methods and design expertise for small clinical trials to be [...] Read more.

The explosion of knowledge concerning the interplay of genetic and environmental factors determining pathophysiology and guiding therapeutic choice has altered the landscape in pediatric clinical pharmacology and pharmacy. The need for innovative research methods and design expertise for small clinical trials to be undertaken in sparse populations has been accentuated. At the same time, shortfalls in critical human resources represent a key challenge, especially in low- and middle-income countries where the need for new research and education directions is greatest. Unless a specific action plan is urgently developed, there will be a continuing gap in availability of the essential expertise needed to address treatment challenges in special patient populations such as neonates, patients suffering from rare or neglected diseases, and children of all ages. Full article

(This article belongs to the Collection Development of Medicines for Paediatric and Rare Diseases)

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Open AccessReview

The Fetus Can Teach Us: Oxygen and the Pulmonary Vasculature

by Payam Vali and Satyan Lakshminrusimha

Children 2017, 4(8), 67; https://doi.org/10.3390/children4080067 - 3 Aug 2017

Cited by 40 | Viewed by 15171

Abstract

Neonates suffering from pulmonary hypertension of the newborn (PPHN) continue to represent an important proportion of patients requiring intensive neonatal care, and have an increased risk of morbidity and mortality. The human fetus has evolved to maintain a high pulmonary vascular resistance (PVR) [...] Read more.

Neonates suffering from pulmonary hypertension of the newborn (PPHN) continue to represent an important proportion of patients requiring intensive neonatal care, and have an increased risk of morbidity and mortality. The human fetus has evolved to maintain a high pulmonary vascular resistance (PVR) in utero to allow the majority of the fetal circulation to bypass the lungs, which do not participate in gas exchange, towards the low resistance placenta. At birth, oxygen plays a major role in decreasing PVR to enhance pulmonary blood flow and establish the lungs as the organ of gas exchange. The failure of PVR to fall following birth results in PPHN, and oxygen remains the mainstay therapeutic intervention in the management of PPHN. Knowledge gaps on what constitutes the optimal oxygenation target leads to a wide variation in practices, and often leads to excessive oxygen use. Owing to the risk of oxygen toxicity, avoiding hyperoxemia is as important as avoiding hypoxemia in the management of PPHN. Current evidence supports maintaining arterial oxygen tension in the range of 50–80 mm Hg, and oxygen saturation between 90–97% in term infants with hypoxemic respiratory failure. Clinical studies evaluating the optimal oxygenation in the treatment of PPHN will be enthusiastically awaited. Full article

(This article belongs to the Special Issue New Trend in Pediatric Cardiology: Pulmonary Hypertension)

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Open AccessReview

Gut–Liver Axis Derangement in Non-Alcoholic Fatty Liver Disease

by Marco Poeta, Luca Pierri and Pietro Vajro

Children 2017, 4(8), 66; https://doi.org/10.3390/children4080066 - 2 Aug 2017

Cited by 104 | Viewed by 12683

Abstract

Non-alcoholic fatty liver disease (NAFLD) is the most frequent type of chronic liver disease in the pediatric age group, paralleling an obesity pandemic. A “multiple-hit” hypothesis has been invoked to explain its pathogenesis. The “first hit” is liver lipid accumulation in obese children [...] Read more.

Non-alcoholic fatty liver disease (NAFLD) is the most frequent type of chronic liver disease in the pediatric age group, paralleling an obesity pandemic. A “multiple-hit” hypothesis has been invoked to explain its pathogenesis. The “first hit” is liver lipid accumulation in obese children with insulin resistance. In the absence of significant lifestyle modifications leading to weight loss and increased physical activity, other factors may act as “second hits” implicated in liver damage progression leading to more severe forms of inflammation and hepatic fibrosis. In this regard, the gut–liver axis (GLA) seems to play a central role. Principal players are the gut microbiota, its bacterial products, and the intestinal barrier. A derangement of GLA (namely, dysbiosis and altered intestinal permeability) may promote bacteria/bacterial product translocation into portal circulation, activation of inflammation via toll-like receptors signaling in hepatocytes, and progression from simple steatosis to non-alcoholic steato-hepatitis (NASH). Among other factors a relevant role has been attributed to the farnesoid X receptor, a nuclear transcriptional factor activated from bile acids chemically modified by gut microbiota (GM) enzymes. The individuation and elucidation of GLA derangement in NAFLD pathomechanisms is of interest at all ages and especially in pediatrics to identify new therapeutic approaches in patients recalcitrant to lifestyle changes. Specific targeting of gut microbiota via pre-/probiotic supplementation, feces transplantation, and farnesoid X receptor modulation appear promising. Full article

(This article belongs to the Special Issue Pediatric Nonalcoholic Fatty Liver Disease)

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Graphical abstract

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Open AccessBrief Report

by Meaghann S. Weaver, Cheryl Darnall, Sue Bace, Catherine Vail, Andrew MacFadyen and Christopher Wichman

Children 2017, 4(8), 65; https://doi.org/10.3390/children4080065 - 1 Aug 2017

Cited by 15 | Viewed by 5547

Abstract

Pediatric palliative care studies often rely on proxy-reported instead of direct child-reported quality of life metrics. The purpose of this study was to longitudinally evaluate quality of life for pediatric patients receiving palliative care consultations and to compare patient-reported quality of life with [...] Read more.

Pediatric palliative care studies often rely on proxy-reported instead of direct child-reported quality of life metrics. The purpose of this study was to longitudinally evaluate quality of life for pediatric patients receiving palliative care consultations and to compare patient-reported quality of life with parent perception of the child’s quality of life across wellness domains. The 23-item PedsQL™ V4.0 Measurement Model was utilized for ten child and parent dyads at time of initial palliative care consultation, Month 6, and Month 12 to assess for physical, emotional, social, and cognitive dimensions of quality of life as reported independently by the child and by the parent for the child. Findings were analyzed using Bland–Altman plots to compare observed differences to limits of agreement. This study revealed overall consistency between parent- and child-reported quality of life across domains. Physical health was noted to be in closest agreement. At the time of initial palliative care consult, children collectively scored their social quality of life higher than parental perception of the child’s social quality of life; whereas, emotional and cognitive quality of life domains were scored lower by children than by the parental report. At the one year survey time point, the physical, emotional, and social domains trended toward more positive patient perception than proxy perception with congruence between quality of life scores for the cognitive domain. Findings reveal the importance of eliciting a child report in addition to a parent report when measuring and longitudinally trending perceptions on quality of life. Full article

(This article belongs to the Special Issue Pediatric Palliative Care)

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Open AccessCase Report

Middle Cerebral Artery Stroke as Amusement Park Injury: Case Report and Review of the Literature

by Abby Baumgartle, Laura Wolfe, Vinay Puri, Karen Moeller, Salvatore Bertolone and Ashok Raj

Children 2017, 4(8), 64; https://doi.org/10.3390/children4080064 - 31 Jul 2017

Cited by 3 | Viewed by 12891

Abstract

Strokes as amusement park injuries are rare, but have been reported in the literature. Only about 20 cases of cerebrovascular accidents after amusement park visits have been described. We report a healthy 12-year-old boy who presented with facial droop, slurred speech, and inability [...] Read more.

Strokes as amusement park injuries are rare, but have been reported in the literature. Only about 20 cases of cerebrovascular accidents after amusement park visits have been described. We report a healthy 12-year-old boy who presented with facial droop, slurred speech, and inability to use his right arm after riding roller coasters at a local amusement park. He was evaluated and found to have a left middle cerebral artery (MCA) infarction. The patient was treated with anticoagulants and has recovered with no major residual symptoms. It is likely that his neurological symptoms occurred due to the high head accelerations experienced on the roller coasters, which are more detrimental to children due to immature cervical spine development and muscle strength. Early diagnosis of dissection and stroke results in a favorable prognosis. Providers and parents should be aware of the potential risk of roller coasters and act quickly on neurologic changes in children that have recently been to an amusement park. Full article

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Open AccessReview

Persistent Pulmonary Hypertension in the Newborn

by Bobby Mathew and Satyan Lakshminrusimha

Children 2017, 4(8), 63; https://doi.org/10.3390/children4080063 - 28 Jul 2017

Cited by 51 | Viewed by 29914

Abstract

Persistent pulmonary hypertension of the newborn (PPHN) is a syndrome of failed circulatory adaptation at birth due to delay or impairment in the normal fall in pulmonary vascular resistance (PVR) that occurs following birth. The fetus is in a state of physiological pulmonary [...] Read more.

Persistent pulmonary hypertension of the newborn (PPHN) is a syndrome of failed circulatory adaptation at birth due to delay or impairment in the normal fall in pulmonary vascular resistance (PVR) that occurs following birth. The fetus is in a state of physiological pulmonary hypertension. In utero, the fetus receives oxygenated blood from the placenta through the umbilical vein. At birth, following initiation of respiration, there is a sudden precipitous fall in the PVR and an increase of systemic vascular resistance (SVR) due to the removal of the placenta from circulation. There is dramatic increase in pulmonary blood flow with a decrease in, and later reversal of shunts at the foramen ovale and ductus arteriosus. The failure of this normal physiological pulmonary transition leads to the syndrome of PPHN. PPHN presents with varying degrees of hypoxemic respiratory failure. Survival of infants with PPHN has significantly improved with the use of gentle ventilation, surfactant and inhaled nitric oxide (iNO). PPHN is associated with significant mortality and morbidity among survivors. Newer agents that target different enzymatic pathways in the vascular smooth muscle are in different stages of development and testing. Further research using these agents is likely to further reduce morbidity and mortality associated with PPHN. Full article

(This article belongs to the Special Issue New Trend in Pediatric Cardiology: Pulmonary Hypertension)

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Open AccessReview

DSM-5 Changes in Attention Deficit Hyperactivity Disorder and Autism Spectrum Disorder: Implications for Comorbid Sleep Issues

by Ujjwal P. Ramtekkar

Children 2017, 4(8), 62; https://doi.org/10.3390/children4080062 - 27 Jul 2017

Cited by 24 | Viewed by 10360

Abstract

Attention Deficit Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD) are the most common neurodevelopmental disorders. Despite significant comorbidity, the previous diagnostic criteria prohibited the simultaneous diagnosis of both disorders. Sleep problems are highly prevalent in both disorders; however, these have been studied [...] Read more.

Attention Deficit Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD) are the most common neurodevelopmental disorders. Despite significant comorbidity, the previous diagnostic criteria prohibited the simultaneous diagnosis of both disorders. Sleep problems are highly prevalent in both disorders; however, these have been studied independently for ADHD and ASD. In the context of revised criteria in the Diagnostic Statistical Manual of Mental Disorders 5th edition (DSM-5) that allows combined diagnosis of ADHD and ASD, this short review presents an overview of relationship between sleep problems, ADHD and ASD, as well as conceptualizing the shared pathophysiology. The practical considerations for clinical management of sleep problems in combination with ADHD and ASD are also discussed. Full article

(This article belongs to the Special Issue Sleep Medicine in Children and Adolescents)

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Open AccessArticle

Influence of Socioeconomic Status on Knowledge of Obesity and Diabetes among Adolescents in Chennai, South India

by Pranati Panuganti, T.S. Mehreen, Ranjit Mohan Anjana, Viswanathan Mohan, E. Mayer-Davis and Harish Ranjani

Children 2017, 4(8), 61; https://doi.org/10.3390/children4080061 - 25 Jul 2017

Cited by 3 | Viewed by 7387

Abstract

The Obesity Reduction and Awareness of Non-communicable disease through Group Education (ORANGE) Phase II program, is a school-based intervention aimed at healthy lifestyle practices for sixth and seventh grade adolescents (n = 2345) attending private (n = 1811) and government (n = 534) [...] Read more.

The Obesity Reduction and Awareness of Non-communicable disease through Group Education (ORANGE) Phase II program, is a school-based intervention aimed at healthy lifestyle practices for sixth and seventh grade adolescents (n = 2345) attending private (n = 1811) and government (n = 534) schools in Chennai. The objectives of this paper are (a) to describe the intervention activities and their outcomes qualitatively and (b) to report changes in body mass index (BMI) of the intervention group participants. This intervention strategy used a teacher-peer-training model in each school for long-term sustainability of the lessons learned from this program. During each intervention session, teachers led a classroom discussion on the health topic of interest, and peers facilitated small-group learning activities. Anthropometric measurements of participants were assessed pre- and post-intervention. We found government school students perceived hygienic actions (e.g., drinking clean water, taking baths daily) as healthy habits for preventing diabetes, whereas private school students associated an expensive lifestyle (e.g., eating at restaurants, riding a car) with diabetes prevention. Overall, the mean post-intervention BMI (18.3 kg/m2) was in the normal range compared to the pre-intervention BMI (17.7 kg/m2) (p < 0.0001). These results suggest that future interventions should be tailored for adolescents from different socio-economic groups while acknowledging their varied perceptions. Full article

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Children, Volume 4, Issue 8 (August 2017) – 14 articles

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