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Children
Volume 12
Issue 7
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Children, Volume 12, Issue 7 (July 2025) – 152 articles

Cover Story (view full-size image): This study examined sex-specific associations between childhood BMI patterns and cardiometabolic risk in adolescence, using data from a Korean longitudinal cohort that followed children from the age of 7 to 18. Boys who maintained an overweight status during childhood showed elevated liver enzyme levels and a shorter stature, while girls exhibited higher blood pressure and earlier pubertal onset. These sex-specific differences underscore the need for early intervention strategies tailored to reducing the long-term health risks associated with childhood obesity. View this paper
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19 pages, 631 KiB  
Article
Feeling the World Differently: Sensory and Emotional Profiles in Preschool Neurodevelopmental Disorders
by Federica Gigliotti, Maria Eugenia Martelli, Federica Giovannone and Carla Sogos
Children 2025, 12(7), 958; https://doi.org/10.3390/children12070958 - 21 Jul 2025
Viewed by 806
Abstract
Background/Objectives: Atypical sensory processing is increasingly recognized as a transdiagnostic dimension of neurodevelopmental disorders (NDDs), with critical implications for emotional and behavioral regulation. This study aimed to identify distinct sensory profiles in preschool children with NDDs and to examine their associations with emotional–behavioral [...] Read more.
Background/Objectives: Atypical sensory processing is increasingly recognized as a transdiagnostic dimension of neurodevelopmental disorders (NDDs), with critical implications for emotional and behavioral regulation. This study aimed to identify distinct sensory profiles in preschool children with NDDs and to examine their associations with emotional–behavioral and cognitive/developmental functioning. Methods: A total of 263 children (aged 21–71 months) diagnosed with autism spectrum disorder (ASD), language disorder (LD), or other NDDs (ONDD) were recruited. Sensory processing was assessed using the SPM-P, emotional–behavioral functioning was assessed via the CBCL 1½–5, and cognitive/developmental levels were assessed through standardized instruments. Latent profile analysis (LPA) was conducted to identify sensory subtypes. Group comparisons and multinomial logistic regression were used to examine profile characteristics and predictors of profile membership. Results: Three sensory profiles emerged: (1) Multisystemic Sensory Dysfunction (20.1%), characterized by pervasive sensory and emotional difficulties, primarily observed in ASD; (2) Typical Sensory Processing (44.9%), showing normative sensory and emotional functioning, predominantly LD; and (3) Mixed Subclinical Sensory Processing (35%), with subclinical-range scores across multiple sensory and emotional domains, spanning all diagnoses. Higher cognitive functioning and fewer internalizing symptoms significantly predicted membership in the typical profile. A gradient of symptom severity was observed across profiles, with the Multisystemic group showing the most pronounced emotional–behavioral impairments. Conclusions: Distinct sensory–emotional phenotypes were identified across diagnostic categories, supporting a dimensional model of neurodevelopment. Sensory profiles were strongly associated with emotional functioning, independently of diagnostic status. Early sensory assessment may therefore offer clinically meaningful insights into emotional vulnerability and inform targeted interventions in preschool populations with NDDs. Full article
(This article belongs to the Special Issue Children with Specific Neurodevelopmental Disorders: Assessment and Intervention (2nd Edition))
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11 pages, 640 KiB  
Article
Reference Values for Respiratory Impedance in Bulgarian Children Aged 2–8 Years Using the Forced Oscillation Technique (FOT)
by Plamena Stoimenova, Stoilka Mandadzhieva and Blagoi Marinov
Children 2025, 12(7), 957; https://doi.org/10.3390/children12070957 - 21 Jul 2025
Viewed by 285
Abstract
Background/Objectives: The forced oscillation technique (FOT) is a non-invasive, effort-independent method for assessing respiratory mechanics and is particularly suited for young children who cannot reliably perform spirometry. This study aimed to evaluate the main anthropometric determinants of respiratory impedance parameters—resistance (Rrs) and [...] Read more.
Background/Objectives: The forced oscillation technique (FOT) is a non-invasive, effort-independent method for assessing respiratory mechanics and is particularly suited for young children who cannot reliably perform spirometry. This study aimed to evaluate the main anthropometric determinants of respiratory impedance parameters—resistance (Rrs) and reactance (Xrs)—in healthy Bulgarian children aged 2 to 8 years. Methods: A total of 100 healthy children were evaluated using a commercially available device at oscillation frequencies of 5, 11, and 19 Hz. Anthropometric data were collected, and FOT measurements were conducted following ATS/ERS guidelines. Stepwise multiple linear regression was applied to identify predictors of Rrs and Xrs. Results: Height (mean height of the children: 113.89 ± 8.46 cm) emerged as the most significant determinant of both Rrs and Xrs across all frequencies with a moderate inverse correlation observed between Rrs at 5 Hz and height (r = −0.446; p < 0.001). Weight additionally influenced reactance at 5 Hz. The mean R5–19 was 0.55, but no significant associations with height or weight were found. Stepwise regression confirmed height as the sole consistent predictor, while sex and age had no significant effect. Conclusions: This study is the first to present the determinants of key FOT parameters in a population of Bulgarian children. Height was identified as the strongest predictor of respiratory impedance and should be prioritized in the development of reference values for children under 8 years old. These findings reinforce the clinical utility of FOT in early childhood. Full article
(This article belongs to the Section Pediatric Pulmonary and Sleep Medicine)
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17 pages, 560 KiB  
Review
Navigating a New Normal: A Mixed-Methods Study of the Pediatric Tracheostomy Parent-Caregiver Experience
by Laine DiNoto, Adrianne Frankel, Taylor Wheaton, Desirae Smith, Kimberly Buholtz, Rita Dadiz and Kathryn Palumbo
Children 2025, 12(7), 956; https://doi.org/10.3390/children12070956 - 21 Jul 2025
Viewed by 394
Abstract
Objective: To explore the experiences and self-efficacy of parent-caregivers providing care for a child with a tracheostomy tube. Study Design: Parent-caregivers completed surveys and participated in semi-structured interviews about their experiences learning to care for their child with a tracheostomy tube. Survey data [...] Read more.
Objective: To explore the experiences and self-efficacy of parent-caregivers providing care for a child with a tracheostomy tube. Study Design: Parent-caregivers completed surveys and participated in semi-structured interviews about their experiences learning to care for their child with a tracheostomy tube. Survey data were analyzed using descriptive statistics. Interviews were transcribed verbatim and analyzed thematically through coding. Results: Fifteen parent-caregivers participated in the survey, 13 of whom completed an interview. After receiving a tracheostomy, children were hospitalized a median of 6 months prior to discharge home. At the time of our study, children had been home for a median of 3.5 years. Parent-caregivers felt more prepared to perform routine daily care compared to triaging a change in medical status. Parent-caregiver self-efficacy in performing tracheostomy care skills improved with experience at home. Four themes were identified from interviews: new identity formation, enduring education, child and family biopsychosocial support, and establishing normalcy. Parent-caregivers shared that education was more than just acquiring skills; it also involved discovering diverse ways of learning and building confidence in one’s own abilities to fulfill the many types of roles they serve to successfully care for and keep their child safe while supporting their social and emotional needs as parent-caregivers. Conclusions: Parent-caregivers’ reflections on their experiences provide critical insight into their psychosocial needs and challenges in providing care to children with tracheostomies. Further investigation of lived experiences is vital to shaping a community that can support families of medically complex children. Full article
(This article belongs to the Special Issue Healthcare and Transition in Children with Special Needs, Complex Chronic Illness, and Medical Technology Dependence)
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13 pages, 380 KiB  
Article
Association Between Carbohydrate Quality Index During Pregnancy and Risk for Large-for-Gestational-Age Neonates: Results from the BORN 2020 Study
by Antigoni Tranidou, Antonios Siargkas, Ioannis Tsakiridis, Emmanouela Magriplis, Aikaterini Apostolopoulou, Michail Chourdakis and Themistoklis Dagklis
Children 2025, 12(7), 955; https://doi.org/10.3390/children12070955 - 20 Jul 2025
Viewed by 348
Abstract
Background/Objectives: To assess the association between early pregnancy carbohydrate quality, as measured by the Carbohydrate Quality Index (CQI), and the risk of delivering a large-for-gestational-age (LGA) infant in a Mediterranean pregnant cohort of northern Greece. Methods: We analyzed singleton pregnancies from [...] Read more.
Background/Objectives: To assess the association between early pregnancy carbohydrate quality, as measured by the Carbohydrate Quality Index (CQI), and the risk of delivering a large-for-gestational-age (LGA) infant in a Mediterranean pregnant cohort of northern Greece. Methods: We analyzed singleton pregnancies from the BORN 2020 prospective cohort in Greece. Dietary intake was assessed via a validated food frequency questionnaire, and CQI was computed from glycemic index, fiber density, whole-to-refined grain ratio, and solid-to-liquid carbohydrate ratio. Multivariable logistic regression was used to estimate the association between CQI (in tertiles) and LGA risk, defined as birthweight >90th percentile. Results: Among the 797 participants, 152 (19.1%) delivered LGA infants, and 117 (14.7%) were diagnosed with GDM. Of those with GDM, 23 (19.7%) delivered LGA infants. In the total population, higher maternal weight (p < 0.001), height (p = 0.006), and pre-pregnancy BMI (p = 0.004) were significantly associated with LGA. A greater proportion of women with LGA had a BMI > 25 (p = 0.007). In the GDM subgroup, maternal height remained significantly higher in those who delivered LGA infants (p = 0.017). In multivariable models, moderate CQI was consistently associated with increased odds of LGA across all models (Model 1: aOR = 1.60 (95% CI: 1.03–2.50), p = 0.037, Model 2: aOR = 1.57 (95% CI: 1.01–2.46), p = 0.046, Model 3: aOR = 1.58 (95% CI: 1.01–2.47), p = 0.044, Model 4 aOR: 1.70; 95% CI: 1.08–2.72; p = 0.023), whereas high CQI was not. In the GDM subgroup, a significant association between high CQI and increased LGA risk was observed in less adjusted models (Model 1 aOR: 6.74; 95% CI: 1.32–56.66; p = 0.039, Model 2 aOR: 6.64; 95% CI: 1.27–57.48; p = 0.044), but this was attenuated and became non-significant in the fully adjusted model (aOR: 3.05; 95% CI: 0.47–30.22; p = 0.28). When examining CQI components individually, no consistent associations were observed. Notably, a higher intake of low-quality carbohydrates (≥50% of energy intake) was significantly associated with increased LGA risk in the total population (aOR: 4.25; 95% CI: 1.53–11.67; p = 0.005). Conclusions: Higher early pregnancy intake of low-quality carbohydrates was associated with an elevated risk of LGA in the general population. However, CQI itself showed a non-linear and inconsistent relationship with LGA, with moderate, but not high, CQI linked to increased risk, particularly in GDM pregnancies, where associations were lost after adjustment. Both carbohydrate quality and quantity evaluations are essential, particularly in high-risk groups, to inform dietary guidance in pregnancy. Full article
(This article belongs to the Special Issue Recent Advances in Maternal and Fetal Health (2nd Edition))
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13 pages, 601 KiB  
Article
Differences of Sex Development: A Study of 420 Patients from a Single Tertiary Pediatric Endocrinology Center
by Silvia Ventresca, Laura Chioma, Rosario Ruta, Mafalda Mucciolo, Pasquale Parisi, Agnese Suppiej, Sandro Loche, Marco Cappa and Carla Bizzarri
Children 2025, 12(7), 954; https://doi.org/10.3390/children12070954 - 19 Jul 2025
Viewed by 530
Abstract
Background: Differences of sex development (DSD) are a group of congenital conditions characterized by atypical development of genital structures. The diagnosis is complex and involves clinical, hormonal, and genetic evaluations. Objective: To describe the clinical profile, diagnosis, and management of patients [...] Read more.
Background: Differences of sex development (DSD) are a group of congenital conditions characterized by atypical development of genital structures. The diagnosis is complex and involves clinical, hormonal, and genetic evaluations. Objective: To describe the clinical profile, diagnosis, and management of patients with DSD, with particular attention to genetic diagnosis. Study design: Retrospective study from a tertiary care pediatric hospital in Italy. Methods: 420 patients with DSD referred to the Endocrine Unit of Bambino Gesù Children’s Hospital in Rome, Italy, between 2016 and 2023 were included. Results: 75 patients had a 46,XY karyotype, 135 had a 46,XX karyotype, and 210 had chromosomal mosaicism. In our group of pediatric DSD patients, 21/420 patients were born from pregnancies induced with assisted reproduction techniques (ICSI/FIVET). Of these 21 patients, 5 had sex chromosome mosaicism. Using next-generation sequencing (NGS), we identified three new genetic variants: one in the AR gene, one in the NR5A1 gene, and one in the SRY gene. The use of NGS significantly improved the diagnostic yield, and a definitive diagnosis was reached in 84.76% of the entire cohort. Conclusions: This study highlights the challenges in the management of patients with DSD from early recognition to treatment and follow-up. A multidisciplinary approach is essential for a comprehensive evaluation of these conditions and to understand the role and clinical significance of the genetic variants. Full article
(This article belongs to the Section Pediatric Endocrinology & Diabetes)
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18 pages, 882 KiB  
Review
The Association Between Skipping Breakfast and Anxiety and Depression in Adolescents—A Scoping Review
by Tatiana Naumoska, Kristina Zafirovski and Fahad Hanna
Children 2025, 12(7), 953; https://doi.org/10.3390/children12070953 - 19 Jul 2025
Viewed by 1309
Abstract
Background: Anxiety and depression are among the most common mental health disorders affecting adolescents worldwide. Skipping breakfast is a prevalent dietary behaviour linked to inadequate nutrient intake, which may contribute to the development or exacerbation of mental health issues in this age group. [...] Read more.
Background: Anxiety and depression are among the most common mental health disorders affecting adolescents worldwide. Skipping breakfast is a prevalent dietary behaviour linked to inadequate nutrient intake, which may contribute to the development or exacerbation of mental health issues in this age group. Despite growing interest, a comprehensive synthesis of evidence on the association between breakfast omission and adolescent anxiety or depression remains limited. Objectives: This scoping review aimed to synthesise existing research on the association between skipping breakfast and the risk of anxiety and/or depression in adolescents. Methods: A systematic scoping review was conducted using the Joanna Briggs Institute (JBI) methodological framework. A comprehensive search of PubMed, ProQuest, and EBSCOhost databases was performed, focusing on studies published in English between 2014 and 2024. Keywords included “skipping breakfast,” “risk,” “anxiety,” “depression,” and “adolescen*.” Studies were screened and selected based on predefined inclusion and exclusion criteria. Results: Out of 1671 initially identified studies, 12 met the inclusion criteria. The majority were cross-sectional (n = 9), with one prospective cohort study, one secondary data analysis, and one systematic review with meta-analysis. Most studies reported a significant association between breakfast skipping and increased risk of anxiety and depression in adolescents. Only one study reported no significant relationship between the two variables. Conclusions: This review underscores a consistent association between skipping breakfast and elevated risk of anxiety and depression among adolescents. While causality remains to be established, breakfast omission emerges as a modifiable lifestyle factor with potential public health implications. These findings highlight the need for prospective research, as well as the importance of community- and school-based health promotion strategies that advocate for regular and nutritious breakfast consumption as part of broader mental health support efforts. Full article
(This article belongs to the Section Pediatric Mental Health)
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13 pages, 1732 KiB  
Article
Clinical and Phenotypic Characteristics of Early-Onset Inflammatory Bowel Disease: A Five-Year Observational Study
by Ivan S. Samolygo, Marina A. Manina, Ekaterina A. Yablokova, Pavel A. Stribul, Alexander V. Novikov, Anton S. Antishin, Albina S. Pestova, Alexander S. Tertychnyy, Daniel Munblit and Svetlana I. Erdes
Children 2025, 12(7), 952; https://doi.org/10.3390/children12070952 - 18 Jul 2025
Viewed by 446
Abstract
Background: Inflammatory bowel diseases with an early-onset form (EO-IBDs) make up a special disease group with certain clinical and phenotypic characteristics. This article discusses the features of such early onset in a group of children, based on five years of monitoring a registry [...] Read more.
Background: Inflammatory bowel diseases with an early-onset form (EO-IBDs) make up a special disease group with certain clinical and phenotypic characteristics. This article discusses the features of such early onset in a group of children, based on five years of monitoring a registry of children with IBD from a specialized center. Methods: This retrospective single-center cohort study included pediatric patients diagnosed with EO-IBD between 2019 and 2024. Clinical, laboratory, and endoscopic data were collected from medical records, including fecal calprotectin, inflammatory markers, disease activity indices, and endoscopic severity scores. Localization was classified according to the Paris system, and histological activity was assessed using the IBD-DCA score. Results: There were 20 patients with ulcerative colitis (UC) and 17 with Crohn’s disease (CD). Clinical activity was moderate or high (p = 0.179). UC was more characterized by diarrhea and rectal bleeding. CD was more often accompanied by abdominal pain, weight loss, and fever. In total, 82.4% of patients with CD had an inflammatory form. UC-like intestinal lesion was typical of both nosologies—L3 64.7% and E4 60% forms in CD and UC, respectively. Morphological activity was moderate for both nosologies (p = 0.54). IBD-U was present in 43.2% of patients. The median time after which it was possible to diagnose UC was 24 weeks (IQR 20–48) and 40 weeks (IQR 30–45.5) for CD (p = 0.56). Conclusions: Our study confirms the presence of characteristic signs of EO-IBD development, such as a frequent family history of IBD, high or moderate clinical activity during diagnosis verification, colon damage, and a high frequency of extraintestinal manifestations. Full article
(This article belongs to the Special Issue Pediatric Inflammatory Bowel Disease: Update on Treatment and Therapeutic Endpoints)
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11 pages, 1058 KiB  
Article
Mandibular Dentoalveolar Expansion in Early Mixed Dentition Using the Clara Expander: A Case Series
by Esther García-Miralles, Clara Guinot-Barona, Laura Marqués-Martínez, Juan Ignacio Aura-Tormos and Victor Marco-Cambra
Children 2025, 12(7), 951; https://doi.org/10.3390/children12070951 - 18 Jul 2025
Viewed by 320
Abstract
Objective: Mandibular expansion remains controversial due to concerns about long-term stability and effectiveness. While maxillary expansion protocols are well established, investigations into mandibular expansion remain limited. This study evaluates the efficacy of the Clara Expander appliance for mandibular expansion in early mixed [...] Read more.
Objective: Mandibular expansion remains controversial due to concerns about long-term stability and effectiveness. While maxillary expansion protocols are well established, investigations into mandibular expansion remain limited. This study evaluates the efficacy of the Clara Expander appliance for mandibular expansion in early mixed dentition, assessing skeletal and dental changes using cone-beam computed tomography (CBCT). Materials and Methods: This prospective longitudinal study was conducted in Valencia, Spain, with a population of healthy children aged 6–10 years presenting negative osseodental mandibular discrepancies. CBCT scans were performed before and after treatment to evaluate mandibular dimensional changes, with statistical analyses conducted and a significance threshold of p < 0.05. A total of seven subjects were included in this case series, allowing for a descriptive analysis of treatment outcomes within this specific clinical context. Results: CBCT analysis confirmed significant mandibular expansion following the Clara Expander protocol. Post-treatment findings showed statistically significant increases in dental parameters, including Tooth 6 (furcation, MD = −2.25; p = 0.015), Tooth E (furcation, cementoenamel junction, vestibular, lingual, all p < 0.001), Tooth D (all variables significant), and Tooth C (furcation, MD = −4.18; p = 0.002; cementoenamel junction, MD = −3.56; p = 0.015). Conclusions: The Clara Expander appliance effectively promotes skeletal and dental mandibular expansion, with minimal adverse effects. Its user-friendly, non-invasive design enhances patient compliance and outcomes, contributing valuable data to the field of mandibular expansion and informing future research and clinical applications. Full article
(This article belongs to the Section Pediatric Dentistry & Oral Medicine)
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18 pages, 655 KiB  
Systematic Review
Indocyanine Green Fluorescence Navigation in Pediatric Hepatobiliary Surgery: Systematic Review
by Carlos Delgado-Miguel, Javier Arredondo-Montero, Julio César Moreno-Alfonso, Isabella Garavis Montagut, Marta Rodríguez, Inmaculada Ruiz Jiménez, Noela Carrera, Pablo Aguado Roncero, Ennio Fuentes, Ricardo Díez and Francisco Hernández-Oliveros
Children 2025, 12(7), 950; https://doi.org/10.3390/children12070950 - 18 Jul 2025
Viewed by 407
Abstract
Introduction: Near-infrared fluorescence (NIRF) imaging with indocyanine green (ICG) is now widely regarded as a valuable aid in decision-making for complex hepatobiliary procedures, with increasing support from recent studies. Methods: We performed a systematic review following PRISMA guidelines, utilizing PubMed, CINAHL, [...] Read more.
Introduction: Near-infrared fluorescence (NIRF) imaging with indocyanine green (ICG) is now widely regarded as a valuable aid in decision-making for complex hepatobiliary procedures, with increasing support from recent studies. Methods: We performed a systematic review following PRISMA guidelines, utilizing PubMed, CINAHL, and EMBASE databases to locate studies on the perioperative use ICG in pediatric hepatobiliary surgeries. Two independent reviewers assessed all articles for eligibility based on predefined inclusion criteria. We collected data on study design, patient demographics, surgical indications, ICG dosing, timing of ICG injection, and perioperative outcomes. Results: Forty-three articles, including 930 pediatric patients, from 1989 to 2025 met the inclusion criteria for narrative synthesis in our systematic review, of which 22/43 (51.2%) were retrospective studies, 15/43 were case reports (34.9%), 3/43 (7.0%) were experimental studies, and the other three were prospective comparative studies (7.0%). The current clinical applications of ICG in hepatobiliary pediatric surgery include bile duct surgery (cholecystectomy, choledochal cyst, biliary atresia), reported in 17 articles (39.5%), liver tumor resection, reported in 15 articles (34.9%), liver transplantation, reported in 6 articles (14.6%), and liver function determination, reported in 5 articles (12.2%). Conclusions: ICG fluorescence navigation in pediatric hepatobiliary surgery is a highly promising and safe technology that allows for the intraoperative localization of anatomic biliary structures, aids in the identification and resection of liver tumors, and can accurately determine hepatic function. The lack of comparative and prospective studies, and the variability of the dose and timing of administration are the main limitations. Full article
(This article belongs to the Special Issue Advances and Controversies in Paediatric Gastrointestinal and Hepatobiliary Surgery: Update)
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13 pages, 3525 KiB  
Article
Epidemiologic Investigation of a Varicella Outbreak in an Elementary School in Gyeonggi Province, Republic of Korea
by Gipyo Sung, Jieun Jang and Kwan Lee
Children 2025, 12(7), 949; https://doi.org/10.3390/children12070949 - 18 Jul 2025
Viewed by 508
Abstract
Background/Objectives: On 6 June 2023, two varicella cases were reported at a highly vaccinated elementary school in Gyeonggi Province, Republic of Korea. We investigated the outbreak to describe its transmission dynamics; quantify attack rates in school, household, and private-academy settings; and assess [...] Read more.
Background/Objectives: On 6 June 2023, two varicella cases were reported at a highly vaccinated elementary school in Gyeonggi Province, Republic of Korea. We investigated the outbreak to describe its transmission dynamics; quantify attack rates in school, household, and private-academy settings; and assess the impact of coordinated control measures. Methods: A case-series study included 89 teachers and students who had contact with suspected patients. Using case definitions, laboratory tests, questionnaires, and environmental assessments, we evaluated exposures and factors facilitating spread. Results: Varicella developed in 23 of 89 contacts (25.8%); laboratory confirmation was obtained in 2 (8.7% of cases). The mean incubation period was 13 days. Epidemic-curve and network analyses indicated that the outbreak began with a single index case and extended through household contacts and private educational facilities, ultimately involving multiple schools. Conclusions: Breakthrough transmission can occur even when single-dose coverage exceeds 95%, particularly as vaccine-induced immunity may wane over time. Poorly regulated extracurricular facilities, such as private academies, act as bridging hubs that amplify spread across grades and even between schools. For timely detection and control, these venues should be incorporated into routine varicella surveillance, and rapid, coordinated infection-control measures are required across all educational settings. Full article
(This article belongs to the Special Issue Pediatric Infectious Disease Epidemiology)
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22 pages, 8428 KiB  
Article
Platelet and Fibrinogen Contribution to Clot Strength in Premature Neonates with Sepsis
by Dimitra Gialamprinou, Christos-Georgios Kontovazainitis, Abraham Pouliakis, Alexandra Fleva, Anastasia Giannakou, Elisavet Diamanti, Panagiotis Kratimenos and Georgios Mitsiakos
Children 2025, 12(7), 948; https://doi.org/10.3390/children12070948 - 18 Jul 2025
Viewed by 361
Abstract
Background/Objectives: Platelet transfusions are administered to preterm neonates with thrombocytopenia prophylactically to decrease their bleeding risk. The amplitude difference between the extrinsic rotational thromboelastometry (EXTEM) and the fibrinogen rotational thromboelastometry (FIBTEM) assays is considered an index of platelet contribution to clot strength, [...] Read more.
Background/Objectives: Platelet transfusions are administered to preterm neonates with thrombocytopenia prophylactically to decrease their bleeding risk. The amplitude difference between the extrinsic rotational thromboelastometry (EXTEM) and the fibrinogen rotational thromboelastometry (FIBTEM) assays is considered an index of platelet contribution to clot strength, guiding transfusion management. The difference in maximum clot elasticity (MCE) (namely the platelet contribution to clot elasticity—MCEplatelet) is considered highly accurate. Limited data exist to specify the contribution of platelets and fibrinogen in clot formation during sepsis in neonates with thrombocytopenia. We investigated the potential of MCFplatelet (platelet contribution to clot firmness) and MCEplatelet in reflecting platelet count and function in septic preterm neonates. We simultaneously assessed the contribution of both platelets and fibrinogen to clot strength during sepsis. Methods: We compared 28 preterm neonates with sepsis born (gestational age 24+1-34+3) with 30 healthy counterparts by using rotational thromboelastometry (ROTEM) and platelet flow cytometry. Results: MCEplatelet showed a higher association with platelet count in the sepsis group than MCFplatelet (R2 = 47.66% vs. R2 = 18.79%). MCEplatelet (AUC = 0.81) had better discrimination capability than MCFplatelet (AUC = 0.78) in platelet count <100 × 103/L. MCEplatelet was poorly associated with platelet function. The contribution of platelets was significantly lower (MCEplatelet = 84.03 vs. 89.21; p < 0.001) compared with fibrinogen (36.9 vs. 25.92; p < 0.001) in the sepsis group. Conclusions: MCEplatelet has a better predictive value than MCFplatelet. In clinical practice, the elasticity difference between EXTEM and FIBTEM may replace the amplitude difference. The higher contribution of fibrinogen in clot strength during neonatal sepsis results in higher MCF, even in neonates with thrombocytopenia. Full article
(This article belongs to the Section Pediatric Neonatology)
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13 pages, 227 KiB  
Article
Perceptions of Parental Needs in General Pediatric Inpatient Units: A Comparative Study Between Nurses and Parents in Saudi Arabia
by Hawa Alabdulaziz, Malak Alharthi, Sara Alhazmi, Alyaa Hawsawi, Shahad Almuhyawi and Zahra Almalki
Children 2025, 12(7), 947; https://doi.org/10.3390/children12070947 - 18 Jul 2025
Viewed by 342
Abstract
Introduction: Hospitalization of children creates significant emotional and psychological stress for parents, highlighting the importance of addressing their needs in pediatric care settings. Aims: This study examines the perceptions of both parents and pediatric nurses regarding the needs of hospitalized children. [...] Read more.
Introduction: Hospitalization of children creates significant emotional and psychological stress for parents, highlighting the importance of addressing their needs in pediatric care settings. Aims: This study examines the perceptions of both parents and pediatric nurses regarding the needs of hospitalized children. Method: A cross-sectional survey using the validated Needs of Parents of Hospitalized Children (NPQ) was administered to 218 parents and 218 pediatric nurses in four hospitals in Jeddah, Saudi Arabia. Key domains assessed included trust, information, and support. Group differences were evaluated using non-parametric statistical analyses. Results: Trust was prioritized more by parents (83.9%) than nurses (72.4%) (p < 0.05). Both groups deemed information important, but parents (87.2%) rated it as more necessary than nurses (74.1%) (p = 0.02). Parents (79.8%) expressed a greater need for support compared to nurses (67.3%) (p = 0.03). Conclusions: This study identified perceptual differences between parents and nurses regarding trust, communication, and support. Some differences were statistically significant at the p < 0.01 level, while others were suggestive (p-value between 0.01 and 0.05) and require further investigation. These disparities suggest a need to foster mutual understanding and improve communication practices to better align healthcare delivery with family expectations and strengthen family-centered care. Full article
(This article belongs to the Section Pediatric Nursing)
16 pages, 289 KiB  
Article
Temperamental Dimensions in Early Childhood: Gender Differences and Their Relationship to Emotional and Behavioral Disorders in a Longitudinal Study
by Teresa Navarro-Ariza, Lidia Infante-Cañete, Dolores Madrid-Vivar, Agustín Wallace Ruiz and Elena Alarcón-Orozco
Children 2025, 12(7), 946; https://doi.org/10.3390/children12070946 - 18 Jul 2025
Viewed by 279
Abstract
Background: This longitudinal study aims to explore the stability and changes in child temperament dimensions between the ages of three and six, analyzing their relationship with emotional and behavioral problems, differentiated by gender. Method: This study involved 24 boys and 25 [...] Read more.
Background: This longitudinal study aims to explore the stability and changes in child temperament dimensions between the ages of three and six, analyzing their relationship with emotional and behavioral problems, differentiated by gender. Method: This study involved 24 boys and 25 girls from various early childhood education centers in Málaga, Spain. To assess temperament, the Spanish adaptation of the Children’s Behavior Questionnaire was used, while emotional and behavioral problems were evaluated using the SPECI Screening for Emotional and Behavioral Problems in Children. Results: Findings indicate that 9 out of the 15 temperament dimensions remained stable, while 4—anger/frustration, attentional focusing, perceptual sensitivity, and sadness—showed significant changes in the total sample. The gender-specific analysis revealed different developmental patterns for boys and girls. Girls exhibited changes in attentional focusing, fear, and perceptual sensitivity, while boys showed changes in anger/frustration and attentional focusing. In addition, girls scored higher in discomfort and fear, whereas boys stood out in activity levels. Regarding behavioral problems, girls’ externalizing symptoms were significantly associated with attentional focusing and smiling/laughter, while internalizing symptoms were linked to low-intensity pleasure and perceptual sensitivity. Conclusions: These findings highlight the importance of addressing temperament from a gender-differentiated perspective when designing educational and family interventions aimed at promoting socioemotional development. Full article
(This article belongs to the Section Pediatric Neurology & Neurodevelopmental Disorders)
11 pages, 501 KiB  
Article
Comparison of Carbapenem vs. Amikacin Antimicrobial Therapy for Pediatric Acute Pyelonephritis Caused by Extended-Spectrum Β-Lactamase-Positive Enterobacteriaceae
by Burcu Ceylan Cura Yayla, Tuğba Bedir Demirdağ, Anıl Tapısız, Yeşim Özdemir Atikel, Hasan Tezer, Elif Ayça Şahin, Kayhan Çağlar, Sevcan A. Bakkaloğlu and Necla Buyan
Children 2025, 12(7), 945; https://doi.org/10.3390/children12070945 - 18 Jul 2025
Viewed by 370
Abstract
Objectives: Acute pyelonephritis (APN) caused by extended-spectrum β-lactamase (ESBL)-positive Enterobacteriaceae poses a growing therapeutic challenge in children, as carbapenems remain the mainstay of treatment even when susceptibility to alternative agents such as amikacin is demonstrated. However, the widespread and inappropriate use of [...] Read more.
Objectives: Acute pyelonephritis (APN) caused by extended-spectrum β-lactamase (ESBL)-positive Enterobacteriaceae poses a growing therapeutic challenge in children, as carbapenems remain the mainstay of treatment even when susceptibility to alternative agents such as amikacin is demonstrated. However, the widespread and inappropriate use of carbapenems can lead to carbapenem resistance. The aim of this study was to compare the clinical efficacy of amikacin and carbapenems in the management of pediatric acute pyelonephritis caused by ESBL-positive Enterobacteriaceae. Methods: We analyzed cases of pediatric acute pyelonephritis caused by ESBL-positive Enterobacteriaceae that were treated with either carbapenems or amikacin over a two-year period. This study compared microbiological cure, clinical improvement, and recurrence rates across the amikacin and carbapenem treatment groups. Results: Fifty-five patients were evaluated. The median age of the patients was 3 years (range, 0.1–13 years). The causative agents were E. coli in 43 cases (78.2%) and Klebsiella spp. in 12 cases (21.8%). All were susceptible to both carbapenem and amikacin in vitro. Twenty patients (36.3%) received a carbapenem and thirty-five (63.7%) received amikacin. Twenty-four (43.6%) had an underlying urological disease. No difference was observed between the groups in terms of microbiological cure, clinical improvement, or recurrence rates. Conclusions: Amikacin may be a potential alternative to carbapenems for treating pediatric ESBL-positive APN when in vitro susceptibility is confirmed. Full article
(This article belongs to the Special Issue Infectious Disease Epidemiology in Children: Latest Developments and Treatments)
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13 pages, 819 KiB  
Article
Evaluating the Effectiveness of Biodiverse Green Schoolyards on Child BMI z-Score and Physical Metrics: A Pilot Quasi-Experimental Study
by Bo H. W. van Engelen, Lore Verheyen, Bjorn Winkens, Michelle Plusquin and Onno C. P. van Schayck
Children 2025, 12(7), 944; https://doi.org/10.3390/children12070944 - 17 Jul 2025
Viewed by 378
Abstract
Background: Childhood obesity is a significant public health issue linked to poor diet, low physical activity, and limited access to supportive environments. Green schoolyards may promote physical activity and improve health outcomes. This study evaluated the impact of the Green Healthy Primary School [...] Read more.
Background: Childhood obesity is a significant public health issue linked to poor diet, low physical activity, and limited access to supportive environments. Green schoolyards may promote physical activity and improve health outcomes. This study evaluated the impact of the Green Healthy Primary School of the Future (GHPSF) intervention—greening schoolyards—on children’s BMI z-scores, waist circumference, and hip circumference over 18 months, and compared these effects to those observed in the earlier Healthy Primary School of the Future (HPSF) initiative. Methods: This longitudinal quasi-experimental study included two intervention and two control schools in Limburg, a province both in the Netherlands and Belgium. Children aged 8–12 years (n = 159) were assessed at baseline, 12 months, and 18 months for anthropometric outcomes. Linear mixed models were used to estimate intervention effects over time, adjusting for sex, age, country, and socioeconomic background. Standardized effect sizes (ESs) were calculated. Results: The intervention group showed a greater reduction in BMI z-scores at 12 months (ES = −0.15, p = 0.084), though this was not statistically significant. Waist circumference increased in both groups, but less so in the intervention group, at 12 months (ES = −0.23, p = 0.057) and 18 months (ES = −0.13, p = 0.235). Hip circumference and waist–hip ratio changes were minimal and non-significant. GHPSF effect sizes were comparable to or greater than those from the HPSF initiative. Conclusions: Though not statistically significant, trends suggest that greening schoolyards may support favorable changes in anthropometric outcomes. Further research with larger samples and longer follow-up is recommended. Full article
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23 pages, 2062 KiB  
Review
A Systematic Review of the Bibliometrics and Methodological Research Used on Studies Focused on School Neighborhood Built Environment and the Physical Health of Children and Adolescents
by Iris Díaz-Carrasco, Sergio Campos-Sánchez, Ana Queralt and Palma Chillón
Children 2025, 12(7), 943; https://doi.org/10.3390/children12070943 - 17 Jul 2025
Viewed by 564
Abstract
Objectives: The aim of this systematic review is to analyze the research journals, sample characteristics and research methodology used in the studies about school neighborhood built environment (SNBE) and the physical health of children and adolescents. Methods: Using 124 key terms [...] Read more.
Objectives: The aim of this systematic review is to analyze the research journals, sample characteristics and research methodology used in the studies about school neighborhood built environment (SNBE) and the physical health of children and adolescents. Methods: Using 124 key terms across four databases (Web of Science, PubMed, Sportdiscus and Transportation Research Board), 8837 studies were identified, and 55 were selected. The research question and evidence search were guided by the “Population, Intervention, Comparison, Outcomes” (PICO) framework. Results: Most studies were published in health-related research journals (67.3%) and conducted in 16 countries, primarily urban contexts (44.4%). Cross-sectional designs dominated (89.1%), with participation ranging from a minimum of 7 schools and 94 students to a maximum of 6362 schools and 979,119 students. Street network distances are often defined by 1000 or 800 m. The SNBE variables (135 total) were often measured via GIS (67.2%). In contrast, 70.6% of the 45 physical health measures relied on self-reports. Conclusions: This systematic review highlights the diverse approaches, gaps, and common patterns in studying the association between the SNBE and the physical health of children and adolescents. Therefore, this manuscript may serve as a valuable resource to examine the current landscape of knowledge and to guide future research on this topic. Full article
(This article belongs to the Special Issue Motor Skills and Integral Health in Children and Adolescents: Keys to an Active Future)
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13 pages, 839 KiB  
Perspective
Inclusion in Motion: Promoting Equitable Physical Activity and Health in Childhood and Adolescence
by Vidar Sandsaunet Ulset, Luca Oppici, Karin Hamre, James Robert Rudd, Annett Victoria Stornæs, Heidi Marian Haraldsen and Reidar Säfvenbom
Children 2025, 12(7), 942; https://doi.org/10.3390/children12070942 - 17 Jul 2025
Viewed by 435
Abstract
Inclusion in play, physical education, outdoor life, organized sports, and other movement-based activities can promote resilience and support physical, emotional, and social well-being. These arenas are particularly important for reducing health disparities and preventing social marginalization across the lifespan. Yet, children and adolescents [...] Read more.
Inclusion in play, physical education, outdoor life, organized sports, and other movement-based activities can promote resilience and support physical, emotional, and social well-being. These arenas are particularly important for reducing health disparities and preventing social marginalization across the lifespan. Yet, children and adolescents from vulnerable or disadvantaged backgrounds encounter persistent barriers to participation, rooted in broader inequalities related to their socioeconomic position, disability, gender, ethnicity, and access to supportive environments. This perspective outlines how inclusive movement contexts, when informed by developmental systems theory and resilience frameworks, can interrupt trajectories of marginalization and promote long-term equity in health, education, and work inclusion. We emphasize the need for interdisciplinary approaches, combining longitudinal and qualitative methods, to uncover how vulnerability and participation interact dynamically over time. By integrating insights from developmental science, education, public health, and spatial ecology, we identify strategic pathways for research and action. Addressing these challenges requires coordinated efforts across sectors and stakeholders to co-create inclusive, context-sensitive interventions. Full article
(This article belongs to the Special Issue Promoting Healthy Lifestyles in Children and Adolescents)
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29 pages, 2281 KiB  
Systematic Review
The Pathway Is Clear but the Road Remains Unpaved: A Scoping Review of Implementation of Tools for Early Detection of Cerebral Palsy
by Álvaro Hidalgo-Robles, Javier Merino-Andrés, Mareme Rose Samb Cisse, Manuel Pacheco-Molero, Irene León-Estrada and Mónica Gutiérrez-Ortega
Children 2025, 12(7), 941; https://doi.org/10.3390/children12070941 - 17 Jul 2025
Viewed by 883
Abstract
Background/Objectives: International guidelines recommend the combined use of the General Movement Assessment (GMA), Hammersmith Infant Neurological Examination (HINE), and magnetic resonance imaging (MRI) to support early and accurate diagnosis of cerebral palsy (CP). However, their implementation remains inconsistent. This study aimed to [...] Read more.
Background/Objectives: International guidelines recommend the combined use of the General Movement Assessment (GMA), Hammersmith Infant Neurological Examination (HINE), and magnetic resonance imaging (MRI) to support early and accurate diagnosis of cerebral palsy (CP). However, their implementation remains inconsistent. This study aimed to map their reported global use and identify associated enablers and barriers. Methods: A scoping review was conducted following JBI and PRISMA-ScR guidelines. Systematic searches were performed in PubMed, Cochrane, PEDro, ProQuest, Web of Science, and Scopus. Eligible studies were charted and thematically analyzed, focusing on tools use and implementation factors at individual, organizational, and system levels. Results: Fourteen articles (seven surveys, seven implementation studies) from seven countries met the inclusion criteria. While awareness of GMA, HINE, and MRI was generally high, routine clinical use was limited—particularly outside structured implementation initiatives. Major barriers emerged at the system level (e.g., limited training access, time constraints, lack of standardized referral pathways) and social level (e.g., unclear leadership and coordination). Conclusions: The limited integration of GMA, HINE, and MRI into routine practice reflects a persistent “know–do” gap in early CP detection. Since implementation is shaped by the dynamic interplay of capability, opportunity, and motivation, bridging this gap demands sustained and equitable action—by addressing system-wide barriers, supporting professional development, and embedding early detection within national care pathways. Full article
(This article belongs to the Special Issue Children with Cerebral Palsy and Other Developmental Disabilities)
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9 pages, 290 KiB  
Article
Primary and Secondary Prophylaxis of Gastrointestinal Bleeding in Children with Portal Hypertension: A Multicenter National Study by SIGENP
by Naire Sansotta, Paola De Angelis, Daniele Alberti, Fabiola Di Dato, Serena Arrigo, Matteo Bramuzzo, Benedetta Calcaterra, Mara Cananzi, Maurizio Cheli, Andrea Chiaro, Francesco Cirillo, Mara Colusso, Grazia Di Leo, Simona Faraci, Paola Gaio, Giuseppe Indolfi, Silvia Iuliano, Daniela Liccardo, Antonio Marseglia, Matteo Motta, Federica Nuti, Filippo Parolini, Sara Renzo, Francesca Sbravati, Marco Sciveres, Claudia Mandato and Angelo Di Giorgioadd Show full author list remove Hide full author list
Children 2025, 12(7), 940; https://doi.org/10.3390/children12070940 - 17 Jul 2025
Viewed by 366
Abstract
Background/Objectives: Portal hypertension (PH) is a common complication in children with chronic liver diseases. Primary and secondary prophylaxis of variceal bleeding in these patients remains controversial. Our study aims to evaluate the management of gastrointestinal (GI) varices in children with PH in [...] Read more.
Background/Objectives: Portal hypertension (PH) is a common complication in children with chronic liver diseases. Primary and secondary prophylaxis of variceal bleeding in these patients remains controversial. Our study aims to evaluate the management of gastrointestinal (GI) varices in children with PH in Italy. Methods: A questionnaire was sent to 21 major pediatric hepatology centers. It included 34 questions referring to the medical, endoscopic, radiological, and surgical management of GI varices. Results: Out of 21 centers, 16 returned a completed questionnaire (survey response rate 76%) with a high level of completeness. A total of 1206 children with PH were under follow-up. Splenomegaly associated with hypersplenism was the main indication for endoscopic surveillance in all centers (100%). Primary prophylaxis was performed with endoscopy plus non-selective beta-blockers (NSBBs) in 50%, endoscopy alone in 38%, and NSBBs alone in 12%. All centers managed acute variceal bleeding with endoscopy within 24 h, acid suppression, and octreotide infusion. Secondary prophylaxis of variceal bleeding was conducted using endoscopy (100%) and NSBBs (87%). Transjugular intrahepatic portosystemic shunt (TIPS) was considered a good option when endoscopic treatment failed in 94% of centers. Conclusions: In Italy, there is broad consensus among centers regarding the management of gastrointestinal varices in children with portal hypertension. All participating centers endorsed the use of endoscopic screening for children presenting with clinical signs of portal hypertension. Nonetheless, further research is essential to establish evidence-based guidelines and to improve overall quality of care. Full article
(This article belongs to the Section Pediatric Gastroenterology and Nutrition)
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16 pages, 2779 KiB  
Article
Ambulatory Blood Pressure Monitoring in Children: A Cross-Sectional Study of Blood Pressure Indices
by Sulaiman K. Abdullah, Ibrahim A. Sandokji, Aisha K. Al-Ansari, Hadeel A. Alsubhi, Abdulaziz Bahassan, Esraa Nawawi, Fawziah H. Alqahtani, Marwan N. Flimban, Mohamed A. Shalaby and Jameela A. Kari
Children 2025, 12(7), 939; https://doi.org/10.3390/children12070939 - 16 Jul 2025
Viewed by 337
Abstract
Background: Ambulatory blood pressure monitoring (ABPM) is increasingly recognized as a more reliable indicator of blood pressure status in children than clinic-based measurements, with superior predictive value for cardiovascular morbidity and mortality. However, evidence on the clinical utility of ABPM-derived indices, such as [...] Read more.
Background: Ambulatory blood pressure monitoring (ABPM) is increasingly recognized as a more reliable indicator of blood pressure status in children than clinic-based measurements, with superior predictive value for cardiovascular morbidity and mortality. However, evidence on the clinical utility of ABPM-derived indices, such as pulse pressure (PP), pulse pressure index (PPI), rate pressure product (RPP), ambulatory arterial stiffness index (AASI), and average real variability (ARV), remains underexplored in the pediatric population, particularly among children with chronic kidney disease (CKD). Objective: To evaluate the correlation between ABPM-derived indices in children, with a subgroup analysis comparing those with and without CKD. Secondary objectives included identifying factors associated with AASI and ARV and assessing their utility in cardiovascular risk stratification. Methods: In this bicentric cross-sectional study, 70 children (41 with CKD and 29 controls) were enrolled. ABPM indices (PP, PPI, RPP, AASI, and ARV) were calculated, and both descriptive and inferential statistical analyses, including linear regression, were performed. Results: Systolic and diastolic hypertension were significant predictors of elevated ARV (p < 0.05), while body mass index (BMI) and glomerular filtration rate (GFR) were positively associated with AASI (p < 0.05). Use of angiotensin-converting enzyme inhibitors (ACEIs) was associated with reduced arterial stiffness (p = 0.02). Significant differences were observed in weight, BMI, PP, and PPI between the CKD and non-CKD groups, with ABPM demonstrating greater sensitivity in detecting vascular health markers. Conclusions: ABPM-derived indices, particularly PP, PPI, and ARV, show promise in improving cardiovascular risk assessment in children. These findings support the broader use of ABPM metrics for refined cardiovascular evaluation, especially in pediatric CKD. Full article
(This article belongs to the Section Pediatric Nephrology & Urology)
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12 pages, 439 KiB  
Article
Non-Invasive Capnography Versus Pulse Oximetry for Early Detection of Respiratory Depression During Pediatric Procedural Sedation: A Prospective Observational Study
by Laura Català Altarriba, Sean Yeh Hsi, Aude Marie Ravit, Sònia Brió Sanagustín and Xoan González-Rioja
Children 2025, 12(7), 938; https://doi.org/10.3390/children12070938 - 16 Jul 2025
Viewed by 388
Abstract
Background/Objectives: Continuous ventilation monitoring during pediatric sedation is essential, as respiratory depression may occur silently and may not be detected promptly by conventional methods such as pulse oximetry. Non-invasive capnography has been proposed to improve early detection of respiratory compromise. This prospective observational [...] Read more.
Background/Objectives: Continuous ventilation monitoring during pediatric sedation is essential, as respiratory depression may occur silently and may not be detected promptly by conventional methods such as pulse oximetry. Non-invasive capnography has been proposed to improve early detection of respiratory compromise. This prospective observational study evaluated the diagnostic accuracy of non-invasive capnography, compared to pulse oximetry, for detecting respiratory depression in pediatric patients undergoing sedation. Methods: We conducted a single-center, prospective observational study at a tertiary pediatric hospital, enrolling 101 patients (ages 1–17 years) undergoing sedation for diagnostic or therapeutic procedures. Patients were monitored using both pulse oximetry and non-invasive capnography. Episodes of respiratory depression—defined as apnea, hypopneic hypoventilation, bradypneic hypoventilation, and desaturation—were recorded. We compared the diagnostic performance and time to detection between capnography and pulse oximetry. Results: We identified 93 episodes of respiratory depression in 52 patients (51.1%). Capnography detected all apnea episodes and 76.9% of hypopneic hypoventilation episodes that were not identified by pulse oximetry. The median time advantage of capnography over pulse oximetry was 35 s (p = 0.0055). Combining capnography and pulse oximetry identified more events than pulse oximetry alone (93 vs. 53 episodes). Conclusions: Non-invasive capnography improves the early detection of respiratory depression compared to conventional monitoring with pulse oximetry in pediatric procedural sedation. While these findings support its routine use to enhance patient safety, larger multicenter studies are needed to demonstrate its diagnostic accuracy and impact on clinical outcomes. Full article
(This article belongs to the Section Pediatric Anesthesiology, Pain Medicine and Palliative Care)
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11 pages, 219 KiB  
Article
Diagnostic Accuracy of a Machine Learning-Derived Appendicitis Score in Children: A Multicenter Validation Study
by Emrah Aydın, Taha Eren Sarnıç, İnan Utku Türkmen, Narmina Khanmammadova, Ufuk Ateş, Mustafa Onur Öztan, Tamer Sekmenli, Necip Fazıl Aras, Tülin Öztaş, Ali Yalçınkaya, Murat Özbek, Deniz Gökçe, Hatice Sonay Yalçın Cömert, Osman Uzunlu, Aliye Kandırıcı, Nazile Ertürk, Alev Süzen, Fatih Akova, Mehmet Paşaoğlu, Egemen Eroğlu, Gülnur Göllü Bahadır, Ahmet Murat Çakmak, Salim Bilici, Ramazan Karabulut, Mustafa İmamoğlu, Haluk Sarıhan and Süleyman Cüneyt Karakuşadd Show full author list remove Hide full author list
Children 2025, 12(7), 937; https://doi.org/10.3390/children12070937 - 16 Jul 2025
Viewed by 907
Abstract
Background: Accurate diagnosis of acute appendicitis in children remains challenging due to variable presentations and limitations of existing clinical scoring systems. While machine learning (ML) offers a promising approach to enhance diagnostic precision, most prior studies have been limited by small sample [...] Read more.
Background: Accurate diagnosis of acute appendicitis in children remains challenging due to variable presentations and limitations of existing clinical scoring systems. While machine learning (ML) offers a promising approach to enhance diagnostic precision, most prior studies have been limited by small sample sizes, single-center data, or a lack of external validation. Methods: This prospective, multicenter study included 8586 pediatric patients to develop a machine learning-based diagnostic model using routinely available clinical and hematological parameters. A separate, prospectively collected external validation cohort of 3000 patients was used to assess model performance. The Random Forest algorithm was selected based on its superior performance during model comparison. Diagnostic accuracy, sensitivity, specificity, Area Under Curve (AUC), and calibration metrics were evaluated and compared with traditional scoring systems such as Pediatric Appendicitis Score (PAS), Alvarado, and Appendicitis Inflammatory Response Score (AIRS). Results: The ML model outperformed traditional clinical scores in both development and validation cohorts. In the external validation set, the Random Forest model achieved an AUC of 0.996, accuracy of 0.992, sensitivity of 0.998, and specificity of 0.993. Feature-importance analysis identified white blood cell count, red blood cell count, and mean platelet volume as key predictors. Conclusions: This large, prospectively validated study demonstrates that a machine learning-based scoring system using commonly accessible data can significantly improve the diagnosis of pediatric appendicitis. The model offers high accuracy and clinical interpretability and has the potential to reduce diagnostic delays and unnecessary imaging. Full article
(This article belongs to the Section Global Pediatric Health)
9 pages, 292 KiB  
Article
Clinical and Echocardiographic Factors Influencing Patent Ductus Arteriosus Treatment in Preterm Neonates
by Mi Ae Chu, So Young Shin, Jae Hyun Park and Hee Joung Choi
Children 2025, 12(7), 936; https://doi.org/10.3390/children12070936 - 16 Jul 2025
Viewed by 235
Abstract
Objective: We evaluated how pre-treatment clinical and echocardiographic findings influence treatment decisions for patent ductus arteriosus (PDA) in preterm neonates. Study Design: Preterm neonates weighing < 1500 g and diagnosed with PDA were enrolled. They were categorized into conservative, medical, and [...] Read more.
Objective: We evaluated how pre-treatment clinical and echocardiographic findings influence treatment decisions for patent ductus arteriosus (PDA) in preterm neonates. Study Design: Preterm neonates weighing < 1500 g and diagnosed with PDA were enrolled. They were categorized into conservative, medical, and surgical groups based on treatment. Results: A total of 242 preterm neonates (120 boys and 122 girls) participated, with a mean gestational age of 27.9 ± 2.2 weeks and a birth weight of 1034.3 ± 239.3 g. Multivariate logistic regression revealed that oliguria (p < 0.001), inotropic drug use (p = 0.049), low PDA flow velocity (p = 0.039), and left atrial enlargement (p = 0.002) were significantly associated with medical or surgical treatment decisions. Additionally, a low base deficit prior to medical therapy was associated with the decision to proceed with surgical intervention after medical treatment failure (p = 0.006). Conclusions: Oliguria, inotropic drug use, low PDA flow velocity, and left atrial enlargement were significantly associated with aggressive treatment decisions in preterm neonates with PDA. Furthermore, a low base deficit influenced the need for surgery following medical therapy failure. Our findings suggest that comprehensive monitoring of both clinical and echocardiographic factors may support treatment decision-making in PDA management in preterm neonates. Full article
(This article belongs to the Section Pediatric Cardiology)
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12 pages, 3647 KiB  
Article
Impact of Intracystic Hemorrhage on Therapeutic Outcomes in Macro/Mixed Cystic Lymphatic Malformation: A Retrospective Cohort Study
by Tao Han, Daolin Ye, Jie Cui, Songming Huang and Weimin Shen
Children 2025, 12(7), 935; https://doi.org/10.3390/children12070935 - 16 Jul 2025
Viewed by 283
Abstract
Objectives: This research aims to examine the impact of intracystic hemorrhage (ICH) on therapeutic outcomes in children with macro or mixed cystic lymphatic malformation (cLM). Methods: This retrospective study included macro/mixed cLM cases with or without ICH who underwent treatment between [...] Read more.
Objectives: This research aims to examine the impact of intracystic hemorrhage (ICH) on therapeutic outcomes in children with macro or mixed cystic lymphatic malformation (cLM). Methods: This retrospective study included macro/mixed cLM cases with or without ICH who underwent treatment between January 2019 and June 2024. All patients were diagnosed using preoperative imaging findings and intraoperative indocyanine green (ICG) lymphography. The baseline data of enrolled cases were retrospectively collected. The clinical characteristics were documented, including gender, age, histological typing, location, maximum diameter, and intracystic condition. Patients with or without ICH were divided into two groups. The dependent variables for predicting an excellent outcome were analyzed using multivariable logistic regression models after adjusting for potential factors using a univariable regression model. Postoperative variables, including duration of negative drainage, local infection, scar hyperplasia, and follow-up, were compared between the two groups. Results: A total of 83 cLM patients were included (ICH group: n = 36 and without ICH group: n = 47). A complete absence of afferent lymphatic vessels was demonstrated using intraoperative ICG lymphography, suggesting the isolated nature of ICH cases. ICH (p = 031; OR, 2.560; 95% CI, 1.089–6.020) was identified as the main predictor, and younger patients (p = 035; OR, 0.415; 95% CI, 0.183–0.940) had a lower potential for excellent outcomes. For the postoperative variables, the ICH group exhibited a shorter duration of negative drainage than the without ICH group (p < 0.001), while no significant differences were found regarding local infection (p = 0.693) and scar hypertrophy (p = 0.648). Conclusions: Although characterized by aggressive progression and compressive symptoms, ICH emerges as an independent favorable prognostic predictor in macro/mixed cLM management, potentially attributable to its isolated nature. Full article
(This article belongs to the Special Issue Advances in Pediatric Surgery: Innovative Approaches and Emerging Technologies)
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14 pages, 2345 KiB  
Article
Clinical Experience in the Management of a Series of Fetal–Neonatal Ovarian Cysts
by Constantin-Cristian Văduva, Laurentiu Dira, Dominic Iliescu, Dan Ruican, Anișoara-Mirela Siminel, George Alin Stoica, Mircea-Sebastian Şerbănescu and Andreea Carp-Velișcu
Children 2025, 12(7), 934; https://doi.org/10.3390/children12070934 - 16 Jul 2025
Viewed by 322
Abstract
Introduction: Fetal ovarian cysts are known to be a common form of fetal abdominal masses in female fetuses, often resulting from hormonal stimulation in utero. Although many resolve spontaneously without sequelae, others can develop into more complex pathologies, such as intracystic hemorrhage or [...] Read more.
Introduction: Fetal ovarian cysts are known to be a common form of fetal abdominal masses in female fetuses, often resulting from hormonal stimulation in utero. Although many resolve spontaneously without sequelae, others can develop into more complex pathologies, such as intracystic hemorrhage or torsion, which can compromise ovarian integrity and long-term reproductive outcomes. Early detection and appropriate follow-up evaluation are therefore crucial for optimal perinatal management. Materials and Methods: We conducted a retrospective study of 12 cases of fetal ovarian cysts diagnosed by routine prenatal ultrasound examinations over a two-year period at our institution. Inclusion criteria were the presence of a cystic adnexal lesion detected in utero, detailed prenatal ultrasound documentation, and a comprehensive postnatal examination. Sonographic features such as cyst size, internal echogenicity, and signs of vascular compromise were recorded. The mother’s clinical variables, including gestational age at diagnosis and relevant medical conditions, were noted. Postnatal follow-up evaluation consisted of ultrasound examinations and, if indicated, pediatric surgical consultation. Results: Of the 12 cases, 9 were characterized by a simple cystic morphology. All spontaneously regressed postnatally and did not require surgical intervention. Three were defined as complex cysts showing septations or echogenic deposits; one of these cysts required immediate surgical exploration for suspected torsion. No cases with a malignant background were identified. All infants showed a favorable course with normal growth and development until follow-up evaluation. Conclusions: This series emphasizes that most fetal ovarian cysts are benign and often resolve without intervention, highlighting the benefit of systematic prenatal imaging. Nevertheless, complex or large cysts require close prenatal and neonatal monitoring to diagnose complications such as torsion. Full article
(This article belongs to the Special Issue Advances in Prenatal Diagnosis and Their Impact on Neonatal Outcomes)
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16 pages, 278 KiB  
Review
Component-Resolved and Multiplex-Specific IgE Diagnostics: Utility in Anaphylaxis and Beyond
by Mirjana Turkalj, Ivana Banić and Gordana Fressl Juroš
Children 2025, 12(7), 933; https://doi.org/10.3390/children12070933 - 16 Jul 2025
Viewed by 599
Abstract
The diagnosis of allergic diseases and anaphylaxis is complex and encompasses a broad spectrum of in vitro and in vivo diagnostic tests. The choice of diagnostic tests is related to the presumed pathophysiological mechanism of the allergic reaction. In the past decade the [...] Read more.
The diagnosis of allergic diseases and anaphylaxis is complex and encompasses a broad spectrum of in vitro and in vivo diagnostic tests. The choice of diagnostic tests is related to the presumed pathophysiological mechanism of the allergic reaction. In the past decade the implementation of component-resolved diagnostics (CRD) into clinical practice has significantly improved the depicting of sensitization profiles, which has aided in the assessment of clinically relevant allergen components that are associated with true allergy, as well as the levels of risk of severe anaphylactic reactions. Recently, multiplex-specific immunoglobulin E (IgE) platforms have emerged for better selection of patients at risk for anaphylaxis and have improved the selection criteria for patients undergoing allergen immunotherapy, including novel regimes such as oral immunotherapy. This review describes the advantages of the utilization of component-resolved diagnostics and multiplex assays in clinical settings, especially in cases of anaphylaxis when no clear trigger is recognized or where multiple culprits are suspected. As multiplex component-resolved diagnostics becomes more readily available globally and with the use of novel approaches, CRD will certainly be a crucial tool in personalized and individually tailored management plans and reduce the financial burden of anaphylaxis. Full article
(This article belongs to the Special Issue Genomic Medicine and Rare Undiagnosed Diseases in Children: New Developments in Precision Healthcare)
17 pages, 768 KiB  
Article
Interrelationship of Preschoolers’ Gross Motor Skills, Digital Game Addiction Tendency, and Parents’ Parenting Styles
by Savaş Aydın, Ramazan Sak and İkbal Tuba Şahin-Sak
Children 2025, 12(7), 932; https://doi.org/10.3390/children12070932 - 16 Jul 2025
Viewed by 642
Abstract
Background: Motor performance in childhood predicts physical fitness, cognitive capacity, socio-emotional development, and academic success. Parenting styles are especially important to such performance in the preschool period, as children’s gross motor abilities are shaped in part by their interactions with parents. Young children’s [...] Read more.
Background: Motor performance in childhood predicts physical fitness, cognitive capacity, socio-emotional development, and academic success. Parenting styles are especially important to such performance in the preschool period, as children’s gross motor abilities are shaped in part by their interactions with parents. Young children’s physical activity is also declining as they spend more time on screens. Methods: This quantitative survey-based study examined the relationships among 252 preschoolers’ gross motor skills, their tendency to become addicted to digital games, and their parents’ parenting styles. Results: The sampled preschoolers’ gross motor skill development and game addiction tendencies were both low, while the participating parents reported high levels of democratic and overprotective parenting attitudes, low levels of authoritarian ones, and moderate levels of permissive ones. Motor skills were not associated with children’s addiction tendency or parents’ democratic (also known as authoritative), authoritarian, or permissive styles. However, overprotective parenting was positively and significantly associated with gross motor skill scores. While no significant relationship was found between children’s digital game addiction tendencies and their parents’ adoption of a democratic parenting style, such tendencies were positively and statistically correlated with the authoritarian and permissive parenting styles. One dimension of such tendencies, constant gameplay, was also positively and significantly correlated with overprotective parenting. Conclusions: Although the participating children’s digital game addiction tendencies were low, the findings indicate that parents and carers should guide children to reduce their screen time and promote increased interaction with their surroundings and other people to mitigate screen time’s known negative effects on gross motor coordination. Full article
(This article belongs to the Section Pediatric Orthopedics & Sports Medicine)
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16 pages, 745 KiB  
Article
Immature Platelet Fraction as a Sensitive Biomarker in Neonatal Sepsis: Diagnostic Performance Preceding Thrombocytopenia
by Ilkay Er and Medeni Arpa
Children 2025, 12(7), 931; https://doi.org/10.3390/children12070931 - 15 Jul 2025
Viewed by 345
Abstract
Background: Early and accurate diagnosis of neonatal sepsis remains a clinical challenge due to nonspecific signs and limitations of conventional biomarkers. The immature platelet fraction (IPF), a novel hematologic parameter reflecting thrombopoietic activity, has emerged as a potential early sepsis indicator. This [...] Read more.
Background: Early and accurate diagnosis of neonatal sepsis remains a clinical challenge due to nonspecific signs and limitations of conventional biomarkers. The immature platelet fraction (IPF), a novel hematologic parameter reflecting thrombopoietic activity, has emerged as a potential early sepsis indicator. This study aimed to evaluate the diagnostic value of IPF in neonatal sepsis prior to the onset of thrombocytopenia. Methods: This prospective study enrolled neonates with early-onset sepsis (EOS), late-onset sepsis (LOS), and healthy controls. IPF, C-reactive protein (CRP), procalcitonin (PCT), and hematologic indices were measured at diagnosis and 48–72 h post-treatment. Diagnostic performance was evaluated via ROC curve analysis, and correlations between IPF and inflammatory/hematologic markers were examined. IPF levels were also compared based on blood culture results. Results: IPF levels were significantly higher in both EOS (n: 56) and LOS (n: 50) groups compared to controls (n: 44) (p < 0.001). ROC analysis showed excellent diagnostic performance, with AUCs of 0.98 (EOS) and 0.99 (LOS). Following antibiotic treatment, IPF levels declined significantly (p < 0.001), supporting its dynamic value. Strong and moderate correlations were found with MPV and CRP, respectively, and an inverse association with platelet count, but not with PCT. Moreover, IPF levels were higher in culture-positive cases compared to culture-negative ones (13.1% vs. 9.8%; p = 0.017) and exhibited diagnostic performance comparable to CRP in predicting blood culture positivity. Conclusions: This study presents original and clinically relevant data supporting IPF as a promising and practical hematologic biomarker for early detection and treatment monitoring of neonatal sepsis. Its integration into standard sepsis evaluation protocols may improve early risk stratification and clinical decision-making in neonatal intensive care settings. Full article
(This article belongs to the Special Issue Providing Care for Preterm Infants)
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16 pages, 539 KiB  
Article
Virtual Reality as a Non-Pharmacological Aid for Reducing Anxiety in Pediatric Dental Procedures
by Laria-Maria Trusculescu, Dana Emanuela Pitic, Andreea Sălcudean, Ramona Amina Popovici, Norina Forna, Silviu Constantin Badoiu, Alexandra Enache, Sorina Enasoni, Andreea Kiș, Raluca Mioara Cosoroabă, Cristina Ioana Talpos-Niculescu, Corneliu Constantin Zeicu, Maria-Melania Cozma and Liana Todor
Children 2025, 12(7), 930; https://doi.org/10.3390/children12070930 - 14 Jul 2025
Viewed by 403
Abstract
Background/Objectives: Dental anxiety in children is a common issue that can hinder the delivery of effective dental care. Traditional approaches to managing this are often insufficient or involve pharmacological interventions. This study shows the potential of virtual reality (VR) to aid in reducing [...] Read more.
Background/Objectives: Dental anxiety in children is a common issue that can hinder the delivery of effective dental care. Traditional approaches to managing this are often insufficient or involve pharmacological interventions. This study shows the potential of virtual reality (VR) to aid in reducing anxiety in children undergoing simple dental procedures. By immersing children in relaxing VR environments (such as beaches, forests, mountains, or underwater scenes with calm music), the objective is to assess VR’s effectiveness in calming pediatrics patients during these procedures. Methods: Children scheduled for minor dental treatments wore a wearable device that monitored pulse, perspiration, and stress levels. Each child’s baseline data was collected without the VR headset, followed by data collection during VR exposure before and during dental procedures. VR scenarios ranged from soothing nature scenes to animated cartoons, designed to foster relaxation. Results: The data collected showed a reduction in physiological indicators of stress, such as lower heart rate and reduced perspiration, when the VR headset was used. Children appeared more relaxed, with a calmer response during the procedure itself, compared to baseline levels without VR. Conclusions: This study provides preliminary evidence supporting VR as an effective tool for reducing anxiety and stress in pediatric dental patients. By offering an engaging, immersive experience, VR can serve as an alternative or complementary approach to traditional anxiety management strategies in pediatric dentistry, potentially improving patient comfort and cooperation during dental procedures. Further research could determine if VR may serve as an alternative to local anesthesia for non-intrusive pediatric dental procedures. Full article
(This article belongs to the Special Issue Children’s Behaviour and Social-Emotional Competence)
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9 pages, 301 KiB  
Article
Impaction of Deciduous and Permanent Teeth Related to Local Obstacles: A Retrospective Study of 10 Years of Institutional Experience
by Luisa Limongelli, Giuseppe Barile, Giusy Fanelli, Tommaso Corsalini, Saverio Capodiferro and Massimo Corsalini
Children 2025, 12(7), 929; https://doi.org/10.3390/children12070929 - 14 Jul 2025
Viewed by 315
Abstract
Background: Dental eruption pathways could be influenced by several factors, both general and local, with different prevalence and morbidity. This study aims to report our experience of pediatric impacted teeth due to local factors, with the exclusion of the third molars, illustrating [...] Read more.
Background: Dental eruption pathways could be influenced by several factors, both general and local, with different prevalence and morbidity. This study aims to report our experience of pediatric impacted teeth due to local factors, with the exclusion of the third molars, illustrating their prevalence, diagnostic and therapeutic pathways, and treatment outcomes. Methods: The inclusion criteria were minor age (<18 years) and the presence of impacted teeth due to a local cause, excluding wisdom teeth. The complete diagnostic and therapeutic procedures and their outcomes were described. The relationship between the treatment and the outcomes was assessed with a chi-square test. Results: One hundred twelve patients with a single impaction were included in the study. The local causes of single impaction were: 63 odontogenic cysts (57%), 24 supernumerary teeth (21%), 17 odontogenic tumors (15%), and eight primary bone lesions (7%). During the follow-up period, 83 teeth erupted spontaneously 12–36 months following surgery (74%), 12 were extracted during surgery (11%), and 17 needed orthodontic traction to achieve their aesthetic and functional position (15%). The relationship between mini-invasive surgery and spontaneous eruption was significant (p < 0.00001). Conclusions: Within the limitations of this study, mini-invasive surgical treatment preceded by a correct diagnosis may lead to a spontaneous eruption of permanent teeth, avoiding further orthodontic intervention and premature loss of permanent teeth. Full article
(This article belongs to the Collection Advance in Pediatric Dentistry)
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