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Volume 12
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Children, Volume 12, Issue 9 (September 2025) – 116 articles

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10 pages, 1366 KB  
Case Report
Using Functional Education Appliance on One Patient with Class III Malocclusion in Mixed Dentition: A Case Report
by Chun-Yuan Chiu, Shang-Wen Chiu and Chung-Hsing Li
Children 2025, 12(9), 1219; https://doi.org/10.3390/children12091219 - 11 Sep 2025
Abstract
Background/objective: Class III malocclusion is a relatively common clinical problem among Asian patients, which is caused by skeletal discrepancies and involves complex factors. In growing patients, early intervention with myofunctional appliances can help correct jaw relationships more effectively. This case report presents the [...] Read more.
Background/objective: Class III malocclusion is a relatively common clinical problem among Asian patients, which is caused by skeletal discrepancies and involves complex factors. In growing patients, early intervention with myofunctional appliances can help correct jaw relationships more effectively. This case report presents the use of prefabricated myofunctional appliances (EF and MRC) to address Class III malocclusion through growth modification. Case description: A 9-year-old girl was diagnosed with skeletal Class III and a complete anterior crossbite. She underwent treatment with the prefabricated myofunctional appliances, worn during sleep and an additional two hours during the day for 51 months. The outcomes resulted from a combination of skeletal and dental changes, including a decrease in skeletal discrepancy (ANB: −5° to −2°), upper incisor proclination (U1 to SN: 112.5° to 123°), uprighting of the lower incisor (L1 to MP: 93.5° to 90°), and an increase in cranial flexure angle (123° to 125°) with a vertical mandibular growth pattern. The treatment improved facial profile, reduced skeletal discrepancy, corrected the anterior crossbite, and enhanced interdigitation. Conclusions: Prefabricated myofunctional appliances are effective options for managing skeletal Class III malocclusion in pediatric patients with vertical mandibular growth patterns, producing favorable skeletal and dentoalveolar changes. Full article
(This article belongs to the Special Issue Early Orthodontic Treatment in Children: A Focus on Behavior Intervention and Management)
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10 pages, 1332 KB  
Article
Unique Bone Marrow Findings of FDG-PET/CT in Acute Leukemia in Children: Comparison to Inflammatory Diseases
by Yuta Suenaga, Kazuo Kubota, Motohiro Matsui, Atsushi Makimoto, Junko Yamanaka, Shinji Mochizuki, Masatoshi Hotta, Miyako Morooka Chikanishi and Hiroyuki Shichino
Children 2025, 12(9), 1218; https://doi.org/10.3390/children12091218 - 11 Sep 2025
Abstract
Background/Objectives: Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) is a valuable imaging modality for detecting malignancies and diagnosing fever of unknown origin (FUO). However, data regarding FDG accumulation in bone marrow among pediatric acute leukemia (AL) cases are limited. In this study, we [...] Read more.
Background/Objectives: Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) is a valuable imaging modality for detecting malignancies and diagnosing fever of unknown origin (FUO). However, data regarding FDG accumulation in bone marrow among pediatric acute leukemia (AL) cases are limited. In this study, we aimed to compare FDG-PET/CT findings between children with AL and those with inflammatory diseases (IDs), including FUO, and develop a scoring system for differential diagnoses. Methods: We retrospectively analyzed FDG-PET/CT findings in six children with AL and 22 with IDs. The maximum standardized uptake value (SUV max), visual score (VS), and spread score (SS) were evaluated across various bone marrow sites, including vertebrae, pelvic bone, humerus, forearm, and femur. Statistical analysis consisted of Mann–Whitney U test for group comparisons and receiver operating characteristic curve (ROC)/area under the curve (AUC) analyses to assess diagnostic performance. Results: SUV max, VS, and SS were significantly higher in children with AL across all evaluated sites. The combined VS + SS scoring system yielded the highest diagnostic accuracy. A simplified version using only the VS of the middle humerus and femur plus the SS showed comparable effectiveness. Conclusions: FDG-PET/CT in children with AL showed high FDG accumulation in bone marrow areas in the whole body. The simple scoring system, which comprises FDG accumulation in the middle portion of the extremities and the whole body, appears to be helpful in distinguishing AL from IDs in children. FDG-PET/CT-based visual scoring may provide supportive information alongside conventional diagnostics in pediatric acute leukemia. Full article
(This article belongs to the Special Issue Childhood Hematologic and Oncologic Diseases: Emerging Insights and Next-Generation Solutions)
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11 pages, 229 KB  
Article
Executive Functions and Child Psychopathology: Contextual Differences and Predictors for Detection and Psychoeducational Intervention
by Juan Manuel Núñez, Ana Soto-Rubio and Marián Pérez-Marín
Children 2025, 12(9), 1217; https://doi.org/10.3390/children12091217 - 11 Sep 2025
Abstract
Background/Objectives: Executive functions (EFs) play a fundamental role in children’s cognitive and emotional regulation and have been identified as key transdiagnostic predictors of psychopathology. Children with Special Educational Needs (SENs) are particularly vulnerable to difficulties with EFs and emotional–behavioural adjustment. This study aimed [...] Read more.
Background/Objectives: Executive functions (EFs) play a fundamental role in children’s cognitive and emotional regulation and have been identified as key transdiagnostic predictors of psychopathology. Children with Special Educational Needs (SENs) are particularly vulnerable to difficulties with EFs and emotional–behavioural adjustment. This study aimed to examine the differences in the psychopathological symptoms between pupils with and without SENs and to explore the predictive ability of dimensions of EFs for psychopathology detection in both school and family contexts. Methods: A total of 123 primary school children (aged 6–12 years) participated in the study. Their psychopathology was assessed using the SPECI questionnaire completed by their teachers, while their EFs were measured using the BRIEF-2 from school and family perspectives. The analyses included mean difference tests and a backward stepwise multiple regression using the predictors that showed significant Pearson’s correlations with the psychopathological dimensions. Results: The students with SENs showed significantly higher levels of psychopathological symptoms, particularly in their attention, anxiety, and clinical global scores. The regression models revealed that several dimensions of EFs, such as inhibition, planning, task monitoring, and cognitive regulation, significantly predicted internalising, externalising, and total symptoms. The school-based models demonstrated greater explanatory power compared to the family-based models, suggesting that school contexts may be more sensitive for detecting EF-related difficulties. Conclusions: The results underline the transdiagnostic relevance of EFs in child psychopathology and support their integration into early detection and intervention strategies, especially in educational contexts. Strengthening the assessment of EFs in schools could contribute to a more accurate identification of at-risk pupils and inform targeted support for children with SENs. Full article
(This article belongs to the Section Global Pediatric Health)
13 pages, 265 KB  
Article
Effects of Paediatric Post-COVID-19 Condition on Physical Function and Daily Functioning: A Cross-Sectional Study
by Aroia Goicoechea-Calvo, Roser Coll-Fernández, Natalia Navarro Expósito, Marc Colomer Giralt, Alba González-Aumatell, María Méndez-Hernández, Clara Carreras-Abad, Natàlia Pallarès Fontanet, Cristian Tebe Cordomi, M. J. Durà Mata and Carlos Rodrigo
Children 2025, 12(9), 1216; https://doi.org/10.3390/children12091216 - 10 Sep 2025
Abstract
Background/Objectives: Lack of objective evidence exists regarding changes in physical function and impact on daily functioning in paediatric post-COVID-19 condition (PPCC). This study aimed to assess exercise capacity, fatigue, and peripheral and respiratory muscle strength in PPCC patients compared with healthy controls. Additionally, [...] Read more.
Background/Objectives: Lack of objective evidence exists regarding changes in physical function and impact on daily functioning in paediatric post-COVID-19 condition (PPCC). This study aimed to assess exercise capacity, fatigue, and peripheral and respiratory muscle strength in PPCC patients compared with healthy controls. Additionally, the impact of PPCC on domains of daily life was evaluated. Methods: A cross-sectional study was performed. Study variables: exercise capacity (6 min walk test, 6MWT), inspiratory muscle strength (maximal inspiratory pressure, PImax), handgrip strength (handheld dynamometer, HHD), quadriceps femoris muscle thickness (QF MT), rectus femoris muscle thickness (RF MT), rectus femoris cross-sectional area (RF CSA), rectus femoris echo-intensity (RF EI), fatigue (Paediatric Functional Assessment of Chronic Illness Therapy-Fatigue, pedsFACIT-F), and physical activity (Assessment of Physical Activity Levels Questionnaire, APALQ). Results: A total of 115 PPCC patients and 227 healthy controls were included. The PPCC group had lower 6MWT (509.00 ± 86.12, p < 0.001), PImax (68.71 ± 26.23, p < 0.001), HHD (82.84 ± 29.09, p < 0.001), APALQ (7.94 ± 3.14, p < 0.001), pedsFACIT-F (24.51 ± 11.01, p < 0.001), QF MT mid-thigh (33.21 ± 7.99, p = 0.011), and higher RF EI (p < 0.001) vs. controls. Only 37.63% of the PPCC group resumed previous sports, 43.48% were unable to attend school full-time and 28.7% could not participate in after-school activities. Conclusions: Paediatric post-COVID-19 condition patients exhibited significant impairments in terms of physical function, with a high impact on daily functioning. This knowledge is necessary to provide targeted therapeutic interventions. Full article
(This article belongs to the Special Issue Viral Respiratory Infections and Bacterial Superinfections in Children)
16 pages, 523 KB  
Article
Red Cell Distribution Width-to-Platelet Ratio and Other Hematological Markers as Early Predictors of Bronchopulmonary Dysplasia in Preterm Infants
by Baran Cengiz Arcagok and Ibrahim Kandemir
Children 2025, 12(9), 1215; https://doi.org/10.3390/children12091215 - 10 Sep 2025
Abstract
Background/Objectives: Bronchopulmonary dysplasia (BPD) frequently affects preterm infants and is associated with lasting morbidity. Early prediction remains challenging. The present study investigated whether hematological inflammatory markers—platelet-to-lymphocyte ratio (PLR), red cell distribution width (RDW), and red cell distribution width-to-platelet ratio (RPR)—can predict the development [...] Read more.
Background/Objectives: Bronchopulmonary dysplasia (BPD) frequently affects preterm infants and is associated with lasting morbidity. Early prediction remains challenging. The present study investigated whether hematological inflammatory markers—platelet-to-lymphocyte ratio (PLR), red cell distribution width (RDW), and red cell distribution width-to-platelet ratio (RPR)—can predict the development of BPD in preterm neonates. Methods: We performed a retrospective cohort study involving 100 infants born at less than 32 weeks’ gestation. Complete blood count (CBC) parameters were collected at birth, 72 h, 1 week, and 2 weeks of life. Associations between PLR, RDW, RPR, and BPD development were analyzed. Multivariate regression and receiver operating characteristic (ROC) curve analyses were carried out to evaluate the predictive performance of the markers. Results: Forty-nine percent of infants developed BPD. Those with BPD had significantly higher RDW, PLR, and RPR values, and lower lymphocyte and platelet counts at various time points. Gestational age, respiratory distress syndrome, and hematological indices independently predicted BPD. ROC analysis showed that RDW ≥ 67.2 and PLR ≥ 98.13 at 72 h, and RPR ≥ 0.3 at 7 and 14 days had good predictive performance. A combined scoring system, including clinical and hematological markers, achieved high sensitivity and specificity. Conclusions: Hematological inflammatory markers, especially RPR, PLR, and RDW, derived from routine CBC tests may serve as accessible, cost-effective tools for early BPD risk stratification in preterm infants. Additional studies are needed to confirm these results and better define their relevance in clinical practice. Full article
(This article belongs to the Section Pediatric Neonatology)
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12 pages, 836 KB  
Systematic Review
Pediatric Spinal Solitary Fibrous Tumor: A Systematic Review of a Rare Condition
by Andrea Trezza, Chiara B. Rui, Stefano Chiaravalli, Veronica Biassoni, Elisabetta Schiavello, Sabina Vennarini, Ester Orlandi, Giorgio G. Carrabba, Maura Massimino and Carlo G. Giussani
Children 2025, 12(9), 1214; https://doi.org/10.3390/children12091214 - 10 Sep 2025
Abstract
Background: Spinal solitary fibrous tumors (SFTs) are a rare oncological entity, almost anecdotal in the pediatric population. They have a high relapse rate and represent an ongoing oncological challenge. Methods: In this article, we conducted a systematic review starting from a case report [...] Read more.
Background: Spinal solitary fibrous tumors (SFTs) are a rare oncological entity, almost anecdotal in the pediatric population. They have a high relapse rate and represent an ongoing oncological challenge. Methods: In this article, we conducted a systematic review starting from a case report to highlight the current state of the art in managing these tumors. Results: Spinal solitary fibrous tumors (SFTs) are rare, slow-growing neoplasms that can be either intra- or extramedullary. Only a limited number of studies focus on primary pediatric spinal cord localization. Five pediatric cases of spinal SFT have been documented in the literature. On MRI, they typically present as highly vascularized, contrast-enhancing masses. Histologically, they are composed of spindle-shaped cells within a collagenous stroma featuring staghorn-shaped blood vessels. More aggressive subtypes, such as dedifferentiated SFTs, resemble high-grade sarcomas. The NAB2–STAT6 fusion is a key marker, driving EGFR signaling, collagen production, and fibrosis. Additional diagnostic markers include CD34, CD99, and Bcl-2. Surgical resection remains the primary treatment. In metastatic cases, chemotherapy—mainly with anthracyclines, dacarbazine, or temozolomide—is employed, although no standardized pediatric protocols exist. Anti-angiogenic agents, including tyrosine kinase inhibitors, have shown promise. Radiotherapy is used postoperatively for local disease control, but its impact on survival is still under investigation. Conclusions: Surgery remains the cornerstone of treatment, significantly impacting the natural history of the disease and symptom control. While clinical trials exploring radiotherapy and chemotherapy are ongoing in adults, no specific treatment protocol has been established for pediatric patients. Full article
(This article belongs to the Section Pediatric Hematology & Oncology)
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10 pages, 212 KB  
Article
Risk Factors for Early Neonatal Hypocalcemia in Preterm Neonates Born After 32 Weeks Gestation
by Jelena Sabljić, Edita Runjić, Klara Čogelja, Blagoja Markoski, Marijana Barbača and Boris Bačić
Children 2025, 12(9), 1213; https://doi.org/10.3390/children12091213 - 10 Sep 2025
Abstract
Background/Objectives: Early neonatal hypocalcemia is a common metabolic disorder in premature neonates with various risk factors, including perinatal asphyxia and fetal growth restriction (FGR). We aimed to investigate the incidence of early neonatal hypocalcemia in preterm neonates with and without FGR and [...] Read more.
Background/Objectives: Early neonatal hypocalcemia is a common metabolic disorder in premature neonates with various risk factors, including perinatal asphyxia and fetal growth restriction (FGR). We aimed to investigate the incidence of early neonatal hypocalcemia in preterm neonates with and without FGR and to explore several maternal and neonatal risk factors for early neonatal hypocalcemia. Cardiotocography (three-tiered fetal heart rate categorization) was a novel risk factor. Materials and methods: This was a secondary analysis of the retrospective, single-center, case-control study of neonates admitted to a neonatal intensive care unit (NICU) between January 2021 and December 2023. The study included 24 neonates with FGR and 124 control neonates without FGR born at 33 to 36 6/7 gestational weeks. Results: Total serum Ca was significantly lower in control neonates (2.042 (SD 0.208)) compared to neonates with FGR (2.178 (SD 0.180)) (p = 0.004), and early neonatal hypocalcemia was significantly higher in control neonates (42.75%) compared to neonates with FGR (4.35%) (p < 0.001). There was no statistical difference in acid base and blood gas analysis between FGR and control (p > 0.05). Logistic regression with the backward method showed that FGR reduces the probability of early neonatal hypocalcemia by 96.3% (t = 9.679, p = 0.001), and cesarean delivery increases it by 2.702 times (t = 6.963, p = 0.004). Conclusions: In this observational study, FGR was found to reduce and cesarean delivery was found to increase the probability of early neonatal hypocalcemia in moderate and late neonates. Clinicians should consider screening neonates born by cesarean delivery for early neonatal hypocalcemia. Three-tiered fetal heart rate categorization and acid base and blood gas analysis upon NICU admission cannot alert neonatologists to early neonatal hypocalcemia. Full article
(This article belongs to the Section Pediatric Neonatology)
19 pages, 1174 KB  
Systematic Review
Viral and Bacterial Etiology of Common Respiratory Infections in Children in Sub-Saharan Africa: A Systematic Review
by Jordy Exaucé Demboux Lyelet, Pembe Issamou Mayengue, Félix Koukouikila-Koussounda, Eric M. Leroy, Pierre Becquart and Fabien Roch Niama
Children 2025, 12(9), 1212; https://doi.org/10.3390/children12091212 - 10 Sep 2025
Abstract
Background/Objectives: Respiratory infections are a major global public health problem, with potentially serious consequences. Indeed, they remain one of the main causes of morbidity and mortality in children under 5 in developing countries. Etiological information on respiratory infections is crucial for prevention [...] Read more.
Background/Objectives: Respiratory infections are a major global public health problem, with potentially serious consequences. Indeed, they remain one of the main causes of morbidity and mortality in children under 5 in developing countries. Etiological information on respiratory infections is crucial for prevention and case management strategies. This review describes the etiology of respiratory infections reported in studies conducted in sub-Saharan African countries. Methods: PubMed, HINARI and Google Scholar search engines were used for bibliographic research, and only data from sub-Saharan Africa were considered. Articles published between 2010 and 2023, in English or French, were included in this review. Results: After a thorough search, 2175 documents were identified. Critical review and removal of duplicates identified 347 full-text studies, which underwent rigorous evaluation. A total of 50 articles were retained, with studies conducted in 24 sub-Saharan African countries, most of them in Cameroon (12%). Thirty-three (66%) were cross-sectional studies, and thirty-seven (74%) were hospital-based surveys. Respiratory syncytial virus was most frequently identified (0.6% to 59%), followed by rhinovirus (7.5% to 73%). The most frequent bacteria were Streptococcus pneumoniae (1–96%) and Haemophilus influenzae (2.5–54%). Conclusions: This study suggests that acute respiratory infections in sub-Saharan Africa, mainly in children, are primarily caused by viruses and a few bacteria. Full article
(This article belongs to the Section Pediatric Pulmonary and Sleep Medicine)
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9 pages, 216 KB  
Article
Discussion of the Fetus in Fetal Cardiology Consultations: A Qualitative Study
by Samantha Syme, Kelsey Schweiberger, Judy C. Chang, Ann Kavanaugh-McHugh, Abdesalam Soudi, Justin T. Clapp, Nadine A. Kasparian, Robert M. Arnold and Kelly W. Harris
Children 2025, 12(9), 1211; https://doi.org/10.3390/children12091211 - 10 Sep 2025
Abstract
Background: While prenatal diagnosis of congenital heart disease is increasingly common, and communication is essential to minimizing familial stress, little is known about how the fetus is discussed in this setting. This study observed how clinicians and families refer to the fetus during [...] Read more.
Background: While prenatal diagnosis of congenital heart disease is increasingly common, and communication is essential to minimizing familial stress, little is known about how the fetus is discussed in this setting. This study observed how clinicians and families refer to the fetus during initial fetal cardiology consultations. Methods: Initial fetal cardiology consultations from one institution were recorded and transcribed verbatim. A codebook was developed and used to code the transcripts. Codes included any reference to the fetus and any attribution of agency or mental states to the fetus. Results: Nineteen consultations performed by five clinicians from one academic institution were included. Clinicians and families most frequently referred to the fetus using personal terminology (e.g., third-person pronouns, a given name, or “son” or “daughter”). Impersonal terminology (e.g., “baby”) was used less frequently, followed by medical terminology (e.g., “fetus”), which was only used in two consultations. In about half of the consultations, clinicians conferred agency or mental states on the fetus by attributing actions, emotions, or knowledge to the fetus. Conclusions: Fetal cardiology clinicians primarily use personal terminology when referring to the fetus during initial consultations. Familial preferences need to be evaluated to optimize communication and support. Full article
(This article belongs to the Section Pediatric Cardiology)
10 pages, 585 KB  
Brief Report
Epidemiological Trends in Pediatric Osteoarticular Infections—Results from a Single-Center Retrospective Study Covering 2015–2023
by Evelien B. van Kempen, Ayla Scholma, Nam Nam Cheung, Mirjam van Veen and Joost H. van Linge
Children 2025, 12(9), 1210; https://doi.org/10.3390/children12091210 - 10 Sep 2025
Abstract
Background: Pediatric infectious disease epidemiology has changed since the COVID-19 pandemic. To investigate possible changes in the epidemiology of pediatric osteoarticular infections (pOAIs), entailing osteomyelitis (OM), septic or infectious arthritis (AR), and osteomyelitis combined with arthritis (OA), we aimed to assess the number [...] Read more.
Background: Pediatric infectious disease epidemiology has changed since the COVID-19 pandemic. To investigate possible changes in the epidemiology of pediatric osteoarticular infections (pOAIs), entailing osteomyelitis (OM), septic or infectious arthritis (AR), and osteomyelitis combined with arthritis (OA), we aimed to assess the number of pOAI cases, pathogen distribution, and outcomes across the pre-, mid-, and post-pandemic periods. Methods: We conducted a single-center retrospective cohort study in the Dutch Juliana Children’s Hospital, including patients aged 0–18 years diagnosed with OM, AR, or OA between 2015 and 2023. Cases were grouped into three periods: pre-pandemic (P1: 2015–2019), mid-pandemic (P2: 2020–2021), and post-pandemic (P3: 2022–2023). Data on demographics, clinical course, imaging, microbiology, and outcomes were extracted from medical records. Results: A total of 118 pOAI cases (median age 2 years, IQR 1–8) were included. OM occurred in 50%, AR in 42%, and OA in 8% of cases. Annual case counts increased from an average of 10/year in P1 to 21/year in P3. Although the difference between P1 and P2 was not statistically significant (IRR 1.20; 95% CI 0.70–2.06), there was a significant increase in P3 compared to P1 (IRR 1.97; 95% CI 1.31–2.97). Pathogen detection was achieved in 50% of cases. Staphylococcus aureus remained the most frequently identified pathogen overall. From P1 to P2, proportions of Kingella kingae and GAS declined, while Staphylococcus aureus remained stable. In P3, Kingella kingae increased, Staphylococcus aureus decreased, and GAS remained relatively unchanged. However, none of these changes were statistically significant. No patients required PICU admission or experienced fatal outcomes. Conclusion: This study suggests an increase in pOAI after the COVID-19 pandemic. While patient characteristics and outcome remained similar over time, pathogen distribution seems to have changed throughout the periods. Full article
(This article belongs to the Section Pediatric Infectious Diseases)
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14 pages, 727 KB  
Review
Risk Factors for Transition of Care in Disorders of Gut–Brain Interaction: A Narrative Review and Expert Opinion
by Miguel Saps, Samantha Arrizabalo and Jose M. Garza
Children 2025, 12(9), 1209; https://doi.org/10.3390/children12091209 - 10 Sep 2025
Abstract
Background: Disorders of gut–brain interaction (DGBI) have a significant impact on the quality of life of children and families. Forty percent of children with recurrent abdominal pain continue to have symptoms into adulthood. Specialized programs for the transition of adolescents with DGBI to [...] Read more.
Background: Disorders of gut–brain interaction (DGBI) have a significant impact on the quality of life of children and families. Forty percent of children with recurrent abdominal pain continue to have symptoms into adulthood. Specialized programs for the transition of adolescents with DGBI to adult care are scarce. There are no widely accepted guidelines for transition of care. Identifying risk factors for persistence of symptoms into adulthood is key to identifying the optimal population that should be part of such programs and guidelines design. Methods: A narrative comprehensive review was conducted using predefined keywords to identify risk factors for persistent DGBI in children/adolescents. Results: Female sex, psychological distress, family history of DGBI, and certain comorbidities had stronger evidence for persistence, whereas other risk factors rely on limited data. Conclusions: It is suggested that transition programs should focus on adolescents presenting with multiple coexisting risk factors. The program should at least include pediatric and adult neurogastroenterologists, dieticians, psychologists, and social workers. Tertiary prevention through psychological support, school-based programs, and management of anxiety and sleep disturbances may reduce the persistence of symptoms. Prospective studies should refine risk stratification and guide transition strategies. Full article
(This article belongs to the Special Issue Innovations in Pediatric Disorders of the Gut-Brain Interaction: Bridging Science, Treatment, and Long-Term Outcomes)
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18 pages, 979 KB  
Article
A School-Based Intervention Program to Reduce Weight Stigma in Adolescents
by Mariacarolina Vacca, Silvia Cerolini, Anna Zegretti, Andrea Zagaria, Edoardo Mocini and Caterina Lombardo
Children 2025, 12(9), 1208; https://doi.org/10.3390/children12091208 - 10 Sep 2025
Abstract
Background/Objectives: Weight-based stigma represents a pervasive psychosocial challenge affecting youth worldwide, with significant implications for mental and physical health. Although school-based interventions have been suggested as effective strategies to reduce weight bias, evidence regarding their content and efficacy in real-world educational contexts remains [...] Read more.
Background/Objectives: Weight-based stigma represents a pervasive psychosocial challenge affecting youth worldwide, with significant implications for mental and physical health. Although school-based interventions have been suggested as effective strategies to reduce weight bias, evidence regarding their content and efficacy in real-world educational contexts remains limited. The present study aimed to evaluate the effectiveness of a school-based intervention designed to reduce internalized weight stigma among Italian adolescents. Methods: A total of 539 secondary school students (Mage = 15.91 years; SD = 1.38; 51.5% males) from 10 schools in Italy were randomly assigned to either an intervention group (61.2%, n = 330) receiving the program or a minimal intervention control group (38.8%, n = 209). The intervention integrated psychoeducational modules and activities based on cognitive dissonance theory to address maladaptive weight-related attitudes and associated psychopathological outcomes. Pre- and post-intervention assessments evaluated internalized weight bias and body dissatisfaction in both groups. Results: A significant reduction in internalized weight bias was observed among students perceiving themselves as overweight following the intervention. Additionally, a marginally significant decrease in body dissatisfaction was reported in the intervention group from pre- to post-intervention. No comparable changes were found in the control group. Conclusions: These findings suggest that incorporating cognitive dissonance-based psychoeducational content within school-based programs may be a promising approach for reducing internalized weight stigma in adolescents. Further research is warranted to refine intervention strategies, explore the mechanisms underlying the observed effects, and assess the scalability and long-term impact of such initiatives in school settings. Full article
(This article belongs to the Special Issue Social-Emotional Skills, Resilience, and Behavioral Problems in Children)
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11 pages, 456 KB  
Case Report
Hereditary Spherocytosis: Review of Presentation at Birth
by Nadine-Stella Achenjang, Elizabeth Jadczak, Rita M. Ryan and Mary L. Nock
Children 2025, 12(9), 1207; https://doi.org/10.3390/children12091207 - 10 Sep 2025
Abstract
Background/Objectives: We wished to raise awareness of Hereditary Spherocytosis (HS) as a potential cause of early and significant hemolytic newborn jaundice. Methods: We utilized three recent cases from our experience to discuss hyperbilirubinemia etiologies to be considered when a baby has [...] Read more.
Background/Objectives: We wished to raise awareness of Hereditary Spherocytosis (HS) as a potential cause of early and significant hemolytic newborn jaundice. Methods: We utilized three recent cases from our experience to discuss hyperbilirubinemia etiologies to be considered when a baby has hemolytic hyperbilirubinemia, including HS, and presented a review of the literature about this disorder including presentation and evaluation in the neonate. Results: We found that ABO hemolytic disease of the newborn (HDN) is often considered as the etiology for presumed hemolytic hyperbilirubinemia even when the direct antiglobulin test (DAT) is negative. When there is a mother-baby ABO mismatch and baby’sDAT is negative, another etiology should be sought. HS should be considered in these cases as the prevalence of HS is as frequent as 1 in 2000 in certain populations, it is the third most common hemolytic disorder after ABO isoimmunization and G6PD deficiency, and it is the most common cause of non-immune hemolytic hyperbilirubinemia in neonates with kernicterus. The indices to look for in the complete blood count that are suggestive for HS are MCHC > 36.5–37 g/dL, an MCHC:MCV ratio (HS Index) > 0.36, and increased RDW. The lack of spherocytes on the newborn peripheral blood smear, family history, initial anemia, and reticulocytosis do not eliminate the diagnosis of HS. Conclusions: HS is common and should be included in the differential diagnosis for hemolytic hyperbilirubinemia. Red blood cell indices can suggest the diagnosis of HS, and eosin 5’ maleimide (EMA) testing can be used to make the diagnosis. If DAT-negative ABO HDN is the leading diagnosis for hyperbilirbinemia, a different etiology should urgently be sought. Full article
(This article belongs to the Special Issue Genetics and Precision Medicine with Hematologic Diseases in Children)
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10 pages, 402 KB  
Article
Evaluation of Oral Health and Oral Health-Related Quality of Life in Children with Adenoid Hypertrophy
by Münevver Çoruh Kılıç, Kenan Cantekin, Emre Haylaz, Fahrettin Kalabalık, Korhan Kılıç, Hasan Basri Bircan and Mihriban Güner
Children 2025, 12(9), 1206; https://doi.org/10.3390/children12091206 - 10 Sep 2025
Abstract
Background/Objectives: Adenoid hypertrophy (AH), one of the most common pathologies in children, is a major cause of mouth breathing. Mouth breathing causes dry mouth, which removes the beneficial effects of saliva necessary for oral health. Therefore, an oral microflora favorable to caries [...] Read more.
Background/Objectives: Adenoid hypertrophy (AH), one of the most common pathologies in children, is a major cause of mouth breathing. Mouth breathing causes dry mouth, which removes the beneficial effects of saliva necessary for oral health. Therefore, an oral microflora favorable to caries is promoted. The primary objective of this study is to evaluate the oral health of children diagnosed with AH between the ages of 3 and 14 and to determine the early childhood oral health impact scale. Methods: This descriptive study was conducted between November 2019 and November 2020, involving 16 boys and 14 girls diagnosed with AH at the Department of Otorhinolaryngology, Faculty of Medicine, Atatürk University. These children, diagnosed with adenoid hypertrophy, were referred to the Department of Pedodontics, Faculty of Dentistry, Ataturk University, for the evaluation of their oral health prior to surgery. Oral examinations were performed on the pediatric participants under dental unit light by the same pedodontist, and their demographic data and DMFT/dmft scores were recorded. Data for the Early Childhood Oral Health Impact Scale (ECOHIS-T) were obtained from volunteers with communication skills and their parents. SPSS 21.0 software was used in the statistical evaluation of the data. A Chi-square test was used to assess differences between groups. Results: The mean age of the children was 5.9 ± 2.6 years. There was no statistically significant difference between AH grades 2, 3, and 4 in terms of dentition periods, gender, and occlusion (p = 0.177, p = 0.495). The scores of the first nine and last four questions of the ECOHIS-T were found to be higher in children with grade 4 AH (p = 0.011, p = 0.043). The DMFT index was also higher in children with grade 4 AH (p = 0.010). Conclusions: Tooth decay is more prevalent in children with severe adenoid hypertrophy. This condition was also observed to negatively affect their quality of life. Regular check-ups and preventive care are needed to improve the quality of life of these children. Full article
(This article belongs to the Section Pediatric Dentistry & Oral Medicine)
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13 pages, 3040 KB  
Article
The Utility of Umbilical Cord Pulse Oximetry—A Translational Study with Four Minutes of Deferred Cord Clamping Using an Asphyxiated Preterm Ovine Model
by Justin Helman, Mausma Bawa, Sylvia Gugino, Nicole Bradley, Lori Nielsen, Arun Prasath, Clariss Blanco, Mary Divya Kasu, Hamza Abbasi, Munmun Rawat and Praveen Chandrasekharan
Children 2025, 12(9), 1205; https://doi.org/10.3390/children12091205 - 10 Sep 2025
Abstract
Background: Expert guidelines recommend using pulse oximetry (PO) in the delivery room to monitor oxygen saturation (SpO2) and heart rate (HR). Umbilical cord pulse oximetry (UCP) is a novel concept that, despite being postductal, could provide accurate measurements of SpO2 [...] Read more.
Background: Expert guidelines recommend using pulse oximetry (PO) in the delivery room to monitor oxygen saturation (SpO2) and heart rate (HR). Umbilical cord pulse oximetry (UCP) is a novel concept that, despite being postductal, could provide accurate measurements of SpO2 and HR, as it overcomes barriers associated with skin pigmentation. Methods: This pilot study used NONIN pulse oximetry on an intact umbilical cord that underwent deferred cord clamping (DCC) to evaluate umbilical cord SpO2 in a preterm asphyxiated ovine model (N of 5) with an HR of <100 bpm. The UCP HR served as a surrogate marker for umbilical vessel flow. A receiver operator characteristic (ROC) curve was used to evaluate UCP parameters with arterial saturations (SaO2) and carotid HR between 2 and 10 min. Results: Following asphyxia, five preterm lambs underwent DCC for 4 min. A significant relationship was noted between SaO2 and umbilical SpO2 (area under the curve (AUC) of 0.907, CI 0.857–0.968, p < 0.0001) along with carotid and umbilical HR (AUC) of 0.842 (CI 0.663–0.902, p < 0.0001). Conclusions: In a translational preterm model, UCP accurately predicted preductal SaO2 and carotid HR (a surrogate for umbilical flow). Using UCP in the delivery room will help guide supplemental oxygen and determine the optimal duration of clamping the umbilical cord. These proof-of-concept studies/pilot findings require validation with larger animal cohorts and newborn infants. Full article
(This article belongs to the Special Issue Advances in Intensive Care for Critically Ill Neonates: Clinical Diagnosis and Treatment)
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11 pages, 692 KB  
Article
High-Intensity Physical Activity During Late Adolescence Predicts Young Adult CT-Based Finite Element Bone Strength in Emerging Adulthood: Iowa Bone Development Study
by Soyang Kwon, Kathleen F. Janz, Indranil Guha, Alex V. Rowlands, Oscar Rysavy, Punam K. Saha, Chandler Pendleton, Euisung D. Shin and Steven M. Levy
Children 2025, 12(9), 1204; https://doi.org/10.3390/children12091204 - 9 Sep 2025
Abstract
Objective: This study investigated associations between physical activity (PA) during late adolescence and emerging adulthood and bone strength in emerging adulthood by utilizing advanced finite element analysis of computed tomography (CT/FEA) technology beyond the traditional dual-energy X-ray absorptiometry (DXA) method. Methods: This study [...] Read more.
Objective: This study investigated associations between physical activity (PA) during late adolescence and emerging adulthood and bone strength in emerging adulthood by utilizing advanced finite element analysis of computed tomography (CT/FEA) technology beyond the traditional dual-energy X-ray absorptiometry (DXA) method. Methods: This study included 266 participants (152 females) from the Iowa Bone Development Study. PA volume (average acceleration) and intensity (intensity gradient) metrics were calculated from ActiGraph accelerometer data collected at ages 17, 19, 21, and 23 years. Compressive modulus and compressive stiffness of the tibia were estimated at age 23 via CT/FEA of the tibia. Sex-specific linear regression models were used to evaluate associations between PA metrics and bone outcomes, adjusting for age, height, weight, musculoskeletal fitness, and calcium intake. Results: Intensity gradient averaged over 17–23 years of age was positively associated with compressive stiffness at age 23 years in both females and males (p < 0.01). Intensity gradient was positively associated with compressive modulus in females (p < 0.01), but not in males. No significant associations were found between average acceleration and either compressive stiffness or modulus in either sex (p > 0.05). Conclusions: Using a state-of-the-art CT/FEA method, this study suggests that high-intensity PA during late adolescence and emerging adulthood improves bone strength. Full article
(This article belongs to the Special Issue Physical Fitness and Health in Adolescents)
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20 pages, 713 KB  
Article
Early Parenting Effects on Childhood Delay of Gratification and Adolescent Allostatic Load
by Heather Leonard, Atika Khurana and Derek Kosty
Children 2025, 12(9), 1203; https://doi.org/10.3390/children12091203 - 9 Sep 2025
Abstract
Background/Objectives: Early parenting can influence child self-regulatory skills, which are in turn linked to allostatic load (AL)—a predictor of future morbidity and mortality. However, this mechanistic pathway from early parenting to later AL has not been tested using longitudinal data. Methods: [...] Read more.
Background/Objectives: Early parenting can influence child self-regulatory skills, which are in turn linked to allostatic load (AL)—a predictor of future morbidity and mortality. However, this mechanistic pathway from early parenting to later AL has not been tested using longitudinal data. Methods: We analyzed longitudinal data (N = 1364) from the Study of Early Child Care and Youth Development to examine relationships between early childhood (ages 2–3) observed parenting behaviors (i.e., autonomy support, supportive presence and hostility) and a comprehensive index of adolescent (age 15) AL, and assessed delay of gratification (at 54 months) as a mediator and moderator of these associations. Results: Maternal supportive presence and hostility in early childhood were directly associated with adolescent AL. All three early childhood parenting behaviors were associated with delay of gratification at 54 months. There was no evidence of mediation or moderation. Conclusions: The findings suggest the important role of early parenting behaviors in predicting long-term AL outcomes. Full article
(This article belongs to the Section Global Pediatric Health)
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21 pages, 1337 KB  
Review
Clinical Impact of Patient-Specific 3D Models in Neonatal Surgery: A Case-Based Review of Applications and Future Directions
by Oscar Girón-Vallejo, Bernardo Garcia-Nuñez, Isidoro Narbona-Arias, Alexander Siles-Hinojosa, Francisco Javier Murcia-Pascual, Moutasem Azzubi, Ignacio Gorriti, Dario Garcia-Calderon, Antonio Piñero-Madrona and Lucas Krauel
Children 2025, 12(9), 1202; https://doi.org/10.3390/children12091202 - 9 Sep 2025
Abstract
Three-dimensional (3D) modeling and printing technologies are increasingly used in pediatric surgery, offering improved anatomical visualization, surgical planning, and personalized approaches to complex conditions. Compared to standard imaging, patient-specific 3D models—virtual or printed—provide a more intuitive spatial understanding of congenital anomalies, tumors, and [...] Read more.
Three-dimensional (3D) modeling and printing technologies are increasingly used in pediatric surgery, offering improved anatomical visualization, surgical planning, and personalized approaches to complex conditions. Compared to standard imaging, patient-specific 3D models—virtual or printed—provide a more intuitive spatial understanding of congenital anomalies, tumors, and vascular anomalies. This review compiles evidence from pediatric surgical fields including oncology, abdominal, and thoracic surgery, highlighting the clinical relevance of 3D applications. The technological workflow—from image segmentation to computer-aided design (CAD) modeling and multimaterial printing—is described, emphasizing accuracy, reproducibility, and integration into hospital systems. Several clinical cases are presented: neuroblastoma, cloacal malformation, conjoined twins, and two cases of congenital diaphragmatic hernia (one with congenital pulmonary airway malformation, CPAM). In each, 3D modeling enhanced anatomical clarity, increased surgeon confidence, and supported safer intraoperative decision-making. Models also improved communication with families and enabled effective multidisciplinary planning. Despite these advantages, challenges remain, such as production time, cost variability, and lack of standardization. Future directions include artificial intelligence-based automation, expanded use of virtual and mixed reality, and prospective validation studies in pediatric cohorts. Overall, 3D modeling represents a significant advance in pediatric precision surgery, with growing evidence supporting its safety, clinical utility, and educational value. Full article
(This article belongs to the Section Pediatric Surgery)
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12 pages, 747 KB  
Article
Diagnostic Value of Leukocyte Count, C-Reactive Protein, and Procalcitonin in Pediatric Liver Transplant Patients During the First Week Postoperative: A Longitudinal Study from a Tertiary Center and a New Diagnostic Method for Predicting Systemic Infection
by Zerrin Onal, Elif Turkmen, Demet Demirkol, Ugur Can Leblebici, Ibrahim Kandemir, Tugce Goksu Yilmaz, Selda Hancerli Torun, Feza Ekiz, Ilgin Ozden and Ozlem Durmaz
Children 2025, 12(9), 1201; https://doi.org/10.3390/children12091201 - 9 Sep 2025
Abstract
Background/Objectives: Infection is a major complication during the early postoperative period following pediatric liver transplantation (LT). Prompt diagnosis and treatment are essential to prevent death. We aimed to assess the diagnostic value of procalcitonin (PCT), white blood cell count (WBC), and C-reactive protein [...] Read more.
Background/Objectives: Infection is a major complication during the early postoperative period following pediatric liver transplantation (LT). Prompt diagnosis and treatment are essential to prevent death. We aimed to assess the diagnostic value of procalcitonin (PCT), white blood cell count (WBC), and C-reactive protein (CRP) levels for detecting bacterial infection and SIRS within the first week after LT. Methods: Demographic data, vital signs, laboratory results (PCT, CRP, WBC), and culture findings on the 1st, 4th, and 7th days between January 2010 and 2024 were collected retrospectively. Results: The study included 88 patients. Seventy-two percent had cirrhotic liver disease. SIRS was present in 17% (n = 15), and bacterial growth was detected in 20% (n = 18). Bacterial growth was found in 80% of patients with SIRS (n = 12/15) and in 8% of SIRS-negative patients (n = 6/73). PCT levels were significantly elevated on days 1, 4, and 7, and CRP levels on days 4 and 7 in patients with SIRS. PCT elevation was significant on days 1, 4, and 7, while WBC increase was noted on day 7 in patients with bacterial growth. Body temperature ≥ 37.1 °C and PCT ≥ 5.1 ng/dL on the first day together showed a sensitivity of 72.2% and specificity of 84.3% for bacterial growth. Similarly, body temperature ≥ 37.1 °C and PCT ≥ 9.2 ng/dL on the first day yielded 73% sensitivity and 95% specificity for diagnosing SIRS. Cirrhotic patients exhibited limited or no WBC response to bacterial growth. Conclusions: PCT, CRP, and WBC alone are insufficient for diagnosing infection. Combined assessment of body temperature changes and PCT elevation may serve as more accurate indicators. Nonetheless, close monitoring of culture results and clinical signs, with serial physical exams, can aid timely infection management or prevent unnecessary antibiotic adjustments. Full article
(This article belongs to the Special Issue Advances in Pediatric Gastroenterology (2nd Edition))
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14 pages, 549 KB  
Article
Impact of a Strength Training Program on Physical Performance in U10 Soccer Players: A Quasi-Experimental Trial
by Adrián Torregrosa-Domínguez, Iván Moreno-Camacho, Eduardo José Fernández-Ozcorta and Rafael Ramos-Véliz
Children 2025, 12(9), 1200; https://doi.org/10.3390/children12091200 - 8 Sep 2025
Abstract
Background/Objectives: The integration of strength training in grassroots youth soccer remains limited, often due to persistent myths regarding its safety and utility. This study evaluated the effectiveness of a tailored, playful strength training program in young players and analyzed the influence of the [...] Read more.
Background/Objectives: The integration of strength training in grassroots youth soccer remains limited, often due to persistent myths regarding its safety and utility. This study evaluated the effectiveness of a tailored, playful strength training program in young players and analyzed the influence of the Relative Age Effect (RAE) on physical development and training response. Methods: A 14-week quasi-experimental pretest–posttest design was conducted with 27 federated male soccer players aged 9–10 years (experimental: n = 15; control: n = 12). The intervention consisted of twice-weekly, game-based strength training sessions integrated into the regular team routine. Outcomes included validated anthropometric (BMI) and functional (handgrip strength, standing long jump, Illinois agility test) indicators. RAE was analyzed according to birth quartile. Non-parametric statistical analyses and effect size (r) calculations were used. Results: The experimental group achieved significantly greater pre–post gains in handgrip strength than controls (right and left). Agility and standing long jump improved within the experimental group, but between-group differences were not significant. BMI decreased within the experimental group, yet the net between-group difference in BMI change was not significant in the context of a higher baseline BMI (p = 0.047). Although the Relative Age Effect (RAE) influenced baseline BMI, no moderating effect was detected on performance variables or training-induced changes in this sample. Conclusions: In U10 soccer players, a playful, context-integrated strength program produced superior gains in handgrip strength compared with usual practice. Improvements in agility and standing long jump were observed within the intervention group, but did not exceed those of the controls. BMI changes were not different between the groups and must be interpreted with caution, given baseline imbalances. In this sample, RAE did not moderate training response. Full article
(This article belongs to the Special Issue Physical Fitness and Health in Adolescents)
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16 pages, 255 KB  
Article
Weight Status, Psychosocial Factors, and Health-Related Quality of Life Among Jordanian Adolescents: A Cross-Sectional Study Using Structural Equation Modeling
by Randa AlQaisi, Walid Al-Qerem, Belal Al-Zu’bi, Basil Al-Tah, Moath H. Daher, Mu’taz I. Alfreahat, Nasser A. Mousa, Seif D. Jankhout, Ansam O. Atrooz and Judith Eberhardt
Children 2025, 12(9), 1199; https://doi.org/10.3390/children12091199 - 8 Sep 2025
Abstract
Background/Objectives: Childhood and adolescent obesity is a growing public health concern in Jordan, with implications for both physical and psychological well-being. While obesity’s physical effects are well-documented, less is known about its broader association with adolescents’ quality of life (QoL), particularly in Middle [...] Read more.
Background/Objectives: Childhood and adolescent obesity is a growing public health concern in Jordan, with implications for both physical and psychological well-being. While obesity’s physical effects are well-documented, less is known about its broader association with adolescents’ quality of life (QoL), particularly in Middle Eastern contexts. This study aimed to investigate the associations between weight status, psychosocial factors, and health-related quality of life (HRQOL) among Jordanian adolescents. This study aimed to investigate the associations between weight status, psychosocial factors, and HRQoL among Jordanian adolescents. Methods: A cross-sectional study was conducted with 719 adolescents (63.3% female) aged 11–18, recruited from public schools and pediatric clinics in three regions of Jordan. Data were collected using validated questionnaires assessing demographics, health behaviors, mental health (PHQ-9, GAD-7, SMFQ), and HRQoL (PedsQL 4.0). Structural equation modeling (SEM) was used to examine direct and indirect pathways predicting physical and psychological QoL. Results: Bullying emerged as a key mediator between weight status and QoL, particularly for physical well-being. Depression and anxiety were significant predictors of poorer psychological QoL. Positive school experience, academic performance, physical activity, and paternal education were positively associated with QoL. Nutritional habits were inversely associated with anxiety levels. Model fit indices supported the adequacy of both the physical and psychological QoL models. Conclusions: The findings highlight the interconnected relationship of weight-related stigma, school environment, and lifestyle behaviors on adolescent well-being. Multi-component, school-based interventions targeting bullying, physical activity, and mental health literacy may be effective in improving QoL in this population. Full article
(This article belongs to the Special Issue Clinical Assessment of Developmental Psychopathology in High-Risk Neonates and Children)
21 pages, 1643 KB  
Review
The Autistic Toe Walking: A Narrative Review for Interventions and Comparison with Idiopathic Toe Walking
by Luiz Renato Agrizzi de Angeli, Bárbara Lívia Corrêa Serafim and Julio Javier Masquijo
Children 2025, 12(9), 1198; https://doi.org/10.3390/children12091198 - 8 Sep 2025
Abstract
Background/Objectives: Idiopathic toe walking (ITW) is a diagnosis of exclusion in children who demonstrate a persistent toe-walking gait without an identifiable underlying neuromuscular or orthopedic pathology. The classification of toe-walking behavior (TWB) in children with Autism Spectrum Disorder (ASD) remains an area of [...] Read more.
Background/Objectives: Idiopathic toe walking (ITW) is a diagnosis of exclusion in children who demonstrate a persistent toe-walking gait without an identifiable underlying neuromuscular or orthopedic pathology. The classification of toe-walking behavior (TWB) in children with Autism Spectrum Disorder (ASD) remains an area of debate, with some considering it a part of the broader ITW spectrum, while others view it as a distinct entity. Children with TWB associated with ASD (Autistic Toe Walking—ATW) present unique clinical challenges. This subgroup exhibits a higher prevalence of toe walking, and their gait patterns are often associated with underlying neurodevelopmental differences, frequently leading to increased resistance to conventional treatment approaches and higher rates of persistence and recurrence. This narrative review aims to summarize the available evidence on interventions for ATW, highlight differences compared to ITW and discuss implications for clinical practice. Methods: A literature search was performed, including articles that addressed interventions for toe walking in children with ASD. Results: The literature is limited and heterogeneous. Identified interventions include physiotherapy, orthoses, botulinum toxin injections, serial casting, and surgical procedures. Evidence of effectiveness is scarce, with most studies consisting of small case series. ATW differs from classic ITW in some aspects of pathophysiology and clinical presentation. Treatment decisions should balance potential benefits with risks, particularly regarding repeated anesthesia exposure during casting versus earlier surgical options. Conclusions: Evidence for managing ATW is limited. While comparisons to ITW may be useful, clinicians must recognize that they present distinct characteristics. Future research should focus on standardized definitions and controlled trials to guide management. Full article
(This article belongs to the Special Issue Children with Autism Spectrum Disorder: Diagnosis and Treatment)
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20 pages, 2350 KB  
Article
Assessment of Gross Motor Skills Performance in Italian Children with and Without Visual Impairment
by Giulia Chiara Castiglioni, Giulia Hirn, Marco Lippolis and Matteo Porro
Children 2025, 12(9), 1197; https://doi.org/10.3390/children12091197 - 8 Sep 2025
Abstract
Background/Objectives: Vision plays a key role in acquiring and automating fundamental movement skills. Evidence from Italy is scarce. This study compared Test of Gross Motor Development–2 (TGMD-2) performance between Italian children with visual impairment (VI) and sighted peers and explored differences by degree [...] Read more.
Background/Objectives: Vision plays a key role in acquiring and automating fundamental movement skills. Evidence from Italy is scarce. This study compared Test of Gross Motor Development–2 (TGMD-2) performance between Italian children with visual impairment (VI) and sighted peers and explored differences by degree of VI (severe VI vs. blindness). Methods: This was a cross-sectional study including 38 children (VI: n = 19, 5–12 y; sighted: n = 19, 5–11 y). VI was classified per the WHO criteria. TGMD-2 was administered with adaptations suitable for VI (e.g., high-contrast cones, auditory balls, verbal cueing). Group differences (VI vs. sighted; blindness vs. severe VI; severe VI vs. sighted) were analyzed with Mann–Whitney U (α = 0.05). For participants > 10 y, raw scores were analyzed and age-equivalent scores were summarized to calculate developmental gaps. Results: Children with VI scored lower than sighted peers on locomotor, object control, and total TGMD-2 scores (all p < 0.001). Within VI, blindness was associated with lower locomotor, object control, and total scores than severe VI (p = 0.013; p = 0.043; p = 0.013). Children with severe VI also scored lower than sighted peers across outcomes (all p < 0.001). Based on age-equivalent estimates, average gross motor performance in VI was ~4–5 years below chronological age; values < 3 years were set to 3 years for calculation (the floor effect). Conclusions: Italian children with VI show reduced gross motor competence compared with sighted peers, with a substantial developmental lag. Findings support early adapted physical education and structured movement opportunities to promote participation and inclusion. Future studies should examine long-term outcomes and contextual factors shaping motor competence in youth with VI. Full article
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13 pages, 391 KB  
Article
Factors Associated with Intubation After Less Invasive Surfactant Administration (LISA); A Single-Center Cohort from Saudi Arabia
by Kamal Ali, Abdulghani Lodhi, Saleh S. Alqarni, Mohanned Alrahili, Mohamed Almahdi, Reem Alharbi, Rahaf Alshahrani, Monirah Alroshoud, Ahad Aldhafiri, Amal Alharbi, Maisa Alqahtani, Abdulaziz Homedi, Ibrahim Ali and Saif Alsaif
Children 2025, 12(9), 1196; https://doi.org/10.3390/children12091196 - 8 Sep 2025
Abstract
Background: Less invasive surfactant administration (LISA) can reduce exposure to mechanical ventilation in preterm infants, but factors associated with LISA failure in routine practice remain uncertain, particularly outside Europe. Methods: We performed a single-center retrospective cohort at King Abdulaziz Medical City, [...] Read more.
Background: Less invasive surfactant administration (LISA) can reduce exposure to mechanical ventilation in preterm infants, but factors associated with LISA failure in routine practice remain uncertain, particularly outside Europe. Methods: We performed a single-center retrospective cohort at King Abdulaziz Medical City, Riyadh (June 2023–June 2025). Inborn preterm infants at 26–34 weeks of gestation who received LISA as first-line surfactant therapy were included. The primary outcome was LISA failure, defined as intubation within 72 h for apnea, escalating oxygen requirement, or respiratory acidosis. Secondary outcomes included intraventricular hemorrhage (IVH), NICU length of stay, and other major morbidities. Multivariable logistic regression (gestational age as the anchor variable with a limited number of additional covariates) was used to identify predictors of failure and of IVH. Kaplan–Meier methods (log-rank test) were used to compare time to NICU discharge. Results: Forty-one infants were included (median gestational age: 30 weeks; median birth weight: 1300 g). LISA failure occurred in 39% of the cohort. Compared with infants with successful LISA, those who failed were more premature (median GA: 28 vs. 29 weeks; p = 0.009), had lower birth weight (1100 g vs. 1270 g; p = 0.011), higher IVH rates (38% vs. 8%; p = 0.020), and longer NICU stay (60 vs. 40 days; p = 0.041). Lower gestational age was the only independent factors associated with LISA failure (adjusted OR 1.44; 95% CI: 1.07–1.95; p = 0.018). LISA failure was independently associated with IVH (adjusted OR 10.08; 95% CI: 1.29–78.50; p = 0.027). Kaplan–Meier analysis showed significantly prolonged NICU stay among infants with LISA failure (p = 0.011). Conclusions: LISA is feasible in a high-acuity Middle Eastern NICU. However, failure—closely linked to lower gestational age—is associated with IVH and prolonged hospitalization. Careful patient selection and procedural planning are essential to optimize outcomes. Full article
(This article belongs to the Section Pediatric Neonatology)
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2 pages, 127 KB  
Editorial
Advances in Childhood Diabetes
by Zvi Laron
Children 2025, 12(9), 1195; https://doi.org/10.3390/children12091195 - 8 Sep 2025
Viewed by 84
Abstract
Despite great technological advances in Type 1 Diabetes (TID) [...] Full article
(This article belongs to the Special Issue Advances in Childhood Diabetes)
15 pages, 5899 KB  
Article
The “Bergamo Approach” for Pediatric and Adolescent Polytrauma—A One-Center Experience
by Nicola Guindani, Maurizio Cheli, Daniela Ferrari, Giovanna Colombo, Ezio Bonanomi, Federico Chiodini and Maurizio De Pellegrin
Children 2025, 12(9), 1194; https://doi.org/10.3390/children12091194 - 8 Sep 2025
Viewed by 201
Abstract
Introduction. Pediatric polytrauma (PPT) and major trauma in pediatric patients (PMT) present unique challenges compared to adult trauma care due to distinct anatomical and physiological differences. PPT/PMT remains the leading cause of death in children, responsible for over 50% of pediatric deaths and [...] Read more.
Introduction. Pediatric polytrauma (PPT) and major trauma in pediatric patients (PMT) present unique challenges compared to adult trauma care due to distinct anatomical and physiological differences. PPT/PMT remains the leading cause of death in children, responsible for over 50% of pediatric deaths and 15% of pediatric hospital admissions due to its long-term effects. This single-institution study focuses on the initial management of PPT/PMT from an orthopedics and traumatology point of view. Material and Methods. In the present study, data of PPT/PMT managed in one single institution, an academic level I pediatric trauma center, in patients <18 years of age, were analyzed over different periods. Over a 10-year period, diaphyseal femur fractures were analyzed as indicators of damage control (DCO) versus definitive treatment. Over a 4-year period (2021–2024), the associated lesions of PPT (head injuries, thoracic and abdominal lesions, spine lesions, major blood vessel lesions, and major musculoskeletal injury) were analyzed. Over a 1-year period (2019), the overall in-hospital mortality and admission rates in the pediatric intensive care unit were analyzed. Results. In the 10-year period, among 298 diaphyseal femur fractures, 46/298 (15%) were classified as PPT in which DCO was performed according to age as follows: in the age-group 15–17 years 23/23 (100%) with temporary external fixation (ExFix); in the age group 12–14 years, 9/14 (64%) with ExFix and 5/14 (26%) and elastic stable intramedullary nails (ESINs); in the age group 5–11 years, 1/5 (20%) with ExFix and 4 with ESIN; in the age group 0–4 years, 2/4 (50%) with ESIN and 2/4 (50%) with a cast. In the 4-year period, PPT/PMTs were associated with 60% head injury, 25% thoracic lesion(s), 18% abdominal lesion(s), 16% spine injury, 5% lesion of a major blood vessel, and 30% major musculoskeletal injuries. In 2019, there were 193 patients admitted to the emergency room as PPT/PMT: 115 were ≤12 years old and 78 were >12 years old. On admission, 46% were admitted to the pediatric intensive care unit, and 65% were admitted to the department of traumatology as inpatients. The in-hospital mortality rate was 7%. Discussion and Conclusions. In our institution, pediatric trauma is assessed using the Pediatric Trauma Score (PTS), and the workup follows the ATLS guidelines with a dedicated trauma team. The role of the orthopedic surgeon during the primary evaluation of PPT/PMT is to contribute to stopping bleeding and hemorrhagic shock. In PPT/PMT, DCO in adolescents is superimposable to adults, whilst in babies and children, DCO is still performed, but it is not a form of temporary external fixation. Full article
(This article belongs to the Section Pediatric Orthopedics & Sports Medicine)
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17 pages, 693 KB  
Review
Hyperferritinemia and Macrophage Activation Syndrome in Septic Shock: Recent Advances with a Pediatric Focus (2020–2025)
by Efrossini Briassouli, Natalia Syrimi and Stavroula Ilia
Children 2025, 12(9), 1193; https://doi.org/10.3390/children12091193 - 8 Sep 2025
Viewed by 158
Abstract
Macrophage activation syndrome (MAS), a hyperinflammatory condition driven by uncontrolled immune activation, is widely recognized as a critical complication in pediatric septic shock. This syndrome shares pathophysiological features with hemophagocytic lymphohistiocytosis (HLH) and other cytokine storm syndromes, and it contributes to significant morbidity [...] Read more.
Macrophage activation syndrome (MAS), a hyperinflammatory condition driven by uncontrolled immune activation, is widely recognized as a critical complication in pediatric septic shock. This syndrome shares pathophysiological features with hemophagocytic lymphohistiocytosis (HLH) and other cytokine storm syndromes, and it contributes to significant morbidity and mortality in pediatric and adult patients. Hyperferritinemia—a hallmark of MAS—is not only a diagnostic clue but also a prognostic marker for poor outcomes in sepsis. High ferritin levels are strongly suggestive of MAS, yet even moderate elevations in combination with the trend of ferritin levels can be indicative of heightened mortality risk. Distinguishing MAS from severe sepsis or other hyperinflammatory syndromes in children (such as multisystem inflammatory syndrome in children (MIS-C)) can be challenging, as clinical features often overlap. However, early recognition and timely immunomodulatory therapy, particularly corticosteroids and targeted biologic agents, can be life-saving. Recent advances emphasize a syndromic approach to diagnosing MAS within the spectrum of hyperferritinemic sepsis, using scoring tools or MAS-specific criteria adapted to sepsis or MIS-C contexts. Ongoing studies aim to refine biomarker-based stratification and therapeutic algorithms. This review synthesizes current knowledge on MAS as a complication of sepsis, including the diagnostic importance of ferritin levels, differential diagnosis with other cytokine storm syndromes, and the latest therapeutic approaches. It underscores the importance of early suspicion and intervention to reverse immune dysregulation and improve outcomes in critically ill pediatric patients. Full article
(This article belongs to the Special Issue Diagnosis, Treatment and Outcomes of Pediatric Septic Shock)
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17 pages, 472 KB  
Article
Associations of TAS1R2 and TAS2R38 Genetic Variants with Sugar-Sweetened Beverage Intake and Obesity Risk in Kuwaiti Adolescents: A Cross-Sectional Study
by Razan Yousef, Dalal Usamah Zaid Alkazemi, Mohamed Abu-Farha, Jehad Abubaker, Sriraman Devarajan, Abdur Rahman and Fahd Al-Mulla
Children 2025, 12(9), 1192; https://doi.org/10.3390/children12091192 - 8 Sep 2025
Viewed by 206
Abstract
Background/Objectives: Obesity is increasing worldwide, driven by unhealthy dietary habits and sedentary lifestyles. Genetic variations in taste receptor genes, particularly TAS1R2 and TAS2R38, may influence taste preferences, dietary intake, and obesity risk. This study examined associations between TAS1R2 and TAS2R38 polymorphisms, [...] Read more.
Background/Objectives: Obesity is increasing worldwide, driven by unhealthy dietary habits and sedentary lifestyles. Genetic variations in taste receptor genes, particularly TAS1R2 and TAS2R38, may influence taste preferences, dietary intake, and obesity risk. This study examined associations between TAS1R2 and TAS2R38 polymorphisms, sugar-sweetened beverage (SSB) intake, and obesity risk in Kuwaiti adolescents. Methods: A cross-sectional study was conducted among 260 adolescents aged 11–14 years recruited from public schools in Kuwait. Genotyping of five single-nucleotide polymorphisms (SNPs) was performed using TaqMan assays. Associations between SNPs, SSB intake, and obesity parameters were evaluated using multinomial logistic regression and non-parametric tests, adjusted for age, sex, nationality, BMI z-scores, basal metabolic rate, and physical activity. p-values were corrected using the Benjamini–Hochberg method. Results: The rs713598 SNP in TAS2R38 showed a marginal association with BMI percentiles and z-scores. Adolescents carrying the CC genotype of rs10246939 SNP in TAS2R38 had significantly lower odds of high SSB consumption (>3 servings/week) compared with T-allele carriers (p = 0.018, OR= 0.24, 95% CI = 0.08–0.79). No significant associations were detected for TAS1R2 SNPs. Conclusions: Variations in TAS2R38 were linked to obesity measures and beverage intake in Kuwaiti adolescents, supporting a potential genetic contribution to dietary behaviors. These findings highlight the importance of taste receptor genetics in obesity research, though replication in larger and more diverse populations is required. Full article
(This article belongs to the Section Pediatric Gastroenterology and Nutrition)
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11 pages, 868 KB  
Article
Neonatal Renal Ultrasound Reference Values in Romanian Term Newborns: Correlations with Anthropometric Characteristics
by Leonard Năstase, Adrian-Ioan Toma, Alexandru Dinulescu and Adelina Androne
Children 2025, 12(9), 1191; https://doi.org/10.3390/children12091191 - 8 Sep 2025
Viewed by 268
Abstract
Background: The establishment of population-specific reference values for neonatal renal dimensions is essential for accurate assessment of kidney development. Currently, standardized reference data for renal volume in Romanian newborns are lacking. This study aims to establish normal renal dimensions and volumes in Romanian [...] Read more.
Background: The establishment of population-specific reference values for neonatal renal dimensions is essential for accurate assessment of kidney development. Currently, standardized reference data for renal volume in Romanian newborns are lacking. This study aims to establish normal renal dimensions and volumes in Romanian term newborns and evaluate their correlations with anthropometric characteristics. Methods: A prospective study was conducted at Polizu Maternity, Bucharest, Romania, involving a cohort of 100 term newborns with a gestational age (GA) between 37 and 42 weeks, all delivered at the INSMC “Alessandrescu-Rusescu” Polizu Maternity Hospital. Routine renal ultrasound was performed for all term newborns within the first 72 h of life. Renal dimensions were measured in the longitudinal and axial sections, and the volume was calculated. Results: The average kidney dimensions were as follows: length 42.0 ± 3.4 mm, width 22.6 ± 2.6 mm, and thickness 19.9 ± 2.5 mm. Renal volume ranged from 5.1 to 18.9 mL, with an average of 10.2 ± 2.5 mL. The kidney volume was significantly correlated with gestational age (r = 0.195; p = 0.05) and birth length (r = 0.267; p = 0.008), and most strongly with birth weight (r = 0.306; p = 0.002). Conclusions: This study provides the first reference values for renal dimensions in Romanian term newborns. Renal volume shows modest correlations with anthropometric characteristics, particularly birth weight. These reference values may serve as baseline measurements for future longitudinal studies investigating renal development and disease risk. Full article
(This article belongs to the Special Issue Ultrasonography Interventions in Neonatal and Perinatal Medicine)
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16 pages, 7984 KB  
Technical Note
Tips and Tricks for Installation of the SLIM Nail in Osteogenesis Imperfecta with Narrow Medullary Canals: A Surgical Guide with Case Insights
by Peter Joseph Mounsef, Jack Legler and Reggie Hamdy
Children 2025, 12(9), 1190; https://doi.org/10.3390/children12091190 - 7 Sep 2025
Viewed by 183
Abstract
Introduction: Osteogenesis imperfecta (OI) presents significant surgical challenges due to bone fragility, narrow medullary canals, and complex deformities. While telescoping rods like the Fassier–Duval (FD) system are commonly used in growing patients, they are unsuitable when the canal diameter is too small or [...] Read more.
Introduction: Osteogenesis imperfecta (OI) presents significant surgical challenges due to bone fragility, narrow medullary canals, and complex deformities. While telescoping rods like the Fassier–Duval (FD) system are commonly used in growing patients, they are unsuitable when the canal diameter is too small or when patients approach skeletal maturity. The Simple Locking Intramedullary (SLIM) nail offers a solid, non-telescoping alternative in these cases. Methods: We describe the surgical technique for SLIM nail implantation and highlight key technical pearls developed through institutional experience, focusing on preoperative planning, intraoperative strategies, and the management of unique anatomical challenges in OI patients. Results: Three cases illustrate the application of these techniques: the first case demonstrates SLIM nail insertion in a 3-year-old child with a narrow IM canal to correct significant bowing; reaming was performed retrograde from the osteotomy site for the proximal segment and antegrade for the distal segment. The second case is a 15-year-old OI patient with a disengaged FD rod and narrow IM canal showing insertion of SLIM rod, and the third case is a 16-year-old patient with femoral deformity and telescoping rod who needed revision with SLIM nail and supplemental plate fixation. Conclusions: The SLIM nail is a viable option for select OI patients. Full article
(This article belongs to the Section Pediatric Orthopedics & Sports Medicine)
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