Pediatr. Rep., Volume 18, Issue 4 (August 2026) – 27 articles

Background/Objectives: Road traffic accidents represent the leading cause of death in children and adolescents in Brazil. In the state of Piauí, non-specialized facilities frequently manage critically injured pediatric patients. Targeted training programs are considered a key strategy for improving outcomes. This study assessed the feasibility of adapting a pediatric trauma course developed in a high-income setting for medical first responders in both pre-hospital and in-hospital settings in a resource-limited environment in northeastern Brazil. Methods: This prospective non-randomized mixed-methods feasibility-oriented implementation and educational evaluation study involved the design of a simulation-based course based on a literature review by a German interprofessional and interdisciplinary team. Local adaptation was achieved through a needs assessment, field visits, and stakeholder collaboration. Implementation included the training of Brazilian instructor candidates, who subsequently delivered the course under supervision. Data were collected using study-specific, non-validated questionnaires at two timepoints and analyzed descriptively and exploratively. Results: A total of 98 healthcare professionals participated in the needs assessment (mean experience 9.7 ± 6.3 years; 62.2% nursing staff); 66 completed the pediatric trauma management section. Although familiarity with the ABCDE approach was high (86%), confidence in pediatric trauma management was significantly lower than management in adults (47% vs. 68%, p = 0.0018), particularly for invasive procedures. During implementation, 38 participants completed the course, with a 100% recommendation rate; approximately 80% felt prepared to teach independently. However, participants and instructors highlighted the need for more practical training, longer course duration, and follow-up instructor training. Conclusions: A context-adapted, simulation-based pediatric trauma training program was feasibly implemented and well accepted in a resource-limited region of Brazil. The train-the-trainer approach shows promise for strengthening local pediatric trauma capacity, but sustained implementation requires continued instructor development, supervised teaching, and long-term evaluation of educational and clinical outcomes. Full article

A previously healthy 19-month-old female presented after her family found her upon awakening to be sleepy, uninterested in eating, and lethargic. On arrival, blood gas showed profound metabolic acidosis with normal lactate that did not improve with normalization of glucose and sodium. Her acidosis continued to worsen, so a broad workup was initiated, considering ingestions, DKA, and inborn errors of metabolism. In collecting further history, the patient’s nutrition history included a combination of breastfeeding and a vegan diet followed by her family. Her B12 level returned undetectably low. She improved dramatically over the next several hours after receiving an injection of cyanocobalamin. Ultimately, she was confirmed to have methylmalonic acidemia secondary to severe Vitamin B12 deficiency. Full article

Objective: This study examined reading behavior and screen time in children and adolescents and their associations with sleep behavior and behavioral difficulties. Methods: This study was conducted as part of the LIFE Child study (Germany). Participants were 579 6- to 10.5-year-old children (younger age group) and 972 10.5- to 18-year-old children and adolescents (older age group). Information on reading (duration of reading, on paper or electronically), screen time, sleep difficulties, and behavioral difficulties was assessed via parental (younger sample) or self-reported (older sample) questionnaires. Associations of reading behavior and screen time with child age, sex, maternal education, behavioral difficulties, and sleep difficulties were assessed using linear regression analyses. Results: Girls reported longer reading times than boys, whereas boys reported longer daily screen time. In the younger age group, reading time increased with age. Daily screen time increased with age in both age groups. Higher screen time was significantly associated with more sleep difficulties in both age groups and with more behavioral difficulties in the older age group. In the younger age group, reading time was not associated with screen time, sleep difficulties, or behavioral difficulties. In the older age group, however, longer reading times were significantly associated with longer screen time, more behavioral difficulties, and more problematic sleep. Conclusions: These results indicate that both the use of electronic media and reading behavior are relevant for understanding child health and development. The findings suggest that guidance for families of older children should address not only screen use but also balance and context of reading activities. Full article

Introduction/Aims: Myopathies with Tubular Aggregates (TAM) are rare, chronic neuromuscular disorders that may be inherited or acquired. The aim of this report is to present the diagnostic pathway and the challenges encountered in a family with three members affected by TAM caused by a rare ORAI1 variant. Case report: Two siblings (15 and 11 years old) developed severe rhabdomyolysis triggered by a viral respiratory infection. Histopathological analysis demonstrated numerous tubular aggregates with mild focal secondary inflammatory changes and no immunophenotypic evidence of autoimmune inflammatory myopathy. Whole-exome sequencing identified a likely pathogenic heterozygous missense variant, NM_032790.3(ORAI1):c.319G>A (p.Val107Met), in the ORAI1 gene, in both children and their asymptomatic mother. Conclusions: The identification of a rare ORAI1 variant in this family supports the association with TAM, broadens the spectrum of phenotypic presentation, and illustrates the phenotypic variability that may exist even among affected members of the same family. Careful interpretation of inflammatory changes in muscle biopsy, together with immunohistochemical and genetic findings, is essential to avoid misclassification of hereditary tubular aggregate myopathy as autoimmune inflammatory myopathy. Full article

Objectives: To compare clinical outcomes and racial disparities of children hospitalized for acute asthma exacerbation who required any respiratory support: invasive mechanical ventilation (IMV), non-invasive modalities (non-invasive ventilation (NIV) and high-flow nasal cannula (HFNC)). Methods: We searched PubMed, Embase, Cochrane, and Scopus for randomized controlled trials (RCTs) and observational studies published between 2010 and 2025 that involved pediatric asthma patients (0–18 years) who received HFNC, NIV, or IMV. Network meta-analyses (NMA) were conducted separately for RCTs (change in asthma score) and observational studies (PICU length of stay). Subgroup analyses compared respiratory support modalities and failure rates. Racial and ethnic disparities were analyzed narratively. Results: In five RCTs (n = 233), compared to oxygen, HFNC showed no significant benefit (MD = 0.24; p = 0.58), whereas NIV showed the greatest improvement in asthma scores (mean difference [MD] = 1.24; p = 0.07), reaching significance in sensitivity analysis (MD = 2.5; p < 0.001). Observational NMA found no differences in PICU stay between respiratory support modalities, but HFNC was associated with 2-fold increase in PICU stay in a subgroup analysis compared to standard oxygen (p = 0.04) and with a higher failure rate compared to NIV (12.6% vs. 2.6%; OR = 5.3, p < 0.001). Black children had higher odds of intubation. Conclusions: Available evidence suggests that NIV may confer greater short-term clinical benefit in children with severe acute asthma requiring respiratory support, although findings should be interpreted cautiously given the limited and heterogeneous data. Further high-quality studies with standardized outcomes are needed to inform respiratory support selection. Full article

There remains a widespread lack of knowledge regarding hidradenitis suppurativa (HS) among physicians in the United States, impeding timely diagnosis and implementation of comprehensive treatment interventions. Despite the presence of supporting communities for affected adolescents and their caretakers, the overall awareness of HS remains low, and a greater consensus on the treatment of HS is needed. Current research highlights the lack of standardized pediatric guidelines for treatment of HS largely due to the varied nature of the disease and limited efficacy of current therapies. Our study aims to explore the relationship between the chronic skin condition HS and social–emotional concerns, mental health, and physical health issues in US children and adolescents. Using the Arksey and O’Malley framework and PRISMA-ScR reporting, we searched PubMed/MEDLINE, Scopus, Web of Science, Cochrane Library, and Embase for U.S. studies (2015–2025) on pediatric HS (<18 years) and social–emotional, mental health, or quality-of-life outcomes. Recommendations were synthesized, and study quality was appraised with CASP checklist methods and rigor. Ten studies (2020–2025) met inclusion criteria. Pediatric HS was associated with depression, anxiety, social withdrawal, shame, low self-esteem, and reduced quality of life. Physical comorbidities increased psychosocial burden. Socioeconomic and racial disparities worsened outcomes and access to care. Studies emphasized early diagnosis, routine screening, multidisciplinary management, and disparity-focused interventions. Findings may inform clinical practice and guide research initiatives aimed at improving outcomes for children and adolescents with HS. Full article

Objective: Extracorporeal Membrane Oxygenation (ECMO) has long been used in the treatment of acute respiratory and circulatory failure by providing time for damaged organs to recover. The aim of this study was to evaluate the safety and feasibility of interhospital transport of pediatric patients with acute respiratory failure who had undergone venovenous extracorporeal membrane oxygenation (VV ECMO) initiated at the referring facilities. Subjects and methods: Because of the critical condition of these patients, the high risk associated with transport, and the failure of conventional therapies, ECMO was initiated at the referring center. After cannulation, the patients were transported by ground ambulance to the Pediatric Intensive Care Unit in Poznań for further treatment. Results: Fourteen patients aged 2 months to 11 years with acute respiratory failure were transferred to our ECMO center. The mean time from decision to departure was 7.62 h, and the mean ICU stay before transfer was 4.14 days. The mean transport distance was 157.5 km. No mortality occurred during transport, and no serious adverse events were reported. Two technical complications were noted. Conclusions: Interhospital transport of pediatric patients on VV ECMO initiated at referring centers was feasible and safe, with favorable outcomes in patients who have exhausted conventional intensive care options. Effective collaboration between referring hospitals, ECMO centers, and emergency medical services was essential for optimal results. Full article

Background/Objective: In 2022, the American Academy of Pediatrics (AAP) revised the guidelines used to manage neonatal hyperbilirubinemia with a focus on reducing unnecessary testing and phototherapy. However, pediatricians’ knowledge and compliance with the current guidelines have not been assessed. We conducted a survey to evaluate New Jersey pediatricians’ current knowledge and practice patterns with the newly proposed guidelines. Patients and Methods: A questionnaire consisting of 28 closed-ended Likert-scale questions, along with demographic data, was distributed twice in 2024 to all members of the New Jersey AAP Chapter. Of 128 respondents, 120 who defined their involvement in the care of neonates with hyperbilirubinemia were analyzed. Results: The majority of survey respondents were general pediatricians (71.7%). Up to 70% recognized the risk factors for developing severe hyperbilirubinemia, except for Down Syndrome. Up to 60% of respondents utilized transcutaneous bilirubin in low-risk hyperbilirubinemia neonates and serum bilirubin after phototherapy initiation in high-risk neonates as recommended by the AAP. Almost all of the respondents followed the AAP recommended post-discharge follow-up and/or bilirubin measurement. The majority reported phototherapy initiation at the recommended thresholds; however, only 12.5% of surveyed pediatricians followed the recommended threshold for phototherapy discontinuation. Conclusions: Surveyed pediatricians in our study were most likely to comply with the 2022 AAP guidelines; however, opportunities remain for improving pediatricians’ awareness of specific risk factors, reducing unnecessary laboratory testing and discontinuation of phototherapy at the recommended level. Full article

Background/Objectives: Preterm birth is associated with increased risk of motor delay and broader neurodevelopmental vulnerability. Existing reviews have examined neonatal therapy, family-centered care, or early developmental intervention broadly, but the independent evidence for physiotherapy-based interventions in which parents actively deliver or support motor or sensorimotor activities remains uncertain. This review evaluated the effects of early physiotherapy with structured, guided parental involvement on motor development in preterm infants and examined intervention content, parental burden, safety, adherence, and durability of effects. Methods: The review followed PRISMA 2020 and a prespecified PICO framework. The original PubMed, Scopus, and PEDro search was updated through 9 July 2026 using PubMed/MEDLINE, PEDro, Cochrane CENTRAL, ClinicalTrials.gov, backward and forward citation tracking, and linked-report searches. Eligible studies were randomized controlled trials of early physiotherapy, motor, or structured sensorimotor intervention with an active parent-delivered or parent-supported component and a validated motor or neurodevelopmental outcome. Multiple publications from the same randomized cohort were linked and participants were counted once. Risk of bias was evaluated with Cochrane RoB 2, intervention reporting with TIDieR, and certainty with GRADE. Results: Ten reports represented five independent randomized cohorts and 393 unique randomized infants. The Norwegian Parent-Administered Physical Therapy Intervention (NOPPI) produced a moderate short-term improvement in TIMP performance at term-equivalent age, but no consistent advantage in general movements, motor performance at 3 or 24 months, or school-age motor outcomes. COPCA and a NICU-to-home physiotherapy program produced developmental improvement over time or selected short-term gains, without consistent superiority over active or developmental care comparators. A parent-administered sensorimotor intervention by Fucile et al. improved oral-feeding outcomes but not TIMP motor performance, and its linked 18-month follow-up did not demonstrate a clear developmental advantage. Badura et al. found no significant effect of a 10-week parent-delivered general-movement-based program on MOS-R or Bayley-III motor outcomes; adherence was variable, and a transient increase in maternal depressive symptoms at discharge highlighted the importance of treatment burden. Conclusions: Guided parental involvement is feasible and may enhance short-term motor performance when activities are individualized, active, cue-responsive, and closely supervised. However, current evidence does not establish sustained superiority over well-structured usual or traditional care, developmental normalization, or benefit from passive sensorimotor input alone. Clinical implementation should combine competency-based parent training, explicit infant stress cues and stopping rules, realistic dose targets, ongoing professional support, and monitoring of adherence, parental well-being, and adverse events. Full article

Background/Objectives: Children with cancer admitted to the pediatric intensive care unit (PICU) are at increased risk for post-intensive care syndrome (PICS-p) due to prolonged immobility, deep sedation, and severe illness. The ABCDEF bundle offers a framework for enhancing ICU care and patient recovery, but implementing all components in pediatric oncology patients is challenging. This study assesses the development and implementation of the BRAVE (Beginning Restorative Activities Very Early) initiative, specifically BRAVE2, to integrate the comprehensive ABCDEF bundle and a nurse-led mobility program, in collaboration with rehabilitation specialists, within a pediatric oncology intensive care unit. Methods: BRAVE2 was a quality improvement project conducted in a single pediatric ICU from 2022 to 2023. We analyzed ICU data to assess patient demographics, frequency of physical and occupational therapy (PT/OT) consultations, time to initial mobilization, and delirium screening rates (CAPD score of 9 or higher) for patients with ICU stays over 48 h. BRAVE2 addressed all elements of the ABCDEF bundle, including regular pain assessments, evaluation of spontaneous breathing readiness, sedation adjustments, delirium screening, early mobilization, and family engagement. Outcomes were monitored using statistical process control methods. Results: Of 140 patients, 117 (84%) remained in the ICU for more than 48 h. The delirium screening rate was 15.5%, consistently below the target of 30%. PT/OT consultations within 72 h occurred in 80.7% of patients, and early mobilization in 49.7% of patients, both below the 80% goal. However, 90.4% of patients with tracked mobility were able to ambulate during their ICU stay. No mobility-related safety incidents were reported. Conclusions: Rolling out a full ICU liberation plan in a pediatric oncology ICU is possible, and implementing a comprehensive one is feasible and sustainable despite challenges. Although therapist-led early mobilization did not meet targets, incorporating nurse-led mobility strategies and routine delirium screening has established a scalable model to enhance ICU care and support long-term recovery for these patients. Full article

Background/Objectives: Children in early childhood experience higher rates of suspension and expulsion than K–12 students, with persistent racial disparities. Methods: This retrospective descriptive observational study examined exclusionary practices among children ages 0–5 reported by providers participating in a state-level Infant and Early Childhood Mental Health Consultation (IECMHC) initiative within the United States. Results: Providers (n = 689) reported that 3.50% of children were excluded in the 12 months prior to service initiation (1.90% suspended; 1.60% expelled), with higher rates among older children (ages 3–5), males, and Black, Indigenous, People of Color (BIPOC) children. Among a subset of providers of children (n = 395) receiving child-and-family-focused (CFF) consultation, only 28 were expelled (7.09%), with the highest rate observed in children ages 30–36 months. Children expelled during CFF consultation more frequently exhibited atypical protective factors, elevated behavioral concerns, aggression at referral, and higher cumulative adverse childhood experiences (ACEs). Conclusions: Findings suggest that CFF consultation may help mitigate childcare exclusionary practices when children present with severe social-emotional-behavioral challenges. Important considerations for future childcare research and prevention efforts are provided. Full article

Background: Children with Autism Spectrum Disorder (ASD) frequently exhibit severe food selectivity and micronutrient deficiencies, impacting growth and nutritional status. Evidence on integrated nutritional interventions in resource-constrained settings remains limited. Objective: To assess the feasibility and preliminary pre–post changes associated with a 12-week multicomponent nutritional intervention among Vietnamese children with ASD. Methods: In this exploratory single-arm pilot study, 56 children with ASD (mean age 59.0 ± 22.3 months; 80.4% male) were recruited from five community centers in Nghe An Province, Vietnam. The intervention comprised caregiver nutrition education, individualized dietary counseling, and daily multi-micronutrient supplementation. Anthropometric indicators, biochemical markers, feeding behaviors, and dietary intake were assessed at baseline and after 12 weeks. Pre–post changes were evaluated using paired statistical tests, and multivariable linear regression examined factors associated with growth response. Results: The study achieved a 100% completion rate, with all 56 recruited participants finishing the 12-week intervention and all scheduled follow-up assessments. Among children < 60 months, mean Weight-for-Age Z-score (WAZ) increased from −0.66 to −0.28 and mean Height-for-Age Z-score (HAZ) from −1.18 to −0.97 (p < 0.001). For children older than 60 months, mean HAZ increased from −0.87 to −0.58 (p < 0.001) and Body Mass Index-for-Age Z-score (BAZ) from −0.20 to 0.06 (p = 0.006). Significant increases occurred in serum zinc (10.29 to 11.72 µmol/L; p = 0.001), ferritin (31.74 to 34.79 ng/mL; p = 0.001), and hemoglobin (122.73 to 124.77 g/L; p = 0.002), while albumin remained unchanged. Concurrent improvements were observed in feeding behaviors and nutrient-dense food intake. Regression analysis indicated that lower baseline anthropometric status was significantly associated with greater gains in WAZ and HAZ. Conclusions: This community-based multicomponent intervention was feasible and associated with short-term improvements in feeding behaviors, dietary intake, selected biomarkers, and growth measures in children with ASD, supporting further evaluation in randomized controlled trials. Full article

Background: The chromosomal microdeletion syndrome 2q13 is characterized by craniofacial dysmorphism, developmental delay, intellectual disability, autism spectrum disorder, attention deficit hyperactivity disorder, cardiac abnormalities, and seizures. Case Presentation: In this study, we present a descriptive genomic observation of a teenage boy presenting with epilepsy, intellectual disability, and mild facial dysmorphism, found to carry a 48.55 kb 2q13 microdeletion restricted to the BUB1 locus alongside a concurrent 11q21 microdeletion. While his clinical features overlap with the 2q13 microdeletion spectrum, the exact pathogenic contribution of each variant remains a subject of hypothesis due to the lack of parental inheritance data. Conclusions: Further research is necessary to ascertain the impact of the concurrence of small deletions on these disorders. This case underscores the clinical complexity introduced by compound minor copy number variations and emphasizes the value of molecular cytogenetics in evaluating idiopathic neurodevelopmental disorders. Full article

Background: Prematurity remains a major global health challenge and is a leading cause of neonatal morbidity and mortality worldwide. The risk of adverse outcomes is inversely associated with gestational age and birth weight. Although advances in neonatal intensive care have improved survival rates over recent decades, very-low-birth-weight (VLBW) preterm neonates continue to experience substantial morbidity and remain vulnerable to long-term complications. Objective: This study aimed to evaluate the morbidity and mortality of very-low-birth-weight preterm neonates (<1500 g) admitted to the Neonatal Intensive Care Unit (NICU) of the Hospital Regional de Alta Especialidad de Ciudad Victoria (HRAEV), Mexico. Materials and Methods: A retrospective observational cohort study was conducted through a review of medical records of VLBW preterm neonates admitted to the NICU between January 2019 and December 2023. Demographic, perinatal, clinical, and outcome-related data were collected and analyzed. Results: A total of 58 VLBW preterm neonates were included. Mean gestational age was 29.8 ± 2.7 weeks, and mean birth weight was 1109 ± 238 g. The most common morbidities were respiratory distress syndrome (81.0%), apnea of prematurity (72.4%), hyperbilirubinemia (68.9%), pneumonia (34.5%), sepsis (32.7%), patent ductus arteriosus (25.8%), bronchopulmonary dysplasia (26.9% among infants who survived to 36 weeks’ PMA), necrotizing enterocolitis (15.5%), and intraventricular hemorrhage (12.0%) and retinopathy of prematurity (8.6%). Overall mortality was 10.3%. Conclusions: VLBW preterm neonates remain at high risk for significant morbidity despite relatively favorable survival rates. Respiratory distress syndrome, apnea of prematurity, hyperbilirubinemia, and sepsis were the most frequent complications, whereas deaths occurred mainly in the context of severe respiratory and systemic complications, including neonatal asphyxia, pulmonary hypertension, sepsis, shock, and multiple organ failure. Survival outcomes should be interpreted cautiously because of differences in study populations, referral patterns, local viability practices, and study design across neonatal settings. Full article

Growing evidence indicates a bidirectional relationship between the gut microbiota and sleep disturbances in children, with the microbiota–gut–brain axis (MGBA) mediating this interaction. Sleep, circadian rhythms, and the gut microbiota form an interdependent and developmentally dynamic network that plays a crucial role in neurodevelopment during infancy and childhood. Although the mechanisms underlying this complex interaction have not yet been fully elucidated, emerging evidence suggests that multiple dimensions of sleep—including duration, quality, timing, and regularity—are closely associated with gut microbial composition and function. These findings support the rationale for nutritional and microbiota-targeted interventions during critical developmental windows. However, most mechanistic and taxonomic evidence derives from adult or mixed-age cohorts, while methodological heterogeneity, geographic bias, and the predominance of cross-sectional studies limit causal inference. This review provides an overview of the recent literature investigating the role of the gut microbiota in sleep and sleep disorders in children and summarizes potential microbiota-based therapeutic strategies. Full article

Background and Importance: Congenital encephalocele refers to the protrusion of CNS tissue through a skull defect. As a rare neural tube malformation, clinical evidence is particularly limited for large encephaloceles, and management is subject to ongoing discussions. Clinical Presentation: A 3-month-old boy presented with a left hemisphere herniation above the level of the Sylvian fissure into a congenital parietal encephalocele. No focal deficits were appreciated. We hypothesized that early prenatal damage due to protruding brain tissue may have resulted in unihemispheric motor control of both body sides. As such, surgical repair guided by intraoperative electrophysiology and plastic reconstruction was scheduled. Intraoperatively, bilateral and symmetric extremity response upon transcranial electric stimulation of the contra-lesional right hemisphere was detected, whereas no responses from direct cortical and subcortical stimulation of the herniated brain parenchyma were elicited. Complete resection of the herniated supra-insular hemisphere was provided, and no ischemic changes or new deficits occurred. At 24-month follow-up, the patient showed voluntary movements with both upper extremities and voluntary grasping with his left (non-paretic) hand, no mirror movements, no signs of spasticity, good eye contact, and could speak several words. Conclusions: Safe resection with excellent outcome can be provided even for large encephaloceles. Intraoperative electrophysiological findings aid in identifying the absence of cortico-spinal projections and appear helpful to avoid post-operative deficits. Full article

Background/Objectives: Acute bronchiolitis is one of the leading respiratory infections in infants and represents a substantial burden on healthcare services. Parents’ knowledge, attitudes and practices are key to its prevention and home management. The aim of this study was to analyze parents’ knowledge, attitudes, and practices regarding the prevention and home management of bronchiolitis in infants in Gran Canaria, Spain. Methods: A cross-sectional observational study was conducted. The Bronchiolitis Knowledge, Attitudes and Practices Questionnaire was used, comprising 26 items grouped into four dimensions: risk factors, signs and symptoms, prevention, and care/pharmacological support. Data were collected using an online questionnaire. Descriptive analyses, nonparametric tests, and multiple linear regression were performed. Statistical analysis was conducted using Jamovi (version 2.4.12). Statistical significance was set at p < 0.05. Results: A total of 162 parents were included. The mean normalized total score indicated an overall level of parental knowledge, attitudes, and practices regarding acute bronchiolitis. Prevention was the dimension with the lowest scores, whereas signs and symptoms and care/pharmacological support showed comparatively better results. Higher overall scores were associated with educational level and previous experience with bronchiolitis. Conclusions: Parents showed insufficient knowledge, attitudes and practices, particularly in relation to prevention. Targeted educational interventions are needed to improve the home management of bronchiolitis and help reduce healthcare burden. Full article

Artificial intelligence (AI) is increasingly recognized as a transformative technology in healthcare, with growing evidence supporting its applicability across time-critical clinical environments. This perspective aims to evaluate the integration of AI and machine learning (ML) into pediatric emergency departments (PEDs) across three core domains: clinical decision support, stakeholder engagement, and medical education. Within clinical decision support, ML architectures have demonstrated high predictive performance across several high-acuity clinical scenarios, including triage stratification, pediatric traumatic brain injury risk classification, early sepsis detection and clinical deterioration prediction, and dermatological assessment. Model interpretability and real-world implementability remain critical prerequisites for clinical adoption, with explainability methods representing fundamental instruments to enhance transparency and stakeholder trust. Regarding stakeholder engagement, the triadic dynamic among clinicians, caregivers, and patients defines a unique communication challenge in PEDs, with large language models (LLMs) showing preliminary utility; however, stakeholder-inclusive model validation and robust data privacy protections for minors remain key challenges, particularly regarding legal ambiguities of LLM deployment in clinical pipelines. In medical education, AI-driven simulation platforms and LLM-generated adaptive curricula represent promising tools for competency-based training across pediatric emergency scenarios. Future directions emphasize the imperative of prospective multicenter validation in pediatric-specific cohorts, rigorous data quality standards addressing conformance, completeness, and plausibility, and the development of pediatric-tailored governance frameworks. Real-world implementation will require the systematic involvement of all stakeholders—including children, caregivers, clinicians, developers, and institutions—as co-designers of equitable, transparent, and safe AI systems for this uniquely vulnerable population. Full article

Background/Objectives: Digital technologies are increasingly used in interventions for children with Autism Spectrum Disorder (ASD) to support language development. However, existing evidence remains fragmented due to heterogeneity in intervention types, participant characteristics, and outcome measures. This systematic review aims to synthesize current empirical findings on the effects of digital interventions on language development in children with ASD and to identify key factors influencing intervention effectiveness. Methods: A systematic review was conducted in accordance with PRISMA 2020 guidelines. Searches were performed in PubMed, Scopus, Web of Science, ERIC, and PsycINFO for studies published between 2010 and 2025. Eligible studies included experimental, quasi-experimental, and intervention-based designs involving children aged 2–18 years with ASD and reporting at least one language-related outcome. Data extraction was performed independently by two reviewers using a structured form. Methodological quality was assessed using the Joanna Briggs Institute (JBI) checklist and CASP tools. Due to heterogeneity across studies, a narrative synthesis approach was applied. Results: A total of 61 studies met the inclusion criteria. Findings indicate that digital interventions generally have positive effects on language development in children with ASD, with stronger and more consistent outcomes in receptive and expressive language domains. Intervention effectiveness varied according to duration, intensity, content quality, and contextual factors such as family involvement and technological access. Conclusions: The evidence suggests that digital interventions may have positive effects on language development in children with ASD, particularly in receptive and expressive language domains. Among intervention types, video modeling and AI-supported approaches appear to show promising outcomes; however, these findings should be interpreted with caution due to the limited number of AI-focused studies and substantial heterogeneity in study designs, sample characteristics, and outcome measures. Gamified and mobile applications demonstrate moderate effects, especially in vocabulary and pragmatic language skills. Overall, intervention effectiveness varies according to duration, intensity, content quality, and contextual factors such as family involvement and technological access. Future research should prioritize standardized methodologies and longitudinal designs. Full article

Background. Children’s health-related quality of life (HRQoL) has been associated with both individual and family-related factors, including internalizing symptoms and parental psychological well-being. Although previous research has highlighted the role of parental mental health, evidence from non-clinical community samples remains limited, particularly when parent-proxy reports are used. Methods. A cross-sectional study was conducted among 242 parents of children aged 8–12 years in Northern Greece. Parents completed proxy measures of children’s HRQoL and internalizing symptoms, as well as self-reported measures of their own HRQoL and anxiety. Nonparametric tests were used for bivariate analyses, and multiple linear regression was applied to identify independent predictors of children’s HRQoL. Results. Higher parental mental HRQoL was positively associated with children’s HRQoL (ρ = 0.213, p = 0.031), while parental anxiety (trait anxiety: ρ = −0.204, p = 0.004; state anxiety: ρ = −0.314, p < 0.001) and parent-reported child internalizing symptoms (depression: ρ = −0.369, p < 0.001; anxiety: ρ = −0.322, p < 0.001) were negatively associated with HRQoL; however, in the multivariable model, only parental mental HRQoL (B = 0.344, p = 0.020) and parental education (B = −2.944, p = 0.044) remained significantly associated with parent-proxy child HRQoL, explaining 29.2% of the variance in children’s HRQoL (R² = 0.292). Conclusions. The findings suggest that parent-proxy child HRQoL is associated with parental psychosocial functioning in this community-based sample. Parental mental HRQoL was the strongest independent correlate of parent-proxy child HRQoL. However, given the exclusive use of parent-proxy reports and the convenience-based sample, these findings should be interpreted cautiously, as shared method variance, rater-related effects, and limited generalizability may have contributed to the observed associations. Further multi-informant and longitudinal studies conducted in more diverse populations are warranted. Full article

Background: Sepsis is a leading cause of pediatric mortality worldwide, disproportionately affecting children in low- and middle-income countries (LMICs). However, timely recognition of potential sepsis and access to healthcare resources needed to diagnose pediatric sepsis according to international guidelines are challenging in LMICs. This exploratory study aimed to develop machine learning (ML) models to detect pediatric sepsis and septic shock using a simplified set of clinical data contextualized for practical use in resource-limited settings. Methods: This was a secondary analysis of an observational study of 100 children with potential sepsis admitted to a non-profit referral hospital in Dhaka, Bangladesh. The outcomes were sepsis as defined by a Phoenix Sepsis Score (PSS) ≥ 2 and septic shock (sepsis plus PSS cardiovascular sub-score ≥ 1). Models were trained using either clinical + laboratory variables or clinical-only variables. A single 24 h worst-value assessment window was derived per patient; stratified 5-fold cross-validation was used to maintain class proportions across the training and test folds. Model performance was assessed using area under the precision–recall curve (AUPRC) and area under the receiver operating characteristic curve (AUROC) with 95% confidence intervals (CIs) derived from a 2000-resample patient-level bootstrap of out-of-fold classifications. Logistic regression coefficients were used to assess feature contributions. Results: For sepsis classification, the non-laboratory model achieved an AUPRC of 0.942 (95% CI: 0.884–0.979) and an AUROC of 0.945 (95% CI: 0.890–0.983), with comparable performance from the clinical + laboratory model (AUPRC 0.941, 95% CI: 0.880–0.981; AUROC 0.945, 95% CI: 0.881–0.986). For septic shock, AUROCs of 0.870 (95% CI: 0.761–0.952) and 0.878 (95% CI: 0.758–0.967) were observed. However, these estimates should be interpreted cautiously, given the low prevalence (23%) and absence of external validation. SpO₂:FiO₂ ratio, GCS, and systolic blood pressure were consistently strong predictors across models. Conclusions: ML models using pragmatic clinical variables demonstrate preliminary diagnostic performance, with the non-laboratory model showing discrimination comparable to models incorporating laboratory data. Logistic regression demonstrated the most stable performance and may represent an early proof of concept for assistive diagnostic support. However, these models are not clinically usable without external validation. These findings are hypothesis-generating; external validation in larger, independent cohorts is essential before any clinical use, particularly for septic shock. Full article

Fecal calprotectin (FC) is a potential biomarker of gastrointestinal inflammation; however, its physiological behavior in preterm newborns remains poorly understood. This prospective cohort study aimed to characterize the longitudinal variability of FC concentrations during the first month of life in preterm newborns of ≤34 weeks of gestational age admitted to a neonatal intensive care unit. Altogether, 48 preterm newborns and 42 mothers were examined, with 124 fecal samples collected weekly. The median FC levels exhibited wide interindividual and intraindividual variations, ranging from 56 µg/g in the first week to 65 µg/g in the third week, with no significant association with clinical or laboratory variables. No confirmed cases of NEC occurred during follow-up. Among the five preterm newborns with clinical suspicion of NEC, FC levels fluctuated without a consistent temporal pattern or discriminatory profile. Because stool samples were collected according to a predefined weekly schedule rather than at symptom onset, transient FC changes associated with acute gastrointestinal events may not have been captured. The very small number of newborns with clinically suspected NEC, particularly during later follow-up, substantially limited the statistical power of subgroup analyses. Therefore, statistical comparisons involving this subgroup should be interpreted as exploratory and hypothesis-generating rather than confirmatory. Therefore, FC levels may vary substantially in preterm newborns and, within the limitations of this study, these findings primarily characterize the baseline longitudinal variability of FC rather than its diagnostic value for NEC and support cautious interpretation of isolated FC measurements in this population. Full article

Background: Noonan syndrome is a rare genetic disorder from the group of RASopathies, characterized by facial dysmorphism, congenital heart defects, hematologic abnormalities, and growth impairment. Case Presentation: We report the case of an 8-year-old girl with Noonan syndrome admitted for evaluation of abdominal pain and failure to thrive. Hematological evaluation before EGD did not identify contraindications to biopsy, and initial laboratory tests, including coagulation parameters, were normal. Several hours after upper gastrointestinal endoscopy, the patient developed abdominal pain and coffee-ground vomiting. Abdominal ultrasonography revealed an intramural duodenal hematoma (58 × 37 mm), which was confirmed and further characterized by computed tomography as an extensive, long-segment lesion involving the duodenum. Progressive anemia required transfusion of blood products. Conservative management, including nasogastric decompression, parenteral nutrition, and pharmacological treatment, was implemented. Despite the severity and prolonged clinical course, gradual clinical and radiological improvement was achieved, and the patient was discharged in good general condition after one month. Conclusions: Intramural duodenal hematoma is an extremely rare complication of upper gastrointestinal endoscopy with duodenal biopsy. This case highlights the importance of individualized assessment and close monitoring in patients with Noonan syndrome, and indicates that this complication should be considered early when abdominal pain, vomiting, or progressive anemia develops after the procedure, even when hematological evaluation and baseline coagulation parameters are reassuring. Full article

Large congenital melanocytic nevi (LCMN) of the face can pose significant functional, esthetic, and psychosocial challenges in childhood. In selected patients, staged excision offers a practical reconstructive strategy when primary closure is not feasible without distortion of nearby facial landmarks. We report the management of a child with a facial LCMN using a planned multistage surgical approach aimed at lesion removal while preserving contour and minimizing scar burden. The lesion was excised sequentially over three procedures, with careful attention given to relaxed skin tension lines and facial esthetic units. When required, adjunctive reconstruction was performed to optimize closure and support tissue healing. This approach allowed a gradual reduction in the nevus, improved tissue accommodation, and avoidance of excessive tension on the surrounding skin. Postoperative recovery was uncomplicated, and the final esthetic outcome was satisfactory for both the patient and parents. Staged excision was selected over tissue expansion and skin grafting because it allowed progressive lesion reduction while preserving adjacent facial landmarks and minimizing donor-site morbidity. This technical case highlights the importance of individualized surgical planning, preservation of facial esthetic units, and staged scar placement when managing large facial congenital melanocytic nevi in pediatric patients. The educational value of the report lies in illustrating the decision-making process used to balance lesion removal, esthetic outcomes, and long-term surveillance in a challenging facial location. Full article

Background/Objectives: Pediatric IgA nephropathy (IgAN) is often considered to have a favorable early course. However, its progression is variable, and the prognostic value of histopathological classifications, such as MEST-C, remains incompletely defined in children. This study aimed to characterize clinicopathological features and the early disease course in pediatric IgAN and to descriptively examine histopathological findings and clinical outcomes. Methods: This retrospective, single-center study included children with biopsy-confirmed IgAN diagnosed between 2016 and 2025. Clinical, laboratory, and histopathological data were collected, and biopsies were assessed using the Oxford MEST-C classification. Follow-up data, including estimated glomerular filtration rate (eGFR), were analyzed descriptively, with follow-up extending from diagnosis to early 2026. Results: Fourteen patients were included, showing heterogeneous clinical presentations. Mesangial hypercellularity was observed in all cases (100%), with frequent endocapillary hypercellularity (78.6%) and segmental sclerosis (57.1%), consistent with a predominance of active lesions. Over a median follow-up of approximately five years, renal function remained stable in 57.1% of patients, declined in 21.4%, and improved in 14.3%, indicating variability in renal function during follow-up and potential reversibility in a subset of patients. One patient (7.1%) developed severe acute kidney injury requiring temporary dialysis, followed by full recovery. Given the descriptive design and limited sample size, no conclusions regarding associations between histopathological findings and renal outcomes can be drawn. Conclusions: Within this small cohort, pediatric IgAN showed variable renal function courses ranging from stability to decline or partial recovery. These findings should be considered descriptive and hypothesis-generating, supporting longitudinal monitoring in larger pediatric cohorts. Full article

Background: Artificial intelligence (AI)-driven markerless motion capture (MMC) technologies are increasingly being integrated into pediatric healthcare to improve the assessment and management of movement disorders. These video-based systems enable non-invasive motion analysis without wearable sensors, facilitating more natural movement assessment in children, particularly those with neurological or developmental conditions. Objectives: We evaluated the clinical applicability of AI-based MMC tools in pediatric settings for diagnosis, monitoring of motor development, and rehabilitation. Methods: This systematic review was registered in PROSPERO (CRD42024511787) and conducted by two independent reviewers, with a third reviewer resolving disagreements. The literature published between 2018 and 2025 was systematically searched. Studies involving pediatric populations or clinically relevant pediatric applications of MMC were included. Results: Of 1521 identified studies, 52 were finally selected. The included studies evaluated populations across a wide age range. However, seven of the included articles were specifically focused on underage populations. Infant studies primarily analyzed whole-body movements, emphasizing the relevance of global motor patterns in early development. OpenPose and AlphaPose were the most frequently used frameworks in pediatric research because of their automatic full-body key point detection, whereas DeepLabCut was commonly selected for its customizable labeling capabilities. Theia3D emerged as a promising clinically applicable solution with high accuracy. Most studies evaluated kinematic parameters as objective markers of motor performance and development. However, methodological heterogeneity and limited pediatric-specific validation remain important limitations. Conclusions: AI-driven MMC technologies show considerable potential to support objective, accessible, and child-friendly movement assessment in pediatric clinical practice. Full article