Children

11 pages, 523 KiB

Open AccessArticle

Arterial Stiffness and Subclinical Inflammation in Children with Familial Mediterranean Fever: A Comprehensive Analysis

by Nadide Melike Sav, Hasan Baki Altinsoy, Betul Turen and Ayşe Gökçe

Children 2025, 12(2), 232; https://doi.org/10.3390/children12020232 - 14 Feb 2025

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Background/Objectives: Familial Mediterranean fever (FMF) is a chronic autoinflammatory disease. Throughout the disease, subclinical inflammation persists into the remission period. It is known that chronic inflammation causes endothelial dysfunction and, as a consequence, arterial stiffness occurs. In this study, carotid and aortic [...] Read more.

Background/Objectives: Familial Mediterranean fever (FMF) is a chronic autoinflammatory disease. Throughout the disease, subclinical inflammation persists into the remission period. It is known that chronic inflammation causes endothelial dysfunction and, as a consequence, arterial stiffness occurs. In this study, carotid and aortic intima–media thicknesses (IMT) and arterial stiffness were measured in FMF patients to evaluate the risk of possible vascular damage due to chronic inflammation. Methods: The study included pediatric patients with FMF who had been in remission for a minimum of 3 months. Carotid and aortic IMT and arterial stiffness measurements were conducted using sonoelastography. The acute-phase reactants were also evaluated in all participants. Results: Carotid artery stiffness measurements by strain elastography were significantly higher in the patient group than in the control group. However, the aortic and carotid IMT were similar between the two groups. The acute-phase reactants were significantly higher in the patient group than in the control group. Conclusions: This study demonstrated that arterial stiffness increased in pediatric FMF patients. According to the results of the present study, the effects of chronic inflammation on arterial tissues may lead to atherosclerotic changes in the later stages of the disease and may pose a risk for coronary diseases. Arterial ultrasonographic and elastographic measurements to be performed periodically in children with FMF are noninvasive methods that can be used to evaluate the course of endothelial damage. We aimed to show that arterial stiffness may be a marker of early cardiovascular disease. Full article

(This article belongs to the Special Issue Pediatric Radiologic Imaging: The Current Status and Further Prospects)

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9 pages, 875 KiB

Open AccessSystematic Review

Hypo- and Hypernatremia in Extremely Low Birth Weight Infants in the First 10 Days of Life: A Review

by Myrna Pace, Stijn van Sas, Thomas Salaets, Annouschka Laenen, Anke Raaijmakers and Karel Allegaert

Children 2025, 12(2), 231; https://doi.org/10.3390/children12020231 - 13 Feb 2025

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Abstract

Background/Objectives: Sodium regulation is critical in extremely low birth weight (ELBW, <1000 g) infants. This study aimed to provide a comprehensive overview of sodium dynamics and related variables in ELBW infants in their first 10 days of life through a structured literature review. [...] Read more.

Background/Objectives: Sodium regulation is critical in extremely low birth weight (ELBW, <1000 g) infants. This study aimed to provide a comprehensive overview of sodium dynamics and related variables in ELBW infants in their first 10 days of life through a structured literature review. Methods: Applying PRISMA guidelines, six databases were searched (1 August 2023) on sodium measurements in ELBW cohorts, with quality assessment (RoB2, ROBINS-1, Newcastle Ottawa scale) of retained papers, and subsequent data extraction in line with these PRISMA guidelines to describe findings. Results: Only eight heterogeneous studies could be retained, including observational cohort studies (n = 5), case–control studies (n = 2, Tegaderm application yes/no, gestational age < 24 or 24–28 weeks), and only one randomized trial (sodium restriction versus no sodium restriction). Definitions of hyper- or hyponatremia were also heterogeneous, with incidence ranges for hyper- (8–92.2%) and hyponatremia (0–52.9%). Peak sodium values were observed on days 2–4 in the individual studies. When pooled and compared to the cohort mean sodium values, the highest increases in mean serum sodium values were observed on day 3 (+4, range, −0.6 to +8.6 mEq). Variables of sodium values were related to care factors [incubator settings (open/closed, double-/not double-walled, humidity), fluid regimens (water volume, sodium supplementation), occlusive skin care], as well as related maturational factors (postnatal age, gestational age, small versus appropriate for gestational age, SGA/AGA). Conclusions: Based on a structured literature review, patterns of sodium changes over postnatal age in ELBW cases were documented. Besides incubator settings, fluid regimens, or occlusive skin care, these patterns also depend on maturational factors of the ELBW infant (gestational age, postnatal age, SGA/AGA). These complexities emphasize the need for nuanced interpretation, the relevance of standardizing clinical practices and research definitions, and the need to report on additional datasets. Full article

(This article belongs to the Special Issue Renal and Cardiovascular Consequences of Prematurity)

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13 pages, 1933 KiB

Open AccessSystematic Review

Chest Compression Superimposed with Sustained Inflation or 3:1 Compression/Ventilation Ratio During Neonatal Cardiopulmonary Resuscitation in the Delivery Room: A Systematic Review and Meta-Analysis

by Jenny Koo, Anup C. Katheria, Brenda Law, Anne Lee Solevåg, Gerhard Pichler and Georg M. Schmölzer

Children 2025, 12(2), 230; https://doi.org/10.3390/children12020230 - 13 Feb 2025

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Abstract

Background: Current resuscitation guidelines recommend a 3:1 chest compression/ventilation (C:V) ratio, which is associated with high morbidity and mortality. An alternative might be continuous chest compression superimposed with high distending pressure or sustained inflation (CC + SI). Objective: To compare CC + SI [...] Read more.

Background: Current resuscitation guidelines recommend a 3:1 chest compression/ventilation (C:V) ratio, which is associated with high morbidity and mortality. An alternative might be continuous chest compression superimposed with high distending pressure or sustained inflation (CC + SI). Objective: To compare CC + SI with 3:1 C:V during neonatal cardiopulmonary resuscitation (CPR). Methods MEDLINE (through PubMed), Google Scholar, EMBASE, and Clinical Trials.gov through June 2024. Randomized controlled trials comparing CC + SI with 3:1 C:V during neonatal CPR in the delivery room were included. Data Analysis included Risk of bias was assessed using the Covidence collaboration tool, and results were pooled into a meta-analysis using a fixed effects model. Main outcomes were In-hospital mortality (primary). Time to return of spontaneous circulation (ROSC) and air leak (secondary). Results: Two studies were included. The pooled data suggests no difference in infant mortality between CC + SI versus 3:1 C:V during neonatal CPR (RR 0.64, 95% CI 0.21,1.7, p = 0.33, I² = 63%). The use of CC + SI during neonatal CPR could result in 182 fewer per 1000 (from 351 fewer to 311 more) infant deaths. The pooled data suggested a significant reduction in time to ROSC with CC + SI versus 3:1 C:V during neonatal CPR (mean difference 115 s (from 184.75 to 45.36 s), p = 0.001, I² = 26%). Air leak was not different between groups. Conclusions: While in-hospital mortality and air leak were not different between groups, time to ROSC was significantly reduced. A large clinical trial is warranted to assess if CC + SI improves outcomes. Full article

(This article belongs to the Special Issue Advances in Neonatal Resuscitation and Intensive Care)

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12 pages, 356 KiB

Open AccessArticle

Sodium Glycerophosphate vs. Inorganic Phosphate Use in Parenteral Nutrition for Preterm Infants: A Retrospective Study

by Jung-Ting Chang, Yu-Jun Chang, Lih-Ju Chen, Cheng-Han Lee, Hsiao-Neng Chen, Jia-Yuh Chen and Chien-Chou Hsiao

Children 2025, 12(2), 229; https://doi.org/10.3390/children12020229 - 13 Feb 2025

Viewed by 346

Abstract

Background/Objectives: Sodium glycerophosphate improves the adverse side effects of parenteral nutrition. Therefore, this study aimed to evaluate different outcomes, including metabolic bone disease and electrolyte imbalance, associated with the use of sodium glycerophosphate or inorganic phosphate in parenteral nutrition for preterm neonates. Methods: [...] Read more.

Background/Objectives: Sodium glycerophosphate improves the adverse side effects of parenteral nutrition. Therefore, this study aimed to evaluate different outcomes, including metabolic bone disease and electrolyte imbalance, associated with the use of sodium glycerophosphate or inorganic phosphate in parenteral nutrition for preterm neonates. Methods: This retrospective cohort study enrolled 402 newborns admitted to the neonatal intensive care unit of one medical center between January 2019 and September 2021. Of them, 205 received sodium glycerophosphate as parenteral nutrition, while the other 197 received inorganic phosphate. Baseline characteristics and growth parameters, including body weight, body length, and head circumference in the first year of life; calcium and phosphate content of parenteral nutrition in the first 4 weeks; calcium, phosphorus, alkaline phosphatase (ALP), and creatinine levels; and morbidities were compared. Results: During the first 4 weeks, the calcium and phosphate contents of parenteral nutrition were significantly higher in the sodium glycerophosphate vs. inorganic phosphate group. Growth parameters did not differ significantly between groups. The sodium glycerophosphate group showed a higher mean serum phosphate level (4.0 ± 1.2 mg/dL vs. 3.5 ± 1.3 mg/dL, p = 0.001), lower serum ALP level (402.8 ± 202.8 U/L vs. 466.4 ± 228.6 U/L, p = 0.004), lower seizure incidence (4.9% vs. 13.2%, p = 0.003), and higher hypocalcemia incidence (41.5% vs. 31.5%, p = 0.038). However, there were no significant intergroup differences in other common morbidities such as metabolic bone diseases of prematurity, bronchopulmonary dysplasia, electrolyte imbalance, hypoglycemia, retinopathy of prematurity, or intraventricular hemorrhage. Conclusions: Compared to inorganic phosphate, sodium glycerophosphate is associated with higher serum phosphate levels, lower ALP levels, and reduced seizure incidence in premature infants. However, as the study was retrospective and single-center, further randomized controlled trials are needed to confirm these findings. Full article

(This article belongs to the Section Pediatric Neonatology)

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16 pages, 212 KiB

Open AccessArticle

Perceived Impact of Epilepsy and Its Treatment on Pediatric Patients and Their Families

by Redab Al-Ghawanmeh, Ala’a F. Al-Shaikh, Salma Burayzat, Ruba M. Jaber, Mohammad Al-Tamimi, Osama Zidan and Samah Aburahmeh

Children 2025, 12(2), 228; https://doi.org/10.3390/children12020228 - 13 Feb 2025

Viewed by 194

Abstract

Background: Epilepsy is the most common chronic neurological condition in children, with a prevalence of 0.3% in Jordan. It significantly impacts patients’ and their families’ lives, shaped by cultural and socioeconomic factors. This study assessed the perceived impact of epilepsy on children and [...] Read more.

Background: Epilepsy is the most common chronic neurological condition in children, with a prevalence of 0.3% in Jordan. It significantly impacts patients’ and their families’ lives, shaped by cultural and socioeconomic factors. This study assessed the perceived impact of epilepsy on children and their families in Jordan. Method: This was a hospital-based, cross-sectional study recruiting 184 children under 18 years with epilepsy using a custom-designed questionnaire. Results: Nearly half of the patients experienced epilepsy onset before age three, and seizures were controlled in 73%. Around 60% of parents were satisfied with their understanding of the disease. Male gender and older age at diagnosis were associated with greater perceived severity, while older age at diagnosis correlated with a negative impact on caregivers’ earning potential. Patients with more anti-epileptic drugs reported more social constraints and older children expressed concerns about medication and seizure-related injuries. Cultural factors, such as family size and history, were associated with higher caregiver burden, emphasizing the importance of culturally sensitive assessment tools. Conclusions: Effective seizure control and quality of life improvements should be priorities in managing epilepsy in children. Cultural factors are strongly linked to caregiver burden, emphasizing the need for culturally sensitive assessment tools for enhancing support and care outcomes across diverse populations. Full article

(This article belongs to the Section Pediatric Neurology & Neurodevelopmental Disorders)

14 pages, 921 KiB

Open AccessSystematic Review

Changes in the Upper Airway Dimension Following the Use of Functional Appliances in Children with Obstructive Sleep Apnea: A Systematic Review

by Andrea Scribante, Maurizio Pascadopoli, Paolo Zampetti, Chiara Rocchi, Francesca Falsarone and Maria Francesca Sfondrini

Children 2025, 12(2), 227; https://doi.org/10.3390/children12020227 - 13 Feb 2025

Viewed by 195

Abstract

Introduction: Obstructive Sleep Apnea Syndrome (OSAS) is a sleep-related breathing disorder common in children, often linked to craniofacial anomalies like retrognathic mandibles in Class II malocclusions. Functional appliances (FAs) have been proposed as non-invasive treatments to improve OSAS symptoms by modifying upper [...] Read more.

Introduction: Obstructive Sleep Apnea Syndrome (OSAS) is a sleep-related breathing disorder common in children, often linked to craniofacial anomalies like retrognathic mandibles in Class II malocclusions. Functional appliances (FAs) have been proposed as non-invasive treatments to improve OSAS symptoms by modifying upper airway dimensions. Objective: this systematic review evaluates the effectiveness of functional appliances in improving upper airway structures in children with OSAS. Materials and Methods: the study was conducted according to PRISMA guidelines, analyzing studies published between 2004 and 2024 on PubMed, Scopus, Web of Science, Embase, and Cochrane Library databases. Inclusion criteria focused on growing patients (≤14 years) with OSAS and Class II skeletal malocclusions treated with FAs. Results: Of 1298 articles screened, four studies met the inclusion criteria. All studies reported a significant increase in upper airway dimensions of approximately 21% after treatment with FAs. Specifically, the cephalometric and tomographic evaluations revealed a clear enlargement of the superior posterior airway space of about 0.5 mm and a consequent improvement of the respiratory function. Discrepancies arose regarding changes in soft palate length and hyoid bone position, perhaps due to the measurement methods’ variation. Conclusions: Functional appliances appear effective in improving upper airway dimensions and alleviating OSAS symptoms in children. However, the limited number of studies, small sample sizes, and short follow-up periods emphasize the need for further research to confirm long-term efficacy and standardize evaluation protocols. Full article

(This article belongs to the Special Issue Sleep Disorders in Children: Presentation, Early Identification and Treatment)

19 pages, 581 KiB

Open AccessArticle

The Factors Influencing Feeding Practices of Primary Caregivers of Preschoolers: A Theory-Based Cross-Sectional Study

by Qutaibah Oudat, Rebecca C. Lee, Elaine L. Miller, Sarah Collins Couch and Tamilyn Bakas

Children 2025, 12(2), 226; https://doi.org/10.3390/children12020226 - 13 Feb 2025

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Abstract

Background/Objectives: Primary caregivers play a pivotal role in shaping children’s dietary behaviors, which are critical in preventing childhood obesity. This study aimed to examine the extent to which demographic characteristics and caregiver factors, including dietary beliefs and intentions to provide a healthy diet, [...] Read more.

Background/Objectives: Primary caregivers play a pivotal role in shaping children’s dietary behaviors, which are critical in preventing childhood obesity. This study aimed to examine the extent to which demographic characteristics and caregiver factors, including dietary beliefs and intentions to provide a healthy diet, influence feeding practices among primary caregivers of preschool-aged children. Methods: This study included a cross-sectional dataset comprising data collected from 146 primary caregivers of preschool-aged children (3–5 years). Participants were recruited using snowball and convenience sampling from Facebook and community settings in Cincinnati, Ohio. Feeding practices were assessed using the Comprehensive Feeding Practices Questionnaire (CFPQ), while caregiver demographic characteristics, dietary beliefs, and intentions were measured through self-administered surveys. Hierarchical multiple linear regression was employed to identify predictors of feeding practices. Results: The findings reveal that primary caregivers’ feeding practices were shaped by multiple factors, including dietary beliefs (behavioral, normative, and control), intentions, and demographic characteristics. Each subscale of feeding practices was predicted by different factors, highlighting the unique influence of these factors on feeding behaviors. Conclusions: This study underscores the complex interplay between caregiver cognitive (dietary beliefs and intentions) and demographic factors in shaping feeding practices. The findings highlight the importance of targeting caregiver beliefs and intentions in interventions aimed at promoting healthier feeding practices, contributing to the prevention of childhood obesity. Importantly, future research is needed to explore these factors in more diverse populations and validate cognitive measures for broader application. Full article

(This article belongs to the Special Issue Update on Pediatric Nutritional and Metabolic Disorders)

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14 pages, 1036 KiB

Open AccessArticle

Nutrimetry and Evaluation of Intestinal Parasites and Anaemia in Malnourished Schoolchildren from Toliara (Madagascar)

by Maria Valentina Alfano, Mónica Gozalbo, Gabriela Tapia-Veloz, Venny Guirao, Jose M. Soriano and María Trelis

Children 2025, 12(2), 225; https://doi.org/10.3390/children12020225 - 13 Feb 2025

Viewed by 266

Abstract

Background/Objectives: This study aimed to determine the malnutrition status, prevalence of intestinal parasites and anaemia, and the hygiene and sanitation conditions of children participating in the nutritional recovery programme at Las Salinas school of the ONG Bel Avenir in Toliara (Madagascar). The ultimate [...] Read more.

Background/Objectives: This study aimed to determine the malnutrition status, prevalence of intestinal parasites and anaemia, and the hygiene and sanitation conditions of children participating in the nutritional recovery programme at Las Salinas school of the ONG Bel Avenir in Toliara (Madagascar). The ultimate goal of the ONG Bel Avenir is to apply synergistic strategies to effectively combat malnutrition. Methods: A total of 49 schoolchildren aged 6 to 17 years enrolled in the nutritional recovery programme were studied. Data collection included sociodemographic information, hygiene and sanitation practices, and haematological and anthropometric measurements. Results: All participants were found to have anaemia. Regarding intestinal parasites, Giardia intestinalis was detected in 93.9% of cases, and Trichuris trichiura was identified in 28.6% of cases. Nutritional assessments revealed that 100% of the participants experienced thinness or acute malnutrition, while 32.6% exhibited stunting or impaired growth. Conclusions: The findings underscore the critical relationship between nutritional status and factors such as parasitology, haematology, and hygiene. Tools like the Nutrimetry assessment enable more specific diagnostics, guiding targeted interventions to address malnutrition. This study highlights the urgent need for policies and collaborative actions to improve the health conditions of the children in Madagascar. Full article

(This article belongs to the Special Issue Infant and Early Childhood Nutrition)

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10 pages, 1693 KiB

Open AccessArticle

The Development of Standardized National Head Circumference Growth Charts for Jordanian Children Aged 0–5 Years: A Longitudinal and Cross-Sectional Study

by Walid Al-Qerem, Anan Jarab, Ahmad Al-Azayzih, Judith Eberhardt, Ruba Zumot, Fawaz Alasmari and Alaa Hammad

Children 2025, 12(2), 224; https://doi.org/10.3390/children12020224 - 13 Feb 2025

Viewed by 329

Abstract

Background: Head circumference (HC) is a key indicator of growth and brain development in children, used to identify abnormalities like microcephaly and macrocephaly. While WHO growth standards are widely adopted, they may not account for regional variations due to genetic, environmental, and socio-economic [...] Read more.

Background: Head circumference (HC) is a key indicator of growth and brain development in children, used to identify abnormalities like microcephaly and macrocephaly. While WHO growth standards are widely adopted, they may not account for regional variations due to genetic, environmental, and socio-economic factors. This study aimed to develop and validate national HC growth charts for Jordanian children aged 0–5 years and compare them with WHO standards. Method: This study analyzed 628,456 HC measurements from 250,276 Jordanian children (51.6% boys, 48.4% girls) aged 0–1800 days, using data from the Hakeem program. Only healthy children were included. HC measurements followed international guidelines, and data were analyzed using the Lambda–Mu–Sigma (LMS) statistical method. Percentiles were calculated, and growth patterns were compared with WHO standards. Results: National HC-for-age growth charts were developed for the 3rd, 15th, 50th, 85th, and 97th percentiles. Median percentiles for Jordanian children aligned with WHO standards, but the 3rd percentile was lower, particularly for girls after 840 days. The 97th percentile diverged after 240 days, with larger HC measurements observed in Jordanian children. Conclusions: This study provides the first validated HC growth charts for Jordanian children, addressing the limitations of international standards in reflecting regional variations. These charts offer clinicians and public health professionals a precise tool for assessing and monitoring growth, promoting better health outcomes in Jordanian children. Full article

(This article belongs to the Section Pediatric Neurology & Neurodevelopmental Disorders)

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11 pages, 426 KiB

Open AccessArticle

Clinical Associations with Lenticulostriatal Vasculopathy (LSV) at Birth: A Case–Control Study

by Aikaterini Kyriakopoulou, Kyriakos Samikos, Aikaterini Kanavaki, Efthymia Alexopoulou, Maria Argyropoulou, Theodora Psaltopoulou, Christina Kanaka-Gantenbein, Argyrios Dinopoulos, Melpomene Giorgi, Anastasia Antoniadou, Iliani Filippa, Nikolaos Siafakas, Stylianos Serghiou and Vassiliki Papaevangelou

Children 2025, 12(2), 223; https://doi.org/10.3390/children12020223 - 12 Feb 2025

Viewed by 272

Abstract

Objective: To investigate the clinical characteristics associated with the presence of LSV at birth. Design: Prospective 1:1 case–control study. Setting: Two tertiary neonatal units in Athens, Greece. Patients: Premature neonates (≤36 weeks gestational age) who underwent cerebral ultrasound within the first 3 weeks [...] Read more.

Objective: To investigate the clinical characteristics associated with the presence of LSV at birth. Design: Prospective 1:1 case–control study. Setting: Two tertiary neonatal units in Athens, Greece. Patients: Premature neonates (≤36 weeks gestational age) who underwent cerebral ultrasound within the first 3 weeks of life, where LSV was detected. Main outcome measure: Associations between LSV and clinical characteristics at birth. Both unmatched and matched analyses stratifying the study population by gestational week were conducted. Two-sided p-values were computed using the likelihood ratio test. Results: This study included 166 participants (83 cases and 83 controls). Neonates with LSV exhibited more concurrent cerebral findings, notably periventricular echogenicity. LSV was correlated with higher z-scores for head circumference and body length. LSV was not associated with congenital CMV. Conclusions: This study indicated a relationship between LSV and increased head circumference and body length. Further research is warranted to explore LSV’s pathophysiological mechanisms. Full article

(This article belongs to the Special Issue Maternal–Fetal Health: Helping Children Grow)

15 pages, 3007 KiB

Open AccessArticle

Sleep Apnea Syndrome in Children: A Retrospective Study of 419 Cases and Polysomnographic Findings with Implications for Rapid Treatment

by Lechosław Paweł Chmielik, Anna Kasprzyk, Zuzanna Sala, Tadeusz Chmielik, Grzegorz Jacek Hatliński, Grażyna Mielnik-Niedzielska and Artur Niedzielski

Children 2025, 12(2), 222; https://doi.org/10.3390/children12020222 - 12 Feb 2025

Viewed by 261

Abstract

Sleep-related disorders are responsible for many serious health conditions, one of these being sleep apnea syndrome, which arises through various mechanisms. Polysomnography is currently used as the gold standard method for diagnosing patients suffering from sleep breathing disorders, thus enabling accurate and swift [...] Read more.

Sleep-related disorders are responsible for many serious health conditions, one of these being sleep apnea syndrome, which arises through various mechanisms. Polysomnography is currently used as the gold standard method for diagnosing patients suffering from sleep breathing disorders, thus enabling accurate and swift clinical diagnosis. Background/Objectives: By using the parameters obtained from polysomnography, this retrospective study has aimed to determine the groups of children that are particularly vulnerable to severe forms of breathing disorders, divided according to diagnoses made of tonsillar hypertrophy forms and sleep apnea as well as by the severity grades and types of apnea, to facilitate rapid and appropriate treatment. Methods: The subjects were 419 children (from 2017 to 2024) who had been initially diagnosed with sleep apnea syndrome (36.99% girls and 63.01% boys), upon whom various parameters of polysomnography examinations were retrospectively evaluated. The subjects were broken down into groups according to three diagnoses and the types and severities of apnea. The following statistical analyses were used: Kruskal–Wallis tests, post-hoc testing and correlation. Results: Tonsillar hyperplasia was found in 334/419 subjects. The total apnea incidence was highest in the total mild severity grouping (53.33%), while the highest total apnea incidence in the apnea type grouping was found in the central apnea grouping at 31.74%, of which the highest sub-group incidence of apnea was found in those with the mild form (25.54%). The highest incidence of apnea was found in its mild form in subjects with pharyngeal and palatine tonsil hypertrophy (19.57%). The highest apnea incidence for those initially diagnosed with sleep apnea was 10.74% for the central apnea type. Children with hypertrophy of the pharyngeal tonsil and palatine tonsils had the more severe form of apnea than in the other cases in terms of AHI. Apnea severity, AHI, ODI and BS below 89% were highest/longest in the peripheral apnea type, whereas the REM sleep time %-age was lowest in this type. Strong positive correlations were found between AHI with ODI and sleep time below 89%, whereas strong negative correlations were found between AHI with average and minimum saturation variables. Conclusions: Polysomnography findings of especially mild or severe sleep apnea in children with tonsillar hyperplasia should indicate that surgical treatment is needed as soon as possible. Full article

(This article belongs to the Section Pediatric Pulmonary and Sleep Medicine)

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16 pages, 1043 KiB

Open AccessArticle

Ocular Biometry Distribution and One-Year Growth in Eight-Year-Old Southern European Schoolchildren Under the CISViT Project

by Mariam El Gharbi, Laura Guisasola, Alba Galdón, Valldeflors Vinuela-Navarro, Joan Pérez-Corral, Núria Tomás and Núria Vila-Vidal

Children 2025, 12(2), 221; https://doi.org/10.3390/children12020221 - 12 Feb 2025

Viewed by 286

Abstract

Objective: To analyse variations in axial length (AL), corneal radius (CR) and the AL/CR ratio over one year in eight-year-old schoolchildren, considering sex, ethnicity and refractive error. Methods: Vision screenings were conducted in 16 schools in Terrassa (Barcelona, Spain) with eight-year-old [...] Read more.

Objective: To analyse variations in axial length (AL), corneal radius (CR) and the AL/CR ratio over one year in eight-year-old schoolchildren, considering sex, ethnicity and refractive error. Methods: Vision screenings were conducted in 16 schools in Terrassa (Barcelona, Spain) with eight-year-old children as part of the CISViT project. Measurements included ocular biometrics (AL and CR) and non-cycloplegic autorefraction for refractive error. Parental questionnaires provided demographic data (birth date, ethnicity). The same procedures were repeated after one year. Results: Ocular biometric parameters differed by sex and ethnicity. Boys and children of Maghreb descent had longer AL and flatter CR than girls and Caucasian children (p < 0.001 for both visits). The AL/CR ratio was higher in boys than girls (p = 0.002 in the initial visit and p = 0.011 in the follow-up visit) but consistent across ethnicities (p = 0.291 and p = 0.390). AL and AL/CR ratio differed significantly by refractive error status (p < 0.001 in both visits), increasing in more myopic children, while CR showed no significant difference. In myopic children, the AL/CR ratio exceeded 3.0, and typical sex-based biometric differences diminished. Growth rates for AL and AL/CR ratio were similar across sex and ethnicity, indicating minimal demographic influence. Conclusions: AL and CR differ significantly by sex and ethnicity, with demographic differences evident in baseline measurements but not in growth rates over one year. The consistency of the AL/CR ratio across ethnicities, despite sex-based differences, supports its utility as a reliable metric for assessing refractive development in diverse populations. Full article

(This article belongs to the Special Issue The Treatment of Myopia and Refractive Errors in Children)

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28 pages, 460 KiB

Open AccessArticle

Association Between Family Planning and Early Childhood Development: Secondary Analysis of the 2018 Turkey Demographic and Health Surveys

by Gamze Gezgen Kesen and Sıddıka Songül Yalçın

Children 2025, 12(2), 220; https://doi.org/10.3390/children12020220 - 12 Feb 2025

Viewed by 279

Abstract

Background and Objectives: Early childhood development (ECD) significantly influences long-term academic and social outcomes. Family planning (FP) can affect ECD by altering family dynamics and resource allocation. We aimed to investigate the association between the unmet need for family planning (UMNFP) and early [...] Read more.

Background and Objectives: Early childhood development (ECD) significantly influences long-term academic and social outcomes. Family planning (FP) can affect ECD by altering family dynamics and resource allocation. We aimed to investigate the association between the unmet need for family planning (UMNFP) and early childhood development (ECD), as well as family child care practices in Türkiye. Materials and Methods: We included mothers with children under 5 years from the “2018 Turkey Demographic and Health Surveys” (TDHS). Dependent variables included the ECD index, child care practices. Independent variables included FP needs, child–family characteristics. The study applied complex sample analysis. Results: The UMNFP was not associated with poorer child care practices; however, the availability of multiple types of toys or books was associated with the presence of UMNFP. Children from families with UMNFP had engaged in a smaller number of activities compared to their peers. However, on developmental assessments, these children did not perform differently than the comparison group. Factors such as maternal education and socioeconomic status also significantly moderated these effects, highlighting the complex interplay between FP and ECD. Conclusions: UMNFP is not associated with adverse child care practices but is related inversely to some educational activities and engagement in Türkiye, though no direct relationship with early childhood development (ECD) outcomes was identified. Expanding access to FP services and addressing socioeconomic disparities have the potential to improve child care practices, thereby contributing to more equitable developmental outcomes nationwide. Full article

(This article belongs to the Special Issue Children's Public Health and Healthcare: Global Perspective and New Trends)

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7 pages, 178 KiB

Open AccessCase Report

Diagnosis and Treatment of Neonatal Diabetes Caused by ATP-Channel Mutations: Genetic Insights, Sulfonylurea Therapy, and Future Directions

by Michela Trada, Chiara Novara, Martina Moretto, Edoardo Burzi, Davide Tinti and Luisa De Sanctis

Children 2025, 12(2), 219; https://doi.org/10.3390/children12020219 - 12 Feb 2025

Viewed by 237

Abstract

Background: Neonatal diabetes (NDM) is a rare genetic disorder diagnosed in infants under six months of age, characterized by persistent hyperglycemia resulting from insufficient or absent insulin production. Unlike the more common forms of diabetes, such as type 1 diabetes (T1D) and type [...] Read more.

Background: Neonatal diabetes (NDM) is a rare genetic disorder diagnosed in infants under six months of age, characterized by persistent hyperglycemia resulting from insufficient or absent insulin production. Unlike the more common forms of diabetes, such as type 1 diabetes (T1D) and type 2 diabetes (T2D), NDM is predominantly caused by monogenic mutations affecting ATP-sensitive potassium (K-ATP) channels in pancreatic beta cells. The most common mutations involved in NDM are found in the KCNJ11 and ABCC8 genes, which encode the Kir6.2 and SUR1 subunits of the K-ATP channel, respectively. These mutations prevent normal insulin secretion by disrupting the function of the K-ATP channel. While genetic advances have identified about 40 genes implicated in NDM, the KCNJ11 and ABCC8 mutations are most commonly seen. Methods: This review provides a comprehensive exploration of the genetic basis, clinical presentation, and treatment strategies for NDM including the role of sulfonylureas, which have revolutionized the management of this condition. Furthermore, it presents a detailed case study of an infant diagnosed with an ABCC8 mutation, illustrating the pivotal role of genetic testing in guiding clinical decisions. Conclusions: Finally, the article discusses challenges in management, such as the persistence of neurological impairments, and outlines potential directions for future research including genetic therapies and prenatal diagnosis. Full article

(This article belongs to the Special Issue Advances in Childhood Diabetes)

3 pages, 130 KiB

Open AccessEditorial

Child and Adolescent Psychiatry: Unmet Needs Before and After the COVID-19 Pandemic

by Matteo Chiappedi

Children 2025, 12(2), 218; https://doi.org/10.3390/children12020218 - 12 Feb 2025

Viewed by 252

Abstract

The SARS-CoV-2 pandemic formally began on 11 March 2020, when the World Health Organization declared it as an evolution of the Public Health Emergency of International Concern (PHEIC) [...] Full article

(This article belongs to the Special Issue Child and Adolescent Psychiatry: A Post-COVID Era?)

11 pages, 428 KiB

Open AccessArticle

Adolescents’ Self and Bullying Victimisation: The Key Role of Gender

by Matteo Perazzini, Danilo Bontempo, Marco Giancola, Simonetta D’Amico and Enrico Perilli

Children 2025, 12(2), 217; https://doi.org/10.3390/children12020217 - 12 Feb 2025

Viewed by 292

Abstract

Background/Objectives: The primary factors influencing victimisation in bullying have recently become a topic of debate in the psychological literature. This research sought to explore the association between self-criticism (as captured in terms of inadequate self, hated self, and reassured self) and bullying [...] Read more.

Background/Objectives: The primary factors influencing victimisation in bullying have recently become a topic of debate in the psychological literature. This research sought to explore the association between self-criticism (as captured in terms of inadequate self, hated self, and reassured self) and bullying victimisation, also addressing the moderating effects of gender. Methods: This study relies on a cross-sectional research design, enrolling a sample of 328 adolescents (M_age = 14.93; SD_age = 0.81; 162 females, 49.4%). Participants completed a short questionnaire about their age, gender, and family’s socio-economic status. They also answered questions from the Forms of Self-Criticising/Attacking and Self-Reassuring Scale and the Florence Bullying and Victimisation Scales. Results: Statistical analysis indicated gender moderated only the interplay between hated self and bullying victimisation. Conclusions: Through a multidimensional approach, these findings provided further insight into the primary factors of self to the phenomenon of bullying victimisation, also yielding further evidence about the key role of gender during a critical developmental stage, such as adolescence. Limitations, implications, and future research directions are discussed. Full article

(This article belongs to the Section Pediatric Mental Health)

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16 pages, 1233 KiB

Open AccessReview

Risk and Protective Factors for Obstructive Sleep Apnea Syndrome Throughout Lifespan: From Pregnancy to Adolescence

by Duilio Petrongari, Francesca Ciarelli, Paola Di Filippo, Armando Di Ludovico, Sabrina Di Pillo, Francesco Chiarelli, Giulia Maria Pellegrino, Giuseppe Francesco Sferrazza Papa, Luana Nosetti and Marina Attanasi

Children 2025, 12(2), 216; https://doi.org/10.3390/children12020216 - 12 Feb 2025

Viewed by 309

Abstract

Background: Obstructive sleep apnea syndrome (OSAS) in children is indeed a significant and often underdiagnosed condition. The risk factors for OSAS vary across different stages of life. Objectives: Identifying risk factors early can help in taking preventive measures to reduce the likelihood of [...] Read more.

Background: Obstructive sleep apnea syndrome (OSAS) in children is indeed a significant and often underdiagnosed condition. The risk factors for OSAS vary across different stages of life. Objectives: Identifying risk factors early can help in taking preventive measures to reduce the likelihood of developing OSAS, and different life stages may require different interventions. Results: During pregnancy, maternal factors such as obesity, smoking, and genetic predispositions can increase the risk of OSAS, while breastfeeding serves as a protective factor. For children aged 2 to 12, adenotonsillar hypertrophy is the primary cause of airway narrowing, with other contributing factors including obesity, craniofacial abnormalities, and increased nasal resistance. In adolescence, obesity and craniofacial abnormalities remain the main risk factors. Conclusions: By reviewing and understanding these risk factors, healthcare providers can offer more personalized and effective care, ultimately leading to better health outcomes for individuals at all stages of life. Full article

(This article belongs to the Special Issue Pediatric Sleep Medicine: A Look Back and a Look Ahead)

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13 pages, 1472 KiB

Open AccessArticle

Comparative Evaluation of Alveolar Nerve Block with 2% Lidocaine–Epinephrine and 4% Articaine–Epinephrine Buccal Infiltration in Mandibular Premolar and Molar Region in Children: A Double-Blind, Randomized Trial

by Jelena Komsic, Sanja Vujkov, Isidora Neskovic, Duska Blagojevic, Ana Tadic, Bojan Petrovic and Branislav Bajkin

Children 2025, 12(2), 215; https://doi.org/10.3390/children12020215 - 12 Feb 2025

Viewed by 242

Abstract

Background/Objectives: Effective pain control in pediatric dentistry combines behavior management, local anesthesia, and follow-up care. This study compared the efficacy of inferior alveolar nerve block (IANB) with 2% lidocaine and epinephrine versus buccal infiltration (BI) with 4% articaine and epinephrine in treating [...] Read more.

Background/Objectives: Effective pain control in pediatric dentistry combines behavior management, local anesthesia, and follow-up care. This study compared the efficacy of inferior alveolar nerve block (IANB) with 2% lidocaine and epinephrine versus buccal infiltration (BI) with 4% articaine and epinephrine in treating primary molars, permanent premolars, and molars in children. Methods: Sixty children aged 5–18 years were randomly assigned to two groups in a double-blind study. One group received 1.7 mL BI with 4% articaine, and the other 1.8 mL IANB with 2% lidocaine for dental treatment. Pain was assessed using the self-reported Visual Analog Scale (VAS) and Wong–Baker Faces Pain Rating Scale (W-BFRS), while anesthesia effectiveness and behavior were evaluated using the Frankl Behavior Rating Scale (FBRS) and vitality tests. Results: The articaine group reported significantly lower pain scores on all scales (VAS: 1.23 ± 2.01; FBRS: 0.47 ± 0.57; W-BFRS: 1.33 ± 2.04) than the lidocaine group (VAS: 3.17 ± 1.64; FBRS: 1.26 ± 0.45; W-BFRS: 3.17 ± 1.64). Articaine also outperformed lidocaine in secondary measures, with higher positive responses on the questionnaires (articaine: 8.37 ± 1.61 vs. lidocaine: 5.27 ± 1.41, p < 0.001). Conclusions: Buccal infiltration with 4% articaine is more effective than 2% lidocaine administered via IANB for invasive dental procedures in children, providing superior pain control and positive patient responses. Full article

(This article belongs to the Section Pediatric Dentistry & Oral Medicine)

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13 pages, 377 KiB

Open AccessArticle

Nationwide Incidence of Acute Alcohol Intoxication in Adolescents in Belgium: A Validation Study of Belgian Health Insurance Data Through Comparison with Retrospective Hospital Chart Data in Antwerp, Belgium

by Hanna van Roozendaal, Stijn Verhulst, Inge Glazemakers, Xavier Rygaert, Michiel Callens, Ann De Guchtenaere, Jozef De Dooy, Nico van der Lely and Guido Van Hal

Children 2025, 12(2), 214; https://doi.org/10.3390/children12020214 - 11 Feb 2025

Viewed by 312

Abstract

Background/Objectives: This study investigates the incidence of acute alcohol intoxication (AAI) in adolescents in Belgium, by comparing nationwide estimations based on health insurance data with a recently published hospital chart study in Antwerp. In this way, the scope of AAI among adolescents [...] Read more.

Background/Objectives: This study investigates the incidence of acute alcohol intoxication (AAI) in adolescents in Belgium, by comparing nationwide estimations based on health insurance data with a recently published hospital chart study in Antwerp. In this way, the scope of AAI among adolescents in Belgium can be estimated more precisely. Methods: Health insurance data collected by the Intermutualistic Agency (IMA) regarding 12- to 17-year-olds admitted at emergency departments in Antwerp in 2019–2021 and receiving a blood test to screen for blood alcohol concentration were validated by data derived from a recently conducted retrospective hospital chart study regarding AAI among adolescents in Antwerp. To compare the incidence of adolescents with AAI between these two datasets, a Poisson regression analysis was performed. Results: The findings reveal that the approximations based on administrative health insurance data present a significant underestimation of the incidence of AAI (p < 0.001): the number of admissions in Antwerp determined by the hospital chart study was 21% higher over 2019–2021. Correcting for this underestimation reveals an estimation for the nationwide average yearly incidence of AAI admissions among adolescents of 33.5 per 10,000 instead of 27.7 per 10,000 in Belgium over 2019–2021. Conclusions: These results imply that the occurrence of AAI among Belgian youth is larger than previously estimated. Therefore, a higher fraction of Belgian adolescents are at risk of serious health consequences due to AAI. This underlines the importance of the development of effective intervention strategies regarding indicated prevention and follow-up. Full article

(This article belongs to the Section Global Pediatric Health)

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31 pages, 1809 KiB

Open AccessSystematic Review

The Management of IgG4-Related Disease in Children: A Systematic Review

by Evdoxia Sapountzi, Eleni P. Kotanidou, Vasiliki-Rengina Tsinopoulou, Lampros Fotis, Liana Fidani and Assimina Galli-Tsinopoulou

Children 2025, 12(2), 213; https://doi.org/10.3390/children12020213 - 11 Feb 2025

Viewed by 292

Abstract

Background/Objectives: IgG4-related disease (IgG4-RD) is a multi-organ disease with greatly varying therapeutic approaches and a lack of specific treatment algorithms. This systematic review aimed to determine the therapeutic approaches for pediatric IgG4-RD in real-word practice. Methods: We searched PubMed and Google [...] Read more.

Background/Objectives: IgG4-related disease (IgG4-RD) is a multi-organ disease with greatly varying therapeutic approaches and a lack of specific treatment algorithms. This systematic review aimed to determine the therapeutic approaches for pediatric IgG4-RD in real-word practice. Methods: We searched PubMed and Google Scholar for articles on pediatric IgG4-RD cases published in English from 2012 to August 2024, focusing on treatments and outcomes. Study type, treatment(s), dose/regimen, age and sex, organ(s) involved, and treatment outcomes were manually extracted from each study. Results: Of the 219 studies identified, we analyzed 81 studies, including 114 pediatric IgG4-RD cases. Fifty-seven percent of patients suffered from multi-organ disease and required several treatment schemes. Around 75% received steroids, alone or in combination, regardless of the organ affected. The treatment outcomes were positive in most cases, although relapses occurred in approximately 30% of patients, usually upon steroid tapering. Other common therapeutic approaches included immunosuppressants, often used as steroid-sparing agents, with azathioprine and mycophenolate mofetil being the most common; surgery for localized disease; and biologics, mainly rituximab, used in more severe/refractory cases. Uncommon but effective therapies included adalimumab and ruxolitinib. Drug combinations seemed to be more efficacious than monotherapies across studies. Patients > 10 years old more frequently received aggressive approaches (surgery and rituximab) and more often experienced relapses. Relapse rates were higher among females. Conclusions: This review highlights the use of systemic steroids as an effective first-line treatment for pediatric IgG4-RD, but also underscores the use of non-steroid-based alternatives in combination with steroids or other immunosuppressants for the effective management of IgG4-RD. Full article

(This article belongs to the Special Issue Advances in Research on Childhood Immune and Allergic Diseases)

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14 pages, 244 KiB

Open AccessArticle

Family-Centered Model and mHealth Through Early Intervention in Rural Populations: A Quasi-Experimental Study

by Estíbaliz Jiménez-Arberas, Yara Casáis-Suárez, Sara Menéndez-Espina, Sergio Rodríguez Menéndez, Alba Fernández Méndez and José Antonio Prieto Saborit

Children 2025, 12(2), 212; https://doi.org/10.3390/children12020212 - 11 Feb 2025

Viewed by 303

Abstract

Background: Considering the challenges of Early Childhood Intervention (ECI), especially in rural areas with limited access to resources, it is essential to explore innovative strategies to address these barriers. Recent research highlights the use of mHealth to improve the accessibility and effectiveness of [...] Read more.

Background: Considering the challenges of Early Childhood Intervention (ECI), especially in rural areas with limited access to resources, it is essential to explore innovative strategies to address these barriers. Recent research highlights the use of mHealth to improve the accessibility and effectiveness of interventions. This study aims to evaluate the impact of mHealth interventions within the family-centered model on child development and familial quality of life, compared to the child-centered model. Methods: This study employs a quasi-experimental design with pre- and post-test measures across two control groups (control group 1: child-centered model and control group 2: family-centered model) and one experimental group (family-centered model with mHealth). The sample consisted of 55 children (11 girls and 44 boys) aged 0 to 6 years old with neurodevelopmental disorders that resided in rural areas from June to September 2023. For the assessment of the family unit, an ad hoc sociodemographic questionnaire, the Family Quality of Life Scale, the Family Confidence Scale, and the Family Outcomes Scale were used. Children were evaluated using the Pediatric Evaluation of Disability Inventory and the Battelle Developmental Inventory Screening Test. Results: Results revealed significant differences between the experimental group (EG) and the control groups. The EG, which received mHealth-based interventions within the family-centered model, demonstrated the greatest improvements in variables related to family quality of life and the child’s social functioning. Conclusions: mHealth appears to be a promising solution for improving access to early childhood intervention in rural areas, enhancing childhood development and a family’s quality of life. Strong therapeutic relationships, supported by interdisciplinary and individualized approaches, are key to maximizing its impact. Full article

(This article belongs to the Special Issue Family-Centered Care in Pediatric Health)

12 pages, 4282 KiB

Open AccessArticle

Simplifying the Diagnosis of Pediatric Nystagmus with Fundus Photography

by Noa Cohen-Sinai, Inbal Man Peles, Basel Obied, Noa Netzer, Noa Hadar, Alon Zahavi and Nitza Goldenberg-Cohen

Children 2025, 12(2), 211; https://doi.org/10.3390/children12020211 - 11 Feb 2025

Viewed by 289

Abstract

Background/Objectives: To simplify diagnosing congenital and acquired nystagmus using fundus photographs. Methods: A retrospective study included patients with congenital or childhood-acquired nystagmus examined at a hospital-based ophthalmology clinic (September 2020–September 2023) with fundus photos taken. Exclusions were for incomplete data or low-quality images. [...] Read more.

Background/Objectives: To simplify diagnosing congenital and acquired nystagmus using fundus photographs. Methods: A retrospective study included patients with congenital or childhood-acquired nystagmus examined at a hospital-based ophthalmology clinic (September 2020–September 2023) with fundus photos taken. Exclusions were for incomplete data or low-quality images. Demographics, aetiology, orthoptic measurements, and ophthalmologic and neurological exams were reviewed. Two independent physicians graded fundus photos based on amplitude (distance between “ghost” images), the number of images visible, and the direction of nystagmus. Severity was rated on a 0–3 scale using qualitative and quantitative methods. Photographic findings were compared to clinical data, and statistical analysis used Mann-Whitney tests. Results: A total of 53 eyes from 29 patients (16 females, 13 males; mean age 12.5 years, range 3–65) were studied: 25 with binocular nystagmus and 3 with monocular nystagmus. Diagnoses included congenital (n = 15), latent-manifest (n = 3), neurologically associated (n = 2), and idiopathic (n = 9). Types observed were vertical (n = 5), horizontal (n = 23), rotatory (n = 10), and multidirectional (n = 15). Visual acuity ranged from 20/20 to no light perception. Fundus photos correlated with clinical diagnoses, aiding qualitative assessment of direction and amplitude and mitigating eye movement effects for clearer retinal detail visualization. Conclusions: Fundus photography effectively captures nystagmus characteristics and retinal details, even in young children, despite continuous eye movements. Integrating fundus cameras into routine practice may enhance nystagmus diagnosis and management, improving patient outcomes. Full article

(This article belongs to the Section Pediatric Ophthalmology)

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15 pages, 3969 KiB

Open AccessArticle

Novel Inflammatory Biomarkers for Autism Spectrum Disorder Detected by Plasma Olink Proteomics

by Tiying Lv, Mingbang Wang, Ling Kui, Jun Wu and Yang Xiao

Children 2025, 12(2), 210; https://doi.org/10.3390/children12020210 - 11 Feb 2025

Viewed by 333

Abstract

Background: Research evidence has recently shown an association between autism spectrum disorder (ASD) and inflammation. For example, the expression of inflammatory cytokines is abnormal in children with ASD, and maternal inflammation can lead to ASD-like behavior in offspring. These studies suggest that inflammation [...] Read more.

Background: Research evidence has recently shown an association between autism spectrum disorder (ASD) and inflammation. For example, the expression of inflammatory cytokines is abnormal in children with ASD, and maternal inflammation can lead to ASD-like behavior in offspring. These studies suggest that inflammation plays an important role in the occurrence and development of ASD. Inflammatory cytokines may, therefore, be potential biomarkers for ASD. In the present study, we sought to systematically identify inflammatory biomarkers of children with ASD. Methods: We used Olink proteomics to comprehensively examine differentially expressed inflammation-related proteins in 60 children with ASD and 28 children with typical development (TD). We validated our findings using published data. Results: A total of 18 inflammation-related proteins were differentially expressed between the ASD and TD groups. Compared with the TD group, the expression of all differentially expressed proteins was up-regulated in the ASD group. Furthermore, eight differentially expressed proteins showed good diagnostic efficacy, as delineated by area under the curve (AUC) values of > 0.7. To our knowledge, this is the first time that up-regulated interleukin-17C (IL-17C), chemokine ligand (CCL)-19, and CCL20 have been detected in the plasma of children with ASD (with AUC of 0.839, 0.763, and 0.756, respectively). We also found that there was a negative correlation between inflammatory cytokines and SRS scores. Conclusions: Multiple inflammatory markers were increased in children with ASD. IL-17C, CCL19, and CCL20 exhibit potential as biomarker candidates for ASD. Elevated expression levels of cytokines may enhance social ability in ASD. Full article

(This article belongs to the Special Issue Human Genetics and Bioinformatics in Pediatric Diseases)

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14 pages, 380 KiB

Open AccessArticle

“I Wish No Child Died Like This”: Analyzing Responses from Parents of Babies Who Died of Complex Congenital Heart Disease in a Pediatric Intensive Care Unit

by Francesca Benedetti, Viviana Verzeletti, Simonetta Papa, Luca Giacomelli and Caterina Agosto

Children 2025, 12(2), 209; https://doi.org/10.3390/children12020209 - 10 Feb 2025

Viewed by 283

Abstract

Background: The death of a child due to complex congenital heart disease (CCHD) in pediatric intensive care units profoundly affects families, often resulting in lasting grief and emotional distress. Despite advancements in pediatric palliative care (PPC), significant gaps persist in communication and end-of-life [...] Read more.

Background: The death of a child due to complex congenital heart disease (CCHD) in pediatric intensive care units profoundly affects families, often resulting in lasting grief and emotional distress. Despite advancements in pediatric palliative care (PPC), significant gaps persist in communication and end-of-life (EoL) planning. This study explores the experiences and perceptions of bereaved parents to identify areas for improvement in PPC delivery. Methods: A qualitative phenomenological design was used to analyze the lived experiences of 18 bereaved parents whose children died from CCHD at a tertiary cardiac center. Semi-structured telephone interviews were conducted, incorporating five open-ended questions. Data were analyzed inductively using Colaizzi’s method to identify recurring themes and subthemes. Results: Four key thematic areas emerged: communication issues, the parental role, child care, and bereavement support. Parents highlighted inconsistent communication, lack of preparedness for EoL decisions, and emotional isolation as major challenges. Positive experiences often involved compassionate healthcare providers and structured psychological support. A significant proportion of parents identified family support and faith as key coping mechanisms, while others expressed dissatisfaction with post-mortem follow-up and the absence of long-term bereavement care. Conclusions: Bereaved parents’ experiences underscore the need for improved communication strategies, greater parental involvement in care, and enhanced bereavement support. Integrating structured decision-making pathways early in the care trajectory may help mitigate parental distress and improve the quality of EoL experiences for children with CCHD. Full article

(This article belongs to the Section Pediatric Anesthesiology, Pain Medicine and Palliative Care)

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14 pages, 2058 KiB

Open AccessArticle

Integrating Kata Training into School Education: Effects on Sustained Attention and Cognitive Performance in 8–9-Year-Old Children

by Fuat Gökdere, Erdem Uylas, Fatih Çatıkkaş, Erkan Günay, Halil İbrahim Ceylan and Murat Özgören

Children 2025, 12(2), 208; https://doi.org/10.3390/children12020208 - 10 Feb 2025

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Abstract

(1) Background: The ability to sustain attention in primary school children aged 8–9 years plays a critical role in maintaining focus for extended periods, enabling them to comprehend and integrate large amounts of information. Enhancing sustained attention during this formative stage significantly improves [...] Read more.

(1) Background: The ability to sustain attention in primary school children aged 8–9 years plays a critical role in maintaining focus for extended periods, enabling them to comprehend and integrate large amounts of information. Enhancing sustained attention during this formative stage significantly improves a child’s capacity to acquire and consolidate new skills and knowledge, laying a strong foundation for academic and cognitive development. (2) Objectives: This study aimed to assess the effect of an 8-week kata training program on attention and its components in 8–9-year-old school-age children, a critical developmental period for attention. (3) Methods: After excluding the participants who gave a low number of correct answers in the pre-test or created a ceiling effect, 43 participants, aged 9.12 ± 0.40 years, were included in this study. This study, conducted during the academic term, included three measurement phases and a familiarization session. Attention parameters were evaluated using the Bourdon–Vos Test, and participants were categorized into Low Performers (LP) and High Performers (HP) based on pre-test scores. The intervention group (INT) underwent kata training thrice weekly for 8 weeks, while the control group (CON) followed their regular activities. Post-training, attention parameters were reassessed using the Bourdon–Vos Test. (4) Results: In the post-intervention analysis, significant improvements in the number of correct responses were observed in both the LP (p < 0.001, Cohen’s d = −1.333) and HP (p = 0.001, Cohen’s d = −1.644) groups within the INT group. In the CON group, significant improvement was observed only in the HP group (p = 0.031, Cohen’s d = −0.948). Regarding attention processing speed, significant pre-post improvements were found exclusively in the INT group (p < 0.001). Block-wise analysis revealed significant differences only in Block 1 of the CON group (p = 0.011, Cohen’s d = −0.522). However, in the INT group, significant improvements were observed in both Block 1 (p < 0.001, Cohen’s d = −1.200) and Block 2 (p = 0.004, Cohen’s d = −0.678). (5) Conclusions: The findings of this study highlight the effectiveness of an 8-week kata training program in enhancing sustained attention and cognitive processing speed among 8–9-year-old children, particularly in low-performing groups. This suggests that integrating structured kata-based motor and cognitive activities into school curricula can serve as a promising strategy for addressing attention deficits and promoting cognitive development during this critical developmental period. Future studies should examine the long-term effects of kata training on attention and related cognitive functions, such as working memory and executive control. Investigating neurophysiological mechanisms through neuroimaging and including diverse age groups with larger samples could further validate these findings. Full article

(This article belongs to the Special Issue Health Benefits of Physical Activity for Children and Adolescents: 2nd Edition)

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21 pages, 3294 KiB

Open AccessArticle

Role of Sex in Shaping Brain Network Organization During Reading in Developmental Dyslexia

by Tihomir Taskov and Juliana Dushanova

Children 2025, 12(2), 207; https://doi.org/10.3390/children12020207 - 10 Feb 2025

Viewed by 319

Abstract

Background/Methods: The influence of sex on brain organization was investigated in functional reading networks in 8-year-old children, in those typically developing and those with developmental dyslexia (DD), utilizing the minimum spanning tree model. Results: The word reading task revealed subtle sex differences in [...] Read more.

Background/Methods: The influence of sex on brain organization was investigated in functional reading networks in 8-year-old children, in those typically developing and those with developmental dyslexia (DD), utilizing the minimum spanning tree model. Results: The word reading task revealed subtle sex differences in brain connectivity and highlighted even small individual variations in functional connectivity characteristics, particularly among boys with DD. In girls, significantly stronger connections and core hubs were identified within and between motor, parietal, and visual networks in posterior brain regions in both hemispheres, particularly in the θ (dyslexics) and δ (normolexics) frequency bands. In contrast, boys showed a more diffuse connectivity pattern, predominantly in the left hemisphere, encompassing anterior heteromodal and sensorimotor networks. Girls exhibited greater network complexity (bigger leaf fraction, kappa, and tree hierarchy), particularly in the θ and δ frequency bands, while boys with DD showed increased network efficiency, except for in the γ2 band (smaller diameter and bigger leaf fraction). Therefore, gender-specific differences in brain network organization may affect reading development and dyslexia. While sex may influence brain network development, its impact on the sensorimotor and frontoparietal networks of 8-year-old children is relatively limited. Significant sex differences were observed in only a small subset of children, primarily in higher (β2-γ2) frequency bands. Conclusions: Interindividual variations were evident only in boys with DD, impacting both sensorimotor and association networks. Different rates of cortical network maturation between sexes with DD during childhood may contribute to variations associated with disruptions in brain network development, even within fundamental networks like the sensorimotor network. Full article

(This article belongs to the Section Pediatric Neurology & Neurodevelopmental Disorders)

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12 pages, 877 KiB

Open AccessArticle

Predictors of Ventricular Abnormalities in Children with Idiopathic Ventricular Extrasystoles

by Rita Kunigeliene, Odeta Kinciniene, Germanas Marinskis and Vytautas Usonis

Children 2025, 12(2), 206; https://doi.org/10.3390/children12020206 - 9 Feb 2025

Viewed by 328

Abstract

Background and Objectives: Ventricular extrasystoles, which are the most common arrhythmias in healthy children and adolescents, could be a reliable factor for the prognosis of structural heart diseases. However, extrasystoles arising in hearts with primary myocardial diseases or channelopathies might cause life-threatening events [...] Read more.

Background and Objectives: Ventricular extrasystoles, which are the most common arrhythmias in healthy children and adolescents, could be a reliable factor for the prognosis of structural heart diseases. However, extrasystoles arising in hearts with primary myocardial diseases or channelopathies might cause life-threatening events or be associated with arrhythmia-induced cardiomyopathy. The relationship between ventricular extrasystoles and ventricular abnormalities in children remains controversial. The aim of this study was to evaluate prevalence of ventricular abnormalities in children with ventricular extrasystoles. Materials and Methods: This was a retrospective cohort study of pediatric outpatients in Vilnius University Hospital Santaros Clinics because of ventricular extrasystoles. The inclusion criteria were 3–18-year-old children with more than 5% extrasystoles per 24 h. The exclusion criteria were previous diagnoses of congenital heart defects, cardiomyopathies, and channelopathies. We reviewed the results of electrocardiography, cardiac imaging, and cardiogenetic tests. Results: In total, 131 patients (55.7% males) were included from a database of 915 patients, of whom 79.4% ventricular extrasystoles were found incidentally. Ventricular extrasystoles were monomorphic—95.4%, multiform—4.6%, and consecutive—29.8%. Cardiac magnetic resonance imaging was performed on 22.9% of patients with one-third of the pathological findings (ventricular dysfunction and myocardial fibrosis). Ventricular dysfunction was associated with a higher frequency of ventricular extrasystoles, with a median highest frequency of 26.5% per 24 h. Cardiogenetic testing was performed on only five (3.8%) patients, and RyR2 mutation was detected in one. Conclusions: According to our results, ventricular dysfunction was strongly associated with a higher burden of ventricular extrasystoles. Full article

(This article belongs to the Special Issue Current Developments and Future Trends in Congenital Heart Diseases Interventional Cardiology and Cardiac Surgery)

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24 pages, 2636 KiB

Open AccessArticle

Immunomodulatory Tissue Factors in the Gallbladder Walls of Pediatric Patients with Chronic Calculous Cholecystitis

by Kaiva Zīle Zariņa, Māra Pilmane and Aigars Pētersons

Children 2025, 12(2), 205; https://doi.org/10.3390/children12020205 - 8 Feb 2025

Viewed by 371

Abstract

Background: The rising rates of gallstones and cholecystectomy in pediatric populations underscore the increasing concern regarding chronic cholecystitis. However, the morphopathogenesis of pediatric calculous cholecystitis is still not well understood. This study aimed to determine the expression and distribution of immunomodulatory factors interleukin-12 [...] Read more.

Background: The rising rates of gallstones and cholecystectomy in pediatric populations underscore the increasing concern regarding chronic cholecystitis. However, the morphopathogenesis of pediatric calculous cholecystitis is still not well understood. This study aimed to determine the expression and distribution of immunomodulatory factors interleukin-12 (IL-12), interleukin-13 (IL-13), interleukin-1β (IL-1β), sonic hedgehog protein (SHH), nuclear factor NF-kappa-B p65 subunit (NFkBp65), and heat shock protein 60 (HSP60) in the gallbladder walls of pediatric patients with chronic calculous cholecystitis. Methods: In total, 11 gallbladder samples were collected from pediatric patients with calculous cholecystitis during cholecystectomy, while 5 healthy gallbladder samples served as controls. IL-12, IL-13, IL-1β, SHH, NFkBp65, and HSP60 were detected by immunohistochemistry. The number of positive structures in gallbladder wall epithelium, vasculature, and inflammatory infiltrate was assessed semi-quantitatively by microscopy. A Mann–Whitney U test and Spearman’s rank-order correlation coefficient were calculated. Results: Statistically significant differences were observed between patient and control samples in the expression of IL-1β, SHH, and NFkBp65 in the epithelium, as well as in the expression of IL-12, SHH, and HSP60 in the blood vessels. The expression of IL-1β was stronger in the epithelium of controls, while other markers were more prominent in patient samples. Conclusions: An increased number of NFkBp65, IL-12, and HSP60 positive cells in patient gallbladder tissue suggests a significant role of these tissue factors in driving immune modulation and sustaining the inflammation in pediatric chronic calculous cholecystitis. The noticeable expression of SHH in patient gallbladder tissue indicates its part in tissue regeneration and repair processes, as well as in modulating inflammation and vascular responses in calculous cholecystitis. The significant positive correlations between the factors studied highlight the importance of their coordinated interaction and intricate crosstalk in the morphopathogenesis of calculous cholecystitis. Full article

(This article belongs to the Section Global Pediatric Health)

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16 pages, 2278 KiB

Open AccessArticle

Exploring Self-Reported Physical Activity Levels and Physical Fitness in Italian Children: A Mediation and Moderation Analysis

by Domenico Monacis, Italo Sannicandro and Dario Colella

Children 2025, 12(2), 204; https://doi.org/10.3390/children12020204 - 8 Feb 2025

Viewed by 622

Abstract

Background/Objectives: Skill-related physical fitness is a crucial factor influencing health status during childhood. Starting from the lack of knowledge in the field of skill-related physical fitness and levels of physical activity in Southern Italy, this cross-sectional study aims to explore the mediating and [...] Read more.

Background/Objectives: Skill-related physical fitness is a crucial factor influencing health status during childhood. Starting from the lack of knowledge in the field of skill-related physical fitness and levels of physical activity in Southern Italy, this cross-sectional study aims to explore the mediating and moderating influence of PAL on the association between BMI and skill-related physical fitness. Methods: The sample (N = 387 students; male = 196, age = 12.2 ± 0.87 yrs; female = 191, age = 12.3 ± 0.93) was recruited from schools in the Apulia Region. The assessment included standing long jump (SLJ), 2 kg medicine ball throw (MBT) and 10 × 5 shuttle run (10 × 5) as indicators of physical fitness, and a self-report for measuring daily physical activity (PAL). A 2 (gender) × 3 (BMI cutoff)-factorial ANOVA was performed to highlight differences between groups for physical fitness components and PAL. Then, mediation and moderation models were created, establishing BMI as the independent variable, physical fitness tests as dependent variables, and PAL as the mediator and moderator variable. Results: The findings showed higher physical fitness and PAL in male and female normal-weight groups than in those who were overweight and obese. Mediation analysis revealed that higher PAL improved performance in SLJ (b = 0.091, p < 0.01, R² = 17.16%), led to a modest understanding of the variation in MBT (ΔR² = 0.026), and significantly reduced the time spent to perform 10 × 5 (p < 0.0, R² = 10.72%). Conclusions: Despite the obtained results, future research is needed to further understand the association between physical fitness and the sociocultural determinants of physical activity to guide institutional policies and interventions to prevent poor health habits. Full article

(This article belongs to the Special Issue Recent Advances in Children’s Motor Development: From Birth to Adolescence)

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28 pages, 792 KiB

Open AccessReview

The Impact of Parental Behaviors on Children’s Lifestyle, Dietary Habits, Screen Time, Sleep Patterns, Mental Health, and BMI: A Scoping Review

by Cátia Maia, Diogo Braz, Helder Miguel Fernandes, Hugo Sarmento and Aristides M. Machado-Rodrigues

Children 2025, 12(2), 203; https://doi.org/10.3390/children12020203 - 8 Feb 2025

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Abstract

Background and Objectives: Childhood obesity and being overweight are influenced by the family environment, diet, sleep, and mental health, with parents playing a key role in shaping behaviors through routines and practices. Healthy parental habits can encourage positive outcomes, while poor routines and [...] Read more.

Background and Objectives: Childhood obesity and being overweight are influenced by the family environment, diet, sleep, and mental health, with parents playing a key role in shaping behaviors through routines and practices. Healthy parental habits can encourage positive outcomes, while poor routines and stress often lead to unhealthy weight gain. This study analyzed the impact of parental behaviors on children’s lifestyles and habits, as well as the trend and intensity of the effect of these behaviors on different age groups. Methods: A systematic review of 1504 articles from Web of Science, PubMed, Scopus, and APA PsycNet (as of 22 July 2024) included studies on parents and children aged 4–18 years, focusing on physical activity, sleep, screen time, nutrition, and mental health. Twenty-six studies were analyzed, including 19 cross-sectional and 7 longitudinal studies. The outcomes included physical activity, sedentary behaviors, eating and sleeping habits, mental health, and BMI. Bias was assessed using JBI tools according to the GRADE framework and Newcastle-Ottawa Quality Assessment. Results: The studies involved 89,545 youths and 13,856 parents. The key findings revealed associations between parental physical activity, sleep, dietary habits, mental health, screen time, and their children’s BMIs. Parenting styles significantly influence children’s behaviors. This review highlights the crucial influence of parenting styles and behaviors on children’s physical activity, diet, sleep, and mental health, emphasizing the link between family dynamics and childhood obesity. The findings stress the importance of targeting parental habits in interventions focused on healthy routines and stress management. Longitudinal studies are needed to determine causality, while research involving diverse populations is essential to enhance the applicability of these findings. Full article

(This article belongs to the Special Issue Childhood and Teenage Learning, Lifestyle, Health Factors and Physical Activity in Children)

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Children, Volume 12, Issue 2 (February 2025) – 122 articles

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